Bakgrund HBTQI-personer står för samma hälsoproblematik som övriga befolkningen. Däremot löper de större risk för depression, suicidalitet och ohälsa, såsom bröstcancer, analcancer och övervikt. Inom denna grupp används även beroendeframkallande substanser i högre grad. HBTQI-personer utsätts för sociala påfrestningar vilket påverkar det dagliga livet. Den osynlighet HBTQI-personer har i vården påverkar utkomsten av den medan vårdpersonal samtidigt uttrycker att okunskap finns för HBTQI-specificerad vård. Syfte Syftet var att belysa HBTQI-personers upplevelser av mötet med vården inom somatisk vård. Metod Denna icke-systematisk litteraturöversikt är utförd med en kvalitativ design där 15 vetenskapliga artiklar inkluderats. Sökordskombinationer i databaserna CINAHL och Pubmed användes för att inhämta artiklarna. Artiklarna kvalitetsgranskades utifrån ett bedömningsinstrument för att sedan genomgå en analys. I analysen skapades teman och subteman baserat på de olika artiklarnas resultat. Resulta tHBTQI-personer upplevde främst negativa upplevelser av vårdmötet. Heteronormativitet, bristande kunskaper i HBTQI-specifik vård och vårdkvalitet samt en oförmåga att bilda en tillitsfull relation till vårdgivaren var orsakerna till detta. Framgångsfaktorer i vårdmöte tvar när HBTQI-personer upplevde en personcentrerad vård där kommunikation, respekt, öppenhet, intresse och medkänsla upplevdes. Slutsats Samtliga artiklar påvisade negativa upplevelser av vårdmötet som övervägande. En utökad kunskap hos vårdpersonalen i HBTQI-specifik vård skulle kunna utmana de negativa upplevelserna HBTQI-personer upplever samt bjuda in till en mer välkomnande vård där kvalitet och kunskap finns men också en god kommunikation med öppenhet och intresse.

Shared decision-making (SDM) for contraceptive counseling and method initiation is a hallmark of patient-centered care; SDM is associated with patient satisfaction, method continuation, and the prevention of pregnancy and short inter-pregnancy intervals. To achieve a high-quality experience for women Person-centered approach to counseling is the preferred approach to achieve SDM. Demographic factors and women’s perceptions of their providers have been linked to decision-making. Literature is lacking on SDM practices in safety net clinics, particularly in local health departments. Exploring these constructs is important to inform practices and policies for family planning. This research aimed to examine: 1) the influence of sociodemographic factors on SDM; 2) the influence of SDM on contraceptive method choice; and 3) the effect that women’s perceptions of their providers might have on SDM and associated contraceptive method choice, among non-white women in South Carolina and Alabama. Secondary data were from a longitudinal study that surveyed women of reproductive age (16 to 44 years) from the two states. The data used for this research were collected from non-white women between October 2018 and September 2020 as part of a larger evaluation effort. Bivariate and multinomial analyses were conducted to assess associations and relationships. In Study 1, significant differences in SDM were observed for income and age, with younger women and lower income women having increased odds of engaging in SDM compared to older and higher income counterparts. In Study 2, multinomial analysis indicated that, compared to those who maintained autonomy over their decision, those whose decisions were shared and provider-driven had higher odds of choosing a short-acting method over a less effective method (OR = 1.608 and OR = 2.314, respectively). In Study 3, associations between SDM and women’s perceptions of providers were observed. Compared to those who maintained decision-making autonomy and had positive perceptions of providers, those who engaged in SDM and those whose decisions were least autonomous were more likely to choose a short-acting method over other, less effective contraceptive methods. There is need to further examine whether SDM is underutilized in these settings.

Symptom research with advanced lung cancer patients has primarily focused on symptom severity, frequency, and distress; yet, little is known about advanced lung cancer patients’ priorities and success criteria for symptom improvement. To address these gaps in the literature, this study examined these outcomes using a modified Patient Centered Outcomes Questionnaire (PCOQ), which has largely been used with adults with chronic pain. Advanced lung cancer patients (<i>N</i> = 102) were recruited from the Indiana University Simon Cancer Center to participate in a one-time self-report survey, including demographic and medical questionnaires, symptom treatment history, standardized measures of symptom severity and quality of life, and the modified PCOQ focused on eight common symptoms in advanced lung cancer. Cancer information was collected from medical records. My primary aim was to evaluate the construct validity of the PCOQ. As hypothesized, symptom severity ratings on the PCOQ were positively correlated with standardized assessments of the same symptoms as well as functional status. Greater severity of most symptoms on the PCOQ was also correlated with worse quality of life, and greater severity of four symptoms was correlated with having more medical comorbidities. Positive, moderate correlations were found between the severity and importance of seeing improvement in cough, fatigue, sleep problems, and pain on the PCOQ. Patients considered low levels of symptom severity to be acceptable following symptom treatment; no differences were found across the eight symptoms. Latent profile analysis identified four patient subgroups based on the importance of seeing improvement in each of the symptoms: (1) those who rated all symptoms as low in importance (<i>n</i> = 12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (<i>n</i> = 29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (<i>n</i> = 23); and (4) those who rated all symptoms as highly important (<i>n</i> = 33). These subgroups were unrelated to demographic and clinical factors, except for functional status. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Furthermore, patients have heterogeneous priorities for symptom management, which has implications for tailoring treatment.

