Background: Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) experience ongoing or recurrent symptoms after discharge, regardless of their ultimate medical diagnosis. A comprehensive understanding of post-ED symptom trajectories is lacking. Aims: Aim 1 was to determine trajectories of severity of common symptoms (chest pressure, chest discomfort, unusual fatigue, chest pain, shortness of breath, lightheadedness, upper back pain and shoulder pain) in the six months following an ED visit for potential ACS. Aim 2 was to identify relationships between symptom trajectories and baseline physiologic factors (age, gender, diabetes status, diagnosis, comorbidities, functional status) and situational factors (marital status, insurance status, education level). Aim 3 was to identify relationships between symptom trajectories and health service use (outpatient visits and calls, ED visits, 911 calls, hospitalization) in the six months after the ED visit. Methods: This was a secondary data analysis from a study conducted in five U.S. EDs. Patients (n=1002) who had abnormal electrocardiogram or biomarker testing and were identified by the triage nurse as potentially having ACS were enrolled. Symptom severity was assessed in the hospital and 30 days and six months post-discharge using the 13-item ACS Symptom Checklist. Symptom severity was modeled across the three study time points using growth mixture modeling. Model selection was based on interpretability, theoretical justification, and statistical fit indices. Patient characteristics were used to predict trajectories using logistic regression and differences in health service use were tested using chi-square analysis. Results: Between two and four distinct trajectory classes were identified for each symptom. Identified trajectories were labeled "tapering off," "mild/persistent," "moderate/persistent," "moderate/worsening," "moderate/improving," "late onset," and "severe/improving." Age, sex, diabetes, BMI, functional status, insurance status, and diagnosis significantly predicted symptom trajectories. Clinic visits and phone calls, 911 calls, ED visits, and probability of hospitalization varied significantly among trajectories. Conclusions: Research on the individual nature of symptom trajectories can support patient-centered care. Patients at risk for ongoing symptoms and increased health service use can be targeted for education and follow-up based on clinically observable characteristics. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations.

Bakgrund: Sjuksköterskans kliniska arbete ska präglas av ett etiskt förhållningssätt som genomsyrar omvårdnadsarbetet i att skapa vårdrelationer och patientdelaktighet. God vård är allt mer jämställt med begreppet personcentrerad vård, att se människan och personen i patienten. Syfte: Att utforska hur personcentrerad vård kan utföras i sjuksköterskans kliniska arbete. Metod: En litteraturstudie av 20 artiklar har genomförts. Resultat: Analysen genererade ett antal strategier som presenterades i fem teman: Att se personen, Att lyssna, Att skapa relationer, Att visa respekt och empati, Att skapa stödjande miljö. Slutsats: Det är essentiellt att förstå att trots varierande strategier är det nödvändigt att flera strategier bör tillgås för att uppnå personcentrerad vård i alla situationer. Klinisk betydelse: Denna studie bidrar med kunskap om vad personcentrerad vård innebär och ger ökad insikt i hur det kan uppnås i det dagliga kliniska arbetet. / Background: The nurse work within an ethical framework that provides guidelines in the requirements of establishing nurse-patient relationships and in shared decision making. Good quality in nursing care depend on to what degree the nurse meet these requirements, which is equated to patient-centered care: to place the person of the patient in the center of care. Aim: To explore how patient-centered care may be performed in the nurse’s clinical setting. Methods: A literature review of 20 articles was performed. Results: The analysis resulted in various strategies. These strategies are presented in five main themes: To see the person, To listen, To create relationships, To show respect and empathy, To create healing environments. Conclusion: Despite the fact that there are various strategies, it is essential to understand that a combination of them is needed, in order to truly fulfil person-centered care. Clinical significance: This study may contribute to knowledge on how patient-centered care may be achieved in the everyday clinical setting.

