護理專業對護病關係義涵的建構承襲南丁格爾時代的護理典範，以及Hildegard E. Peplau 的<護理的人際關係>，將護理的功能位置定義在理解與協助病患的需求，因此護病關係實屬<療癒性>的人際關係。 護士在不容質疑的護理價值中形構自己的護士角色，那是不自覺與缺乏自我省察的護病關係。事實上，護病關係是不對等關係，專業化的助人功能與角色本身蘊含權力關係的互動。本研究參照傅柯的觀點，對權力的體認其實大部分是正面或構成面；傅柯本身並不斥責權力的社會關係，權力的正面效應是構成與塑造人類生活的運作機制，而真理也是人類建構與塑造而成為實際人類生活的「真理」。護士身為照顧者必須提供助人的角色，但是自己也是醫療技術宰制的受困者，面對病患的需求召喚，護士如何承擔被他者喚起的主體，而自我情緒察覺是啟動自身照顧倫理的動能。 人的知識建構與變化受到體制一連串新的權力技術的演變所控制，病房常態的護理活動是受到醫療制度與社會文化的歷史因素的影響。台灣醫療生態在經濟與效用的實務趨向中，護病關係的事實內涵產生形變與爭議。而護士在照護決策中的權力運作展現，同時也承受臨床機構影響護士照護工作的權力因素。 本研究以批判民俗誌的知識論與方法學進行臨床護病關係現象的田野觀察，揭露臨床結構所習以為常且不自覺的權力關係中，以及護士的面對這權力現象的認同政治。研究場域為精神專科療養院的急性病房，進行近半年時期間斷的護理現場觀察，並訪談15位病房護士，透過敘述訪談對話歷程，協助護士自我察覺在護病關係中的權力互動與消長。發現從醫療專業、醫療空間與病房管理等架構脈絡，理解護士被賦予理所當然的權力地位；闡述醫療生態受到健保制度、機構評鑑與精神衛生法等脈絡影響，護病關係也走向經濟成本與價值效率的考驗；從對病患主體的關懷，轉向為配合醫療體制的經濟價值互動，因此病患主體的照護已經被現有體制邊緣化。 本研究的結果企圖啟動護士反思護病關係的質變化與工具化，護士的自覺可以實踐與再構以人文關懷為主的護病關係，並提供給學校護理教育在實務訓練的參照教材。 / Nurse-patient relationship in nursing takes on Florence Nightingale age , as well as Hildegard E. Peplau’s therapeutic relationship, defines the function of care in understanding and contributing to the patient's needs. Nurses in the nursing care of unquestionable value formulation in their nursing role; it is not self-consciousness and lack of self-examination of nurse-patient relations. In fact, the nurse-patient relationship is unequal relationship, as professional help functionality roles and power relations embedded interaction This study based on Foucault's power and knowledge view, recognition of power largely positive composition; Foucault does not rebuke the social relations of power, power is the positive effect of composition and operation mechanism of shaping human lives, and truth is the construction and shaping of mankind became the actual human life "truth". Nurse role as helper must be provided need for patient, but medical institute dominate self of nurse, then face to patients’ needs calling, nurses how to assume he associated with herself subject, and emotions awareness is self-care for nurse. Construction and changes of human knowledge are controlled by the institutional evolution of a series of new power technologies, Ward nursing routine and activity are under the influence of medical systems and factors of socio-cultural history. Taiwan medical ecology trends of eco-economy and effectiveness, nurse-patient relations is deformation and disputes. Power of nurses is in care decisions making, but also is coercion under the factors of clinical institutions. This research with epistemology and methodology of critical ethnography, observed nurse-patient relations of nursing field, discovered habit and unconsciously power of NPR, and identified politics for power relationship. Research field of mental acute ward of Psychiatry, observation and collection on the half-year, and interviewed 15-Ward nurse, through narrative interviews with dialogue process to help nurse self-awareness flowing power of nurse-patient relations. The outcomes are to be owned power of NPR from the medical profession, medical space and ward management routines.；and elaborated that medical ecology was challenged by health insurance system, the evaluation of medical and mental health law , nurse-patient relationship to economic cost and value efficiency tests; From the subjects care of patient turn to tie in with the economic value of health care system interactions, the subject of patient care has been marginalization of existing institutions. The results of the research attempts to start reflection on nursing quality for variation and tools of nurse-patient relations, the consciousness of power in NPR and active humanistic concern nurse-patient relations, and made available to schools of nursing education in the practical training of reference materials.

