No description available.

SAMMANFATTNING Begrepp som patientcentrerad vård och helhetssyn i vården verkar användas av olika yrkeskategorier, inom hälso- och sjukvård, vilket kan ur kvalitetssynpunkt kan resultera i oklarheter inom den kliniska verksamheten. Syfte: Syftet med studien var att ta reda på vilka likheter och skillnader begreppen patientcentrerad vård och helhetssyn i vården har i den vetenskapliga litteraturen. Begreppen söktes i databaserna CINAHL och PubMed. Metod: Den metod som används för att jämföra begreppen byggde på Segestens begreppsanalysmodell. Resultat: Det som främst skiljer begreppet helhetssyn i vården från patientcentrerad vård är den andliga dimensionens centrala roll. Resultatet visar även att ett patientcentrerat arbetssätt förbättrar ekonomiska resultat. Det är främst sjuksköterskor som använder sig av helhetssyn i vården. Patientcentrerad vård verkar användas främst av läkare men begreppet förekommer även bland sjuksköterskor. Det gemensamma för begreppen då det gäller karaktäristika, förutsättningar och konsekvenser, är det som definieras i kraven på god vård enligt hälso- och sjukvårdslagen. Slutsats: sjukvårdspersonalens arbetssätt och syn på patienten utifrån patientcentrerad vård och helhetssyn i vården värnar om patientens bästa. Det som skiljer begreppen kan bero på vilken yrkesgrupp som undersökts i respektive studie. Studier av begreppet patientcentrerad vård uppfattas vara mer genomförda på läkargruppen samtidigt som helhetssyn i vården tycks vara mer förekommande då det gäller sjuksköterskegruppen. Fler studier behövs för att identifiera användningen av dessa begrepp och om deras betydelse i den kliniska verksamheten. / SUMMARY Concepts such as patient-centered care and holistic care seem to be used by different professions in healthcare. Looking upon these concepts from the aspect of quality, ambiguities can arise in clinical practice. Objective: The purpose of this study was to compare the similarities and differences between the concepts of patientcentered care and holistic care as they are presented in scientific literature. The terms were searched for in the databases CINAHL and PubMed. Method: The method used to compare the concepts was based on Segesten concept analysis model. Results: what differentiates the concept of holistic care of the patient-centered care is the central role of spiritual dimension. The results also show that a patient-centered care improves economic results. The term holistic health care seems to be used primarily by nurses, while patient-centered care seems to be used primarly by physicians, even though the term does occur among nurses. Conclusion: both patient-centered care and holistic care seem to have the same goal, that of preserving the patient`s best interests. What distinguishes the concepts may depend on the profession which was examined in each study. Research studies on patient-centered care have been carried out primarily on physicians, while studies on the holistic approach in health care have focused on nurses. More studies are needed to identify the use of these concepts and their importance in clinical practice. Nyckelord: Patient-centeredness, patient-centered care, holistic care, holistic nursing.

Om eller när en person drabbas av ohälsa, orsakad av exempelvis sjukdom eller olyckshändelse kan känslan av hopp vara en styrka som bidrar till att klara av situationer som kan upplevas svåra eller krävande. Hopp beskrivs som ett mångdimensionellt begrepp och kan vara en nödvändig del i anpassningen till en ny situation. Transition innefattar processen i en förändring hos människor som av olika anledningar drabbas av ohälsa, där hoppet är en väsentlig del. Hopp kan upplevas på olika sätt, därför finns det ett värde om vårdpersonal kan ge personcentrerad omvårdnad, en individuellt utformad vård. Litteraturöversiktens syfte är att beskriva personers upplevelser av hopp vid olika tillstånd av ohälsa. En kvalitativ ansats valdes där 10 artiklar inkluderades. En analys genomfördes av datan enligt Fribergs fem analyssteg. Huvudfynden visar hoppet som en livskraft, dels som aktivt hopp men också passivt och realistiskt hopp. Dessutom kan en drivkraft inom hoppet vara att återfå förlorade förmågor. Det framkommer också att källor till hopp kan vara fysisk utveckling, stöd från omgivningen och en andlig tro. I diskussionen belyses hur sjuksköterskan kan använda realistiskt hopp i omvårdnaden samt hur sjuksköterskan kan anpassa informationen till en person med ohälsa. Upplevelsen av hopp behöver inte vara kopplat till vilken typ av ohälsa en person lider av. Hopp upplevs på liknande sätt av olika människor. / People affected by ill health (caused by sickness, or injury) can believe that the feeling of hope is a strength that contributes to their coping of the situation. Hope can be defined as a multidimensional concept and is often a necessary part of the adjustment or transition process to a new situation. Transition involves the process of change or development in an individual who is suffering from ill health, where hope is an essential part of the process. Hope can be experienced in different ways. Therefore it is of value that health care professionals can provide person-centered care, or also known as individual designed care. The purpose of this literature overview was to present individual’s experiences of hope in various states of ill health. A qualitative approach was chosen with 10 studies examined. After data collection, analysis of these studies, according to Friberg’s  five-step analysis, was undertaken. The main findings of the literature overview show that hope for some, is a life force, and is an active condition/state. It has also been shown to be passive and realistic. In addition, having hope can also provide individuals with the opportunity to regain lost abilities. It also appears that the sources of hope can be from; personal physical development, environmental support and spiritual beliefs. The implications for clinical practice highlight how nurses can use realistic hope, to assist in the care of their clients. It also demonstrates how nurses can adapt information to a person with ill health.  The clients’ experiences of hope need not be linked to any specific type of illness. Finally, hope is experienced in a similar way by many individuals.

