In the last decade, many first-episode psychosis programs have been developed in the United States and elsewhere. First-episode psychosis typically affects adolescents and young adults. These programs, therefore, emphasize early intervention to alter long-term consequences and address specific needs of the affected population. Open Dialogue, which has shown promise in Finnish studies, is one such program that is gaining popularity outside of Finland. The program emphasizes active involvement of family and collaborative decision making. The three studies in this dissertation elucidate how Open Dialogue can contribute to current treatment options and describe considerations in adaptation and implementation of Open Dialogue in the United States. The Promoting Action on Research Implementation in Health Services (PARiHS) framework describing the role of evidence, context, and facilitation in successful implementation provides the theoretical basis for these studies. Study One is a systematic scoping review of the literature describing first-episode psychosis programs. Study Two is a qualitative study of stakeholder experiences in a pilot study of the Open Dialogue model in the United States. It examines perceived usefulness, contextual support, and factors facilitating participation. Study Three examines organizational characteristics that supported implementation at the agency where the program was piloted in the United States. The scoping review of first-episode psychosis programs indicates a need for further research regarding their long-term benefits, optimal duration and intensity, and critical components. Family intervention appears to be beneficial, suggesting that the Open Dialogue approach to family support might be a valuable addition warranting further investigation. Stakeholders involved in the Open Dialogue pilot identified several unique and beneficial features of the approach, focusing particularly on the value of family involvement, transparency, respectfulness, and collaborative nature of the approach. The compatibility of the Open Dialogue model with agency values, strong leadership support and vision, alongside organizational capacity to deliver the services emerge as critical factors in successful implementation of the model in the pilot study. As per the PARiHS framework, contextual factors, particularly funding of this model of services in the United States healthcare environment are key determinants to address for the future implementation of Open Dialogue in the United States. / 2019-12-31T00:00:00Z

BACKGROUND: People survive repeated health crises that used to be fatal and, at times, treatment intended to prolong life, prolongs death instead. Many people die in hospitals although they say they prefer to die at home. At the same time, research identifies multiple ways the American healthcare system is ill equipped to serve patients at the end of life. Presently, 20% of Americans die in Intensive Care Units (ICU), thus ICUs represent an important setting for learning about end-of-life care and death in America today. PURPOSE: To explore the nature of ICU care as perceived by family members, this qualitative study analyzed 693 reports from surveys mailed to family members of patients who died in the ICU of a major Boston hospital between 2009 and 2015. The study focused on experiences of received services as reported in responses to the survey’s three open-ended questions regarding helpful and unhelpful aspects of care surrounding the patient’s death. Family member experiences with social work services were also explored. METHODS: Data were assessed using the Family-centered Care (FCC) model, an emerging framework for provision of best practices in hospital settings. This framework emphasizes that patients, families, and health care providers work in partnership to set treatment goals. Since FCC has been correlated with better outcomes, one research objective here was to explore the extent to which family members’ experiences reflected the presence of FCC. The study also assessed family members’ experiences that fell outside the realm of FCC. Using NVivo software, analysis was guided by Braun and Clarke’s (2012) six-phase thematic analysis approach. FINDINGS AND IMPLICATIONS: Family members described numerous positive experiences. Deaths were humane and the delivery of FCC was evident. An in-depth data analysis provided illuminating details of FCC and explicated over 47 themes important to families’ ICU experiences. Families reported that they received emotional support, were well-informed, and were treated with respect. Findings suggest that FCC is possible in an ICU setting, supporting the use of FCC in ICU care and suggesting that it could profoundly improve the quality of end-of-life care. Responses concerning the role of social work were limited.

Patient-care skills in medicine have become more important over time to promote the health and well-being of patients. It has become critical to research how medical schools can best teach students patient-care skills. This is a mixed-method study on the experiences of first and second-year Boston University School of Medicine students and faculty about the relationship between their medical school curriculum and patient-centered care skills including communication, empathy, and the cultural context of care. Patient-centered care and its accompanying skills (empathy, communication, and cultural context of care) are supported and developed at the Boston University school of Medicine. These skills are promoted through curricular adaptation influenced by changing concerns within biomedicine. As well as Doctoring 1 and 2 courses, their patient-actor events, and the development of students’ professional physician identity. Methods will include participant observation and review of curriculum and program documents. This study also includes surveying first and second-year students and in-depth interviews with students and faculty. The conclusion of this study is the importance of evaluating medical school curriculum as it relates to patient-centered care skills, and particularly how those skills are utilized in the clinical world.

