The purpose of this project was to evaluate the effects of relationship-based care (RBC) on patient satisfaction. RBC is a caring model that promotes a caring and healing environment by establishing and maintaining therapeutic relationships between patient, self, and coworker. The Centers for Medicare & Medicaid Services links Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores with reimbursement to hospitals. It is essential to not only achieve high patient satisfaction scores in order to ensure full financial reimbursement, but also to ensure high quality, patient-centered care. The current project assessed samples from 2 medical surgical groups, one system-wide and the other only patients from a single inpatient unit with sample sizes approximately 2,900 and 250 respectively. Data were collected retrospectively 3 times using the Press Ganey webpage at pre implementation, 6 months, and 12 months post RBC training. Results from an ANOVA indicated only a slight increase in post intervention HCAHPS scores with no statistical significant improvement. However, this increase indicates a positive trend, suggesting that the implementation of RBC may have assisted in improving patient responses. This evaluation has implications for the continued implementation for the enhancement of patient-centered care. These findings suggest that a nursing care model provides a collective belief to define a specific attitude to deliver care, facilitate professional development, and improve outcomes. By following RBC, nurses share a similar philosophy toward a caring environment.

Syftet med studien var att undersöka hur sjuksköterskor på en allmänpediatrisk avdelning disponerar sin tid gällande administrativa arbetsuppgifter jämfört mot direkt och indirekt patientkontakt. För att granska detta fenomen utfördes en aktivitetsstudie. Metod designen var icke experimentell deskriptiv observationsstudie. Där sju olika sjuksköterskor följdes under femton dagar där tidmätning skedde av på förhand kategoriserade aktiviteter. Kategoriseringsschema innehöll nio olika kategorier. Resultatet visade att 19,53 procent av arbetspasset vilket motsvarar 97 minuter spenderades med direkt patientkontakt respektive de 24,3 procent vilket motsvarar 120 minuter per dag till administrativa göromål. Dessutom uppmättes det att sjuksköterskorna blev avbrutna i snitt 26 gånger under ett åtta timmars arbetspass vilket resulterar till 3,25 avbrott per timme. Forskarnas slutsats är att det finns flera fördelar med ökad tid för patientkontakt och att detta är synnerhet gällande på en allmänpediatrisk avdelning. / The aim of the study was to examine how nurses at a general pediatric unit dispose of their time regarding administrative duties compared to direct interaction with the patient. To appropriately survey this phenomenon an activity study was conducted. The method for data collection was a nonexperimental descriptive observational study where seven nurses were followed for a total of fifteen days where the amount of time of their activities where noted according to an activity schedule that was formed beforehand. The schedule contained nine categories including the amount of interruptions nurses where subject to. The result of the study showed that roughly 19,53 percent of the nurses’ time, which is the equivalent to 97 minutes, were spent directly with the patients compared to the 24,3 percent, which amounts to 120 minutes a day, she spent with administrative tasks. Furthermore it was found that a nurse is in average interrupted 26 times during an eight hour shift which gives an average of 3,25 interruptions every hour. In conclusion the authors found ground that there are many benefits with increased nurse-patient time and believe this is especially true in a general pediatric unit.

No description available.

