| 1. |
- Johansson, Yvonne A., 1956-
(författare)
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Delirium hos äldre patienter som vårdas på sjukhus : identifiering av symtom, tecken och riskfaktorer samt journalförda vårdåtgärder
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I samband med sjukhusvård kan äldre patienter riskera försämrad hälsa, inklusive delirium. Delirium, som är vanligt hos äldre patienter på sjukhus, är ett akut och allvarligt tillstånd med svåra konsekvenser för såväl patienten som för närstående, vårdpersonal och hälso- och sjukvård. Det är viktigt att delirium förebyggs, identifieras och behandlas. Forskning visar dock på brister i vården, vilket kan påverka patienternas hälsa och välbefinnande negativt. Det övergripande syftet med avhandlingen var att identifiera och beskriva symtom, tecken, riskfaktorer och vårdåtgärder vid delirium hos äldre patienter som vårdas på sjukhus samt att utvärdera tillämpbarheten av ett bedömningsinstrument för att identifiera delirium. Alla deltagande patienter var 65 år och äldre och rekryterades från ett länssjukhus (I-IV) och ett universitetssjukhus (III, IV). Dessutom ingick de bedömare som bedömt delirium med bedömningsinstrumentet 4AT i delarbete IV. Delarbetena bestod av en kvantitativ subgruppsanalys (n=25) av en punktprevalensstudie (n=210), en retrospektiv journalgranskning (n=78) med kvalitativ analys och två tvärsnittsstudier baserade på samma urval (n=200) med kvantitativa (III, IV) och kvalitativa analyser (IV). Data samlades in genom strukturerade intervjuer, validerade instrument, patientjournaler, frågeformulär och en öppen intervjufråga.Patienterna rapporterade svåra och besvärande symtom vilka hade journalförts i begränsad omfattning (14%). Även kognitiv funktionsnedsättning och patienternas beskrivningar av sitt välbefinnande hade journalförts i liten utsträckning. Patienternas tecken på delirium ledde till nedsatt förmåga att såväl delta i sin egen vård som att undvika skada. Vårdpersonalen svarade delvis på patienternas tecken på delirium då åtgärderna kunde vara både anpassade, bristfälliga och utöver vanlig vård. Skörhet var den starkaste riskfaktorn för delirium. Andelen patienter med delirium ökade med svårighetsgraden av skörhet. Den svenska versionen av bedömningsinstrumentet 4AT för att identifiera delirium hade diagnostisk precision och klinisk användbarhet med hög interbedömarreliabilitet. Bedömningsinstrumentet 4AT tolererades väl av patienterna, var lätt att använda och tog några minuter att genomföra. Detta innebär att det nu finns ett enkelt bedömningsinstrument för delirium på svenska som kan användas för att bedöma delirium hos äldre patienter som vårdas på sjukhus.Endast en mindre del av den studerade vården kan ses som personcentrerad och patientsäker. Struktur, systematik och ett helhetsperspektiv tycktes saknas, liksom ett personcentrerat förhållnings- och arbetssätt. För att minska incidensen av delirium, lidande och kostnader behöver vården förbättras. Det finns behov av att öka kunskapen om delirium och att se delirium som en vårdskada inom all vård. Vidare finns behov av att utveckla vården genom att tydligt integrera ett personcentrerat och patientsäkert förhållnings- och arbetssätt för att nå en helhetssyn på patienten. Målet är att främja hälsa och välbefinnande genom att förebygga delirium. För att möjliggöra identifiering av individuella vårdbehov är det en förutsättning att etablera en tillitsfull vårdrelation med den äldre patienten, där patientens perspektiv tillvaratas. Individuella vårdbehov behöver identifieras strukturerat och systematiskt genom bedömning med bedömningsinstrument av symtom, tecken, välbefinnande, delirium och riskfaktorer för delirium innefattande skörhet samt kognitiv funktionsnedsättning. Detta möjliggör individuellt anpassade vårdåtgärder.Ett individuellt anpassat omhändertagande som överensstämmer med ett integrerat personcentrerat och patientsäkert förhållnings- och arbetssätt skulle kunna bidra till att minska incidensen av delirium vilket kan skapa positiva effekter för såväl patienter som för vårdpersonal och hälso- och sjukvård.
