Individualiserad omvårdnad är något både patienter och sjukvårdspersonal strävar efter. För att legitimera individualiserad omvårdnad som eftersträvansvärd krävs dock en förankring av begreppet i omvårdnadsvetenskaplig litteratur. Studiens syfte är att utifrån omvårdnadsvetenskaplig litteratur undersöka: • Vad individualiserad omvårdnad är • Hur denna individualiserade omvårdnad beskrivs i omvårdnadsteoretisk litteratur • Hur individualiserad omvårdnad kan uppnås • Hur omvårdnad kan se ut när den inte är individualiserad Datamaterialet består av omvårdnadsteoretisk litteratur från sent 1800-tal fram till idag och resultatet visar att individualiserad omvårdnad är grunden för god omvårdnad. Denna goda och individualiserade omvårdnad skapas i en jämbördig relation mellan sjuksköterska och patient, en relation där sjuksköterskan lyssnar och kommunicerar. Resultatet har bidragit till påvisande av ett antal attribut, vilka är: Relation, inlevelse, delaktighet och helhet. Dessa bildar en förståelse av det sammansatta begreppet individualiserad omvårdnad. / Individualized care is something both patients and healthcare personnel strive for. To legitimate individualized care as something to strive for an abutment to nursing care theories is necessary. The aim of this study is to investigate: • What individualized care is • How it is described in scientific nursing care literature • How individualized care can be obtained • What the caring process can look like when it is not individualized The data consists of scientific nursing literature from late 19thcentury to present time and the result shows that individualized care is the foundation that good care is built upon. Good and individualized care is created in an equal relationship between nurse and patient, a relationship where the nurse listens and communicates a good and individualized care is created. The study has contributed to point out a number of attributes including: relation, empathy, participation and entirety. These attributes constitute to an understanding of the compounded concept individualized care.

<p>Individualiserad omvårdnad är något både patienter och sjukvårdspersonal strävar efter. För att legitimera individualiserad omvårdnad som eftersträvansvärd krävs dock en förankring av begreppet i omvårdnadsvetenskaplig litteratur. Studiens syfte är att utifrån omvårdnadsvetenskaplig litteratur undersöka:</p><p>• Vad individualiserad omvårdnad är</p><p>• Hur denna individualiserade omvårdnad beskrivs i omvårdnadsteoretisk litteratur</p><p>• Hur individualiserad omvårdnad kan uppnås</p><p>• Hur omvårdnad kan se ut när den inte är individualiserad</p><p>Datamaterialet består av omvårdnadsteoretisk litteratur från sent 1800-tal fram till idag och resultatet visar att individualiserad omvårdnad är grunden för god omvårdnad. Denna goda och individualiserade omvårdnad skapas i en jämbördig relation mellan sjuksköterska och patient, en relation där sjuksköterskan lyssnar och kommunicerar. Resultatet har bidragit till påvisande av ett antal attribut, vilka är: Relation, inlevelse, delaktighet och helhet. Dessa bildar en förståelse av det sammansatta begreppet individualiserad omvårdnad.</p> / <p>Individualized care is something both patients and healthcare personnel strive for. To legitimate individualized care as something to strive for an abutment to nursing care theories is necessary. The aim of this study is to investigate:</p><p>• What individualized care is</p><p>• How it is described in scientific nursing care literature</p><p>• How individualized care can be obtained</p><p>• What the caring process can look like when it is not individualized</p><p>The data consists of scientific nursing literature from late 19thcentury to present time and the result shows that individualized care is the foundation that good care is built upon. Good and individualized care is created in an equal relationship between nurse and patient, a relationship where the nurse listens and communicates a good and individualized care is created. The study has contributed to point out a number of attributes including: relation, empathy, participation and entirety. These attributes constitute to an understanding of the compounded concept individualized care.</p>

