| 1. |
- Bergh, Ingrid, 1956, et al.
(författare)
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Ways of talking about experiences of pain among older patients following orthopaedic surgery.
- 2005
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Ingår i: Journal of advanced nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 52:4, s. 351-9
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to examine how older patients who had undergone hip surgery described their experience of pain. BACKGROUND: A verbal report of pain is considered to be the single most reliable indicator of a person's pain experience. When assessing pain, healthcare professionals must be able to interpret the content of pain reports in order to understand older patient's pain experiences. METHODS: The study was carried out in two orthopaedic and two elder care wards in a large university hospital in Sweden in 2000. Altogether, 38 patients with hip replacement (mean age = 75) and 22 patients with hip fracture (mean age = 81) took part. A face-to-face interview was conducted with each patient on the second day after operation. Data were transcribed and analysed using descriptive qualitative content analysis. FINDINGS: Participants expressed their pain in a nuanced and detailed way in everyday language. Four main themes with sub-themes emerged: (a) objectification (localizing; quantifying; characterizing; temporalizing); (b) compensating (substitution; picturing); (c) explaining (functionalizing pain and its relief; externalizing pain and its relief); (d) existentializing (present pain orientation; future pain orientation). CONCLUSIONS: Exploring the ways older patients talk about pain is expected to result in a better understanding of the older patient's need of empathic individualized care and in the optimization of pain management.
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| 2. |
- Bergh, Ingrid, et al.
(författare)
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Worst experiences of pain and conceptions of worst pain imaginable among nursing students
- 2008
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Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 61:5, s. 484-491
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Tidskriftsartikel (refereegranskat)abstract
- This paper is a report of a study to explore nursing students' own worst experiences of pain as well as their conceptions of the worst pain imaginable. Background.Pain is a personal experience, often assessed using a visual analogue scale. The endpoints of this scale are labelled with the extremes for pain experience (e.g. no pain to worst pain imaginable). People may understand the meaning of `no pain', but it is unclear what meaning they assign to `worst pain imaginable'. This indicates that a rating along the Visual Analogue Scale-line is dependent on the individual's previous experiences. Methods. Data were collected during the autumn of 2002. In total, 549 nursing students completed a questionnaire focusing on two main questions: `What is the worst experience of hurt, ache or pain you have had?' and `What is the worst pain imaginable for you?' Content analysis was used for data analysis. Results. The students' worst experience of pain was mostly related to acute or traumatic painful conditions, pain associated with female physiology, inflicted pain, psychological suffering and chronic painful conditions. The worst pain imaginable was described as condition-related pain, overwhelming pain, experiences of losses, deliberately inflicted pain, psychological suffering and as vicarious pain. Conclusion. The findings imply that nursing students, when they are imagining pain, include dimensions such as hope of relief, grief, control over the situation, powerlessness and empathy for and suffer with other people's pain. Further research is needed to explore why professional experience as a nurse diminishes the ability to imagine patients' pain.
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| 3. |
- Jakobsson, Eva, 1960, et al.
(författare)
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Clinical problems at the end of life in a Swedish population, including the role of advancing age and physical and cognitive function.
- 2008
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 36:2, s. 177-82
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To improve the understanding of specific clinical problems at the end of life, including the role of advancing age, physical function and cognitive function. METHODS: The study is part of an explorative survey of data relevant to end-of-life healthcare services during the last 3 months of life of a randomly selected sample of the population of a Swedish county. Data were selected through retrospective reviews of death certificates and medical records, and comprise information from 12 municipalities and 229 individuals. RESULTS: A range of prevalent concerns was found. Overall deterioration, urinary incontinence, constipation, impaired skin integrity, anxiety and sleep disturbances were significantly associated with dependency on others for activities of daily living; pulmonary rattles and swallowing disturbances were associated with cognitive disorientation; excepting cough, advancing age did not have significant impacts on these prevalent clinical concerns. CONCLUSIONS: A range of distressing conditions constitute a common pathway for many individuals at or near the end of life. The incorporation of health promotion as a principle of palliative care will probably benefit individuals at the end of life, and includes a proactive focus and emphasis on enhanced well-being at the time of diagnosis of a life-threatening illness. For individuals with physical and cognitive limitations imparting a state of dependency, it is reasonable to provide assurance of care for individuals' specific needs by professionals with both training for and competence in this special and sometimes unique clinical environment.