Bakgrund : Kommunikation i hälso- och sjukvården är viktig för att inte misstag ska uppstå och är betydande vid en överlämning av patientansvaret. I slutenvården sker en rapportering genom att sjuksköterskan som arbetat lämnar över patientansvaret till sjuksköterskan som ska påbörja sitt arbetspass. Bedsiderapportering är en rapporteringsmetod som innebär att patienten är närvarande under rapporten, som kan ske vid patientens sängkant eller i ett enskilt rum. Sjuksköterskor anser att bedsiderapportering ökar patienternas delaktighet men upprätthållandet av sekretess kan i vissa fall påverkas negativt. Sjuksköterskan ska arbeta utifrån ett personcentrerat förhållningssätt, vilket innebär att respektera patientens delaktighet, självbestämmande och integritet. Syfte: Att sammanställa patientens upplevelser av och attityder till bedsiderapportering mellan sjuksköterskor vid ett skiftbyte, inom eller i anslutning till slutenvård. Metod: En litteraturöversikt. Resultatet utgår från 15 vetenskapliga artiklar som var publicerade mellan år 2011 och 2017. Resultat: Delaktighet ansågs öka hos patienter vid användning av bedsiderapportering. Däremot fanns det patienter som önskade mer delaktighet. Patienterna kunde kontrollera att informationen som gavs under bedsiderapportering var korrekt. Vissa patienter upplevde svårigheter att förstå språket medan andra inte påpekade detta som ett problem. Rapporteringsmetoden riskerade inte upprätthållandet av sekretess men däremot kunde flerbäddssalar göra det. Känslig information skulle diskuteras med försiktighet. Konklusion : Bedsiderapportering har en positiv effekt på patienternas delaktighet i hälso- och sjukvården. Patienternas delaktighet i rapportering minskar risken för att fel information om patienten vidarebefordras. Sekretess kan bevaras ytterligare och känslig information bör hanteras varsamt vid användning av bedsiderapportering. / Background : Communication in health care is important to prevent mistakes and is significant during patient handover. A patient handover is performed in hospitals when the outgoing nurse gives a patient report to the incoming nurse. Bedside handover is a method where the patient is present during the report, and it can be done at the patient’s bedside or in a private room. Nurses believe that bedside handover increases patient participation. However, the privacy of the patient can be negatively affected. Nurses need to have an approach with individual focus, which means to respect the patient’s participation, autonomy and integrity. Aim: To compile the patient’s experiences and attitudes regarding bedside handover between nurses during a handover, in or in connection to in-patient health care. Method: A literary review. The result is based on 15 different scientific studies. The studies were published between 2011 and 2017. Results: Patient participation did increase during bedside handover, but some patients wished to have more participation. Patients could verify that the information during bedside handover was correct. Some patients did find it hard to understand the language used by the personnel, other patients did not see this as an issue. The reporting method did not endanger the privacy of patients, but could be negatively affected if a room were shared. Sensitive information should be carefully discussed. Conclusion: Bedside handover has a positive effect on patient participation in health care. Patient participation reduces the risk of inaccurate information about the patient being passed on. The privacy of patients can be further maintained, and sensitive information should be handled carefully during bedside handover.

