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Background: The health-promoting intervention BeWell™, which includes photo-supported conversations, is intended for people with stress-related illnesses. Its focus is on improving the individual’s health and well-being by addressing what contributes to well-being from the patient’s own perspective. There is no current knowledge of the experiences of occupational therapists of using BeWell™ in primary health care. It is thus important to gain knowledge of their experiences of using this intervention as part of investigating its feasibility. Aim: To describe the occupational therapists’ experiences of photo-supported conversations about well-being (BeWell™) with patients diagnosed with stress-related illnesses. Material and methods: Six occupational therapists, working in primary health care, who had conducted the photo-supported conversations about well-being (BeWell™), were interviewed individually, and one focus group discussion was also conducted. Systematic text condensation was used as the analysis method. Results: Three main themes with two to three subgroups in each were identified; Discovering well-being through images, Enhancing patient’s own efforts towards well-being, and Contributing to one’s own well-being. Conclusions and significance: The results provide important knowledge for the continued research work with BeWell™ by investigating how the users of the intervention experienced it.

Det finns många fördelar med att amma varför amning är förstahandsvalet. Antalet kvinnor som helammar sitt nyfödda barn minskar trots att majoriteten av svenska kvinnor planerar att helamma. WHO rekommenderar att barnet helammas till sex månaders ålder. Trots rekommendationen helammas 44 procent av barnen globalt vid sex månaders ålder. Amning är en del av barnmorskans kompetensområde vilket innebär att de ska främja amning. Barnmorskor har en plikt att genomföra amningsrådgivning till samtliga kvinnor. Många kvinnor upplever initialt amningssvårigheter och för att förhindra tidigt amningsstopp är barnmorskans amningsstöd grundläggande. För att utveckla barnmorskans amningsstöd är det därför viktigt att ta reda på hur kvinnor upplever att det är att ta emot amningsrådgivning. Syftet med studien var att undersöka kvinnors upplevelse av amningsstöd och amningsinformation från barnets födelse till sex månaders ålder. Metoden som valdes var en litteraturöversikt med systematisk metod. Studier med kvalitativ och mixad metod inkluderades och endast kvalitativa data användes i resultatet. Databassökning genomfördes i Pubmed och Cinahl. Därefter kvalitetsgranskades artiklarna och endast de som uppfyllde kvalitetskraven inkluderades i resultatet. Vald data analyserades sedan genom integrerad analys. I resultatet inkluderades femton artiklar. Likheter och skillnader i hur kvinnor upplevde amningsstödet identifierades och utformade subkategorierna: kontinuitet inom vårdkedjan, tid för amningsstöd, praktiskt amningsstöd, betydelsen av bekräftelse och uppmuntran samt information och rådgivning. Utifrån subkategorierna identifierades sedan kategorierna kontinuitet och tillgänglighet samt vårdpersonalens bemötande. Slutsatsen indikerade att kvinnorna hade både positiva och negativa upplevelser av amningsrådgivning. I resultatet framkom faktorer som barnmorskor kan påverka kvinnans amningsupplevelse på egen hand genom sitt bemötande. Vidare urskildes faktorer som barnmorskorna inte, There are many benefits to breastfeeding and it is the preferred choice. Despite the majority of the Swedish women intending to exclusively breastfeed, the numbers are decreasing. WHO recommends exclusive breastfeeding until six months, however only 44 percent globally follow through. Midwives are experts in the field of breastfeeding, they should promote and provide efficient support. Many women experience initial difficulties with breastfeeding, and to prevent early disruption of breastfeeding, the midwife's support is essential. Understanding women's perception of breastfeeding advice is key to improving midwives' support. The aim of the study was to examine women's experiences of breastfeeding support and breastfeeding information from birth to six months of age. The method was a literature review using a systematic approach. Studies with qualitative and mixed methods were included, and only qualitative data were used in the results. A database search was conducted in PubMed and Cinahl. The articles were quality-reviewed, and only those meeting the quality criteria were included in the results. The selected data was then analyzed through integrated analysis. The results included fifteen articles. Similarities and differences in how women experienced breastfeeding support were identified and constituted the subcategories: continuity within the healthcare chain, time for breastfeeding support, practical breastfeeding support, the significance of affirmation and encouragement and information and guidance. Based on the subcategories, these categories where formulated: continuity and accessibility, as well as healthcare professionals' approach. The conclusion indicated that women had both positive and negative experiences of breastfeeding advice. The results revealed factors that midwives can independently influence women’s breastfeeding experience with their approach. Furthermore, factors were identified that midwives cannot change on their own, such as the content

Bakgrund: Psykisk ohälsa innebär ofta plågsamma symtom och en ökad samsjuklighet för individen. Samhället har stigmatiserat personer med psykisk ohälsa långt tillbaka i vår historia. Psykiatrin har genomgått stora förändringar under det senaste århundradet. Idag är var tredje besök i primärvården av en person som har någon form av psykisk ohälsa. Sjuksköterskor inom primärvården upplever sig inte vara tillräckligt förberedda i mötet med den psykiatriska patientgruppen. Hur bemötandet utformas är betydande för patientens välbefinnande, värdighet, delaktighet, jämlikhet och säkerhet. Bemötandet bör vara personcentrerat och utgå från patientens livsvärld. En god dialog, inkluderande god kommunikation och information, krävs för att ge ett gott bemötande. Syfte: ​Syftet var att beskriva hur patienter med psykisk ohälsa upplever bemötandet i primärvården.​ Metod: ​En litteraturöversikt av tio redan publicerade originalartiklar. Datainsamlingen av artiklar utfördes i databaserna Cinahl och PubMed. Artiklarna analyserades enligt Fribergs analysmetod. Resultat: ​I resultatet framkom tre teman; ”Att se hela människan och möta individuella behov”, ”en respektfull vårdrelation“ och ”en kamp för att få likvärdig och rättvis vård”.​ Sammanfattning: ​Ur resultatet framkom att patienter med psykisk ohälsa upplever bemötandet inom primärvården på olika sätt. Vid ett bra bemötande etablerades en god vårdrelation och patienterna upplevde sig delaktiga och bemötta med respekt och värdighet. Vissa patienter beskrev istället ett dåligt bemötande, med dålig kommunikation och en fragmenterad vård. Patienter upplevde sig även stigmatiserade av vårdpersonal.​, Background: ​Mental illness often involves painful symtoms and an increased co-morbidity for the individual. Society has stigmatized people with mental illness far back in our history​. Psychiatry has undergone major changes over the past century. Today, every third visit to primary care is by a person who has some form of mental illness. Nurses in primary care do not fell sufficently prepared when meeting patients in the psychitric patient group. How the treatment is framed is important for the patients well-being, dignity, patient participation, equality and safety. Treatment should be person-centred and based on how the persons percive her world. A good dialogue, including good communication, is required to provide a good treatment. Aim: ​The aim was to describe how patients with mental illness experience encounters in primary care.​ Method: ​A literature review of ten original articles already published. The data collection of articles was carried out in the databases Cinahl and PubMed. The articles were analyzed according to Friberg's analysis method.​ Results: ​​In the result, three themes emerged; "Seeing the whole person and meeting individual needs", "a respectful care relationship" and "a fight to get equal and fair care".​ Summary: ​The result showed that patients with mental illness experience the treatment in primary care in different ways. With good treatment, a good care relationship was established and the patients felt involved and treated with respect and dignity. Some patients instead described poor treatment, with poor communicationand fragmented care. Patients also felt stigmatized by healthcare staff.

Background: There is growing evidence that conversations between healthcare professionals and patients with serious illness can improve the quality of end-of-life cancer care. Yet, there is lack of insight into how different healthcare professions collaborate to deliver serious illness communication, as well as patients’ and caregivers’ perceptions of this collaboration between the nurse and physician. This study explores the interdisciplinary collaboration between nurses and physicians in serious illness conversations with patients diagnosed with multiple myeloma and their caregivers. Methods: Eleven dyadic interviews were conducted with 22 patients and caregivers, and two focus group interviews involving four nurses and the other with four physicians. Data analysis and reporting were conducted using reflexive thematic analysis within phenomenological epistemology. Results: The interdisciplinary collaboration was characterized by three main themes: (1) Importance of relationships, (2) Complementary perspectives, and (3) The common goal. Conclusion: This study highlights the importance of interdisciplinarity in serious illness conversations as it enhances the use of existential and descriptive language when addressing medical, holistic, and existential issues. The use of broader language also reflects that interdisciplinary interaction strengthens the expertise of each professional involved in patient care. Through interdisciplinary collaboration, the preferences, hopes, and values of the patient and caregiver can be integrated into the treatment plan, which is key in providing the delivery of optimal care. To promote cohesive and coordinated collaboration, organizational changes are recommended such as supporting continuity in patient–healthcare professional relationships, providing interdisciplinary training, and allocating time for pre-conversation preparation and post-conversation debriefing.

The tacit practical knowledge of psychologists and support staff to foster a real connection between support staff and people with intellectual disabilities and challenging behaviour was explored. Therefore, six dyads comprising individuals with intellectual disabilities and challenging behaviour and their support staff were video recorded during joint engagement in an activity. To tap into the implicit knowledge of professionals about when staff have ‘a real connection’ with a person with an intellectual disability, 10 psychologists and 10 support staff were asked to pinpoint these moments in the pre-recorded video compilation. They also shared their interpretations about what they considered to be a real connection. The results displayed that participants designated real connections as occurring when they noticed concrete interactions taking place. Based on thematic analysis of the data, four themes were identified that encapsulated what professionals deemed to be a real connection. In conclusion: joint engagement in an activity appears to be a context that fosters opportunities for real connection. Furthermore, support staff should adopt a sensitive attitude and create a safe atmosphere, to establish real connections. Participants designated real connections as occurring when they noticed concrete interactions taking place. Based on thematic analysis of the data, four themes were identified that encapsulated what professionals deemed to be a real connection.

BackgroundEfforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients' experiences.ObjectiveTo explore patients' perspectives on opioid taper experiences to ultimately improve taper processes and outcomes.DesignQualitative study.ParticipantsPatients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions.ApproachFrom 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers.Key resultsParticipants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3-36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes.ConclusionsFrom patients' perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships

Bakgrund: Transpersoner har betraktats som en marginaliserad och utsatt grupp i samhället. Det har framkommit exempel på diskriminering och stigmatisering från samhällsstrukturer och normer. Både från omgivningen och internaliserat. Vidare har det visat sig leda till att transpersoner löper ökad risk för psykisk ohälsa och missbruk utöver deras transspecifika omvårdnadsbehov. Syfte: Litteraturstudien beskrev transpersoners erfarenheter av bemötandet i hälso- och sjukvården. Metod: Studien var en beskrivande litteraturstudie. Huvudresultat: De mest framträdande fynden i resultatet innefattade kommunikationen mellan vårdgivare och transpersoner. Negativa upplevelser av vårdmöten karaktäriserades av när transpersonerna blev bemötta respektlöst utifrån affirmerat pronomen och identitet. Negativa upplevelser präglades även av vårdpersonalens egna värderingar, där transfobi beskrevs, eller en skillnad i kunskap mellan vårdgivare och transpersonen gällande transhälsa. Resultatet av respektlösheten kunde i sin tur leda till att vården fick minskad kvalité eller uteblev. Goda upplevelser i möten präglades av respekt för individen, kunskap om transhälsa samt acceptans och förståelse. Slutsats: Hur transpersoner bemötts inom hälso- och sjukvården har präglats av positiva och negativa erfarenheter. Att vårdpersonalen haft transhälsorelevanta kunskaper och förmåga att möta transpersonen med ett holistiskt och personcentrerat förhållningssätt har potential att kunna bidra till att öka hälsa och förebygga ohälsa., Background: Transgender people have been seen as a marginalized and vulnerable group in society. Examples of discrimination and stigmatization have emerged from societal structures and norms. Both from the environment and internalized. Furthermore, it has been shown that transgender people are at increased risk of mental illness and substance abuse in addition to their trans-specific nursing needs. Aim: The literature study described transgender persons experiences of professional-patient relations in health care. Method: The study was a descriptive literature review. Main results: The most prominent findings included communication between caregivers and transgender people. Negative experiences of care meetings were characterized by when the transgender people were treated disrespectfully by not referring to their affirmed pronoun and identity. Negative experiences were also characterized by the care staff's own values, where transphobia was described, as well as a difference in knowledge between caregivers and the transperson regarding transhealth. The result of this disrespect could in turn lead to quality of care being reduced or care being not available. Good experiences in meetings were characterized by respect for the individual, knowledge of transhealth as well as acceptance and understanding. Conclusion: How transgender people have been treated in health care has been characterized by positive and negative experiences. The fact that healthcare staff have had transhealth-relevant knowledge and the ability to meet the transgender person with a holistic and person-centered approach has the potential to contribute to increasing health and preventing ill health.

Bakgrund Sexuellt våld är ett utbrett folkhälsoproblem som drabbar kvinnor över hela världen. Det sexuella våldet kan komma att påverka kvinnors fysiska och psykiska hälsa livet ut. I vården sker möten ständigt och för hälso- och sjukvårdspersonal ingår det i den professionella hållningen att oavsett omständigheter främja ett gott bemötande gentemot patienten. Hälso- och sjukvården har ett stort ansvar i mötet med sexuellt våldsutsatta kvinnor, då mötet kan komma att påverka kvinnans möjligheter till stöd, återhämtning och tillit till vården. Syfte Syftet med studien var att beskriva sexuellt våldsutsatta kvinnors upplevelser och erfarenheter av mötet med hälso- och sjukvården. Metod En icke-systematisk litteraturöversikt genomfördes och resulterade i 15 vetenskapliga artiklar av kvalitativ och kvantitativ design. Artiklarna togs fram med hjälp av databaserna CINAHL och PubMed samt via manuella sökningar. De valda artiklarna kvalitetsgranskades med hjälp av Sophiahemmet Högskolas bedömningsunderlag och analyserades med hjälp av integrerad analys. Resultat Resultatet visade att positiva upplevelser och erfarenheter präglades av god kommunikation som genomsyrades av empati, respektfullhet och lyhördhet. I sin tur präglades negativa upplevelser och erfarenheter av okunskap hos personalen, dömande attityder och väntetid. Likaså lyftes lugn och avskild vårdmiljö, möjlighet att välja personal samt tillräcklig uppföljning och stöd som faktorer som saknades i mötet. Slutsats Sexuellt våldsutsatta kvinnor hade både positiva och negativa upplevelser och erfarenheter av hälso- och sjukvården och flera aspekter saknades i mötet. Med hjälp av ökad kunskap om kvinnors utsatthet och förbättrad förståelse för sexuellt våldsutsatta kvinnors upplevelser och erfarenheter kan nya riktlinjer kring omhändertagandet utformas och därmed förbättra vården och lindra lidande., Background Sexual violence is a widespread public health problem affecting women around the world. Sexual violence may affect women's physical and mental health throughout life. In healthcare encounters occur regularly and for personnel within healthcare, it is part of the professional attitude to promote a rewarding treatment to the patient, regardless of the circumstances. Health services have a great responsibility in the encounter with sexually abused women, as the encounter may affect the woman's opportunities for support, recovery and trust for healthcare. Aim The purpose of this study was to describe sexually abused women’s experience of their encounter with healthcare. Method A non-systematic literature review was conducted and resulted in 15 scientific articles of both qualitative and quantitative design. The articles were retrieved from the databases CINAHL, PubMed and through manual searches. The included articles were reviewed using Sophiahemmet University’s template for quality assessment and the results were analyzed with a thematic analysis approach. Results The results showed that positive experiences were characterized by good communication based on empathy, respect and sensitivity. In contrast, negative experiences were characterized by ignorance among the staff, judgmental attitudes and waiting time. Likewise, a calm and secluded care environment, the freedom to choose staff and sufficient support and follow-up were highlighted as factors that were lacking in the encounter. Conclusions Sexually abused women had both positive and negative experiences of health care, and several aspects were missing in the encounter. With the help of increased knowledge about women's vulnerability and an improved understanding of sexually abused women experiences, new guidelines regarding care can be developed, and thereby improve care and alleviate suffering.

Evidence for the nocebo effect, a phenomenon characterised by suboptimal treatment efficacy, worsening of symptoms, or the occurrence of adverse events caused by an individual's negative treatment expectations, is growing across a multitude of medical fields. Within dentistry, little attention has been paid to patients' negative expectations, despite a number of studies supporting the influence of related factors, such as dental fear and anxiety, on the severity of peri- and post-operative dental pain. Only recently, a small number of commentaries and letters have emerged, urging dentists to recognise the possible existence of nocebo effects in dentistry and its implications for patient care. The present review summarises essential evidence of the nocebo phenomenon especially in relation to pain and drug administration. Subsequently, an overview of the current evidence of the nocebo phenomenon in the dental field is presented. Finally, based on the general knowledge of the nocebo effect, the review indicates fruitful arrays of research into the nocebo effect in dentistry.

Bakgrund: Egentlig depression är ett växande folkhälsoproblem i Sverige. Sjukdomen drabbar samhället, vården och individen. En utmaning för personer med egentlig depression är att hålla en hälsosam struktur och regelbundenhet i sin vardag. Det leder till svårigheter med egenvård, att följa medicinska ordinationer och hälsoråd. Egenvård är handlingar som individen utför för att förbättra sin hälsa. Det är en viktig del i behandlingen av egentlig depression som kan lindra symtom och påskynda tillfrisknande. Syfte: Att undersöka hur relationen mellan patient och vårdpersonal påverkar motivationen till egenvård hos patienter med egentlig depression. Metod: En litteraturstudie av 13 kvalitativa vetenskapliga originalartiklar. Sökningen omfattade artiklar publicerade mellan 2002 och 2022 i databaserna PubMed, CINAHL och PsycInfo. En manifest litteraturanalys användes för att identifiera faktorer som påverkat patienternas motivation till egenvård. Materialet kondenserades till meningsbärande enheter varefter de kategoriserades. Resultat: Litteraturstudien identifierade två kategorier av avgörande delar i bemötandet: specifika ageranden och förhållningssätt. I kategorin specifika åtgärder inkluderas de enskilda handlingarna involvering, informerande, att ställa specifika frågor och att ge patienten tillräcklig tid. De är alla faktorer med en positiv effekt på patientens självbild, motivation och egenvårdsförmåga. Kategorin förhållningssätt innehåller subkategorierna tillit, förståelse, uppmuntran och kontinuitet. De beskriver delar i bemötandet som sjukvårdspersonalen behöver bemästra för att ge patienten goda förutsättningar att sköta sin egenvård. Slutsats: För att ge patienter med egentlig depression goda förutsättningar för egenvård måste vårdpersonalen tillgodose patientens behov av både specifika ageranden och förhållningssätt som ökar motivationen., Background: Major depressive disorder (MDD) is a growing public health concern in Sweden. The illness affects the society, healthcare system and the individual. One challenge for people with MDD is to maintain a healthy structure and regularity in everyday life. This leads to difficulties in self-care, following ordinations and medical advice. Self-care are actions performed by the individual to improve health. It is an important part of the treatment of MDD which can ease symptoms and expedite recovery. Aim: To investigate how the relation between patient and health professionals affect motivation related to self-care concerning patients with MDD. Method: A literature study of 13 qualitative original articles published between 2002 and 2022 in the databases PubMed, CINAHL and PsycInfo. A manifest literature analysis was employed to identify factors affecting the motivation to self-care. The material was condensed into meaningful units and then categorized. Results: The study identified two categories crucial to the approach: specific acts and disposition. The specific acts category includes involvement, information, asking specific questions and giving the patient enough time. All of them are factors with a positive effect on patients’ self-image, motivation and it strengthened capabilities for self-care. The category disposition included the subcategories trust, understanding, encouragement and continuity. They describe parts in the approach that healthcare professionals need to master to give good prerequisites for patients to handle their self-care. Conclusion: To provide patients with MDD optimal conditions for self-care, health professionals need to fulfil the patient’s requirements of both specific acts and disposition at every healthcare contact.

Community housing services adopt care models such as rehabilitation, recovery-oriented care and person-centered planning to improve the quality of life of service users with an intellectual or psychiatric disability. However, the way these care models are implemented and practiced can negatively impact service users’ experience with the service as their complex needs go unmet. In this paper, we conceptualize these experiences through developing the counternarrative of burdens of support. For this we draw on burden of treatment theory. We conducted ethnographic fieldwork in a community service organization in the Netherlands. This included participant observation (84 h), interviews with service users (n = 20), experts-by-experience (n = 8), family members (n = 10) and photovoice workshops. Our analysis identifies four burdens of support: burden of self-determination; re-identification; responsibilisation and re-placement. The results show that burden of support is very much a relational concept: through their support, professionals can aggravate or alleviate burden.

