| 1. |
- Rönnberg, Linda, 1979-
(författare)
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Tracheal Extubation of Patients Cared for in the Anesthesia Setting : Experiences Described by Registered Nurse Anesthetists and Anesthesiologists
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background In Sweden, extubation is an interdisciplinary process involving teamwork between Registered Nurse Anesthetists (RNA) and Anesthesiologists, and comprehensive demands are placed on the professionals providing anesthesia. The extubation of the endotracheal tube after General Anesthesia (GA) is a critical moment for the patient. In that moment, the patient is in a vulnerable state and at risk of suffering severe complications, such as hypoxia, laryngospasm, aspiration, and hypertension. Anesthesia deals with identifying options, making risk assessments and reconsiderations. Clinical decision-making in anesthesia includes making decisions quickly and sometimes re-evaluating these just as quickly. In the often brief meeting prior to anesthesia, a relationship with the patient emerges and an unspoken demand arises: to care for the life that is placed in the hands of the anesthetists.Aim The overall aim was to gain an understanding of the Registered Nurse Anesthetists’ and Anesthesiologists’ experiences of their decision-making practices in the process of extubation of the endotracheal tube in the anesthesia setting with patients undergoing general anesthesia.Method This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design using focus-group interviews (I) and Individual interviews (II) to collect data. A total of 20 RNAs from two hospitals and 17 Anesthesiologists from three hospitals were included, using a consecutive sampling strategy. Both studies were analyzed with qualitative content analysis and adopted an inductive approach to seek a deeper understanding of the phenomena, using manifest content analysis. In order to explore how the RNAs and Anesthesiologists experience the process of extubation and to identify nuances between them, the two studies were merged together in this licentiate thesis.Results When merging these studies (I, II) together by combining subcategories from both, six themes emerged. The theme, Assembling unique decisions, deals with the how the RNAs (I) and Anesthesiologists (II) assess, prepare, prevent and reconsider when planning for the extubation. Acting upon sensibilities consists of them recognizing patterns, leaning on their experience, and being receptive to different inputs from the patient and other professionals. The third theme, Being guided by intuition, included how the RNAs and Anesthesiologists relied on their feelings and were guided by emotions when deciding when to extubate. Safeguarding the patient deals with them protecting and acting as an advocate for the patient and how they focus on and are humble in the process of extubation. In the fifth theme, Being in a vulnerable position, the RNAs (I) felt they were on their own when making the decision on when to extubate, while the Anesthesiologists (II) felt as if they were one of the team. Using their own receptivity included how they established a connection with the patient and sensed the atmosphere.Discussion In their first encounter with the patient, or when obtaining knowledge about the patient, the RNAs and Anesthesiologists had already started to tailor a mental plan of the extubation unique to each patient. The plan consisted of small pieces of information being gathered and assembled together during the anesthesia, and this information is then combined with their experience of similar situations and with their intuition with the aim of safeguarding the patient. RNAs and Anesthesiologists act upon sensibilities when deciding on when to extubate. These strategies align with the concept of phronesis, a form of knowledge understood as practical wisdom that facilitates good clinical judgement in being rational, which is based on pre-understanding, experience, and interpersonal relationships and which is difficult to teach to someone else.
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| 2. |
- Brolin, Rosita, 1958-
(författare)
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"Jag kan öppna fönstret när jag vill" : Boendesituationen för personer med psykisk funktionsnedsättning
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to explore and develop knowledge about the housing situation for people with psychiatric disabilities, based on the residents' perspectives.Methods: Three studies are based on a new Swedish questionnaire (SHPD) containing preconceived questions (Studies I-II) and two open-ended questions (Study III), while two studies are theory-generating (Studies IV-V). I - the psychometric properties of SHPD (ICC, descriptive statistics, factor analysis); II - the degree and predictors of housing satisfaction (descriptive statistics, logistical regression analysis); III - the best and worst in housing situation (qualitative content analysis); IV-V - Classic grounded theories about people with psychiatric disabilities, living in supported housing (IV) and in ordinary housing with housing support (V).Results: The results show good psychometric properties for SHPD, a generally high degree of housing satisfaction, and reveal security, privacy and choice as important predictors for satisfaction. Life in supported housing is shown to be characterized by constant togetherness, limited self-determination and violated integrity. Being deprived of self-determination emerged as the main concern for residents, who handle this through striving for meaning. Life in ordinary housing with housing support is shown to be characterized by independence, self-determination, loneliness, and sometimes lack of support. The impossible mission in everyday life emerged as the main concern for residents, who deal with this concern through mastering everyday life. The housing support staff are important facilitators in the process of mastering everyday life, and the continuity of housing support is a prerequisite for the process to succeed.Conclusions: The thesis contributes knowledge about the housing situation for people with psychiatric disabilities. The thesis raises awareness of a need for changes in housing support services towards housing forms and support that strengthen the residents' integrity and autonomy. The individuals' experiences need to be considered in planning and performance of housing support services, and security, privacy, choice, social support and continuity in housing support need to be prioritized.
