Bakgrund: Patienter som har genomgått kirurgi i tarmen har ofta svårt att komma igång att äta den första postoperativa tiden, trots att tarmfunktionen har återkommit. Ett malnutritionstillstånd med negativ påverkan för kroppen att motstå sjukdom och komplikationer kan uppstå och leda till fördröjd återhämtning och förlängd vårdtid. Det finns sparsamt med studier av patienters perspektiv på sin egen nutrition vid inneliggande vård på sjukhus och här har en kunskapslucka uppmärksammats. Syfte: Syftet var att utforska hur måltidssituationen genomfördes på två kirurgiska vårdavdelningar för patienter som genomgått ett tarmkirurgiskt ingrepp, med specifikt fokus på patientens perspektiv, samt att belysa de hinder och möjligheter som fanns för patienterna till att påverka sitt näringsintag. Metod: Fokuserad etnografisk observationsstudie med efterföljande intervjuer. Etnografisk dataanalys med öppen kodning av handlingsmönster som växte fram till kategorier. Resultat: Patienterna hade en god medvetenhet om sitt sjukdomstillstånd och vad som krävdes för deras tillfrisknande. De hade förståelse för betydelsen av ett gott näringsintag och därmed utfördes också egenvårdshandlingar för att tillgodose dessa behov. De hinder som resultatet visade har indelats i kategorierna kunskapsbrist, fysiska hinder, yttre omständigheter samt personliga förutsättningar. Slutsats: Patienternas personliga förutsättningar behöver tas till vara mer genom en fördjupad dialog mellan patient och sjuksköterska. Utökad patientinformation och patientdelaktighet ses som möjligheter till att förbättra patienternas näringsintag under vårdtiden. Däremot finns yttre omständigheter som inte kan påverkas av sjuksköterskan, som de täta måltiderna, och dessa behöver lyftas i verksamheterna. Den övergripande miljön och rutiner vid måltider kan förbättras med fokus på estetik och platsen för måltiden. / Background: Patients who have undergone intestinal surgery often have difficulties starting to eat during the first postoperative days, despite the fact that the bowel function has returned. As a result, the threat of malnutrition, and its negative effect on the body to resist illness can create complications which may result in delayed recovery and consequently longer stay in hospital. There are sparse studies of patients’ perspectives on their own nutrition in hospital care and a knowledge gap has been noted. Aim: The aim of this study was to explore how mealtime situations were performed in two surgical wards for patients having intestinal surgery, with a specific focus on the patient's perspective, and to identify barriers and opportunities affecting the patients nutritional intake. Method: A focused ethnography observation study with following interviews. Ethnographic data analysis with open coding of patterns of action which developed into categories was used. Result: The patients showed a high awareness about their state of illness and what was needed for their recovery. They understood the importance of a good nutritional intake and therefore self-care actions were performed to satisfy those needs. The obstacles that were shown in the results have been divided into the categories lack of knowledge, physical obstacles, external circumstances and personal conditions. Conclusion: The patients´personal conditions needs to be taken into consideration through a deepened dialogue between the patient and the nurse. Extended patient information and patient participation are seen as opportunities to improve the patients´ nutritional intake during the hospital stay. There are external circumstances that can not be influenced by the nurse, for example the close mealtimes, which needs to be lifted in the hospital organization. The overall environment and hospital routines concerning mealtimes can be improved, focusing on esthetics and the place for the meal intake.

A Thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy December 2015 Johannesburg. / Introduction There has been little published in South Africa regarding quality improvement in health and in particular the involvement of patients in this intervention. There is evidence globally that both quality improvement efforts and particularly the engagement of the users adds value to health services. Three projects were conceived around this core concept as explained below. 1. Systematic review. Patients’ involvement in improvement initiatives: a qualitative systematic review After a search was done of databases, 5121 papers were found to be potentially relevant. After screening and critical appraisal for eligibility, it was found that 31 articles qualified for analysis. These were then assessed using JBI software and 5 categories and 2 metasynthesised findings were documented. In summary, there were enablers and barriers to involving patients. The five categories which lead to these 2 findings were the following: (1) although patient participation in QI is acknowledged and encouraged by many policies and documents globally, it is difficult to implement; (2) there are differing views between patients and providers as to the process; (3) on the positive side, different levels of involvement of patients in QI were demonstrated; 4) practical, appropriate and innovative results emerged; (5) individual or group support and incremental development through skills and enablement contributed towards success 2. The Integration of Non Communicable Chronic Diseases (NCDs) and HIV/Aids and mental health care through the involvement of chronically ill patients using Empowerment Evaluation (EE). At 9 primary care clinics, the process of EE was followed with chronically ill stable patients and appropriate healthcare workers. This was an additional intervention in an ongoing QI cycle on the integration of all chronic illnesses into one model, based on Lean principles. Steps followed were ‘’taking stock’’ ie assessing patients’ and HCWs’ impressions of the services at the clinic in a measured way, creating a vision and using this as a yardstick for the project and then problems and solutions being co-managed by the collaborative team. A total of 37 interventions were discussed and 23 implemented in the time frame. Innovative solutions were implemented and teams were empowered by the potential they experienced. 3. An exploration of childhood nutrition and wellness in a subdistrict by patient inclusivity in QI using experience based codesign (EBCD) with mothers/caregivers of malnourished children . Following the steps of EBCD, staff and patients exposed to health services regarding ill children, were interviewed, feedback was given of the findings separately and then in a combined meeting and co-design teams were created to work with the prioritised quality improvement interventions. Touch points in the system were examined through emotional mapping, video interviews and observations. Within the 10 month period of the project, 38 interventions were identified and 25 accepted and implemented at different levels. Conclusion The methodologies were chosen to fit with the qualitative aspect of the research. There were concrete appropriate improvement outcomes due to the engagement of service users in both the primary care clinics serving chronically ill patients and the paediatric system in one subdistrict eg the flow of patients improved, logistical improvements like direct admissions for very ill children, school and library opportunities for admitted ill children etc occurred. Subjective gains like the acknowledgement of their power role by patients and a flattening of the healthcare worker hierarchy were also experienced in the research. Other findings were that unexpected roleplayers were identified, the timeframe of such QI cycles needs to be considered especially regarding the resilience of patients and resources were not an importatn limitation. However some modifications would have to be considered to make these research approaches common practice. The particular research methodologies have not been published in a South African context before and have also not been used for paediatric or integrated chronic illness research and therefore contribute both content and process information to health systems research in South Africa. / MT2017

