| 1. |
- Karlsson, Staffan, 1959-
(författare)
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Older people`s public health care and social services : Functional ability, health complaints, agreement in needs assessment and care satisfaction
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to describe and compare functional ability and health complaints of older people receiving municipal care in relation to housing and informal care, and factors associated with medical health care, municipal care and informal care. Further, the aim was to investigate agreement in needs assessments between personnel and older people and to investigate care satisfaction and health-related quality of life among older people receiving municipal care and services. Study I and II included 1958 persons aged 65 years and above, who were assessed for functional ability, health complaints, and level of informal and municipal care and service. Study II in addition included data from a register including medical health care. In study III (n=152), standardised needs assessments were performed by the staff. Later, the older person’s view was collected in a personal interview concerning functional ability, health complaints, public and informal care. In addition (Study IV, n=166), SF-12 was used for measuring health-related quality of life and for measuring care satisfaction. Cohabitation was a predictor of a combination of municipal and informal care at home (OR: 5.935), while assistance with Instrumental Activities of Daily Living (IADL) provided by municipal home care and services predicted municipal care only (OR: 0.344). Care in special accommodation was predicted by advanced age (OR: 1.051), dependency in IADL (OR: 19.883), Personal Activities of Daily Living (PADL) (OR: 02.695), and impaired cognitive ability (OR: 3.849) with receiving municipal care only as a reference. Living alone (OR: 0.106), dependency in IADL (OR: 11.348) and PADL (OR: 2.506), impaired cognitive ability (OR: 3.448), impaired vision or blindness (OR: 1.812) and the absence of slowly healing wounds (OR: 0.407) were predictors of special accommodation with a combination of informal and municipal care at home as a reference. 35% of those with public care at home were admitted to hospital and 76% had contact with outpatient care by physician compared to 26% and 87% respectively of those in special accommodation. Living in special accommodation was associated with more contacts with primary health care (B=0.643) and fewer contacts with specialist care (B=-0.722). Informal care was associated with more contacts with primary health care (B=0.413), specialist care (B=0.787), admissions to (B=0.265) and days in hospital (B=1.573). Agreement for dependency in IADL and PADL varied between good (κ=0.78) and moderate (κ=0.43). Poor agreement was found for dizziness (κw=0.17) and fair agreement for impaired hearing, urinary incontinence, pain, anxiety and depressed mood (κw between 0.21 and 0.37). Older persons reported more health complaints than were found in the personnel’s assessments, although significantly lower estimation was found only for incontinence and vision. Agreement for provided public care at home was poor, while for informal care it varied between very good and moderate. Low care satisfaction was associated with dependency in IADL (B=-1.338 and B=-1.630), impaired mobility (B=-12.579), blindness (B=-26.143), faeces incontinence (B=-11.898 and B=-17.529) and anxiety (B=-6.105 and B=-27.197), while high care satisfaction was associated with dependency in PADL (B=2.109) and receiving informal care with IADL from spouse (B=8.738). In special accommodation, low care satisfaction had to do with continuity, timing, the staff’s personal characteristics and with their ability to give service. At home, the older people were the least satisfied with the staff’s ability to do housework and to give medical care, with the staff’s amount of time and with their own influence over their care.
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| 2. |
- Chatchumni, Manaporn, 1974-
(författare)
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Post-operative pain management practice : Current situation and challenges within nursing practice in a Thai context
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients’ recovery after surgery is one of the most important health processes in planned hospital healthcare and has a direct impact on welfare and welfare systems. Therefore, what nurses do in the immediate postoperative period is of vital importance. This thesis addresses the question of understanding how nurses work in managing post-operative pain by exploring their daily nursing practices and experiences in responding to the patient in pain within a Thai cultural context.The project applied a qualitative methodology where the local culture and its day-to-day practices of pain management were studied by using observations, focus groups, in-depth interviews and a critical incident interview approach with nurses. Informants were recruited at a public hospital in Bangkok in a surgical ward. In all, 100 hours of observations, 39 interviews and 69 descriptions of critical incidents related to nurse’s pain management were gathered. The data analysis followed the principles of qualitative research.The findings showed that, although there is a clearly defined approach to pain management, the response system followed by the nurses to address patients’ pain is complex and includes much lead time between assessing patients’ pain and the nurses responding to the pain. Furthermore, nurses are caught in what is labeled a patient paradigm, where evidence of pain often is double- and triple-checked by scoring and recording signs that are then subject to confirmation by a third party. Underpinning this is a culture of pain management cultivated between the nurses that rests first and foremost on their own experiences and a working/professional culture where nurses offer each other practical help in urgent situations, but seldom discuss event-based strategies together. Nevertheless, when nurses described situations when they were successful in practicing pain management, they considered their own engagement and their availability of time, space and therapeutic options to be important.Keywords: Culture of nursing, Nursing in pain management, Pain assessment, Perception of pain, Pain management, Pain post-operative
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| 3. |
- Erdner, Anette, 1946-
(författare)
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Berättelser om ensamhetens vardag hos människor med psykiska funktionshinder
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation deals with people with mental illness that currently live in their own accommodation in the community. Common to all mentally ill people is their serious difficulties in carrying out activities and meeting needs in important areas of life. Terms such as "normalisation" and "integration" into the community of this group were important words full of promise at the time the psychiatric reform was carried out. However, there is some strong evidence that the psychiatric reform has not been completely successful. Despite the knowledge that loneliness and social isolation commonly occur among people with mental illness, there is little research that describes how mentally ill people themselves experience their life situation. The overall aim of the dissertation was to gain deeper understanding of the life situation of peop with mental illness via their own narratives on how their day-to-day life appears to them, ar through this gain knowledge of the type of support needed for them to live a satisfactory life. Various data acquisition methods were applied. Study I involved in-depth interview of two men and two women on their daily life. Data acquisition in Study II was via participant observations, an activity unit for people with mental illness. Photographs were used for Studies III and IV Eight informants were issued with disposable cameras and asked to take approximately 10 pictures of objects, situations and/or individuals. These photographs were then used as a basis for follow-up interviews. Results from Study I showed that informants were aware both of their illness and their psychosocial disadvantages, and that they had insight into what was required of them to influence their situation, while simultaneously having insight into their poor ability to tak initiatives. Informants in Study II experienced themselves as unwelcome, vulnerable and marginalised individuals with little hope of a change in existence, resulting in anxiety over the future. They felt trust was lacking in relation to other people and experienced themselves as not accepted in the company of others or by society. Study III provided description of informants occupied with themselves and their existence. The informants tell of a form of spirituality giving them a sense of peace and tranquillity, but which only exists for them at the beginning and end ol life. Animals are more loyal than people and make no demands, but are however, according to the informants, in a position of dependence on humans. Possessions are of significance to the informants, meaning they see their possessions as part of themselves. In Study IV informants related how they would like their future to appear. They also told what having an identity meant to them, how identity is formed in individuals, what having a mental illness and feeling good means. The informants showed a longing to be seen, but at the same time not wanting to be seen. Finding a meaning with life was important since it could end at any moment.In summary, the findings point to an existential loneliness that consists of a life pattern consisting of an interaction between the impact of the mental illness and the identity as a mentally ill person feelings of marginalisation and abandonment. Experiencing that life has a meaning, possibility o social exchange and a sense of control seem to be important for the persons with mental illness in this study. Consequently, it can be inferred that if the care of people with mental illness pays attention to the dimensions of existential loneliness persons with mental illness may be helped to experience that life has a meaning despite their disability.
