Problemställning: eHälsa är nutiden och framförallt framtiden inom hälso- och sjukvård och anses kunna stärka delaktighet och medbestämmande för patienten. Den nya tidens patienter kräver ökad insyn, delaktighet och självbestämmande.                                   Syfte: Syftet med studien var att belysa eHälsa med fokus på patient empowerment.                                                                                                                                                                                                                               Metod: Litteraturstudie med 14 vetenskapliga artiklar som utifrån en induktiv ansats har granskats, analyserats och jämförts.                                                                                                                                                                    Resultat och konklusion: Resultatet visar att eHälsa ökar tillgängligheten för hälsoinformation samt hälso- och sjukvård i hemmet. eHälsa kan och bör användas som ett komplement i vården för att stärka patient empowerment, detta under förutsättning att patienten har förmåga att hantera och förstå informations- och kommunikationsverktygen, samt att ett samarbete finns med hälso- och sjukvården.                                                                                                                Implikation: Vidare forskning som berör hur sjuksköterskan kan implementera eHälsa i omvårdnadsarbetet behövs. eHälsa som begrepp bör även belysas tillsammans med övriga riktlinjer som berör informations- och kommunikationsteknologi i Kompetensbeskrivning för legitimerad sjuksköterska. Patientutbildning i eHälsa och dess tjänster bör ingå i den praktiska vårdverksamheten för att optimera egenvård och därmed bidra till att patienten erhåller empowerment. Det är även av stor vikt att sjuksköterskestuderande redan under utbildning får kunskap om eHälsa och eHälsotjänster. / Problem: eHealth is the present and, in particular, the futures of health care. It is considered to be able to strengthen the involvement and participation of the patient. The modern patient demand increased transparency, participation and autonomy.                                                                                                                                                                                                                                                                                                                                                       Aim: The aim of this study was to highlight eHealth, focusing on patient empowerment.                                                                                                                                                                                                                                                                                                                                               Method: A literature study with 14 scientific articles, that have been reviewed, analyzed and compared with an inductive approach.                                                                                                                                                              Results and conclusions: The results show that eHealth increases the availability of health information and health care at home. eHealth can and should be used as a supplement in health care to enhance patient empowerment, provided that the patient has the ability to manage and understand information and communication tools, and that collaboration exists with the health care provider.                                                                                                                                 Implication: Further research on how nurses can implement eHealth within the nursing practice is needed. eHealth as a concept should also be highlighted along with other guidelines related to information and communication technology in the Description of Competence for Registered Nurses. Patient education in eHealth and its services should be included in the health care practice to optimize self care for patients, so that they thereby could receive empowerment. It is also of great importance that the student nurse, already during education, gains knowledge of eHealth and eHealth services.

Bakgrund: Patienter som drabbas av svår sjukdom och vårdas på intensivvårdsavdelning upplever känslor av total förlust av kontroll, förstärkt av oförmågan att kommunicera. Att få kunskap, kontroll och inflytande över sin vård leder till mindre smärtlindring och kortare vårdtid. Patientcentrering i vården brister dock, vilket kan leda till ökade kostnader för såväl samhället som patienter. Syfte: Att identifiera och beskriva hinder mot empowerment till patienter inom intensivvård samt vilka möjligheter som finns för att överbrygga dessa hinder.  Metod: En systematisk litteraturstudie analyserad i två steg med meta-syntes enligt Evans samt meta-aggregation, inspirerad av Joanna Briggs’ Institute. Resultat: Både hinder och lösningar för empowerment till intensivvårdspatienten finns på flera plan. Sjukdomen gör att patienten förlorar förmåga till empowerment, vårdmiljön känns skrämmande, vårdpersonal upplevs vara avvisande och brister i arbetsmiljön leder till sämre möjlighet till delaktighet. Specialistsjuksköterskan inom intensivvård behöver ge patienten indirekt delaktighet, förklara vårdmiljön, skapa en ömsesidig relation och uppmuntra delaktighet. Ett stödjande ledarskap och goda arbetsvillkor är andra nödvändiga förutsättningar för detta.  Slutsats: Genom en ökad medvetenhet om de hinder som finns för empowerment till intensivvårdspatienten kan specialistsjuksköterskor och arbetsgivare aktivt arbeta för att komma över hindren och istället stärka patientens möjligheter att bli en del av vårdteamet. / Background: To become critically ill and be cared for at an ICU involves feelings of total loss of control, reinforced by the inability to communicate. Gaining knowledge, control and influence over the nursing care results in reduced need for pain relief and shorter stay in hospital. Patient centered care is however lacking. This might incur a higher cost for society, as well as the patient in the form of suffering.Aim: To identify and describe barriers to patient empowerment in critical care and what means there are to overcome these barriers. Method: Systematic literature review, analysed in two steps with meta synthesis according to Evans and meta aggregation, inspired by the Joanna Briggs’ Institute. Results: Barriers as well as possibilities for patient empowerment in ICU were found on various levels. Being critically ill disables the patient from feeling or receiving empowerment, the nursing environment is frightening, staff is perceived as dismissive and working conditions impede patient participation. The specialist nurse in intensive care needs to give the patient indirect participation, explain the nursing environment, create a mutual relationship and encourage participation. Good working conditions and a supportive workplace leadership are also required.  Conclusion: By being aware of what the barriers to patient empowerment in the ICU are, specialist nurses and employers can actively engage in the work to overcome them, as well as engaging in the support of the patient to become part of the care team.

