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.

A computer interview has been found to be valuable in eliciting information. This thesis describes the use of a CIS in two different clinical settings (GP surgery and chiropractic clinic), with the aims of aiding recognition of patients with anxiety or depression and enhancing communication between patient and clinician. The Hospital Anxiety and Depression Scale (HADS) was included in the computer interview. 60 patients used the CIS in both settings, 6 GPs and 3 chiropractors were involved in the study. A high level of acceptance of the CIS was found in patients and clinicians in both settings. 99% of patients rated the system as “easy” or “extremely easy to use”. In the GP surgery, 80% of patients felt that they were “possibly” (68.33%) or “definitely” (11.67%) more focussed for the consultation. In the chiropractic clinic, 41.7% of patients said they disclosed new information and 33.3% felt better prepared for the consultation. The CIS aided the recognition of some individuals with anxiety or depression, more so within the chiropractic clinic than in the GP surgery. The information in the interview transcript was considered more useful by the chiropractors than the GPs (85% v 21.67%); this could be partially attributable to the fact that the chiropractors added 15 reassessment questions to the question set, whilst the GPs only added 4, more general, questions. The CIS also helped to highlight communication issues and show trends within the patient populations. Although the CIS was found to be of benefit in both settings, the GPs felt that it was more appropriate for use with specific patient groups. In the chiropractic clinic, the CIS was an effective addition to the periodic patient reassessment process. It would be possible to deliver other, individualised screening interviews using the CIS, delivery of which could be enhanced using handheld devices.

Background: Considering the increasing requirements and needs facing primary health care, the aspiration to use nurses as care providers has increased. This is done to improve the availability, effectiveness, and to dispense the available resources. Aim: The purpose of this study is to illuminate the patient's experiences of meeting nurses as care providers in primary health care. Method: Six qualitative, three quantitative, and one mixed method articles were analyzed to create a literature review. Results: Generally, the patients were satisfied with meeting nurses as care providers in primary health care. The result showed that the patients described relationship, trust, participation, and communication with nurses as significant aspects to feel secure. That the nurses made time available, as well as were easy to contact, were also aspects that contributed to the patients feeling secure. Uncertainties regarding the nurse's role, competence, and not being able to choose level of care were aspects that affected the insecurity. Conclusion: Nurses in primary health care have big opportunities to develop the meeting in a way that the patient feels secure in health care. Most patients experience great satisfaction with care provided by nurses. Considering the above facts, it seems possible to develop health care led by nurses. / Med de ökade behov och krav som ställs på primärvården i västvärlden och den resursbrist på personal som råder är det en ekvation som är svår att lösa. Ett sätt att möta dessa behov är att uppgiftsväxla vården och använda sjuksköterskor i stället för läkare i större utsträckning då det i tidigare studier visat på lika bra eller förbättrad tillgänglighet, effektivitet och kvalitet. Denna litteraturbaserade studie belyser patienters upplevelser av mötet med sjuksköterskor som vårdgivare inom primärvården. I resultatet har tio vetenskapliga artiklar, både kvalitativa och kvantitativa analyserats. I resultatet framkommer vikten av att utveckla en förtroendefull relation genom kommunikation och delaktighet med sjuksköterskan. En förutsättning för att det skall kunna ske är att det finns tillräckligt med tid en annan aspekt är möjligheten till kontinuitet, att träffa samma sjuksköterska vid upprepade tillfällen. Kan vården tillgodose dessa behov finns stora förutsättningar för att patienten skall känna trygghet och tillit till vården. I dagens sjukvård med ökad efterfrågan på vård, ekonomiska utmaningar och personalbrist finns risk för att dessa behov inte tillgodoses. Med en ökad kunskap hos sjuksköterskorna och vårdorganisationen om patienternas behov kan detta bidra till en mer individanpassad och tillfredsställande vård för patienten. Det visar sig också att många patienter har en oklar uppfattning om vad sjuksköterskans roll egentligen innebär.