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| 3. |
- Enarsson, Per, 1962-
(författare)
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Mellan frihet och trygghet : personalgemensamt förhållningssätt i psykiatrisk omvårdnad
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The common staff approach in psychiatric care has not been studied explicitly before. Earlier studies in related areas of social processes in psychiatric care highlight the importance of the interaction between the patient and the carer to understanding communication patterns and attitudes. Other studies on social order and power in psychiatric care shows carers and patients as taking part in a hierarchical system in which patients are subordinate to carers. Aim: The overall aim of this thesis is to study the phenomenon of the common staff approach in psychiatric care, how it emerges, and how it is used and experienced by both carers and patients. Method: In the first study, grounded theory was applied to data from observations and interviews carried out with carers and clients in two psychiatric care group dwellings. In the second and third studies, a phenomenological hermeneutic method was used to analyse narrative interviews conducted with nine careers working on psychiatric wards and nine patients with experience of psychiatric in-care, respectively. In the fourth study, qualitative content analysis was used to analyse data obtained by a vignette method from interviews with 13 carers with experience of working in psychiatric in-care. Results: A common staff approach can be understood as a social process in municipality-level group dwellings and psychiatric in-care, imposed by carers on clients or patients with the aim of restoring a predetermined order desired by the carers. When the order is disturbed the carers try to restore it by adopting a common and consistent approach towards the single patient perceived as the threat to order. Barriers to the success of a common staff approach, from the point of view of the carers, include the likelihood that colleagues will interpret situations differently, the chance that patients might succeed in dividing carers into “good” and “bad” camps, and the knowledge that the patient suffers under a common staff approach. The patients’ experiences partly confirm those of the carers – the dominant picture is that the patient feels persecuted and suffers under a common staff approach. However in some situations, patients can perceived the common approach as supportive and aimed to promote their recovery. Carers’ ethical reasoning about the common staff approach is usually applied on an individual basis; it can change depending upon the patient, the situation, and the proposed approach, as well as upon how the approach might affect other patients, staff members, or the carers themselves. Conclusions: The overall results from the four studies show that the common staff approach may meet carers’ needs, which under the approach take precedence over those of patients, but that the approach is more an exercise in asserting power and maintaining control than it is a therapeutic technique; that it is a difficult choice for the single carer to choose between the interests of the patient and the approval of colleagues; that the patient often suffers when a common staff approach is used; and that carers are seldom aware of the suffering experienced by the patient being managed by such an approach. A common staff approach has no part in a care-strategy; it is not an intentional care-plan; instead it appears to be a way for carers who feel vulnerable and under pressure to maintain order by controlling particular patients.
