| 1. |
- Andreassen Devik, Siri
(författare)
-
Hjemmesykepleie til eldre som bor på bygda med uhelbredelig kreft
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The need to deliver high-quality palliative homecare has been underscored in current professional guidelines and demands for efficacy, as well as in the preferences of patients and their families. Indeed, demographic changes and an increased risk of cancer among older people pose challenges to the home healthcare settings in Norway and the rest of the world. Yet, little is known about how older persons experience living with incurable cancer and how palliative home nursing care may increase their quality of life. Moreover, few studies have focused on rural contexts or explored such settings can influence the delivery and outcome of care. In rural contexts, long distances and limited health-related human resources challenge the provision of specialised services, and palliative patients living in rural municipalities most often receive services from district nurses without special training in oncological or palliative care. The aim of this thesis was thus to explore experiences with, and meanings of, rural home nursing care among older persons living with incurable cancer. The thesis consists of five studies, all with qualitative designs, and performed in rural municipalities.Study I was designed as a case study involving individual interviews and observations to explore how older persons diagnosed with incurable cancer and living alone have experienced daily life while commuting for policlinic palliative chemotherapy. By extension, the aim of Study II, conducted as a secondary analysis of material collected in study I, was to illuminate and interpret the meanings of the lived experiences of the participants in that study. By contrast, Study III used individual interviews to illuminate and interpret the meaning of the lived experience of older persons with incurable cancer, yet who have received home nursing care. Meanwhile, Study IV entailed individual interviews with nurses working in home nursing care. Its aim was to illuminate and interpret the meaning of nurses' lived experiences among severely ill patients in their homes. Lastly, Study V involved individual interviews with bereaved family members; its aim was to explore their perceptions of suffering in older persons receiving palliative home nursing care during their final phase of life. The findings of Study I showed that older persons interviewed hovered between hope and fear, experienced stressful commutes, and were constantly exhausted. Experiences with long, tiring taxi trips, of having few supportive people nearby, and of being offered hardly any local healthcare services made these persons highly vulnerable. Nevertheless, their demands were few, and they rarely complained. The findings of Study II showed a complex, yet comprehensive situation in which physical symptoms and emotions had become entangled. Four themes were found: enduring by keeping hope alive, becoming aware of being one one's own, living up to expectations of being a good patient, and being at risk of losing identity and value. Suffering related to care, or the lack therefore, was the most striking discovery, and the older persons seemed to endure by keeping hope alive. Besides hoping for survival, their hopes also included a desire to be recognised and treated with respect, though such often seemed to go unnoticed. The findings of Study III revealed three themes: being content with what one gets, falling into place, and losing one's place. The phrase picking up the pieces was found useful for summing up the meaning of one's lived experience. In that sense, the three themes referred to how the pieces symbolized the remaining parts of life or services available in their environment and how the older persons might see themselves as pieces in a puzzle. Participants exhibited strong place attachment, involving physical insideness, social insideness, and autobiographical insideness, which suggested that the rural context might provide and advantageous healthcare environment. Interestingly, nurses' personal engagement and willingness to be involved in caring relationship appeared to be more important than any special competence or technical skills. The findings of Study IV showed that patients' expressions left impressions that caused emotional waves in the nurses. Four themes were found: being open for the presence of the Other, being satisfied, being frustrated, and being ambivalent. Understanding and balancing this emotional dimension in care seemed to cause confusion and distress for the nurses, and realizing how their feelings might prompt either generosity or aloofness towards the patient was upsetting. Thatinterpretation suggested confusion regarding what it means to be a professional nurse.Lastly, the findings of Study V showed that bereaved family members perceived suffering related to the illness, to the care, and to the life of their ill relatives during their final phase of life. Well-being emerged as having significant, contrasting elements. Well-being related to other people, to the home, and to activity, in all of which the essence referred to a state of dwelling-mobility. The findings suggested that nurses in this context need to seek out patients' and their families members' experiences with comfort and with disturbance. Nursing and palliative care that become purely disease- and symptom-focused can end with all parties' giving up and divert attention from social and cultural factors that may contribute to well-being when cure is not the goal.The findings of this thesis could alter some current knowledge in the field. From a patient perspective, the rural context is not necessarily disadvantaged, care is not necessarily caring, and the alleviation of suffering and cultivation of wellbeing are not necessarily two sides of the same coin. Home nursing care is often seen as a precondition for staying at home. Working in patients' homes allows nurses to witness and become involved in each patient's unique situation. However, impressions of patients' expressions awake feelings in nurses that have the power to bring about caring actions. At the same time, the fear of being unprofessional or unable to deliver proper care bothers nurses and might threaten the closeness that patients desire. Home nursing is care organized in a system in which services are predefined, apportioned, and bound to specific procedures, and the holistic ideals of the palliative care philosophy are often not within the framework of the system in which district nurses work.
