BACKGROUND Worldwide, hypertension is the third leading risk factor contributing to death, surpassed only by malnutrition and smoking. 1 Hypertension is common and treatable and because uncontrolled hypertension has serious consequences, preventive measures and control of blood pressure should be a high priority. A healthy lifestyle remains the cornerstone of the management of blood pressure (BP) for all severities of hypertension. It is possible to prevent the development of hypertension and to lower blood pressure levels by simply adopting a healthy lifestyle. 2 Health care workers can assess and contribute to the management of hypertension with exercise adequately if the patient is educated and convinced that lifestyle changes are essential and indeed the most cost effective method of obviating cardiovascular disease. METHODS Patients with hypertension (N=110) were identified from a cohort of patients attending the outpatients department of Carletonville Hospital, a district hospital situated in the mining town of Carletonville, South Africa, and were then invited to participate in the study. A crosssectional descriptive study design was used to determine the knowledge and attitudes of these patients with respect to the importance of lifestyle modification in the management of hypertension. This was achieved by administering a questionnaire. Descriptive and inferential statistical methods were employed to analyze the data. RESULTS The largest number of respondents fell in the 50-59 year old age groups (28%). Females (62%) made up a significant majority of the study population. The population breakdown included the following: Black respondents were 75%, while 24 % were white and 1% coloured. Body Mass Index was more than 25 in 81% of the respondents and 84% of the population had schooling levels below high school. Fifty seven percent (57%) of the respondents ate fried foods regularly, 70 % cooked with salt, 18% add salt to their food, while 14% ate red meat regularly and 26 % consumed alcohol, with 6 % having more than 3 beers/day. The majority of participants led sedentary lifestyles according to the physical activity score, with 74% having little or no activity. At the time of the study 69% had blood pressure (BP) levels above 140/90 mmHg with only 42% knowing what their normal BP should be. Seventy seven percent (77%) believed that exercise lowers BP, and only 30% reported having received such advice from a medical professional. Ninety five percent (95%) believed that a balanced diet is important in controlling hypertension and fifty one percent (51%) reported having being advised by a medical professional about a balanced diet. Ninety four percent (94%) knew that adding salt to food affects BP and sixty nine percent (69%) reported having being told by a medical professional about the effects of excessive salt intake in their diets. Eighty percent (80%) believed that alcohol affects blood pressure and forty four percent (44%) reported having received such information from a medical professional. Seventy five percent (75%) believed that smoking affects BP and thirty six percent (36%) got this information from a medical professional. DISCUSSION The results indicate that respondents reported having received advice about lifestyle modification from medical professionals. The advice varied between areas of lifestyle change, which included education on diet, alcohol, smoking and exercise. The most frequently given advice was on diet and salt intake, with exercise being the least often information provided to the patients by medical professionals. Reduced salt intake advice was the most frequently reported (69%), followed by a balanced diet (51%), reduced alcohol intake (44%), not smoking (35%) and benefits of exercise (30%).Despite this most of the respondents were leading sedentary lifestyles, were overweight (BMI>25) and had BP`s greater than 140/90 mmHg . The reasons provided for not exercising varied from “not being used to it”, “no- time” to “body pain”. Twenty one percent (21%) were not on a proper diet due to financial reasons, 16% stated lack of information as the reason and 9% just found unhealthy food to be very tempting. CONCLUSION The results of this study suggest that although patients do receive advice on lifestyle modification, it is not effective in changing patient behavior, and may therefore be inadequate and not emphasized enough and also not all patients are advised by medical professionals about lifestyle change. The reason for this is not known. Greeff (2006) in his study emphasized that building a trusting relationship between the healthcare worker and the patient is one of the most important aspects when motivating patients. 2

Diabetes typ 2 är en endokrin sjukdom där insulinfrisättningen från pankreas betaceller är nedsatt, vilket leder till insulinresistens. Det är en tyst och smygande sjukdom som främst upptäcks när patienter har utvecklat komplikationer. De vanligaste komplikationerna är ögon, njure, fot och hjärt- och kärlsjukdomar. Ärftlighet, hög ålder, fysisk inaktivitet och fetma är vanliga orsaker till diabetes typ 2, vilket gör att livsstilsförändringar exempelvis ökad fysisk aktivitet, viktminskning och sunda matvanor är betydelsefullt vid behandlingen av sjukdomen. Aktuellt examensarbete syftar till att beskriva vuxna patienters upplevelser av livsstilsförändringar vid diabetes typ 2. Det bygger på en litteraturstudie bestående av åtta kvalitativa artiklar. Resultatet består av följande huvudteman, en förändrad tillvaro, känna sig åsidosatt och känna sig hälsosam. Dessa huvudteman är uppbyggda av fem subteman så som ”kroppen spelar roll”, ”en inre kamp för livsstilsförändringar”, ”behov av information”, patientens möte med sjukvården”, ”bryta gamla vanor” och ”upplevelser av livsstilsförändringar”. Resultatet visar att drabbas av diabetes typ 2 innebär förändringar i patientens vardag, vilket ger känslan av en förändrad tillvaro. Det framkommer i resultatet att patienterna får ett otillfredsställande möte med hälso- och sjukvårdspersonal, vilket leder till att de känner sig åsidosatta. Därtill får patienterna en bristfällig information om diabetes typ 2, vilket innebär att de erhåller en ofullständig upplysning om livsstilsförändringar och komplikationer. Slutligen upplevde patienterna livsstilsförändringar som nödvändiga men svåra och energikrävande. Slutsatsen tydliggör patienternas behov av stöd, undervisning och vägledning, vilket är bra att sjuksköterskan blir medvetet om.

