Background: More people than ever before are now seeking refuge from war and terror in other countries (UNHCR, 2016). This has as a consequence that the health care in many Western countries faces new patient categories which don’t speak the language and are culturally different from what health professionals are familiar with. Ethical considerations are important, since being misunderstood and not met with dignity or respect can cause care-related suffering. This may increase the suffering already experienced due to loss of security, family and friends. Aim: To illustrate refugees’ experiences in the contact with health care. Method: This is a literature-based, qualitative study. 15 articles were selected to investigate refugees’ experiences of health care. The analysis resulted in 2 themes, each containing 3 subthemes. Results: The main themes that emerged were: Feeling acknowledged and respected, and Overcoming language and cultural barriers. The result mainly reveals that language barriers are common, and that refugees consider it important to be seen as individuals, which is not always the case in health care. Conclusion: The challenge in caring for refugees as a nurse consists in ensuring there is a common understanding. While being aware of a patient’s history, it is also important to see the individual in a person-centered approach. / Att bryta upp från familj och allt man känner sig trygg med försätter människan i en utsatt position. Den vilsenhet detta medför skapar ett lidande. Som sjuksköterska är det viktigt att vara medveten om detta. Författarna till detta litteraturbaserade arbete har studerat 15 vetenskapliga artiklar där flyktingars perspektiv av olika vårdmöten står i fokus. Resultatet visar att flyktingar upplever språket som det största problemet i mötet, men att även deras kultur och religion spelar in i vad de tycker är en bra vård. I många fall känner flyktingar sig förbisedda eller diskriminerade. Detta har i många fall att göra med att de inte blir bemötta som individer utan ses som en del av en annan kultur. För att undvika problem med språkförbistringar är det att föredra att anlita tolk. Detta är emellertid inte helt problemfritt. Tolkar påverkar mötet på olika sätt beroende på vem patienten är. Studiens resultat visar att många flyktingar föredrar en tolk av samma kön. Det bidrar till att de lättare kan öppna upp sig och att intima situationer, exempelvis avklädning, inte blir så svåra att hantera. Samma förhållanden råder när det gäller kön på vårdpersonal. Att undersökas av någon av motsatt kön kräver att detta upplevs som ofrånkomligt och väl förankrat. De upplevelser som har med kultur och religion att göra varierar mellan flyktinggrupper och enskilda personer. De berör hur man vill bli bemött och behandlad. Det visar sig att patienterna i många fall är ovana vid ett personcentrerat förhållningssätt. Att utveckla ett sådant förhållningssätt är dock viktigt, eftersom brister i detta gör att flyktingarna känner sig diskriminerade och förbisedda. Det kan även leda till att de går miste om viktig information om sin sjukdom och rekommenderade behandling. Om sjuksköterskor tillämpar personcentrerad vård där patientberättelsen och partnerskap ligger till grund kan vårdlidande undvikas.

The period of transition from high school is challenging for most adolescents. There are a substantial number of life-changing decisions that transpire during this time. Choices must be made regarding career paths, continued education, future residence, and avenues for social activities and general integration in the community. Person-centered planning provides a structure for addressing these questions, with the interests and aspirations of the individual at the forefront. While much has been written about person-centered planning, there is still a sparse evidence base to support its use and no formal examination of the fidelity of implementation of these programs. This study utilized a multiple-baseline single subject design to assess the effects of structured meetings with performance feedback on fidelity of implementation of participants' action plan steps in their person-centered plan. Analysis of the results suggests a strong functional relation between the use of structured follow-up with performance feedback and activity related to the person-centered plan action plan. Quality of life data were also gathered prior to planning and prior to and following the performance feedback intervention, with little change in the scores across the three points in time. Social validity was also assessed. The implications of these findings are discussed.

