Hjärtvikt är en vanligt förekommande kronisk sjukdom i Sverige som ger symtomen trötthet, andfåddhet och ben svullnader. Personers förmåga att utöva en god egenvård är en mycket viktig del, och kan öka livskvalitén och överlevnaden vid hjärtsvikt. Litteraturgenomgången tyder på att det hos vissa personer med hjärtsvikt finns en bristande förmåga att utöva egenvård. Syfte: Att beskriva och identifiera vilka faktorer som påverkar personers egenvård vid hjärtsvikt. Metod: En litteraturöversikt med kvalitativ ansats utfördes. Totalt 10 studier granskades och analyserades med hjälp av Fribergs femstegsmodell. Resultat: Ur granskningen och analysen kom fem subteman fram som sedan delades in i två huvudteman. Huvudteman blev sociala faktorer och hälsofaktorer. Resultatets underteman blev miljöfaktorer, erfarenhet och kunskap, relationer och stöd, emotionella uttryck samt fysiologiska faktorer. Några av de faktorer som redovisades i resultatets olika underteman var ålder, tillgänglighet, nedstämdhet och bristfällig kunskap, de faktorerna påverkade egenvården hos personer. Slutsats: Det är viktigt att som sjuksköterska vara medveten om att olika faktorer kan ha olika betydelse för personens egenvårds hantering, vikten av personcentrerad omvårdnad är tydlig Nyckelord: hjärtsvikt, omvårdnad, egenvård, egenvårdshantering / Heart failure is a common chronic disease occurring in Sweden. Symptom that can arise is fatigue, shortness of breath and edema. The ability to practice a good self-care is a really important part and can increase the quality of life and the survival with heart failure. A review of previous studies suggests that some person’s with heart failure have a lacking ability to practice an adequate self-care. Purpose: The purpose of the study is to describe and identify the factors that influence a person’s self-care in heart failure. Method: A literature review with a qualitative approach was carried out. A total of 10 studies was reviewed and analyzed with the use of the five step-model created by Friberg. Result: Out of the survey and the analysis, five subthemes were found which later were divided into two themes. The themes that were created were social factors, and health factors. The subthemes of the result were factors in the environment, experience and knowledge, relations and support, emotional expression and physiological factors. Some of the factors that will be found in the subthemes are, age, availability, depression and lack of knowledge, which was factors that gave an impact to the self-care of a person. Conclusion: It is important as a nurse to be aware of the fact that different factors could have various meanings for a person’s self-care management, the importance of person-centered-care is very clear. Keywords: heart failure, self-care, nursing, self-care management

Sleep problems affect a considerable number (49-86%) of patients undergoing peritoneal dialysis (PD) treatment. Insomnia i.e. difficulties to initiate and/or maintain sleep or too early wakening, combined with daytime symptoms, seems to be the dominating problem. Despite these facts there is a lack of research in PD-patients, especially studies with objective data on the sleep-wake cycle and evaluation of sleep promoting non-pharmacological  interventions. The overall aim of this thesis was to describe sleep problems from different perspectives, and how these problems affect daily life and health in patients treated with PD at home. The aim was also to evaluate an individualised non-pharmacological intervention for improvement of sleep quality outcomes. Four studies were conducted during eight years, starting in 2002. Patients from six hospitals in the south-east of Sweden were invited to participate. In addition, data from a reference group with Coronary Artery Disease and a population group were used for comparisons with PD-patients in one of the studies. Data was collected by self-reported questionnaires, actigraphy registrations and interviews. Sleep was evaluated in a 17-week single-case study with an intervention focusing on sleep hygiene advice. Data from a total of 700 sleep-wake cycles was collected in the patients’ homes. The main findings clearly demonstrated that PD-patients have seriously fragmented sleep compared to the CAD- and population group, and that the PD-patients have a high prevalence of insomnia. The sleep was mainly disturbed by pruritus and Restless Legs Syndrome (RLS). Daytime impairments and a frequent napping behaviour were detected. The prevalence of fatigue was also reported to be extremely high. The patients described that an ever-present tiredness and poor sleep had consequences in their everyday life both physically, mentally, socially and existentially. The nurse-led intervention demonstrated that individual, non-pharmacological sleep interventions can improve sleep and daytime activities in PD-patients. This thesis elucidates that deteriorated sleep with serious fragmentation leads to a variety of daytime impairments and fatigue. By adopting “renal supportive care” in clinical work a more elaborate assessment and individualised non-pharmacological treatment of sleep problems may improve sleep quality and activity in frail patients undergoing peritoneal dialysis at home.

