Background: Over the last decade, diabetes health coaching, also referred to as diabetes coaching, has emerged as a patient-centered intervention to assist individuals with type 2 diabetes mellitus (T2DM) in acquiring independence with self-management. The structure and delivery of such interventions have varied greatly while showing improvements in glycemic control. However, literature continues to show a gap around the patient experience of receiving diabetes coaching support. Objective: To explore the perceived experience of receiving telephone-based diabetes health coaching among community-based adults with T2DM within the Canadian context. Methods: A qualitative exploration with an interpretive descriptive design was carried out. Participants from the intervention group of a larger randomized controlled trial who had received a telephone-based diabetes coaching intervention over one year were invited to participate in a telephone interview with open-ended questioning. Findings: A total of 12 participants were interviewed and four major themes were identified. (1) Adapting to life with T2DM reflects how coaching helped individuals to integrate diabetes into their lives by addressing misconceptions, providing knowledge, encouraging awareness, and easing transition onto insulin. (2) Heightened mindfulness of diabetes-related wellness captured the greater attention participants’ gave to their overall well-being and self-management behaviours. (3) Behaviour change guided by the participant highlights the differences in participants’ motivation, readiness to make changes, external factors that influenced their ability to make self-management behaviour changes. (4) Lastly, valuing a supportive relationship illustrates that participants felt the unique coach-client relationship was reliable, holistic, non-judgmental, and encouraging. Conclusion: Overall, participants found diabetes coaching to be positive and highlighted the various ways it was able to support their ability to more effectively self-manage their diabetes. / Thesis / Master of Science in Nursing (MSN)

The impetus for the recognition of the need for legal partners in healthcare came from Boston City Hospital in 1993. The hospital provided care to the largest uninsured and underinsured population in the New England states. The pediatric patients were noted by Dr. Barry Zuckerman to have difficulty in recovering from medical illnesses. He linked their inability to improve their health to poor housing, food insecurity, and basic social determinants of health. His hiring of a part-time lawyer led to a national movement for the development of medical-legal partnerships. The American Bar Association, the National Center for Medical-Legal Partnerships at George Washington University in Washington, DC and the American Academy of Pediatrics formed the first national medical-legal partnership in 2007. Joint resolutions were passed for members to become partners with the other professional colleagues to “address the legal and social issues affecting patient health and well-being.” The American Bar Association resolution led to the creation of the Medical-Legal Partnership Pro Bono Project. In 2015, the East Tennessee State University College of Nursing nurse-led community health center was awarded a small grant from the National Nurse Centers Consortium to participate in the development of a medical-legal partnership. The health center is staffed by Nurse Practitioners who provide health care for the underserved in northeast Tennessee. The patients are diverse and include homeless, migrants, residents of public housing, uninsured, and underinsured. Partnering with the Tennessee Justice Center in Nashville, Tennessee, the nurse-led medical legal partnership improved lives of pediatric patients, adults, pregnant women across the state, and advocacy rights for those who cannot speak for themselves.

No / The Silences Framework as a tool for exploring marginalised perspectives The Silences Framework was devised for use as a vehicle for exposing additional viewpoints in studies revolving around sensitive subjects and marginalised perspectives. Cyril’s presentation conveys the use of The Silences Framework in the provision of a nurse-led intervention for custodial community based ex-offenders. ‘Screaming Silences’ as exposed were located in the subjective experiences of ex-offenders known as the ‘listener’ and the social and personal context in which their experiences occurred. Crucially, The Silences Framework as used sought to acknowledge and redress the balance of power relating to ‘what and whose’ experience count in a research study. Epistemologically, the generation of knowledge using the framework necessitated an anti-essentialist perspective which was interpretive in nature. Thus, the intent was to arrive at what constitutes as truth from the lived experiences of the individuals researched. It is hoped that this presentation will facilitate understanding by unravelling the process of using The Silences Framework to underpin applied research and concurrently contribute to the wider use of the framework in research with other marginalised groups.