The Baby-boom generation, a major contributor to an unprecedented increase in older-aged people, is known for its zest for life and autonomy. Boomers are predicted to enter nursing homes in record numbers with multiple chronic illnesses and person-centered health care expectations. The purpose of this work was to describe current chronic illness management practices in nursing homes focused on person-centered (resident-directed) care and involvement of residents in health-related decision-making and self-care activities. Four projects were undertaken to accomplish this objective: (1) a systematic review of the quantitative literature regarding the management of type 2 diabetes, an exemplar chronic illness; (2) a synthesis of the qualitative literature describing chronically ill, older-aged adults' perceptions of chronic illness care decision-making; (3) an ethnographic pilot study describing the meaning of having type 2 diabetes to nursing home residents; and (4) a qualitative descriptive study of secondary data describing nursing home stakeholder perceptions of opportunities for resident involvement in chronic illness decision-making and self-care activities. Wagner's Chronic Care Model, modified for the nursing home, was the sensitizing framework for this research. Twenty studies met criteria for the systematic review, which described a lack of adherence to clinical practice guidelines and rare inclusion of the resident and family in management practices. The synthesis of 7 qualitative studies revealed 4 themes: (1) Being recognized because I matter; (2) Awareness of importance; (3) Empower through connections and opportunities; and (4) Time is precious. Cognitively capable older-aged adults described benefits from involvement in health care decisions and harm from non-involvement. They perceived inadequate time spent with health care providers as a major determinant of involvement. The pilot ethnography included 3 residents. Findings revealed a perception of few diabetes management choices but many unspoken resident preferences. The qualitative descriptive secondary analysis study included 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Stakeholders perceived many opportunities for resident involvement in decision-making and self-care, but described as many limitations. Findings indicated a shortage of health care providers and differing stakeholder ideas of purpose and goals restricted resident involvement. Clinical, research, and policy implications were discussed. / text

Person-centered care (PCC) has been recognized by the Institute of Medicine as a critical element in the redesign of our nations healthcare system. Evidence suggests that the physical environment contributes to a more person-centered inpatient healthcare experience. This study explored the relationships among demographic characteristics of individuals receiving care in skilled nursing facilities, satisfaction with nursing care, perceived ambiance of the healthcare environment, and the perception of PCC. Descriptive statistics, Pearson’s correlation, Spearman’s rho, and hierarchical linear regression were used to analyze the data and answer the research questions. In addition, content analysis was used identify possible themes from the comments by the participants regarding the overall care experience. The sample consisted of 71 individuals (48 women) between the ages of 38 and 97 (M = 71.34, SD = 11.51) having received rehabilitation and/or nursing care in fourteen short-stay SNFs in Texas. A small positive significant relationship was found between the perception of personalized care and years of education (r = .27, p = .012). Moreover, a strong positive significant relationship was found between satisfaction with nursing care and PCC (r = .76, p <. 001), perceived ambiance and PCC (r = .57, p < .001), and satisfaction with nursing care and ambiance (r = .52, p < .001). Hierarchical linear regression only included years of education, satisfaction with nursing care, and ambiance since they were the only variables that had a significant relationship with the outcome variable. The analysis showed that satisfaction with nursing care was the strongest predictor of PCC accounting for 53% of the variance. In addition, ambiance was identified as a significant predictor of the perception of PCC after controlling for education and satisfaction with nursing care. Overall, the three variables accounted for 64% of the variance in the perception of PCC. This was the first study to explore the relationship between perceived ambiance of an inpatient healthcare setting and the perception of person centered care. These findings indicate that the physical environment is an important element that can influence the perception of personalized care in a short-stay SNF setting. / text

To meet the growing demand for community-based adult services (CBAS) adult day health care (ADHC) programs, it is important these programs make the necessary modifications in their systems of care to embrace a person-centered care (PCC) model. This study was designed to create an assessment to determine a community-based CBAS/ADHC program's readiness to meet the new federal standards as determined by the program's current operational evidence and by center participants', their families' as well as staff's perspectives. This was measured by self-report of access to the community, choice of setting, individual rights, autonomy and independence, choice of services and supports, center accessibility as well as their needs and preferences in the practice. Results will assist similar CBAS/ADHCs in identifying the necessary modifications within their own program to continue as a certified licensed entity and remain a viable agency.