Background: 1,3 billion people in the world suffer from hypertension, and it is considered a leading global risk factor for death and disability. Patients who are diagnosed with this condition are recommended to undergo lifestyle changes to reduce the incidence of secondary diseases. Aim: The aim of this study was to describe patients experience of lifestyle changes to promote health in hypertension. Method: An analysis method with a foundation in qualitative research was used to contibrute to evidence-based nursing. The authors utilized Friberg’s methodology of qualitative studies. This litterature-based study incorporates 10 qualitative articles. Results: This study found that patients encounter diverse barriers and factors in their experiences with lifestyle changes, Two themes emerged; 1: ‘Insight into the complexity of lifestyle changes’. Subthemes that emerged in this theme was; ‘Barriers and challenges’, and ‘Social and psykosocial factors’. 2: ‘Breaking old patterns and navigating through challenges’. Subthemes was; ‘Motivation’, Strategies and insights’, and ‘Finding support in one’s enviroment’. Conclusion:It is crucial for nurses to possess the necessary competence to structure person- centered lifestyle changes in consultation with patients and their specific conditions. Increased knowledge and education on this subject would likely enhance patients health, preserve their dignity and have a preventive effect against further complications

Pancreatic cancer is a form of severe neoplasm with a swift disease progression and a high rate of mortality. It is the 12th leading cause of death globally for all cancer-related mortalities. Diagnosis is often late in the disease progression due to the late manifestation of symptoms which limits curative treatment options, resulting in primary palliative treatments. Patients experience a broad variety of symptoms that affect their physical and mental health causing a tremendous symptom burden. Therefore, the aim of this study was to describe the patient’s experience of living with pancreatic cancer. A literature review of qualitative and quantitative research articles was conducted to answer the purpose of this study. Data was collected through Cinahl, PsycINFO and PubMed and generated eleven articles which were analyzed, nine qualitative and two quantitative. The results were presented in two categories living in uncertainty which presented the patients emotions associated with getting the diagnosis together with unmeet informational needs and living with an unwell body which presented the physical bodily changes. This study concluded that pancreatic cancer has a significant impact on both the patients’ physical and mental health. Furthermore, there was a correlation between physical and psychological symptoms that all affected the patients' state of well-being. Moreover, patients experienced a lack of sufficient information concerning the disease. Therefore, it is of utmost importance that the patient is seen as a whole entity by the healthcare personnel to meet the individual care needs that arise from the illness.

Background: The population is growing, which places higher demands on palliative care and the need for knowledge development in nursing. Suffering is a big part of living with a terminal illness and relive suffering is part of the nurses' area of responsibility. It is of value for nurses to get insight into the patients' world of life, to provide individual palliative nursing measures. The aim in nursing is to promote quality of life through person-centered care. Aim: The aim of this study was to describe adult patients' experiences of suffering and alleviation in palliative care. Method: The study was based on a qualitative literature study, with six scientific articles. The articles were selected from the databases Cinahl and PsycInfo, with delimitations for Peer- Reviewed, adults, English language and published between 2013-2023. To analyze the articles, the five-step model of Friberg (2017) was used. Results: Three themes emerged from the analyses: Emotional suffering, Physical suffering and Close to death. This study showed patients different and similar experiences of suffering and alleviated suffering at the end of life. Reliving experiences was based on preparation for death, be treated with respect and compassion, be seen and heard, discuss thoughts about life and death and maintain the activities of importance. Conclusion: By providing compassionate care, active listening, and being genuinely interested in the patients' wellbeing, increased patients' experience of life quality and gave them a sense of relief. The care measures should be individually tailored due to every patient’s unique needs. It is therefore important for nurses to have a knowledge of how suffering could appear and choose fitting palliative care measures to reach the goal of relieved suffering