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| 4. |
- Lundström, Sofie, 1971-
(författare)
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Hälsa, levnadsvanor och erfarenheter av förändring av levnadsvanor hos personer med psykossjukdom – hälsofrämjande aspekter inom psykiatrisk omvårdnad
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Personer med psykossjukdom har ofta sämre fysisk hälsa jämfört med befolkningen i övrigt, delvis relaterat till ohälsosamma levnadsvanor såsom låg fysisk aktivitet, ohälsosam kost, tobaksbruk och riskfull alkoholkonsumtion. Trots att hälsofrämjande insatser har framhållits som betydelsefullt för att minska ojämlikheten i hälsa har inte det hälsofrämjande arbetet fått en given plats inom psykiatrisk vård. Ökad kunskap behövs dels om vilka levnadsvanor som påverkar hälsan, dels om vilka aspekter som påverkar möjligheten till förändring av levnadsvanor för personer med psykossjukdom.Syfte: Det övergripande syftet med avhandlingen var att utforska hälsorelaterade levnadsvanor och upplevd hälsa, samt erfarenheter av förändring av levnadsvanor och främjande aspekter för förändring, hos personer med psykossjukdom.Metod: Avhandlingen består av fyra delstudier. Delstudie I var en kvantitativ tvärsnittsstudie med syftet att kartlägga hälsorelaterade levnadsvanor och upplevd hälsa hos personer med psykossjukdom samt att undersöka könsskillnader och skillnader utifrån känsla av sammanhang (SOC). Data samlades in från personer med psykossjukdom som deltog i en hälsofrämjande levnadvaneintervention (n = 65). Beskrivande och jämförande analyser genomfördes på data, insamlad före interventionens start för att kartlägga självskattad hälsa, livskvalitet, BMI och levnadsvanor. För delstudie II som hade en kvalitativ design genomfördes narrativa intervjuer med personer med psykossjukdom som deltagit i en hälsofrämjande levnadsvaneintervention (n = 10). Syftet var att belysa innebörden av den levda erfarenheten av förändring av levnadsvanor hos personer med psykossjukdom. En fenomenologisk hermeneutisk metod användes för att analysera intervjutexterna. Deltagare i delstudie III bestod av sjuksköterskor som arbetade på olika psykiatriska öppenvårdsmottagningar (n = 15). Semistrukturerade intervjuer genomfördes för att beskriva deras erfarenheter av aspekter som främjar fysisk hälsa och stödjer hälsosamma levnadsvanor för personer med psykossjukdom. Intervjutexterna analyserades med kvalitativ innehållsanalys. Delstudie IV var en kvantitativ uppföljningsstudie och bestod av insamlad data från personer med psykossjukdom som deltagit i en hälsofrämjande levnadsvaneintervention (n = 54). Data, som bestod av självskattningar, kliniska mått och blodprover, samlades in före interventionens start, efter 12 månader och efter 24 månader. Flernivåanalys användes som metod för att undersöka hälsorelaterade förändringar efter deltagande i en hälsofrämjande levnadsvaneintervention.Resultat: Resultatet i delstudie I visade att personer med psykossjukdom hade högre BMI, lägre självskattad hälsa och livskvalitet, var mer stillasittande och rökte mer jämfört med befolkningen i övrigt. Personer med stark SOC skattade sin livskvalitet bättre och rökte mindre jämfört med de med svag SOC. Kvinnor konsumerade mer frukt och grönsaker än män. I delstudie II beskrevs innebörden av levnadsvaneförändringar, av personer med psykossjukdom: som en kamp med inre och yttre begränsningar, att det var något som måste göras på egen hand men tillsammans med andra och att längtan efter ett liv i harmoni kan motivera till förändringar. I resultatet av delstudie III framhöll sjuksköterskor aspekter som kan främja hälsa och hälsosamma levnadsvanor för personer med psykossjukdom. Sjuksköterskornas erfarenheter var: att ha ett hälsofrämjande fokus i varje möte, att stödja med varje persons förutsättningar i åtanke och att ta ansvar för hälsofrämjande insatser på varje nivå inom organisationen. Resultatet i delstudie IV visade en positiv förändring av fysisk aktivitet. Förändringen var associerad med antal tillfällen personen hade deltagit i hälsogrupp. Förändring av självskattad hälsa var positivt associerad med känslan av sammanhang. Således kan det antas att hälsofrämjande insatser som genomförs i grupp kan förbättra fysisk aktivitet, och att känslan av sammanhang bör stärkas för en bättre upplevd hälsa hos personer med psykossjukdom. Konklusion: Det finns såväl individuella aspekter som relationella, organisatoriska och samhälleliga aspekter som påverkar möjligheten till förändring av levnadsvanor. Inre styrka, en positiv självbild och positiva erfarenheter är individuella aspekter som tillsammans med relationella aspekter såsom stöd och att få ingå i en gemenskap, kan främja förändringar hos personer med psykossjukdom. På en organisatorisk och samhällelig nivå är samverkan, ansvarsfördelning samt kunskap och kompetens viktiga ingredienser för att främja det hälsofrämjande arbetet inom psykiatrisk vård. Det hälsofrämjande arbetet bör, tillsammans med insatser såsom utbildning och praktiskt stöd, fokusera på insatser som kan öka personens känsla av sammanhang och stärka resurser. Sjuksköterskan inom psykiatrisk vård har en nyckelposition för att utveckla den hälsofrämjande omvårdnaden, där fysisk och psykisk hälsa integreras, och där personens egen förmåga till förändring främjas. Ett salutogent och personcentrerat förhållningssätt, kan bidra till en hälsofrämjande omvårdnad, men för att kunna utveckla det hälsofrämjande arbetet inom psykiatrisk vård behöver individuella, relationella samt organisatoriska och samhälleliga aspekter beaktas. Således behöver det i samverkan tas ett gemensamt ansvar för hälsa och hälsosamma levnadsvanor, och organisatoriska strukturer behöver utvecklas för att möjliggöra en personcentrerad vård och för att utveckla de hälsofrämjande insatserna för personer med psykossjukdom.
