Yes / Many intervention studies lack an investigation and description of the factors that are relevant to its success or failure, despite its relevance to inform future interventions. This study aimed to explore the facilitators and barriers to the implementation of a psycho‐educational intervention for care assistants caring for people with dementia in aged‐care facilities. A process evaluation was carried out alongside a pretest/post‐test controlled study conducted in aged‐care facilities. Seven focus‐group interviews involving 21 care assistants (female; mean age 43.37 ± 10.0) and individual semi‐structured interviews with two managers (female; mean age 45.5 ± 10.26) were conducted 2 weeks and 6 months after the intervention, in two aged‐care facilities. Interviews were recorded, transcribed and submitted to content analysis by two independent researchers. Results were organised into implementer, participant and organisation level hindered and facilitator factors. Findings enable the interpretation of the experimental results and underscore the importance of collecting the perception of different grades of staff to obtain information relevant to plan effective interventions. / Foundation for Science and Technology (FCT). Grant Number: SFRH/BD/72460/2010 and RIPD/CIF/109464/2009

Yes / The quality of care for persons living with dementia in institutional care settings is of global concern. The provision of person-centred care (PCC) for people with dementia is internationally recognised as best practice, which promotes possibilities for people with dementia to experience well-being. However, there remains a lack of evidence of approaches that can help to support delivery of PCC for older people with dementia in long-term care, in South Africa. Dementia Care Mapping (DCM) is a successful practice development tool, originating in the UK, used for supporting the implementation of PCC. However, to date it has not been considered for use by South African occupational therapists working in residential care facilities. This article defines the components of the DCM tool, its process of use and potential outcomes for care practice. In an attempt to scrutinise the value of findings from an occupational therapy perspective, the Kawa Model is drawn upon to explain how the data from DCM can be interpreted. The Kawa Model provides a strong focus on how a sense of being is promoted by a person's context, and is an established vehicle to aid understanding of the potential for application of PCC in South African care facilities.

Bakgrund: Hjärtsvikt är en vanligt förekommande kronisk sjukdom, som ökar runt om i världen i takt med att befolkningen blir äldre. Personen som drabbas måste lära sig att leva med och hantera sjukdomen, då det dagliga livet kommer att påverkas. Syfte: Att beskriva personers upplevelser av att leva med hjärtsvikt. Metod: Litteraturöversikt baserad på 12 stycken kvalitativa vetenskapliga artiklar. Data samlades in via Medline och CINAHL samt sekundärsökning. Dataanalys utfördes enligt Fribergs metod.  Resultat: Analysen resulterade i fem kategorier som beskriver personers upplevelser av att leva med hjärtsvikt; ett förändrat liv, känna trygghet och stöd, begränsningar i vardagslivet, osäker framtid och att vara beroende av vård.  Slutsats: Personer som lever med hjärtsvikt får en förändrad livssituation som påverkar dem fysiskt, psykiskt, socialt och existentiellt. Att personerna känner trygghet i sin vardag krävs för hantering av sjukdomen.  Kliniska implikationer: Sjuksköterskan ska informera och vägleda personen i sin sjukdom, samt hjälpa personen att hitta resurser för att klara av vardagen och sin livssituation. / Background: Heart failure is a common chronic disease, increasing around the world as the population gets older. The person who is affected must learn to live with and manage the disease, since the daily life will be affected.  Aim: To describe persons’ experiences of living with heart failure. Method: A literature study based on 12 scientific qualitative articles. Medline, CINAHL and secondary search was used to collect data. Fribergs analyze method was used to analyze the data.  Results: The analysis resulted in five categories that describe persons’ experiences of living with heart failure; a changed life, feeling secure and supported, limitations in daily life, uncertain future and being dependent on care. Conclusion: People living with heart failure have a changed life situation that affects them physically, mentally, socially and existentially. For these people to feel secure in their daily life it is required of them to cope with the disease. Clinical implications: The nurse must inform and guide the person in their illness, help the person find resources to cope with everyday life and their life situation.