Bakgrund: En av grunderna för den palliativa vården är patienten, att patienten trots sin svåra situation får uppleva en god livskvalitet. Känsla av kontroll är även det en grund för den palliativa vården, vilket kan påverkas av personcentrerad vård. Vid en väl uppfylld personcentrerad vård kan en känsla av kontroll infinna sig hos patienten, vilket är en stor betydande del i den annars något svårt greppbara situationen. Syfte: Syftet är att sammanställa tidigare forskning om upplevelser hos patienter som erhåller palliativ vård i sitt eget hem. Metod: Detta är en litteraturöversikt som är baserad på 15 olika artiklar. Datainsamlingen har skett via sökningar i databaserna PubMed och CINAHL och är systematiskt analyserade innan de är sammanställda i resultatet. Resultat: Majoriteten av patienterna upplevde den palliativa vården i hemmet som positiv, vårdpersonalen ansågs vara trevliga, pålästa och engagerade. Patienterna poängterade även att för att behålla en god livskvalitet var en grundläggande del att patientens personlighet fick bevaras, att patienten ses som en person och inte som sin sjukdom. Det var också viktigt för patienterna att de fick känna sig självständiga och behövda. Konklusion: Patienterna upplevde att de blev väl omhändertagna samt att deras önskan sattes i fokus. För att detta skall uppnås var det viktigt att sjuksköterskan uppmuntrade och lyfte patientens åsikter, behov och vilja. / Background: One of the fundamentals of palliative care is the patient, to give the patient a decent quality of life despite their difficult situation. A sense of control is another essential part of palliative care, this can be obtained by person centered care. By well performed person centered care the patient may feel like they are in control, which is important in a situation that otherwise can be hard to handle. Aim: The aim of this study was to state previous research on how patients experiences palliative care in their own home. Methods: This is a literature review based on 15 articles. The articles who were found in the databases PubMed and CINAHL is systematically analyzed before they were compiled in the result. Results: The majority of patients experiences the palliative care in their own home as positive, they thought that the staff was kind, well prepared and committed. The patient also pointed that the essential part to maintain a good quality of life was to retaining the patients personality, and that the patient are being seen as a person and not as their disease. Other important things for the patients was to feel independent and to have a feeling of being needed. Conclusions: The patients felt that they were taken care of in a good way and that their wishes about their care was prioritized. For this to be achieved, the nurse encourages the patient's opinions, needs and will.

Bakgrund: Den perioperativa vården syftar till en individuellt anpassad vård som tillgodoser patientens unika behov. Kvalitativ forskning om ungdomars upplevelser av detta är begränsad.  Syfte: Syftet var att undersöka ungdomars tankar inför operation och upplevelser av den perioperativa vården.  Metod: Studien genomfördes som en kvalitativ intervjustudie med semistrukturerade frågor. Datan analyserades med hjälp av systematisk textkondensering (STC). Tio ungdomar i åldrarna 12 till 17 år som hade genomgått operation under generell anestesi intervjuades på ett universitetssjukhus i Mellansverige under våren 2018.  Resultat: Analysen resulterade i tre kategorier “tankar kring anestesi, kirurgi och livet”, “erfarenheter av den preoperativa informationen” och “faktorer som påverkar välbefinnandet”. Ungdomarna fokuserade på hur operationen skulle påverka det sociala livet. De hade frågor och tankar som berörde såväl anestesin och kirurgin vilket hanterades på olika sätt. De besked och den information ungdomarna fick under det preoperativa vårdförloppet upplevdes som bristfällig och oanpassad, vilket bidrog till stress och oro. Delaktighet och personcentrerad omvårdnad bidrog till trygghet och en bra relation mellan patient och vårdare.  Slutsats: Resultatet visade på att personalen som är involverad i den perioperativa vården behöver kunskap om ungdomars upplevelser och erfarenheter av den perioperativa vården och operation för att på så sätt kunna förstå vilka omvårdnadshandlingar som är viktiga att ta hänsyn till utifrån ett ungdomsperspektiv. Kunskapen kan användas för att utveckla riktlinjer och den perioperativa vården för att främja patientbemötandet utifrån ungdomars unika förutsättningar. / Introduction: The perioperative care aims at an individually adapted care that meets the patient's unique needs. Qualitative research on adolescents experiences in this subject is limited.  Aim: The purpose was to investigate the thoughts of adolescents on the operation and experiences of perioperative care.  Methodology: The study was conducted as a qualitative interview study with semistructured questions. The data was analyzed using systematic text condensation (STC). Adolescents aged 12 to 17 years who had undergone surgery under general anesthesia were interviewed at a university hospital in central Sweden in the spring of 2018.  Results: The analysis resulted in three categories "thoughts about anesthesia, surgery and life", "experiences of preoperative information" and "factors that affect well-being". The adolescents focused on how the operation would affect the social life. They had questions and thoughts that concerned both anesthesia and surgery, which was handled in different ways. The information the adolescents received during the preoperative stage were perceived to be inadequate and inappropriate, which contributed to stress and concern. Participation and person-centered care contributed to a feeling of safety and a good relationship between patients and caregivers.  Conclusion: The result showed that the personnel involved in the perioperative care need knowledge about the experiences of young people in perioperative care and surgery in order to understand which caring actions are important to take into account from an adolescent perspective. This knowledge can be used to develop guidelines and the perioperative care based on adolescents unique conditions.