Self-care is the key to living a long and healthy life for people with diabetes. Yet numerous studies show that self-care is far from optimal. This has resulted in attempts to understand the progress underlying self-care behavior in the efforts of mediating more effectively. While there are an abundance of studies focusing on African-American women and diabetes management, there is a considerable gap in health education literature regarding the self-care management experiences of African-American men living with type 2 diabetes. The management and impact of type 2 diabetes on the sense of self, lifestyle, and significant others of the African-American man are not clearly comprehended. Therefore, the purpose of the study was to explore the knowledge, beliefs, and self-care management practices of African American men living with type 2 diabetes. This was an exploratory study utilizing qualitative methodology to understand the knowledge, beliefs, and existing self-care management practices of up to 50 African-American men, ages 18-70, living with type 2 diabetes. Participants had one-on-one semi structured interviews with the primary investigator. The instruments that were used consisted of two parts: one was a self-administered paper/pencil questionnaire to collect socio-demographic information. The second was a semi-structured interview. The study significance was to identify and understand the barriers to type 2 diabetes management and how they had an adverse influence on self-care. A combination of high barriers, poor daily self-care, management, and knowledge possibly put those with type 2 diabetes at an elevated risk for subordinate self-care management. Barriers had a role in reality and diabetes researchers and educators are charged with recognizing the complications of what individuals with type 2 diabetes need to do improve and enhance their health. The study findings revealed that the participants labored with managing their diabetes and some counted on their own potential or performance, as well as the encouragement of their family, extended family, neighbors, and friends. Also, many of the participants had a unified theme in that regarding self-care management, having type 2 diabetes affected those in their surrounding environment, not just the person living with the illness. In conclusion, the study findings suggest that future diabetes research and education among African-American men should give attention to male masculinity and the powerful influence it has on utilizing preventive health services. The limited amount of African-American men included in empirical type 2 diabetes research could help explain the under addressed barriers and complexities to positive self-care management.

Heart failure is a complex chronic disease affecting 6.6 million people in the United States, with an annual cost of $39.2 billion per year. African Americans are at an especially high risk for poor outcomes and readmissions from heart failure complications, as they are 2.5 times more likely to develop heart failure than other ethnic groups. This disease requires a high level of patient self-care management, and evidence suggests that African Americans do not always receive culturally sensitive education, which can lead to suboptimal self-care practices. The practice-focused question for this educational program asked whether nurses of African American patients with heart failure could use a culturally sensitive health education toolkit to improve patients’ knowledge of self-care management. The purpose of this doctoral project was to determine if a culturally sensitive toolkit could increase nursing knowledge. The population focus was nurses caring for African American heart failure patients with frequent readmissions from a high-risk heart failure clinic in New Jersey. The use of Hofstede’s cultural dimensions and an exhaustive literature review guided this doctoral project. The tool used to assess participants’ pre- and post-knowledge was the cultural awareness and sensitivity tool. There were 11 participants comprised of nurses, nurse case managers, and advanced practice nurses; they exhibited a 1.92% improvement in knowledge after the education session. This outcome shows that this educational program was effective and has the potential to contribute to social change by educating nurses on providing effective, culturally sensitive self-care education to African American heart failure patients to increase their adherence to self-care practices.

Diabetes is a challenging chronic disease for adult patients to manage effectively. Poor adherence to prescribed medications treatment is one of the main reasons for poor blood sugar control. Despite healthcare providers' efforts to emphasize the importance of taking medications, adult patients with Type II diabetes frequently present with complications related to persistent failure to adhere to prescribed medication regimen. These patients should thoroughly understand why adhering to a strict medication regimen to maintain control of their blood sugar is so important. The purpose of this project, guided by Orem's self-care deficit nursing theory, was to develop an educational module toolkit that identifies best practices for nurses to address issues of medication adherence with adult patients with Type II diabetes. Future implementation of these toolkit resources may enhance nurses' ability to teach adult patients how to adhere to their medication regimen. Five participants, all considered professional diabetes content experts, were invited to evaluate the educational module toolkit subject matter. The completion response rate was 100% (n = 5). The content experts rated survey items using a 5-point Likert scale where 1= strongly disagree, 2= disagree, 3= not applicable, 4 = agree and 5= strongly agree and responded to 2 questions that allowed for narrative feedback. The experts were satisfied with the content of the educational module toolkit; suggesting that the toolkit may serve as a functional guide for nurses assisting adult patients with diabetes. Improved medication regimen compliance may produce cascading effects; helping these patients achieve a better quality of life while producing positive social change within their families and communities.

