Personcentrerad vård beskrivs som att se hela människan och kunna sätta sig in i den andras livssituation. Respekt och förståelse för val och önskningar ska leda till självbestämmande och delaktighet i vård och behandling. Implementering av ett personcentrerat synsätt förordas för att möta de förväntningar som finns på god vård där patienten kan vara trygg och känna tilltro till vården. Att utvärdera personcentrerad vård är viktigt för att visa hur grundläggande behov som trygghet och tillit tillgodoses vid en förändrad vårdmodell. Syftet med studien var att belysa faktorer i personcentrerad vård som påverkar patientens upplevelse av trygghet och tillit. Studien utfördes som en systematisk litteraturstudie där sex kvalitativa och fyra kvantitativa vetenskapliga artiklar, publicerade mellan 2009-2014, analyserades utifrån en induktiv metod. I resultatet framkom faktorer som påverkade trygghet och tillit för patienten vid personcentrerad vård vilka delades in i tre kategorier: vårdrelationen, informations- och kunskapsutbytet samt organisatoriska faktorer. Resultatet visar att person-centrerad vård bidrar till att skapa trygghet och tillit för patienten. Förutsättningarna är en ömsesidig, respektfull relation, att patienten får kunskap och information om sin sjukdom för att vara delaktig och medbestämmande i vård och beslut. En kompetent sjuksköterska som bidrar till kontinuitet och tillgänglighet i vården skapade trygghet och tillit. För att utvärdera effekterna av personcentrerad vård krävs ytterligare forskning kring införande i klinisk verksamhet. Kännedom om vad som påverkar skapandet av trygghet och tillit för patienten kan bidra till kvalitetsförbättring vid utvecklandet av personcentrerad vård. / Patient centered care is described as seeing the entire person and the person’s right to mutual respect, understanding and empowerment during care. The implementation of patient centered care is advocated to meet the expectations of high quality healthcare where patients experience safety and a trusting environment. Evaluation of patient centered care is important to demonstrate how the basic needs of trust and safety are provided for in a transfer to a different care model. The aim of this study was to describe factors that influence trust and safety when the patient is cared for in a patient centered manner. A systematic literature review was undertaken and six qualitative and four quantitative articles published between 2009-2014 were analysed based on an inductive method. Factors that influenced trust and confidence in patient centered care emerged from the results and were described in three categories: the nurse-patient relationship, sharing of information and knowledge, and organisational factors. The overall results shows that patient centered care generates trust and safety for the patient. Facilitators are a mutual, respectful nurse-patient relationship, the gaining of knowledge about the disease to be able to participate in care and decision-making. A knowledgeable, skilled nurse who contributes to continuity and accessibility generates trust and safety. Further research is needed to evaluate the effects of patient centered care in clinical practice. Gaining awareness of facilitators that create trust and confidence for the patient may contribute to quality improvements when developing patient centered care.

::Dissertation (D.P.H.)--University of Michigan.

::Dissertation (D.P.H.)--University of Michigan.

Licentiatavhandling (sammanfattning) Linköping : Linköpings universitet, 2010. / Härtill 2 uppsatser.

Background: Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) experience ongoing or recurrent symptoms after discharge, regardless of their ultimate medical diagnosis. A comprehensive understanding of post-ED symptom trajectories is lacking. Aims: Aim 1 was to determine trajectories of severity of common symptoms (chest pressure, chest discomfort, unusual fatigue, chest pain, shortness of breath, lightheadedness, upper back pain and shoulder pain) in the six months following an ED visit for potential ACS. Aim 2 was to identify relationships between symptom trajectories and baseline physiologic factors (age, gender, diabetes status, diagnosis, comorbidities, functional status) and situational factors (marital status, insurance status, education level). Aim 3 was to identify relationships between symptom trajectories and health service use (outpatient visits and calls, ED visits, 911 calls, hospitalization) in the six months after the ED visit. Methods: This was a secondary data analysis from a study conducted in five U.S. EDs. Patients (n=1002) who had abnormal electrocardiogram or biomarker testing and were identified by the triage nurse as potentially having ACS were enrolled. Symptom severity was assessed in the hospital and 30 days and six months post-discharge using the 13-item ACS Symptom Checklist. Symptom severity was modeled across the three study time points using growth mixture modeling. Model selection was based on interpretability, theoretical justification, and statistical fit indices. Patient characteristics were used to predict trajectories using logistic regression and differences in health service use were tested using chi-square analysis. Results: Between two and four distinct trajectory classes were identified for each symptom. Identified trajectories were labeled "tapering off," "mild/persistent," "moderate/persistent," "moderate/worsening," "moderate/improving," "late onset," and "severe/improving." Age, sex, diabetes, BMI, functional status, insurance status, and diagnosis significantly predicted symptom trajectories. Clinic visits and phone calls, 911 calls, ED visits, and probability of hospitalization varied significantly among trajectories. Conclusions: Research on the individual nature of symptom trajectories can support patient-centered care. Patients at risk for ongoing symptoms and increased health service use can be targeted for education and follow-up based on clinically observable characteristics. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations.