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| 4. |
- Gransjön Craftman, Åsa
(författare)
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Medicine management in municipal home care : delegating, administrating and receiving
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to investigate how delegation of medication is handled in municipal home care. Specific aims were to 1) explore the prevalence of medication use in older adults over time; 2) describe district nurses’ experiences of the delegation of medication management to municipal home care personnel; 3) explore and describe how home care assistants experience receiving the actual delegation of the responsibility of medication administration; and 4) to describe how older adults, living at home, perceive receiving assistance from home care assistants to manage their own medication. Study I: Changes were explored in medication use over a period of 20 years among three cohorts of older adults aged 78+ years and living in Stockholm, Sweden (1517 participated in 1987; 1581 in 2001; and 1206 in 2007). All were included, whether living at home or in an institution. Univariate analysis was carried out, as well as multivariate logistic regression models. The mean number of drugs increased for both genders in all age groups: from 2.8 in 1987 to 5.8 in 2007 for those aged 78+ years, the corresponding figures for 96+ years was 3.6 and 7.7. Overall (1987, 2001 and 2007), drugs for the cardiovascular system were most frequent (53.1%, 60.8% and 68.7% respectively). Prevalence of polypharmacy (concurrent use of five drugs or more) increased from 27.0% (1987) to 53.9% (2001), and 65.3% (2007). Adjusting for age, gender, education and cognition, the odds of using analgesics and psychotropics were significantly higher in 2007 compared to 1987; OR (95% CI) of 3.3 (2.8-4.0) and 1.3 (1.1-1.6) respectively. Cognitively intact elderly primarily used hypnotics, whereas cognitively impaired elderly used hypnotics, sedatives and antidepressants. People living at home used fewer drugs. For those living in institutions, polypharmacy increased from 24.4% in 1987 to 95.3% in 2007. Corresponding figures for those living in service buildings were 44.6% to 82.4%. Study II: District nurses’ (DNs) perceptions of the concept of delegating the administration of medication to unlicensed personnel (home care aides, HCAs) working in municipal social care were described. Twenty DNs were interviewed and the interviews were audio taped. Data were collected from April 2009 to August 2010 and analysed using content analysis. Findings revealed that the statutes of delegation were outdated and appeared to be incompatible with day to day practice. Communication between DNs and HCAs, as well as tutoring, was regarded as important. The DNs found it imperative to be available to the HCAs and made an effort to create a trusting atmosphere. Delegation of administration of medication to a person, who lacked knowledge of medication, for example when it is proper to mix pills or blend them in a thick liquid, was reported by the DN as being stressful. This was explained by various responsible authorities and the growing number of social service groups. Despite this, the DNs did not see any major problems with the fact that the HCAs work for a separate authority (the county council vs. the municipality). Study III: The purpose was to explore and describe how HCAs experience receiving the delegation of medicine management, and how they handle the responsibility that comes with the delegation. Four focus groups consisting of 19 HCAs were conducted. Data were analysed using qualitative content analysis. According to the HCAs, health and social care depends on delegation arrangements to function effectively, but mainly it relieves a burden for DNs. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among HCAs of the content of the statutes of delegation. Accepting delegation to administer medication was an inevitable and a routine fact, regarded as a mandatory task that had become an implicit prerequisite for social care work in the municipality. Study IV: Finally, we wanted to describe how older people, living at home, experience the use and assistance of administration of medicines in the context of social care. Ten older adults, aged 68 to 94 years, were interviewed in their own homes. Latent content analysis was used. There were divided feelings about being dependent on assistance in handling medication, since it interfered with their autonomy at a time of health transition. On the other hand, the assistance eases daily life with regard to practical matters and improves adherence to a medicine regimen. Participants were balancing empowerment and a dubious perception of the home care assistants’ knowledge of medicine and safety. The trust in the physicians’ and DNs’ knowledge about medication routines was seen as a guarantee with regard to medicines in general and the medicine regimen in particular. The perceived strained work situation for HCAs risks placing older people in an adverse position in relation to HCAs with their heavy workload and limited schedules. This may negatively influence the care relationship and patient safety. Conclusions: This thesis reports: 1) A dramatic increase in medication use in older adults from the late 1980s to the mid- 2000s in central Stockholm, Sweden; 2) DNs cannot manage their workload without delegating the administration of medication to unlicensed personnel (HCAs) in the present organisational model of health- and social care; 3) Accepting the delegation to administer medication was inevitable and had become routine to meet the needs of a growing number of older home care recipients; and 4) Assistance with handling medication eases daily life and medicine regimen adherence. Dependence on assistance may affect older adults’ sense of autonomy. Perceived safety varied relating to HCAs’ knowledge of medicine. We believe our results may contribute to a better understanding of how health and social care, two fields spanning sociology and nursing, perceive and adjust to the given frames; in the first place by indicating how delegated administration of medication to older people living at home is perceived by the care recipients, DNs, and HCAs and also by illustrating how the possibility of delegating medical chores can give temporary tasks a manifest transition from licensed to unlicensed personnel.