Bakgrund Sedan en tid tillbaka har webbåtkomst av patientjournalen utvecklats och blivit möjlig för patienterna såväl i Sverige som i flera länder globalt. Sedan tillgången till journalen underlättats för patienterna tar allt fler chansen att läsa i sina journaler. Med bakgrund av detta undersöks patienternas upplevelser och erfarenheter av att läsa sina journaler i denna litteraturstudie.  Syfte Syftet var att belysa vuxna patienters upplevelser av att läsa journalen vid kontakt med hälso- och sjukvården. Metod En icke-systematisk litteraturöversikt genomfördes genom att samla in data och granska 17 vetenskapliga originalartiklar. Artiklarna innefattar varierande typer av studiedesign. Författarna granskade de utvalda originalartiklarna efter Sophiahemmets Högskolas bedömningsunderlag för kvalitetsgranskning, för att sedan analysera artiklarna genom en integrerad analysmetod. Utefter detta presenterades resultatet uppdelat efter tre teman som författarna fann under analysen.  Resultat Genom granskningen upptäcktes tre huvudteman. De teman som upptäcktes då patienternas upplevelser av att läsa sina journaler undersöktes var: Patienternas upplevelse av: patientdelaktighet, av att inhämta, tolka och förstå journalinformation och personcentrering. Under dessa huvudkategorier sågs ett antal subteman. Dessa subteman innefattade patienternas upplevelser av eller kring deltagande, kommunikation, medicinsk terminologi, förståelse, tekniska svårigheter, reaktioner och känslor, partnerskapet, egenmakt och egenvård. Slutsats Enligt studien var patienterna till stor del positiva över tillgången till patientjournalen och ville läsa sina journalanteckningar. Skillnader fanns mellan olika grupper av patienter när det kom till vilka som tyckte sig ha mest nytta av att läsa journalerna. Patienterna upplevde språkbruket och den medicinska terminologin som används i journalen som svårt att förstå. Enligt studien kan en ökad personcentrering och patientdelaktighet, vid och kring journalföringen, leda till positiva erfarenheter hos patienterna såväl som det kan ge minskade risker inom vården. En ökad personcentrering vid journalföring kan även bidra till att stärka patienternas möjligheter till ett högre mått av hälsolitteracitet. / Background For some time now, web access to the medical records has developed and become possible for patients both in Sweden and in several countries globally. Since access to medical records has been made easier for patients, more and more people are taking the chance to read their medical records. Against this background, the patients attitudes and experiences of reading their medical records are examined in this litteraturestudy. Aim The aim was to shed light on adult patients' experience of reading their medical record when in contact with the health care system. Method The authors created a non-systematic literature review by collecting data and reviewing 17 scientific articles. The articles included were of various types. The authors reviewed the selected articles according to Sophiahemmet University's assessment document for quality review and then analyzed the articles through an integrated analysis method. Following this, the results were presented divided according to three themes that the authors found during the analysis. Results Through the review, three main themes were discovered. The themes that were discovered when the patients' experiences of reading their medical records were examined were: The patients' experience of: patient participation, of obtaining, interpreting and understanding medical record information and person-centeredness. Under these main categories, several sub-themes were seen. These sub-themes included the patients' experiences of or around participation, communication, medical terminology, understanding, technical difficulties, reactions and feelings, the partnership, empowerment and self-care. Conclusions According to the study, patients for the most part had positive experiences while reading their medical records and wanted to continue doing so. There were differences between groups of patients when it came to who found that they had the most benefit from reading the medical records. The patients found the language and medical terminology used in the medical record difficult to understand. According to the study, increased person-centredness and patient participation in record keeping can lead to increased positive experiences for patients as well as reduced risks in care. An increased person-centredness in recordkeeping can also contribute to strengthening patients' opportunities for a higher measure of health literacy.

