| 1. |
- Johansson, Carl, 1986-
(författare)
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The quest for cultural sensitivity : how cultural sensitivity can be practised while mitigating othering in Swedish eldercare
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The need to provide culturally sensitive care for older adults with immigrant backgrounds has been expressed by care professionals. Meanwhile there is a lack of consensus about how this should be done, and critical perspectives in research highlight the danger of causing this group to be viewed as problem bearers. This thesis explores the possibility of using the welfare theory of health to achieve cultural sensitivity while limiting the risk of othering. It uses a goal-oriented perspective of health that could be useful in an active ageing context. Study I used a mixed-methods design and the Delphi method. Study II used a quantitative design and survey method. Study III used a qualitative design and semi-structured interviews. Study IV used a qualitative design and vignette method.Study I showed that municipal decision-makers in eldercare find it hard to agree on what cultural sensitivity entails. They prefer to consider individual preferences in less complex cases, but look for fixed cultural categories in more complex cases. Study II showed that the welfare theory of health can be used as a viable, personal, holistic approach to health among older adults, and that it can be measured with the HACT questionnaire. Study III built on the questionnaire in Study II, expanding it to include immaterial capital theory. It elucidated how immaterial resources of older adults with immigrant backgrounds, such as social capital, influence their goals related to good ageing. Study IV showed that assistant nurses could use the welfare theory of health to increase cultural sensitivity in their work. However, like the decision makers, they looked for fixed cultural categories in more complex cases.The thesis shows how the welfare theory of health can be used to conceptualize cultural sensitive care with a starting point in the personal goals of older adults with immigrant backgrounds. With the help of immaterial capital theory, the thesis can shed light on the importance of immaterial resources, such as social capital, both in forming those goals and as resources to achieve them. With this knowledge, decisions and practices aiming to provide culturally sensitive care could be based on assessments of needs and resources without relying on preconceived and fixed ideas about other cultures.
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| 2. |
- Kirvalidze, Mariam, et al.
(författare)
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Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts’ perspective
- 2024
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 1365-2796 .- 0954-6820. ; 295:6, s. 804-824
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Tidskriftsartikel (refereegranskat)abstract
- Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers’ scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.
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| 3. |
- Asztalos Morell, Ildikó, et al.
(författare)
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Middle-class older adults living alone in urban India : Older adults’ understandings of ageing alone
- 2023
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Ingår i: Journal of Religion, Spirituality & Aging. - : Informa UK Limited. - 1552-8030 .- 1552-8049. ; , s. 1-26
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Tidskriftsartikel (refereegranskat)abstract
- This study sheds light on the value systems of the middle-class metropolitan older adults living alone, on the ageing self and the person's relationship to the surrounding society based on eight interviews. Ageing research has emphasized the traditional features of elderly care in India including its collectivist values rooted in filial piety and the extended family as well as embracement of disengagement influenced by the Hindu texts on two phases in later life: "hermit" and "renunciate". Increased social and geographical mobility, however, challenges traditional family systems. Using the example of the urban middle-class older adults living alone, this study explored whether living alone constitutes a challenge to the norms that previous research associated with Indian elderly care. Using abductive phenomenographic analysis the study found that the understandings of older adults in the study show great reflexivity concerning key aspects of their lives. Although the life conditions of older adults living alone deviated in many aspects from dominant traditional norms of filial piety and a care regime based on strong intergenerational interdependence, their responses and reflections mirrored assemblages of values deeply rooted in Hindu Vedic philosophy of the Ashramas and perceptions of independence, autonomy and self-reliance associated with Western "productive" aging.
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| 4. |
- Gusdal, Annelie K, 1963-, et al.