abstract: Health and healing in the United States is in a moment of deep and broad transformation. Underpinning this transformation is a shift in focus from practitioner- and system-centric perspectives to patient and family expectations and their accompanying localized narratives. Situated within this transformation are patients and families of all kinds. This shift's interpretation lies in the converging and diverging trails of biomedicine, a patient-centric perspective of consensus between practitioner and patient, and postmodern philosophy, a break from prevailing norms and systems. Lending context is the dynamic interplay between increasing ethnic/cultural diversity, acculturation/biculturalism, and medical pluralism. Diverse populations continue to navigate multiple health and healing paradigms, engage in the process of their integration, and use health and healing practices that run corollary to them. The way this experience is viewed, whether biomedically or philosophically, has implications for the future of healthcare. Over this fluid interpenetration, with its vivid nuance, loom widespread health disparities. The adverse effects of static, fragmented healthcare systems unable to identify and answer diverse populations' emergent needs are acutely felt by these individuals. Eradication of health disparities is born from insight into how these populations experience health and healing. The resulting strategy must be one that simultaneously addresses the complex intricacies of patient-centered care, permits emergence of more localized narratives, and eschews systems that are no longer effective. It is the movement of caregivers across multiple health and healing sources, managing care for loved ones, that provides this insight and in which this project is keenly interested. Uncovering the emergent patterns of caregivers' management of these sources reveals a rich and nuanced spectrum of realities. These realities are replete with opportunities to re-frame health and healing in ways that better reflect what these diverse populations of caregivers and care recipients need. Engaging female Mexican American caregivers, a population whose experience is well-suited to aid in this re-frame, this project begins to provide that insight. Informed by a parent framework of Complexity Science, and balanced between biomedical and postmodern perspectives, this constructivist grounded theory secondary analysis charts these caregivers' processes and offers provocative findings and recommendations for understanding their experiences. / Dissertation/Thesis / Ph.D. Healthcare Innovation 2013

Bakgrund: Ögonsjuksköterskan möter såväl vuxna som barn inom ögonsjukvården, dock saknas studier som behandlar ögonsjuksköterskans erfarenhet av att vårda barn. Vikten av att anpassa bemötande och kommunikation till barnets ålder och mognadsnivå samt göra dem delaktiga i vården poängteras såväl i svensk lagstiftning som i studier. Detta kan innebära en utmaning för sjuksköterskor som saknar specialistutbildning inom barnsjukvård och sällan möter barn i sin verksamhet. Syfte: Att belysa ögonsjuksköterskans upplevelse av att bemöta och vårda barn vid en ögonakutmottagning. Metod: En kvalitativ intervjustudie där sju ögonsjuksköterskor intervjuades med hjälp av en semistrukturerad intervjuguide. Data analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra kategorier och tio underkategorier, där de fyra kategorierna omfattar: Möte med barn - en positiv utmaning, Skapa en trygg relation, Att bemöta barn är också att bemöta föräldrar samt Vägar till ny kunskap. Konklusion: Ett bättre utnyttjande av ögonsjuksköterskans kompetens på ögonakutmottagningen, där ögonsjuksköterskan kan ta ett större ansvar när det gäller mottagningsbesök med barn, samt ett utökat teamsamarbete rekommenderas. För att kunna bedriva en patientsäker vård bör evidensbaserade riktlinjer utarbetas när det gäller vård och bemötande av barn. Barns och föräldrars upplevelser i samband med besök på ögonakutmottagningen kan närmare beforskas i syfte att utveckla omvårdnaden. / Background: The ophthalmic nurse meets both adults and children in the ophthalmic care, there is a lack of studies regarding the ophthalmic nurse’s experience when it comes to meeting children. The importance of the health care staff adapting the treatment and communication to the child's age and level and involving them in care is emphasized in Swedish legislation, as well as in studies. This can pose a challenge to nurses who lack specialist training in child care and rarely encounter children in their work. Aim: The aim of this study was to illustrate the ophthalmic nurse’s experience of meeting and caring for children in the eye emergency room. Method: The study has a qualitative research approach based on semi-structured interviews with seven ophthalmic nurses. The data was analyzed using qualitative content analysis. Result: The analysis resulted in four categories and ten subcategories, where the four categories are: Meeting the child - a positive challenge, Creating a safe relation, Meeting children is also meeting parents and Ways to new knowledge. Conclusion: A better use of the ophthalmic nurse’s competence in the eye emergency room and improvement of team collaboration are recommended. To be able to carry out a safe patient care there is a need for evidence-based guidelines regarding care and treatment of children. Finally, suggestion of further research on children's and parents' experience of nursing in the eye emergency room is recommended.

