En vårdfilosofi kan fungera som en grund för hur man ska handla och en förklaring till varför man har handlat som man har. Studien syftar till att beskriva en personcentrerad vårdfilosofi och hur den kommer till uttryck i demensvård. I denna studie har kvalitativa studier av demensvård med ett personcentrerat perspektiv analyserats för att öka förståelsen för hur denna vård upplevs av patienterna och hur den uttrycks i vården.På grund av att patienter med demenssjukdom är extremt sårbara och beroende av andra för sitt välbefinnande är det speciellt viktigt att formulera en vårdfilosofi inom demensvård.Det som är återkommande i resultatet av studien är synen på patienten som en person. Att bli sedd som en person och inte som en sak eller diagnos ger mening åt livet och möjlighet till att uppleva välbefinnande.Personcentrerad vård inom demensvård innebär att bekräfta patienten, vara närvarande i mötet, lyssna till och försöka tolka patientens berättelse, ge patienten frihet och möjlighet att välja och bestämma över sin situation, hjälpa patienten att bevara sina relationer och underlätta eller kompensera för personens förlorade förmågor. / <p>Program: Fristående kurs</p><p>Uppsatsnivå: C</p>

Foodservice is integral to safe, adequate and satisfactory food allergy management in the hospital setting. To date, research focused on objective measures of energy and protein provision, implementation and evaluation of food allergy guidelines and assessment of process failures leading to allergen exposure. There is a lack of focus on taking a person-centred approach to understanding the barriers and enablers to optimal food allergy management. A mixed methods phenomenological approach was espoused at a tertiary acute care hospital in Melbourne, Victoria. Data collection techniques included 24-hr diet recall, foodservice satisfaction questionnaires and semi-structured qualitative interviews, all delivered by an Accredited Dietitian. Statistical and thematic analysis was conducted, followed by convergence of the results from each phase of the study. Mean energy intake indicated 64% of requirements and 81% of protein requirements were met; which included external food intake to supplement the hospital diet for around half of the patients. Most patients rated their overall food service satisfaction as ‘Good’, with food quality being the lowest rated foodservice dimension. Addressing sensory, variety and communications aspects of foodservice were focus areas identified by the study patients. These included improving bland flavours and plain appearance, restricted menu choices and automated allergen interface between systems. With a person-centred care focus, the study identified new findings on the views and attitudes of patients with a food allergy on foodservice management in hospital. Within the Food and Meal Science field, the study may be seen as an initial exploratory enquiry for future research on food allergy.

The Stress and Coping Cyclical Amplification Model of Perfectionism in Illness posits, that in the context of a chronic illness, both perfectionistic strivings and concerns contribute to poor health outcomes. Similarly, person-centred models, such as the tripartite model of perfectionism, claim that high levels of both perfectionism concerns and strivings reflect an “unhealthy” perfectionism that takes a toll on well-being. To date there are few comparative tests of these models for physical and mental health outcomes in healthy versus chronically ill individuals. The aim of the current study was to investigate the implications of perfectionism for health by testing how within-person combinations of perfectionism varied in relation to health outcomes, and between fibromyalgia patients (n = 89) and healthy controls (n = 123). Supporting both models, within-person combinations of high perfectionistic strivings and concerns were associated with high stress and poor mental and physical health compared to other within-person combinations. These links were more robust for fibromyalgia patients compared to controls, and stress mediated the association with physical health outcomes only for the fibromyalgia patients. Findings support the value of taking a person-centred approach for understanding how perfectionistic strivings contributes to poor health in the context of chronic illness.