ABSTRACT Notions of quality of life dictate philosophies and policies for services for people with developmental disabilities. There is an abundance of research on quality of life, much of which has influenced the significant amount of study of quality of life for people with developmental disabilities. According to specialist developmental disability nurses, however, this research has little meaning for one group of people with developmental disabilities with whom they work - people with severe multiple impairments. Nevertheless, judgements and decisions about the lives of this group continue to be driven by the idea of quality of life. While the literature review found that researchers are urged to seek the perceptions of people regarding their own quality of life by asking them, some authors have noted the difficulty in pursuing such a method with people, such as people with severe multiple impairments, who are unable to communicate in the usual ways. Given, then, that it is difficult to directly determine the views of people with severe multiple impairments, this study sought the perceptions of nurses about the quality of life of the people with whom they work. In order to discover and conceptualise nurses' views, a symbolic interaction perspective was chosen to guide this study and data were analysed using the grounded theory approach. The study was conducted in two stages. Stage One consisted of semi-structured indepth interviews with expert nurses to explore their perceptions of quality of life for the people with whom they worked. A significant finding in these interviews was that perceptions of quality of life are mediated by interaction. Consequently, Stage Two involved a participant observation study in which the interactions of nurses and people with severe multiple impairments were examined. Specialist developmental disability nurses have a unique view of quality of life for people with severe multiple impairments. They refer to it as 'just little things', a phrase which masks complex nursing knowledge and skills, and which can be described by four interrelated categories which emerged from the data: humans being, supporting, becoming intimate, and situated belonging. As nurses become more intimate with individuals, they perceive that people with severe multiple impairments are humans being as they wish, and that quality resides in supporting their everyday lives in a context of situated belonging. This thesis represents a new conceptualisation of quality of life for people with severe multiple impairments, a conceptualisation which may have significance for other groups and, indeed, for the whole quality of life enterprise. This conceptualisation draws on knowledge not usually related to quality of life, that is, knowledge of the body, of the emotions, of identity and of humanness. Such findings demonstrate the power of an interpretive approach in explicating the meanings nurses have regarding quality of life. Further, these findings have implications for how the question of quality of life is approached, for how different ways of thinking about people impact on quality of life, and for the importance of the life in quality of life.

Fibromyalgi (FMS) är ett syndrom som främst karaktäriseras av kroniska smärtor i olika delar av kroppen. Patienter med FMS upplever ofta skepsis och misstro i mötet med vården på grund av att deras symptom är osynliga. Samtidigt kan det vara svårt för sjuksköterskor och övrig vårdpersonal att veta hur de ska förhålla sig till en sjukdom som inte uppvisar några kliniska fynd och vars etiologi fortfarande är relativt okänd. Dessa omständigheter gör vårdrelationen komplex. Syftet med denna studie är därför att utforska hur vårdrelationen upplevs mellan patienter med FMS och sjuksköterskor. 11 artiklar har analyserats, ur vilka ett huvudtema, fyra teman och två subteman identifierades. Resultatet visar att brist på tid, kunskap och förståelse resulterar i en problematisk vårdrelation. Betydelsen av att vårda dessa patienter i ett multiprofessionellt team framgår även. I diskussionen utvecklas på vilka sätt patienter med FMS och sjuksköterskor upplever vårdrelationen olika. Sjuksköterskornas känslor av maktlöshet kan från patientens sida istället uppfattas som ointresse och brist på engagemang, vilket kan medföra att patienterna tar med sig negativa känslor in i nya vårdmöten.

