Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: The role of the physiotherapist in the neonatal intensive care unit is unclear. How other neonatal healthcare professionals and physiotherapists themselves perceive their role in the management of neonates, their practice patterns and services, their role in the neonatal intensive care multidisciplinary team, their use of evidence-based practice and awareness of the profession in this setting has not been well explored. This information is lacking in the South African healthcare context as well. Therefore, the aim of the study was to explore and describe the perception of doctors, nurses and physiotherapists of the role of the physiotherapist in public and private sector neonatal intensive care units in South Africa. Methods: A qualitative exploratory research design was used. All medical practitioners (paediatricians and neonatologists), nurses and physiotherapists working in the neonatal intensive care units in two private sector and two public sector hospitals in the Cape Metropole region in the Western Cape South Africa who provided consent to participate were included. An inclusive (total population) sampling method was used where all healthcare professionals working in these units were invited to an individual face-to-face audiotaped interview using a semi-structured interview guide and conducted by the researcher at a time and place convenient to the participants following informed consent. Data was transcribed verbatim and analysed using both deductive and inductive thematic content analysis to develop codes, categories and themes. Trustworthiness was ensured by ensuring credibility, conformability, dependability and transferability of data. Ethics was obtained from the relevant Institutional Review Board. Results: Twenty-one healthcare professionals participated, including doctors (n=5), nurses (n=6) and physiotherapists (n=10). The mean age in years of the participants was 41+/–11 years with the physiotherapists having the lowest mean age. The participants had various years of general and neonatal intensive care experience and physiotherapists in specific only had basic undergraduate qualifications with minimal specialised training in neonatal intensive care. Five major themes emerged namely: i) the role of the physiotherapists in the management of the neonatal ICU patient, ii) practice patterns and services iii) teamwork iv) training and qualifications including evidence-based practice, v) awareness of and exposure to neonatal intensive care physiotherapy. Conclusion: Physiotherapists working in this neonatal intensive care setting need to promote their profession through education of other neonatal healthcare professionals in order to improve awareness, referral patterns and integration into the multidisciplinary team. Evidence-based practices and improving training and skills development in the area of neonatal physiotherapy can be further explored in this setting.

Bakgrund  Patienter som drabbas av afasi till följd av stroke upplever svårigheter att förmedla behov och att de ej görs delaktiga, vilket riskerar leda sämre vård. Det verbala språket är en vital del i kommunikationen och social samvaro tillsammans med någon form av kommunikation är en förutsättning för relationsskapandet i vården. Vårdpersonal riskerar, ofta på grund av kunskapsbrist i kommunikation och alternativa kommunikationsvägar, att undvika patienter med afasi och fokusera samtalet kring omvårdnadsåtgärder. Detta kan leda till att patienter med afasi ges få möjligheter att uttrycka behov och göra sig hörda och möjligheten till delaktighet begränsas.   Syfte Att belysa vårdpersonalens upplevelse av patientdelaktighet i mötet med patienter med afasi till följd av stroke. Metod Studien genomfördes som en litteraturöversikt med 15 inkluderade artiklar med kvalitativ och kvantitativ design. Artiklarna är framtagna genom sökningar i databaserna Pubmed och Cinahl och daterade mellan åren 2010 och 2019. Resultat Resultatet framkommer tre kategorier som alla hade betydelse för patientdelaktighet. Dessa var; kunskap, kommunikation och relationen. I kategorin kunskap framkommer att ökad kunskap hos vårdpersonalen leder till ett ökat självförtroende som skapar större förutsättningar för patientens delaktighet i vården. Kommunikation framkommer vara det som till största delen påverkar upplevelsen av delaktighet. Med effektiv kommunikation upplevs delaktigheten öka då patienten ges möjlighet att medverka i sin vård i större utsträckning. Relationen och bemötandet i vården är beroende av vårdpersonalens attityder som kan förstärka eller minska delaktigheten. Slutsats Kommunikation var den faktor som till största delen påverkade delaktigheten. Vårdpersonal upplever att ökad kunskap och större