The patient centered care (PCC) model is recommended by the Institute of Medicine for individuals with intellectual and developmental disabilities. The problem identified in this quality improvement (QI) project was that PCC practices had not been included in the training curriculum within the organization. Framed within the plan-do-study-act model of QI, the purpose of this project was to develop an educational initiative on PCC that included a curriculum plan, a pretest/posttest, a protocol, a revision of the training policy, and an implementation and evaluation plan. Drawing upon the evidence-based literature and using a team approach, a curriculum plan on PCC practices was developed which included a pretest/posttest to evaluate staff knowledge on the curriculum before and after the training. Three content experts from the committee approved the curriculum and validated the pretest/posttest items. The content validation index was 0.99 showing that each item reflected the content and objectives of the curriculum. As well, a training protocol was developed which identified the steps for provision of the curriculum to maintain consistency for all users. The training policy was revised to set expectations for all staff for the incorporation of the PCC practices into the organization. This initiative will be implemented into the organization using Kurt Lewin’s model of change to guide PCC practices. A recommendation was made to add a small section on “people’s first language” to the training to preserve patients’ dignity and respect during communication. This project contributes to social change by promoting PCC practices among healthcare workers thus limiting healthcare disparities and improving access for persons with intellectual developmental disabilities.

This study documents an experience in which a small group of cognitively and developmentally disabled adults expressed their personal goals and views related to art museum visits. A review of literature related to disability studies, museum access and inclusive programs, art therapy, and person-centered thinking provide background and context. Case study and qualitative interviews are used as methodologies to support an investigation of the use of person-centered thinking in the implementation of art museum programming for the study participants. Person-centered thinking is considered and assessed as an approach to structuring meaningful collaborations between visitors with disabilities and art museums. Data collected in the forms of visual and written response, observation, and documentation of interviews inform the findings, discussion, and analysis of the study's research goals. The resulting case study may be used by museums to structure visits with similar groups. This study contributes to a growing body of knowledge pertaining to how museums can best collaborate with disabled populations to create inclusive programs.

Bakgrund: Kvinnor som röker kan drabbas av minskad fertilitet och det kan ta längre tid för dem att bli gravida. Forskning visar att rökning i samband med graviditet bland annat kan leda till missfall, låg födelsevikt och plötslig spädbarnsdöd. En stor andel av dessa kvinnor är medvetna om riskerna rökning under graviditet kan medföra men trots det fortsätter de att röka. Om vårdgivaren är medveten om de bakomliggande faktorerna till kvinnornas rökbeteende kan hen erbjuda kvinnan en individanpassad omvårdnad. För att kunna erbjuda rätt vård är personcentrerad omvårdnad viktigt. Syfte: Syftet var att beskriva vad som gör att kvinnor fortsätter röka under graviditeten. Metod: Litteraturöversikt med en beskrivande design av både kvalitativa och kvantitativa studier. Resultat: Nio faktorer som påverkar kvinnans fortsatta rökbeteende under graviditeten har hittats. Faktorerna är: nikotinberoende, relationsrelaterade problem, stress, behov av egentid och avslappning, partnern, brist på kunskap och motivation, sociala nätverk, förträngning samt bristande stöd från vårdgivaren. Slutsats: Det är viktigt att sjuksköterskan förstår varför en kvinna väljer att röka under graviditetsperioden. Förstår sjuksköterskan vad som ligger bakom rökbeteendet hos den gravida kvinnan kan det bli lättare för hen att erbjuda rätt vård. / <p>+</p>

