Bakgrund  Övervikt karaktäriseras som ett BMI inom intervallet 25–30, och obesitas diagnosticeras vid ett BMI över 30. Enligt WHO är cirka 1,5 miljarder vuxna överviktiga och över 500 miljoner vuxna uppfyller kriterierna för obesitas. Tidigare forskning påvisar att stigmatisering av denna patientgrupp förekommer inom hälso- och sjukvård. Därmed finns behov av ytterligare forskning kring överviktiga och obesa patienters erfarenheter av viktrelaterad stigma inom hälso- och sjukvård. Syfte  Syftet var att beskriva överviktiga och obesa patienters upplevelse av viktstigma i mötet med Hälso- och sjukvård. Metod  Studien är utförd i form av en icke-systematisk litteraturöversikt. Resultatet baserades på 16 vetenskapliga originalartiklar. Samtliga artiklar hämtades från databaserna CINAHL och PubMed. Kvaliteten på de valda artiklarna granskades med hjälp av Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Vid analys och sammanställning av resultatet användes integrerad analys, vilket resulterade i tre huvudkategorier. Resultat  Resultatet belyste överviktiga och obesa patienter upplevelser av viktrelaterad stigmatisering inom hälso- och sjukvård. Tre huvudkategorier identifierades; Patienternas upplevelse av kommunikation, Patienternas upplevelse av påverkan på vårdkvalitet, samt Negativa känslor som konsekvens av viktstigma. Utifrån huvudkategorierna formulerades sex underkategorier; Kommunikationsbarriärer, Personcentrerat bemötande, Nedsättande bemötande, Felaktigt vårdfokus, samt Vårdbarriärer. Slutsats Denna studie visade på att överviktiga och obesa patienter upplever stigmatisering i mötet med hälso- och sjukvård, vilket kan leda till lidande och misstro inför sjukvården. Det framkom även att denna patientgrupp upplever att det finns en osäkerhet bland vårdpersonal kring hur viktfrågor ska tas upp med patienten. Då stigmatisering resulterar i ökad risk för vårdfel och försämrad hälsa inom denna patientgrupp, samt utgör hinder för att bedriva personcentrerad omvårdnad är det av vikt att ett förbättringsarbete sker inom detta område. / Background  Overweight is categorized as a BMI between 25-30, while obesity is diagnosed in patients with a BMI over 30. About 1.5 billion adults are overweight and over 500 million are obese. Studies show that this patient group experiences stigmatization when in contact with health care, and therefore further research of overweight and obese patient’s experiences of weight-related stigma in the health care system is needed. Aim  The aim of this study was to describe overweight and obese patients' experiences of weight-related stigma in the health care system. Method  The method used to conduct the study was a non-systematic literature review. The result was based on 16 scientific original articles. The articles have been obtained from the databases CINAHL and PubMed. The quality of the articles has been externally reviewed based on Sophiahemmet University's assessment basis for scientific classification and quality. The data was compiled and analysed through an integrated data analysis, which resulted in three main categories. Results  The results illustrated overweight and obese patients’ experiences of weight-related stigma in healthcare. Three main categories were identified: Patients' experiences of communication, Patients’ experiences of impact on quality of health care, and Negative emotions as a consequence of weight-related stigma. As subcategories six themes were identified: Communication barriers, Person-centred treatment, Derogatory treatment, Incorrect focus of care and Barriers to health care. Conclusions  This essay showed that there is stigma against this category of patients, which can lead to suffering and mistrust against the health care system among these patients. The study also showed that overweight and obese patients experience an uncertainty among health care providers about how weight related issues should be addressed with the patient. Because of the increased risk of care errors, as well as negative impact on health and person-centred care associated with weight-related stigma, this is an area in need of improvement.

