Trots lagstiftning kring patienters delaktighet i vården ses en tydlig brist på delaktighet vid vårdplanering hos patienter inom psykiatrisk vård. Syftet med det här arbetet var att sammanställa kunskap genom en metasyntes för att nå en djupare förståelse av patienters upplevelser av delaktighet vid vårdplanering i den psykiatriska vården. Detta genom frågeställningarna vad beskriver patienter främjar respektive hindrar delaktighet vid vårdplanering i den psykiatriska vården. Tio artiklar svarade mot vårt syfte och inkluderades. Analysen av dessa resulterade i att tre teman identifierades: 1.“Det yttre lagret: Vårdplanen som ett värdefullt stödverktyg eller en meningslös upprepning” 2. Det mellersta lagret: “Att navigera oenigheter för en känsla av att äga innehållet”, och 3. Det inre lagret: “En vilja att ses som expert men en samtidigt upplevd maktlöshet”. De tre identifierade lagren syntetiserades i syfte att få en djupare förståelse och ny kunskap av patienters upplevelser av delaktighet i vårdplaneringsprocessen. Syntesen visar på tre lager som har en bestämd ordning där kärnan i syntesen och de tre identifierade lagren utgår från individen, som är expert.

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No / Estimates show that as many as one in 10 patients are harmed while receiving hospital care. Previous strategies to improve safety have focused on developing incident reporting systems and changing systems of care and professional behaviour, with little involvement of patients. The need to engage with patients about the quality and safety of their care has never been more evident with recent high profile reviews of poor hospital care all emphasising the need to develop and support better systems for capturing and responding to the patient perspective on their care. Over the past 3 years, our research team have developed, tested and refined the PRASE (Patient Reporting and Action for a Safe Environment) intervention, which gains patient feedback about quality and safety on hospital wards. Methods/design A multi-centre, cluster, wait list design, randomised controlled trial with an embedded qualitative process evaluation. The aim is to assess the efficacy of the PRASE intervention, in achieving patient safety improvements over a 12-month period. The trial will take place across 32 hospital wards in three NHS Hospital Trusts in the North of England. The PRASE intervention comprises two tools: (1) a 44-item questionnaire which asks patients about safety concerns and issues; and (2) a proforma for patients to report (a) any specific patient safety incidents they have been involved in or witnessed and (b) any positive experiences. These two tools then provide data which are fed back to wards in a structured feedback report. Using this report, ward staff are asked to hold action planning meetings (APMs) in order to action plan, then implement their plans in line with the issues raised by patients in order to improve patient safety and the patient experience. The trial will be subjected to a rigorous qualitative process evaluation which will enable interpretation of the trial results. Methods: fieldworker diaries, ethnographic observation of APMs, structured interviews with APM lead and collection of key data about intervention wards. Intervention fidelity will be assessed primarily by adherence to the intervention via scoring based on an adapted framework. Discussion This study will be one of the largest patient safety trials ever conducted, involving 32 hospital wards. The results will further understanding about how patient feedback on the safety of care can be used to improve safety at a ward level. Incorporating the ‘patient voice’ is critical if patient feedback is to be situated as an integral part of patient safety improvements.

