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Bakgrund: Den svenska hälso- och sjukvården eftersträvar att arbeta personcentrerat. En del i att arbeta personcentrerat är att patienten ska få vara delaktig. Att arbeta med patientdelaktighet i hemsjukvården kan vara utmanande eftersom sjuksköterskan har regler och rutiner att följa. Om inte patientdelaktighet främjas riskerar det att patientens vård inte blir personcentrerad och därmed möter den kommunala hemsjukvården inte lagstadgade krav. Syfte: Att belysa sjuksköterskans erfarenheter av att främja patientdelaktighet för att uppnå en personcentrerad vård inom kommunal hemsjukvård. Metod: En kvalitativ intervjustudie med induktiv design valdes för att svara på studiens syfte. Datamaterialet inhämtades genom åtta semistrukturerade intervjuer med fem distriktssköterskor och tre sjuksköterskor. Datamaterialet analyserades inspirerat av Graneheim och Lundmans kvalitativa innehållsanalys.   Resultat: Analysen resulterade i två huvudkategorier och åtta underkategorier.  Sjuksköterskorna beskrev hur de arbetar för att bjuda in patienten i mötet, det gjordes genom att skapa och upprätthålla ett förtroende i mötet med patienten, lyssna in patienten, samarbeta med patienten, delge information, ge tid för patienten och att se patientens resurser. Sjuksköterskorna lyfte organisationens betydelse, hur de hade lagar och riktlinjer att följa och hur samverkan skedde både med och utan patienten. Slutsats: Patienten ska få tillåtas vara en aktiv medskapare i sin vård. Det finns en förbättringspotential för hur vården ska arbeta med patientdelaktighet för att möta lagstadgade krav. Det finns en otydlighet om vad patientdelaktighet innebär och sjuksköterskorna behöver vägledning och stöd från organisationen. / Background: The Swedish health service strives to work person-centered. Part of working person-centered is that the patient should participate. Working with patient participation in home care can be challenging because the nurse has rules and guidelines to follow. Unless patient participation is promoted, there is a risk that the patient's care will not become person-centred and thus the municipal home care does not meet legal requirements. Aim: To highlight the nurses experience in promoting patient participation in achieving person-centered care in municipal home care.  Method: A qualitative interview study with inductive design was chosen to answer the purpose of the study. The data was obtained through eight semi-structured interviews from five district nurses and three nurses. The data was analysed inspired by Graneheim and Lundman's qualitative content analysis.   Results: The analysis resulted in two main categories and eight subcategories. The nurses described how they work to invite the patient into the meeting, it was done by creating and maintaining a trust in the meeting with the patient, listening to the patient, collaborating with the patient, sharing information, giving time for the patient and seeing the patient's resources. The nurses emphasized the importance of the organization, how they had laws and guidelines to follow and how collaboration took place both with and without the patient. Conclusion: The patient should be allowed to be an active co-creator in their care. There is potential for improvement in how healthcare should work with patient participation to meet legal requirements. There is a lack of clarity about what patient participation means and nurses need guidance and support from the organisation.

Objectives: 1) To evaluate the impact of an interprofessional blended learning course on pharmacy and medical students’ communication skills; 2) To compare pre- and post-course communication skills across cohorts. Method: Pharmacy (N = 57) and medical (N = 67) students enrolled in a required Communication Skills for Health Professionals course completed asynchronous online modules and face-to-face standardized patient interview sessions over the course of 1 semester. Students completed pre- and post-course objective structured clinical examinations with standardized patients and were evaluated by trained faculty using the validated Common Ground Instrument. Communication skill domains evaluated on a 1 to 5 scale included: rapport building, agenda setting, information management, active listening, addressing feelings, and establishing common ground. Nonparametric statistical tests were used to examine paired pre-/post-course domain scores within professions and pre- and post-course scores across professions. Results: Performance in all communication skill domains increased significantly for pharmacy and medical students (p valuesImplications: The blended learning Communication Skills for Health Professionals course improved students’ interpersonal communication skills across multiple domains. Fostering communication skill development in medical and pharmacy students could improve the extent to which future health care professionals engage in patient-centered communication.