This licentiate thesis is based on the growing interest in Swedish elderly care. The aim of this thesis is to investigate what generates satisfaction with elderly care among older persons. The dominant ideology in both privately and publically run elderly care is individualized care, also called person-centered care, which holds the older person’s satisfaction as one of the main quality indicators. The proportion of older people is increasing and to maintain high levels of satisfaction with elderly care will require more knowledge. Data from the National Board of Health and Welfare’s (2012) nationwide survey on seniors’ experiences with elderly care was collected. Statistical analyses of this sample formed the basis for the results of the thesis and were reported in two papers. Study I used Donabedian’s (1988) model of quality of care in terms of structure, process, and outcome, and all municipal units in Sweden were included (N = 324). The results showed that structural variables (i.e. budget, staff, and training level) have minimal or no relationships with older persons’ satisfaction with care, while process variables (i.e. experiences of respect, information, and influence) have strong relationships with satisfaction with care. Study II made use of the long-standing person versus situation- model in social psychology, and was analyzed on an individual level (N = 95,000). The results showed that care process factors (i.e. experiences of treatment, safeness, staff- and time-availability) had a stronger relationship, than individual factors (i.e. health, anxiety, and loneliness) with satisfaction with care. The results also showed that older persons with home care generally felt better treated than older persons in nursing homes, but also felt less safe. Mediational analyses, based on this comprehensive elderly data, suggest that the individual aging condition of loneliness can be countered by providing safeness and treatment, resulting in high satisfaction with care. In conclusion, satisfaction with elderly care in Sweden today can largely be explained from a psychological perspective by the older persons’ perception of the care process, not by the amount of structural resources or the conditions of the aging persons. These findings could help facilitate the future quality development in municipalities and care organizations.

This licentiate thesis is based on the growing interest in Swedish elderly care. The aim of this thesis is to investigate what generates satisfaction with elderly care among older persons. The dominant ideology in both privately and publically run elderly care is individualized care, also called person-centered care, which holds the older person’s satisfaction as one of the main quality indicators. The proportion of older people is increasing and to maintain high levels of satisfaction with elderly care will require more knowledge. Data from the National Board of Health and Welfare’s (2012) nationwide survey on seniors’ experiences with elderly care was collected. Statistical analyses of this sample formed the basis for the results of the thesis and were reported in two papers. Study I used Donabedian’s (1988) model of quality of care in terms of structure, process, and outcome, and all municipal units in Sweden were included (N = 324). The results showed that structural variables (i.e. budget, staff, and training level) have minimal or no relationships with older persons’ satisfaction with care, while process variables (i.e. experiences of respect, information, and influence) have strong relationships with satisfaction with care. Study II made use of the long-standing person versus situation- model in social psychology, and was analyzed on an individual level (N = 95,000). The results showed that care process factors (i.e. experiences of treatment, safeness, staff- and time-availability) had a stronger relationship, than individual factors (i.e. health, anxiety, and loneliness) with satisfaction with care. The results also showed that older persons with home care generally felt better treated than older persons in nursing homes, but also felt less safe. Mediational analyses, based on this comprehensive elderly data, suggest that the individual aging condition of loneliness can be countered by providing safeness and treatment, resulting in high satisfaction with care. In conclusion, satisfaction with elderly care in Sweden today can largely be explained from a psychological perspective by the older persons’ perception of the care process, not by the amount of structural resources or the conditions of the aging persons. These findings could help facilitate the future quality development in municipalities and care organizations.

Background: In Sweden, approximately 35,000 termination of pregnancies is performed annually. According to the abortion law, women have the right to terminate the pregnancy until week 18+0 without giving the reason for the termination. Undergoing a late termination means a vulnerable situation for the women and midwives have a great responsibility in the care. Women's autonomy is central to midwives' work, but the work can be stressful and create ambivalence. Midwives experience a lack of support in situations that have negatively affected midwives. Previous research shows knowledge gaps in midwives' experiences and the difficulties midwives experience. Aim: To investigate the experiences of midwives regarding late termination of pregnancy. Method: A qualitative method with an inductive approach was used. Ten midwives were interviewed with semi-structured questions using an interview guide. The interviews were recorded, transcribed and analyzed using qualitative content analysis. Results: Four categories and ten subcategories were created. The professional role of midwives was to support women and work individually was considered important. Pain relief and information to women were significant to the women's experience. The work involved difficult situations where ambivalence occurred. The support of colleagues was important to the midwives. However, a lack of resources hampered the work of midwives. Conclusion: Midwives described the work as meaningful but at times stressful. Women were in focus, but working conditions were in need of improvement. To support and empower women, midwives need continuous education and the right conditions / Bakgrund: I Sverige utförs cirka 35 000 avbrytande av graviditet årligen. Enligt abortlagen har kvinnor rätt att avbryta graviditeten fram till vecka 18+0 utan att uppge orsak till avbrytandet. Att genomgå ett sent avbrytande innebär en utsatt situation för kvinnorna och barnmorskor har ett stort ansvar vid omhändertagandet och vården. Kvinnornas autonomi är centralt i barnmorskors arbete men arbetet kan vara påfrestande och skapa ambivalens. Barnmorskor upplever ett bristande stöd i situationer som påverkat barnmorskorna negativt. Tidigare forskning visar kunskapsluckor i barnmorskornas erfarenheter samt vilka svårigheter barnmorskor upplever. Syfte: Att undersöka barnmorskors erfarenheter av vård i samband med sent avbrytande av graviditet. Metod: Kvalitativ metod med induktiv ansats användes. Tio barnmorskor intervjuades med semistrukturerade frågor med intervjuguide. Intervjuerna spelades in via ljudfil, transkriberades och analyserades med kvalitativ innehållsanalys. Resultat: Fyra kategorier och tio subkategorier skapades. Barnmorskornas professionella roll var att stödja kvinnor och arbeta individanpassat ansågs betydelsefullt. Smärtlindring och information till kvinnor var betydande för kvinnornas upplevelse. Arbetet innebar svåra situationer där ambivalens förekom. Kollegornas stöd var viktigt för barnmorskorna. Dock försvårade avsaknad av resurser barnmorskornas arbete. Slutsats: Barnmorskor beskrev arbetet som meningsfullt men stundtals påfrestande. Kvinnorna var i fokus men arbetsvillkoren var i behov av förbättringar. För att stödja och stärka kvinnor behöver barnmorskor kontinuerlig kompetensutveckling och få rätt förutsättningar.

