Syfte: Att undersöka hur nöjda patienter 75 år och äldre är med vården som bedrivs på akutmottagningen på Akademiska sjukhuset i Uppsala avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Metod: Deskriptiv tvärsnittstudie. 38 patienter 75 år och äldre som besökt Akademiska sjukhusets akutmottagning svarade på en enkät avseende hur nöjda de var med sitt besök. Resultat: Patienter 75 år och äldre var i stort mycket nöjda över vården som bedrivs på Akademiska sjukhusets akutmottagning. Patienterna var minst nöjda över väntetiden som ibland ansågs vara för lång i relation till deras besvär. Ingen skillnad gick att utläsa mellan hur nöjda män och kvinnor var med vården avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Någon skillnad gick inte heller att utläsa mellan hur nöjda patienterna var med vården och vilken typ av besvär; medicinskt, kirurgiskt eller ortopediskt som patienten hade sökt för. Slutsats: Studien visar att de patienter 75 år och äldre som besvarade enkäten i stort är mycket nöjda med vården som bedrivs på Akademiska sjukhusets akutmottagning avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Resultaten går inte att generalisera och mer forskning krävs på området. / Aim: To investigate the satisfaction levels of patients aged 75 years and older for care received at the emergency department of Akademiska hospital in Uppsala with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication and pain relief. Method: Descriptive cross section study. 38 patients aged 75 years and older who visited Akademiska’s emergency department answered by completing a form regarding how satisfied they were with their visit. Results: Patients aged 75 and older were generally very satisfied with the care offered by Akademiska’s emergency department. Patients were least satisfied with waiting times, which were sometimes felt to be too long in relation to their symptoms. No significant difference was recorded between the satisfaction levels between men and women for the care offered with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication or pain relief. Neither were any significant differences recorded between the types of symptoms - medical, surgical or orthopaedic - that the patients were seeking treatment for. Conclusion: The study shows that patients aged 75 and over who answered the form were generally very satisfied with the care offered by Akademiska hospital’s emergency department with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication and pain relief. These results cannot be generalized and more research is required in this area.

Stroke är en stor orsak till funktionsnedsättningar. Dödligheten från stroke har minskat de senaste åren och därmed har antalet överlevanden med funktionsnedsättningar ökat. Svårigheten av en funktionsnedsättning kommer sig av vad den leder till för den enskilde individen. Målet vid omvårdnaden vid stroke ska individualiseras och arbeta för att uppnå största möjliga hälsa. Meleis transitionsteori beskriver en individs övergång från ett stabilt tillstånd till ett nytt och processen däremellan. Syfte: Syftet med denna litteraturstudie var att beskriva patienternas upplevelser av funktionsnedsättningar efter stroke. Metod: Litteraturstudie baserad på tio vetenskapliga artiklar. Resultat: De strokedrabbade upplevde emotionella reaktioner av de funktionsnedsättningar som de drabbats av. De upplevde också förändringar i sina dagliga aktiviteter och hur de genomförde dessa. De upplevde en förlust av sin identitet och de förlorade sin autonomi i och med att de inte längre kunde klara sig själva. Slutsats: Denna litteraturstudie visar att patienter upplever funktionsnedsättningar efter stroke som en livsförändrande händelse som påverkar hela deras liv. De som drabbas är inte förberedda på i hur stor utsträckning de kommer att påverkas, både socialt och emotionellt, av funktionsnedsättningarna. De tvingas att omstrukturera vardagen, vilket ofta upplevs frustrerande och är tidskrävande / Stroke is a major cause of disability. Mortality from stroke has decreased in recent years and therefore the number of survivors with disabilities has increased. The difficulty of a disability is defined from what impact the disability has on the individuals’ life. The goal of nursing in stroke should be individualized and aim to achieve maximum health. Meleis transition theory describes an individual's transition from one stable state to a new one and the process in between. Purpose: The purpose of this study is to describe patients' experiences of disability after stroke. Method: Literature study based on ten scientific articles. Results: The stroke victims experienced emotional reactions from the disabilities that they had suffered. They also experienced changes in their daily activities and how they carried them through. They experienced a loss of their identity and they lost their autonomy in that they no longer could care for themselves Conclusion: This literature review shows that patients experience impairments after stroke as a life-changing event that affects their entire lives. Those affected are not prepared for how much they will be affected, both socially and emotionally, by their impairment. They are forced to restructure everyday life which is often frustrating and time-consuming

No description available.