|
|
| 2. |
- Eivergård, Kristina
(författare)
-
Språkets makt : en studie av vårdpersonals tal om psykiatriska patienter och brukare
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this dissertation was to critically examine, based on three selected psychiatric care environments, how healthcare staff talk about patients and users with a focus on how notions of gender are produced and reproduced during rounds and in reportings.Reportings and rounds are daily activities in almost all healthcare practices. It takes place three to four times a day and is ideally aimed at creating continuity and alignment in the care. In psychiatric contexts, the reportings and rounds constitute important tools in assessing which approach and treatment are most appropriate. Studies on verbal reporting have mainly been carried out in somatic care and have been focused on the reportings’ content, type, cost and time required. Research also suggests that healthcare staff find it difficult to move away from a strictly medical perspective and that reporting and rounds take place in a ritualized way where the staff are socialized into what is valid information to pass on. The reportings can also serve as a way for healthcare staff to support each other in their work. The research also applies in psychiatric care contexts where different power structures also become apparent in the use of language. However, how psychiatric care staff talk about patients and users in reportings and on rounds based from a gender perspective has not been studied to any great extent.The dissertation is based on four sub-studies, all with qualitative research design. The empirical material in all sub-studies consisted of sound recordings from rounds and reports in three different psychiatric care contexts; general psychiatry, forensic psychiatry and municipal psychiatry. In sub-study I and II, content analysis was employed and in sub-study III and IV, discourse analysis was employed. Sub-study I showed how the healthcare staff used everyday words and concepts in both reports as in the rounds. The words and concepts formed the basis for assessing the patient's behaviour and mental condition and decisions about nursing and treatment. Sub-study II showed that the language discourse of the healthcare staff reproduced a gender order in which the female patients were expected to behave according to feminine norms in order to be acceptable as women and, as patients. In sub-study III, the statements studied showed a family oriented caring practice and how power techniques in terms of discursive norms around masculinity contributed to the subordination of men cared for in. The results also revealed how the healthcare staff reproduced a heteronormativity gender order through the language used. In sub-study IV, the statements showed a discourse of care where various techniques of power such as intimacy and confession were used to persuade the users to behave according to feminine or masculine norms. The statements also showed a heteronormative and heterosexual order in which the paradox between the need for support and maintaining one's dignity was clarified.The conclusion of the sub-studies together was that the reports and rounds was a scene for which everyday words and concepts were used to describe and assess patients and users. These everyday words and concepts reproduced power orders in which different disciplining power techniques were displayed. The language also reproduced a heteronormative gender order in which notions of femininity and masculinity participated in the assessments of patients and users´ mental states. Because the patients were not involved in the conversations about themselves, healthcare staff were given the possibility to describe and position the patients and users in ways that they themselves were not aware of. In order to create opportunities to break with stereotypical gender patterns as well as patterns of dominance and subordination in psychiatric nursing and care, students, as well as healthcare staff, should work with awareness and critical reflection on discursive norms and how language constructs the patient and user.