Background: Since the beginning of the epidemic, more than 70 million people have been infected with Human Immunodeficiency Virus (HIV) and the disease continues to be a public health issue all around the world. There are around 42.000 people in the Philippines living with HIV and therefor the nurses and other health care personal play a key part of the persons lives when undergoing treatments. Aim: The aim of this study was to describe Philippine nurses’ experiences of caring for patients with HIV. Method: A qualitative method was used and data was collected through semi structured interviews with five Philippine nurses at a hospital in Baguio. The interviews were analyzed with qualitative content analysis. Results: The findings resulted in two main themes. The first theme, Nurse patient relationship, shows that a nurse patient relationship is important when caring for HIV patients, including getting to know the patient, the importance of trust and giving person centered care. Factors that may be obstacles in the process of building a relationship is also included in this theme. The second theme, Important aspects of caring, including factors such as having conversations, listening and supporting the patient. Discussion: The main findings were discussed in relation to the literature and Travelbee’s human to human theory. The main focus in the discussion was the nurse and patient relationship and important aspects of caring for HIV patients. / Bakgrund: Mer än 70 miljoner personer har drabbats av Humant immunbristvirus (HIV) sedan epidemin startade och sjukdomen är idag fortfarande ett globalt hälsoproblem. I Filippinerna lever cirka 42 tusen personer med HIV och därför har sjuksköterskor och annan sjukvårdspersonal en viktig roll i patienternas liv när det gäller att möta och vårda dessa patienter. Syfte: Syftet med denna studie var att beskriva Filippinska sjuksköterskors upplevelse av att vårda patienter med HIV. Metod: För att genomföra studien användes en kvalitativ metod där data samlades in genom semistrukturerade intervjuer med fem Filippinska sjuksköterskor på ett sjukhus i Baguio. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Resultatet i studien inkluderar två huvudteman. I det första temat: relationen mellan sjuksköterskan och patienten, beskrivs vikten av att skapa en relation med sina patienter. För att skapa en relation bör sjuksköterskan lära känna patienten, skapa tillit och ge personcentrerad vård. Hinder och svårigheter i processen att skapa en förtroendefull relation med sin patient tas även upp i detta tema. I det andra temat beskrivs viktiga aspekter som sjuksköterskorna bör ha i åtanke när de träffar och vårdar patienter med HIV. Diskussion: Resultatet från intervjuerna i studien diskuterades i relation till relevant litteratur och Travelbee’s teori. Fokus i diskussionen var relationen mellan sjuksköterskan och patienten samt viktiga aspekter vid vårdande av HIV patienter.

Compassion fatigue är ett psykiskt och fysiskt tillstånd som utvecklas över tid när sjuksköterskan känner medkänsla och empati för sina patienter, då resultatet visar att stödjande insatser kan hjälpa att förebygga tillståndet hos sjuksköterskor borde detta fenomen lyftas fram. Compassion fatigue kan påverka sjuksköterskans koncentrations- och bedömningsförmåga och resultera i att olika misstag i arbetet begås. Compassion fatigue är ett problem för sjukvården i stort, eftersom tillståndet påverkar omvårdnaden, arbetssituationen samt den enskilda sjuksköterskan negativt. Syftet med litteraturstudien var att belysa compassion fatigue ur ett sjuksköterskeperspektiv, i vilken studiens teoretiska utgångspunkt var Joyce Travelbees interaktionsteori. Studien genomfördes som en allmän litteraturstudie, databassökning gjordes systematiskt med sökord som var relevanta för syftet. Litteraturstudien baserades på tre kvalitativa och åtta kvantitativa artiklar som analyserades och kvalitetsgranskades. Resultatet visade att Bidragande orsaker till compassion fatigue, Upplevelser relaterat till compassion fatigue och Att förebygga compassion fatigue. Med en insikt om att hög arbetsbelastning och en hög stressnivå hos sjuksköterskor kan leda till compassion fatigue går det att arbeta preventivt, vilket är det mest effektiva. Detta skulle bespara både vårdpersonal och patienter lidande och förbättra kvaliteten i omvårdnaden. Vidare forskning skulle kunna ligga till grund för fortsatt förbättringsarbete inom klinisk verksamhet. / Compassion