A quality patient experience is one of the highest priorities for hospitals as patients and families are looking to healthcare providers to meet their demands for quality service. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures the extent to which providers effectively communicate pertinent information such as communication about medications. On a 20-bed intermediate care unit, the HCAHPS item scores relating to nurse communication and communication about medicine were inconsistent and, on most occasions, were below the comparison benchmark of the 50th percentile when compared to other like hospitals. The purpose of this quality improvement project guided by the patient-centered care model, needs based theory, and adult learning theory, was to test the impact of an educational module for nurses on best practices for teaching patients about medications. Thirty nurses consented to participate in the teach-back sessions. Results of the pre- and posttest, evaluating the nurses' knowledge and attitude about teach-back, were analyzed using the Wilcoxon Signed Ranks test and findings showed an improvement in knowledge scores (z = -2.833, p = .005). However, no statistically significant changes occurred in nurse attitudes toward teach-back. A comparison of descriptive HCAHPS scores on communication about medications and nurse communication showed that scores improved from a low of 58% top box to 74% after the teach-back education. These findings indicated that using teach-back could enhance communication about medications. Effectively communicating pertinent health information using teach-back may have significant consequences for nurse-patient-family engagement contributing to positive social change.

Introduction: Cardiovascular diseases (CVD) remain the leading cause of death in the United States (U.S.), accounting for one in three deaths annually. Within the U.S., disparities in CVD outcomes and risk factors exist across demographic groups and geographic areas, such as the Central Appalachian region where the burden is higher than state and national rates. Patient-centered care (PCC), is a model of health care delivery that has been shown to improves disease outcomes and quality of life, and is critical in addressing disparities in health care. However, little is known about how high-risk Central Appalachian populations understand or perceive such a model. As such, the objective of this study was to examine the perceptions of PCC among community-dwelling CVD patients/caregivers in the region. Methods: A qualitative study design applying thematic analysis was utilized for data collection and analysis. Seven focus group discussions across six states in Central Appalachia were conducted, and comprised of 78 middle-aged participants selected through purposive sampling. Sessions were guided by standardized instrument regarding current efforts in their communities concerning CVD; challenges and needs; appropriate approaches to their cardiovascular issues; understanding and views about patient-centeredness; and related priorities. The discussions were audio-recorded, transcribed, and then coded for thematic analysis using NVivo qualitative data analysis software. Dependability of data analysis was achieved through an audit trail tracking the NVivo process. Results: Data analysis identified interpersonal relationships with health care providers (HCPs) as the most important aspect of PCC among participants. When asked what PCC meant to them, each group discussed the interpersonal relationship they wanted from HCPs, barriers that kept them from achieving this relationship, and how it impacted their care. Within this theme, two overarching subthemes emerged: (1) developing long-term relationships with HCPs, and (2) developing partnerships with HCPs. The first theme had subthemes that included: turnover of HCPs in their geographical location, the disappearance of family physicians, and preferences related to seeing a physician versus a physician’s assistant or nurse practitioner. The second theme’s subthemes included: communication, feeling cared for as an individual, and input into care. Conclusion: Patients/caregivers stressed the importance of interpersonal relationships with providers in the delivery of PCC. However, patients recognized when PCC was not being provided, provided examples of interactions that were not conducive to providing PCC, and reported feeling disempowered as a person and a patient. The results of this research can be utilized to understand patient/caregiver perceptions of PCC, and indicates the need for further research to reconcile these viewpoints with those of providers to improve the delivery of care, and health outcomes.