Bakgrund: Personcentrerad vård blir allt viktigare i dagens sjukvård. Avsikten med det är att patienten ska inkluderas som en del av teamet. Patientens rätt till delaktighet står reglerat i patientlagen som anger att vården ska utformas i samråd med patienten. Informationsöverföringsprocessen är en kritisk del i vården som ofta ligger till grund för de patientskador som uppstår. Bedsiderapportering är en relativt ny form av överrapportering där målet är att göra patienten delaktig genom att överrapporteringen sker vid patientens säng. Sjukvårdspersonalen ska förvissa sig om att adekvat information nått fram och uppfattats av patienten och eventuella närstående. Syfte: Syftet var att beskriva vuxna patienters erfarenheter av bedsiderapportering. Metod: En litteraturöversikt har utförts enligt Fribergs metod. Till resultatet har sex kvalitativa, två kvantitativa och två artiklar med mixad metod använts. Dorothea Orems omvårdnadsteori har använts som teoretisk referensram. Resultat: I resultatet framkom tre teman om patienternas erfarenheter och upplevelser av bedsiderapportering: patientens önskan om delaktighet, att känna sig informerad, och hantering av känslig information. Diskussion: Resultatet diskuterades utifrån Orems omvårdnadsteori och adekvat litteratur. Orem belyser vikten av att sjuksköterskan med hjälp av patientens delaktighet och engagemang skapar en god vårdrelation, vilket är avgörande för att sjuksköterskan ska kunna göra en korrekt bedömning av patientens aktuella status. Vidare beskrivs patient empowerment som ett förhållningssätt som sjuksköterskan bör använda sig av i omvårdanden av patienten. Det här bör göras med avsikt att stärka patientens möjlighet till egenvård. / Background: In today's healthcare, person-centered care becomes increasingly important with the intention of including the patient as part of the team. The patient's right to participation is regulated in the law, which states that care should be designed in consultation with the patient. A critical part of the care is the communication between health care professionals about the patients’ condition. Bedside shift reports is a relatively new concept in healthcare with the purpose to make the patient involved in the care. Healthcare professionals must ensure that adequate information has been identified and perceived by the patient and any related persons. Aim: The aim was to describe adult patients’ experiences of bedside shift reports. Method: A literature review was performed according to Friberg's method. A total of ten scientific articles were included in the review, of which six were qualitative, two were quantitative and two articles used a mixed method. Dorothea Orem’s nursing theory has been used as a theoretical frame of reference. Results: The results revealed three themes about patients’ experiences of bedside shift reports: the patient's desire for participation, to feel informed, and handling of sensitive information. Discussion: The result were discussed based on Orem's nursing theory and adequate literature. Orem illuminates that the nurse, with help from the patients’ participation and commitment create a good healthcare relationship, which is crucial for the nurse to be able to make a proper assessment of the patient current status. Furthermore, patient empowerment is described as an approach that the nurse should use in the care of the patient. This should be done with the intention to strengthen the patient's ability to selfcare.

