Bakgrund: Hypotermi är ett vanligt förekommande problem inom operationssjukvården som kan leda till allvarliga följder för patienten och ökade kostnader för samhället. Förebyggande åtgärder i det preoperativa skedet har visat sig viktiga för att minska risken att hypotermi utvecklas. Syfte: Syftet var att undersöka patienters kärn- och perifera temperatur under de preoperativa förberedelserna vid dagkirurgi. Hypotesen var att patienters kärn- och perifera temperatur sjönk under de preoperativa förberedelserna. Metod: Totalt 50 patienter på en dagkirurgisk avdelning på ett mellanstort sjukhus i Sverige gav sitt muntliga samtycke att medverka i studien. Kroppstemperaturen mättes vid två tillfällen; när de precis bytt om till patientskjorta samt när de placerats på operationsbordet. Kärntemperaturen mättes med en axillartermometer, och den perifera temperaturen mättes på fyra punkter med en infraröd termometer. Datan var normalfördelad och statistisk signifikans beräknades med parat t-test. Resultat: Resultatet visar att det inte sker någon signifikant förändring av patienternas kärntemperatur men att den perifera temperaturen förändras. Riktningen är dock inte entydig då resultatet visar att mätpunkterna på överkroppen sjunker medan mätpunkterna på underkroppen stiger. Slutsats: Kärntemperaturen kan vara oförändrad genom de preoperativa förberedelserna, men det innebär inte att temperaturen ligger inom rekommendationerna för preoperativ kärntemperatur. Mer forskning krävs för att studera patientens kroppstemperatur genom hela den perioperativa processen, dvs. pre- intra, och postoperativt. / Background: Hypothermia is a common problem within the surgical context and can lead to serious consequences for the patient and increased costs for society. Efforts to prevent hypothermia in the preoperative phase have proven important to minimize the risk of developing hypothermia. Aim: The aim was to examine core- and peripheral temperature of surgical outpatients, during the preoperative phase. The hypothesis was that the temperature would decrease during the preoperative preparation. Method: 50 patients, at a medium-sized hospital in Sweden, participated. The temperature was measured twice; when the patient had changed into surgical attire, and when placed on the operating table. The core temperature was measured using an axillary thermometer, and the peripheral temperature was measured at four locations using an infrared thermometer. The data was normally distributed and paired t-test was used for statistical analysis. Result: The results show that there was no significant change in core temperature, whereas a change occurred in the peripheral temperature. The direction of change was incoherent, where the points of measurements on the upper body decreased in temperature, while the points of measurement on the lower extremities increased. Conclusion: The core temperature can remain unchanged during the preoperative period. This does not imply that the temperature is within preoperative temperature recommendations. More research, studying the temperature throughout the perioperative process, is necessary to attain knowledge regarding the development of the temperature of the patient undergoing surgery.

Syfte Syftet med studien var att utforska distriktssköterskors användning av MI för livsstilsförändringar hos patienter med svårläkta bensår. Design Kvalitativ intervjustudie med en induktiv ansats. Metod Författarna intervjuade åtta distriktsjuksköterskor som arbetar på vårdcentral. Dessa distriktsjuksköterskor arbetade med patienter med bensår. Författarna använde sig av en kvalitativ design där data insamlades genom semistrukturerade intervjuer som spelades in på band och transkriberades. Resultat I studien framkom det att patienter som tog till sig råd om livsstilsförändringar upplevde distriktssköterskorna hade en högre livskvalité. Dock kunde distriktssköterskorna uppleva en lägre livskvalité hos patienter som hade mycket smärta av såren, trots att de tog till sig de råden om livsstilsförändringar. Distriktssköterskorna arbetade personcentrerat och använde sig av MI i sina samtal under besök, dock användes endast vissa delar och inte hela konceptet av MI. De delar man använde sig av var öppna frågor, bekräftelse och sammanfattning. Slutsats I studien framkommer det att det är av stor vikt att arbeta personcentrerat vid