|
|
| 3. |
|
|
| 4. |
- Moe, Aud
(författare)
-
Jeg vil leve til jeg dør : Livslyst hos hjemmeboende kronisk sykeeldste eldre
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One challenge in the Western world is the risk of functional impairmentand chronic disease accompanying older age. In Norway it is expected thatmost chronically ill older persons will continue to live at home and receivehelp from home nursing care. The inner strength of the oldest old, as seenin relation to the help that is given, and whether the help has contributed tostrengthen the will to live has been explored only to a limited extent.Meaning in life and daily routines can be related to the will to live,understood as enjoying life and having the courage to live. The aim of thisstudy is to develop knowledge in regard to chronically ill oldest olderpersons and the possibilities and limitations in their will to live when theyreceive help from home nursing care.This study uses the quantitative method (n=120, Article 1 and Article 2) todescribe the characteristics of inner strength using the questionnairesResilience Scale, Sense of Coherence Scale, Purpose in Life Test, and Self-Transcendence Scale. Inner strength was seen in relation to mental andphysical health using the questionnaire SF-36. The qualitative method wasused to illuminate how the oldest older persons experienced living at homewith chronic illness (n=13, Article 3) and receiving help from home nursingcare (n=11, Article 4). The participants in this study were 80 years old orolder, living at home with chronic illnesses, and receiving help from homenursing care. All participants were determined to have the mental capacityto take part in this study.The analysis showed in Article 1 that the oldest old had an inner strengthexpressed as ”sense of coherence” and ”purpose in life.” Their innerstrength was accompanied by the ability for self-transcendence. Mentalhealth was predicted by self-transcendence (p < 0.001) for the total sampleand for women. Physical health was predicted by self-transcendence (p <0.01) for the total sample. Low resilience contributed to vulnerability for theparticipants. They were vulnerable in terms of limited perseverance, selfreliance,and existential aloneness (Article 2). On the contrary, theyexperienced equanimity and meaning. Meaning in daily life (Article 3)sometimes meant feelings of insufficiency and dependency. In contrast,they also experienced joy in life, gratitude for living at home, and aneagerness to participate in activities that made them feel alive. Theyexperienced both good and bad days, which depended on their illness butwas also based on how their needs for help and support were met. InviiArticle 4, receiving help indicated different experiences. Being ill anddependent on help led to days with illness, treatment, and receiving care. Italso indicated they were in need of professional help. Receiving help couldmean being at the mercy of helpers, which could imply unworthy help, asthey had no influence on the help they got from incompetent nurses whofocused only on tasks, with limited flexibility in their work, using theirhomes as a working place. This situation of receiving help from busynurses caused the old person to feel inferior as a human being. Other timesit meant receiving help from nurses who took care with respect to the oldperson and confirmed him or her as a human being. The older personswanted to be seen, met, and supported to strengthen their courage to meetthe challenges of being old and ill.According to the ethics of caring, human beings are vulnerable andmutually dependent on each other. This influences the possibilities andlimitations of ”the other” in experiencing a will to live. ”Receiving theother” can contribute to the will to live, influenced by the help received inan asymmetric dependency in which the nurses are caught in the tensionbetween suffering and the will to live for the oldest older person in need ofhelp. In this tension, the will to live is dependent on help that is given in arelationship characterized by caring and responsibility for the other.
