| 1. |
- Arvidsson, Susann
(författare)
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Health promoting factors in people with chronic musculoskeletal pain or with rheumatic diseases: a descriptive and interventional study
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis with a salutogenic approach was to describe health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, and to evaluate the effects of an intervention study with a self-care promoting PBL-program for people with rheumatic diseases having chronic musculoskeletal pain, sleep disturbances and/or fatigue. Methods: This thesis is comprised of four samples: a randomly selected sample from a Swedish general population (study I) and three different samples containing people with rheumatic diseases registered at a hospital for rheumatic diseases in the southwest of Sweden (studies II, III and IV). Study I had a longitudinal cohort design with an eight-year follow-up in a general population. There were 1109 participants without chronic pain and 700 participants with chronic musculoskeletal pain. Study II had a longitudinal cohort design with participants with rheumatic diseases (n=185) 12 months after rehabilitation at a hospital for rheumatic diseases. Study III had a descriptive qualitative design with a phenomenological approach based on a reflective life-world perspective. Twelve participants were interviewed about their experiences about health-promoting self-care. Study IV had a randomised controlled design with post-test six months after the one-year self-care promoting problem-based learning (PBL) program for people with rheumatic diseases. The participants were randomly assigned to the experimental group, 54 participants, or to the control group, 148 participants. Data in studies I, II and IV were analysed with statistics. In study III a Husserlian phenomenological approach based on a reflective life-world perspective was used in the data collection and analysis. Results: Study I: Although participants without chronic musculoskeletal pain reported better health-related quality of life (HRQL) than participants with chronic musculoskeletal pain, similar health factors were found to promote a better HRQL in the eight-year follow-up. The most important factors were feeling rested after sleep and having good sleep structure. Study II: The most important factors promoting better outcome in HRQL 12 months after rehabilitation in participants with rheumatic diseases were having a strong sense of coherence (SOC), feeling rested after sleep, having work capacity, and having good sleep structure. Study III: The meaning of health-promoting self-care as experienced by people with rheumatic diseases was that self-care takes place against a background of continual hope and belief to be able to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three interrelated constituents elucidated the experiences: dialogue, power struggle and choice. Study IV: At the six month follow-up the participants in the experimental group had stronger empowerment after participation in the self-care promoting PBL-program compared with the control group which only got standard care for people with rheumatic diseases. There were no differences in HRQL, self-care ability, SOC, pain, quality of sleep or fatigue between the experimental group and the control group. The participants in the experimental group also stated that they had implemented lifestyle changes which they had not done without the PBL-program. Conclusion: The results of this thesis provide a valuable and useful insight in health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, but also in that people with rheumatic diseases have benefit from taking part in patient education with a self-care promoting PBL-program. These results contribute to evidence supporting the introduction of a more salutogenic approach in rheumatology care and research.
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| 2. |
- Nygren Zotterman, Anna, 1976-
(författare)
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Encounters in primary healthcare from the perspectives of people with long-term illness, their close relatives and district nurses
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- People with a long-term illness and their close relatives regard encounters as the foundation of their relationshipwith the district nurses within the primary healthcare setting. The overall aim of this doctoral thesis was todescribe and elucidate the experiences of encounters for people with long-term illness, their close relatives anddistrict nurses within a primary healthcare setting. From the overall aim, specific aims were formulated asfollows: to describe district nurses’ views on quality of healthcare encounters in primary healthcare (I), toelucidate meanings of encounters for patients with long-term illness within the primary healthcare setting (II), toelucidate meanings of encounters for close relatives of people with a long-term illness within a primaryhealthcare setting (III) and to describe the experiences of dignity encounters from the perspective of people withlong-term illness and their close relatives within a primary healthcare setting (IV). Data were collected fromfocus group interviews (I), narrative interviews (II, III), and semi-structured interviews (IV). The interviewswere analysed using thematic content analysis (I, IV) and phenomenological hermeneutics (II, III). The findingsshow that encounters are given great importance among people who have a long-term illness, their closerelatives, and district nurses in the setting of primary healthcare. The manner in which the encounter wasexperienced in the relationship with healthcare personnel was, at many times, crucial for the whole careexperience to be viewed as beneficial or not. The findings show that district nurses described that the encountersformed the basis of their work as an important aspect and that many times they were difficult because of stressand lack of time. The first meeting with the patient was important since it was unique and unrepeatable. Districtnurses considered themselves as being the patients ‘advocate’ who helped them and protected their interests.They indicated the importance of confirming the patient as a person deserving of respect, and if a meeting turnedout poorly, it was their duty to give the patient an apology (I). The findings also show that patients with a longtermillness experienced that good encounters had