Increasing numbers of older patients with cognitive impairment and disturbed behaviour are likely to present to acute care hospitals in the future. Nurses are not well disposed towards care due to safety and morale issues caused by knowledge deficits, job stress, oppressed group behaviours and ageist attitudes. Patient outcomes are often poor with multiple adverse events, long lengths of stay and levels of mortality. Disturbed behaviour may be caused by delirium, depression or other mental disorders and dementia or all. The research question addressed was “Can the instigation of a person-centred approach to care of patients with cognitive impairment and disturbed behaviour result in decreased nursing stress, improved patient care practices, outcomes and relatives’ satisfaction?” A conceptual framework incorporating the constructs of Person-Centred Care, the Integrated Structural Model of Human Behaviour and Practice Development informed the action research methods utilised. The processes of facilitation were used to undertake four action research cycles incorporating plans, actions, observations and reflections in one 25-bed acute aged care ward in a large tertiary referral hospital The first cycle involved setting up the study, recruitment of nurses and patients, gathering of baseline data and application of nonparticipant observational studies of the quality of nurse-patient interactions which served to inform the plan for interventions. The following three cycles demonstrated efforts to undertake those interventions through strategies to increase nursing empowerment and knowledge in the context of constant staff turnover and diversions that compromised support and participation. During the study there were few apparent adverse patient outcomes with significant improvements in patient analgesic administration, relatives’ satisfaction with care, nursing care practices involving the completion of a Communication and Care Cues form and nurses’ interactions with the patients. New care planning tools were developed that will enable ongoing activities for practice improvement. Conversely, there was a significant increase in the nurses’ stress levels when caring for hypoactive delirious patients, a trend towards more emotional exhaustion, high nursing turnover and increased sick leave rates. Nursing care practices were unchanged and the new care planning tools were not well utilised. Reflection on the implications and limitations of action research methods supported by practice development strategies in the dynamic, often chaotic environment experienced during the study, suggested that if there is an absence of hierarchical managerial sponsorship for such activities, then sustainable change is difficult. Therefore, it was shown that a person-centred approach to care of patients with cognitive impairment and disturbed behaviour using action research methods in this environment, can result in some enhanced nurse-patient interactions, patient care practices, outcomes and relatives’ satisfaction. However, progress is likely to be slow and time consuming. Further improvements require attention to the well-being status of the nurses through actions that generate feelings of empowerment through individual recognition, knowledge enhancement, adequate access to patient information and sufficient time to undertake their duties as equal members of the multidisciplinary team.

Benämningen patient är ett kollektivt begrepp, som sätter sjukdomen och dess behandling i fokus. Hälso-och sjukvården har haft svårt att förändra sitt traditionella perspektiv där patienten betraktas längst ner i den hierarkiska sjukvårdsorganisationen. För att förändra det traditionella perspektivet så har ett nytt synsätt utformats där begreppet "patient" byts ut till "person". Personcentrerad vård började införas inom äldre- och demensvården, men tankar finns om att det även ska införas inom specialistvården. Syftet med studien var att utifrån litteraturen beskriva vad som kännetecknar personcentrerad vård ur ettomvårdnadsperspektiv. Studien genomfördes som en litteraturstudie och baserades på 13 vetenskapliga artiklar. Tre huvudgrupper kännetecknade personcentrerad vård; Att patientens livsvärld beaktas av sjuksköterskan, Att en ömsesidig vårdrelation skapas genom sjuksköterskan förhållningssätt och Att en gynnsam arbetsmiljö och vårdkultur skapas. Resultatet visade att personcentrad vård hade ett värde för patienten eftersom det leder till en maktförflyttning från sjuksköterskan till patienten. Sjuksköterskans förhållningssätt och attityd till yrkesrollen påverkar förmågan att utöva personcentrerad vård. Ombyggnation av lokaliteter och vårdmiljöer är betydelsefullt, men det mest centrala är att sjuksköterskan reflekterar, vågar utmana traditionellt rutinbeteende, föra patientens talan och att ledningen är positivt inställd till personcentrerad vård. Vidare forskning behövs om sambandet mellan personcentrerad vård och en effektivare vård med kortare vårdtider samt patientens upplevelse av delaktighet och tillfredställelse med vården. / The term patient is a collective term that sets the disease and its treatment in focus. Health care has had difficulties to change traditional ways of thinking in which the patient is classified at the bottom of the hierarchical medical care organization. In order to change traditional thinking a new approach has been designed where the term "patient" is changed to "person". Personcentred care is being brought into elderly and dementia care, but there are intentions also to integrate it in specialist care. The purpose of this study was that from literature describe the characteristics of personcentred care from the nursing perspective. The study was conducted as a literature study and was based on 13 scientific articles. The results showed what signifies personcentred care out of three main groups: patient's life-world observed by the nurse, a mutual care relationship is created by the nurse attitude and a favorable safety and health culture is created. Personcentred care makes a difference for the patient because it leads to a control transfer from the nurse to the patient. The nurses approach and attitude to the professional role affects the ability to practice personcentred care. Re-building of facilities and health care environment is important, but the most important is that the nurse reflects, dare to challenge the traditional routine behavior, speak for the patient and that the management is supportive to the personcentred care. Further research is needed whether personcentered care will lead to more efficient care with shorter hospital stays and if the patient feels more involved and satisfied with the quality of care.