Bakgrund: Behandling av svår fetma med Bariatrisk kirurgi har ökat kraftigt. Målet med kirurgin är att minska sjuklighet och dödlighet genom viktminskning. Kirurgin påverkar även människors fysiska, psykiska och sociala liv. Syfte: Syftet med litteraturstudien var att beskriva hur patienter upplever sin livssituation efter Bariatrisk kirurgi. Metod: Studien genomfördes som en allmän litteraturstudie och baserades på 11 vetenskapliga artiklar. Resultat: Resultaten presenterades i fem huvudkategorier som speglar människors upplevelse av sin livssituation efter genomgång av Bariatrisk kirurgi; Förändrad kroppsuppfattning, känsla av ändrade relationer, positiva och negativa känslor relaterade till operationen, känslor relaterade till förändrat ätbeteende, och hälsorelaterade upplevelser. Slutsats: Förutom viktminskningen, kan Bariatrisk kirurgi även ha både positiv och negativ påverkan på människors fysiska och psykosociala liv. Det är därför viktigt att vårdpersonalen har kunskap kring hur de som opererats upplever sin livssituation, så att de kan vägleda och stödja dem. / Background: The treatment of severe obesity with Bariatric surgery has shown a dramatic increase. The goal of Bariatric surgery is through weight loss, reduce morbidity and mortality. However, the physical, mental and social life of the patients is affected following the surgery. Purpose: The aim of this study is to describe what patients experience in their life situation after undergoing Bariatric Surgery. Method: The study was conducted as a literature study and was based on 11 scientific articles. Results: The results are presented in five main catego-ries reflecting what people experience in their life situation after undergoing Bariatric Sur-gery: altered body image, sense of changing relationships, positive and negative feelings re-lated to the surgery, feelings related to their altered feeding behavior, and health-related expe-riences. Conclusion: Apart from weight loss, Bariatric surgery can also have both positive and negative impacts on the physical and psychosocial lives of patients. It is therefore im-portant that health professionals have knowledge about what Bariatric patients may experi-ence in their lives, so that they can provide them with appropriate guidance and support.

Information technologies are making their way into health care. While they have been primarily in the domain of the health care providers, applications are being created for use by patients. This qualitative study looks at the usability of an electronic tool with a broader view of patient-as-user; the research question asks how this tool stands up to an assessment of the tool’s usability. Usability seeks to find out how easy a system is to use, whether the system is acceptable, and whether the system is enjoyable to use. Qualitative description techniques were employed for a broader perspective on the usability results. Key findings indicate that patients need to be in control of the process of using self-reporting tools; patients want to be able to use these applications at home; computer technologies do not replace the need for human contact in the health care setting; self-reporting assessment tools can give a voice to patients who are otherwise silent; privacy concerns must be handled. Few studies have attempted to look at patients as they use electronic applications, but if we want patients to use them, tools need to be designed with the patient-as-user in mind, considering diverse levels of functioning among patients.