The task of ensuring Patient Safety is, more than ever, central in Healthcare. The report “To Err is Human” [Kohn et al. 2000], was revealing alarming numbers of incidents, injuries and deaths caused by deficiencies in healthcare activities. The book initiated assessment and change of Healthcare methods and procedures. In addition, numerous reports to Swedish HSAN (Medical Responsibility Board) have shown a high rate of information and communication deficiencies in Healthcare has a direct or indirect cause of incidents, injuries and deaths. Despite numerous of new sophisticated tools for information management in recent years, e.g., tools such as Electronic Health Records (EHR) and Clinical Decision Support Systems (CDSS), the threats to Patient Safety have not been redeemed. Rather to the contrary. Underlying reasons for this paradox are twofold. Firstly, advancements in diagnosing techniques have given rise to increasing volumes of data at the same time as the number of patients has increased due to demographic changes and advancements in treatments. Secondly, the information processing systems are far from aligned to related workflow processes. In short, we do not at present have interoperability in our Healthcare systems. In this doctoral dissertation, we present an in-depth analysis of two different “HSAN-typical” cases, where Patient Safety was jeopardized by incomplete information flows and/or information breakdowns. The cases are mirroring the apprehension of Simplicity, that is, Occam´s Razor of Diagnostic Parsimony. A well-known protocol used in Healthcare and implemented in most (knowledge based) CDSS. This rule of thumb is the foundation for the well-known adage: “when you hear hoof beats, think horses, not zebras”. Hickam´s Dictum is one well known objection to the simplifications of Occam´s Razor stating "Patients can have as many diseases as they damn well please". Of course, this Dictum is harder to implement effectively! In the thesis we suggest a visualization tool Visual Incidence Anamneses (VIA) to provide middle out compromise between Ockham and Hickam but providing means to increase Patient Safety. The findings of our Study for the thesis have resulted in a number of Aspects and Principles as well as Core-principles for future CDSS design, That is, tools and methodologies that will support designing and validating Interoperability of Healthcare systems across patient-centric workflows. The VIA tool should be used as the initiating point in a patient (individual) centered workflow, quickly visualizing vital information such as symptoms, incidents and diagnoses, occurring earlier in the medical history, at different times, to ground further vital decisions on. The visualization will enable analysis of timelines and earlier diagnoses of the patient, using visually salient nodes for visualization of causalities in context. Furthermore, support for customization of the tool to the views of stakeholders, members of healthcare teams and empowerments of the patient, is crucial.

The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and evaluate the labor-induction teaching tool in a 9-room labor and delivery unit that averages approximately 1,500 births per year. The teaching tool content was obtained from existing patient education information from the organization's resource library. The nurses piloted the teaching tool for all patients admitted for the induction of labor for 3 weeks. Patient comments supported the use of the teaching tool to improve knowledge, increase participation in decision making, and enhance overall satisfaction. The nurses voluntarily completed an online survey that indicated the teaching tool was easy to use, positively impacted workflow, and supported informed choice. Patient charts were audited and showed a 94% compliance with documentation of education. The success of the teaching tool in improving patient education and decision-making capacity supports the development of other teaching tools, encourages patient and family-centered care, and improves the delivery of quality care.

