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| 2. |
- Andreassen Devik, Siri
(author)
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Hjemmesykepleie til eldre som bor på bygda med uhelbredelig kreft
- 2016
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Doctoral thesis (other academic/artistic)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.
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| 3. |
- Brenne, Tor S., et al.
(author)
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Etterutdanningsnettverket i Namdal : visjon og virkelighet
- 2009
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Reports (other academic/artistic)abstract
- Etter 10 år som et forsøk/prosjekt har EiNa endelig fått sin permanente organisering gjennom en partnerskapsavtale. EiNa-partnerskapet har nå medlemmer som dekker det meste av helseog sosialtjenestene i Namdalen. I tillegg er også oppvekstsektorens ansatte tatt inn i målgruppen for EiNas aktivitet. Denne rapporten er del 2 i det evalueringsprosjektet som styret i EiNa initierte i 2009 og som ble gjennomført av Høgskolen i Nord-Trøndelag. Del 1 presenterte virksomheten gjennom 10 år dels som en historiefortelling, dels med dokumentasjon av prosess og avtaler som EiNa er bygd opp omkring og dels gjennom å presentere aktiviteten i oversikter og i statistikk. Denne rapporten tar for seg resultatene av en brukerundersøkelse som ble gjennomført våren 2009.
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| 4. |
- Enmarker, Ingela, et al.
(author)
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Utprøving av kommunal behandlingsenhet : erfaringer og utfordringer i bruk av akuttplasser i sykeheim
- 2014
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Reports (other academic/artistic)abstract
- Denne rapporten redegjør for følgeforskning av det 3-årige prosjektet «Akuttplasser i sykehjem»(UP-8) –et prosjekt gjennomført i regi av Midtre Namdal Samkommune (Namsos, Overhalla, Fosnes og Namdalseid) i samarbeid medOsen kommune og Flatanger kommune. Prosjektet UP-8 er ett av flere underprosjekt til «Helhetlige helsetjenester». Følgeforskningen er bestilt av Midtre Namdal Samkommune, og har vært ledet av Ingela Enmarker.Hensikten med UP-8 har værtå klargjørehvordan sykehjemstjenesten kanstyrkes og utvikles i tråd med samhandlingsreformens ideer, herunder utrede hvordan kommunene skal kunne bli i stand til å gi tilbud til pasienter både før, istedenfor og etter sykehusinnleggelse. Under prosjektperioden våren 2011 til sommeren 2013 er akuttsenger utredet og prøvd ut ved Overhalla Sykehjem.Følgeforskningen avUP-8 har pågått fra våren 2012 til januar 2014, og har vært finansiert gjennom strategiske midler i Høgskolen i Nord-Trøndelag (HiNT); Namdalsmidler. Hensikten med prosjektet har vært å beskrive erfaringer og utfordringer i bruken av akuttplasser vedOverhalla sykeheim, samt skape aksjoner som kan lede til heving av kvaliteten på tjenestetilbudet. Vi vil rette en stor takk til pasienter, pårørende og pleiepersonale som har vært involvert.
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| 5. |
- Moe, Aud, et al.
(author)
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Hjemmeboende kronisk syke eldre
- 2010
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Conference paper (other academic/artistic)abstract
- Introduksjon: Studien er en del av en større studie om hjemmeboende kronisk syke eldre som mottar hjelp fra hjemmesykepleien. Denne delen av studien fokuserer på de eldres sikkerhet. Målet med paperet er å beskrive eldre menneskers erfaringer opplevelser i forhold til sikkerhet. Metode: Inklusjonskriterier: 80 år eller eldre med en eller flere kroniske sykdommer, og som mottar hjelp fra hjemmesykepleien. Data ble samlet inn gjennom dybdeintervju med 13 eldre, kvinner (n=5) og menn (n=8), i alderen 80-94 år. Transkriberte data ble analysert gjennom manifest innholdsanalyse, og bearbeidet til kategorier og underkategori. Resultat: Dette paperet omhandler kategorien "Sikkerhet for hjemmeboende syke eldre" med underkategoriene "Assistanse gjennom tilrettelegging", "Assistanse gjennom hjelpemidler" og "Assistanse fra hjemmesykepleien". Studien viste at eldre ønsket å bo hjemme. For mange av de som bodde i tradisjonelt hjem var familien en forutsetning for å bo hjemme. Å bo i tradisjonelt hjem ga mulighet til å være i kjente omgivelser, og for noen ga det nærhet til familien. I omsorgsboligene hadde de eldre et hjem tilpasset dagliglivets aktiviteter, med private eiendeler og mulighet for sosiale aktiviteter. Konklusjon: Datamaterialet viste at de eldre som deltok i studien fikk oppfylt ønsket om å bo hjemme var, enten i tradisjonelle hjem tilpasset deres behov, eller gjennom tilpasning ved å flytte til omsorgsbolig tilrettelagt for deres behov.
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| 6. |
- Moe, Aud
(author)
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Jeg vil leve til jeg dør : Livslyst hos hjemmeboende kronisk sykeeldste eldre
- 2013
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Doctoral thesis (other academic/artistic)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.
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| 7. |
- Olsen, Rose Mari
(author)
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Informasjonsutveksling mellom sykepleiere i hjemmesykepleie og sykehus ved overføring av eldre pasienter
- 2013
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Doctoral thesis (other academic/artistic)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.
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| 9. |
- Solum Myren, Gunn Eva
(author)
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Dagaktivitetstilbud for personer med demens som bor hjemme : ”Dagen i dag den kan bli vår beste dag”
- 2018
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Doctoral thesis (other academic/artistic)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.
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