The thesis describes the phenomenon women’s health and illness experiences following a myocardial infarction (MI). The purpose of the thesis is to explore women’s experiences of their care and health processes, as well as their experiences of body, lifeworld and meaningful relationships related to the illness. A reflective lifeworld approach, based on phenomenological philosophy, is used. The thesis is comprised of four studies; three are based on interviews with a total of 26 women following an MI, followed by a fourth, theoretical, study. The first study explores women’s experiences of care and health processes following an MI, with a particular focus on well-being and participation (I). The findings show that an MI is an event that suddenly interrupts the ordinary life of the women. Participation is a sense of being involved in their own health and care processes, which may also encourage them to take responsibility for health promoting activities in a healthy and meaningful way. The second study explores women’s lifeworld experience of their bodies and lives following an MI (II). This study finds that an MI, as a major event in the women’s lives, influences and restricts their everyday activities over a long period of time. Following the illness, they live with an existential uncertainty about their life and the heart, and this feeling entails suffering for them. The third study explores the meaning of close relationships and sexuality to women’s health and well-being following an MI (III). The mmeaning of close relationships appears to be vitally intertwined with their long-term health process; both health processes and relationships are affected after an MI. The suffering following an MI can be compared to taking a fall, where meaningful close relationships can function as a safety net that catches the women in their fall. The fourth study is a concept development aimed at elucidating the meaning of the concepts uncertainty, control, secure and risk in relation to the thesis phenomenon and the findings of the empirical interview studies (IV). The existential uncertainty is an important matter in the women’s health processes. In these processes the concepts control, secure and risk play a central role. Women who have suffered an MI want to be as safe as possible in order to live well. The analysis illuminates a paradox, that the women’s ambition to achieve greater safety may lead them into an even greater experience of uncertainty. The conclusion is that women’s experiences of health and illness can be described as a journey characterized by existential uncertainty. The women’s lives go through different existential phases following an MI, which is a major event. They are not prepared for the reactions that this event causes and are in need of support and guidance to manage their illness experiences. If acknowledged and well met, the significance and meaning of the women’s reactions and experiences can give impetus and energy to their health processes.

Aim: The overall aim is to examine how a patient perspective, grounded in caring science, can be preserved and developed in the context of hospital care. Methods: The first study examines attitudes towards caring science in a clinical practice. Data were collected through focus group interviews with seven nurses, three head nurses and four senior preceptors. An interpretive approach guided the study. The results called for collaboration between clinical praxis and the academy, according to how caring science can be preserved and developed. Study II–III functioned in accordance with this goal and were conducted in collaboration with a hospital ward for people over seventyfive years of age. In an attempt to develop care the patients were invited to attend a team meeting. The data in these studies were collected using interviews and observations. Fifteen patients (study II) and nine nurses (study III) who had experienced patient participation in a team meeting participated. In these studies, a reflective lifeworld approach guided the research process. Study IV is presented as a general structure and philosophical examination in the light of Heidegger and Merleau-Ponty’s philosophies. Main Findings: To preserve and develop a patient perspective is strongly connected to existential issues, such as lived time, intersubjectivity and a meaningful existence. For the patients, vulnerability is exposed and increased when the need for hospital care arises. The team meeting is experienced as an emotional situation where existential dimensions need to be recognized. The nurses desire to develop caring is challenged by organizational and economic demands. Time presents both a possibility for an encounter as well as a threat to excellent care. Conclusions: There is a need to challenge narrow processes in modern health care that value the staffs’ work and the patients’ vulnerability in quantifiable measures of efficiency. The challenge is to take into account something that is invaluable - human existence. / <p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Linnéuniversitetet försvaras vid offentlig disputation, 15 september 2014, klockan 10.30 i sal Myrdal, Hus K, Växjö</p>