[Truncated abstract] This PhD project was comprised of three major studies. Study 1 utilised the Nominal Group Technique (NGT) to identify a typology of difficult patients in private practice physiotherapy and to determine strategies physiotherapists use and would like to improve, when dealing with such patients. Physiotherapists (n=37) also shared their expectations of patients and their perceptions of patient expectations of physiotherapy. Results showed that the two areas most difficult to manage were behavioural problems of patients followed by patient expectations. To assist in their interaction with difficult patients, physiotherapists identified communication skills and behaviour modification techniques as strategies they would most like to learn. While physiotherapists expressed the greatest number of expectations in the behavioural domain, identification of patient expectations was not elicited as a strategy to manage difficult patients. Results of this qualitative study contribute to the evolving literature relating to physiotherapist-patient interactions and form a useful basis for educational programs directed at improving the therapeutic relationship in private practice physiotherapy. Study 2 involved applying the NGT with separate groups of patients (n=26) to identify patient expectations of the qualities of a ‘good’ physiotherapist, and to ascertain the characteristics of good and bad experiences in private practice physiotherapy. Findings indicated that the qualities of a ‘good’ physiotherapist related to their communication ability, professional behaviour and organisational ability, and characteristics of the service provided. The most important expectations of patients were for example, symptomatic relief, self-management strategies and ‘hands on’ treatment; associated with the physical domain. When comparing equivalent groups from Study 1, with patient expectations, most patient groups identified that the most important expectations of physiotherapists would relate to patient behaviours such as; compliance, honesty, payment of their account, being punctual, cooperating, trusting and showing respect for their physiotherapist. However, physiotherapists’ rankings of the most important expectations held by patients were not congruent with patient rankings providing an explanation as to why problems may arise in the physiotherapistpatient interaction from the patient’s perspective. Based on the findings of Study 2 it was suggested that physiotherapists should actively seek to involve patients in their management. To do this effectively, physiotherapists would benefit from further training in communication skills to ensure that they can successfully adopt a patientcentred approach and to optimise the physiotherapist-patient interaction in private practice physiotherapy.

Bakgrund: Hemodialys är en livsuppehållande behandling för människor med kronisk njursvikt. Men behandlingen påverkar människans livssituation med till exempel begränsad frihet, känsla av bundenhet till dialysmaskinen och känsla av beroende från vårdpersonal. Den framgångsrika utvecklingen av teknologin har gett patienterna möjlighet att behandla sig själva med hemodialys i hemmet (HHD), vilket kan förbättra patienters livssituation. För att behandlingen ska fungera krävs vårdpersonalens kunskap och engagemang att utbilda patienten i egenvården. För närvarande används behandlingsformen i hemmet i låg omfattning i förhållande till totala antalet patienter i hemodialys, men antalet användare ökar. Sjuksköterskor behöver förstå patienters upplevelser av behandlingen för att kunna förbättra och erbjuda individanpassad omvårdnad. Syfte: Att beskriva patienters upplevelser av att leva med hemodialys i hemmet. Metod: Detta är en litteraturöversikt med tio vetenskapliga artiklar till grund som beskriver och analyserar nya uppkomna teman utifrån de likheter som framkom i resultatdelarna. Resultat: Resultatet visar på att trots behandlingen och sjukdom finns det möjlighet att uppleva hälsa och välbefinnande. Detta redovisas under sju teman: 1) Ökad frihet med HHD ger ett aktivt liv; 2) Medvetenhet om egenvårdens betydelse; 3) Att inte känna sig som patient; 4) Att inleda HHD och en förändrad hemmiljö; 5) Relation med anhöriga och vårdpersonal; 6) Sjukdom och behandling som börda; 7) Hopp och oro inför framtiden. Diskussion: Resultatet diskuteras utifrån patientens perspektiv med hjälp av Orems omvårdnadsteori. Hälsa upplevs när patienten omvärderar och accepterar sin situation. Patientens förmåga till egenvård ökas, vilket främjas genom patientens aktiva medverkan i sin behandling. Detta är möjligt genom sjuksköterskans stöd till att öka patientens egenvårdskapacitet utifrån individuella behov. / Background: Hemodialysis is a life-sustaining treatment for people with end stage renal disease. But the treatment affects individual's life situation with for example limited freedom, feeling of bondage to the dialysis machine and feeling of dependence from healthcare professionals. The successful development of technology has given patients an opportunity to treat themselves with hemodialysis in the home (HHD), which may improve patients' lives. It requires knowledge and involvement of nursing staff in educating the patient in self-care for the achievement of successful functioning of treatment. Currently the usage of this treatment in the home is in low scope in relation to the total number of patients on hemodialysis, but the number of users increases. There is a need for nurses to understand patients' experiences of treatment in order to improve and offer individualized care. Aim: To describe patients' experiences of living with hemodialysis in the home. Methods: This is a literature review with basis of ten scientific articles, which describes and analyzes new themes based on similarities that emerged in resulting parts. Results: The findings show that it is possible to experience health and well-being despite treatment and disease. These findings are presented in the following seven themes: 1) Increased freedom with HHD provides an active life; 2) Awareness of self-care importance; 3) Feeling of not being a patient; 4) Accommodating HHD and changed home environment; 5) Relationship with family members and health professionals; 6) Burden of disease and treatment; 7) Hope and uncertainty about the future. Discussions: The findings are discussed from the patient's perspective using Orem's nursing theory. Health is experienced when the patient re-evaluated and accepted his situation. The patient's ability to self-care increases, which is promoted through the patient's active participation in care. This is possible through the nurse‟s support to increase the patient's self-care capacity based on individual needs.

