| 1. |
- Thulesius, Hans, et al.
(författare)
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Learner-centred education in end-of-life care improved well being in home care staff: a prospective controlled study.
- 2002
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Ingår i: Palliative Medicine. - : SAGE Publications. - 1477-030X .- 0269-2163. ; 16:4, s. 54-347
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden. Another rural district in the same region served as a control area. A 20-item questionnaire measuring attitudes towards end-of-life care was designed, and the Hospital Anxiety and Depression (HAD) scale was used to measure mental well being. Increased agreement to 18 of 20 attitude statements was seen in the education group, while 2 of 20 items showed a decreased agreement in the control group. Test retest reliability of the 20-item questionnaire was good (r =0.92). The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group (95% CI=2.1– 3.7; P<0.001), and was 6.8 for both years in the control group. Our study shows that a comprehensive educational programme not only improved attitudes towards end-of-life care, but also the mental well being of the home care staff.
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| 2. |
- Bendix, Marie, et al.
(författare)
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Insulin and glucagon in plasma and cerebrospinal fluid in suicide attempters and healthy controls
- 2017
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Ingår i: Psychoneuroendocrinology. - : Elsevier. - 0306-4530 .- 1873-3360. ; 81, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Mental disorders and related behaviors such as suicidality and violence have been associated to dysregulation of e g carbohydrate metabolism. We hypothesized that patients after suicide attempt, compared to healthy controls, would have higher insulin and lower glucagon levels in plasma and cerebrospinal fluid and that these changes would be associated to violent behavior. Twenty-eight medication-free patients (10 women, 18 men), hospitalized after suicide attempt, and 19 healthy controls (7 women, 12 men) were recruited with the aim to study risk factors for suicidal behavior. Psychological/psychiatric assessment was performed with SCID I and II or the SCID interview for healthy volunteers respectively, the Karolinska Interpersonal Violence Scale (KIVS) for assessment of lifetime violence expression behavior, the Montgomery-Asberg-Depression-Scale (MADRS) and the Comprehensive Psychological Rating Scale (CPRS) for symptomatic assessment of depression and appetite. Fasting levels of insulin and glucagon were measured in plasma (P) and cerebrospinal fluid (CSF). Suicide attempters had higher insulin- and lower glucagon-levels in plasma- and CSF compared to controls. Except for P-glucagon these associations remained significant after adjusting for age and/or BMI. Patients reported significantly more expressed interpersonal violence compared to healthy volunteers. Expressed violence was significantly positively correlated with P- and CSF-insulin and showed a significant negative correlation with P-glucagon in study participants. These findings confirm and extend prior reports that higher insulin and lower glucagon levels in plasma and cerebrospinal fluid are associated with suicidal behavior pointing towards a potential autonomic dysregulation in the control of insulin and glucagon secretion in suicidal patients.
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| 3. |
- Hansson, Max, 1956-
(författare)
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Att implementera med hjälp av samverkan : En studie av implementering av ett stödboende med samverkan som metod
- 2021
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this licentiate thesis studies how a systematic work of implementing a supported housing develops from idea to practice with the purpose to analyze collaboration and its impact on the development of the implementation. The study followed how the four organizations created a collaboration to implement a supported housing.; the social services in Kalmar municipality, the Swedish Prison and Probation Service in the form of the local probation service in Kalmar, the association KRIS (Kriminellas Revansch I Samhället, [Criminals' Revenge In Society]) in Kalmar and Kalmarhem AB a housing company, The starting point for the study consists of a process evaluation of an implementation process, how collaboration established between the organizations, how collaboration as a way of working affects the process and finally the split-up of the project. The study conducted in two parts: partly during the years 2006-2008 when implementation studied, partly during the years 2014-2015 when the split-up of the project studied. The methods used was interviews, participatory observations and document studies. The empirical evidence collected during the two periods forms the basis for the analysis.The results indicate that collaboration created between the actors of the implementation is of crucial importance. That is, how the actors confronted and solved the problems that arose during the implementation and that both time and various forms of resources are required to create a comprehensive collaboration. The concluding part of the study describes how a split-up of collaboration takes place. The change can attributed to a new arrangement with clear operational management in accordance with the impact of New Public Management [NPM]. A consequence for the supported housing, in line with this logic, was a separation and division of clients and contractors and division between businesses in accordance with a competitive mindset.At the time of writing, the supported housing remains, albeit in a different form. One explanation is that during the implementation, a close and sustainable collaboration was developed that could withstand some of the threats created through changed forms of governance. This indicates that the collaboration that developed between the four organizations can still provide some space if it is able to find forms that can fit into new control logics.
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| 4. |
- Lindqvist, Gunilla, et al.