Background: Dementia impairs cognitive functions, such as memory and speech, changing a person’s life forever. Providing person-centred care to these persons intend to retain their identities, dignity and autonomy. Such care demands time, devotion and good knowledge of the caring nurse. Dementia is expected to increase in the future and therefore nurses will have to face new challenges. Aim: To describe nurses’ experience of providing person-centred care for people with dementia. Method: A literature review of 15 articles, published between 2009-2016, that have been read and analysed through content-analysis. Results: Nurses experience a positive change in their attitudes, when providing person-centred care to people with dementia, as they gained better understanding of their patients’ dignity and integrity. Education, training and support from management were seen as key factors for providing up-to-date care. Time was viewed as a hindrance for person-centred care, and often led to nurses prioritizing other routines. Two common outcomes of person-centred care were increased satisfaction as well as emotional burnout. Conclusion: Since dementia is increasing and nurses find person-centred care time-consuming, there is a risk of such care becoming poor. To prevent this nurses need good leadership and education. / Bakgrund: Demenssjukdomar försämrar den kognitiva funktionen, så som minne och tal, vilket förändrar en persons liv för alltid. Att ge personcentrerad vård till dessa personer ämnar behålla deras identitet, värdighet och autonomi. En sådan typ av vård kräver tid, hängivenhet och god kunskap av den behandlande sjuksköterskan. I framtiden förväntas alltfler att insjukna i demenssjukdom och sjuksköterskan kommer därför att behöva möta nya utmaningar. Syfte: Att beskriva sjuksköterskans upplevelse av att ge personcentrerad vård till personer med demenssjukdom. Metod: En litteraturstudie där 15 artiklar, publicerade mellan 2009-2016, har blivit lästa och analyserade genom innehållsanalys. Resultat: Sjuksköterskor upplevde en positiv förändring i sin inställning när de gav personcentrerad vård till personer med demenssjukdom. Framförallt då de fick ökad förståelse för deras patienters värdighet och integritet. Utbildning, övning och stöd från ledningen sågs som nyckelfaktorer för att kunna ge aktuell vård. Tiden sågs som ett hinder för personcentrerad vård och ledde ofta till att sjuksköterskorna prioriterade andra rutiner. Två vanliga följder av vårdandet rapporterades vara såväl ökad tillfredsställelse som emotionell utmattning. Konklusion: Eftersom demenssjukdomar ökar och sjuksköterskor finner personcentrerad vård som tidskrävande, finns det en risk att sådan vård fallerar. För att förhindra detta behöver sjuksköterskor gott ledarskap och utbildning.

Sambandet mellan patienters förväntningar inför axeloperation och i vilken utsträckning dessa påverkar den upplevda nöjdheten är inte entydigt. Positiva förväntningar är viktiga samtidigt som orealistiskt höga förväntningar kan ge lägre patientnöjdhet. Uppföljning utifrån individens upplevelse är viktig för att följa resultat och öka patientnöjdheten i en personcentrerad vård. Syftet med denna studie var att redogöra för en grupp axelopererade patienters mål inför operation, måluppfyllelse efter ett år och undersöka eventuella samband mellan olika förväntningar och grad av måluppfyllelse. Syftet var också att beskriva upplevd livskvalitet före och ett år efter operation, korrelera skattad livskvalitet och måluppfyllelse efter ett år samt undersöka eventuella skillnader i skattade värden beroende på bakgrundsfaktorer. Metoden var en  korrelerande prospektiv registerbaserad studie. Huvudresultatet visade hög grad av patientnöjdhet både för skattad livskvalitet och uppfyllelse av personligt mål, sambandet mellan dessa värden var starkt. Smärtfrihet var den vanligaste förhoppningen. Signifikant samband mellan olika förväntningar och uppnått mål sågs i grupperna ¨återgå till arbete¨ och ¨smärtfri nattetid¨. Kvinnor skattade signifikant lägre värden än män före operation men ingen signifikant skillnad kan ses vid ettårsuppföljningen. Slutsatsen var att undersökningsgruppen inför operation hade höga förväntningar och att dessa i stor utsträckning uppnåtts. Likaså sågs tydlig ökning i skattad livskvalitet. Minskad smärta/smärtfrihet var tydligt den viktigaste förväntan inför operation. Denna utvärdering av patientens upplevelse av måluppfyllelse och livskvalitet kan ge återkoppling i arbetet för att stärka och utveckla en personcentrerad vård. / The correlation between the expectations before shoulder surgery and to which extent they affect patient satisfaction is not unambiguous. Positive expectations are important whilst unrealistic expectations could lead to reduced patient satisfaction. Follow up based on the experiences of the individual is important to follow results and increase patient satisfaction in a person centred care. The aim of this study was to narrate the preoperative goals and the fulfilment of these goals after one year for a group of patients who had undergone shoulder surgery and to investigate the eventual relationship between different expectations and degree of goal fulfilment. The aim was also to describe the perceived life quality before and one year after surgery, to correlate perceived life quality and goal fulfilment after one year and to examine eventual differences in assessed values due to demographic factors. The method was a correlative prospective register based study. The main result showed high degree of patient satisfaction for both assessed life quality and fulfilment of personal expectations, the correlation between these values where strong. Relief of pain was the most common expectation. Significant correlation between expectations and goal assessment where seen in the groups ¨return to work¨ and ¨relief of nocturnal pain¨. Women assessed significant lower values than men before operation but no significant differences where seen at the follow-up after one year. The conclusion was that the study population had high preoperative expectations and that these where fulfilled to a great extent. An explicit increase in perceived life quality was also seen. Relief or reduction of pain was clearly the most important expectation before surgery. This evaluation of patients’ sense of goal fulfilment and perceived life quality might give feed back in the work to strengthen and generate a person centred approach.