Bakgrund: Åldrandet är en process som berör hela människan som inkluderar både kropp, själ, psyke, och det sociala sammanhanget där det är viktigt att värna om den äldres autonomi samt hens värdighet. Inom vården har sjuksköterskan det största ansvaret för att kunna identifiera individens omvårdnadsbehov. Ett gott bemötande och en öppen kommunikation är nödvändigt för att förstå individens behov och därmed kunna bidra till att främja individens hälsa. Syfte: Beskriva patienters upplevelser av bemötande inom sjukvården. En litteraturöversikt rörande åldrarna 65 och äldre i Sverige. Metod: Litteraturöversikten baseras på 12 vetenskapliga kvalitativa artiklar från databaserna Cinahl och MedLine samt en manuell sökning. Sökorden var dignity (värdighet), autonomy (autonomi), elderly (äldre), nursing (omvårdnad), patients (patient) perspective (perspektiv), older patient (äldre patienter), experiences (erfarenheter), health care (hälsovård), home nursing (hemsjukvård), emergency department (akutmottagning). Resultat: Litteraturöversikten påvisade att det rådde brister i bemötande av äldre patienter oavsett vårdform. När vårdpersonalen uppträdde på ett paternalistiskt sätt hotades den äldres självbestämmande och värdighet. Detta gav sig uttryck när personalen förutsatte vad som är bäst för patienten utan att samråda med hen. Situationer där personalen var stressade och uppträdde oengagerad resulterade i brister gällande kommunikation vilket orsakade att den äldre upplevde otrygghet, minskad delaktighet och misstro till vården. Diskussion: Resultatdiskussionen berör begrepp som värdighet, autonomi och integritet som hade stor betydelse för den äldre patientens upplevelse av bemötande. Dessa begrepp diskuteras gentemot den teoretiska utgångspunkten gällande vårdande kommunikation av Belinda Dewar (2011). / Background: Aging is a process that affects all aspects of the individual, his/her physical health, mental health, soul and social health and it is important to protect the individual’s autonomy as well as his/her dignity. In the context of healthcare it is the nurse who has the biggest responsibility to identify the individual needs of a patient. A professional treatment and open communication is crucial for understanding the needs of the individual and promote the individual´s health. Aim: The aim was to describe experiences of encounters within the health care system. A literature review regarding ages 65 and older in Sweden. Method: This literature review is based on findings in 12 scientific articles, which are found in Cinahl and MedLine databases as well as through a manual search. Keywords during the search were dignity, autonomy, elderly, older, nursing, patients, perspective, experiences, health care, home nursing, emergency department. Results: The study shows that there is room for improvement in treatment of elderly patients, regardless of care setting. When the caregivers behaved in a patronizing way they threatened the patient’s self-determination and dignity. This was particularly clear when the staff presuppose what is best for the patient without consulting him/her. Stressed and unengaged staff members showed a lack of communication towards the patient, which resulted in a feeling of unsafety, loss of participation and increased distrust of the health care system. Discussion: In the discussion terms such as dignity, autonomy and integrity had a high degree of importance for the elderly patient. These terms are explained and discussed towards Researcher Belinda Dewar’s (2011) model for the caring conversation, which was the theoretical framework supporting this literature reviews´ discussion.

