| 41. |
- Pajalic, Zada, 1967-, et al.
(författare)
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The experiences of elderly people living at home related to their receiving meals distributed by a municipality in Sweden
- 2012
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Ingår i: Journal of Food Research. - : Canadian Center of Science and Education. - 1927-0887 .- 1927-0895. ; 1:1, s. 68-78
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to describe the experiences of elderly people, living at home who receive hot meals that are distributed by their municipality. Qualitative content analysis was used to analyse the (n=13) interviews. The results showed that feelings of dependency, loneliness and gratitude were expressed by the participants in the study related to their meals being delivered home. Dependency was expressed as not having influence over the food products the meals were made from. Loneliness was expressed as being isolated and being confined at home alone due to difficulties getting out of the house, which was associated with the costs of taxis transportation. Gratitude was expressed by the sincere thanks for the possibility of receiving traditional meals delivered daily.The major conclusion of the study was the indication that greater attention should be paid to meet both the practical and psychological needs of elderly people.
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| 42. |
- Quell, Robin, et al.
(författare)
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Using tactile stimulation in a dementia care facility with plasma prolactine as an outcome measure : a pilot study
- 2008
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Ingår i: Archives: the international journal of medicine. - 1791-4000. ; I:3, s. 123-129
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is poor scientific documentation supporting tactile stimulations’ benefit as a nursing intervention. It has been theorized that older adults with dementia experience high anxiety and stress levels. High prolactin levels are associated with psychosomatic reactions and have been used to measure stress levels in adults.AimTo evaluate tactile stimulation’s effectiveness on anxiety and stress in older adults, with dementia diagnosis or signs of dementia and living in a dementia care facility, as manifested by plasma prolactin levels.Materials and MethodsTactile stimulation was given weekly by trained staff members to half the residents of a Swedish dementia care facility.The subjects were randomly selected (n=20) and were tracked in the study for a minimum of 28 weeks. The remaining half elders made up the control team (n=20). Diagnostic groups were formed according the severity of dementia. Plasma prolactin levels were drawn at baseline and post intervention. Medications caused the exclusion of 12 residents and seven dropped out due to other causes. ResultsThere was no difference in plasma prolactin levels between the intervention (n=11) and control (n=12) group. A significant main effect between the diagnostic groups was found as well as a trend towards a positive correlation between age and plasma prolactin levels. There was no gender difference in plasma prolactin levels.ConclusionsOur hypothesis that reduced plasma prolactin levels could be detected in elders treated with tactile stimulation, indicating alleviated stress, was not supported by the preliminary results of the present study. Further evaluation of tactile stimulation with larger study groups and a better understanding of prolactin’s sensitivity, complexity and interaction with medications could contribute to the outcome and problems of the study. The use of neuropsychological assessment could enrich the research data and help the evaluation.
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| 43. |
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| 44. |
- Rasoal, Dara, 1980-, et al.
(författare)
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Clinical Ethics Support for Healthcare Personnel : An Integrative Literature Review
- 2017
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Ingår i: HEC Forum. - Dordrecht, Netherlands : Springer. - 0956-2737 .- 1572-8498. ; 29:4, s. 313-346
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Forskningsöversikt (refereegranskat)abstract
- This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different coun-tries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a ‘‘bot-tom-up’’ perspective might give healthcare personnel opportunities to think and reflect more than a ‘‘top-down’’ perspective. A ‘‘bottom-up’’ approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a ‘‘top-down’’ approach risks removing such moral responsibility.
