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.

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.