No description available.

Stroke är en av de vanligaste orsakerna till död och funktionsnedsättning. Det är främst personer över 65 år som drabbas. Fysisk, psykisk och social påverkan förekommer ofta. Hjärninfarkt och hjärnblödning är de två orsakerna till stroke och högt blodtryck är en bidragande orsak. Symtom på stroke kan till exepmpel vara förlamning eller talsvårigheter. Att bli sjuk eller uppleva ohälsa innebär påfrestningar och omställningar i livet för hela familjen. Syftet var att beskriva hur partnern påverkas av att leva med en person som drabbats av stroke. Litteraturöversikt har valts som design och tolv artiklar, som är kvalitetsgranskade och etiskt godkända, har inkluderats i resultatet. De databaser som användes var CINAHL, Medline och PsycInfo. Artiklarna analyserades i fem steg. I resultatet framkom sex teman: Förändringar i hälsan, Förändringar i relationen, Förändringar i vardagslivet, Förändringar inför framtiden, Vägen tillbaka till det tidigare livet och Behovet av stöd och information. Det framkom att deltagarna upplevde stora individuella förändringar som var fysiskt och psykiskt påfrestande. Partners upplevde att deras hälsa också påverkades negativt. De upplevde även sociala förändringar, till exempel isolering i hemmet. Det framkom i artiklarna att god kunskap och information hade underlättat bearbetningen av situationen. Partnerna upplevde att deras ansvar för sin livskamrat hade ökat i samband med strokehändelsen. I diskussionen diskuterades vikten av information och kunskap för att upprätthålla god hälsa. / Stroke is one of the most common causes of death and disability. It´s most common that people who are older than 65 years is affected. Physical, mental and social symptoms are common occurrences. Cerebral infarction and haemorrhage are the two causes of stroke and may occur because of high blood pressure, among other factors. Symptoms may present themselves as paralysis and dysarthria. Being sick or experience poor health can cause stress in life for the whole family. The aim of this study was to describe how the spouse is affected by living with a person affected by stroke. Literature review has been chosen as design, twelve articles, that has been quality and ethical approved is included in the result. Databases used in this study were CINAHL, Medline and PsycInfo. These articles were analyzed with five steps. In the result, six themes emerged: Changes in health, Changes in the relationship, Changes in everyday life, Changes for the future, Finding a way back to a normal life and The need for information and support. The result of the studies showed that the participants experienced individual changes that physical and mentally demanding. The spouses experienced that their health was affected negatively. They also experienced social changes in their lives, such as isolation. It emerged from the studies that knowledge and information was important, but was inadequate. The participants experienced that their responsibility for their sick partner had increased after the stroke. The importance of information and knowledge to maintain good health was also discussed in the conclusion.

