UK Health policy over the past decade has sought to accelerate established trends of moving services for type 2 diabetes into primary care. This has aimed to make services more accessible and to enable patients to benefit from having their diabetes care incorporated into the “generic and holistic” approach of primary care. However, in 2004 the introduction of a new General Medical Services (nGMS) contract signalled a change in primary care by linking clinical targets to financial rewards on a larger scale than ever before. Diabetes is one of nineteen financially incentivised clinical areas under the nGMS contract (2006). This thesis considers how these health policies may have influenced the organisation and experience of providing and receiving care for type 2 diabetes in Scottish primary care settings. It also aims to bridge two usually separate areas of sociological interest: how health professionals interpret and implement policy, and how patients experience and perceive chronic illness and their health care. A multiple case study approach was employed in order to compare and explore the organisation and experience of type 2 diabetes care associated with three general practices of differing size and location. In each case study a period of non participant observation was undertaken and in-depth interviews conducted with health professionals and their type 2 diabetes patients. Analysis of these data shows that multiple factors influence the way diabetes care is organised and experienced in primary care. I argue that the local context of interpersonal relationships of trust, professional identities and role expectations influence both the organisation of care and the way patients interpret that organisation. Moreover, the meanings patients attribute to the local organisation of diabetes care can inform their perceptions of their condition and influence their desire to be involved in diabetes management.

Författarna har studerat hur kvinnor utsatta för våld i en nära relation upplever bemötandet i vården, genom granskning av elva kvalitativa studier. Resultatet visar att känslan av skuld och skam är stor hos kvinnor som utsätts för våld i en nära relation. Kvinnorna vill berätta om sin situation, men endast om de upplever att sjuksköterskan vill lyssna, har tid och kan han-tera informationen. Flertalet kvinnor önskade att sjuksköterskan skulle fråga dem om våldet, de längtade efter att någon skulle ta kontroll över situationen. Oftast känner sig kvinnorna dömda, förlöjligade och respektlöst bemötta av hälso- och sjukvården efter de berättat om våldet som försiggår i relationen. Kvinnor som levt under hot och våld från sin man har ofta en bräcklig och skev självbild. Vilket ökar deras osäkerhet och förstärker eventuella negativa upplevelser i vården. I och med det kan ett dåligt bemötande från vårdpersonalen i värsta fall öka kvinnornas känsla av hjälplöshet och bekräfta skammen de bär på. Studien påvisar att hälso- och sjukvården är en mycket viktig instans för kvinnor utsatta för våld av sin partner, trots detta finns sällan kunskap hos personalen. Författarna har funnit brister i bemötandet och omhändertagandet av kvinnorna och även i kontakten med andra viktiga instanser. Vårdpersonalen behöver kunskap, handlingsplaner och riktlinjer för att kunna lotsa kvinnorna vidare i deras väg mot ett liv utan hot och våld. När väl kvinnan samlat mod till sig för att erkänna sin situation i vården och inte blir tagen på allvar kan det i vissa fall få förödande konsekvenser. Medan en genuint intresserad sjuksköterska som har kunskap och är villig att lägga sin tid på kvinnan och relationen till henne, kan vara livsavgörande. Sjuksköterskan kan hjälpa henne en bit på vägen till ett liv utan smärta, rädsla och ensamhet. / Background: Violence against women is a major global public health issue, which has an impact on women’s lives and mental health. Aim: To explore healthcare experiences of women exposed to intimate partner violence. Method: Literature based study with eleven qualitative studies. Results: The women who sought help felt ashamed for the violence and most of them didn’t get the help they needed. They felt that the caregivers didn’t believe in their stories or their experiences. The health care professionals made them feel like objects and not human beings. Few women had a good experience of the care they were given, in those cases the caregivers had asked the women about the violence and gave them time to talk and made them feel safe and comfortable. Conclusion: Nearly all of the women had feelings of shame and guilt. They wanted the caregiver to ask them about the violence, because they found it hard to reveal it themselves. Caregivers need more knowledges about intimate partner violence and its impact on the women to offer right kind of help.They also need guidelines to know how to meet and help these women.

