Yes / & aims Parenteral nutrition (PN) provides nourishment and hydration as an intravenous infusion to patients with intestinal failure (IF). The aim of the study is to generate theory that explains the experiences of adult patients living with home parenteral nutrition (HPN) and complex medication regimens. Methods A grounded theory methodology was used to explore the experiences of twelve patients receiving HPN. A semi-structured interview was conducted and recorded in each participant's home setting. Each interview was transcribed verbatim. The simultaneous process of data collection and analysis was followed reflecting the principles of the constant comparative approach. Results A total of 15 patients gave written consent, with 12 of them agreeing to be interviewed. All the participants had previously undergone surgery as a result of chronic ill health or sudden illness. Analysis revealed two core categories: stoma and HPN, and these were supported by the subcategories: maintaining stoma output, access to toilets, managing dietary changes, maintaining the HPN infusion routine, access to technical help to set up an HPN infusion, mobility with HPN equipment and general health changes. The strategy of living with loss was demonstrated by all the participants, and this was supported by the action strategies of maintaining daily activities and social interactions. Conclusions This study generates new understanding and insight into the views and experiences of patients receiving HPN in the UK. The findings from these participants have been shown to resonate with the Kubler-Ross Model [1] of the five stages of grief. The theory of living with loss was generated by the use of a grounded theory methodology. This small scale exploratory study reveals opportunities for improvements in practice to be considered by the nutrition support team (NST) and other healthcare professionals involved in the patient's hospital stay prior to discharge on HPN.

Forskning visar på att patienter önskar kontinuitet, då de upplever att det bidrar till känslan av trygghet och närhet. Det ger sjuksköterskan möjlighet att lära känna personen och en möjlighet att bättre följa upp gjorda åtgärder. Syfte Syftet med denna studie var att beskriva vilka faktorer som har samband med patientens upplevelse av kontinuitet i vården. Metod Studien har genomförts som en litteraturstudie. Resultat Resultatet visade att det var viktigt för kontinuiteten att de fick träffa en sjuksköterska som de kände sedan tidigare och att det var samma sjuksköterska vid alla vårdtillfällen. Det var även viktigt att sjuksköterskan de träffade var uppdaterad på deras medicinska historia. En viktig faktor som höjde kontinuiteten var om patienten hade en kronisk sjukdom, då de patienterna oftare kräver regelbunden uppföljning med fler besök hos vården. Patienterna upplevde större kontinuitet om vården utfördes av sjuksköterska istället för av andra vårdgivare Sjuksköterskorna var mer anpassningsbara, flexibla och tog sig mer tid med patienten. Slutsats Studien visar att kontinuitet är något som patienter upplever som viktigt när de möter vården men det saknas forskning om hur vården ska organiseras, för att kontinuiteten ska upplevas bättre ur ett patientperspektiv, balanserat mot organisationens behov av att spara tid och pengar. / Research shows that patients wants continuity, as they feel it adds to the feeling of security and closeness That it gives the nurse the opportunity to get to know the person and an opportunity to better follow up actions. Aim The aim of this study was to investigate the factors that influence patient perception of continuity of care. Method This study was conducted as a literature review. Result The results showed that it was important for the continuity that they got to meet a nurse they knew from before, and it was the same nurse at every appointment. It was also important that who they met, was up to date on their medical history. An important factor that increased continuity was if the patient has a chronic disease, which increases the need to require regular follow-up with more visits to health care. Patients experienced greater flexibility of care performed by a nurse instead of a doctor, the nurses took more time with the patient and that it was more effective. Conclusion The study shows that continuity is important when patients recieve care, but there is no research about how care should be organized, for continuity to be perceived better from a patient perspective, balanced against the needs of the organization to save time and money.

Background: It is valuable that the patients experience a good encounter with the nurse at the emergency department. There are several factors that can influence the encounter and the patients' perception of the nurses and the surroundings at the emergency department. To not be seen as the person you are or not treated well, is a common reason why patients feel health suffering. It is the patients' experience of the circumstances which determines whether situations cause health suffering or not. Aim: The aim of this study was to describe patients' experiences of the encounter with the nurse at the emergency department. Method: The method used in this study was a literature review, based on qualitative studies. Ten articles were analyzed according to Friberg's (2012) qualitative content analyze in five steps. Results: The researchers found five themes that specifically stood out when studies were researched. The themes were feelings of: participation, being seen, abandonment, being dependent and vulnerability. Conclusion: The experience of the encounter with the nurse at the emergency department differ from each patient. All patients want to meet a nurse who characterises kindness and warmth. The nurses are the ones who can control the outcome of the encounter at the emergency department.

