The social work profession requires the accumulation of theory, knowledge, skills and their integration into practice. The department of social work at UNISA trains students according to the person-centred approach (PCA). The question thus arises whether the social workers trained in PCA at UNISA are able to integrate theory into practice in their different areas of employment. Exploring this would give the department of social work an opportunity to re-visit the teaching of PCA and make some improvements if necessary. The qualitative study was conducted with social workers employed in different welfare organizations in Pretoria. The following themes emerged from the analysis: the perceived significance of building relationship with clients, the organizational influence in counselling, unique experiences with regard to colleagues who graduated from other institutions, challenges in handling a conflict or crisis situation, and lastly the nature of statutory cases. The conclusions were drawn and recommendations were presented. / Social Science / M.A. (Mental Health)

Socialstyrelsens brukarundersökning visar att äldre som bor på särskilt boende är mest missnöjda med de aktiviteter och den sociala samvaron som verksamheten erbjuder. Äldreomsorgen bygger på den nationella värdegrunden som innefattar att den äldre ska få leva ett värdigt liv och känna välbefinnande, men det är inte klart hur denna värdegrund påverkar personalens arbetssätt eller de sociala aktiviteter som erbjuds. Vår studie angriper denna fråga. Fem särskilda boenden var representerade både från kommunala och privata vårdgivare i två olika kommuner. Semistrukturerade intervjuer genomfördes med de särskilda boendes enhetschefer, som sedan transkriberades och tematiskt analyserades. Vårt resultat tyder på att den nationella värdegrunden inom äldreomsorgen tolkas olika på alla de särskilda boendena. Alla enhetschefer la stor vikt på personcentrerad vård, men trots det så erbjöd man liknade sociala aktiviteter ofta då som gruppaktivitet. Resultaten diskuterar vi med hänvisning till Aktivitetsteorin och Gerotranscendenceteorin. / Research shows that many nursing home residents are disappointed with their level of social interaction and activity. Care of older people is argued to be underpinned by national core values such as supporting dignity and well-being, but it is not clear how such values influence nursing home staff practices or the social activities provided. Our study addressed this question. Five nursing homes, representing both private and public care providers, were sampled from two different municipalities. Semi-structured interviews were carried out with the homes’ respective heads of unit, transcribed, and thematically analysed. Our results indicate that the national values for care of older people were interpreted uniquely within each home. All heads of units emphasised the importance of person-centred care, yet similar social activities were offered by all homes, with a focus on group activities. We discuss our results with reference to activity theory and gerotranscendence.

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice. Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV). Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV). Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability.

This is a multi-method ethnographic study, grounded in symbolic interactionism and social constructionism, which seeks to explore the social worlds of people with dementia in institutional long-term care. Carried out over six months, it uses non-participant observation, Dementia Care Mapping, video-recording, focused conversations and extensive fieldnotes to document types of interactions that fourteen people with dementia received in everyday ward life and during weekly creative sessions facilitated by occupational therapy (OT) staff. Using Kitwood’s (1997) work on person-centred care and Sabat’s (2001) work on selfhood (Selfs 1-3) it identifies their responses to such interactions in terms of their well or ill-being and expressions of Self. The study shows that everyday staff interactions with participants, while sometimes positive, were more often limited in their potential for maintaining or increasing well-being. Sometimes staff interactions were abusive; causing participant ill-being. Participants expressed Selfs 1-3 verbally and visually, although some of these expressions were subtle, fleeting and fragile. During creative sessions, OT staff engaged in sustained positive interactions, raising participant well-being and facilitating Self-expression; a fragile expression of Self could become a robust expression of Self, a past Self could be reclaimed and a desired Self co-constructed. My findings suggest that, in their interactions during creative sessions, OT staff generally recognised and supported Self of participants, raising well-being. However, ward staff did not fully recognise and therefore could not support Self in their interactions with participants, resulting in participant ill-being. This is a crucial finding, which could partially explain the differences in interaction types I observed, and the corresponding differences in participant well-being and Self-expression. This thesis argues for integrating the selfhood and person-centred approaches into an innovative staff-training programme, in order to bring about transformational change in practice. This might encourage care staff to reach out, recognise and respond to aspects of Self as they carry out care; promoting more positive ways of interacting with their patients, increasing patient well-being and fostering staff satisfaction.

