| 1. |
- Björk, Annette, et al.
(författare)
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A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden
- 2020
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis Group. - 0803-9488 .- 1502-4725. ; 74:8, s. 602-612
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Attention-deficit/hyperactivity disorder (ADHD) is associated with lifestyle-related diseases. Therefore, a nurse-led lifestyle intervention including interpersonal relationships, health education and cognitive support was developed to facilitate healthier lifestyle habits.Aim: The aim was to develop a lifestyle intervention and investigate its impact on mental and physical healthMethod: The 52-week intervention included 35 adults with ADHD. In a pre- and post-test design, symptoms of ADHD were measured with the Adult ADHD Self-Report Scale, quality of life was measured with the Adult ADHD Quality of Life scale and mental health was measured with the Hospital Anxiety and Depression scale. Lifestyle habits and dimensions of health were measured by the Lifestyle-Performance-Health Questionnaire and physical fitness was measured by the VO2 Max Test and calculations of waist circumference and body mass index. Result: Post-tests for a group of 25 persons showed positive changes following the intervention regarding weekly physical activity, quality of life and general and mental health. Lifestyle habit support was found to be important. The impact of the intervention should be confirmed in a long-term study with a control group.Conclusion: This intervention may be beneficial and may be implemented in a primary healthcare setting or in other open care units.
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| 2. |
- Björk, Annette, et al.
(författare)
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Health, lifestyle habits, and physical fitness among adults with ADHD compared with a random sample of a Swedish general population
- 2018
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Ingår i: Society, health and vulnerability. - : Informa UK Limited. - 2002-1518. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Persons with Attention Deficit Hyperactive Disorder (ADHD) represent a high-risk population according to health and lifestyles. In the present study, 48 adults with ADHD were recruited to a forthcoming lifestyle intervention. The ADHD sample was matched to a random sample of 42 persons from a Swedish general population that was selected from LIV (a Lifestyle-Performance-Health project).Objective: To identify potential differences in health, lifestyle habits, and physical fitness between adults with and without ADHD.Method: Self-reported questionnaires and physical fitness tests.Results: The ADHD group show worse health outcomes with higher odds ratios for bad general health (OR;13 CI; (3,4–50)), and poorer lifestyle habits with higher odds ratios for low weekly exercise (OR; 3,8 CI; (1,2–13)). When adjusting for education, employment status, and cash margin, the ADHD sample did not show decreased aerobic fitness (OR; 0,9 CI; (0,8–1,0), but lower odds ratios for doing less sit-ups (OR; 0,6 CI; (0,4–0,9)) compared to the general population group.Conclusion: It is not possible to prove that the ADHD diagnosis itself cause the worse health and lifestyle. Other lifestyle factors may have negative consequences of adult ADHD, such as lower levels of education, less succeed in working life, and minor financial margins.
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| 3. |
- Björk, Annette, et al.
(författare)
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Perspectives on Everyday Suffering among People with Adult Attention Deficit Hyperactivity Disorder and Concurrent Mental Disorders
- 2017
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 7, s. 583-598
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the perceptions of everyday suffering among adults with attention deficit hyperactivity disorder (ADHD) and comorbid mental disease. Directed content analysis guided by Eriksson’s theory on human suffering was performed on data from 20 individual interviews. Expressions of both suffering and well-being were identified; the former centred on loneliness and related to life, illness, and care, which supported Eriksson’s theory, whereas expressions of well-being related to ADHD diagnosis and supportive social relationships. Nevertheless, results indicate the need to expand those expressions in order to better contribute to developing a supportive rehabilitation regimen that can provide more interpersonal care.