förståelse för patienten påverkar kommunikationen med patienter med afasi positivt. Ökad kunskap bidrog även till ett ökat självförtroende vilket främjar relationsskapandet och kommunikationen. Detta främjar patientendelaktigheten och synliggör patientens bevarade förmågor, vilket stärker patientens tro på sig själv. / Background Patients suffering from aphasia as a result of stroke may have difficulty conveying needs and are at risk for poor medical outcomes. The verbal language is a vital part of communication and social interaction and some form of communication is a prerequisite for the caring relation between patient and nurse. Nurses lack knowledge of communication and alternative communication routes, which means that there are few calls initiated to communication. Nurses are there for at risk of avoiding the patient and focus the conversation around medical tasks. This can lead to patients with aphasia having few opportunities to express their health care needs and make themselves heard and their possibility to participate is severely limited. Aim The aim was to illustrate measures that promote participation between nurses and patients suffering from aphasia as a result of stroke. Method This study was conducted as a literature review with inductive design. The literature review includes 15 articles with qualitative and quantitative design. The articles were collected through searches in the databases Pubmed and Cinahl and are dated between 2010 and 2019. Results The result is presented in three categories that were all relevant for patient participation. The categories are; knowledge, communication and relationship. The knowledge category emerges that increased knowledge among healthcare professionals leads to increased self-confidence that creates greater conditions for patient participation in care. Communication appears to be, what for the most part, affects the experience of patient participation. With effective communication, patient participation is perceived to increase as the patient is given the opportunity to participate in their care to a greater extent. The relationship and response in care depend on the attitudes of health professionals that can strengthen or reduce participation. Conclusions Communication was the factor that mostly affected participation. Healthcare professionals feel that increased knowledge and greater understanding of the patient affects communication with patients with aphasia positively. Increased knowledge also contributed to increased self-confidence, which encourage communication and the ability to establish a relationship. This promotes patient participation and makes the patient's preserved abilities visible, which strengthens the patient's belief in themselves.

Bakgrund: En femtedel av Sveriges befolkning lider av någon form av långvarig smärta. För att förstå smärta krävs en helhetssyn som omfattar biologiska och kulturella aspekter. Smärta kan ha en inverkan på en individs känslor, tankar och personliga förhållanden och det påverkar en individs uppfattning om sig själv och sin livsmening. Långvarig smärta är en av de främsta orsakerna till sjukskrivning och sjukvårdskonsumtion. Kvinnor drabbas i större utsträckning av långvarig smärta än män. Det finns en risk att kvinnor med långvarig smärta kan komma att utveckla utbrändhet. Syfte: Att undersöka kvinnors upplevelse av vårdmötet vid långvarig smärta. Metod: Litteraturstudien har en kvalitativ ansats. Totalt tio stycken vetenskapliga artiklar valdes att ingå i denna litteraturstudie. Databaserna CINAHL och PubMed användes för att söka fram artiklarna. En innehållsanalys genomfördes. Resultat: Fyra huvudkategorier analyserades fram som sammanfattade de kvinnliga patienternas upplevelse av vårdmötet. Kategorierna var Utmaningen med att bli avfärdad, Kamp för att få rätt hjälp, Vikten av trygghet och engagemang samt Mötets negativa inverkan på välmåendet. Berättelser om hur kvinnorna på olika sätt blivit bemötta av vårdpersonal framkom. Kvinnor vittnade om olika strategier och sätt att försöka anpassa sig till upplevda förväntningar för att få ett bättre resultat av mötet. Konklusion: Resultatet visade på en brist på adekvat hjälp och förståelse hos läkare i mötet med vården. Kvinnorna bemöttes ofta med misstro. Kvinnorna hade ett behov av att bli bemötta med empati och det var avgörande för upplevelsen av vårdmötet. Sjuksköterskans kännedom om patientens upplevelse av mötet med läkare kan bidra till en ökad möjlighet att kunna utföra personcentrerad vård då omvårdnaden behöver anpassas till individen. / Background: A fifth of Sweden's population suffers from some form of long-term pain. To understand pain, a holistic view is required that includes biological and cultural aspects. Pain can have an impact on an individual's