Bakgrund: Demenssjukdom är en folksjukdom som beräknas öka i omfattning de närmaste åren. I dagens samhälle stigmatiseras personer med demenssjukdom och synen på demenssjukdom är ofta negativ. För att förbättra den personcentrerade vården till personer med demenssjukdom behöver sjuksköterskans svårigheter i arbete med detta kartläggas. Syfte: Syftet med denna litteraturöversikt var att sammanställa vilka svårigheter sjuksköterskan upplever i arbetet med personcentrerad vård inom demensomsorgen. Metod: En litteraturöversikt med ett resultat baserat på 15 vetenskapliga artiklar. Artiklarna söktes i databaserna PubMed och CINAHL med sökorden Person-Centered, Dementia, Nursing och Approach. Artiklarna kvalitetsgranskades med hjälp av kvalitetsgranskningsmallar. Artiklarnas resultatdelar analyserades genom att söka efter skillnader och likheter. Dessa skillnader och likheter sammanställdes i kategorier. Resultat: Resultatet baseras på dessa fyra kategorier: Sjuksköterskans svårigheter i kommunikation till personer med demenssjukdom, Sjuksköterskans och övrig vård- och omsorgspersonals negativa attityder, Kompetens- och kunskapsbrist och Hur sjuksköterskan påverkas av organisationens struktur – som tidsbrist och bristande stöd. Slutsats: Denna litteraturöversikt har identifierat vilka svårigheter sjuksköterskan upplever i arbetet med personcentrerad vård inom demensomsorgen. Svårigheterna som identifierades var på individ-, team- och organisationsnivå. Slutsatsen av detta är att det krävs en förändring på dessa nivåer för att förbättra den personcentrerade vården inom demensomsorgen. / Background: Dementia is a common disease which is expected to extent in the coming years. In today´s society people with dementia are stigmatized and the perception of dementia are often negative. In order to improve the person-centered care for people with dementia, the nurse´s difficulties in working with this needs to be explored. Aim: The purpose of this literature review was to describe the difficulties nurses experience working with person-centered care in care of people with dementia. Method: A literature review with a result based on 15 scientific articles. The articles were searched on the databases PubMed and CINAHL with the keywords Person centered, Dementia, Nursing and Approach. The articles were quality checked using quality review templates. The result sections of the articles were analyzed by searching for differences and similarities. These differences and similarities were sorted into categories. Results: The results is based on these four categories: Nurse´s difficulties in communication to the person with dementia, Nurse´s and other career´s negative attitudes, Lack of experience and knowledge, and How the nurse are affected by the structure of the organization – such as lack of time and lack of organizational support. Conclusion: This literature review has identified what difficulties the nurse experience in the work of person-centered care in dementia care. The difficulties identified were at individual-, team- and organizational levels. The conclusion of this is that it requires a change in these levels to improve person-centered care in dementia care.

Samhället har höga förväntningar på både en god patientsäkerhet och vårdkvalitet. För att uppnå en god personcentrerad och patientsäker hälso- och sjukvård måste samverkan ske på ett interpersonellt plan. Icke-verbal kommunikation är viktig för att upprätthålla en säker vård eftersom den utgör mellan 55 och 97 procent av vår kommunikation, och anses vara mer inflytelserik än verbal kommunikation.Syftet med examensarbetet var att beskriva dels hur icke-verbal kommunikation ser ut dels undersöka effekten i en vårdkontext. En litteraturöversikt har genomförts där tretton artiklar med kvantitativ ansats har använts och analyserats enligt Polit och Becks niostegsmodell för att skapa en överblick av kunskapsläget.Resultatet visade flertalet effekter som bland annat ökad patientnöjdhet, empati, dämpad oro, subjektiv smärtupplevelse, omtänksamhet och förståelse. Bemötande kan tolkas på olika sätt och det är därför viktigt att som sjuksköterska förstå att även små icke-verbala uttryck, medvetna som omedvetna, kan leda till missförstånd. Det är viktigt att man som sjuksköterska informera sig om varje patient för att lättare förstå hur icke-verbal kommunikation kan förmedlas och tydas. / Society has high expectations for both good patient safety and quality of care. In order to achieve a good person-centered and patient-safe health care, collaboration must take place on an interpersonal level. Non-verbal communication is important for maintaining a safe care as it represents between 55 and 97 percent of our communication, which is considered more influential than verbal communication.The purpose of the thesis was to describe how non-verbal communication is performed and examine the effect in a care context. A literature review has been carried out where thirteen articles with a quantitative approach have been used and analyzed according to Polit and Beck's nine-step model to create an overview of the state of knowledge.The result showed several effects such as increased patient satisfaction, empathy, subdued anxiety, subjective pain experience, thoughtfulness and understanding. Treatment can be interpreted in different ways and it is therefore important that as a nurse understand that even small non-verbal expressions, conscious as unconscious, can lead to misunderstandings. It is important that nurses inform themselves about each patient in order to more easily understand how non-verbal communication can be conveyed and interpreted.