En grundförutsättning för folkhälsan är delaktighet och inflytande i samhället. Delaktighet är ett mångtydigt begrepp, och patientdelaktighet, som kan ses som ett mycket komplext begrepp, innebär således rätten till delaktighet i allt som rör den egna vården. I svensk sjukvård innebär det att all sjukvårdspersonal enligt hälso- och sjukvårdslagen har skyldighet att bidra till patientens delaktighet.Flertalet åtgärder via lagar och förordningar har under senaste årtiondet vidtagits för att stärka patientens ställning i vården. Vilka faktorer påverkar då patientens upplevelse av delaktighet? Syftet har varit att genom en litteraturstudie av kvalitativa vetenskapliga artiklar ur ett patientperspektiv, belysa faktorer som påverkar patientens upplevelse av delaktighet i vården, oavsett kontext. Den kvalitativa ansatsens främsta mål är att skapa ökad förståelse för människors livs- och sjukdomslidande som kan uppstå till följd av olycka och/eller sjukdom, och ge oss kunskap om hur dessa erfarenheter, upplevelser förväntningar och behov kan bemötas. Vårdlidande är något som vården skall kämpa för att inte behöva utsätta patienterna för. Resultatet presenterar fyra huvudteman; Kommunikation, förhållningssätt, organisationens struktur samt tid.Diskussionen tar upp att dagens organisationer har mycket att förändra, men även attityder och inställningen hos vårdpersonalen behöver förändras för att kunna inbjuda patienten till delaktighet. / Program: Fristående kurs

Utifrån våra erfarenheter som sjuksköterskor har vi en gemensam upplevelse av att det finns problem runt läkemedel och äldre. Det finns studier som visar att mellan 10 till 20 procent av äldre som läggs in akut på sjukhus beror på läkemedelsrelaterade problem. Biverkningar av läkemedel kan för den äldre ge ett lidande istället för ett lindrande. För att komma vidare tror vi att sjuksköterskor i mötet med den äldre behöver skapa förutsättningar för delaktighet i läkemedelsbehandling och därmed kunna uppfatta den äldres behov såväl uttalade som outtalade. Vad är det som hindrar och möjliggör patientens delaktighet i sin läkemedelsbehandling? Syftet med uppsatsen är att belysa den äldres förutsättningar för delaktighet i sin läkemedelsbehandling. Vi har genomfört en litteraturstudie av kvalitativa artiklar som har analyserats utifrån resultatens likheter och skillnader.Resultatet beskrivs i tre huvudteman och underteman. Huvudteman är, förväntningar, relation och kontroll. Äldres förutsättningar för delaktighet i sin läkemedelsbehandling är att det i mötet finns en ömsesidig vilja att nå varandra, att sjuksköterskan behöver goda kunskaper i vårdkommunikation samt att sjuksköterska och patient vågar dela kunskap med varandra.I diskussionen påpekas behovet av kunskap i kommunikation, individanpassad information och synliggörandet av sjuksköterskans roll vid läkemedelsbehandling. / <p>Program: Fristående kurs</p><p>Uppsatsnivå: C</p>

O aprimoramento dos processos que envolvem a comunicação do profissional de saúde com o paciente é fundamental para a humanização destes procedimentos e para a melhor qualificação dos resultados. A efetiva comunicação profissional-paciente incorpora uma complexa gama de habilidades que não são aprendidas informal ou intuitivamente. Deste modo, o ensino de tais habilidades necessita ser incorporado na formação dos Fonoaudiólogos. O guia de Calgary-Cambridge fornece estrutura, baseada em evidência, para análise e ensino de habilidades de comunicação na entrevista com o paciente. O objetivo deste trabalho foi realizar e avaliar um workshop para que os estudantes de graduação em Fonoaudiologia integrassem as habilidades comunicativas centradas no paciente com os procedimentos técnicos do processo de seleção e adaptação do aparelho de amplificação sonora individual (AASI). Participaram deste estudo 27 discentes (sexo feminino) do 4o ano do Curso de graduação em Fonoaudiologia da FOB/USP, com idades entre 20 e 27 anos, que não haviam recebido treinamento formal sobre habilidades de comunicação profissional-paciente. Foi realizado um workshop baseado na ferramenta Time and Talk (Ida Institute) adaptada do guia Calgary-Cambridge. Dentre as atividades, três consultas simuladas com atores profissionais interpretando pacientes reais foram utilizadas para exercício das habilidades de comunicação profissional-paciente e aconselhamento. Os participantes responderam ao Questionário dos Níveis do Supervisionado-Revisado (Supervisee Levels Questionnaire Revised SLQ-R) antes e após o workshop. Também responderam à Escala do Desenho da Simulação (Simulation Design Scale - SDS), escala visual analógica e a quatro perguntas abertas a respeito do impacto do workshop. Métodos quantitativos e qualitativos foram empregados para análise. Em média, os resultados do SLQ-R foram similares aos descritos na literatura para principiantes em atividades de aconselhamento. Houve uma diminuição significativa (teste t pareado) da pontuação na subescala Consciência sobre si e Motivação do SLQ-R pós-workshop que, aliado aos resultados qualitativos, sugeriram que o workshop levou a um novo entendimento do processo de comunicação/aconselhamento ao paciente e à maior conscientização dos participantes sobre seus atributos e limitações. Pontuações médias próximas do máximo foram obtidas na SDS, indicando a presença e importância das características da simulação, em particular a Fidelidade/Realismo e a possibilidade de ter o Feedback e realizar a Reflexão sobre a consulta, sendo isto também corroborado com os dados qualitativos. Na escala visual analógica a mediana igual a 8 indicou que os participantes acreditaram em sua habilidade de realizar o aconselhamento ao paciente após o workshop. A análise qualitativa indicou que os participantes julgaram como elementos mais desafiadores da