Sammanfattning Bakgrund: Tidigare forskning visar att personer med allvarlig psykisk ohälsa är mindre fysiskt aktiva än resterande befolkning. De är som grupp i riskzonen för drabbas av fysiska hälsoproblem samt att dö i förtid av somatiska sjukdomar. Vårdpersonal har observerat samband mellan fysisk aktivitet och mindre besvär av symtom och lägre läkemedelsbehov. Utbudet av forskning som svarar på hur fysisk aktivitet kan upplevas främja återhämtning hos personer med allvarlig psykisk ohälsa är däremot begränsat.  Syfte: Syftet med studien är att med utgångspunkt i tidigare forskning beskriva hur personer med allvarlig psykisk ohälsa erfar att fysisk aktivitet främjar återhämtning. Metod: Metasyntes, en induktiv och kvalitativ analysmetod. Resultat: Utifrån analysen presenteras fyra teman Att få en starkare tro på sig själv och framtiden, Att uppleva mening och gemenskap, Att få struktur i livet och Att kontrollera och minska psykiska symtom som i sin tur tillsammans ledde fram till nyckelmetaforen en positiv spiral. Slutsats: Sjuksköterskan, eller vårdaren, kan genom att stödja patienten till fysisk aktivitet främja såväl allians som en start som ger fart åt patientens återhämtningsprocess. Nyckelord: allvarlig psykisk ohälsa, fysisk aktivitet, gemenskap, mening, patienters upplevelse, positiv spiral, återhämtning / abstract Background: Previous research shows that people with severe mental illness are less physically active than the remaining population. As a group, they are in risk of physical problems and premature death. Health professionals have observed a connection between physical activity and less discomfort caused by symptoms as well as a lower need of medical treatment. The amount of available research regarding experiences of physical activity and what it means for recovery amongst people with severe mental illness is limited. Aim: The aim of the study based on previous research is to describe how people with serious mental illness experience that physical activity promotes recovery. Method: Metasynthesis, an inductive and qualitative method of analysis. Results: the analysis provided four themes To have a stronger belief in oneself and the future, To experience meaning and community, To get structure in life and To control and reduce mental symtoms wich in turn together led to the key metaphor as a positive spiral. Conclusion: The nurse, or the caregiver, can, through supporting the patient to physical activity, promote both an alliance and a start that gives momentum to the patient's recovery process. Keywords: severe mental illness, physical activity, community, meaning, patient experience, positive spiral, recovery

Bakgrund Humant immunbristvirus, Hiv, är en kronisk virusinfektion som utan behandling leder till Acquired Immunodeficiency Syndrome, Aids, vilket är en dödlig sjukdom. Hiv identifierades i början av 1980-talet och då var det främst homosexuella män och missbrukare som drabbades, eftersom Hiv primärt smittar via blod och sexuella kontakter. På grund av dess ursprung finns det föreställningar och fördomar om vilka som drabbas av Hiv. Det har lett till att personer med Hiv utsatts för diskriminering och stigmatisering, både från samhället och hälso- och sjukvårdspersonal. Det har länge funnits behandling som gör risken att föra smittan vidare till någon annan osannolik, men trots det har sjukdomen länge ansetts vara ett av de mest stigmatiserade medicinska tillstånden i världen.   Syfte Syftet var att beskriva hur personer med Hiv upplever och påverkas av bemötandet från hälso- och sjukvårdspersonal. Metod En icke-systematisk litteraturöversikt utfördes och resultatet baserades på 19 kvalitativa vetenskapliga originalartiklar från olika länder. Artiklarna identifierades i databaserna Public Medline och Cumulative Index of Nursing And Allied Health Literature med hjälp indexord och en manuell sökning. Samtliga artiklar som ingick i litteraturöversiktens resultat kvalitetsgranskades och analyserades utifrån en integrerad dataanalys.    Resultat Resultatet visar att personer med Hiv både hade positiva och negativa upplevelser av bemötandet från hälso- och sjukvårdspersonal. Negativa upplevelser förknippades med stigmatisering, överdrivna försiktighetsåtgärder, bristande sekretess, samt bristande kommunikation. Positiva upplevelser identifierades när hälso- och sjukvårdspersonal visade stöd och empati, hade god kommunikativ förmåga, samt när relationen med mellan patient och hälso- och sjukvårdspersonal upplevdes god. Kunskapsbrist och fördomar hos hälso- och sjukvårdspersonal identifierades vara bidragande faktorer till brister i bemötandet, vilket kunde ha negativ inverkan på patienters följsamhet i behandling.  