(författare)
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Healthcare and social care professionals’ experiences of respite care: a critical incident study
- 2024
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - 1748-2623 .- 1748-2631. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionAging in place is favoured among older persons and supported by research in Sweden, although it poses challenges for overburdened informal caregivers. While respite care can offer support, its accessibility is hindered by organizational challenges and informal caregivers' delays in using it. The experiences of informal caregivers are well-studied, but the professionals' experiences of respite care quality and critical incident management are underexplored.AimTo explore professionals' experiences of critical incidents in respite care, consequences for the persons being cared for, and strategies to manage critical incidents.Materials and methodsA qualitative, critical incident technique was used, and three group interviews with a total of 16 professionals were conducted.ResultsBarriers to quality respite care included communication gaps during care transitions, environmental shortcomings in respite care facilities, lack of support for informal caregivers, and inadequacies in respite care decisions. Strategies to manage critical incidents included individualized care, continuity and communication in care transitions, a conducive environment, support for informal caregivers, and care professionals' positive approach.ConclusionsThe study emphasizes the need for focused efforts on communication, continuity, and a supportive environment. Addressing identified challenges and applying suggested strategies will be key to maximizing the potential of respite care as a vital support for care recipients and their informal caregivers.
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| 5. |
- Gustafsson, Lena-Karin, Docent, 1966-
(författare)
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Arbete i multiprofessionella team
- 2022. - 1
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Ingår i: OMVÅRDNAD I HEMMET VID KOMPLEXA VÅRDBEHOV. - Lund : Studentlitteratur. - 9789144144061 ; , s. 35-50
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Bokkapitel (populärvet., debatt m.m.)
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| 6. |
- Gustafsson, Lena-Karin, Docent, 1966-, et al.
(författare)
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Dilemmas in rehabilitation and patient strategies in an intensive home intervention: a follow-up study
- 2023
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - 1748-2623 .- 1748-2631. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The original project, where older persons received reablement performed by an interprofessional team showed success factors for IHR. However, since there is a lack of knowledge about why some persons do not recover despite receiving IHR, this study follows up patients' experiences of IHR.Aim To describe older persons' perceived dilemmas in the reablement process within the framework of IHR.Method 11 CIT interviews with participants who have previously received IHR, were analysed, interpreted and categorized according to CIT. The study was approved by the Swedish Ethical Review Authority.Results The results showed disease-related dilemmas, fatigue or pain so that participants could not cope with the prescribed exercises. New diseases appeared, as well as medication side effects made exercising difficult, and painkillers became a prerequisite for coping with IHR. Low self-motivation and mistrust towards the staff emerged like lack of trust due to otherness such as sex, cultural background, or language also became critical.Conclusions Interventions that consider individual- and contextual dilemmas are very important. By recognizing critical situations, this study can work as a basis of evidence to further develop interventions for older people living in their own homes and to ensure them to stay there.
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| 7. |
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| 8. |
- Gustafsson, Lena-Karin, Docent, 1966-, et al.
(författare)
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Implementation of a New Integrated Healthcare Model; Quality Aspects to Support the Complex Home Care of Older Adults with Multiple Needs
- 2024
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Ingår i: Journal of Multidisciplinary Healthcare. - : DOVE MEDICAL PRESS LTD. - 1178-2390. ; 17, s. 2879-2890
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people's homes. Materials and Method: Open-ended group interviews with personnel were carried out, three of the group interviews preimplementations of the model, and three of the group interviews post -implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis. Results: The quality of the integrated care model was based on care -chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person -centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants' experiences of the post -implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting. Conclusion: Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question. Plain language summary: The intention of the present study was to follow the process of working with a new model of providing care at home, thus preventing increased numbers of hospital readmissions, based on the professionals point of view of what quality care is for older adults with complex care needs due to multimorbidity, living in their own home. The professionals were interviewed in group settings on several occasions during the implementation. The result showed hopeful expectations expressed by the professionals before the new model was implemented, such as a hope for getting more time for high -quality care for the older adults with multimorbidity. During the teamwork, the conversation within the team members was praised as a key factor that included shared professionalism from professionals with different levels of education and focus on their work. According to the staff, unnecessary hospital stays were reduced, while the interprofessional care -chain cooperation was improved through the work of the integrated care team. For many team members, the positive difference in both work and care satisfaction was highlighted in comparison to regular home care as they were able to use their multi -disciplinary skills and support.
