Att som äldre drabbas av grav synnedsättning påverkar livet på olika sätt och för ögonsjuksköterskan blir det viktigt att förstå dessa patienters upplevelser. Syftet var att undersöka äldres upplevelser av att drabba av åldersrelaterade ögonsjukdomar som ger en kraftigt nedsatt syn. Studien är en integrativ litteraturstudie där analysen resul­te­rade i tre områden av särskild betydelse för dessa patienter; att förlora sitt obero­ende, livet blev inte som planerat samt att finna nya vägar. Resultatet visar att äldre med synnedsättning var mindre aktiva, mindre självständiga, och mindre nöjda med livet än de med god syn. Det visade sig att äldres syn hade stor betydelse för deras upplevelse av hälsa. Genom ett personcentrerat förhållningssätt kan ögonsjuksköters­kan bemöta dessa pa­tienter i deras livsförändring och genom samtal förbereda patien­ten inför hur livet kan komma att förändras med synnedsättning, samt skapa realist­iska förhoppningar inför framtiden. Ögonsjuksköterskan kan förmedla kontakt med stödfunktioner såsom Syn­verksamheten och därmed hjälpa patienterna att finna nya lösningar i vardagen. / Learning how to live with severe visual impairment in old age affects many areas in their everyday life and for an ophthalmic nurse it is important to understand these pa­tients’ experiences. The aim of the study was to find out elderly people’s experiences of suffering of age-related visual impairment. The study is an integrative literature study in which the analysis resulted in three areas of special meaning for these pa­tients: loosing independence, life was not as planned and finding new ways. The result shows that elderly with visual impairment where less active, less independent, and less ple­ased with life than those with good visual ability. Research showed that el­der´s visual ability had great meaning of how they experienced their health. Having a person centered approach the ophthalmic nurse can support these patients in their life­style changes and through a dia­logue prepare patients for the upcoming changes of life living with visual impairment. The ophthalmic nurse can also support the patients to get realistic expectations of the future. The ophthalmic nurse can me­diate contact with supportive functions such as Synverksamheten, and thereby help pati­ents to find solutions coping with their everyday life.

Bakgrund: För att skapa en så bra livskvalitet som möjligt för personen med demenssjukdom behöver vården och omsorgen ges utifrån ett personcentrerat förhållningssätt med personen i fokus istället för demenssjukdomen i sig. Levnadsberättelsen är ett betydelsefullt verktyg för att lära känna personen med demenssjukdom. Syfte: Att beskriva vårdpersonalens erfarenheter av att använda levnadsberättelsen inom särskilda boenden för personer med demenssjukdom.Metod: Kvalitativ intervjustudie med vårdpersonal på särskilda boenden för personer med demenssjukdom. Resultat: Levnadsberättelsen var viktig för att lära känna personen vilket var betydelsefullt för att planera omvårdnaden och bemöta personen på bästa sätt. Den kunde bidra till att bibehålla funktioner och vanor samt vara en hjälp vid samtal som kunde stimulera och väcka minnen. Levnadsberättelsen kunde också vara en hjälp för att förebygga och lindra BPSD. Utbildning och ett gott ledarskap sågs som framgångsfaktorer för ett väl fungerande arbete med levnadsberättelsen. Slutsats: Levnadsberättelsen är en förutsättning för att kunna bedriva personcentrerad vård inom särskilt boende för personer med demenssjukdom. Den är en hjälp för att kunna respektera personens vilja och önskemål samt för att kunna planera vården och omsorgen därefter. Utbildning av vårdpersonal samt goda chefsegenskaper har kunnat ses som framgångsfaktorer för ett lyckat arbete med levnadsberättelsen. / Background: In order to create as good quality of life as possible for the person with dementia, care need to be given based on a person-centered approach with the person in focus instead of the dementia itself. The life-story is important for getting to know the person with dementia. Purpose: To describe the health professionals experience of using the life-story in nursing homes for people with dementia. Method: Qualitative interview study with healthcare professionals experience of using life-stories in nursing homes for people with dementia. Results: The life-story was important in order to get to know the person, which was important for planning nursing and responding to the person in the best way. It could help maintain functions and habits as well as help in conversations that could stimulate and wake up memories. The life-story could also help to prevent and alleviate BPSD. Education and good leadership were seen as success factors for a well-functional work with the life-story. Conclusion: The life-story is a prerequisite for being able to conduct personal care in nursing homes for people with dementia. It is a help to respect the person's will and wishes, and by acting on the basis of the life-story, then plan the care. Education of health professionals and good management skills has been seen as success factors for successful work with the life-story.

