| 1. |
- Elmqvist, Carina, 1964-
(författare)
-
Akut omhändertagande : i mötet mellan patienter, närstående och olika professioner på skadeplats och på akutmottagning
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To describe and develop understanding of the patient’s first encounter with the involved persons at the scene of an accident and at the emergency department; with a special focus on describing the meaning of emergency care of patients in these caring contexts. Method: The thesis uses a reflective lifeworld research (RLR) approach founded on phenomenological philosophy. The purpose with this approach is to describe the essential meaning and the variations of a phenomenon. Interviews with a lifeworld perspective were used for data collection and analyzed according to the RLR approach for searching for the essence of the phenomenon. The four essences in the studies (I-IV) establish a general structure for the phenomenon.Findings: Emergency care is characterized by an organisation, whose goal and resources are focused on life-saving, and that encounters a human being with needs of emergency care as well as existential support. The responsibility in emergency care means an intertwining of doing and being. The one who is in charge takes responsibility for performing or “doing” medical actions, and by “being” close and present in the situation the patient can at the same time feel an existential support. The responsibility for the injured or ill body is handed over to a chain of persons with more and more specialized competence and resources. This hand-over entails a relief for all involved but fails in one link in the chain, namely to explicitly hand back the responsibility to the patient. When the patient’s condition allows the distance to be larger the responsibility pales and the existential support decreases. A gap between doing and being arises where the patient is left to regain control and independence. The intertwining of doing and being, which appears as soon as the one in charge is close and present to the patient, facilitates the hand-over to the patient who in a natural way is able to receive the responsibility with possibilities to be able to conclude the encounter.Conclusions: A new understanding of emergency care appears which entails more than just life support measures. Emergency care includes different ways of communication in order to hand over the responsibility and complete the care chain back to the patient in a safe way. The results highlight the importance of empowering patients with a confirming, communicative contact throughout the whole caring process in order for them to retain their identity. There are also implications for educating students and personnel in inter-professional communication and work. In order to assist the intertwining between doing and being there are needs for the development of supportive structures for inter-professional reflection, which in turn would improve the interaction between patients and professionals in their encounter.
|
|
| 2. |
- Kneck, Åsa, 1973-
(författare)
-
Living with diabetes : a lifelong learning process
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Living with diabetes, as a lifelong illness, is interlaced with learning and to face continual changes. However, the role of time in this learning process is not yet well understood. The overall aim of the thesis was to gain a deepened understanding of learning to live with diabetes for those recently diagnosed and over a three year period. The thesis, involving four studies where qualitative inductive content analysis (I, III) and phenomenological hermeneutical interpretation (II, IV) were used, has a lifeworld approach and a qualitative and longitudinal design. Thirteen persons, recently diagnosed with diabetes (type I or II), were interviewed on three different occasions over a three year period. All interviews focused on the experience of living with diabetes and situations where diabetes had to be taken into account. The aim of study I was to reach an understanding of how learning to live with diabetes is experienced in the first 2 months after diagnosis. The findings revealed to be taken over by a new reality, with a body that played a role in life with the health care service as a necessary partner. The aim of study II was to illuminate the meaning of learning to live with diabetes three years after being diagnosed. The findings revealed learning as making decisions through use of different sources of information and as solving the life-puzzle – a delicate balance to create a desired life. The aim of study III was to identify patterns in learning when living with diabetes, from recently being diagnosed, and over a 3-year period. In the findings five patterns were identified illuminating different learning processes emerging over time. A longer time living with diabetes did not per se mean increased satisfaction in living well with illness or increased confidence in understanding one’s own needs. The aim of the IV study was to illuminate the meanings of trigger situations in learning to live with diabetes. The findings revealed trigger situations, such as being encumbered by vulnerability and temporality in unsustainable situations with an unpredictable body and a life involving new concerns for the future. The thesis conducted that learning was an informal and ongoing everyday process in life. Time living with diabetes meant both an increased mastery of a changed life situation, but also increased difficulties in achieving well-being and with a dependency on health care. Hence, health care interventions must adhere to the individual’s needs and not be based on duration of illness. Understanding the body and the role of health care, as well as what facilitates and hampers learning, changed with time. It is therefore important that health care personnel illuminate the individual understanding and experiences of those living with diabetes as this was found to be important for the learning process as well as for their sense of well-being.