Bakgrund: Bröstcancer är den vanligaste typen av cancer hos kvinnor och med hjälp av mammografi screeningar kan cancern hittas i ett tidigt skede. En annan anledning till att söka sjukvård är om kvinnorna känner något ovanligt i bröstet. För att diagnostisera bröstcancer används diagnostikmetoden trippeldiagnostik som består av mammografi och ultraljud med eventuell biopsi. Under kvinnans gång, från att misstänka bröstcancer, genom undersökningarna till och med de får sin diagnos uppkommer olika känslor. Syfte: Syftet med denna litteraturstudie var att belysa kvinnors upplevelser i samband med trippeldiagnostiken vid misstänkt bröstcancer. Metod: Åtta vetenskapliga artiklar hittades via databassökningar inom CINAHL och Scopus, samt manuella sökningar. Dessa artiklar granskades och analyserades för att besvara syftet. Resultat: Utifrån analyser av de åtta artiklar redovisas med tre kategorier och sex underkategorier. Kategorierna var ”Kommunikationen vid undersökningstillfället”, ”Upplevelser av undersökningarna” och ”Väntan på besked”. Konklusion: Att misstänka bröstcancer upplevdes skrämmande, oroväckande och ångestfylld. Känslorna följer kvinnorna hela vägen till och med de får sin diagnos. Med hjälp av litteraturstudien ”Den värsta tiden i mitt liv…” kan röntgensjuksköterskor få en inblick i hur kvinnor upplever de olika momenten inför sin diagnos och kan därmed informera, bemöta och undersöka kvinnorna på ett respektfullt och professionellt sätt. / Background: Breast cancer is one of the most common cancer diseases for women. With the help of regular participation of mammography screening there is a high rate of finding breast cancer in an early state. Another way to find breast cancer is when women feel something abnormal in their breast, for example a lump. To diagnose breast cancer you use examinations such as mammography and ultrasound with possible biopsy sample, these examinations are called triple diagnosis. Through the experience of suspecting breast cancer, during the breast examinations until the moment women get their diagnosis different feelings arise. Aim: The aim of this literature study was to elucidate women's lived experience during the triple diagnosis of suspected breast cancer disease. Method: Eight scientific articles were found through database searching on the databases CINAHL and Scopus. Manual search were also made. The search and analyzing were made to fulfill the purpose of this literature study. Results: The eight analyzed articles were summed up to three categories and six subcategories. These categories were “Communication at the time of the examination”, “Examination-experience” and “In the process of waiting for results”. Conclusions: Women who suspect having breast cancer experienced the feelings of fear, worry and anxiety throughout the whole process until diagnosis. The literature study “The worst time of my life…” gives X-ray nurses an insight of women‘s lived experiences of the examinations through their time of suspected breast cancer. With this insight x-ray nurses learn to inform, examine and meet their patients professionally and with respect.

Bakgrund: Ren intermittent katetrisering (RIK) är en åtgärd som utförs dagligen på ett flertal patienter inom sjukvården, där sjukvårdspersonal tränger innanför patientens integritetssfär. Patienter har olika personliga gränser för när den personliga integriteten hotas och deras upplevelse vid RIK postoperativt, är sparsamt belyst i tidigare forskning.  Syfte: Att beskriva patienters upplevelse av ren intermittent kateterisering postoperativt. Metod: Datainsamlingen genomfördes med semistrukturerade intervjuer där tretton patienter som kateteriserats postoperativt deltog. Data analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visade att patienterna upplevde vårdpersonalen som kompetenta och de förlitade sig på att vårdpersonalen visste vad som var bäst för patienterna som också kände sig omhändertagna. Det upplevdes vara viktigt att bevara den personliga integriteten och de påtalade vikten av tillräckligt insynsskydd vid kateteriseringen vilket inte alltid varit tillfyllest. Patienterna uttryckte också rädsla dels för smärta i samband med kateteriseringen och dels för att de trodde att det var något fel eftersom de inte kunde urinera. Några beskrev det som en lättnad att få hjälp att tömma blåsan, medan andra kände sig utlämnade och upplevde det som att de inte hade något val. Majoriteten av patienterna hade inte fått/kom inte ihåg att de fått adekvat information om att kateterisering kunde komma att behövas postoperativt och de påtalade vikten av att detta gavs innan operationen. Slutsats: Vårdpersonalens bemötande av patienter som behöver genomgå RIK är av största vikt för patientens upplevelse av vårdsituationen. Vikten av att information ges, som är adekvat och lättförståelig, poängteras. Det är en fördel om patienten görs delaktig i sin vård och att hänsyn även tas till speciella önskemål, som t.ex. kön på den som utför kateteriseringen. / Background: Clean intermittent catheterization is an action that is performed daily on several patients in health care, where health care staff penetrates inside the patients privacy sphere. Patients’ have different personal limits when privacy is threatened and research with focus on the patients experience of clean intermittent catheterization postoperatively is limited. Aim: To describe patients’ experience of clean intermittent catheterization postoperatively. Method: Data collection was conducted by using semi-structured interviews with thirteen patients that had been catheterized postoperatively. Data were analysed using qualitative content analysis. Result: The result showed that patients’ experienced health care staff as competent and they relied on that the medical staff knew what was best for the patients who also felt cared for. It felt to be important to preserve privacy and they stressed the importance of sufficient transparency protection during catheterization which had not always been satisfactory. The patients’ expressed fear partly for pain associated with catheterization and partly because they thought there was something wrong since they were unable to urinate. Some described it as a relief to get help emptying the bladder, while others felt vulnerable and felt that they had no choice. The majority of patients’ had not got or could not remember if they had received adequate information that catheterization could be needed postoperatively and they emphasized importance of that this information was given before surgery. Conclusion: Health care staff treatment of patient’s requiring clean intermittent catheterisation is crucial for the patient's experience of the care situation. The importance that the information given is adequate and understandable was emphasized. It is an advantage if the patient is involved in care and that consideration to special requests, such as that the gender of the person performing catheterisation is considered.