Bakgrund: De människor som invandrar till olika länder har med sig sitt eget språk, kultur, synsätt och vanor vilket har skapat ett behov på kulturellt anpassad vård. Sjuksköterskan som möter den mångkulturella patienten i sitt dagliga arbete kan uppleva en kulturkrock omvårdnadsarbetet. Kulturella skillnader och kommunikationssvårigheter ses som ett hinder för en god vårdrelation mellan sjuksköterska och patient. Syfte: Att beskriva sjuksköterskans upplevelser i vårdandet av den mångkulturella patienten Metod: En litteraturöversikt baserad på 15 vetenskapliga artiklar med publicering mellan åren 2008- 2018 från databaserna PubMed, Cinahl och Web of Science. Resultat: Det framträdde tre huvudteman: språkbarriärer, kulturella problem samt utbildningsbehov. Språkbarriärer upplevdes som ett stort hinder och en utmaning i vårdandet av patienter från andra kulturer. Sjuksköterskans upplevelser i mötet med den mångkulturella patienten påverkades av av kulturella- och kommunikationsproblemen mellan patient och sjuksköterska. Problemen för sjuksköterskorna att möta den mångkulturella patientens omvårdnadsbehov kunde bero på bristande kunskap och utbildning om olika kulturer. Slutsats: Det behövs mer kunskap hos sjuksköterskan om andra kulturer för att enklare kunna möta den mångkulturella patienten. / Background: People who immigrate to different countries have their own language, culture and habits. This has created a need for culturally adapted care. The nurse who meets the multicultural patient can experience a cultural clash in their work. Cultural differences and communication problems between nurse and patient is seen as an obstacle in providing good healthcare. Aim: To describe the nurse’s experiences in caring for the multicultural patient Method: A literature review based on 15 scientific articles with data collection from PubMed, Cinahl and Web of Science. Result: Three main themes were presented: language barriers, cultural problems and the need for education. The results show that language barriers pose a major obstacle and a challenge in the care of patient from other cultures. The nurse’s experience of caring for the multicultural patient was affected by the lack of knowledge about other cultures. Conclusion: The nurses need more knowledge about other cultures to make it easier in the meeting with the multicultural patient.

The acute care setting is designed to provide short-term care for people who require treatment for a severe episode of acute illness and exacerbations of chronic conditions. Yet, more than half of Canadians die in acute hospitals every year. Evidence shows that nurses in acute care units feel limited in their ability to provide quality end-of-life care due to a variety of factors. As a result, the needs of patients that are dying are often overlooked, which can cause them to experience a loss of identity and control, as well as suffering at the end-of-life; a unique time in one’s life trajectory marked by significant changes in personhood. Personhood is the philosophical underpinning of the frequently used concept ‘person-centered care’ – one of the fundamental ideologies of nursing and a central concept in palliative care. An interpretive description design was used to explore the following research question: What do nurses’ stories reveal about the ways in which they engage, or fail to engage, with personhood in end-of-life care in acute care units? To appreciate the culture in which participant stories were situated, a literature review of acute care culture, end-of-life care in acute care units, and the concept of personhood was conducted. Eight nurses from an acute medical-surgical ward of a tertiary care hospital in Eastern Ontario were interviewed for this study. Thematic analysis was used to analyze the data, which elucidated tensions between participants’ ability to enact ethical end-of- life care reflective of their values and the contextual constraints of working in a culture of biomedicine. Exploring these tensions provided insight on the nuances and complexities of navigating ethical end-of-life care in an acute care setting as well as implications for nursing practice, education, and research with particular attention to promoting moral communities in acute care that value personhood and biomedicine equally.

According to World Health Organization 1.5 million people die every year due to diarrhoeal diseases. Diarrhoeal diseases may be caused by a multitude of different reasons, though WHO highlights the fact that 58% of these, are caused by lack of clean water, sanitation and hygiene. A qualitative study conducted with nurses working at different departments at a hospital in Tanzania. Semi-structured interviews were performed with ten nurses and the interviews were analysed through content analysis. The purpose was to describe nurses' experiences of working with self-care for patients suffering from gastroenteritis. Nurses experience that patients need more self-care knowledge, and the common perception is that patients are happy to receive the nurses’ advice regarding basic hygiene. It appears that the nurses find that there are no social structures that can help people maintain good health, despite their own efforts to maintain good health, there is not always prerequisite to maintain it. The community health workers are considered important for all people entitled to experienced health, for human rights and for people to get the right care when they need it. / Titel: Egenvård vid gastroenterit i Tanzania - Sjuksköterskors perspektiv. Enligt Världshälsoorganisationen dör 1,5 miljoner människor varje år på grund av diarrésjukdomar. Diarrésjukdomar kan bero på flera olika orsaker, däremot framhäver Världshälsoorganisationen att 58% av dessa orsakas av brist på rent vatten, sanitär utrustning och hygien. En kvalitativ studie utförd med sjuksköterskor som arbetar vid olika avdelningar på ett sjukhus i Tanzania. Semistrukturerade intervjuer genomfördes med 10 sjuksköterskor och intervjuerna analyserades med en kvalitativ innehållsanalys. Syftet var att beskriva sjuksköterskors upplevelse av arbetet med egenvård för patienter som är drabbade av gastroenterit. Sjuksköterskor beskriver att de upplever att patienter behöver mer kunskaper gällande egenvård, och den gemensamma uppfattningen är att patienterna är tacksamma för att få sjuksköterskans råd angående basal hygien. Det framkommer att sjuksköterskorna upplever att det saknas samhälleliga strukturer som kan hjälpa människor att kunna bibehålla en god hälsa, trots deras egna försök att upprätthålla en god hälsa så finns inte alltid förutsättningen att underhålla den. De lokala hälsoarbetarna som finns anses vara viktiga för alla människors rätt till upplevd hälsa, för mänskliga rättigheter och för att människor ska få rätt vård när de behöver det.

