My overall objective in this dissertation was to develop more integrative perspectives of several aspects of academic motivation. Rarely have researchers and theorists examined a more comprehensive model of academic motivation that pools multiple constructs that interact in a complex and dynamic fashion (Kaplan, Katz, and Flum, 2012; Turner, Christensen, Kackar-Cam, Trucano, and Fulmer, 2014). The more common trend in motivation research and theory has been to identify and explain only a few motivation constructs and their linear relationships rather than examine complex relationships involving 'continuously emerging systems of dynamically interrelated components' (Kaplan et al., 2014, para. 4). In this dissertation, my co-author and I focused on a more integrative perspective of academic motivation by first reviewing varying characterizations of one motivation construct (Manuscript 1) and then empirically testing dynamic interactions among multiple motivation constructs using a person-centered methodological approach (Manuscript 2). Within the first manuscript (Chapter 2), a theoretical review paper, we summarized multiple perspectives of the need for autonomy and similar constructs in academic motivation, primarily autonomy in self-determination theory, autonomy supports, and choice. We provided an integrative review and extrapolated practical teaching implications. We concluded with recommendations for researchers and instructors, including a call for more integrated perspectives of academic motivation and autonomy that focus on complex and dynamic patterns in individuals' motivational beliefs. Within the second manuscript (Chapter 3), we empirically investigated students' motivation in science class as a complex, dynamic, and context-bound phenomenon that incorporates multiple motivation constructs. Following a person-centered approach, we completed cluster analyses of students' perceptions of 5 well-known motivation constructs (autonomy, utility value, expectancy, interest, and caring) in science class to determine whether or not the students grouped into meaningful 'motivation profiles.' 5 stable profiles emerged: (1) low motivation; (2) low value and high support; (3) somewhat high motivation; (4) somewhat high empowerment and values, and high support; and (5) high motivation. As this study serves as a proof of concept, we concluded by describing the 5 clusters. Together, these studies represent a focus on more integrative and person-centered approaches to studying and understanding academic motivation. / Ph. D.

Yes / The notion of person-centered care has been important in investigating relationships between people with dementia and paid carers, and measures are available to assess this. It has been suggested that person-centered care may be a useful construct to apply to understand family-care relationships. However, no measures of person-centered care in this context exist. The study aimed to develop an observational measure of person-centered care for this purpose. Method: First, a coding system incorporating a range of behaviors that could be considered person-centered or non-person-centered was constructed. Examples included a code relating to whether the person with dementia was involved in planning a task, and a code relating to how the spouse responded to confusion/distress. Second, 11 couples, where one partner had a dementia, were recruited and videotaped cooperating on an everyday task. The system was applied to the care-giving spouse's behaviors, labeling examples of behavior as person-centered or non-person-centered. The final step involved assessing the inter-rater reliability of the system. Results: The system captured nine categories of behavior, which were each divided into person-centered and non-person-centered types. The system had good reliability (Cohen's κ coefficients were: 0.65 for category and whether behaviors needed to be placed in a category; 0.81 for category excluding the decision about whether behaviors needed to be placed in a category; and 0.79 in relation to whether behaviors were person-centered or non-person-centered.) Conclusions: Although the small sample size limits the implications of the results, the system is a promising quantitative measure of spousal person-centered care.

No / Dementia is a global concern. Although effort is being put toward finding a cure, many advances have been made in ensuring excellence in dementia care. In the United Kingdom, the concept of person-centered dementia care has transformed what is expected for individuals with dementia. Now embraced in national policy in the United Kingdom, it was pioneered by Thomas Kitwood and Kathleen Bredin and driven by a con-cern for the quality of care for indi-viduals with dementia in care homes. The purpose of the current article is to describe key concepts of Kitwood’s pioneering work in person-centered dementia care and to use them to inform current community-based supports and services for individuals with dementia in their own homes, whether alone or with family carers. / Full text is unavailable due to publisher copyright restrictions.

