Yes / Evidence suggests that patients can meaningfully feed back to healthcare providers about the safety of their care. The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect feedback from patients to support service improvement. The intervention is being implemented in acute care settings with patient feedback collected by hospital volunteers for the first time. To undertake a formative evaluation which explores the feasibility and acceptability of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders. Design: A qualitative evaluation design was adopted across two acute NHS Trusts in the UK between July 2014 and November 2015. We conducted five focus groups with hospital volunteers (n = 15), voluntary services and patient experience staff (n = 3) and semistructured interviews with ward staff (n = 5). Data were interpreted using framework analysis. Results: All stakeholders were positive about the PRASE intervention as a way to support service improvement, and the benefits of involving volunteers. Volunteers felt adequate training and support would be essential for retention. Staff concentrated on the infrastructure needed for implementation and raised concerns around sustainability. Findings were fed back to the implementation team to support revisions to the intervention moving into the subsequent summative evaluation phase. Conclusion: Although there are concerns regarding sustainability in practice, the PRASE intervention delivered in collaboration with hospital volunteers is a promising approach to collect patient feedback for service improvement. / The Health Foundation (Closing the Gap in Patient Safety Programme).

Bakgrund: Patientens rätt att vara delaktig i planering och genomförande av sin vård betonas idag, men många patienter är mindre delaktiga än de önskar vara. Det finns många fördelar med att patienten är delaktig. Syfte: Att beskriva vilka faktorer som påverkar patientens delaktighet i omvårdnad från patientens och sjuksköterskans perspektiv inom somatisk slutenvård. Metod: Litteraturstudie baserad på 16 vetenskapliga artiklar, publicerade mellan åren 2006 och 2015. Sökning skedde i databaserna PubMed och CINAHL, samt i de funna artiklarnas referenslistor. Resultat: Fem kategorier med faktorer som påverkade patientens delaktighet i omvårdnad identifierades; kunskap, relationen mellan patienten och sjuksköterskan, sjuksköterskans förhållningssätt, patientens situation och egenskaper samt organisationen. Slutsats: Faktorerna inom de fem kategorierna utgör ett komplicerat samspel och varje patient är en unik person med egna önskemål och preferenser för delaktighet. / Background: The patient's right to participate in planning and implementation of their care is stressed today but many patients are less involved than they would like to be. There are several positive outcomes of patient participation, Aim: To describe factors influencing patient participation in nursing care, from the patient’s and the nurse’s perspectives in somatic inpatient care. Method: A literature review based on 16 articles, published between 2006 and 2015. A literature search was made in the databases PubMed and CINAHL, and in the reference lists. Results: Five categories with factors that affected patient participation in nursing care were identified; knowledge, the relationship between the patient and the nurse, the nurse’s approach, the patient’s situation and characteristics and the organization. Conclusion: The factors within the five categories form a complex interaction and each patient is a unique person with its own wishes and preferences for participation.

Höft- och knäprotesoperationer är idag en vanlig operation vid artros i höft- och knäled. Trotsminutiösa infektionsförebyggande förberedelser inför operationen drabbas ändå en delpatienter av postoperativa infektioner. Vid ortopedisk proteskirurgi är postoperativainfektioner ett direkt hot mot den nya inopererade leden och kan leda till långabehandlingstider som påverkar patientens livskvalitet under lång tid. Syftet med studien var att utforska patienters möjlighet till delaktighet i tidig upptäckt avpostoperativ infektion utifrån given information vid operation för höft- eller knäprotes. Semi-strukturerade intervjuer genomfördes med tio patienter med diagnostiserad postoperativinfektion efter höft- eller knäprotesoperation. Transkriberade intervjuer analyserades medinnehållsanalys. Journaler granskades för att beskriva patientens tidigare sjukdomar. Resultatet visade att första tecknen på infektion kan beskrivas med temat: Vad är normalt ochvad är inte normalt. Två kategorier beskriver patienternas Möjlighet till delaktighet ochHinder till delaktighet i det infektionsförebyggande arbete före, under och efter operation. Det handlade om hur patienten hade förstått eller inte förstått given information, vilketkategoriserades som subkategorier. Personcentrerad vård kan vara ett redskap för att stärka patienternas förutsättningar tilldelaktighet och ökar möjligheterna för att förhindra att vårdskador så som postoperativainfektioner uppstår. / Surgery with prosthetic joint replacement of the hip and knee in patients with osteoarthritis is a common procedure. Despite meticulous preparation prior to surgery, surgical site infections develop in some patients. A surgical site infection is a direct threat to the new implanted joint and can lead to long treatments that affect quality of life over time. The aim of this study was to explore patients´ participation in early detection of a surgical site infection based on the information given in conjunction to surgery for hip and knee replacement. Semi structured interviews were conducted with ten patients diagnosed with surgical site infection after hip or knee replacement surgery. Transcribed interviews were analyzed using content analysis. Medical records were reviewed to describe the patients´ comorbidity. The result showed that the first signs of infection can be described with the theme; What is normal and what is not normal? Two categories describe patients´ Possibility of participation and Barriers to participation in infection prevention before and after surgery. It was all about How the patient had understood or not understood the given information which was categorized as subcategories. Person-centered care can be a tool that enables patients´ possibilities to participate in their care and increases the possibilities to prevent adverse events such as surgical site infections.

