| 1. |
- Fart, Frida, 1992-
(författare)
-
The Ageing Gut, in Health and Disease
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is a global ageing phenomenon, which stress the importance for an improved health for the increased population of older adults. One important factor for a good health is a well-functioning gut. Hence, this thesisinvestigates several aspects of gut health for older adults, spanning from overall gut health in community-dwelling older adults, to investigating a gut disease model: inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis. When investigating community-dwelling older adults, gastrointestinal symptoms were found to be common and correlated to a lower experience of well-being. In addition, more than half of the population did not reach the recommended intake of several macronutrients, including protein and fibre. Compared to a group of active older adults, still practising orienteering, i.e., senior orienteers, community-dwelling older adult’s further showed signs of a less healthier gut microbiota, including lower levels of Faecalibacterium prausnitzii.By investigating the disease model of inflammatory bowel disease, later onset of Crohn’s disease seemed to have less hyperresponsive adaptive immune response toward the own gut microbiota, which seems to be due to a less genetic predisposition among later onset individuals. Interestingly, an environmental pollutant, per- and polyfluoroalkyl substances (PFAS), was increased in the serum of late-onset ulcerative colitis patients compared to healthy controls. A higher level of PFAS further correlated to a disturbed bile acid pool. In addition, PFAS induced an increased intestinal permeability across ileal and colonic murine tissue. In conclusion, the work included in this thesis further emphasises the importance of a maintained gut health. In addition, the work highlights diet, an active life-style, gut microbiota and environmental factors, for example PFAS, as targets of future interventions studies with the aim to improve gut health and overall health among older adults.
|
|
| 2. |
- Liedström, Elisabeth, 1952-
(författare)
-
Life situation of next of kin to persons in need of care-cronic sorrow, burden, quality of life
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Nursing research has been performed during the last 20-30 years, about the next of kin’s vulnerability. Despite this, the health care system has had difficulties to integrate the next of kin in a way that gives support. The overall aim of the thesis was to describe and further explore the life situation of the next of kin to persons who are long-term ill, disabled, and/or older, and in need of care. Method: Multiple methods were used. Study I had a descriptive design, 44 next of kin of patients with multiple sclerosis were interviewed, latent content analysis was used for the analysis. Study II had a mixed method approach; the descriptive core study was analyzed with directed content analysis. The supplementary study with descriptive, correlative design was analyzed with descriptive and correlative statistics. Forty-four next of kin of patients with multiple sclerosis were interviewed; thereafter 37 of them answered a questionnaire about Quality of Life. Study III had a descriptive, explorative design. Twelve next of kin of older persons were interviewed with repeated informal conversational interviews, analyzed with latent content analysis. Study IV was cross-sectional with a descriptive, correlative design. Eighty-four next of kin of persons who were long-term ill, disabled, and/or older answered two questionnaires about Burden and Quality of Life that were analyzed with descriptive and correlative statistics. Results and Conclusions: Next of kin described a balance/imbalance in their relations to others and a high burden, but in general a good Quality of Life. Some next of kin also experienced chronic sorrow. Significant correlations were found between interpersonal relations and Quality of Life as a whole. Love and obligations were two anchor points on a continuum, describing the next of kin’s relationship to the ill/disabled person. The relationship with the health care personnel was described through cooperation and obligations. Good communication was seen as the key to balance the relationship with others. One possibility to achieve symmetrical communications is to adapt the Partnership Model, as a tool for creating good relationships. Honest and specific communication between the health care personnel, the next of kin, and the care receiver are necessary.
|
|
| 3. |
- Algilani, Samal, 1981-
(författare)
-
To be at one's best : The evolution of Optimal Functionality and its possible implementation in an ICT-platform
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- At the Nutrition and Physical Activity Research Centre for Optimal Health and Functionality through Life (NUPARC), a research gap was uncovered regarding the concept optimal functionality based on the older adult’s own perspective. The overall aim was to explore the concept of optimal functionality among older adults and the possibility of creating and developing an ICT-platform to measure it. Method: An existing cohort from NUPARC was used for recruitment in studies I-III and to some extent study IV. A scoping study design and framework was adopted for the inclusion of the articles in Study I. Study II had a descriptive design. Six focus group discussions were conducted and analysed using qualitative deductive content analysis to extend the qualitative understanding. Study III used a phenomenological approach describing the experience of mental health and its impact on the ability to function as optimally as possible. Six interviews were analysed using Giorgi’s phenomenological approach. Study IV was a feasibility study and included 8 older adults using an ICTplatform for a period of four weeks. Results: Optimal Functionality comprises three major corner stones: Body-related factors, Self-related factors and External factors (I) accompanied by nine aspects, and according to older adults it is a matter of functioning as optimally as possible (II). The three major cornerstones are intricately linked and all but the mental aspects were included in the discussions (II). Life situations affecting mental health, consequences of mental health and strategies for maintaining good mental health were described by older adults as having an impact on mental health and affecting their ability to function as optimally as possible (III). The older adults managed the usage of an ICT-tool well and it was perceived as meaningful (IV). Conclusion: Optimal functionality is holistic, subjective, dynamic and applicable to all older adults. Identification of the factors involved can help the older adults on their path to health. An ICT-platform can facilitate the identification of the factors for optimal functionality and the eventual measurement of it.