Introduction: Burnout is an occupational condition characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. While medical students begin schooling with mental health profiles similar to or better than peers who pursue other careers, there is a downward trajectory throughout school suggesting this phenomenon often originates in medical school. For physicians and residents, burnout has been linked to poor outcomes such as patient safety, might contribute to suicidal ideation and substance abuse, and may undermine professional development. Furthermore, there is a lack of surveillance of the prevalence of medical student burnout in a small-sized school setting. Methods: The Maslach Burnout Inventory (MBI), a 22-question survey, is largely accepted as the gold standard for assessment; however, we utilized the 7-question, Well-Being Index (WBI), which has been shown equal efficacy as the full MBI. Eligible participants were currently enrolled in their respective class at the East Tennessee State University Quillen College of Medicine. Each year, a participant was given a WBI survey during the winter season (overall response rate 83%, n = 239). Results: Overall the self-reported burnout rate over the two-year study period was 65.2% and was significantly higher in those reporting as female (71%). There was also variation tracking the class from one year to the next. The second year at this institution showed the highest reported amount of burnout (75%, n=145) while the lowest amount of burnout reported was during the fourth year at 47%. Conclusions: Burnout experienced at this institution was reportedly higher than national average. There are limitations to this study as the periods in which medical students were asked to answer the survey were consistently at the same time in the calendar year, but the host institution’s curriculum had been changed so that it might not match up accordingly. Furthermore, class sizes changed from year to year and might skew the data. This information suggests that burnout prevalence is higher at Quillen College of Medicine and intervention strategies to address burnout should be pursued.

Bakgrund: Utskrivningsprocessen har förändrats på grund av sjukvårdsreformer med mål att stärka patienters ställning och förkorta vårdtider inom sluten vård. Samtidigt som en åldrande befolkning med ökande multisjukhet och komplexa vårdbehov ställer höga krav på samverkan mellan berörda parter. Äldre patienters upplevelse av utskrivningsprocessen är av intresse för sjuksköterskor i rollen som samordnare av insatser under utskrivningsprocessen. Syfte: Syftet var att belysa äldre personers upplevelser av utskrivningsprocessen från slutenvård till primärvård. Metod: Efter en kvalitetsgranskning gjordes en litteraturöversikt enligt Fribergs metod på nio kvalitativa och tre kvantitativa studier ur databaserna CINAHL och PubMed. Resultat: Ur analysen identifierades fem teman under utskrivningsprocessen och var patienters: informationsbehov och vårdpersonalens betydelse, känsla av utsatthet, nöjdhet och tillfredställelse med vården, strategier och empowerment, samt anhörigas betydelse för patienterna. Slutsats: Äldre patienter upplevelser av utskrivningsprocessen var brist på delaktighet och samordning vilket gav upphov till känslor av oro, stress, förvirring och maktlöshet. Patienter upplevde en ojämlik tillgång till insatser, i synnerhet personer ≥ 80 år. Bristande kommunikation mellan vårdpersonal och patienter påverkar patienters upplevelse av utskrivningsprocessen negativt och orsakade vårdlidande. / Background: The hospital discharge process (DP) has changed due to healthcare reforms whose aim has been to promote the status (voice) of patients and to shorten hospital stays. At the same time as an ageing population with increased multimorbidity and complex care needs puts high demands for integrated care on the partners concerned. Elderly patients’ experiences of the hospital discharge process are of interest to nurses in their role as coordinators of integrated care during the discharge process. Aim: The aim was to highlight older persons’ experiences of the discharge process from inpatient to primary care. Method: Following a quality review, a literature review was conducted according to the method by Friberg on nine qualitative and three quantitative articles from the databases CINAHL and PubMed. Results: From the analysis five themes emerged during the DP and were patients’: need for information and the importance of care personnel, feeling of vulnerability, satisfaction with health care, strategies and empowerment as well as the importance of relatives for the patients. Conclusion: Older patients’ experiences of the DP were lacking in participation and integrated care which aroused feelings of concern, stress, confusion and powerless. Patients experienced an unequal access to care and support, especially persons ≥ 80 years. Lack of communication between care professionals and patients influence patients experience of the DP negatively and can lead to health care-induced suffering.