Bakgrund: Personer som drabbats av glaukom eller diabetes ska erbjudas undersökningar regelbundet. Sjuksköterskeledd mottagning är en åtgärd för att möta efterfrågan. Syftet med studien var att undersöka personers erfarenhet av besök vid sjuksköterskeledd mottagning inom ögonsjukvård. Metod: Tvärsnittsstudie med kvantitativ ansats och konsekutivt urval. Under en månad svarade 187 respondenter som besökte ögonmottagningen med anledning av diabetes eller glaukom på en enkät. Sex enkätfrågor modifierade från den nationella patientenkäten avsåg att undersöka erfarenheten av besöket. Enkäten besvarades digitalt direkt efter besöket. Enkätsvaren var icke parametrisk på ordinalnivå med gradering 1= nej inte alls till 5 = Ja helt och hållet. Resultat: Medianvärdet och typvärdet blev 5 i alla enskilda frågor och det totala medelvärdet blev 4,96. Det fanns inga skillnader i erfarenhet avseende ålder, anledning till besök, besökstyp eller upplevda synbesvär. Konklusion: Personer som besökte den sjuksköterskeledda ögonmottagningen erfor att mottagningen bedrevs personcentrerat. Frågor som ställdes med bakgrund i personcentrerad vård besvarades instämmande av majoriteteten. / Background: People struck by glaucoma or diabetes shall be offered examination on a regular basis. Nurseled clinic is a measure to cope with the demand. The purpose of the study was to analyze people’s experience of a nurse-led clinic within ophthalmology. Method: Cross sectional study with quantified approach and consecutive selection. During one month, 187 participants who visited the clinic for control of diabetic and glaucoma responded to a survey. Six questions modified from the Swedish National Patient Survey were used. The data was collected in a digital format directly after the visit. Questionnaire responses were on a non parametric ordinal scale with responses between 1, no, not at all to 5 yes, I agree. Result: Median and mode showed 5 and the total mean value showed 4,96. There was no difference in the experience related to age, diagnosis, type of visit and vision impairment. Conclusion: Visitors to a nurseled ophthalmology clinic experienced the clinic to be carried out personcentered. The questionnaire was inquired targeted in personcentered care and was agreed by the majority.

Bakgrund: I alla tider har kvinnor stöttat andra kvinnor under förlossningen och den födande kvinnan ses som huvudperson. Omfattande forskning finns på kvinnors behov av professionellt stöd under förlossningen. Nyligen har även pappors upplevelse och behov uppmärksammats. Pappans förlossningsupplevelse är av betydelse för pappans och barnets interaktion, i transitionen till faderskapet och för hans egna välbefinnande. Inom området behövs mer kunskap om pappors behov av professionellt stöd vid födseln av sitt första barn. Denna kunskap behövs för att pappor ska uppleva ett professionellt stöd. Syfte: Att beskriva det professionella stödets betydelse för pappors upplevelse av sitt första barns födelse. Metod: Sex informanter har blivit intervjuade över telefon. En kvalitativ innehållsanalys har använts för att besvara studiens syfte. Resultat: Information, kommunikation, delaktighet och tillgänglig förlossningspersonal är betydande för pappors upplevelse av det professionella stödet. Pappor avläser barnmorskans kroppsspråk och känner tillit till förlossningspersonalen som utstrålar kompetens och säkerhet. Pappor anser att deras huvudsakliga uppgift är att vara ett stöd till den födande kvinnan och ett professionellt stöd möjliggör för detta. Konklusion: Professionellt stöd till pappan är betydelsefullt för att han ska uppleva förlossningen som hanterbar. / Background: Throughout time women have supported each other during childbirth with the woman in labor seen as the main character. Extensive research exists on women’s need for professional and social support during the labor process. Recently, the fathers’ experiences and needs have been given attention. Father´s childbirth-experience is important for father-child bonding, in the transition to parenthood and his own well-being. More knowledge about fathers’ experiences with professional support during their first child’s birth is expected. This knowledge is needed so the fathers experience professional support. Aim: To describe the meaning of professional Support for fathers during the birth of their first child. Method: Six participants have been interviewed over telephone. A qualitative content analysis has been used to answer the aim of the study. Results: Information, communication, participation and available birth attendants are important for the fathers experience with professional support. Fathers read the midwives body language and feel faith in the birth attendants who radiate competence and certainty. The fathers consider that their main task is to be supportive for the woman in labor, and professional support makes that possible. Conclusion: Professional support for fathers during childbirth is important for their feeling of manageability.