consulta simulada lidar com as emoções do paciente (25%) e o processo de empatia (21%). Dentre as mudanças que pretendiam realizar em seu comportamento clínico após o workshop, a escuta ativa (45%) e empatia (33%) foram os mais citados. Foi sugerido ampliar o oferecimento do workshop e consultas simuladas (90%) para todos os anos do Curso de Fonoaudiologia. O workshop permitiu sensibilizar o discente quanto à importância do uso de habilidades de comunicação paciente efetivas e levou a uma reflexão e crítica sobre suas próprias habilidades. / The improvement of processes involving communication between the health professional and the patient is fundamental for the humanization of these procedures and the best qualifying results. Effective professional-patient communication incorporates a complex range of skills that are not learned informally or intuitively. Thus, the teaching of such skills needs to be incorporated into the audiologists´ training. The Calgary-Cambridge guide provides evidence based structure for analysis and teaching of communication skills in the interview with the patient. The aim of this study was to implement and evaluate a workshop for SLP-audiology undergraduate students integrate patient centered communication skills with the technical procedures of the hearing aid fitting process. Participated in this study 27 female students from the 4th year of undergraduation in SLP-Audiology at FOB / USP, aged between 20 and 27, who had not received formal training in professional-patient communication skills. A one-day workshop based on the \"Time and Talk\" tool (Ida Institute), adapted from the Calgary-Cambridge, guide was conducted. Among the activities, three simulated consultations with professional actors playing real patients were used for professional-patient communication and counseling skills training. Participants responded to the Supervisee Levels Questionnaire Revised (SLQ-R) before and after the workshop. They also responded to the Simulation Design Scale - SDS, visual and analogue scale and four open questions about the impact of the workshop. Quantitative and qualitative methods were used for analysis. On average, the SLQ-R results were similar to those described in the literature for beginners in counseling activities. There was a significant decrease (paired t-test) score on the SLQ-R subscale \"Self and others awareness post-workshop that, combined with the qualitative data, suggested that the workshop led to a new understanding of the process of communication/counseling for the patient and greater awareness of the participants about their attributes and limitations. Average scores near the maximum were obtained in SDS, indicating the presence and importance of simulation features, in particular the Fidelity/Realism and Feedback/Reflection, this being also supported by the qualitative data. On the visual analog scale a median of 8 indicated that participants believed in their ability to perform patient counseling after the workshop. Qualitative analysis indicated that participants deemed as the more challenging elements of the simulation dealing with patient\'s emotions (25%) and the process of empathy (21%). Among the changes that they intended to perform in their clinical behavior after the workshop, active listening (45%) and empathy (33%) were the most cited. It was suggested to expand the workshop offering and simulated consultations (90%) for each year of undergraduation course. The workshop allowed the students to raise awareness about the importance of using effective patient communication skills and led to reflection and criticism about their own abilities.

O aprimoramento dos processos que envolvem a comunicação do profissional de saúde com o paciente é fundamental para a humanização destes procedimentos e para a melhor qualificação dos resultados. A efetiva comunicação profissional-paciente incorpora uma complexa gama de habilidades que não são aprendidas informal ou intuitivamente. Deste modo, o ensino de tais habilidades necessita ser incorporado na formação dos Fonoaudiólogos. O guia de Calgary-Cambridge fornece estrutura, baseada em evidência, para análise e ensino de habilidades de comunicação na entrevista com o paciente. O objetivo deste trabalho foi realizar e avaliar um workshop para que os estudantes de graduação em Fonoaudiologia integrassem as habilidades comunicativas centradas no paciente com os procedimentos técnicos do processo de seleção e adaptação do aparelho de amplificação sonora individual (AASI). Participaram deste estudo 27 discentes (sexo feminino) do 4o ano do Curso de graduação em Fonoaudiologia da FOB/USP, com idades entre 20 e 27 anos, que não haviam recebido treinamento formal sobre habilidades de comunicação profissional-paciente. Foi realizado um workshop baseado na ferramenta Time and Talk (Ida Institute) adaptada do guia Calgary-Cambridge. Dentre as atividades, três consultas simuladas com atores profissionais interpretando pacientes reais foram utilizadas para exercício das habilidades de comunicação profissional-paciente e aconselhamento. Os