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Background: In Sweden and Northern Europe, cardiovascular disease mortality rates are high. The clinical picture in the Western world is dominated by lifestyle diseases in which individual behavior and attitudes have a significant impact on the health effect. In the society cardiovascular disease is seen as an illness factor and contribution to disability. Conditions for a good life are not only good health also factors such as intimate relationships and meaningful work which affect the person's quality of life. Aim: Lifestyle changes and quality of life for patients, regarding cardiovascular disease. Method: A literature review was made. Eight articles, quantitative and qualitative were analyzed. The analysis revealed three themes and four subthemes. Results: Through interventions bodily- and behavioral change occurred, for example weightloss, better cholesterol- and bloodpressure levels and increased physical activity. Respondents also had better quality of life. Great importance was laid on education and information about different lifestyle changes. On the contrary, the nursing staff was careless with the documentation. Conclusion: Lifestyle changes such as smoking cessation, increased physical activity, reducing obesity and improving dietary habits and psychosocial factors such as reduced stress and depression, have a positive impact on the health of cardiovascular disease. Because these changes should not affect patients' quality of life, the nurse's communication and information are important. It's also important to combine good lifestyle changes with good quality of life, as adherence then is better. The nurse has to consider the patients whole life situation.

Objective: To determine if a prediabetes lifestyle intervention program, tailored to rural adults from Southwestern Ontario, could decrease the risk of Type 2 Diabetes (T2D) development through positive lifestyle changes. Methods: Forty-nine intervention participants and 34 controls partook in the study. At baseline individuals diagnosed with prediabetes chose the lifestyle intervention group (6 sessions) or control group (1 session). Intervention participants were provided with tailored education which promoted positive lifestyle changes known to help prevent or delay the development of T2D. Results: Lifestyle changes and long-term improvement of T2D modifiable risk factors were achieved by the intervention participants from baseline to post-program, unlike their control counterparts, such as increasing their average daily intake of vegetables and fruit servings (p<0.001) and reducing their fasting glycemia (p=0.003). Conclusion: Positive lifestyle changes through this 6-month tailored community-based intervention was successful in helping many rural adults with prediabetes prevent the development of T2D

Class of 2006 Abstract / Objectives: To determine if Polycystic Ovarian Syndrome (PCOS) patients treated with lifestyle changes and metformin resulted in ovulation after six months of treatment. Methods: A retrospective chart review of initial patient visits at an infertility clinic were obtained. Patients that were given a diagnosis of PCOS were further reviewed for age at initial diagnosis, weight, height, ovarian cysts, lifestyle recommendations (diet, exercise, and vitamin use), metformin recommendations and usage, and if ovulation occurred after six months of treatment. Results: A total of 1011 charts were reviewed. At the initial office visit, 206 (20.38%) of these patients were classified as having PCOS. Of PCOS patients, 113 (54.85%) patients ovulated after six months of treatment. In the average initial weight, ovulators averaged slightly less weight than did non-ovulators (171.77 pounds ± 44.26 vs. 188.65 pounds ± 51.37, p=0.0121). This also follows true for the initial BMI of ovulators vs. non-ovulators (29.53 kg/m2 ± 10.14 vs. 32.69 kg/m2 ± 13.03, p=0.0521). There was a significant difference in metformin use between ovulators and non-ovulators (90.27% vs. 73.12%, p=0.0024). More ovulators were found to continue metformin treatment as compared to non-ovulators. Conclusions: In this specific infertility clinic setting, 20.3% of patients were diagnosed with PCOS at the initial office visit. Of these PCOS patients, treatment with lifestyle changes and metformin use resulted in 55% of patients achieving ovulation at six months. This study shows that weight loss, through lifestyle modification and metformin treatment, increases this population’s chances of ovulation within six months of therapy.