Abstrakt Bakgrund: Empatitrötthet är ett relativt okänt begrepp som kan drabba sjukvårdspersonal och inte minst sjuksköterskor som oftast arbetar patientnära. Empatitrötthet har visat sig ge en negativ inverkan på den egna hälsan, privatlivet samt på förmågan att förse patienterna med en säker och personcentrerad omvårdnad. Syfte: Att beskriva sjuksköterskans erfarenheter av empatitrötthet. Metod: En litteraturöversikt enligt Fribergs metod baserad på sju kvalitativa artiklar och en mixad metod. Artiklarna är hämtade från databaserna Cinahl, Pubmed, Scopus, och PsycINFO. Även sekundära sökningar inkluderades. Resultat: Analysen resulterade i fyra huvudkategorier; En mödosam arbetsmiljö upplevs leda till empatitrötthet, olika tillkortakommanden som upplevs leda till empatitrötthet, upplevda negativa symtom och konsekvenser av empatitrötthet och hanteringsstrategier som upplevs minska eller motverka empatitrötthet Konklusion: Litteraturstudiens resultat visar på att sjuksköterskors empatitrötthet riskerar att inverka negativt på både privata och arbetsrelaterade plan samt kan påverka omvårdnadsförmågan och patientsäkerheten negativt. Empatitrötthet bör lyftas som begrepp och förklaras så att sjukvården blir mer medveten om vad tillståndet kan innebära samt hur det kan påverka omvårdnaden på ett negativt plan. Det är önskvärt att adekvata strategier appliceras för att minska och motverka empatitrötthet vid ett tidigt skede. / Abstract   Background: Compassion fatigue is a relatively unknown concept that can affect healthcare profession and in particular nurses that works close to the patients. Compassion fatigue has shown to have a negative impact on nurses well-being, the private life and the ability to perform a safe and person-centered care for the patients. Aim: To describe nurse's experience of compassion fatigue. Methods: A literature review according to Friberg's method based on seven qualitative studies and one mixed method. The studies were found using Cinahl, PubMed, Scopus and PsycINFO. Secondary searches were also included. Result: The analysis resulted in four main categories; an arduous work environment is perceived to lead to compassion fatigue, various shortcomings that are experienced lead to compassion fatigue, negative symptoms and consequences experienced by compassion fatigue and management strategies to counter or reduce the feeling of compassion fatigue. Conklusion: The results of the literature study show that the condition of compassion fatigue risks having a negative impact on both private and work-related levels among nurses and can negatively affect the ability of nursing and patient safety. Compassion fatigue should be highlighted as a concept and explained so that the health industry becomes more aware of what the condition may cause and and how it can affect nursing negatively. It is desirable that adequate strategies should be applied to reduce and counteract compassion fatigue at an early stage.

Background: Registered nurses in the emergency department are exposed to a high workload, and the work environment is stressful. Frequent reports of burnout in the health care profession are a fact, and nurses are a particularly vulnerable group. Aim: The aim of this study was to investigate registered nurses’ experiences of work-related stress in the emergency department. Method: A literature review including 13 quantitative and qualitative studies was conducted. The databases CINAHL and Pubmed were used to find relevant research for this study’s intended purpose. The authors read all the studies multiple times to gain understanding and to find connections between the results. Results: The findings in this study revealed three main themes: the feeling of inadequacy, not having control and, finally, the deterioration of their health. The nurses conveyed that they were not capable of performing optimal care due to a lack of recourses paired with a high workload. The feeling of endangering the patients' safety because of the nurses' stress was recurring. The nurses described multiple coping mechanisms to handle stressful situations at emergency departments, but none that really worked. Conclusion: The nurses in the emergency department feel that work-related stress has a negative impact on their mental and physical health. Feelings such as powerlessness, guilt towards the patients and shame were common. Most nurses described that they were not satisfied with the quality of the care they provided. All nurses expressed the need for more resources to manage stress and to provide appropriate patient-safe care.