No

No / The current context of offender health in England and Wales indicates that the health needs of ex-offenders are significantly greater than those of the general population with a lack of equity existing between need and supply. The study presented herein is aimed at mapping the ex-offender health pathway towards identifying “touch points” in the community for the delivery of nurse-led interventions. The study was underpinned by the “Silences Framework” which enabled the study to gain theoretically by situating power with ex-offenders. A total of 26 respondents were ranked on the basis of poor health with those scoring the lowest and confirming their ranking through a confirmation of a health condition selected as cases and interviewed over the course of 6 months. These interview narratives were validated by interviewing individuals in the professional networks of ex-offenders and were analysed using the inductive qualitative thematic approach. The study uncovered that ex-offenders were not prepared in prison for the continuity in access to health care in the community on release. Ex-offender’s on-release preparation did not enquire as a matter of procedure on whether an offender was registered with a General Practitioner (GP) or had the agency to register self with a practice on release. Postrelease, the study uncovered a disparity between services, which address the physical health needs of ex-offenders and those which address their mental and substance misuse health needs. Finally, the study identified the site of postrelease supervision as the “touch point,” where a nurse-led intervention could be delivered.

No

Yes / This study was a qualitative case study underpinned by “The Silences Framework” aimed at mapping the ex-offender health pathway towards identifying “touch points” in the community for the delivery of a nurse-led intervention. Participants meeting the study inclusion criteria were quantitatively ranked based on poor health. Participants scoring the lowest and endorsing their ranking through a confirmation of a health condition were selected as cases and interviewed over 6 months. Individuals in the professional networks of offenders contextualized emergent themes. The study indicated that pre-release, offenders were not prepared in prison for the continuity in access to healthcare in the community. On release, reintegration preparation did not routinely enquire whether offenders were still registered with a general practitioner or had the agency to register self in the community. Participants identified the site of post-release supervision as the “touch point” where a nurse-led intervention could be delivered.

Syfte: Att testa den patientenkät som används i utvärdering av en leversjuksköterskemottagning på patienter med dekompenserad levercirros för att undersöka upplevelsen av att besvara frågorna samt frågornas relevans till patientens situation. Metod: Pilotstudiens metod var mixad. Resultat: Spridningen av deltagarnas upplevelse av oro/obehag av enkäten var stor (VAS 6-100 millimeter). Vid få sjukdomssymtom väcktes oro om framtida sjukdomsutveckling men vid längre tids sjukdom kändes samtliga symtom igen, tankar om tidigare beteende uppstod vid alkoholsorsakad sjukdom. En mindre spridning (VAS 66-92 millimeter) sågs gällande hur viktiga/väsentliga frågorna upplevdes. Frågor om bemötande ansågs viktiga och påverkade upplevelsen av rätten till vård. Kompletterande frågor om individuellt anpassad information samt upplevelsen av delaktighet vid information efterfrågades. Deltagarna visade hög uppskattning (VAS 73-95 millimeter) till att sjukdomen/situation uppmärksammades genom enkäten. Besöken till sjuksköterskan skiljde sig från läkarbesök. Sjuksköterskan fokuserade på egenvård och mer tid fanns för information. För en informant innebar försöksverksamheten ökade antal sjukhusbesök, samordning innebar för- och nackdelar. Vid symtom på fatigue och nedsatt koncentrationsförmåga upplevdes enkäten lång, tvådelad enkät efterfrågades. Vid lindrig sjukdom upplevdes enkäten inte ansträngande. Språket var enkelt att förstå och innehållet upplevdes relevant. De öppna frågeställningarna tillförde inte något för de tre informanterna. / Purpose: To test the patient questionnaire used in the evaluation of an intervention with nurse-led clinic for patients with decompensated liver cirrhosis to examine the experience of answering the questions as well as their relevance to the patient's situation. Method: The pilot study was conducted with a mixed method. Results: The variation of the participants' experience of anxiety/discomfort of the questionnaire was large (VAS 6-100 millimeters). Individuals with few disease symptoms had concerns about future development of the disease, in the case of long disease experience all the symptoms was familiar. Following alcohol induced disease thoughts of past behavior occurred. A smaller variation (VAS 66-92 millimeters) was seen regarding the experience of how important/essential the questions felt. Questions about treatment were considered important and affected the perception of care. Questions about individualized information was requested as well as the experience of participation in the exchange of information. The participants showed a high appreciation (VAS 73-95 millimeters) that the disease/situation was highlighted by the survey. The visits to the nurse differed from appointments to physicians. The nurse focused on self-care and more time was available for information. For one informant the intervention increased the total number of hospital visits, coordination meant advantages and disadvantages. Symptoms of fatigue and impaired concentration made the questionnaire experienced as too long, a two-parted questionnaire was requested, the size was not strain in mild disease. The language was easy to understand and the content perceived relevant. The open issues brought nothing for the three informants.