Bakgrund: Anorexia nervosa är en svår ätstörning som kännetecknas av lågt BMI, rädsla inför viktuppgång samt ångestproblematik. Sjukdomen orsakar stort lidande för både patienten själv och anhöriga. I dagsläget saknas tillräckligt med forskning kring upplevelse och behandling. Sjukdomen är komplicerad och sjuksköterskan har en viktig roll i omvårdnaden för dessa patienter och behöver därmed bred kunskap om bemötandet av dessa. Syfte: Syftet med studien var att beskriva vårdupplevelser inom slutenvården för patienter med anorexia nervosa. Metod: Studien baserades på 12 vetenskapliga artiklar med kvalitativ ansats som togs fram ur databaserna PubMed och CINAHL. Artiklarna granskades och analyserades av författarna för att besvara studiens syfte. Genom Högskolan i Gävles kvalitativa granskningsmall relevansbedömdes artiklarna. Materialet analyserades och resulterade i tre huvudteman: Upplevelser av sjukdom, upplevelser av vårdmiljön och upplevelser av vårdrelationen. Huvudresultat: Patienterna beskrev upplevelser av att vårdas med anorexia nervosa på en slutenvårdsavdelning och hur sjukdomen påverkade deras upplevelser. Patienterna beskrev ett behov av att ses som en helhet och att sjuksköterskorna hade ett individanpassat förhållningssätt. Vårdrelationen hade stor betydelse för patienternas upplevelse och behandling och genom ökad kunskap kunde sjuksköterskorna förbättra vårdupplevelsen. Slutsats: Studien visade att upplevelsen av slutenvårdsbehandling varierade från fall till fall och det behövdes ett individanpassat förhållningssätt av sjuksköterskan vid behandling av dessa patienter. Att skapa en god relation var en grundsten för omvårdnaden av patienter med anorexia nervosa. Genom ökad förståelse och kunskap hos sjuksköterskan kunde patienternas vårdupplevelse inom slutenvården förbättras. / Background: Anorexia nervosa is a severe eating disorder characterized by low BMI, fear of weight gain and anxiety problems. The disease causes great suffering for both the patient itself and relatives. Currently, there is a lack of sufficient research on experience and treatment. The disease is complicated and the nurse has an important role in the care of these patients and therefore needs a broad knowledge of how to respond to these patients. Aim: The aim of this study was to describe patient´s experiences of being treated for anorexia nervosa in an inpatient ward. Method: The study was based on 12 scientific articles with qualitative approaches that were extracted from the databases PubMed and CINAHL. The articles were reviewed and analyzed by the authors. Through the University of Gävle's qualitative review template, the articles were assessed for relevance. The material was analyzed and resulted in three main themes: Experiences of illness, experiences of care environment and experiences of care relationships. Main results: The patients described the experience of being treated with anorexia nervosa in an inpatient ward and how the experience was affected by their disease. The patients described a need to be seen as a whole and that the nurses had an individual approach. The care relationship was of great importance to the patients' experience and treatment, and through increased knowledge the nurses were able to improve the experience. Conclusions: The study showed that the experience of inpatient treatment varied from case to case and that an individually tailored approach by the nurse is needed when treating these patients. Creating a good relationship is a cornerstone of nursing care for patients with anorexia nervosa. Through increased understanding and knowledge by the nurse, patients' experience of inpatient care can be improved.

SAMMANFATTNING   Bakgrund: En ökad belastning har beskrivits på Sveriges akutmottagningar. Tidigare forskning beskriver missnöje bland både vårdpersonal och patienter på grund av den komplexa miljön på akutmottagningar. Patienters perspektiv behövs för att utveckla verksamheten.  Syfte: Studiens syfte är att beskriva patienters upplevelse av att vistas på en akutmottagning. Metod: Deskriptiv litteraturstudie med en kvalitativ ansats. De databaser som har använts i denna studie för att hitta samtliga artiklar var Cinahl och PubMed.  Resultat: Tre huvudteman framgick ur resultaten; kommunikation, information och negativa känslor. Subteman innefattade ett respektfullt bemötande, att förstå-, bli sedd och hörd, interaktion, information och väntetider, information och delaktighet i vårdprocessen, kontinuerlig information och respons, förlorad integritet, smärta och obehag, att känna sig övergiven samt rädsla och ångest. Inom dessa teman beskrev patienterna sina förväntningar, behov och känslor. Slutsats: Resultaten stämmer överens med vad som beskrivits i tidigare forskning. Den teoretiska referensramen, KASAM, kunde användas för att förstå vad som kan påverka patienternas upplevelser.  Nyckelord: akutmottagning, information, kommunikation, känslor, patientupplevelse / ABSTRACT Background: An increased workload has been described in Sweden's emergency departments. Previous research describes dissatisfaction among both healthcare professionals and patients due to the complex environment of the emergency department. The patient's perspective is needed to develop the organization.  Aim: The purpose of the study is to describe patients' experience of their visit in an emergency department.   Method: A descriptive literature study with a qualitative approach. The databases that have been used in this study were Cinahl and PubMed. Results: Three main themes emerged from the results; communication, information and negative emotions. The subtheme included: respectful treatment, understanding, being seen and heard, interaction, information and waiting times, information and participation in the care process, continuous information and response, lost privacy, pain and discomfort, feeling abandoned and fear and anxiety. Within these themes, the patients described their expectations, needs and feelings. Conclusion: The results are in line with what has been described in previous research. The KASAM theoretical frame of reference could be used to understand what can influence patients' experiences. Keywords: communication, emergency care, emotions, information, patient experience

