Bakgrund: Ungefär en procent av Sveriges befolkning har en utvecklingsstörning. Ett kriterie för att ha en utvecklingsstörning är bland annat ett IQ på 70 eller lägre.  En utvecklingsstörning innebär en nedsättning i de kognitiva funktionerna vilket kan leda till svårigheter med kommunikationen. Bemötandet är ett abstrakt begrepp med olika dimensioner och innefattar bland annat genomförandet av ett samtal. Syfte: Syftet med fördjupningsarbetet var att belysa hur vuxna patienter med en utvecklingsstörning blir bemötta inom vården. Bemötandet beskrivs utifrån patienternas egna, anhörigas och vårdpersonalens perspektiv. Metod: Fördjupningsarbetet är en allmän litteraturstudie genomförd på ett systematiskt sätt. Resultatet är baserat på 12 kvalitativa respektive kvantitativa vetenskapliga artiklar. Artiklarna har kvalitetsbedömts samt bearbetats med hjälp av induktiv innehållsanalys. Resultat: Attityder i bemötandet av patienter med en utvecklingsstörning fungerade överlag positivt, men även negativa attityder förekom. Detta berodde ofta på bristande förståelse. Vårdpersonalen hade ofta bristande kunskaper gällande vård och kommunikation gentemot denna patientgrupp. Det visade sig även att anhöriga och assistenter ofta fick ta stort ansvar i samband med patientens kontakt med vården. / Background: Approximately one percent of the Swedish population has a developmental disability. A diagnostic criteria for developmental disorders includes an IQ below 70. To meet, or to encounter a patient in the right way, is an abstract concept with different dimensions including the ability of having a conversation. Aim: The aim of this study was to illuminate health care professionals attitudes towards adult patients with a developmental disability. The treatment is described from the patient’s own view, the relative’s view and the health care professional’s view. Method: This overview was done in a systematic way. The result is based upon 12 qualitative and quantitative scientific articles. The articles has been quality assessed and processed using an inductive content analysis. Result: In general, health care professionals have a positive attitude towards individuals with developmental disabilities as patients. However negative attitudes did exist, often due to a lack of understanding. Many health care professionals have insufficient knowledge about how to provide care for and communicate with this group of patients. Relatives and assistants often had to take a great deal of responsibility regarding to the context of the patients contact with health care.

In human service organizations it is important to enlighten the significance of human encounters. The aim of this study was to explore nursing students experiences of developing empathy and professional relationship in encounters with patients and next of kin during their education. Interviews with five nursing students were carried out. The method of analysing content analysis was used. One main theme and five subthemes were presented. The main theme was described as a process of developing courage and awareness. The students challenged themselves and their beliefs and through this they gained self-knowledge and courage. During periods of clinical practice the usefulness of theoretic knowledge became evident for the students. The developing of awareness and the gain of courage made them more secure in human encounters. The result of this study lead to a deeper understanding of the significant elements for nursing students development towards a professional relationship in human encounters.

Bakgrund: Övervikt är ett folkhälsoproblem i västvärlden. Att leva med övervikt kan innebära ett stort lidande. Sjuksköterskan är ofta den som har mest regelbundna kontakter med överviktiga patienter. Sjuksköterskans uppgift är att bemöta patienter på ett värdigt sätt oavsett ålder, utseende, funktion eller prestationsförmåga. Syfte: Syftet med litteraturstudien var att belysa bemötandet av patienter med övervikt i hälso- och sjukvården. Metod: Studien genomfördes som en litteraturstudie baserat på nio vetenskapliga artiklar. Resultat: Resultatet presenteras ur två perspektiv, ett patientperspektiv och ett sjukvårdspersonalsperspektiv. Studien visade att bemötandet till överviktiga patienter upplevdes både positivt och negativt. Patienterna upplevde att de fick en god relation med sjukvårdspersonalen. Andra tyckte att de blev dömda direkt utifrån sin övervikt. Sjukvårdspersonal upplevde att övervikt var ett känsligt område att arbete inom. Slutsats: För en lyckad vårdrelation där bemötandet upplevs positivt bör sjukvårdspersonalen vara medveten om sina attityder och se hela människan. / Background: Overweight is a public health problem in the Western world, and the disease can cause severe suffering. Usually, the nurse has the most contact on a frequent basis with overweight patients. The nurse’s task is to treat patients in a dignified manner regardless of age, appearance, function or capacity. Aim: The aim with this literature study was to enlighten the encountering with overweight patients in the health care system. Method: This study was carried out as a literature study based on nine scientific articles. Result: The result is presented from the patient’s perspective as well as from the health care professionals’ perspective. The study shows that the encountering with overweight patients is experienced both negatively and positively. The patients could feel that they established a good relationship to the health care professionals. Other patients experienced that they were judged directly by their overweight. The health care professionals experienced that overweight were a sensitive area to work within. Conclusion: For a caring relation where the encountering is experienced as positive, the health care professionals should be aware of their attitudes in the caring relation and consider the different aspects of the human they treat.