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| 5. |
- Summer Meranius, Martina, 1971-
(författare)
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"Era delar är min helhet" : En studie om att vara äldre och multisjuk
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to describe what it means to be old and live with multimorbidity. An additional aim is to examine and describe the contextual meaning of the phenomenon in ordinary housing and nursing homes, and a third aim is to deepen our understanding of the situation for old people who also are ill. The thesis uses a caring science perspective and a reflective lifeworld approach founded on phenomenological philosophy. This approach searches for and describes the meaning of a phenomenon, its variations and its essential meaning structure. Interviews were used for data collection and data were analyzed for meaning, searching for the essence of the phenomenon. The findings are presented in two empirical studies and one philosophical excursion. The empirical studies have been further thematized with the essential meanings from the empirical studies. The philosophical excursion is the result of a more profound understanding of the thematized meanings.The essential meaning of being old and living with multimorbidity in ordinary housing is described as a struggle to maintain identity in a life situation that changes. Multimorbidity and aging pose existential barriers at the same time as the possibility of living an independent life and being oneself is hindered. Ordinary housing is experienced as a place where the old can be themselves, and a place that is associated with independence. On the other hand, multimorbidity threatens the possibility of continuing to live in their private homes, as does the failure of others to meet the old as individuals.The essential meaning of being old and living with multimorbidity in nursing homes is described as striving for independence which brings with it a zest for life and a feeling of security. The older’s degree of independence can change due to the fragile health situation, and is characterized by the experience of not being a burden for the busy caregivers and relatives. Independence can change to insecurity, vulnerability and helplessness.The themes of essential meaning that have been extracted from the empirical studies suggest that the experiences of frailty and loneliness differ more between those living in ordinary housing and in nursing homes than the experiences of trust and independence differ.The philosophical excursion illuminates how older people with multimorbidity experience their lives as an ability to manage their daily lives and not merely an absence of disease symptoms. A person is “just” sick, independently of the objective quantity of diseases s/he may suffer from. Health and wellbeing occur from the ability to live in existential coherence, which is encouraged when the older people are allowed to retain their habits, the ability to be oneself, individual’s life story and by social relationships, as well as by continuity among the caregivers.
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| 6. |
- Audulv, Åsa, 1980-
(författare)
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Being creative and resourceful : Individuals’ abilities and possibilities for self-management of chronic illness
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Individuals’ self-management styles are crucial for how they manage to live with illness. Commonly investigated factors include social support, self-efficacy, health beliefs, and demographics. There is a gap in the literature with regard to in-depth studies of how those factors actually influence an individual’s self-management. The aim of this thesis was to investigate the underlying mechanisms of self-management from the perspective of individuals living with chronic illness. Interviews were conducted with 47 individuals with various chronic illnesses, some of them repeatedly over two and a half years (a total of 107 interviews). The material was analysed with; constructive grounded theory, content analysis, phenomenography, and interpretive description. The Self-management Support Model identified aspects that influenced participants’ self-management: economic and social situation, social support, views and perspectives on illness, attribution of responsibility, and ability to integrate self-management into an overall life situation. For example, individuals with a life-oriented or disease-oriented perspective on illness prioritized different aspects of self-management. People who attributed internal responsibility performed a more complex self-management regimen than individuals who attributed external responsibility. In conclusion, individuals who were creative and resourceful had a better chance of tailoring a self-management regimen that suited them well. People in more disadvantaged positions (e.g., financial strain, limited support, or severe intrusive illness) experienced difficulty in finding a method of self-management that fit their life situation. These findings can inspire healthcare providers to initiate a reflective dialogue about self-management with their patients.
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| 7. |
- Carlsund, Åsa, 1969-
(författare)
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Children`s Mental Health -with focus on family arrangements
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main aim of this thesis was to study children’s mental health with focus on family arrangements. The thesis was based on four studies (I-IV). Study number I, III and IV were quantitative studies with cross sectional design, using the Swedish version of Health behaviour in School- aged children (HBSC), including children aged 11, 13 and 15 years. The data was analysed with multiple linear regression analysis (I) and multivariate logistic regression analysis (III, IV). Study II was of qualitative descriptive design, based on 28 interviews with parents living in shared physical custody with their children. The qualitative study was analysed with inductive latent content analysis.Study I showed that lower levels of SHC and higher levels of SWB were associated with higher degrees of social capital in the family, school and neighbourhood. Social capital in family, school and neighbourhood had a cumulative influence on children’s SHC and SWB. In study II the participating parents described their own as well as the perceptions of their children and former partners. Parents’ perceptions changed from the beginning of shared physical custody, through the current situation, ending with perception of the future. The fifteen year old boys and girls (III) living in shared physical custody were more at risk of being a smoker or having been drunk compared with children living in two parent families. The results of sex <15 years and conduct problems showed that the risks didn’t differ significantly between these two groups. Study IV showed that children living in shared physical custody with their parents were more likely than children in two parent families to report multiple SHC, and low SWB. The variable of communication did not moderate the SHC and SWB of the children in any of these two groups.This thesis contribute with new and deeper understanding of the relatively new phenomenon: shared physical custody, and its associations to children’s mental health. The parent’s perceptions were an important complement to the children’s self reported health. In order to influence the decreasing mental health among children and adolescents, their opinions contributes to further understanding. Narratives from children, parents and practitioners are required in order to further study the association between children’s health outcomes and different family arrangements. Additional studies are needed to clarify how children’s mental health and different family arrangements are related to school, community economy, and society.
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| 8. |
- Eriksson, Monica, 1960-
(författare)
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Recovery from an Acute Myocardial Infarction : A Longitudinal Study of Couples
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate recovery in the relationshipbetween couples following an acute myocardial infarction [AMI]. An additionalaim was to compare differences over time regarding hope and health‐relatedquality of life [HRQoL] for both patient and partner. The thesis is based on fourempirical studies (I‐IV), and has a longitudinal design employing both qualitativeand quantitative methods. A purposive sample was recruited comprising 15couples in which one partner had been diagnosed with an AMI. Study I wascarried out as individual tape‐recorded interviews aimed at describing thepatient´s and their partner´s experiences after hospital discharge. Study II alsoused individual tape‐recorded interviews, this time with the aim of describing andinterpreting the couple´s thoughts and expectations about their future life after thepatients’ discharge. Study III used the HHI‐S and SF‐36 measures to comparechanges over time in self‐rated hope and health‐related quality of life, anddifferences between patients’ ratings and their partner´s. Study IV used repeatedindividual tape‐recorded interviews with the aim of interpreting the couples´narratives about their relationship and daily life. The data were analysed andinterpreted using a number of qualitative content analysis methods (I, II, IV) anddescriptive and comparative statistics (III).Overall, the couples´ recovery from an AMI in the two years after an AMI consisted of a striving to reach some kind of balance and stability in their currentlife situation. The period after discharge from the hospital involved understandingthe importance of the home as a place in which one feels at home and which bringsa feeling of safety, experiencing the phenomenon of security and being at homewithin oneself, and seeking normalisation in returning to an ordinary life (I). Thecouples´ thoughts about their future lives were either optimistic, taking an activeapproach, or pessimistic, taking a wait‐and‐see approach. The couples could bedivided into four positions in terms of their visions of the future: life companions,who were in concordance regarding their future; tightrope walkers, who had incommon a need to reprioritise what they considered important in their future;pathfinders, who had in common an undefined vision of their future and observers, who saw their future including both physical as well as sociallimitations (II). Self‐rated hope and HRQoL both improved over time, but few ofthese improvements were statistically significant, and I found no statistically groupeffects. Estimation of the MDC index revealed that neither HHI‐S nor SF‐36measures stable traits (III). Finally, the repeated interviews revealed how thecouples viewed their daily life, mutual relationships and roles in their relationshipVIIover time. There was an abundant variation in a number of the couples´ storiesabout their relationship and daily life during the recovery period (IV).In conclusion, it is clear that what happen to one party in a relationship influencesthe other party. The couples in the studies showed improvements in both hope andhealth‐related quality of life over time. The HHI‐S and SF‐36 measures seemed tobe sensitive to and affected by the current situation. Going through an AMI is alife‐changing event that makes it necessary for the couple to make adjustments andadapt to their new situation. Different couples have different approaches tohandling this situation; no two couples are the same, and every couple willperceive and deal with the AMI differently. An AMI starts a process of transition,and over time a couple affected by AMI will undergo external as well as internal changes.
