| 17981. |
- Holmberg, Bodil, 1970-, et al.
(författare)
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Caring for older patients with reduced decision-making capacity : a deductive exploratory study of ambulance clinicians’ ethical competence
- 2023
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Ingår i: BMC Medical Ethics. - : BioMed Central (BMC). - 1472-6939 .- 1472-6939. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- Background: As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complexand difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability.Methods: A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis.Results: Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting.Conclusions: Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values
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| 17982. |
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| 17983. |
- Holmberg, Bodil, et al.
(författare)
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Dignity in bodily care at the end of life in a nursing home : An ethnographic study
- 2022
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318 .- 1471-2318. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Nursing homes (NHs) are populated by the frailest older people who have multiple physical or mental conditions and palliative care needs that may convey the violation of dignity. Although dignity is a commonly used concept and a core value of end-of-life care, it is assumed to be complex, ambiguous, and multivalent. Thus, the aim of this study was to explore aspects of dignity in older persons' everyday lives in a NH.DESIGN: A focused ethnographic study design.METHODS: Data consisted of 170 h of fieldwork, including observations (n = 39) with residents (n = 19) and assistant nurses (n = 22) in a Swedish NH. Interviews were undertaken with residents several times (in total, n = 35, mean 70 min/resident). To study dignity and dignity-related concerns, we used the Chochinov model of dignity to direct the deductive analysis.RESULTS: The study showed that residents suffered from illness-related concerns that inhibited their possibilities to live a dignified life at the NH. Their failing bodies were the most significant threat to their dignity, as loss of abilities was constantly progressing. Together with a fear of becoming more dependent, this caused feelings of agony, loneliness, and meaninglessness. The most dignity-conserving repertoire came from within themselves. Their self-knowledge had provided them with tools to distinguish what was still possible from what they just had to accept. Socially, the residents' dignity depended on assistant nurses' routines and behaviour. Their dignity was violated by long waiting times, lack of integrity in care, deteriorating routines, and also by distanced and sometimes harsh encounters with assistant nurses. Because the residents cherished autonomy and self-determination, while still needing much help, these circumstances placed them in a vulnerable situation.CONCLUSIONS: According to residents' narratives, important dignity-conserving abilities came from within themselves. Dignity-conserving interventions did occur, such as emphatic listening and bodily care, performed in respect for residents' preferences. However, no strategies for future crises or preparing for death were observed. To protect residents' dignity, NHs must apply a palliative care approach to provide holistic care that comprises attention to personal, bodily, social, spiritual, and psychological needs to increase well-being and prevent suffering.
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| 17984. |
- Holmberg, Bodil, et al.
(författare)
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Elements of assisted bodily care : Ethical aspects
- 2020
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 27:6, s. 1377-1395
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy, and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim having exposedness to assistant nurses’ routines. The provider-receiverin congruence revealed here warrants investigation.Aim: To describe the elements of assisted bodily care, as performed in a nursing home.Research design: Data were collected through thirty-nine observations of assisted bodily care, analyzed with qualitative content analysis.Participants and research context: Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home.Ethical considerations: The research was conducted in line with the Declaration of Helsinki,further approved by the regional ethics committee.Findings: Findings show, that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Still, assistant nurses attempt to adapt this work to older persons’wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care.Discussion: Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. On the contrary, they seem to know older persons well enough to adapt assisted bodily care according to their preferences and support self-determination. This indicates that openness to older persons’ life-worlds may be more important than the amount of time available.Conclusions: Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could prepare agreement on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all.
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| 17985. |
- Holmberg, Bodil, et al.
(författare)
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End-of-life care in a nursing home : Assistant nurses' perspectives
- 2019
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 26:6, s. 1721-1733
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in.OBJECTIVE: To describe assistant nurses' perspectives of providing care to older persons at the end of life in a nursing home.RESEARCH DESIGN: Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee.RESULTS: Three main categories emerged; "Death a natural part of life"; "The older person's well-being"; and "Care in the moment of death"; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons' dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions.DISCUSSION: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded.CONCLUSION: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development.
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| 17986. |
- Holmberg, Bodil
(författare)
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När kroppen inte räcker till : Assisterad kroppslig omvårdnad i livets slut på vård- och omsorgsboende
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med denna avhandling var att belysa vård i livets slut på vård- och omsorgsboende, med inriktning mot den kroppsliga omvårdnaden, utifrån äldre personers, undersköterskors och anhörigas perspektiv. Avhandlingen bygger på fyra delstudier. Tre analysmetoder användes;innehållsanalys (I & III), fenomenologisk hermeneutik (II) och fenomenografi(IV). Datainsamlingen omfattade individuella intervjuer (I, II & IV) och observation (III). Fynden visar att; (I) undersköterskor känner de äldre personerna och värnar deras självbestämmande, välbefinnande och värdighet. I sitt arbete fokuserar de främst på kroppslig omvårdnad. Äldre personer (II) upplever kroppslig omvårdnad som en assistans, växelvis i form av ett fängelse eller som en njutning. De värnar sitt självbestämmande, men anpassar sig efter de omständigheter som bestäms av andra. Det är främst undersköterskor som utför assisterad kroppslig omvårdnad (III), medan äldre tar del i det de kan, trots nedsatt kroppslig förmåga. Anhöriga räknar med att äldre personer utövar fullt självbestämmande gällande assisterad kroppslig omvårdnad (IV). Själva bidrar de med en assisterad kroppslig omvårdnad som inte innefattar intimhygien, medan de förblir observanta på undersköterskors arbete. Avhandlingen belyser att assisterad kroppslig omvårdnad kan överbrygga äldres kroppsliga begränsningar och leda till välbefinnande när självbestämmandet främjas. Sådan assisterad kroppslig omvårdnad kan utgöra en väsentlig del av en palliativ omvårdnad för äldre personer på vård- och omsorgsboende i livets slut.