Sjuksköterskans professionella ansvar är att främja människors hälsa, förebygga sjukdom, återställa hälsa samt att lindra lidande, detta kan ske genom personcentrerad vård. Vid personcentrerad vård är det människan som är i behov av vård som ska sättas i centrum. Akutsjukvård innebär inte bara att ge kritiskt sjuka patienter snabb vård, den ska också vara individanpassad utifrån den patient som söker vård. Våld i nära relation är ett globalt problem som drabbar både kvinnor och män. Det kan ge konsekvenser genom det direkta fysiska traumat samt en rad följdsjukdomar som kan ha en mer psykisk påverkan på offrets livskvalité. För samhället kostar det stora summor årligen. Alla konsekvenser av våld i nära relation kan leda personen som blir utsatt för våld i nära relation till att uppsöka sjukvård, där sjuksköterskor på akutmottagningar har en möjlighet identifiera dessa patienter. Det finns flera kartlagda faktorer som påverkar detta, några är främjande och andra är barriärer som hindrar identifiering och personcentrerad vård.   Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av faktorer som kan påverka mötet med patienter som utsatts för våld i nära relation.   Studien var en intervjustudie med kvalitativ ansats. Åtta intervjuer (inklusive en pilotintervju) genomfördes på akutmottagningar på tre sjukhus i Mellansverige med hjälp av semistrukturerade intervjuer. Rådata analyserades genom induktiv innehållsanalys.   Resultatet visade på faktorer som påverkade mötet med patienter som utsatts för våld i nära relation och delades upp i två kategorier “Sjuksköterskans upplevda arbetssituation” och “Sjuksköterskans kunskap”. Faktorerna var knutna till den specifika arbetsplatsen och den interprofessionella stöttningen från kollegor i situationer som behöver få ta tid. De handlade också om sjuksköterskans egna förvärvade kunskap och de upplevda brister på kunskap som fanns generellt inom akutkliniken kring att möta patienter som utsatts för våld i nära relation. Faktorerna kunde ses som goda förutsättningar för att ge personcentrerad vård samt barriärer mot personcentrerad vård till patienter som är utsatta för våld i nära relation.   De intervjuade sjuksköterskorna använde personcentrerad vård för att vårda patienter som utsatts för våld i nära relation. Det fanns en kunskapsbrist och det saknades fastslagna rutiner samt kunskap om befintliga rutiner för hur sjuksköterskan skulle och kunde agera i mötet med patienter som utsatts för våld i nära relation. Ofta saknades en tydlig förankring angående problematiken kring våld i nära relation hos klinikledningen. Samarbete både med kollegor, andra professioner och andra instanser var något som kunde vara både en barriär mot att ge personcentrerad vård men också en främjande faktor. / The nurses’ professional responsibility is to further people's health, prevent disease, reconstruct health and ease pain, this can be done through person centered care. In person- centered care it is the person in need of care that should be in the center. Emergency medical service means not only to give critically ill patients fast care, it should also be fitted to the individual seeking care. Intimate partner violence [IPV] is a global problem that affects both women and men. It can cause consequences though the direct physical trauma and a range of secondary diseases that can have a more psychological influence on the victim’s quality of life. To the society it causes high costs yearly. All the consequences of IPV can cause the person affected to seek health care, where nurses at the Emergency department [ED] have an opportunity to identify these patients. There are several charted factors that affect this, some are encouragement, and some are barriers that inhibits identification and person-centered care.   The aim of this study was to describe nurses experience of factors that can affect the meeting with patients subjected to intimate partner violence.   This study has a qualitative research design. Eight semi structured interviews were conducted at Emergency Departments at three hospitals in the middle of Sweden. The raw data was the analyzed with inductive content analysis.   The results showed factors that affected the meeting with patients subjected to IPV and was split into two categories “Work Environment” and “Knowledge”. The factors were connected to the specific workplace and the interprofessional support from colleagues in situations that needed to take time. They also dealt with the nurses own acquired knowledge and the perceived inadequacies that was generally in the ED about meeting patients subjected to IPV. The factors could be regarded as good pre-requisites to give person centered care and barriers against person centered care towards patients subjected to IPV.   The nurses that were interviewed used person-centered care to give care to patients subjected to IPV. There were a lack of education and a lack of established routines and knowledge about existing routines for how the nurse should and could act in meeting patients subjected to IPV. There were often lacking a clear establishment about the problematics surrounding IPV at the clinic management. Collaboration with both colleges, other professions and other authorities was something that could be both a barrier against giving person centered care but also an encouragement.