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| 9. |
- Hörberg, Ulrica, 1968-
(författare)
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Att vårdas eller fostras. Det rättspsykiatriska vårdandet och traditionens grepp
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context.
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| 10. |
- Junehag, Lena
(författare)
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Peer mentoring - A complementary support to persons after an acute myocardial infarction
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to investigate the experience of having an acute myocardial infarction in newly afflicted persons living in sparsely populated counties, and whether an intervention with peer mentors would provide support by affecting the perception of illness, health related quality of life and everyday life. The aim was also to describe the support of peer mentors from their perspective and what the mentoring meant to them. The thesis was based on four empirical studies (I-IV) and had a prospective, longitudinal, quasi-experimental, comparative design. A suitable sample was recruited, comprising 72 individuals who were newly afflicted with an acute myocardial infarction (AMI) for the first time; 34 of them were offered contact with a peer mentor, while 38 were not. Furthermore, 34 peer mentors participated in the project. The results were based on data collected from 28 individuals with mentors, 33 individuals without and 22 peer mentors. In studies I and III, qualitative approaches were used based on individual interviews with 20 newly afflicted individuals with (n=11) and without (n=9) mentors one year after AMI. The aims were to describe individuals’ perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event (I) and to describe individual perceptions of their lifestyle and support, 1 year after an AMI with or without mentorship (III). Study II was quantitative, consisting of data from questionnaires IPQ-R and SF-36 answered by 61 newly afflicted individuals with (n=28) and without (n=33) mentors. It aimed to investigate whether changes in illness perception and health-related quality of life occur over time after an intervention with peer mentors 1, 6 and 12 months after an AMI. Study IV had a mixed design and included peer mentors with the purpose to describing the personal meaning of being a peer mentor, for a person recovering from an acute myocardial infarction. Data consisted of individual interviews (n=15) and some data from IPQ-R and SF-36 that were provided on two occasions (n=22). All of the interviews (I, III, IV) were digitally recorded and analysed by qualitative content analysis, while the quantitative studies included descriptive data and were further compared using analysis of variance (ANOVA) (II) and the paired-sample t-test (IV). The results from all four studies are interpreted and presented together, and they show differences and similarities between the newly afflicted with or without peer mentors and the peer mentors. The results comprise six main areas; the meaning of becoming a person with an AMI (I, II, III) pointed toward an awareness of the situation expressed both in positive and negative terms, as being thankful or of being afraid of having a second AMI. View at health care (I) indicated that follow-up after discharge was sometimes a positive experience but more often resulted in dissatisfaction with this part of the health-care system. Consequences (II) showed significant effects between groups in the dimensions ‘consequences’ and ‘timeline acute/chronic’ (IPQ-R), with higher mean values for those without mentors and a significant effect of time in both dimensions. There were also physical consequences for many of the participants (I, II, III, IV) as well as psychological consequences (I, II, IV). Everyday life (I, III) was affected by AMI that sometimes limited activities. There were demands to change areas of life-style that were perceived as both positive and negative. Health (II, III, IV) showed that health increased for most individuals during the year, as confirmed by significant values for time for those newly afflicted. The peer mentors showed a decrease in mean values but expressed that they felt healthier after compared with before their commitment. Meaning of support (I, IV) indicated that families and relatives had an important, supportive role for newly afflicted participants. The mentorship showed that the relationship was, in some cases and for different reasons, unsuccessful. However, most of them were satisfied, and new friendships arose. More of the mentors felt pride and were thankful because their experience was shown to be valuable to others in addition to themselves. The results were synthesised using the Human Becoming nursing theory, which confirmed that recovery after an AMI is a process that occurs over time in which that those afflicted must accept and be comfortable being a person who is afflicted by an AMI. Some tendencies indicated an advantage for the newly afflicted participants who had received contact with a peer mentor. Conclusion: Because the mentor had experienced the same event, the relationship contributed to the security of the mentee. The peer mentors matured with the task because they felt that their experience was valuable and they felt unique.
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| 11. |
- Olsson, Helén, 1961-
(författare)
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Att minska risken för våld och att främja återhämtning i den rättspsykiatriska vården : Patienters och personalens erfarenheter av vägen mot återhämtning
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Detta avhandlingsarbete är utfört inom en rättspsykiatrisk vårdkontext och återspeglar patienters[1] och personals[2] erfarenheter och upplevelser av vändpunkter i samband med minskad risk för våld och återhämtning. Med utgångspunkt från ett holistiskt och salutogent hälsovetenskapligt perspektiv har avhandlingen ett tvärvetenskapligt förhållningssätt. Teoretiska ämnesdiscipliner såsom psykiatrisk omvårdnad, kriminologi och sociologi har influerat arbetet.Avhandlingens övergripande syfte var att utifrån de salutogena aspekterna i det rättspsykiatriska omvårdnadsarbetet undersöka vad som är relaterat till vändpunkter i samband med minskad risk för våld och vad som bidrar till återhämtning. Avhandlingen baseras på fyra olika studier. Syftet med den inledande kvantitativa delstudien (I) var att identifiera och jämföra rättspsykiatriska patienter som sänkt sin bedömda risk för våld med 30 % eller mer enligt riskbedömningsinstrument HCR-20. Resultatet visade att den bedömda risken för våld minskade över tid. En demografisk analys genomfördes för att studera skillnader mellan de patienter som sänkt sin bedömda risk för våld och de som inte sänkt sin risk. Det framgick att rättspsykiatriska patienter som bedömts med hjälp av riskbedömningsinstrumentet HCR-20, minskade den bedömda risken för våld, både på kort och på lång sikt. Den rättspsykiatriska vården fungerade bäst när det gällde att förbättra de kliniska riskfaktorerna (C-skalan).Riskhanteringen (R-skalan) gällande eventuell utskrivning och framtida friförmåner visade inte samma goda progress. Demografiska karaktäristika såsom ålder, alkohol och drogmissbruk och psykiatriska diagnoser var inte relaterade