Bakgrund: Delaktighet innebär en aktiv medverkan. I vården är delaktighet ömsesidig och beroende av både vårdpersonal och patient med anhöriga. Sjuksköterskans kärnkompetenser består bland annat av personcentrerad vård, vilken utgår från patientens behov. För att skapa en säker personcentrerad vård av kvalitet bör sjuksköterskan bland annat ha kunskap om delaktighet.   Syfte: Att beskriva patientens upplevelse av delaktighet i vården. Metod: En litteraturöversikt genomfördes med kvalitativ och induktiv ansats. CINAHL och MedLine har använts som databaser, vilket genererade i tio kvalitativa artiklar. Resultat: Fyra kategorier och nio subkategorier analyserades fram och resulterade i att patienten upplever delaktighet vid kommunikation, delaktighet genom relation, möjlighet till delaktighet och via vårdpersonalens förhållningssätt till delaktighet. Slutsats: Förståelse för patientens upplevelser av delaktighet har betydelse för att klarlägga och främja delaktighet samt forma en personcentrerad vård av kvalitét. / Background: Participation means an active involvement. In health care, participation is mutual and dependent on both healthcare professionals and patients with relatives. Six competencies for nursing consists among others patient-centered care, based on patient needs. In order to create a safe patient-centered quality care, the nurse should, for example, have knowledge of participation. Aim: To describe patients experience of participation in healthcare. Methods: A literature review was carried out with qualitative and inductive approach. CINAHL and MedLine were used as databases, which summed up in ten qualitative articles. Results: Four categories and nine subcategories were analyzed and resulted in patient´s experience of participation. Patient experienced participation thorough communication, participation thorough relationship, possibility to participation and by healthcare professionals’ attitudes to participation. Conclusions: Understanding of patients´ experience of participation is important to clarifying and promoting participation and shaping a patient-centered care of quality.