|
|
| 5. |
- Olsen, Rose Mari
(författare)
-
Informasjonsutveksling mellom sykepleiere i hjemmesykepleie og sykehus ved overføring av eldre pasienter
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Darlig samhandling og informasjonsutveksling mellom ulike niva i helsetjenesten har i de senere ar vart gjenstand for bekymring verden over. I Norge ble det gjennom samhandlingsreformen for alvor satt fokus pa behovet for styrking av samarbeidet mellom spesialist‐ og primarhelsetjenesten. Malet med denne avhandlingen var a utvikle kunnskap om sykepleieres informasjonsutveksling knyttet til overforing av eldre pasienter mellom medisinsk sengepost og hjemmesykepleie.Avhandlingen bestar av fire delstudier. I delstudie I ble det gjennomfort fokusgruppeintervju med sykepleiere ved sykehus og hjemmesykepleie i den hensikt a beskrive deres opplevelse av barrierer som pavirker informasjonsutvekslingen. I delstudie II og III ble det gjort en granskning av pasientjournaldata for eldre pasienter innlagt ved medisinsk sengepost. Pasientene var mottakere av hjemmesykepleie for og etter sykehusinnleggelsen. Hensikten med delstudie II var a undersoke forekomst av sykepleierapporter sendt ved overforing, og a identifisere sammenhengen mellom forekomst av sykepleierapporter ogkarakteristika ved pasient og pasientforlop. For delstudie III var hensikten a undersoke innholdet i sykepleierapporter som sendes fra sykehus til hjemmesykepleie ved utskriving, og a identifisere sammenhengen mellom innholdet i sykepleierapportene og karakteristika ved pasient og pasientforlop. Delstudie IV ble gjennomfort som en casestudie knyttet til overforing av ni eldre pasienter. Ved hjelp av observasjon, intervju samt granskning av sykepleiedokumentasjon var hensikten a identifisere og beskrive innholdet i skriftlig og muntlig informasjon som utveksles mellom sykepleiere i hjemmesykepleie og sykehus i forbindelse med eldre hjemmeboende pasienters sykehusinnleggelse, og a identifisere nar og hvordan denne informasjonen utveksles.I delstudie I ble det funnet en rekke barrierer som pavirker sykepleiernes informasjonsutveksling negativt og kan bidra til at eldre pasienter settes i en sarbar og utsatt situasjon. Barrierene kan beskrives ut fra tre hovedtema med tilhorende undertema. Barrierer assosiert med sykepleier: "mangel pa motivasjon", "mangel pa kontroll", og "mangel pa kunnskap". Barrierer assosiert med mellommenneskelige prosesser: "liten tilgjengelighet", "ulike syn" og "mangel pa tillit". Barrierer assosiert med organisasjonen: "mangel pa ressurser", "uklare ansvarsforhold", "manglende kontinuitet i personalet" og "uhensiktsmessige rutiner og retningslinjer".Resultater fra delstudie II viste at forekomst av sykepleierapport var 1 % (N= 102) ved innleggelse og 69 % ved utskriving. Forekomst av utskrivingsrapport var assosiert med alder, kjonn, type medisinsk avdeling, samt lengde pa sykehusoppholdet. Delstudie III viste at informasjon relatert til fysisk helse forekom hyppigere enn informasjon relatert til psykisk helse. Utskrivingsrapportene (N=70) var strukturert i henhold til VIPS‐modellen. Forekomsten av psykisk relaterte VIPS‐sokeord var signifikant hoyere for kvinnelige enn for mannlige pasienter, for pasienter i den eldste aldersgruppen enn for pasienter i den yngste aldersgruppen, og for pasienter innlagt ved geriatrisk enhet enn for pasienter innlagt ved generell medisinsk avdeling. Forekomsten av fysisk relaterte sokeord var signifikant hoyere for pasienter innlagt ved generell medisinsk avdeling enn for pasienter innlagt ved geriatrisk enhet. Mens kjonn og type medisinsk avdeling var signifikante prediktorer for psykisk relaterte sokeord i sykepleierapportene, var type medisinsk avdeling en signifikant prediktor for fysisk relaterte sokeord.Resultater fra delstudie IV viste at utveksling av informasjon mellom sykepleierne i hjemmesykepleien og sykehuset i all hovedsak skjer i forbindelse med utskriving. Det ble ikke gitt informasjon fra hjemmesykepleien til sykehuset ved innleggelse for noen av casene. Informasjon i forhold til fysiske forhold dominerte bade den skriftlige og muntlige kommunikasjonen. Opplysninger om pasientens subjektive opplevelse var sjelden gitt, og forekom bare i den muntlige kommunikasjonen. Det ble funnet forskjeller i den muntlige og den skriftlige informasjonen relatert til psykososiale forhold og sammensatt status. Mal, sykepleietiltak og eventuell effekt ble sjelden rapportert.Avhandlingen viser at informasjonsutvekslingen mellom sykepleiere i hjemmesykepleie og sykehus ved overforing av eldre pasienter er mangelfull bade nar det gjelder forekomst og innhold. Nar det ikke utveksles adekvat informasjon om pasientens helsestatus ved overforing, blir det vanskelig for sykepleier pa neste niva a yte hensiktsmessig omsorg rettet mot pasientens spesifikke behov. Studien avdekket mange barrierer for informasjonsutveksling, og beskrivelsen av disse vil kunne hjelpe bade sykepleiere i praksis og deres ledere til a vare mer oppmerksomme pa de forutsetninger som trengs for a oppna en tilfredsstillende informasjonsutveksling og styrking av kontinuiteten.
