| 41. |
- Fagerberg, Ingegerd, et al.
(författare)
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"Learning by doing" : or how to reach an understanding of the research method phenomenological hermeneutics
- 2009
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Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 29:7, s. 735-739
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Tidskriftsartikel (refereegranskat)abstract
- One problem addressed in teaching graduate students qualitative research methods is practising the cognitive and conative skills that students need to generate both rich data and meaningful analysis. The aim of the study was to illuminate development in a group of pre-doctoral and doctoral students as they learnt the phenomenological hermeneutics research method. In a course comprising 18 doctoral students we used the "guided path" pedagogical approach and decided to use a subject of which everyone has lived experience, "troubled conscience", for the phenomenological hermeneutic analysis conducted with the students. As the students progressed in their learning experience of the research method, they analysed their data according to the steps in the method, and we as teachers conducted separate analyses of the same data. The results point in the same direction as previous studies in the field. This is discussed in terms of strength of the pedagogical approach and the students' learning, since despite the fact that their data are limited and not very detailed they were able to come up with results that were in line with previous research.
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| 42. |
- Fischer Grönlund, Catarina, 1962-, et al.
(författare)
-
Communicative and organizational aspects of clinical ethics support
- 2019
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 33:6, s. 724-733
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Tidskriftsartikel (refereegranskat)abstract
- Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.
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| 43. |
- Fischer Grönlund, Catarina, 1962-, et al.
(författare)
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Development, validity and reliability testing the Swedish Ethical Climate Questionnaire
- 2019
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 26:7-8, s. 2482-2493
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas' four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to present the construction of and to test the psychometric properties of the Swedish Ethical Climate Questionnaire.METHOD:: An expert group of six researchers, skilled in ethics, evaluated the content validity. The questionnaire was tested among 355 healthcare workers at three hospitals in Sweden. A parallel analysis (PA), an exploratory factor analysis and confirmatory factor analysis were performed.ETHICAL CONSIDERATIONS:: The participants included in the psychometric analysis were informed about the study, asked to participate in person and informed that they could withdraw at any time without giving any reason. They were also assured of confidentiality in the reporting of the results.FINDINGS:: The parallel analysis (PA) recommended one factor as a solution. The initial exploratory factor analysis with a four-factor solution showed low concordance with a four-factor model. Cronbach's alpha varied from 0.75 to 0.82; however, since two factors only consisted of one item, alpha could not be reported. Cronbach's alpha for the entire scale showed good homogeneity (α = 0.86). A confirmatory factory analysis was carried out based on the four requirements and showed a goodness-of-fit after deleting two items. After deletion of these items, Cronbach's alpha was 0.82.DISCUSSION:: Based on the exploratory factor analysis, we suggest that the scale should be treated as a one-factor model. The result indicates that the instrument is unidimensional and assesses ethical climate as a whole.CONCLUSION:: After testing the Swedish Ethical Climate Questionnaire, we found support for the validity and reliability of the instrument. We found the 10-item version of Swedish Ethical Climate Questionnaire satisfactory. However, we found no support for measuring different dimensions and, therefore, this instrument should be seen as assessing ethical climate as of whole.
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| 44. |
- Fischer Grönlund, Catarina, et al.
(författare)
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Ethically difficult situations in hemodialysis care : nurses' narratives
- 2015
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 22:6, s. 711-722
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.RESEARCH QUESTION: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses' experiences of being in ethically difficult situations that give rise to a troubled conscience.RESEARCH DESIGN: This study has a phenomenological hermeneutic approach.PARTICIPANTS: Narrative interviews were carried out with 10 registered nurses working in dialysis care.ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.RESULTS: One theme, 'Calling for a deliberative dialogue', and six sub-themes emerged: 'Dealing with patients' ambiguity', 'Responding to patients' reluctance', 'Acting against patients' will', 'Acting against one's moral convictions', 'Lacking involvement with patients and relatives' and 'Being trapped in feelings of guilt'.DISCUSSION: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.CONCLUSION: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.
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| 45. |
- Fischer Grönlund, Catarina, et al.
(författare)
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Managing Ethical Difficulties in Healthcare : Communicating in Inter-professional Clinical Ethics Support Sessions
- 2016
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Ingår i: HEC Forum. - : Springer Science and Business Media LLC. - 0956-2737 .- 1572-8498. ; 28:4, s. 321-338
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Tidskriftsartikel (refereegranskat)abstract
- Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) inspired by Habermas' theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved.