This thesis explores treatment satisfaction and dissatisfaction in patients with chronic low back pain (CLBP). Chapters 1 and 2 provide background on CLBP, and treatment satisfaction and dissatisfaction. Chapter 3 presents study 1, the systematic review which identified research concerning treatment satisfaction and dissatisfaction in patients with CLBP. Findings indicated a need to define the concept, and establish appropriate measurement based on patient input and evidence to support the reliability and validity of items. Chapter 4 presents study 2, a qualitative study. Ten patients with CLBP taking medication and/or receiving physiotherapy were interviewed. A conceptual model of CLBP and a thematic map of treatment satisfaction and dissatisfaction were developed. Satisfaction was related to being 'happy' or 'pleased', and maintaining normal functioning. Treatment not working, causing discomfort, or negatively affecting health-related quality of life, as well as inconvenience of medication, lack of information, not feeling involved in treatment decisions, lack of trust and confidence in healthcare professionals, and being misdiagnosed or undiagnosed, were associated with dissatisfaction. Chapter 5 documents the development of the CLBP Treatment Satisfaction Questionnaire, based on patient input from study 2. Cognitive debriefing showed items were relevant and understood by patients. Chapter 6, study 3, explored the psychometric properties of the questionnaire. The longitudinal design involved data collection from 249 patients, some of whom participated in follow-ups. Results indicated that treatment satisfaction/dissatisfaction involves an appraisal of the following seven domains: 'Information Provided about Back Pain and Treatment', 'Burden of Back Pain', 'Impact of Back Pain and Treatment on Relationships', 'Satisfaction with the Treatment Process', 'Problems with Side Effects of Medication', 'Adherence to Physiotherapy', and 'Medication Acceptability'. Some evidence of reliability and validity are presented. This thesis concludes with Chapter 7, a discussion of the main findings of the studies, strengths and limitations, and recommendations for future research.