Miljöbegreppet har i modern omvårdnadsforskning fått en allt bredare och djupare dimensiondär människan i sin miljö betraktas ur ett holistiskt perspektiv. Personcentrerad vård är ettarbetssätt där man utgår från patienten som person som inte kan reduceras till enbart sinsjukdom. Att som vårdgivare vara medveten om den fysiska miljön, personers handlingar ochhur den organisatoriska filosofin är uppbyggd skapar en större möjlighet att kunna arbetapersoncentrerat. Personcentrering är det som patienten upplever, medan personcentrerad vårdär arbetssättet som genererar patientens upplevelse av personcentrering. Personcentreratklimat är den miljö där personcentrerad vård sker. De förhållanden som formas mellanpatienten, vårdpersonal, närstående och teknik liksom miljöns atmosfär, omgivning ochomvärld, är avgörande för om patienten kommer att uppleva miljön som vårdande eller ickevårdande. Syftet med studien var att undersöka och beskriva förekomst av personcentrerad vård blandpersoner som vårdats i en högteknologisk vårdmiljö i samband med hjärtkirurgi ochhjärtsvikt. Metoden var en icke-experimentell tvärsnittsstudie som genomfördes inom högteknologiskahjärtsjukvård. Datainsamlingen utfördes med hjälp av två patientrapporterade mått: BeingTaken Seriously Questionnaire - Patient version (BTSQ-P) och Person-Centered ClimateQuestionnaire - Patient version (PCQ-P). Resultatet visade att patienterna upplevde att vården var personcentrerad utifrån att bli tagenpå allvar och att den innefattade ett personcentrerat klimat. Regressionsanalysen visade att ettsäkert klimat är den viktigaste komponenten för känslan av att bli tagen på allvar. Slutsatsen var att högteknologisk hjärtsjukvård inte enbart genererar goda medicinska resultatutan också kan bidra till personcentrerad vård. Vidare drar vi lärdom av studiens resultat medkunskapen om att ett säkert klimat är den viktigaste faktorn inom det personcentreradeklimatet, för patientens upplevelse av personcentrering. / In modern nursing research, the concept of the environment has acquired an ever broader anddeeper dimension where people in their environment are viewed from a holistic perspective.Person-centered care is a way of working that is based on the patient as a person who cannotbe reduced to his or her illness alone. As a caregiver, being aware of the physicalenvironment, people's actions and how the organizational philosophy is structured creates agreater opportunity to be able to work person-centered. Person-centeredness is what thepatient experiences, while person-centered care is the way of working that generates thepatient's experience of person-centeredness. Person-centered climate is the environment inwhich person-centered care takes place. The relationships that are formed between the patient,care staff, relatives and technology, as well as the environment's atmosphere, surroundingsand settings, are decisive for whether the patient will experience the environment as caring oruncaring. The aim of the study was to investigate the prevalence of person-centered care amongstpeople who have been cared for in a high-tech care environment in connection with heartsurgery and heart failure. The method was a non-experimental cross-sectional study conducted in high-tech cardiaccare. Data collection was performed using two patient-reported measures: Being TakenSeriously Questionnaire - Patient version (BTSQ-P) and Person-Centered ClimateQuestionnaire - Patient version (PCQ-P). The results showed that the patients felt that the care was person-centered based on beingtaken seriously and that it included a person-centered climate. The regression analysis showedthat a safe climate is the most important component for the feeling of being taken seriously. The conclusion was that high-tech cardiac care not only generates good medical results butcan also contribute to person-centered care. Furthermore, we learn from the study results withthe knowledge that a safe climate is the most important factor in the person-centered climate,for the patient's experience of person-centering.