Bakgrund: Besöken på akutmottagningar för barn i Sverige ökar hela tiden. För att möta detta har allt fler sjukhus börjat använda sig av sjuksköterskebesök. Syfte: Att beskriva barnsjuksköterskans erfarenhet av att självständigt bedöma och behandla sjuka barn på en akutmottagning. Metod: En kvalitativ intervjustudie med induktivt förhållningssätt. Urvalet bestod av elva barnsjuksköterskor med erfarenhet av sjuksköterskebesök. Materialet analyserades med manifest innehållsanalys. Resultat: Barnsjuksköterskans erfarenhet av sjuksköterskebesök visade sig vara positiva. Hen ansåg att sjuksköterskebesök innebar att arbetet blev mer stimulerande och utvecklande. Barnsjuksköterskan hade en betydande uppgift i att barnen kom till rätt vårdnivå både för barnets bästa och för att verksamheten skulle fungera på ett bra sätt. Det fanns potential och vilja att utveckla sjuksköterskebesök på akutmottagning för barn. Slutsats: Sjuksköterskebesök är positivt för barnsjuksköterskan, för att det bidrar till att barnsjuksköterskan utvecklas i sin profession vilket i sin tur skapar arbetsglädje. På grund av sjuksköterskebesök kan barnen som inte är i behov av en läkarbedömning få hjälp snabbare vilket leder till kortare väntetider på akutmottagningarna. / Background: Visits in the Swedish emergency units for children are increasing. In order to meet this, more and more hospitals are using nurse-led consultations. Aim: The purpose of this study was to describe the pediatric nurse´s experience of independently assess and treat children in the emergency department for children. Method: A qualitative interview study with inductive approach. The sample consisted of eleven pediatric nurses with experience of nursing visits. The material was analyzed with manifest content analysis. Results: The pediatric nurse´s experience of nurse-led consultation turned out to be positive. He/she considered that nurse-led consultations meant that the work became more stimulating, interesting and developing. The pediatric nurse had a significant task in that the children reached the right level of care both for the child's best interests and the activities. There was potential and willingness to develop nurse-led consultations to the emergency department for children. Conclusion: Nursing visits are positive for the pediatric nurse, because they contribute to the pediatric nurse developing in her profession, which in turn creates job satisfaction. Due to nurse visits, children who do not need a medical assessment can get help more quickly, which leads to shorter waiting times in the emergency department. In addition, the business benefits as nurse visits are more cost-effective.