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| 2. |
- Eriksson, Kerstin
(författare)
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Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pain is a common postoperative experience. Guidelines recommend performing regular pain assessments, which include self-rated pain and additional communication to capture patients' experiences. During hospitalisation, pain intensity is found to be a vital factor influencing other aspects of an early physical recovery, and is consequently an important item in questionnaires for recovery. These tools consist of extensive questionnaires which are difficult to use in everyday clinical work. A simplified method of monitoring postoperative recovery would benefit both patients and healthcare professionals.Aim: The overall aim of this thesis was twofold: (A) to determine the ability of extending the use of pain ratings to reflect and predict early physical postoperative recovery and (B) to describe patients’ perspectives on pain assessments.Methods: The studies were carried out at one (I), three (IV) and four hospitals (II, III) involving general surgical and orthopaedic inpatients. Two quantitative methods were used based on data from questionnaires and medical records. They consisted of one cross-sectional study (I) and one study with repeated measures (IV). An association was sought between pain intensity and postoperative recovery on days 1 and 2 (I, IV), and prehospital data (IV). Two qualitative methods were used involving a phenomenographic (III) approach and Critical Incident Technique (IV), where semi-structured interviews were performed postoperatively and analysed inductively in accordance with the approach.Results: An association was found between moderate/severe average pain intensity compiled from monitoring records and impact on early physical postoperative recovery on day 1 (I). Retrospective average pain intensity at rest and during activity reflected impact on recovery on postoperative day 1 (IV). Severe pain intensity at rest and during activity on postoperative day 1 predicted impact on physical recovery items on day 2 (IV). The use of the Numeric Rating Scale (NRS 0-10) was considered to facilitate communication about pain, but to involve difficulties of interpretation and place demand on healthcare professionals and care routines (II). Patients’ descriptions of their experiences when in need of describing pain indicated two main areas: patients’ resources when needing to describe pain and ward resources for performing pain assessments (III). Descriptions of their actions when they were in pain indicated two main areas: patients used active strategies when needing to describe pain or patients used passive strategies when needing to describe pain (III).Conclusions: This thesis contributes to knowledge about the possibility of using patients' self-rated average pain intensity to reflect early physical postoperative recovery on day 1 and to predict recovery on the following day. The pain scale gave patients and healthcare professionals a shared vocabulary, which facilitated communication. Furthermore, dialogue during pain assessments was described as critical in ascertaining whether pain intensity had an impact on different aspects of physical recovery. Environmental factors such as the attitude of healthcare professionals, workload and staffing influenced how pain assessments were performed.
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| 3. |
- Siouta, Eleni
(författare)
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Communication in Patient Involvement in Decision making : Examples from consultations on atrial fibrillation
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AbstractBackground: Further knowledge is needed regarding communication that occurs in practice between patients with atrial fibrillation (AF) and health professionals in consultations to understand the issue of patient involvement in treatment decisions.Overall aim: The overall aim of this thesis is to contribute knowledge on communication between patients and health professionals (cardiology nurses and cardiologists), focussing on how they create involvement in decision making in consultations.Specific aims: (1) To describe (i) the topics that patients with AF discuss with cardiology nurses and cardiologists; (ii) the use of discursive space in consultations between these participants; and (iii) the frequency at which patients, cardiology nurses, and cardiologists introduce identified topics. (2) To describe the different types of resistance by patients to treatment with warfarin and how cardiologists respond to such resistance. (3) To examine how patients describe involvement and communication in decision making regarding treatment in consultations with cardiology nurses and cardiologists. (4) To examine how cardiologists describe their views on patient involvement in AF treatment decisions, their perceptions regarding efforts to involve patients, and how they handle decisions.Methods: A qualitative design was used. In study I, the sample consisted of 23 videotaped consultations between patients with AF and cardiology nurses and cardiologists at six nurse-led cardiology outpatient clinics. Content analysis was used to obtain a description of topics that were discussed. The patterns of dominance for the various topics and participants were examined. In study II, the sample consisted of 11 videotaped consultations between patients with AF and cardiologists. Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin. In study III, 22 patients with AF were interviewed directly after their consultations with cardiology nurses and cardiologists. Content analysis was used for the resulting data. In study IV, 10 cardiologists were interviewed in cardiology clinics at four Swedish hospitals and qualitative content analysis was used.Findings: In study I, a medically driven agenda dominated the patient-driven agenda. However, when the patients initiated conversations about their life with AF (the topic that received the least amount of space on the agenda), involvement was created. In study II, the patients’ resistance could be viewed as a source of knowledge about patients’ real-life situations and what motivates them. In study III, despite not being actively involved in the decision-making process, the patients experienced a sense of involvement when they felt understood and were listened to. In study IV, by taking into account the patients’ feelings in the consultations, and by actively encouraging the patients to be involved, the cardiologists contributed to patient involvement.Conclusions: Patients, cardiology nurses, and cardiologists create involvement in decision making in consultations as communicative projects. Patients strive for space and create involvement by showing resistance to the decisions suggested by health professionals. However, involvement is not only an issue about obtaining space in the consultations, but is also associated with obtaining clarification, building confidence, feeling understood, trusting cardiology nurses and cardiologists, and having confidence in receiving consistent care within an established relationship. On a theoretical level, this thesis sheds light on the interaction between the concepts of communication, involvement, and decision making.
