Under 2022 gjordes nästan 1,8 miljoner besök på akutmottagningar i Sverige, fördelat på 68 olika sjukhus. De vanligaste sökorsakerna var buksmärta, extremitetsskador och bröstsmärta och bakom dessa sökorsaker finns många olika diagnoser. Syftet med studien var att beskriva patienters och anhörigas upplevelser av och åsikter om akutmottagningar. Metoden som användes var en netnografisk innehållsanalys. I studien samlades text och sifferbetyg från publika onlinerecensioner av Sveriges största sjukhus in. Dessa sjukhus står tillsammans för mer än en femtedel av akutbesöken i landet årligen.  Resultatet visar på att de som skriver onlinerecensioner av akutsjukvård är en polariserad grupp och att över hälften (56,8%) har en negativ upplevelse av akutmottagningar. Resultatetpresenteras i sju kategorier av upplevelser och åsikter om akutmottagningar. Kategorierna är upplevelser av personalens bemötande, behov av information, upplevelser av väntetider, behov av smärtlindring, upplevelser av arbetssätt och den fysiska miljön, systemkritiska åsikter och olika upplevelser och åsikter om vad som är akut. Slutsatsen är att de som skriver onlinerecensioner av akutsjukvård i den här studien är mer negativt inställda jämfört med respondenter i andra studier. Delar av resultatet och de upplevelser och åsikter som förekommer i flera av kategorierna får stöd av tidigare studier. Den här studien har dock identifierat kategorier som berör vårdkontexten. Dessa kategorier saknas ofta i studier där man använt sig av intervjuer och enkäter. / Almost 1,8 million visits were registered at 68 different emergency wards in Sweden 2022. The most frequent reasons were stomach pain, injuries to extremities and chest pain. There is a great variance in the underlying diagnoses. The purpose of this study was to describe patients and their relatives’ experiences and opinions of emergency care wards. The method used was a netnographic content analysis. Patient online reviews was collected from the five largest hospitals in Sweden. They account for more than a fifth of all emergency care. The result shows that those who write online reviews of emergency care is a polarised group, with more than 50 percent holds a negative view of the emergency ward. The result is divided into seven categories which includes experiences and opinions of the emergency wards. The categories concerns staff attitudes, access to information, waiting times, pain relief, work processes and the physical environment, political opinions and different views on what constitutes an emergency. The conclusions are that those who write online reviews of emergency care tend to hold more negative opinions on the received care compared with respondents in other studies. Parts of the results and the opinions and experiences described in this study occurs in several other studies. Furthermore, this study has identified that some of the opinions regarding political opinions rarely occur in other studies.

Bakgrund Psykisk ohälsa är en betydande utmaning för folkhälsan globalt. Elektrokonvulsiv terapi (ECT) är en väl etablerad behandlingsmetod inom psykiatrin och har visat sig vara en mycket effektiv metod mot flera psykiska sjukdomar. Trots detta fortsätter den att vara mycket kontroversiell och missförstådd. Det förekommer att patientens och familjemedlemmarnas acceptans av ECT påverkas av hur vårdpersonal presenterar behandlingen. Sjuksköterskors kunskap om och inställning till ECT kan alltså ha en direkt påverkan på patienternas val av behandling. Syfte Syftet var att belysa patienters erfarenheter av att genomgå ECT. Metod För att besvara syftet har en har icke systematisk litteraturöversikt använts som studiedesign. Sökningarna gjordes i fritext, i databaserna Public Medline och PsycINFO. De tio artiklarna granskades därefter i enlighet med Sophiahemmet Högskolas bedömningsunderlag. För att strukturera redovisningen av resultaten gjordes en integrerad analys där olika kategorier identifierades och sammanfattade resultaten i de olika artiklarna. Resultat Många patienter kände stark rädsla inför ECT-behandlingen. Deras upplevelser påverkades ofta av tidigare exponering för dramatiska representationer av ECT i filmer och media. Stöd från nära och kära ansågs vara avgörande för hur behandling upplevdes. I flera studier framställdes ECT som en effektiv och livräddande behandling. Patienternas tidigare kunskap och attityder gentemot ECT påverkade deras beslut att samtycka till behandlingen. Dessutom upplevde många patienter att processen att skaffa information var komplex och varierande. Slutsats Litteraturöversikten visar att patienters erfarenheter av ECT kan variera. Påverkande faktorer var mängden stöd och information de hade fått samt deras tidigare kunskap och fördomar. De som hade fått information och stöd var ofta nöjdare med behandlingen. Många deltagare uttryckte rädsla för biverkningar och flera återberättade hur