| 1. |
- Fjelltun, Aud-Mari, et al.
(författare)
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Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents : a comparative study.
- 2009
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:4, s. 736-747
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses' physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly's functional levels may illuminate the extent of the carers' workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi-Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly's need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.
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| 2. |
- Fjelltun, Aud-Mari Sohini, et al.
(författare)
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Carers' and nurses' appraisals of needs of nursing home placement for frail older in Norway
- 2009
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Ingår i: Journal of Clinical Nursing. - Malden : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 18:22, s. 3079-3088
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The aim of this paper was to explore carers' and nurses' appraisals concerning if and when nursing home placement for frail older people awaiting placement was needed and to illuminate ethical issues involved in decisions regarding nursing home placement.Background. Requesting nursing home placement can be a complicated decision for carers, causing feelings of failure, anxiety and guilt. After the necessity of nursing home care is determined, the names of the older people are put on waiting lists. While waiting, home health care provides support services. Even with this care, many of the older people and their carers face difficult life situations.Design. This is a descriptive and comparative cross-sectional study using qualitative methods.Methods. The convenience sample (n = 36) comprised 11 carers of older people on a nursing home placement waiting list in Norway and 11 nurses caring for these older people. Every one willingly participated in interviews that were transcribed and analysed by qualitative content analysis.Results. Various similarities and differences between nurses' and carers' appraisals were found. Complex ethical issues of justice, equality, autonomy, beneficence and justifiability in nursing were involved in decision making concerning nursing home placement. Four categories constructed were: 'appraising nursing home to be the level of care needed', 'appraising the older people as able to continue living at home', 'being ambivalent about nursing home placement' and 'being sceptical about use of coercion regarding nursing home placement'.Conclusions. Not all of the older people awaiting nursing home placements could be placed in nursing homes when beds became available. The situations were complex and involved ethical issues. Relevance to clinical practice. Despite insufficient resources in home health care, providing appropriate support for older people and their carers means that nurses have to consider individual concerns in each situation, cooperate with carers, respect their appraisals of needs and argue for the timely nursing home placement of older people.
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| 3. |
- Fjelltun, Aud-Mari Sohini, et al.
(författare)
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Carers' experiences with overnight respitecare : a qualitative study
- 2009
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Ingår i: Vård i Norden. - 0107-4083 .- 1890-4238. ; 29:3, s. 23-27
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to explore experiences with overnight respite care (ORC) of Norwegian carers who provided care to frail elderly awaiting nursing home placement. Background In many Western countries respite care has become part of health care service provision, and various types of respite care are available. The intent with respite care can be twofold; caring for the care receiver and supporting the carer. Methods This was a descriptive qualitative study. Interviews were conducted with 15 carers, transcribed and analysed by qualitative content analysis. Findings The carers described various experiences with ORC. If ORC supported the family unit, it was welcomed by carers and experienced as supportive. If ORC did not support the family unit, many carers rejected ORC, and it was experienced as non-supportive. Two categories were constructed: 'experiencing ORC as supportive for the family as a unit' and 'not experiencing ORC as supportive for the family as a unit'. Conclusion To support more carers, nurses have to listen to carers’ experiences about ORC. Nurses need to take responsibility for the family as a unit and provide more flexible ORC services based on both carers’ and elderly’s needs.
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| 4. |
- Fjelltun, Aud-Mari Sohini, et al.
(författare)
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Nurses' and carers' appraisals of workload in care of frail elderly awaiting nursing home placement.
