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Bakgrund: Personcentrerad vård (PCV) används allt oftare inom såväl somatisk som psykiatrisk vård, med övervägande positiva effekter för individen. Kliniska studier pågår men ett annat sätt att utvärdera arbetssättet är att följa hur indikatorer från patientregister utvecklas efter införande. Syfte: I denna studie analyseras indikatorerna utifrån kunskapen om att psykiatriska kliniken på Gotland har infört PCV 2016 och har därav haft möjligheten att närmare följa indikatorernas utveckling. Metod: Denna studie har genom deskriptiv analys identifierat resultat som tyder på att det sker förändringar i indikatorutvecklingen över tid som kan kopplas till införande av PCV år 2016. Resultat: Tydligaste resultatet är minskningen av antalet individer och vårdtillfällen inom slutenvården. Minskningen av Individuella planer är tydlig och borde analyseras närmare med genusperspektiv. Resultat inom områden säker vård är inte tydliga, men ingalunda negativa, med bibehållna låga värden. Slutsats: Resultaten i denna studie tyder på att det sker förändringar i indikatorutveckling över tid som kan kopplas till införande av PCV år 2016. / Background: Person-centered care (PCV) is increasingly used in both somatic and psychiatric care, with predominantly positive effects for the individual. Clinical studies are ongoing, but another way of evaluating methods is to follow how indicators from patient registries develop after implementation. Purpose: In this study, the indicators are analyzed based on the knowledge that the psychiatric clinic at Gotland has introduced PCV 2016 and has thus had the opportunity to closely monitor the indicators' development. Method: Through descriptive analysis, this study has identified results that indicate that there are changes in indicator development over time that can be linked to the introduction of PCV in 2016. Outcome: The clearest result is the reduction in the number of individuals and inpatient care. The reduction of Individual plans is clear and should be analyzed in more detail with a gender perspective. Results in areas of safe care are not clear, but by no means negative, with low numbers maintained. Conclusion: The results in this study indicate that there are changes in indicator development over time that can be linked to the introduction of PCV in 2016.

Bakgrund: I begreppet AKS ingår hjärtinfarkt och instabil angina. Hjärtinfarkt drabbar cirka 25 300 personer i Sverige årligen och för att förhindra återinsjuknande följer ett omfattande sekundärpreventivt arbete med start redan på sjukhuset. Sekundärpreventionen bygger på egenvård där information är en viktig komponent. Informationen berör många områden och syftar till att ge patienten förståelse och medverka till en förändrad livsstil. Cirka en tredjedel av patienterna som haft hjärtinfarkt når de nationella målvärdena för sekundärpreventionen. Tidigare forskning har visat att patienter upplever informationen under vårdtiden som otillfredsställande. Patienter som har dålig förståelse för sin hjärtsjukdom deltar också mer sällan i sekundärpreventiva behandlingsprogram. Personcentrerad vård har positiva effekter på följsamhet till behandling och behandlingens resultat. Individens förmåga att förändra sin situation påverkas också av graden av hälsolitteracitet och empowerment. Syfte: Syftet var att beskriva behovet av information för att erhålla förståelse hos patienter med akut koronart syndrom från insjuknande till hjärtrehabilitering. Metod: Mixad litteraturöversikt med systematisk sökstrategi. Totalt 16 artiklar inkluderades, lika många kvantitativa som kvalitativa artiklar. En integrativ analys av materialet utfördes i syfte att sätta artiklarnas resultat i relation till varandra samt identifiera likheter och skillnader. Därefter identifierades kategorier som beskriver de granskade artiklarnas resultat. Resultat: I resultatet framkom tre huvudkategorier; all information är viktig, information genom hela vårdförloppet efterfrågas och anpassad information är meningsfull. Patienter ansåg inte att någon information var oviktig och information efterfrågades vid insjuknande även om den första tiden vid AKS präglades av chock. Även efter hjärtrehabilitering och två år efter AKS fanns behov av information om bland annat farmakologisk behandling, vilket också var det informationsområde som nämndes i flest studier. En återkommande fråga hos patienterna var varför AKS drabbat just dem. De önskade kongruens i information från olika källor och hade svårt att applicera standardiserad information på sin egna situation. De efterfrågade individuellt anpassad information som gavs när de själva var redo för det och som inkluderade anhöriga. Slutsats: Behovet av information är omfattande och patienter ansåg inte att någon information var oviktig. Även information i ett skede som präglas av chock är efterfrågad och betydelsefull. Individuell information underlättar förståelse för relevans av livsstilsförändringar och möjliggör delaktighet. Informationsbehovet varierade över tid och kvarstod till viss del efter två år. / Background: The term ACS includes myocardial infarction and unstable angina. Myocardial infarction afflicts approximately 25 300 individuals in Sweden annually and to prevent recurrent ACS an extensive secondary prevention effort starts while patients are still in hospital. Secondary prevention builds upon self care where information is an important component. The information concerns a variety of areas and aims to increase the patient’s understanding and participation in lifestyle change. Just about one third of patients suffering from myocardial infarction reaches the secondary prevention goals. Previous research has shown that patients find the information received during the hospital stay unsatisfactory. Patients with a low understanding more rarely participates in secondary prevention programmes. Person centered care positively affects treatment compliance and results. The individual’s ability to change their situation is also affected by the amount of health literacy and empowerment. Aim: The aim was to describe the need of information to obtain understanding in patients with acute coronary syndrome from sickening to cardiac rehabilitation. Method: Mixed literature review with a systematic search strategy. In total, 16 articles were included of which half was quantitative and half was qualitative. An integrated analysis of the material was conducted in purpose of relating the results to each other and to identify similarities and differences. Thereafter categories that describe the reviewed literature were identified. Results: In the result three main categories emerged; all information is valuable, information is requested throughout the entire care chain and adapted information is meaningful. Patients did not find any information unimportant and the information was requested at the initial phase of getting ill although the phase was characterized by shock. Even after cardiac rehabilitation and two years after ACS a need of information about pharmacological treatment existed among others, which was the information area requested in most studies. A reappearing question among patients was why the ACS had happened to them. They wished for congruence in information from different sources and found it hard to apply standardized information to their own situation. They requested individually adapted information delivered at a time when they were ready for it, that also included their family. Conclusion: The need of information is extensive and patients did not consider any information unimportant. Even information in a state characterized by shock is requested and valuable. Individual information facilitates understanding of the relevance of lifestyle changes and enables participation. The information need varied over time and remained after two years to some extent.