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| 17987. |
- Holmberg, Bodil, 1970-, et al.
(författare)
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Self-determination in older patients: Experiences from nurse-dominated ambulance services
- 2024
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Ingår i: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; , s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe ambulance clinicians' experiences of self-determination in older patients.Design: The study had an inductive and explorative design, guided from a life-world perspective.Methods: Thirty-two Swedish ambulance clinicians were interviewed in six focus groups in November 2019. The data were analysed with content analysis, developing manifest categories and latent themes.Findings: The ambulance clinicians assessed the older patients' exercise of self-determination by engaging in conversation and by being visually alert, to eventually gain an overall picture of their decision-making capacity. This assessment was used as a platform when informing older patients of their rights, thus promoting their participation in care. Having limited time and narrow guidelines counteracted ambulance clinicians' ambitions to support older patients' general desire to avoid hospitalization, which resulted in an urge to displace their responsibility to external decision-makers.Conclusion: Expectations that older patients with impaired decision-making ability will give homogeneous responses mean an increased risk of ageist attitudes with a simplified view of patient autonomy. Such attitudes risk the withholding of information about options that healthcare professionals do not wish older patients to choose. When decision-making is difficult, requests for expanded guidelines may paradoxically risk alienation from the professional nursing role.Implications and Impact: The findings show ambulance clinicians' unwillingness to shoulder their professional responsibility when encountering older patients with impaired decision-making ability. In assuming that all older patients reason in the same way, ambulance clinicians tend to adopt a simplistic and somewhat ageist approach when it comes to patient autonomy. This points to deficiencies in ethical competence, which is why increased ethics support is deemed suitable to promote and develop ethical competence. Such support can increase the ability to act as autonomous professionals in accordance with professional ethical codes.Reporting Method: This study adhered to COREQ guidelines.Patient and Public Contribution: None.
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| 17988. |
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| 17989. |
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| 17990. |
- Holmberg, Christine, et al.
(författare)
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Tidsanvändningsstudien : En studie av arbetsmiljön vid Växjö universitet
- 2004
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I slutet av 2003 påbörjades undersökningen Tidsanvändningsstudien, vilken ingår som en del i det pågående arbetsmiljöarbetet vid Växjö universitet. Undersökningen syftar till att få mer kunskap om hur arbetsförhållandena vid universitetet ser ut och ska i sin tur på lång sikt förbättra arbetsvillkoren för de anställda. I första hand är projektet inriktat mot arbetsvillkor kopplade till arbetstid, arbetsuppgifter och arbetssituation där anställdas åsikter och synpunkter ska komma fram. Ett stort antal arbetsplatser genomgår idag förändringar och det finns betydande risker för negativ stress och ohälsa i samband med dessa omställningar. Universitet har under de senaste tio åren blivit en alltmer betydelsefull del av samhället och samtidigt ett föremål för ett större politiskt intresse och inflytande, vilket har fått som följd att de idag också är utsatta för dessa samhälleliga krav på förändring. Universiteten som arbetsplats består, enligt tidigare undersökningar, av personal som ofta är mycket nöjda med sina arbetstider, arbetsuppgifter och sin arbetssituation, trots detta har många anställda arbetsrelaterade besvär och antalet sjukskrivningar är höga. Vår uppgift var att studera arbetsmiljön vid Växjö universitet. Undersökningen riktar sig till samtliga anställda vid Växjö universitet och för att kunna ta del av allas uppfattningar av arbetsmiljön valdes enkätundersökning som insamlingsmetod. I rapporten redovisas oftast vad samtliga anställda anser om arbetsmiljön, men eftersom universitetet är en stor arbetsplats förekommer det variationer beroende på kön, yrkestillhörighet och vilken institution/sektion/enhet personen tillhör. I rapporten har personalens åsikter och uppfattningar om Växjö universitet som arbetsplats sammanställts och därefter analyserats utifrån faktorer som påverkar deras arbetsmiljö. Det som framkommit är att en stor del av personalen är nöjda med arbetstiden, arbetsuppgifterna och arbetssituationen. De flesta känner att de har frihet att själva planera i stor utsträckning vilka tider de ska arbeta. De har en variation i arbetsuppgifterna som medför att arbetet känns omväxlande och arbetsmiljön beskrivs som stimulerande och god. Samtidigt beskriver anställda en arbetsmiljö som bland annat består av; stor och ojämn arbetsbörda, tidsbrist, dåligt samvete och arbetet upplevs som splittrat och stressigt. Utifrån personalens uppfattningar om arbetstid, arbetsuppgifter och arbetssituation hittade vi gemensamma drag som kan sammanfatta arbetsmiljön vid Växjö universitet. Arbetsmiljön kännetecknas av frihet och flexibilitet, hög arbetsbelastning och hög lojalitet. Slutsatsen är att hög lojalitet och fria och flexibla arbetsvillkor gällande arbetstiden och arbetsuppgifter i kombination med hög arbetsbelastning gör att individen upplever: - oro att inte hinna med alla arbetsuppgifter på ordinarie arbetstid - oro att inte leva upp till ställda arbetskrav - att arbetet ger dåligt samvete eftersom det alltid finns arbetsuppgifter att utföra - att det inte finns någon ersättare vid sjukdom - negativ stress och ohälsa För anställda resulterar detta ofta i långa arbetsveckor med övertid och hem- och helgarbete för att hinna utföra arbetsuppgifterna samt hög sjuknärvaro på arbetsplatsen.
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