The complexity and lack of coordination of the U.S. health care system is especially challenging for older adults, many of whom have multiple chronic conditions. The faith community is a potential partner to assist them, due to strong religiosity of older adults and specific characteristics of faith communities. This study explores the knowledge and practices of faith community nurses (FCNs) in meeting care coordination needs of older adults and identifies a model of gap-filling by FCN practice. An approach combining both quantitative and qualitative approaches was used. A survey was distributed to all known FCNs in Kentucky. From the 60 respondents, 15 FCNs were selected for personal interviews, and six care recipients were also interviewed. Survey data revealed a relatively older workforce, M=57 years, with 73% in nursing for more than 20 years. All served as FCNs in their own congregations, mostly as volunteers. FCNs relied on informal rather than formal assessments, with little consistency in type of health-related information obtained from congregants. The combined interview data revealed themes including, strong grounding in faith, sense of congregational family, reliance on general nursing assessment skills, intentional empowerment, bridging expanses, trust, and continuity. Findings suggest that FCNs in Kentucky identify and fill significant gaps in health care for older adults. Spirituality and religious rituals were important for FCNs and those they served. Congregants sought out FCNs to answer questions, interpret medical information, and assist with health care interactions. The stability of the FCNs in the lives of congregations was regarded as important; congregants counted on FCNs presence through transitions in health. A model to explain FCN intervention was developed based on integration of a social ecological perspective with the WHO International Classification of Functioning, Disability, and Health. This model reflects contextual factors that occur throughout nested environments that surround each individual, including immediate family, congregational family, health and social care systems, and societal policies. FCNs serve as a bridge between and among these nested environments, connecting them and facilitating change within each level.

Bakgrund: Anknytningen underlättas mellan barn och föräldrar om de kan vara tillsammans redan från förlossningen. Teamarbete förbättrar kvalitén och bidrar till helhetsperspektiv i vården. En god arbetsmiljö och ett gott samarbete mellan personal är viktigt för effektiviteten av samvård. Att undersöka personalens förväntningar inför ett nytt arbetssätt är betydelsefullt eftersom det kan avspegla sig i den vård som senare ges.Syftet med studien var att belysa personalens förväntningar inför sammanslagning av olika vårdavdelningar och att samtidigt införa samvård.Metoden var en kvalitativ metod med totalt 14 deltagare i tre fokusgruppsintervjuer. Datainsamlingen analyserades med en kvalitativ innehållsanalys.Resultatet sammanfattades med temat ”Tryggt och välkänt eller nytt och osäkert – förändringsarbetets balansgång” som beskrev personalens känslor inför sammanslagningen. Kategorierna ”Att få en bra miljö för föräldrar och personal”, ”Att samarbeta med familjen i fokus”, ”Att förena två kliniker och kulturer” och ”Att genomgå en arbetsplatsförändring” beskrev de förväntningar och farhågor personalen uttryckte.Slutsatser: Resultatet visade på förväntningar av att vård- och arbetsmiljö skulle förbättras samt att samarbetet mellan klinikerna skulle bli mer effektivt. Det framkom att det var av betydelse att ha fungerande informationsflöden, uppleva delaktighet samt ha en tydlig ledning i en genomgripande organisationsförändring. / Background: The bonding between child and parent is aided when child and parent can be together as soon as possible from delivery. Teamwork improves quality and contributes to a holistic-perspective on nursing. A good work environment and good cooperation between staff is important for the efficiency of family-centered care. It is significant to investigate the expectations of the staff before introducing a new way of working, since it may reflect in the quality of care later given.The aim of this study was to illustrate the staffs’ expectations on the fusion of care units and whilst introducing family-centered care.The method was a qualitative method, with three focusgroup interviews of a total of 14 participants. Data was analyzed using qualitative content analysis.The result was summarized with the theme “safe and common or new and uncertain – the balance of change” that described the feelings of the staff before the fusion. The categories “achieving a good environment for parents and staff”, “to cooperate focusing on the family”, “uniting two clinics and cultures” and “to experience a change in establishment” described the expectations and fears of the staff.Conclusions: Results showed expectations of improved care- and work environment, and that the cooperation between clinics would become more efficient. It was important having a clear flow of information, to feel participant and to have a straight-forward management in order to create a functioning way of work in family-centered care.