ECT hade räddat deras liv. / Background Mental disorders represent a significant public health concern globally. Electroconvulsive therapy (ECT) is a well-established treatment method in psychiatry and has proven to be a highly effective for several psychiatric disorders. Nevertheless, it remains to be controversial and misunderstood. It is recognized that patients and family members acceptance of ECT is often influenced by how healthcare professionals present the treatment. Therefore, nurses’ knowledge and attitudes toward ECT can directly impact patients’ treatment choices. Aim The aim was to illuminate patients' experiences of undergoing ECT. Method To address the purpose, a non-systematic literature review was used as the study design. Searches were conducted using free text in the databases Public Medline and PsycINFO. The ten articles were then reviewed according to the assessment criteria of Sophiahemmet University. To structure the presentation of the results, an integrated analysis was conducted, identifying different categories and summarizing the findings from the various articles. Results Many patients experienced strong fear before undergoing ECT treatment. Their experiences were often influenced by prior exposure to dramatic representations of ECT in movies and media. Support from loved ones was considered crucial to the experience of treatment. In several studies, ECT was portrayed as an effective and life-saving treatment. Patients’ prior knowledge and attitudes toward ECT influenced their decisions to consent to treatment. Additionally, many patients found the process of obtaining information to be complex and varied. Conclusions The literature review demonstrates that patients experience of ECT can vary. Influential factors included the amount of support and information they had received, as well as their prior knowledge and prejudices. Those who had received information and support were often more satisfied with the treatment. Many participants expressed fear of side effects, and several recounted how the treatment had saved their lives.

Bakgrund: Samsjuklighet förekommer ofta hos personer med psykisk sjukdom. Det är vanligt att de behöver hjälp inom den somatiska vården. Trots att psykisk sjukdom är utbrett i samhället är detta tillstånd fortfarande behäftat med stigma. En form av stigmatisering är diagnostisk överskuggning, vilket innebär att fysiska symptom felaktigt tolkas som symptom på den psykiska sjukdomen. Detta leder till underdiagnostisering och felbehandling. Stigma kan internaliseras och leda till självanklagelser och undvikande av kontakt med till exempel sjukvården. Syfte: Syftet var att undersöka hur personer med psykisk sjukdom upplever den somatiska sjukvården. Metod: En litteraturöversikt innehållande tolv vetenskapliga artiklar; tio kvalitativa samt två kvantitativa. Resultat: Fyra huvudteman utkristalliserades: ”Att inte bli tagen på allvar”, ”Längtan efter någon som lyssnar”, ”Självanklagelser och skam” samt ”Upplevelser av barriärer”. Diskussion: Resultatet diskuterades mot Erikssons omvårdnadsteori och Nordenfelts teori om värdighet samt mot konsensusbegreppen människa, hälsa och miljö. Det mest framträdande temat var upplevelsen av att inte bli tagen på allvar. Patienterna kände att vårdpersonalen viftade bort deras upplevelser och tolkade att de fysiska symptomen gick att härleda till den psykiska sjukdomen. Detta är exempel på stigma i handling, en företeelse som bidrar till minskad värdighet och vårdlidande hos patienten. / Background: Medical comorbidity is common in people with mental illness. There is still a strong stigma attached to mental illness. One of these could be diagnostic shadowing, a process where health professionals wrongly presume that physical symptoms are consequences of the patient´s mental illness. Diagnostic overshadowing can lead to underdiagnosis and mistreatment of the physical condition. Stigma and self-discrimination could also prevent people with mental illness from seeking treatment. Aim: The aim was to investigate how people with mental illness experience somatic health care. Method: A literature review was conducted which included twelve articles: ten with qualitative design and two with quantitative design. Results: Four main themes emerged: "Experience of not being taken seriously", "Longing for someone who listens", "Self-discrimination and shame" and "Experiences of barriers". Discussion: The results was discussed in relation to Eriksson's nursing theory, Nordenfelt theory of dignity and the consensus concepts of person, health and environment. The most distinct and common theme was the experience of not being taken seriously. The health professionals did not listen to the patients and assumed that the physical symptoms were consequences of the mental illness. This is stigma in action and it contributes to suffering and affects the patient’s sense of dignity.