Hjärtsvikt drabbar cirka två procent av befolkningen och sjukdomen påverkar personens vardag och förmåga till att utföra vardagliga sysslor. Prognosen för hjärtsvikt är allvarlig, personer som blivit diagnostiserade med hjärtsvikt har en median överlevnadstid på cirka 2 år. Med hjälp av egenvård kan prognosen och förmågan att utföra vardagliga sysslor förbättras.  Syftet var att undersöka vilken betydelse personcentrerad vård kunde ha för personer med hjärtsvikt gällande egenvård, livskvalitet och symtombörda.  Metoden som användes var en litteraturstudie som inkluderade tio kvantitativa studier. Artiklarna valdes från databaserna PubMed och CINAHL. Dorothea Orems omvårdnadsteori användes som teoretisk referensram i studien. Resultatet påvisade att en personcentrerad vård kan förbättra egenvården hos personer med hjärtsvikt. Några resultat visade att personcentrerad vård gav en förbättring gällande livskvalitet, medan andra resultat inte visade på en signifikant förbättring gällande livskvalitet. En personcentrerad vård visade ingen förbättring på symtombördan hos personer med hjärtsvikt. Slutsatsen var att en personcentrerad vård förbättrar egenvården hos personer med hjärtsvikt. Personcentrerad vård kan i vissa fall även leda till en förbättrad livskvalitet, men det visade ingen förbättring gällande symtombördan hos personer med hjärtsvikt. / Heart failure affects circa two percent of the population and the illness affects the person’s everyday life and the ability to perform everyday tasks. The prognosis for heart failure is serious, people that have been diagnosed with heart failure have a median survival time of approximately 2 years. With the help of self care the prognosis and the ability to perform everyday tasks can be improved.  The aim of this study was to examine what importance person centered care have for people with heart failure concerning self-care, quality of life and symptom burden.  The method that was used was a literature study which included ten quantitative studies. The articles were chosen from the databases PubMed and CINAHL. Dorothea Orem’s nursing theory was used as theory framework in this study. The results showed that a person centered care may improve self-care in people with heart failure. Some results showed that a person centered care improved quality of life, while other results did not show any significant improvement on quality of life. A person centered care did not show any improvement in symptom burden for people with heart faliure.  The conclusion was that person centered care may improve self-care for people with heart failure. Person centered care may in some cases also result in an improved quality of life, but it did not show any improvement in the symptom burden for people with heart failure.

This session is developed by, and presenters invited by, Cultural and Linguistic Considerations Across the Discipline. This session was developed by the Convention Program Committee to increase SLPs’ awareness regarding research and clinical applications of the International Classification of Functioning, Disability and Health (ICF) across pediatric and adult populations around the world. Discussants provide perspectives from Australia, Brazil, Canada, Jamaica, and the United States.