feelings, thoughts and personal relationships and it affects an individual's perception of himself and the meaning in life. Long-term pain is one of the main reasons for sick leave and healthcare consumption. Women suffer from long-term pain to a greater extent than men. There is a risk that women with long-term pain may develop burnout. Aim: To investigate women's experiences of healthcare encounters in cases of chronic pain. Method: The literature study has a qualitative design. A total of ten scientific articles were chosen to be included in this literature study. The databases CINAHL and PubMed were being used in order to search for the articles. A content analysis was carried out. Result: Four main categories were found that summarized the female patients' experience of the health care meeting. The categories were: The challenge of being dismissed, Struggle to get the right help, The importance of feeling secure and The meeting's negative impact on their well-being. Stories emerged about how the women were treated in different ways by healthcare staff. Women testified about different strategies and ways of trying to adapt to perceived expectations in order to get a better result from the meeting. Conclusion: The result showed a lack of adequate help and understanding by doctors in the meeting with healthcare. The women were often met with distrust. The women had a need to be treated with empathy and that was of importance for the experience of the health care encounter. The nurse´s knowledge of the patient's experience of the meeting with the doctor can contribute to an increased possibility of being able to perform person-centered care as the care needs to be adapted to the individual.

This thesis presents the results of an ethnographic study conducted in a hospital corridor of high complexity, emphasizing the perceptions of health professionals in this context. It accepts the prospect of Health Sociology and Anthropology of Health to analyze and interpret the field taking into account its dynamics. The locus of the research was the General Hospital of the State of Alagoas, Maceió located in the capital. The overall goal of the research was to understand through the discourses of nurses and nursing assistants about their perceptions of professional practices and relations of hierarchy that is waged daily in the workplace. The study subjects were women working in a hospital corridor on the first floor of the hospital, known as green area. The authors conducted an analysis of the distribution of occupations between the sexes in the labor market and the Brazilian state of Alagoas, in the health field, highlighting points of inequality and social prestige in some professions, such as nursing, Medicine and Nursing Assistant. Analysis of Brazilian health policy took from the review of health manuals with special interest how the organization has given the networks of high complexity care in hospitals emergency. Given the multiple social relations that are waged in a hospital emergency emphasized other interactions that are presented through the statements of nursing assistants, involving new subjects: medical and general service providers. From the analysis of issues such negotiations (exchange on duty), the insulation, the representation of the coat. The survey points for maintaining a standard of the health traditional hierarchical relationship, where the role of the physician is still central to the growth of new categories in the art, as is the case of the nursing staff. The discourses of nursing aides pointed to a claim of professional recognition against the persistence of gender inequalities in relation to the occupation of jobs in health, manifest in the wage gap between men and women. Overall, the perceptions of informants revealed their perceptions of the social space where they exercised their crafts and how they experienced their daily work practices. / FAPEAL - Fundação de Amparo à Pesquisa do Estado de Alagoas / Esta dissertação traz os resultados de uma pesquisa etnográfica realizada em um corredor hospitalar de alta complexidade, enfatizando as percepções das profissionais de saúde nesse contexto. Foi aceita a perspectiva da Sociologia da Saúde e Antropologia da Saúde para analisar e interpretar o campo levando em consideração a sua dinâmica. O lócus da pesquisa foi o Hospital Geral do Estado de Alagoas, localizado na capital Maceió. O objetivo geral da investigação foi compreender por meio dos discursos das enfermeiras e auxiliares de enfermagem suas percepções acerca das práticas profissionais e das relações de hierarquia que se travavam cotidianamente no ambiente de trabalho. Os sujeitos da pesquisa foram mulheres que trabalham em um corredor de internação localizado no primeiro andar do