The present study evaluated affective, relational, and emotional behaviors associated with symptom reduction and clinical outcomes in psychotherapy. It relied on 36 therapist-client dyads and assessed client symptoms using the Counseling Center Assessment of Psychological Symptoms (CCAPS-34) as the progress monitoring and outcome assessment tool used by university counseling centers before every psychotherapy session. The research examined the first administration scores and the last administration scores of the CCCAPS to determine the level of clinical improvement. The researcher used the revised Specific Affect Coding System (SPAFF) to code the therapist and client interactions throughout the entire first psychotherapy session. The results revealed significant effects between the affective exchanges in the therapeutic relationship of both the therapist and the client on clinical outcomes. The researcher employed multivariate statistics with appropriate univariate follow-up procedures to determine group differences between SPAFF codes on the symptom outcome groups and CCAPS subscales. The researcher also used path analysis following Actor Partner Independence Model assumptions (Kenny et al., 2020) to examine the interdependent emotional dynamics between therapist and client on client symptom outcomes, and these revealed significant effects between SPAFF scores observed in the first session on client outcomes at the termination of therapy. The results add to the current research literature, highlighting patterns of significant affective behaviors in the first psychotherapy session on client outcomes. The study reveals that the first session cannot be minimized, as it has a greater impact on client outcomes than previously believed. The conclusion also outlines the study’s implications for clinical practice, graduate training, and research., 2022, Includes bibliography., Degree granted: Dissertation (PhD)--Florida Atlantic University, 2022., Collection: FAU Electronic Theses and Dissertations Collection

BACKGROUND: More than 1 million Americans receive primary care from federal homeless health care programs yearly. Vulnerabilities that can make care challenging include pain, addiction, psychological distress, and a lack of shelter. Research on the effectiveness of tailoring services for this population is limited. OBJECTIVE: The aim was to examine whether homeless-tailored primary care programs offer a superior patient experience compared with nontailored (mainstream) programs overall, and for highly vulnerable patients. RESEARCH DESIGN: National patient survey comparing 26 US Department of Veterans Affairs (VA) Medical Centers homeless-tailored primary care (H-PACTs) to mainstream primary care (mainstream PACTs) at the same locations. PARTICIPANTS: A total of 5766 homeless-experienced veterans. MEASURES: Primary care experience on 4 scales: Patient-Clinician Relationship, Cooperation, Accessibility/Coordination, and Homeless-Specific Needs. Mean scores (range: 1-4) were calculated and dichotomized as unfavorable versus not. We counted key vulnerabilities (chronic pain, unsheltered homelessness, severe psychological distress, and history of overdose, 0-4), and categorized homeless-experienced veterans as having fewer (≤1) and more (≥2) vulnerabilities. RESULTS: H-PACTs outscored mainstream PACTs on all scales (all P<0.001). Unfavorable care experiences were more common in mainstream PACTs compared with H-PACTs, with adjusted risk differences of 11.9% (95% CI=6.3-17.4), 12.6% (6.2-19.1), 11.7% (6.0-17.3), and 12.6% (6.2-19.1) for Relationship, Cooperation, Access/Coordination, and Homeless-Specific Needs, respectively. For the Relationship and Cooperation scales, H-PACTs were associated with a greater reduction in unfavorable experience for patients with ≥2 vulnerabilities versus ≤1 (interaction P<0.0001). CONCLUSIONS: Organizations that offer primary care for persons experiencing homelessness can improve the primary care experience by tailoring the design and

Mental health nurses are struggling to describe their nursing identity as professional discipline in a changing mental health care. Measuring nurse-sensitive patient outcomes and demonstrating nursing's effect(s) experienced by patients contribute to (re)discover the specific nursing identity. However, a valid and reliable scale is currently lacking. The aim of this study was the development and psychometric evaluation of the Mental Health Nurse-Sensitive Patient Outcome Scale (MH-NURSE-POS) for inpatient psychiatric hospital settings. This three-staged study resulted in a scale capturing how inpatients experience the contribution of nurses in their treatment in psychiatric hospitals. First, a draft questionnaire was developed based on a literature review, an independent expert's advice, and an experts panel. Second, the content validity was tested in a two-round Delphi-procedure and focus groups with patients. A pilot test, based on cognitive interviews, confirmed the feasibility of the questionnaire. Third, the psychometric properties of the mental health nurse-sensitive patient outcomes were determined in a sample of 353 patients. The cross-sectional study included a convenience sample of five psychiatric hospitals (Belgium). The factor structure (Kaiser-Meyer-Olkin measure of sampling adequacy 0.924; Bartlett's test of sphericity χ2 = 4162.537; df = 231; P < 0.001), convergent validity by the Individualized Care Scale (Pearson correlation 0.660; P < 0.001), and reliability (Cronbach's Alpha 0.854) were evaluated. The factor analysis resulted in a four-factor solution representing growth, expression, control, and motivation. The Mental Health Nurse-Sensitive Patient Outcome Scale is a valid and reliable tool to measure the effectiveness of mental health nurses from the patient perspective.

Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described. Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization. Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods.

BackgroundAlthough there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives.MethodsQualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers.ResultsFour themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth's life choices.ConclusionYouth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care ex

BackgroundMultiple myeloma (MM) is an incurable cancer with complex treatment options. Trusting patient-clinician relationships are essential to promote effective shared decision-making that aligns best clinical practices with patient values and preferences. This study sought to shed light on the development of trust between MM patients and clinicians.MethodsNineteen individual semi-structured interviews were conducted with MM patients within 2 years of initial diagnosis or relapse for this qualitative study. Interviews were recorded and transcripts were coded thematically.ResultsWe identified three main themes: (1) externally validated trust describes patients' predisposition to trust or distrust clinicians based on factors outside of patient-clinician interactions; (2) internally validated trust describes how patients develop trust based on interactions with specific clinicians. Internally validated trust is driven primarily by clinician communication practices that demonstrate competence, responsiveness, listening, honesty, and empathy; and (3) trust in relation to shared decision-making describes how patients relate the feeling of trust, or lack thereof, to the process of shared decision-making.ConclusionMany factors contribute to the development of trust between MM patients and clinicians. While some are outside of clinicians' control, others derive from clinician behaviors and interpersonal communication skills. These findings suggest the possibility that trust can be enhanced through communication training or shared decision-making tools that emphasize relational communication. Given the important role trust plays in shared decision-making, clinicians working with MM patients should prioritize establishing positive, trusting relationships.

Bakgrund Våld mot kvinnor, vilket innefattar intimt partnervåld (även benämnt våld i nära relationer) är ett erkänt globalt problem där cirka var tredje kvinna blir utsatt någon gång i livet. Många av dessa kvinnor har kontakt med hälso- och sjukvården under tiden de blir utsatta oavsett om det är direkt relaterat till våldet eller ej. Där har hälso- och sjukvården ett ansvar att bemöta och behandla dessa kvinnor på ett tillfredsställande och evidensbaserat sätt som upplevs emotionellt stärkande och hjälpande av den utsatta kvinnan. Syfte Syftet var att belysa den våldsutsatta kvinnans upplevelse av processen kring berättandet om intimt partnervåld för hälso- och sjukvårdspersonal. Metod En icke-systematisk litteraturöversikt gjordes i syfte att sammanställa existerande forskning i ämnet. Datainsamlingen gjordes i september 2021 genom sökningar i databaserna PubMed och CINAHL. Kvalitetsgranskning av inkluderade artiklar gjordes via Sophiahemmet högskolas bedömningsunderlag. Dataanalys gjordes i tre steg utifrån en integrerad modell där huvudteman och underteman identifierades. Resultat Under analysen av de 15 inkluderade artiklarna så återfanns tre huvudteman: upplevelse av barriärer som försvårar berättande, upplevelse under berättande om IPV samt upplevelse av förbättringsmöjligheter efter berättande. Dessa tre teman belyser olika aspekter av kvinnors upplevelse innan, under och efter berättande om intimt partnervåld för hälso- och sjukvårdspersonal. Slutsats Kvinnorna som deltagit i studierna hade många liknande upplevelser av att berätta om intimt partnervåld för hälso- och sjukvården. Många kvinnor beskrev att de upplevt mångabarriärer för att berätta om våldet och att de hade positiva och negativa upplevelser kring hur de blivit bemötta av hälso- och sjukvårdspersonal. För hälso- och sjukvården finns detstora möjligheter till förbättring i området och förslag på hur detta kan göras nämns även av kvinnorna., Background Violence against women, one aspect of which is intimate partner violence, is a globally recognized problem which approximately one third of all women will be exposed to during their lifetime. Many of these women are in contact with the health care system during the abuse, regardless if they are seeking help for something directly related to the violence or something else. The health care system has an obligation and responsibility to treat these women in a satisfactory and evidence-based way that the women experience as emotionally strengthening and aid-providing. Aim The aim was to illustrate the battered woman's experience of the process surrounding disclosure of intimate partner violence to health care personnel. Method The method of choice was a non-systematic literature review to compile previous research of the subject matter. The collection of data was made in September 2021 through using the databases PubMed and CINAHL. The quality of the included articles was examined using Sophiahemmet University’s template for quality assessment. Data analysis was made using an integrated method where main themes and subthemes were identified. Results During the data analysis of the 15 included articles three main themes were identified: the experience of barriers hindering disclosure, the experience of disclosing intimate partner violence and the experience of opportunities for improvement after disclosure. These three themes illustrate different aspects of women’s experience before, during and after disclosure of intimate partner violence to health care personnel. Conclusions The women who participated in the studies shared many similar experiences related to disclosing intimate partner violence in health care settings. Many women described how they had overcome many different barriers to be able to disclose the violence and that they had both positive and negative experiences when it came to how health care personnel reacted and processed this information. M

