This research explored health decision-making processes among people recently diagnosed with type 2 diabetes. Our analysis suggested that diagnosis with type 2 was followed by a period of intense emotional and cognitive disequilibrium. Subsequently, the informants were observed to proceed to health decision-making which was affected by three separate and interrelated factors: knowledge, self-efficacy, and purpose. Knowledge included cognitive or factual components and emotional elements. Knowledge influenced the degree of upset or disequilibrium the patient experienced, and affected a second category, agency: the informants’ confidence in their ability to enact lifestyle changes. The third factor, purpose, summarized the personal and deeply held reasons people gave as they made decisions concerning their health, eating and exercising. We propose this model, grounded in informant stories, as a heuristic, to guide further inquiry. From these stories, the patient is seen as more active and the interrelated influences of knowledge, agency, and purpose, synergistically interact to explain changes in health behaviors.

Large portions of the US population live in poor inner-city communities. Health needs assessment data have shown that these communities have disproportionately high rates of chronic illnesses. The patient-centered medical home (PCMH) model was developed to address the gaps that exist in the primary care system, and emphasizes a redesign of primary care that is patient centered, utilizes multiple levels of healthcare professionals, information technology, and care coordination. However, little evidence exists on the value of this model which may explain why it has not gained wide acceptance by primary care providers. Therefore, this study was designed to examine the efficacy of the PCMH model through emergency department and inpatient utilization reductions, and with a specific focus on the role of social connectedness. This research used existing data on 706 participants from Columbia University and a local New York inner-city hospital. An in-depth analysis of hospital utilization data, using an unpaired two-sample t-test and linear regression, found that the PCMH framework strengthens continuity of care and care coordination, and helps reduce avoidable hospitalization utilization. Additionally, these reductions were greater for study participants with strong social support networks. This research highlights the relationships between primary care, social support networks, and good health outcomes. Over time, further enhancement of the PCMH and systemic changes to the delivery of care may contribute to the development of a stronger primary care system that place patients at the center of care, focuses on the importance of social connectedness, and contributes to a lasting impact on society through the development of overall healthier communities.

Adolescent obesity is a growing health concern in the United States due to its increasing prevalence and comorbidities that can reduce longevity and increase morbidity. Advanced practice nurses (APNs) providing care in school-based health centers (SBHC) located in marginalized communities are uniquely positioned to work with adolescent students challenged with obesity. The management of adolescent obesity requires advanced skills and knowledge to promote healthy lifestyles, prevent obesity, and to directly address the many factors that contribute to the condition. The purpose of this project was to develop an education program for APNs to prepare them to work with students in prevention and control of adolescent obesity in the SBHC. The Shuler nurse practitioner practice model provided the framework to guide the project. A literature search yielded evidence-based care guidelines for adolescent obesity that were used to develop the education program. The program was provided to a panel of 5 clinical experts made up of 2 APNs and 3 pediatricians who work with adolescents who are obese. The panel evaluated the program using a 5-item, Likert-style questionnaire covering the 5 objectives of the program. Results ranged from a mean score of 3.4 to 4.0, indicating that the expert panel agreed or strongly agreed that the program met the objectives. This education program was provided to the SBHC administration and will be implemented in the next school term. The project may promote positive social change through increased APN knowledge of clinical practice guidelines for managing adolescent obesity and through improved adolescent health.

Health portals are dedicated web pages for medical practices to provide patients access to their electronic health records. The problem identified in this quality improvement project was that the health portal in the urgent care setting had not been available to staff nor patients. To provide leadership with information related to opening the portal, the first purpose of the project was to assess staff and patients' perceived use, ease of use, attitude toward using, and intention to use the portal. The second purpose was to evaluate the portal education materials for the top 5 urgent care diagnoses: diabetes, hypertension, asthma, otitis media, and bronchitis for understandability and actionability using the Patient Education Material Assessment Tool, Simple Measures of Goobledygook, and the Up to Date application. The first purpose was framed within the technology acceptance model which used a 26-item Likert scale ranging from -3 (total disagreement) to +3 (total agreement). The staff (n = 8) and patients (n = 75) perceived the portal as useful (62%; 60%), easy to use (72%; 70%), expressed a positive attitude toward using (71%; 73%), and would use the technology (54%; 70%). All materials were deemed understandable (74%-95%) with 70% being the acceptable percentage. Diabetes, otitis media, and bronchitis were deemed actionable (71-100%), but hypertension (57%) and asthma (40%) had lower actionability percentages. Hypertension, asthma, and otitis media had appropriate reading levels (6-8th grade). However, diabetes (10th grade) and bronchitis (12th grade) were higher with the target being less than 8th grade level. All handouts were found to be evidence-based. Recommendations were to revise the diabetes and bronchitis educational handouts to improve readability. Social change can be promoted by this project by facilitating positive patient outcomes at urgent care clinics.

