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Det öppna journalsystemet: patienters upplevelser av att läsa sin journal
Sophiahemmet University.
Sophiahemmet University.
2022 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesisAlternative title
The open records system : patients' experiences of reading their medical records (English)
Abstract [sv]

Bakgrund

Sedan en tid tillbaka har webbåtkomst av patientjournalen utvecklats och blivit möjlig för patienterna såväl i Sverige som i flera länder globalt. Sedan tillgången till journalen underlättats för patienterna tar allt fler chansen att läsa i sina journaler. Med bakgrund av detta undersöks patienternas upplevelser och erfarenheter av att läsa sina journaler i denna litteraturstudie. 

Syfte

Syftet var att belysa vuxna patienters upplevelser av att läsa journalen vid kontakt med hälso- och sjukvården.

Metod

En icke-systematisk litteraturöversikt genomfördes genom att samla in data och granska 17 vetenskapliga originalartiklar. Artiklarna innefattar varierande typer av studiedesign. Författarna granskade de utvalda originalartiklarna efter Sophiahemmets Högskolas bedömningsunderlag för kvalitetsgranskning, för att sedan analysera artiklarna genom en integrerad analysmetod. Utefter detta presenterades resultatet uppdelat efter tre teman som författarna fann under analysen. 

Resultat

Genom granskningen upptäcktes tre huvudteman. De teman som upptäcktes då patienternas upplevelser av att läsa sina journaler undersöktes var: Patienternas upplevelse av: patientdelaktighet, av att inhämta, tolka och förstå journalinformation och personcentrering. Under dessa huvudkategorier sågs ett antal subteman. Dessa subteman innefattade patienternas upplevelser av eller kring deltagande, kommunikation, medicinsk terminologi, förståelse, tekniska svårigheter, reaktioner och känslor, partnerskapet, egenmakt och egenvård.

Slutsats

Enligt studien var patienterna till stor del positiva över tillgången till patientjournalen och ville läsa sina journalanteckningar. Skillnader fanns mellan olika grupper av patienter när det kom till vilka som tyckte sig ha mest nytta av att läsa journalerna. Patienterna upplevde språkbruket och den medicinska terminologin som används i journalen som svårt att förstå. Enligt studien kan en ökad personcentrering och patientdelaktighet, vid och kring journalföringen, leda till positiva erfarenheter hos patienterna såväl som det kan ge minskade risker inom vården. En ökad personcentrering vid journalföring kan även bidra till att stärka patienternas möjligheter till ett högre mått av hälsolitteracitet.

Abstract [en]

Background

For some time now, web access to the medical records has developed and become possible for patients both in Sweden and in several countries globally. Since access to medical records has been made easier for patients, more and more people are taking the chance to read their medical records. Against this background, the patients attitudes and experiences of reading their medical records are examined in this litteraturestudy.

Aim

The aim was to shed light on adult patients' experience of reading their medical record when in contact with the health care system.

Method

The authors created a non-systematic literature review by collecting data and reviewing 17 scientific articles. The articles included were of various types. The authors reviewed the selected articles according to Sophiahemmet University's assessment document for quality review and then analyzed the articles through an integrated analysis method. Following this, the results were presented divided according to three themes that the authors found during the analysis.

Results

Through the review, three main themes were discovered. The themes that were discovered when the patients' experiences of reading their medical records were examined were: The patients' experience of: patient participation, of obtaining, interpreting and understanding medical record information and person-centeredness. Under these main categories, several sub-themes were seen. These sub-themes included the patients' experiences of or around participation, communication, medical terminology, understanding, technical difficulties, reactions and feelings, the partnership, empowerment and self-care.

Conclusions

According to the study, patients for the most part had positive experiences while reading their medical records and wanted to continue doing so. There were differences between groups of patients when it came to who found that they had the most benefit from reading the medical records. The patients found the language and medical terminology used in the medical record difficult to understand. According to the study, increased person-centredness and patient participation in record keeping can lead to increased positive experiences for patients as well as reduced risks in care. An increased person-centredness in recordkeeping can also contribute to strengthening patients' opportunities for a higher measure of health literacy.

Place, publisher, year, edition, pages
2022. , p. 35
Keywords [en]
Patient record, Patient participation, Health literacy, Person-centered care
Keywords [sv]
Patientjournal, Patientdelaktighet, Hälsolitteracitet, Personcentrering
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-4672OAI: oai:DiVA.org:shh-4672DiVA, id: diva2:1717578
Educational program
Sjuksköterskeprogrammet
Uppsok
Medicine
Supervisors
Examiners
Available from: 2022-12-09 Created: 2022-12-08 Last updated: 2022-12-09Bibliographically approved

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Självständigt arbete Arreman&Samuelsson(514 kB)69 downloads
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Citation style
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