till minskad risk för våld, dock var kvinnliga patienter och patienter utan psykopatidiagnos mer benägna att sänka sin risk för våld. Ett urval av de patienter som minskade sin risk för våld med 30 % eller mer utgjorde basen för delstudie II och III.I delstudie II intervjuades tretton rättspsykiatriska patienter om upplevelser och erfarenheter kring vad som bidrar till minskad respektive ökad risk för våld inne på en rättspsykiatrisk avdelning. Data analyserades med hjälp av en tolkande beskrivning (Interpretive Description). Studien visade att orsakerna till ökad respektive minskad risk för våld var processrelaterad, där interaktioner mellan personal och patienter bidrog till en utveckling som antingen präglades av välbefinnande eller disharmoni. Delstudie II utgjorde en viktig kunskapskälla som präglade ansatsen i delstudie III och IV. Detta med hänvisning till att flertalet patienter i delstudie II lämnade intressanta beskrivningar av vändpunkter i samband med minskad risk för våld och återhämtning.Sålunda intervjuades i delstudie III, tio rättspsykiatriska patienter om deras upplevelser av förändringsprocesser i samband med vändpunkter och återhämtning. Dataanalysen skedde med hjälp av en kvalitativ innehållsanalys. Processen beskrevs utifrån tre faser där man i högriskfasen upplevde kaotiska och överväldigande känslor. Vändpunkten upplevdes som ett känsligt skede som präglades av att tvingas hitta en ny, konstruktiv väg i livet. Återhämtningsfasen präglades av ett accepterande och en mognad. Stöd och erkännande från omgivningen ansåg främja dessa processer.Delstudie IV bestod av intervjuer med tretton personal. Syftet var att belysa upplevelser och erfarenheter kring rättspsykiatriska patienters vändpunkter och återhämtning. Kvalitativ innehållsanalys användes för att analysera data. Beskrivningar kring hur en vändpunkt kunde bevaras och främjas baserades på vikten av att vara uppmärksam, lyhörd och att inte skynda på processen. En vändpunkt upplevdes genom att patienten uppvisade synbara positiva förändringar. Sammansättningen på personalen och patienterna ansågs påverka atmosfären på avdelningen, och bidrog till huruvida processen mot vändpunkter och återhämtning underlättades eller försvårades.Avhandlingen visar hur ett ständigt växelspel mellan patienter och mellan personal bidrog till huruvida vårdatmosfären upplevdes såsom hälsofrämjande eller ej. Vidare framgår att processer kring vändpunkter i samband med minskad risk för våld och återhämtning präglades av känslor av sårbarhet och utsatthet. Processen beskrevs som ett känsligt förlopp som behövde understödjas av förtroendefulla relationer med andra, samt möjligheter att få vistas i en trygg miljö.[1] Den vetenskapliga litteraturen använder sig av begrepp såsom client, consumer, service user eller forensic patient för att beteckna människor som är inskrivna inom den rättspsykiatriska vården. Inom det psykiatriska svenska fältet kan begreppen brukare, vårdtagare eller patient förekomma. I denna avhandling kommer begreppet patient och vårdtagare omväxlande att användas för att beteckna de människor som är föremål för den rättspsykiatriska vården. De patienter som deltagit i avhandlingens två delstudier kommer omväxlande att benämnas såsom deltagare eller patienter, för att åstadkomma en varierande och läsvänlig text.[2] I denna avhandling anser begreppet personal den personalkategori som arbetar med omvårdnad inom en rättspsykiatrisk kontext. Det är främst sjuksköterskor och skötare som inkluderas i begreppet omvårdnadspersonal inom den vetenskapliga litteraturen. Sjuksköterskor benämns såsom registered mental health nurses eller registered nurses. Övrig omvårdnadspersonal tituleras till exempel som nurse manager eller assistant nurses. När begreppen personal, vårdare eller omvårdnadspersonal används i denna avhandling avses då den personalkategori som arbetar närmast patienten med omvårdnad och ingen åtskillnad kommer att göras mellan de båda yrkesgrupperna. Personalen som deltar i delstudie IV har omväxlande kallats för personal eller vårdare.
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| 12. |
- Sjöling, Mats, 1968-
(författare)
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Experiences of abandonment and anonymity among arthroplastic surgery patients in the perioperative period : some issues concerning communication, pain and suffering
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med avhandlingsarbetet är att illustrera och belysa upplevelsen av att vara patient med behov av ledprotes, avseende aspekterna kommunikation, smärtupplevelse, lidande och tillfredsställelse med vård och behandling. Under väntetiden för ledprotesoperation upplever deltagarna i studierna lidande i olika former, tillika att vården är otillgänglig och onåbar i ett ansiktslöst system (I). Att få information om sin sjukdom vad man kan/får/ska göra är nästan omöjligt. Kontakten med sjukvården är svår att upprätta och det är mestadels patientens ansvar att söka information om vad som händer (II). Den bristfälliga kommunikationen som deltagarna i delstudie I upplever, leder till att de känner sig missförstådda och nedvärderade av sjukvårdssystemet, och därmed befinner sig i en ständig kamp för att få sitt vårdbehov bekräftat. Under deltagarnas vandring i sjukvårdssystemet förändras deras negativa uppfattning om vården till att bli mer positiv när en reell kommunikation och personlig kontakt etablerats (IIV). Fynden i arbetena (I-IV) tolkas inom ramen för Katie Erikssons och Lennart Fredrikssons beskrivningar av lidande och det vårdande samtalet. En del deltagare i studierna har av egen kraft, eller till följd av personliga egenskaper uppnått insikter om sig själva och försonats med sitt lidande, på så sätt har de kunnat bibehålla eller uppnå mening i sin tillvaro. Av egen kraft, eller med hjälp av anhöriga kan individerna få sitt lidande bekräftat och därmed möjligheten att kunna lida ut och försonas med sig själv och den förändrade tillvaron. Så länge som sjukvården upplevs som ett ansiktslöst system finns det deltagare i avhandlingen som inte klarar av att ta itu med sitt lidande. Under patientens vandring i sjukvårdssystemet blir det uppenbart att systemet får ett ansikte först när deltagarna kan relatera till vården i form av en reell person. Vården får inte ett ansikte så länge som patienten upplever sig dåligt bemött utan detta sker när det med Fredrikssons termer uppstår ett vårdande samtal. Under väntetiden för operation finns det relativt få tillfällen där ett vårdande samtal har möjlighet att uppstå. Möjligheten för detta är dock större när patienten väl är inlagd på sjukhuset för att bli opererad, vilket återspeglas i den höga grad av tillfredsställelse med vården som uttrycks i delstudie II-IV. Patienterna är tillfredsställda med vård och behandling, trots att de har upplevt postoperativ smärta i en hög grad. I delstudie III var det 68% (n=40) och i delstudie IV 83.5% (n=50) som hade upplevt smärtor motsvarande ≥ 4 på Visuell Analog Skala (VAS). Under sjukhusvistelsen upplever sig patienten bekräftad och synlig i systemet. Synligheten är ömsesidig då även vården (systemet) får ett ansikte på patienten. I ett vårdande samtal uppstår en känsla av tillit och när detta sker vågar patienten och vårdaren kommunicera på ett öppet sätt där de båda är närvarande i situationen
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| 13. |