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| 9. |
- Gustafsson, Lena-Karin, Docent, 1966-
(författare)
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Vård av multisjuka äldre i hemmet
- 2022. - 1
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Ingår i: Omvårdnad i hemmet vid komplexa vårdbehov. - Lund : Studentlitteratur AB. - 9789144144061 ; , s. 339-348
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Bokkapitel (populärvet., debatt m.m.)
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| 10. |
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| 11. |
- Hochwälder, Jacek, et al.
(författare)
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Psychometric evaluation of the subjective well-being measure GP-CORE in a group of older adults in Sweden.
- 2022
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The world's growing population of older adults is one population that needs to be focused more regarding subjective well-being. It is therefore important to evaluate self-report instruments that measures general well-being for this specific group - older adults. The aim of the present study was to investigate psychometric properties of the Swedish translation of the GP-CORE (general population - Clinical Outcomes in Routine Evaluation) in a group of older adults (> 65 years).METHODS: In this study, a psychometric evaluation of the GP-CORE is presented for 247 Swedish older adults (> 65 years), 184 women and 63 men who applied for home care assistance for the first time.RESULTS: The psychometric evaluation showed high acceptability; provided norm values in terms of means, standard deviations and quartiles; showed satisfactory reliability in terms of both internal consistency and stability; showed satisfactory validity in terms of convergent and discriminant validity; provided a very preliminary cut-off value and quite low sensibility and sensitivity and showed results which indicated that this scale is sensitive to changes. One gender difference was identified in that women without a cohabitant had a higher well-being than men without a cohabitant (as measured by GP-CORE).CONCLUSIONS: The GP-CORE showed satisfactory psychometric properties to be used to measure and monitor subjective well-being in older adults (> 65 years) in the general population of community dwelling. Future studies should establish a cut-off value in relation to another well-being measure relevant for mental health in older adults.
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| 12. |
- Johansson, Carl, et al.
(författare)
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Culturally sensitive active ageing seen through the lens of the welfare theory of health : assistant nurses’ views
- 2023
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Assistant nurses caring for older adults with immigrant backgrounds are on the front lines of a practical, theoretical, and policy battlefield. They need to implement culturally sensitive care provision while not overstating the importance of culture, thereby, contributing to a negative picture of older immigrants as especially problematic. One proposed way to strike such a balance is the welfare theory of health (WTH). In this article, we let assistant nurses apply the WTH to a series of questions in four different vignettes representing the life stories of older persons who characterize typical dilemmas described by the theory. The results show that, through the lens of the WTH, assistant nurses looked for individual care preferences rather than stereotypical ideas about cultural characteristics. Further, the assistant nurses expressed a desire to get to know the persons more deeply to better interpret and understand their individual preferences. Thus, the theoretical framework is useful not only for exposing vulnerabilities to which some older adults with immigrant backgrounds may be exposed, but also for finding ways to mitigate the vulnerability by illuminating vital life goals and using them as a framework to organize care. This approach allows for mitigating the gap between the vital life goals and available resources to achieve a holistic state of health.
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| 13. |
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| 14. |
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| 15. |
- Johansson, Carl, et al.
(författare)
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Spotting good ageing : using welfare theory of health to frame the agency of older adults with immigrant backgrounds to attain good ageing
- 2023
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Ingår i: Nordic Social Work Research. - : Informa UK Limited. - 2156-857X .- 2156-8588.
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Tidskriftsartikel (refereegranskat)abstract
- Care providers for older immigrants in Sweden find themselves in a paradox. Individuals and associations call for culturally sensitive elderly care. However, implementing this comes at the risk of over-culturizing needs and behaviours, drawing a negative picture of ‘the problem of immigrants’ that needs to be solved with special interventions. To find a balance in this paradox, we applied the welfare theory of health to grasp a new understanding of the phenomena and draw a holistic picture of a person’s needs and resources available to achieve good ageing, reaching beyond the cultural paradox. Semi-structured qualitative interviews were conducted with older adults with immigrant backgrounds in Sweden. The interviews were analysed using content analysis. Combining welfare theory of health with immaterial capital theories offered a holistic theoretical approach to good ageing. This took its departure from the agency of older adults, mitigating the gap between their vital life goals and available resources to reach these goals. Although informants wanted caring interventions from close family, we identified distinct responses to mitigate the diminished trust older adults had in the capability of welfare institutions to provide adequate elderly care.