hospital, denominado área verde. Procedeu-se a uma análise da distribuição de profissões entre os sexos no mercado de trabalho brasileiro e no Estado de Alagoas, no campo da saúde, destacando pontos de desigualdade e prestígio social em algumas profissões, como Enfermagem, Medicina e Auxiliar de Enfermagem. A análise da política de saúde brasileira se deu a partir da revisão dos manuais de saúde, com especial interesse a forma como tem se dado a organização das redes de atendimentos de alta complexidade nos hospitais de emergência. Tendo em vista, as múltiplas relações sociais que se travam em um ambiente hospitalar de emergência, enfatizei outras interações que se apresentaram, por meio das falas das auxiliares de enfermagem, envolvendo novos sujeitos: médicos e prestadores de serviços gerais. A partir da análise de questões como negociações (troca de plantão), os isolamentos, a representação do jaleco. A pesquisa aponta para a manutenção de um padrão de relação hierárquica tradicional na saúde, onde o papel do médico ainda é central, frente ao crescimento de novas categorias na área, como é o caso da equipe de enfermagem. Os discursos das auxiliares de enfermagem apontaram para uma reivindicação de reconhecimento profissional frente à persistência das desigualdades de gênero com relação à ocupação dos postos de trabalho na saúde, manifesto nas diferenças salariais de homens e mulheres. De modo geral, as percepções das informantes revelavam suas percepções sobre o espaço social onde exerciam seus ofícios e, a maneira como vivenciavam diariamente suas práticas de trabalho.

Background: Patients in the emergency department are not always satisfied with the care received and the nursing care in the emergency department is sometimes described as instrumental and non-holistic. Structured quality improvement work and evidence-based practice are needed. Aim: The overall aim was to emphasize general patients in the emergency department to enhance the knowledge on how they perceive the quality of care and how the care could be improved through collaboration with the healthcare professionals. Methods: Four studies, with quantitative and qualitative designs, were conducted in a Swedish emergency department. Two hundred patients answered a questionnaire, after which 22 healthcare professionals comprising five focus groups were interviewed, and finally 200 patients were included in an intervention study. Results: The following five areas for improvement were identified: “information, respect and empathy”, “pain relief”, “nutrition”, “waiting time” and “general atmosphere”. Of these areas, the healthcare professionals prioritized “information, respect and empathy”, “waiting time” and “pain relief” to be highlighted in the quality improvement work. Although goals and suggestions for changes were stated, barriers to quality improvement at different levels in the health care were detected. The results of the intervention study showed that structured nursing assessment of the patients’ abdominal status and nurse-initiated intravenous opioid analgesic could increase frequency of analgesic and reduce time to analgesic in the emergency department. Patients perceived lower pain intensity and improved quality of care in pain management. Conclusions: An uncomplicated nursing intervention, related to pain management, based on the results from a patient questionnaire and interviews with healthcare professionals, can improve the care process and pain management in the emergency department, as well as patients’ perceptions of the quality of care in pain management. To succeed with continuous quality improvement work, barriers to change should be addressed.

Many healthcare providers are at risk of compassion fatigue and burnout from prolonged occupational stress, which can adversely affect workers, patients, and the healthcare system. This qualitative research project inquired into eight female healthcare providers’ experiences of sustaining their own wellbeing. Participants (27 to 60 years old) engaged in semi-structured interviews and participant observation of a self-care activity. Themes were found relating to the variety of self-care strategies used, challenges and supports in the work context, and the important role of authenticity in health promotion practice. Self-care strategies included: social support, pacing, taking breaks, exercise, nutrition, emotional self-care, adapting self-care routines over time, goal setting and prioritization. Supports to wellbeing included: flexible scheduling, taking personal responsibility for wellness, workplace wellness programs, and positive relationships with supervisors, colleagues, friends and family. This arts-informed research project is presented in graphic novel form to enhance its accessibility.