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| 4. |
- Björk, Annette
(författare)
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Stödjande gemenskap : Utveckling och utvärdering av en intervention för livsstilsförändring bland vuxna med adhd
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The entire project revolves around a lifestyle intervention that has been developed, implemented and evaluated. The intervention included adults with ADHD and comorbid mental illness. ADHD (Attention Deficiency Hyperactive Disorder) is a neuropsychiatric diagnosis/disability characterized by attention problems, impulsivity and hyperactivity and can affect education, working life, social relationships and form the basis for impaired lifestyle habits. Previous research shows shortened life expectancy in adults with ADHD, which related to deteriorating lifestyle habits. In the long run, the disability may be the basis for impaired living conditions and lifestyle habits and contribute to the individual's well-being and quality of life. In the field of health sciences, it is important to alleviate suffering, promote health and prevent ill health. Thus, the overall aim of this dissertation is to analyze living conditions among people with ADHD and mental illness, as well as to develop and evaluate a lifestyle intervention for this group.The PhD project includes four sub-studies: Study I, a qualitative interview study (n = 20) of adults with ADHD and mental illness, aimed at describing experiences of everyday suffering in this group. The analysis showed experiences of both suffering and well-being in living with ADHD. The focus of the suffering was the experience of loneliness, both regarding relationships in life, relationships in health care, but also to ADHD diagnosis and mental illness. Well-being was experienced when diagnosed with ADHD but also in relation to supportive social relationships. Study II, a quantitative descriptive and comparative study, aimed to gain more knowledge about people withADHD and their health situation. One group of people with ADHD (n = 48)was compared to the normal population without ADHD (n = 42). The results showed poorer health outcomes regarding self-perceived general health and the group with ADHD was less weekly physical active but nevertheless had no decreased aerobic fitness compared to the normal population. Study III, aquantitative descriptive study (n = 25), aimed to examine the degree of acceptance of the intervention and its impact on lifestyle habits, health and well-being, MBI and physical fitness. The tests before and after completing intervention showed small positive effects regarding weekly physical activity, quality of life and general- and mental health. Study IV, a qualitative study(n = 15), with adults with ADHD and comorbid mental illness aimed to investigate the experience of participating in a nurse-led lifestyle intervention. The analysis, based on material from interviews, showed that the participants perceived the intervention as supportive, which is related to the interpersonal relationships that arose in the intervention. Through supportive kindship with the other participants in the intervention, lifestyle habits and health experience were improved.The conclusion of the thesis is that the lifestyle intervention, based on interpersonal relationships and supported kindship, can be useful for making lifestyle changes in adults with ADHD and mental illness. Such support is important because adults with ADHD and mental illness experience a lack of and a desire for social support and has an increased risk of deteriorating health and unhealthy lifestyles. However, future adjustments to the content of the intervention must be made to improve the lifestyle intervention towards more sustainable lifestyle changes. Above all, the lifestyle intervention ought to be continuous. It is also of great importance for further research that insider perspective is used, that is, investigate the professionals' experiences regarding the intervention.
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| 5. |
- Mentsen Ness, Tove, et al.
(författare)
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Older south sami women and men’s expectations regarding home healthcare in sweden
- 2021
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Ingår i: Australian Journal of Advanced Nursing. - : Australian Nursing and Midwifery Federation. - 0813-0531 .- 1447-4328. ; 38:4, s. 41-48
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to describe the views and expectations concerning home healthcare from the perspective of older South Sami women and men in comparison with each other. Study design and methods: In this study, 56 older South Sami women (n=31) and men (n=25) were interviewed by telephone, using semi-structured interviews. Data was subjected to qualitative content analysis. Results: Our results revealed both similarities and some slight differences between the male and female participants. Both male and female participants expected the same care providers over time, in addition to expecting competence. Additionally, our female participants stressed that care providers should use time in their encounters with them as care receivers. For some female participants, this was related to competence. The findings also revealed that the care providers’ cultural backgrounds were of importance to both female and male participants, even if female participants preferred care providers with a South Sami background to a greater extent. The male participants stressed that having care providers with a South Sami background could be of importance, but they were more concerned about the care providers’ competence in the encounters with them as future care receivers. The main findings show that older South Sami women and men mostly have similar expectations of future home healthcare. Conclusions: Our results highlight that having the same care providers over time, with the necessary competence, is of importance to our participants. Additionally, participants prefer their care providers to have a South Sami background – although not at the expense of competence – and this was especially highlighted by the South Sami men. Implications for research, policy, and practice: Our study indicates that, if possible, in encounters with South Sami women and men, home healthcare services should facilitate for the same care providers over time and that they should be competent, preferably of a South Sami background, and speak South Sami if the care receiver has mastered the Sami language.
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| 6. |
- Ness, Tove Mentsen, et al.