The hippocratic principle "primum non nocere" (above all do no harm) has always been and still is the strong foundation of medical conduct. For a long time healthcare professionals created the image of infallibility of medicine. Even within the "closed" hierarchies mistakes and malpractice were never openly discussed. This paper first investigates reasons for medical mistakes and introduces the legislation when malpractice occurs. Secondly ethical questions concerning medical mistakes are discussed through the lens of Beauchamp and Childress' principles of biomedical ethics (nonmaleficence, beneficence, respect for autonomy, justice). Thirdly, an ethically defensible strategy to deal with failure and malpractice is proposed. This proposal stresses how to improve the patient-physician communication by involving patients' experiences in order to increase patient safety and lower costs in the healthcare system. In regard to tackling medical harm there is the strong recommendation to follow four directives: open disclosure and explanation, adequate restorative and/or compensatory actions, fair and square apologies and information about strategies to avoid recurrence.

Background and objective: Patients’ and parents’ involvement in nursing students’ pediatric clinical practice assessment is informal. This study explored patients’ and parents’ perceptions of their role in students’ formative assessment. Approach: Interviews were conducted with patients and parents admitted at the study setting who received care from a nursing student. They were transcribed verbatim. Data was analyzed using a qualitative content analysis while Lincoln and Guba’s criteria of rigor and trustworthiness were upheld. Findings: Three categories emerged from the data: 1) Patients’ and parents’ current involvement in the assessment of nursing students’ pediatric clinical practice; 2) How they would like to be involved; and 3) The benefits and challenges of their involvement. Conclusion: This study has provided an understanding of patients’ and parents’ past encounters with nursing students, the elements of care that they would want to assess, and their perceived benefits and challenges of their involvement.

SAMMANFATTNING Bakgrund: Patientcentrerad vård innebär att varje patient ses som en individ istället för en diagnos och fokuserar på dennes resurser istället för behov samt att patienten ska vara delaktig i vårdprocessen. RCC - Regionalt cancercentrum verkar för att förbättra och stärka patienternas inflytande och ställning inom cancervården genom patientrepresentation i patientråd och vårdprogramgrupper där patientens upplevelser, kunskap och åsikter kring cancervården tas till vara på. Enligt tidigare forskning inom området är kunskapen allt för begränsad för att kunna kartlägga betydelsen. Syfte: Studien syftar till att ur ett patientperspektiv undersöka patientrepresentanternas upplevelser och åsikter om deras arbete i vårdprogramgrupperna och patientrådet i Uppsala Örebro-regionen. Metod: Åtta patientrepresentanter från RCC:s vårdprogramgrupper och patientråd intervjuades enligt en semi-konstrukturerad intervjuguide. Därefter gjordes en innehållsanalys enligt Lundman och Hällgren-Graneheim. Resultat: Ur intervjuerna erhölls två kategorier; patientföreträde och erfarenheter av vården. Ur dessa identifierades sex subkategorier. Patientrepresentanterna var överlag nöjda med det bemötande de fått inom såväl inom vårdprogramgrupperna och patientrådet. Samtliga var positiva till sitt arbete dock fanns en osäkerhet huruvida de påverkade och medverkande till en förändring av vården eller om deras roll enbart hade funktion som alibi. Forskningen inom området är sparsam och det finns svårigheter att mäta resultaten av patientmedverkan. Slutsats: Enligt studien upplever patientrepresentanterna sin roll, sitt arbete och bemötande från professionen som positivt dock fanns en osäkerhet om hur stor inverkan på vården de hade. För att slutsatsen av studien ska kunna generaliseras krävs dock en större studie som omfattar samtliga patientrepresentanter inom RCC. / Background: Patient-centered care means that each patient is seen as an individual rather than a diagnosis and focus on the patient's resources instead of needs, and should be involved in the care process. RCC - Regional cancer center works to enhance patient empowerment and status in cancer care by patient representation in patient council care programs and groups, in which the patient´s experiences, knowledge and opinions about cancer care is being utilized. According to previous research, there is currently not enough evidence to identify the importance of patient involvement in health care. Aim: The study aimed to explore patient representatives' experiences and opinions of their work in care programs and patient council of Uppsala Örebro region from a patient perspective. Method: Eight patient representatives of the RCC's program of care groups and patient council were interviewed according to a semi-constructed interview guide. A content analysis by Lundman and Hällgren-Graneheim was used. Results: From the interviews two categories were obtained; patient representation and experience of care. From these categories six subcategories were identified. The informants were generally satisfied with their treatment. All respondents were positive about their work, however, there is uncertainty whether their work lead to changes in the health care. Conclusion: The finding of this study, suggests that patients' representatives perceive their role, work and attitude as positive. For the results of the study to be able to generalize, a larger study that includes all patient representatives in RCC is required