Bakgrund: Patientdelaktighet är en lagstadgad rättighet och ses som önskvärt och fördelaktigt. Det är dock vanligt förekommande att patienter hamnar utanför själva processen och bara blir ett instrument i den. Syfte: Syftet var att, ur ett patientperspektiv, beskriva hinder och möjligheter för vuxna patienters delaktighet i sin vård. Metod: En litteraturöversikt där 13 kvalitativa artiklar låg till grund för analys och resultat. Resultat: Hindren för delaktighet beskrevs som att känna rädsla, oro och skam, inget intresse visas för patienten, att sakna information och kunskap och patientens försämrade hälsostatus samt fysiska och mentala tillstånd. Möjligheterna beskrevs med fenomenen vårdpersonal som lyssnar, att det finns förtroende, vårdpersonal som uppmuntrar och skapar motivation, en informationssökande patient och att känna sig frisk. Slutsats: Patientdelaktighet påverkar personcentrerad omvårdnad och både patienten och vårdpersonalen har ett stort ansvar i huruvida patientdelaktighet och sedermera personcentrerad omvårdnad kan uppstå. Patienter och sjuksköterskor tycker ofta lika i sak vad gäller patientdelaktighet. Resultatet är ett verktyg för vårdpersonal att lättare identifiera vad som behövs för att möjliggöra respektive vad som hindrar patientdelaktighet. Ett arbetssätt för att göra patienten delaktig i sin vård är att vårdpersonal ska lyssna, visa intresse och delge patienten information. / Background: Patient participation is statutory and considered as desirable and profitable. Nevertheless it is common that patients are excluded from the patient participation process. Aim: The aim was to, from an adult patient perspective, describe barriers and facilitators to patient participation in their own care. Method: A literature review with 13 qualitative articles analysed to the result. Result: The barriers were described as patients feeling fear, anxiety and shame, no interest is shown towards the patient, not having information and knowledge and the patients’ impaired health status and physical and mental status. The facilitators were described as nursing staff are listening, available trust, nursing staff that encourages and creates motivation, an information seeking patient and to feel healthy. Conclusion: Patient participation affects person-centred care and the patient and nursing staff have a great responsibility in whether patient participation and later on person-centred care may arise. Patients and nurses often have similar thoughts about patient participation. The result is a tool designed for nursing staff to in an easier way identify what is needed to facilitate patient participation and what hinders it. A way of working in making the patient to participate in their care is that nursing staff shall listen, show interest and inform the patient.

The older population in Thailand is growing, and the number of older people who suffer from health problems is increasing as well. The health situation of the older population challenges healthcare providers to care for older people. Healthy aging is key to promoting the health of older people and sustaining their well-being. However, little is known about healthy aging in Thailand, especially in northeastern Thailand, or the Isan region, where the number of older people is increasing. Thus, this thesis aims to understand the factors associated with perceived health and healthy aging and how older people and their relatives in the Isan region conceptualize healthy aging. This thesis also focuses on how community nurses experience the meaning and promotion of healthy aging in this region. This thesis includes four studies. The first is a quantitative cross-sectional study with 453 participants aged 60 years or older. The second and third studies are qualitative with a phenomenographic approach that is based on lifeworld theory. Participants in the second and third studies include 17 older people and 14 relatives who are responsible for caring for older people, respectively. The fourth study is a qualitative study that involves focus group interviews with 36 community nurses who work with older people in the Isan region. The findings of the first study show a variance (24.3%) in perceived health and healthy aging based on residential area, marital status and disability status. The meaning of healthy aging, which was derived from the second, third and fourth studies, was divided into three domains: being interconnected; being able to do something good and feeling strong; and thinking beyond the capacity and functions of body and mind. The promotion of healthy aging was described as “providing health assessments”, “sharing knowledge”, and “having limited resources”. The findings of the first study revealed the key factors that will help healthcare providers promote healthy aging. The findings of the second, third and fourth studies revealed that older people, their children and grandchildren, and community nurses attach different meanings to healthy aging. The finding regarding promotion of healthy aging emphasizes that the person-centredness should be integrated in practice when promoting healthy aging. The results of this thesis will be useful to policymakers, who can apply this enhanced understanding of healthy aging to develop healthcare practices that promote healthy aging.