- 2009
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:1, s. 57-66
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study is to describe carers' and nurses' appraisals of workload in care of frail elderly awaiting nursing home (NH) placement. BACKGROUND: Carers' workload of care for frail elderly awaiting NH placement has been studied separately from that of nurses' workload. The literature neither addressed a comparison of carers' and nurses' appraisals of psychological and physical workloads nor the most strenuous factors common to the workloads of both nurses and carers in care of the same elderly person. The terms 'carers' and 'nurses' in this paper refer to informal caregivers and to both enrolled nurses and Registered Nurses respectively, when no particular one is stated. METHOD: The sample comprised 11 nurses and 11 carers paired based on care provided to the same elderly person awaiting NH placement in Norway. Data collected by a workload-scale was analyzed by descriptive statistics. Data collected by individual interviews were analyzed by qualitative content analysis. Carers' and nurses' appraisals of workload were compared and contrasted and most strenuous factors described. FINDINGS: The findings show that both carers and nurses rated workload levels maximum. Carers' highest ratings concerned psychological workload, while nurses' highest ratings concerned physical workload. The workload ratings concerning elderly with advanced dementia disease were most similarly aligned. Qualitative content analysis showed three categories that describe the most strenuous factors common to the workloads of both carers and nurses. These were feeling responsible, burdened and ambivalent. CONCLUSION: This study reports carers' and nurses' appraisals of workload in care of frail elderly awaiting NH placement. The results show many similarities and some differences. These results may help guide policy development to address resource allocations to elderly care. Further research is needed to address workloads of care for elderly awaiting NH placement.
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| 5. |
- Henriksen, Nils, et al.
(författare)
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Nursing home placement in Norway : characteristics of older people assigned to placement
- 2015
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Ingår i: Nordisk sygeplejeforskning. - : Universitetsforlaget. - 1892-2678 .- 1892-2686. ; 5:2, s. 133-150
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Tidskriftsartikel (refereegranskat)abstract
- To determine the characteristics of older people assigned to nursing home placement and to illuminate the factors emphasised in the assignments, thirty-two home health care leaders in a Norwegian municipality completed a questionnaire regarding their assessment of the levels of functioning of the assigned individuals. These assessments were compared with assessments of individuals who had been placed on a waiting list to receive an assignment and of residents who had already been admitted to a nursing home. The individuals who had received assignments had higher rates of cognitive impairment, memory disturbances, disorientation and psychiatric symptoms compared with the individuals awaiting placement. The individuals with assignments had better motor function and a greater ability to accomplish daily activities without assistance than those in the other two groups. The physical workloads were the lowest for the carers of older people assigned to placement. Individuals without cognitive impairment and with low/worse motor function had to wait longer for nursing home placement than individuals with cognitive impairment. Older people with low/worse motor function required more assistance with their daily activities from informal carers. The implications for nursing are to recognise the physical workloads of carers and the necessity of offering them respite and support.
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| 6. |
- Normann, Hans Ketil, et al.
(författare)
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Attitudes of Registered Nurses towards patients with severe dementia
- 1999
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 8:4, s. 353-359
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Tidskriftsartikel (refereegranskat)abstract
- Meeting the needs and wishes of people with severe dementia is difficult and demanding for carers, and a number of approaches can be used in encounters with dementia sufferers. The aim of this study was to explore how registered nurses in a northern Norwegian county thought about approaching people with severe dementia. A patient case was used as a vignette, followed by a questionnaire with 13 sets of statements, each set containing two alternative approaches (one reality orientation approach and one personhood focused approach). In 12 out of the 13 sets of statements the reality orientation alternative was usually chosen, but responses to the statement regarding the meaning of confusion tended more towards the personhood focused approach. RNs with more than the basic education and staff nurses working in a team nursing system, chose the personhood focused approach significantly more often than RNs with no post-basic education and nurses working in a primary nursing system. The article discusses how reflection on daily experiences can improve one's ability to reflect on one's own experiences and encourage a personhood focused approach. Working in a team means gaining opportunities to reflect together with coworkers, while working in a primary nursing care system might afford fewer such opportunities.
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| 7. |
- Normann, Hans Ketil, et al.