Bakgrund: Demens är ett samlingsnamn för en grupp olika sjukdomar som drabbar hjärnan och dess funktioner. Terapidjur används för att lugna och förbättra livskvaliteten hos personer med demenssjukdomar. För att undvika problem som allergier, kostnader för skötsel och skador som kan uppstå vid användandet av levande djur har därför robotdjur utvecklats. Syfte: Att sammanställa aktuell forskning som beskrivit effekter och erfarenheter av robotdjur inom demensvården. Metod: En litteraturöversikt grundad på 15 vetenskapliga artiklar, publicerade mellan åren 2013 och 2018. Resultat: De flesta studierna visade på positiva effekter på social interaktion och att intervention med robotdjur kunde främja psykiskt välbefinnande och reducera ensamhet hos äldre med demenssjukdom. Resultatet från de olika studierna visade att med hjälp av ett robotdjur kunde isolering och avskärmning brytas. Inverkan på aggression och utåtagerande beteende varierade vid interaktion med robotdjur. Slutsats: Resultatet av denna studie visade att användande av robotdjur kan ha positiv effekt på social interaktion och livskvalitet. Vidare kan användande av robotdjur ha en lugnande inverkan och dämpa agitation samt reducera nedstämdhet hos äldre personer med demenssjukdom. / Background: Dementia is an umbrella term which involves a number of diseases that effects the brain and its functions. Animal assisted therapy is being used to calm and enhance the overall quality of life for people who suffers from dementia. To avoid problems like allergies and costs that involves care for the animals and for the damages that they might cause, the development of the robotic animal has begun. Aim: To compile current research, which highlights the effects and experiences of using robotic animal in the care of people who suffers from dementia. Method: Literature review based upon 15 scientific studies, published between the years 2013 and 2018. Results: Most studies pointed towards a positive effect upon social interaction and that intervention with a robotic animal could promote mentaly well-being as well as reducing loneliness in elderly people suffering from dementia. The result from the studies showed that using a robotic animal could help break isolation among the participants. The effects on aggression and extroverted behaviour when using an robotic animal showed a varying result. Conclusion: The results of this study shows that the use of robotic animals could have positive effects on social interaction and quality of life. A robotic animal could also have a calming impact on agitation and reduce depression in people who suffers from dementia.