Introduktion: Personcentrerad vård (PCV) kan beskrivas som en vård som strävar efter att synliggöra och tillgodose hela personens fysiska och psykiska behov. Det pågår mycket arbete med att utveckla personcentrerade arbetssätt för att stärka patientens ställning. Många studier visar att PCV är bra för patienterna, men få studier beskriver upplevelser kring personcentrerade arbetssätt ur sjukvårdspersonalens perspektiv. Syfte: Att beskriva sjuksköterskors upplevelse av att arbeta utifrån ett personcentrerat arbetssätt på en geriatrisk slutenvårdsavdelning. Metod: En kvalitativ intervjustudie genomfördes med tio, kliniskt verksamma, sjuksköterskor på en akutvårdsavdelning från ett sjukhus i mellansverige. Data samlades in med hjälp av en halvstrukturerad intervjuguide och dataanalysen utfördes med ett beskrivande fenomenologiskt förhållningssätt genom Colaizzis (1978) analysmodell. Resultat: De sex teman som identifierades var: Känsla av delaktighet hos alla, Behov av avsatt tid, Kontinuitet i teamsamarbete, Ledarskapets betydelse, Positiv påverkan på arbetsmiljön och Sjuksköterskans professionella utveckling främjas. Informanterna uttryckte ökad grad av arbetstillfredsställelse, bättre psykosocial arbetsmiljö och mindre stress i jämförelse mot hur de upplevde sin arbetssituation innan arbetssättet infördes. Slutsats: Resultatet visar vilka förutsättningar som krävs för att ett strukturerat arbetssätt ska lyckas. Alla som är involverade i den äldres vård behöver samarbeta och ett personcentrerat arbetssätt behöver vara multiprofessionellt och teambaserat med en gemensam målbild och vårdfilosofi. / Introduction: Person-centered care (PCC) can be described as care that strives to make visible and meet the entire person's physical and mental needs. There is a lot of work going on to develop person-centered working methods to strengthen the patient's position. Many studies show that PCC is good for patients, but few studies describe perceptions of person-centered working methods from the perspective of healthcare professionals. Aim: To describe nurses' experience of working based on a person-centered working methods in a geriatric inpatient ward. Method: A qualitative study with a descriptive phenomenological approach was conducted. Ten clinically active nurses at a geriatric medicine ward, from a hospital in central Sweden, participated in the survey. Data were collected using a semi-structured interview guide and analyzed using Colaizzi's (1978) phenomenological analysis model. Results: The six themes identified were: A feeling of participation among all, A need for time set aside, A continuity in teamwork, The importance of leadership, Positive impact on the work environment, and The nurse's professional development was promoted. The informants expressed an increased degree of job satisfaction, a better psychosocial work environment and less stress in comparison to how they experienced their work situation before the work method was introduced. Conclusion: The result shows the conditions required to successfully establish and maintain a structured person-centered working method. Everyone involved in the elderly person's care need to collaborate and a person-centered approach needs to be multi-professional and team-based with a common goal picture and care philosophy.

Syfte: Syftet med studien var att beskriva distriktssköterskors upplevelser och erfarenheter av patientundervisning till patienter med diabetes samt att identifiera aspekter som kan relateras till ett personcentrerat förhållningssätt. Metod: Deskriptiv design med kvalitativ ansats med semistrukturerade intervjuer användes vid datainsamlingen. Vid urvalet användes strategiskt urval. Nio intervjuer utfördes med distriktssköterskor på sex olika vårdcentraler i Mellansverige. Vid analysen användes kvalitativ innehållsanalys. Resultat: Distriktssköterskorna önskade mer kunskap om invandrares kost- och motionsvanor. Distriktssköterskorna uttryckte att det var roligt och spännande med patientundervisning och att det var viktigt att de var engagerade. Distriktssköterskorna ville arbeta mer i team och de upplevde att de hade för lite tid avsatt för patientundervisning. De ansåg att de arbetade personcentrerat men det var svårare att arbeta personcentrerat vid gruppundervisning än vid enskild undervisning. Slutsats: Distriktssköterskor bör ha god kunskap om kulturella skillnader hos patienter med diabetes. Distriktssköterskorna upplever brist på tid- och resurser och önskar samarbeta mera i team. Det är viktigt med ett personcentrerat förhållningssätt där distriktssköterskorna utgår från den enskilda individen. En distriktssköterska som är engagerad och trivs med sitt arbete kan lättare klara av det ökade trycket och arbetsbelastningen. / Aim: The aim of the study was to describe district nurses´ perceptions and experiences of patient education for patients with diabetes and to identify aspects that can be related to a person-centered approach. Methods: Descriptive design with qualitative approach with semi structured interviews were used for data collection. In the selection process was strategically selection used. Nine interviews were conducted with district nurses at six different medical centers in central Sweden. In the analysis used qualitative content analysis. Results: District nurses wanted more knowledge about immigrants' eating and exercise habits. District nurses expressed that it was fun and exciting with patient education and that it was important that they were engaged. District nurses wanted to work more in teams and they felt they had too little time set aside for patient education. They felt that they were working person-centered but it was more difficult to work person centered at group education than private education. Conclusion: District nurses should have good knowledge of cultural differences in patients with diabetes. District nurses perceive lack of time and resources and want more cooperate in teams. It is important with a person-centered approach, where district nurses based on the individual person. A district nurse who is engaged and enjoy their work can help dealing with the increased pressure and workload.