Bakgrund: Sjuksköterskans kliniska arbete ska präglas av ett etiskt förhållningssätt som genomsyrar omvårdnadsarbetet i att skapa vårdrelationer och patientdelaktighet. God vård är allt mer jämställt med begreppet personcentrerad vård, att se människan och personen i patienten. Syfte: Att utforska hur personcentrerad vård kan utföras i sjuksköterskans kliniska arbete. Metod: En litteraturstudie av 20 artiklar har genomförts. Resultat: Analysen genererade ett antal strategier som presenterades i fem teman: Att se personen, Att lyssna, Att skapa relationer, Att visa respekt och empati, Att skapa stödjande miljö. Slutsats: Det är essentiellt att förstå att trots varierande strategier är det nödvändigt att flera strategier bör tillgås för att uppnå personcentrerad vård i alla situationer. Klinisk betydelse: Denna studie bidrar med kunskap om vad personcentrerad vård innebär och ger ökad insikt i hur det kan uppnås i det dagliga kliniska arbetet. / Background: The nurse work within an ethical framework that provides guidelines in the requirements of establishing nurse-patient relationships and in shared decision making. Good quality in nursing care depend on to what degree the nurse meet these requirements, which is equated to patient-centered care: to place the person of the patient in the center of care. Aim: To explore how patient-centered care may be performed in the nurse’s clinical setting. Methods: A literature review of 20 articles was performed. Results: The analysis resulted in various strategies. These strategies are presented in five main themes: To see the person, To listen, To create relationships, To show respect and empathy, To create healing environments. Conclusion: Despite the fact that there are various strategies, it is essential to understand that a combination of them is needed, in order to truly fulfil person-centered care. Clinical significance: This study may contribute to knowledge on how patient-centered care may be achieved in the everyday clinical setting.

Bakgrund : Kommunikation i hälso- och sjukvården är viktig för att inte misstag ska uppstå och är betydande vid en överlämning av patientansvaret. I slutenvården sker en rapportering genom att sjuksköterskan som arbetat lämnar över patientansvaret till sjuksköterskan som ska påbörja sitt arbetspass. Bedsiderapportering är en rapporteringsmetod som innebär att patienten är närvarande under rapporten, som kan ske vid patientens sängkant eller i ett enskilt rum. Sjuksköterskor anser att bedsiderapportering ökar patienternas delaktighet men upprätthållandet av sekretess kan i vissa fall påverkas negativt. Sjuksköterskan ska arbeta utifrån ett personcentrerat förhållningssätt, vilket innebär att respektera patientens delaktighet, självbestämmande och integritet. Syfte: Att sammanställa patientens upplevelser av och attityder till bedsiderapportering mellan sjuksköterskor vid ett skiftbyte, inom eller i anslutning till slutenvård. Metod: En litteraturöversikt. Resultatet utgår från 15 vetenskapliga artiklar som var publicerade mellan år 2011 och 2017. Resultat: Delaktighet ansågs öka hos patienter vid användning av bedsiderapportering. Däremot fanns det patienter som önskade mer delaktighet. Patienterna kunde kontrollera att informationen som gavs under bedsiderapportering var korrekt. Vissa patienter upplevde svårigheter att förstå språket medan andra inte påpekade detta som ett problem. Rapporteringsmetoden riskerade inte upprätthållandet av sekretess men däremot kunde flerbäddssalar göra det. Känslig information skulle diskuteras med försiktighet. Konklusion : Bedsiderapportering har en positiv effekt på patienternas delaktighet i hälso- och sjukvården. Patienternas delaktighet i rapportering minskar risken för att fel information om patienten vidarebefordras. Sekretess kan bevaras ytterligare och känslig information bör hanteras varsamt vid användning av bedsiderapportering. / Background : Communication in health care is important to prevent mistakes and is significant during patient handover. A patient handover is performed in hospitals when the outgoing nurse gives a patient report to the incoming nurse. Bedside handover is a method where the patient is present during the report, and it can be done at the patient’s bedside or in a private room. Nurses believe that bedside handover increases patient participation. However, the privacy of the patient can be negatively affected. Nurses need to have an approach with individual focus, which means to respect the patient’s participation, autonomy and integrity. Aim: To compile the patient’s experiences and attitudes regarding bedside handover between nurses during a handover, in or in connection to in-patient health care. Method: A literary review. The result is based on 15 different scientific studies. The studies were published between 2011 and 2017. Results: Patient participation did increase during bedside handover, but some patients wished to have more participation. Patients could verify that the information during bedside handover was correct. Some patients did find it hard to understand the language used by the personnel, other patients did not see this as an issue. The reporting method did not endanger the privacy of patients, but could be negatively affected if a room were shared. Sensitive information should be carefully discussed. Conclusion: Bedside handover has a positive effect on patient participation in health care. Patient participation reduces the risk of inaccurate information about the patient being passed on. The privacy of patients can be further maintained, and sensitive information should be handled carefully during bedside handover.