behandling av sår, samt att motivera patienten att vara delaktig i sin behandling för bästa resultat. Författarna tror att med mer utbildning i MI och att MI används som hjälpmedel för att motivera varje enskild individ för livsstilsförändringar ger en förbättrad möjlighet till att få patienten mer motiverad, delaktig i sin vård och därmed få en förbättrad livskvalité och förbättrad läkning av det svårläkta bensåret. / Purpose The purpose of the study was to explore district nurses' use of MI for lifestyle changes in patients with severe leg ulcers. Design Qualitative interview study with an inductive approach. Method The authors interviewed eight district nurses working at the health center. These district nurses worked with patients with leg ulcers. The authors used a qualitative design and data was gathered through semi structured interviews that were recorded on tape and transcribed. Results The study found that according to the interviewed nurses, patients who receive advice about lifestyle changes experience a higher quality of life. Patients with a lot of pain due to leg ulcers, experience a lower quality of life even after undertaking the advice of life style changes. District nurses worked with person-centred care and use MI in their conversations during patient appointments. However, only certain parts of the MI is used and not the entire concept. The parts used are open questions, confirmation and summary. Discussion The study found that it is of great importance to use person-centred care in the treatment of wounds, as well as to motivate the patient to be involved in his treatment for best results. The authors believe that increased education on the use of MI and actual increased use of MI provide a big opportunity to get the patients more motivated, involved in their own care and thereby an improved quality of life and improved healing of the severe leg wound.

Sammanfattning Bakgrund: Antalet sköra äldre personer kommer att öka i hela världen. I Sverige kommer antalet äldre personer över 80 år stiga från cirka 500 000 år 2014 till 800 000 år 2030. Genom en ökad medellivslängd ökar behovet av kommunal hälso- och sjukvård. För att kunna möta olika behov hos de sköra äldre som bor hemma behöver vården vara personcentrerad. Syfte: Syftet med denna studie är att beskriva distriktssköterskors upplevelse av kommunikation med sköra äldre personer inom kommunal hälso- och sjukvård.   Metod: En kvalitativ studie med induktiv ansats. Intervjuer gjordes med 12 distriktssköterskor utifrån en semistrukturerad intervjuguide, de analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visat att distriktssköterskorna har många och varierande erfarenheter av att kommunicera mer sköra äldre personer. När distriktsköterskorna kommunicerar med den sköra äldre personen, kan olika hinder uppstå som distriktssköterskorna försöker hitta lösningar på för att uppnå målet med ett respektfullt bemötande i personcentrerad omvårdnad. Slutsats: Kommunikationen mellan distriktssköterskan och den sköra äldre patienten är komplex med utmaningar som tidsbrist, fysisk och kognitiv nedsättning hos den sköra äldre personen. / Summary Background: The number of frail elderlies will increase worldwide. In Sweden, the number of elderly persons over the age of 80 will rise from 500 000 in 2014 to 800 000 in 2030. Increased life expectancy increases the need for municipal health care. In order to meet different needs of the frail elderly persons who live at home, the care needs to be person-centred. Purpose: The purpose of this study is to describe how the district nurse communicate with frail elderly people in municipal health care. Method: A qualitative study with an inductive approach. Interviews were made with 12 district nurses based on a semi-structured interview guide, they were analysed with qualitative content analysis. Result: The results show that the district nurses have varied experiences of communication with frail elderly people. When the district nurses communicate with frail elderly person, they encounter various obstacles that they try to find solutions for in order to achieve the goal of respectful treatment in persons-centred care. Conclusion: Communication between the district nurse and the frail elderly person is complex with challenges such as lack of time, physical and cognitive impairment in the frail elderly person.