Background: Good pain relief can reduce suffering, decrease the prevalence of postoperativecomplications and shorten the hospital stay. The nurse has an important responsibility toevaluate and meet the patient's need for pain relief. There exists several shortages regarding how this is managed today and a need for development of the organization as well as pain reliefin practice. Investigation of patients' experiences of post-operative pain and pain relief can increase the understanding of what it means to have pain and what factors are considered important for good postoperative pain relief. The frame of reference for this article is Katie Eriksson's theory about human suffering.  Aim: The aim was to describe patients' experiences of post-operative pain and pain relief. Method: The study was a qualitative literature study with ten original articles found via PubMed and CINAHL. A content analysis was used. The quality control was performed in accordance to SBU:s form for quality in original articles by qualitative methodology. The content analysis was implemented using the methodology by Forsberg and Wengström. Result: Patients who were sufficiently informed both verbally and by writing experienced better control over the pain. Lacking information and prior experiences of side effects loweredthe expectations of pain relief. The expectations were also influenced by the patient'supbringing and environment. Healthcare personnel who took responsibility and had goodpersonal treatment increased the feeling of safety. Factors that worsened the pain relief and the experience of pain were difficulties in describing the pain, lack of information, stressfulworking conditions for the personnel, side effects of the medicines and a willingness to meet the expectations of the healthcare personnel. Conclusion: Pain is an individual experience and pain relief is a complex field. There existsseveral factors that promote respectively exacerbate the experience of pain and pain relief. The factors show the significance of nurses´ responsiveness and to work in partnership with thepatient. It also indicates a need for change regarding the high workload and lack of routines inpain relief care. Keywords: Pain relief, patient experience, postoperative pain.

De-restricted 15/11/2013

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

Introduktion: Patienter med psykisk sjukdom har ett ökat vårdbehov på grund av ökad risk för samsjuklighet. Detta gör att de är en patientgrupp vårdpersonal möter i alla delar av vården. Forskning visar att vårdpersonal kan känna en rädsla för patienter med psykisk sjukdom samt se dem som oförutsägbara.  Syfte: Syftet med litteraturöversikten är att undersöka hur personer med psykisk sjukdom upplever bemötande från vårdpersonal inom hälso- och sjukvården. Metod: Allmän litteraturöversikt baserad på tolv kvalitativa originalartiklar. Litteratursökning genomfördes i databaserna PsycInfo, PubMed samt CINAHL.  Resultat: Resultatet indelades i följande kategorier: Att inte bli trodd på, att bli bemött med ointresse, brist på respekt för patientens delaktighet och att inte bli lyssnad på. Personerna med psykisk sjukdom upplevde att vid många tillfällen att de inte blev tagna på allvar vilket skapade osäkerhet och självstigmatisering. Detta resulterade i att de var mindre benägna att söka vård. Deltagarna i studierna upplevde att de fick sämre bemötande, blev inte trodda på samt fick vänta längre på vård på grund av sin psykiska sjukdom. Positiva upplevelser av bemötande uttrycktes när patienterna haft en kontinuerlig vårdkontakt samt blivit bemötta med empati. Slutsatser: För att personer med psykisk sjukdom ska få ett gott bemötande krävs det att de känner sig prioriterade, blir lyssnade och trodda på samt känner sig delaktiga i sin vård. Den psykiska sjukdomen ska tas i beaktande dock inte överskugga andra problem och sjukdomar. Sjuksköterskor bör få utökad klinisk och teoretisk praktik inom ämnet psykiatri för att minska rädsla och fördomar och därmed främja ett bättre bemötande. / Introduction: Patients with mental illness have an increased need for care due to an increased risk of co-morbidity. This means that they are a patient group that health professionals meet in all parts of care. Research shows that healthcare professionals can feel a fear of patients with mental illness and see them as unpredictable. Aim: The purpose of this literature review is to investigate how people with mental illness experience encounters with healthcare professionals. Method: General literature review based on twelve qualitative original articles. A literature search was carried out in the databases PsycInfo, PubMed and CINAHL.  Results: The result was divided into the following categories: Not being believed, to be met with disinterest, lack of respect for patient participation and not being listened to. The persons with mental illness experienced on many occasions that they were not taken seriously, which created insecurity and self-stigmatization. This resulted them being less likely to seek care. The participants in the studies felt that they were categorized because of their mental illness, received worse treatment and had to wait longer for care because of this. It was perceived that healthcare professionals believed that patients with mental illness lied. Positive experiences of treatment were expressed by the patients when they had continuous care contact and were treated with empathy. Conclusion: In order for persons with mental illness to receive good treatment, it is necessary for them to feel prioritized, to be listened to and believed in, and to feel involved in their care. Categorization of patients with mental illnesses should be avoided. Nurses should receive increased clinical and theoretical practice in the subject of psychiatry to reduce fear and prejudice to promote better encounters with patients.