Bakgrund En stor del av de patienter som frekvent söker vård lider av psykosomatiska sjukdomar (MUPS) och somatiseringssyndrom (MUS). Båda dessa tillstånd grundar sig i psykiska påfrestningar men yttrar sig i form av fysiska symptom. Stress är en psykisk påfrestning som är mycket utbredd i vårt samhälle idag. När människan utsätts för stress startar en rad olika fysiska processer i kroppen, som en del av vår överlevnadsinstinkt. Trots det är det många som stressar sig sjuka. Då kroppen inte får chans till återhämtning ökar risken för ohälsa med risk för psykosomatiska sjukdomar och somatiseringssyndrom som följd. Syfte Studiens syfte var att belysa upplevelser hos patienter med psykosomatiska sjukdomar och somatiseringssyndrom i den somatiska vården. Metod En litteraturöversikt valdes som metod, där 16 artiklar inkluderades. Artiklarna var av kvantitativ eller kvalitativ metod och analyserades enligt metoden integrerad analys. Resultat Patienter med MUPS/MUS lider av ohälsa och remitteras runt till olika vårdenheter utan att få den hjälp de behöver. Detta innebär ytterligare påfrestning på hälsan hos dessa patienter. Starka känslor såsom utanförskap, oro, skam och rädsla för sin egna ohälsan genomsyrar dessa patienters upplevelser. Kunskapen för dessa sjukdomstillstånd är bristfällig och det saknas tydliga riktlinjer och behandlingsmetoder inom vården. Slutsats Stigmatisering kring psykisk ohälsa skapar skam och utanförskap, vilket patienter med MUPS/MUS i stor utsträckning upplever. Bristande kunskap har visat på ineffektiv behandling vilket dessutom medför enorma kostnad för samhället. Sambandet mellan kropp och själ får inte förbises. Sjukvårdspersonal bör därför utbildas i att se den psykologiska faktorn bakom de fysiologiska symptomen. / Background A large proportion of patients who frequently seek health care suffer from psychophysiologic disorders (MUPS) and somatoform disorders (MUS). Both of these conditions derive from mental illness yet they manifest as physical symptoms. Stress is a psychological phenomenon which is widely spread in our society today. When a person is exposed to stress, a variety of physical reactions commence within our body, due to our survival instinct. In spite of this, a lot of people become physically and mentally ill from stress. When our body is deprived of recovery, there is a higher probability for lack of health and therefore the risk of developing psychophysiologic disorder and somatoform syndromes increases. Aim The purpose of the study was to illuminate patients with psychophysiologic disorders and somatoform disorders and their experiences within the somatic healthcare. Method A literature review has been conducted with an including total of 16 articles. The chosen articles consisted of quantitative or qualitative methods, analyzed according to the integrated analysis method. Results Patients with MUPS/MUS suffer from lack of health and are often referred to various care units without getting the help they need. This leads to further distress with a decreased health experience. Strong emotions such as exclusion, anxiety, shame and fear of lacking health permeate these patients' experiences. The knowledge regarding these conditions are insufficient and no distinct guidelines nor clear treatments exist within the healthcare system. Conclusions The stigmatization regarding mental illness leads to feelings of shame and exclusion for these patients. The lack of knowledge leads to ineffective treatment, which also entails an increased economic burden for the society. The relationship between the body and the soul must not be overlooked. Healthcare professionals need to be educated in the ability to recognize the underlying psychological factors behind the physiological symptoms.