Syftet med studien var att undersöka och beskriva patienters upplevelse av telerehabilitering, närmare bestämt fysioterapeutisk intervention genom distanskontakt via videolänk. Den valda metoden var en kvalitativ litteraturstudie. Studiernas evidens graderades med metod beskriven av SBU. En beskrivande innehållsanalys av de inkluderade studiernas resultat gjordes, enligt anvisningar av Friberg. Som resultat framträdde ett övergripande tema med fem kategorier. Temat var Videomöte en möjlighet när den utgår från individens behov. Kategorierna var: Kompetent och erfaren fysioterapeut tillgänglig, Behandling tillgänglig i hemmet, Egen resursökning ger ökad empowerment, Relationer på distans, Teknisk utrustning. Slutsatsen visar att både positiva och negativa upplevelser finns beskrivna. Telerehabilitering möjliggör en professionell behandling där patientens empowerment kan öka. Individuellt anpassat stöd är viktigt, både vad det gäller den fysioterapeutiska behandlingen och hur tekniken används. Teknik som fallerar kan ge en negativ upplevelse. Telerehabilitatering har begränsningar både i fysioterapeutens möjligheter till undersökning och begränsningar i vad som syns på videon. Det är viktigt att ta hänsyn till aspekter gällande personlig integritet. / The aim of this study was to explore and describe patients experiences of telerehabilitation, more specific physical therapy modalities by distance in real-time video communication. The chosen method was performing a qualitative literature study. The studies were graded regarding evidens with a method described by Swedish Agency for Health Technology Assessment and Assessment of Social Services. A descriptive content analysis of the included studies result was performed, according to instructions by Friberg. In the result one theme with five underlying categories emerged. The theme was: Videomeeting is a possibility when it takes ground from the individuals needs. The five categories were: Competent and experienced physical therapist is available, Treatment available at home, Increased personal resources leads to increased empowerment, Relations at distance, Technical equipment. Conclusion shows that both positive and negative experiences are described. Telerehabilitation can make it possible to give a professional treatment where the patients empowerment may increase. Individual support is important, both according to the physical therapy modality and to the usage of technology. Technology that fails can give a negative experience. Telerehabilitation has its limitations both in the physiotherapist’s possibilities for examination and in what is visible in the video. It is important to take notice to personal integrity aspects.