fatigue is a mental and physical condition that develops over time when the nurse feels compassion and empathy for her patients, since the results show that supportive interventions can help prevent the condition, this phenomenon should be emphasized. Compassion fatigue can lead to changes in the nurse's ability to concentrate and judge and result in various mistakes in the work. Compassion fatigue is a major concern for healthcare as the condition adversely affects the nursing, the work situation and the individual nurse. The purpose of the literature study was to emphasize compassion fatigue from a nursing perspective, in which the theoretical starting point of the study was Joyce Travelbee's interaction theory. The study was conducted as a general literature study, database search was done systematically with keywords that were relevant to the aim. The literature study was based on three qualitative and eight quantitative articles that were analyzed and quality-reviewed. The results show Contributing causes of Compassion Fatigue, Experiences Related to Fatigue and Preventing Compassion Fatigue. With an insight that high workload and a high levels of stress in nurses can lead to compassion fatigue, one can work preventively, which is most effective. This would save both healthcare and patients suffering and improving the quality of nursing care. Further research could provide a basis for continued improvement work in clinical operations.

Bakgrund: Brister i kommunikation och informationsöverföring är en av de största orsakerna till vårdskador. För att arbeta mot en säkrare vård måste patienterna bli delaktiga. Delaktiga patienter är nyckeln till personcentrerad och säker vård. Ett sätt att involvera patienterna är genom att de får delta i bedsiderapportering. Syfte: Att beskriva patienters upplevelser när sjuksköterskor använder bedsiderapportering vid skiftbyten.  Metod: En litteraturöversikt med induktiv ansats, baserad på sju artiklar med kvalitativ design och tre artiklar med mixad design. Artiklarna är hämtade från CINAHL och Medline. Resultat: Analysen resulterade i två teman, inkluderande vårdrelation och samtal på lika villkor. Patienterna upplevde att bedsiderapportering kunde främja delaktighet i vården, patienterna fick vara en del av informationsutbytet och bidra med meningsfull information. Patienternas känsla av trygghet ökade och sjukhusupplevelsen förbättrades vid säkerställandet av informationsutbytet. Däremot framkom även önskan från patienterna om ökat deltagande, bibehållen konfidentialitet och bli inbjuden i bedsiderapporteringen av sjuksköterskorna. Slutsats: Resultatet framhäver både positiva och negativa upplevelser. Bedsiderapportering kan vara ett steg mot mer personcentrerad vård men ytterligare riktlinjer behövs som berör hur konfidentialiteten bör hanteras. Framtida forskning behövs för att studera om metoden är lämplig för alla patientgrupper. / Background: Healthcare related injuries are often caused by insufficient communication and poor transferring of information. To make healthcare better the patients need to be included in the process. Keeping the patients involved is the key to patient-centred and safer health care. One way to involve the patient is through implementing “bedside handover”. Aim: To describe patient’s experiences when nurses implement bedside handover during shift change. Method: The study is a literature review with an inductive approach, based on seven articles with a qualitative method and three articles with mixed methods. The articles were taken from the databases CINAHL and Medline. Results: The results generated in in two themes: healthcare relationship and conversations on equal terms. The patients experienced that bedside handover could promote participation in care, patients could be a part of the information exchange and contribute with meaningful information. Patients' sense of security increased, and the hospital experience improved when they could secure the information. However, some patients wished for increased participation, maintained confidentiality and to be more invited to participate in the nursing bedside handover. Conclusion: The result highlights both positive and negative experiences. Bedside reporting can be a step toward more person-centered care, but additional guidelines are needed that address how confidentiality should be handled. Future research is needed to study whether the method is appropriate for all patient groups.