health-promoting effects on their health and recovery. Patientsfelt well when they were welcomed as a person with respect, interest, and attention by the healthcare personnel.They wanted to participate in their own care by receiving regular information and follow-up dialogues abouttheir status with the healthcare personnel. Continuity with the healthcare personnel laid the foundation for apersonal and a trustful relationship (II). Close relatives of people with a long-term illness wanted to beencountered as part of the ill person’s family as they accompanied him or her to the healthcare centre. To beconfirmed as a family was important, as it gave meaning to their lives and strengthened their well-being. A goodencounter was characterised by aspects of being involved in the care of the ill person and being respected as avaluable person (III). The findings show that people with a long-term illness and their close relatives experienceddignity in the encounter when they had access to care. They experienced that it was important to be encounteredwith dignity, as it meant receiving help with their needs from the healthcare personnel. To be confirmed by beingseen and listened to was important. When the couples experienced dignity in the encounter, they felt satisfiedwith the care they received. To be encountered with dignity made they feel valuable; this facilitated their healthand well-being, and it contributed to a good impression of the healthcare personnel within primary healthcare(IV). In conclusion, the findings of this thesis show that healthcare encounters are more than just meetings; theyalso mean being confirmed as a human being by being treated with respect, engagement and dignity. Healthcarepersonnel should promote encounters for people with long-term illness and their close relatives in order tosupport their feelings of being regarded as persons and to feel that they are welcomed to primary healthcare withtheir needs, which can empower their health and well-being.
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| 3. |
- Bergsten, Ulrika, 1966-
(författare)
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Patients' and healthcare providers' experiences of the cause, management and interaction in the care of rheumatoid arthritis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings: Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.
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| 4. |
- Franzén, Elin, 1982-
(författare)
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Radio : Vardagsliv tillsammans med ett massmedium
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines the radio medium as a phenomenon of experience. The perspective relates to phenomenological philosophy, dealing with human knowledge as an ongoing intentional relationship with the world: to experience is to grasp things such as they appear to the subjective consciousness. Radio is accordingly understood as a phenomenon that is given meaning through the individual user’s encounters with the medium in its constitutive forms. The research is based on a qualitative material of approximately 200 questionnaire responses and interviews with 17 persons, describing the presence of the medium in the current lives of the participants as well as through their lifetime, which, from a phenomenological viewpoint, makes radio appear both in terms of a present phenomenon and objects of recollection. The experiences that were documented in the late 2010s thus span almost the entire history of the radio medium in Sweden.The everyday embeddedness of radio is analyzed by focusing on three constitutive aspects that have emerged in the empirical data: technical equipment, mediated content, and temporal structures. By breaking down the phenomenon into these aspects, the thesis presents a detailed description of the ways in which radio is integrated into and constitutes everyday contexts. Encounters with technical equipment, mediated content, and temporal structures are analytically described in terms of biographical orientations toward shifting media environments throughout the history of the medium. How radio has been present in life shapes experiences of radio in the present. Likewise, today’s media use defines how radio appears as a phenomenon of the past. Throughout the thesis, participants navigate radio environments in the shape of smartphones, transistor radios, vacuum tube receivers, linear flows of broadcasting, and on demand-structures. Radio is shown to be one of many interlaced components in the complex making of the everyday.
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| 5. |
- Jormfeldt, Henrika
(författare)
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Dimensions of Health among Patients in Mental Health Services
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Empirical studies focusing on the subjective experience of health among patients in contact with the mental health services are rare and most questionnaires are based on a medical model that emphasizes objectively observed disease-oriented health indicators. In studies I and II perceptions of the concept of health among patients and nurses in mental health services were explored and described using a phenomenographic approach. The perceptions and description categories that emerged from these studies were transformed into a number of items forming a questionnaire intended to measure subjectively experienced health among patients in mental health services. In study III, a randomly selected sample was used to test the psychometric properties of the new Health Questionnaire. A factor analysis revealed three factors labelled Autonomy, Social Involvement and Comprehensibility. The purpose of study IV was to examine the construct validity of the Health Questionnaire. The hypothesis was that subjectively experienced health would be positively associated to self-esteem, empowerment and quality of life, and negatively associated to psychiatric symptoms, perceived stigmatization experiences and perceived attitudes of devaluation and discrimination. This hypothesis was mainly confirmed insofar that overall health was positively correlated to self-esteem, empowerment and quality of life and negatively correlated to symptoms, attitudes of devaluation and discrimination and rejection experiences. The results of this thesis show that health is more than just an absence of disease and support a focus on health promotion interventions in mental health care.