Patients in psychiatric care experience a need for and expect to develop interpersonal relationships with professional caregivers and to be respected and listened to. Despite demands for care to be person-centred and recovery-oriented, patients experience that psychiatric inpatient care fails to meet their expectations. Nursing research suggest that nurses aspire to engage with and meet the needs of patients, but that the strenuous reality of inpatient care prevents them from doing so. Exploring the content and context of psychiatric inpatient care from the perspective of professional caregivers might provide valuable insights regarding what caregivers do, and more importantly it can aid in understanding why they do what they do.This thesis aimed to explore the content and context of adult psychiatric inpatient care from the perspective of professional caregivers. This was achieved by clarifying the concept of person-centred care in the context of inpatient psychiatry, describing staff members’ reasoning on their choice of action and perceptions of interprofessional collaboration in challenging situations in inpatient psychiatric care settings, and exploring nurses’ experiences of good nursing practice in the specific context of inpatient psychiatry. A systematic review of the literature identified 34 scholarly papers that were analysed using evolutionary concept analysis. Focus group interviews were conducted with 26 professional caregivers and analysed using qualitative content analysis. Individual qualitative interviews were conducted with 12 skilled, relationship-oriented nurses and analysed using an interpretive descriptive approach to qualitative analysis.Reviewing the literature on person-centred care in inpatient psychiatry clarified how person-centred care is expected to result in quality care when interpersonal relationships are used to promote recovery. Professional caregivers’ reasoning on choice of action described different concerns in caregiver-patient interaction resulting in a focus on either meeting patients’ individual needs or solving staff members’ own problems. Describing professional caregivers’ perceptions of interprofessional collaboration suggested that they are being constrained by difficulties in collaborating with each other and a lack of interaction with patients. Exploring nurses’ experiences of good nursing practice revealed how circumstances in the clinical setting affect nurses’ ability to work through relationships. It is argued that these findings describe the workings of two opposing forces in psychiatric inpatient care. The concept of caring as a process forms the basis for discussing the content of care as a moral endeavour in which nurses strive to do good. The concept of demoralizing organizational processes is used to discuss the context of care as demoralizing and allowing for immoral actions.The main conclusions to be drawn are that, from a nursing perspective, nurses in psychiatric inpatient care need to focus on patients’ experiences and needs. For this they need sufficient resources and time to be present and develop relationships with patients.Nurses in psychiatric inpatient care also need to take personal responsibility for their professional practice. Attempts to transform psychiatric care in a person-centred direction must consider all of these aspects and their interrelatedness. Further research on psychiatric inpatient care is needed to understand more about how the content of care relates to the context of care. / <p>Godkänd; 2015; 20150526 (sebgab); Akademisk avhandling som med vederbörligt tillstånd av Filosofiska fakulteten vid Luleå tekniska universitet för avläggande av Filosofie doktorsexamen kommer att offentligen försvaras i Deltasalen, D 770, Luleå tekniska universitet fredagen den 25 september 2015, kl. 10.00. Fakultetsopponent: Docent Ulla Hällgren Graneheim, Institutionen för omvårdnad, Umeå universitet Betygsnämnd: Professor Margareta Lilja, Institutionen för hälsovetenskap, Luleå tekniska universitet Professor Johan Sandström, Institutionen för ekonomi, teknik och samhälle, Luleå tekniska universitet Docent Lauri Kuosmanen, Institutionen för omvårdnad, Åbo universitet Huvudhandledare: Professor Stefan Sävenstedt, Institutionen för hälsovetenskap, Luleå tekniska universitet Biträdande handledare: Universitetslektor Malin Olsson, Institutionen för hälsovetenskap, Luleå tekniska universitet Professor Rolf Adolfsson, Institutionen för klinisk vetenskap, Umeå universitet</p>