Bakgrund: Idag finns cirka 150 000 individer i Sverige med demenssjukdom och gruppen växer i takt med att befolkningen blir äldre. Personcentrerad vård har sitt ursprung inom humanistisk psykologi och begreppet beskrevs redan på 1960-talet. Personcentrerad vård är en av sjuksköterskans sex kärnkompetenser och är en god grund för att tillgodose de varierande behov som finns hos den komplexa patientgruppen. Syfte: Syftet med litteraturstudien är att belysa vad sjuksköterskans erfarenheter är av att ge personcentrerad vård till patienter med demenssjukdom. Metod: En litteraturstudie vars resultat baseras på studier med kvalitativ ansats. Vid sökning användes databaserna; CINAHL, PsycINFO och PubMed. Resultatets femton artiklar analyserades enligt Forsberg och Wengströms (2016) femstegsmetod. Resultat: Resultatet presenterades med hjälp av fyra huvudteman; organisationen, patientrelationen, kommunikation, vårdmiljö samt sju underteman; stöd på arbetsplatsen, kompetensutveckling, tids- och personalbrist, livsberättelsen - patientens historia, personliga attribut, samverkan i team och dokumentationsrutiner. Konklusion: Hälso- och sjukvården är en komplex organisation och sjuksköterskan står inför många utmaningar. Otillräckligt stöd från både ledning och kollegor samt vårdmiljöns utformning var alla faktorer som påverkade sjuksköterskans möjlighet att tillgodose personcentrerad vård. Vidareutbildning i kommunikation och demenssjukdomar upplevde sjuksköterskorna gynnsamt för deras arbete. Även vikten av att ha en god relation till patienten och att lära sig deras livshistoria framhölls som viktiga komponenter i den personcentrerade vården. / Background: Today there is approximately 150 000 individuals with dementia in Sweden and the group is expanding at the same time the population is ageing. Person centred care has its roots in humanistic psychology and the concept was described already in the 1960’s. Person centred care is one of the nurses’ six core competencies and is a good foundation for the various needs amongst the complex patientgroup. Aim: The aim for the literature review is to illustrate nurses’ experiences of giving person centred care to patients with dementia. Method: A literature review with a result based on studies with a qualitative approach. Databases used was CINAHL, PsycINFO and PubMed. The fifteen articles of the result were analyzed according to Forsberg and Wengströms (2016) model of five steps. Results: The result was presented using four main themes; the organisation, patient-relations, communication, care environment and seven subthemes; workplace support, quality of competens, lack of time and personel, lifestory - a patient’s history, personal attributes, team cooperation and documentation routines. Conclusion: The health-care system is a complex organisation and the nurse faces many challenges. Insufficient support from both management and colleagues and the formation of the care environment was all factors that affected the nurses’ ability to provide person centred care. More education in communication and different types of dementia illnesses were seen by nurses as positive contribution in their work. Even the importance of having a good relationship with the patient and learn about their lifestory was brought to daylight as important components in person centred care.

Many researchers have suggested positive patient-health provider relationships can positively impact patient outcomes. A few focused explicitly on bariatric weight loss surgery (BWLS) professional-patient interactions. This study is significant because BWLS is a recommended tool to combat obesity. The purpose of this study was to analyze the perceptions of BWLS education nurses regarding their patient encounters. This mixed methods research study used an online survey combining quantitative Likert scale questions and open-ended qualitative questions, with social cognitive theory as the theoretical foundation. These explored viewpoints relate to their patient relations expressed by a health professional. Health professional beliefs incorporated into patient interactions has merit within BWLS continuum from presurgery requirements, to the procedure, and post-surgery lifestyle. Many respondents are employed in obesity services programs and received 'snowballs' from other contacted health professionals. The analyzed written response word clouds favor patient-focused care. Participation reluctance by not answering or skipping short answer perspective questions was a quantitative trend. Data revealed survey specific noticeable qualitative tendencies favorable toward patient-centered care and patient health accountability. The anticipated positive social change is a better understanding of issues surrounding the choice for and against BWLS and improved healthcare and health professional-patient communications.

Schools of nursing educators are faced with redesigning nursing education to meet the complexity of implementing communication and patient- centered care to improve patient safety. This qualitative case study addressed the problem that teaching communication and patient- centered care were not threaded throughout curriculum, which left many new graduates nurses unprepared. The purpose of this study was to understand classroom experiences of new graduate nurses to meet performance outcomes. The research questions focused on understanding the classroom experiences of new graduates' of a nursing program by assessing the two concepts and how to address preparatory practices. The target populations were new graduates' of nursing programs who had been working in a hospital for less than 1 year and are registered nurses. Emergent themes regarding the new graduates classroom experiences strengths and areas of improvements were extracted from the 10 participants interview questions, and practice experiences from the journal recordings were manually coded, validated , triangulated, and member checked with eight themes that emerged from face-to-face interviews, theoretical frameworks, and the current literature. The researcher determined that the new graduates' nurses were self-motivated to implement communication and patient centered care, however incorporating the two concepts in the class instructions would be a safer preparatory experience. This study may contribute to positive social change through raising awareness regarding the overall standard of nursing education, which may lead to a reevaluation of nursing curricula and teaching strategies so that new graduate nurses may master the complexity of clinical practices resulting in positive performance outcomes