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| 6. |
- Blomberg, Ann-Catrin, 1956-
(författare)
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Att vårda patienten inom operationssjukvård : en fenomenografisk studie
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syfte: Det övergripande syftet med avhandlingen var att beskriva uppfattningar av operationssjuksköterskans vårdande inom operationssjukvård och perioperativ vårdMetod: En kvalitativ beskrivande design med en fenomenografisk metod valdes i båda studierna (I och II). I studie I samlades data in genom intervjuer med 16 strategiskt utvalda legitimerade sjuksköterskor och studenter i sista terminen av grundutbildningen till sjuksköterska. I studie II samlades data in genom intervjuer med 15 kliniskt verksamma operationssjuksköterskor. Båda studierna analyserades enligt fenomenografisk metod.Resultat: Resultatet av studie I visade att operationssjuksköterskans yrkesfunktion uppfattades som osjälvständig men ändå med ansvar för patientens vård utifrån specifika kunskaper i hygien och operationsmetodik. Omvårdnaden i yrkesfunktionen var otydlig och uppfattades som fragmentarisk eftersom operationssjuksköterskor enbart var delaktiga i en del av patientens vårdprocess och hade få möjligheter att skapa en vårdrelation med patienten. Resultatet i studie II visade att operationssjuksköterskor ville följa patienten hela vägen. Det innebar att lära känna patienten både före och efter operationen och därigenom bli ansvariga för att säkerställa patientens kontinuitet och säkerhet i vården. Genom att hålla ett vakande öga skyddade de patientens kropp och bevarade patientens värdighet.Konklusioner: Operationssjuksköterskans yrkesfunktion ansågs som fragmenterad och uppfattades vara medicinskt och tekniskt inriktad. Det framkom att vårdandet inom operationssjukvård och perioperativ vård var otydlig. Det fanns en vilja att bli mer delaktig i patientens vård och att vårdandet blev tydligare för andra yrkeskategorier inom vård.
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| 7. |
- Larsson, Ingrid
(författare)
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Person-centred care in rheumatology nursing in patients undergoing biological therapy : An explorative and interventional study
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to explore and evaluate rheumatology nursing from a person-centred care perspective in patients undergoing biological therapy.Methods: This thesis focuses on patients with chronic inflammatory arthritis (CIA) who were undergoing biological therapy at a rheumatology clinic in Sweden. Papers I and II had an explorative descriptive design with a phenomenographic approach. The 40 participants were interviewed about their dependence on or independence of a nurse for the administration of their infusions or injections. Paper III had a randomized controlled design involving 107 patients in the trial. The objective of the intervention was to replace every second monitoring visit at a rheumatologist-led clinic by a visit to a nurse-led rheumatology clinic, based on person-centred care. Paper IV had an explorative descriptive design with a qualitative content analysis approach. Interviews were conducted with 20 participants who attended the nurse-led rheumatology clinic.Findings: Dependence on a rheumatology nurse for administration of intravenous infusions was described as invigorating due to the regular contact with the nurse, which provided security and involvement (paper I). Independence of a nurse for subcutaneous injections was understood by the patients in different ways and was achieved by struggling to cope with injecting themselves, learning about and participating in drug treatment (paper II). Patients with stable CIA receiving biological therapy were monitored by a nurse-led rheumatology clinic without any difference in outcome when compared to monitoring carried out at a rheumatologist-led clinic, as measured by the Disease Activity Score 28. Replacing one of the two annual rheumatologist outpatient follow-up visits by a visit to a nurse-led clinic for the monitoring of biological therapy was found to be safe and effective (paper III). A nurse-led rheumatology clinic, based on person-centred care, added value to the follow-up care of patients with stable CIA undergoing biological therapy by providing a sense of security, familiarity and participation (paper IV).Conclusions: This thesis contributes a valuable insight into person-centred care as the core of rheumatology nursing in the area of biological therapy. The rheumatology nurse adds value to patient care when she/he gives patients an opportunity to talk about themselves as a person and allow their illness narrative to constitute a starting point for building collaboration, which encourages and empowers patients to be an active part in their biological therapy and become autonomous. A nurse who provides person-centred care and keeps the patients’ resources and needs in focus serves as an important guide during their healthcare journey.