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| 5. |
- Andreassen Devik, Siri
(författare)
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Hjemmesykepleie til eldre som bor på bygda med uhelbredelig kreft
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)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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| 6. |
- Eivergård, Kristina
(författare)
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Språkets makt : en studie av vårdpersonals tal om psykiatriska patienter och brukare
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this dissertation was to critically examine, based on three selected psychiatric care environments, how healthcare staff talk about patients and users with a focus on how notions of gender are produced and reproduced during rounds and in reportings.Reportings and rounds are daily activities in almost all healthcare practices. It takes place three to four times a day and is ideally aimed at creating continuity and alignment in the care. In psychiatric contexts, the reportings and rounds constitute important tools in assessing which approach and treatment are most appropriate. Studies on verbal reporting have mainly been carried out in somatic care and have been focused on the reportings’ content, type, cost and time required. Research also suggests that healthcare staff find it difficult to move away from a strictly medical perspective and that reporting and rounds take place in a ritualized way where the staff are socialized into what is valid information to pass on. The reportings can also serve as a way for healthcare staff to support each other in their work. The research also applies in psychiatric care contexts where different power structures also become apparent in the use of language. However, how psychiatric care staff talk about patients and users in reportings and on rounds based from a gender perspective has not been studied to any great extent.The dissertation is based on four sub-studies, all with qualitative research design. The empirical material in all sub-studies consisted of sound recordings from rounds and reports in three different psychiatric care contexts; general psychiatry, forensic psychiatry and municipal psychiatry. In sub-study I and II, content analysis was employed and in sub-study III and IV, discourse analysis was employed. Sub-study I showed how the healthcare staff used everyday words and concepts in both reports as in the rounds. The words and concepts formed the basis for assessing the patient's behaviour and mental condition and decisions about nursing and treatment. Sub-study II showed that the language discourse of the healthcare staff reproduced a gender order in which the female patients were expected to behave according to feminine norms in order to be acceptable as women and, as patients. In sub-study III, the statements studied showed a family oriented caring practice and how power techniques in terms of discursive norms around masculinity contributed to the subordination of men cared for in. The results also revealed how the healthcare staff reproduced a heteronormativity gender order through the language used. In sub-study IV, the statements showed a discourse of care where various techniques of power such as intimacy and confession were used to persuade the users to behave according to feminine or masculine norms. The statements also showed a heteronormative and heterosexual order in which the paradox between the need for support and maintaining one's dignity was clarified.The conclusion of the sub-studies together was that the reports and rounds was a scene for which everyday words and concepts were used to describe and assess patients and users. These everyday words and concepts reproduced power orders in which different disciplining power techniques were displayed. The language also reproduced a heteronormative gender order in which notions of femininity and masculinity participated in the assessments of patients and users´ mental states. Because the patients were not involved in the conversations about themselves, healthcare staff were given the possibility to describe and position the patients and users in ways that they themselves were not aware of. In order to create opportunities to break with stereotypical gender patterns as well as patterns of dominance and subordination in psychiatric nursing and care, students, as well as healthcare staff, should work with awareness and critical reflection on discursive norms and how language constructs the patient and user.
