Abstrakt Bakgrund: Typ 2 diabetes är en livsstilssjukdom som ökar både i Sverige och globalt. Egenvården är en viktig del i behandlingen av sjukdomen och är en livslång uppgift. Sjuksköterskan har en viktig roll i att, genom stöd, undervisning och vägledning, motivera och stärka personens egenvårdskapacitet. För att bättre förstå personens behov i egenvården är det betydelsefullt att sjuksköterskan får ta del av personers erfarenheter av egenvård vid typ 2 diabetes. Syfte: Syftet med denna litteraturstudie var att belysa personers erfarenheter av egenvård vid typ 2 diabetes. Metod: Litteraturstudie baserad på tolv kvalitativa artiklar. Artiklarna söktes i databaserna Cinahl och PubMed. Artiklarna kvalitetsgranskades och analyserades och kategorier och underkategorier identifierades.  Resultat: Resultatet kategoriserades i fyra kategorier och elva underkategorier. Dagligt liv med underkategorier kost, fysisk aktivitet, läkemedelsbehandling och blodsockerkontroll. Stöd; socialt stöd, stöd i samband med sociala sammankomster, familjen som stöd och tron som stöd. Psykiska aspekter; motivationens betydelse för egenvård och känslor i samband med egenvård. Kunskap/information; kunskap och förståelse och behov av diabetesutbildning. Konklusion: Erfarenheter av egenvård varierar från person till person. Att kunna stödja och motivera personen till egenvård ställer stora krav på sjuksköterskans omvårdnadskapacitet. Mycket talar för att Orems egenvårdsteori är användbar i sjuksköterskans arbete med detta.  Nyckelord: Typ 2 diabetes, egenvård, Orem, patientperspektiv, omvårdnad.

Postoperativ smärta är en smärta som är förväntad av både patient och sjuksköterska. Mötetmellan sjuksköterska och patient med postoperativ smärta innefattar sjuksköterskans kunskap och fördomar om smärta, samt patientens känsla av utlämnande och upplevelse av smärta. Syftet var att genom en litteraturstudie belysa viktiga faktorer i mötet mellan sjuksköterska och patient med postoperativ smärta. Därtill två frågeställningar; Vad är viktigt för sjuksköterskan i bemötandet av patienter med postoperativ smärta? Vad är viktigt för patienten med postoperativ smärta i mötet med sjuksköterskan? Metod Litteraturstudie med Graneheim och Lundmans analysmetod som verktyg. Litteraturstudien grundar sig i vetenskapliga artiklar. Resultat Nio betydelsefulla faktorer i mötet mellan sjuksköterska och patient med postoperativ smärta framkom ur artiklarna. Resultatet presenteras i sjuksköterskan perspektiv och ur patientens perspektiv. Föreliggande studier visar på att det finns hinder i kommunikationen mellan sjuksköterska och patient med postoperativ smarta. Diskussion En rak och klar kommunikation är en viktig faktor i mötet mellan sjuksköterska och patient med postoperativ smärta. Sjuksköterskan hjälper patienten att uttrycka sig och är beroende av förmågan att observera även det icke-verbala kroppsspråket. Genom att sjuksköterskan ger patienten god information skapas en trygghet och mötet mellan sjuksköterska och patient med postoperativ smärta blir mer optimal.

The 2001 Institute of Medicine's (I.O.M.) landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century observes that, "[though] medical science and technology have advanced at a rapid pace,...the health care delivery system has floundered in its ability to provide consistently high-quality care" (I.O.M. 2001). The report recommended six quality aims for a twenty-first century health care system; one of them being patient-centered care. It explains patient-centered care as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions" (I.O.M. 2001). This research is aimed at directly addressing this I.O.M. recommendation and seeks to understand quality care in the context of the I.O.M. guideline which clearly states that to achieve quality "the patient is the source of control of interactions" with the provider system. The objectives of this project are: (i) to gain a deeper and clearer understanding of the ways patients as customers of an outpatient clinic evaluate health care providers, and (ii) to determine if varying definitions of service quality exist with in a clinic containing a complex constituency. The project site chosen was the set of outpatient clinics at USF Health that makes for a complex site (e.g. eighty different specialties, outpatient surgical units, practicing and academic environment, multi-disciplinary teams at work involving multiple levels of health care professionals and complex inter-personal relationships) to carry out this research. The formal hypothesis can be stated as follows: H1: There exist identifiable differing classes of patients with varying perceptions of Service Quality in an outpatient setting. The subsequent research questions that the research aims to address are that, given that differing patient classes can be identified, do they have an impact on the overall patient-perceived quality and how significant is the impact? The project will contribute to a change in the approach at the clinic from a profession-centered to a patient-centered effort. It will raise the awareness among clinicians about how patients view quality care which can then be integrated into the system, institutionalized over time and thus help them improve their ability to provide quality care as preferred by patients. It will also serve to educate and empower the patients by increasing their participation and strengthening their role as partners with clinicians in a health care system. According to a review of the consumer health literature (Hibbard 2003), patients who collaborate with their health care providers and play an active role in their health care have improved health outcomes. It also enables future work in metric identification to promote continuous improvement in care provision. Though the research was conducted at a specific outpatient setting, it will have wider applicability as it can be a model worth emulating more broadly. The study also contributes to the academic literature that clearly indicates that there is a recognized need for more research on the delivery of outpatient care (Hammons 2003). Additionally, the study can be applicable and useful in other environments with complex constituencies (e.g. university classrooms, public transportation and travel industry).