Bakgrund: Andelen äldre i befolkningen ökar nationellt och internationellt, och med ökande ålder ökar både fysisk och psykisk ohälsa. Äldre personer med ohälsa i form av kognitiv svikt (oftast demenssjukdom) kan bli beroende av vård och omsorg i särskilda boenden för äldre för att kunna känna trygghet och välbefinnande samt ha ett gott liv, i gemenskap med andra. Dock visar utvärderingar av särskilda boenden för äldre att vården ofta kan vara uppgiftscentrerad och inte motsvara de äldres individuella behov och önskemål. Personcentrerad vård är en vårdmodell som beskrivs kunna tillgodose äldre personers multidimensionella behov och önskemål, genom att personens livshistoria, personlighet, kapacitet och perspektiv uppmärksammas, respekteras och inkluderas i vården. Den vetenskapliga litteraturen inom området visar dock att det finns begränsad kunskap om förekomsten av personcentrerad vård i särskilda boenden för äldre i Sverige och internationellt, liksom om vilka faktorer som är mest betydelsefulla för att särskilda boenden för äldre ska bedriva en personcentrerad vård. Syfte: Syftet med denna avhandling var att beskriva faktorer som samvarierar med förekomst av personcentrerad vård i särskilda boenden för äldre i Sverige. Metod: Samtliga delstudier var tvärsnittstudier och data samlades in genom enkäter till äldre med kognitiv svikt och personal i särskilda boenden för äldre i Sverige. I studie I bestod insamlad data av skattningar av personcentrerad vård från vårdpersonal (n=1465) i 182 särskilda boendeenheter. I studie II insamlades data i form av vårdpersonalens (n=1169) skattningar av personcentrerad vård och proxyskattningar av de äldres (n=1261) livskvalitet, ADL-förmågor, smärta, depressiva symtom och agitation i 151 särskilda boendeenheter. Delstudie III baserades på data i form av personalskattningar (n=1169) av personcentrerad vård, tillfredställelse med arbete och vård, samvetsstress, arbetsbelastning och psykosocialt klimat i samma 151 särskilda boendeenheter. Även delstudie IV baserades på data från de 151 särskilda boendeenheterna och inkluderade skattningar av de äldre och vårdpersonal, men också skattningar av organisation och miljö vid dessa enheter (n=151). Samtliga studiernas data analyserades med hjälp av statistiska analyser, beskrivande, bivariata och multivariata analysmetoder. Resultat: Studie I visade att enkätinstrumentet The Person-Centred Care Assessment Tool (P-CAT) har tillfredställande psykometriska egenskaper för intern konsistens och test-retest-reliabilitet. Instrumentet består av två subskalor: Individualisering av vården och Stöd från organisation och miljö. Delstudie II visade att de boendes ADL-förmågor och livskvalitet skattades bättre vid enheter som kan beskrivas som mer personcentrerade. Delstudie III visade att en mer personcentrerad vård har samband med att personalen upplever ett positivt psykosocialt klimat, mindre samvetsstress, lägre arbetsbelastning samt högre tillfredställelse med vård och arbete. Studien visade också att personcentrerad vård var positivt relaterat till i vilken omfattning vårdarna hade vidareutbildning i demensvård. Delstudie IV visade att vårdmiljön var mest betydelsefull för förekomsten av personcentrerad vård vid boendeenheterna och att en gynnsam vårdmiljö innebar att personal upplevde att det var ett positivt psykosocialt klimat på enheten, att de hade tid att prata med eller bara vara med de boende samt att de upplevde sig ha en gemensam värdegrund, låg arbetsbelastning och en fysisk miljö som var anpassad till de boendes behov. Slutsatser: Resultaten i avhandlingen visar att den svenska versionen av P-CAT kan användas för valida och reliabla utvärderingar av personcentrerad vård samt att den kan rekommenderas för fortsatt forskning och vårdutveckling inom särskilda boenden för äldre. Resultatet visar också att den vård- och arbetsmiljö som omger de äldre och vårdpersonal i särskilda boenden för äldre är betydelsefull för förekomsten av personcentrerad vård. Dessa aspekter behöver fokuseras ytterligare för att kunna erbjuda en personcentrerad vård. Vidare är det psykosociala klimatet och förekomsten av en upplevd gemensam värdegrund viktig att förstå och prioritera om vården ska utvecklas mot en ökad personcentrering. Fortsatt forskning och kliniskt utvecklingsarbete behövs för att operationalisera och implementera de komponenter som bidrar till ett positivt psykosocialt klimat och en personcentrerad värdegrund på särskilda boenden för äldre. Dessutom behövs en ökad förståelse för hur en sådan värdegrund kan omsättas i personcentrerade interaktioner, handlingar, aktiviteter och prioriteringar. Det vore alltså önskvärt att äldrevården utvecklades mot ett mer personcentrat förhållningssätt, eftersom avhandlingens resultat visar att högre grad av personcentrerad vård i särskilda boenden för äldre var positivt relaterat till välbefinnande och tillfredställelse för såväl de äldre som för vårdpersonal. / Introduction: The proportion of older people in the population increases nationally and internationally, with a declining physical and mental health often accompanying older age. Older people with health issues such as cognitive impairment or dementia often become dependent upon residential aged care to feel safe, experience well being and a good life with others. However, it