Bakgrund: Psykisk ohälsa är ett folkhälsoproblem som förekommer i alla åldrar och har stora konsekvenser för individens livskvalitet. En problematisk aspekt med psykisk ohälsa är att det är ett stigmatiserat hälsoproblem i samhället. Tidigare forskning visar att det finns svårigheter för patienter med psykisk ohälsa att ha kontakt med hälso- och sjukvården. Den somatiska akutmottagningen fokuserar på fysiska skador och sjukdomar. Vården upplevs därför som otillräcklig för patienter med psykisk ohälsa. Syfte: Syftet var att undersöka hur vuxna patienter med psykisk ohälsa upplever att de blir bemötta av sjuksköterskor när de söker vård på en akutmottagning, oavsett om kontaktorsaken relateras till fysiska eller psykiska besvär. Metod: En litteraturstudie baserad på 13 empiriska artiklar. Databaserna som användes vid datainsamlingen var PubMed och PsycINFO. Artiklarna genomgick en innehållsanalys. Joyce Travelbees omvårdnadsteori utgjorde studiens teoretiska referensram. Resultat: Fem kategorier identifierades som beskriver upplevelser av sjuksköterskors bemötande på akutmottagning hos patienter med psykisk ohälsa. Kategorierna var: positiva upplevelser, upplevda brister, individens svårigheter, yttre påverkande faktorer samt önskemål för ett likvärdigt bemötande. De mest problematiska aspekterna i sjuksköterskornas bemötande ansågs vara ett bristande engagemang och ett fördömande beteende. Fysisk hälsa ansågs också vara viktigare än psykisk hälsa. Slutsats: Det finns brister i sjuksköterskornas bemötande av personer med psykisk ohälsa på akutmottagningar. Problematiken ligger i stigmatiseringen kring psykisk ohälsa. Därför krävs ny forskning och mer kunskap för att uppmärksamma och hitta lösningar på de brister som finns. / Background: Mental health is a public health problem that could be found in different ages and has big consequences for the individual ́s quality of life. One problematic aspect is the ongoing stigmatisation in the society. Previous research has shown difficulties for mental health patients to have contact with health care facilities. In the emergency department, the physical illness is a priority. Therefore, the health care is perceived as insufficient for patients with mental health problems. Aim: The aim of this study was to explore the experiences of adults with mental health issues, regardless of the nature of the health seeking reason, and how they perceive that they get treated by the nurses in the emergency departments. Method: It ́s a literature research based on 13 empirical articles. The databases that has been used to find relevant articles was PubMed and PsycINFO. A content analysis was made on the articles. Joyce Travelbees nursing theory was used as a theoretical framework for this study. Result: Five categories was identified explaining experiences of nurses ́ treatment in the emergency department among patients with mental health issues. The catagories were: positive experiences, perceived shortcomings, individual difficulties, external impact factors and requests for equal treatment. The most problematic aspects of the nurses ́ patient treatment were lack of involvement and a judgemental behavior. Physical health was also considered as more important than mental health. Conclusion: Shortcomings were found in the nurse ́s treatment of patients with mental health issues in the emergency departments. The problematic factor is the stigmatisation of mental health. For that reason, new research and more knowledge is required to highlight and find solutions to the problem.

Background: Stoma surgeries are increasing in Sweden each year. Colorectal cancer, inflammatory bowel diseases, and trauma are some conditions that might lead to an ostomy. Having an ostomy could bring changes to the body and the person’s body image, leaving the person feeling imprisoned in his or her own body. Aim: The aim was to illuminate people’s experiences of getting and living with an ostomy. Method: A literature-based study was conducted in which nine qualitative articles were studied and analysed. Three new themes and eight sub-themes arose from the analysed articles. Results: The main themes of the study were: ”Changes in close relationships and sexual life”, where it was found to be difficult to start a new sexual relationship after the surgery and that the stoma also had effects on family relations and friendships. ”Limitations in social and physical activities”, where the result showed that persons with ostomies were constantly worried about leakage and odour, and had difficulties performing physical activities such as work or exercise. ”A new self”, people who had had stoma surgery were found to experience difficulties in adapting to their new body and accepting the stoma as part of their body. Common for all themes was the importance of support from family and friends. Conclusion: Persons who have had colostomy or ileostomy surgery all have different needs and challenges. It is important to see to their individual needs.