Bakgrund: Användandet av informellt tvång riskerar begränsa patientens självbestämmande i   utformandet av sin vård. Trots detta vidmakthåller vårdpersonal användandet av informellt tvång på grund av dess effektivitet för patientens följsamhet till föreslagen behandling och för att upprätthålla en säker vårdmiljö. Att begränsa patientens självbestämmande utöver vad som regleras i lag är i gråzonen till vad som kan betraktas vara tillåtet. Syfte: Att beskriva patienters erfarenheter av informellt tvång samt beskriva alternativ som främjar personcentrerad vård.  Metod: En systematisk integrativ litteraturöversikt av nio kvalitativa artiklar. Dataanalysen genomfördes utifrån Whittemore och Knafls metod.   Resultat: Två övergripande teman identifierades; Vårdens inverkan på informellt tvång och Konsekvenser av informellt tvång med två respektive tre subteman som inspirerades av   NANDA-I; Otillräcklig relation, Potential för förbättrad stresshantering, Risk för hotad värdighet, Maktlöshet samt Defensiv- och ineffektiv stresshantering. Slutsats: Vårdpersonalens användande av informellt tvång har medfört negativa upplevelser och   hanteringsstrategier för patienterna. Ur patienternas beskrivningar återfanns alternativ till det informella tvånget som är kunskap vårdpersonal kan använda sig av för att arbeta enligt principer för personcentrerad vård. / Background: The use of informal coercion poses a risk to limit the patient’s autonomy in the formation of their care. Regardless of this, healthcare personnel maintain the use of informal coercion due to its effectiveness in compliance, and maintaining a safe care environment. This restrictive act of patient’s autonomy is in a grey area to what can be considered as allowed.  Aim: To describe patients’ experiences of informal coercion and alternatives that promote person-centered care. Method: A systematic integrative review of nine qualitative articles. The data analysis was performed based on the method by Whittemore and Knafl. Results: Two major themes were identified; The impact of care on informal coercion and Consequences of informal coercion with two, respective three minor themes inspired by NANDA-I; Ineffective relationship, Readiness for enhanced coping, Risk for compromised human dignity, Powerlessness, Defensive- and ineffective coping.  Conclusions: Healthcare personnels’ use of informal coercion has led to negative experiences and coping for the patients. From the patients’ descriptions, alternatives were found, which is knowledge that   healthcare personnel can use to work according with principles for person-centered care.