participantes responderam ao Questionário dos Níveis do Supervisionado-Revisado (Supervisee Levels Questionnaire Revised SLQ-R) antes e após o workshop. Também responderam à Escala do Desenho da Simulação (Simulation Design Scale - SDS), escala visual analógica e a quatro perguntas abertas a respeito do impacto do workshop. Métodos quantitativos e qualitativos foram empregados para análise. Em média, os resultados do SLQ-R foram similares aos descritos na literatura para principiantes em atividades de aconselhamento. Houve uma diminuição significativa (teste t pareado) da pontuação na subescala Consciência sobre si e Motivação do SLQ-R pós-workshop que, aliado aos resultados qualitativos, sugeriram que o workshop levou a um novo entendimento do processo de comunicação/aconselhamento ao paciente e à maior conscientização dos participantes sobre seus atributos e limitações. Pontuações médias próximas do máximo foram obtidas na SDS, indicando a presença e importância das características da simulação, em particular a Fidelidade/Realismo e a possibilidade de ter o Feedback e realizar a Reflexão sobre a consulta, sendo isto também corroborado com os dados qualitativos. Na escala visual analógica a mediana igual a 8 indicou que os participantes acreditaram em sua habilidade de realizar o aconselhamento ao paciente após o workshop. A análise qualitativa indicou que os participantes julgaram como elementos mais desafiadores da consulta simulada lidar com as emoções do paciente (25%) e o processo de empatia (21%). Dentre as mudanças que pretendiam realizar em seu comportamento clínico após o workshop, a escuta ativa (45%) e empatia (33%) foram os mais citados. Foi sugerido ampliar o oferecimento do workshop e consultas simuladas (90%) para todos os anos do Curso de Fonoaudiologia. O workshop permitiu sensibilizar o discente quanto à importância do uso de habilidades de comunicação paciente efetivas e levou a uma reflexão e crítica sobre suas próprias habilidades. / The improvement of processes involving communication between the health professional and the patient is fundamental for the humanization of these procedures and the best qualifying results. Effective professional-patient communication incorporates a complex range of skills that are not learned informally or intuitively. Thus, the teaching of such skills needs to be incorporated into the audiologists´ training. The Calgary-Cambridge guide provides evidence based structure for analysis and teaching of communication skills in the interview with the patient. The aim of this study was to implement and evaluate a workshop for SLP-audiology undergraduate students integrate patient centered communication skills with the technical procedures of the hearing aid fitting process. Participated in this study 27 female students from the 4th year of undergraduation in SLP-Audiology at FOB / USP, aged between 20 and 27, who had not received formal training in professional-patient communication skills. A one-day workshop based on the \"Time and Talk\" tool (Ida Institute), adapted from the Calgary-Cambridge, guide was conducted. Among the activities, three simulated consultations with professional actors playing real patients were used for professional-patient communication and counseling skills training. Participants responded to the Supervisee Levels Questionnaire Revised (SLQ-R) before and after the workshop. They also responded to the Simulation Design Scale - SDS, visual and analogue scale and four open questions about the impact of the workshop. Quantitative and qualitative methods were used for analysis. On average, the SLQ-R results were similar to those described in the literature for beginners in counseling activities. There was a significant decrease (paired t-test) score on the SLQ-R subscale \"Self and others awareness post-workshop that, combined with the qualitative data, suggested that the workshop led to a new understanding of the process of communication/counseling for the patient and greater awareness of the participants about their attributes and limitations. Average scores near the maximum were obtained in SDS, indicating the presence and importance of simulation features, in particular the Fidelity/Realism and Feedback/Reflection, this being also supported by the qualitative data. On the visual analog scale a median of 8 indicated that participants believed in their ability to perform patient counseling after the workshop. Qualitative analysis indicated that participants deemed as the more challenging elements of the simulation dealing with patient\'s emotions (25%) and the process of empathy (21%). Among the changes that they intended to perform in their clinical behavior after the workshop, active listening (45%) and empathy (33%) were the most cited. It was suggested to expand the workshop offering and simulated consultations (90%) for each year of undergraduation course. The workshop allowed the students to raise awareness about the importance of using effective patient communication skills and led to reflection and criticism about their own abilities.