Background: In Havana, Cuba, they have established a great availability of health centers that work close to the patients and their families, both geographically and socially. Family-centered nursing is something that is sought within the health care in the Western world. Numerous studies have shown that family-centered nursing increases patient safety and patient satisfaction and to provide psychological support to family members has shown to contribute to a better well-being to both them and the patient. Aim: To describe nurses’ experiences of involving family members in home-based care provided through consultorios in Havana, Cuba. Method: A qualitative study was completed with semi-structured interviews with five nurses that was currently working or had been working at consultorios in Havana, Cuba. Analysis was done according to qualitative content analysis based on the approach presented by Graneheim and Lundman. Results: The data resulted in two main-themes. The family members were presented as informants to the nurses, psychological support to the patients and as an asset to the nurse. The nurses further explained the importance of seeing the whole picture of their patient’s situation, how they educate family members to be involved in the care and how they support the family members psychologically. Discussion: The nurses’ experience of family members' role and their work to involve them was discussed in relation to previous research and the concept of family-centered care as presented by Benzein, Hagberg and Saveman. / Bakgrund: I Havanna, Kuba, har de upprättat en stor tillgänglighet av sjukvårdsinstanser och hälsocenter som arbetar nära patienterna och deras familjer, både geografiskt och socialt, så kallade consultorios. Familjecentrerad omvårdnad är något som eftersträvas inom sjukvård i västvärlden. Ett flertal studier har visat att familjecentrerad omvårdnad ökat patientsäkerheten och patientens tillfredställelse av vården och att psykologiskt stöd för anhöriga bidrar till en bättre hälsa både för dem och patienten. Syfte: Att beskriva sjuksköterskors erfarenheter av att involvera familjemedlemmar i hemsjukvård som bedrivs utifrån consultorios i Havanna, Kuba. Metod: En kvalitativ studie med semistrukturerade intervjuer genomfördes och fem sjuksköterskor som arbetade eller har arbetat på consultorios i Havanna, Kuba, deltog. Resultatet bearbetades utifrån kvalitativ innehållsanalys baserad på den strategi som beskrivits av Graneheim och Lundman. Resultat: I resultatet framkom två huvudteman. Familjemedlemmarna presenterades dels som informanter men också som en tillgång i sjuksköterskans arbete samt som ett psykologiskt stöd till patienterna. Vidare berättade sjuksköterskorna vikten av att se hela bilden av deras patienters situation, hur de utbildar familjemedlemmar i omvårdnaden och hur de stödjer familjemedlemmar psykologiskt. Diskussion: Sjuksköterskornas upplevelse av familjemedlemmars roll och deras arbete med att involvera dessa diskuterades i relation till tidigare forskning och begreppet familjecentrerad omvårdnad som det beskrivits av Benzein, Hagberg och Saveman.

Online Health Seeking (OHS) is widespread and widely studied, but its ideal fit in healthcare is still unclear. OHS is seemingly emblematic of patient self-interest and control and is an intuitive fit with the tenets of patient-centered care (PCC). Researchers have made only a few attempts to evidence or leverage this connection, focusing instead on describing the figures and typical characteristics of OHS. Finding, consuming and sharing online health and wellness information is one of the common online activities, and consumers are generally satisfied with their results despite using simple and error-prone search strategies. Physicians are interested in their patients' OHS, but for a variety of constraints including time, compensation and traditional roles in medicine, most patient OHS goes unshared with doctors. Healthcare facilitators, a relatively new class of health professional that works to bridge the gap between their client's health and personal life, may be an ideal partner for patients in OHS. In this dissertation I share my investigation of the OHS-PCC connection, presenting a case study of a type of healthcare facilitator that has embraced OHS. By studying OHS, I was also able to contribute to the collaborative information seeking (CIS) community. CIS theory and social search tools have pointed to social factors that can influence the entire process of information seeking. In this dissertation I argue that nearly any social search design can be seen as situated or embedded in a unique socio-environmental context. I suggest that social search tools can be used as probes to understand the environment, and that interactions with a search tool can illustrate phenomena far beyond direct search motivations and goals. I also hypothesize that social search field studies can produce changes in their environment, producing changes in user relationships outside of the experimental search system. My study of OHS is an opportunity to test these hypotheses by creating a collaborative search tool that seeks to use OHS as a tool to improve patient-provider relationships. In this dissertation I present the results of a series of field studies at a local clinic that centers on a unique form of health facilitator. Drawing on several formative investigations and related work I synthesize design guidelines for a collaborative OHS tool and describe Snack, a collaborative search tool for OHS customized to my field site. I also present results from Snack's field study and an analysis of email messages between advisors and clients at the clinic. My results show that these health facilitators embraced OHS as a tool to guide and connect with their clients, but fell from this practice after a change at their clinic. After analyzing these results I discuss what makes health facilitators good OHS partners and cover implications for future OHS-based interventions. I also report the positive connections I found between OHS and other quality of care indicators like patient-centered care and the Multidimensional Health Locus of Control. Finally, I consider social search's utility as a probe and intervention in light of my results.