Introduction: The studies reported in this thesis investigated a number of patient orientated aspects of its current diagnosis, management and treatment in Kuwait. A comprehensive literature survey is presented with a detailed critical analysis of the very limited number of published material relevant to type 2 diabetes in Kuwait is also provided. A concise list of aims and objectives is also provided. Methodology: The methodology used to derive knowledge of the present situation from the patient perspective, was a series of relevant questions, devised based on the internationally used diabetes Michigan questionnaire. Face to face interviews were used throughout for both patients and medical staff. Suitable data analysis was performed. Results: A pilot study consulted 10 Kuwaiti and 10 non-Kuwaiti patients, and after analysis of their data it was found to be reliable, appropriate and capable of being analysed and so was extended to a larger study of 109 diabetic patients. These 109 diabetic patients were studied in thirteen clinics distributed throughout Kuwait. Two groups of patients were studied – Kuwaiti nationals and non-Kuwaitis both of whom were treated at these clinics during their residency in Kuwait. 38 questions were asked including demographics, medical treatment, monitoring of their disease, physiological consequences and dietary aspects. The major findings were that patients considered two major areas could be improved to enhance the treatment of their disease. The first was to improve the degree of empathy shown to them by the medical/nursing staff and secondly to provide simple practical advice on exercise, dietary considerations and renal aspects of their disease. More comprehensive findings are presented in the thesis but many of these were minor compared with these two major aspects. Also presented are interviews with the medical staff in Kuwait who treat diabetic patients and the problems they face when treating their disease. The opinions and views of selected ophthalmologists and renal specialists are also presented. Medical views were also sought in the UK- Ascot Rehabilitation above their experiences treating diabetic patients from Kuwait. Another aspect of the study was to interview Kuwaiti nationals who had been sent to a clinic in Ascot, UK for the treatment of the serious consequences of their conditions. Many of these were had type 2 diabetes and their views and perspectives of their treatment in Kuwait were gathered as being representative of the long term treatment of this condition. Discussions and Conclusions: The thesis discusses in some detail all the results which were obtained and concludes with a series of recommendations which could be taken to improve the treatment of type 2 diabetes in Kuwait.

Bakgrund:Sverige förändras och blir ett mer mångkulturelltsamhälle. Sjuksköterskan behöver arbeta utifrån ett helhetsperspektiv för attkunna ge en patientcentrerad vård. Utmaningar kan uppstå när det finnskommunikationssvårigheter på grund av språkbarriären och olika kulturellatraditioner, vilket kan medföra olika värderingar om vad hälsa -och sjukvårdinnebär. Syfte: Att belysa sjuksköterskors upplevelser av kulturmötenmed patienter. Metod: En litteraturstudie med grund i kvalitativ ansats.Resultat: Kulturskillnader var något som väckte en reaktion hossjuksköterskorna i mötet med patienten. Det berodde bland annat på annorlundavärderingar, traditioner och attityder. Det mest framträdande varspråkbarriären och även anhörigas deltagande i omvårdnaden, en aspekt som mångasjuksköterskor upplevde att det försvårade möjligheten till en individanpassadomvårdnad. Andra skillnader var matkulturen, religion samt känslomässigauttryck och beteenden. Slutsats: Resultatet överensstämde med tidigareforskning som gjorts inom valt fenomen. De sjuksköterskor som sällan mötte patienterfrån andra kulturer upplevde oftast större utmaningar inom omvårdnaden medan desjuksköterskor som hade mer frekventa kulturmöten samt mer erfarenhet av attvårdat patienter med en annan kulturellbakgrund uppvisade en högre grad avkulturkompetens Det behövs ytterligare kunskap och utbildning om andrakulturer, något som skulle kunna implementeras under sjuksköterskeutbildningen föratt på så sätt förbereda sjuksköterskorna inför kulturella vårdmöten. En mervarierad personaluppsättning med olika kulturella bakgrunder skulle kunnaberika och underlättar omvårdnaden. Kliniskbetydelse: Det finns bådekunskapsbrist och kommunikationssvårigheter vid kulturmöten inom vården.Professionell tolk bör inkallasvid behov och utveckla kulturmedvetenheten genomklinisk utbildning hos sjuksköterskor och övriga vårdpersonal. / Background: Sweden is changing and becoming a more diverse society. Nurses need to work holistically in order to provide a patient-centered care. Challenges may arise when there are communication difficulties due to language barriers and different cultural traditions, which may cause different values about what health-care involves. Aim: To illuminate nurses' experiences of cultural encounters with patients Method: A literature review with grounding in qualitative approach. Results: A cultural difference was something that brought a reaction of the nurses in the encounter with the patient. Something that was partly due to different values, traditions and attitudes. The most prominent was the language barrier and also relatives' participation in their care; one aspect that many nurses felt that it hindered the possibility of an individualized care. Other differences were food culture, religion, and emotional expression and behavior. Conclusion: These results were consistent with previous research undertaken in the chosen phenomenon. The nurses who rarely met patients from other cultures usually experienced major challenges in nursing, while those nurses who had more frequent cultural encounters and more experience tended patients with a different cultural background showed a higher level of cultural competence. The need for further knowledge and education about other cultures is something that could be implemented during nursing education in order to prepare nurses to cultural care encounters. A more diverse set of staff with different cultural backgrounds could enrich and facilitate nursing care. Clinical significance: There is both a lack of knowledge and communication difficulties in cultural encounters in health care. Professional interpreter should convene when necessary and develop cultural awareness through clinical training of nurses and other healthcare professionals.