Bakgrund: Enligt svensk lagstiftning har patienten en laglig rätt att vara delaktig i sin vård. Detta betyder också att sjuksköterskan har en skyldighet gentemot patienten att göra hen delaktig. Trots denna rättighet upplever patienter att de ibland inte ges möjlighet till att vara delaktiga. Syfte: Syftet med den här studien är att beskriva patientdelaktighet och sjuksköterskans möjlighet att främja respektive hindra patientens upplevelse av delaktighet. Metod: Studien är en litteraturöversikt vars resultat är baserat på tio vetenskapliga artiklar som publicerats mellan åren 2005-2016. Resultat: Patienten anser att det är viktigt att sjuksköterskan ger möjlighet för patienten att uttrycka sig och tilldelas information om vårdsituationen. Genom detta gavs patienten möjlighet till att vara delaktig. Patienten vill bli sedd och hörd samt ses som en jämlik partner i vården. För detta behövs en etablerad relation mellan sjuksköterska och patient. Konklusion: Studier visar att patienten upplever att det finns hinder för att upprätthålla patientdelaktighet samt att sjuksköterskans förhållningssätt har betydelse för patientens upplevelse av delaktighet. / Background: According to Swedish law, patients have a legal right to be involved in their care. This also means that the nurse has a obligation towards the patient to make her/him involved. Despite this right, patients feels that they are not given the opportunity to be involved in their care. Aim: The aim of this study is to describe patient participation and nurses opportunity to promote and prevent the patient’s experience of participation. Method: The study is a literature review whose results are based on ten scientific articles published between the years 2005-2016. Results: The patient believes it is important that the nurse give the opportunity towards the patient to express themselves and be informed about the care situation. Through this the patient was given the opportunity to be involved. Patients want to be seen and heard, and seen as an equal partner in care. This requires an established relationship between nurse and patient. Conclusion: Studies show that patients find that there are obstacles to maintain patient participation and that the nurse’s approach is relevant to the patient’s experience of participation.

The thesis describes the phenomenon women’s health and illness experiences following a myocardial infarction (MI). The purpose of the thesis is to explore women’s experiences of their care and health processes, as well as their experiences of body, lifeworld and meaningful relationships related to the illness. A reflective lifeworld approach, based on phenomenological philosophy, is used. The thesis is comprised of four studies; three are based on interviews with a total of 26 women following an MI, followed by a fourth, theoretical, study. The first study explores women’s experiences of care and health processes following an MI, with a particular focus on well-being and participation (I). The findings show that an MI is an event that suddenly interrupts the ordinary life of the women. Participation is a sense of being involved in their own health and care processes, which may also encourage them to take responsibility for health promoting activities in a healthy and meaningful way. The second study explores women’s lifeworld experience of their bodies and lives following an MI (II). This study finds that an MI, as a major event in the women’s lives, influences and restricts their everyday activities over a long period of time. Following the illness, they live with an existential uncertainty about their life and the heart, and this feeling entails suffering for them. The third study explores the meaning of close relationships and sexuality to women’s health and well-being following an MI (III). The mmeaning of close relationships appears to be vitally intertwined with their long-term health process; both health processes and relationships are affected after an MI. The suffering following an MI can be compared to taking a fall, where meaningful close relationships can function as a safety net that catches the women in their fall. The fourth study is a concept development aimed at elucidating the meaning of the concepts uncertainty, control, secure and risk in relation to the thesis phenomenon and the findings of the empirical interview studies (IV). The existential uncertainty is an important matter in the women’s health processes. In these processes the concepts control, secure and risk play a central role. Women who have suffered an MI want to be as safe as possible in order to live well. The analysis illuminates a paradox, that the women’s ambition to achieve greater safety may lead them into an even greater experience of uncertainty. The conclusion is that women’s experiences of health and illness can be described as a journey characterized by existential uncertainty. The women’s lives go through different existential phases following an MI, which is a major event. They are not prepared for the reactions that this event causes and are in need of support and guidance to manage their illness experiences. If acknowledged and well met, the significance and meaning of the women’s reactions and experiences can give impetus and energy to their health processes.