En psykossjukdom medför att perceptionen av världen och andra människor förändras. Patienter med en psykossjukdom upplever sig ha sämre livskvalitet och hälsa än andra individer i samhället och de upplever ofta lidande på grund av sin sjukdom. Sjuksköterskor upplever blandade känslor i samband med vård av patienter med en psykossjukdom, men deras grundläggande uppgift är trots detta att främja hälsa, förebygga sjukdom, återställa hälsa och att lindra lidande. Syftet med denna studie är att belysa hur patienter med en psykossjukdom upplever vården på en psykiatrisk slutenvårdsavdelning, ur ett patientperspektiv. Studien är en systematisk litteraturstudie och data analyserades med en induktiv latent innehållsanalys. Resultatet visade att patienternas upplevelser kan beskrivas i fyra områden: rädsla och osäkerhet påverkar interaktionen med andra; tvångsåtgärder: skrämmande men nödvändiga; självbestämmande, delaktighet och välbefinnande; samt vårdpersonalen är avgörande för patienternas upplevelser. I studien diskuteras rädsla och osäkerhet; att vårdpersonalen och upplevelserna påverkar attityden till behandlingen; vårdpersonalens betydelsefulla roll när patienten har svåra symtom; individualiserad vård och god kommunikation bidrar till ökat välbefinnande samt att mer kompetens hos vårdpersonal kan minska bruket av tvångsåtgärder. Studiens slutsats är att sjuksköterskor har en central roll i patienternas upplevelse av vården. De har ansvar för att interaktionen med patienten och relationsbyggande fortlöper samt att användandet av tvångsinsatser motiveras och enbart sker när det är absolut nödvändigt, annars finns risk att behandlingsresultat och följsamhet av behandling efter utskrivning påverkas negativt. / A psychosis means that the perception of the world and other people change. Patients with a psychotic disorder perceive themselves as having poorer quality of life and health than other individuals in the community and they often experience suffering because of their illness. Nurses experience mixed feelings while caring for patients with a psychotic disorder, but in spite of this a nurse’s fundamental duty is to promote health, prevent disease, restore health and to alleviate suffering. The purpose of this study is to highlight how patients with a psychotic disorder experience health care in a psychiatric inpatient ward, from a patient perspective. The study is a systematic literature review and data were analyzed using an inductive latent content analysis. The results showed that patients 'experiences involved four areas: fear and insecurity affects the interaction with others; coercive measures: scary but necessary; autonomy, participation and welfare, and nursing staff is crucial for patients' experiences. In the study, several areas were discussed about the patient's experiences: fear and insecurity; that care staff and experiences affect the attitude to treatment; healthcare personnel's important role when the patient experience severe symptoms; individualized care and good communication contribute to increased well-being, and that more skills in healthcare professionals can reduce the use of coercive measures. The study's conclusion is that nurses have a central role in the patients' experience of the health care. They are responsible for the interaction with the patient and for keeping the building of the nurse-patient relationship in progress. They are also responsible so that the use of coercive action is justified and only occurs when it is absolutely necessary, otherwise there is a risk that the treatment results and adherence to treatment after discharge are adversely affected.