Hjärtsvikt är ett komplext syndrom som förekommer i alla åldrar och ökar hos den äldre befolkningen. Behandlingen och omhändertagandet av personer med hjärtsvikt har under de senaste decennierna strukturerats och förbättrats. Trots detta är hjärtsvikt associerat med ökat behov av sjukhusvård och höga sjukhuskostnader. Många personer med hjärtsvikt i Sverige är underbehandlade och når inte upp till den rekommenderade basbehandlingen. Det finns få hjärtsviktsmottagningar i primärvården, vilket är oroväckande. För att nå en effektiv behandling krävs patientens delaktighet, följsamhet och kunskap vilket möjliggörs med hjärtsviktsköterskans stödjande insatser. Samtidigt finns det lagar som förespråkar exempelvis patientens delaktighet, självbestämmande, tillgänglighet men även samverkan mellan olika aktörer, vilka är viktiga delar för ett strukturerat omhändertagande inom hjärtsviktsvården. Vidare visar forskning att personcentrerad vård främjar patientens delaktighet i sin vård och behandling samt minskar behovet av sjukhusinläggning och därmed sjukhuskostnader. Syftet var att belysa sjuksköterskors erfarenheter av att arbeta personcentrerat med personer med hjärtsvikt i primärvården. Metoden var kvalitativ och designen var en intervjustudie. Sju sjuksköterskor som arbetade i hjärtsviktsmottagning i primärvården rekryterades i denna studie. Sjuksköterskorna intervjuades utifrån en semistrukturerad intervjuguide. Intervjuerna analyserades med en manifest kvalitativ innehållsanalys och med en induktiv ansats. I resultatet identifierades sjuksköterskornas erfarenheter i fyra kategorier. Den första kategorin: ”Aspekter i mötet med patienten”, den andra kategorin: ” Patientens delaktighet”, den tredje kategorin: ” Personcentrerad vård som teamarbete” och den fjärde kategorin: ”Journalföringens betydelse för personcentrerad vård”. Först och främst var det viktigt att skapa en förtroenderelation med patienten i omvårdnadsarbetet. Sjuksköterskorna utgick från patientens berättelse för att identifiera patientens behov och resurser. Det var också viktigt att ha tillräckligt med tid avsatt till varje patient. Sjuksköterskorna betraktade patienten och dess anhöriga som partner i vården och tillsammans kom de överens om en gemensam vårdplan. För att öka patientens delaktighet i sin egenvård gav sjuksköterskorna egenvårdsinformation för att öka tryggheten och förbättra livskvaliteten. Sjuksköterskorna hade även nära samarbete med multidisciplinärt team för att tillgodose patientens komplexa behov. Det fanns dock olika journalsystem i primärvården och i hemsjukvården, vilket kunde försvåra kontinuiteten i vården. Slutsatsen blev att sjuksköterskorna ansåg sig arbeta på ett personcentrerat förhållningssätt vilket också belystes i denna studie. Detta tyder på att vården är på väg mot personcentrerad vård. Sjuksköterskorna främjade patientens delaktighet och arbetade i multidisciplinära team i syftet att tillgodose patientens komplexa behov och öka patientens trygghet, förbättra livskvalitet samt förebygga onödiga sjukhusinläggningar. / Heart failure is a complex syndrome that occurs in all ages and mostly increase in elderly population. The treatment and disposal of people with heart failure has been structured and improved in recent decades. Despite this, heart failure is associated with an increased need for hospital care and high hospital costs. Many people with heart failure in Sweden are under-treated and do not reach the recommended basic treatment. It is worrying that there are few heart failure office visits in primary care. In order to achieve effective treatment, the patient's involvement, compliance and knowledge are required, making it possible to support the heartfactor's supportive efforts. At the same time there are laws that advocate, for example, patient participation, self-determination, accessibility, but also interaction between different actors, which are important elements for structured care in heart failure. Furthermore, research shows that person-centered care promotes patient involvement in their care and treatment as well as reducing the need for hospitalization and thus hospital costs. The aim of this study was to illuminate nurses' experiences working person-centered with heart failure in primary care. The method used was qualitative and the design was an interview study. Seven nurses who worked in nurse-led heart failure clinics in primary care participated in the study. Nurses were interviewed, using a semi-structured interview guide. The interviews were analyzed by manifest content analysis and with an inductive approach. The nurses’ experiences were identified in four categories. The latter are respectively the following:” Aspects of the meeting with the patient", "Patient Participation", " Person-centred care as teamwork" and finally " " Importance of documentation in person-centred care". To start with, it was important to establish a relationship of trust in nursing work. Nurses went from the patient's story to identify the patient's needs and resources. Moreover, it was important to have enough time allocated for each patient. They considered the patient and his relative as a partner in the care and agreed on a joint care plan. In order to increase patient involvement in self-care, nurses provided self-care information to enhance safety and improve quality of life. Nurses worked closely with multidisciplinary teams to meet the patient's complex needs. However, there were different journal system in primary care and home healthcare, which could complicate continuity care process. The conclusion was that nurses consider utilizing a person-centered working care method; which was also illuminated in this study. This indicates that healthcare is heading towards person-centered care. Nurses promoted patient involvement and worked in multidisciplinary teams in order to meet the patient's complex needs, increase patient safety, improve quality of life and prevent unnecessary hospitalization.