|
|
| 6. |
- Rönngren, Ylva
(författare)
-
Supporting healthy lifestyle habits in persons with mental disorders : The development of a nurse-led lifestyle intervention
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Persons with mental disorders have an increased risk of developing health problems. One reason for this is poor lifestyle habit support. The aim of this thesis was to develop and evaluate a nurse-led lifestyle intervention for persons with mental disorders. Two versions of the intervention were conducted in the municipality (versions I, II) and one in a primary healthcare setting (version III). The educational elements of the intervention were led by nurses and practically executed by nursing staff (study II and III). In study IV education was both led and executed in practice by nurses. Data were collected through focus groups, individual interviews, and measurements. Study I, a qualitative development study, showed that, when motivating for lifestyle changes, it was important to structure daily life and provide emotional support. Loneliness, lack of knowledge and support, and general resources were identified as barriers to lifestyle changes. Version I contained health education for nursing staff and individual lifestyle habit support to persons with mental disorders, which included physical exercises and cognitive support. Study II was a qualitative acceptability study of the intervention (version I) and its assessment tools. The intervention with its relational, educational, and supportive dimensions and the assessment tools was promising. In Study III (version II), a quantitative pilot study, persons with mental disorders received health education together with the nursing staff. The intervention provided improvements to various degrees in health-related variables of quality of life, cognitive performance, walking capacity, and waist circumference. Study IV (version III), a qualitative study, included health education and individual lifestyle habit support for young adults with mental illness. The young adults experienced challenges including psychiatric symptoms, loneliness, and a lack of social understanding. The thesis results showed that the core components of the intervention with interpersonal relationships, where nursing staff played an important role, and further components such as health education and health discussions, in addition to cognitive support, worked well together to support lifestyle habit changes. Those components already exist and may therefore be easy to implement into daily nursing practice in different housing conditions and with individuals of different ages and needs for mental health care support. Group education was a way not only to develop new health strategies but also to establish social relationships. The intervention may also be modified to work with other groups of persons who need more explicit lifestyle habit support. However, to better determine the efficacy and sustainability of the intervention, larger studies over a longer time should be conducted.