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| 4. |
- Jakobsson, Eva
(författare)
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End-of-life care in a Swedish county : patterns of demographic and social conditions, clinical problems and health care use
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is broad consensus in both international and national policy statements that care provided at end-of-life should be different from care provided during other periods of life. There is a need for comprehensive knowledge about the broad population of individuals who access the public health care system during the last period of life. The purpose of this thesis therefore, is to make a contribution to a broader understanding of the nature of end of-life and end-of-life care for these individuals. The study was undertaken through retrospective examinations of death certificates, medical records and nursing records in a randomly selected sample of adults who accessed the public health care system, and who died in the County of Västra Götaland, Sweden, during 2001. The sample consisted of 229 persons. The majority of individuals in this study were aged eighty or more at time of death. Men died four years younger, and were significantly more likely to live apart from their partners at time of death, whereas women were significantly more likely to live alone. There were also significant differences in residential environment at time of death, with one-half residing in private homes and the other half in residential care facilities, and this environment was significantly associated with many of the variables analyzed in this study. The group in residential care facilities was, on average, nearly 10 years older than those in private homes. The most common places of death were acute care hospitals and residential care facilities. The less old persons more often died at acute care hospitals whereas the oldest group more commonly died at residential care facilities. The likelihood of inpatient care during last three months of life, including the expected number of hospital admissions, was significantly higher among residents of private homes than among individuals in residential care facilities. However, the presence of mental disorder(s), mainly dementia, was associated with less utilization of both inpatient and hospital-based outpatient care, regardless of residence. Conversely, the likelihood of using outpatient primary care services was significantly higher among residents of residential care facilities than among those in private homes. Factors such as advancing age, ADL-dependency, and living alone increased the likelihood of receiving care at residential care facilities, whereas presence of neoplasm(s) and musculoskeletal disease(s) increased the likelihood of care in a private home. The mean number of all health care services used was 2.67. A wide range of highly prevalent symptoms and problems was identified in the study group, especially among persons who were ADL-dependent. A specific turning point, reflecting onset of the dying process and reorientation of care, was documented in almost three-quarters of the medical or nursing records. Two thirds of these turning points were documented within the last week of life. Findings from this study provide policymakers, health care providers, and professional caregivers with both a reminder and a framework which may contribute to a more mindful and comprehensive understanding of commonplace end-of-life concerns. It is, in fact, suggested that the public health care system as a whole take greater note of the present situation and that it proactively focus on the development of standards for end-of-life care. Its content should be formulated and based on systematic and detailed insights into the identities of the individuals who utilize the health care system at the end of life, where and from whom they receive care, and most importantly, the nature of their problems and needs. Moreover, steps must be taken to continually audit end-of-life care provided by the public health care system, with an objective to constantly improve the scope, quality, and trustworthiness of its services
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| 5. |
- Jakobsson, Eva, 1960, et al.
(författare)
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End-of-life in a Swedish population: demographics, social conditions and characteristics of places of death.
- 2006
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Ingår i: Scandinavian journal of caring sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 20:1, s. 10-7
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of this study were to identify and describe the demographics and social conditions as well as characteristics of the places of death in a randomly selected sample that died in a county in Sweden during 2001. The present study reports part of the findings from a larger study undertaken during 2003 using a survey design of retrospective reviews of death certificates, medical records, and nursing records. Among several noteworthy findings are: first, an examination of these individuals' living arrangements reveal not only a large and vulnerable group that lives alone at the end-of-life but also a group living separated from their partners near end-of-life; second, individuals differ with respect to residence prior to death, that is private homes versus residential care facilities, imparting highly different contexts of care at the end-of-life; and third, a high prevalence of institutionalized deaths demonstrates that places of death other than hospitals and residential care facilities are uncommon, if not rare. It is concluded that increased attention to the social circumstances of the time period surrounding individuals' at the end-of-life is essential. There is need to develop more integrated models of care for dying people. Contemporary services available are not designed to meet a wide range of peoples' needs at the end-of-life. Home-based care, residential care and hospital care must be adapted to the changing patterns of dying. The services available should be organized to the benefit of the users rather than around the providers. This is the first study of its kind of a Swedish sample and while the data are limited to one county in Sweden its findings may contribute to a deeper understanding of demographic and social patterns at the end-of-life in general.
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| 6. |
- Jakobsson, Eva, et al.
(författare)
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The turning point : Identifying end-of-life care in everyday health care practice
- 2007
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Ingår i: Contemporary Nurse. - : EContent Management Pty Ltd. - 1037-6178 .- 1839-3535. ; 27:1, s. 107-118
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Tidskriftsartikel (refereegranskat)abstract
- There is a broad consensus among international policy statements that care provided at end-of-life should be different from care provided during other periods of life which assumes a turning point which reflects the onset of the dying process and the associated care reorientation. Few studies derived from empirical data have described this turning point from a clinical perspective. With the purpose to increase the clinical understanding about the nature Of such turning points this study explores this phenomenon as determined from health-care records Of a representative sample of adults who accessed the public health care system, and who died in the County of Vastra Gotaland, Sweden, during 2001 (n = 229). Record entries reflecting a turning point, that is recognition as being at the end-of-life and a message about a switch from curative, life-extending or rehabilitative care to an emphasis on palliation, were found in slightly less than 70% of the records while slightly more than 30% lacked such descriptions. The record entries were analyzed with content analysis. As a whole, the descriptions were largely relying on a biomedical discourse and typically put in terms of signs of declining processes, undefined serious condition, Prognostications of fatal outcome or justifications of given up active treatments. The procedures which followed the recognition of a turning point revealed that nurses and physicians typically emphasize procedures directed to the patients' families, on re-orientation Of treatments and on approaches to further care. The picture of the patients' last time of life as reflected from these record entries is that end-of-life is described in biomedical and factual-oriented terms. The end-of-life care was broadly described in vague terms with lack Of concrete care plans. Holistic and good end-of-life care as revealed in this study is indistinguishable, highly embedded in a medical model of care and, hence, an abstract and unknown territory without specific content.