Interventions are needed to improve health outcomes by increasing the practice of evidence based medicine ( EBM ). Patient mediated interventions have been little studied but hold promise : they target identified barriers to EBM and particular types of patient mediated intervention have shown success. Furthermore, consumers are now being given information about evidence but the effects of this on EBM have yet to be properly assessed. The aim of this study was to show whether informing patients about research evidence leads to improved application of that evidence in their medical care. The study trialed a relatively low cost manual, developed using current best practice, which summarised Cochrane Reviews of evidence. The study focused on chronic obstructive pulmonary disease ( COPD ), a high - cost, high - burden chronic disease, showing a large gap between evidence and clinical practice. The study comprised a controlled before - and - after trial and a process evaluation. The trial assessed the success of this manual in changing medical practice for three indicator treatments ( influenza vaccination, bone density testing and pulmonary rehabilitation ) and in changing patient quality of life, knowledge, communication with doctor, satisfaction with information and anxiety. Results were analysed by median split of socioeconomic disadvantage. At 3 months the manual was associated with lower anxiety for participants with lowest socioeconomic disadvantage. At 12 months the manual was associated with higher pulmonary rehabilitation enrolment for participants with greatest socioeconomic disadvantage. Other outcome measures showed no significant change. Limitations included loss of power from unexpectedly good baseline care and adjustments for baseline differences. The process evaluation showed that the manual was read more than a control pamphlet at both 3 and 12 months but a minority of manual recipients reported talking to their doctor about topics from the manual. Very little treatment change was reported. Patient attitudes to evidence and doctor / patient communication norms appeared to be barriers for this patient group. New protocols for the design of behavioural interventions provide a framework for overcoming these barriers in future interventions. / Thesis (Ph.D.)--School of Medicine, 2006.

<p><strong>Syfte: </strong>Syftet har varit att beskriva hur patienter uppfattar begreppet egenvård samt deras uppfattningar gällande information om egenvård.</p><p><strong>Metod: </strong>Empirisk studie med kvalitativ design. Strategiskt urval av åtta patienter som genomgått stamcellstransplantation. Datainsamling skedde genom semistrukturerade intervjuer.</p><p><strong>Resultat: </strong>Patienter uppfattar att egenvård är att ta hand om sig så att den egna fysiska samt psykiska hälsan främjas, utan inblandning av sjukvården. De flesta patienter uppfattade att informationen om egenvård hade varit tillfredsställande. Dock förekom svårigheter med att koppla ihop begreppet egenvård med den information som givits om egenvårdande åtgärder. Ett fåtal av informanterna ansåg att informationen om egenvård hade varit av bristande kvalitet. Informanter upplevde svårigheter med att tillgodogöra sig informationen om egenvård. Kontinuerlig och upprepad information upplevdes som positivt. Personalens tillgänglighet samt möjlighet att ta sig tid värderades högt. Majoriteten av de intervjuade saknade ingen information om egenvård men däremot en förklaring av vad själva begreppet egenvård betyder.</p><p><strong>Slutsats:</strong> På hematologkliniken används inte begreppet egenvård när information om egenvård ges till patienter. Därmed finns det ett behov av att definiera och tydliggöra vad begreppet egenvård innebär. Patienter värderar personalens tillgänglighet samt förmåga att ge individanpassad och upprepad information högt, eftersom det ökar förmågan att tillgodogöra sig informationen om egenvård.</p> / <p><strong>Aim:</strong> The aim was to describe how patients perceive the concept of self-care and their perceptions concerning self-care information. <strong> </strong></p><p><strong>Method:</strong> Empirical study of qualitative design. Eight patients undergoing stem cell transplantation was strategically selected.  Semi-structured interviews were used. <strong></strong></p><p><strong>Results: </strong>Patients perceive that self-care is to take care of oneself in order to promote physical and mental health, without involvement of health care. Most patients felt that the need of self-care information had been content. Patients had difficulties in linking the concept of self-care with the information that had been given about self-care interventions. A few informants felt that the self-care information had been unsatisfactory. Informants experienced difficulties in assimilating the information. Continuous and repeated information was appreciated. The staff´s availability and  willingness to take time for the patient were valued highly. The majority of the interviewees did not lack any self-care information but were in need of an explanation of what the concept of self-care means.</p><p><strong>Conclusion:</strong> The term self-care is not used when information about self-care is given. The concept of self-care needs to be defined. Staff availability and the ability to provide personalized and repeated information is appreciated, because it increases the ability to assimilate information about self-care.</p><p><strong></strong></p>