Bakgrund Personer som har problem orsakade av användandet av opioider kan påträffas inom vården i direkt koppling till deras användande av substansen eller vid uppsökande av vård av andra anledningar. Som sjuksköterska finns möjligheten att identifiera ett beroende eller riskbruk och stötta personen till en förändring i livsstilen eller till egenvård (Skärsäter & Wiklund, 2019). Genom att ge omvårdnad på den egna individens villkor respekteras individens värdighet och integritet vilket är avgörande för individens uppfattning av bemötandet (Svensk Sjuksköterskeförening, 2016). Syfte Syftet var att beskriva hur personer som använder opioider upplever mötet med hälso- och sjukvårdspersonal. Metod En icke-systematiskt litteraturöversikt utfördes och baserades på 17 vetenskapliga artiklar av kvalitativ design. Artiklarna eftersöktes i databaserna CINAHL och PubMed med hjälp av lämpliga sökord samt så genomfördes även en manuell sökning. Kvalitén på artiklarna granskades utefter Sophiahemmet Högskolas bedömningsunderlag och vidare användes en integrerad analys vilket resulterade i tre huvudkategorier och sex subkategorier. Resultat Resultatet bestod av tre huvudkategorier och sex subkategorier. Huvudkategorierna var Patienters upplevelser av vårdpersonalens kompetens, Patienters upplevelser av vårdpersonalens attityder och Patienters upplevelser av samarbetet med vårdpersonal. Subkategorierna var kunskap, kommunikation, stigmatisering, tillit, delaktighet och relationen mellan vårdpersonal och patient. Resultatet visade att majoriteten av patienter upplevt stigmatisering relaterat till deras bruk av opioider. Patienter upplevde även att de inte var delaktiga i sin vård samt förbisedda i sin behandling. Slutsats Resultatet från litteraturöversikten påvisade upplevd stigmatisering kring patienter som använder opioider. En stor del av stigmatiseringen kring patientgruppen grundade sig i okunskap hos hälso- och sjukvårdspersonal om “substance use disorder”, Background People with problems caused by the use of opioids may be found in healthcare, either directly related to their use of the substance or when outreaching for other reasons. As a nurse, you have the opportunity to identify an addiction or risk use, and support the person to a change in lifestyle or to self-care (Skärsäter & Wiklund, 2019). By providing care on the individual's terms, the dignity and integrity of the individual are respected, which is crucial to the individual's perception of the treatment (Svensk Sjuksköterskeförening, 2016). Aim The aim was to describe how people who use opioids experience the encounter with health care professionals Method A non-systematic literature review was performed and based on 17 scientific articles of qualitative design. The articles were searched in the CINAHL and PubMed databases using the applicable keywords. A manual search was performed. Subsequently, the quality of the articles was examined according to Sophiahemmet University's assessment data and an integrated analysis was further used, resulting in three main categories and six subcategories. Results The result consisted of three main categories and six subcategories. The main categories were: Patients’ experiences of Healthcare Professionals competence, Patients’ experiences of Healthcare Professionals’ attitudes and Patients’ experiences of collaboration with Healthcare Professionals. The subcategories were knowledge, communication, stigma, trust, participation and the relationship between healthcare professionals and patients. The results showed that the majority of patients experienced stigma related to their use of opioids. Conclusions The results of the literature review show perceived stigma around patients using opioids. Much of the stigma surrounding the patient group has been based on ignorance among health professionals about substance use disorder (SUD). A strong link between healthcare professionals' knowledge of SUD and their

Bakgrund Långvarig smärta är smärta som varat längre än tre månader, och utgör ett folkhälsoproblem som medför stora kostnader för samhället. Dessutom har tillståndet hög samsjuklighet vad gäller psykisk ohälsa och påverkar livskvaliteten negativt. Vårdpersonal upplever att de saknar kunskap om långvarig smärta och ser patientgruppen som komplex. De barriärer som finns i vårdandet av patienter med långvarig smärta kan leda till brister i såväl bemötandet som i det personcentrerade förhållningssättet. Syfte Syftet var att beskriva hur patienter med långvarig smärta upplever hälso- och sjukvårdspersonalens bemötande. Metod Designen icke-systematisk litteraturöversikt användes för att besvara syftet. Datainsamlingen skedde genom sökning efter artiklar i databaserna CINAHL och PubMed. Artiklarna kvalitetsgranskades innan det slugiltiga urvalet. Resultaten från 15 artiklar analyserades enligt en integrerad analysmetod. Litteraturöversikten utfördes i enlighet med Helsingforsdeklarationen. Resultat Resultatet presenteras i fyra kategorier som beskriver upplevelser kring olika aspekter av bemötande ur patienternas perspektiv. Kategorin om upplevelser av kommunikation handlade om samtalet och informationen från personalen. I kategorin om partnerskapet beskrevs upplevelser av delaktighet, tillit, stöd och kontinuitet. I en kategori beskrevs känslan av att inte vara önskad inom vården som kom från att patienterna kände sig förminskade, missförstådda, ifrågasatta samt övergivna av hälso- och sjukvården. I samma kategori framkom att patienterna kände att de måste agera på ett visst sätt och att det fanns en kunskapsbrist hos personalen. Patienterna hade även en önskan att bli sedda som individer och att bli tagna på allvar, vilket beskrevs i den sista kategorin. Slutsats Patienterna hade blandade negativa och positiva upplevelser av hälso- och sjukvårdspersonalens bemötande. De brister som fanns i bemötandet kan förklaras som en avsaknad av ett personcentrerat förhållnings, Background Long-term pain is pain that has lasted for longer than three months. It is seen as a public health issue and comes at a large cost to Swedish society. The condition also has a high comorbidity especially with psychiatric disease, and a negative impact on quality of life. Health professionals experience that they have a lack of knowledge about long term pain and view the patient group as complex. The barriers that exist in caring for these patients can lead to a lack of person-centered care. Aim The aim was to describe how patients with long-term pain experience their meetings with health professionals. Method A non-systematic literature review design was used for this study. The data was collected from two databases, CINAHL and PubMed. A review of the quality of the articles was carried out before the final selection. The results from 15 articles were analysed using an integrated analysis. The literature review was made in accordance with the Declaration of Helsinki. Results The results are presented using four categories describing different aspects of meetings between patients and health professionals. The category relating experiences of communication included conversation with and information from the staff. Within the category about partnership between patients and health professionals, experiences of participation, trust, support, and continuity were described. In one category the patient’s perception of not being wanted in healthcare was described, it came from feelings of being diminished, misunderstood, questioned, and abandoned by the health-care system. It emerged that long-term pain patients felt they must act in a certain way and also that there was a lack of knowledge on the part of the staff. The patients also wanted to be seen as individuals and taken seriously, which was described in the last category. Conclusions The patients had both negative and positive experiences of their meetings with health professionals. The shortcomings that e

Bakgrund: Bröstcancer drabbar cirka 9000 kvinnor varje år i Sverige. Kvinnor drabbas både psykisk och fysiskt. Beroende på vilket stadium man är i livet hanterar kvinnor bröstcancerdiagnoser på olika sätt. Som sjuksköterska är det viktigt att se hela patienten för att kunna skapa en god vårdrelation och ge god vård. Syfte: Syftet var att beskriva kvinnors upplevelser av vårdpersonalen bemötande vid bröstcancer. Metod: Litteraturöversikten har utförts av tio kvalitativa vetenskapliga studier som analyserats enligt Fribergs beskrivning av sammanställning av kvalitativ forskning. Vetenskapliga artiklar var hämtade från CINAHL Complete och Pubmed och har analyserats och delats upp i teman. Resultat: I resultatet presenteras fyra teman utifrån tio artiklar (1) Att känna stöd från vårdpersonal (2) Att känna sig ensam i sin sjukdom (3) Att känna sig informerad (4) Kvinnors behov av kommunikation. Slutsats: Kvinnor med bröstcancers känsla av delaktighet och trygghet påverkas av vårdpersonalens bemötande. Vårdpersonalens förmåga att inkludera och integrera med patienten i kombination med kommunikationen är viktig för att främja vård upplevelsen och ge kvinnor med bröstcancer hopp och trygghet., Background: Breast cancer affects about 9,000 women each year in Sweden. Women are affected both mentally and physically. Depending on the stage you are in in life, women handle breast cancer diagnoses in different ways. As a nurse, it is important to see the whole patient in order to create a good care relationship and to provide good care. Aim: The purpose was to describe women's experiences of healthcare professionls treatment of breast cancer. Method: The literature review that has been performed by ten qualitative scientific studies that have been analyzed according to Friberg's description of a compilation of qualitative research. Scientific articles were taken from CINAHL Complete and Pubmed and have been analyzed and divided into themes. Results: The result present four themes based on ten articles (1) Feeling supported by healthcare professionals (2) Feeling alone in their illness (3) Feeling informed (4) Women's need for communication. Conclusion: Breast cancer patient’s feeling of inclusion and safety depends on how they are received by health care professionals. Their ability to integrate with the patient and maintain healthy communication is paramount to further their experience and to give women with breast cancer hope and stability. Breast neoplasms, professional-patient relations, communication, qualitative studies, literature review, nurse-patient relations.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug-resistant bacterium that causes serious infections. Specific measures to prevent the spread of MRSA are required within health care, and insufficient knowledge and lack of compliance to these measures have been identified in healthcare professionals. The need to adhere to special guidelines in order to prevent the spread of infection have been shown to create negative feelings for carriers of multidrug-resistant bacterium. Aim: The aim of this study was to investigate different aspects of living and being cared for with known carriage of MRSA. The fist aspect aimed to investigate how people experience their knowledge and the information they receive from the healthcare. The second aspect aimed to investigate their feelings and existence in relation to their carriage. The third aspect aimed investigate their experiences and encounters with health care. Method: Literature study with systematic approach and inductive method. The results were analysed with inspiration from thematic synthesis and based on ten qualitative original articles. Results: Getting MRSA was shocking and shameful, and many blamed the health care for contracting MRSA. Living with MRSA had a negative impact on daily life. Life felt lonely and isolated, and people were scared to infect others. Being cared for with MRSA was described with experiences of lack knowledge from the health care professionals, inconsistencies in adherence to hygiene measures and unprofessional behaviour. Being cared for in isolation had a negative impact on the persons’ independence, their relations with the health care professionals and the quality of care. Conclusion: Getting MRSA is perceived as stigmatising and frightening, and the health care fails to provide adequate information to counteract these feelings. People feel sadness, abandonment and uncertainty about the future. The behaviour of health care professionals and their compliance with, Bakgrund: Meticillinresistenta Staphylococcus aureus (MRSA) är en multiresistent bakterie som orsakar allvarliga infektioner. För att förhindra spridning av MRSA krävs särskilda hygienrutiner inom vården, och otillräcklig kunskap och bristande följsamhet till dessa har identifierats hos vårdpersonal. För att inte sprida smitta behöver personer med bärarskap av multiresistenta bakterier förhålla sig till särskilda riktlinjer, vilket har visat sig skapa negativa känslor för personerna. Syfte: Syftet var att undersöka olika aspekter av att leva och vårdas med känt bärarskap av MRSA. Den första aspekten syftade till att undersöka hur personerna upplever sin kunskap och informationen de får från vården. Den andra aspekten syftade till att undersöka deras känslor och tillvaro i relation till bärarskapet. Den tredje aspekten syftade till att undersöka deras erfarenheter och upplevelser av mötet med vården. Metod: Litteraturstudie med systematisk ansats och induktiv metod. Resultatet analyserades med inspiration av tematisk syntes och baseras på tio kvalitativa originalartiklar. Resultat: Att få MRSA var chockartat och skamfyllt, och många beskyllde vården för att ha fått MRSA. Att leva med MRSA påverkade vardagen negativt. Livet kändes begränsat, ensamt och isolerat och personerna var rädda för att smitta andra. Att vårdas med MRSA beskrevs med upplevelser av bristande kunskap hos vårdpersonalen, inkonsekvens i följsamhet till hygienrutiner och oprofessionellt bemötande. Att vårdas under isolering för MRSA inverkade negativt på personernas upplevelse av självständighet, relationen till vårdpersonalen och kvaliteten på omvårdnaden. Slutsats: Att få MRSA upplevs stigmatiserande och skrämmande och vården misslyckas med att ge adekvat information för att motverka dessa känslor. Personerna känner sorg, övergivenhet och framtiden känns osäker. Vårdpersonalens beteende och följsamhet till hygienrutiner är inkonsek