Grove and Fisk ¡]1983¡^ had used the noun and idea of drama performance in the theater to compare the offering of service, such attendants as known as performer, customers as known as audience, and separate the front and back stage of service encounter clearly. At the same time, they offer the structure to easily understand the process of the wholly service contact and to help estimate the influence of each important link of service contact. So, this research focused on ¡§perceived value¡¨ of customer experiences through which, the ¡§visualized service backstage¡¨ in the service contact promotes the interaction of consumers and suppliers. Moreover, this study used the involvement of the back stage information and attention of attendants¡¦ appearance to moderate consumer experiences. The results showed that ¡§visualized service backstage¡¨ has positive influence on ¡§perceived value¡¨ with different levels, and customers have more consciousness on ¡§experience value¡¨. Actually the service with ¡§visualized service backstage¡¨ can really improve customers¡¦ perceived value. It not only can strengthen consumers¡¦ experience value, but also promote other different values of consumers. In fact, if service providers can use this advantage to create more perfect service performance by which the front stage and the back stage fully support. And it could bring to people more different service value than others. In addition, through the analysis of this study and real practices, it can help the service providers understand which value is the key factor to be attention for offering visualized service backstage.

The basic premise of this dissertation is that other customers, as part of the service environments, have direct or indirect influences on target customer¡¦s interpersonal attraction and then affect overall service experience. These effects received increasing attention in recent service marketing literature. However, most of studies dedicated their attention to the effect of other customers¡¦ behaviors; thus, an obvious limitation of existing literature is the neglect of other customers¡¦ characteristics. This research gap became the major research motivation of this dissertation. Moreover, this dissertation introduced an important but rarely discussed psychological response ¡V target customer¡¦s interpersonal attraction. Based on relevant literature, the author proposed a overall framework which considered the effects of other customers¡¦ behaviors, observable similarity, and physical appearance on target customer¡¦s interpersonal attraction evaluation. Moreover, the author also explored the relationship between target customer¡¦s interpersonal attraction evaluation and his/her overall satisfaction, purchase intention, and anxiety perception. Four scenario-based experiments were conducted to verify proposed hypotheses. In Experiment 1, the effects of other customers¡¦ appropriate / inappropriate behaviors and observable similarity were examined. The results indicated significant main effects and an interaction effect. Other customers¡¦ observable similarity had an alleviating effect on interpersonal attraction. Experiment 2 tested the relationships between other customers¡¦ behaviors, physical appearance, and interpersonal attraction. Results were similar to findings of Experiment 1. Other customer¡¦s physical appearance had an alleviating effect. A supplementary survey reported that people tend to justify physically-attractive persons¡¦ inappropriate behaviors. Experiment 3 concerned about the negative effects of physical appearance on interpersonal attraction by manipulating other customers¡¦ appraisals toward target customer¡¦s product choice. The last experiment empirically verified the stabilizing effect proposed by marketing scholars. The author found that other customers¡¦ anxiety-reducing behaviors could lower target customer¡¦s perceived anxiety and produce higher interpersonal attraction. In all four experiments, target customers¡¦; interpersonal attraction had positive correlation with overall satisfaction, purchase intention, or anxiety perception. Interpersonal attraction at least partially mediated manipulated factors¡¦ effects on satisfaction. This dissertation¡¦s last chapter provided summary of experiment findings, theoretical and managerial implications, research limitations, and future research directions.