Many healthcare providers are at risk of compassion fatigue and burnout from prolonged occupational stress, which can adversely affect workers, patients, and the healthcare system. This qualitative research project inquired into eight female healthcare providers’ experiences of sustaining their own wellbeing. Participants (27 to 60 years old) engaged in semi-structured interviews and participant observation of a self-care activity. Themes were found relating to the variety of self-care strategies used, challenges and supports in the work context, and the important role of authenticity in health promotion practice. Self-care strategies included: social support, pacing, taking breaks, exercise, nutrition, emotional self-care, adapting self-care routines over time, goal setting and prioritization. Supports to wellbeing included: flexible scheduling, taking personal responsibility for wellness, workplace wellness programs, and positive relationships with supervisors, colleagues, friends and family. This arts-informed research project is presented in graphic novel form to enhance its accessibility.

En ökad utbredning av psykisk ohälsa ses världen över och är ett stort folkhälsoproblem både i Sverige och globalt. Fysiska besvär som inte blivit tagna på allvar av den somatiska vården, självstigma, samt vårdpersonalens okunskap är faktorer som gör att många patienter med psykisk ohälsa drar sig för att söka vård. En del i sjuksköterskans ansvarsområde är att främja hälsa, för att främja hälsa hos patienter med psykisk ohälsa krävs bland annat fördjupad kunskap om psykisk ohälsa. Syftet var att belysa vårdpersonalens erfarenheter av att vårda patienter med psykisk ohälsa i den somatiska vården. En litteraturstudie genomfördes med litteratursökningar i tre databaser och åtta artiklar inkluderades. Materialet bearbetades med stöd från innehållsanalys. I resultatet framkom tre kategorier: Vårdpersonalens erfarenheter av patienter med psykisk ohälsa; Vårdpersonalens erfarenheter av bristande kunskap om psykisk ohälsa; Vårdpersonalens erfarenheter av organisationsstrukturer. Resultatet visade att vårdpersonalen hade bristande kunskap om psykisk ohälsa. En oförberedd organisation, kännetecknad av tidsbrist hos vårdpersonalen framkom även. Tidsbristen ledde till att det inte fanns möjlighet att etablera en förtroendefull relation. Majoriteten av vårdpersonalen hade en välvilja gentemot patienter med psykisk ohälsa. Vårdpersonalen upplevde att ingen tog ansvar för patienterna med psykisk ohälsa och att de ständigt föll mellan stolarna. / An increased prevalence of mental illness is seen worldwide and it's a major public health issue both in Sweden and global. Physical problems that haven't been taken seriously, self-stigma and healthcare professional´s lack of knowledge are influencing parts that make patients with mental illness less willing to seek care. One of the nurse's fundamental responsibilities is to promote health. In order to promote health among patients with mental illness, better knowledge about mental illness is required. The aim of this study was to illustrate healthcare professional´s experiences of nursing patients with mental illness in the somatic healthcare. A literature study was accomplished with searches in three databases and eight articles were included. The material was analysed with support from content analysis. The result emerged in three categories: Healthcare professional´s experiences of patients with mental illness; Healthcare professional´s experiences of lacking knowledge about mental illness; Healthcare professional´s experiences of organizational structures. The findings revealed that the healthcare professionals experienced a lack of knowledge about mental illness. An unprepared organization characterised by lack of time was also found. The lack of time led to impossibility to establish a trustful relationship. The majority of the healthcare professionals had a benevolence towards the patients with mental illness. A feeling that the patients always fell between the chairs and that nobody takes responsibility for them occurred by the healthcare professionals.