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| 16. |
- Johansson, Carl, et al.
(författare)
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Swedish experts' understanding of active aging from a culturally sensitive perspective - a Delphi study of organizational implementation thresholds and ways of development
- 2022
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Ingår i: Frontiers in Sociology. - : FRONTIERS MEDIA SA. - 2297-7775. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundInternational migration and aging populations make for important trends, challenging elderly care regimes in an increasingly globalized world. The situation calls for new ways of merging active aging strategy and cultural sensitivity. This study aim to illuminate the gap between cultural sensitivity and active aging to identify perceived thresholds by Swedish municipal officials in the understanding of older late-in-life-immigrants situation. MethodsDelphi methodology in three rounds. Twenty-three persons in municipal decision-making positions participated and generated 71 statements, of which 33 statements found consensus. ResultsThe 33 statements show that the decision makers prefer not to use cultural sensitivity as a concept in their work, but rather tailor interventions based on individual preferences that may or may not be present in a certain culture. However, as the complexity of care increases, emphasis drifts away from personal preferences toward text-book knowledge on cultures and activity.
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| 17. |
- Kumpula, Esa
(författare)
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Vårdarnas patientnära arbete inom rättspsykiatrisk vård : det komplexa samspelet mellan samhällsskydd och vårdande utifrån genusperspektiv
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Forensic psychiatric care (FPC) is characterized by the complex interaction between mental illness and the crime the patient has committed. For patient care, this means that male nursing staff are often assigned a superior position within FPC, while female nursing staff are presented as especially suited for providing the care itself. The overall aim was, from a gender perspective, to map patterns of patient care within FPC. Method: The dissertation is based on four qualitative studies. One is a literature study, while the other three adopt an ethnographic approach. The data in Study I consists of peer-reviewed articles that were theoretically analyzed. The Data in Study II consists of interviews that were analyzed by discourse psychology. The data in Study III consists of four focus groups. A thematic analysis was performed on the data. In Study IV, the data consists of observations, field notes and interviews, which were analyzed by thematic analysis. Results: Study I show that health in FPC can be perceived as a complex interplay between protecting society, constructions of masculinity and the physical body. Study II illustrates that nursing staff’s talk about patient care should not be separated from structures framing FPC. Study III illuminates that when nursing staff ignore gender in FPC, this may render invisible patients’ unique health needs linked to their life situation. Study IV reveals a pattern in how protecting society is constructed as superior to providing care. This result can be linked to a gender order that results in unequal conditions for nursing staff’s patient care. Conclusion: The results show how the dual goals are intertwined with nursing staff’s gender values, which affect the nurse-patient relationship and health-promoting activities. By constructing protection of society as having higher priority than care, a gender order is maintained that justifies categorization of patients. Failure to pay attention to the interaction between the dual goals and gender may lead to nursing staff overlooking patients’ individual situations and health needs.
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| 18. |
- Pongthippat, Weerati, et al.