From the day their child is diagnosed, parents of children with special needs are traveling on a journey of extremes. The stress parents experience can lead down many paths filled with stress, worries, and concerns as their constant companion. These conditions exert extreme pressure on parents and can lead to life-altering changes. Parents who are resilient and able to cope with continuous change will ultimately weave through the unknown to a place of positive growth known as post-traumatic growth. The research project was based on qualitative data obtained from interviews with eleven parents of children with special needs. One of the many service professionals these parents interact with on a regular basis is service coordinators. Service coordinators know many personal details related to each family and are in a position to support parents positively to encourage post-traumatic growth. Separate interviews were conducted with nine service coordinators to collect qualitative data for this project. The researcher also conducted an analysis of peer-reviewed research articles and discovered the key factor related to parent’s resilience is encouraging social support provided by peer parents. This increases their resilience and is a critical factor towards achieving positive post-traumatic growth. During research analysis, the researcher found Family-Centered Care to be the most promising method for service coordinators to interact with families and increase the factors of resilience in parents. The current focus at Regional Centers is person-centered thinking. While this practice is beneficial for the clients served, it lacks the holistic consideration of the client and their family together. Future practice recommendations for service coordinators would include policy changes within the Regional Centers to focus on parent’s strengths to discern the supports required to provide the highest quality of care for their children. Training for service coordinators to promote resilience and increase post-traumatic growth in parents would provide additional support in a parent’s life. Support is the key factor in supporting post-traumatic growth. When parents feel supported, they can achieve more and join in stronger collaboration with service coordinators.

The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and evaluate the labor-induction teaching tool in a 9-room labor and delivery unit that averages approximately 1,500 births per year. The teaching tool content was obtained from existing patient education information from the organization's resource library. The nurses piloted the teaching tool for all patients admitted for the induction of labor for 3 weeks. Patient comments supported the use of the teaching tool to improve knowledge, increase participation in decision making, and enhance overall satisfaction. The nurses voluntarily completed an online survey that indicated the teaching tool was easy to use, positively impacted workflow, and supported informed choice. Patient charts were audited and showed a 94% compliance with documentation of education. The success of the teaching tool in improving patient education and decision-making capacity supports the development of other teaching tools, encourages patient and family-centered care, and improves the delivery of quality care.