|
|
| 7. |
- Solum Myren, Gunn Eva
(författare)
-
Dagaktivitetstilbud for personer med demens som bor hjemme : ”Dagen i dag den kan bli vår beste dag”
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis was to examine how persons with dementia in who live at home experience day care services and what the services mean to them, their relatives and care staff. For persons with dementia, everyday life often lacks social and sensory stimuli, and research has shown that their relatives experience a burden of care that strains their quality of life. In response, more knowledge is necessary about how municipal services in should be designed to ensure that persons with dementia can stay at home for as long as possible. From 2020, municipalities in Norway, will have a statutory duty to offer day care services to persons with dementia. The thesis is based on four qualitative studies. In study I, fieldwork comprised observations and informal conversations with persons with dementia (participants) who receive care from two day care services and staff. Study II involved semi-structured interviews and study III, narrative interviews with relatives, whereas study IV involved semi-structured interviews with care staff. In study I, results revealed that location and buildings affected the inclusion of participants in activities. Where as homey, familiar environments contributed to greater activity among participants, institutional environments contributed to greater passivity, at least from the perspective of participants and staff. In turn, the meaningfulness of participants’ everyday lives depended on staff adaptiveness in exercising person-centred care. In study II, relatives of persons with dementia reported that the pre- and post-diagnosis periods were challenging for them and that the day care services, especially the daily routines that they established, were thus exceptionally meaningful. The relatives reported not only that could they afford to rest on days when the persons with dementia received day care services but that the participants experienced those days to be meaningful as well. At the same time, they reported struggling with deciding for how long it would be reasonable for the persons with dementia to live at home. In study III, results revealed that living with persons with dementia affected the everyday lives of spouses and cohabitants, who had to assume new roles and adapt to living lives full of commitment, singularity, anxiety and oneliness. Spouses and cohabitants not only sought to optimally manage their domestic arrangements but also conceal from others how they felt or thought about their situations. To those ends, day care services therefore helped them to persevere in caring for and living with their loved ones, as well as afforded them time to pursue their personal interests. Being visited by day care staff prevented them from having to ask for help because staff members were there to offer it instead.…Last, during study IV, staff reported striving to implement person-centred care by ensuring the dignity of participants and their relatives and facilitating meaningful activities according to individual needs. However, staff also reported facing various barriers in realising person-centred care, including staff shortages, different levels of functioning among participants and limitations in the design of spaces and their location. When developing day care services, it is important to consider both the physical design and location of buildings in which care will be offered. Person-centred care can guide the organization of adequate, tailored day care services able to afford persons with dementia meaningful everyday lives.
|
|
| 8. |
- Voraroon, Supaporn, 1977-
(författare)
-
Participation in shareholding networks for the care of older persons in rural Thailand : Older persons’ and relatives’ experiences
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore how older persons and family caregivers experience taking part in shareholding networks related to health promotion activities for older people in rural areas in Thailand. The thesis had a qualitative research design and is based on original articles (I-IV). Data were collected through paired interviews with older persons and their relatives (I), individual interviews with older persons (II), and by narrative interviews (III-IV). Qualitative data was analyzed with content analysis, phenomenological hermeneutics, and phenomenological philosophy. Study I showed that older persons and their family members experienced outsider status and disregard for older persons` individuality in the community, when participating in shareholding networks. The theme of outsider status described shortcomings in healthcare encounters and the theme of disregard described the lack of engagement of authorities and caregivers in older persons’ care. The concept of participation emerged as a framework for understanding interviewees’ experiences. Local authorities, older individuals, and their family members should engage in dialogue in order to support healthcare based on shared understanding. Study II identified four categories that reflected expressions of health promotion elements in shareholding networks activities: empowerment to control health, participation in society, self-determination, and shared responsibility. All of this can be seen as an important part of a health process. The results indicated that shareholding networks activities contributed to peer volunteering support that has potential to be an effective strategy for increasing activities in older adults, particularly among those who are inactive and socially disengage. Shareholding networks for the care of older people in rural areas seems to promote and preserve volunteerism that satisfies the individual old person's needs—from a holistic perspective—as a way to strengthen self-care. Study III found that older person’s lived experiences with participation in shareholding networks entailed both positive meaning and negative meaning. The participation could be understood as being satisfying, being valuable, being frustrating, and being boring. Study IV showed that participating in shareholding networks activities entails an always-present existence of aging intertwined with life. Its constituents further described the essential meaning of the phenomenon: “experience of improved self-management”, “feeling of increased self-esteem”, and “bridging the gap in the care of older people”. Participation in shareholding networks activities meant keeping contact with oneself and being able to have a life that corresponds to how one perceives oneself to be and must therefore be understood from a holistic perspective that satisfies the individual older person’s needs in the process of strengthening self-care. This thesis concluded that participants experienced benefits when they participated in shareholding networks for the care of older people in rural areas. Participation improved their health, increased their independence and their self-care ability, as well as strengthened their feelings of dignity. Health professionals should initiate a dialogue with shareholding participants to develop a cooperating model of care focusing on the participants` needs. Healthcare must be based on shared understandings and reflections on existential issues such as identity, trust, self-confidence and dignity.
|
|