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Recent changes in legislation and access to information, through sources such as the media, may have influenced peoples' expectations for information about their prescribed medication. As a result, health care professionals may perceive an increased pressure to provide information. A case study approach was employed to examine the sources and scope of information patients draw upon when they are prescribed oral steroids for asthma. The aim was to examine the extent to which patients can be said to exercise an `informed choice' when they take prescribed medication. The role and importance of GPs (general practitioners) in informing the choices patients make was also examined. Both qualitative and quantitative methods were employed. Interviews conducted with both patients and GPs indicated `gaps' in understanding. Although the GP was the preferred source of information, patients reported that the choices they made were based on information from a range of sources. General practitioners justified not providing information to patients so as to `protect' patients from knowledge of side effects. However, there was some awareness of the range of sources of information used by patients. A vignette technique was employed to further investigate GPs' recognition and understanding of the range of sources of information patients' use to inform the choices they make. Approximately half of the GPs who responded to the vignette recognised the influences presented. General practitioners who had been practising for a shorter period of time were significantly more likely to recognise these influences. The conclusions draw on the literature of the sociology of the professions. In spite of the way in which the Government has sought to encourage patients to act as consumers, the state has also continued to endorse GPs right to make decisions concerning the level of information to provide. If GPs do not believe it is in the interests of patients to be provided with information to make choices about their medications then the information available to patients may be limited. This will have an impact on the ease with which patients may make `medically' informed choices about their prescribed medication. Only when the communication between patients and GPs improves, will it be possible for a relationship to develop where patients may be assured of gaining information from their GP at the level they feel is appropriate to enable them to make informed choices about their medication.

Det har visat sig att patienterna vårdade vid thoraxkirurgens vårdavdelning i Uppsala  upplever en brist i samband med information.   Syftet med denna studie var att undersöka patienternas upplevelse av informationen de  fått vid utskrivningssamtalet med sjuksköterskan, en vecka efter utskrivning. De  intervjuade hade genomgått ingrepp i hjärtat och fått information utifrån rutiner som  avdelningen framarbetat från socialstyrelsens föreskrifter och allmänna råd. En kvalitativ  ansats valdes och telefonintervjuer genomfördes med fem patienter en vecka efter att de  skrivits ut. Data analyserades med innehållsanalys. Resultatet visade att patienterna hade  positiva upplevelser av informationen de fått vid utskrivningssamtalet med  sjuksköterskan och analysen resulterade i tre huvudkategorier med subkategorier. Dessa  var viktig information med subkategorin specifik information och trygghet inför  hemgång, motivation med subkategorierna erfarenhet nyfikenhet och mottaglighet och  kunskap och kunskapsförändring med subkategorierna varierande information, vikten av  fortsatt stöd, nöjda patienter och djupare insikt som leder till trygghet. Den information  som uppskattades av patienterna var informationen angående egenvård och de intervjuade  uttryckte att de var nöjda med de råd de fått angående egenvård. Samtliga patienterna  upplevde informationen som individuellt anpassad till det informationsbehov de hade och  slutsatsen är att de rutiner som avdelningen följer medför att patienterna är  välinformerade och trygga inför hemgång. / Previous studies at the thorax surgical ward in Uppsala indicates that the patients’  experience a lack in context of information.  The aim of this study was to examine the patients’ experiences and thoughts concerning  the information given by a nurse at a discharge discourse one week after discharge. The  participants had all had heart surgery and been given information elaborated from the  Swedish health authorities directions and general advices.   The study had a qualitative method and data was collected through telephone interviews  with 5 patients, one week after discharge. Data was analysed with content analysis. The  result indicates that patients’ consider the information as positive and the analysis  resulted in three main categories with subcategories. These were important information  with the subcategory specific information, motivation with the subcategory experience  curiosity susceptibility and knowledge and development of knowledge with the  subcategories variation in information, the importance of continuing support, satisfied  patients’ and deeper knowledge leads to security.  Information that the patients’ appreciated concerned self-care and all interviewed were  pleased with the given advises concerning self-care and considered the information as  adjusted to their information need.  The conclusion is that the routines that the thorax surgical ward in Uppsala uses, entail  the patients´ to feel well-informed and secure before discharge.