Bakgrund: Användning av djur i vården har visat sig ge många positiva effekter på människan. Oavsett människors ålder och tillstånd kan djur bidra med att förbättra psykiska, fysiska och sociala funktioner. Bra bemötande, personcentrerat förhållningssätt och goda mellanmänskliga relationer krävs för att kunna ge god omsorg. Närhet och tillhörighet är en del av de grundläggande mänskliga behoven. Livskvalitet handlar om hur individen värderar sitt psykiska, fysiska och sociala välbefinnande och att förbättra livskvalitet kan ofta ses som målet med omvårdnaden. Syfte: Att beskriva hur djurassisterade interventioner påverkar hälsorelaterad livskvalitet hos vårdtagare. Metod: Deduktiv litteraturöversikt genomfördes med nio kvantitativa artiklar. I dataanalysen användes Fribergs trestegsmodell. Resultat: Det framkom sex domäner som ingick i hälsorelaterad livskvalitet: fysiskt, socialt, mentalt, emotionellt, aktivitet och funktion samt tillfredsställelse. Utöver domänerna framkom generell livskvalitet. Inget enhetligt resultat kunde påvisas inom de olika domänerna, dock sågs signifikant förbättring i den generella livskvaliteten i majoriteten av studierna. Signifikant förbättring var mest förekommande i den sociala domänen. Slutsats: Djur inom vården påverkar hälsorelaterad livskvalitet i varierande utsträckning hos olika vårdtagargrupper. Djur kan påverka vårdtagarnas livskvalitet positivt och är därmed lämpligt att använda som ett komplement i behandling och rehabilitering inom vården. / Background: The use of animals in healthcare has shown to give many positive effects on humans. Regardless of people’s age and conditions, animals can contribute to the improvement of mental, physical and social functioning. A positive attitude, a person-centred approach and good interpersonal relationships are needed to provide good care. Intimacy and belonging are a part of the basic human needs. Quality of life is about how individuals value their mental, physical and social well-being. To improve quality of life often can be seen as the goal of nursing. Purpose: To describe how animal-assisted interventions influence health related quality of life in patients. Method: Deductive literature review was conducted with nine quantitative articles. To analyze the data Friberg’s three-stage model was used. Results: Six domains emerged in the concept of health related quality of life: physical, social, mental, emotional, activity and function and satisfaction. In addition to the domains a general quality of life emerged. No homogenous results could be seen in the different domains; however, in the majority of the studies there was significant improvement in the general quality of life. The most significant improvement was seen in the social domain. Conclusion: Animals in healthcare have different levels of impact on health related quality of life in different patient groups. Animals may positively affect patient’s quality of life and it is therefore suitable for use as a supplement in treatment and rehabilitation in healthcare.

Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings:  Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.