has been shown that residential aged care can largely be taskoriented and not tailored to residents' needs and wishes. Person-centred care is a contemporary best practice model of care that can meet the multidimensional needs and preferences of older people dependent on care, by acknowledging, respecting and including each person’s life story, personality, capacities, and perspective in care. Nevertheless, the research literature indicates a limited knowledge on the extent to which residential aged care units are person-centred in Sweden and internationally, as well as a limited knowledge into factors of importance for person-centred care in residential aged care units. Aim: The overall aim of this thesis was to describe factors that associate with person-centred care in Swedish residential aged care units. Methods: The thesis consists of four studies with cross-sectional designs, and data was collected through resident and staff surveys in Swedish residential aged care units. Study I collected data consisting of ratings of person-centred care from staff (n=1465) in 182 residential aged care units. Study II collected data consisting of staff (n=1169) ratings of person-centred care and proxy ratings of resident (n=1261) quality of life, ADL-capacity, pain, depressive symptoms and agitated behaviours, in 151 residential aged care units. Study III was based on staff (n=1169) ratings of person-centred care, satisfaction with care and work, job strain, stress of conscience, and perceived psychosocial climate in the same 151 residential aged care units as in study II. Study IV was also based on data from the 151 residential aged care units as described in study II and III, and included ratings of resident and staff variables, as well as variables related to the organization and environment at the units. Data was analyzed using statistical analyses such as descriptive, bivariate, and multivariate methods. Results: Study I showed that the Person-Centred Care Assessment Tool (PCAT) has satisfactory psychometric properties relating to internal consistency and test-retest reliability. The tool consists of two subscales: Extent of personalizing care and Amount of organizational and environmental support. Study II showed that residents were rated as having higher quality of life and better ability to perform activities of daily living in units described as being more person-centred. Study III highlighted that person-centred care was associated with higher staff satisfaction, less job strain, less stress of conscience, and a positive psychosocial unit climate. Person-centredness of care was also positively associated with the extent to which staff had continuing education in dementia care. Study IV showed that the environment is the most influential factor for person-centred care, and that an environment facilitating person-centred care consists of a positive psychosocial unit climate, where staff perceives having time to spend being with residents, where staff perceives a shared philosophy of care, a low job strain, and a physical environment adapted to residents’ needs. Conclusions: The results of the thesis show that the Swedish version of the P-CAT can be used for valid and reliable assessment of unit personcentredness, and that it can be recommended for further research and practice development in residential aged care. The results of the thesis also show that the environment of care and work that encapsulates residents and staff in residential care units is important for person-centred care. These aspects need further focus to enable person-centred care in residential aged care units. Furthermore, the psychosocial climate and the presence and content of a shared philosophy of care are important to understand and prioritize if care is to move towards increased person-centredness. Further research and practice development work is needed to operationalize and implement the components that contribute to a positive psychosocial climate and a person-centred philosophy in residential aged care units, as well as to increase the knowledge of how such a philosophy of care can be translated into person-centred actions, interactions, activities and priorities. strive towards developing person-centredness further within aged care is desirable, as the results in this thesis indicate that residential aged care units

Recent decades have seen increasing recognition of the importance of patient involvement during patient-professional interactions and promotion of preventative and long term approaches to healthcare for those with long-term conditions. The concepts of 'shared decision making' and 'personalised care planning' have both been advocated by patient groups, policy-makers, professional bodies and academia as best practice. During shared decision making, patients and healthcare professionals work in equal partnership to decide the best course of action. Shared decision making is a central tenet of personalised care planning, as it aims to foster partnerships between patients and healthcare professionals when making decisions, but personalised care planning also describes an overall approach to healthcare that is forward-planning and preventative, rather than episodic and reactive. Despite the breadth of support for such approaches, in reality