Sammanfattning Bakgrund Demenssjukdom bidrar ofta till att personerna i senare sjukdomsförlopp behöver flytta till särskilt boende, vilket ställer krav på omvårdnadsperonalen att ha förståelse och kunskap om hur vårdmiljön påverkar personer med kognitiv svikt. Riktlinjer visar att miljön måste uppfylla både fysiska och psykosociala aspekter och omvårdanden ska vara personcentrerad. Metod Artikelsökning gjordes i databaserna CINAHL och PubMed där lämpliga artiklar valts ut, samt via fri- och sekundärsökning som analyserades med integrerad analys. Syfte Syftet med litteraturöversikten är att beskriva hur en personcentrerad vårdmiljö kan påverka personer med demenssjukdom inom särskilt demensboende. Resultat Resultatet visar att personcentrering av vårdmiljön har stor betydelse för personer med demenssjukdom och kan implementeras i alla tillgängliga boendeformer. Att göra miljön så hemlik som möjligt är viktigt och naturen har en positiv inverkan på personer med demens och utomhusmiljön kan också bidra med multisensorisk stimulans. Belysning, buller, och temperatur har också betydelse för exempelvis beteendestörningar. Förbättrad orientering kan erhållas genom användning av symboler och minnesboxar men också genom användning av färger. Slutsats Personcentrering av vårdmiljön har stor betydelse för personer med demenssjukdom när det gäller upplevelse av trygghet, välmående och livskvalitet, och sjuksköterskan kan anpassa miljön med rätt kunskap och engagemang. / Summary Background Dementia often leads to moving into assisted living/ nursing homes, which adds a great responsibility for the staff to understand how the environment affects people with dementia. Guidelines show that the environment must take both physical and psychosocial aspects into consideration and the care should be person-centered. Method Articles were chosen from two databases; CINAHL and PubMed. Free- and secondary references of interest were also found. The chosen articles were analysed with integrated analysis. Aim The aim of this review was to explore how the living environment affect people with dementia in assisted living and nursing homes for people with dementia. Result The result shows that person-centered care environment have great importance for people with dementia, and can be implemented in all available living facilities. Making the home environment as homelike as possible is important, and nature has a positive influence on people with dementia and can provide multisensory stimulance. Light, noise and temperature can induce behavioral changes. Improved orientation can be attained by the use of symbols and memory boxes, and also through the use of colors. Conclusion Person-centered care environment is of great importance for people with dementia to restore the sense of security, wellbeing and quality of life, and with knowledge and commitment the nurse can adjust the environment to fit its purpose.

Bakgrund: Patientrapportering är det informationsutbyte mellan vårdpersonal som handlar om den vårdsökande personens hälsotillstånd. Tidigare forskning visar att kommunikationsbrister kan få allvarliga konsekvenser för den vårdsökande. Vid bedsiderapportering förflyttas rapporteringen till sängkanten. Därmed kan den vårdsökande själv vara delaktig i rapporteringen. Syfte: Att beskriva vårdsökandes och sjuksköterskors upplevelse och uppfattning av bedsiderapportering. Metod: En litteraturöversikt genomfördes utifrån 11 studier som svarade mot syftet. Dessa kvalitetsgranskades och analyserades med hjälp av Fribergs trestegsmodell. Resultat: Från artiklarna med fokus på vårdsökande personer framkom tre teman: 1) Ger ökad trygghet. 2) Integriteten kan påverkas 3) Kommunikation anpassad efter vårdsökande. Från artiklarna med fokus på sjuksköterskor framkom tre teman: 1) Att komma vårdsökande närmare. 2) Vikten av att hantera sekretess och känslig information rätt. 3) Förbättrad kommunikation. Slutsats: Huvudfynden som framkom var ökad säkerhet samt ökad delaktighet. Dessa huvudfynd är begrepp som en personcentrerad omvårdnad bygger på och för den vårdpersonal som ämnar bedriva en personcentrerad omvårdnad skulle bedsiderapportering med fördel kunna implementeras som rapporteringsmodell. / Background: Nurse-to-nurse shift report means the exchange of information about the patient’s state of health between health care professionals. Previous research shows that errors within the communication are common and that it can lead to serious consequences for the patient. Bedside handover means that the shift report is conducted to the patient’s bedside, therefore the patient can also be actively involved in it.  Aim: To describe patients' and nurses’ experience and views of bedside report. Method: A literature review was conducted based on 11 studies that corresponded to the purpose. These were quality checked and analyzed with Friberg's three-stage model. Results: Articles focusing on patients was revealed into three themes: 1) Provides increased safety. 2) The integrity could be affected. 3) Communication adapted to patient. Articles focusing on nurses was revealed into three themes: 1) To get closer to the patient. 2) The importance of dealing with privacy and sensitive information in a correct way. 3) Improved communication. Conclusion: The main findings in this literature review were increased patient safety and increased sense of patient participation. These findings are notions which the person-centered care is based on. Health care professionals who intend to pursue a person-centered care should consider implementing bedside handover as their report model.