Introduction: The studies reported in this thesis investigated a number of patient orientated aspects of its current diagnosis, management and treatment in Kuwait. A comprehensive literature survey is presented with a detailed critical analysis of the very limited number of published material relevant to type 2 diabetes in Kuwait is also provided. A concise list of aims and objectives is also provided. Methodology: The methodology used to derive knowledge of the present situation from the patient perspective, was a series of relevant questions, devised based on the internationally used diabetes Michigan questionnaire. Face to face interviews were used throughout for both patients and medical staff. Suitable data analysis was performed. Results: A pilot study consulted 10 Kuwaiti and 10 non-Kuwaiti patients, and after analysis of their data it was found to be reliable, appropriate and capable of being analysed and so was extended to a larger study of 109 diabetic patients. These 109 diabetic patients were studied in thirteen clinics distributed throughout Kuwait. Two groups of patients were studied – Kuwaiti nationals and non-Kuwaitis both of whom were treated at these clinics during their residency in Kuwait. 38 questions were asked including demographics, medical treatment, monitoring of their disease, physiological consequences and dietary aspects. The major findings were that patients considered two major areas could be improved to enhance the treatment of their disease. The first was to improve the degree of empathy shown to them by the medical/nursing staff and secondly to provide simple practical advice on exercise, dietary considerations and renal aspects of their disease. More comprehensive findings are presented in the thesis but many of these were minor compared with these two major aspects. Also presented are interviews with the medical staff in Kuwait who treat diabetic patients and the problems they face when treating their disease. The opinions and views of selected ophthalmologists and renal specialists are also presented. Medical views were also sought in the UK- Ascot Rehabilitation above their experiences treating diabetic patients from Kuwait. Another aspect of the study was to interview Kuwaiti nationals who had been sent to a clinic in Ascot, UK for the treatment of the serious consequences of their conditions. Many of these were had type 2 diabetes and their views and perspectives of their treatment in Kuwait were gathered as being representative of the long term treatment of this condition. Discussions and Conclusions: The thesis discusses in some detail all the results which were obtained and concludes with a series of recommendations which could be taken to improve the treatment of type 2 diabetes in Kuwait.