- Westerbotn, Margareta
(författare)
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Drug Use Among the Very Old Living in Ordinary Households : Aspects on Well-being, Cognitive and Functional Ability
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In Sweden today a major proportion of the population survive to old ages. To a large extent, the oldest old are capable of living longer in their own households; some of them are very healthy while others have multiple diagnoses or ailments caused by a normal ageing process. This means that many elderly persons receive their health care needs in their own home, and in the future this will be even more common. Drug use of the elderly is a complex field, and many drugs have side effects complicating the medical treatment and decreasing the quality of life. Aim: This thesis aims to explore and describe the medicine use and the medical situation of very old persons (¡Ý84 years) living in ordinary households, and to obtain knowledge of their views on the use of drugs.Methods: This thesis combines quantitative and qualitative research methods. The quantitative studies (Study I, II and III) were based on data from the Kungsholmen Project, a population based study of elderly people living in a district of the inner city of Stockholm, Sweden. Data collection of the present studies was carried out from the third follow-up 1997-1998. The qualitative data (Study IV) was obtained 2005 through in-depth interviews with 25 elderly men and women, aged 85-97 years, living in ordinary households in Stockholm, Sweden. A pre-tested semi-structured questionnaire was used for the interviews.Results: The findings in Study I demonstrated that cardiovascular diseases are very frequent in this population (62%). Heart failure (47%) and hypertension (37%) were the most common conditions; and diuretics (69%), nitrates (31%) and cardiac glycosides (30%) were the most commonly prescribed drugs. Multivariate regression analyses showed that while being affected by a CV disease did not affect the emotional well-being of the participants (PANAS-PA, p=0.171; PANAS-NA, p=0.209), the use of cardiac glycosides (p=0.006) and nitrates (p=0.008) was associated with increased negative feelings. Study II revealed that 88% of the population took medicines on a regular basis, and only 23% of them received help with the handling of their medicines. Using logistic regression models controlling for sociodemographic variables, cognitive and functional status, female gender (OR: 2.8; 95% CI: 1.2-6.5) was the only variable associated with regular use of medicines. The results also showed that older age and functional disability as measured by ADL, increased the risk of receiving help with medicines, while higher cognitive status decreased the odds of receiving help. Using multiple regression models, we found that the only factor related to not receiving help from a family member was that of living alone (OR:0.05; 95% CI: 0.006-0.4). Study III showed that the prevalence of pain among very old persons was 46%, and the prevalence of pain treatment was 71%. Results from logistic regression analysis using all variables in the model indicated that pain reporting was not associated with age, gender or living conditions, but decreased with decreasing cognitive status and with increasing functional disability. Furthermore, pain treatment was not associated with age, gender, living conditions, cognitive and functional status. The qualitative data in Study IV indicated that most of the participants managed their medicines by themselves and were very content with this. Those elderly who received help with their medicines were also very pleased with this help. The findings also revealed that the most important components for the elderly to be able to remain living in their homes and to handle their medicines by themselves, were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back-up.Conclusions: This study revealed that a large proportion of very old people (¡Ý84 years) were living in ordinary households and used medicines regularly. Being a woman and living alone were associated with receiving help with medicines from the community help services. Cognitive and functional ability were revealed to be significant factors in the management of medicines, but also to affect the pain reporting, and type of received pain treatment. Most of the older participants managed to handle their medicines by themselves, and were very pleased by doing this. However, most of them were concerned about the risk of losing their memory, as they are getting older, because they knew that they would not be able to manage themselves any more and therefore would have to move to an institution.
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| 14. |
- Andersson, Sandra, 1978-
(författare)
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Validation of antibodies for tissue based immunoassays
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In situ protein detection in human tissues using antibodies reveals the cellular protein localization, and affinity-based proteomic studies can help to discover proteins involved in the development of diseases. However, antibodies often suffer from cross-reactivity, and the lack of positive and negative tissue controls for uncharacterized proteins complicates the mapping of the proteome. The aim of this thesis is thus to improve the methodology for validating antibodies used for immunostaining on formalin-fixed paraffin-embedded tissues.Two of the papers include comparisons between mRNA-expression and immunostaining of corresponding protein. In paper I, ISH and IHC staining patterns were compared on consecutive TMA-slides. The study of well-characterized genes showed that ISH could be used for validation of antibodies. ISH was further used for antibody evaluation, and could validate four out of nine antibodies showing potentially interesting staining patterns. In paper III, transcriptomic data generated by RNA-sequencing were used to identify tissue specific expression in lymphohematopoietic tissues. An increased expression in one or more of these tissues compared to other tissue types was seen for 693 genes, and these were further compared to the staining patterns of corresponding proteins in tissues.Antibody labeling is necessary for many immunoassays. In paper II, two techniques for antibody-biotinylation were compared, aiming to find a stringent labeling method for antibodies used for immunostaining on TMAs. The ZBPA-method, binding specifically to Fc-part of antibodies, was found to be superior to the Lightning Link-biotinylation kit targeting amine groups, since labeling of amine groups on stabilizing proteins in the antibody buffer causes unspecific staining.The localization of the estrogen receptor beta (ERβ) in human normal and cancer tissues was studied in paper IV. Thorough evaluation of 13 antibodies using positive and negative control cell lines showed that only one antibody, PPZ0506, is specific for ERβ in all three immunoassays used. Contradictory to previously published data, tissue profiling using PPZ0506 showed that ERβ is expressed in a limited number of normal and cancer tissues.In conclusion, the present investigations present tools for validation of antibodies used for large-scale studies of protein expression in tissues.