The purpose of the quality improvement (QI) project was to examine the relationship between amended nursing education concerning diabetes mellitus (DM) Type 2 self-care management incorporating Tune in, Explore, Assist, Communicate, and Honor (TEACH) and Motivational Interviewing (MI) strategies and techniques and the Glycosylated hemoglobin (HgbA1C) of veteran patients with uncontrolled diabetes. The target sample included the 2 licensed practical nurses and 2 registered nurses assigned to 2 primary care teams, and the 10 purposively sampled patients with uncontrolled DM Type 2 from each team. The nurses' competencies were measured through descriptive comparison before and after nursing education implementation using the instrument Patient Education: TEACH for Success Self-Assessment Questionnaire. The nurses' confidence and their perceived importance of the TEACH and MI skills application and skill assessment for promoting health behavior change were tested inferentially with a paired t test before and after nursing education implementation using the instrument Clinician Importance and Confidence Regarding Health Behavior Counseling Questionnaire. The primary care team developed their skills tailored to each patient's needs, considering the guiding principles and premises of the health belief model (HBM). Patients' self-care management knowledge, skills and confidence were improved. The project decreased the elevated HgbA1C of patients measured after the project initiative. The QI project leads to positive social change by decreasing the number of patients with uncontrolled diabetes among the veteran population. The patients and their providers can develop individualized plans of care for diabetes management by educating, redirecting, and evoking behavioral changes in the veteran patients by using a team approach.

Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep.  Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients. The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep. Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients. The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients. Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL. This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.

Bakgrund: Globalt ses en ökning av diabetes typ2, där livsstilsförändringar anses vara den främsta anledningen. I diabetesvården svarar i huvudsak sjuksköterskan för undervisning i diabetespatientens egenvård, vilken är viktig för behandlingen av patientens sjukdom. Metod: En allmän litteraturstudie genomfördes, där 19 vetenskapliga artiklar ligger till grund för resultatet. Syfte: Att belysa hur patienter med diabetes typ2 upplever diabetesvården. Resultat: I artiklarna beskrivs betydelsen av stöd och kunskap, möte med sjuksköterskan, upplevda besvikelser, vad patienterna efterfrågar och olika mål i diabetesvården. Patienterna efterfrågar kunnig vårdpersonal, som lyssnar på dem, tar deras kunskap på allvar och ser dem som individer. Gruppundervisning önskas av patienter, som vill kunna samtala om sina livserfarenheter och om hur det är att leva med diabetes. Besvikelser handlar om att patienter tycker personalen ofta saknar empati och inte ger tillräcklig och relevant information, som skulle kunna hjälpa dem bättre att hantera sin sjukdom. Det framkom, att sjuksköterskor och patienter kan ha olika mål, vilket kan skapa motstånd hos patienterna, när det gäller att själv medverka till bättre hälsa. Slutsats: Sjuksköterskor bör lyssna på patientens berättelse och mål kring sin sjukdom och förklara för patienten om vikten av att ändra livsstil. / Background: Globaly diabetes type2 is increasing, mainly because lifestyle changes. In diabetes care nurses mainly teach diabetes patients self care management, which is important for the treatment of their illness. Method: A general literature review with 19 scientific articles as a basis of the result. Aim: To illuminate patients with diabetes type2 experience diabetes care. Result: Articles describe the importance of support and knowledge, the meeting with the nurse, disappointments, what patients inquire for and different goals in diabetes care. The patients require a competent medical staff  prepared to listen, to take patients’ knowledge seriously and see them as individuals. Group education is wanted by patients to enable them to share life experiences and knowledge about living with diabetes. Disappointments are about patients feeling lack of empathy from the medical staff, and not receiving enough information to help them handle their diabetes better. Nurses and patients can have different goals, which may lead to the patients resisting to participate and improve their health by self care. Conclusions: Nurses needs to listen to what the patients are telling, to their goals about their illness and, by explaining, try to make them understand the importance of changing lifestyle.