Background: Hypertension is a global health problem that can lead to serious complications such as stroke and congestive heart failure. Nurses' work includes promoting lifestyle changes, motivating, compliance with medication, and providing regular follow-ups to improve blood pressure. More knowledge is needed on which working methods nurses use to promote health and support sustainable lifestyle changes. Aim: To illuminate the nurse's ways of working to promote health through lifestyle changes and self-care in persons with hypertension. Method: A literature review according to Friberg was chosen as the method. Database searches were carried out in CINAHL, PubMed and PsycInfo. Nine scientific articles were included after having been analysed, classified and compiled in an article matrix. Result: The analysis resulted in two main themes and five subthemes. The first theme was Creating change which described how the nurse responded to the patient's specific opportunities, expectations, knowledge needs and motivation for initiating lifestyle change. The second theme was Maintaining change which describes how the nurse guides, promotes and follows up the person to create a sustainable lifestyle change and an improved self-care strategy. Conclusion: The nurse's ways of working to promote health through lifestyle change and self-care in persons with hypertension can be designed in different ways. Regardless of which nursing philosophy lies behind it, it appears that a person-centred approach stimulates the person's motivation for a changed lifestyle through increased participation and responsibility. / Högt blodtryck och konsekvenser av detta är ett stort globalt problem. Livsstilsförändringar är en långsiktig investering i förbättrad hälsa för personer med högt blodtryck. På de flesta kliniker är detta sjuksköterskans arbetsuppgift och då det är viktigt att finna ett bra och fungerande arbetssätt och utgå från den pedagogiska skolning och den träning som behövs för detta. I sjuksköterskans omvårdnadsarbete är hälsa ett centralt begrepp. Sjuksköterskan skall främja hälsa och förhindra ohälsa genom att identifiera och bedöma personens resurser och förmåga till egenvård, delge kunskap, motivera och stödja. I kompetensbeskrivningen för sjuksköterskor tydliggörs även att sjuksköterskan skall bedriva sitt arbete med omsorg och respekt för integritet och värdighet och att sjuksköterskans kompetens och förmåga att tillvarata personens resurser är av betydelse. Utförandet av egenvård stödjs av Orems omvårdnadsteori som grundar sig i att personer skall kunna delta i sin egenvård i så stor utsträckning som möjligt och att personen kan behöva stöd av sjuksköterskan för att kunna göra det. Kunskap, egenansvar och motivation är viktiga byggstenar. Att personen blir delaktig i sin vård och behandling, erhåller kunskap och stöds i att kunna identifiera sin egenvårdsbrist och kapacitet och kan ta beslut för förändring är ett av målen i behandling av hypertoni. Detta är en utmaning för sjuksköterskan och därmed är det viktigt med bra och effektiva arbetssätt för detta finns. Enligt Socialstyrelsen (2018) önskar majoriteten att få diskutera sina levnadsvanor och få stöd till förändring utav dessa före farmakologisk behandling. Därför är det viktigt att sjuksköterskor arbetar med utbildning, rådgivning och uppföljning för att stödja livsstilsförändringar. Litteraturöversiktens resultat visar att sjuksköterskans arbetssätt med att främja livsstilsförändring och egenvård hos personer med hypertoni är en aktiv process som startar med att ge personerna de rätta förutsättningarna för att skapa en livsstilsförändring. Detta kan ske genom att individanpassa det pedagogiska mötet, vilket bygger på en kartläggning av personens tidigare kunskaper, erfarenheter och motivation. Sjuksköterskan kan därigenom möta, ge information och adekvat kunskap på rätt nivå. Motiverande samtal är en metod som stärker personens förmåga till att fatta egna beslut om livsstilsförändringar och egenvård med stöd av sjuksköterskan. Sjuksköterskans utbildningsnivå och bemötande ligger till grund för ett lyckat förändringsarbete. För att nå en mer hållbar förändring används empowerment som arbetssätt för att få personen aktiv i processen genom att känna ett egenansvar för både en kort- och långsiktig förändring.

The thesis set out to explore means of coping with change when in a state of isolation and basic parameters and references in life have been lost. Isolation may be a result of a change in environment, such as an interstate move to take up a new job,or changing from an office environment to home based work. It can result from relational changes such as marriage breakdown or from major life stage changes such as retirement. The first stage of the study involved the establishment of a collaborative group to explore issues that each member had experienced in coping with change. The second stage was an individual exploration of the author's own journey involving changes in work environments and interstate moves. The third stage was a consideration of literature that reflected and supported the thesis, of gathering information from relevant case studies conducted.Out of these stages came the hypothesis that people cope with change in isolation through a sense of belonging associated with several factors.Reflections on the research process and methodologies have been considered and implications arising out of the research are discussed. The thesis concludes with evocations of the impact of the research findings on others. / Master of Science (Hons)(Social Ecology)