(författare)
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Informal home caregiving in a gender perspective : A selected literature review
- 2004
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Ingår i: Vård i Norden. - 0107-4083 .- 1890-4238. ; 24:4, s. 26-30
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Tidskriftsartikel (refereegranskat)abstract
- An informal home caregiver is a person (family member or friends) who takes care of or participates to some degree in the care of a person in the home. This study provides a selected review of literature published 1982-2003 of the informal home caregiving from a gender perspective. A computer-aided search using MEDLINE and CINAHL was carried out. The final number of articles was 45. The main findings were that there are differences in informal caregiving due to gender. Gender differences were found in categories such as affected lifeworld, health problems, managing ability and caregivers experience from caring for a care receiver with different diseases. It is of importance that the informal caregiver is involved in the planning and that a planning act takes place. If society involves the informal home caregiver we can avoid the caregiver being the hidden victim of illness and disability. It is known that burdensome caregiving can result in encroachment due to exhaustion.
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| 5. |
- Sandgren, Anna, 1970-, et al.
(författare)
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Anticipatory Caring
- 2008
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Ingår i: The Grounded Theory Review. - 1556-1542 .- 1556-1550. ; 7:3
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Tidskriftsartikel (refereegranskat)abstract
- Today, more and more people die in own homes and nursinghomes, which fundamentally affects community nursing. The aimof this study was to develop a grounded theory of palliative homenursing care and we analyzed interviews and data related to thebehavior of community nurses caring for palliative cancerpatients. Doing Good Care emerged as the pattern of behaviorthrough which nurses deal with their main concern, their desireto do good care. The theory Doing Good Care involves threecaring behaviors; anticipatory caring, momentary caring andstagnated caring. In anticipatory caring, which is the optimalcaring behavior, nurses are doing their best or even better thannecessary, in momentary caring nurses are doing bestmomentarily and in stagnated caring nurses are doing good butfrom the perspective of what is expected of them. When nursesfail in doing good, they experience a feeling of letting the patientdown, which can lead to frustration and feelings of powerlessness.Depending on the circumstances, nurses can hover between thethree different caring behaviors. We suggest that healthcareproviders increase the status of palliative care and facilitate fornurses to give anticipatory care by providing adequate resourcesand recognition.
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| 6. |
- Sandgren, Anna, 1970-
(författare)
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Deciphering Unwritten Rules : Patients, relatives and nurses in palliative cancer care
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on palliative cancer care in acute care hospitals and home care settings. The overall aim was to generate a grounded theory explaining the latent patterns of behavior of patients, relatives and nurses. The thesis includes one population-based study with cross-sectional design and four classic grounded theory studies.Study I was conducted in two acute care hospitals. In this 5-year follow-up study, the proportion of hospitalized palliative cancer patients had decreased. The patients were older with more symptoms and care needs per patient. In both years, the most common symptoms were pain and deterioration and the most common cancer sites were prostate and colorectal. The results showed that associations between symptoms, care needs and cancer site were mostly weak.In study II, striving for emotional survival emerged as the pattern of behavior through which nurses in acute care hospitals deal with their main concern, the risk of being emotionally overloaded. Striving for emotional survival involves emotional shielding, emotional processing and emotional postponing. In study III, doing good care emerged as the pattern of behavior through which nurses in home care deal with their main concern, their desire to give good care. Doing good care involves three different caring behaviors: anticipatory caring, momentary caring and stagnated caring. In study IV, living on hold emerged as the pattern of behavior through which patients and relatives deal with their main concern, being put on hold. Living on hold involves three modes: fighting, adjusting and surrendering.The overall theory, deciphering unwritten rules, explains how patients, relatives and nurses are dealing with the uncertainty of how to act and behave. Deciphering unwritten rules involves figuring out, deliberating, maneuvering and evaluating.In conclusion, this thesis demonstrates the complexities of palliative cancer care and the importance of knowledge, resources and counseling. Patients should be cared for at the right care level according to their care needs and the care focus should be on treating symptoms irrespective of the diagnosis. The palliative care approach therefore needs to be implemented in all caring contexts with dying people.
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| 7. |
- Sandgren, Anna, et al.