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| 4. |
- Backman Lönn, Beatrice, 1974-
(författare)
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The registered nurse as a clinical research nurse
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Clinical research studies are important for the developmentof new treatments in healthcare. The quality of clinical research relies on the competence, skills, and knowledge of the research team. Clinical research nurses (CRNs) are important members of clinical research teams as they are responsible for various tasks specified in study procedures. Internationally, nurses have been engaged as CRNs in in many areas of medicine, such as oncological research, for several decades. However, there is a lack of consensus concerning their professional role and a clear work description is lacking. In Sweden, nurses are becoming increasingly involved in research as CRNs, yet the CRN role is undefined as there is no Swedish national competence description that could guide CRNs’ work tasks, requirements for education, and management of ethical issues. Furthermore, the processof becoming a CRN is not understood. Increasing international research into the CRN role has shown that the role differs between countries.There is a lack of Swedish studies, including studies of the process of transitioning from being a registered nurse (RN) to a CRN. Since consensus is lacking concerning the CRN role in Sweden, we need to explore it further and examine how nursing perspectives are influencing it. The overall aim of this thesis was therefore to explore the professional role of CRNs in Sweden and the transition of RNs to being CRNs.Methods: Both quantitative (studies I and II) and qualitative (studies III and IV) methods were used. The analyses are based on data from questionnaires and individual interviews of CRNs in Sweden. In study I, descriptive statistics and test–retest analyses were used to analyze the validity and reliability of the translated CTNQ-SWE. In study II, descriptive statistics and one-way ANOVA were used to analyze reported work tasks, perceptions, and differences between groups of CRNs. In studies III and IV, qualitative content analysis according to Graneheimet al., (2004) was used to analyze the transition, i.e., becoming and being a CRN.Results: CRNs perform new and diverse work tasks and are often involved throughout the study process, with the greatest activity in data management and the actual conducting and evaluation of clinical studies (e.g., scheduling and performing procedures and tests according to the research protocols). There is seldom any work description or competence framework to guide nurses through the transition to the CRN role, placing them in an uncertain position where they must struggle to adaptiv to their new role and work tasks. To perform these new work activities, CRNs need more support as well as education in research procedures, regulations, and ethics. During the transition, CRNs improve their knowledge of research, regulations, and ethics and increase their experience of clinical research practice and collaboration in networks. They also learn and develop from dealing with challenging situations, such as the informed consent process. Furthermore, problem solving, study requirements, and ethical reasoning are emphasized as challenging. When passing through the different phases of transition to the CRN role, the nurses achieve expanded competence, change didentity, and growing confidence as informal leaders. CRNs also advocate for patient rights and mentor others involved in research, but they simultaneously lack acknowledgement and a formal leadership role.Conclusions and clinical implications: This thesis provides important insights into the CRN role in Sweden. It highlights the transition of RNs to becoming CRNs as well as their experiences of working as and becoming CRNs. The thesis reports that CRNs, overall, seem to be satisfied with their work, but some of their experiences highlight that skills, education, and organizational structures require improvement; forexample, appropriate introduction and support are required during the transition to the CRN role. Ethical challenges call for ongoing discussion in research teams. One conclusion is that CRNs’ competences and tasks need to be clarified. Developing clear competence pathways for nurses to become CRNs, including mentorship and support, could be one way of acknowledging CRNs’ important work, thereby creating a better outlook for high-quality clinical research procedures. Making the CRN professional title more homogeneous nationally and internationally would make comparisons easier. This would clarify CRNs’ work tasks and role in Sweden and extend the nursing perspective on ethics. This thesis adds to a slowly growing body of literature on the CRN role and is relevant to both practitioners and policymakers. Additionally, it illustrates a need to develop both educational and mentoring support aswell as career pathways for RNs to become CRNs, which could improve the quality of clinical research in Sweden.