Bakgrund: De människor som invandrar till olika länder har med sig sitt eget språk, kultur, synsätt och vanor vilket har skapat ett behov på kulturellt anpassad vård. Sjuksköterskan som möter den mångkulturella patienten i sitt dagliga arbete kan uppleva en kulturkrock omvårdnadsarbetet. Kulturella skillnader och kommunikationssvårigheter ses som ett hinder för en god vårdrelation mellan sjuksköterska och patient. Syfte: Att beskriva sjuksköterskans upplevelser i vårdandet av den mångkulturella patienten Metod: En litteraturöversikt baserad på 15 vetenskapliga artiklar med publicering mellan åren 2008- 2018 från databaserna PubMed, Cinahl och Web of Science. Resultat: Det framträdde tre huvudteman: språkbarriärer, kulturella problem samt utbildningsbehov. Språkbarriärer upplevdes som ett stort hinder och en utmaning i vårdandet av patienter från andra kulturer. Sjuksköterskans upplevelser i mötet med den mångkulturella patienten påverkades av av kulturella- och kommunikationsproblemen mellan patient och sjuksköterska. Problemen för sjuksköterskorna att möta den mångkulturella patientens omvårdnadsbehov kunde bero på bristande kunskap och utbildning om olika kulturer. Slutsats: Det behövs mer kunskap hos sjuksköterskan om andra kulturer för att enklare kunna möta den mångkulturella patienten. / Background: People who immigrate to different countries have their own language, culture and habits. This has created a need for culturally adapted care. The nurse who meets the multicultural patient can experience a cultural clash in their work. Cultural differences and communication problems between nurse and patient is seen as an obstacle in providing good healthcare. Aim: To describe the nurse’s experiences in caring for the multicultural patient Method: A literature review based on 15 scientific articles with data collection from PubMed, Cinahl and Web of Science. Result: Three main themes were presented: language barriers, cultural problems and the need for education. The results show that language barriers pose a major obstacle and a challenge in the care of patient from other cultures. The nurse’s experience of caring for the multicultural patient was affected by the lack of knowledge about other cultures. Conclusion: The nurses need more knowledge about other cultures to make it easier in the meeting with the multicultural patient.

Bakgrund: Delaktighet innebär en aktiv medverkan. I vården är delaktighet ömsesidig och beroende av både vårdpersonal och patient med anhöriga. Sjuksköterskans kärnkompetenser består bland annat av personcentrerad vård, vilken utgår från patientens behov. För att skapa en säker personcentrerad vård av kvalitet bör sjuksköterskan bland annat ha kunskap om delaktighet.   Syfte: Att beskriva patientens upplevelse av delaktighet i vården. Metod: En litteraturöversikt genomfördes med kvalitativ och induktiv ansats. CINAHL och MedLine har använts som databaser, vilket genererade i tio kvalitativa artiklar. Resultat: Fyra kategorier och nio subkategorier analyserades fram och resulterade i att patienten upplever delaktighet vid kommunikation, delaktighet genom relation, möjlighet till delaktighet och via vårdpersonalens förhållningssätt till delaktighet. Slutsats: Förståelse för patientens upplevelser av delaktighet har betydelse för att klarlägga och främja delaktighet samt forma en personcentrerad vård av kvalitét. / Background: Participation means an active involvement. In health care, participation is mutual and dependent on both healthcare professionals and patients with relatives. Six competencies for nursing consists among others patient-centered care, based on patient needs. In order to create a safe patient-centered quality care, the nurse should, for example, have knowledge of participation. Aim: To describe patients experience of participation in healthcare. Methods: A literature review was carried out with qualitative and inductive approach. CINAHL and MedLine were used as databases, which summed up in ten qualitative articles. Results: Four categories and nine subcategories were analyzed and resulted in patient´s experience of participation. Patient experienced participation thorough communication, participation thorough relationship, possibility to participation and by healthcare professionals’ attitudes to participation. Conclusions: Understanding of patients´ experience of participation is important to clarifying and promoting participation and shaping a patient-centered care of quality.

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