Bakgrund: Patienter på kirurgisk vårdavdelning uttrycker ett stort informationsbehov vid utskrivning och upplever att väsentlig information saknas. Enligt patientlagen har patienter rätt till individanpassad information och delaktighet i sin vård. Högt flöde av patienter på kirurgiska vårdavdelningar och förkortade vårdtider kan medföra att patienter behöver klara av många delar av sin egenvård i hemmet efter en operation Syfte: Att undersöka hur patienter som skrivits ut från kirurgisk vårdavdelning upplever att deras informationsbehov har tillgodosetts för att klara av den första tiden i hemmet. Metod: Kvalitativ intervjustudie med ett bekvämlighetsurval. Åtta patienter som vårdats på kirurgisk vårdavdelning inkluderades. Intervjuerna analyserades med systematisk textkondensering. Resultat: Det framkom tre teman som beskriver patienternas upplevelser av hur deras informationsbehov blev tillgodosett. Patienterna beskrev upplevelser av oro och rädsla på grund av bristande information om kroppens återhämtning efter kirurgi. En kunskapsbrist hos patienter efter utskrivning bidrog till upplevelser av osäkerhet kring egenvård. Anpassad information och möjlighet att ställa frågor ansågs vara viktigt. Slutsats: Trots att patienter på kirurgisk vårdavdelning upplever att de får välanpassad och användbar information inför hemgång är det inte tillräckligt för att de ska känna sig trygga i hemmet. Avsaknad av viktig information och kunskap skapade känslor av oro och rädsla. Det är viktigt att utforma utskrivningssamtalet med fokus på patientdelaktighet och patientens individuella behov. Här finns ett område för specialistsjuksköterskan inom kirurgisk vård med sin kompetens att förbättra. / Background: Patients treated in surgical wards require self-care information at discharge. They demand information that suits their needs and express a lack of essential information. Swedish regulation states that patients have the right to get individualized information and to be able to participate in their care. Due to the large volume of patients in surgical wards and shortened length of stay, patients may be required to handle more aspects of self-care at home. Aim: The aim is to understand how surgical patients feel their information needs have been met, in order for them to confidently take care of themselves after discharge. Method: Qualitative interview study with a convenience sample of eight patients treated in surgical wards, analyzed using systematic text condensation. Findings: Three themes emerged which explained how patients felt their information needs were met. Patients describe a sense of anxiety and fear at home due to lack of information concerning recovery after surgery. A lack of knowledge after discharge led to insecurities related to self-care. Adapted information and possibilities to ask questions were perceived as important. Conclusion: Patients treated in surgical wards perceive discharge information as well-adapted and useful. However, it is perceived as not being extensive enough. A lack of essential information, coupled with a lack of knowledge led to feelings of anxiety and fear. With these results in mind, it is important to individualize the information given to patients at discharge, and to improve the patient participation during this process. This is an area that registered nurses, specialized in surgical care, have potential to improve.

Bakgrund: Patientdelaktighet är en lagstadgad rättighet och ses som önskvärt och fördelaktigt. Det är dock vanligt förekommande att patienter hamnar utanför själva processen och bara blir ett instrument i den. Syfte: Syftet var att, ur ett patientperspektiv, beskriva hinder och möjligheter för vuxna patienters delaktighet i sin vård. Metod: En litteraturöversikt där 13 kvalitativa artiklar låg till grund för analys och resultat. Resultat: Hindren för delaktighet beskrevs som att känna rädsla, oro och skam, inget intresse visas för patienten, att sakna information och kunskap och patientens försämrade hälsostatus samt fysiska och mentala tillstånd. Möjligheterna beskrevs med fenomenen vårdpersonal som lyssnar, att det finns förtroende, vårdpersonal som uppmuntrar och skapar motivation, en informationssökande patient och att känna sig frisk. Slutsats: Patientdelaktighet påverkar personcentrerad omvårdnad och både patienten och vårdpersonalen har ett stort ansvar i huruvida patientdelaktighet och sedermera personcentrerad omvårdnad kan uppstå. Patienter och sjuksköterskor tycker ofta lika i sak vad gäller patientdelaktighet. Resultatet är ett verktyg för vårdpersonal att lättare identifiera vad som behövs för att möjliggöra respektive vad som hindrar patientdelaktighet. Ett arbetssätt för att göra patienten delaktig i sin vård är att vårdpersonal ska lyssna, visa intresse och delge patienten information. / Background: Patient participation is statutory and considered as desirable and profitable. Nevertheless it is common that patients are excluded from the patient participation process. Aim: The aim was to, from an adult patient perspective, describe barriers and facilitators to patient participation in their own care. Method: A literature review with 13 qualitative articles analysed to the result. Result: The barriers were described as patients feeling fear, anxiety and shame, no interest is shown towards the patient, not having information and knowledge and the patients’ impaired health status and physical and mental status. The facilitators were described as nursing staff are listening, available trust, nursing staff that encourages and creates motivation, an information seeking patient and to feel healthy. Conclusion: Patient participation affects person-centred care and the patient and nursing staff have a great responsibility in whether patient participation and later on person-centred care may arise. Patients and nurses often have similar thoughts about patient participation. The result is a tool designed for nursing staff to in an easier way identify what is needed to facilitate patient participation and what hinders it. A way of working in making the patient to participate in their care is that nursing staff shall listen, show interest and inform the patient.