The patient centered care (PCC) model is recommended by the Institute of Medicine for individuals with intellectual and developmental disabilities. The problem identified in this quality improvement (QI) project was that PCC practices had not been included in the training curriculum within the organization. Framed within the plan-do-study-act model of QI, the purpose of this project was to develop an educational initiative on PCC that included a curriculum plan, a pretest/posttest, a protocol, a revision of the training policy, and an implementation and evaluation plan. Drawing upon the evidence-based literature and using a team approach, a curriculum plan on PCC practices was developed which included a pretest/posttest to evaluate staff knowledge on the curriculum before and after the training. Three content experts from the committee approved the curriculum and validated the pretest/posttest items. The content validation index was 0.99 showing that each item reflected the content and objectives of the curriculum. As well, a training protocol was developed which identified the steps for provision of the curriculum to maintain consistency for all users. The training policy was revised to set expectations for all staff for the incorporation of the PCC practices into the organization. This initiative will be implemented into the organization using Kurt Lewin’s model of change to guide PCC practices. A recommendation was made to add a small section on “people’s first language” to the training to preserve patients’ dignity and respect during communication. This project contributes to social change by promoting PCC practices among healthcare workers thus limiting healthcare disparities and improving access for persons with intellectual developmental disabilities.

Background and objective: Patients’ and parents’ involvement in nursing students’ pediatric clinical practice assessment is informal. This study explored patients’ and parents’ perceptions of their role in students’ formative assessment. Approach: Interviews were conducted with patients and parents admitted at the study setting who received care from a nursing student. They were transcribed verbatim. Data was analyzed using a qualitative content analysis while Lincoln and Guba’s criteria of rigor and trustworthiness were upheld. Findings: Three categories emerged from the data: 1) Patients’ and parents’ current involvement in the assessment of nursing students’ pediatric clinical practice; 2) How they would like to be involved; and 3) The benefits and challenges of their involvement. Conclusion: This study has provided an understanding of patients’ and parents’ past encounters with nursing students, the elements of care that they would want to assess, and their perceived benefits and challenges of their involvement.

This minor thesis reports an attempt to describe and understand moments of experiential meaning within the dance therapy process for a patient with dementia. It also documents an attempt to develop a methodology which could adequately grasp the complexities of such an experience. A phenomenological approach with its emphasis on allowing the phenomenon to reveal itself through multiple perspectives seemed the most appropriate for this study. However, while phenomenology influenced the format of the dance therapy sessions as well as the constitution and analysis of the data, ultimately a hermeneutic analysis was employed for further explication of the material. The study consisted of four individual dance therapy sessions with an 85 year old patient with moderate dementia. The researcher/therapist worked improvisationally and a music therapist provided improvised music. After the sessions, all of which were videotaped, the patient was videotaped viewing the dance session video, in order to obtain her verbal or non-verbal responses to the material. It was decided to focus on the 'significant moments', selected intuitively as moments which seemed high points of the session. A naive description was made, on which an adaptation of Giorgi's four-phase method of analysis was applied. Certain foci, such as energy flow, were identified and individually described. In time, it became clear that the written descriptions alone were insufficient and that reflection would need to cover all the material from multiple sources and perspectives. This was done, and the data were later further explicated by reference to writings on dance therapy, dance aesthetics and the philosophical concept of the embodied self, and Sacks's neurological writings on the awakened self. The conclusions of the research were that the patient was not only transformed within the dance session and able to re-create aspects of her old self, but also underwent, through the experience as a whole (the dance and the reflection upon it, facilitated by the video viewing), a change in awareness, through which she reintegrated the past with the present and, in her words, 'came out of the cupboard...into the brightness'.

While the concept of person-centred care in dementia has been around for 15 years or more and has attracted much interest and enthusiasm, aged care facilities continue to have difficulty in actually implementing and maintaining person-centred practices. In this study I explore the experience of one aged care facility in order to identify the barriers to changing care practice. The research took place in an ethno-specific (Jewish) aged care facility, Star of David, which was in the process of setting up a program for its residents with dementia based on person-centred principles. The methodology used in the research study was ethnographic, involving participant observation and interview, with a particular focus on a limited number of participants: four residents and their families, four senior staff, four personal care attendants and the executive director. Interviews were also conducted with staff members from three other aged care facilities. The findings showed that Star of David was unable to bring about substantial change in its care practices, while the external interviews and the literature suggest that other facilities have similar difficulties. I identify three major types of barrier: procedural barriers within the institution itself; (government) policy; and barriers relating to hegemonic values and beliefs which underpin established health care practice. These three types of barrier interact with and reinforce one another. I conclude that if we are to change care practice in institutions, we must address all of these barriers at the same time. Finally, I suggest that person-centred care itself, which continues to place emphasis on professional service provision, may only be the beginning of necessary change. In order to be truly person-centred, we need to move towards a more community based or public health approach which recognizes the need of all persons to be treated both as significant individuals and accepted as part of a community.