| 61. |
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| 62. |
- Josefsson, Karin
(författare)
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Municipal elderly care : implications of registered nurses' work situation, education, and competence
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Registered nurses (RNs) are key figures in municipal elderly care. It is a challenge to create necessary conditions that enable them to provide quality nursing care. These studies aimed to increase insight into RNs work conditions in municipal elderly care, and to compare RNs working solely in dementia care (DC) with RNs working in general elder care (GC). The specific aims were to describe RNs’ perceptions of: (I) their work situation, regarding demands, influences, and social support, as well as RNs characteristics; (II) violence and threats directed at them, other staff, and care recipients, as well as access to prevention measures and routines for handling violence and threats; (III) their education and competence development; (IV) their needs for knowledge, possibilities for competence development, supervision, organisation of RNs’ development, financial support, competence utilisation, and managers’ competence. A descriptive and comparative design was used. The setting consisted of 60 special housing with subunits in a large city in the middle of Sweden. A total of 213 RNs participated, with a response rate of 62%. Of those, 95 (45%) worked in DC and 118 (55%) in GC. A structured questionnaire, designed for these studies was used. Study I showed on average high time pressure in both groups. Greater knowledge and higher emotional and conflicting demands were found in DC. The majority reported greater opportunities to plan and perform daily work tasks than to influence the work situation in a wider context. On average, there was a high level of support at work from management and fellow workers. Study II indicated that RNs had witnessed and experienced a high degree of indirect threats, direct threats of violent acts, and violent acts, with care recipients also subject to threats and violence. The RNs in DC had greater access to education in managing threats and violence, and routines for managing violence and a door with a lock to their working unit. Study III revealed that RNs possessed a broad range of formal competence. On average, the RNs had 18 years of work experience as an RN. The majority lacked a Degree of Bachelor in Nursing. Few had adequate specialist competence. RNs in DC were willing to invest more in competence development whereas RNs in GC were more motivated to invest in competence development by seeking another position and by attaining a greater authority to make important decisions at work. Study IV showed that, on average, the RNs did not lack or hardly lacked knowledge in the examined domains. RNs in GC lacked knowledge of dementia, falls, and fall injures to a greater extent than RNs in DC. RNs in DC perceived greater possibilities for competence development at work. Most RNs, especially in GC, requested a better organisation for competence development. The majority of RNs had no supervision. Although the utilisation of the competence of RNs was high, RNs used their highest competence about half of the working hours. The employers’ financial contribution to RNs’ continuing education was poor. Conclusions drawn from the studies are: (I) RNs’ time pressure needs to be decreased and their influence on decisions increased. (II) Violence occurs equally frequently without any difference between DC and GC. More often, RNs in DC are offered education on how to manage violence and threats, and have routines for management of violence. Therefore, municipal authorities should increase staff education for management of violence and creating safety routines. Violence needs to be taken seriously with a ‘zero tolerance’ attitude. (III) It is important to develop the RNs’ competence and increase the utilisation of their competence. It is also essential to increase the number of RNs who have specialist competence. (IV) Better organisation and greater possibilities for RNs’ competence development is needed. Employers need to make a greater financial contribution to RNs’ competence development. RNs also need supervision. When combined, high demands and low control in the work situation form the most critical combination for the health of RNs. This may lead to sick-absenteeism and staff turnover. Thus, RNs’ time demands should be decreased, violence be minimised, and influence in decision-making increased in both groups. Further research is required on RNs’ competence development, family conditions, leisure, health, their ‘ideal work’, and the concept of general elder care.
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| 63. |
- Kihlgren, Annica, et al.
(författare)
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Managements' perception of community nurses' decision-making processes when referring older adults to an emergency department
- 2006
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 14:6, s. 428-436
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, older adults are living and being cared for under the responsibility of their respective community. Extensive reorganizations in the community led to management having different backgrounds, which may have caused uncertainty among community nurses, especially in decision-making processes. The aim was to understand how 10 nurses, 10 doctors and 10 home care assistants as leaders for the nurses conceptualized the decision-making processes of community nurses, when referring older persons to Emergency Departments, and whether perceptual differences and/or similarities exist. Narrative interviews and content analysis were performed. The managers had differing views, but all felt there was a need to feel secure in order to trust professional decisions as being correct, thus avoiding inappropriate referrals. Management could see nurses' exposed position, but had varying solutions. This might lead to different messages being given regarding what is important and might explain why the nurses reported that the managers did not understand them.