Bakgrund: Sexuella- och könsminoriteter faller utanför hetero- och tvåkönsnormen som finns i samhället och utsätts för diskriminering på olika sätt överallt i världen. Personer inom gruppen sexuella- och könsminoriteter har rapporterat negativa erfarenheter av vårdmötet, till exempel i form av homofoba och transfoba attityder, vilket kan medföra att hbtq-personer undviker att söka vård. Sjuksköterskan kan vara med och förbättra detta då hen har ett ansvar att främja insatser som tar särskild hänsyn till utsatta gruppers hälsa och sociala behov.  Syfte: Syftet var att beskriva vilka faktorer som påverkar upplevelsen av bemötande från vårdpersonal enligt personer som ingår i gruppen sexuella- och könsminoriteter. Metod: Deskriptiv litteraturöversikt användes som metod och i resultatanalysen ingick 14 originalartiklar som undersökte sexuella- och könsminoriteters upplevelse av vårdmötet. Resultat: Det visade sig vara viktigt när vårdpersonal gav personcentrerad vård, respekterade patientens identitet och att de utvecklade en tillits- och förtroendefull relation. Det var även viktigt att vårdpersonal hade specifik kunskap inom området och använde ett könsneutralt språk i vårdmötet. Negativa faktorer var upplevelse av diskriminering och att vårdpersonal gjorde hetero- eller cisnormativa antaganden.  Slutsats: Vårdpersonal bör vara medveten om att normer och förutfattade meningar kan påverka vårdmötet utan att de tänker på det. För att undvika stereotypt bemötande bör vårdpersonal respektera patientens identitet och ha mer kunskap om behov som är unika för sexuella- och könsminoriteter. / Background: Sexual and gender minorities do not conform to heterosexual and gender-binary social norms and are subjected to different forms of discrimination all over the world. Members of these minorities have reported instances of negative experiences of healthcare encounters which can result in a hesitation to seek further care. Given their responsibility to promote healthcare interventions tailored to the needs of marginalised groups, nurses could play an important role in resolving this issue. Aim: The aim of the study was to describe which factors affect the experience of an encounter with a health professional according to people who identify as a sexual or gender minority.  Method: The study comprised a descriptive literature review of 14 empirical studies which explored the experience of sexual and gender minorities in relation to the healthcare encounter. Result: The following factors were revealed to be particularly influential in determining the healthcare experiences of sexual and gender minorities. Positive factors included: when health professionals delivered person-centered care, respected the patient’s sexual and gender identity, and when they could develop a trusting relationship with a healthcare professional. It was also important that health professionals were knowledgeable and used gender-neutral language. Negative factors included instances of discrimination and when health professionals made hetero- or cis-normative assumptions.  Conclusion: Health professionals need to be aware of the impact that norms and preconceptions can have on the healthcare encounter. To avoid stereotypical treatment, health professionals should respect the patient’s identity and have more knowledge about sexual and gender minority-specific needs.

This study was conducted to assess Masters of social Work students’ interest in gerontology. Students’ gerontological knowledge, attitude and experience with the aging population was examined to see if they have any influence on interest in working with older adults. The positivist worldview was used to identify students’ behavior toward older adults while checking to see if correlates to interest in working with that population. Survey questionnaire was used to collect information on student’s interest in working with older adults, their knowledge, attitude and experience. Modified versions of Palmore Facts on Aging Quiz (FAQ) and Kogan’s Attitude Toward Old People (KAOP) scales were used to collect information on students’ knowledge and attitude toward older adults. Additional questions about demographic data was included along with direct question on interest in working with the older adults. The results from the use of the quantitative approach allowed further statistical analysis using SPSS to identify relationships between the variables. The study found relationships between knowledge of aging and interest in aging-related work. The study recommends that future research examine factors that influence attitude and implementing gerontological education and training in social work programs to improve student’s interest in aging related work.

Objective: We aimed to analyze the birth experience of women with caesarean section (CS) and the influence of clarification. Furthermore weaknesses of care from women’s view should be determined. Method: Online survey of women who had at least one CS Results: We analyzed data of 383 women. 47,8% women had a primary, 52,2% a secondary CS . The birth experience ranged from wonderful (13,3%) to gruesome (25,1%). There were significant more women with secondary CS whose birth experience was associated with negative emotions. Regarded in hindsight for 29,0% the CS was better than expected and 39,6% stated it had been worse than assumed. Almost half of participants stated having coped (rather) bad with the CS and its concomitants. The opportunity of psychological consultation in hospital or at least addresses to contact when needed were repeatedly required. In this survey the birth experience as well as the meeting of expectations toward CS depended on the satisfaction with the antenatal discussion by obstetricians and the clarification by medical staff while for antenatal classes no significant influence could be proved. Conclusions: A substantial amount of women had a negative birth experience. More effort concerning clarification and patient-centered care is required.