Bakgrund: Årligen drabbas 12000 individer av afasi i Sverige. Det är ett stort samhällsproblem. Sannolikheten att som sjuksköterska stöta på dessa individer är därmed stor. Sjuksköterskor är i behov av mer kunskap om de kommunikationsmöjligheter som finns för att kunna främja hälsa hos individer med afasi. Syfte: Syftet med denna litteraturstudie var att belysa vilka möjligheter individer med afasi har till kommunikation. Metod: Vald metod var en litteraturöversikt med fokus på empirisk forskning i form av kvalitativa och kvantitativa vetenskapliga artiklar som sammanställdes för att få en överblick över kunskapsområdet. Sökorden som användes var Communication, Aphasia, Nursing, Strategies, Health och Well-being. Resultat: Examensarbetets resultat baserades på 15 vetenskapliga artiklar. Följande huvudområden framkom i resultatet: Materiella hjälpmedel för kommunikation, Verbal och icke verbal kommunikation, Kommunikationsfrämjande miljö och Kommunikationsfrämjande icke-materiella faktorer. Slutsats: De möjligheter till kommunikation som framkom i resultatet passar olika bra på olika individer med afasi och kan därför inte vara applicerbara på samtliga av dessa. Det visade sig dock att det är av vikt att sjuksköterskor har en medvetenhet om de olika möjligheter till kommunikation som finns hos individer med afasi, samt lär känna individen i fråga. Detta för att underlätta kommunikation och främja hälsa och välbefinnande hos dessa individer. / Background: Each year 12 000 individuals get affected by aphasia in Sweden. It is a big problem in the society. The chance of facing these individuals as a nurse is therefore very big. Nurses are in need to gain more knowledge about the different communication possibilities to be able to promote health in these individuals. Aim: The aim of this literature review was to illustrate communication possibilities for individuals with aphasia Method: The chosen method was a literature review with focus on empirical research in the form of qualitative and quantitative scientific articles, which were compiled in order to attain an overview on the current field of knowledge. Search terms that were used in this study were Communication, Aphasia, Nursing, Strategies, Health and Well-being. Result: The result was based on 15 scientific articles. Following main areas were identified in the result: Physical facilities for communication, Verbal and nonverbal communication, Communication enabling environment and Communication enabling non- material factors. Conclusion: The communication possibilities identified in this study cannot be applied to all individuals with aphasia. It appeared though, that it is important that nurses have an awareness of different communication possibilities in individuals with aphasia, but also take time to get to know the individual in question. This is important when facilitating communication and hence promoting health and well-being in these individuals.

Background: Patients’ recovery from surgery differs when they are in a hospital setting or at home. However, an often forgotten aspect of post-operative ambulatory care is the patients' recovery at home following ambulatory surgery.Aim: To explore and describe the patients’ experiences of recovery at home following the ambulatory surgery procedure.Method: A systematic review of 7 qualitative studies in English with pre-specified criteria was conducted. An overview of qualitative evidence derived from the 17 identified main themes across the 7 primary studies was analyzed.Result: Seven thematic analysis themes were identified as being core to the patients’ experience during recovery process at home: physical symptoms, a period of regaining pre-operative functions, psychological effects, the surgical wound, delayed recovery process, social support, and the sick-role condition.. These seven themes were described patient's experiences at home following ambulatory surgery from early stage of recovery to the time of getting back to normal life.Conclusion: Recovery at home following ambulatory surgery seemed to be challenging, a quality self-care at home was lacking in the form having full control and knowledge about symptoms; adequate information, education and medication during self-care management; sufficient support by carer and nurses; and enough time-off for recovery.

Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings:  Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.