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| 64. |
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| 65. |
- Langius-Eklöf, Ann, et al.
(författare)
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Health-related quality of life in relation to sense of coherence in a Swedish group of HIV-infected patients over a two-year follow-up
- 2009
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Ingår i: AIDS Patients Care and STDs. - New York : Mary Ann Liebert. - 1087-2914 .- 1557-7449. ; 23:1, s. 59-64
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present study was to describe HIV-infected patients' self-reported health-related quality of life (HRQOL) in relation to sense of coherence over a 24-month period. A total of 104 HIV-infected patients (71% males) answered questionnaires at three times at 12-month intervals. At the same time, clinical characteristics were collected from the patients' medical records. HRQOL was measured by the HIV-symptom scale, the Health Index, and the Well-Being Scale. Coping ability was measured with the 29-item sense of coherence (SOC) scale. The patients were divided into three groups depending on SOC scores (low, moderate, high). The results indicate that the group with low SOC scores rate their HRQOL worse than the other groups at all three measurements (p values from <0.05 to <0.001). Over the 2-year period, the patients' CD4 cell count=mm3 increased significantly (p values <0.001), indicating good response to antiretroviral treatment. However, their HRQOL did not improve during these 2 years. Patients with higher SOC rate their HRQOL better than those with a lower SOC, during these years. Future studies should investigate the predictive value of the SOC scale of HRQOL in HIV-infected patients.
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| 66. |
- Langius-Eklöf, Ann, et al.
(författare)
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Sense of coherence and psychiatric morbidity in terms of anxiety and depression in patients with major depression before and after electric convulsive treatment
- 2009
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Ingår i: Scandinavian Journal of Caring Sciences. - Oxford : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 23:2, s. 375-379
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Tidskriftsartikel (refereegranskat)abstract
- The specific aim of this study was to explore if the Sense of Coherence (SOC) Scale reflects and overlaps with standardized psychiatric assessments of depression and anxiety leading to the main hypothesis that the degree of depression decreases while the SOC scores remain stable. Fifteen patients with a diagnosis of major depression according to Axis I in DSM-IV and planned electric convulsive treatment (ECT) participated in the study. The clinician-rated instruments, Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Function (GAF), and the self-assessment instruments such as SOC and the Comprehensive Psychopathological Rating Scale-Self Rating Scale for Affective Syndromes (CPRS-S-A) were used before and after the treatment. The patients showed statistically significant improvements in clinician-rated depression (p < 0.001) and functional status (p < 0.001), and in self-rated anxiety (p = 0.001) and depression (p = 0.003). There was no significant improvement in SOC (p = 0.213). No significant correlations were found between the SOC scores and any of the measures except for GAF after treatment (r = 0.57, p = 0.039); the lower the SOC scores the greater was the functional dysfunction. In conclusion, the SOC Scale seems not to be a measure of psychopathology in terms of depression or anxiety merely.
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| 67. |
- Lidskog, Marie, et al.
(författare)
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Learning about each other : Students' conceptions before and after interprofessional education on a training ward
- 2008
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Ingår i: Journal of Interprofessional Care. - : Informa UK Limited. - 1356-1820 .- 1469-9567. ; 22:5, s. 521-533
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Tidskriftsartikel (refereegranskat)abstract
- In interprofessional work the striving of the members of each profession to establish their own positive in-group identity can be a source of conflict and have a negative effect on care. To counteract this, interprofessional training wards (IPTWs) have been developed in Sweden. The aim of the present study was to investigate similarities and differences in how student nurses, student occupational therapists and student social workers perceived their own and the other two professions before and after clinical education on an IPTW. Sixteen students were interviewed before and after the training on an IPTW in municipal care for older people in Sweden. A coding scheme developed in an earlier study was used in the analysis of the interviews. The findings indicate that there are changes in the students' stereotyped views, enhancing understanding of each other's professions after three weeks' clinical education on the IPTW. In some areas, however, there are still discrepancies between the description of own profession and the others' understanding of this profession that need to be confronted. In interprofessional training during education in social and health care there needs to be a balance between on the one hand the particular professional identity, on the other the shared identity implied by membership of the health-care team focusing on a common goal.
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| 68. |
- Lidskog, Marie, et al.