Akutsjukvård bedrivs dygnet runt och inkluderar ett brett spann av olika åkommor vilka ej kan anstå. Smärta är mycket vanligt förekommande på en akutmottagning och är ofta underbehandlad. Bedömning av smärta genomförs medelst utförlig smärtanamnes samt självskattning av smärtan. Personcentrerad vård syftar till att se individens behov och ta tillvara dennes resurser för att gemensamt planera och genomföra vården, vilket utmynnar i ett partnerskap med två jämbördiga parter. Akutsjuksköterskan förväntas ta ett större ansvar för behandlingar och egna bedömningar kontra den grundutbildade sjuksköterskan. Akutsjuksköterskan ska kunna bedöma och initiera avancerad omvårdnad samt farmakologisk behandling. Sjuksköterskan är i regel den första professionen patienten möter på en akutmottagning och kan därför anses vara en lämplig initiativtagare till att påbörja smärtlindring. På flera platser i världen används protokoll med generella direktiv på smärtstillande läkemedel syftande till att användas för att minska patientens smärta och lidande innan dess att läkarbedömning har genomförts. Syftet med denna litteraturöversikt var att undersöka effekterna av sjuksköterskeinitierad smärtlindring.   Metoden som använts är en litteraturöversikt med ett systematiskt tillvägagångssätt. Totalt 15 artiklar inkluderades efter sökningar i databaserna CINAHL samt PubMed. Artiklarna kvalitetsgranskades och sammanställdes i en artikelmatris. En integrerad analys mynnade ut i fyra kategorier samt fem underkategorier. Resultatet visar att patienterna snabbare fick smärtlindring efter införande av sjuksköterskeinitierad smärtlindring. Fler patienter erhöll smärtstillande läkemedel och fler patienter inkluderades i sin vård genom ökad frekvens av smärtskattning. En ökad nöjdhet med behandlingen kunde ses, det fanns även tendenser till att fler patienter blev adekvat smärtstillade.  Inga patienter drabbades av några allvarliga biverkningar. Slutsatsen är att sjuksköterskeinitierad smärtlindring är ett bra verktyg specialistsjuksköterskan kan använda med flera positiva effekter och utan allvarliga negativa effekter för patienter. Smärtlindringen ges snabbare och till synes med god effekt. / Emergency care is provided around the clock and includes a wide range of different ailments which cannot wait to be treated. Pain is commonly present in an emergency department and is often undertreated. Assessment of pain is carried out by means of detailed pain medical history taking and self-assessment of the pain. Person-centered care aims to see the individual's needs and make use of his or her resources to jointly plan and implement the care, which results in a partnership with two equal parties. The specialist emergency nurse is expected to take greater responsibility for treatments and own assessments compared to a registered nurse. The specialist emergency nurse must be able to assess and initiate advanced care and pharmacological treatment. The nurse is usually the first profession the patient meets in an emergency department and can therefore be considered a suitable initiator to start pain relief. In several places in the world, protocols are used with general directives on painkillers intended to be used to reduce the patient's pain and suffering before a medical assessment by a doctor has been carried out. The aim of this literature review was to investigate the effects of nurse-initiated pain protocols in emergency departments. The method used is a literature review with a systematic approach. A total of 15 articles were included after searches in the databases CINAHL and PubMed. The articles were quality checked and compiled in an article matrix. An integrated analysis resulted in four categories and five subcategories. The results show that the patients received pain relief more quickly after the introduction of nurse-initiated pain relief. More patients received painkillers and more patients were included in their care through increased frequency of pain assessment. An increased satisfaction with the treatment could be seen, there were also tendencies towards more patients experiencing adequate pain relief. No patients suffered any serious side effects. The conclusion is that nurse-initiated pain protocols are a good tool the specialist nurse can use with several positive effects and without serious negative effects for patients. The pain relief is given more timely and seemingly with good effect.