BACKGROUND: Personalized medicine may increase the amount of probabilistic information patients encounter. Little guidance exists about communicating risk for multiple diseases simultaneously or about communicating how changes in risk factors affect risk (hereafter risk reduction). PURPOSE: To determine how to communicate personalized risk and risk reduction information for up to 5 diseases associated with insufficient physical activity in a way laypeople can understand and that increases intentions. METHODS: We recruited 500 participants with <150 min weekly of physical activity from community settings. Participants completed risk assessments for diabetes, heart disease, stroke, colon cancer, and breast cancer (women only) on a smartphone. Then, they were randomly assigned to view personalized risk and risk reduction information organized as a bulleted list, a simplified table, or a specialized vertical bar graph (risk ladder). Last, they completed a questionnaire assessing outcomes. Personalized risk and risk reduction information was presented as categories (e.g., very low). Our analytic sample (N = 372) included 41.3% individuals from underrepresented racial/ethnic backgrounds, 15.9% with vocational-technical training or less, 84.7% women, 43.8% aged 50 to 64 y, and 71.8% who were overweight/obese. RESULTS: Analyses of covariance with post hoc comparisons showed that the risk ladder elicited higher gist comprehension than the bulleted list (P = 0.01). There were no significant main effects on verbatim comprehension or physical activity intentions and no moderation by sex, race/ethnicity, education, numeracy, or graph literacy (P > 0.05). Sequential mediation analyses revealed a small beneficial indirect effect of risk ladder versus list on intentions through gist comprehension and then through perceived risk (bIndirectEffect = 0.02, 95% confidence interval: 0.00, 0.04). CONCLUSION: Risk ladders can communicate the gist meaning of multiple pieces of risk in

Introduction: Idiographic, or individual-level, methodology has been touted for its potential clinical utility. Empirically modeling relationships between symptoms for a single individual may offer both the client and therapist information that is useful for case conceptualization and treatment planning. However, few studies have investigated the feasibility and utility of integrating idiographic models in a clinical setting.Methods: Clients (n = 12) completed ecological momentary assessment regarding psychological symptoms five times per day for three weeks. Clients also generated predictions about the associative and directed relationships in their networks. Graphical vector autoregression was used to generate contemporaneous and directed networks from each client's data, and both clients and therapists completed self-report questionnaires regarding the feasibility and utility of these methods.Results: Results indicated that the idiographic model structures varied widely across participants and differed markedly from the client's own predictions. Clients found the models useful, whereas their therapists demonstrated a more tempered response.Discussion: These results echo previous findings suggesting that clients are willing to complete intensive data collection and are interested in the output, whereas therapists may be less open to idiographic methods. We provide recommendations for future implementation of personalized models in clinical settings.

This article looks at two pedagogical initiatives based on “Paideia Education” in order to analyze their contributions to the production of democratic relations and the co-production of care in primary health care. The first of these initiatives was a seminar on matrix support (2015-2016) that trained 94 specialists, and the second was a seminar on family care (2018-2020) that trained 149 professionals. The 243 participating health professionals came from five different municipalities in Brazil. The results obtained through questionnaires and field diaries kept during the seminars indicate that “Paideia Education” has the ability to motivate professionals to incorporate notions such as the expanded clinic and matrix support into primary health care, and fosters the sharing of care and the co-construction of autonomy with users. However, authoritarian management practices are still frequently directed towards professionals, practiced among professionals themselves, and directed towards patients, and therefore it is necessary to invest in a greater democratization of services beyond training., Este artículo parte de dos iniciativas pedagógicas de “formación Paideia” con el propósito de analizar sus contribuciones en la producción de relaciones democráticas y en la coproducción del cuidado en atención primaria de la salud. La primera iniciativa realizó una capacitación en apoyo matricial (2015-2016) que reunió a 94 especialistas y, la segunda, una capacitación en salud familiar (2018-2020), que reunió a 149 profesionales. Los 243 profesionales de la salud participantes provenían de cinco municipios brasileños. Los resultados obtenidos a través de cuestionarios y diarios de campo elaborados durante los cursos señalan que la formación Paideia motiva a los profesionales a incorporar una clínica ampliada y el apoyo matricial en atención primaria de la salud, y propicia compartir el cuidado y la co-construcción de la autonomía junto a los usuarios. Sin embargo, aún son frecuentes las prácticas autoritarias de la gestión hacia las y los profesionales, entre profesionales, y desde las y los profesionales hacia las personas usuarias, de modo que es necesario invertir, más allá de la formación, en una mayor democratización de los servicios.

Rather than measure demographic factors such as socioeconomics, the aim of this study was to examine the lived experience of frequent attenders by synthesizing findings on their encounters with healthcare personnel. The Scopus, CINAHL, PsycARTICLES, and PubMed (Medline) databases were searched in May 2020 in order to screen studies by title and abstract (n = 1794) and full‐text (n = 20). Findings from the included studies (n = 6) were then pooled using meta‐aggregation, yielding the following results: difficulties in resolving frequent attenders’ situations may create “service circles,” frustrating patients with their situation; frequent attenders’ own expertise regarding their condition should be recognized and valued alongside that of healthcare professionals when performing collaborative care; a lack of empathy and disparagement may make frequent attenders feel misunderstood and unappreciated; frequent attenders should be recognized as individuals by taking their circumstances into account and providing support accordingly. Frequent attenders’ experiences demonstrate the importance of shared decision‐making, continuity of care, and acknowledging these patients’ individual circumstances. Identifying the variety of frequent attenders’ service needs by synthesizing their experiences is a practical way of organizing patient‐centered healthcare services.

[Resumo] O proceso de converterse en nai está contemplado como un dos máis bonitos na vida, algo moi común pero que aínda así, trae grandes dúbidas e aumento do estrés na vida diaria dos pais. O persoal sanitario forma parte neste proceso de cara á maternidade xa que estamos presentes en todo o embarazo, formamos parte no momento do parto e tamén do puerperio, o que provoca que, cando os pais teñan dúbidas ou medos se dirixan a nós. O continuo contacto alimenta a interacción entre persoas, o que nos leva á comunicación, se esta contén un feedback positivo favorecerá o interese dos pacientes para preguntarnos máis dúbidas e así conseguiremos un fluxo de boa información que mellorará moito a satisfacción dos pais. Pero aínda así, sabendo isto, a relación da comunicación entre pacientes e profesionais segue sendo considerada insuficiente e mellorable nalgúns aspectos. OBXECTIVO O obxectivo principal deste proxecto é coñecer desde unha metodoloxía cualitativa de carácter descritivo que influencia, positiva ou negativa, ten a comunicación enfermeira na satisfacción co embarazo e puerperio. METODOLOXÍA O paradigma escollido é a investigación con enfoque e perspectiva cualitativa. Paradigma fenomenolóxico descritivo e simbólico. Recollerase información, un mes despois da súa alta, a través de entrevistas en profundidade ás pacientes que estiveran na planta de puerperio do Hospital Materno-Infantil Teresa Herrera de A Coruña. RESULTADOS ESPERADOS Os resultados que podemos esperar son a creación de protocolos, guías ou cursos de formación para mellorar as capacidades comunicativas do persoal sanitario para crear un ambiente de satisfacción cada vez maior. Dar visibilidade á importancia da comunicación en todo o proceso de embarazo, parto e puerperio por parte da enfermaría cara as pacientes., [Abstract] The process of becoming a mother is considered one of the most beautiful in life, something very common but still brings great doubts and an increase in stress in the parents' daily life. Healthcare personnel are part of this process with regard to motherhood since we are present throughout the pregnancy, we are part of the moment of delivery and also of the puerperium, which means that, when parents have doubts or fears, they turn to us .The continuous contact feeds the interaction between people, which leads us to communication, if it contains positive feedback, it will favor the interest of patients to ask us more questions, thus we will achieve a better information flow, which will greatly improve patient satisfaction. fathers. But even so knowing this, the communication relationship between patients and professionals is still considered insufficient in some aspects. OBJECTIVE The main objective of this project is to know from a qualitative methodology of a descriptive nature what influence, positive or negative, nursing communication has on satisfaction with pregnancy and the puerperium. METHODOLOGY The paradigm chosen is research with a qualitative focus and perspective. Descriptive and symbolic phenomenological paradigm. Information will be collected through in-depth interviews with patients who have been in the puerperium plant of the Teresa Herrera Maternal and Child Hospital in A Coruña, one month after discharge. EXPECTED RESULTS The results we can expect are the creation of protocols, guides or training courses to improve the communication skills of healthcare personnel to create an environment of increasing satisfaction., [Resumen] El proceso de convertirse en madre está contemplado como uno de los más bonitos en la vida, algo muy común pero que aún así trae grandes dudas y un aumento del estrés en la vida diaria de los padres. El personal sanitario forma parte de este proceso de cara a la maternidad ya que estamos presentes en todo el embarazo, formamos parte en el momento del parto y también del puerperio, lo que provoca que, cuando los padres tengan dudas o miedos se dirijan a nosotros. El contínuo contacto alimenta la interacción entre personas, lo que nos lleva a la comunicación, si ésta contiene un feedback positivo favorecerá al interés de los pacientes para preguntarnos más dudas, así conseguiremos un flujo de buena información que mejorará mucho la satisfacción de los padres. Pero aún así, sabiendo esto, la relación de la comunicación entre pacientes y profesionales sigue siendo considerada insuficiente en algunos aspectos. OBJETIVO El objetivo principal de este proyecto es conocer desde una metodología cualitativa de carácter descriptivo que influencia, positiva o negativa, tiene la comunicación enfermera en la satisfacción con el embarazo y el puerperio. METODOLOGÍA El paradigma escogido es la investigación con enfoque y perspectiva cualitativa. Paradigma fenomenológico descriptivo y simbólico. Se recogerá información, un mes después de recibir el alta, a través de entrevistas en profundidad a las pacientes que fueron atendidas en la planta de puerperio del Hospital Materno-Infantil Teresa Herrera de A Coruña.RESULTADOS ESPERADOS Creación de protocolos, guías o cursos de formación para mejorar las capacidades comunicativas del personal sanitario para crear un ambiente de satisfacción cada vez mayor. Dar visibilidad a la importancia de la comunicación en todo el proceso del embarazo, parto y puerperio por parte de enfermería de cara a las pacientes.