Bakgrund: Ungefär 2 % av Sveriges befolkning lider av hjärtsvikt, vilket motsvarar cirka 200 000 personer. Globalt är 26 miljoner människor drabbade av hjärtsvikt. Hjärtsvikt har en större inverkan på livskvaliteten än många andra kroniska sjukdomar. Patienterna påverkas både psykiskt, fysiskt och socialt. Prognosen för hjärtsviktspatienter är dålig, av nydiagnostiserade hjärtsviktspatienter avlider 23 % inom ett år. Hälso- och sjukvårdskostnaden för hjärtsviktspatienter uppgick till 7,7 miljarder kronor 2017, vilket motsvarade 2,7 % av Sveriges totala sjukvårdskostnader. Syfte: Syftet med litteraturöversikten är att beskriva patienters erfarenheter av att leva med hjärtsvikt. Metod: Examensarbetet har utformats som en litteraturöversikt. Vetenskapliga artiklar har hämtats från databaserna Cinahl och PubMed. Resultatet baseras på 15 vetenskapliga artiklar, 14 kvalitativa och en mixed method artikel. Resultat: Patienternas erfarenheter av att leva med hjärtsvikt kunde delas in i sex huvudkategorier: Copingstrategier, fysisk påverkan, psykisk påverkan, social påverkan, möte med hälso- och sjukvården samt patienters kunskap. Trots att hjärtsvikt är ett somatiskt sjukdomstillstånd, upplevde flera patienter att hjärtsvikten hade en omfattande inverkan på den psykiska hälsan. Slutsats: Hjärtsvikt påverkar patienten på alla plan, och det är individuellt hur den drabbade upplever sin situation. Genom att hälso- och sjukvårdspersonalen tillämpar ett personcentrerat förhållningssätt, där vården utgår från den unika patientens berättelse och utformas i samråd med patienten, stärks egenvårdsförmågan och därmed även livskvaliteten. / Background: About 2 % of the Swedish population suffer from heart failure, which corresponds to about 200 000 people. Globally, 26 million people suffer from heart failure. Heart failure has a greater impact on the quality of life than many other chronic diseases. Patients are affected both mentally, physically and socially. The prognosis for heart failure patients is poor, 23 % by newly diagnosed heart failure patients will die within one year. Healthcare costs for heart failure patients amounted to SEK 7.7 billion in 2017, which corresponded to 2.7 % of Sweden's total healthcare costs. Aim: The aim of this literature review was to describe patients’ experiences of living with heart failure. Method: A literature review. Research articles has been collected from the Cinahl and PubMed databases. The results are based on 15 research articles, 14 qualitative and one mixed method article. Results: The patients’ experiences of living with heart failure could be divided into six main categories: Coping strategies, physical impact, psychiatric impact, social impact, meeting with health care and patient knowledge. Although heart failure is a somatic disease state, several patients experienced that the heart failure had an extensive impact on mental health. Conclusion: Heart failure has an impact on the patient in several ways, and it is individual how the affected person experiences his or her situation. By the healthcare staff applying a person-centered approach, where the care is based on the unique patient's story and is designed in collaboration with the patient, the self-care ability and thus also the quality of life is strengthened.

This study is sponsored by Minor Field Study (MFS) scholarships from the University of Borås, funded by the Swedish International Development Cooperation Agency (SIDA). Thailand is a densely populated developing country situated in Asia. The relatives are the most important social network in Thailand. People all over the world, including Thai people are in need of aftercare when they have left the hospital. In Thailand this care mostly executed by relatives.There is not much research done that shows the patient‟s perspective of home care in Thailand so it is important to do this study. The aim of the study is to illuminate the Thai patients‟ perspective of being cared in their own home. The qualitative interviews were made with six patients at a hospital in Bangkok. The authors had one in beforehand-prepared question, but had to put in some stimulating questions in all of the interviews. To describe and analyze the result the authors did qualitative content analysis. The criteria to take part in this study were that the interviewees were Thai, over 25 years old and had experiences of being cared in their own home, by relatives or by professionals.The result is presented with meanings units, codes, sub-categories, categories and content areas. The content areas are; the patient does not experience any problems with home care and the patient experience problems with home care. The categories are good experiences and naturally and hard experiences. The authors then made sub-categories and named them; safety, family as caregiver is expected, solidarity, grateful, sense of guilt, insecure and hard to be dependent.The authors found out that all the interviewees experienced home care as something naturally, when it is a part of life to be cared by your relatives in Thailand. This expression fits in under the first content area, but some of the interviewees also expressed feelings that fit in under the opposite content area. In the end of the study the authors discusses different choices that they have done, and the consequences that followed with them, in a discussion of the method. Even the use of an interpreter is discussed in this part. In the discussion of the result the authors discusses the most interesting parts of the result and verify this with references from scientific articles. One thing that the authors found out was that home care in Thailand can be expressed with both positive and negative experiences from the same person. / Program: Sjuksköterskeutbildning

No description available.