Bakgrund: Studier visar att patienten, framför allt kvinnor, upplevde sig utlämnade, nervös, ångestfyllda och oroliga inför och under det korta mötet med anestesisjuksköterskan innan operation. Syftet: är att undersöka patientens upplevelse av obehag och delaktighet i mötet med anestesisjuksköterskan inför en nedsövning och om patientens kön har någon betydelse för detta. Metod: En kvantitativ tvärsnittsstudie med ett deskriptivt förhållningssätt där enkät valts som datainsamlingsmetod med totalt 44 respondenter. Resultat: Majoriteten av respondenterna upplevde ingen obehagskänsla inför en anestesi, av de få som upplevde påtaglig med obehag var samtliga kvinnor. Medan en majoritet av respondenter kände sig delaktiga i vårdarbetet inför en nedsövning, var en fjärdedel inte tillfredsställda. En fjärdedel av respondenterna önskade större delaktighet, medan övriga inte ville eller inte visste ifall de ville vara delaktiga. Männen kände sig mindre delaktiga i vårdarbetet än kvinnorna samtidigt som de inte hade en större önskan om att vara delaktiga. Kvinnor däremot kände sig mer delaktiga, än män, och hade dessutom en önskan om att vara delaktiga. Ingen signifikant skillnad fanns mellan kvinnor och mäns svar. Slutsats: Även om en majoritet av de patienter som genomgick en operation som krävde generell anestesi antingen kände sig delaktiga eller inte eftersökte mer delaktighet i sjuksköterskan vårdarbetet så var det fortfarande en fjärdedel som inte kände sig delaktiga. En tredjedel av respondenterna hade en positiv inställning till att med egna händer hålla i syrgasmasken under preoxygeneringen. När det kommer till patientens upplevelse av obehag inför en anestesi så visar denna studie att en tydlig majoritet inte upplever någon form av obehag, av dem få som upplevde påtagligt med obehag var samtliga kvinnor.   Nyckelord: Obehagskänsla, preoxygenering, delaktighet, patientcentrerad vård. / Background: Studies have shown that patients, especially women, feel themselves vulnerable, nervous, anxious and apprehensive before and during the brief meeting with the nurse anesthetist before surgery. Aim: The purpose of this study is to examine the patient's experience of uneasiness, participation in the meeting with the nurse anesthetist, before a general anesthetic, and if the patient's gender has bearing   Method: A quantitative cross-sectional study with a descriptive approach where survey was selected as data collection method, with a total of 44 participants. Results: The majority of respondents experienced no uneasiness before an anesthesia, the few who experienced significantly uneasiness were all women. The study showed that the majority of respondents already felt a sense of involvement involved in the care work before a general anesthetic, but still 25% did not ensure patients needs. 25 % of the respondents expressed a desire for greater involvement, while rest of the respondents did not want to, or did not know whether they wanted to be more involved. Male respondents felt less involved currently, but also expressed least interest for greater involvement. Female respondents, on the other hand, felt more involved than men, and at the same time also expressed a desire to be involved. No significant difference was found between women's and men's responses. Conclusion: A majority of the patients who underwent a surgery requiring general anesthesia did feel a level of involvement in the care work performed by nurses. While a majority did not want to be involved at all in the care work, 25% did not feel, but wished to be involved. One way to accommodate and increase involvement would be to offer the patients to hold the oxygen mask with their own hands during preoxygenation. Nearly a third of the respondents would have agreed to do so if they had been given the option. When it comes to patient’s uneasiness before an anesthesia does this study shows that a clear majority does not experience any kind of uneasiness, those who experienced significantly uneasiness with were all women.   Keywords: Uneasiness, preoxygenation, participation, patient-centered care.