they are not routinely adopted. Multiple Sclerosis (MS) is a heterogeneous neurodegenerative long term condition, which is unpredictable with limited treatments available. Such uncertainty and complexity position MS as an interesting long term condition to explore decisional and information needs. This doctoral research comprises of three methods stages. Firstly, two systematic reviews assessing the effectiveness of personalised care planning for people with long-term conditions and people with MS were carried out. Secondly, 22 in-depth semi-structured qualitative interviews were carried out with people with MS across the UK to explore experiences of decision making and interactions with healthcare professionals. Purposive sampling was carried out and data saturation determined sample size. A modified grounded theory approach was used and thematic analysis of interview data was carried out. Lastly, a series of structured qualitative interviews were carried out with 6 consultant neurologists. This stage was iterative in that problematic areas identified during analysis of interview data from stage 2 were presented to neurologists in infographic form to further examine issues raised. Framework analysis was carried out on neurologist interview data to examine their interpretations and potential solutions. Although there appears to be some evidence demonstrating that personalised care planning is effective for people with long term conditions, such favourable effects were not demonstrated in the context of MS. Based on the findings from the systematic reviews it is unclear whether personalised care planning is effective for people with MS and there is a clear gap in the literature examining this. Findings from the interview stages suggest there are key areas which are lacking in terms of information and decisional support. Such areas included the type and amount of information around the time of diagnosis, support when choosing disease modifying drugs and discussions about approaches outside mainstream medicine. Findings from neurologist interview data corroborated those from MS interview data, but through examination of issues raised it also highlighted some of the complexities and challenges of involving patients and enacting shared decision making in reality. This research identified key areas that require improvement for people with MS in terms of provision of the information and decisional support. Although in theory personalised care planning and shared decision making are positioned as best practice, in reality it is unclear whether they are effective or appropriate for people with MS. The way in which such approaches are enacted are complex and require careful consideration. Potential barriers and pitfalls identified within this study suggest a lack of clarity in how to respond to challenges and further investigation into how patient involvement is enacted is needed.

Background: This research explores whether rural Community Maternity Units (CMUs) contribute to NHS Scotland’s Quality Ambitions of safe, effective and person centred care. Currently there is no available recent evidence regarding the quality of this particular model of care in a rural setting. This research makes an important contribution given that most women are encouraged to access local maternity services. Design: An exploratory case study was used with a hermeneutic phenomenological approach to the qualitative data collection and analysis. Quantitiative data were collected and analysed to provide descriptive statistics. Methods: The study was conducted in three phases. In phase one a retrospective medical records review was undertaken to provide quantitative data on the care provided. Phase two was an observation of team meetings, interviews with staff and focus groups with stakeholders in roles aligned to the provision of care at the CMUs. In phase three observations of clinical encounters and interviews with women informed by aide memoire diaries were used. Findings: Maternity services provided by the CMU teams achieved a consistently high standard of safety and effectiveness when measured against national guidelines, standards and other evidence. The stakeholders appreciated the ability within these small teams to provide local, accessible services to women with effective support when required from tertiary services. The women valued person centred and relationship based continuity of antenatal carer, provided by compassionate named midwives, but were disappointed by the discontinuity when complications occurred. Conclusions: The CMUs’ physical position within the community, smallness of scale and the midwifery team’s ethos of normality within a socially based but medically inclusive service facilitated local access for most women to maternity care. This service provision addressed NHS Scotland’s Healthcare Quality Strategy of improving health and reducing inequalities for the people of Scotland. The role of the named midwife was key to providing high quality care by maintaining connections across contextual boundaries for women experiencing normal and complicated pregnancies. This research provides an original contribution to the study of rural maternity service provision in Scotland to help inform future sustainability and service development of rural CMUs.

