Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings:  Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.

Increasing numbers of older patients with cognitive impairment and disturbed behaviour are likely to present to acute care hospitals in the future. Nurses are not well disposed towards care due to safety and morale issues caused by knowledge deficits, job stress, oppressed group behaviours and ageist attitudes. Patient outcomes are often poor with multiple adverse events, long lengths of stay and levels of mortality. Disturbed behaviour may be caused by delirium, depression or other mental disorders and dementia or all. The research question addressed was “Can the instigation of a person-centred approach to care of patients with cognitive impairment and disturbed behaviour result in decreased nursing stress, improved patient care practices, outcomes and relatives’ satisfaction?” A conceptual framework incorporating the constructs of Person-Centred Care, the Integrated Structural Model of Human Behaviour and Practice Development informed the action research methods utilised. The processes of facilitation were used to undertake four action research cycles incorporating plans, actions, observations and reflections in one 25-bed acute aged care ward in a large tertiary referral hospital The first cycle involved setting up the study, recruitment of nurses and patients, gathering of baseline data and application of nonparticipant observational studies of the quality of nurse-patient interactions which served to inform the plan for interventions. The following three cycles demonstrated efforts to undertake those interventions through strategies to increase nursing empowerment and knowledge in the context of constant staff turnover and diversions that compromised support and participation. During the study there were few apparent adverse patient outcomes with significant improvements in patient analgesic administration, relatives’ satisfaction with care, nursing care practices involving the completion of a Communication and Care Cues form and nurses’ interactions with the patients. New care planning tools were developed that will enable ongoing activities for practice improvement. Conversely, there was a significant increase in the nurses’ stress levels when caring for hypoactive delirious patients, a trend towards more emotional exhaustion, high nursing turnover and increased sick leave rates. Nursing care practices were unchanged and the new care planning tools were not well utilised. Reflection on the implications and limitations of action research methods supported by practice development strategies in the dynamic, often chaotic environment experienced during the study, suggested that if there is an absence of hierarchical managerial sponsorship for such activities, then sustainable change is difficult. Therefore, it was shown that a person-centred approach to care of patients with cognitive impairment and disturbed behaviour using action research methods in this environment, can result in some enhanced nurse-patient interactions, patient care practices, outcomes and relatives’ satisfaction. However, progress is likely to be slow and time consuming. Further improvements require attention to the well-being status of the nurses through actions that generate feelings of empowerment through individual recognition, knowledge enhancement, adequate access to patient information and sufficient time to undertake their duties as equal members of the multidisciplinary team.

Bakgrund I arbetet möter sjuksköterskan många olika individer. En grupp individer som har ett stort behov av personcentrerad vård är intellektuellt funktionsnedsatta. Bemötandet och personcentrerad omvårdnad av denna individgrupp upplevs variera allt efter sjuksköterskans erfarenhet och kunskap. Syfte Studiens syfte var att undersöka personcentrerad omvårdnad utifrån sjuksköterskans upplevelse till individer med intellektuell funktionsnedsättning. Metod Litteraturstudien består av 13 kvalitativa och två kvantitativa artiklar och är från olika länder. Artiklarna har publicerats mellan år 2007-2017. Sökningar har gjorts i databaserna Cinahl och PubMed. Resultat Resultatet presenteras i fem kategorier med respektive underrubriker; Individanpassat bemötande (bemötande i vården, utåtagerande beteende, vikten av informationsutbyte); Kommunikation i vården (faktorer som kan påverka kommunikationen, anpassad kommunikation); Samarbete med anhöriga; Behov av kunskap och utbildning; Stöd och samarbete. Konklusion Personcentrerad omvårdnad som möter individens behov framkommer i studien som viktiga beståndsdelar i mötet med individer med intellektuell funktionsnedsättning. För att arbeta personcentrerat och med utgångspunkt från individens behov behöver sjuksköterskan ha förståelse för individgruppen, kunskap och praktisk utbildning för att bli mer trygg i sitt bemötande. / Background At work, the nurse meets many different individuals. A group of individuals with a high need for person-centered care is intellectually impaired. The perception and person-centered care of this individual group is experienced varies according to the nurse's experience and knowledge. Aim The purpose of the study was to investigate the person-centered nursing based on the nurse's experience with individuals with intellectual impairment. Method The literature study consists of 13 qualitative and two quantitative articles and is from different countries. The articles have been published between 2007-2017. Searches have been made in the databases Cinahl and PubMed . Results The result is presented in five categories with respective subheadings; Individualized treatment (treatment in care, outpatient behavior, importance of information exchange); Communication in healthcare (factors that may affect communication, custom communication); Collaboration with relatives; Need for knowledge and education; Support and cooperation. Conclusion Person-centered nursing that meets the needs of the individual appears in the study as important elements in the meeting with individuals with intellectual disabilities. To work personally and based on the needs of the individual, the nurse needs an understanding of the individual group, knowledge and practical training to be more confident in their treatment.

