Bakgrund: Bröstcancer är den vanligaste cancerformen i Sverige när det gäller cancerdiagnos hos kvinnor. Det är en livshotande diagnos som ofta behandlas med kirurgi i form av mastektomi. Mastektomi medför både psykisk och fysisk påfrestning på kvinnorna som kan ge upphov till lidande. Sjuksköterskan har ansvar för kvinnan och den personcentrerade vården där både psykiska, fysiska och sociala svårigheter ska uppmärksammas. Syfte: Syftet var att belysa kvinnors upplevelser av vårdprocessen i samband med mastektomi till följd av bröstcancer. Metod: En litteraturstudie baserad på kvalitativ forskning valdes som metod och analyserades systematiskt. Resultat: I resultatet framställs tre huvudteman med tillhörande subteman. Det första huvudtemat Ett förändrat liv med tillhörande subteman Den initiala reaktionen och Behov av stöd. Det andra huvudtemat Information och delaktighet med tillhörande subteman Individanpassad information och Delaktighet och påtryckning samt det tredje huvudtemat En förändrad livsvärld med subteman Förlust, sorg och rädsla och Acceptera det nya. Konklusion: Kvinnor som drabbas av bröstcancer, med efterföljande mastektomi, upplever känslor som kräver ökat stöd där vården behöver arbeta personcentrerat. Kvinnorna behöver känna delaktighet och trygghet i sin vård. Individanpassad information och närvarande vårdpersonal har positiv betydelse för vården av kvinnor efter mastektomi. / Background: Breast cancer is the leading cancer diagnosis amongst women in Sweden. Breast surgery referred to as mastectomy is the most common treatment for this life- threatening condition. A mastectomy is both physically and mentally challenging and as a result can lead to suffering. Nurses have a duty of care regarding individualised care and in the identification of physical, mental and social difficulties related to the diagnosis. Aim: The purpose of this study was to highlight women's experiences of the care process related to mastectomy due to breast cancer. Method: A qualitative literature review-based approach was chosen and the the literature was systematically analysed. Findings: The result identified three main themes with associated subthemes. The first main theme A changed life with associated subthemes The initial reaction and Need for support. The second main theme Information and participation with associated subthemes Individualised information and Participation and pressure, as well as the third main theme A changed lifeworld with subthemes Loss, grief and fear and Accept the new. Conclusion: Women who suffer from breast cancer, with a subsequent mastectomy, experience feelings that require increased support where care needs to be person-centred. These women need to feel participation and security in their care. Individualised information and high healthcare staff presence have a positive impact on the care of women after a mastectomy.

Yes / Although training and workforce development are high on the policy agenda at present (eg DoH 2009), there has been less progress in thinking about the kind of education that might be needed in order to provide dementia care that is genuinely person-centred. A continuing obstacle here is the tendency to assume that people who have dementia are to be understood ¿ as a group ¿ by virtue of their shared diagnosis rather than by their lived experience, in which diagnosis is an interruption rather than the whole story. Three approaches to overcoming this obstacle that I will discuss below are arts-based learning, teaching social history awareness, and increasing the involvement of the ¿experts by experience¿, people with dementia themselves.

No / The author explains how Dementia Care Mapping can be used as powerful preventative tool for safeguarding people with dementia from abuse. Used as part of the process of developing person-centred care, the Dementia Care Mapping tool can be used to identify the preconditions of abuse within care settings.

Yes / People with dementia occupy up to one quarter of acute hospital beds. However, the quality of care delivered to this patient group is of national concern. Staff working in acute hospitals report lack of knowledge, skills and confidence in caring for people with dementia. There is limited evidence about the most effective approaches to supporting acute hospital staff to deliver more person-centred care. This study aimed to evaluate the efficacy of a specialist training programme for acute hospital staff regarding improving attitudes, satisfaction and feelings of caring efficacy, in provision of care to people with dementia. A repeated measures design, with measures completed immediately prior to commencing training (T1), after completion of Foundation level training (T2: 4–6 weeks post-baseline), and following Intermediate level training (T3: 3–4 months post-baseline). All participants received the 3.5 day Person-centred Care Training for Acute Hospitals (PCTAH) programme, comprised of two levels, Foundation (0.5 day) and Intermediate (3 days), delivered over a 3–4 months period. Staff demographics and previous exposure to dementia training were collected via a questionnaire. Staff attitudes were measured using the Approaches to Dementia Questionnaire (ADQ), satisfaction in caring for people with dementia was captured using the Staff Experiences of Working with Demented Residents questionnaire (SEWDR) and perceived caring efficacy was measured using the Caring Efficacy Scale (CES). The training programme was effective in producing a significant positive change on all three outcome measures following intermediate training compared to baseline. A significant positive effect was found on the ADQ between baseline and after completion of Foundation level training, but not for either of the other measures. Training acute hospital staff in Intermediate level person-centred dementia care is effective in producing significant improvements in attitudes towards and satisfaction in caring for people with dementia and feelings of caring efficacy. Foundation level training is effective in changing attitudes but does not seem to be sufficient to bring about change in satisfaction or caring efficacy. Keywords