Currently, the care of premature newborn infants and their parents is mainly focused on the so-called Newborn Individualized Developmental Care and Assessment Program (NIDCAP) that is aimed at protection of the developing central nervous system of a premature child.The aim of nursing care is to help premature child to cope with the premature delivery. To adjust the environment and the way of care so it suits the individual needs of every child. The support of the parental role and the efforts to involve parents in the care of a newborn infant as early as possible are stressed. The following objectives were defined in the diploma thesis. To process experience with introducing new forms of the developmental care of excessively or extremely premature newborn infants from the point of view of nursing. To characterize current provision of individualized developmental care of newborn infants born before week 32 of gestation. To map the role of the nurse in delivering individualized developmental care and to find out how parents perceive the developmental care of excessively and extremely premature newborn infants. 4 research questions were raised on the basis of the objectives of the thesis. Which forms of the individualized developmental care are used in care of a newborn infant born before week 32 of gestation most? Which problems do nurses have to cope when employing individualized developmental care in the day-to-day care of newborn infants born before week 32 of gestation with and which roles of nurses are applied most when providing care? How do parents of newborn infants born before week 32 of gestation perceive the care of their child included in the individualized developmental care? The theoretical part of the thesis deals with the issue of excessively and extremely premature newborn babies, characteristics of the individualized developmental care and the nursing strategies, the role of a nurse and the role of parents. The practical part is focused on the qualitative research. The results of the research suggest the nurses have included the individualized developmental care into the nursing care of premature newborn infants at the Department of Neonatal Medicine in the Hospital in České Budějovice, however, not in its full extent. The parents perceive the included aspects of this care positively,the nursing staff is important. The research has identified problems nurses have to cope with when they implement this care and what the reserves in the implementation are. A map of the individualized developmental care that can be used by nurses in practice is the result of the research.

Bakgrund: Hjärt-kärlsjukdom är den dominerande dödsorsaken i Sverige. För personen som drabbas är det en otäck händelse som påverkar individens livsvärld. Levnadsvanor såsom ohälsosamma matvanor, brist på daglig fysisk aktivitet samt tobaksanvändning är alla riskfaktorer. För att förhindra ett återinsjuknande är det viktigt att patienten tar till sig av de egenvårdsråd som ges av sjukvården efter en hjärtinfarkt. Syfte: Syftet med studien är att belysa patienters upplevelser av att följa egenvårdsråd efter att ha insjuknat i hjärtinfarkt. Metod: Studien har genomförts som en litteraturöversikt där kvalitativa artiklar har använts. Resultat: Två domäner i form av främjande och hindrande faktorer med fem kategorier och ytterligare underkategorier togs fram och bildade resultatet. I resultatet framkom att individualiserat stöd från sjukvårdspersonal var av stor vikt, för att möjliggöra förändring och ta till sig av de egenvårdsråden givna av sjukvården. Ytterligare framkom att vägledning kring hur livsstilsförändringen kan se ut samt stöd från anhöriga och jämlika spelade en betydande roll för möjligheten att implementera nya levnadsvanor. Slutsats: Slutsatsen som kan antas är att tydligheten och strukturen kring arbetet med patienter under eftervården bör tydliggöras och utformas i ett samarbete med patienter och närstående. / Background: Cardiovascular disease is the dominant cause of death in Sweden. For the person affected it is a fearful event that affects the whole life. Living habits such as unhealthy eating, tobacco use and lack of daily physical activity are all risk factors. To prevent a recurrence, it is important that the patient follows the self-care advice given by the healthcare after a heart attack. Aim: The aim of the study is to shed light on patients' experiences of following self-care advice after having had a heart attack. Method: The study has been conducted as a literature review where qualitative articles have been used. Results: Two domains in the form of promoting and hindering factors with five categories and additional subcategories were developed and formed the result. The results showed that individualized support from healthcare professionals was of great importance, to enable change and absorb the self-care advice given by healthcare. It also emerged that guidance on what lifestyle change can look like as well as support from relatives and peers played a significant role in the possibility of implementing new lifestyles. Conclusion: The clarity and structure of the work with patients during aftercare should be clarified and designed in collaboration with patients and relatives.