Psykisk ohälsa är ett växande folkhälsoproblem och förutspås vara den största sjukdomsbördan i världen år 2030. Första vårdkontakten för patienter med psykisk ohälsa är vanligtvis sjuksköterskor i telefonrådgivning inom primärvård. Sjuksköterskor i telefonrådgivning upplever att de bland annat saknar erfarenhet, kunskap samt rätt verktyg för att ge adekvat rådgivning när de möter patienter med psykisk ohälsa. Det är därmed relevant att undersöka sjuksköterskans upplevelse av att bedöma psykisk ohälsa vid telefonrådgivning inom primärvården. Sex sjuksköterskor med olika lång erfarenhet av arbete i telefonrådgivning intervjuades. Dataanalysen genomfördes med hjälp av Elo och Kyngäs kvalitativa innehållsanalys med en induktiv ansats. Två kategorier framträder i resultatet, ”att känna sig otillräcklig” samt ”att känna sig otrygg” följt av 7 subkategorier. Det finns behov av psykiatrisk specialistkompetens inom primärvården för att möta behoven relaterat till psykisk ohälsa i samhället. Sjuksköterskan känner sig otillräcklig vid bedömning av psykisk ohälsa i telefonrådgivning, vilket belyser vikten av tillgång till spetskompetens på arbetsplatsen. / Mental illness is a public health problem that is predicted to be the biggest burden of disease in the world by the year 2030. Telenurses in primary care are usually the first to encounter patients with mental illness. Telenurses feel that they lack experience and knowledge or the right tools to provide adequate care when they encounter mental illness. It is thus relevant to further research the nurses experience of assessing mental illness through telenursing in primary care. Six nurses with different lengths of experience in working in primary care telenursing were interviewed and the collected data were analyzed using Elo and Kyngäs qualitative content analysis with an inductive approach. Two categories appeared in the result, “to feel inadequate” and “to feel insecure” followed by seven subcategories. Feelings of inadequacy and insecurity emerged when facing mental illness and the conclusion of this study highlights the importance of access to expertise in the workplace, such as a psychiatric nurse.

Non-suicidal self-injury includes deliberately damaging the tissues of one's own body. Self-harming behaviour is a growing problem and the number of patients seeking care related to self-harm has increased the last years. Despite this, the number of people who don´t seek care is assumed to be high. Self-harming behaviour is a complex area with many underlying causes and functions. Patients with self-harming behaviour are a vulnerable group because of the stigma involved in injuring oneself. How patients with self-harming behaviour are treated in healthcare can have a major impact on future confidence in healthcare. The aim of this qualitative literature study was to explore how patients with self-harming behaviour experience the treatment in health care. Three main themes and six sub-themes emerged. Being acknowledged includes; patients' positive experiences, Being seen and Feeling confident. Not being taken seriously includes; the negative experiences, Feeling diminished and To feel shame and guilt. The third main theme, Being in the care chain, includes; A negative spiral and Social network. Altogether, the themes present the patient's experience of the treatment in the health care system and how structural factors contribute to the patient's experience. Negative experiences such as not being seen and heard and a feeling of shame caused an insecurity which made it difficult for the patient to seek care and to be honest with the health care staff. Patients felt that there was a lack of knowledge among health care professionals. More knowledge is needed to improve the treatment.

Varje dag blir människor utsatta för sexuella övergrepp, detta är en traumatisk händelse som kan framkalla en krisreaktion hos den som blivit utsatt. Det är därför viktigt att sjuksköterskor vet hur de på bästa vis ska bemöta dessa personer. Syftet med denna studie var att undersöka vad sjuksköterskor som arbetar med denna patientgrupp anser är ett bra bemötande. En kvalitativ empirisk metod användes. Semistrukturerade intervjuer genomfördes på två gynekologiska akutmottagningar i södra Sverige. Datamaterialet som framkom ur intervjuerna analyserades med hjälp av en kvalitativ innehållsanalys. I studiens resultat framkom tre övergripande teman: patientcentrerad vård, kompetens och samverkan. Under dessa teman framkom faktorer som var till hjälp för att få till stånd ett bra bemötande, och faktorer som försvårade det. Faktorer som påverkade bemötandet positivt var: bra samverkan med polisen, möjlighet att skapa en avskild och lugn miljö, följsamhet för patientens vilja och behov, kontinuerlig information till patienten samt att ge patienten möjlighet att tala om vad som hänt. Faktorer som påverkade bemötandet negativt var: den stressiga miljön på akutmottagningen, sjuksköterskornas behov av att distansera sig från patienten samt ett icke fungerande samarbete med andra yrkeskategorier. Det visade sig även att sjuksköterskorna var noga med att aldrig döma patienten eller den situationen hon befann sig i. Studiens slutsats var att utbildning och specialiserade kliniker behövs för att bemöta denna patientgrupp på bästa vis. / Every day, people are exposed to sexual assault. This is a traumatic event that can provoke a crisis reaction from the victim. It is therefore important that nurses know the best way to respond to these persons when encountering them. The purpose of this study was to examine what nurses who work with this patient group consider to be a good encounter. An empirical qualitative method was used. Semi-structured interviews were conducted in two gynecological emergency departments in southern Sweden. The data that emerged from the interviews were analyzed with the help of a qualitative content analysis. The result of the study reveals three main themes: patient-centered care, competence and cooperation. These themes revealed factors that were helpful in bringing about a good encounter, and factors that made it difficult. Helpful factors where: good cooperation with the police, the possibility to create a secluded and peaceful environment for the patient, adherence to the patient's desire, continuously inform the patient and give the patient an opportunity to talk about what had happened. Factors that made the good encounter difficult was: a stressful environment in the emergency room, nurses feeling the need to distance themselves from the patient and poor cooperation with other professionals. Another find was that the nurses were careful never to judge the patient or the situation the patient was in. The conclusion of the study was that education and specialized clinics are needed to meet the needs of this patient group.