Yes / This study assessed the effects of a person-centred care based psycho-educational intervention on direct care workers' communicative behaviours with people with dementia living in aged care facilities. An experimental study with a pre-posttest control group design was conducted in four aged care facilities. Two experimental facilities received an eight-weekly psycho-educational intervention aiming to develop workers’ knowledge about dementia, person-centred care competences and tools for stress management; control facilities received an education-only, with no support to deal with stress. A total of 332 morning care sessions, involving fifty-six direct care workers (female, mean age 44.72±9.02), were video-recorded before and two weeks after the intervention The frequency and duration of a list of verbal and non-verbal communicative behaviours were analysed. Within the experimental group there was a positive change from pre to post-test on the frequency of all workers’ communicative behaviours. Significant treatment effects in favour of the experimental group were obtained for the frequency of inform (p<0.01, ƞ2partial=0.09) and laugh (p<0.01, ƞ2 partial=0.18). Differences between groups emerged mainly in relation to non-verbal communicative behaviours. The findings suggest that a person-centred care based psycho-educational intervention can positively affect the direct care workers’ communicative behaviours with residents with dementia. Further research is required to determine the extent of the benefits of this approach. / Foundation for Science and Technology

Yes / This study aimed to assess the effects of a psycho-educational intervention, designed to improve direct care workers’ stress, burnout and job satisfaction and person-centered communicative behavior with people with dementia. A pretest-posttest control group design was conducted in four aged-care facilities. Two experimental facilities received a psycho-educational intervention; two control facilities received an education-only. Data were gathered from fifty three care workers at baseline, immediately and six months after the intervention, through self-administrated instruments and video-recorded morning care sessions. The experimental group showed a significant decrease in care workers’ burnout and a significant improvement in several communicative behaviors (e.g., involvement). Stress levels deteriorated at six months and no intervention effects were found for job satisfaction. The findings highlight the importance of providing care workers with both technical competences and tools for stress management as this might be associated with a reduction of their levels of exhaustion and improved communicative behaviors. / Foundation for Science and Technology

No / Introduction There is growing awareness of the importance of patient centered care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents. However, there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services. This is the first step in developing measurable indicators of PCC in diagnostic radiography. Methods A multi-method two stage approach was undertaken using survey and interview data collection techniques. Ethical approval was granted by University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 1 of the study, the online, cross sectional survey. Participants were asked to indicate their level of agreement to a series of attitudinal statements using a 5-point Likert scale. Statements were paired, but not co-located to increase validity. Participants were invited to provide free text comments to supplement their responses. Stage 2 of the project is reported separately. Results Survey responses were received from all 3 participant subgroups. A minimum response rate of 30 participants per sub-group was set as a target. Response rates varied across subgroups, with only radiography managers failing to meet the expected response threshold. Wide disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Conclusion It is evident that there is still work required to ensure parity between expectations of service users and deliverers on what constitutes high quality PCC. Implications for practice Further work is required to identify measurable service delivery outcomes that represent PCC within radiographic practice.

No / Introduction There is growing awareness of the importance of patient centred care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents, but there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services in order to develop measurable indicators of PCC. Methods This project was funded by the College of Radiographers Industry Partnership Scheme. Ethical approval was granted by the University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 2 of the project, which was a series of focus groups and telephone interviews to enable deeper discussion and exploration of PCC. Situational vignettes were used to promote discussion and debate and encourage suggestions for PCC approaches. Audit tools to assess engagement with PCC were developed at individual and organisational level. Results Four focus groups and six telephone interviews were carried out in total. Focus groups were held in a variety of locations to promote attendance. Telephone interviews were used to capture participants who could not attend a focus group in person. Disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Perceived levels of care and the effectiveness of communication appeared to be the key influences on whether PCC was delivered. Conclusion It is evident from the results of Stage 1 and Stage 2 that we have some way to go before we have parity in how care within diagnostic radiography is perceived, experienced and delivered. Audit tools and an educational toolkit are offered as ways to support increased PCC within diagnostic radiography practice. Implications for practice Several service improvements and audit tools are offered to support the increased delivery of PCC.