(författare)
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‘Contradictions in having care providers with a South Sami background who speak South Sami’ : older South Sami People in Sweden's expectations of home nursing care
- 2020
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 34:2, s. 436-445
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Tidskriftsartikel (refereegranskat)abstract
- The Sami are an indigenous population with multiple languages and dialects living in northern areas of Sweden, Norway, Finland, and the Kola Peninsula. The South Sami population lives in central regions of Sweden and Norway, and consist of about 2000 people. In this study, 56 older South Sami people from Sweden participated. Semi-structured interviews were conducted over the telephone and analysed through qualitative content analysis. The main findings show that older South Sami people's expectations of having care providers with a South Sami background speaking South Sami in home nursing care contain contradictions in and between participants. Participants had different preferences regarding having care providers with a South Sami background speaking South Sami in the future. When providing care to older South Sami people, individual adjustments are of importance, and our study showed that participants had different expectations despite having similar backgrounds.
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| 7. |
- Ness, Tove M., et al.
(författare)
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‘The same care providers over time who make individual adjustments and have competence’ Older South Sami People in Sweden's expectations of home nursing care
- 2020
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 34:1, s. 181-189
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Tidskriftsartikel (refereegranskat)abstract
- This study is part of a larger research project designed to examine the view of home nursing care from the perspective of older South Sami people in Sweden. In the present study, we present findings from the point of view of their expectations of home nursing care. The Sami are an indigenous population living in northern Sweden, Norway, Finland and the Kola Peninsula, and consist of different Sami people, of which the South Sami population is one. This population consists of approximately 2000 persons living in the central regions of Sweden and Norway. Fifty-six older South Sami people participated in the study. Semi-structured interviews were conducted over the telephone and were analysed using latent content analysis. The main findings show how older South Sami people's expectation for home nursing care contains the same care providers over time, individual adjustments and competent care providers and do not differ from the general Swedish population. Interpersonal interaction is a hallmark of nursing care and other healthcare disciplines. Ideally, interpersonal care is achieved when individual care providers have few care receivers, which promote continuity in care, individual adjustments based on the care receivers individual needs and care providers with professional and relational competence.
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| 8. |
- Andreassen Devik, Siri, et al.
(författare)
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Nurses’ experiences of compassion when giving palliative care at home
- 2020
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 27:1, s. 194-205
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Tidskriftsartikel (refereegranskat)abstract
- Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised.Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data.Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes.Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content.Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective.
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| 9. |
- Björk, Annette, et al.
(författare)
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The Importance of Belonging to a Context : A Nurse-Led Lifestyle Intervention for Adult Persons with ADHD
- 2021
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Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 42:3, s. 216-226
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Tidskriftsartikel (refereegranskat)abstract
- Living with attention deficit hyperactivity disorder (ADHD) and mental illness involves an increased risk of lifestyle-related diseases. Although there are several ways to provide support to adult persons with ADHD, there is a lack of non-medical strategies for this purpose. This study explore how adult persons with ADHD with mental illness experienced taking part in a nurse-led lifestyle intervention. Fifteen participants participated in a 52-week lifestyle intervention. The analysis revealed two main categories; Building trusting relationships and Health together. This nurse-led lifestyle intervention could be an alternative or complement to current approaches to promoting health in adults with ADHD.
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| 10. |
- Brodin, Kerstin
(författare)
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Den vakna patienten : En kvalitativ studie om intraoperativ omvårdnad
- 2018