Bakgrund: Diabetes Mellitus är en samling av kroniska sjukdomar, som påverkar kroppensförmåga att hantera blodsockernivån. I Sverige uppskattas att cirka 470 000 människor liderav sjukdomen. Det mest effektiva sättet att förebygga diabetes sena komplikationer är attpatienten själv bedriver en god egenvård. Sjuksköterskans roll i diabetesbehandling är av storbetydelse, då de stödjer och handleder patienter att bedriva god egenvård. Syfte: Syftet meddenna litteraturstudie var att undersöka sjuksköterskors erfarenhet av patienters följsamhet tillegenvårdsråd vid diabetes typ 2. Metod: Studien har genomförts som en kvalitativlitteraturstudie baserat på tio artiklar som har hämtats från databaserna CINAHL ochPubMed. SBU:s granskningsmall har använts för kvalitetsgranskning. Analysen gjordesutifrån metoden som är för kvalitativ innehållsanalys. Resultat: Resultatet presenteras utifråntre kategorier: Sociokulturella aspekters betydelse, Förutsättningar inom vården ochSjuksköterskans kunskap. Ur dessa skapades även tio underkategorier: Religiöst tankesätt,Kulturellt tankesätt, Stöd från anhöriga, Egenvård och delaktighet, Samverkan i team medandra vårdprofessioner, Resurser och stöd, Personcentrerad vård, Erfarenhet, Utbildning,Sjuksköterskornas metod att förmedla kunskap Slutsats: Sjuksköterskor upplevde att etteffektivt samspel mellan sjuksköterskor och övriga professioner, ökade deras motivation ochsjälvförtroende i diabetesbehandlingen för både patienter och sjuksköterskor. Vidare framgårdet att hänsyn till patienters sociokulturella aspekter och bruk av ett personcentrerattillvägagångssätt är avgörande faktorer i patientens följsamhet till sjuksköterskors rådgivning / Background: Diabetes Mellitus is a collection of chronic diseases which affect the body’sability to regulate the blood sugar level. In Sweden alone, there are approximately 470 000diagnosed patients. The most effective method to counteract and treat the disease is for thepatient in question to establish proper self-care practices. The nurse plays a central role in thediabetes treatment since the nurse supports and guides the patient to conduct a good self-careroutine. Aim: This literature review aims to investigate nurses’ experience of patientcompliance to self-care advice regarding diabetes type 2. Method: The study has beenconducted as a literature review of ten articles, where a qualitative approach has been used tocompile a result. The articles have been collected from the databases CINAHL and PubMed.Further, the quality of the studies has been examined with the help of SBU’s review templatefor qualitative studies. The analysis was conducted by the method presented in qualitativecontent analysis. Result: The result was presented from three categories: The importance ofsociocultural aspects, Conditions in the care and the nurses’ knowledge. From thesecategories a total of ten subcategories were used: Religious mindset, Cultural mindset,Support from relatives, Self-care and participation, Cooperation in teams with othercare-professions, Resources and support, Personcentred care, Experience, Education and thenurses’ method to convey information. Conclusion: Nurses experienced that an effectiveteamwork with the other involved professions increased their motivation and self-confidenceand made the diabetes treatment easier for both patients and nurses. Further, it was clear thatconsideration to the patients’ sociocultural aspects and using a patient-centered approach arecrucial factors that affect patients’ adherence to the nurses’ advice.