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.

The purpose of this comparative case study was to explore English language teachers&rsquo / beliefs, assumptions and knowledge about learner-centeredness and the European Language Portfolio (ELP) and to see how they implement their understanding of learner-centeredness in their classrooms. The study was conducted at one public and one private primary school in Istanbul. Focus group interviews were held in each school with thirteen teachers of English and then individual interviews and observations were carried out with four volunteer teachers during the spring semester, 2004-2005. The four participant teachers were observed in their classrooms ten times along with before- and after-class observation reflections facilitated by the researcher. A follow up interview was conducted with each teacher at the end of the observations. In addition, these observations were accompanied by document analysis. Data from the interviews and before- and after-class reflections were inductively analyzed. For the analysis of observation data and documents, a learner-centered data analysis model was constructed by the researcher. The results of the data indicated that there were differences between public school teachers and private school teachers in the way they defined and implemented learner-centeredness. Lack of knowledge about the ELP was observed in both public and private school teachers. Results revealed that there is a need for in-service training programs that will cater for the needs of public school teachers if the aim is to implement learner-centeredness in schools.

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This study explores how cancer patients in remission derive meaning in their lives. A need for social work intervention was identified with cancer survivors, especially those patients who are in remission and who have to continue their lives, in spite of the incurable status of their cancer. In line with literature, the researcher, in her role as social worker at a radiation oncology clinic, observed that patients often report that they find benefit in the cancer experience. The framework for conducting this study is based on the existential theory and the ultimate concern of human existence, that life has meaning under all circumstances. Meaning and meaning-centeredness is described. The role of a meaning-centered approach to oncology social work was argued. The Meaning-Centered Counselling and Therapy (MCCT) model was described from a literature perspective, and proposed as an intervention model. MCCT offers a model that includes the existential domain in interventions. Within the context of this study, remission refers to the period that the cancer is under control. It may be that there is no indication of the cancer, but the cancer is expected to recur, or that some of the symptoms have disappeared, or that the progression of the cancer has slowed down. During remission, patients are under surveillance only, or on maintenance treatment. Thus, they do not have regular contact with the oncology team. Patients live with uncertainty and ambiguity, resuming activities, responsibilities, careers and relationships that were influenced by the cancer diagnosis and treatments. The demands of living in remission are described. This research study explores the quest for meaning in patients who are living with incurable, recurrent cancer. The goal of this research study was to explore meaning-centeredness in adult cancer patients who are in remission. This research study was guided by the following research question: “Does meaning-centeredness play a role in adult cancer patients’ coping with remission?” The research population included oncology patients who are in remission, and have experienced one or more recurrences, and where the cancer has metastasised. A qualitative approach was followed, using the collective case study design. The research was conducted at the Radiation Clinic, Sandton Oncology Centre in Morningside, Johannesburg. Data was collected using an interview schedule to guide 4 focus group interviews, totalling 21 participants, who were selected by means of purposive sampling. All participants gave voluntary and informed consent to take part, and the focus group interviews were voice-recorded, with their permission. The researcher transcribed these recordings. Creswell’s steps for qualitative data analysis were implemented. From the findings, the following themes and sub-themes were identified, demonstrating the search for meaning amongst these participants who are in remission and answering the research question: Theme 1: Meaning-construal associated with attribution with the sub-themes of hope, spirituality, and death awareness and a foreshortened future. Theme 2: Meaning-construal associated with appraisal, with the sub-themes of benefit finding, growth, relationships, and an increased appreciation of life, and prioritising. Theme 3: Meaning-construal associated with reappraisals, with sub-themes of sense of self, sense of coherence, assumptive world, adapting to new normal, and transcendence. The findings demonstrated that a perspective that provided the participants with the means to explore their unique meanings, purposes, and life tasks helped them to cope with remission and the fear or reality of recurrence or metastases. Participants were able to derive meaning in their lives despite living with incurable cancer. Participants, who had integrated the knowledge that their cancer is incurable and recurrent into their meaning-system, were able to adapt and adjust to living in remission. They had a sense of purpose and maintained realistic hope. Their hopes were proportional to the prognosis. They did not dwell on their own death, but focused on what life offers them each day. They developed a new normal that incorporates the knowledge of a foreshortened future, coping with side effects and late effects of treatment, and the uncertainty that the cancer is expected to recur or metastasise again. They were aware of their life tasks, and embraced life to the full. Intervention strategies, based on the existential oriented proposition that life has meaning under all circumstances, were recommended. This included the Meaning-Centered Counselling and Therapy (MCCT) model for integration in oncology social work. Recommendations in this study include enhancing the understanding of members of the trans-disciplinary team regarding the needs and experiences of patients in remission. Furthermore, a better understanding of the role of meaning-centeredness intervention amongst oncology social workers can improve interventions, specifically for patients in remission. / Dissertation (MSW)--University of Pretoria, 2014. / Social Work and Criminology / MSW