Background: In Sweden 1500-2000 people fall ill with psychosis every year and approximately 30,000-40,000 people live with schizophrenia, which is the most common psychotic illness. Symptoms of psychosis such as lack of perception of reality and thought disorders cause difficulties in communication for healthcare professionals. When caring for people with psychotic illnesses healthcare professionals require knowledge about treatment and caregiving for this patient group. Aim: The aim of the study was to describe people with psychotic illnesses experience with healthcare professionals. Method: Nine articles are included in this literature study and the results were analyzed using a thematic analysis. Result: Two main themes with associated sub-themes have been identified to answer the aim of this study. The first main theme is Obstacles in the meeting that resulted in three sub-themes, Lack of conversational support, Lack of individually tailored patient information and Participation. The second main theme is Affirmative meetings with two sub-themes of Confidence, trust and security in the meeting and To see the person behind the illness. Conclusion: The results indicate that a relationship built on respect and empathy enables person-centered nursing. Inadequate communication and information are described as negative experiences that created difficulties in the meeting / Bakgrund: I Sverige insjuknar 1500-2000 personer i psykos varje år och cirka 30 000-40 000 personer lever med schizofreni, den vanligaste psykossjukdomen. Symtom på psykos såsom bristande verklighetsuppfattning och tankestörningar medför svårigheter i kommunikationen för vårdpersonalen. Vid vårdandet av personer med psykossjukdomar behövs det kunskap kring behandling och omvårdnadsbehov samt bemötande. Syfte: Syftet med studien var att beskriva hur personer med psykossjukdomar upplever mötet med vårdpersonal. Metod: En litteraturstudie med nio vetenskapliga artiklar inkluderades och analyserades utifrån en tematisk analys. Resultat: Två huvudteman med tillhörande subteman har identifierats för att besvara syftet. Första huvudtemat var hinder i mötet som resulterade i tre subteman: Brist på samtalsstöd, Brist på individanpassad patientinformation och Delaktighet. Det andra huvudtemat var Bekräftande möten med två subteman Förtroende, tillit och trygghet i mötet samt Att se människan bakom sjukdomen.    Slutsats: Resultaten tyder på att en relation som är byggd på respekt och empati möjliggör för personcentrerad omvårdnad. Bristfällig kommunikation och information beskrivs som negativa upplevelser som skapade svårigheter i mötet.

BakgrundVåld i nära relationer är ett globalt folkhälsoproblem och en kränkning av den mänskliga rättigheten. Konsekvenser av våldet är olika psykiska, reproduktiva och sexuella hälsoproblem. Vårdpersonal bör identifiera kvinnor som utsatts för våld i nära relationer genom observationer, riktlinjer och screening. SyfteSyftet är att beskriva kvinnors upplevelser av vårdpersonalens bemötande i situationer när de utsatts för våld i nära relation av sin partner. MetodEn litteraturöversikt med inslag av den metodologi som används vid en systematisk översikt. Resultatet är sammanställt av 13 artiklar som sökts fram i databaserna Cinahl och PubMed. ResultatTre huvudkategorier identifierades till resultatet. Huvudkategorierna är: Bemötandet viktigt för främjande av värdighet, Att uppleva ett bristfälligt bemötande från vårdpersonalen samt Brist på integritet. SlutsatsKvinnor upplever till största del att vårdpersonal saknar empati, inte har tid eller inte tar kvinnorna på allvar när de talar om att de utsätts för våld i nära relation. Ett fåtal kvinnor upplever bemötandet positivt med empati och förtroende från vårdpersonal. Fortsättningsvis bör fokus ligga på att ge våldsutsatta kvinnor ett lugnt och empatiskt bemötande där kvinnorna får den tid de behöver. / BackgroundIntimate partner violence is a global health issue and a violation of human rights. Consequences of the violence are psychological, reproductive and sexual health problems. Healthcare professionals should identify women who have been subjected to intimate partner violence through observations, guidelines, and screening. AimThe aim is to describe women's experiences of how healthcare professionals’ meet them in situations when the women have been subjected to intimate partner violence. MethodA literature review with elements of the methodology used in a systematic review. The result is made from 13 articles found in the databases Cinahl and PubMed. ResultsThree main categories were identified for the results. The main categories are: Treatment important for the promotion of dignity, Experiencing inadequate treatment from healthcare professionals and Lack of integrity. ConclusionsWomen mostly feel that healthcare professionals lack empathy, don't have time or don't take them seriously when the women talk about being exposed to intimate partner violence. A few women experience the treatment positively with empathy and trust from healthcare professionals. In the future, the focus should be on giving women subjected to violence a calm and empathetic treatment where the women get the time they need.