Background: Patient experience has become an essential quality indicator in healthcare. Purpose: The purpose of this thesis was to conduct a concept analysis of the patient experience. Methods: Walker and Avant’s methodology served as the framework for this concept analysis. Data were retrieved from seven databases and one search engine. The literature search used keywords related to "patient experience" and included articles published at any time up until March 2018. A total of 257 articles and organizational websites were included in the analysis after meeting the inclusion criteria. Results: Twenty attributes were found to define the patient experience: communication, respect for patients, information/education, patient-centered care, comfort/pain, discharge from hospital, hospital environment, professionalism/trust, clinical care/staff competency, access to care, global ratings, medication, transitions/continuity, emotional dimension, outcomes, hospital processes, safety/security, interdisciplinary team, social dimension, and patient dependent features. Conclusion: The results of this study will guide and clarify the critical concepts towards an explicit definition of the patient experience.

Today, nurses represent many cultures and ethnic backgrounds. In their leadership style, nurse leaders must learn to embrace cultural intelligence or cultural quotient (CQ), that is, an extension of emotional intelligence that affords them the ability to manage a culturally diverse workforce. Historically, CQ has been relevant to business, locally and globally. But it is also important to explore the CQ of nurse leaders. Scholarly studies show that leaders with CQ are responsible for developing innovative employee behaviors, forward-thinking ideas, and creativeness in the workplace. CQ has a theoretical foundation in the 2003 research of Early and Ang who focused on CQ and the ability to lead in culturally diverse situations. This theoretical foundation will support the qualitative case study approach used to explore the CQ of nurse leaders. Ten participants were selected to answer semi structured interview questions, which were designed to produce data to answer research questions about the meaning of CQ to nurse leaders, the patient experience, self-awareness of CQ, and leadership practice. Thematic data analysis using the MAXQDA software program was the analysis tool. The results are expected to create positive social change by providing evidence-based results that can enhance the CQ of nurse leaders, their leadership style, and their practice in the United States. This study will add to the existing literature and its results may help the reader to reflect on the importance of CQ in their practice of leadership in the nursing profession.

Introduction Attention deficit hyperactivity syndrome (ADHD) is a neuropsychiatric disorder that is characterized by three core symptoms: inattention, hyperactivity, and impulsivity. The prevalence of ADHD is estimated to be 3-10 %. The number of ADHD diagnosis and prescriptions of central stimulants that are used to treat the disorder have been steadily growing which has led to debates about the diagnostic process and pharmacological treatment. The ethics of the diagnostic process and treatment have been discussed, and it has been pointed out that there’s a lack of knowledge about how the ADHD patients experience the diagnosis and treatment. Aim The aim of this study is to review the existing knowledge of the ADHD patient experiences concerning the diagnosis and the medical treatment, and to examine this knowledge in the light of medical ethics. Method This is a scoping review. Eight studies were included in this study. The inclusion criteria were that the participants of the studies were interviewed by using semi-structured interviews, both genders were included, and that the interviews covered both diagnosis and medical treatment. Material was analysed by using qualitative content analysis. Results Four main themes emerged from the material: access, diagnosis, treatment, and impairment. All the main themes include several sub-categories. Conclusion In the light of the principles of biomedical ethics the diagnostic process and the treatment measures of ADHD are not ethically trouble-free. Studying the patient experiences does evoke ethical question of patients’ autonomy and the justification of distribution of needed services.