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| 15. |
- Harrefors, Christina
(författare)
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God vård och användning av digitala hjälpmedel : Föreställningar hos äldre och vårdpersonal
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe the perceptions about care and the use ofdigital assistive technology among elderly people and caregivers. Perceptions are continuallychanging depending on technical and socio-political developments and changes in society.The research presented here consists of data gathered to assess these perspectives, and thesubsequent analysis and interpretation.In study I and II, individual interviews were conducted with twelve healthy elderlycouples living in their own homes. All participants were 70 years of age or older and none ofthem received any professional care or social support. The interviews were substantiated bywritten scenarios considered to be realistic descriptions of imaginary examples of the state ofhealth and wellbeing for themselves in the future. The participants were asked what theybelieved would be the best solution concerning quality care and the use of assistivetechnology in each scenario. A qualitative content analysis was used to analyze the text.For study III and IV, a questionnaire was developed to probe the perceptions of a digitalphoto diary for use by people with dementia. The respondents were employees of the Swedishmunicipalities in a position to be able to influence the implementation of digital assistivetechnology for use by people with dementia. The data was analyzed with descriptive statistics,multivariate statistics and qualitative content analysis.The first study revealed that participants tried to maintain their sense of self and desireddignified care. The receipt of care in one’s own home was considered preferable as it enabledpartners to remain together; later on, in contrast, the best care was perceived to be that offeredby a nursing home with well-trained nursing staff. In study II, the use of assistive technologywas perceived to be an asset by participants since it would enable them to continue living anormal life despite having some disabilities. In the absence of a partner or if their cognitiveimpairment increased, their willingness to use assistive technology would decrease, and thetechnology was considered to be an obstacle. In both studies there was a pervading concernabout the risk of losing a sense of individuality in the absence of meaningful relationships.In study III, perceptions related to the prerequisites for and consequences of using thedigital photo diary were investigated. The analysis of factor analysis concerningconsequences, revealed four factors; trust, vulnerability, dependency/independency andcontrol. The results interpreted from the qualitative data emphasized the importance ofPersonalization and the preservation of dignity when using the device. The prerequisite mostoften specified was the need for digital photo diary to be introduced in an early stage of thedisease.In study IV, caregivers’ perceptions on how persons with mild dementia will experiencethe usage of a digital photo diary were examined. The digital photo diary considered wasperceived to contribute to a Sense of autonomy, Sense of self-esteem and a Sense of trustamong people with dementia.These findings highlight the context-dependence of the perceptions about quality careand the use of digital assistive technology for elderly people. An overall understanding of theresults emphasizes the importance of personalized and dignified support, and this should betaken into consideration when organizing quality care and implementing new digital assistivetechnology for use by elderly people.
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| 16. |
- Hedman, Maria
(författare)
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Autonomy and Participation in Care For Older People : Descriptions by Older People, Registered Nurses, Case Managers, First Line Managers and Local Authorities Senior Medicine Advisors
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Overall aim: To describe the essence of autonomy and participation for older people in care, and how to promote this in care for them.Method: A descriptive design with a phenomenological approach. Sixteen older people (I) and 13 registered nurses (II) participated in individual face-to-face interviews (I and II). Twelve case/care managers and supervisors participated in a focus group interview, they were grouped by profession, case managers, first line managers and local authority senior medicine advisors, four in each group and interviewed once (III and IV). The data analyses were guided by Giorgi’s descriptive phenomenological method (I and II) and the systematic text condensation by Malterud (III and IV).Findings: The informants were in agreement that maintaining older people’s health and wellbeing promote autonomy and participation, and supportive relationships are relevant (I–IV). Older people focused on everyday life experiences they made by choice and managing on their own, as strengthening self-esteem and self-identity (I). The registered nurses focused on caring for frail older people and their need for acknowledgement in everyday care. They noted that of providing choices as enable older people to have joyful everyday life experiences (II). The managers and supervisors focused on informed consent, and legislation, and offered solutions to securing a meaningful everyday life by caring for older people’s wishes and needs. They also spoke of the risk the severe consequences could result from older people’s decision-making and their health conditions (III). Relatives were respected as a resource and attended to in everyday care for older people but the focus was the older person in their present life situation and their individual rights (IV).Conclusion: Promoting to autonomy and participation for older people were maintained health and wellbeing, and the possibility to manage on their own terms. Informed consent, shared decision-making, supportive relationships and acknowledgement of relatives in the life-changing situations were ways to promote autonomy and participation. To promote autonomy and participation in care for older people is also to provide for choices that are meaningful to the older person at end of life in a joyful and permissive atmosphere.
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| 17. |
- Isaksson, Ulf, 1959-
(författare)
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Våld mot vårdare i sjukhemsvård
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aimed to explore factors related to the prevalence of violence towards caregivers working in a nursing home context. The aim was also to describe caregivers’ perceptions and experiences of violence in a nursing home context. The thesis comprises four studies. Study I includes data regarding environmental and organizational factors, residents’ and caregivers’ characteristics, and violence. Data concerning job satisfaction and working climate were also obtained. In study II, questionnaires were used to collect data concerning caregivers’ exposure to violence and their personal characteristics. Data concerning personality traits, coping resources, and burnout were collected by means of instruments. In order to illuminate caregivers’ perceptions of violence (III) and experiences of being exposed to violence (IV) interviews were performed. Quantitative data were analyzed by means of comparative and descriptive statistics. The interviews were transcribed and interpreted using a qualitative content analysis method. The results showed that 15 percent of the residents exhibited violent behaviour during the week of in-vestigation. A significant higher proportion of male residents were assessed by the caregivers to present violent behaviour compared to female residents. A discriminate analysis showed that the prevalence of behavioural symptoms and psychiatric symptoms, residents needing assistance with dressing, the caregivers’ psychological workload, and job satisfaction were the strongest discriminators between nursing home wards with a high versus low proportion of residents with violent behaviour (I). The results from study II showed that among the 196 caregivers participating in the study, 68 % re-ported exposure to violence during the previous year. Twenty-two percent reported exposure several times per week, and 51 % reported exposure at least once during the previous month. A higher proportion of caregivers 50 years or younger were exposed to violence compared to older caregivers. A higher proportion of caregivers with a work experience of three years or more reported exposure to violence compared to less experienced caregivers. A higher proportion caregivers who reported exposure to violence assessed symptoms on burnout and motherly rejection. No significant differences between the two groups were found concerning coping resources, defence mechanisms, temperament, and character. Study III showed that caregivers’ perceptions of violence are subjective and in the eye of the beholder. The caregivers perceive violence as challenging and expressed that caring situations had to be solved even though their own safety is perceived to be in danger. The caregivers perceive violence as intentional when the residents are judged to have a good cognitive capacity and are perceived to be conscious. However, the care-givers perceive violence as excusable when the residents are described as old and sick. The caregivers perceive violence as ordinary and as a part of the work situation. The caregivers also perceive violence as contextual since similar violence is accepted at the work place but not outside it. The result from study IV showed that the caregivers’ experiences of exposure to violence range be-tween being overwhelmed by contradictory emotions and being resigned. The caregivers have preconceived ideas towards the violent behaviour and describe being on guard in order to avoid being exposed to violence. The caregivers experience that they lose the control over a violent situation and strive to regain the control. They are overwhelmed by emotions such as surprise, anger, and repulsiveness and describe a resignation hav-ing to care for violent residents. Caring for violent residents is described as a constant struggle and the care-givers express a disappointment over insufficient support. The caregivers strive to regain the control by means of seeking excuses for the violent behaviour or by support from colleagues. The conclusions from this thesis are that the prevalence of violence is related to factors among the residents as well as the caregivers, that caregivers’ perceptions of violence are subjective and caregivers’ experi-ences varies between being overwhelmed by contradictory emotions and resignation. There is a risk that vio-lence in nursing homes becomes a norm, is accepted, and in this way is maintained. The boundary between what is acceptable and what is not acceptable becomes erased, the caregiver resigns, and the violence is not looked upon as a divergence but becomes a part of the working situation. It is therefore important that the problems with violence at nursing homes are attended to and that the caregivers are supported in their work.