The Critical Factors of Service Encounter satisfaction: Research on Restaurant Industry Author: Shao-Feng Chao Advisor: Dr. Yi-Heng Chou Abstract According to Directorate-general of Budget Accounting and Statistics Executive Yuan¡¦s survey of commerce and service industries in 1996, the statistics showed that the weight of Taiwan¡¦s restaurant industry became more and more influential in commerce. Its contribution to economic productivity cannot be ignored. However, the smaller business size and the easiness for entry enhance the competition and make it hard for operators to survive. To succeed in operation, the managers of restaurants have to emphasize not only the quality of physical goods but also the excellence of service quality, delivering what customers need and want. Many researchers have studied on service quality in recent years. They mainly use the closed questionnaire to measure how factors influence quality. It helps to understand service quality, but there are still some disadvantages. For example, its measure is closed and customers are no more than attitude accountants. Furthermore, the results can only show a part of service process, expressing no service encounters. To see more details about the service encounter between customers and service providers, this research adopts ¡§Critical Incident Technique¡¨(CIT). Customers¡¦ and service employees¡¦ opinions about the critical incidents which impacts on service encounters of fast-food restaurants and deluxe restaurants were collected, coded, and analyzed under the dramaturgical theory and Bitner¡¦s standard (BBM principle). It is to compare customers¡¦ view with service employees¡¦ and to identify the critical factors to service encounter satisfaction of fast-food restaurants and deluxe restaurants in Taiwan. The finding of the research is as followed. I. The critical factors to service encounter satisfaction of fast-food restaurants are: A. service employees¡¦ attitude and behavior, B. service employees¡¦ professional skills, C. the timely provision of service and the response to unreasonably delay, D. the performance of service processes and systems and the response to core service failure. II. The critical factors to service encounter satisfaction of deluxe restaurants are: A. the allocation of service environment, B. service employees¡¦ attitude and behavior, C. the quality of physical products, D. the timely provision of service and the response to unreasonably delay, E. the performance of service processes and systems and the response to core service failure. III. Service employees¡¦ attitude and behavior, the timely provision of service, and the performance of service processes and systems are all the critical factors to service encounter satisfaction no matter in fast-food restaurants of in deluxe restaurants. V. The factors, service employees¡¦ professional skills and the attention to customers, are only critical to service encounter satisfaction of fast-food restaurants. VI. The factors, the allocation of service environment, the quality of physical products, and the response to customers¡¦ preference, are only critical to service encounter satisfaction of deluxe restaurants. Key words: service quality, service encounter, dramaturgical theory, critical incident technique, restaurant industry

As virtual channels on the internet grow full-blown, two major chain department store corporations in Taiwan entered internet markets one after another in 2007. Since the department store is a typical service industry highly based on interactions, the salesclerk has been a major mediator for serving customers and therefore face-to-face interaction between consumers and salesclerks is especially important. With the coming of brand-new self-service system combined with technology, consumers are able to take advantage of the technology to serve themselves. The relationship between corporations and consumers is hence transformed with a delivery system of ¡§low contact but high technology.¡¨ Researchers of previous studies mainly focus on interpersonal-based service encounter for investigation of relationship marketing and customer loyalty and researches about technology-based self-service and interaction with consumers are rarely seen. This research takes department store customers as subjects of investigation and adopts their viewpoints from questionnaire, aiming to probe into the influence of the department store¡¦s introduction of self-service technology on the effect of relationship marketing for better understanding of the relationship between the effect and customers loyalty. The study will take questionnaire survey of internet, and put the questionnaire on the Telecommunication Laboratories (TL) website to gather data via the customer¡¦s e-mail in cooperation with the Web-based Newspaper for the credit card users of the department store of the department store. The questionnaire will put for one month from February 1 to February 28, 2008 to gather enough data for analysis. A total of 1412 copies of questionnaire are issued, retrieving 396 copies, with 1016 copies of effective questionnaire. Structural Equation Modeling is used in this research. The followings are four points of conclusion: (1) the quality of web-based self service has significantly positive influence on result indicators of relational benefits by means of customer relational benefits; (2) the quality of web-based self service, except for delivery service speed, has significantly positive influence on customer relational benefits; (3) customer relational benefits have significantly positive influence on result indicators of relational benefits; (4) customer relational benefits bring significant effect as a mediator between web-based self service and result indicators of relational benefits. Therefore, we suggest that the department store managers shall create more elements of relationship benefit so that the customers all feel highly of the relationship benefit in the hope to enhance the customer's satisfaction and loyalty on the enterprise.