|
|
| 3. |
- Rytterström, Patrik, 1970-
(författare)
-
Tradition och horisont : vårdkulturens betydelse för vårdens praxis
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main aim of this thesis was to illuminate and understand aspects of care culture as a meaning–making process that influences the care praxis. In health care there is increasing recognition of the impacts on organizational culture of health-related matters. Although the factors studied affect care and nursing care, there has been little research from a caring science perspective. Care culture is understood from a hermeneutic perspective as a meaning-making process related to tradition, horizon and “bildung”. These three concepts give care a meaning cohesion that helps caregivers to orient themselves and acquire a care praxis.Study I was an interview study with seventeen nurses working on different wards. Study II was a focus group study, and included three focus groups with 24 nurses and a secondary qualitative analysis of interviews from study I. Both studies I and II used a phenomenological-hermeneutic approach. Study III was a hermeneutic documentary analysis conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. Study III was a hermeneutic documentary analysis conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. Study IV was a case study involving 12 individual interviews and one focus group interview that included four participants. All participants were working at various levels in the municipal organization and were directly or indirectly connected to a mistreatment situation. This research also included a two-day field study and a document study. The individual interviews and focus group interviews were analyzed using a phenomenological hermeneutic approach.The findings show that care culture can be experienced as positive and enabling of good care but also as defective and an obstacle to good care. Three different care cultures were identified: a service, a social and a motherhood culture. All cultures showed traces of caring values, but from a caring theory perspective, none of them fully demonstrated understanding of the notion of existential caring revealed as the integration of freedom and vulnerability. By studying the underlying traditions and the caregivers’ horizon, the care culture can be illuminated and understood through its expression in praxis. From gaining a comprehensive understanding, a caring ideal could open up and reflect the care culture´s boundaries. This means that ideals can have different interpretations depending on the conditions the care praxis is based on. The gap between care theory and praxis can therefore be understood to mean that the care culture does not use Bildung as a process of alienation and appropriation, resulting in no transformation of the prevailing tradition.Care culture could be distinguished from three different perspectives. They are referred to in this thesis as the prevailing, the visionary and the critical perspective. Developing a hermeneutic concept of culture, understood as the care culture´s critical perspective, could serve as an opportunity for a reinterpretation of nursing theory´s meta-paradigm concept of environment.
|
|
| 4. |
- Gustafsson, Christine, 1967-
(författare)
-
Närhet på distans : Nattsjuksköterskors vårdande i kommunal äldreomsorg
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Registered nurses’ [RNs] experiences of caring in nursing, working conditions for caring and reflection in municipal night care was explored to create expanded knowledge and understanding of care for older people. As a consequence of the Ädelreform and development in hospital health care a displacement from clinical health care to municipal care of older people has taken place. Night RNs’ work in the complex municipal care of older people implies single handed work in a consultative function. The RNs are distanced from the care receivers; it is care staff who mainly perform bed side caring. Municipal RNs’ care for older people during nights means trusting their own knowledge and reflective ability, in having nursing responsibility for large groups of old care recipients. This thesis takes point of departure in a qualitative research approach, with four empirical studies. These have been accomplished in a medium sized municipality in the middle parts of Sweden. The aims of the part studies were: to elucidate municipal night nurses’ experiences of the meaning of caring in nursing (I), to explore Swedish municipal night nurses’ experiences of their working conditions for caring in nursing (II), to examine the caring for care staff offered by municipal night nurses, in the setting of old care recipients people enrolled in the municipal social care system (III) and to describe nurses’ conception of reflection in their working situation (IV). Data were collected with interviews (I, II, IV), diary notes (II) and participative observations (III). The data were analyzed with phenomenological hermeneutics (I), thematic content analysis (II, III) and phenomenography (IV). The results reveal that night RNs caring in nursing means the paradoxes: being close at a distance, being responsible without control and being independently dependent. Caring in nursing means a caring stance in prioritizing and taking responsibility for care recipients and care of care staff (I). Night RNs’ caring is dependent on the organization and care staff, and is complex by the fact that the RNs are not care staff leaders. The RNs’ autonomy prerequisite the ability to handle their work, which mainly means mediated caring communicated by telephone (II). The night RNs’ care of care staff means an informal nursing leadership. With their medical competence and authority the RNs occupy a superior caring leader function in nursing (III). Reflection is conceptualized as an instrument to handle the working situation and requires capacity of presence, flexibility and courage. To reflect is experienced to use knowledge, ethics and also personal values, in considering, estimating and assessing caring situations and actions (IV). The conclusion of the studies (I-V) is that the night RNs’ caring is dependent on the prerequisites described in the dimensions of the organization, self-understanding and vocational and professional relations. The RNs must be able to reflect and handle the situation of caring at a distance, without loosing the vocational fundamental condition of caring, though the consultant function implies that they seldom encounter the care recipients. Increased quality, development and creating possibilities for dignity in care for older people means the RNs must participate more in bed side caring. The RNs should also be caring leaders and be given the opportunity for adequate specialist training in gerontology nursing.