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| 45. |
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| 46. |
- Rasoal, Dara, 1980-
(författare)
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Perspectives on clinical ethics support and ethically difficult situations : reflections and experiences
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Healthcare personnel encounter ethically difficult situations in their everyday work and clinical ethics support might be important to support healthcare personnel to deal with these situations. The overall aim of this thesis was to describe perspectives on clinical ethics support, experiences of being in ethically difficult situations and experiences of facilitating ethics reflection. Methods. Study I had a descriptive design in which research articles were reviewed (n=54). In study II audio-recorded moral case deliberation (n=70) in 10 Swedish workplaces in hospitals and community care were analysed. In study III interviews were conducted with facilitators (n=11) of moral case deliberation. Study IV used non-participant observation during three weeks as well as informal conversations with healthcare personnel (n=12) in community home healthcare. Results and conclusion. In study I, two perspectives emerged on clinical ethics support, a “Top-down” perspective, where an individual or a group of “experts” in ethics could recommend the best course of action and a “Bottom-up” perspective that allows healthcare personnel to manage ethically difficult situations through ethical reflections led by a facilitator. Studies II and IV showed how ethically difficult situations on different levels are often connected with emotions and uncertainties. Study III showed the role of the facilitator to be fundamental in creating a space for self-reflection among healthcare personnel. Study IV showed that healthcare personnel face complex demands and expectations from the healthcare organization regarding the provision of care as well as having to meet the needs of patients and their next-of-kin. To conclude, healthcare personnel needed to find a balance among demands and expectations in order to satisfy those stakeholders involved and they had to seek compromise. There is a need for clinical ethics support that helps healthcare personnel reflect individually and collectively on ethically difficult situations they encounter in their everyday clinical practice. From this standpoint, a “Bottom-up” perspective may reduce the risk of moral distress among healthcare personnel and promote care based on person-centred values.
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| 47. |
- Skovdahl, Kirsti, 1964-, et al.
(författare)
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Demanding behaviours and workload in elderly care in Sweden : occurrence at two time points within a decade
- 2008
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Ingår i: Scandinavian Journal of Caring Sciences. - Oxford : Blackwell. - 0283-9318 .- 1471-6712. ; 22:3, s. 323-330
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the occurrence of demanding behaviours in persons ‡65 years receiving home care or living in sheltered accommodation at two points in time, 1993 and 2002. Another aim was to investigate whether the perceived workload in staff had changed during this period. All persons ‡65 years living at home and utilizing home care services or those who lived in some form of sheltered housing were included and assessed by staff using a three-part questionnaire, in two cross-sectional studies. The study group comprised 1187 and 1017 participants which equals 77% and 99% respectively. Symptoms and degree of behavioural and psychiatric symptoms common in dementia that were assessed with a subscale in The Gottfries-Bra°ne-Steen Scale, demonstrated an all over increase from 1993 to 2002. Items from The Multi Dimensional Dementia Assessment Scale (MDDAS) measured a decrease in ‘daily’ occurrences of dementia symptoms but an increase in ‘sometimes per week’. A mixed pattern was seen concerning behaviours where increases as well as decreases were found. The behaviours ‘constantly seeking attention’ and ‘shrieking continuously’ increased significantly. The number of individuals showing restless, aggressive or shrieking behaviours increased significantly over the decade. Two items from the MDDAS were used to measure the workload. The physical workload increased significantly over the decade whereas the rising tendencies of the psychological workload were not statistically significant. The mean age over the decade had increased from 83 to 86 years, which together with the findings make the recipients of home care and sheltered housing a very vulnerable group. The demanding problems place considerable pressure on staff.
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| 48. |
- Skovdahl, Kirsti, 1964-, et al.