<p>Alkoholkonsumtion och narkotikaanvändning ökar i världen idag och leder till konsekvenser för den somatiska sjukvården då patienter med missbruksproblematik blir mer vanligt förekommande. Personer med missbruksproblematik upplever sig ofta som tillhörande en stigmatiserad grupp och mötet med vården som något negativt. Syftet med studien var att undersöka upplevelser av mötet med vården hos patienter med missbruksproblematik. Litteraturstudien baseras på 11 vetenskapliga artiklar som analyserades. I resultatet framkom 3 kategorier, negativa upplevelser i mötet med vården, barriärer till att söka vård samt positiva upplevelser i mötet med vården. Stigmatisering och att bli annorlunda behandlad var negativa upplevelser av vården och även barriärer till att söka vård. God vård beskrevs främst som att ha en god relation till vårdaren och då missbruket sågs som en sjukdom istället för ett personligt misslyckande. En ökad kunskap skulle kunna eliminera de fördomar och den stigmatiserade syn som existerar gentemot denna patientgrupp. Det skulle kunna möjliggöras genom att medicinsk utbildning inom området blev obligatorisk för vårdpersonal. Vidare skulle kvantitativ forskning kunna bidra med resultat för ökad generaliserbarhet.</p> / <p>Alcohol consumption and drug abuse are increasing around the world today. This leads to consequences for somatic health care when patients with substance abuse disorders gets more common. People living with an addiction often experience themselves as belonging to a stigmatized group and their interaction with health care as something negative. The purpose of this study was to examine experiences of health care among substance abusers. The literature</p><p>study was based on 11 scientific articles that were analyzed. In the result 3 categories emerged, negative experiences in the interaction with health care, barriers to health care seeking and positive experiences in the interaction with health care. To be stigmatized and treated differently was negative experiences from health care and even a barrier to health care seeking. High quality care was mostly described as having a good relation with the health care provider and when the substance abuse was seen as a disease, not a personal failure. An increased knowledge could eliminate the prejudices and the stigmatization that exists toward this group of patients. This could be made by making the education about this subject compulsory to health care staff. Furthermore quantitative research could contribute with a result to an increased generalization.</p>

<p>Enligt Hälso- och sjukvårdslagen har patienten rätt att bli bemött med respekt för sitt självbestämmande och sin integritet. Många patienter blir dåligt bemötta i vården, de känner sig kränkta, utelämnade och maktlösa. Psykiatrisk tvångsvård kan innebära en konflikt mellan att bedriva god vård och utöva tvång. Det är därför av största vikt att undersöka hur tvångsvårdade patienter upplever att de blivit bemötta och vad bra bemötande är vid psykiatrisk tvångsvård. Syftet med denna studie är att undersöka hur patienter upplever att de blivit bemötta vid psykiatrisk tvångsvård. Studien genomfördes som en litteraturstudie med kvalitativ innehållsanalys som metod. Manifest och latent ansats användes. Resultatet baserades på 12 vetenskapliga artiklar och en avhandling. Resultatet i studien presenteras i två huvudteman: Dåligt bemötande vid tvångsvård och bra bemötande vid tvångsvård. Sex underteman framkom: att inte vara delaktig i vården, att bli bemött med makt, att förlora sitt människovärde, att känna sig delaktig i vården, att få god omvårdnad och att känna sig som en människa. Genom att ta reda på patienters upplevelse och behov, kan vården bli individuellt anpassad. Bra bemötande leder till att patienten känner sig respekterad och bekräftad som människa.</p>