Slutsats Patienter upplevde att kunskapsbrist om Hiv hos hälso- och sjukvårdspersonal var starkt sammankopplat med negativa upplevelser av bemötandet. Negativa upplevelser i form av diskriminering och stigmatisering från hälso- och sjukvårdspersonal kunde leda till en lägre grad av psykisk hälsa. Positiva upplevelser av bemötandet associerades med en hög grad av kunskap bland hälso- och sjukvårdsperonal, vilket kunde öka Hiv-positiva patienters hälsa och välbefinnande. / Background Human immunodeficiency virus, Hiv, is a chronic viral infection that without treatment leads to Acquired Immunodeficiency Syndrome, Aids, which is a deadly disease. Hiv was identified in the early 1980’s and it was mainly gay men and addicts who were affected, as Hiv is primarily transmitted through blood and sexual contact. Due to its origin, there are notions and prejudices about who is affected by Hiv, which has led to people with Hiv being subjected to discrimination and stigmatization, from society and health care professional. There has long been treatment that makes the risk of passing the infection on to someone else unlikely, despite this, the disease has long been considered one of the most stigmatized medical conditions in the world.  Aim The purpose of this literature review was to investigate how people with Hiv experience and are affected by the encounter from health care professionals.  Method A non-systematic literature review was performed and the result was based on 19 qualitative original scientific articles from different countries. The articles were identified in the databases Public Medline and Cumulative Index of Nursing And Allied Health Literature using index words and one manual search. All included articles in the literature review's results were quality reviewed and analyzed through an integrated data analysis.  Results The result shows that people with Hiv had both positive and negative experiences by the encounter from health care professionals. Negative experiences were associated with stigma, excessive precautions, lack of confidentiality, and lack of communication. Positive experiences were identified when health care professionals showed support and empathy, had good communication skills, and when the relationship between patient and provider was experienced as good. Lack of knowledge and prejudices among health care professionals were considered to be contributing factors to shortcomings, which could have a negative impact on patients' treatment adherence.  Conclusions Patients experienced the lack of knowledge about Hiv among health care professionals as strongly linked to negative experiences of the treatment. Negative experiences as discrimination and stigmatization from health care professionals could lead to a lower degree of mental health. Positive experiences from the encounter were associated with a high degree of knowledge among health care workers, which had positive effects on health and well-being of Hiv-positive patients.

Bakgrund  Användningen av den elektroniska journalen (e-journalen) har sedan år 2020 ökatexceptionellt, delvis till följd av Covid-19 pandemin. Legitimerad hälso- och sjukvårdpersonal är enligt lag skyldiga att dokumentera vårdbesök. E-journalen är ett verktyg för alla som medverkar kring patientens vård och är ett sätt att dela vårdinformation med andra vårdgivare vilket bidrar till en bättre och säkrare vård. Syfte Syftet var att beskriva patienters upplevelser av att ha tillgång till egen e-journal. Metod Icke-systematisk litteraturöversikt som baserats på 15 vetenskapliga originalartiklar med kvantitativ, kvalitativ och mixad metod. PubMed och CINHAL användes som databaser för sökningen som utfördes med hjälp av indexord i kombination med fritextsökningar. Artiklarna genomgick en kvalitetsgranskning baserad på Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering. Resultatet sammanställdes och analyserades utifrån en integrerad dataanalys. Resultat Resultatet sammanställdes i två huvudkategorier och fem underkategorier. Huvudkategorierna var: Upplevda fördelar av tillgången till e-journalen och Upplevda nackdelar av tillgången till e-journalen. Resultatet visade att de upplevda fördelarna bland annat var en upplevd förbättrad kommunikation mellan vårdpersonal och patienter och en känsla av delaktighet hos patienten. Andra upplevda fördelar var en ökad kunskap för sin sjukdom och sin vård samt en förbättrad möjlighet till egenvård. Upplevda nackdelar anspelar på patientens upplevelse av rädsla och oro kring e-journalen samt språkliga och tekniska svårigheter ett internetbeserat verktyg kan ge.  