Increasing numbers of older patients with cognitive impairment and disturbed behaviour are likely to present to acute care hospitals in the future. Nurses are not well disposed towards care due to safety and morale issues caused by knowledge deficits, job stress, oppressed group behaviours and ageist attitudes. Patient outcomes are often poor with multiple adverse events, long lengths of stay and levels of mortality. Disturbed behaviour may be caused by delirium, depression or other mental disorders and dementia or all. The research question addressed was “Can the instigation of a person-centred approach to care of patients with cognitive impairment and disturbed behaviour result in decreased nursing stress, improved patient care practices, outcomes and relatives’ satisfaction?” A conceptual framework incorporating the constructs of Person-Centred Care, the Integrated Structural Model of Human Behaviour and Practice Development informed the action research methods utilised. The processes of facilitation were used to undertake four action research cycles incorporating plans, actions, observations and reflections in one 25-bed acute aged care ward in a large tertiary referral hospital The first cycle involved setting up the study, recruitment of nurses and patients, gathering of baseline data and application of nonparticipant observational studies of the quality of nurse-patient interactions which served to inform the plan for interventions. The following three cycles demonstrated efforts to undertake those interventions through strategies to increase nursing empowerment and knowledge in the context of constant staff turnover and diversions that compromised support and participation. During the study there were few apparent adverse patient outcomes with significant improvements in patient analgesic administration, relatives’ satisfaction with care, nursing care practices involving the completion of a Communication and Care Cues form and nurses’ interactions with the patients. New care planning tools were developed that will enable ongoing activities for practice improvement. Conversely, there was a significant increase in the nurses’ stress levels when caring for hypoactive delirious patients, a trend towards more emotional exhaustion, high nursing turnover and increased sick leave rates. Nursing care practices were unchanged and the new care planning tools were not well utilised. Reflection on the implications and limitations of action research methods supported by practice development strategies in the dynamic, often chaotic environment experienced during the study, suggested that if there is an absence of hierarchical managerial sponsorship for such activities, then sustainable change is difficult. Therefore, it was shown that a person-centred approach to care of patients with cognitive impairment and disturbed behaviour using action research methods in this environment, can result in some enhanced nurse-patient interactions, patient care practices, outcomes and relatives’ satisfaction. However, progress is likely to be slow and time consuming. Further improvements require attention to the well-being status of the nurses through actions that generate feelings of empowerment through individual recognition, knowledge enhancement, adequate access to patient information and sufficient time to undertake their duties as equal members of the multidisciplinary team.

This research embraces an eco-systemic perspective of human behaviour (Bronfenbrenner, 1979) and uses participatory action research methodology to explore with young people, and those 'immersed in the system' (Carr & Kemmis, 1986) of education, their views and school experiences, to facilitate increased participation, empowerment and professional collaboration to support future school transitions. This study has been carried out in the South-West of England (inner-city and suburban areas), involving young people and their families, schools, alternative placement providers and multi-agency professionals. The following research aims were addressed: 1) To improve our understanding of the views and perspective of young people who have experienced school exclusion. 2) To explore multiple stakeholder perspectives of using a person-centred planning (PCP) approach to support school transition/re-integration and the perceived ‘supports' and 'barriers’ to implementation. 3) To explore the use of PCP in supporting positive outcomes for young people, 'post transition/re-integration' to mainstream school. 4) To consider the implications for future practice and research. This was a two part study, consisting of two research papers. The participants in paper one of the study were young people (N=12) identified by their settings as having experienced prior school exclusion, with an impending transition (or re-integration) to mainstream education. Paper one explored young people’s perspective to better understand the supports and barriers that have impacted upon their educational journeys, what they attribute as causes for their school exclusion and what they believe will help them in their future. A person-centred planning approach informed the data gathering process (Smull, Sanderson, Sweeney, Skelhorn, George & Bourne, 2005) and semi-structured interviews were analysed using thematic analysis based on Braun and Clarke’s (2006) framework. The individual interviews explored 'with' each young person, their views and perspective, and contributed towards the 'preparing to plan' stage of Person Centred Planning (PCP) being implemented in paper two. Paper two explored the use of Person Centred Planning (PCP) in supporting young people (N=6) in their school transition/re-integration to mainstream education. This involved young people from study one and a range of stakeholders including their family, friends, school/placement staff and multi-agency professionals. This focussed on exploring multiple stakeholder experiences of the ‘supports' and 'barriers’ of using a PCP approach in 'real life' practice. It also explored perceptions of the impact and efficacy of the approach over time in supporting young people across key outcome areas, 'post' transition/re-integration. Findings from paper one indicated young people's capacity to express themselves clearly and reflect meaningfully upon their educational journeys. Each young person made their own decision as to how they would participate and contribute their views and how the information would be used. Key findings indicated a range of perceived 'supports' and 'barriers' that young people identified as having impacted upon them. These encompassed the systems of school, family and community and, consistent with existing research, highlighted the significance of positive and caring relationships, access to help and support and experiencing a sense of belonging (Lown, 2005; Mainwaring & Hallam, 2010; O'Connor, Hodkinson, Burton & Torstensson, 2011).Young people's causal attributions referred to negative teacher relationships, peer bullying, rejection and perceived injustice. A distinct finding from this study referred to young people's sense of isolation when they felt that help was being denied at a time when they were experiencing negativity across the contexts of family, school and community. Young people referred to not feeling understood and supported and reflected upon this impacting on their behaviour in school. Findings also indicated that whole school behavioural systems posed a barrier to young people being able to access the help and support of key adults they had identified and to their inclusion in the wider school community. Findings from paper two indicated positive support from all stakeholder groups that PCP enabled the young person to be fully involved in their transition planning, facilitating a positive ethos that embraced equality and collaboration. Exploration of stakeholder views highlighted some negative reflections on the use of PCP, particularly in relation to its 'time consuming' nature and a range of key factors were identified as supportive and/or obstructive to implementing PCP in practice. When exploring perceptions of impact and efficacy over time, there were clear indications of positive development for each young person across key outcome areas. The majority of positive reflections were consistent across stakeholders groups and related to increased school attendance, improved emotional understanding, social interaction and academic progress. All individual targets were reviewed 'post transition/re-integration' and were deemed to have 'met' or 'exceeded' the expected levels. Furthermore, there have been clear references to changes made at a systems and environmental level that have underpinned these positive changes and emphasised the role that others play as ‘agents of change’ (Fielding, 2001). These findings have been assimilated and the implications for educational psychology practice and research considered.