<p>Psykiatrireformen kom 1995 och innebar att<strong> </strong>kommunerna tog över ansvaret för patienter som var placerade på psykiatriska boenden, med följden att patienterna slussades ut till hemkommunerna. Reformen innebar att sjuksköterskor inom den kommunala somatiska vården allt oftare träffar på dessa patienter. Detta leder till höga krav på denna yrkesgrupp, då det finns begränsat med kunskap inom psykiatri hos allmänsjuksköterskor. Syftet i denna litteraturstudie är att studera sjuksköterskors attityder och om dessa påverkar bemötandet och omvårdnaden av patienter med psykiska sjukdomstillstånd. En litteraturöversikt genomfördes för att belysa syftet, med en analysmetod av Friberg (2006). Vetenskapliga artiklar samlades in, genom sökning i databaserna Cinahl, PsycINFO och manuell sökning. Sjuksköterskors attityder gentemot psykisk sjuka patienter kan präglas av föreställningar att dessa patienter är aggressiva, opålitliga, introverta/apatiska och bisarra. Dessa attityder avspeglas i sjuksköterskornas omvårdnad och bemötande i negativ bemärkelse. Rädsla, fördömande, aggressivitet och avståndstagande är fyra olika förhållningssätt som sjuksköterskorna kan ha i omvårdnaden av psykiskt sjuka patienter. Det är framförallt sjuksköterskor inom den somatiska vården som har mest negativa attityder gentemot psykisk sjuka. Attityderna har en negativ roll i bemötandet och omvårdnaden. Sjuksköterskors erfarenhet och utbildning visar sig ha en positiv betydelse för omvårdnaden av psykiskt sjuka patienter.</p> / <p>The psychiatric reform act was passed in 1995 and this reform integrated patients back into their home communities and put them in contact with somatic care nurses on an outpatient basis. These changes put a high demand on the already limited resources of the municipality care profession. The objective was to determine if nurse´s attitudes influence the care for patients with mental illness. This review is based on additional science articles which were collected from the Cinahl and PsycINFO databases and manual search. The articles were analyzed with a method based on Friberg (2006). Nurses' attitudes towards mentally ill patients are influenced by perceptions that patients are aggressive, unpredictable, inward looking/apathetic and bizarre. These attitudes reflect negatively in the nurses' care and assessment. Fear, condemnation, aggression and distancing are four different approaches taken by nurses caring for mentally ill patients. In particular nurses within the somatic care have the most negative attitudes towards mentally ill patients. Misconceptions and negative attitudes have a negative impact on the care and treatment of the mentally ill. Nurses' experience combined with higher education has been demonstrated to have a positive impact.</p>