Slutsats Tillgången till e-journalen upplevs i helhet som positiv av patienter. E-journalen kan ses som ett verktyg för dem att bli mer delaktiga i sin vård, få en bättre kunskap om sin vård samt öka sin förmåga till egenvård. Dock framkom även negativa aspekter, så som oro samt språkliga och tekniska svårigheter som inte bör ignoreras. Hälso-och sjukvårdspersonal bör ha insikt i dessa upplevda för-och nackdelar för att kunna stärka de positiva upplevelserna samt förebygga och förhindra de negativa utfallen av e-journalen. / Background Since 2020, the use of the e-journal has increased exceptionally, partly as a result of the Covid-19 pandemic. All licensed healthcare professionals are obliged by law to document healthcare visits. Electric health records (EHR) can be used by all involved in a patient’s care and is a way to share information between healthcare professionals. This in turn provides safer and better healthcare. Aim The aim was to describe patients' experiences of having access to their electronic health records. Method Non-systematic literature review based on 15 original scientific articles using quantitative and qualitative methods. PubMed and CINHAL were used as databases for the search, which was performed using index words in combination with free text searches. The articles underwent a quality review based on Sophiahemmet University's assessment documents for scientific classification and quality regarding studies with a quantitative and qualitative method approach. The results were compiled and analyzed based on integrated data analysis. Results The results were compiled into two main categories and five subcategories. The main categories were: Perceived benefits of access to EHRs and Perceived disadvantages of access to EHRs. The result showed that perceived benefits were improved communication between healthcare professionals and patients and an improved feeling of participation for the patient. Other perceived benefits were the patients’ understanding of the illness and their care, as well as improving the patients’ opportunities for self-care. Perceived obstacles and disadvantages allude to the patients’ experience of fear and anxiety around EHR as well as the difficulties in language and technical obstacles an internet-based tool can cause. Conclusions Access to EHR is generally perceived as positive by patients. EHRs can be seen as a tool for them to become more involved in their care, gain a better knowledge of their care and increase their ability to self-care. However, negative aspects also emerged, such as anxiety and linguistic and technical difficulties that should not be ignored. Healthcare professionals should have insight into these perceived benefits as well as perceived obstacles to strengthen the positive experiences as well as prevent the negative outcomes of EHRs.

Bakgrund Den existentiella dimensionen av omvårdnad kan uppfattas som svår att både definiera, studera och utöva. I den palliativa vården, när livets slut blir en realitet, är de existentiella frågorna mer aktuella än någonsin och sjuksköterskan har en viktig roll i att bemöta de behov som uppstår. Syfte Syftet med litteraturöversikten är att sammanställa aktuell forskning kring faktorer som påverkar existentiellt välbefinnande hos patienter som vårdas palliativt. Metod Arbetet utfördes som en litteraturöversikt där 13 vetenskapliga artiklar undersöktes genom innehållsanalys. Artiklarna valdes ut genom systematiska databassökningar. Artiklar med kvalitativ, kvantitativ, samt mixad metod inkluderades. Resultat De mest betydelsefulla faktorerna för att främja existentiellt välbefinnande hos patienter som vårdas palliativt innefattar andligt stöd, religiös tro, förmåga att känna mening, fungerande copingstrategier, bibehållen känsla av kontroll och sociala relationer. Slutsats Bland de faktorer som påverkar existentiellt välbefinnande hos patienter som vårdas palliativt är både inre och yttre resurser representerade. Bland de yttre resurserna utmärkte sig goda nära relationer som en viktig skyddsfaktor. Inre resurser såsom andlighet, religiös tro, inre styrka, acceptans, samt förmåga att skapa mening, emotionell balans och harmoni, kunde alla bidra till ökat existentiellt välbefinnande. / Background The existential dimension of nursing can be hard to define, study and practice. In palliative care, when death is suddenly a reality, existential matters are more relevant than ever, and nurses have a vital role in meeting any needs that can arise. Aim The aim of this literary review is to compile research on factors influencing the existential well-being of patients receiving palliative care. Method The study was carried out as a literary review where 13 articles were studied through content analysis. The articles were selected through systematic database searches. Articles of qualitative, quantitative and mixed method were included. Results The most important factors in fostering existential well-being include spiritual support, religious faith, ability to find meaning, well-functioning coping strategies, maintained sense of control and social relations. Conclusions Among the factors influencing existential well-being in patients receiving palliative care,both internal and external resources are represented. Outer resources included close relationships which proved to be a protective factor. Internal resources such as spirituality, religious faith, inner strength, acceptance, as well as the ability to find meaning, emotional balance, and harmony, could all help increase existential well-being.