Due to its unsupervised nature, undergraduate education requires students to manage their own learning. They need to use self-regulated learning (SRL) strategies in order to achieve academic success. However, college students often have insufficient regulatory skills and strategies, suggesting the need for substantive and practical support. Supplemental Instruction (SI) is a well-recognized academic intervention that utilizes peer-led study groups for difficult college courses, through which students can develop their SRL abilities. This study focuses on the role of the SI program in college students’ development of SRL from a person-centered perspective. First, this study examines the heterogeneous effects of the SI intervention on students’ development of SRL by combining latent profile modeling and propensity score matching. Second, it explores the changes in student SRL profiles over the intervention period and determines factors affecting the prediction of such changes using latent transition modeling. Results identify three distinct student profiles: competent regulator, self-confident regulator, and goal-oriented regulator. Within the competent regulator profile, both SI and non-SI attendees’ overall SRL scores significantly decreased over time, though non- SI attendees showed a greater downturn. For the self-confident regulator profile, only SI attendees’ overall SRL scores increased. Both SI and non-SI attendees in the goal-oriented regulator profile had small decreases in scores, which were not statistically significant. Regarding students’ longitudinal transitions between SRL profiles, students in the most desirable profile (competent regulator) remained most stable over time. Students’ SRL in the goal-oriented regulator profile was most malleable in a positive way; approximately 40% of these students moved into the competent regulator profile. In addition, students whose decision to attend the SI sessions was more mastery-oriented tended to fall into more positive transition groups. Furthermore, students whose levels of self-confidence in learning, critical thinking skills, and group work skills increased as a result of their participation in SI sessions were more likely to become members of more positive transition groups. The findings of this study extend previous work by longitudinally examining individual differences in college students’ SRL development. They also provide significant implications for the future design of more targeted interventions.

Bakgrund: Personcentrerad vård (PCV) används allt oftare inom såväl somatisk som psykiatrisk vård, med övervägande positiva effekter för individen. Kliniska studier pågår men ett annat sätt att utvärdera arbetssättet är att följa hur indikatorer från patientregister utvecklas efter införande. Syfte: I denna studie analyseras indikatorerna utifrån kunskapen om att psykiatriska kliniken på Gotland har infört PCV 2016 och har därav haft möjligheten att närmare följa indikatorernas utveckling. Metod: Denna studie har genom deskriptiv analys identifierat resultat som tyder på att det sker förändringar i indikatorutvecklingen över tid som kan kopplas till införande av PCV år 2016. Resultat: Tydligaste resultatet är minskningen av antalet individer och vårdtillfällen inom slutenvården. Minskningen av Individuella planer är tydlig och borde analyseras närmare med genusperspektiv. Resultat inom områden säker vård är inte tydliga, men ingalunda negativa, med bibehållna låga värden. Slutsats: Resultaten i denna studie tyder på att det sker förändringar i indikatorutveckling över tid som kan kopplas till införande av PCV år 2016. / Background: Person-centered care (PCV) is increasingly used in both somatic and psychiatric care, with predominantly positive effects for the individual. Clinical studies are ongoing, but another way of evaluating methods is to follow how indicators from patient registries develop after implementation. Purpose: In this study, the indicators are analyzed based on the knowledge that the psychiatric clinic at Gotland has introduced PCV 2016 and has thus had the opportunity to closely monitor the indicators' development. Method: Through descriptive analysis, this study has identified results that indicate that there are changes in indicator development over time that can be linked to the introduction of PCV in 2016. Outcome: The clearest result is the reduction in the number of individuals and inpatient care. The reduction of Individual plans is clear and should be analyzed in more detail with a gender perspective. Results in areas of safe care are not clear, but by no means negative, with low numbers maintained. Conclusion: The results in this study indicate that there are changes in indicator development over time that can be linked to the introduction of PCV in 2016.

