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Sökning: WFRF:(Skovdahl Kirsti) > Kihlgren Mona

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1.
  • Fläckman, Birgitta, et al. (författare)
  • Consequences of working in elder care during changes and cutbacks in the organisation while education and clinical supervision was provided : A mixed methods study
  • 2015
  • Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 5:9, s. 813-827
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Reorganization and downsizing can disrupt a competent staff and conflicts can arise between what the employee is being asked to do and their knowledge and competences. Reduced job satisfaction among nursing home staff with increased workload and strain can occur. Aim and Objectives: The aim was to investigate the organizational climate and prevalence of burnout symptoms among caregivers over time in three Swedish nursing homes (NH I-III) undergoing organizational changes, while education and clinical supervision were provided. Design: The study design combines qualitative and quantitative methods in a longitudinal two-year follow-up project in NH I-III. Methods: Support through education and clinical supervision was provided for caregivers only at NH I and NH II. At NH I-III caregiver self-assessments and interviews were completed and analysed three different times. Results: NH I revealed improvement and increased innovation over time, while NH II showed a decline with no ability to implement new knowledge. NH III retained a more status quo. Conclusions: Organizational changes and cutbacks, occurring at different times, appeared to cause major stress and frustration among the three personnel groups. They felt guilty about not meeting their perceived obligations, seemed to have lost pride in their work but kept struggling. The changes seemed to over-shadow attempts to improve working conditions through education and clinical supervision initially. Implications for practice: It will be important to learn from reorganizations and the consequences they will have for the staff and quality of care. Important topics for future research are to study financial cutbacks and changes in organizational processes in care of older people to be able to develop a more person centered care for older people.
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2.
  • Häggström, Elisabeth, et al. (författare)
  • To feel betrayed and to feel that you are betraying the older residents : caregivers' experiences at a newly opened nursing home
  • 2004
  • Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 13:6, s. 687-696
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: In Sweden and internationally, little research has focused on the working situation of Enrolled Nurses and Nurses' Aides who form the majority of workers in geriatric care today. With this in mind, it is important to focus on how these occupational groups experience their working situation with older residents in municipal care.AIMS AND OBJECTIVES: The aim of the study was to investigate the deeper meaning of work satisfaction and work dissatisfaction at a newly opened nursing home for older residents. The study focused on the narratives supplied by the caregivers at the nursing home. The participants included: one Registered Nurse, sixteen Enrolled Nurses, and three Nurses' Aides. All were directly involved in patient care.DESIGN: The present study is part of a larger longitudinal study within the municipal geriatric care system in Sweden, with a quasi-experimental design.METHOD: The interviews were analysed with a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur.RESULT: The caregivers experiences of work satisfaction and work dissatisfaction was expressed in four themes: (i) 'Experience of betrayal' describes how the staff felt let down in several ways; (ii) 'Experience of failing others' describes how the staff felt that they did not pay enough attention to older people, in several different ways; (iii) 'Experience of insufficiency' describes how the staff encountered overwhelming demands from several directions; (iv) 'Experience of work satisfaction' describes how the staff felt that they were given support in various ways. Each theme emerged from several subthemes that originated from the caregivers' narratives.CONCLUSIONS: The study shows that the caregivers' experience of work dissatisfaction overshadows their experience of work satisfaction. It also suggests that their feelings of failing the older residents are connected to their own experiences of feeling betrayed.RELEVANCE TO CLINICAL PRACTICE: The findings can be used when other nursing homes in municipal care are opened, as a means of preventing work dissatisfaction and increasing work satisfaction among future employees.
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3.