Sammanfattning Bakgrund: I Sverige har cirka 200 000 personer hjärtsvikt. Sjukdomen kan vara kronisk, komplex och innebär en livslång behandling. Det är en allvarlig sjukdom där cirka 50 % med svår hjärtsvikt dör inom ett år. Det finns inga klara riktlinjer när transition till palliativ vård för patienter med hjärtsvikt sker. Syfte: Syftet var att identifiera erfarenheter som sjuksköterskor ansåg vara av betydelse för att initiera palliativ vård för patienter med hjärtsvikt, samt vilka åtgärder som därefter vidtogs. Metod: En kvalitativ design med induktiv ansats valdes. Totalt genomfördes 15 ostrukturerade intervjuer, alla intervjuer analyserades utifrån Critical Incident Technique. Resultat: Det framkom att ett allmänt försämrat hälsotillstånd var erfarenheter som sjuksköterskan ansåg vara av betydelse för transition till palliativ vård. I resultatet framkom även att åtgärder som vidtogs ledde till att vården blev mer palliativt inriktad. Slutsats: Att identifiera patienter med hjärtsvikt som var i behov av palliativ vård var viktigt men svårt och krävde kunskap. Det finns behov av att utarbeta hjälpmedel och verktyg för att underlätta identifieringen till palliativ vård, eftersom det leder till att vården blir mer personcentrerad och behandlingsstrategin förändras. / Abstract Background: In Sweden, approximately 200,000 people have heart failure. Heart failure can be chronic, complex and involves lifelong treatment. It is a serious disease in which about 50% with severe heart failure die within a year. There are no clear guidelines when transition to palliative care for patients with heart failure occurs. Objective: The purpose was to identify experiences that nurses considered to be important for initiating palliative care for patients with heart failure, and what actions thereafter were taken. Methods: A qualitative design with inductive approach was chosen for this study. A total of 15 unstructured interviews were conducted and analyzed on the basis of the Critical Incident Technique. Results: The result was divided into two parts. It was found that a generally deteriorated health were experiences that the nurse considered to be of importance for transition to palliative care. In the results it emerged that measures that was taken led to more oriented palliative care for the patients. Conclusion: To identify patients with heart failure who were in need of palliative care was important but difficult and required knowledge. There is a need to develop aids and tools to facilitate identification for palliative care, as it causes care to be more person-centered and the treatment strategy changes.

Background: The number of people seeking asylum in Sweden reached a record level by 2015. Inequalities in the healthcare of migrants can lead to poor health outcomes and an unsatisfactory health meeting. Language translation is considered the minimum that should be offered to ensure the care recipients access to a good, safe and satisfactory care. Culture also has an impact on the recipient's experience of healthcare and consists of much that is unconscious and constantly changing in interaction with the individual's lived experience. Efforts to bridge the gap between migrant healthcare recipients and healthcare providers whom usually belong to a majority population, include the application of culturally competent care and strategies for "culture brokering". These methods do not however consider the lack of insight into the care recipient's cultural frame of reference. An Intercultural Mediator (IM) is themselves a migrant who, based on common denominators such as language, gender and shared experience of being immigrant can act as an intermediary or bridge builder during the healthcare meeting. Mediation can be used to highlight the care recipient's lifeworld story and promote a person-centered care that is not precluded by pre-defined opinions and stereotypes concerning the impact of culture, but instead addresses the person's vulnerability, resources and personal abilities. Aim: The aim of this study is to investigate IM's specific role and how the IM can contribute to a more person-centered care in the context of the healthcare meeting of short duration within in-patient settings. Method: The study is based on ethnography conducted through participatory observation, informal dialogue at a healthcare clinic and hospital in Malta. Results: The results are based on four categories describing IM's role in the creation of person-centered care for migrant care recipients; Being a fellow human, creating a bridge between care recipients and care providers, being a part of the team and balancing power situations and creating cultural awareness. Conclusions: An IM is an important addition to healthcare agencies. IM utilizes the dyadic conversation preceding the healthcare meeting to establish trust and prepare the care recipient for the encounter. During the triadic meeting with the care recipient and caregiver, the IM interprets and ensures that the participants understand each other. The IM's presence creates space for the migrant care recipient to express his needs based on his everyday reality and cultural reference frame. In highlighting the care recipient's story, the IM is able to contribute to a more person-centered healthcare meeting, which may result in a better outcome. However, the lack of organisation of mediation services, lack of cultural awareness amongst care providers as well as exclusion from the healthcare practitioners' community of practice may hinder the effectiveness and stability of mediation services.