Bakgrund: För att skapa en så bra livskvalitet som möjligt för personen med demenssjukdom behöver vården och omsorgen ges utifrån ett personcentrerat förhållningssätt med personen i fokus istället för demenssjukdomen i sig. Levnadsberättelsen är ett betydelsefullt verktyg för att lära känna personen med demenssjukdom. Syfte: Att beskriva vårdpersonalens erfarenheter av att använda levnadsberättelsen inom särskilda boenden för personer med demenssjukdom.Metod: Kvalitativ intervjustudie med vårdpersonal på särskilda boenden för personer med demenssjukdom. Resultat: Levnadsberättelsen var viktig för att lära känna personen vilket var betydelsefullt för att planera omvårdnaden och bemöta personen på bästa sätt. Den kunde bidra till att bibehålla funktioner och vanor samt vara en hjälp vid samtal som kunde stimulera och väcka minnen. Levnadsberättelsen kunde också vara en hjälp för att förebygga och lindra BPSD. Utbildning och ett gott ledarskap sågs som framgångsfaktorer för ett väl fungerande arbete med levnadsberättelsen. Slutsats: Levnadsberättelsen är en förutsättning för att kunna bedriva personcentrerad vård inom särskilt boende för personer med demenssjukdom. Den är en hjälp för att kunna respektera personens vilja och önskemål samt för att kunna planera vården och omsorgen därefter. Utbildning av vårdpersonal samt goda chefsegenskaper har kunnat ses som framgångsfaktorer för ett lyckat arbete med levnadsberättelsen. / Background: In order to create as good quality of life as possible for the person with dementia, care need to be given based on a person-centered approach with the person in focus instead of the dementia itself. The life-story is important for getting to know the person with dementia. Purpose: To describe the health professionals experience of using the life-story in nursing homes for people with dementia. Method: Qualitative interview study with healthcare professionals experience of using life-stories in nursing homes for people with dementia. Results: The life-story was important in order to get to know the person, which was important for planning nursing and responding to the person in the best way. It could help maintain functions and habits as well as help in conversations that could stimulate and wake up memories. The life-story could also help to prevent and alleviate BPSD. Education and good leadership were seen as success factors for a well-functional work with the life-story. Conclusion: The life-story is a prerequisite for being able to conduct personal care in nursing homes for people with dementia. It is a help to respect the person's will and wishes, and by acting on the basis of the life-story, then plan the care. Education of health professionals and good management skills has been seen as success factors for successful work with the life-story.

abstract: Chronic illness can be a stressful experience that requires coping and support. In the last twenty years, Shared Medical Appointments (SMAs) were developed in U.S. healthcare as a response to the rising rates and challenges of chronic disease management. Due to the infancy of the SMA model, however, little is known or understood about the benefits of group medical care for patients. To date, scholars have not explored or systematically observed the communicative aspects of the SMA model. Communal coping, a theoretical framework that foregrounds group interaction and communication, offers a pragmatic lens for exploring how patients collectively cope with the stressors of chronic illness in the context of SMAs. Using qualitative methods, I conducted participant observation of SMAs at a Veterans Affairs hospital to analyze the communicative, transactional nature of communal coping as it unfolded among heart failure patients, family members, and providers in context. I also conducted interviews with SMA attendees. Analysis is based on 56 hours of fieldwork and 14 hours of interviews. Findings of this dissertation revealed group members who attended heart failure SMAs engaged in communal coping to manage the stressors of chronic illness. Group members moved through four primary phases of the communal coping process: (1) establish a communal coping orientation; (2) discuss shared stressors; (3) engage in cooperative action; and (4) practice communal reflexivity. Findings suggest patients become empowered by group interaction during SMAs as they move through each phase of the communal coping process. This dissertation also highlights various communicative strategies providers' use during SMAs to facilitate communal coping and group interaction. Theoretically, this dissertation expands upon existing knowledge of communal coping by exploring how individuals embody and socially construct the communal coping process. Specifically, this dissertation extends past models of communal coping with the addition of the communal reflexivity phase and through conceptualizing communal coping as a facilitated process of empowerment. Pragmatically, this research also offers insight to the benefits patients derive from attending SMAs, such as reduced feelings of stigma and isolation and improved motivation. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2015

Background Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is a neurologic disease. Between 0,1-2,6% of the world’s population is estimated to have ME/CFS. Even though a lot of people are affected there is a lack of knowledge about the disease. Its symptomatology affects the whole body and is severely debilitating. It’s at utmost importance that this subject is studied so that nurses can get an increased knowledge about ME/CFS. Aim The aim was to highlight people's experiences of living with ME/CFS. Method A literature-based study based on analysis of ten qualitative scientific studies was performed. Results Four main themes and fourteen subthemes were revealed. The main themes were about changing living conditions, lack of knowledge, changes in the body and existential changes. Changes were a major part of the result and people with ME / CFS experienced that the changes could be both positive and negative. The results showed that there is a knowledge gap regarding ME / CFS, which has serious consequences for people with the diagnosis. Conclusion The conclusion of the study was that knowledge, information and support is important for people with ME / CFS. By working person-centered, the nurse can help people with ME / CFS feel better.