|
|
| 4. |
- Kjällman Alm, Annika, 1963-
(författare)
-
Long-Term Ongoing Structured Support in Early Stage of Dementia: A Family Affair
- 2014
-
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.
|
|
| 5. |
- Odzakovic, Elzana, 1986-
(författare)
-
Neighbourhood nursing : connection, place and meaning in the everyday experience of dementia
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Recent policy is marked by a shift towards enabling people with dementia to remain at home and in their neighbourhoods, yet little is known about the wider perspective of neighbourhood as an everyday place of connection, practice and meaning in the lives of people with experience of dementia. Aims: The aim of this thesis is twofold. The first aim is to explore the neighbourhood as an everyday place for people with experiences of dementia. The second aim is to explore neighbourhood as a place for practice. Methods and Designs: Five studies are included in the thesis with both quantitative and qualitative designs. Study I had a cross-sectional exploratory and descriptive design. A total cohort of 17, 405 people with a dementia diagnosis were identified and matched with data about home care services and housing, and were then associated with socio-demographic factors in three county councils: Östergötland, Stockholm and Västerbotten. Study II had a phenomenological design; 14 community-dwelling people diagnosed with dementia in the County of Östergötland participated using walking interviews. Study III had an inductive and exploratory qualitative design including 14 community-dwelling people living alone with dementia in England, Scotland and Sweden involving multiple data collection methods. Study IV had an inductive and explorative qualitative design that included 22 people with the lived, personal and professional experiences of dementia and used semi-structured individual and group interviews. Study V had an inductive and explorative qualitative design where the perspectives of 18 participants (registered and specialist nurses) were included using shadowing as the main method for data collection. Findings: In study I, 72% of the cohort was living in ordinary housing and 28% in special housing of the total of 17, 405 people with a dementia diagnosis. Overall, 52% of 17, 405 people with dementia in three county councils (Östergötland, Stockholm and Västerbotten) were living alone. Study II revealed that walking in the neighbourhood was an integral part of their day-to-day activities that helped them to manage life with dementia. Connection to nature by being outdoors was a restorative practice for people living with dementia. Neighbourhood was often described as a social context, although some participants living alone revealed that their social contacts were mainly staff working in municipal home care. In study III, participants across all three field sites channelled their efforts to stay connected to the neighbourhood into creating new ways of maintaining social networks and relationships. By participating in several activities (provided in the United Kingdom by the third-sector and charitable groups, and in Sweden, by the municipalities), bonds of friendship were created. However, the impact of stigma surrounding dementia was highlighted by the participants, which caused experiences of involuntary solitude or loneliness. Despite the impact of stigma, participants took control over their lives by searching for new daily social connections in the neighbourhood and were by no means passive in the face of the challenges in everyday life. In study IV, the participants discussed how dementia was stigmatized in the community. People living with dementia were often not being respected as active citizens with their own resources in the community. Being socially active in a group or in public spaces were strategies to maintain a social role in the community. Participants with different experiences of dementia wanted the day care centres and teams to be more centrally involved in person-centred care and health-promoting improvements. Finally, in study V, participants struggled with the commonly held view of their role and their workplace within the health care system, interpreting it as being invisible, as if placed in a black box. The tasks and responsibilities of the participants were shifting to assistant nurses, neighbours and family members according to the socio-economic level of the municipality. Nonetheless, the participants were clearly part of the neighbourhood. The findings of this thesis have been integrated into a combined thematic analysis based on the five studies to reach an overall representation of people’s experiences of neighbourhood as an everyday place and a place for practice in the context of dementia. Five main themes (and three sub-themes) emerged from the analysis: (1) walkable attachment to the lived neighbourhood; (2) daily activities promote health and well-being; (3) opportunities for social connections; (4) just treat us as active citizens; (5) neighbourhood: a place for practice. The analysis suggested the neighbourhood was not only described as a walkable, social and citizenship arena in the context of dementia; it was also a place where practice was ongoing around the clock (studies II, III, IV and V) because most of the people with dementia are living in ordinary housing (study I). Conclusion: The thesis presents a new foundation and knowledge to understand neighbourhood as a place for everyday life and practice by applying a new lens for understanding. The neighbourhood can be understood as a place linked by connections that people actively searched out, and where the meaning of place emerges via movement of the body through the world. It is also a site where practices support everyday life for people with dementia, especially for those living alone with dementia. This points to the need to re-think nursing practice, where “neighbourhood nursing” as a formal model with a lifeworld perspective has to be established in dialogue with citizens.