Background Most cancer patients undergo external radiotherapy (RT) at some stage during their treatment trajectory. RT is often associated with unfamiliar procedures where the technical environment, side effects and interaction with staff seem to play a major role in the patient’s treatment experience. These experiences could sometimes lead to disruption of the treatment which may have negative consequences for the outcome. The overall aim of this thesis was to gain further knowledge about how patients experience RT and the related processes. Such knowledge is of vital importance when developing and improving care within a high-tech RT environment. Aim The overall aim of this thesis was to gain further knowledge about how patients experience RT and the related processes. Such knowledge is of vital importance when developing and improving care within a high-tech RT environment. Methods To gain further knowledge and understanding about patients experience of RT both quantitative (I, II, III) and qualitative (III, IV) methodology were used. The data in the thesis focused on patients undergoing external RT at different RT units in Sweden. Study I and II, focused on two regions, the northern region of Sweden and the region of Stockholm and Gotland.  Study III and IV were performed at eight different RT units in Sweden. Results In Study I, two types of topical agents (Calendula Weleda cream vs. Essex cream) were compared regarding reducing the risk of severe acute radiation skin reactions (ARSR). No difference in severe ARSR was found between the groups and the patients reported low levels of ARSR. In Study II, the influence of an RT unit’s psychosocial climate and treatment environment on cancer patients’ anxiety during external RT was evaluated. Data was collected (questionnaire) from 892 patients. The results showed that both the treatment environment and the psychosocial climate of the RT unit significantly impacted cancer patient anxiety levels. In Study III & IV, a questionnaire to measure the patient´s experience during external RT was developed and tested. The results showed that the RT Experience Questionnaire (RTEQ), with 23 items, was a tentatively valid and reliable instrument to measure how patients experience the RT process and the environment in the treatment room. In Study IV, written comments from the open-ended question “Is there anything else you want us to know?” in the preliminary RTEQ was analysed with qualitative content analysis. This data was abstracted into the following four major categories reflecting the experience of the RT process:  Experiences in the high tech RT environment; Understanding the RT procedures and side effects; Dealing with daily life during RT and The nurses’ role and performance. Conclusion The RT environment and the RT related processes seem to impact cancer patients, both physically and psychologically. A person-centered care approach, as well as attention to the design, both of the treatment process and the physical environment could significantly improve the patient experience and patient involvement. The results also highlight the importance of taking patient experiences into account when introducing new RT methods and techniques.

Aims. The aim of this study was to explore the effects of the health consultation experience for people with learning disabilities, particularly in terms of their self-concept Background. Annual health checks have been introduced as a reasonable adjustment for health providers to make in meeting the needs of people with learning disabilities, who experience significantly poorer health outcomes than the general population. Evaluation of the health consultation from the service user perspective can inform this service provision. Design. A constructivist grounded theory approach, based on symbolic interactionism, was used to explore the meaning of the health consultation experience for the person with learning disabilities, and its effects on their sense of self. Methods. Purposive and snowballing sampling was used to recruit 25 participants with learning disabilities through a GP practice, self-advocacy groups and a health facilitator. Nine individual interviews, three interviews with two participants, three focus groups (n=7, n=5 and n=3), and an audio-recorded health check consultation were carried out (with two participants interviewed twice and four attending two focus groups), as well as a member check used to assess the resonance of the findings. Data collection was undertaken in different primary care trusts across the north west of England. Data were subjected to constant comparative analysis, using a symbolic interactionist approach, to explore all aspects of the health consultation experience and its effects on the self. Findings. Current expectations, attitudes and feelings about health consultations were strongly influenced by previous experience. Participants negotiated their own reality within the consultation, which affected their self-concept and engagement with their health care. Respectful and secure health professional – service user relationships, developed over time, were central to an effective consultation. Perspectives on the consultation, and engagement within it, were co-constructed with a companion, who could help to promote the personhood of the service user with support from the health professional. Anxiety, embarrassment and felt stigma were identified as significant barriers to communication and engagement within the consultation. Conclusions. People with learning disabilities have similar health consultation needs and expectations to other people, but may have more difficulties in engaging with the process and building trusting relationships with the health professional, due to previous negative experiences, anticipated stigma and loss of self within health settings leading to a fear of disclosure. This, combined with difficulties in communication and cognitive processing, results in less satisfactory outcomes persisting over time. The effects of triadic consultations are generally positive, particularly where relatives or health facilitators are involved. However, continuity of companion as well as health professional is needed, and more service user engagement should be supported. Fundamental attitude change by health professionals, supported by specific educational initiatives to enhance their understanding of the service user perspective, is needed to reduce health inequalities. Participatory research by people with learning disabilities should inform future health care practice.

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.

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.

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.