Background The care relationship is central for psychiatric nursing. People with a psychosis diagnosis encounter symptoms that result in difficulties for the interpersonal communication. Stigma and previous experiences of compulsory care are obstacles that hinder or complicate the patient's participation in their care. A person-centered caring relationship increases adherence and the patient's possibility to be a part of their recovery. Therefore it is important for the psychiatric nurse to gain a deeper understanding of what specific strategies and practices the nurse uses to enhance the potential of the care relationship and provide a person-centered care. Aim The aim of the study is to describe the nurse´s experience of the care relationship with people who have a psychosis diagnosis. Method The study was conducted at two outpatient facilitations in Sweden. Eight nurses were asked about their experiences of the care relationship during individual semi-structured interviews. The data was analyzed by using a qualitative content analysis. Results The result was presented in three categories; Trust - essential for a supportive care relationship, Careful perception of the person's boundaries and conditions and Structural possibilities and limitations. The three categories consisted of six subcategories that emphasized the importance of the nurse creating trust and an equal meeting. The care relationship was related to getting to know the person’s history by using the nurse’s personal characteristics and how the nurse handled challenging conditions. Difficulties in creating such a relationship could be demands from the organization or the power dynamics within the health care facilitation. Conclusion By creating trust and an equal meeting the nurse is able to get to know the person’s history and thereby provide a person-centered care for people with psychosis diagnosis.

Bakgrund: Det har länge rapporterats om brister i bemötande i hälso- och sjukvården, inte minst inom psykiatrin. Vårdpersonal möter patienter med psykisk ohälsa oavsett arbetsplats. Patienternas uppfattning av vårdkvalitet inom psykiatrin har knappt undersökts i Sverige då det tidigare funnits en skepticism kring om en person som har varit tvångsvårdad eller lider av en störd verklighetsuppfattning varit kapabel till att ge ett trovärdigt svar. Patienterna anser att en god relation mellan patient och personal är grundläggande för god vårdkvalitet.Syfte: Syftet med denna litteraturstudie var att undersöka hur vuxna patienter med psykossjukdom upplever hälso- och sjukvården.Metod: Syftet besvarades genom en deskriptiv litteraturstudie. Artiklar som har inkluderats var av kvalitativ ansats. Inkluderade artiklar har genomgått en kvalitetsanalys med resultatet hög eller medelhög kvalitet.Resultat: I resultatet framkom följande teman: bemötande, patient-vårdpersonalrelation, behandling, delaktighet och information samt miljö. Patienterna beskrev att de upplevt bristande bemötande från vårdpersonal. De beskrev önskvärda egenskaper hos vårdpersonal och vad som gjorde det möjligt att bygga en god relation. Vidare beskrev patienterna vikten av att få information och av att vara delaktiga i sin vård, samt upplevelsen av bristerna gällande detta.Slutsats: Det är tydligt att det finns brister i hälso- och sjukvården ur ett patientperspektiv och att mer forskning inom området krävs. De problemområden som upptäcktes var bemötande, patient-vårdpersonalrelation, miljö, behandling och delaktighet/ information.Nyckelord: Psykossjukdomar, upplevelse av bemötande, sjuksköterske-patient relation

Communication Skills of Novice Psychiatric Nurses with Aggressive Psychiatric Patients by Rose L. Moss MS, University of Hartford, 1996 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University March 2015 The transition from novice nurse to a competent psychiatric staff nurse is often associated with major communication challenges, primarily when caring for aggressive patients. Guided by Peplau's theory, this quantitative study assessed the communication skills of novice psychiatric nurses (N = 25) who worked 24 months or less in the state psychiatric hospital with aggressive psychiatric patients. Additionally, certain demographic data such as gender, age range, level of education, and length of time working were analyzed to determine their impact on communication skills. The survey consisted of 20 questions which assessed demographic data, communications skills, and hospital-based orientation. Based on ANOVA, novice nurses did not differ on hospital-based orientation based on gender, age, level of education, or length of time working. Novice nurses' communication skills did not differ by gender, age or level of education; however, novice psychiatric nurses who had worked 19-24 months had stronger communication skills than those working less time with aggressive patients (F = 6.9, p < 0.005). A communication skills class during hospital orientation to prepare novice nurses to communicate effectively with aggressive patient was recommended to nursing leadership and staff. A communication skills class held during hospital orientation could enhance the nurse-patient relationship, cultivate a safer and secure milieu, and improve patient outcomes. The findings have implications for positive social change for staff development to improve the hospital orientation for novice psychiatric nurses to become better equipped as effective communicators with aggressive psychiatric patients.