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| 46. |
- Fischer, Regina Santamäki, et al.
(författare)
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Embracing opposites : meanings of growing old as narrated by people aged 85
- 2008
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Ingår i: The International Journal of Aging & Human Development. - Farmingdale, N.Y. : Baywood. - 0091-4150 .- 1541-3535. ; 67:3, s. 259-71
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Tidskriftsartikel (refereegranskat)abstract
- Many old people suffer from prolonged and multiple bodily ailments, new diseases, and increased risk for disadvantages and losses in life. Aging also means becoming mature and wise. This study illuminates the meaning of the lived experience with respect to changes in late life. Using a phenomenological hermeneutic method, this study analyzes transcribed interviews of 15 85-year-old people. Four themes were formulated: embracing weakness and strength, embracing slowness and swiftness of time, embracing reconciliation and regret, and embracing connectedness and loneliness. From these analyses, growing old was described as--maintaining one's identity in spite of the changes that come with aging and, embracing opposites--being changed and feeling being the same.
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| 47. |
- Fjelltun, Aud-Mari, et al.
(författare)
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Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents : a comparative study.
- 2009
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:4, s. 736-747
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses' physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly's functional levels may illuminate the extent of the carers' workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi-Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly's need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.
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| 48. |
- Fjelltun, Aud-Mari Sohini, et al.
(författare)
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Carers' experiences with overnight respitecare : a qualitative study
- 2009
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Ingår i: Vård i Norden. - 0107-4083 .- 1890-4238. ; 29:3, s. 23-27
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to explore experiences with overnight respite care (ORC) of Norwegian carers who provided care to frail elderly awaiting nursing home placement. Background In many Western countries respite care has become part of health care service provision, and various types of respite care are available. The intent with respite care can be twofold; caring for the care receiver and supporting the carer. Methods This was a descriptive qualitative study. Interviews were conducted with 15 carers, transcribed and analysed by qualitative content analysis. Findings The carers described various experiences with ORC. If ORC supported the family unit, it was welcomed by carers and experienced as supportive. If ORC did not support the family unit, many carers rejected ORC, and it was experienced as non-supportive. Two categories were constructed: 'experiencing ORC as supportive for the family as a unit' and 'not experiencing ORC as supportive for the family as a unit'. Conclusion To support more carers, nurses have to listen to carers’ experiences about ORC. Nurses need to take responsibility for the family as a unit and provide more flexible ORC services based on both carers’ and elderly’s needs.
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| 49. |
- Fjelltun, Aud-Mari Sohini, et al.
(författare)
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Nurses' and carers' appraisals of workload in care of frail elderly awaiting nursing home placement.
- 2009
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:1, s. 57-66
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study is to describe carers' and nurses' appraisals of workload in care of frail elderly awaiting nursing home (NH) placement. BACKGROUND: Carers' workload of care for frail elderly awaiting NH placement has been studied separately from that of nurses' workload. The literature neither addressed a comparison of carers' and nurses' appraisals of psychological and physical workloads nor the most strenuous factors common to the workloads of both nurses and carers in care of the same elderly person. The terms 'carers' and 'nurses' in this paper refer to informal caregivers and to both enrolled nurses and Registered Nurses respectively, when no particular one is stated. METHOD: The sample comprised 11 nurses and 11 carers paired based on care provided to the same elderly person awaiting NH placement in Norway. Data collected by a workload-scale was analyzed by descriptive statistics. Data collected by individual interviews were analyzed by qualitative content analysis. Carers' and nurses' appraisals of workload were compared and contrasted and most strenuous factors described. FINDINGS: The findings show that both carers and nurses rated workload levels maximum. Carers' highest ratings concerned psychological workload, while nurses' highest ratings concerned physical workload. The workload ratings concerning elderly with advanced dementia disease were most similarly aligned. Qualitative content analysis showed three categories that describe the most strenuous factors common to the workloads of both carers and nurses. These were feeling responsible, burdened and ambivalent. CONCLUSION: This study reports carers' and nurses' appraisals of workload in care of frail elderly awaiting NH placement. The results show many similarities and some differences. These results may help guide policy development to address resource allocations to elderly care. Further research is needed to address workloads of care for elderly awaiting NH placement.
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| 50. |
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