Bakgrund: Sverige tar emot många asylsökande vilket har medfört att arbetsbelastningen för distriktssköterskor inom primärvården har ökat. Några av de svårigheter som distriktssköterskan ställs inför när det gäller omvårdnaden och omhändertagandet kring asylsökande är bland annat, att bemöta dem med vänlighet och respekt och att försöka lindra deras lidande. Syfte: Syftet med studien var att beskriva asylsökandes upplevelser av bemötande från distriktssköterskor och övrig vårdpersonal på en flyktinghälsa och vårdcentral. Metod:Kvalitativ design med en induktiv ansats valdes till denna studie. Semistrukturerade intervjuer utfördes med hjälp av professionell telefontolk med 12 asylsökande. Materialet analyserades med kvalitativ innehållsanalys med fokus på det latenta innehållet. Resultat: Bemötande har många dimensioner som kan ge upphov till många olika känslor. Asylsökande har i vårdmötet upplevt bemötande som orsakat dem otrygghet och vårdlidande men även bemötande som har gett dem trygghet och känslan av att vara betydelsefulla som människor. Slutsats: Upplevelser kring varje vårdmöte är individuella och unika. Vårdlidande kan uppstå genom att asylsökande upplever otrygghet i det vårdande mötet. Om asylsökande däremot upplever trygghet i vårdmötet kan deras lidande lindras. / Background: Sweden receives many asylum seekers which implies that the workload of district nurses in primary care has increased. Some of the difficulties that the district nurse face when it comes to the nursing care and the specific care of asylum seekers is, among other things, to treat them with kindness and respect and to try to lessen their suffering. Purpose: The purpose of this study was to describe the asylum seekers' experiences of nurse-patient encounters with the district nurses and other health professionals at a refugee health clinic and health center. Method: Qualitative design with an inductive approach was chosen for this study. Semi-structured interviews were conducted with the help of professional telephone interpreters’ with 12 asylum seekers. The material was analyzed using qualitative content analysis focusing the latent content. Results: Treatment (nurse-patient encounters) have many dimensions that can cause many different feelings. Asylum seekers have in the health care encounter experienced treatment that caused them a sence of insecurity and suffering due to care but also the nursing staffs’ attitude has given them increased confidence and a feeling of being an important person. Conclusion: Experiences of each nurse-patient encounter is individual and unique. Care suffering can be caused by that asylum seekers are experiencing a sence of insecurity in the encounter with health care. But if they experience security in the encounter with health care staff, their suffering lessened.

Swedish health care is currently facing problems, such as lack of financial resources, staff shortage and dissatisfaction among patients and professionals. Patients’ dissatisfaction was the point of departure for the present study, and one approach dealing with this problem was investigated. It was hypothesised that a patient-centred perspective could offer a possible solution. The aim of the study was to explore health care professionals’ and medical students’ understanding of their professional role and the patient encounter. A further goal was to determine whether these understandings could be developed by educational interventions. Students and professionals have been either interviewed or responded to a survey about their professional role and the patient encounter. Qualitative analysis was used. One group- and one individualised intervention were carried out. The participants’ understandings of their professional role were taken as the starting point for learning. The results showed that a minority of medical students and professionals in diabetes care had incorporated a patient-centred perspective. Nurses in telephone advisory services recognised the patients’ needs, but experienced conflicting demands of being both carer and gatekeeper. A non-optimal match between patients’ needs and what professionals understand as their role could cause some of the problems. Competence development could be achieved by taking the participants understanding of the professionals’ role and of the patient encounter as a starting point for reflection. The results have implications for changes in organisation and education in health care, to optimise outcomes of care. Time for reflection, mentoring and professional development is needed.

Patients' use of medicines is widely recognised as sub-optimal with a high proportion of patients with a long-term condition not taking their medicines as prescribed. Research and policy guidance emphasise the importance of partnership within the patient-prescriber encounter in enhancing patients' use of medicines. There is however considerable evidence that this is not usually achieved by medical prescribers, limiting the extent to which shared decision-making occurs about prescribed medicines. There is a general assumption that nurse prescribers, who within the United Kingdom have comparable prescribing rights to medical doctors, demonstrate greater abilities in collaborative working with patients leading to an enhanced use of medicines. Research evidence is however limited, particularly in relation to the ways in which patients' use of medicines is discussed and negotiated within the patient-nurse prescriber encounter. This study focused on the management of patients' use of medicines within the patient-nurse prescriber encounter. Seven nurse prescribers, working within a number of clinical specialities in both primary and secondary care settings, were recruited to the study together with their patients who were living with one or more long-term conditions (n=21). Data collection involved the non-participant observation of out-patient consultations to examine the management of patients' use of medicines within the encounter and semi-structured interviews with both patients and prescribers. Discourse analysis was undertaken to examine underpinning assumptions, views and beliefs regarding the management of patients' use of medicines. Asymmetry was evident within the encounters with prescribers controlling the agenda for discussion and interrupting patients' attempts to demonstrate their knowledge. Patient accounts of the moral approach adopted in managing their condition in the context of their everyday lives were also ignored. Biomedical and contrasting moral discourses are examined. An interpretive framework derived from the work of Michel Foucault is used to explain the operation of disciplinary, pastoral and bio-political power within the encounter and the extent to which subjugation of patients' knowledge and resistance were evident. Foucault's concept of technologies of the self is examined to explore its potential application in enhancing patients' medicines use.

The purpose of this study was to explore nurse-patient encounters from the perspective of the Home Healthcare Registered Nurse. A qualitative descriptive design was used to collect data from a purposive sample of 20 home healthcare registered nurses from Connecticut, Massachusetts, and Rhode Island currently or previously employed as a home healthcare nurse. Four themes and one interconnecting theme emerged from the data: Objective Language; Navigating the Unknown; Mitigating Risk; Looking for Reciprocality in the Encounter; and the interconnecting theme of Acknowledging Not All Nurse-Patient Encounters Go Well. One goal of the study was to propose an empirically informed definition of what constituted a difficult encounter. An important early finding was that the terms difficult patient and difficult encounter were not generally used by study participants. HHC RNs voiced a preference for objective and nonjudgmental language to communicate outcomes of nurse-patient encounters. Three types of HHC RN-patient interactions emerged from the data, with constructive encounters the norm and non-constructive or destructive encounters less frequent. A constructive encounter is when two or more human beings, the nurse on the one side, and the patient, caregiver, or both on the other, interact to achieve a mutually agreed upon outcome. A nonconstructive encounter is when one or more human beings obstruct efforts to achieve at least one positive outcome. A destructive encounter is when one or more human beings direct anger at or physically aggress toward another human being. Strategies to promote reciprocality are routinely employed during HHC RN-patient encounters, but HHC RNs who miss cues that a strategy is ineffective or failed may be at risk in the home. Study data lend support to key concepts, assumptions, and propositions of Travelbee’s (1971) Human-to-Human Relationship Model. Study results provide a foundation for further research to increase the understanding, recognition, and development of empirically derived responses to non-constructive or destructive encounters such that HHC RNs are safe and best able to meet patients’ healthcare needs.