Bakgrund: Bröstcancer drabbar många kvinnor världen över. Ett vanligt och effektivt sätt att behandla sjukdomen är genom en mastektomi, som innebär avlägsnandet av en del av, eller hela bröstet. Att genomgå en mastektomi är ofta påfrestande och kräver stöd från både närstående och sjukvården. Mastektomin medför en modifierad kropp och därmed förändrade tankar om kroppsuppfattningen. Syfte: Syftet med litteraturstudien var att utforska kvinnors upplevelser av en förändrad kropp efter en bröstcancerrelaterad mastektomi.  Metod: En kvalitativ icke-systematisk litteraturstudie genomfördes med tio empiriska artiklar från databaserna Cinahl och Pubmed. Artiklarna blev kvalitetsgranskade och därefter analyserade, kodade och tematiserade för att generera ett sammanställt resultat som svarar till syftet.  Resultat: Fyra huvudteman upprättades; första intrycket efter mastektomin, att anpassa sig till en förändrad kropp, förändrade relationer och tacksamhet över att vara vid liv. Utöver huvudteman framkom även nio subteman.  Slutsats: Upplevelsen efter en mastektomi är individuell vilket ökar behovet av personcentrerad vård för kvinnorna. En förändrad kroppsuppfattning visade sig vara förekomande efter mastektomin och påverkade fler aspekter av kvinnans liv, både i relationen till sig själv och andra, därmed är det viktigt som sjuksköterska att tidigt att även involvera anhöriga i behandlingen och vården. Trots alla negativa konsekvenser efter mastektomin framgick även en tacksamhet för livet, där hälsan ansågs som viktigare än bröstet. / Background: Breast cancer affects many women worldwide. A common and effective way to treat the disease is through a mastectomy, which involves the removal of part of or all of the breast. Undergoing a mastectomy is often stressful and requires support from both relatives and the healthcare system. The mastectomy entails a modified body and thus changed thoughts about the body image. Purpose: The purpose of the literature study was to explore women's experiences of a changed body after a breast cancer-related mastectomy. Method: A qualitative non-systematic literature study was carried out with ten empirical articles from the databases Cinahl and Pubmed. The articles have been quality reviewed and then analyzed, coded and thematized to generate a compiled result that meets the purpose. Results: Four main themes were established; first impression after the mastectomy, adjusting to the changed body, changed relationships and thankful to be alive. In addition to these main themes, eight sub-themes also emerged. Conclusion: The experience after a mastectomy is individual, which increases the need for person-centered care for women. A changed body perception was found to be prevalent after mastectomy and affected various aspects of a woman’s life, both in relation to herself and others. Therefore, it is important as a nurse to involve family members early in the treatment and care. Despite all the negative consequences after mastectomy, there was also gratitude for life where health was considered more important than the breast.

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SAMMANFATTNINGBakgrund: Specialistsjuksköterskor anser att extubation är svårare och mer komplext än intubation. Extubation kräver mycket fokus på patientens fysiska behov vilket kan försvåra för vårdpersonal att uppfylla patientens psykosociala behov. Forskning visar att patienter har obehagliga minnen från att vara intuberade och bli extuberade. Syftet: Syftet var att undersöka hur patienten görs delaktig vid extubation på intensivvårdsavdelning. Metod: Designen var en fokuserad etnografiskt observationsstudie med deduktiv ansats. Urvalet var patienter som opererades elektivt och vårdades postoperativt på Thoraxintensivvårdsavdelning vid ett universitetssjukhus. Tio patienter observerades när de blev extuberade av intensivvårdspersonalen. Sedan utfördes en semistrukturerad intervju om patientens erfarenhet av att bli extuberad och om de kände sig delaktiga.  Resultat: För att göra patienten delaktig gav personalen information, var stöttande, närvarande och respekterade patientens värdighet och integritet. Detta gjorde personalen genom fysisk beröring, att benämna patienten med namn, samt att utföra extubation avskilt. Resultatet kan inte säkerställa att det går att etablera en vårdrelation under extubation då en vårdrelation endast etablerades vid två av tio tillfällen. Majoriteten av patienterna hade inga minnen av att bli extuberade. Slutsats: Personalen gjorde patienterna delaktiga under extubation genom att ge information, vara närvarande och stöttande samt genom att visa patienten värdighet och respekt. Patienterna kunde göras delaktiga utan att en vårdrelation etablerades, detta tyder på att begreppet vårdrelation behöver en tydligare definition. Trots att majoriteten av deltagarna inte hade minnen från extubationen bör de göras delaktiga. / ABSTRACT. Background: Specialist nurses consider extubation more difficult and complext than intubation. Extubation requires a lot of focus on the patient's physical needs, which can prove it difficult for specialist nurses to fulfill the patient's psychosocial needs. Research shows that patients have unpleasant memories of being intubated and being extubated. Aim: The aim was to investigate how patient participation was fulfilled during extubation in a intensive care unit. Method: The design was a focused ethnographic observational study with a deductive approach. The sample was patients who underwent elective surgery and received postoperative care in the thoracic intensive care unit in a university hospital. Ten patients were observed as they were extubated by the intensive care personnel. A semi-structured interview was then conducted about the patient's experience of being extubated and whether they felt involved. Main result: To increase the patience participation, the staff were informative and supportive, present and respected the patient's dignity and privacy. Staff did this through physical touch, calling the patient by name, and performing extubation separately. The results cannot ensure that it is possible to establish a care relationship during extubation as a care relationship was only established on two out of ten occasions. The majority of patients had no memory of being extubated.  Conclusion: Patient participation during extubation can be achieved through information, staff presence and support. It’s possible to achieve patientparticipant without establishing a caring relationship. The majority of participants did not have memories of extubation, however, patient participation should still be achieved.