Bakgrund: Depression är ett av nutidens vanligaste folkhälsoproblem och kommer att bli: desto vanligare i framtiden. Personer som lider av depression söker sig vanligtvis till den allmänna sjukvården innan de remitteras till specialpsykiatrisk vård. Den vårdpersonal som i första hand bemöter dessa patienter är sjuksköterskan, vilkas ansvar medför stora krav på kunskap patientbemötande samt god kännedom om hur det är att leva med depression. Syfte: Syftet var att beskriva patientens upplevelser av att leva med depression Metod: Litteraturöversikten baseras på tio vetenskapliga kvalitativa artiklar Resultat: Det identifierades tre huvudteman (som benämns perioder) med åtta underteman gällande upplevelser av depression. Dessa tre perioder är: Individens upplevelse i början av sjukdomsperioden, Upplevelsen i mitten av sjukdomsperioden, och Upplevelse i slutet av sjukdomsperioden Under den första perioden hade patienterna bristande insikt om sina upplevelser och vad dessa kan beror på. Den andra perioden karakteriseras av fler känsloupplevelser såsom smärta och lidande samt känslor av skuld och skam. Den tredje perioden visar stigmatiseringens påverkan, som kan beror på fördomar och uteslutande attityder från omgivningen. Diskussion: Diskussionen utgår från Husserls livsvärldsteori med fokus på sjuksköterskans omvårdnad. / Background: Depression is one of the most common health problems and is increasing. People suffering from depression typically consult primary health care before being referred to specialized psychiatric care. In these cases, the initial patient-healthcare contact is between patient and nurse. This entails significant responsibility on behalf of nurses to treat patients with competence and understanding. Nurses must possess extensive knowledge of what it is like to suffer from depression. Aim: The aim was to describe patients who live with depression and their experiences with the depression Method: The literature review is based on ten scientific articles of qualitative design Results: Three main themes, here in referred to as periods, were identified on the basis of the results. These themes consist of eight subthemes. The three main periods are the individual's experience during the early stages of illness; the experience in the middle of a period of illness; and the experience at the end of the period of illness. During the first period, the patients were ignorant of the nature of their experiences. In the second period they had further emotional experiences, such as pain and suffering and feelings of guilt and shame. The third period involves the effects of stigmatization, which arose due to prejudice and exclusion by others Discussion: The discussion was based on Husserl's life-world theory with a focus on nursing care.

Bakgrund: Stroke är en folksjukdom som drabbar cirka 20 000-25 000 personer i Sverige varje år och leder till syrebrist i hjärnan. De symtom som uppkommer vid en stroke varierar beroende på vilken del av hjärnan som skadas Tiden från första symtom tills att behandling sätts in har en stor inverkan på hur allvarliga skador det blir. De vanligaste symtomen är domning eller förlamning och en lång rehabilitering väntar oftast. Syfte: Syftet med denna litteraturstudie var att beskriva personers upplevelser efter att ha drabbats av en stroke samt att beskriva undersökningsgrupperna i de valda artiklarna. Metod: En beskrivande litteraturstudie som baseras på tolv kvalitativa vetenskapliga artiklar. Databaserna Cinahl och Medline via PubMed användes för att söka artiklarna, via högskolan i Gävle. Huvudresultat: I resultatet presenteras personers upplevelser efter en stroke utifrån deras fysiska och psykiska hälsa, samt det sociala livet. Funktionsnedsättningar var den vanligaste fysiska förändringen i livet som fick dessa personer att uppleva en psykisk påfrestning, bland annat depression, rädsla och förändrad självbild. Det sociala nätverket påverkas genom isolering på grund av den fysiska funktionsnedsättningen och den psykiska påfrestningen. Totala antalet deltagare i studien var 184 personer vars erfarenheter och upplevelser studerades, 53,3% var män och 46,7% var kvinnor. Slutsats: Alla personer som drabbats av en stroke upplevde någon form av förändring i det dagliga livet. Därför krävs det att vårdpersonalen har kunskap om hur olika individer hanterar denna livsförändring. Det kunde vara allt från fysiska, psykiska och sociala förändringar. Stödhjälp ansågs varit en viktig del under rehabiliteringsprocessen för dessa personer. / Background: Stroke is a widespread disease in Sweden and it affects approximately 20 000-25 000 persons every year and it leads to oxygen deprivation in the brain. The symptoms that are caused by a stroke very depending on which part of the brain that is damaged. The time between the first symptoms of a Stroke and the first treatment of the disease is another major reason of how serious the damage becomes. The most common symptoms are numbness or paralysis and a long time of rehabilitation waits for the person that suffers from a stroke. Aim: To describe people´s experience after having suffered a stroke and to describe the included articles study-group.. Method: A descriptive literature study based on twelve qualitative scientific articles. The databases Cihnal and PubMed was used to search the articles, through the University of Gävle. Results: People's experiences after a stroke based on their physical and mental health, their social life are being presented in the results. Movement disabilities was the most common physical change in people’s life and also the reason why people experienced psychological distress such as depression, fear and a different view of themselves. Their social network is affected because of their physical movement disabilities and psychological distress. The total amount of people participating in the study was 184 persons whose experiences were studied, 53, 3% were men and 46, 7 % were women. Conclusion: Every person who suffered from a stroke experienced some kind of change in their daily life. Therefore, it requires that health professionals have the knowledge of how individuals manage this life-changing. It could be anything from physical, psychological to social changes in their lives. Supportive help for the affected people has been an important part of the rehabilitation process.