The concept of patient empowerment, although acknowledged by the medical community as important, is rarely understood and seldom given priority in the illness trajectory of the cancer patient. A pilot study of a Shared Care Model amongst haematological cancer patients highlighted the fact that some patients spoke of a sense of empowerment and an overall sense of greater control when more fully included in the treatment and management of their condition. The research which forms the basis of this thesis focused on the role of empowerment in the wellbeing of cancer patients. There were three objectives to be met by completing this research. Firstly, to demonstrate that empowerment is a uniquely identifiable concept and can be measured separately from other quality of life indicators. Secondly, the study sought to explore that concept that empowerment takes into account the way in which patients act upon their prognosis and optimise the outcomes of treatment. Thus it is believed that accessing tailored resources and support structures benefit cancer patients and those who are caring for them such as close family members and friends by helping the patient achieve an individual level of empowerment. Finally, the research sought to explore the concept that empowerment improves psychological outcome in patients. The benefits are increased empowerment and an active use of coping strategies amongst patients in order to regain a measure of control over their illness. The Patient Empowerment Scale was developed to measure empowerment as an individual construct. '...' The Patient Empowerment Scale (15 items) was shown to be a reliable measure of empowerment and fitted the model well. A qualitative methodological approach sought to address and explore the second and third concepts. In addition, the concept of empowerment as it relates to motivation and self-efficacy was investigated qualitatively using in-depth interviewing technique. A phenomenological methodology was used to explore the 'lived experience of cancer patients' in regard to regaining control of their illness and the management thereof. Participants were interviewed using concepts identified for the Patient Empowerment Scale such as support strategies and use of resources. A series of interviews with breast cancer patients were conducted whereby patients responded to a number of questions. The questions explored areas such as support mechanisms in relation to cancer, their relationships with health professionals and significant others and their attitude toward and use of other resources and support systems such as support groups, spirituality, complementary therapies. In addition their views on acceptance and adaptation to their altered health status were explored. Results The research confirmed that it is feasible to measure empowerment as a separate quality of life indicator. Furthermore, that empowerment is linked to motivation and self-efficacy beliefs. The research also demonstrated that there are a number of core areas which are fundamental to regaining control and increasing empowerment for patients. These core areas are linked to support mechanisms, willingness to adapt and to access resources tailored to meet their needs. Patient empowerment emerged as a key aspect of enhanced quality of life regardless of prognosis and improved psychological outlook.

This thesis aims to examine how patient empowerment based on Internet information has impact on health care processes and patient &ndash / physician relationship. The process of empowerment is analyzed in three main steps / searching and obtaining information / sharing and discussing obtained information with providers / and involving decision making process. Study domain covers with breast cancer patients continuing their treatment in hospitals. In-depth interview methodology has been employed. Interviews are conducted in two settings: one is a university hospital / other is a state hospital of Ministry of Health. Sample size was 20 patients and 6 doctors. As result of study we observed that most of the breast cancer patients have low level of empowerment. This is mainly caused by perception of cancer and high level of anxiety of patients. Most of the middle class women even though they use Internet in everyday life, they neither want to search for information on their cancer not they want to involve in decision making.. Some of the educated upper middle class use Internet however they do not share gathered information with their doctors. They mainly use this information to test competency of doctor. Most patients prefer to seek for information until they made a decision, mostly finding a trustable doctor. Even though some of upper middle class, high education women use Internet intensively, they do not involve in decision and leave the responsibility to the doctor. Young generation regardless of their socio economic situation has tendency to use internet and getting empowered.

Diabetes mellitus is a significant problem in the United States with the burden being greater in the African American population. Because diabetes is complex and costly, the importance of self-care management changes the disease management paradigm from “provider-centered” to patient-centered”. Empowerment is a possible solution for barriers to better diabetes management. Patient empowerment is helping patients discover and develop the inherent capacity to be responsible for their own life. Although patient empowerment is a valuable philosophy, there are gaps between the philosophy and actual practice. There are limited studies addressing the effectiveness of patient empowerment at improving diabetes management. Therefore, this study examined the association of patient empowerment and diabetes management by gender, age, socioeconomic status and education level by using the data from the Patient Empowerment to Improve Diabetes Care intervention conducted in the Diabetes Clinic of the Grady Health System (GHS). In this study, diabetes management was measured by glycated hemoglobin (HbA1c) level which shows the average blood glucose level over the past two to three months. Patient empowerment was measured by two standardized tools which were the Diabetes Empowerment Scale-Short Form and Patient Activation Measure. In this study, patient empowerment scores measured by these tools were not associated with HbA1c level in African American diabetes patients of the Diabetes Clinic of the GHS. Further study is necessary to understand the association between patient empowerment and diabetes disease management by using different measures of patient empowerment, different levels of disease management, and measurement in different settings.