Adolescent obesity is a growing health concern in the United States due to its increasing prevalence and comorbidities that can reduce longevity and increase morbidity. Advanced practice nurses (APNs) providing care in school-based health centers (SBHC) located in marginalized communities are uniquely positioned to work with adolescent students challenged with obesity. The management of adolescent obesity requires advanced skills and knowledge to promote healthy lifestyles, prevent obesity, and to directly address the many factors that contribute to the condition. The purpose of this project was to develop an education program for APNs to prepare them to work with students in prevention and control of adolescent obesity in the SBHC. The Shuler nurse practitioner practice model provided the framework to guide the project. A literature search yielded evidence-based care guidelines for adolescent obesity that were used to develop the education program. The program was provided to a panel of 5 clinical experts made up of 2 APNs and 3 pediatricians who work with adolescents who are obese. The panel evaluated the program using a 5-item, Likert-style questionnaire covering the 5 objectives of the program. Results ranged from a mean score of 3.4 to 4.0, indicating that the expert panel agreed or strongly agreed that the program met the objectives. This education program was provided to the SBHC administration and will be implemented in the next school term. The project may promote positive social change through increased APN knowledge of clinical practice guidelines for managing adolescent obesity and through improved adolescent health.

Health portals are dedicated web pages for medical practices to provide patients access to their electronic health records. The problem identified in this quality improvement project was that the health portal in the urgent care setting had not been available to staff nor patients. To provide leadership with information related to opening the portal, the first purpose of the project was to assess staff and patients' perceived use, ease of use, attitude toward using, and intention to use the portal. The second purpose was to evaluate the portal education materials for the top 5 urgent care diagnoses: diabetes, hypertension, asthma, otitis media, and bronchitis for understandability and actionability using the Patient Education Material Assessment Tool, Simple Measures of Goobledygook, and the Up to Date application. The first purpose was framed within the technology acceptance model which used a 26-item Likert scale ranging from -3 (total disagreement) to +3 (total agreement). The staff (n = 8) and patients (n = 75) perceived the portal as useful (62%; 60%), easy to use (72%; 70%), expressed a positive attitude toward using (71%; 73%), and would use the technology (54%; 70%). All materials were deemed understandable (74%-95%) with 70% being the acceptable percentage. Diabetes, otitis media, and bronchitis were deemed actionable (71-100%), but hypertension (57%) and asthma (40%) had lower actionability percentages. Hypertension, asthma, and otitis media had appropriate reading levels (6-8th grade). However, diabetes (10th grade) and bronchitis (12th grade) were higher with the target being less than 8th grade level. All handouts were found to be evidence-based. Recommendations were to revise the diabetes and bronchitis educational handouts to improve readability. Social change can be promoted by this project by facilitating positive patient outcomes at urgent care clinics.

Bakgrund En stor del av de patienter som frekvent söker vård lider av psykosomatiska sjukdomar (MUPS) och somatiseringssyndrom (MUS). Båda dessa tillstånd grundar sig i psykiska påfrestningar men yttrar sig i form av fysiska symptom. Stress är en psykisk påfrestning som är mycket utbredd i vårt samhälle idag. När människan utsätts för stress startar en rad olika fysiska processer i kroppen, som en del av vår överlevnadsinstinkt. Trots det är det många som stressar sig sjuka. Då kroppen inte får chans till återhämtning ökar risken för ohälsa med risk för psykosomatiska sjukdomar och somatiseringssyndrom som följd. Syfte Studiens syfte var att belysa upplevelser hos patienter med psykosomatiska sjukdomar och somatiseringssyndrom i den somatiska vården. Metod En litteraturöversikt valdes som metod, där 16 artiklar inkluderades. Artiklarna var av kvantitativ eller kvalitativ metod och analyserades enligt metoden integrerad analys. Resultat Patienter med MUPS/MUS lider av ohälsa och remitteras runt till olika vårdenheter utan att få den hjälp de behöver. Detta innebär ytterligare påfrestning på hälsan hos dessa patienter. Starka känslor såsom utanförskap, oro, skam och rädsla för sin egna ohälsan genomsyrar dessa patienters upplevelser. Kunskapen för dessa sjukdomstillstånd är bristfällig och det saknas tydliga riktlinjer och behandlingsmetoder inom vården. Slutsats Stigmatisering kring psykisk ohälsa skapar skam och utanförskap, vilket patienter med MUPS/MUS i stor utsträckning upplever. Bristande kunskap har visat på ineffektiv behandling vilket dessutom medför enorma kostnad för samhället. Sambandet mellan kropp och själ får inte förbises. Sjukvårdspersonal bör därför utbildas i att se den psykologiska faktorn bakom de fysiologiska symptomen. / Background A large proportion of patients who frequently seek health care suffer from psychophysiologic disorders (MUPS) and somatoform disorders (MUS). Both of these conditions derive from mental illness yet they manifest as physical symptoms. Stress is a psychological phenomenon which is widely spread in our society today. When a person is exposed to stress, a variety of physical reactions commence within our body, due to our survival instinct. In spite of this, a lot of people become physically and mentally ill from stress. When our body is deprived of