<p></p><p>Studies have shown that patients receiving mechanical ventilation in an intensive care unit (ICU), who are entirely dependent on the nursing staff, often experience frustration due to a temporary loss of the voice source. Limited communication is an important factor contributing to patient discomfort. Nursing staff also report communication as frustrating and difficult.</p><p>The aim of the present study is to introduce a neck-type electrolarynx as a communication aid in an ICU, to study the nursing staff experiences of communication with tracheotomized patients receiving mechanical ventilation, and to examine the patient´s experiences regarding communicative abilities. Communication between a ventilator treated, tracheotomized patient and members of the nursing staff was recorded and analyzed according to principles of Conversation Analysis (CA).</p><p>The results show that several members of the nursing staff experience difficulties communicating with tracheotomized patients receiving mechanical ventilation. A majority believe that the conditions for communication could be improved. The results of CA also indicate that an electrolarynx may be an effective and appropriate communication aid for ventilator treated, tracheostomized patients. Further research is needed to broaden the knowledge of<strong> </strong>the electrolarynx as a communication aid for these patients.</p><p>Keywords: communication, mechanical ventilation, electrolarynx, patient experience, nursing staff experience, Conversation Analysis (CA).</p>

The overall aim of this thesis was to describe experiences of emergency treatment among people injured in traffic accidents, and to test and evaluate the effects of follow-up telephone calls from a nurse during the subsequent phase. The thesis is based on four sub-studies of motorists, bicyclists, and pedestrians who had fallen in traffic during the years 2002-2005. The participants were aged 18 to 70 years old and had minor (MAIS 1) or nonminor (MAIS 2+) injuries. Sub-study I was a qualitative study in which individual narrative interviews were conducted with nine persons who had sustained traffic injuries. The aim of this study was to describe the injured individuals’ experiences of pre-hospital and hospital care and subsequent rehabilitation. The interviews were analysed using content analysis, and the experiences of the interviewees were formulated into four themes: facing commotion, experiencing trust and security, lacking security and support, and struggling to return to everyday life. The results showed that a sensitive caregiver who provides comprehensible information facilitates both the emergency treatment and the subsequent period of care and rehabilitation. Sub-study II was a cross-sectional study in which the participants (n=565) estimated their perceptions of the quality of care in the accident and emergency department (A&amp;E) after an injury event. The Mini-KUPP (“Quality from the Patient’s Perspective”) questionnaire was used to estimate quality of care at the A&amp;E. The questionnaire was posted to the subjects’ home addresses three weeks after the visit to the A&amp;E. The results showed that the quality of care was scored on the top half of the scale by all three road user categories. In a multiple logistic regression analysis, significant connections emerged between good quality of care and a short waiting time, non-minor injuries (MAIS2+), higher age, and higher levels of education. The factor most closely associated with the perception of good quality of care was a short waiting time. Sub-study III was a stratified and randomised intervention study including 568 injured persons. In addition to modern trauma care, the intervention group received follow-up via telephone, three weeks after the injury, by a nurse who provided advice and support during the rehabilitation period. The control group received modern trauma care but no follow-up. Both groups estimated their health-related quality of life two weeks (baseline) and six months after the injury. After six months, estimates of health-related quality of life were generally higher in the intervention group than in the control group. A sub-group analysis found that the differences were most pronounced for the group who had received adequate advice in connection with the telephone follow-up. Of the three road user categories, the motorists gained the greatest benefit from the telephone intervention, with milder problems with regard to pains/difficulties and essential activities. Sub study IV was a health economic study. The calculations were built on the results from study III (n=568). A cost utility analysis was performed, including the costs for the intervention and the QALYs gained. The results showed that the telephone intervention was cost-effective. The total gain in the intervention group was 2.60 QALYs, while the car occupants gained 1.54 QALYs. The cost per QALY gained was 16 000 SEK overall and 8 500 SEK for car occupants. Conclusion: A sensitive caregiver who also provides good information can instil security and trust in the patient. For the purposes of generally improving the quality of care in an A&amp;E, the aim above all should be a short waiting time, but the treatment of minor injuries should also be improved. Access to a supportive nurse who is able to provide advice during the subsequent phase has the potential to improve health-related quality of life in a cost-effective way.