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| 5. |
- Junehag, Lena
(författare)
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Peer mentoring - A complementary support to persons after an acute myocardial infarction
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to investigate the experience of having an acute myocardial infarction in newly afflicted persons living in sparsely populated counties, and whether an intervention with peer mentors would provide support by affecting the perception of illness, health related quality of life and everyday life. The aim was also to describe the support of peer mentors from their perspective and what the mentoring meant to them. The thesis was based on four empirical studies (I-IV) and had a prospective, longitudinal, quasi-experimental, comparative design. A suitable sample was recruited, comprising 72 individuals who were newly afflicted with an acute myocardial infarction (AMI) for the first time; 34 of them were offered contact with a peer mentor, while 38 were not. Furthermore, 34 peer mentors participated in the project. The results were based on data collected from 28 individuals with mentors, 33 individuals without and 22 peer mentors. In studies I and III, qualitative approaches were used based on individual interviews with 20 newly afflicted individuals with (n=11) and without (n=9) mentors one year after AMI. The aims were to describe individuals’ perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event (I) and to describe individual perceptions of their lifestyle and support, 1 year after an AMI with or without mentorship (III). Study II was quantitative, consisting of data from questionnaires IPQ-R and SF-36 answered by 61 newly afflicted individuals with (n=28) and without (n=33) mentors. It aimed to investigate whether changes in illness perception and health-related quality of life occur over time after an intervention with peer mentors 1, 6 and 12 months after an AMI. Study IV had a mixed design and included peer mentors with the purpose to describing the personal meaning of being a peer mentor, for a person recovering from an acute myocardial infarction. Data consisted of individual interviews (n=15) and some data from IPQ-R and SF-36 that were provided on two occasions (n=22). All of the interviews (I, III, IV) were digitally recorded and analysed by qualitative content analysis, while the quantitative studies included descriptive data and were further compared using analysis of variance (ANOVA) (II) and the paired-sample t-test (IV). The results from all four studies are interpreted and presented together, and they show differences and similarities between the newly afflicted with or without peer mentors and the peer mentors. The results comprise six main areas; the meaning of becoming a person with an AMI (I, II, III) pointed toward an awareness of the situation expressed both in positive and negative terms, as being thankful or of being afraid of having a second AMI. View at health care (I) indicated that follow-up after discharge was sometimes a positive experience but more often resulted in dissatisfaction with this part of the health-care system. Consequences (II) showed significant effects between groups in the dimensions ‘consequences’ and ‘timeline acute/chronic’ (IPQ-R), with higher mean values for those without mentors and a significant effect of time in both dimensions. There were also physical consequences for many of the participants (I, II, III, IV) as well as psychological consequences (I, II, IV). Everyday life (I, III) was affected by AMI that sometimes limited activities. There were demands to change areas of life-style that were perceived as both positive and negative. Health (II, III, IV) showed that health increased for most individuals during the year, as confirmed by significant values for time for those newly afflicted. The peer mentors showed a decrease in mean values but expressed that they felt healthier after compared with before their commitment. Meaning of support (I, IV) indicated that families and relatives had an important, supportive role for newly afflicted participants. The mentorship showed that the relationship was, in some cases and for different reasons, unsuccessful. However, most of them were satisfied, and new friendships arose. More of the mentors felt pride and were thankful because their experience was shown to be valuable to others in addition to themselves. The results were synthesised using the Human Becoming nursing theory, which confirmed that recovery after an AMI is a process that occurs over time in which that those afflicted must accept and be comfortable being a person who is afflicted by an AMI. Some tendencies indicated an advantage for the newly afflicted participants who had received contact with a peer mentor. Conclusion: Because the mentor had experienced the same event, the relationship contributed to the security of the mentee. The peer mentors matured with the task because they felt that their experience was valuable and they felt unique.
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| 6. |
- Karlsson, Christina
(författare)
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Detection and assessment of pain in dementia care practice : Registered nurses’ and certified nursing assistants’ experiences
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice.Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV).Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV).Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability.