|
|
| 6. |
- Rasoal, Dara, 1980-
(författare)
-
Perspectives on clinical ethics support and ethically difficult situations : reflections and experiences
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Healthcare personnel encounter ethically difficult situations in their everyday work and clinical ethics support might be important to support healthcare personnel to deal with these situations. The overall aim of this thesis was to describe perspectives on clinical ethics support, experiences of being in ethically difficult situations and experiences of facilitating ethics reflection. Methods. Study I had a descriptive design in which research articles were reviewed (n=54). In study II audio-recorded moral case deliberation (n=70) in 10 Swedish workplaces in hospitals and community care were analysed. In study III interviews were conducted with facilitators (n=11) of moral case deliberation. Study IV used non-participant observation during three weeks as well as informal conversations with healthcare personnel (n=12) in community home healthcare. Results and conclusion. In study I, two perspectives emerged on clinical ethics support, a “Top-down” perspective, where an individual or a group of “experts” in ethics could recommend the best course of action and a “Bottom-up” perspective that allows healthcare personnel to manage ethically difficult situations through ethical reflections led by a facilitator. Studies II and IV showed how ethically difficult situations on different levels are often connected with emotions and uncertainties. Study III showed the role of the facilitator to be fundamental in creating a space for self-reflection among healthcare personnel. Study IV showed that healthcare personnel face complex demands and expectations from the healthcare organization regarding the provision of care as well as having to meet the needs of patients and their next-of-kin. To conclude, healthcare personnel needed to find a balance among demands and expectations in order to satisfy those stakeholders involved and they had to seek compromise. There is a need for clinical ethics support that helps healthcare personnel reflect individually and collectively on ethically difficult situations they encounter in their everyday clinical practice. From this standpoint, a “Bottom-up” perspective may reduce the risk of moral distress among healthcare personnel and promote care based on person-centred values.
|
|
| 7. |
- Almevall, Ariel
(författare)
-
Health in later life: A nursing perspective
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The ongoing demographic shift towards an older population calls for a corresponding shift to a proactive approach, aiming for health and well-being in old age. This dissertation addresses the need for increased knowledge about health in the context of aging at home. It explores the roles of relationships, home, health, and well-being while examining the various factors influencing health. The disseration also explores how key stakeholders in home care organizations percive a good life for older persons. From a nursing perspective, the disseration explores pathways of change and experiences related to health, guided by the caritative caring theory, which underscores health as wholeness and holiness. By thoroughly examining self-rated health, relationships, and the experiences of older persons receiving home support, along with key stakeholders' perceptions, the dissertation aims to provide valuable insights for nursing practices and the promotion of health in later life.This dissertation aims to explore health in later life, specifically concentrating on widowed women living alone with extensive home care needs. This exploration encompasses both the perspective of older widows and that of key stakeholders. For a comprehensive understanding health, the disseration also study self-rated health among older persons over a 20-year period, exploring its associations to health and well-being factors, including survival. Additionally, the dissertation explores the shared relationship between older women and nurses.This dissertation comprises one quantitative and three qualitative studies, all centred around older persons aged 80 years and older. Paper I is a quantitative, longitudinal study investigating changes in Self-Rated Health (SRH) across the aging spectrum. The study included 1595 participants initially (aged 59-79) and 541 participants at follow-up (age 80-96). Most participants rated their health as "Quite good" (54.5%) at baseline. Over the study period, 42.6% had stable SRH, 40.6% had declined, and 16.8% had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p<0.05). Paper II is a qualitative study about the concept of a good life for single-living older women with extensive care needs. This involved individual interviews with 11 participants aged 82-95, analysed through reflexive thematic analysis. Paper III is a qualitative description of key stakeholders' perceptions regarding a good life for the oldest old persons living at home with extensive care needs. The study utilized qualitative focus groups with 28 participants aged 31-69 (1 man, 27 women), analysed through qualitative content analysis. Paper IV is a qualitative study that aim to explore the meaning of relationship between older women and registered nurses in home care. The research employed qualitative methods, including focus groups and individual interviews, with 11 older women (aged 82-95) and 5 registered nurses (aged 35-47), analysed using qualitative content analysis. In conclusion, health in later life is not merely about avoiding a decline in health; rather, it involves integrating existing aspects into an ever-changing situation. However, challenges such as living alone, experiencing depressive symptoms, and coping with illness and/or functional disability can pose threats, risking overall health and survival. In contrast, for those living with disabilities and illnesses with extensive care needs, the significance of daily life becomes paramount. Simultaneously, the relationship between older women and registered nurse emerges as a recurring connection with the potential not only to enhance daily life but also to serve as a consistent and supportive presence in the home.