<p><em>Syfte:</em> Utvärdering av hur patienter upplever den förbokade återbesökstiden, väntetiden samt personalens bemötande vid återbesöket. Syftet är även att undersöka hur personal på ortopedens nyinrättade ”snabbmottagningen” vid AS upplever stress, patientflöde samt telefonförfrågningarna, efter införandet enligt Lean-modellen</p><p><strong></strong><em>Metod:</em> Deskriptiv kvantitativ enkätstudie. Slumpmässigt urval utfördes på patienter och av hundra procent (n=55) tillfrågade, deltog fyrtionio procent (n=27). Av hundra procent tillfrågad personal (n=14), deltog sextiofyra procent (n=9). Urvalet utförde avdelningschefen.</p><p><strong></strong><em>Resultat<strong>:</strong></em> Utvärderingen av patienternas upplevelser av planerad återbesökstid, bemötande och väntetid på snabbmottagningen var generellt mycket bra. Personal på ortopedmottagningens snabbmottagning upplevde ingen större förändring efter införandet enligt Lean-modellen.</p><p><strong></strong><em>Slutsats:</em> Resultatet visar att patienterna upplevde den planerade återbesökstiden generellt mycket bra. Personalens upplevde inte att arbetet förändrats. Fler och större studier behövs för att utvärdera organisationsförändringar som initierats av Lean-modellen.</p> / <p><em>Aim:</em> Evaluation of paitents’ experiences of the prebooked time for next appointment, the waiting time and the staff’s treatment at the next appointment. The aim is also to examine how the staff at the newly established orthopedic “quickreception” at the Uppsala University hospital experience stress, patientflow and the telephonerequests, after the introduction according to the Lean-model.</p><p><em>Method</em>: Descriptive quantitative inquirystudy. Patients were selected randomly and out of one hundred percent (n=55) who were asked, fortynine percent (n=27) participated. Out of one hundred percent (n=14) of the staff asked, sixtyfour percent (n=9) participated. The selection was made by the head of the ward.</p><p><em>Results</em>: Evaluation of the patients’ experiences of the planned time for next appointment, treatment and waiting time at the “quickreception” was generally very good. The staff at the orthopedic “quickreception” did not experience a big change after the introduction according to the Lean-model.</p><p><em>Conclusion:</em> The results show that the patients experienced the planned time for next appointment generally very good. The staff did not experience that the work had changed. More and larger studies are needed to evaluate changes of organisations that were initiated by the Lean-model.</p>

Objective: When caring for a patient with Anorexia Nervosa (AN) it is difficult for the registered nurses to develop a good nurse-patient relationship due to a lack of understanding for the illness.  It is important for the nurse to understand the suffering that the AN patients experience, and what makes them feel better, to be able to improve the patient-nurse relationship. This study aims to explore what makes patients with AN feel better during the illness and the process of recovery. Method: A qualitative scientific approach was used. Eight autobiographies were selected as data for this study. Both English and Swedish books were used. The data was analyzed using a qualitative method of data analysis. Results: The ways patients with AN could feel better are presented in seven themes: being seen as a whole individual behind the illness, being able to trust and find security, taking responsibility for recovery, finding motivation to keep fighting towards recovery, when one's suffering is noticed, filling a void, and the strengthening of the relationship between care giver and patient. This study may help registered nurses understand the needs of the patient recovering from AN and help them meet these needs in a better way. / Avsikt: För sjuksköterskor är det svårt att utveckla en bra sjuksköterske-patient relation när de vårdar patienter med anorexia nervosa (AN), eftersom det finns brister i deras förståelse för sjukdomen. För att kunna stärka relationen mellan sjuksköterskor och patienter är det viktigt för sjuksköterskan att förstå det lidandet som patienter med AN upplever och vad som kan lindra det.  Syftet med denna studie är att utforska vad som får patienter med AN att må bättre under sjukdomens lopp och tillfrisknandet. Metod: En kvalitativ metod valdes för att utföra studien. Sex självbiografier valdes som data till studien. Böcker skrivna på svenska och engelska användes. En kvalitativ dataanalys, enligt Dahlberg, användes för att tolka data. Resultat: Resultatet presenteras i sju teman: att bli sedd som en individ bakom sjukdomen, att kunna känna tillit och hitta trygghet, att ta eget ansvar för tillfrisknandet, att hitta motivation för att fortsätta kämpa mot tillfrisknandet, att ens lidande uppmärksammas, att fylla ett tomrum efter sjukdomen och att stärka relationen mellan vårdare och patient. Denna studie kan hjälpa allmänna sjuksköterskor att förstå de behov patienter med AN har och hjälpa dem att bemöta deras behov på ett bra sätt.