Bakgrund Uppskattningsvis 100 miljoner människor världen över lever i hemlöshet och orsakerna ärindividuella, komplexa och multifaktoriella. Att vara hemlös förknippas med ett försämrathälsotillstånd, såväl psykiskt som fysiskt, och likaså en överdödlighet i jämförelse medövriga befolkningen. Många hemlösa undviker att söka vård, eller väntar tills symtomenhar blivit så pass allvarliga att de behöver uppsöka akutsjukvård. Förhoppningen meddenna litteraturöversikt är därför att bidra med kunskap om hur hemlösa ska bemötas. Syfte Att beskriva hemlösas erfarenheter och upplevelser av hälso- och sjukvården. Metod En icke-systematisk litteraturöversikt utfördes och baserades på 15 vetenskapligaoriginalartiklar med kvalitativ metodansats. Inkluderade artiklar inhämtades fråndatabaserna PubMed och CINAHL. Artikelsökningarna utfördes med hjälp av sökord somtagits fram utifrån föreliggande syfte och därefter tillämpades avgränsningar. Artiklarnakvalitetsgranskades utifrån Sophiahemmet Högskolas bedömningsunderlag och derasresultat analyserades med en integrerad dataanalys. Resultat Den integrerade analysen av artiklarnas resultat gav upphov till två huvudkategorier:Bemötande och praktiska svårigheter att erhålla vård. Centrala fynd var hemlösasbeskrivna upplevelser av diskriminering i vården samt vikten av ett värdigt och flexibeltbemötande. Hemlösa uttryckte även praktiska svårigheter i vårdsökandet, både påindividnivå samt på samhälls- och organisationsnivå. Slutsats Vårdpersonals nedvärderande och dömande bemötande beskrevs som diskriminerande ochhämmade hemlösas vårdsökande. Däremot angavs relationen främjas då hemlösainvolverades i sin egen vård, och då vårdpersonalen var flexibel och lyssnade aktivt. För attförse hemlösa med adekvat vård krävs kunskap om deras upplevelser av hälso- ochsjukvården. / Background Approximately 100 million people are homeless worldwide and the causes are individual, complex, and multifactorial. Homelessness is associated with poor physical and mental health. In addition, the mortality rate among homeless people is elevated compared to the rest of the population. Many homeless people avoid seeking medical care or wait until symptoms are severe enough to require emergency medical care. The hope with this review is therefore to contribute with knowledge about how homeless people should be cared for. Aim The aim of this study was to describe homeless people's experiences with health care. Method A non-systematic literature review, based on 15 scientific qualitative articles, was conducted. The articles were obtained from PubMed and CINAHL databases. The searches were performed using keywords developed based on the aim of the study. The quality of the articles was checked using Sophiahemmet University assessment basis. The articles’ results were subjected to integrated data analysis. Results The integrated analysis of the articles’ results gave rise to two main categories: Experiences of patient-healthcare provider encounters and practical difficulties in obtaining care. Central findings were homeless peoples’ described experiences of discrimination in care and the importance of dignified and flexible treatment. The homeless also expressed practical difficulties in seeking care, both at the individual level as well as at the societal and organizational level. Conclusions Attitudes from healthcare staff that were demeaning and judgmental were described as discriminatory and as a barrier to homeless people seeking care. On the other hand, it was stated that the relationship was promoted when the homeless were involved in their own care, and when the health care staff were flexible and listened actively. In order to provide the homeless with adequate care, knowledge of their experiences of health care is required.