Bakgrund: I begreppet AKS ingår hjärtinfarkt och instabil angina. Hjärtinfarkt drabbar cirka 25 300 personer i Sverige årligen och för att förhindra återinsjuknande följer ett omfattande sekundärpreventivt arbete med start redan på sjukhuset. Sekundärpreventionen bygger på egenvård där information är en viktig komponent. Informationen berör många områden och syftar till att ge patienten förståelse och medverka till en förändrad livsstil. Cirka en tredjedel av patienterna som haft hjärtinfarkt når de nationella målvärdena för sekundärpreventionen. Tidigare forskning har visat att patienter upplever informationen under vårdtiden som otillfredsställande. Patienter som har dålig förståelse för sin hjärtsjukdom deltar också mer sällan i sekundärpreventiva behandlingsprogram. Personcentrerad vård har positiva effekter på följsamhet till behandling och behandlingens resultat. Individens förmåga att förändra sin situation påverkas också av graden av hälsolitteracitet och empowerment. Syfte: Syftet var att beskriva behovet av information för att erhålla förståelse hos patienter med akut koronart syndrom från insjuknande till hjärtrehabilitering. Metod: Mixad litteraturöversikt med systematisk sökstrategi. Totalt 16 artiklar inkluderades, lika många kvantitativa som kvalitativa artiklar. En integrativ analys av materialet utfördes i syfte att sätta artiklarnas resultat i relation till varandra samt identifiera likheter och skillnader. Därefter identifierades kategorier som beskriver de granskade artiklarnas resultat. Resultat: I resultatet framkom tre huvudkategorier; all information är viktig, information genom hela vårdförloppet efterfrågas och anpassad information är meningsfull. Patienter ansåg inte att någon information var oviktig och information efterfrågades vid insjuknande även om den första tiden vid AKS präglades av chock. Även efter hjärtrehabilitering och två år efter AKS fanns behov av information om bland annat farmakologisk behandling, vilket också var det informationsområde som nämndes i flest studier. En återkommande fråga hos patienterna var varför AKS drabbat just dem. De önskade kongruens i information från olika källor och hade svårt att applicera standardiserad information på sin egna situation. De efterfrågade individuellt anpassad information som gavs när de själva var redo för det och som inkluderade anhöriga. Slutsats: Behovet av information är omfattande och patienter ansåg inte att någon information var oviktig. Även information i ett skede som präglas av chock är efterfrågad och betydelsefull. Individuell information underlättar förståelse för relevans av livsstilsförändringar och möjliggör delaktighet. Informationsbehovet varierade över tid och kvarstod till viss del efter två år. / Background: The term ACS includes myocardial infarction and unstable angina. Myocardial infarction afflicts approximately 25 300 individuals in Sweden annually and to prevent recurrent ACS an extensive secondary prevention effort starts while patients are still in hospital. Secondary prevention builds upon self care where information is an important component. The information concerns a variety of areas and aims to increase the patient’s understanding and participation in lifestyle change. Just about one third of patients suffering from myocardial infarction reaches the secondary prevention goals. Previous research has shown that patients find the information received during the hospital stay unsatisfactory. Patients with a low understanding more rarely participates in secondary prevention programmes. Person centered care positively affects treatment compliance and results. The individual’s ability to change their situation is also affected by the amount of health literacy and empowerment. Aim: The aim was to describe the need of information to obtain understanding in patients with acute coronary syndrome from sickening to cardiac rehabilitation. Method: Mixed literature review with a systematic search strategy. In total, 16 articles were included of which half was quantitative and half was qualitative. An integrated analysis of the material was conducted in purpose of relating the results to each other and to identify similarities and differences. Thereafter categories that describe the reviewed literature were identified. Results: In the result three main categories emerged; all information is valuable, information is requested throughout the entire care chain and adapted information is meaningful. Patients did not find any information unimportant and the information was requested at the initial phase of getting ill although the phase was characterized by shock. Even after cardiac rehabilitation and two years after ACS a need of information about pharmacological treatment existed among others, which was the information area requested in most studies. A reappearing question among patients was why the ACS had happened to them. They wished for congruence in information from different sources and found it hard to apply standardized information to their own situation. They requested individually adapted information delivered at a time when they were ready for it, that also included their family. Conclusion: The need of information is extensive and patients did not consider any information unimportant. Even information in a state characterized by shock is requested and valuable. Individual information facilitates understanding of the relevance of lifestyle changes and enables participation. The information need varied over time and remained after two years to some extent.