 Studies have shown that patients receiving mechanical ventilation in an intensive care unit (ICU), who are entirely dependent on the nursing staff, often experience frustration due to a temporary loss of the voice source. Limited communication is an important factor contributing to patient discomfort. Nursing staff also report communication as frustrating and difficult. The aim of the present study is to introduce a neck-type electrolarynx as a communication aid in an ICU, to study the nursing staff experiences of communication with tracheotomized patients receiving mechanical ventilation, and to examine the patient´s experiences regarding communicative abilities. Communication between a ventilator treated, tracheotomized patient and members of the nursing staff was recorded and analyzed according to principles of Conversation Analysis (CA). The results show that several members of the nursing staff experience difficulties communicating with tracheotomized patients receiving mechanical ventilation. A majority believe that the conditions for communication could be improved. The results of CA also indicate that an electrolarynx may be an effective and appropriate communication aid for ventilator treated, tracheostomized patients. Further research is needed to broaden the knowledge of the electrolarynx as a communication aid for these patients. Keywords: communication, mechanical ventilation, electrolarynx, patient experience, nursing staff experience, Conversation Analysis (CA).

Syfte: Att utifrån litteratur beskriva upplevelser av palliativ vård hos patienter med obotlig cancer och som vårdas på hospice eller inom den slutna vården, samt att utifrån litteraturen belysa vad dessa patienter anser att en god palliativ vård innefattar. Metod: Beskrivande litteraturstudie baserad på 14 artiklar sökta i databaserna Cinahl, PubMed, PsycInfo och via manuell sökning. Resultatet av analysen sammanställdes i 5 huvudkategorier innehållande 23 underkategorier. Huvudresultat: Patienterna upplevde att en adekvat smärtlindring utan förbehåll och dröjsmål var det viktigaste i den palliativa vården. En god kommunikation och interaktion mellan sjuksköterskan och patienten låg till grund för att en god vård skulle kunna utvecklas. Tillit till sjukvårdspersonalens kompetens och förmågor hade avgörande betydelse för patienternas upplevelse av trygghet. Autonomi hade en central roll för patienterna då delaktighet i vården skapade känsla av kontroll och mening. Miljön på hospice bidrog till att patienterna förlorade sin identitet. Att finna mening med sitt lidande bidrog till att patienterna succesivt accepterade sin situation och kunde finna frid i sin vetskap om det oundvikliga.   Slutsats: Den mellanmänskliga kommunikationen och sjuksköterskans kompetens har nyckelroller för patienternas upplevelse av god palliativ vård. Mer forskning krävs för att möta det växande behovet av kvalificerad palliativ vård. / Purpose: The purpose of this study was to describe the experiences of terminal cancer patients’ receiving palliative care in hospice or in an in-patient care unit, and illuminate what these patients believe that good palliative care involves. Method:  The Literature study had a descriptive design and was based on 14 scientific articles that were retrieved from the databases Cinahl, PubMed, PsycInfo and by manual search. The results of the analysis were compiled into 5 categories containing 23 subcategories. Main Result: Patients experienced that the issue of most importance in palliative care was to obtain adequate pain relief without reservation or delay. Good communication and interaction between the nurse and the patient was the basis for good health care to be developed. Trust in health professionals' skills and abilities were essential to patients' perceptions of security. Autonomy was central for the patients’ participation in their health care, and it created a sense of control and meaning. The environment at the hospice had a negative impact on the patients’ self-image and made them lose their identity. Finding meaning in their suffering helped the patients gradually to accept their situation in order to find peace in their knowing of the inevitable. Conclusion: The interpersonal communication and nursing skills is of crucial importance for patients' perceptions of good health care. More research is needed to meet the growing request of qualified professional palliative care.

Background: Inflammatory bowel disease (IBD) includes Crohn´s disease (CD) and ulcerative colitis (UK). The diseases are chronic and have a pattern of relapses interspersed with relatively symptom-free periods. Common symptoms during relapse are diarrhea, abdominal pain and weight loss. Since you have IBD for life it is important to find ways to relate to and cope with the disease. In that process a nurse can be of great help. Aim: The purpose of this literature review was to increase the understanding of how adult patients with inflammatory bowel disease experience their daily lives.   Method: The method used was a literature review. A literature search was performed in two separate databases which resulted in eleven examined and analyzed articles on the subject.  Results: After the analyze of the articles three different themes emerged: Limitations in daily life, Self-image and self-esteem and finally Self-care and strategies. Several individuals felt limited one way or the other in their daily life. They also described how their self-esteem was affected. Some positive changes due to the disease were also described. For example some changed their exercise and food habits for the better. Discussion: The results are discussed through the perspective of Antonovsky’s (1991/2005) salutogenic view and were connected to how the SOC (Sense of Coherence) was affected. The importance of relatives’ support and self-care was also discussed.