|
|
| 8. |
- Eklund, Anna Josse, 1968-
(författare)
-
Sjuksköterskor som patienters företrädare : Med huvudsakligt fokus på företrädarskap för äldre patienter i kommunal hälso- och sjukvård
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to study nurses’ and managers’ attitudes towards micro social patient advocacy (I) and factors related to patient advocacy (II, III) with the main focus being on advocacy in the care of older patients in community health care together with psychometric testing of the instrument 'Attitudes toward Patient Advocacy Scale-Attitudes toward MIcrosocial Advocacy' (IV).Methods: A quantiative cross-sectional study and a qualitative study were carried out. Nurses (n=207) and managers (n=23) in community health care responded to a questionnaire about patient advocacy, nursing competence, personal traits, quality of care and organisational climate (I, II, IV). Nurses' (n=18) perceptions of influencers of patient advocacy was studied in a phenomenographic study (III).The results showed that nurses and managers reported positive attitudes to patient advocacy (I, II), especially for patients unable to speak for themselves (I). Two areas of nursing competence (Performing the nursing process, Supervision and cooperation) and a dimension of quality of care of older patients were positively associated with attitudes towards patient advocacy (II). Two organisational dimensions were, negatively (dynamism) respectively positively (playfulness), associated with attitudes towards patient advocacy. The nurses' perceptions of influencers of patient advocacy consist of three hierarchically related levels: The nurse's character traits, The nurse’s bond with the patient and The organisational conditions (III). The Swedish version of APAS-AMIA consists of 33 items in a four-factor structure (APAS-AMIA/SE): Support patients’ beliefs and decision-making, Safeguard patients' health care, Support patients to communicate their wishes and Respect patients’ wishes not to participate in decisions regarding care (IV).Conclusions: Maintaining the continuing professional competence of nurses is important, and is ensuring the organisational prerequisites to enable nurses' advocacy for patients.
|
|
| 9. |
- Kirsebom, Marie
(författare)
-
Mind the gap : organizational factors related to transfers of older people between nursing homes and hospital care
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present thesis was to study factors related to transfers of older people between nursing homes, emergency department and hospital care.The thesis was based on four studies and used three methods: focus group discussions, structured review of electronic healthcare records, semi-structured interviews with registered nurses and general practitioners.Study I: nursing home nurses found it difficult to decide whether older residents should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Study II: transfer rate to ED was 594 over 9 months among a total of 431 residents (M 1.37 each). 25% were caused by falls and/or injuries, 63% resulted in hospitalization (M 7.12 days). The transfer rate was 0.00-1.03 transfers/bed; it was higher for private for-profit providers than for public/private non-profit providers. Study III: nursing homes with high transfer rates had fewer updated advance care plans than did nursing homes with lower transfer rates. More nurses from nursing homes with low transfer rates had a specialist education and training in dementia care and had worked longer in eldercare. Study IV: general practitioners perceived registered nurses’ continuity, competence and collaboration with family members as important to quality of care in nursing homes; inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety.The findings indicate that organizational factors could explain differences in transfer rates between nursing homes. The studies highlight the importance of advance care planning together with residents and family members in facilitating future medical decisions. Registered nurses’ continuity and competence are perceived as crucial to quality of care. To meet increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care several changes should be made: Nursing homes should be equipped with suitable medical equipment and registered nurse staff should be matched accordingly; importantly, registered nurses and general practitioners should be able to access each other’s healthcare record systems.
|
|
| 10. |
|
|