In the past decade, mobile communication services such as cell phones and other types of hand-held devices have become relatively cheap, affordable and accessible, especially in developing countries, including Peru. The applications of mobile devices in health, or mHealth, are surfacing and have the potential to improve the delivery and quality of health by eliminating the distance barriers; permitting the availability and retrieval of data in a timely manner; educating the public on prevention; supporting the management of diseases, and promoting patient empowerment to the population, including those that are socially stigmatized. Equally important, in conjunction with technology, training is another important factor to build a critical mass of professionals to develop and evaluate mHealth strategies. In order to take advantage of the technology at hand, health professionals must be able to know how to use these tools that are available to them. The purpose of the study is to explore the research and training, and mHealth strategies being developed in Peru. The study has the following aims: • To examine the process, progress and lessons learned of a) the mobile health initiatives of Peru through the lens of the Cell-POS project, and b) the training initiatives on mHealth in Peru through the lens of the QUIPU project; • To discover how people with HIV can achieve patient empowerment and involvement in managing their own health through the use of cell phones. For the mobile health project (Cell-POS) both quantitative and qualitative data collection was gathered, which resulted in an in-depth research analysis evaluating the efforts and initiatives of mHealth solutions in Peru, with a focus on how the use of mobile technology can help people with HIV feel empowered. In addition, it was explored how mobile health is being positioned in the area of training through the lens of the QUIPU project. A two-day expert meeting which took place on March 26 and March 27, 2010 in Lima, Peru resulted in insightful discussions of the problems and necessities regarding training in Biomedical and Health Informatics; specific issues about the curricula and the level of multidisciplinary were also discussed. Through the QUIPU project it was found that the challenges and needs are very similar across Latin America; however, through collaboration and partnerships, global health initiatives are on a rise. The Cell-POS project examined the feasibility, acceptability, perceived ease of use, and usefulness towards mHealth in relation with patient empowerment. The primary finding was that participants were satisfied and accepted the Cell-POS platform quickly and without difficulty. After six months of use, the results demonstrated that the participants perceived that the messages were clear, effective, and understandable and it was easy to incorporate the Cell-POS system to their daily activities. Most participants perceived that Cell-POS enhanced their knowledge related to HIV treatment and improved their ability to take their medications correctly and on time. Through proper planning, research initiatives and collaborative work, a successful project can be achieved. Peru has great potential, which is already starting to show through the research and work that is currently taken place. This study examines selected mHealth initiatives in the context of research and training of mHealth in Peru. / Graduate

abstract: Chronic illness can be a stressful experience that requires coping and support. In the last twenty years, Shared Medical Appointments (SMAs) were developed in U.S. healthcare as a response to the rising rates and challenges of chronic disease management. Due to the infancy of the SMA model, however, little is known or understood about the benefits of group medical care for patients. To date, scholars have not explored or systematically observed the communicative aspects of the SMA model. Communal coping, a theoretical framework that foregrounds group interaction and communication, offers a pragmatic lens for exploring how patients collectively cope with the stressors of chronic illness in the context of SMAs. Using qualitative methods, I conducted participant observation of SMAs at a Veterans Affairs hospital to analyze the communicative, transactional nature of communal coping as it unfolded among heart failure patients, family members, and providers in context. I also conducted interviews with SMA attendees. Analysis is based on 56 hours of fieldwork and 14 hours of interviews. Findings of this dissertation revealed group members who attended heart failure SMAs engaged in communal coping to manage the stressors of chronic illness. Group members moved through four primary phases of the communal coping process: (1) establish a communal coping orientation; (2) discuss shared stressors; (3) engage in cooperative action; and (4) practice communal reflexivity. Findings suggest patients become empowered by group interaction during SMAs as they move through each phase of the communal coping process. This dissertation also highlights various communicative strategies providers' use during SMAs to facilitate communal coping and group interaction. Theoretically, this dissertation expands upon existing knowledge of communal coping by exploring how individuals embody and socially construct the communal coping process. Specifically, this dissertation extends past models of communal coping with the addition of the communal reflexivity phase and through conceptualizing communal coping as a facilitated process of empowerment. Pragmatically, this research also offers insight to the benefits patients derive from attending SMAs, such as reduced feelings of stigma and isolation and improved motivation. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2015