Introduction: People with Parkinson's disease require individualised medication regimens to achieve symptomatic control whilst managing complications of the treatments and the underlying disease. Patients should continue to receive their individualised regimen when they are admitted to hospital but studies have highlighted that this may not happen. There is a paucity of research about patients' perceptions of the management of antiparkinsonian medicines during a hospital admission and the aim of this study was to explore the perceptions of Parkinson's disease patients admitted to Leeds Teaching Hospitals about the management of their antiparkinsonian medications.Method: Grounded theory methodology was used to allow detailed exploration of patients' perceptions and to generate theory about this under-researched area. Face to face, semi-structured interviews were conducted with 13 Parkinson's disease patients during their hospital admission, fully transcribed and analysed using the constant comparative approach. Results: Categories contributing to the core category of 'patient anxiety' were identified as 'maintaining usual medication routine', 'access to antiparkinsonian medications', 'accuracy and consistency', 'trust in healthcare professionals' and 'staff knowledge about Parkinson's disease'. Strategies used to manage the anxiety were related to the categories 'utilising expertise' in Parkinson's disease and 'patient involvement' in their care. Discussion: The theory suggests that some patients have negative perceptions about the management of their medicines during a hospital admission. Areas for practice development are presented along with areas for future research. Conclusion: This study provides new insight into the perceptions of patients with Parkinson's disease about the management of their medicines during a hospital admission.

The present study applies Driver and Gottman’s (2004a) Turning System to observations of the therapeutic relationship in a quasi-experimental between and within groups design. A sample of 63 full counseling sessions (21 first sessions with clients who return for four sessions, 21 first sessions for clients who terminate therapy prior to four sessions, and 21 fourth sessions) were collected from a university counseling center in South Florida. Clients and clinicians also completed self report evaluations of the therapeutic relationship that were also included in this study (Working Alliance Inventory – Short Form, and the Real Relationship Inventory). A series of multivariate analysis of the variance (MANOVA) tests were performed to assess for significant differences in Turning System behavior between return and dropout groups in the first sessions of therapy, as well as for significant differences between return groups’ first and fourth sessions. Correlation analyses were run for client and therapist self report data and Turning System codes. Overall, the Turning System codes did not predict attrition from therapy; however, significant effects were found for specific behaviors in the return versus dropout comparisons, including client’s uses of negative bids, high level questions, and preoccupied away responses. The Turning System also did not predict clear differences between behaviors in ongoing therapy, though significant effects were again found for individual behaviors enacted by both clients and therapists. Significant negative correlations were also found for return group clients between specific behaviors and ratings of the therapeutic alliance, such as high level questions and preoccupied away responses. Individual behaviors in the therapist return group, such as high level questions, negative bids, and interruptions, correlated negatively with ratings of the therapeutic alliance. The results of this study are presented in an effort to synthesize the data into a narrative for developing effective therapeutic relationships and guidance for future research. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection