Background: Type 2-diabetes is a growing public health problem that cause suffering for people living with the disease and it is expensive for the Swedish healthcare system. The diabetes specialist nurse is often the person who stands for the continuity in the diabetes care and therefore has a big inpact on the outcome. The aim of this study was to describe the diabetes nurse’s experience of nursing care for adults with type 2-diabetes in primary care. The used method is qualitative. Eight diabetes nurses were interviewed with semi structured interviews and the content was analysed with qualitative content analysis. The result showed obstacles, dilemmas and possibilities experienced in diabetes care. Conclusion: There is a winning in knowing about obstacles, dilemmas and possibilities that can be experienced by diabetes specialist nurses in order to maintain a good diabetes care. The experienced obstacles and dilemmas needs to be continuously studied in order to keep evolving the diabetes care.

The purpose of this qualitative pilot study is to explore the patient perspectives about what it is like to receive a bed bath. Examining studies of bath basins versus alternative methods has shown a decrease in the spread of nosocominal infections. However, there is not sufficient evidence evaluating the patient perspectives of assistive bed bathing and interactions with nurses and nursing support staff. This information can provide healthcare providers, especially nurses, with a better understanding of patient perspectives and values. It also supports the national healthcare approach towards patient-centered care.

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Bakgrund: Det är viktigt att det finns kunskap om palliativ vård inom alla verksamheter då patienter i palliativ vård finns överallt inom vården. Finns inte kunskapen kan patientens behov lätt missas. Författarna till den här studien ville få en förståelse för vilka omvårdnadsbehov sjuksköterskor upplever att patienten har i det palliativa skedet. Syfte: Syftet var att undersöka vilka omvårdnadsbehov sjuksköterskor upplever att patienten har i det palliativa skedet och hur dessa behov kan tillgodoses. Metod: En kvalitativ intervjustudie genomfördes på ett sjukhus. Sju sjuksköterskor intervjuades och intervjumaterialet analyserades med manifest innehållsanalys. Resultat: Resultatet visade att sjuksköterskorna upplevde att patienten i palliativ vård har två övergripande omvårdnadsbehov. Dessa är psykosociala behov och omvårdnadsbehov. I psykosociala behov ingår autonomi, behov av uppmärksamhet, kommunikation och socialt nätverk. I omvårdnadsbehov ingår förutom behovet av omvårdnad även behov av omvårdnadskompetent personal. Konklusion: Studien visade att sjuksköterskorna upplevde att patienten i det palliativa skedet har behov av symptomlindring, samtal, bevarad autonomi, att bli behandlad som en individ, att ha ett stödjande socialt nätverk och kompetent personal.

SAMMANFATTNING Begrepp som patientcentrerad vård och helhetssyn i vården verkar användas av olika yrkeskategorier, inom hälso- och sjukvård, vilket kan ur kvalitetssynpunkt kan resultera i oklarheter inom den kliniska verksamheten. Syfte: Syftet med studien var att ta reda på vilka likheter och skillnader begreppen patientcentrerad vård och helhetssyn i vården har i den vetenskapliga litteraturen. Begreppen söktes i databaserna CINAHL och PubMed. Metod: Den metod som används för att jämföra begreppen byggde på Segestens begreppsanalysmodell. Resultat: Det som främst skiljer begreppet helhetssyn i vården från patientcentrerad vård är den andliga dimensionens centrala roll. Resultatet visar även att ett patientcentrerat arbetssätt förbättrar ekonomiska resultat. Det är främst sjuksköterskor som använder sig av helhetssyn i vården. Patientcentrerad vård verkar användas främst av läkare men begreppet förekommer även bland sjuksköterskor. Det gemensamma för begreppen då det gäller karaktäristika, förutsättningar och konsekvenser, är det som definieras i kraven på god vård enligt hälso- och sjukvårdslagen. Slutsats: sjukvårdspersonalens arbetssätt och syn på patienten utifrån patientcentrerad vård och helhetssyn i vården värnar om patientens bästa. Det som skiljer begreppen kan bero på vilken yrkesgrupp som undersökts i respektive studie. Studier av begreppet patientcentrerad vård uppfattas vara mer genomförda på läkargruppen samtidigt som helhetssyn i vården tycks vara mer förekommande då det gäller sjuksköterskegruppen. Fler studier behövs för att identifiera användningen av dessa begrepp och om deras betydelse i den kliniska verksamheten. / SUMMARY Concepts such as patient-centered care and holistic care seem to be used by different professions in healthcare. Looking upon these concepts from the aspect of quality, ambiguities can arise in clinical practice. Objective: The purpose of this study was to compare the similarities and differences between the concepts of patientcentered care and holistic care as they are presented in scientific literature. The terms were searched for in the databases CINAHL and PubMed. Method: The method used to compare the concepts was based on Segesten concept analysis model. Results: what differentiates the concept of holistic care of the patient-centered care is the central role of spiritual dimension. The results also show that a patient-centered care improves economic results. The term holistic health care seems to be used primarily by nurses, while patient-centered care seems to be used primarly by physicians, even though the term does occur among nurses. Conclusion: both patient-centered care and holistic care seem to have the same goal, that of preserving the patient`s best interests. What distinguishes the concepts may depend on the profession which was examined in each study. Research studies on patient-centered care have been carried out primarily on physicians, while studies on the holistic approach in health care have focused on nurses. More studies are needed to identify the use of these concepts and their importance in clinical practice. Nyckelord: Patient-centeredness, patient-centered care, holistic care, holistic nursing.

The complexity and lack of coordination of the U.S. health care system is especially challenging for older adults, many of whom have multiple chronic conditions. The faith community is a potential partner to assist them, due to strong religiosity of older adults and specific characteristics of faith communities. This study explores the knowledge and practices of faith community nurses (FCNs) in meeting care coordination needs of older adults and identifies a model of gap-filling by FCN practice. An approach combining both quantitative and qualitative approaches was used. A survey was distributed to all known FCNs in Kentucky. From the 60 respondents, 15 FCNs were selected for personal interviews, and six care recipients were also interviewed. Survey data revealed a relatively older workforce, M=57 years, with 73% in nursing for more than 20 years. All served as FCNs in their own congregations, mostly as volunteers. FCNs relied on informal rather than formal assessments, with little consistency in type of health-related information obtained from congregants. The combined interview data revealed themes including, strong grounding in faith, sense of congregational family, reliance on general nursing assessment skills, intentional empowerment, bridging expanses, trust, and continuity. Findings suggest that FCNs in Kentucky identify and fill significant gaps in health care for older adults. Spirituality and religious rituals were important for FCNs and those they served. Congregants sought out FCNs to answer questions, interpret medical information, and assist with health care interactions. The stability of the FCNs in the lives of congregations was regarded as important; congregants counted on FCNs presence through transitions in health. A model to explain FCN intervention was developed based on integration of a social ecological perspective with the WHO International Classification of Functioning, Disability, and Health. This model reflects contextual factors that occur throughout nested environments that surround each individual, including immediate family, congregational family, health and social care systems, and societal policies. FCNs serve as a bridge between and among these nested environments, connecting them and facilitating change within each level.

Online Health Seeking (OHS) is widespread and widely studied, but its ideal fit in healthcare is still unclear. OHS is seemingly emblematic of patient self-interest and control and is an intuitive fit with the tenets of patient-centered care (PCC). Researchers have made only a few attempts to evidence or leverage this connection, focusing instead on describing the figures and typical characteristics of OHS. Finding, consuming and sharing online health and wellness information is one of the common online activities, and consumers are generally satisfied with their results despite using simple and error-prone search strategies. Physicians are interested in their patients' OHS, but for a variety of constraints including time, compensation and traditional roles in medicine, most patient OHS goes unshared with doctors. Healthcare facilitators, a relatively new class of health professional that works to bridge the gap between their client's health and personal life, may be an ideal partner for patients in OHS. In this dissertation I share my investigation of the OHS-PCC connection, presenting a case study of a type of healthcare facilitator that has embraced OHS. By studying OHS, I was also able to contribute to the collaborative information seeking (CIS) community. CIS theory and social search tools have pointed to social factors that can influence the entire process of information seeking. In this dissertation I argue that nearly any social search design can be seen as situated or embedded in a unique socio-environmental context. I suggest that social search tools can be used as probes to understand the environment, and that interactions with a search tool can illustrate phenomena far beyond direct search motivations and goals. I also hypothesize that social search field studies can produce changes in their environment, producing changes in user relationships outside of the experimental search system. My study of OHS is an opportunity to test these hypotheses by creating a collaborative search tool that seeks to use OHS as a tool to improve patient-provider relationships. In this dissertation I present the results of a series of field studies at a local clinic that centers on a unique form of health facilitator. Drawing on several formative investigations and related work I synthesize design guidelines for a collaborative OHS tool and describe Snack, a collaborative search tool for OHS customized to my field site. I also present results from Snack's field study and an analysis of email messages between advisors and clients at the clinic. My results show that these health facilitators embraced OHS as a tool to guide and connect with their clients, but fell from this practice after a change at their clinic. After analyzing these results I discuss what makes health facilitators good OHS partners and cover implications for future OHS-based interventions. I also report the positive connections I found between OHS and other quality of care indicators like patient-centered care and the Multidimensional Health Locus of Control. Finally, I consider social search's utility as a probe and intervention in light of my results.