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| 7. |
- Wieslander, Inger
(författare)
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Women’s recovery after a first myocardial infarction from an organisational, a relational and an individual perspective
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore and describe women’s recovery after a first myocardial infarction (MI) from an organisational, a relational and an individual perspective. In this thesis a longitudinal, explorative and descriptive design combining both quantitative (papers I-II) and qualitative (papers III-IV) methods has been used. Data was collected from healthcare professionals at 18 acute hospitals (paper I), which on two occasions answered a questionnaire dealing with cardiac rehabilitation efforts. From these 18 hospitals, 240 women who had suffereda first MI (paper II) were consecutively chosen to answer a questionnaire on three occasions on the subject of social support and social network. Descriptive and inferential statistics were used to analyse data over time. Paper III and IV had an exploratory and descriptive design based on an inductive, qualitative content analysis approach. Interviews were conducted with 20 cardiac rehabilitation nurses (CRN) (paper III) and with 26 women suffering a first MI (paper IV).The results showed that patients with MI, and their next of kin, were offered a well-functioning cardiac rehabilitation on both measurement occasions. None of the hospitals offered a CRP that was specifically designed for women (paper I). The women perceived that the extent of general support, support from relatives, and professional support changed positively over time (paper II). The CRNs experienced that women’s recovery was influenced by their ability to cope with the stresses of life, if they wanted to be involved in their own personal care and how they related to themselves, and their opportunities to receive support (paper III). Women experienced that ability to approach the new perspective of life depended on how they embraced the three dimensions; behaviour, i.e. women’s acting and engaging in various activities, social i.e. how women receive and give support in their social environment, and psychological i.e. their way of thinking, reflect and appreciate life (paper IV).In conclusion, the four studies show that women’s recovery after a first MI is depending on factors emerging from an organisational, a relational and an individual perspective. Using knowledge from these three perspectives the possibility of a holistic approach to women’s recovery process to health will increase and the risk of a reductionist thinking will decrease.
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| 8. |
- Axelsson, Malin, 1964
(författare)
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Personality and adherence to medication treatment
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Striving for improved adherence to medication treatment is of vital concern, as low adherence is a major obstacle in treating many prevalent chronic diseases. Several factors have been identified that seem to influence adherence behaviour, but limited research exists on the significance of personality for adherence to medication treatment. According to the Five-Factor Model (FFM), personality can be described in terms of five broad personality traits: Neuroticism, Extraversion, and Openness to experience, Agreeableness, and Conscientiousness. Reports on health-related quality of life (HRQL), asthma control and selfefficacy may also be influenced by personality. Therefore, the overall aim of the present research project was to explore the significance of personality traits in relation to adherence to medication treatment and asthma control, health-related quality of life and self-efficacy.
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| 9. |
- Åberg, Cecilia, 1976-
(författare)
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Striving for meaning in a diminishing world : Older persons’ experiences of reflective STRENGTH-giving dialogues including a digital tool
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Reflective STRENGTH-Giving Dialogue (STRENGTH) method was developed, grounded in a lifeworld perspective, with a focus on identifying and meeting older persons’ needs for the promotion of health and well-being. In this thesis, STRENGTH, including the digital tool SelfSTRENGTH, was tested in the context of community-dwelling older persons living with long-term health problems.The overall aim was to describe how life with long-term health problems is experienced and influenced by the Reflective STRENGTH-Giving Dialogue intervention, including the SelfSTRENGTH app, by community-dwelling older persons.The research was conducted based on a reflective lifeworld approach, through qualitative and quantitative method studies. Three of the studies had a qualitative, descriptive, and inductive design based on individual interviews and reflection notes with the older persons in the intervention group (Papers I–III). Analysis was conducted using phenomenology (Papers I–II), and phenomenography (Paper III). One study had a quasi-experimental pretest-posttest no-treatment control group design (Paper IV), and was analyzed using nonparametric paired statistics. Altogether, 60 older persons in the fourth age participated in the studies.The finding showed, according to self-reports, that STRENGTH immediately and significantly reduced the impact of health problems on daily life, and increased well-being after each single dialogue. The content and outcome of the dialogues are affected by intersubjectivity, which is influenced by the healthcare professional (HCP) and the older person’s ability, as well as the relationship between them. STRENGTH dialogues that have an existential dimension are described as a starting point to provide a “push” toward joy and meaning. When the understanding of an older person’s holistic situation, including the past, present, and future, is tactfully and sensitively challenged with reflection and an emphasis on possibilities, the dialogues support joy and meaning in life. Dialogues of this nature have been lacking, as older persons may choose not to have that conversation with their family or HCPs, and HCPs may not attend to the older person’s existential needs and concerns. It is important when living in the feeling of a diminishing world for older persons to be involved in decisions that concern their lives and care, and to engage in life projects that improve well-being. This is made possible through the dialogues and use of the SelfSTRENGTH app. However, use of the app is hindered by resistance to digital technology and the occurrence of health problems.To foster healthy ageing, HCPs need increased knowledge and favorable conditions for caring conversations and provision of digital support that older persons with long-term health problems need for participation in a digital society.
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