The self-care management of sickle cell disease (SCD) improves mortality rate; however, compliance with SCD self-care management remains a problem. The purpose of this study was to examine the knowledge and factors that influence compliance with SCD self-care management recommendations among caregivers of children with SCD. The health belief model was used as the theoretical foundation of this study, theorizing that caregivers' perceived susceptibility, severity, and benefits of SCD self-care management will influence compliance. The study used a quantitative research design. A cross-sectional survey was administered to 100 caregivers of children with SCD attending sickle cell clinics in Lagos, Nigeria using convenience sampling. Information was obtained from participants using a structured interviewer-administered questionnaire, and data were analyzed using descriptive statistics, bivariate correlations, and binary logistic regression techniques. Findings confirmed a high adherence rate but low knowledge of SCD self-care management among the caregivers of children with SCD. There was no significant correlation between knowledge of SCD self-care management and adherence. However, the findings from the multivariate analysis identified knowledge as a predictor of adherence and religiosity and total number of barriers as barriers to adherence. Parental health beliefs did not influence adherence to SCD self-care management. These findings have social change implications by guiding the work of health educators, health care providers, and public health practitioners to incorporate group counseling on SCD self-care management at every sickle cell clinic.

Bakgrund Den äldre befolkningen lever allt längre och den kroniska sjukdomen diabetes typ 2 blir allt mer förekommande.Behandlingen av diabetes typ 2 består till stor del av råd om livsstilsförändringar som fysisk aktivitet och rekommendationer om kostvanor i kombination med perorala läkemedel och i vissa fall injektioner med insulin. Samtidigt som den äldre personen har diabetes typ 2 kan individen även ha andra sjukdomar, detta ställer höga krav på den enskilda individen och dialogen mellan sjuksköterskan och patienten. Vården bör därför öka sin förståelse för äldre personers upplevelser av att leva med diabetes typ 2 Syfte Att belysa äldre personers upplevelser av att leva med diabetes typ 2 Metod Litteraturstudien är grundad på tio kvalitativa vetenskapliga artiklar. Artiklarna söktes och valdes från databaserna Pub Med, CINAHL plus with full text samt SWE Pub Resultat Äldre personers upplevelser presenteras i två huvudteman med respektive subteman. Att som äldre leva med diabetes: upplevdes på olika sätt i kroppen från person till person. Att leva med diabetes upplevdes som en balans i tillvaron men även som en ständig kamp. Känslor av uppgivenhet uppstod och svårigheter att känna glädje i livet, medans andra upplevde sjukdomen som en naturlig del i ålderdomen. Kraven på livsstilsförändringar: att känna kravet på att göra livsstilsförändringar kunde vara svåra att hantera. Att misslyckas med sina livsstilsförändringar gav patienterna skuldkänslor. Hälso- och sjukvården ansågs som en trygghet att luta sig emot i händelse av osäkerhet. Att bli bemött som en egen unik individ och att sjuksköterskan hade ett engagemang och tid att lyssna på vad som var viktigt för patienten upplevdes som ett tillfredställande mötet med vård en Diskussion Äldre personer med diabetes typ 2 vill bli bekräftade och sedda som enskilda unika individer och dialogen i mötet med vården har en avgörande och betydande roll / Background The older population is living longer and diseases such as diabetes type 2 are becoming more prevalent in combination with other diseases. The treatment of diabetes type 2 is largely composed of advice on lifestyle changes such as physical activity and recommendations on diet. This places high demands on the individual and on the communication between the nurse and patient. The health authorities should therefore increase their understanding of older patients' experiences of living with diabetes type 2 . Aim To illuminate older people's experiences of living with diabetes type 2 Methods The literature review based on ten qualitative research articles. The articles was taken from Pub Med and CINAHL Plus with Full Text and SWE Pub Results Older people ́s experiences are presented in two main themes and subthemes. Living with diabetes type 2 was perceived differently in the body from person to person. Living with diabetes was seen as a balance in life but also as a constant battle. Feelings of hopelessness arose and difficulties to enjoy life occurred, while others experienced the disease as a natural part of aging. The requirement to make lifestyle changes could be difficult to manage. Failure to apply their lifestyle changes gave patients guilt. Health care was considered a security to rely on in case of uncertainty. To be treated as an individual and the nursés commitment and time to listen to what was important for the patient was experienced as satisfactory nursing care Discussion Older people with diabetes type 2 want to be recognized as unique individuals by their caregiver and dialogue in nursing care has a crucial and significant role