SAMMANFATTNING Bakgrund Synen på hbtq+-individer (homo-, bi-, trans, queer +) och rättigheterna runt omkring har inte alltid varit vad det är idag. Det ansågs vara kriminellt att ha en samkönad partner fram till 1944 och att vara homosexuell ansågs vara en sinnessjukdom fram till 1979. Stigmatisering och diskriminerning av hbtq+-individer har länge varit ett problem i samhället och bidragit till ohälsa. Detta leder till att hbtq+-individer avstår från att söka nödvändig vård.  Syfte Syftet med denna litteraturstudie var att beskriva hbtq+ -individers upplevelser av bemötandet i vården.  Metod  Detta är en litteraturöversikt baserad på 12 originalartiklar med kvalitativ ansats. Artiklarna söktes efter i Cinahl, Psykinfo och PubMed och kvalitetsgranskades med hjälp av en mall för kvalitativa studier från SBU som sedan analyserades tematiskt. Den teoretiska referensramen som använts är Ida Jane Orlandos interaktionsteori.  Resultat Fem kategorier och 11 subkategorier identifierades som beskrev hbtq+-individers upplevelser av vården från: Avslöjande, Vårdpersonalens kommunikation, Upplevelsen av kunskap hos vårdpersonal, Diskriminering och Vårdmiljö.  Slutsats Mötet mellan vårdpersonal och hbtq+-individer var präglat av antagande, heteronormativitet och okunskap kring ämnet. Däremot fanns det vårdpersonal och kliniker som hade ett inkluderande språk och hbtq+-individerna upplevde vårdmiljön som en fristad tack vare detta.  Nyckelord Hbtq+, omvårdnad, patientupplevelser, sjukvård, upplevelser / ABSTRACT Introduction The view of lgbtq+ individuals (lesbian, gay, bisexual, transgender, queer +) and their rights has not always been what it is today. Having a same-sex partner was considered as a crime until 1944 and being homosexual was considered a mental illness until 1979. Stigma and discrimination against lgbtq+ individuals has over a long time been a problem in the society and contributed to ill health. This leads to lgbtq+ individuals refraining from pursuing necessary care.  Aim The purpose of this literature study was to describe lgbtq+ individuals’ experiences of treatment in health care services.  Method This is a literature review based on 12 original articles with a qualitative approach. The articles were searched for in Cinahl, Psykinfo and PubMed and was quality reviewed using a template for qualitative studies from SBU, which then was analyzed thematically. The theoretical framework that was used was Ida Jane Orlando's interaction theory.  Results Five categories and 11 sub-categories were identified that described the lgbtq+ individuals’ experiences of healthcare from: Disclosure, Healthcare staffs communication, Perceived knowledge of healthcare staff, Discrimination and Healthcare environment.  Conclusion The encounter between healthcare professionals and lgbtq+ individuals was characterized by assumptions, heteronormativity and the lack of knowledge. However, there were health care professionals and clinics that had an inclusive language and then the lgbtq+ individuals experienced the healthcare environment as a sanctuary thanks to this.  Keywords Experiences, healthcare, lgbtq+, nursing, patient experience