Bakgrund: Anledningen till att människor söker sig till sjukvården beror ofta på deras hälsobeteende. De behöver göra en förändring, men vad är det som får människor att göra förändringar? Syfte: Syftet med studien var att beskriva på vilka sätt motiverande samtal (MI) varit en användbar metod för att främja livsstilsförändringar. Metod: Studien utfördes som en allmän litteraturstudie. Åtta empiriska studier ingick. Sammankopplingar gjordes med tre teorier som MI bygger på Bems självuppfattningsteori, Roger´s teori om "non-directive counselling" samt "The transteoreticial model of behavior change". Resultat: Sjuksköterskans användbarhet bestod i att använda sig av MI:s tekniker genom att lyssna aktivt, ställa öppna frågor samt att uppmuntra patienten till ett eget ansvar. Begränsningar ur sjuksköterskans perspektiv var svårigheter med nytt tänkande. Utvidgad utbildning och handledning i MI var viktigt vid implementeringen i verksamheterna. De studier som ingick visade i de flesta fall inte att MI som metod skulle vara effektivare än annan typ av rådgivning. Slutsats: I MI samtalet är det viktigt att sätta patienten i fokus, att hjälpa patienten att hitta motivationen samt självförtroende att genomföra förändringar. Vid implementeringen av MI är det viktigt med utbildning och handledning samt att praktik och teori går hand i hand. / Background: The reason of people visiting health care centers often depends on their health behavior. They often need to make a change. The aim of the study: The aim of the study was to describe in which way motivational interviewing has been successful to make lifestyle changes. Method: The study was carried out as a literature review. Associations were made with three of the theories which motivational interviewing is based upon: Bem’s "Self perception theory", Roger’s "Non-directive counseling theory" and "The transtheoretical model of behavior change". Result: The nurse made use of the MI techniques by actively listening, asking open questions and encouraging the patients to take their own responsibility. The limitations, from the nurse’s point of view were problems with the new way of thinking. Extended training and coaching in MI were important for the implementation activities. The studies included showed in most cases that MI as a method wasn´t more effective than any other type of counseling. Conclusion: In MI it´s crucial to put the focus on the patient, to help the patient find the motivation and confidence to make changes. For the implementation of MI it is important to include education, practice and coaching sessions.

Bakgrund: Diabetes är sjukdom som kan leda till sänkt livskvalitet och lidande för personen som drabbats men även till höga kostnader för samhället. Behandlingen kan bestå av en kombination av läkemedel och livsstilsförändringar, där sjuksköterskan stödjer vårdtagarna genom att undervisa och främja deras empowerment. Forskning visar att det är vanligt förekommande att personer med diabetes har låg följsamhet till sin behandling vilket kan leda till sämre blodsockerkontroll samt ökad risk för diabetesrelaterade komplikationer. Syfte: Syftet var att beskriva faktorer som påverkar följsamheten till behandling vid diabetes typ 2. Metod: En litteraturöversikt där tolv kvantitativa artiklar sammanställdes. Resultat: Högre ålder verkar vara en faktor som främjar följsamheten medan lägre ålder innebär lägre följsamhet. Vårdtagarens uppfattning om sjukdomen och behandlingen visade sig också påverka följsamheten. Personens förmåga att ta läkemedel påverkade följsamheten, där minnesproblematik framstår som ledande orsak till låg följsamhet. Socialt stöd och delaktighet i behandlingen samt patientundervisning är andra faktorer som främjar följsamheten. Slutsats: Litteraturstudien visar på faktorer som sjuksköterskan kan uppmärksamma för att identifiera personer som har risk för låg följsamhet och tidigt sätta in åtgärder. Undervisning och stöd är omvårdnadsåtgärder som skulle kunna påverka vårdtagarnas följsamhet positivt. / Background: Diabetes means lower quality of life amongst the ones that suffer from the disease and it also means high costs for society. The treatment consists of a combination of drugs and lifestyle changes where the nurse supports the patient by providing patient education and promoting empowerment. Research has shown that diabetes patients have a low adherence to treatment which may lead to poorer glucose control and an increased risk of diabetesrelated complications. Purpose: The purpose was to describe factors that contributes to non-adherence in persons that are treated for diabetes type 2. Method: A literature review where twelve quantitative articles where analyzed. Results: Older age seems to be a factor that contributes to adherence while younger age seems to predict non-adherence. The persons view and understanding of the disease and treatment seems to influence the adherence. The ability to take medication seems to be important, with memory problems as a leading cause for non-adherence. Social support, patient participation and patient education are other factors that promotes adherence. Conclusion: This literature review shows factors that can be used by the nurse to identify persons in risk of non-compliance and thereby take action early. The nurse’s measures, such as education and support, may have a positive impact on adherence to treatment.