Bakgrund: 80% av de människor som dör varje år i Sverige antas ha varit i behov av palliativa vårdinsatser. För att patienterna ska kunna känna sig delaktiga i sin vård behöver de vara väl informerade om sitt tillstånd. Rapporter visar att inte alla palliativa patienter får ett brytpunktssamtal, vilket ökar risken att patienten inte känner sig delaktig i sin vård. Syfte: Att undersöka patienters upplevelse av delaktighet i sin vård i livets slutskede Metod: Designen är en litteraturöversikt. Datainsamling har skett genom sökningar i databaserna PubMed och CINAHL. Resultat: Resultatet baserades på 15 vetenskapliga artiklar och delades in i fyra kategorier: patientens behov av information, delat beslutsfattande, Patientens preferenser och upplevelse av en god död. De flesta patienter önskade information om sitt tillstånd men inte alla upplevde att de fick detta. Det varierade i hur mycket patienterna ville vara delaktiga i beslutsfattandet. Patienter som önskade delat beslutsfattande upplevde i mindre grad att deras önskningar blev mötta. Konklusion: För att säkerställa att patienterna känner sig delaktiga i sin vård i livets slutskede är det viktigt att se till den enskilda individens behov och anpassa vården utefter dessa, samt vara medveten om att detta kan ändra sig under vårdprocessen. / Background: 80% of the people that die every year in Sweden are believed to have benefited from palliative care. In order for patients to be involved in their care, they must be well informed about their condition. Reports show that not all palliative patients get a breakpoint conversation, which increases the risk that patients don’t feel involved in their care. Aim: To investigate patients’ experiences of participation in their end-of-life care Methods: The design is a literature review. Data collection has been done through searches in the databases PubMed and CINAHL. Results: The result was based on 15 scientific articles and were divided into four categories: patients’ need for information, shared decision-making, patients’ preferences, and experience of a good death. Most patients wanted information about their condition, but not everyone felt that they received it. It varied in how much patients wanted to be involved in the decision-making. Patients who wanted shared decision-making felt less that their wishes were met. Conclusions: To ensure that patients feel involved in their care, it is important to investigate the individual's needs and to adjust the care accordingly, as well as being aware that this may change over time.

The purpose of this study was to examine Residential Care Aides’ (RCAs) experiences of good quality dementia care provision. Informed by a political economy perspective, I sought to understand how RCAs conceptualize quality dementia care, whether such conceptualizations are reflected in their daily care practice and how the organizational care context impedes or facilitates such care provision. Drawing on a focused ethnographic approach, I utilized in-depth interviews, participant observation and the review of selected documents to contextualize RCAs’ experiences within the organizational care environment. Over a 12-month period, in-depth interviews with 29 staff (21 RCAs, 3 LPNs and 5 managers) and 239 hours of participant observation were conducted in four small-scale dementia units in two nursing homes in British Columbia, Canada. In-depth interviews yielded information-rich data about RCAs’ care experiences and their relationships with residents, while participant observation afforded the opportunity to strategically link RCAs’ actions and interactions with what was said, a feature missing from much of the previous research examining staff perceptions of quality dementia care. A select review of facility documents and provincial licensing regulations provided additional insight regarding the relevance of the larger structural context for RCAs’ care experiences. In general, RCAs conceptualized, and exhibited in their daily physical care provision, quality dementia care as that which focused on tangible care outcomes (i.e., keeping residents clean, comfortable, calm and happy), on their care approach (i.e., delivering care in a compassionate, patient and affectionate manner) and was guided by family ideology (i.e., invoking of family metaphors). Inherent in their care provision was a sense of role tension, as they sought to incorporate social interaction with task completion and their co-workers’ conflicting expectations. Study findings also illustrated how, in the face of continued disempowerment and organizational constraints, RCAs sought to