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| 7. |
- Grav, Siv
(författare)
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The relationship between social support, personality and depression in the general population : Focusing on older people
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Today's wide variety of diseases and health problems areinfluenced in part by an aging population and by environmental andlifestyle changes. Depression is one of the most quickly growingdisorders, causing a huge decrease in quality of life. Depression alsoincreases with age. The expected increase in the number of olderpeople in the years to come might lead to an increasing problem ofincreased case loads for primary health care in the coming years asthe delivery of healthcare services shifts from clinical settings to thehome. People who lack social support are more likely to experiencepoorer quality of life, including depression. Personality is a robustpredictor of behaviour and essential life outcomes. The aim of thisthesis is to describe the relationship between social support,personality and depression in the general population, with a focus onolder people.This thesis used data from the Nord-Trondelag Health Study(HUNT), a large census population survey in Norway. Paper I (n=40,659), II (n= 35,832), and III (n=35,797) used data from HUNT3(2006-2008), and Paper IV (n=25,626) used data from both HUNT2(1995-1997) and HUNT3. Paper I, II, and III used cross-sectionaldesigns and paper IV used a longitudinal design. The age of thesample was 20−89, divided into three age-groups: 20−64 years(adults), 65−74 years (old), and 75−89 years (oldest old). Depressionwas measured with the Hospital Anxiety and Depression Scale(HADS in the HUNT2 and 3), personality was measured with a shortversion of the Eysenck Personality Questionnaire (EPQ in theHUNT3), and social support was examined with single questionsabout perceived support from friends (HUNT2 and 3).iiiThe main finding in Paper I was that self-rated perceived supportwas significantly associated with depression, even after controllingfor age and gender, emotional support (OR = 3.14), and tangiblesupport (OR = 2.93). The effects of emotional and tangible supportdiffer between genders. Interaction effects were found for age groupsas well as emotional and tangible support. Paper II showed arelationship between depression and both neuroticism andextraversion in a general population. Older people are more likely toscore low on extraversion (E) than younger people. Interactions wereobserved between neuroticism and age, neuroticism and gender, andextraversion with depression. The interaction terms indicates a highscore on neuroticism (N) is enhanced by introversion, older age, andbeing a male with depression. Paper III showed a significantassociation between levels of perceived social support, personality,sense of community in the neighbourhood, and civic participation.Women frequently reported higher levels of social support, andhigher scores on both extraversion and neuroticism than men, whilemen reported higher sense of community in the neighbourhood andlevels of civic participation than women. Paper IV showed that riskfactors had a greater effect on new cases than on recovery fromdepression. The greatest association with new cases of depressionwas found for male sex, the oldest age group, melancholics, thosewho lacked social support, those who never participated in socialactivities, those with decreasing community in the neighbourhood,those with poor health, and those who have gotten divorced. Thegreatest association with recovery from depression was found forfemale sex, sanguine temperament, those with social support, thosewho participated in social activities, those with increasingivcommunity in the neighbourhood, and those who have obtainedbetter health.The findings show that both social support and personality arerisk factors for developing depression. Nurses should put extra effortinto how they care for patients with low extraversion, highneuroticism and, low social support in order to help these patientsavoid depression. Nurses have to "see the patient" and "care about",and respect patient’s values, preferences and expressed needs.
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| 8. |
- Hammarström, Lars
(författare)
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Encounters with patients in forensic inpatient care : Nurses lived experiences of patient encounters and compassion in forensic inpatient care
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Forensic psychiatry is characterised by compulsory care and long hospital stays, where nurses care for patients with severe mental illness, who often have committed crimes. The main objective is to rehabilitate the patient to once again become a part of society by improving mental health and decreasing the risk of criminal relapse. This is mainly achieved through encounters with the patients. Encountering patients in forensic psychiatry means coming face to face with suffering and the duality of caring, doing what is best for the patient and protecting society.Aim: The purpose of the study was to obtain a deeper understanding of encounters with patients with mental illness in forensic inpatient care as experienced by nurses.Method: This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design. A total of 13 nurses working at a forensic psychiatric hospital in Sweden were recruited through a purposive sample to participate in the studies through narrative interviews. Study I was analysed with phenomenological hermeneutics in line with Lindseth and Norbergh (2004) in order to illuminate the lived experience of nurses’ encounters. Study II was a secondary supplementary analysis, which applied hermeneutics in line with Fleming, Gaidys, and Robb (2003) to gain a deeper understanding of nurses’ compassion in forensic psychiatry. The two studies were merged to provide a comprehensive understanding in this licentiate thesis.Findings: Study I illuminated the meaning of nurses’ lived experiences of encounters with patients with mental illnesses in forensic inpatient care, that is the nurses’ desire to do good despite being confronted with their own emotions as fear, humiliation, and disappointment. Encounters were also occasionally perceived as positive, awakening emotions of compassion, competence, pride, trust, satisfaction, and gratification regarding the patient’s recovery. However, a source of conflict was the struggle between doing what was best for the patient and protecting society. The study comprised of four themes: being frustrated, protecting oneself, being open-minded, and striving for control. Study II aimed to gain a deeper understanding of nurses’ compassion in providing forensic psychiatric inpatient care with three themes: recognising suffering and need for support, responding to patient suffering, and reacting to one’s own vulnerability. Abstracting to a main theme of being compassionate in forensic psychiatry which is described as an emotional journey, an ongoing inner negotiation between own vulnerability and expressions of suffering. This inner negotiation of making sense of patients’ plea and how they were perceived was crucial for determining the development of compassion rather than turning to control and rules as a means to protect oneself.Discussion: A interpretation of the studies (I, II) revealed two topics, being sensitive and responsive and keeping distance, which were reflected upon against the theoretical framework of Kari Martinsen. The studies showed that nurses faced a variety of encounters that forced them to face their own vulnerability and that trust could reduce power imbalances as well as help deal with societal, man-made constructs. The nurses’ encounters with incomprehensible expressions of suffering also show that nurses need to find a way to make room for “expressions of life”– taking a step back and turning their gaze inwards – in order to regulate their own emotions. This may better equip nurses to encounter patients with compassion and kindness rather than turning to norms and rules to protect themselves and guard their own vulnerability. Rather than distancing themselves from the patients, nurses can instead take a step back to come closer to their patients.