Bakgrund: Diabetes typ 2 är en folksjukdom som drabbar oftast vuxna och äldre vuxna. Diabetes typ 2 påverkar alla på vardaglig nivå, men det finns forskning som visar att kvinnor med diabetes typ 2 är mer utsatta på grund av att de väljer att prioritera andras hälsa och välmående. Syfte: Att beskriva hur kvinnor med diabetes typ 2 upplever sitt dagliga liv. Metod: En litteraturöversikt gjordes genom att nio stycken vetenskapliga artiklar av kvalitativ karaktär söktes fram från databasen CINAHL. Analysen har haft induktivt förhållningssätt och tidsspannet för artiklarna har varit mellan 2010 - 2019. Resultat: Analysen ledde till tre teman: en komplicerad tillvaro, en påtaglig stress och betydelsen av en stödjande omgivning. Kvinnornas tillvaro upplevdes komplicerad på grund av minskad självständighet i det vardagliga livet. Stress var en upplevelse som gjorde vardagen mer utmanande då deras blodglukosvärde var kopplad till deras upplevelse av stress. Kvinnor som upplevde omgivningens stöd hade det lättare att följa diabetesrekommendationer jämfört med kvinnor som inte hade det. Slutsats: Personcentrerad omvårdnad var viktig för kvinnorna för att få mer kunskap och stöd för att uppnå optimal egenvård då dålig egenvård relaterades till tidsbrist och otillräcklig kunskap om hur de skulle sköta sin diabetes. / Background: Diabetes type 2 is a common disease that usually affects adults and older adults. Diabetes type 2 affects everyone at everyday level, but research indicates that women with type 2 diabetes are more vulnerable because they choose to prioritize the health and well-being of others.Aim: To describe how women with type 2 diabetes experience everyday life.Method: A literature review was made by searching for nine scientific articles of qualitative character from the database CINAHL. The analysis has had an inductive approach and the time span for the articles has been between 2010 - 2019.Results: The analysis led to three themes: a complicated existence, a tangible stress and the importance of a supportive environment. The existence of women was experienced complicated due to reduced independence in everyday life. Stress was an experience that made everyday life more challenging as their blood glucose value was linked to their experience of stress. Women who experienced the support of the environment was able to follow diabetes recommendations easier than women who lacked the environment support.Conclusions: Person-centered nursing was important for women to gain more knowledge and support in achieving optimal self-care since poor self-care was related to lack of time and insufficient knowledge of how to manage their diabetes.

Bakgrund: Diabetes mellitus typ 2 är en sjukdom som blir allt vanligare. Personer som diagnostiserats med sjukdomen behöver bryta gamla rutiner och tillämpa livsstilsförändringar som är anpassade för sjukdomen. För att kunna genomföra dessa livsstilsförändringar krävs kunskap om diabetes mellitus typ 2. Hälso- och sjukvårdspersonalen har ett stort ansvar att ge personerna relevant och personcentrerad patientundervisning för att livsstilsförändringar ska kunna ske.Syfte: Att beskriva vad personer med diabetes mellitus typ 2 upplever främjar och hindrar livsstilsförändringar. Metod: En litteraturöversikt med kvalitativ design och ett induktivt förhållningssätt gjordes. Resultat: Det framkom att bra bemötande och personcentrerad patientundervisning av hälso- och sjukvårdspersonal genererade god självhantering och motivation till livsstilsförändringar hos personerna med diabetes mellitus typ 2. Bristande kunskap om sjukdomen på grund av otillfredsställande patientundervisning ledde till osäkerhet om behandlingen, och oro över att göra fel hindrade personerna att utföra livsstilsförändringar. Slutsats: En personcentrerad patientundervisning är nyckeln till goda livsstilsförändringar för personer med diabetes mellitus typ 2. När personerna får individanpassad undervisning genererar det god kunskap om sjukdomen som förbättrar personernas genomförande av livsstilsförändringar. / Background: Type 2 diabetes mellitus is an increasingly common disease. People diagnosed with type 2 diabetes mellitus need to break old routines and apply lifestyle changes that are appropriate for the disease. To be able to implement these lifestyle changes, knowledge of type 2 diabetes mellitus is required. The healthcare staff have a huge responsibility to give the persons relevant and person-centred patient education, so that lifestyle changes can take place. Purpose: to describe what people with diabetes mellitus type 2 experience promote and prevent lifestyle changes.Method: A literature review with qualitative design and an inductive approach was made. Result: It emerged that a good encounter and person-centred patient education of healthcare professionals generated good self-management and motivation for lifestyle changes in the persons with type 2 diabetes mellitus. Lack of knowledge about the disease due to unsatisfactory patient education led to uncertainty about the treatment, and concerns about wrongdoing prevented people from lifestyle changes. Conclusion: A person-centred patient education is the key to good lifestyle changes for people with type 2 diabetes mellitus. When the individuals receive individualized education, it generates good knowledge of the disease that improves the self-management and performance of lifestyle changes.