Background: Therapist’s emotional reactions toward patients in clinical facilities are a key concept in the treatment of personality disorders. Considering only clinical settings specialized in treatment of personality pathology the present paper aimed at: (1) assessing any direct relationship between patient symptom severity and therapist emotional response; (2) exploring patients’ functioning configurations that can be associated with specific therapist reactions (3) investigating whether these relationships remains significant when accounting for other setting variables related to patients or therapist. Methods: The present study included 43 outpatients with personality disorders who underwent a psychotherapy treatment in two Italian facilities dedicated to outpatients with personality disorders and their 19 psychotherapists. The Symptom Checklist-90-Revised (SCL-90R) was used to explore clinical severity condition. Psychotherapists completed the Therapist Response Questionnaire (TRQ) to identify pattern of therapists’ response and the Shedler-Westen Assessment Procedure-200 (SWAP-200) in order to assess personality traits of the patients. Results: No significant relationship between the clinical severity of the symptoms and the therapist’ responses was found. Even when controlled for clinical severity condition, duration of the treatment, age and educational level of the patient or years of therapist experience, most of SWAP-200 traits appeared to be significant predictors of therapist’ emotional responses. Conclusions: The present study confirms the value of therapists’ emotional response as a useful tool in understanding psychological processes related to clinical practice highlighting its context-dependent dimension.

[Abstract] A generic qualitative research, using a poststructuralist feminist perspective, was conducted in a Spanish gynaecology unit with the following aims: (a) to analyse how asymmetric power relations in relation to biomedical knowledge and gender shape the medical encounters between gynaecologists and women diagnosed with cervical intraepithelial neoplasia and (b) to explore the cognitive, moral, and emotional responses expressed by patients. A total of 21 women diagnosed with cervical intraepithelial neoplasia were recruited through purposive sampling. Semi-structured interviews were recorded and transcribed, and a thematic analysis was carried out. Two major themes were identified: (a) gendered relations in cervical intraepithelial neoplasia medical encounters are based on hidden, judgmental moral assumptions, making women feel irresponsible and blamed for contracting the human papillomavirus infection; (b) biomedical power is based on the positivist assumption of a single truth (scientific knowledge), creating asymmetric relations rendering women ignorant and infantilised. Women reacted vehemently during the interviews, revealing a nexus of cognitive, moral, and emotional reactions. In medical encounters for management of cervical intraepithelial neoplasia, patients feel they are being morally judged and given limited information, generating emotional distress. Healthcare professionals should question whether their practices are based on stereotypical gender assumptions which lead to power asymmetries during encounters.

[Abstract] Health professionals play an important role in addressing parents who are hesitant or reluctant to immunise their children. Despite the importance of this topic, gaps remain in the literature about these experiences. This meta-ethnography aimed to synthesise the available body of qualitative work about the care experiences of community and hospital health professionals in encounters with parents hesitant or reluctant to vaccinate their children. The aim is to provide key information for the creation of strategies that address vaccine hesitancy or refusal and ensure public trust in vaccination programs, which are required in a pandemic context such as the current one. (2) Methods: Noblit and Hare’s interpretive meta-ethnography of 12 studies was followed. A line of argument synthesis based on a metaphor was developed. (3) Results: The metaphor “The stone that refuses to be sculpted”, accompanied by three themes, symbolises the care experiences of health professionals in their encounters with parents that hesitate or refuse to vaccinate their children. (4) Conclusions: The creation of clearer communication strategies, the establishment of a therapeutic alliance, health literacy and the empowerment of parents are recommended. The incorporation of health professionals in decision making and the strengthening of multidisciplinary teams interacting with such parents are also included

High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long-term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi-structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards.

BACKGROUND: Patient participation is associated with satisfaction and improved health-related outcomes. In gastrointestinal endoscopy, patient participation is an underexplored area. OBJECTIVE: To gain understanding on patients' experiences, attitudes and preferences concerning patient participation in the endoscopy pathway. METHODS: Semi-structured interviews with endoscopy patients (n = 17, female n = 8, male n = 9, ages 19-80 years) were performed. Interview transcripts were analysed using qualitative content analysis. Participants were recruited by purposive sampling from an endoscopy unit in a Swedish university hospital. Inclusion:≥ 18 years, fluency in Swedish and recent experience of endoscopy at the unit. RESULTS: Five generic categories emerged, two within the area of the patient's role, which was described as active or passive/included or excluded. Another three generic categories related to factors, critical to active participation, including organizational aspects, impressions of staff and individual circumstances were identified. In this context, patient participation described in the interviews was on a low to basic level, although sometimes reaching a higher level when staff 'invited' patients in decision making. DISCUSSION: This study contributes to the understanding of patient participation in endoscopy. Patients are in an inferior position and need support from the staff for an active role in their care. Although there were variations on the perceived importance of different factors, a heavy responsibility lies on the endoscopy staff to acknowledge the patients' individual needs and to facilitate patient participation. CONCLUSIONS: Endoscopy staff has a key role in supporting patient participation. In endoscopy settings, patient participation is vulnerable to multiple factors.

BackgroundEffective communication and respect for women's autonomy are critical components of person-centered care. Yet, there is limited evidence in low-resource settings on providers' perceptions of the importance and extent of communication and women's autonomy during childbirth. Similarly, few studies have assessed the potential barriers to effective communication and maintenance of women's autonomy during childbirth. We sought to bridge these gaps.MethodsData are from a mixed-methods study in Migori County in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical). Providers were asked structured questions on various aspects of communication and autonomy followed by open ended questions on why certain practices were performed or not. We conducted descriptive analysis of the quantitative data and thematic analysis of the qualitative data.ResultsDespite acknowledging the importance of various aspects of communication and women's autonomy, providers reported incidences of poor communication and lack of respect for women's autonomy: 57% of respondents reported that providers never introduce themselves to women and 38% reported that women are never able to be in the birthing position of their choice. Also, 33% of providers reported that they did not always explain why they are doing exams or procedures and 73% reported that women were not always asked for permission before exams or procedures. The reasons for lack of communication and autonomy fall under three themes with several sub-themes: (1) work environment-perceived lack of time, language barriers, stress and burnout, and facility culture; (2) provider knowledge, intentions, and assumptions-inadequate provider knowledge and skill, forgetfulness and unconscious behaviors, self-protection and comfort, and assumptions about women's knowledge and expectations; and (3) women's ability to demand or command effective communication and respect for their autonomy-women's lack of participation, women

Statement of purposeIntentional violent injury is a leading cause of disability and death among young adults in the United States. Hospital-based violence intervention programs (HVIPs), which strive to prevent re-injury through intensive case management, have emerged as a successful and cost-effective strategy to address this issue. Despite the importance of strong therapeutic relationships between clients and their case managers, specific case manager behaviors and attributes that drive the formation of these relationships have not been elucidated.MethodsA qualitative analysis with a modified grounded theory approach was conducted to gain insight into what clients perceive to be crucial to the formation of a strong client-case manager relationship. Twenty-four semi-structured interviews were conducted with prior clients of our hospital's HVIP. The interviews were analyzed using constant comparison method for recurrent themes.ResultsSeveral key themes emerged from the interviews. Clients emphasized that their case managers must: 1) understand and relate to their sociocultural contexts, 2) navigate the initial in-hospital meeting to successfully create connection, 3) exhibit true compassion and care, 4) serve as role models, 5) act as portals of opportunity, and 6) engender mutual respect and pride.ConclusionsThis study identifies key behaviors of case managers that facilitate the formation of strong therapeutic relationships at the different stages of client recovery. This study's findings emphasize the importance of case managers being culturally aligned with and embedded in their clients' communities. This work can provide a roadmap for case managers to form optimally effective relationships with clients.

This study compared community health workers' (CHW) stigma towards people living with HIV (PLH) and people who use drugs (PWUD) and explored the relationship between stigma and CHWs' confidence level in providing HIV/drug-related services. Using two sets of identically worded questions, levels of stigma towards PWUD and PLH were measured among 120 CHW from 60 communes in Vietnam. The associations between CHWs' confidence in service provision and stigma towards PWUD and PLH were examined using a linear mixed-effects regression model. The majority of the CHW reported higher levels of stigma towards PWUD than towards PLH. Compared to the CHW reporting higher stigma towards PWUD, those with higher stigma towards PLH were significantly less confident in service provision. Social opprobrium attached to drug-using behaviors can be a major driver behind the overall HIV stigma. CHWs' fear of HIV infection should be tackled to boost their confidence in HIV/drug-related care provision.