Abstract Sexual autonomy is the right and capacity of each individual to decide and make choices about whom, when, and how they express themselves sexually. Individuals with intellectual disabilities have frequently been marginalized, oppressed, and left out of discussions about sexuality placing them at risk of abuse, unsafe sex practices, and unplanned pregnancies. The purpose of this qualitative study was to examine the usefulness of person-centered planning techniques in the development of an individual service plan that address the social-sexual needs of individuals with intellectual disabilities. Purposeful sampling was used to select 8 participants for this study. Specific participants were selected because they possessed personal perspectives and experiences regarding person-centered planning techniques. Data collection included semi-structured, open-ended questions with face-to-face interviews and document review. Code development began with systematic organization of narrative data that was thematically analyzed using open-coding. Findings showed the person-centered individual service plan is a tool that can empower and promote social-sexual autonomy for individuals with intellectual disabilities if service and support administrators initiate a conversation about social-sexual activity. Implications for social change include increased advocacy for sexual autonomy, greater social acceptance of relationships, inclusive sexuality programming for individuals with intellectual disabilities and professional development training for service and support administrators.

This minor thesis reports an attempt to describe and understand moments of experiential meaning within the dance therapy process for a patient with dementia. It also documents an attempt to develop a methodology which could adequately grasp the complexities of such an experience. A phenomenological approach with its emphasis on allowing the phenomenon to reveal itself through multiple perspectives seemed the most appropriate for this study. However, while phenomenology influenced the format of the dance therapy sessions as well as the constitution and analysis of the data, ultimately a hermeneutic analysis was employed for further explication of the material. The study consisted of four individual dance therapy sessions with an 85 year old patient with moderate dementia. The researcher/therapist worked improvisationally and a music therapist provided improvised music. After the sessions, all of which were videotaped, the patient was videotaped viewing the dance session video, in order to obtain her verbal or non-verbal responses to the material. It was decided to focus on the 'significant moments', selected intuitively as moments which seemed high points of the session. A naive description was made, on which an adaptation of Giorgi's four-phase method of analysis was applied. Certain foci, such as energy flow, were identified and individually described. In time, it became clear that the written descriptions alone were insufficient and that reflection would need to cover all the material from multiple sources and perspectives. This was done, and the data were later further explicated by reference to writings on dance therapy, dance aesthetics and the philosophical concept of the embodied self, and Sacks's neurological writings on the awakened self. The conclusions of the research were that the patient was not only transformed within the dance session and able to re-create aspects of her old self, but also underwent, through the experience as a whole (the dance and the reflection upon it, facilitated by the video viewing), a change in awareness, through which she reintegrated the past with the present and, in her words, 'came out of the cupboard...into the brightness'.

While the concept of person-centred care in dementia has been around for 15 years or more and has attracted much interest and enthusiasm, aged care facilities continue to have difficulty in actually implementing and maintaining person-centred practices. In this study I explore the experience of one aged care facility in order to identify the barriers to changing care practice. The research took place in an ethno-specific (Jewish) aged care facility, Star of David, which was in the process of setting up a program for its residents with dementia based on person-centred principles. The methodology used in the research study was ethnographic, involving participant observation and interview, with a particular focus on a limited number of participants: four residents and their families, four senior staff, four personal care attendants and the executive director. Interviews were also conducted with staff members from three other aged care facilities. The findings showed that Star of David was unable to bring about substantial change in its care practices, while the external interviews and the literature suggest that other facilities have similar difficulties. I identify three major types of barrier: procedural barriers within the institution itself; (government) policy; and barriers relating to hegemonic values and beliefs which underpin established health care practice. These three types of barrier interact with and reinforce one another. I conclude that if we are to change care practice in institutions, we must address all of these barriers at the same time. Finally, I suggest that person-centred care itself, which continues to place emphasis on professional service provision, may only be the beginning of necessary change. In order to be truly person-centred, we need to move towards a more community based or public health approach which recognizes the need of all persons to be treated both as significant individuals and accepted as part of a community.