Bakgrund: Syftet med palliativ vård är att förbättra livskvalitet och minska lidandeför patienter och anhöriga. För att en god palliativ vård av hög kvalitet ska kunna gesbehöver ett personcentrerat förhållningssätt tillämpas av sjuksköterskor som har encentral roll inom palliativ vård. Syfte: Syftet med studien var att belysasjuksköterskans upplevelser av att arbeta personcentrerat vid palliativ vård. Metod: Litteraturstudie med induktiv ansats. Sökningar utfördes i databaserna: PsycINFO,CINAHL och PubMed vilket resulterade i nio vetenskapliga artiklar. Resultat: Litteraturstudien resulterade i fyra huvudkategorier: betydelsen av helhetssynen,betydelsen av relationer, betydelsen av smärt- och symtomlindring, betydelsen avupplevda barriärer. En helhetssyn av människan som vårdas är viktig för att ge enpersoncentrerad vård. Helhetssynen bör innefatta individuella val, behov ochönskningar. Relationen mellan sjuksköterskan och patienten ska prioriteras samtidigtsom sjuksköterskan ska ha en relation med de anhöriga. En optimal smärtlindring kanadministreras om sjuksköterskan lär känna patienten och får en helhetsbild. Konklusion: Kategorierna innefattar beskrivningar av sjuksköterskors upplevelser avatt vårda patienter som är palliativa och samtidigt främja personcentrerad vård. / Background: The purpose of palliative care is to improve quality of life and decrease suffering for patients and relatives. To implement a good palliative care with high quality, there is a need for a person-centered approach from nurses who have a central role in palliative care. Aim: The aim of the study was to illuminate experiences of nurses working with person-centered care during palliative care. Method: A literature review with an inductive approach. The searches were performed in the databases: PsycINFO, CINAHL and PubMed which resulted in nine scientific articles. Result: The litterature review resulted in four main categories: importance of the holistic view, importance of relationships, importance of pain and symptom relieving, importance of experienced barriers. An holistic view of people who are receiving care is important in order to give person-centered care. The holistic view should include individual options, needs and desires. The relationship between the nurse and the patient should prioritise as well as the nurse needs to have a relationship with the relatives. Optimal pain and symptoms relief can administrate when the nurse gets to know the patient with a overall picture. Conclusion: The categories include description of nurses’ experience caring for palliative patients and at the same time implement person-centered care.

Bakgrund Missfall drabbar ca 20% av alla kvinnor med bekräftade graviditeter i Sverige. Den vanligaste orsaken till missfall är kromosomavvikelser hos fostret. Riskfaktorer för missfall är bland annat om kvinnan har diabetes mellitus eller en sköldkörtelsjukdom som inte är medicinskt välinställd. Även livsstilsrelaterade riskfaktorer föreligger. Vid missfall kan kvinnan uppleva en känsla av att sakna kontroll och hjälplöshet. Ett missfall kan upplevas traumatiskt och förlusten kan påverka kvinnan under en längre tid. Viktiga omvårdnadsåtgärder som lyfts upp är information om vem kvinnan kan kontakta och allmän information, samt även att vara lyhörd som sjuksköterska. Syfte Syftet var att belysa kvinnors upplevelse av omvårdnad vid missfall.​ Metod En litteraturöversikt som inkluderat 7 kvalitativa artiklar samt 3 artiklar med mixad metod. Litteratursökningen genomfördes i databaserna Cinahl complete och PubMed. Resultat Resultatet presenteras i tre huvudteman: Vårdmiljön skapar oro och ovisshet, Vikten av omvårdnadsinformatik och Vikten av psykosocialt stöd. Resultatet visar bland annat på att kvinnor upplevde att väntan på svar kring diagnostiseringen av missfallet skapade ångest och oro, medan snabb hantering och behandling värdesattes. Även en bristande medkänsla från sjuksköterskor i samband med missfall framkom och bristande information kring missfall samt att många kvinnor kände att de lämnades frågandes efter ett missfall. Slutsats Trots vissa positiva upplevelser av omvårdnad vid missfall, såsom tydlig information och emotionellt stöd från sjuksköterskor, var de negativa upplevelserna övervägande. Kvinnor upplevde en otrygg vårdmiljö, bristande bemötande och bristande information. Kvinnor efterfrågade mer information samt tydlig och direkt kommunikation samt uppföljning. Den känslomässiga hanteringen av förlusten upplevdes lättare om sjukvårdspersonal hade ett bemötande med medkänsla då det upplevdes som tröstande. / Background Miscarriage affetcs around 20% of all women with confirmed pregnancies in Sweden. The most common cause of miscarriage is chromosomal abnormalities in the fetus. Various diseases can consitute risk factors, such as diabetes mellitus or thyroid disease that’s not medicaly well-controlled. Lifestyle-related risk factors also exist. During a miscarriage, the women can experience a sense of lacking control and helplessness. A miscarriage can be perceived as traumatic and the loss can impact the woman for an extended period. Essential nursing measures that were highlighted include providing information about who the women can contact and general information. Additionally, being attentive as a nurse is important. Aim The aim was to enlighten women’s experience of nursing care in the context of miscarriage. Method A literature review including 7 qualitative atricles and 3 articles with mixed method. The literature search was conducted in the databases Cinahl complete and PubMed. Results The results are presented in three main themes: The healthcare environment creates anxiety and uncertainty, The importance of nursing informatics and The importance of psychosocial support. The findings indicated, among other things, that women experience anxiety and worry during the wait for diagnostic results of the miscarriage, quick handling and treatment was valued. A lack of compassion from nurses in connection with miscarriage was evident, leaving many women with unanswered questions after a miscarriage.​ Conclusions Despite some positive experiences of care during miscarriage, such as clear information and emotional support from nurses, the negative experiences were dominant. Women perceived an insecure care environment, inadequate treatment och lack of information. Women sought more information as well as clear and direct communication and follow-up. The emotional handling of the loss was perceived easier if the nurses approached it with compassion, as it was found to be comforting.