provide quality dementia care by negotiating their peer and supervisory relationships and selectively breaking formal and informal policies/procedures. Salient to RCAs’ experiences of personhood was the limited recognition and appreciation they received from management and the manner in which work-life balance, staffing coverage, human resource management practices and limited information sharing further devalued them and their work. Study findings draw attention to the importance of: acknowledging the role of structural constraints in the pervasiveness of a task-oriented work culture; attending to (and facilitating) staff personhood; facilitating supportive peer and supervisory relationships and; fostering effective management practices as a means of potentially improving care quality. As such, the study sheds important light on what RCAs require within their work environments to help facilitate resident well-being, reinforcing the assertion that residents’ care conditions are inextricably linked to RCAs’ care work conditions. / Graduate / 0351

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice. Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV). Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV). Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability. / <p>Study IV</p><p>Karlsson C, Ernsth Bravell M, Ek K, Johansson L &amp; Bergh I (2014): Reliability and face validity of the Abbey Pain Scale-SWE in Swedish dementia care practice. Submitted June, 2015.</p>

Bakgrund: Forskning visar att personer med psykisk sjukdom löper ökad risk för fysisk ohälsa men erhåller inte likvärdig vårdkvalité som övriga patientgrupper. Syfte: Litteraturöversiktens syfte var att beskriva faktorer av betydelse för vårdpersonalens upplevelse av att vårda patienter med psykisk sjukdom inom somatisk respektive psykiatrisk vård samt att beskriva faktorer av betydelse för upplevelsen av att som patient med psykisk sjukdom vårdas inom somatisk respektive psykiatrisk vård. Metod: Litteratursökning utfördes i databaserna PubMed, ScienceDirect, Cinahl och PsycInfo. Efter urval utifrån inklusions- och exklusionskriterier samt kvalitetsgranskning återstod 22 artiklar som analyserades genom innehållsanalys. Resultat: Enligt litteraturöversiktens resultat var attityder och fördomar, yrkeserfarenhet, kunskap och kompetens samt arbetsmiljö faktorer av betydelse för upplevelsen av att vårda patienter med psykisk sjukdom inom somatisk vård. Inom psykiatrisk vård var attityder och fördomar, erfarenhet samt kön faktorer av betydelse. Enligt litteraturöversiktens resultat var vårdrelation och personcentrering faktorer av betydelse för upplevelsen av att som patient vårdas inom somatisk vård. Inom psykiatrisk vård var vårdrelation samt självbestämmande och delaktighet faktorer av betydelse. Konklusion: Resultatet talar för att det råder brist på personcentrering inom såväl somatisk som psykiatrisk vård och att personcentrerad vård är en förutsättning för att kravet om god hälsa och vård på lika villkor ska kunna uppnås. / Background: Research shows that individuals with mental illness have an increased risk of somatic diseases, yet won’t receive equal care as other patients. Aim: The aim was to describe factors relevant to nursing staff’s experience of caring for patients with psychiatric disorders within somatic and psychiatric care respectively, and to describe factors of importance for the experiences of patients with psychiatric disorders who receive care within somatic and psychiatric care respectively. Method: Literature search was conducted in PubMed, ScienceDirect, Cinahl and PsycInfo. After a selection using inclusion and exclusion criteras as well as a quality review 22 articles remained which were analysed using content analysis Results: According to the result of the literature review attitudes and prejudice, professional experience, knowledge and competence and work environment were factors relevant to the experience of caring for patients with psychiatric disorders within somatic care. Within psychiatric care attitudes and prejudice, experience and gender were relevant factors. According to the result of the literature review care relation and person-centered care were factors relevant to the experiences of patients with psychiatric disorders receiving treatment within somatic care. Within psychiatric care, care relation and self-determination and involvement were relevant factors. Conclusion: The results indicate a lack of person centered care in both somatic and psychiatric care and that person-centered care is a prerequisite for the achievement of good health on equal terms.