|
|
| 5. |
- Kneck, Åsa, 1973-
(författare)
-
Learning to live with diabetes : as experiencing an expanding life world
- 2011
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Chronic illness, such as diabetes, results in a transition process involving a variety of changes in both bodily function and conditions for living, and requiring broad knowledge and understanding in order to meet new demands. The outcomes of a healthy transition are described as well-being and mastery, in contrast to vulnerability and dependency. Little is known about how time for experience contributes to the transition of living with a chronic illness. Aim: The overall aim of the thesis was to illuminate the transition of living with diabetes during the first three years after diagnosis, in order to reach an understanding of how better to create more person-centred care.Design: The study has a life world phenomenological approach with a longitudinal, descriptive and interpretive design. Thirteen participants were interviewed within two months after diagnosis and again after three years. A selected sample approach was used. For study I a qualitative inductive content analysis was used and for study II a phenomenological-hermeneutic method.Findings: In study I four themes were found; ‘taken over by a new reality,’ ‘the body plays a role in life’, ‘different ways of learning’ and ‘the health care service as a necessary partner’ and in study II one overall theme; Experience for understanding the individual meaning of freedom and control in living with diabetes and two themes ´Solving the life-puzzle – a delicate balance to create the desired life´ and ´The need for being in control of your own health´.Discussion: For a healthy transition when living with diabetes, the ability to interact with others in order to share their experiences was crucial and contributed towards participants understanding themselves and their life world. In order to be able to interact, participants had to understand their body as a subject, interlaced with the self and the life, the lived body. Being able to listen to the body and interpret body cues and circumstantial information also contributed to a healthy transition. When the body with diabetes was objectified, a struggle ensued where incompatible needs were experienced and contradictory information created insecurity. The person then preferred not to interact with others but to be dependent on advice and information from the health care service.Conclusion: This study showed that duration of illness was not of importance for the understanding of living with diabetes. Three years after being diagnosed, living with diabetes meant an experience both of overall balance in one’s existence and of a daily struggle. Health care personnel are open to the unique experience of the person living with diabetes as well as to where the person is in the transition. Patient education in a group setting, with the goal of sharing experiences in a learning process, will be meaningful only if the person has the ability to interact with others.
|
|
| 6. |
- Nygren, Björn, 1949-
(författare)
-
Inner strength among the oldest old : a good aging
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall purpose of this thesis is to describe, explore and illuminate inner strength among the oldest old. The thesis has a salutogenic perspective where strengths and health are in the foreground instead of weakness and ill health. The thesis is part of The Umeå 85+ study and comprises four studies with both quantitative and qualitative data.The aim of Study I was to test reliability and validity of the Swedish language version of the Resilience Scale (RS) in regard to its stability, internal consistency and validity. A convenience sample of 142 participants aged 19 to 85 years answered the questionnaires the first time and 126 on the retest. In Study II scales aimed to measure phenomena related to inner strength, health and development were used. The aim was to describe resilience, sense of coherence, purpose in life, and self-transcendence in relation to perceived physical and mental health in a sample of 125 participants aged 85 to 103 years. Study III aimed to give a more extensive knowledge of resilience among the oldest old. The relationship between resilience and physical health factors, psychological health factors, diseases and social relations were examined among a sample of 192 persons aged 85 to 103 years. In order to deepen the knowledge about inner strength from a life world perspective the aim of study IV was to illuminate the meaning of inner strength as narrated by women and men 85 and 90 years old. The sample consisted of those 18 participants that scored the highest on the scales aimed at measure phenomena related to inner strength.The findings in study I showed that the Swedish version of the RS was both valid and reliable. Construct validity was established by satisfactory correlations coefficient values between the RS and the Sense of Coherence Scale and the Rosenberg Self Esteem Scale. A principal component analysis corresponded well to the