(författare)
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Dementia and aggressiveness : video recorded morning care from different care units
- 2003
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 12:6, s. 888-898
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to illuminate, from video recorded sequences, interactions between individuals with dementia and aggressive behaviour and caregivers who reported problems dealing with such behaviour and caregivers who did not. Nine caregivers and two residents participated.The video recordings were later transcribed into text and analysed by using a phenomenological hermeneutic approach, inspired by Ricoeur's philosophy.The main themes that emerged from the analysis were 'Being involved and developing a positive interaction' and 'Being confined to routines and remaining in negative interaction'.The findings indicated the interactions either to be in a positive or negative spiral. Caregivers who had reported problems dealing with behavioural and psychiatric symptoms in dementia focused on accomplishing the task, where the main focus was on 'the goal itself'. In other sequences with caregivers who had been satisfied with their capability the focus was placed on 'how' the caregivers could reach their goal.Power was central in the material, in different ways, either as a possible way to handle the situation or as a possible way of defending oneself. Parts of Kitwood's framework and Fromm's theory about power 'over' and power 'to', has been used in the comprehensive understanding. Our conclusion is that caregivers should use power 'to' when they have to help persons with dementia and aggressive behaviour, as a part of behavioural and psychiatric symptoms of dementia, for being able to give help in the best possible way. They should also act in a sensitive and reflective manner, with the individual in focus.
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| 49. |
- Skovdahl, Kirsti, 1964-, et al.
(författare)
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Dementia and aggressiveness : stimulated recall interviews with caregivers after video-recorded interactions
- 2004
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Ingår i: Journal of Clinical Nursing. - Oxon, United Kingdom : Wiley. - 0962-1067 .- 1365-2702. ; 13:4, s. 515-525
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In a previous study, nine caregivers and two residents with dementia showing aggressive behaviour, were video recorded. Caregivers who reported problems when dealing with such behaviour and caregivers, who did not, were included in this study.AIM: The aim of the present study was to obtain insight into the reasoning of the caregivers who had reported problems when dealing with older people with dementia and aggressiveness and those who did not relative to their respective video-recorded interactions with these residents. A further aim was to gain insight by discussing their reasoning in relation to each other.METHOD: Stimulated recall interviews were carried out with all the caregivers who had been video taped in the previous study. The text was analysed by thematic content analysis.FINDINGS: Two main ways of thinking and discussing the care situations emerged. The caregivers, who had reported problems in handling behavioural and psychiatric symptoms in dementia earlier, reasoned that they were more focused on their duties, this included being responsible for the resident receiving her weekly shower. For this group of caregivers, the well being of the resident was in focus, but their attention was concentrated on the resident's well being and comfort after their shower. However, these caregivers seemed therefore unwittingly to prevent a positive interaction with the resident. The other caregivers were able to reflect spontaneously and appeared to be self-critical. This caregiver group seemed to sustain a positive interaction with the resident both during and after the shower.RELEVANCE TO CLINICAL PRACTICE: In this study a nurturing and supportive climate and competence seemed to be the conditions necessary to facilitate reflections and promote creativity in the caregivers such that they are able to develop possible ways of handling difficult situations like aggressiveness in residents with dementia.
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| 50. |
- Skovdahl, Kirsti, 1964-, et al.
(författare)
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Different attitudes when handling aggressive behaviour in dementia : narratives from two caregiver groups.
- 2003
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Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 7:4, s. 277-286
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Tidskriftsartikel (refereegranskat)abstract
- This study highlights the experiences of 15 formal caregivers, during interactions with elderly residents suffering from dementia disease and showing aggressive behaviour. The purpose was to study caregivers' reflections about and attitudes to behavioural and psychiatric symptoms of dementia (BPSD) and how they dealt with the symptoms. This was done by comparing care units with high or low levels of aggressive behaviour in residents. A phenomenological-hermeneutic approach was used for the analysis of the interviews. The main themes that emerged were: a need for balance between demands and competence; and a need for support. The findings indicated the importance of a balance for the residents as well as for the caregivers, if a positive relationship was to develop. Furthermore, caregivers stated that support was crucial, not only for the residents but also for themselves, if they were expected to cope with demanding situations. Different types of support were necessary and included: confirmation, feedback, and supervision. Residents who feel appreciated and respected may be less likely to act out their frustrations in an inappropriate manner. Caregivers who strive to understand the meaning behind a resident's behaviour and who master the necessary care-giving skills, and their implementation, could be more successful at curbing distressing behaviour, than caregivers who act merely in a custodial role.
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