This thesis considers the provision of person-centred care (PCC) in acute healthcare. In recent years it has been increasingly recognised that healthcare should be delivered in a person-centred manner and that staff should receive training and support in relation to this. There is a growing body of literature investigating the potential benefits of PCC in relation to both patient and service level outcomes. Paper one of this thesis is a systematic review of the literature examining staff training interventions for improving PCC in acute healthcare settings. The findings offer preliminary support for the positive impact of such training interventions on patient and service level outcomes in hospital environments. The research in this area is not of a uniformly high standard and this paper concludes that further research in this area is required. Paper two is an examination of a modified version of Dementia Care Mapping (Care Mapping – Neurorehabilitation: DCM-NR), an observational tool for measuring and improving PCC. Results provide evidence of the feasibility and validity of DCM-NR in a range of Clinical Neuroscience settings. Future research should examine the impact of DCM-NR on person-centred practices over time.The critical reflection paper considers both the systematic review and the empirical study. It aims to consider both the strengths and limitations of the research, challenges encountered, clinical implications and highlights areas for future research.

Kraven på hälso- och sjukvård växer i takt med den globala populationen. Forskning visar att behovet av vård ökar men att kvalitén på den blir allt lägre, vilket leder till en problematisering huruvida personcentrerad vård går att uppnå eller om det är en idealbild för vården. Vårdpersonal inom hälso- och sjukvård tror sig arbeta utifrån personcentrerad vård där patienten ses som person och sätts i centrum av vårdandet. Av föregående utformades litteraturstudiens syfte, att undersöka hur sjuksköterskans prioriteringar i omvårdnadsarbetet överensstämmer med en personcentrerad vård. Studien genomfördes som en allmän litteraturstudie med stöd av innehållsanalys där en jämförelse tog grund i att finna likheter och skillnader mellan hur sjuksköterskan prioriterade utifrån definitionen av personcentrerad vård. I litteraturstudiens resultat framkommer att sjuksköterskor uttryckte önskan om att bedriva vård utöver den, för dem, nödvändiga vården och att vården snarare genomfördes enligt rutiner där främst de medicinska behoven tillgodosågs än att identifiera patienters samtliga behov. Att bedriva vård i samråd med patienten har visats ha goda och gynnsamma följder för vårdandet, vilket karaktäriseras av den personcentrerade vården. Det anses vara av vikt att mer forskning fastställer hur personcentrerad vård kan implementeras inom hälso- och sjukvård. / With a growing global population the demands on health care increases. Research shows that the need of care is getting bigger but quality is decreasing. A question rises, whether it is even possible to provide person-centred care or if it is an ideal picture of care. Healthcare professionals believe that they work based on person- centered care where the patient is seen as a person and at the heart of care. This led up to the aim of the study which was to show how registered nurses priorities in caring correspond with person-centered care. The study was conducted as a general literature study. Guided by content analysis similarities and differences, in registered nurses priorities related to person-centered care where found. The results show that registered nurses felt, unlike what they would want, that the care provided was not person-centered but rather what was necessary from a medical perspective. Instead of being person-centered and adapted to the individual at hand, care was based on routines. Providing care together with the patient is what characterizes person- centered care and it has beneficial consequences. It is of importance that future research explores how person-centered care could be implemented in health care.