Bakgrund  Sedan sjukdomens uppkomst har 40,1 miljoner människor mist sitt liv till följd av HIV; en kronisk virusinfektion som i obehandlat tillstånd kan vara livshotande. Adekvat behandling kan leda till ett normalt liv med omätbara virusnivåer, god vård och god behandling är således livsviktigt. Att belysa hur personer med HIV upplever vårdmöten med vårdpersonal är väsentligt för att erhålla kunskap om hur vårdpersonal skall förhålla sig i mötet. Vårdmöten av hög kvalitet med ett personcentrerat förhållningssätt kan leda till ökad medicinsk följsamhet, ett ökat välbefinnande och ökad livskvalitet för personer med HIV.  Syfte  Syftet var att belysa hur patienter med HIV upplever möten med vårdpersonal inom vården.  Metod  En icke-systematisk litteraturöversikt genomfördes baserad på 16 vetenskapliga originalartiklar av både kvantitativ och kvalitativ ansats. Data inhämtades från databaserna PubMed och CINAHL. Artiklarna kvalitetsgranskades  Resultat  Resultatet sammanställdes i fyra huvudkategorier: Upplevelser av stigmatisering och diskriminering, upplevelser av kommunikation, upplevelser av relationen mellan patient och vårdpersonal samt upplevelser av bemötande. Upplevelser av respekt och tillit visades vara det mest centrala för att uppnå en relation med vårdpersonal samt för att uppleva en god kommunikation och ett gott bemötande. Fördomar, förutfattade meningar och diskriminerande handlingar visade sig utgöra ett hinder för detta.  Slutsats  Denna litteraturöversikt visade att patientupplevelser av vårdmöten var komplexa. Upplevelser som skildrades i resultatet visade att patienter som kände sig sedda som personer utöver sin sjukdom, blev behandlade med respekt eller kände tillit till personalen upplevde vårdmöten som positiva. Resultatet visade även upplevelser som utgjorde hinder för ett positivt vårdmöte. Ökad förståelse om patienters upplevelser kan ge värdefulla insikter gällande hur vårdpersonalen genom ett professionellt och personcentrerat förhållningssätt kan bidra till upplevelser av positiva vårdmöten. / Background  HIV is a chronic viral infection that can be life-threatening if not treated. Since the emerge of the disease 40,1 million people have deceased. Thus, adequate treatment is vital. Illustrating patient experiences of encounters with healthcare professionals is important to gain knowledge about actions and attitudes that contribute to positive experiences. Encounters of high quality, with a person-centered approach can lead to increased medical compliance, wellbeing and a greater life quality for people with HIV.  Aim  The aim of this literature review was to illustrate how patients with HIV experience encounters with health care professionals within health care settings.  Method  A non-systematic literature review was carried out, with data collected from 16 original scientific articles of both quantitative and qualitative approaches. The data was obtained from the databases PubMed and CINAHL. The articles were quality-reviewed based on Sophiahemmet University's assessment basis for scientific classification. The results from the articles were categorized, collated, and analyzed using an integrated data analysis.  Results  The results were compiled into four main categories: Experiences of stigmatization and discrimination, experiences of communication, experiences of the relationship between patient and health care professionals and experiences of treatment. Experiences of respect and trust were shown to be the most central in encounters to achieve a relationship with healthcare professionals with communication and treatment of good quality. Prejudice, preconceptions, and discriminatory actions proved to be obstacles of positive experiences.  Conclusions  This literature review showed that patient experiences of healthcare encounters were complex. Experiences in the results suggested that patients who felt seen as individuals beyond their illness, were treated with respect and trusted health care professionals had positive experiences. Improved understanding of patients' experiences can provide valuable insights of how healthcare professionals, through a professional and person-centered approach, can contribute to positive experiences of healthcare encounters.