Bakgrund: 2019 drabbades 65 956 människor av cancer. Cancersjukdomar växer globalt och rädslan av att drabbas av cancer är stor. Den onkologiska vården i Sverige ska ges utan dröjsmål och med uppföljning. Standardiserade vårdförlopp (SVF) syftar till att personer som genomgår utredning för cancermisstanke i största möjliga utsträckning får erfara en helhetsorienterad, välorganiserad och professionell vård. Patienternas upplevelser och nöjdhet med vården kan visas i mått med Patient Reported Experience Measures (PREM). Stödet från sjuksköterskor betyder mycket för patienter som genomgått onkologisk vård.Syfte: Syftet var att beskriva upplevelser av vården hos patienter som genomgått onkologisk vård.Metod: En empirisk studie med kvalitativ ansats och beskrivande design. Fritextsvar från en enkätundersökning analyserades med hjälp av kvalitativ innehållsanalys.Huvudresultat: Övergripande temat i studien var att patienterna beskrev att deras upplevelse av den onkologiska vården var beroende av deras helhetssyn på den erhållna vården. En tillfredsställande vårdupplevelse karaktäriseras av att den består av en sammantagen vårdupplevelse med gott bemötande och förhållningssätt från vårdpersonalen, adekvat och förståelig information, att vården erhållits inom, enligt patienten, rimlig tidsram samt med god följsamhet.Slutsats: Föreliggande studie har undersökt vad patienter som genomgått onkologisk vård har för upplevelser av den erhållna vården. Resultatet visade att helhetsupplevelsen är större, detta belyser föreliggande studie. När alla dessa aspekter fungerat väl så har patienterna i stor utsträckning erfara en tillfredsställande helhetsupplevelse. / Background: In 2019 65 956 people were affected by cancer. Cancer diseases are growing globally and the fear of getting cancer is great. Oncological care in Sweden must be provided without delay and with follow-up. Standardized care processes (SVF) aim to enable people who undergo an investigation for cancer suspicion to experience a holistic, well-organized and professional care to the greatest possible extent. Patients' experiences and satisfaction with care can be shown in dimensions with Patient Reported Experience Measures (PREM). The support from nurses means a lot to patients who have undergone oncological care.Aim: The aim was to describe experiences of care in patients who have undergone oncological care.Method: An empirical study with a qualitative approach and descriptive design. Free text responses from a survey were analyzed using qualitative content analysis.Main Result: The overall theme of the study was that the patients described that their experience of the oncological care was dependent on their holistic view of the care received. A satisfactory care experience is characterized by the fact that it consists of an overall care experience with good treatment and attitude from the care staff, adequate and understandable information, that the care was obtained within, according to the patient, a reasonable time frame and with good compliance.Conclusion: The present study has examined what patients who have undergone oncological care have for experiences of the care received. The results showed that the overall experience is greater, this highlights the present study. When all these aspects have worked well, the patients have to a large extent experienced a satisfactory overall experience.