The Patient-Centred Assessment of Symptoms and Activities (P-CASA) is a new idiographic, open-ended assessment that examines each individual patient’s symptoms within the context of his or her daily life. P-CASA asks patients for their most important activities, what interferes with these activities, and any coping strategies. This thesis presents the rationale and design of P-CASA and its first validation study. Sixty patients at the Pain and Symptom Management/Palliative Care Clinic of the BC Cancer Agency (Vancouver Island Centre) completed P-CASA and the Edmonton Symptom Assessment System (ESAS), which is the current nomothetic assessment at the Clinic. The results demonstrated that P-CASA was not redundant with ESAS because it assessed (a) information about patients’ activities and coping strategies, which the ESAS does not; (b) all relevant cancer-related symptoms (not just pain or a fixed list); (c) co-occurring symptoms; (d) more specific details and different priorities about symptoms than in their ESAS. / Graduate

Bakgrund: Palliativ vård utförs i hela världen och det är viktigt att utveckla och följa upp den typen av vård. Palliativ vård utgår från fyra hörnstenar och skall involvera mer än det fysiska i omvårdnaden. Det är viktigt att också lägga märke och ta hand om det psykiska, sociala och andliga. Ett stort mörkertal och brister har identifierats inom den palliativa vården som måste förbättras.  Motiv: 2018 vårdades ca 19% av palliativa patienter i sitt eget hem. Många patienter som är hemma i livets slutskede skickas mellan sjukhus och hemmet för att tillslut dö på sjukhuset trots att deras vilja kanske var att dö hemma. Därför är det viktigt att se hur nöjd distriktssköterskan eller sjuksköterskan på vårdavdelningar samt i hemsjukvården är med sitt arbete och vad som kan förbättras.  Syfte: var att kartlägga och jämföra hur nöjda distriktssköterskor och sjuksköterskor i hemsjukvård samt på vårdavdelning är angående sin insats i palliativ vård.  Metod: En kvantitativ jämförelsestudie med stratifierat urval. En enkätundersökning skickades ut till åtta vårdavdelningar och till femton kommuners hemsjukvård. Deltagarna var distriktssköterskor och sjuksköterskor i norra Sverige, totalt deltog 83. Insamlad data analyserades i Jamovi och presenteras med Chi square test samt Fischer’s exact test.  Resultat: En signifikant skillnad där distriktssköterskor alternativt sjuksköterskor i hemsjukvården är mer nöjd med symtomlindring vad gäller oro/ångest (p=0.038) samt smärta (p=0.021) upptäcktes. Vid jämförelse mellan hemsjukvård och vårdavdelning kring hur nöjd distriktssköterskan eller sjuksköterskan är med sin egna insats framkom en signifikant skillnad där de på vårdavdelningen var mindre nöjd.  Konklusion: En påvisad skillnad kan ses mellan distriktssköterskor och sjuksköterskor i hemsjukvården eller på vårdavdelning vad gäller symtomlindring, vidareutbildning samt läkarkontakt. Fler studier behöver utföras för att få ett mer rättvist resultat.

Bakgrund: Astma är en kronisk inflammatorisk lungsjukdom som drabbar luftvägarna. Behandlingen baseras på symtom med läkemedel och egenvård. Egenvård innebär hälso- och sjukvårdsåtgärder som personen själv utför såsomförebyggande åtgärder av astma. Studier visar att personer med astma har otillräcklig förståelse av sjukdomen och dess egenvård vilket leder till lidande. Genom att ta reda på personers upplevelser av egenvård vid astma kan det bli lättare för vården att ge rätt stöd. Syftet: Syftet var att beskriva vuxna personers upplevelser av egenvård vid astma i det dagliga livet. Metod: Litteraturöversikten baserades på induktiv ansats och kvalitativ design.Resultatet bestod av 11 vetenskapliga artiklar som analyserades efter Fribergs femstegsanalys. Resultat: Resultatet är indelat i tre huvudteman och sex subteman. (1) Förbättradkunskap om astma: behov av information och stöd samt personers egen förståelseav astma. (2) Kroppskontroll: hantering av astmatiskt läkemedel och strategier för att hantera symtom. (3) Sjukdomsidentitet: känna autonomi och acceptans av sjukdomen. Slutsats: Grunden i resultatet är att kommunikationen med vården behöver förbättras. Personer med astma önskar förbättrad information för att kunna ta rätt beslut om sin egenvård och bli mer delaktig i vårdbeslut för att förbättra autonomi. / Background: Asthma is a chronic inflammatory lung disease that affects the patient's airways. The treatment is based on symptoms and is regulated through medication and self-care. Self-care involves healthcare measures the patient does themselves, such as preventive measures for asthma. Studies show that people with asthma have insufficient understanding about the illness and its self-care which leads to suffering. By finding out the persons' experiences of self-care, it can be easier for the nurse to offer the right support. Aim: The aim was to describe adults' experiences of self-care for asthma in daily life.Method: A literature review based on an inductive approach and qualitative design. The result consisted of 11 scientific articles that were analyzed according to Friberg's (2017) five-step analysis. Results: The results are divided into three main themes and six sub-themes: (1) improved knowledge of asthma: need for information and support and Persons’ own understanding of asthma. (2) Body control: management of asthmatic medicationand strategies for managing symptoms. (3) Disease identity: feel the autonomy and the acceptance of disease. Conclusion: The foundation of the result is about communication in healthcare andneeds improving. People with asthma wishes better information for decision making about their self-care, and to become more involved in their healthcare to improve autonomy.