  • Häggström, Elisabeth, et al. (författare)
  • Work satisfaction and dissatisfaction : caregivers' experiences after a two-year intervention in a newly opened nursing home
  • 2005
  • Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 14:1, s. 9-19
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS AND OBJECTIVES: The aim of the study was to investigate, from the narratives of nine enrolled nurses and one nurses' aide directly involved in patient care, the deeper meaning of work satisfaction and dissatisfaction when working with the older people.BACKGROUND: Both nationally and internationally, there is little research documented regarding the working situation of the enrolled nurses and nurses' aides who make up the majority of care for older people today. With this in mind, it is important to focus on how these occupational groups experience their work with the older residents in municipal care, following a two-year intervention.DESIGN: The study is part of a larger longitudinal study, with a quasi-experimental design within the municipal system of care for older people in Sweden. The investigation was carried out following a two-year intervention, which included: education, support and clinical supervision.METHOD: The interviews were performed 12 and 24 months after start of the intervention and were analysed with a phenomenological-hermeneutic method inspired by Ricoeur's philosophy.RESULTS: The findings from these narratives illustrated a change compared with the findings from the first interviews, when the nursing home had just opened. There was a shift from a dominance of dissatisfaction with work, to a dominance of work satisfaction and this was expressed in the following themes: experience of a changed perspective, experience of open doors, and experience of closed doors. Each theme emerged from several different subthemes and each subtheme that had been expressed in the caregivers' narratives was interpreted.CONCLUSIONS: The study shows that the caregivers' experience of work satisfaction in the workplace exceeded their experience of dissatisfaction and that the intervention, consisting of: education, support, and supervision might have facilitated this positive development where the older residents were prioritized. It also shows that communication and understanding between management and staff had increased as the nursing home had opened.RELEVANCE TO CLINICAL PRACTICE: The findings can be used to help to prevent work dissatisfaction, and thereby increase work satisfaction for caregivers working in nursing homes.
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4.
  • Kihlgren, Annica Larsson, 1957-, et al. (författare)
  • Referrals from home care to emergency hospital care : basis for decisions.
  • 2003
  • Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 12:1, s. 28-36
  • Tidskriftsartikel (refereegranskat)abstract
    • The Swedish government implemented a reform, the Adel reform, in the care of older citizens in 1992, so that the communities where older people live became responsible for their care and housing. Nurses were appointed to make sure that older people were given accurate care and to act as supervisors for nurses' aides. In this study, 10 Registered Nurses from community home care services and four consultant head physicians in primary care were interviewed in order to illuminate what they thought influenced nurses' decisions to refer patients for emergency treatment and what support they requested to facilitate the decision. Content analysis showed the necessity of feeling secure in one's role as a community nurse. The categories that developed were: own competence, knowledge about the patient and a supportive working environment. The main theme was To feel safe in one's role - a basis for decision-making. High demands were put on the nurses' competence and their burden of responsibility became too great. This influenced decision-making negatively, if nurses felt that they were lacking in their own personal competence. Training in documentation for the nurses was required, as well as the need for organizations to provide staff with sufficient time for accurate documentation. A greater input of nursing and medical care was required to make it possible for patients to be cared for at home if they so wished. Respondents described considerable deficiencies in their working environment and in co-workers' competence, and nurses' professional roles within the community were not made clear. If these problems were remedied, this would improve working conditions, increase understanding, and reduce feelings of uncertainty among decision-makers.
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6.
  • Quell, Robin, et al. (författare)
  • Using tactile stimulation in a dementia care facility with plasma prolactine as an outcome measure : a pilot study
  • 2008
  • Ingår i: Archives: the international journal of medicine. - 1791-4000. ; I:3, s. 123-129
  • 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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7.
  • Skovdahl, Kirsti, 1964-, et al. (författare)
  • Demanding behaviours and workload in elderly care in Sweden : occurrence at two time points within a decade
  • 2008
  • Ingår i: Scandinavian Journal of Caring Sciences. - Oxford : Blackwell. - 0283-9318 .- 1471-6712. ; 22:3, s. 323-330
  • 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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8.
  • Skovdahl, Kirsti, 1964-, et al. (författare)
  • Dementia and aggressiveness : video recorded morning care from different care units
  • 2003
  • Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 12:6, s. 888-898
  • 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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9.
  • Skovdahl, Kirsti, 1964-, et al. (författare)
  • Dementia and aggressiveness : stimulated recall interviews with caregivers after video-recorded interactions
  • 2004
  • Ingår i: Journal of Clinical Nursing. - Oxon, United Kingdom : Wiley. - 0962-1067 .- 1365-2702. ; 13:4, s. 515-525
  • 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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10.
  • Skovdahl, Kirsti, 1964-, et al. (författare)
  • Different attitudes when handling aggressive behaviour in dementia : narratives from two caregiver groups.
  • 2003
  • Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 7:4, s. 277-286
  • 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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