<p>Mötet mellan sjuksköterskan och närstående har en betydande roll i omvårdnaden, inte minst i ett prehospitalt skede. Sjuksköterskan inom ambulanssjukvården får i komplicerade situationer möta chockade närstående till patienter med hjärtstopp. Syftet med denna studie är att beskriva sjuksköterskans erfarenheter av mötet med närstående till patienter med hjärtstopp inom den prehospitala sjukvården.</p><p>Datainsamlingen har skett genom intervjuer med åtta sjuksköterskor inom ambulanssjukvården. Informanterna har berättat om möten de haft med närstående till patienter med hjärtstopp. Intervjuerna spelades in och transkriberades. Därefter genomfördes en kvalitativ innehållsanalys av texterna där tre huvudteman samt ett antal underteman framkom. Dessa tre huvudteman var ”Kommunicera med närstående”, ”Hantera närståendes reaktioner”, och ” Agera etiskt försvarbart gentemot närstående”.</p><p>Resultatet visar att sjuksköterskans sätt att kommunicera har betydelse för mötet. Genom ett förtroendegivande och tydligt uppträdande försöker sjuksköterskan skapa kontakt med närstående. Detta skapar förutsättning att förmedla lugn och förståelse hos närstående för situationen. Dock kan ibland närstående projicera sin sorg och förtvivlan på sjuksköterskan som kan anklagas för att inte ha gjort tillräckligt. Det framkom att närstående kan komma i andra hand vid de hjärtstopp då endast en ambulansbesättning finns på plats. Genom erfarenhet ökar möjligheten att uppnå ett bra möte mellan sjuksköterskan och närstående.</p> / <p>The encounter between the nurse and relatives is of great significance within healthcare treatment, not the least in prehospital emergency care. Nurses within the ambulance services will in complicated situations meet chocked relatives of patients with cardiac arrest. The aim of the study is to describe nurses’ experiences of the encounter with relatives of patients with cardiac arrest within the prehospital emergency care.</p><p>The collection of data was conducted through interviews with eight nurses within the ambulance services. The informants have rendered encounters they’ve had with relatives of patients with cardiac arrest. The interviews were recorded and transcribed. Thereafter a qualitative content analysis was made on the texts, from where three major themes, and a number of sub themes, emerged. The three major themes were “Communicating with relatives”, “Managing relatives’ reactions” and “Acting ethically correct towards relatives”.</p><p>The result shows that the nurse’s way of communicating affects the encounter. Through a convincing and distinct manner the nurse seeks contact with relatives. This makes it possible to convey calmness to the relatives, and help them comprehend the situation. Sometimes though, relatives can project their grief and despair onto the nurse, who may be accused of not having done enough. It was detected, that relatives may be a second priority in a cardiac arrest-situation where there has only arrived one set of ambulance crew. Through experience the chances to reach a good encounter increases.</p>

<p>En stor del av anmälningarna som kommer till patientnämnden handlar om dåligt bemötande. Patienter som söker vård ska inte känna sig underlägsna eller otrygga på grund av vårdpersonalens bemötande. Ett professionellt vårdande bemötande kan skänka kraft och öka välbefinnandet hos patienten. Ett ökat välbefinnande kan reducera känslan av ohälsa hos patienten. Den patientgrupp studien fokuserar på är de patienter som kommer till akutmottagningen med en icke-brådskande diagnos. De upplever ofta en lägre nivå på bemötandet än patienter med mer brådskande diagnoser. Syftet med studien var att belysa vad som är viktigt för patienten i bemötandet från sjuksköterskan på en akutmottagning. Litteratursökning gjordes i databaser. Med en litteraturstudie på vetenskapliga artiklar gjordes en analys där patienters likheter och skillnader i upplevelsen av bemötandet söktes. Författarna fick fram tolv teman presenterade som förutsättningar och svårigheter för att patienten ska uppleva att den får ett tillfredställande bemötande. Resultatet visar att de patienter som upplevde att sjuksköterskan tog sig tid, gav dem information, bemötte dem med respekt och som individer, får kraft att bemästra den situation de befinner sig i. Att som sjuksköterska förstå hur patienten upplever bemötande är av vikt. Ett bra bemötande från sjuksköterskan kan göra att patienten känner ett ökat välbefinnande och närvaro av hälsa. Detta är en förutsättning för ett snabbare tillfrisknade hos patienten.</p> / <p>A great deal of the reports which arrives to the patient´s committee is about bad encounters. Patients who seek care at an emergency department should not feel inferior or unsafe because of a bad encounter from the nursing staff. A professional and caring encounter will give power and raise the wellbeing within the patient and that must be offered to the patient. A raised feeling of wellbeing might reduce the sense of bad health. The group of patients this study focuses on is the patients which arrive to the emergency department with a non urgent diagnosis. They often experience a lower rate of good encounters than the patients with an urgent diagnosis. The aim of this study was to highlight what´s important for the patient in the nurse-patient encounter in an emergency department. The search for literature was done in databases. A literaturereview was made from articles and an analysis was made where patient’s similarities and differences in the experience of the encounter sought out. The authors found twelve themes presented in possibilities and difficulties so that the patient will experience that the encounter I satisfying. The result shows that if the nurse’s take some time for the patient and gives them information, treats them as individuals and with respect, the patient feel empowerment to handle the situation. It is of importance for the nurse to understand how the patient experiences the encounter. A good encounter from the nurse can make the patient feel a raised wellbeing and a presence of health. This is a possibility for the patient to gain a feeling of better health.</p>