recovery, there is a higher probability for lack of health and therefore the risk of developing psychophysiologic disorder and somatoform syndromes increases. Aim The purpose of the study was to illuminate patients with psychophysiologic disorders and somatoform disorders and their experiences within the somatic healthcare. Method A literature review has been conducted with an including total of 16 articles. The chosen articles consisted of quantitative or qualitative methods, analyzed according to the integrated analysis method. Results Patients with MUPS/MUS suffer from lack of health and are often referred to various care units without getting the help they need. This leads to further distress with a decreased health experience. Strong emotions such as exclusion, anxiety, shame and fear of lacking health permeate these patients' experiences. The knowledge regarding these conditions are insufficient and no distinct guidelines nor clear treatments exist within the healthcare system. Conclusions The stigmatization regarding mental illness leads to feelings of shame and exclusion for these patients. The lack of knowledge leads to ineffective treatment, which also entails an increased economic burden for the society. The relationship between the body and the soul must not be overlooked. Healthcare professionals need to be educated in the ability to recognize the underlying psychological factors behind the physiological symptoms.

Akutsjukvård bedrivs dygnet runt och inkluderar ett brett spann av olika åkommor vilka ej kan anstå. Smärta är mycket vanligt förekommande på en akutmottagning och är ofta underbehandlad. Bedömning av smärta genomförs medelst utförlig smärtanamnes samt självskattning av smärtan. Personcentrerad vård syftar till att se individens behov och ta tillvara dennes resurser för att gemensamt planera och genomföra vården, vilket utmynnar i ett partnerskap med två jämbördiga parter. Akutsjuksköterskan förväntas ta ett större ansvar för behandlingar och egna bedömningar kontra den grundutbildade sjuksköterskan. Akutsjuksköterskan ska kunna bedöma och initiera avancerad omvårdnad samt farmakologisk behandling. Sjuksköterskan är i regel den första professionen patienten möter på en akutmottagning och kan därför anses vara en lämplig initiativtagare till att påbörja smärtlindring. På flera platser i världen används protokoll med generella direktiv på smärtstillande läkemedel syftande till att användas för att minska patientens smärta och lidande innan dess att läkarbedömning har genomförts. Syftet med denna litteraturöversikt var att undersöka effekterna av sjuksköterskeinitierad smärtlindring.   Metoden som använts är en litteraturöversikt med ett systematiskt tillvägagångssätt. Totalt 15 artiklar inkluderades efter sökningar i databaserna CINAHL samt PubMed. Artiklarna kvalitetsgranskades och sammanställdes i en artikelmatris. En integrerad analys mynnade ut i fyra kategorier samt fem underkategorier. Resultatet visar att patienterna snabbare fick smärtlindring efter införande av sjuksköterskeinitierad smärtlindring. Fler patienter erhöll smärtstillande läkemedel och fler patienter inkluderades i sin vård genom ökad frekvens av smärtskattning. En ökad nöjdhet med behandlingen kunde ses, det fanns även tendenser till att fler patienter blev adekvat smärtstillade.  Inga patienter drabbades av några allvarliga biverkningar. Slutsatsen är att sjuksköterskeinitierad smärtlindring är ett bra verktyg specialistsjuksköterskan kan använda med flera positiva effekter och utan allvarliga negativa effekter för patienter. Smärtlindringen ges snabbare och till synes med god effekt. / Emergency care is provided around the clock and includes a wide range of different ailments which cannot wait to be treated. Pain is commonly present in an emergency department and is often undertreated. Assessment of pain is carried out by means of detailed pain medical history taking and self-assessment of the pain. Person-centered care aims to see the individual's needs and make use of his or her resources to jointly plan and implement the care, which results in a partnership with two equal parties. The specialist emergency nurse is expected to take greater responsibility for treatments and own assessments compared to a registered nurse. The specialist emergency nurse must be able to assess and initiate advanced care and pharmacological treatment. The nurse is usually the first profession the patient meets in an emergency department and can therefore be considered a suitable initiator to start pain relief. In several places in the world, protocols are used with general directives on painkillers intended to be used to reduce the patient's pain and suffering before a medical assessment by a doctor has been carried out. The aim of this literature review was to investigate the effects of nurse-initiated pain protocols in emergency departments. The method used is a literature review with a systematic approach. A total of 15 articles were included after searches in the databases CINAHL and PubMed. The articles were quality checked and compiled in an article matrix. An integrated analysis resulted in four categories and five subcategories. The results show that the patients received pain relief more quickly after the introduction of nurse-initiated pain relief. More patients received painkillers and more patients were included in their care through increased frequency of pain assessment. An increased satisfaction with the treatment could be seen, there were also tendencies towards more patients experiencing adequate pain relief. No patients suffered any serious side effects. The conclusion is that nurse-initiated pain protocols are a good tool the specialist nurse can use with several positive effects and without serious negative effects for patients. The pain relief is given more timely and seemingly with good effect.