Chlamydia trachomatis (CT) can cause infertility and is the most common sexually transmitted infection (STI) of bacterial origin in Europe. Surveys in seven countries estimated a population prevalence of 1.4-3.0 % in people 18 to 44 years. Approximately 87% of those diagnosed in Sweden are 15-29 years. Since 1997, with the exception of 2009-2010, despite all efforts, CT has increased steadily in many European countries including Sweden. That made us investigate risk factors associated with catching STIs, especially CT. In Sweden partner notification is mandatory by law when a patient is diagnosed with CT. Centralised partner notification, performed by a few experienced counsellors, and evaluation of the sexual history for at least 12 months back in time, shows superior results compared to other studies. Phone-interviews are a good option in remote areas. “The Västerbotten model” for partner notification fulfils these criteria and our evaluation has functioned as a model for changing recommendations of partner notification in Sweden. Preventing CT by primary prevention such as information and counselling is, however, still of great importance. We investigated whether it was necessary to test for CT in the throat. We found that patients testing positive for pharyngeal CT neither had more symptoms or signs nor a sexual history that differed from others. We therefore believe that we will find most or all of these patients by conventional testing of urine and cervical/vaginal samples. We wanted to further identify risk factors among patients attending a clinic for sexually transmitted infections to enable individualized care depending on risk. None or inconsistent use of condoms with new/temporary partners in combination with having at least one new/temporary partner within the past 6 months could identify persons with risk behaviour and at increased risk of CT (re)infection. Additional information about whether the condom was used during the whole intercourse did not add any risk of infection. A drop-in reception is a good contribution to an opportunistic screening approach. The rate of CT infected is high and the clinic attracts men and individuals ≥25 years old at risk of infection, groups which usually have a reduced test rate. The mean age was 28 years and 58% of the patients were men. The figure of correct condom usage is very low indicating the need for risk reducing counselling also in this grown-population. Among adult STI patients anxiety was common and depression uncommon. Neither was linked to high risk sexual behaviour nor ongoing CT infection. Hazardous alcohol consumption, however, was common and linked to anxiety and high risk sex. We conclude that preventive work can not only focus on STI prevention, but must consider the high frequency of hazardous alcohol consumption, which probably is contributing to sexual risk behaviour.