Bakgrund: Lag om psykiatrisk tvångsvård innebär att sjukvården har rätt att ta bort självbestämmanderätten från en individ om denne lider av en allvarlig psykisk störning. Restriktioner och tvångsåtgärder som tvångsmedicinering, avskiljning och fastspänning kan förekomma. Syfte: Syftet är att belysa hur patienter upplever tvångsåtgärder inom psykiatrisk vård. Metod: En allmän litteraturstudie baserad på 12 vetenskapliga artiklar med kvalitativ ansats. Antonovskys Känsla av sammahang har använts som teoretisk referensram. Resultat: Det framkom att patienter generellt upplevde tvångsåtgärderna som negativa. Åtgärderna väckte en rad olika känslor hos patienterna såsom obehag, rädsla och förlorad autonomi, även återuppväckta minnen förknippade med våldtäkt och andra trauman. Det var många patienter som hade svårt att förstå varför dessa åtgärder utfördes, vilket visade sig som brister i kommunikationen mellan patient och sjuksköterska. Patienterna uttryckte önskan om att få utnyttja sin medbestämmanderätt, själva påverka tvångsåtgärderna och eftersökte en närmare relation till vårdpersonalen. Även om tvångsåtgärderna i största utsträckning var en negativ upplevelse så fanns det patienter som förstod att det var för deras eget bästa liksom för andra patienters och personals säkerhet. Slutsats: Patienterna rapporterade att de ville bli informerade, förstådda och bemötta som medmänniskor med respekt och inte behöva känna sig ensamma och övergivna. Tvångsåtgärder och lidande kan lindras genom att personal utvecklar sitt aktiva lyssnande och kunskap genom att ge adekvat information. Klinisk betydelse: Ökad förståelse för patienter som utsatts för tvångsåtgärder kan ge sjuksköterskor möjligheten att stärka patientens känsla av sammanhang vid tvångsåtgärder genom ökad begriplighet, hanterbarhet och meningsfullhet. Nyckelord: KASAM, tvångsåtgärder, patient upplevelse, psykiatrisk vård &amp; litteraturstudie / Background: The Compulsory Psychiatric Care Act means that healthcare is entitled to remove the autonomy of an individual if he or she suffers from a serious mental disorder. Coercive measures may occur, such as forced medication, isolation and physical restraint. Aim: The aim is to illustrate how patients experience coercive measures in psychiatric care. Method: A literary review based on 12 scientific articles with qualitative approach. Antonovskys Sense of coherence has been used as a theoretical framework. Result: The results show that patients experienced coercive measures as negative. The measures provoked feelings in patients, such as discomfort, fear and loss of autonomy. There were patients who had trouble understanding why these measures were performed, which showed flaws in communication between patient and nurse. The patients expressed the desire to use their right to co-decide, to influence the measures and sought a closer relationship to the caregivers. Although the coercive measures were found to be a highly unpleasant experience, there were patients who understood that it was in their best interests. Conclusion: The patients reported that they wanted to be informed, listened to and treated with respect, and not have to feel alone and abandoned. Coercive measures and the associated suffering could be alleviated by active listening from the staff and the skills to provide adequate information. Clinical Implications: Increased understanding of patients subjected to coercive measures can give nurses the opportunity to strengthen the patients’ sense of coherence when exposed to coercive measures, by increasing their comprehensibility, manageability and meaningfulness.  Keywords: SOC, coercive measures, patient experience, psychiatric care &amp; literature review