Bakgrund: Stroke är ett samlingsbegrepp för hjärninfarkter och hjärnblödningar. Stroke ger ofta livslånga men, såsom afasi. Afasi innebär en reducerad förmåga att förstå talat/skrivet språk och/eller en reducerad förmåga att uttrycka sig adekvat. För att en god och personcentrerad vård ska kunna erbjudas patienter med stroke så är en fungerande kommunikation en förutsättning. Syfte: Syftet är att beskriva faktorer som påverkar personcentrerad vård och kommunikation mellan sjuksköterskan och patienter som drabbats av strokeinducerad afasi. Metod: Studien är en litteraturöversikt. Studien är baserad på 15 vetenskapliga artiklar som lästs och analyserats och där gemensamma teman identifierats. Resultat: Resultatet visade på ett antal strategier som främjade eller försvårade en god kommunikation mellan sjuksköterskan och patienter som drabbats av strokeinducerad afasi. Dessa strategier berörde sju områden: Verbal kommunikation, Icke verbal kommunikation, Att se patienten som en kompetent och unik individ, Uppmärksamhet och engagemang, Tidsaspekten vid kommunikation med afasidrabbade, Den omgivande miljöns betydelse för kommunikationen samt Personalens utbildning och kompetens. Konklusion: Det finns inget standardsvar på hur kommunikationen ska gå till, varje individ är unik och varje situation kräver sin unika lösning. Dock finns det ett antal aspekter och metoder som är betydelsefulla och användbara vid kommunikation med afasidrabbade. Dessa används i olika utsträckning inom vården. / Background: Stroke is a collective term for cerebral infarction and cerebral hemorrhage. Stroke often causes lifelong detrimental effects, such as aphasia. Aphasia means a reduced ability to understand spoken/written language and/or a reduced ability to express oneself adequately. To enable a good and person-centred care for the patients, an effective communication is a prerequisite. Aim: The aim of this study is to describe the factors that influence the person-centred care and communication between the nurse and patients affected by stroke induced aphasia. Method: The study is a literature review on bachelor level. The study is based on 15 scientific articles that have been red and analyzed and where common themes have been identified. Result: The results revealed a number of strategies that promoted and hindered good communication between the nurse and people affected by stroke induced aphasia. These strategies concern seven areas: Verbal communication, Nonverbal communication, Seeing the patient as a competent and unique individual, Attention and involvement, The time aspect of communication with patients with aphasia, The importance of the surrounding environment for communication and The personnel's education and skills . Conclusion: There is no standard answer to how communication shall be achieved, each individual is unique and every situation requires a different solution. However, there are a number of aspects and methods that are important and useful when communicating with aphasic people. These are used to different degrees in health care.

Anderson, P & Sinclair, F. Omvårdnad vid gynekologisk cancer. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö universitet: Fakulteten för hälsa och samhälle, Institutionen för vårdvetenskap, 2019.Bakgrund: Årligen insjuknar cirka 3000 kvinnor i gynekologiska cancersjukdomar i Sverige. Detta omfattar maligna sjukdomar i ovarier, uterus, endometriet, cervix, och äggledare. Kvinnor i alla åldrar och livsfaser insjuknar i sjukdomar som på olika sätt och beroende på vilken livssituation kvinnan befinner sig i, påverkar henne. Sjukdomarna har olika prognos, symtom och behandling och medför således olika behov av omvårdnad. Syfte: Syftet med litteraturstudien var att sammanställa kvinnors erfarenheter av omvårdnad vid gynekologisk cancer. Metod: Litteraturstudier genomfördes med sökningar i databaserna PubMed, Cinahl och PsycINFO, 13 kvalitativa artiklar valdes ut och sammanställdes i resultatet genom innehållsanalys där texterna lästes upprepade gånger, meningsbärande och återkommande delar valdes ut, tolkades och sammanställdes i gemensamma teman. Resultat: Ett huvudtema identifierades under analysens gång; Att bli sedd. Detta konkretiserades i tre teman; Kommunikation, Tillgänglighet och Tillit med totalt fem subteman. Konklusion: Gynekologisk cancer berör de kvinnor som insjuknar på olika sätt, bland annat beroende på vilken livsfas de befinner sig i. Kvinnor som insjuknar i gynekologisk cancersjukdom har en önskan om att ses som en individ och har olika behov av stöd och omvårdnad. Att bli sedd var ett genomgående tema som framkom i litteraturstudierna. Personcentrerad omvårdnad bör vara ett ledord i omvårdnad av gynekologiska cancersjukdomar.Nyckelord: gynekologisk cancer, omvårdnad, personcentrerad vård, sjuksköterska, upplevelser / Anderson, P & Sinclair, F. Nursing care during treatment for gynecological cancer. Degree project in nursing 15 Credits. Malmö University: Faculty of Health and Society, Department of Care Science, 2019.Background: Each year approximately 3000 women in Sweden is diagnosed with gynecological cancer. This includes malignant diseases of the ovaries, uterus, endometrium, cervix and the fallopian tubes. Women of all ages and in all phases of life are afflicted differently, depending upon the phase of life she is in and when the cancer is detected. Gynecological cancers have different prognoses, symptoms and treatments. Aim: The aim of this literature review was to compile women´s perceptions and experiences of nursing care during gynecological cancer. Method: A literature review was conducted using the databases PubMed, Cinahl and PsycINFO, 13 qualitative studies were chosen and analyzed through content analysis. Meaningful parts of the articles were extracted and interpreted. Parts with similar messages were then compiled into themes. Findings: One main theme was identified through the analysis; To be seen. Three themes were then further identified during the analysis; Communication, Accessibility and Trust. Five sub-themes were additionaly included in the results. Conclusion: Gynecological cancer affects women in different ways depending on the phase of life and age they are in. Women are afflicted differently and want to be seen as individuals. To be seen was a recurring theme in the literature review. Person-centred care should be considered a leading word in nursing care for gynecological cancer.Key words: Experiences, gynecological cancer, nurse, nursing care, person-centred care