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| 8. |
- Lindgren, Eva
(författare)
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“It’s all about survival” : Young adults’ transitions within psychiatric care from the perspective of young adults, relatives, and professionals
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim:The overall aim of this thesis was to explore young adults’ transitions within psychiatric care from the perspective of young adults, relatives, and professionals. Method: The thesis includes four studies (I–IV) with a qualitative approach. Data for study I were collected through focus group discussionswith professionals of child and adolescent psychiatry (CAP) and general psychiatry (GenP), and analyzed using deductive content analysisbased on Meleis’s theory of transition. Data for studies II–IVwere collected from individualinterviews with young adults and relatives withexpectations and experiences of transfer from CAP to GenP (II), from young adults with experiences of care in both CAP and GenP (III), andfrom relatives with experiences of parenting young adults with mental illness (IV). The data from studies II–IV were analyzed using grounded theory(GT) as described by Corbin and Strauss.Results:The synthesis of the four studies (I–IV) resulted in a grounded theory, “Support and intrinsic motivation as prerequisites for transition and recovery,” describing young adults’ transitions within psychiatric care. The result shows that young adults with mental illness undergo multiple simultaneous transitions during transfer from CAP to GenP, and that theseinclude developmental, situational/organizational, and health/illness transitions. It was important for the young adult to achieve intrinsic motivation in order to take responsibility for healthcare matters, to continue care, and to strive for recovery. Intrinsic motivation to continue care was created by trustful, caring relationships with professionals who encountered the young adults as a person, with respect to maturity. Furthermore, the result shows the importance of inclusive attitudes towards relatives, with possibilities for them to participate in young adults’ care as well as opportunities to receive professional support for themselves, which facilitated relatives’ abilities to manage their own lives and, moreover, to continue to providesupport to young adults with mental illness.Conclusions:This thesis highlights knowledge about the multiple simultaneous transitions that young adults experience when they reach the age of 18 and have closure of their care at CAP and continue care at GenP. To facilitate these transitions and empower young adults to continue care when it is needed and to strive for recovery, professionals need to take into account the factorsthat facilitate or inhibit healthy outcomes. Transition planning in cooperation with CAP, GenP, the young adult, and his or her relatives is recommended in order to reduce uncertainty about the new situation. It is also important to take into account that young adults need continuity andsupport in order to create trustful relationships. To reduce the risk of “falling into the caring gap,” individual assessments about young adults’ needs,intrinsic motivation to receive care, and access to support from relatives should be implemented in the transition planning. If the young adultsand their relatives fail to receive the support they need, the risk for their dropping out of care is increased.
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| 9. |
- Skundberg Kletthagen, Hege, 1971-
(författare)
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Everyday life of relatives of persons suffering from severe depression : Experiences of health, burden, sense of coherence and encounters with psychiatric specialist health services
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to investigate and describe everyday life among relatives of inpatients with severe depression and their encounter with the psychiatric specialist health services (PSHS).Methods: A descriptive design with a qualitative and quantitative approach was used. Data was collected by means of a questionnaire responded to by 68 relatives and analysed with descriptive statistics (I, III). Individual interviews with 24 relatives were carried out and analysed with phenomenography (II, IV).Main findings: The everyday life of relatives to persons suffering from severe depression was affected. They reported burden and influence on their own health to a various degree (I). The relatives experienced that they were, “Living on the other person’s terms”. Relatives described ambivalent relationships, as they had to adjust their daily life in attempting to manage the situation (II). When the relatives encountered the PSHS, it may have been a long time of worries and struggles for help. They wanted to be a resource and a participant, and to be confident with the health care (IV). The need for support from the PSHS was greater than what they received. Relatives who reported receiving less information had higher burden scores than the others (III).Conclusions: Everyday life of relatives of persons suffering from severe depression is demanding. To be acknowledged as a resource in the treatment and care for the person suffering from depression is important. The mental health nurses being present at the wards 24 hours a day, are in a unique position to support the relatives.
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