(författare)
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"Doing good care" - a study of palliative home nursing care
- 2007
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 2, s. 227-235
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Tidskriftsartikel (refereegranskat)abstract
- Today, more and more people die in own homes and nursing homes, which fundamentally affects community nursing. The aim of this study was to develop a classic grounded theory of palliative home nursing care and we analysed interviews and data related to the behavior of community nurses caring for palliative cancer patients. Doing Good Care emerged as the pattern of behavior through which nurses deal with their main concern, their desire to do good. The theory Doing Good Care involves three caring behaviors; Anticipatory caring, Momentary caring and Stagnated caring. In Anticipatory caring, which is the optimal caring behavior, nurses are doing their best or even better than necessary, in Momentary caring nurses are doing best momentarily and in Stagnated caring nurses are doing good but from the perspective of what is expected of them. When nurses fail in doing good, they experience a feeling of letting the patient down, which can lead to frustration and feelings of powerlessness. Depending on the circumstances, nurses can hover between the three different caring behaviors. We suggest that healthcare providers increase the status of palliative care and facilitate for nurses to give Anticipatory care by providing adequate resources and recognition.
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| 8. |
- Sandgren, Anna, 1970-, et al.
(författare)
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Living on hold in palliative cancer care
- 2010
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Ingår i: The Grounded Theory Review. - Mill Valley, CA : Sociology Press. - 1556-1542 .- 1556-1550. ; 9:1, s. 79-100
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to develop a classic grounded theory of palliative cancer patients and their relatives in the context of home care. We analyzed interviews and data related to the behaviour of both patients and relatives. “Living on hold” emerged as the pattern of behaviour through which the patients and relatives deal with their main concern, being put on hold. Living on Hold involves three modes: Fighting, Adjusting and Surrendering. Mode being may change during a trajectory depending on many different factors. There are also different triggers that can start a reconciling process leading to a change of mode. This means that patients and relatives can either be in the same mode or in different modes simultaneously. More or less synchronous modes may lead to problems and conflicts within the family, or with the health professionals.
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| 9. |
- Sandgren, Anna, et al.
(författare)
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Striving for emotional survival in palliative cancer nursing
- 2006
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Ingår i: Qualitative Health Research. - : Sage Publications. - 1049-7323 .- 1552-7557. ; 16:1, s. 79-96
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Tidskriftsartikel (refereegranskat)abstract
- In this grounded theory study, the authors analyze interviews and participant observation data related to palliative cancer nursing in hospitals. Striving for Emotional Survival emerged as the pattern of behavior through which nurses deal with their main concern, the risk of being emotionally overloaded by their work. It involved three main strategies: Emotional Shielding through Professional Shielding or Cold Shielding; Emotional Processing through Chatting, Confirmation Seeking, Self-Reflecting, or Ruminating; and Emotional Postponing through Storing or Stashing. Emotional Competence is a property of Striving for Emotional Survival that explains more or less adequate ways of dealing with emotional overload. The theory Striving for Emotional Survival can be useful in the nurses' daily work and provides a comprehensive framework for understanding how nurses deal with emotional difficulties. The authors suggest that health care organizations encourage self-care, prioritize time to talk, and offer counseling to nursing staff with emotionally difficult working conditions.
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| 10. |
- Sandgren, Anna, 1970-, et al.
(författare)
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Symptoms, care needs and diagnosis in palliative cancer patients in acute care hospitals: A 5-year follow-up survey
- 2010
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Ingår i: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 49:4, s. 460-466(7)
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Palliative cancer care in acute hospitals is scarcely studied. We therefore described and compared symptoms, care needs and types of cancer sites in 2002 compared to 2007 and analysed the relationships between these factors. METHODS: The study was population-based with a cross-sectional design and was carried out in medical, surgical and oncology wards in two acute care hospitals with no advanced palliative home care service. In 2002, 82 one-day-inventories were done (1 352 patients) compared to 142 one-day-inventories in 2007 (2 972 patients). Symptoms, care needs and cancer site were registered according to a questionnaire. Multiple logistic regression models were used to analyse associations between symptoms, care needs and cancer site. RESULTS: The proportion of palliative cancer patients had decreased during a five year period (14% vs. 11%, p<0.01). The patients were older in 2007 (74 vs. 70 years, p<0.001) and had more symptoms and care needs per patient (2.6 vs. 1.6, p<0.001). The most common symptoms were pain and deterioration and the most common cancer sites were prostate and colorectal cancer in both samples. Associations between symptoms, care needs and cancer site were mostly weak. Deterioration was associated with colorectal cancer, whereas pain was not associated with any specific cancer site. In haematological malignancies there was a high occurrence of infections and a high need of blood transfusions and infusions. Stomach/oesophagus cancers were significantly associated with nausea, nutritional problems and need of infusions while unknown primary malignancies were associated with abdominal surgery and infusions. DISCUSSION: Although we do not know all the causes for hospitalization, this study indicates that more focus should be on the symptoms instead of the specific cancer diagnosis. The findings also indicate that many palliative cancer patients' problems would be suitable for advanced palliative home care instead of acute hospital care.
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