No description available.

Background: In Sweden there are approximately 130 000 to 150 000 people suffering from dementia and according to research this number may double by the year 2050. Dementia is a chronic disorder meaning it is irreversible and those suffering from dementia will deteriorate with time, therefore patients often need specialist care. Knowledge and experience within the field of the various dementia disorders is necessary to provide effective care and ensure quality of life for these patients. According to patients, and relatives of those suffering, the quality of care depends on the relationship between the nurse and patient, and whether nurses have specialist training in dementia care and person centred care (PCC). Aim: The aim of this literature study is to describe nurses' experience of caring for people with dementia. Method: A literature study with descriptive design was conducted based on twelve scientific articles from three different databases: PubMed, Cinahl and PsycINFO. Main results: Through thematic analysing of the twelve chosen scientific articles three main headings emerged along with eight subheadings describing nurses experiences of caring for people with dementia. Theme number one described the importance of individual care in terms of examination, communication, activities and environmental factors. Theme number two focused on relationships that according to the nurses affected the quality of care they provided for the patients. The third theme described nurses' experiences of how resources such as further education as well as better organisation of work and staffing affected their quality of care for patients suffering from dementia. Conclusion: The literature study shows that nurses within dementia care need further education and practical experience to deliver good quality PCC. To make this possible well organised staffing and work structuring from a higher level of management is necessary to create a secure and caring environment where both nurses and patients are satisfied. / Bakgrund: I Sverige finns det mellan 130 000 till 150 000 personer som lider av en demenssjukdom och enligt rapporter kan detta antal komma att fördubblas till år 2050. Demenssjukdomar är kroniska och innebär att tillståndet hos patienten försämras med tiden. Detta innebär att dessa patienter kräver en allt mer anpassad och specialiserad omvårdnad där kunskap och erfarenheter kring demenssjukdom spelar en vital roll för patienternas välmående och livskvalité. Vårdkvalitén enligt patienter och anhöriga avgörs beroende på relationen mellan sjuksköterska och patient samt sjuksköterskornas utbildning och kunskap gällande personcentrerad vård (PCV). Syfte: Att beskriva sjuksköterskors erfarenheter kring omvårdnaden av människor med demenssjukdom. Metod: En beskrivande litteraturstudie där tolv artiklar från databaserna PubMed, Cinahl och PsycINFO står för litteraturstudiens resultat. Huvudresultat: En tematisk analys av de tolv utvalda artiklarna resulterade i tre huvudteman samt åtta underteman där sjuksköterskors upplevelser kring omvårdnaden av människor med demenssjukdom beskrevs. Det första temat fokuserade på individanpassning av vård i form av undersökning, kommunikation, aktiviteter och miljö. Tema nummer två fokuserade på relationer som enligt sjuksköterskorna påverkade kvalitén av omvårdanden av patienterna. Det sista och tredje temat beskrev hur sjuksköterskors erfarenheter av varierande resurser i form av utbildning och organisation av deras arbete och personal påverkade deras omvårdnad för patienter med demenssjukdom. Slutsats: Resultatet av litteraturstudien visar att sjuksköterskor inom demenssjukvården behöver ytterligare specialistutbildning samt praktisk erfarenhet för att möjliggöra god kvalitativ vård i form av PCV. Detta kräver att organisationen kring omvårdnadsarbetet förbättras och stöds på en organisatorisk nivå som resulterar i en trygg och säker arbets- och omvårdnadsmiljö där både sjuksköterskor och patienter trivs.