The prevalence of heart failure is increasing. This is affecting the health care system; thus, making it important with change to meet the new demands. Many effective ways of treating heart failure exists, but changes are required in order to implement them. Before changes can be made, it is important to find current problem areas within the existing heart failure health care system. This study aimed to present an image of current problem areas within the heart failure health care system; in order to do so, it was necessary to speak with both care providers and heart failure patients. A total of 26 heart failure patients and 27 care providers working with heart failure patients in Stockholm County participated in the study. The participants answered survey questions concerning the heart failure care. The results from the care providers were consistent; they thought the patients’ heart failure awareness and the patient education they had received were problems within the heart failure care. In addition, they thought it was necessary for the patients to be active in their care and meet with different professions within the health care. Heart failure patients showed to be a diverse group of individuals; they wanted different kind of care and showed differences in how active they wanted to be. The results also showed differences between the care providers and patients’ perception of the heart failure care. The heart failure care needs to be more individualized to meet each heart failure patients’ needs. It is important with more patient education and to actively work with self-care. In addition, it is important that care providers get sufficient heart failure knowledge and to offer the patients the opportunity to meet with different care provider professions. / Utbredningen av hjärtsvikt ökar, vilket påverkar sjukvårdssystemet. För att möta de nya behoven är det nödvändigt med förändringar. Det finns idag många effektiva behandlingsmetoder för hjärtsvikt, men för att dessa behandlingsmetoder ska kunna implementeras behöver sjukvårdssystemet förändras. Innan dessa förändringar kan genomföras är det viktigt att identifiera problem inom hjärtsviktsvården. Målet med denna studie var att identifiera befintliga problemområden inom hjärtsviktsvården. För att kunna göra detta var det nödvändigt att prata med både sjukvårdspersonal och hjärtsviktspatienter. Sammanlagt har 26 patienter och 27 vårdgivare från Stockholms Län delaktigt. Alla delatagare har svarat på enkätfrågor rörande hjärtsviktsvården. Resultaten från vårdgivarna var konsekventa, de ansåg att patienternas kännedom om hjärtsvikt och den hjärtsviktsutbildning de fått var problemområden. Vårdgivarna ansåg vidare att det var viktigt för patienterna att vara delaktiga i sin vård, samt att de skulle få träffa olika typer av vårdgivare. Hjärtsviktspatienterna visade sig vara en blandad grupp, de ville ha olika typ av vård samt vara olika mycket aktiva i egenvård. Resultaten visade också att det fanns skillnader mellan vårdgivarnas och patienternas uppfattning av hjärtsviktsvården. Hjärtsviktsvården behöver bli mer individualiserad för att kunna tillgodose varje patients behov. Det är viktigt att utbilda patienterna samt att aktivt arbeta med egenvård. Det är även viktigt att vårdgivarna får tillräckligt med kunskap om hjärtsvikt, samt att patienterna erbjuds möjligheten till möten med olika typer av vårdgivare.

The prevalence of heart failure is increasing. This is affecting the health care system; thus, making it important with change to meet the new demands. Many effective ways of treating heart failure exists, but changes are required in order to implement them. Before changes can be made, it is important to find current problem areas within the existing heart failure health care system. This study aimed to present an image of current problem areas within the heart failure health care system; in order to do so, it was necessary to speak with both care providers and heart failure patients. A total of 26 heart failure patients and 27 care providers working with heart failure patients in Stockholm County participated in the study. The participants answered survey questions concerning the heart failure care. The results from the care providers were consistent; they thought the patients’ heart failure awareness and the patient education they had received were problems within the heart failure care. In addition, they thought it was necessary for the patients to be active in their care and meet with different professions within the health care. Heart failure patients showed to be a diverse group of individuals; they wanted different kind of care and showed differences in how active they wanted to be. The results also showed differences between the care providers and patients’ perception of the heart failure care. The heart failure care needs to be more individualized to meet each heart failure patients’ needs. It is important with more patient education and to actively work with self-care. In addition, it is important that care providers get sufficient heart failure knowledge and to offer the patients the opportunity to meet with different care provider professions. / Utbredningen av hjärtsvikt ökar, vilket påverkar sjukvårdssystemet. För att möta de nya behoven är det nödvändigt med förändringar. Det finns idag många effektiva behandlingsmetoder för hjärtsvikt, men för att dessa behandlingsmetoder ska kunna implementeras behöver sjukvårdssystemet förändras. Innan dessa förändringar kan genomföras är det viktigt att identifiera problem inom hjärtsviktsvården. Målet med denna studie var att identifiera befintliga problemområden inom hjärtsviktsvården. För att kunna göra detta var det nödvändigt att prata med både sjukvårdspersonal och hjärtsviktspatienter. Sammanlagt har 26 patienter och 27 vårdgivare från Stockholms Län delaktigt. Alla delatagare har svarat på enkätfrågor rörande hjärtsviktsvården. Resultaten från vårdgivarna var konsekventa, de ansåg att patienternas kännedom om hjärtsvikt och den hjärtsviktsutbildning de fått var problemområden. Vårdgivarna ansåg vidare att det var viktigt för patienterna att vara delaktiga i sin vård, samt att de skulle få träffa olika typer av vårdgivare. Hjärtsviktspatienterna visade sig vara en blandad grupp, de ville ha olika typ av vård samt vara olika mycket aktiva i egenvård. Resultaten visade också att det fanns skillnader mellan vårdgivarnas och patienternas uppfattning av hjärtsviktsvården. Hjärtsviktsvården behöver bli mer individualiserad för att kunna tillgodose varje patients behov. Det är viktigt att utbilda patienterna samt att aktivt arbeta med egenvård. Det är även viktigt att vårdgivarna får tillräckligt med kunskap om hjärtsvikt, samt att patienterna erbjuds möjligheten till möten med olika typer av vårdgivare.