Bakgrund: Psykisk ohälsa betraktas idag som ett folkhälsoproblem. Patienter med psykisk ohälsa lider ofta av samsjuklighet och vårdas därför ofta inom somatisk vård. Vårdvetenskapen förespråkar ett helhetsperspektiv på människan där kropp och själ samverkar och den ena delen aldrig kan uteslutas. Vid psykisk ohälsa kan lyhördhet i vårdrelationen vara avgörande. Sjukvårdspersonal upplever dock att de saknar kunskap i att vårda patienter med psykisk ohälsa. Syfte: Syftet var att belysa patienters upplevelser av att vårdas inom somatisk sjukvård i samband med psykisk ohälsa. Metod: Litteraturöversikt genomfördes med tio vetenskapliga artiklar, åtta med kvalitativ design och två med kvantitativ design. Artiklarna analyserades enligt Fribergs (2012) metod för litteraturöversikt. Resultat: Sex huvudteman identifierades: upplevelser av att möta sjukvårdspersonal, att känna sig förstådd, att vårdgivaren följer upp, att få vara delaktig, hinder för vård och trygghet. Diskussion: Utifrån Erikssons teori om vårdrelation och lidandet diskuteras resultatet. Kunskapsbrist kring psykisk ohälsa skapar osäkerhet hos sjukvårdspersonalen och lidande för patienten. Betydelsen av att se hela människan diskuteras. / Background: Mental illness is nowadays considered a public health problem. Patients with mental illness often suffer co-morbidity and are therefore often cared for within somatic care. According to caring science the holistic perspective of the human with both body and soul is advocated where one part can never be excluded. Sensitivity in the caring relationship can be crucial for a patient suffering from mental illness. However, health personnel themselves experience a lack of knowledge caring for patients with mental illness. Aim: The aim of the literature review was to illustrate patients´ experiences of being cared for within somatic care in conjunction with mental illness. Method: Literature review including ten scientific articles was implemented, eight with a qualitative design and two with a quantitative design. The articles were analyzed according to Friberg’s (2012) method for literature review. Results: Six main themes were identified: experiences of meeting health personnel, experiences of being understood, follow-up by the caregiver, experiences of being involved, experiences of barriers for care and security. Discussion: The result is discussed according to Eriksson's theory of the caring relationship and suffering. Lack of knowledge within mental illness creates insecurity among health personnel and also creates suffering for the patient. The importance of seeing to the human as a whole is discussed.

Coronary artery bypass graft (CABG) är en väl etablerad behandling för patienter med kranskärlssjukdom. Operationen är utmanande och påfrestande för patienten och upplevelserna efter genomgången operation är varierade. Att som sjuksköterska ha kännedom om patienters upplevelser tiden efter operationen är av betydelse för att möjliggöra god omvårdnad och återhämtning för patienten. Syftet var att belysa patienters upplevelser tiden efter en CABG. Studien grundades på 11 vetenskapliga artiklar och genomfördes som en litteraturstudie. Fyra teman framkom i resultatet; den relationella upplevelsen, den kroppsliga upplevelsen, den mentala skörheten och en ny syn på livet. Det framkom att patienterna upplevde stödet från omgivningen som det viktigaste för god återhämtning. Information från vårdpersonalen ansågs till viss del bristfällig av patienterna. Flera upplevde smärta efter operationen och hade delvis symtom kvar, men dessa avtog med tiden. Centralt efter operationen var även oro, men med tiden kom förbättrad livskvalitet och motivation. Det framkom att en CABG var en stor påfrestning för patienten och upplevelserna var både positiva och negativa. Kunskapsluckor avseende patientupplevelser efter operationen finns och ytterligare forskning bör fokusera på området för att ge sjuksköterskestudenter och sjuksköterskor ökad kunskap i mötet med denna patientgrupp. / Coronary artery bypass graft (CABG) is a well-established treatment for patients with coronary artery disease. The surgery is challenging and stressful for the patient and experiences varied after surgery. It’s important for the nurse to be aware of patients’ experiences after surgery to enable good care and recovery for the patient. The aim was to illuminate patients’ experiences during the time after a CABG. The study was based on 11 scientific articles and was conducted as a literature review. Four themes emerged; the relational experience, the bodily experience, the mental fragility and a new view on life. The result showed that patients' experienced the support from the surroundings as the most important for good recovery. Information given by caregivers were in some cases considered inadequate by the patients. Patients experienced pain after surgery and had partial symptoms left, which subsided with time. Concern was a central experience after surgery, but over time came improved quality of life and motivation. A CABG is a major strain for the patients and the experiences were both positive and negative. There are gaps in knowledge regarding patient experiences after the surgery and further research should focus on that area to give nursing students and nurses knowledge in the meeting with these patients.