Background: Diabetes is a chronic disease affecting more and more people and placing increasing demands on health care. The increasing numbers of adults diagnosed with type 2 diabetes are in need of self-management strategies. Learning self-management includes mastering the skills required to complete the complex emotional and physical tasks necessary to manage well-being and to prevent future complications. A technological service developed with the participation of stakeholders may be an alternative way to meet rising needs for self-management. The involvement of various stakeholders enables cooperation, facilitates patient empowerment, and takes into consideration how adults with type 2 diabetes manage their everyday activities. Aim: The overall aim of the licentiate thesis is, by participatory research methods identify self-management support of a future ICT service to facilitate adults with type 2-diabetes. Methods: Two studies were conducted using participatory design (PD) with qualitative methods. Data were collected among recently diagnosed adults and those with longer experience of type 2 diabetes. The adults were recruited from a primary healthcare centre and from a diabetes hospital clinic in Sweden. Study I identified perceived challenges related to self-management among recently diagnosed adults and those with longer experience of type 2 diabetes by using multistage focus groups. Study II reported needs and wishes for an ICT self-management service to facilitate their everyday life and to deal with type 2 diabetes by using a future workshop. Results: Three main challenges were identified; understanding; developing skills and abilities; and mobilizing personal strengths. Both recently diagnosed adults and those with longer experience of diabetes described challenges in understanding the causes of fluctuating blood glucose and in developing and mobilizing skills for choosing healthful food and eating regularly. The recently diagnosed group were more challenged by learning to accept the diagnosis and becoming motivated to change habit while the experienced group were mainly challenged by issues about complications and medications. The adults with type 2 diabetes expressed needs and wishes for an ICT service all fell under the broad category of Acceptance of the diagnosis, with the three suggestions; Trust in partnerships, Communication and Individualized information. Acceptance of the diagnosis was a prerequisite for managing diabetes successfully. Acceptance of the diagnosis also made the participants accept information, learn about their condition, and understand how to personally manage their everyday lives. Trust in partnership with caregivers and Communication facilitated that acceptance and understanding of the disease. Main findings: The adults with type 2 diabetes stated different needs for support during different phases of the disease. The expressed needs and wishes for an ICT service all fell under the broad category of Acceptance of the diagnosis, with three other suggestions; Trust in partnerships, Communication, and Individualized information. The participants’ experience of the participatory methodology as a democratic process and their appreciation of mutual learning contributed to these results, which are consistent with the aims of person centred care. Conclusions: Adults with diabetes have different needs for support during different phases of the disease. From a person-centred perspective it would be desirable to meet individual needs for self-management on peoples’ own terms through a technological service that could reach and connect to a large number of people. Healthcare practitioners need to address the knowledge needs of patients with type 2 diabetes and support them in developing self-management skills. Consistent with person-centred care, practitioners should also encourage patients’ abilities to mobilize their own personal strengths to maintain self-management. / <p><strong>Forskningsfinansiärer:</strong></p><p>Kommunerna i Skåne Nordost</p><p>Högskolan Kristianstad</p>

Bakgrund : Övervikt och fetma är ett folkhälsoproblem, fler människor i världen dör av övervikt än undervikt. Barn med övervikt och fetma har större risk att senare i livet drabbas av sjukdomar som till exempel hjärt- kärlsjukdomar och diabetes. Skolsköterskan möter barn i tidig ålder och har med sin kompetens möjlighet att hjälpa barnen och arbeta preventivt mot övervikt och fetma. Syfte: Att beskriva skolsköterskans erfarenheter av att arbeta med personcentrerad vård relaterat till övervikt och fetma hos barn 6–12 år inom skolhälsovården. Metod: En deskriptiv kvalitativ intervjustudie med induktiv ansats som analyserat enligt Graneheim och Lundmans innehållsanalys. Resultat: Fem huvudkategorier framkom: föräldrarnas reaktioner, omgivande faktorer, redskap och verktyg, inflytande och skolans ansvar. Skolsköterskan är beroende av många olika faktorer för att ge personcentrerad vård till varje elev. Samtliga skolsköterskor beskriver att föräldrarnas inställning är det som avgör i vilken utsträckning de har möjlighet att hjälpa eleven. Slutsats: Studien visar att skolsköterskan är en viktig del i arbetet mot övervikt och fetma men att rätt förutsättningar behövs för att kunna ge stöd och hjälp till varje elev. / Background: Overweight and obesity are a public health problem, more people in the world die of overweight than underweight. Children with overweight and obesity are at greater risk of later in life suffering from diseases such as cardiovascular disease and diabetes. The school nurse meets the child early in childhood and has the ability to help the children and to work against overweight and obesity. Purpose: To describe school nurses experience of working with person-centered care related to overweight and obesity in children 6-12 years in school health care. Method: A descriptive qualitative interview study with inductive approach as analyzed according to Graneheim and Lundman's content analysis. Results: Five main categories emerged: the parents' reactions, surrounding factors, tools and instrument, influence and school responsibility. The nurse is dependent on many different factors to provide person-centered care to each student. All school nurses describe that the parents' attitude determines the extent to which they have the opportunity to help the student. Conclusion: The study shows that the school nurse was an important part of the work towards overweight and obesity, but that the right conditions were needed to provide support and assistance to each student.