Bakgrund: Studier visar att patienten, framför allt kvinnor, upplevde sig utlämnade, nervös, ångestfyllda och oroliga inför och under det korta mötet med anestesisjuksköterskan innan operation. Syftet: är att undersöka patientens upplevelse av obehag och delaktighet i mötet med anestesisjuksköterskan inför en nedsövning och om patientens kön har någon betydelse för detta. Metod: En kvantitativ tvärsnittsstudie med ett deskriptivt förhållningssätt där enkät valts som datainsamlingsmetod med totalt 44 respondenter. Resultat: Majoriteten av respondenterna upplevde ingen obehagskänsla inför en anestesi, av de få som upplevde påtaglig med obehag var samtliga kvinnor. Medan en majoritet av respondenter kände sig delaktiga i vårdarbetet inför en nedsövning, var en fjärdedel inte tillfredsställda. En fjärdedel av respondenterna önskade större delaktighet, medan övriga inte ville eller inte visste ifall de ville vara delaktiga. Männen kände sig mindre delaktiga i vårdarbetet än kvinnorna samtidigt som de inte hade en större önskan om att vara delaktiga. Kvinnor däremot kände sig mer delaktiga, än män, och hade dessutom en önskan om att vara delaktiga. Ingen signifikant skillnad fanns mellan kvinnor och mäns svar. Slutsats: Även om en majoritet av de patienter som genomgick en operation som krävde generell anestesi antingen kände sig delaktiga eller inte eftersökte mer delaktighet i sjuksköterskan vårdarbetet så var det fortfarande en fjärdedel som inte kände sig delaktiga. En tredjedel av respondenterna hade en positiv inställning till att med egna händer hålla i syrgasmasken under preoxygeneringen. När det kommer till patientens upplevelse av obehag inför en anestesi så visar denna studie att en tydlig majoritet inte upplever någon form av obehag, av dem få som upplevde påtagligt med obehag var samtliga kvinnor.   Nyckelord: Obehagskänsla, preoxygenering, delaktighet, patientcentrerad vård. / Background: Studies have shown that patients, especially women, feel themselves vulnerable, nervous, anxious and apprehensive before and during the brief meeting with the nurse anesthetist before surgery. Aim: The purpose of this study is to examine the patient's experience of uneasiness, participation in the meeting with the nurse anesthetist, before a general anesthetic, and if the patient's gender has bearing   Method: A quantitative cross-sectional study with a descriptive approach where survey was selected as data collection method, with a total of 44 participants. Results: The majority of respondents experienced no uneasiness before an anesthesia, the few who experienced significantly uneasiness were all women. The study showed that the majority of respondents already felt a sense of involvement involved in the care work before a general anesthetic, but still 25% did not ensure patients needs. 25 % of the respondents expressed a desire for greater involvement, while rest of the respondents did not want to, or did not know whether they wanted to be more involved. Male respondents felt less involved currently, but also expressed least interest for greater involvement. Female respondents, on the other hand, felt more involved than men, and at the same time also expressed a desire to be involved. No significant difference was found between women's and men's responses. Conclusion: A majority of the patients who underwent a surgery requiring general anesthesia did feel a level of involvement in the care work performed by nurses. While a majority did not want to be involved at all in the care work, 25% did not feel, but wished to be involved. One way to accommodate and increase involvement would be to offer the patients to hold the oxygen mask with their own hands during preoxygenation. Nearly a third of the respondents would have agreed to do so if they had been given the option. When it comes to patient’s uneasiness before an anesthesia does this study shows that a clear majority does not experience any kind of uneasiness, those who experienced significantly uneasiness with were all women.   Keywords: Uneasiness, preoxygenation, participation, patient-centered care.

Introduktion: I litteraturen finns få studier som beskriver patientcentrerad vård i perioperativ vårdmiljö. Den patientcentrerade vården (PCV) syftar till att tillvarata patientens perspektiv för att kunna anpassa vården. Begreppet beskrivs som vård anpassad utifrån patientens behov och värderingar. Behoven identifieras, förutses, samordnas och integreras i vården. PCV kännetecknas av respekt och värdighet för patienten som ges valmöjlighet i alla situationer. Syfte: Studiens syfte var att undersöka operationssjuksköterskans uppfattning om patientcentrerad vård och hur det tar sig uttryck i den perioperativa vårdmiljön Metod: Studien bygger på semistrukturerade intervjuer som analyserats med kvalitativ innehållsanalys. Urvalet bestod av 10 kvinnor med åldersspannet 29-59 år med arbetslivserfarenhet som operationssjuksköterska mellan 2-28 år. Resultat: Operationssjuksköterskorna beskrev PCV som att ha patienten i fokus vilket leder till patientcentrerade vårdhandlingar. Dessa vårdhandlingar innefattar att anpassa sig och omvårdnaden utifrån de behov som identifierats hos patienten. Möjligheterna att utöva patientcentrerad vård påverkas av olika yttre och inre faktorer som arbetsmiljön, stress och framför allt operationssjuksköterskans personliga uppfattning. Konklusion: För operationssjuksköterskorna i studien innebär PCV att ha fokus på patienten och att möjliggöra patientens delaktighet i sin vård. Detta kan göras genom olika omvårdnadshandlingar där värderingar och uppfattningar kring patientcentrerad vård speglas. Både yttre och inre faktorer påverkar vilken patientcentrerad omvårdnad operationssjuksköterskan ger patienten.