(författare)
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Confirmation and lucidity during conversations with a woman with severe dementia
- 2002
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 39:4, s. 370-376
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Tidskriftsartikel (refereegranskat)abstract
- Rationale. Patients with severe dementia sometimes surprise the care providers because they seem to be much more aware of their situation and function much more adequately than usual. Such episodes are labelled 'episodes of lucidity' (ELs). The aim of this study was to describe the characteristics of the particular conversations with a woman with severe dementia when ELs occurred as compared with conversations when she was not lucid.Methodological design. A woman with a probable diagnosis of Alzheimer's disease (AD) was selected. Her Mini Mental State Examination (MMSE) was estimated as 3. The first author met the woman for 4 hours five times over a period of 2 weeks.Research methods. The conversations were tape-recorded and transcribed verbatim. The text was divided into 278 content units and analysed.Findings. Lucidity is promoted by supporting the patient in various ways, that is sharing the patient's view, repeating and reformulating the patient's utterance, reinforcing the patient by using positive utterances, not emphasizing errors and supporting the patient's language in various ways, and avoiding making demands. The relation between the patient and her conversation partner during ELs is characterized by confirmation and communion.Conclusions. This case study indicates that a supportive attitude in conversation with the patient with severe dementia promotes lucidity. A supportive attitude includes the avoidance on the part of the conversational partner making demands on the patient, confirming the patient as an important, unique and valuable person and creating communion. The connection between supporting and avoiding demands and lucidity/nonlucidity during conversation needs further study.
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| 8. |
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| 9. |
- Normann, Hans Ketil, et al.
(författare)
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People with severe dementia exhibit episodes of lucidity : A population-based study
- 2006
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 15:11, s. 1413-1417
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. To describe frequency and characteristics of people with severe dementia who according to care providers, exhibit ELs in a population of those with dementia in institutional care.Background. There are reports in the literature concerning episodes when the resident unexpectedly says or acts in a way that surprises the care provider because the resident seems to be much more aware of her/his situation than usual. This is labelled ‘episodes of lucidity’ (ELs).Design. The study is based on data from a point prevalence study from institutions for the older people in northern Sweden in May 2000.Methods. Out of 3804 residents, assessed by key care providers, by means of the Multi-Dimensional Dementia Assessment Scale (MDDAS) with questions about ELs added, 92 residents were found to have severe dementia and difficulties with verbal communication. The key care providers’ competence in assessing severe dementia was not evaluated. An ethics committee approved the study.Results. Fifty-two residents (57%) were assessed as exhibiting ELs. Residents who showed ELs had higher orientation scores and expressed more emotions than residents who did not show ELs. More residents who exhibited ELs took outdoor walks with their care providers exhibited ELs than those who did not (P = 0·001).Conclusions. Every second resident with severe dementia and difficulties with verbal communication showed ELs.Relevance for clinical practice. The fact that every second resident with severe dementia and difficulties with verbal communication showed ELs and that this was noticed especially when care providers took outdoor walks with the residents imply that closer contact between care providers and residents with severe dementia could change the care providers’ expectations and enhance communication between the parties.
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| 10. |
- Skaalvik, Mari Wolff, et al.
(författare)
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Expressions of Sense of Self Among Individuals With Alzheimer's Disease
- 2016
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Ingår i: Research and Theory for Nursing Practice. - : Springer Publishing Company. - 1541-6577 .- 1945-7286. ; 30:2, s. 161-175
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Tidskriftsartikel (refereegranskat)abstract
- Recent research has challenged the previously held view that people with Alzheimer's disease (AD) lack a sense of self, with several studies demonstrating that the sense of self is partially preserved, even in late stages of AD. The aim of this study was to examine how people with AD express their sense of self (Self 1-3) using the social constructionist theory of selfhood described by Harre (1998). Personal interviews were analyzed deductively. The participants narrated fragments of their life stories and expressed the fear of becoming a burden to family members and of nursing home placement. They expressed Self 1 (personal singularity or personal identity) without any problems, whereas their Self 2 (self-concept) attributes had undergone changes that they had learned to live with. The participants expressed surprisingly few problems with their narratives of Self 3 (social personae), that is, their accounts of interactions with other people. They reported being received positively when they were open about their diagnosis. These results provide further nuances that broaden our understanding of the process of preserving the sense of self, that is, simultaneously being the same and a different person.
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