Bakgrund: Sjuksköterskor inom hemsjukvård har till uppgift att bland flera andra arbetsuppgifter även symtomlindra patienter med palliativt vårdbehov som lider på grund av fysiska, psykiska, psykosociala eller existentiella orsaker. Palliativ vård innebär ett personcentrerat synsätt där kärnan ligger i att se hela människan och inte bara sjukdomen eller det för stunden framträdande symtomet. Palliativ vård bedrivs inom flera verksamheter med olika huvudmän. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av symtomlindring vid palliativ vård i hemsjukvård. Metod: En kvalitativ litteraturöversikt utfördes på 16 artiklar som hittades genom sökningar i databaserna CINAHL, PubMed och PsycInfo. Artiklarnas resultat analyserades med inspiration av integrativ metod. Genom analys framkom tre kategorier med sex underkategorier gällande sjuksköterskors erfarenheter av symtomlindring vid palliativ vård i hemsjukvård. Resultat: Resultatet visar att sjuksköterskor som arbetar inom hemsjukvård behöver kunskap och kompetens inom palliativ vård och symtomlindring. Det behöver även finnas ett fungerande samarbete med ansvarig läkare för att kunna erbjuda patienten en personcentrerad vård och symtomlindring. Att arbeta som sjuksköterska i hemsjukvård kan i arbetet med palliativ vård ge en känslomässig påverkan i form av frustration och oro. Slutsats: För att patienter med palliativt vårdbehov inom hemsjukvård ska få optimal symtomlindring krävs att sjuksköterskor har kunskap och tidigare erfarenhet, vilket påverkar i vilken utsträckning patienters symtom blir lindrade. Det är även viktigt att det finns en fungerande samverkan med ansvarig läkare i primärvård. Läkares engagemang, kunskap, tid och intresse för palliativ vård är avgörande för kvaliteten på vården. / Background: Nurses in home care have the task of among several other tasks, also relieving symptoms of patients with palliative care needs who suffer due to physical, menthal, psychosocial or existential causes. Palliative care involves a person centered approach where the core lies in seeing the whole person, not just the disease or the currently prominent symptom. Palliative care is conducted in many different activities with different principals. Aim: The aim was to describe nurses experiences of symptom management in palliative care in home care services. Method: A qualitative literature review was performed on 16 articles found through searches in the databases CINAHL, PubMed and PsychInfo. The result of the articles were then analyzed with inspiration from an integrative method. Through analysis three categories emerged with six subcategories regarding nurses experiences of symptoms relief in palliative care in home care. Results: The result showed that in order for nurses to be able to offer the patient optimal symptom relief, conditions were required in form of time, right prescriptions, commitment and collaboration with the district physician. Nurses' experience and knowledge of palliative care were also important for the outcome of the effect of symptom relief, as increased experience provided greater security in symptom relief. Regardless of previous experience and knowledge level, more training in symptom relief was requested. Deficiencies in collaboration with the district physician could create anxiety and frustration among the nurses. Conclusion: In order for patients with palliative care needs in home care to receive optimal symptom relief, it is required that nurses have knowledge and previous experience, which affect the extent to which patient´s symptoms are alleviated. It is also important that there is a functioning collaboration with the responsible doctor in primary care. The doctor's commitment, knowledge, time and interest in palliative care are crucial for the quality of care.