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| 7. |
- Jakobsson, Eva, 1960, et al.
(författare)
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The turning point: Clinical identification of dying and reorientation of care.
- 2006
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Ingår i: Journal of palliative medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 9:6, s. 1348-58
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Tidskriftsartikel (refereegranskat)abstract
- Palliative care is increasingly organized within the setting of formal health care systems but the demarcation has become unclear between, on the one hand, care directed at cure and rehabilitation and palliative care aimed at relief of suffering on the other. With the purpose to increase the understanding about the turning point reflecting identification of dying and reorientation of care, this study explores this phenomenon as determined from health care records of a representative sample (n = 229). A turning point was identified in 160 records. Presence of circulatory diseases, sporadic confinement to bed, and deterioration of condition had a significant impact upon the incidence of such turning point. The time interval between the turning point and actual death ranged between one and 210 days. Thirty percent of these turning points were documented within the last day of life, 33% during the last 2-7 days, 19.5% during the last 8-30 days, 13% during the last 31-90 days, and 4.5% during the last 91-210 days of life. The time interval between the turning point and actual death was significantly longer among individuals with neoplasm(s) and significantly shorter among individuals suffering from musculoskeletal diseases. Perhaps this reflects a discrepancy between the ideals of palliative care, and a misinterpretation of the meaning of palliative care in everyday clinical practice. The findings underscore that improvement in timing of clinical identification of dying and reorientation of care will likely favour a shift from life-extending care to palliative care.
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| 8. |
- Jakobsson, Eva, et al.
(författare)
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Utilization of health-care services at the end-of-life
- 2006
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Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 82:3, s. 276-287
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Tidskriftsartikel (refereegranskat)abstract
- End-of-life care poses a growing clinical and policy concern since most people who are dying utilize health-care services during this period of life. Hence, end-of-life care is a common and integral part of the care provided by health-care systems. There is a growing call for the implementation of a palliative approach as an integral part of all end-of-life care. The purpose of this study was thus to provide policy-makers, health-care providers and professional caregivers with increased knowledge about mainstream patterns of health-care utilization during end-of-life. The patterns of use of health-care services in a Swedish population who accessed the health-care system during their last 3 months of life were in this study examined through a retrospective examinations of medical and nursing records (n = 229). We found high prevalences of use of both hospital care, primary care and care provided in people's homes and nearly three quarters of the persons included in the study used between two and three health-care services. However, the probability of using different health-care services was found to be strongly depending on demographic, social, functional and disease related characteristics. The study reveals a considerable use of different health-care services during end-of-life. It is hence essential to, on one hand delineate how such health-care services best can support people at the end-of-life, and on the other hand develop policies which facilitate the process of dying, both in hospitals as well as in peoples’ homes. Implications for policy are discussed.
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| 9. |
- Svensson, Ann-Marie, et al.
(författare)
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'Older Peoples' Descriptions of Becoming and Being Respite Care Recipients'
- 2011
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Ingår i: Journal of Housing For the Elderly. - : Informa UK Limited. - 0276-3893 .- 1540-353X. ; 25:2, s. 159-174
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Tidskriftsartikel (refereegranskat)abstract
- The number of older people in the western world is increasing. Advancing age creates the need for care, including respite care. The aim of this study is to describe the experience of older people of becoming and being respite care recipients. Admission to respite care is a response to a range of practicalities in the home, such as the need to maintain privacy, dissatisfaction with home care, and deterioration in health. However, the participants in this study had little or no involvement in the decision regarding respite care placement. Activities, training, and medical treatment were found to be important to respite care recipients’ satisfactionwith their care.
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| 10. |
- Öhlén, Joakim, 1958, et al.
(författare)
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Impact of the Bologna process in Bachelor Nursing programmes: The Swedish case
- 2011
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Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 31:2, s. 122-128
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Tidskriftsartikel (refereegranskat)abstract
- Summary The higher education reform in Europe known as the “Bologna Process” implies further harmonisation and integration of nursing programmes into the higher education system. This study explores this process in Sweden, where the development of nursing education into an undergraduate programme started in 1977. The aim of this study was to analyse characteristics of the major subject and its relationship to other subject areas, such as medical sciences and social sciences, in Bachelor level nursing programmes in Sweden following initial implementation of the Bologna process. A constructivist approach and descriptive content analysis were employed to analyse the 2008 nursing curricula and syllabi of 27 undergraduate programmes at 26 Swedish universities and university colleges. The results revealed variation in terms and concepts used for the major subject as well as its scientific foundation, demarcation between the major subject and other subjects included in the study programmes and its relationship to the profession. These variations are linked to the variety of research orientations under debate in the Scandinavian countries: Nursing Science and Caring Science; representing different knowledge domains, focus, challenges and visions for the discipline. Potential implications of basing curricula on a major subject other than Nursing Science in a Bachelor level nursing programme are highlighted.
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