Background Patients’ preferences, needs and desires are important when discussing treatment. In consultations between patients with atrial fibrillation (AF) and health professionals, knowledge, understanding and insight about communication patterns are of vital importance for strengthening patient involvement in decision-making about their care and treatment. Aim The general aim of this thesis was to describe communication patterns in consultations between patients with AF and health professionals. Specific aims (1) To describe (i) the topics patients with AF and their nurses and physicians discuss; (ii) the use of discursive space in consultations between these participants; and (iii) the frequencies with which patients and nurses/physicians introduce the identified topics. (2) To describe the types of patient resistance to accepting treatment with warfarin and how cardiologists respond to such resistance. Methods An inductive design was used. In study I, the sample consisted of 23 consultations between patients with AF (13 women and 10 men) and health professionals (5 women and 5 men) who were employed in six different cardiologic outpatient clinics. Content analysis was used to obtain a description of topics discussed. The patterns of dominance for the various topics and participant were explored from the framework of an analysis of dominance (I). In study II, the sample consisted of 11 consultations between patients with AF (7 women and 4 men) and cardiologists (2 women and 3 men). Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin. Findings Study I. Four topics were introduced by both nurses and physicians during the consultations. These were “pathophysiology”, “treatment”, “diagnostic procedures”, and “activity”. In the nurse–patient consultations an additional topic, “routines related to the physician’s responsibilities”, emerged. With respect to the number of words and turns, the distribution of the discourse space was almost equal between nurses and patients, and unequal between physicians and patients. The patients were the dominant initiators of the topic “activity”, which refers to adaptation of activities in daily life in relation to AF. Study II. There were four types of patient resistance to accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggesting other treatment options”, “Stating treatment preferences” and “Questioning or challenging the cardiologist’s treatment recommendations”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information about the recommended treatment” and “Extending their explanation of the purpose of the treatment”. Conclusions The medical-driven agenda dominated over the patient-driven agenda in consultations between health care professionals and patients with AF. During conversations in consultations with nurses, the patients initiated discussion of living with AF and were more talkative than they were with physicians. An awareness of types of patient resistance to treatment would enable cardiologists to consider patients’ experience-based views about their treatment;

Bakgrund: Patientens roll i vården har under det senaste decenniet förändrats. Dagens patienter är allt mer medvetna om rättigheterna som de har i vården. Alla människor har laglig rätt till information och delaktighet i beslutsfattandet som berör deras egen vård. Sjuksköterskans förhållningssätt är av betydelse för patientdelaktigheten. Forskning har visat att det fortfarande kvarstår brister i patientens rätt till delaktighet, det är därför viktigt att veta vad patienten upplever som delaktighet och hur sjuksköterskan kan främja detta. Syfte: Syftet med denna studie är att beskriva patienters upplevelser av delaktighet och hur sjuksköterskan anser att hon eller han ska förhålla sig för att främja patientens delaktighet. Metod: Studien är en litteraturöversikt där både kvalitativa och kvantitativa artiklar har använts. Resultat: Resultatet visar på att patienterna upplever delaktighet när de får information och kunskap vilket leder till kontroll över situationen. Patienterna upplever också delaktighet när de har en bra relation med sjuksköterskan. De förhållningssätt som framkommer i resultatet för hur sjuksköterskan kan främja patientens delaktighet, är när hon eller han etablerar en bra relation, ger information, bidrar till kontroll och ser till patientens resurser. Diskussion: Det är viktigt att sjuksköterskan alltid reflekterar över patientens delaktighet samt får ökad kunskap i detta ämne i både utbildning och yrkesverksamhet. / Background: The patient’s role in health care has changed over the past decade. Today they are more aware of the rights they have in care. All people have the legal right to information and participation in decision making concerning their own care. To include the patient in their own healthcare the approach from the nurse is very important. Research has shown that there still remains a gap in the patients right to participation and because of that, it is important to know what the patients experience as participation and how the nurses could promote this. Aim: The aim of this study is to describe patients’ experience of participation and how nurses believe that they should approach to promote the patient’s participation. Method: The study is a literature review in which both qualitative and quantitative articles were used. Result: The result of the study has shown that patient’s experience participation when they get information and knowledge, which leads to patient feel control over the situation. Patients also experience participation when they have a good relationship with nurses. In order to promote patients participation nurse need to establish a good relationship, provide information, help to control and ensure the patients resources. Discussion: It is important that the nurse always reflect over the patient’s participation and to increase their knowledge in both education and professional activities