This thesis explored symptom clusters in patients with lung cancer before, during and after oncological treatment. A literature review and an interview study was used to explore the symptom cluster experience from the patients’ perspective. A large diversity of symptom cluster constellations were identified, in which fatigue was the most commonly occurring symptom, followed by dyspnea, pain, depression, cough and nutritional impact symptoms. Many symptom assessment instruments were identified, measuring mostly the intensity-dimension alone or in combination with timing. The results also stress that living with symptom clusters during treatment is more about survival than actually living. Patients’ symptom management strategies were shaped by impacting conditions such as knowledge and earlier experience of symptoms. Symptoms were often regarded as unavoidable by the patients and something to accept. How symptoms were recognized by health care professionals further added to the normalization of symptom clusters. Subsequently, patients would not always ask for support, and their quality of life was negatively affected. Holistic person-centered care including multi-dimensional symptom assessment is considered essential to ensure adequate symptom cluster management for patients with lung cancer.

Indiana University-Purdue University Indianapolis (IUPUI) / Shoulder pain was constantly reported as a problematic symptom causing dysfunction and quality of life interference after neck dissection in head and neck cancer patients. Due to a lack of conceptual framework and inconsistency of instrument selection, a comparison among previous studies was almost impossible, making it difficult to understand the phenomenon. The current study applied the University of California, San Francisco School of Nursing Symptom Management Model. The purposes of the study were to (a) describe the symptom experience of shoulder pain at 1 month after neck dissection, (b) describe the relationships among symptom experience of shoulder pain, functional status, and quality of life, and (c) identify the contextual variables, concurrent symptoms, and/or adherence predicting symptom experience of shoulder pain, functional status, and/or quality of life. This was a descriptive study with a convenience sample of head and neck cancer patients. The data were collected via a medical record review, a self-administered survey, and a physical examination. The data from 29 patients were entered for descriptive statistics, Pearson correlations, and multiple regressions. At 1 month after surgery, 62% of patients reported they had shoulder pain at some point within a week. Their shoulder pain was from mild to moderate. Fifty-nine percent complained that shoulder pain bothered them about the moderated level. In the final model, symptom experience, shoulder pain, was significantly correlated with one outcome, active shoulder abduction, but not the other, total quality of life, generic quality of life, and head and neck quality of life. Active shoulder abduction was significantly correlated with three quality of life measures. Adding significant predictors of symptom experience and outcomes into the final model, there is a potential that the model would be useful to guide treatment strategies. Treatment for myofascial pain of the levator scapulae could relieve shoulder pain after neck dissection and improve head and neck quality of life. Those with level V dissection were high risk populations of developing shoulder pain. Risk factors of quality of life, which were depression, loss of sensation, and radiation would describe how an intervention could change or unchange the patient’s life.

Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that affects women’s menstrual cycles and their levels of androgens (male hormones) and cysts on the ovaries. There is a variety of symptoms that come with this endocrine disorder, but insulin resistance is a hallmark symptom of the disorder. It’s shown that 65-70% of women with PCOS have insulin resistance and hyperinsulinemia, this is in women that are overweight, obese, or lean (Marshall & Dunaif, 2012). A lot of women with PCOS find themselves struggling to lose weight because their excess weight is tied to lifestyle and not properly nourishing their bodies, as well as their imbalanced hormones. The understanding of PCOS being a metabolic disorder led to the investigation of the need for registered dietitian nutritionists on the health team of women with PCOS could change the quality of life in women. We developed a survey based on the literature available on the topic of PCOS, diet/nutrition interventions, and the role of RDNs in the healthcare team of PCOS women of childbearing age. Only childbearing-age women (18-44) that have been diagnosed with PCOS were allowed to complete the survey. The survey was comprised of three sections and was designed to be a needs assessment on the need for registered dietitian-nutritionists to be included in the healthcare team of PCOS women. The questions were designed also show any gaps of knowledge or misconceptions about nutrition that these women may have. Lastly, it was designed to examine if women understand how nutrition relates to the management of their symptoms of PCOS and future disease risks. The data from this survey will show the need for RDNs in the healthcare team of PCOS women, and give us an understanding of nutrition education and intervention that could be developed for future studies. This understanding of how RDNs could play a role in symptom management could lead to a better quality of life in PCOS women.