Introduction The prevalence of depressive symptoms in persons with heart failure is higher than in age- and gender-matched populations not suffering from heart failure. Heart failure in itself is associated with an unpredictable trajectory of symptoms, a poor prognosis, high mortality and morbidity, and low health-related quality of life (HrQoL). With the addition of depressive symptoms to heart failure the negative health effects increase further. Though the negative consequences of depressive symptoms in heart failure are well known, there is a knowledge gap about the course of depressive symptoms in heart failure and about how to effectively manage these symptoms. Pharmacological treatment with serotonin reuptake inhibitors has not been able to demonstrate efficacy in persons with heart failure. In a few studies, cognitive behavioural therapy (CBT) delivered face-to-face, has demonstrated effects on depressive symptoms in persons with heart failure. However, currently there are barriers in delivering face-to-face CBT as there is a lack of therapists with the required training. As a solution to this, the use of Internet-based CBT (ICBT) has been proposed. ICBT has been shown to be effective in treatment of mild and moderate depression but has not been evaluated in persons with heart failure. Aim The overall aim of this thesis was to describe depressive symptoms over time and to develop and evaluate an ICBT intervention to treat depressive symptoms in persons with heart failure. Design and Methods The studies in this thesis employ both quantitative (Studies I, II and III) and qualitative (Studies II and IV) research methods. The sample in Study I (n=611) were recruited in the Netherlands. The participants (n=7) in Study II were recruited via advertisements in Swedish newspapers. Studies III and IV used the same cohort of participants (Study III n=50, Study IV n=13). These participants were recruited via an invitation letter sent to all persons who had made contact with healthcare services in relation to heart failure during the previous year, at the clinics of cardiology or medicine in four hospitals in southeast Sweden. Study I had a quantitative longitudinal design. Data on depressive symptoms was collected at baseline (discharge from hospital) and after 18 months. Data on mortality and hospitalisation was collected at 18 and 36 months after discharge from hospital. Study II employed three differentBehind the Screen2patterns of design, as follows: I) The development and context adaptation of the ICBT program was based on research, literature and clinical experience and performed within a multi-professional team. II) The feasibility of the program from the perspective of limited efficacy and function was investigated with a quantitative pre-post design. III) Participants’ experience of the ICBT program was investigated with a qualitative content analysis. Data on depressive symptoms was collected pre and post intervention. The time used for support and feedback was logged during the intervention, and qualitative interviews were performed with the participants after the end of the intervention. Study III was designed as a randomised controlled trial. A nine-week ICBT program adapted to persons with heart failure and depressive symptoms was tested against an online moderated discussion forum. Data on depressive symptoms, HrQoL and cardiac anxiety was collected at baseline (before the intervention started) and after the end of the intervention (approximately 10 weeks after the start of the intervention). Study IV had a qualitative design to explore and describe participants’ experiences of ICBT. The participants were recruited from within the sample in Study III and all had experience of ICBT. Data collection occurred after the ICBT program ended and was carried out using qualitative interviews by telephone. Results The mean age of the samples used in this thesis varied between 62 and 69 years of age. Concerning the symptom severity of heart failure, most persons reported New York Heart Association (NYHA) class II (40-57%) followed by NYHA class III (36-41%). Ischaemic heart disease was the most common comorbidity (36-43%). The vast majority had pharmacological treatment for their heart failure. Six percent of the persons in Study I used pharmacological antidepressants. In Studies II and III, the corresponding numbers were 43% and 18% respectively. Among persons hospitalised due to heart failure symptoms, 38% reported depressive symptoms. After 18 months, 26% reported depressive symptoms. Four different courses of depressive symptoms were identified: 1) Non-depressed 2) Remitted depressive symptoms. 3) Ongoing depressive symptoms. 4) New depressive symptoms. The highest risk for readmission to hospital and mortality was found among persons in the groups with ongoing and new depressive symptoms. A nine-week ICBT program consisting of seven modules including homework assignments on depressive symptoms for persons with heart failure was developed and tested. The RCT study (Study III) showed no significant difference in depressive symptoms between ICBT and a moderated discussion forum. Within-group analysis of depressive symptoms demonstrated a significant decrease of depressive symptoms in the ICBT group but not in the discussion forum group. The participants’ experience of ICBT was described in one theme: ICBT- an effective, but also challenging tool for self-management of health problems. This theme was constructed based on six categories: Something other than usual healthcare; Relevance and recognition; Flexible, understandable and safe; Technical problems; Improvements by live contact; Managing my life better. Conclusion After discharge from hospital, depressive symptoms decrease spontaneously among a large proportion of persons with heart failure, though depressive symptoms are still common in persons with heart failure that are community dwelling. Depressive symptoms in persons with heart failure are associated with increased risk of death and hospitalisation. The highest risks are found among persons with long-term ongoing depressive symptoms and those developing depressive symptoms while not hospitalised. ICBT for depressive symptoms in heart failure is feasible. An intervention with a nine-week guided self-help program with emphasis on behavioural activation and problem-solving skills appears to contribute to a decrease in depressive symptoms and improvement of HrQoL. When ICBT is delivered to persons with heart failure and depressive symptoms the participants requests that the ICBT is contextually adapted to health problems related to both heart failure and depressive symptoms. ICBT is experienced as a useful tool for self-care and something other than usual healthcare. ICBT also requires active participation by the persons receiving the intervention, something that was sometimes experienced as challenging.