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| 18. |
- Olsson, Helén, 1961-, et al.
(författare)
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Turning towards recovery in forensic psychiatric inpatients : A study based on staff experience
- 2014
-
Ingår i: Nordisk sygeplejeforskning. - 1892-2678 .- 1892-2686. ; 4:3, s. 175-188
-
Tidskriftsartikel (refereegranskat)abstract
- Many individuals sentenced to forensic psychiatric care fail in the rehabilitation process, resulting in long-term inpatient hospital care. The concepts of turning points and treatment readiness in forensic settings should therefore be afforded more attention. Much can be learned from the features that characterize trajectories of recovery and processes related to turning points. The aim of this study was to explore forensic nursing staff’s experiences of forensic psychiatric patients’ turning towards recovery. A qualitative content analysis was used to analyse interviews with 13 forensic psychiatric nursing staff. Analysis of the data revealed two main themes with implications for clinical practice: promoting a turning point and recognizing a turning point. In the first of these, the emphasis was on actions and conditions that must exist to promote a turning. In the second, the main experiences related to recognizing a turning point were stories about visible and perceptible changes in the patient. The experiences that stood out most distinctly were those of being able to wait out the patient, and having patience when there was a lack of progression. The composition of staff and patients contributed to whether or not the environment was perceived as salutary.
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| 19. |
- Rising Holmström, Malin, 1966-
(författare)
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The Health Dialogue concept : School children's Self-Reported-Health in a Swedish Context
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore and describe schoolchildren's selfreported-health based on the Health Dialogue concept as well as to identify healthindicators and their possible associations in the perspective of 6 to 16 year-olds,and to provide an analysis of school nurses´ experiences of using the HealthDialogue concept, in the County of Västernorrland. The thesis was based on fourstudies (I-IV). Study I was qualitative using a descriptive design, based onindividual interviews with school nurses who had working experience of using theHealth Dialogue concept. Studies II-IV were quantitative with cross sectional andlongitudinal design based on statistical data from the Health Dialogue concept, apopulation survey among schoolchildren. The data were analyzed usingqualitative content analysis (I) and regression analyses (II-IV).Study I showed that the school nurses had developed their own commonapproach, a health promotion model derived from experiences of working with theHealth Dialogue concept. Study II showed that the most important health variablesinfluencing pre-schoolchildren´s positive self-reported-health were experience ofcomfort in preschool, good sleep, absence of headaches, being physicalactive/playing daily, and not being a victim for bullying. Both boys and girlsneeded to experience comfort, being physical active, and not being bullied. Forgirls, positive self-reported-health seemed to be more dependent on comfort, beingphysical active/playing, and not being bullied, whereas boy’s health was moredependent on eating school lunch daily and not experiencing headaches.Study III revealed that in 10-year-old children´s positive self-reported-health,comfort in school, normal iso- body mass index and absence of headaches wereshown to be significantly important health indicators. Normal iso- body massindex (girls) and absence of headaches (boys) were shown to have a potentiallycausal effect on 10-year-old children's positive self-reported-health. Study IVrevealed several significantly important health indicators in schoolchildren´shealth during three school transitions in the Swedish Education system (betweenthe ages of 6-10, 10-13 and 13-16); not experiencing being sad/depressed,afraid/worried, experiencing the school environment positively (schoolyard andivrestrooms), not being bullied, having good sleep, daily physical activity/play andability to concentrate. Gender and age differences were also identified. The HealthDialogue concept, contributes increased knowledge and a new cross sectional andlongitudinal perspective to individual, school, community and organization’sperception of schoolchildren´s self-reported-health. Furthermore, these resultsdemonstrate the importance and validity of children´s experiences in the context ofhealth and should contribute to future health promotion activities and schoolbasedinterventions.Key words: Health promotion, health dialogue, longitudinal design, school nurses,schoolchildren, self-reported-health.
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| 20. |
- Wälivaara, Britt-Marie
(författare)
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Mobile distance-spanning technology in home care : views and reasoning among persons in need of health care and general practitioners
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this licentiate thesis was to describe views and reasoning about the use of mobile distance-spanning technology (MDST) in health care at home, from the perspectives of persons in need of health care and general practitioners (GP). A descriptive qualitative approach was chosen to achieve the overall aim. Individual qualitative research interviews and qualitative group research interviews were used for data collection. Qualitative content analysis and qualitative thematic content analysis were used for data analysis.The findings show that persons in need of health care at home recognized MDST as being similar to the technology used at hospital. They described the MDST at home as acceptable but still in its infancy. The limited experiences in using MDST led to some persons doubting the reliability of the examinations routinely carried out at home instead of at hospital. When using the MDST, more examinations can be performed at home but there was some overconfidence concerning the possibility of what MDST can achieve. They saw the staff as users of the MDST, and the MDST should not be used by the persons or their family members. The MDST was seen as possible for distance communication but personal meetings with a GP or a nurse also have to be possible. The GPs must know the person concerned before making decisions at a distance. The persons felt that as long as it is easy to go to the healthcare centre or to the hospital the examinations should be done there, but if they are in a bad condition and there are long distances, then examinations at home become relevant. In an emergency situation, going to hospital rather than staying at home was inevitable and obvious. The MDST at home was described as a part of a chain which can be efficient only when other parts of the chain are taken good care of. When the MDST was assumed to be safe and secure then it could be used on a permanent basis at home, but this decision had to be made by DNs and GPs. The GPs reasoned that the MDST should be used with caution. There is a professional caution, which is based on the GPs' professional experiences, responsibilities and skills. Human meetings were seen as important for performing secure judgments and as the basis for health care, but some meetings can be replaced by virtual meetings. A virtual meeting could be useful for the patients and their families but it depends on their expectations. It could benefit them but there is also an overconfidence concerning what MDST can do. The GPs reasoned about the MDST in general and the usability of different diagnostic tools. The MDST was described as being not yet fully developed. Sometimes the MDST could support the GPs' decisions, but when handling very complicated cases, meeting the patient and understanding his or her context was seen as highly important. Expanded access to patient records facilitates the GPs work but the patient's integrity has to be ensured. It is easy for nurses to do more during home visits, but there must be an agreement between the nurse and the GP regarding how to handle the responsibility.The results in this thesis indicate that the participants attach both positive values about MDST as well as believing that some tools have no value at all. This is important when attempting to understand what is important for persons in need of health care and for GPs benefit when planning health care at home for the future.
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