Syftet med studien är att undersöka unga vuxna invandrares erfarenheter av primärvården. En kvalitativ ansats tillämpas för att söka en djupare förståelse för ämnet och fem semistrukturerade intervjuer har genomförts. Genom ett snöbollsurval har informanter, bosatta i Mälardalsregionen, valts ut till studien. Informanterna är i åldrarna 24 och 26 år samt har varit bosatta i Sverige i omkring sex år. Resultatet innehåller redogörelser av informanternas erfarenheter av primärvården samt interaktionen med vårdpersonal. Informanterna upplever att deras redogörelser inte blir tagna på allvar och att de inte blir lyssnade till, vilket har lett till upplevelser av att de inte får tillräcklig vård. Vidare framkommer det att språket är en betydande faktor för hur information överförs samt att kontaktmöjligheterna upplevs vara goda. Person-centred care [PCC] kan användas som modell i arbetet om att förbättra möten i primärvården mellan patienter och vårdpersonal. Vidare bidrar modellen till ökad kunskap bland patienter när de får engagera sig i sin egen vård som kan resultera i ökad folkhälsa. PCC kan minska skillnader i hälsa, detta blir av vikt för studiens målgrupp som påvisats ha sämre hälsa än resterande befolkning. Studien påvisar behov av att förbättra möten i primärvården. / The aim of this study is to examine young immigrant adults’ experiences of primary care. The study uses a qualitative approach to seek a deeper understanding of the selected subject, five semi-structured interviews have been made. A snowball sampling was made to find participants living in regions around Mälardalen. The participants are between the ages of 24 and 26 years old and have lived in Sweden for six years. The results contain statements of the informants’ perceptions of the primary care and interactions with the healthcare professionals. The informants experience their statements not being taken seriously and not being listened to, which has led to the experience of not receiving adequate care. Furthermore, the importance of language, when information transfers between patients and healthcare professionals, emerges. The contact opportunities are positively experienced. Person-centred care [PCC] can be used as a model to improve the meetings in primary-care between patients and healthcare professionals. The model can contribute to increased knowledge for patients when they engage in their own care which can contribute to increased public health. For the study’s target group, who are shown to have poorer health, the PCC model becomes important to reduce differences in health. The study shows a need of improving meetings in the primary care.

Bakgrund: Diabetes Mellitus är mer vanligt förekommande hos individer med intellektuell funktionsnedsättning jämfört med övriga befolkningen. Intellektuell funktionsnedsättning är en kognitiv nedsättning som innebär svårigheter att ta in och bearbeta information samt tillämpa och bygga kunskap. Egenvård är ett begrepp som används för att beskriva de insatser som den enskilde individen vidtar för att lindra eller bota sjukdom och främja hälsa.  Syfte: Att beskriva vad som upplevs påverka egenvården hos individer med intellektuell funktionsnedsättning och diabetes. Metod: Litteraturöversikt, med induktiv ansats, baserad på kvalitativa artiklar via datainsamling gjord i CIINAHL och PsychINFO. Metoden snowballing har även använts för datainsamlingen. Resultatet sammanställdes genom en integrerad analys. Resultat: Svårigheter att ta till sig och använda sig av information upplevs inverka negativt på förmågan till egenvård vid diabetes hos individer med intellektuell funktionsnedsättning och diabetes. Kunskapen hos vårdteamet och stödet från omgivningen upplevs även påverka egenvården. Slutsats: Möjligheten bör finnas inom ramen för sjuksköterskeprogrammet att synliggöra omvårdnad vid intellektuell funktionsnedsättning. Inom vården bör man vidta åtgärder utifrån behovet av mer undervisning om diabetes som är särskilt anpassad för individer som är intellektuellt funktionsnedsatta. Det skulle även vara värdefullt att framtida forskning belyser dessa individers möjlighet till egenvård. / Background: Diabetes mellitus is more common amongst individuals with an intellectual disability compared to the rest of the population. Intellectual disability is a cognitive impairment which results in difficulties with processing information and applying and building knowledge. Self-management is a term used to describe the activities that the individual perform in order to cure disease and promote health. Objective: To describe experiences of what affects self-management amongst individuals with an intellectual disability and diabetes. Method: Literature review, with an inductive approach, with a review of relevant qualitative articles found in CINAHL and PsychINFO. The snowballing method is also used for collecting data. The result is compiled using an integrated analysis.   Result: Difficulties with reciving and using information is experienced to impede the ability to self-manage diabetes amongst individuals with intellectual disability and diabetes. The understanding of diabetes and intellectual disability amongst health care professionals and contextual support is also experienced to affect self-management. Conclusion: Within the context of the nursing program it would be useful with more dedicated education about intellectual disability. More research about these individuals’ ability to self-manage would be useful as well. Within the health care system actions should be taken to meet the need for information that is suited for individuals with intellectual disability.