Background: There are around 150.000 people with dementia in Sweden. It is common to suffer from BPSD sometime during the course of the disease, which adversely affects the quality of life. Symptoms cause impairment to varying degrees, making everyday life difficult to handle independently. Person-centered care means seeing the person behind the disease and it is necessary to find the cause of behavior and to compensate for loss of function. Knowledge of experience of working person-centered is a prerequisite for being able to provide staff with necessary support. Aim: To highlight healthcare professionals' experiences of person-centered care in BPSD. Method: This is a qualitative literature study based on 12 scientific articles. Result: The main themes that emerged were: Own conditions and obstacles, External conditions and obstacles and Contradictory feelings at work. With associated subthemes: Seeing the person behind the disease, To balance between strategies and routines,To take personal responsibility, To have knowledge and experience, Being in need of support and cooperation, To meet organizational / environmental factors, To have access to background information, To feel success and satisfaction and To feel insufficient and powerless. Conclusion: Several conditions that favor dementia care emerged from the results, but there were also factors and obstacles that hampered nursing work. Person-centered work practices increase the possibility of well-being for all involved. In order to care for people with dementia with a person-centered approach, more research in the subject, more resources and in-depth education is required. / Demenssjukdom är ett växande problem inom såväl hälso- och sjukvården som för samhället i stort. Det finns tillgång till symtomlindrande behandling men demenssjukdomar går idag inte att bota utan kan innebära ett stort livslångt lidande för de drabbade men även för deras anhöriga samt en ständig utmaning för vårdpersonal. De flesta drabbas någon gång under sin sjukdomsperiod av beteendemässiga eller psykiska symptom, som till exempel utmanande eller avvikande beteende. Det är viktigt att komma på vad som orsakar symtomen för att kunna lindra, förebygga eller minska lidandet. Syftet med denna studie är att beskriva vårdpersonalens erfarenheter av personcentrerad vård vid Beteendemässiga och Psykiska Symtom vid Demenssjukdom (BPSD) och studiens resultat baseras på en sammanställning av 12 kvalitativa artiklar. Resultatet visade att vårdpersonal beskrev egna och yttre förutsättningar och hinder och motstridiga känslor i arbetet. Att ha helhetssyn, förståelse och kunskap gentemot personer med demenssjukdom underlättar omvårdnaden. Vårdpersonal strävar efter att behandla personer med demenssjukdom utifrån det som passar personen och situationen bäst. Att anpassa mötet och se människan bortom sjukdomen är en viktig utgångspunkt som resulterar i bättre vårdkvalitet. Kunskap och kännedom om tidigare livshistoria är en förutsättning för att lära känna och förstå personen och arbeta personcentrerat vid BPSD. Olika strategier och rutiner används som redskap för att skapa kontakt och tillgodose behov. Vårdpersonal har erfarenhet och medvetenhet om att omvårdnaden av personer med demenssjukdom är komplex och kräver kunskap och tålamod. Det ställs stora krav på vårdpersonalens anpassningsförmåga då det som fungerar ena gången, kanske inte fungerar gången därpå. Vårdpersonalens erfarenheter handlade även om behovet av stöd och samarbete, att möta organisatoriska miljöfaktorer och ha tillgång till bakgrundsinformation om patienten. Samarbete mellan kollegor främjar personcentreringen och bidrar till en förbättrad arbetssituation. Svårigheten i att påverka organisatoriska beslut är märkbar och brist på resurser, samarbete och förståelse från organisationens sida bidrar till att vårdpersonal får svårt att arbeta personcentrerat. Detta tillsammans med vårdpersonalens erfarenheter av hur välfungerande personcentrerad vård gynnar arbetet med personer med BPSD skapar motstridiga känslor i arbetet. Vårdpersonalen kände sig ibland otillräcklig och maktlös men kunde även känna framgång och tillfredsställelse

Abstract Keywords: elderly people, dementia, person-centered care and relatives. Title: To visit someone who is no longer there Author: Ulrika Stenmarck As the number of elderly people increase, the amount of people suffering from age-related illnesses is growing. Such a disease is dementia, which today is a priority research area, both nationally and internationally. It has been found that working in a person-centered way and involving the patient’s relative’s is important for the people cared for by the dementia departments. Despite this, research has shown that the support for relatives is inadequate. The purpose of this study is to identify how individual support, in the field of nursing for dementia patients, can be better adapted to support relatives. By interviewing five relatives and four staff members in a nursing home for dementia patients, answers were sought for regarding; what kind of support the relatives need and how staff work to support relatives. The relatives´ responses were analyzed based on the theories concerning crisis processing related to their relatives´ dementia diagnoses. The answers given from the staff were analyzed based on the theories concerning organizational culture The analysis indicates that the goal of crisis processing for relatives should be to “create their new life”, which seems to be a challenge for a staff that is already carrying a large workload. The results indicate that the staff have succeeded in creating a foundation of values that relatives seem to experience as a safe atmosphere. This atmosphere can be interpreted as the most important support for relatives and a necessity for progress in their crisis processing. As a complement to the unit’s staff, external support for the families can be a solution.