BackgroundThere is a need for a standardized way to measure person-centered care for abortion. This study developed and validated a measure of person-centered abortion care.MethodsItems for person-centered abortion care were developed from literature reviews, expert review, and cognitive interviews, and administered with 371 women who received a safe abortion service from private health clinics in Nairobi, Kenya. Exploratory factor analyses were performed and stratified by surgical abortion procedures and medication abortion. Bivariate linear regressions assessed for criterion validity.ResultsWe developed a 24-item unifying scale for person-centered abortion care including two sub-scales. The two sub-scales identified were: 1) Respectful and Supportive Care (14 items for medication abortion, 15 items for surgical abortion); and 2) Communication and Autonomy (9 items for both medication and surgical abortion). The person-centered abortion care scale had high content, construct, criterion validity, and reliability.ConclusionsThis validated scale will facilitate measurement and further research to better understand women's experiences during abortion care and to improve the quality of women's overall reproductive health experiences to improve health outcomes.

Disrespect and abuse during childbirth are violations of women's human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers' perspectives on the topic are limited. We examined providers' perspectives on the frequency and drivers of disrespect and abuse during facility-based childbirth in a rural county in Kenya. We used data from a mixed-methods study in a rural county in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical) in 2016. Providers were asked structured questions on disrespect and abuse, followed by open-ended questions on why certain behaviours were exhibited (or not). Most providers reported that women were often treated with dignity and respect. However, 53% of providers reported ever observing other providers verbally abuse women and 45% reported doing so themselves. Observation of physical abuse was reported by 37% of providers while 35% reported doing so themselves. Drivers of disrespect and abuse included perceptions of women being difficult, stress and burnout, facility culture and lack of accountability, poor facility infrastructure and lack of medicines and supplies, and provider attitudes. Provider bias, training and women's empowerment influenced how different women were treated. We conclude that disrespect and abuse are driven by difficult situations in a health system coupled with a facilitating sociocultural environment. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless. Interventions to address disrespect and abuse need to tackle the multiplicity of contributing factors. These should include empowering providers to deal with difficult situations, develop positive coping mechanisms for stress and address their biases. We also need to change the culture in facilities and strengthen the health systems to address the system-level stressors.

In dit onderzoeksproject hebben we met behulp van kwantitatieve en kwalitatieve methoden de psychologische impact en kosteneffectiviteit van borstkanker chirurgie geanalyseerd.

Objectives: Physiotherapy is, like all healthcare professions, relational and value-laden. Patient-centred care, evidence-based practice and value-based practices are concepts in which patient values lie at the heart of high-quality healthcare practices. Nevertheless, physiotherapists have limited awareness of what patient values are in the physiotherapy encounter. The purpose of this study is to explore these patient values. Methods: A qualitative study design using content analysis was used involving 17 adult participants with chronic or recurrent musculoskeletal pain. Data were collected during July 2015–July 2016 in three primary care physiotherapy facilities in Rotterdam, The Netherlands. Two researchers analysed the interviews and derived relevant codes from the data. After an iterative process of comparing, analysing, conceptualizing, and discussing the data, a pre-existing analytic framework was refined in which distinct values were delineated. Results: Emerging patient values were encompassed in three themes, each consisting of two to four elements: (1) values about oneself (uniqueness and autonomy), (2) values regarding actions of the professional (technically skilled professional, conscientious professional, compassionate professional, responsive professional) and (3) values regarding interactions between patients and the professionals (partnership and empowerment). Conclusion: This study emphasizes the need for discussing patient values in the clinical encounter and helps physiotherapists to understand what deems to be important for patients with musculoskeletal pain in physiotherapy practice. The results of this study contribute to the existing body of knowledge of this important aspect of the quality of physiotherapy practice and may inspire clinicians and educators to actively implement patient values in clinical practice and the physiotherapy education.

SAMMANFATTNING Bakgrund: Trygghet kan beskrivas som en säkerhet som varje person kan lita på och som medför en skyddande känsla. Patientens upplevelse från ambulansen har en stor påverkan på välbefinnande och livskvalitet efter vårdtidens slut. Hur patienten känner är en av de största informationskällorna för att kunna avgöra hur upplevelsen har varit i ambulansen. Varje vårdsituation i den prehospitala vårdmiljön är unik, vårdmiljöns utformning har en direkt koppling till patientens hälsa. Syfte: Syftet var att beskriva patientens upplevelse av trygghet i prehospital miljö. Metod: Den valda metoden var en allmän litteraturöversikt med induktiv ansats där både kvalitativ och kvantitativ forskning använts. En strukturerad sökning genomfördes i databaserna PubMed och Cinahl. 15 vetenskapliga artiklar inkluderades efter att de analyserats och genomgått kvalitetsgranskning. Resultatet är främst baserat på kvalitativ forskning. Resultat: Resultatet i studien syntetiserades till två huvudkategorier som beskrev patienters upplevelse av trygghet; mellanmänskliga faktorer och yttre faktorer. De mellanmänskliga faktorerna innefattar underkategorierna ambulanspersonalens yrkesskicklighet, deras förmåga till att ge information, skapa förtroende och bedriva en personcentrerad vård. De yttre faktorerna innefattar underkategorierna den prehospitala miljön i sig, patientens exponering av smärta och värme. Slutsats: Litteraturstudiens resultat visade på patientens upplevelse av trygghet i prehospital miljö via huvudfynden mellanmänskliga faktorer och yttre faktorer. De mellanmänskliga faktorerna beskrivs i större omfattning med direkt påverkan på upplevelsen av trygghet genom ambulanspersonalens uppträdande. De yttre faktorerna beskrivs indirekt påverka upplevelsen av trygghet via frihet från lidande. Upplevelsen från ambulansen har påverkan på hur patienten upplever välbefinnande och livskvalitet efter vårdtidens slut. Hur patienten känner är en av de största informa, Background: Safety can be described as a security that every person can rely on and that brings a protective feeling. The patient's experience from the ambulance has a major impact on well-being and quality of life after the end of the care period. How the patient feels are one of the biggest sources of information in order to determine how the experience has been in the ambulance. Every care situation in the prehospital care environment is unique, the design of the care environment has a direct link to the patient's health. Purpose: The purpose was to describe the patient's experience of safety in the prehospital environment. Method: The method chosen was a general literature review with inductive approach where both qualitative and quantitative research was used. A structured search was performed in the PubMed and Cinahl databases. 15 scientific articles were included after being analyzed and subjected to quality review. The result is mainly based on qualitative research. Results: The results of the study were synthesized into two main categories that described the patient's experience of safety; interpersonal factors and external factors. The interpersonal factors include the subcategories of the ambulance staff's professional skills, their ability to provide information, create confidence and conduct a person-centered care. The external factors include the subcategories of the prehospital environment itself, the patient's exposure to pain and heat. Conclusion: The results of the literature study showed the patient's experience of safety in the prehospital environment via the main findings of interpersonal factors and external factors. The interpersonal factors are described to a greater extent with direct impact on the experience of security through the behaviour of ambulance personnel. The external factors are described indirectly affecting the experience of safety through freedom from suffering. The experience from the ambulance has an impact on how th

Bakgrund: HIV är en kronisk immunsjukdom. Idag lever cirka 40 miljoner av världens invånare med HIV. Dagens effektiva behandlingsmetoder innebär att människor med HIV kan vara helt symtomfria utan risk att föra smittan vidare. Personer med HIV upplever att sjukdomen påverkar livssituationen på flera plan då stigmatisering och diskriminering fortfarande är vanligt förekommande i samhället. Syfte: Syftet är att beskriva hur personer med HIV upplever mötet med hälso- och sjukvårdspersonal. Metod: Litteraturöversikten genomfördes enligt Fribergs metod, där databassökning genomfördes i Medline och Cinahl Complete. Sökningarna resulterade i tio artiklar som besvarar studiens syfte. Artiklarna var både av en kvalitativ och kvantitativ design som genomgick en noggrann kvalitetsgranskning. Detta inkluderade även etiska aspekter för att säkerställa att artiklarna höll en hög vetenskaplig standard. Resultat: Resultatet visar att personer med HIV har upplevt både negativa och positiva möten med hälso- och sjukvårdspersonalen. Negativa möten orsakades av ett dåligt bemötande, stigmatisering och diskriminering samt bristfällig kommunikation och information. Positiva möten byggdes på goda kunskaper, lyhördhet, empati samt stöd. Resultatet presenteras i fem teman. Diskussion: Resultatet diskuterades utifrån vårdrelationens betydelse för omvårdnad. Konsensusbegrepp, Travelbees omvårdnadsteori samt hur information och kunskap påverkar patientens upplevelse av vårdmötet låg även i fokus för diskussionen., Background: HIV is a chronic immune disease. Around 40 million people live with HIV in the world today. The effective treatments that exists today means that people with HIV can be completely symptom-free without the risk of passing on the disease. People with HIV feel that the disease affects different aspects of their lives, due to the fact that stigma and discrimination are still common in today's society. Aim: The aim is to describe how people with HIV experience the encounter with healthcare personnel. Method: The literature review was conducted according to Friberg´s method, where the database search was carried out in Medline and Cinahl Complete. The searches resulted in ten articles that answered the aim of the study. The articles were of both a qualitative and quantitative design that underwent a thorough qualitative review. Results: The results show that people with HIV have experienced both negative and positive encounters with healthcare personnel. Negative encounters were caused by poor attitudes, stigmatization, discrimination, inadequate communication and information. Positive meetings were built on good knowledge, responsiveness, empathy and support. The results are presented in five themes. Discussion: The results were discussed based on the importance of how the relationship between healthcare personnel and patients’ effects nursing and how information and knowledge among healthcare personnel affects the patient's experience of care. Consensus Concepts and Travelbee's nursing theory were also used in the discussion.