original version of the RS. Reliability was assured with both satisfactory internal consistency as well as test-retest reliability. The findings in study II showed significant correlations between the scales aimed to measure resilience, sense of coherence, purpose in life and self-transcendence which indicates that the scales reflect some kind of common core, which was interpreted as inner strength. The oldest old scored high on all scales, this indicating that strength can be preserved or perhaps even increased in old age. The finding also showed lack of significant correlations between the scales and perceived physical health but significant correlations between these scales and perceived mental health among the women but not for the men. No significant correlation was found between physical and mental health. In study III a regression analysis showed that a strong resilience among the oldest old was found to be associated with health, mainly represented by absence of depressed mood but also by not being on medication and by the absence of psychological symptoms, but also that raising children in the past gave a meaning to the present by having a family and this produced feelings of feeling safe and secure in facing the inevitable future; that is, being resilient means living in connectedness with one’s past, present, and future. In study IV a phenomenological hermeneutic approach to the interview text disclosed a meaning of inner strength as Life goes on –living it all, meaning that inner strength still makes it possible to live, handle and being open to ones life in many of its potentials. Inner strength means that one can chose to stand up and fight as well as living in reconciliation, a possibility to work hard as well as feeling relaxed, inner strength means having tasks to accomplish as well as feeling content and proud over ones life as well as life itself, it means relying in oneself as well as having faith in others and God (for some), knowing that you as a person is the same as well as accepting and adjusting to changes. It means that one can chose aloneness and still be connected, it is to be living in the present as well as in one’s past and in the future. That is, living in wholeness.The findings of the studies are discussed in relation to personal strengths and a good aging.
|
|
| 7. |
- Swall, Anna, 1977-
(författare)
-
"Being in the present" : the meaning of the interaction between older persons with Alzheimer's disease and a therapy dog
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The number of persons with Alzheimer’s disease is increasing world-wide and the disease affects the persons, their families, the health care system and the economy within society worldwide. The symptoms and behaviours caused by Alzheimer’ disease may be difficult to manage for the person and their caregivers. Alternative methods are recommended before pharmacological treatment. The presence of a therapy dog has been described as beneficial, in for instance increasing well-being and alleviating symptoms and dementia behaviours. The overall aim of this thesis was to gain a deeper understanding of the influence of therapy dogs on persons with Alzheimer’s disease from the person’s and the dog handler’s perspectives. Further, adopting a longitudinal perspective, the study investigates the therapy dog’s influence on activity and sleep for persons with Alzheimer’s disease. Video observations of five persons with Alzheimer’s disease interacting with a therapy dog (I, II), as well as interviews with nine dog handlers (III) were gathered and transcribed. Data was analyzed using a phenomenological hermeneutical method (I, II, III). Registration of activity and sleep was conducted over a period of 16 weeks using an Actigraf that generated curves, and were then analysed using descriptive statistics (III). The time spent with the dog revealed memories and feelings resulting in existential thoughts of oneself and life, which then connected to the present situation (I). Distancing oneself from the symptoms of the disease when interacting with the dog showed a person functioning in the present with the dog, striving for the dog’s best and putting the dog before and above oneself (II). The therapy dog’s presence showed no pattern of effect on the patients’ daytime activity and sleep. The findings instead pointed to a great variety of possible different effects, bringing about increased activity at different time points, for example during night-time sleep (III), creating a respite from illness and contributing wordlessly to an existence but thoroughly directed by the dog handler, where the person was comfortable and took the initiative (IV). In conclusion, the therapy dog team’s presence with the person with Alzheimer’s disease induced meaning that allowed the person’s hidden qualities and abilities to develop and, when observed from a person-centred perspective, also brought out the individual in each person.
|
|
| 8. |
- Dwyer, Lise-Lotte, 1965-
(författare)
-
Dignity in the end of life care : what does it mean to older people and staff in nursing homes?