Psykisk ohälsa är ett växande folkhälsoproblem och förutspås vara den största sjukdomsbördan i världen år 2030. Första vårdkontakten för patienter med psykisk ohälsa är vanligtvis sjuksköterskor i telefonrådgivning inom primärvård. Sjuksköterskor i telefonrådgivning upplever att de bland annat saknar erfarenhet, kunskap samt rätt verktyg för att ge adekvat rådgivning när de möter patienter med psykisk ohälsa. Det är därmed relevant att undersöka sjuksköterskans upplevelse av att bedöma psykisk ohälsa vid telefonrådgivning inom primärvården. Sex sjuksköterskor med olika lång erfarenhet av arbete i telefonrådgivning intervjuades. Dataanalysen genomfördes med hjälp av Elo och Kyngäs kvalitativa innehållsanalys med en induktiv ansats. Två kategorier framträder i resultatet, ”att känna sig otillräcklig” samt ”att känna sig otrygg” följt av 7 subkategorier. Det finns behov av psykiatrisk specialistkompetens inom primärvården för att möta behoven relaterat till psykisk ohälsa i samhället. Sjuksköterskan känner sig otillräcklig vid bedömning av psykisk ohälsa i telefonrådgivning, vilket belyser vikten av tillgång till spetskompetens på arbetsplatsen. / Mental illness is a public health problem that is predicted to be the biggest burden of disease in the world by the year 2030. Telenurses in primary care are usually the first to encounter patients with mental illness. Telenurses feel that they lack experience and knowledge or the right tools to provide adequate care when they encounter mental illness. It is thus relevant to further research the nurses experience of assessing mental illness through telenursing in primary care. Six nurses with different lengths of experience in working in primary care telenursing were interviewed and the collected data were analyzed using Elo and Kyngäs qualitative content analysis with an inductive approach. Two categories appeared in the result, “to feel inadequate” and “to feel insecure” followed by seven subcategories. Feelings of inadequacy and insecurity emerged when facing mental illness and the conclusion of this study highlights the importance of access to expertise in the workplace, such as a psychiatric nurse.

Non-suicidal self-injury includes deliberately damaging the tissues of one's own body. Self-harming behaviour is a growing problem and the number of patients seeking care related to self-harm has increased the last years. Despite this, the number of people who don´t seek care is assumed to be high. Self-harming behaviour is a complex area with many underlying causes and functions. Patients with self-harming behaviour are a vulnerable group because of the stigma involved in injuring oneself. How patients with self-harming behaviour are treated in healthcare can have a major impact on future confidence in healthcare. The aim of this qualitative literature study was to explore how patients with self-harming behaviour experience the treatment in health care. Three main themes and six sub-themes emerged. Being acknowledged includes; patients' positive experiences, Being seen and Feeling confident. Not being taken seriously includes; the negative experiences, Feeling diminished and To feel shame and guilt. The third main theme, Being in the care chain, includes; A negative spiral and Social network. Altogether, the themes present the patient's experience of the treatment in the health care system and how structural factors contribute to the patient's experience. Negative experiences such as not being seen and heard and a feeling of shame caused an insecurity which made it difficult for the patient to seek care and to be honest with the health care staff. Patients felt that there was a lack of knowledge among health care professionals. More knowledge is needed to improve the treatment.