(författare)
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Students' learning experiences from interprofessional collaboration on a training ward in municipal care
- 2008
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Ingår i: Learning in Health and Social Care. - : Wiley. - 1473-6853 .- 1473-6861. ; 7:3, s. 134-145
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Tidskriftsartikel (refereegranskat)abstract
- One way to offer students pursuing health and social care programmes realistic experiences of teamwork is interprofessional training wards where students from different educational programmes learn teamwork by working together. In the present study, a training ward in municipal care for older people was evaluated. Students from occupational therapy, nursing and social work programmes worked together on the ward for 3 weeks to learn with, from and about each other. The aim of the study was to compare students' attitudes towards practice on a training ward before and after and to evaluate goal fulfilment after 3 weeks' interprofessional education on a training ward. An attitude questionnaire was distributed to all students before and after their time on the ward, supplemented with a retrospective goal-fulfilment questionnaire afterwards. The results show that the collaborative, social experience the training ward offers was appreciated by the students and in most respects, met the learning goals set up for the course. The most important learning experience was working together in a real-life setting. However, there are some issues to take into consideration when planning and developing training wards. The setting needs to be realistic and relevant in relation to future roles for all of the student groups involved. The value and purpose of engaging together in basic patient care needs to be the subject of further investigation. When it comes to fostering competent team-workers, training wards seem to be one way forward. But to fully understand the challenges and difficulties involved in planning these wards, the learning achieved must be understood in the context of the setting as a whole, in all its aspects.
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| 69. |
- Lindh, Inga-Britt, 1949-, et al.
(författare)
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Nurses' moral strength : a hermeneutic inquiry in nursing practice
- 2009
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Ingår i: Journal of Advanced Nursing. - 0309-2402 .- 1365-2648. ; 65:9, s. 1882-1890
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper is a report of a study to interpret nurses' experiences of moral strength in practice. Background. Moral strength is said to be beneficial in providing nursing care for patients, thereby contributing to high qualitative care. However, few studies focus on the meaning of nurses' moral strength. Methods. This study included eight Registered Nurses working in different aspects of health care in southern Sweden. Individual interviews were conducted in 2006 and 2007. We recorded, transcribed verbatim, and interpreted the interviews by a method grounded in hermeneutics. Findings. Three themes were interpreted on three different levels: the action level as 'having courage to act on one's convictions', the relational level as 'being attentive and recognizing vulnerability', and the existential level as 'facing the unpredictable'. Overall, moral strength was understood as a driving force to be someone special in the care of patients, i.e. someone who makes a difference. Conclusion. The value of nurses' moral strength in patient care should be recognized. Attention must be given to aspects outside the individual, e.g. professional and institutional processes that influence the work environment. Clinical team supervision can help make such processes visible and supportive.
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| 70. |
- Lindskov, Cecilia
(författare)
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Family centre practice and modernity : a qualitative study from Sweden
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Family centres have become a common institution to promote health and wellbeingamong young children (0-6 years of age) and their parents in Sweden. Thecore of the work is usually based on both maternal and child health care, a preschooland social services, all located under the same roof in the local community.The family centre in this study, known as the "Family House", was the firstof its type to be built in the city of Kristianstad, Sweden.The overall aim of the thesis was to understand family centre practice throughprofessionals' and parents' perceptions of the Family House and its relationship to modernity.The study employed a qualitative design using phenomenography as method tocapture people's perceptions of the practice. The research also drew on the approachof action research, where participants and researchers co-generateknowledge through collaborative communicative processes. Data was generatedfrom semi-structured interviews conducted with nineteen professionals andsixteen individual parents. Dialogue sessions with the professionals of the studyhave been held in order that they and the researcher could enter into a dialoguebased on the findings of the interviews. Data was consequently also generatedfrom these meetings.The way the professionals perceived the practice of the Family House fell intothree categories, namely, as a professional service, the provision of an informalmeeting place for professionals and families with young children or as a broadcommunity-based centre. Parents' perceptions fell into four categories; as aprofessional reception to obtain expert guidance and support, a study circle andliving room to informally share experiences and socialising, and a playgroundfor children where children could interact and learn social skills.One core finding of this thesis is that family centre practice for those involvedcontained a balancing act between simple modern expertise to control the futureand late modern opportunities for self-realisation and reflexivity.Parents and professionals shared the responsibility for children's well-being andthe distinction between private and public was blurred since parents used theHouse as a social arena for developing personal relations. It was also an arenafor integration between Swedes and immigrants based on engagement for bothcultural diversity and similarity.
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