SAMMANFATTNING Bakgrund Vid ett cancerbesked ges mycket information som kan ge psykologiska reaktioner hos patienten.  Att ge individuellt stöd, information och ett bra bemötande är viktigt för att patienten ska känna sig trygga och delaktig i sin vård. Syfte Att utvärdera bröstcancerpatientens upplevelse av information, stöd, bemötande och delaktighet i samband med sitt återbesök hos kontaktsjuksköterska efter operation på Bröstmottagning. Metod En tvärsnittsstudie med kvantitativ ansats då huvudfokus var patientens upplevelse av information, stöd, bemötande och delaktighet. Patienterna fick svara på en elektronisk enkät direkt efter sitt återbesök på mottagningen. Totalt svarade 48 patienter på enkäten. Resultat  Resultatet visade en mycket hög nöjdhetsgrad bland bröstcancerpatienter vad gäller information, stöd, bemötande och delaktighet i samband med återbesöket hos kontaktsjuksköterskan efter bröstkirurgi. Äldre kvinnor var mer nöjda med informationen jämfört med de yngre. Utbildningsnivå hade ingen betydelse för hur nöjd patienten var eller uppfattningen av delaktighet och stöd. Inte heller kunde man påvisa några signifikanta skillnader mellan information och delaktighet mellan de som genomgått bröstbevarande kirurgi kontra tagit bort hela bröstet. Slutsats Kontaktsjuksköterskan har således en viktig roll på mottagningen när det gäller omvårdnad och vårdkvalitet ur ett patientperspektiv. Att kunna identifiera områden som är i behov av förbättring är viktigt. Analysen ger stöd för att det arbetssätt som kontaktsjuksköterskorna och läkarna har idag är positivt för patienten då studien påvisade att majoriteten av patienterna var mycket nöjda med information, stöd, bemötande och kände sig delaktiga vid sitt återbesök hos kontaktsjuksköterska. Nyckelord: Stöd, bemötande, information, patientdelaktighet, bröstcancer patienter. / ABSTRACT Background When a cancer diagnosis is given much information that cause psychological reactions. To provide individual support, information and good treatment is important for the patient to feel confident and involved in their care. Aim To evaluate breast cancer patient's experience of information, support, treatment and involvement during her visits at the contact nurse after surgery at the outpatient clinic. Method A cross-sectional study with a quantitative approach when the main focus was the patient's experience of information, support, treatment and participation. The patients were asked to answer an electronic questionnaire directly after her return visit to the clinic. In total, 48 patients participate in the survey. Results The results showed a very high degree of satisfaction among breast cancer patients in terms of information, support, treatment and participation in connection with the return visit of the contact nurse after breast surgery. Older women were more satisfied with the information compared to younger women. Level of education had no impact on how satisfied patients were or perceptions of participation and support.  There were no significant changes concerning information and participation from those who have undergone breast conserving surgery versus removal of the entire breast. Conclusion The contact nurse plays an important role on reception when it comes to care and quality of care from a patient perspective. To identify areas in need of improvement is important. The analysis provides support for the work procedure that the contact nurses and doctors today are positive using for the breast cancer patients. The study demonstrated that the majority of patients were very satisfied with the information, support, and treatment and felt involved in the visit of the contact nurse. Keyword: Support, treatment, information, patient involvement , breast cancer patients.