Older Norwegian adults with an intellectual disability are today more integrated into society than earlier generations. Some represent the last of the generation that experienced and can talk about childhoods in central institutions and about living under the World War II Nazi regime. The closure of Norwegian institutions, which took place in the1990s, was based on social valuation theories. The post-closure situation for people with intellectual disabilities, their staff and local authorities was very different form what they had experienced previously, local authorities being responsible for providing person-centred services. This thesis examines whether life story work represents an effective approach to the person-centred support of older adults with an intellectual disability, through examining the impact of this work on services users (‘storytellers’) and their life story work supporters (‘interlocutors’). ‘The life story model of identity’ developed primarily by the American psychologist and professor Dan P. McAdams, is a major contribution to the thinking of this study. The model emphasises the importance of service providers’ understanding and knowledge of their service users’ life stories. A combination of critical realism and interpretative phenomenology analysis is advanced as a suitable joint philosophical framework for investigating the impact life story work has on both storytellers with intellectual disabilities (aged 45+) and on the interlocutors they personally chose from their staff group. The Delphi technique was used in a preparatory phase of interviews of six experienced life story workers from three different countries. A Participatory Action Research (PAR) approach was used to prepare the intervention, to develop the LSW programme and for pre- and post-interviews. 38 participants from day centres and residential settings in Norway took part in the study. The results indicate that even staff who had known storytellers for a long time learned new and valuable information. They came into possession of a better understanding of the service users’ behaviour and the interlocutors’ attitudes to service users were changed by the experience of carry out life story work with them. The interlocutors stated that they considered life story work to be ‘important’ in today’s services. The storytellers experienced increased feelings of safety and greater awareness of their abilities, life span (roots) and of themselves as a person (identity and personal development). They expressed pride in their life story work and appreciated the time they had spent talking and working alone with their interlocutors. Storytellers and interlocutors both said that life story work had brought them closer together and the love and appreciation they had for each other was a clear result of the time they had spent together. The eight week programme was, however, also challenging for the interlocutors who had problems finding the opportunity to conduct two hours work a week without interruption from other contextual influences.