Background: ​Induced abortion involves intentionally terminating a pregnancy. This can be donemedically or surgically. Abortion is a common procedure around the world, where the globalspectrum of cultures and perceptions regarding abortion is very varied. Person-centered care,treatment and support are important aspects of the concepts of nursing-care. Aim: ​The purpose of this study is to investigate experiences and psycosocial needs of carerelated to induced abortion, independent of abortion method or length of pregnancy. Method: ​This is a general literature study where previous research has been used to answer thepurpose. The articles were quality reviewed and analyzed thematically. Results: ​Patients and partners experience strong emotions in connection with the abortionprocess, some of which are ambivalent. Experiences of being judged by the care staff also occur,at the same time as the care staff seem to have the opportunity to influence the experience withthe help of different nursing measures. Patients and partners value good treatment and support,while maintaining integrity and autonomy. These factors contributed to a good experience withinduced abortion. Conclusion: ​In an induced abortion situation, patients and partners may experience strongemotions, ambivalent emotions and fear of being convicted. Healthcare professionals play animportant role in ensuring that patients and partners have a good abortion experience. Furtherresearch on the subject is recommended., Bakgrund: Inducerad abort innebär att avsiktligt avsluta en graviditet. Detta kan utföras medicinskt eller kirurgiskt. Abort är ett vanligt förekommande ingrepp världen över, där det globala spektrumet av kulturer och uppfattningar gällande abort är mycket varierad. Omvårdnadsbegreppen personcentrerad omvårdnad, bemötande och stöd är viktiga inom abortvården. Syfte: Det övergripande syftet med denna studie är att undersöka upplevelser och psykosocialt omvårdnadsbehov i samband med inducerad abort, oberoende av abortmetod eller graviditetslängd. Metod: Detta är en allmän litteraturstudie där tidigare forskning har använts för att besvara syftet. Artiklarna kvalitetsgranskades samt analyserades tematiskt. Resultat: Patienter och partners upplever starka känslor i samband med abortprocessen, varav vissa är ambivalenta. Upplevelser av att bli dömd av vårdpersonalen förekommer också, samtidigt som vårdpersonalen tycks ha möjlighet att påverka upplevelsen med hjälp av omvårdnadsåtgärder. Patienter och partners värderar ett gott bemötande och stöd samt bibehållen integritet och autonomi. Dessa faktorer bidrog till en god upplevelse vid inducerad abort. Slutsatser: I en inducerad abortsituation kan patienter och partners uppleva starka känslor, ambivalenta känslor och rädsla inför att bli dömd. Vårdpersonal har en viktig roll i om patienter och partners får en god abortupplevelse. Fortsatt forskning kring ämnet rekommenderas.

O objetivo será compreender a relação entre o corpo e a corporeidade nas esferas social e da saúde, de acordo com alguns atributos dos cuidados transpessoal e transcultural. Refletiu-se sobre o corpo e o poderio estatal, mídia e instituições; sobre o resgate da dimensão ontológica do Ser – a própria corporeidade – amparada pelos cuidados transpessoal e transcultural, fazendo com que a expectativa isolada da cura seja um ponto diante das relações afetivas e socioculturais, além do adoecimento que suscita uma rediscussão entre o existir corporal de adoecidos e profissionais e modelos de cuidado que levem em conta as circunstancias que “marcam” a corporeidade., El objetivo será entender la relación entre el cuerpo y la corporeidad en las esferas social y de salud, de acuerdo con algunos atributos de la atención transpersonal y transcultural. Se reflejó sobre el cuerpo y el poderío estatal, medios e instituciones; sobre el rescate de la dimensión ontológica del Ser -la propia corporeidad- amparada por los cuidados transpersonal y transcultural, haciendo que la expectativa aislada de la cura sea un punto delante de las relaciones afectivas y socioculturales, además de la enfermedad que suscita una rediscusión entre el existir corporal de enfermos y profesionales y modelos de cuidado que tengan en cuenta las circunstancias que "marcan" la corporeidad., The objective will be to understand the relationship between the body and corporeity in the social and health spheres, according to some attributes of transpersonal and transcultural care. Reflected on the body and state power, media and institutions; on the rescue of the ontological dimension of the Being - the corporeality itself – supported by the transpersonal and transcultural care, making the isolated expectation of healing only a point in the face of affective and sociocultural relations; in addition of the sickness that provokes a rediscussion between the corporal existence of sick people and professionals and careful models that take into account the circumstances that "mark" the corporeity.

BackgroundMoral distress is a reason for burnout in healthcare professionals, but the clinical settings in which moral distress is most often experienced by medical students, and whether moral distress is associated with burnout and career choices in medical students is unknown. We assessed moral distress in medical students while caring for older patients, and examined associations with burnout and interest in geriatrics.MethodsA cross-sectional survey study of second-, third-, and fourth-year medical students at an American medical school. The survey described 12 potentially morally distressing clinical scenarios involving older adult patients. Students reported if they encountered each scenario, and whether they experienced moral distress, graded on a 1-10 scale. We conducted a principal axis factor analysis to assess the dimensionality of the survey scenarios. A composite moral distress score was calculated as the sum of moral distress scores across all 12 scenarios. Burnout was assessed using the Maslach Abbreviated Burnout Inventory, and interest in geriatrics was rated on a 7-point Likert scale.ResultsTwo-hundred and nine students responded (47%), of whom 90% (188/209) reported moral distress in response to ≥1 scenario with a median (IQR) score of 6 (4-7). Factor analysis suggested a unidimensional factor structure of the 12 survey questions that reliably measured individual distress (Cronbach alpha = 0.78). Those in the highest tertile of composite moral distress scores were more likely to be burnt out (51%) than those in the middle tertile of scores (34%), or lowest tertile of scores (31%) (p = 0.02). There was a trend towards greater interest in geriatrics among those in the higher tertiles of composite moral distress scores (16% lowest tertile, 20% middle tertile, 25% highest tertile, p-for-tend = 0.21). Respondents suggested that moral distress might be mitigated with didactic sessions in inpatient geriatric care, and debriefing sessions with peers

BackgroundSome opportunities to routinely capture and improve respectful maternity care (RMC) during facility-based childbirth include quality improvement (QI) initiatives, community-based monitoring efforts through community score cards (CSC), and performance-based financing (PBF) initiatives. But there is limited guidance on which types of RMC indicators are best suited for inclusion in these initiatives. We sought to provide practical evidence-based recommendations on indicators that may be used for routine measurement of RMC in programs.MethodsWe used a rapid review approach, which included (1) reviewing existing documents and publications to extract RMC indicators and identify which have or can be used in facility-based QI, CSCs, and PBF schemes; (2) surveying RMC and maternal health experts to rank indicators, and (3) analyzing survey data to select the most recommended indicators.ResultsWe identified 49 indicators spanning several domains of RMC and mistreatment including dignified/nondignified care, verbal and physical abuse, privacy/confidentiality, autonomy/loss of autonomy, supportive care/lack thereof, communication, stigma, discrimination, trust, facility environment/culture, responsiveness, and nonevidence-based care. Based on the analysis of the survey data, we recommend 33 indicators (between 2 and 6 indicators for each RMC domain) that may be suited for incorporation in both facility-based QI and CSC-related monitoring efforts.ConclusionIntegrating RMC indicators into QI and CSC initiatives, as well as in other maternal and neonatal health programs, could help improve RMC at the facility and community level. More research is needed into whether RMC can be integrated into PBF initiatives. Integration of RMC indicators into programs to improve quality of care and other health system outcomes will facilitate routine monitoring and accountability around experience of care. Measurement and improvement of women's experiences will increase maternal health

Despite the importance of psychotherapists' subjective experiencse working with patients with mental issues, little is known about the relationship between therapists' emotional reactions and patients' personality problems. The present study is a systematic review of quantitative research on the association between patients' personality pathology and psychotherapists' emotional, cognitive and behavioural reactions in individual psychotherapy setting. A systematic database search (from January 1980 to August 2019) supplemented by manual searches of references and citations identified seven relevant studies. Significant and consistent relationships were found between therapist reactions and specific personality traits or disorders. In general, odd and eccentric patients tend to evoke feelings of distance and disconnection; emotionally dysregulated patients tend to evoke anxiety and incompetence, and anxious and withdrawn patients tend to evoke sympathy and concern. However, the relatively small sample of studies and methodological inconsistencies across studies limit firm conclusions and suggest the need for more systematic research. Findings from this review indicate that patients who share the same personality disorder or symptoms tend to evoke specific and similar cognitive, emotional and behavioural reactions in their therapists. This suggests that therapists overall reactions toward patients may be source of valuable diagnostic information.

Acculturation may limit HIV-positive Asian Americans' active interactions with patient-healthcare providers (HCP) and utilization of HIV healthcare services; however, the specific mediation effect of acculturation still unknown. A bias-corrected factor score path analysis was performed to examine the proposed model of relations among acculturation, stigma, stress, and patient-HCP relationships. A convenience sample of 69 HIV-positive Asian Americans in San Francisco, Los Angeles, and New York City were recruited and collect data were collected on demographics, HIV-related stigma, stress, and patient-HCP relationships. HIV stigma and stress had a direct, negative effect on patient-HCP relationships. Acculturation had a positive total effect on patient-HCP relationships, and was mediated by HIV stigma and stress. A acculturation also had a direct impact on stigma and stress. Acculturation, HIV-related stigma, and stress are key elements to achieving good patient-HCP relationships, and provide insights on the design of culturally sensitive interventions to improve patient-HCP relationships.

Background and objectivesDelivering care as a patient-centered medical home (PCMH) is being widely adopted across the United States by primary care practices to better meet patient needs. A key PCMH element is measuring patient experience for practice improvement. The National Committee for Quality Assurance (NCQA) PCMH recognition program requires practices to both measure patient experience and engage in continuous practice/quality improvement to attain PCMH recognition and then throughout full PCMH transformation. The NCQA recommends but does not require that practices administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) clinician and group patient experience survey (CG-CAHPS) plus 14 CAHPS PCMH items, known as the CAHPS PCMH survey. We examine aspects of patient experience measured by practices with a varying number of years on their journey of PCMH transformation.MethodsWe randomly selected practices from the 2008-2017 NCQA directory of practices that had applied for PCMH recognition based on region, physician count, number of years and level of PCMH recognition, and use of the CG-CAHPS PCMH survey. We collected characteristics of the practices from practice leader(s) knowledgeable about the practice's PCMH history and patient experience data. We confirmed the patient experience surveys used during their PCMH history and requested copies of their non-CAHPS survey(s). For practices not administering the recommended CG-CAHPS survey (53/105 practices), we obtained and coded the content of their non-CAHPS surveys (68%; 36/53). We mapped the patient experience domains and specific measures to the CG-CAHPS survey (versions 2.0 and 3.0), CAHPS PCMH item set (versions 2.0 and 3.0), and the available CG-CAHPS supplemental items.ResultsWhether or not practices administered the CG-CAHPS items, most of them addressed topics contained in the CG-CAHPS survey such as Access to care, Provider communication, Office staff helpfulness/courteousness, Care