Background: Diabetes is a chronic disease affecting more and more people and placing increasing demands on health care. The increasing numbers of adults diagnosed with type 2 diabetes are in need of self-management strategies. Learning self-management includes mastering the skills required to complete the complex emotional and physical tasks necessary to manage well-being and to prevent future complications. A technological service developed with the participation of stakeholders may be an alternative way to meet rising needs for self-management. The involvement of various stakeholders enables cooperation, facilitates patient empowerment, and takes into consideration how adults with type 2 diabetes manage their everyday activities. Aim: The overall aim of the licentiate thesis is, by participatory research methods identify self-management support of a future ICT service to facilitate adults with type 2-diabetes. Methods: Two studies were conducted using participatory design (PD) with qualitative methods. Data were collected among recently diagnosed adults and those with longer experience of type 2 diabetes. The adults were recruited from a primary healthcare centre and from a diabetes hospital clinic in Sweden. Study I identified perceived challenges related to self-management among recently diagnosed adults and those with longer experience of type 2 diabetes by using multistage focus groups. Study II reported needs and wishes for an ICT self-management service to facilitate their everyday life and to deal with type 2 diabetes by using a future workshop. Results: Three main challenges were identified; understanding; developing skills and abilities; and mobilizing personal strengths. Both recently diagnosed adults and those with longer experience of diabetes described challenges in understanding the causes of fluctuating blood glucose and in developing and mobilizing skills for choosing healthful food and eating regularly. The recently diagnosed group were more challenged by learning to accept the diagnosis and becoming motivated to change habit while the experienced group were mainly challenged by issues about complications and medications. The adults with type 2 diabetes expressed needs and wishes for an ICT service all fell under the broad category of Acceptance of the diagnosis, with the three suggestions; Trust in partnerships, Communication and Individualized information. Acceptance of the diagnosis was a prerequisite for managing diabetes successfully. Acceptance of the diagnosis also made the participants accept information, learn about their condition, and understand how to personally manage their everyday lives. Trust in partnership with caregivers and Communication facilitated that acceptance and understanding of the disease. Main findings: The adults with type 2 diabetes stated different needs for support during different phases of the disease. The expressed needs and wishes for an ICT service all fell under the broad category of Acceptance of the diagnosis, with three other suggestions; Trust in partnerships, Communication, and Individualized information. The participants’ experience of the participatory methodology as a democratic process and their appreciation of mutual learning contributed to these results, which are consistent with the aims of person centred care. Conclusions: Adults with diabetes have different needs for support during different phases of the disease. From a person-centred perspective it would be desirable to meet individual needs for self-management on peoples’ own terms through a technological service that could reach and connect to a large number of people. Healthcare practitioners need to address the knowledge needs of patients with type 2 diabetes and support them in developing self-management skills. Consistent with person-centred care, practitioners should also encourage patients’ abilities to mobilize their own personal strengths to maintain self-management. / <p><strong>Forskningsfinansiärer: </strong>Kommunerna i Skåne Nordost, Högskolan Kristianstad och Region Skåne</p>