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The discussion of a palliative care and a dignified death has almost exclusively been applied to people dying of cancer. As people are getting older and are living longer, nursing homes have become an important place for end-of-life care and death. Dignity is a concept often used in health care documents but their meaning is rarely clarified. The main aim of this thesis was to gain a deeper understanding of what dignity meant to older people in end of life care as well as to nursing home staff. The thesis comprises four studies. The first and second study involved older people living in nursing home settings studied from a hermeneutic perspective. In the first study twelve older people in two nursing homes were interviewed two to four times over a period of 18–24 months during 2002–2003. Altogether, 39 interviews were analyzed by a hermeneutic method. Dignity was closely linked to self-image and identity. The themes of unrecognizable body, dependence and fragility constituted threats to dignity. The third theme, inner strength and sense of coherence, seemed to assist the older people in maintaining dignity of identity. In the second study the aim was to acquire a deeper understanding of how three older women from study I, created meaning in everyday life at the nursing home. A secondary analysis was carried out and showed meaning in everyday life was created by an inner dialogue, communication and relationships with others. The third study was to explore nursing home staff members’ experience of what dignity in end-of –life care means to older people and to themselves. Totally 21 interviews with staff were carried out and analyzed through a qualitative content analysis. The meaning of older people’s dignity was conceptualized as feeling trust, which implied being shown respect. Staff members’ dignity was conceptualized as maintaining self-respect. Dignity was threatened in situations where staff experienced themselves and the older people as being ignored and thereby marginalized. The fourth study was carried out through focus groups discussions with 20 staff members about seven older peoples dying death and care. The analyses showed that conversations and discussions about death were rare. Death was surrounded by silence. It was disclosed that the older dying person’s thoughts and attitudes of death were not explicitly known. A dignified death meant alleviation of bodily suffering and pain and meaningfulness. The staff’s ethical reasoning mainly concerned their experience of a gap between their personal ideals of what a dignified end of life should include and what they were able to provide in reality, which could result in conscious stress. Staff members need training and support. End of life care demands competence and teamwork. A challenge for future care of older people would be to develop a nursing home environment in which human dignity is promoted.
|
|
| 9. |
|
|
| 10. |
- Nordgren, Lena
(författare)
-
När kroppen sätter gränser : En studie om att leva med hjärtsvikt i medelåldern
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present thesis was to describe the meaning of living with heart failure as a middle-aged person. In particular, the relation between the persons’ life-situations and formal care was explored. An additional aim was to uncover the meaning of support as experienced by people living with heart failure in middle age. The study used a caring science perspective and a reflective lifeworld approach, founded on phenomenological philosophy. Interviews were used for data collection and data were analyzed using essence-seeking analysis. The thesis is based on four empirical studies and the results were synthesized into a general structure, presented in the thesis.The results of study I illuminate influences and changes to the life-situation that people living with heart failure in middle age can experience. The social world, i.e. intersubjective relationships, vocational situations, and formal care emerge as fundamental to the individuals, as well as the individuals’ own experiences of themselves and their body. The life-situation is frail and depicted by insecurity and uncertainty. The results of study II illuminate that people living with heart failure in middle age experience exposure and vulnerability in relation to formal care. While the context of formal care provides alleviation and medical treatments, the results at the same time revealed experiences of dependency and unclear participation. The results from studies III and IV clarify that support means to know that help is available concerning practical matters or flexibility at work. However, it also reveals that support means a sense of security or safety in relation to other people, such as friends, families, employees, and formal carers. Knowledge, and control are central aspects of the phenomenon of support in relation to heart failure.The phenomenon’s general structure illustrate that living with heart failure as a middle-aged person is depicted by ambiguity in relation to other persons, daily life and formal care. The general structure is intertwined with an altered experience of the body, and a life-situation in a borderland between health and illness. The phenomenon is illuminated by the meaning constituents: A borderland between health and illness, and A tension between what is supportive and what is not. The phenomenon’s outer horizon is understood as A changed body and a threat against life, meaning that the phenomenon stands out against a background of the limits which the body sets on the persons.The present study illustrates that support from others give people living with heart failure in middle age inner strength which they need if they are to adjust their life goals. However, the results also revealed that formal care at times is insufficient and the support which the patient’s need is forsaken. When people living with heart failure in middle age are to take on their own responsibilities for their health process they need information, knowledge and to be participating in care. Furthermore, formal carers need to focus more on the patient’s social roles and networks. A lifeworld-led perspective in formal care can unite a biomedical and a caring science perspective, and formal carers will be able to pay more attention to the patients’ changed life-situation rather than focusing the patient’s failing hearts.
|
|