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor och patientgruppen bröstcanceröverlevare blir allt större till följd av moderna forskningsframsteg. Då fler kvinnor får chansen att leva ett långt liv efter sin diagnos har livskvalitet blivit ett centralt begrepp och en bibehållen livskvalitet har blivit ett viktigt mål. Forskning har visat att livskvaliteten kan påverkas av att ha överlevt bröstcancer och sjuksköterskor uttrycker svårigheter att tillgodose patientgruppens behov efter avslutad behandling. Syfte: Syftet med litteraturöversikten var att beskriva kvinnors upplevelser av livskvalitet efter att ha överlevt bröstcancer. Metod: En litteraturöversikt med deskriptiv kvalitativ design som baserats på tio kvalitativa vetenskapliga originalartiklar hämtade från PubMed och CINAHL. Resultat: Fyra kategorier med tillhörande subkategorier identifierades: fysisk påverkan, psykisk påverkan, social påverkan och personlig utveckling. Fysisk påverkan beskrev hur den sexuella hälsan, fysiska symtom samt sömn och fatigue inverkade på livskvaliteten. Psykisk påverkan beskrev hur bröstcanceröverlevares livskvalitet påverkades i förhållande till kroppsbild, känsloliv och kognitiv förmåga. Social påverkan beskrev hur livskvaliteten påverkades genom relationer, arbetsliv och ekonomi. Personlig utveckling beskrev hur bröstcanceröverlevarna till följd av upplevelsen fått nytt perspektiv och hur detta påverkade livskvaliteten.  Slutsats: Kvinnor hade olika upplevelser av livskvalitet efter att ha överlevt bröstcancer. Försämrad livskvalitet visade sig orsakas av biverkningar efter behandling och av den existentiella oron som en livshotande sjukdom kan innebära. Vissa bröstcanceröverlevare fick ett nytt perspektiv där tacksamhet, tillfredsställelse och meningsfullhet präglade upplevelsen vilket påverkade livskvaliteten positivt. Sjuksköterskans roll och hälsofrämjande insatser i förhållande till patientgruppens behov visade sig spela en central roll under rehabilitering. / Background: Breast cancer is the most common form of cancer in women and the group breast cancer survivors is growing as modern research advances. Quality of life has become a central concept and an important goal due to the fact that more women get the chance to live a long life after their diagnosis. Research has shown that quality of life can be affected by having survived breast cancer and nurses express difficulties in meeting the needs of these patients after completed treatment. Aim: The aim of the literature review was to describe women's experience of quality of life after surviving breast cancer.   Method: A literature review with descriptive qualitative design based on ten qualitative scientific original articles from PubMed and CINAHL.  Result: Four categories with associated subcategories were identified: physical impact, psychological impact, social impact and personal development. Physical impact described how sexual health, physical symptoms and fatigue affected the quality of life of breast cancer survivors. Psychological impact described how quality of life was affected by body image, emotional life and cognitive ability. Social impact described how the quality of life was affected by relationships, work life and financial position. Personal development described how breast cancer survivors gained a new perspective as a result of the experience and how this had a positive effect on their quality of life. Conclusion: Women had different experiences of quality of life after surviving breast cancer. Reduced quality of life was found to be caused by side effects after treatment and by the existential anxiety that a life-threatening disease can entail. Some breast cancer survivors obtained a new perspective of life, where gratitude, satisfaction and meaningfulness defined the experience and therefore improved their quality of life. The nurse’s role and health-promoting interventions proved to play a key role during breast cancer rehabilitation.

Background: In today's healthcare, it is common for patients to be treated with other patients in a shared room. Patients' experience of being cared for in a shared room can be experienced differently from individual to individual. Purpose: The purpose of this literature review is to investigate patients’ experience of being cared for in a shared room. Method: Literature study with qualitative studies and quantitative studies from the databases CINAHL and PubMed. Results: The result is based on 13 studies with qualitative and quantitative methods. After reviewing all the articles, it resulted in three themes, “Privacy, Well-being and Environment”. The patients had a positive experience with the shared room as it brought a community between the patients in the ward, it created an opportunity to find comfort and think about something other than their health condition. High noise level, impaired sleep, room structure with limited access to windows were perceived as something negative for the patients' experience of being cared for in a shared room. The patients also felt that their integrity and dignity were not respected to the same extent in a shared room. Conclusion: Patients' experiences of being cared for in a shared room can differ greatly. In order for nurses to be able to adapt the care, when it is possible, to each individual patient's needs, it is important to know which factors are decisive for the patients' health. The care environment is of great importance for the psychosocial environment, shared room can both increase well-being but can also give a negative experience for the patient.