Bakgrund: Astma är en vanlig förekommande folksjukdom som drabbar individer i alla åldrar. Det finns olika typer av astma och de vanligaste typerna är den allergiska och den icke allergiska formen av astma. Sjukdomen orsakar förträningar och inflammationer i luftvägarna, vilket försvårar andningen. Symtom som fås vid astma uppvisas genom andnöd, hosta, nattlig dyspnè och tryck över bröstet. Syfte: Syftet var att beskriva vuxna personers erfarenheter av att leva med astma. Metod: En allmän litteraturöversikt genomfördes med elva kvalitativa artiklar som grund. Databaserna Cinahl och Pubmed tillämpades. De elva artiklarna kvalitetsgranskades i enligt med Fribergs metod och analyserades tematiskt. Resultat: Erfarenheten av att leva med astma resulterade i dessa två huvudteman: Att anpassa sig till livet med astma och Vårdpersonalens betydelse för personer med astmas erfarenheten av sjukdomen. I den första huvudteman inkluderas de fyra subteman; Upplevelser av fysiska förändringar, Upplevelsen av emotionella förändringar, Svårigheter med anpassning och Användbara strategier vid anpassning. Slutsats: Att leva med astma medförde livsstilsförändringar i form av fysiska och emotionella begränsningar. Graden av anpassning skiljdes åt beroende på faktorer såsom kulturella antaganden, grundhållning och stöd från anhörig. En allmän syn på astma som mild framfördes existera i samhället. Brister i vårdandet var påtagliga och framfördes påverka delaktigheten. Denna litteraturöversikt har belyst ytterligare om den avgörande roll som sjuksköterskor har när det gäller att inneha ett personcentrerad vårdande och aktivt engagemang vid vård av personer med astma. / Background: Asthma is a common prevalent condition affecting individuals of all ages. There are different types of asthma, with the most common being allergic and non-allergic forms. This disease causes constriction and inflammation in the airways, which makes breathing difficult. Symptoms of asthma include shortness of breath, coughing, nocturnal dyspnea, and chest tightness. Aim: The aim was to describe adults' experiences of living with asthma. Method: A general literature review was carried out with eleven qualitative articles as a basis. Databases Cinahl and Pubmed were applied. The eleven articles were quality checked in accordance with the Friberg method and thematically analyzed. Results: The experience of living with asthma resulted in these two main themes: to adapt life with asthma and the impact of healthcare professionals on the experience of individuals with asthma. In the first main theme, the four subthemes are included: experiences of physical changes, experiences of emotional changes, difficulties with adaptation and useful strategies for adaptation. Conclusions: Living with asthma led to lifestyle changes involving physical and emotional limitations. The extent of adaptation varied based on factors such as cultural beliefs, attitude, and support from relatives. There was a prevalent societal perception of asthma as a mild condition. Observable deficiencies in care were noted to impact involvement. This literature review has further illuminated the crucial role that nurses play in providing person-centered care and active engagement in the treatment of individuals with asthma.