Master of Science / Department of Family Studies and Human Services / Karen S. Myers-Bowman / There are three different approaches for the treatment of lesbian, gay, bisexual, transgender, questioning, and intersex (LGBTQI) sexual orientations: reparative therapies, gay-affirmative therapies, and person-centered approach. These therapeutic approaches will be discussed individually and Kitchener’s Model of Ethical Decision Making or Moral Justification will be applied to each of them with the purpose of identifying which is the most ethical. The American Association for Marriage and Family Therapy (AAMFT) scholars have not created guidelines for working with LGBTQI or made a clear stance on what they believe would be the best approach to take, therefore, clinical and ethical implications and recommendations for the field of marriage and family therapy will be discussed.

Bakgrund: I Sverige insjuknar varje år ungefär 25 000 människor i någon form av demenssjukdom, en sjukdom som ökar världen över och troligtvis kommer att fördubblas inom de närmsta 20 åren. Demenssjukdom drabbar hjärnan vilket påverkar minnet och den kognitiva förmågan och kan ge beteendemässiga och psykiska symtom (BPSD). Studier visar att nio av tio personer någon gång kommer att visa symtom som ångest, oro, vandrande och aggressiva beteenden. Läkemedelsadministrering för att behandla symtom som oro, ångest och agiterande beteenden är inte ovanligt. Dock kan läkemedel ofta orsaka biverkningar hos äldre människor. Att istället använda djurterapi för att behandla symtom som kan uppstå vid demenssjukdomar kan ses som ett positivt alternativ då studier visat att djurterapi har en positiv inverkan på människan med demenssjukdom och andra kognitiva sjukdomar. Syfte: Syftet med denna studie var att beskriva vilken inverkan djurterapi har på människor med demenssjukdom och andra kognitiva sjukdomar. Metod: Studien är en litteraturöversikt baserad på artiklar med kvantitativ och kvalitativ ansats (n=15). Resultat: Resultatet av denna litteraturstudie visar att djurterapi ger minskad stressnivå, minskat uppvisande av aggressiva beteenden, färre vanföreställningar, minskad ångest, nedstämdhet, sorgsenhet, depressiva symtom och apatiska beteenden samt ökning av glädje, lycka, engagemang, vakenhet, medvetenhet, verbala uttryck samt ökat minne. Konklusion: Resultatet tyder på att djurterapi med fördel kan användas som alternativ eller kompletterande behandling för människor med demenssjukdom. Dock ser författarna att utökad forskning behövs för att se långvarig inverkan av djurterapins effekter. / Background: Each year about 25 000 people in Sweden get affected with dementia. The disease increases worldwide and is likely to double within the next 20 years. Dementia affects the brain, which affects memory and cognitive ability and can cause behavioral and psychological symptoms (BPSD). Studies show that nine out of ten people at some time will show symptoms such as anxiety, agitation, wandering and aggressive behaviors. Drug administration to treat symptoms such as agitation, anxiety and agitating behavior is not unusual. Drugs are often likely to cause side effects in older people. If animal-assisted therapy can be used to treat the symptoms that can occur in dementia it can be seen as a positive alternative when studies have shown that animal therapy has a positive effect on people with dementia. Aim: The purpose of this study was to describe the impact of animal-assisted therapy on people with dementia and other cognitive diseases. Method: The study is a literature review based on articles with qualitative and quantitative approach (n = 15). Results: The results of this study show that animal therapy reduces stress levels, decreased production of aggressive behaviors, fewer delusions, decreased anxiety, depression, sadness, depression and apathetic behavior, and increase joy, happiness, commitment, alertness, awareness, verbal and increased memory. Conclusion: The results indicate that animal therapy can be advantageously used as an alternative or complementary therapy for people with dementia. However, the authors think that expanded research is needed to see long-term effects of animal therapy's effects.