Bakgrund: Anorexia nervosa och bulimia nervosa är komplexa ätstörningar som medför stort lidande för patienterna. Patienterna drar sig bort från att söka vård då de bland annat inte har sjukdomsinsikt men även andra bidragande faktorer som medför olika känslor kring vårdupplevelsen. Syfte: Belysa upplevelsen av vården bland patienter med anorexia nervosa och bulimia nervosa. Metod: Litteraturöversikt där elva artiklar valdes ut, granskades och sammanställdes för att besvara syftet. Resultat: Upplevelsen av vården bland patienter med anorexia nervosa och bulimia nervosa redovisas via tre huvudteman; patienters upplevelse av att ta första steget till vård, att vara patient och att tillfriskna under vårdtiden. Under varje huvudtema tillkommer två subteman. Det framkom att det är en komplex vårdprocess som innerverar ett brett spektrum av känslor samt olika faktorer som medför både positiva och negativa känslor för berörd patientgrupp. Det föreligger även betydande faktorer i omvårdnaden som påverkar patientens relation till sjuksköterskan samt hur behandlingen, omvårdnaden och tillfrisknande sker. Konklusion: Att vårda patienter med anorexia nervosa och bulimia nervosa är komplext. Genom visat stöd, kommunikation, empati och en god relation mellan sjuksköterskan och patienten kan en adekvat vård utföras där patienten får en god vårdupplevelse. / Background: Anorexia nervosa and bulimia nervosa are complex eating disorders that cause suffering to patients. Patients tend to avoid seeking treatment because, among other things, they have no insight into the disease, but also other contributing factors that lead to different feelings about the care experience. Aim: To shed light on the experience of care among patients with anorexia nervosa and bulimia nervosa. Method: Literature review where eleven articles were selected, reviewed and compiled to answer the purpose. Findings: The experience of care among patients with anorexia nervosa and bulimia nervosa is reported via three main themes; patients' experience of taking the first step, patients' care experience and recovering during the care period. Under each main theme, two subthemes are added. It turned out that it is a complex care process that innervates a wide range of emotions as well as various contributes both positive and negative emotions for this group of patients. Conclusion: Caring for patients with anorexia nervosa and bulimia nervosa is complex.Through shown support, communication, empathy and a good relationship between the nurse and the patient, adequate care can be carried out where the patient gets a good care experience.

Sjuksköterskor har lång erfarenhet av att möta och vårda multisjuka äldre som lever och lider av långvarig smärta. Smärtan kan visas som symtom orsakad av otillräckligt eller ej adekvat behandling. Det resulterar i en gradvis funktionsnedsättning både fysiskt och psykiskt hos multisjuka äldre. Därför är det av stor vikt att undersöka samt få mer kunskap om hur sjuksköterskor upplever att vårda multisjuka äldre med långvarig smärta. Syftet är att beskriva hur sjuksköterskor upplever att vårda multisjuka äldre med långvarig smärta. Studien har genomförts med en kvalitativ forskningsdesign. Åtta sjuksköterskor deltog och bidrog med sin kunskap och erfarenhet. Materialet som insamlades analyserades med induktiv innehållsanalys. Analysen av sjuksköterskors upplevelse resulterade i tre kategorier; Se hela människan, Lindra smärtan samt Kunskap och kompetens. Kategorierna var i sin tur uppbyggda av totalt sju subkategorier. I diskussionen diskuteras vikten av att ha kunskap om vad individuell anpassning innebär samt en strukturerad smärtlindring som bidrar till att minska patientens lidande. Det är av största vikt är att uppnå en ökning av patientens livskvalité genom förbättring av fysisk och psykisk hälsa. Som blivande specialistsjuksköteror med inriktning Vård av Äldre kan denna kunskap bidra till ett vårdande förhållningssätt, vilket innebär att stötta och hjälpa patienten med att öka sin livskvalitet. / Background: Nurses have for many years cared for multi-sick elderly people whom are suffering from long-term pain. The pain may appear as symptoms caused by inadequate treatment. This results in a gradual impairment of both physical and mental health of the multi-ill elderly. Therefore, it is of great importance to investigate and gain more knowledge about how nurses perceive caring for multi-ill elderly people with long-term pain. Aim: The purpose is to describe how nurses experience caring for multi-sick elderly people with long-term pain. Method: The study has a qualitative inductive approach to elucidate nurses' experience, knowledge and attitude. Data was collected using three phases, eight nurses participated and contributed with their knowledge and experience. The data collected was analyzed by means of qualitative content analysis. Results: The analysis of nurses' experiences resulted in three categories; see the entire person, pain relief, knowledge and competence. The categories were made up by seven subcategories. Conclusion: The importance of having knowledge of what individual adaptation means and having a structured adequate pain relief that helps to reduce the patient's suffering. It is important to achieve an increase in the patient's quality of life through improvement of physical and mental health. As future specialist nurses with a focus on Care for the Elderly, this knowledge can contribute to a way of working that is based on an attitude which means to support and help the patient to increase their quality of life.