(författare)
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Illuminating health aspects for immigrant Thai women in Swedish transnational marriages
- 2024
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Ingår i: BMC Women's Health. - : BioMed Central Ltd. - 1472-6874. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Women who are migrants experience discrimination and face major risks, including sexual exploitation, trafficking, and violence, which affect their health and well-being. This study explored critical health incidents experienced by immigrant Thai women in marriage migration. Methods: A qualitative explorative approach with in-depth interviews was used. Forty immigrant Thai women who currently or previously had a Swedish spouse were recruited for the study. An inductive critical incident technique was used to collect and analyze the data as the first step. In a second deductive step, the Newman system model was used to categorize health dilemmas. Results: The women reported 438 critical health incidents in five main areas. Psychological health dilemmas included emotional abuse, feeling overwhelmed due to family responsibilities and the stress of leaving family behind. Sociocultural health dilemmas included transnational family duties or not performing family duties. Physiological health dilemmas included experiencing physical violence and environmental, domestic or work accidents. Developmental health dilemmas included failing health, difficulties upholding the duties expected of a spouse in the target culture and caring for an elderly husband. Spiritual health dilemmas included critical incidents in which the women perceived themselves to have failed in their hopes and duties as a wife, which intensified their dependence on faith, particularly the Buddhist concept of karma. Conclusion: Professionals in health and welfare practices in Thailand together with professionals in Western countries who work with women in marriage migration situations need to recognize the psychological, sociocultural, physiological, developmental, and spiritual health dilemmas experienced by these women. Furthermore, civil organizations that meet Thai women in foreign countries, such as Buddhist cultural associations, would benefit from the multicultural knowledge revealed by the present study. This knowledge can facilitate healthcare and welfare support for women in marriage migration situations.
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| 19. |
- Söderman, Mirkka, 1973-, et al.
(författare)
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“Intensive-Home-Rehabilitation” Intervention for Older Persons : A Follow-Up Study of Team Members’ Perceptions
- 2023
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Ingår i: Journal of Multidisciplinary Healthcare. - : Dove Medical Press Ltd. - 1178-2390. ; 16, s. 2207-2216
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reablement as a concept includes a health-promoting perspective with the goal of strengthening health and the ability to perform and participate in daily activities, a broader perspective than in general home care and rehabilitation. Reablement interventions have shown to be both more effective and to a greater extent improve the function and health-related quality of life of older persons when compared to traditional home-based care. Success factors for intensive-home-rehabilitation (IHR), an intervention based on the reablement concept, have been described earlier; however, there is a lack of knowledge about why some persons do not recover despite receiving IHR. Aim: The aim was to shed light on the older persons’ conditions during IHR from the perspective of the rehabilitation team members and to describe obstacles to recovery. Methods: Qualitative analysis of health and care records of persons (65+) who received IHR (n=19) performed by an interprofes-sional team. Results: The analysis revealed various problematic situations, dilemmas, that occurred in the older persons’ lives during IHR, as well as their consequences and the strategies employed by the older persons as a result. IHR aspects perceived as successful by the older persons also emerged, as well as differences in experiences of the physical and mental aspects of the IHR. Analysis also revealed reasons why the IHR might be experienced as broadly successful. Conclusion: The older persons seemed to be satisfied with IHR and achieved their goals; however, some seemed to need more time to reach their goals. Background factors such as having additional diagnoses and living alone might affect the rehabilitation process. Implication for Practice: The study provides knowledge regarding the importance of IHR for the recovery process for the increasing numbers of older persons, which might also be useful in other patient groups requiring otherwise long-term rehabilitation and recovery such as after covid-19 infection.
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| 20. |
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| 21. |
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| 22. |
- Westerholm, Jessica, et al.
(författare)
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The need for acute assessments in home healthcare - Swedish registered nurses' experiences
- 2024
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe study aims to describe Swedish RNs' experiences of acute assessments at home. More patients with complex nursing needs are cared for at home due to an ageing population. Registered nurses (RNs) who work with home healthcare need a broad medical competence and clinical experience alongside adapted decision support systems for maintaining patient safety in acute assessments within home healthcare.MethodsA content analysis of qualitative survey data from RNs (n = 19) working within home healthcare in Sweden.ResultsThere were challenges in the acute assessments at home due to a lack of competence since several of the RNs did not have much experience working as an RN in home healthcare. Important information was missing about the patients, such as access to medical records due to organizational challenges and limited access to equipment and materials. The RNs needed support in the form of cooperation with a physician, support from colleagues, and a decision support system.ConclusionTo increase the possibility of patient-safe assessments at home, skills development, collegial support, and an adapted decision support system are needed. Collaboration with primary healthcare, on-call physicians, and nursing staff, and having the opportunity to consult with someone also provide security in acute assessments.
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