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| 9. |
- Kjällman Alm, Annika, 1963-
(författare)
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Long-Term Ongoing Structured Support in Early Stage of Dementia: A Family Affair
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Demenssjukdomar drabbar mer än 35 miljoner människor världen över, en summa som kommer att fördubblas vart tjugonde år. Demens är en global störning av intellektuella funktioner: förmågan att minnas försämras, och förmågor som att orientera sig i tid och rum, språklig förmåga, tankeprocesser som att gå från tanke till handling, problemlösande, utföra saker praktiskt och känna igen föremål. Symtomen följs ofta av förändringar i beteende och personlighet, som låg initiativförmåga, irritation, grovt socialt beteende och humörsvängningar. I Sverige diagnostiseras 25 000 personer per år, totalt så lever 160 000 personer med sjukdomen i Sverige idag. I Sverige ställs diagnosen ofta utifrån blodprover, hjärnröntgen och Mini Mental Score Evaluation-Swedish Revision tillsammans med personens sjukdomshistoria. Efter diagnosen har ofta anhöriga många frågor om hur livet kommer att te sig framöver, är det bra att flytta eller ska man bo kvar? Hur kommer sjukdomen att förändra livet och personligheten hos den drabbade? Tidigare studier visar att dessa frågor ofta förblir obesvarade, det är svårt att få en uppföljning hos läkare och det finns få länder där stöd efter diagnosen är vanligt förekommande. Sverige har sen 2009 lagstiftat om rätten till stöd till anhöriga och närstående med demenssjukdom eller andra kroniska sjukdomar med funktionshinder. Typen av stöd som ges skiljer sig däremot åt, Socialstyrelsen kom därför hösten 2013 ut med riktlinjer för hur stödet bör se ut för att vara effektivt: 8-10 träffar under 3-6 månader med information och socialt stöd till anhöriga.En kommun i norra delen av Sverige har gett långvarigt stöd till personer med demenssjukdom och deras anhöriga sen 2006.Ett nära samarbete med Landstinget i regionen och på senare tid även privata vårdcentraler i området har lett till att stöd kan erbjudas i direkt samband med diagnostillfället. Personerna deltar ofta i stödgrupp inom ca 4-6 veckor efter sin diagnos. Avhandlingens syfte var att fördjupa kunskapen om personernas upplevelse av att vara i stödgrupp under lång tid; den längsta i 4 år. Intervjuer gjordes med anhöriga och personer med demenssjukdom.Resultaten visade att de par som varit med längst i stödgrupp kände sig trygga, de upplevde att de fick god kunskap om demens och var förberedda på den förändring som skulle komma. Resultaten visade också att vara vuxet barn till en person med demens innebar att vara tyngd av ansvar för att agera i den sjuka förälderns intresse trots en djup känsla av sorg of förlust vilket ofta leder till frustration med situationen. Relationerna inom familjen kan förändras efter demens diagnosen både till det bättre; att man sluter upp kring den demenssjuke föräldern men också till det sämre; att familjen splittras då relationerna utsätts för påfrestningar. Personerna med demenssjukdom som deltog i stödgrupperna upplevde och skattade sin känsla av sammanhang högt; att livet var meningsfullt, begripligt och hanterbart. Deras friska partner upplevde mindre begriplighet och hanterbarhet och de vuxna barnen mer meningsfullhet.Avhandlingens resultat har legat till grund för en modell för stöd till personer med demenssjukdom och deras anhöriga kallat PER-modellen®; Pedagogisk, Emotionell och Relationsbaserad modell för stöd.
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