The present study focuses on the caring of patients who have sexually abused children. To do research in a field that has been considered taboo has not been without problems. The conclusive factor for the decision to carry out the research was the fascinating and interesting paradox that, in spite of the caregivers having a mandate from the judicial system to do care for these patients, they do not understand how this care is to be given. The understanding of what caring for these patients can entail is based on the perspectives of the lifeworld of both the patients and the caregivers. The theoretical perspective in this dissertation is that of the caring sciences while the epistemological framework is phenomenology. Research data consist of qualitative interviews. The aim of the first study is to describe the patients’ suffering, and the aim of the second study is to describe the caregivers’ experiences of caring for these patients. The essential meaning of the suffering felt by the patients is described in terms of the patients’ acknowledgement and then betrayal of their yearning to be part of a close human fellowship. The meaning structure of “caring”, can be understood as being lost in an obscure and unknown landscape. It challenges the caregivers and occasionally arouses strongly unpleasant but also strongly threatening feelings. However when the caregivers gain clarity on how to care they are able to find their caring courage and hope, even for these patients. The findings thus show that caring for patients who themselves do not see any opportunity of taking a place among other adults is a great challenge. The study also shows that the support that is needed to be successful in caring for these patients is a caring culture that can permeate both patients and caregivers. These patients, whose criminal acts appear to be bizarre and strange, need to learn to be able to bear their suffering without losing their humanity. The philosophical intermediate chapter shows that it is the body image of the patients that prevents them from becoming whole, i.e. existing fully, by it playing the existential drama that leads to sexual abuse. It appears from this dissertation that in order for caring to be able to relieve the suffering felt by these patients, and thus prevent them from further abuse of children, then it is important as a caregiver to be able to allow the patients just to “be”. The research also shows that in order for caregivers to be able to understand what they receive from the patients they need support from both caring science and existential reflections. Such methods can help to clarify caring and to give possibilities for a freer and more creative thinking. Encountering and understanding different lifeworlds is necessary in order to give care based on a caring perspective. The patient group in the present study have been able to demonstrate this in a clearer way than has previously been done.

No description available.

Communication of hospital discharge instructions between patient and provider is an important component of hospital discharge to ensure that patients have the information they need to manage their post-acute care. Patient perception of this interaction is a key indicator of the quality of services provided. This study examined whether there is a correlation between hospital continuity and transition scores (a measure of patient perceptions of hospital discharge instructions) and hospital readmissions in Ontario. The final regression model for the outcome of all medical readmissions within three days of hospital discharge, showed a significant positive relationship (coefficient=0.0090, p=0.011). The estimate was smaller and not significant once the data was restricted to only community hospitals located outside of Toronto (coefficient=0.0085, p=0.060), and when restricted to urban community hospitals outside of Toronto (coefficient=0.0041, p=0.384). For the outcome of specific medical readmissions within 28 days of hospital discharge, no statistically significant relationship was found.

Communication of hospital discharge instructions between patient and provider is an important component of hospital discharge to ensure that patients have the information they need to manage their post-acute care. Patient perception of this interaction is a key indicator of the quality of services provided. This study examined whether there is a correlation between hospital continuity and transition scores (a measure of patient perceptions of hospital discharge instructions) and hospital readmissions in Ontario. The final regression model for the outcome of all medical readmissions within three days of hospital discharge, showed a significant positive relationship (coefficient=0.0090, p=0.011). The estimate was smaller and not significant once the data was restricted to only community hospitals located outside of Toronto (coefficient=0.0085, p=0.060), and when restricted to urban community hospitals outside of Toronto (coefficient=0.0041, p=0.384). For the outcome of specific medical readmissions within 28 days of hospital discharge, no statistically significant relationship was found.