Bakgrund: Aortaaneurysm är en vidgning på stora kroppspulsådern, en asymtomatisk diagnos som kan blir livshotande om den brister. Aneurysm kan repareras med antingen öppen kirurgi eller endoskopiskt. Män är majoriteten av dessa patienter och rökning, hjärtkärlsjukdomar samt hög ålder utgör riskfaktorer. Syfte: Syftet med litteraturöversikten var att beskriva personers erfarenheter av att leva med ett aortaaneurysm. Metod: Designen är kvalitativ litteraturöversikt med induktiv ansats. Resultatartiklar söktes fram på databaserna CINAHL, PubMed och PsychInfo med hjälp av relevanta sökord för ämnet. Även manuella sökningar gjordes. De framtagna artiklarna lästes med hjälp Fribergs 5-stegsmodell och analyserades utifrån Graneheim och Lundmans kvalitativa innehållsanalys. Analysen resulterade i tre huvudkategorier och sju subkategorier. Resultat: Vägledning i att ha levt med aortaaneurysm, Emotionella aspekter av att ha levt med aortaaneurysm och Livet och vardagen med aortaaneurysm var de tre huvudkategorierna som framkom från analysen, och subkategorierna Information från vården, Kunskap kring diagnosen, Rädsla för diagnosen, Tankar kring döden, En framtid trots diagnos, Mötet med vården samt Begränsningar i vardagen. Information var det som var mest påtagligt och som under tidens gång visade sig kunna påverka övriga subkategorier både positivt och negativt beroende på mängd, leveranssätt och tidpunkt.  Slutsats: Genom denna litteraturöversikt visade sig erfarenheterna variera och dessa var individuella beroende på var i livet deltagaren befann sig och hur livet i övrigt var för deltagaren. Ytterligare studier behövs för att ta fram ett mer personcentrerat och individuellt tillmötesgående för personer med aortaaneurysm. / Background: Aortic aneurysm is a dilation of the aorta, an asymptomatic diagnosis that can become life-threatening if it burst. Aneurysms can be repaired with either open surgery or endoscopically. The majority of patients are men, and smoking, cardiovascular disease and old age are risk factors. Aim: The aim of the literature review was to describe people´s experiences of living with an aortic aneurysm. Method: The design is a qualitative literature review with an inductive approach. Result articles were searched on the databases CINAHL, PubMed and PsychInfo using relevant keywords for the topic. Manual searches were also performed. The produced articles were read using Friberg's 5-step model and analyzed on the basis of Graneheim and Lundman's qualitative content analysis. The analysis resulted in three main categories being selected with seven subcategories. Results:  Guidance in lived aortic aneurysm, Emotional aspects in lived aortic aneurysm and Life and daily living with aortic aneurysm were the three main categories which emerged in our analysis. With the subcategories Information from the healthcare, Knowledge about the diagnosis, Fear of the diagnosis, Thoughts about death, Future despite the diagnosis, Meeting the healthcare and Obstacles in everyday life. Information was what was most noticeable and over time, it turned out to be able to influence other subcategories both positively and negatively depending on quantity, delivery method and time. Conclusion: Through this literature review, the experiences turned out to be varied and these were individual depending on where in life the participant was and how life in general was for the participant. Further studies are needed to develop a more person-centred and individualized approach for people with aortic aneurysm.