The overall aim of the thesis was to investigate whether patient safety can be improved for patients with hip fracture by nutritional intervention and by pharmacological treatment with cranberry concentrate. Another aim was to describe the patients’ experience of involvement in their care. The thesis includes results from four studies that include both quantitative and qualitative design. Studies I and II were intervention studies with a quasi-experimental design, with intervention and comparison groups. Study III was a randomised, double-blind, placebo-controlled trial with intervention and control groups. Study IV took a qualitative approach. Study I showed that when patients with hip fracture received nutritional supplementation according to nutritional guidelines, from admission until five days postoperatively, fewer patients developed pressure ulcers. Study II showed that it is possible to objectively evaluate a short-term nutritional intervention through the nutritional biochemical marker IGF-1, as it was affected by a five-day high-energy regimen. The randomised controlled trial, Study III, showed that a short-term treatment from admission until five days postoperatively with cranberry as capsules does not seem to be useful in preventing positive urine cultures in female patients with hip fracture and a urinary catheter. Finally, Study IV showed that patients with hip fracture reported experiencing very little involvement in their nursing care, to the extent that fundamental aspects of nursing care went unfulfilled. Patients did not feel valued by the nurses and unbearable pain that affected rehabilitation was reported. Positive interactions with nurses, however, did encourage patients to be more active. It is possible for every nurse to improve patient safety at bedside when caring for patients with hip fracture. Simply by increasing caloric/energy intake, it is possible to prevent pressure ulcers. It is also important to involve patients in nursing care, since the patients have experienced low or almost no involvement in care. Nurses need to see each patient as a whole person with different wishes and needs. However, certain prerequisites have to be in place to give nurses the opportunity to increase patient safety at bedside for patients with hip fracture.

My thesis examines patients’ and caregivers’ perspectives on educating healthcare providers(HCPs). Specifically, it examined two research questions: 1) What do patients think about their involvement in the education of HCPs? and 2) What roles do patients want to have in the education of HCPs? It is important for educational leaders and HCPs to understand answers to these questions, from patients’ own perspectives, to make effective changes in current and future health professions education and ultimately, the delivery of patient-centred care. I conducted semi-structured interviews with 27 patients and caregivers for this study. Through conventional content analysis, I identified five themes for what patients think about their involvement in the education of HCPs. Namely, patient involvement in the education of HCPs: (1) is challenging because of power-differentials between themselves and HCPs; (2) requires patient training; (3) needs to start early in HCPs’ education process; (4) can improve patient-HCP partnerships; and (5) requires compensation for patients. I also identified three roles that patients want to have in the education of HCPs. Specifically, they want to: (1) teach HCPs about patients’ expectations, experiences, and perspectives through case studies, storytelling, and research; (2) provide direct feedback to HCPs; and (3) advise on curricula development and admission boards for HCPs. My research adds to the limited research on patients’ and caregivers’ perspectives on their involvement in the education of HCPs, identifies barriers to patient involvement, and provides a foundation that HCPs and educational leaders can use to improve patients’ active involvement in the education of HCPs. Further, it highlights that patients’ voices are important to the education of HCPs. It also illuminates my own perspectives on patient involvement in the education of HCPs, which I share as part of my positionality as a researcher who conducted this study.

Människans livslängd förväntas bli längre vilket leder till att fler personer behöver vård. Vårdpersonal behöver därför använda flera strategier för att förbättra hälsan och livskvalitén, en av strategierna är att patienterna får vara delaktiga i sin vård. Därav är patientdelaktigheten viktig för patienternas välmående och livskvalité. Patientlagen (2014:821) syftar till att hälso- och sjukvården ska stärka patienten samt främja patientens självbestämmande och delaktighet. Syftet var att beskriva patientens uppfattning om delaktigheten i vården. En allmän litteraturstudie utfördes och resultatet baserades på 11 vetenskapliga artiklar. Studieresultatet resulterade i två kategorier: förutsättningar för delaktighet och påverkansfaktorer. Resultatet visade att vårdpersonalens bemötande och tillit påverkade patientdeltagandet och känslan av att vara involverad i sin vård. När patienten fick tillräckligt med information angående sin vård ökade förståelse för hälsosituationen och möjligheten till att vara delaktig i sin vård. Patientdeltagandet ökade när patienterna kände sig hörda och förstådda samt när det skapades en bra. relation med vårdpersonalen. / Human life is expected to be longer, which means that more people need healthcare. Therefore, healthcare professionals need to use several strategies to improve human health and quality of life, one of the strategies being to allow patients to be involved in their care. Hence, patient participat'ion is important for patients' well-being and quality of life. The Patient Act (2014: 821) aims for the health care system to strengthen the patient and promote the patient's self-determination and participation. The purpose was to describe patients' perceptions of participation in healthcare. A systematic literature review was conducted and the result was based on 11 scientific articles. The study resulted in two categories: conditions for participation and influencing factors. The result showed that the care staff's attitude and confidence affected the patient's participation and the feeling of being involved in their healthcare. When the patients received better information regarding their care, they were able to understand their health situation better and were given a greater opportunity to be involved in their own healthcare. Patient participation increased when patients felt heard and understood as well as when a good relationship was created with the healthcare staff.