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Inledning: Som ett resultat av utvecklingen inom anestesi och kirurgi kan allt mer komplexa operationer utföras i lokala eller regionala anestesier. Detta innebär att den kirurgiska patienten kan förbli mer eller mindre vaken genom hela den intraoperativa fasen.Syfte: Syftet med denna avhandling var att få en djupare förståelse för den intraoperativa omvårdnaden när patienten är vaken. Avhandlingen består av två delstudier [I-II] vilka har, beroende på delstudiens syfte, utgått från operationssjuksköterskans perspektiv [I] och patientens perspektiv [II].Metod: Utifrån syftet valdes kvalitativa metoder för båda delstudierna. Data samlades in genom fokusgruppintervjuer [I] och individuella intervjuer [I,II]. Insamlad data analyserades i enlighet med Grundad teori [I] och kvalitativ innehållsanalys [II].Resultat: Studie I visade att det som ansågs vara operationssjuksköterskans huvudangelägenhet var att ta den vakna patienten i beaktande vilket de försökte åstadkomma genom att uppnå och bibehålla en hög moral på sal genom hela processen. För att uppnå hög moral var det tre aspekter som operationssjuksköterskan tog hänsyn till; patienten, teamet och den professionella yrkesrollen. För att uppnå hög moral på sal var operationssjuksköterskorna vaksamma och flexibla. De balanserade mellan patientens behov, teamets behov de behov som var förknippade med säker kirurgi. Moralen beskrevs vara en helhet med målet att ge patienten en positiv upplevelse. Resultatet i studie II visade att patienterna upplevde att de var i en situation de inte hade kontroll över och de var uppmärksamma och reflekterande för att skapa mening och trygghet åt situationen. Det övergripande temat ”att söka efter förtroende i en utsatt och beroende situation” illustrerar hur patienterna tenderade att i första hand tolka det som skedde omkring dem på så sätt att det bringade känslan av att vara trygga. De fyra kategorierna; att erfara stämningen på sal, att möta[o]väntade känselförnimmelser, att uppfatta bevis på säkerhet och att använda individuella strategier, beskriver patienternas upplevelser om vad som påverkade förtroendet samt hur de hanterade dessa upplevelser. Huvudfynden berörde de intraoperativa behoven samt hanteringen och balanseringen mellan dess.Slutsats: Operationssjuksköterskans intraoperativa omvårdnad kan bidra till positiva upplevelser för patienten som är vaken under ett kirurgiskt ingrepp. Operationssjuksköterskans förmåga att tolka och agera på olika intraoperativa behov samt patientens personlighet och egna förmåga att hantera situationen är av stor betydelse för upplevelsen av den intraoperativa fasen.
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| 11. |
- Brodin, Kerstin, et al.
(författare)
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Intraoperative Care of the Conscious Patient from the Perspective of the Operating Theatre Nurse : A Grounded Theory
- 2017
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 7:9, s. 1086-1099
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Intraoperative care includes a unique knowledge of how toperform a safe and effective surgery procedure. Surgery performed under regionalor local anaesthesia allows the patient to remain conscious during theprocedure and is rather common in Swedish healthcare today. Aim: The aimwas to obtain a deeper understanding of the main concerns of operating theatrenurses (OTN) when caring for conscious patients during the intraoperativephase. Methods: Interviews were conducted with 23 OTNs from five differenthospitals in Sweden and analysed according to grounded theory. Findings:The main concern among the OTNs was to take the patient in consideration.The core category “achieve and maintain ethical treatment of patients”in the operating theatre (OT) was a strategy used throughout the intraoperativeprocess. Ethical treatment was described as moral behaviour atdifferent levels and included the team’s behaviour, respectful and individualisedpatientcare, and the working-morale of the professionals. Being vigilantand being flexible were the categories related to the core category. The OTNsconstantly assessed where to pay most attention as they balanced between theneeds of the patient, the team, and the surgery procedure. Conclusion: It isimportant that every patient is taken into consideration and that ethical principlesare held to the highest standards in the OT. A familiar team can facilitatethat. The complex skills that operating theatre nurses develop can beadded to explain important competencies within the profession.
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| 12. |
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| 13. |
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| 14. |
- Davén, Josefine, et al.
(författare)
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Encountering patients with anorexia nervosa - An emotional roller coaster. nurses’ lived experiences of encounters in psychiatric inpatient care
- 2022
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose:The aim of this study was to illuminate the meaning of nurses’ lived experiences of encounters with adult patients with anorexia nervosa in psychiatric inpatient care.Methods:A qualitative phenomenological hermeneutical design was used. Personal interviews with a narrative approach were conducted with 11 nurses with experience of encountering patients with anorexia nervosa in psychiatric inpatient care.Results:Three key themes were revealed: Being overwhelmed by emotions consisting of three subthemes: Bearing feelings of in comprehension, Navigating emotions, and Being disappointed and frustrated; Seeking strength to cope consisting of three subthemes: Relying on colleagues and routines, Feeling hope and motivation, and Building inner security; and Trying to build relations consisting of two subthemes: Getting closer to the patient and Relating to relatives.Conclusion:Our findings illuminate the “emotional roller-coaster” which nurses are embedded in during their daily work experiences. Being able to balance one’s professional role, seeing the person behind the patient, and the illness is important in all nurse-patient encounters. An examination of nurses’ lived experiences can contribute new and important knowledge, an in-depth understanding of the nurses’ work situation, and can help identify any need for increased knowledge.
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| 15. |
- Eivergård, Kristina, et al.
(författare)
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Disciplined into Good Conduct : Gender Constructions of Users in a Municipal Psychiatric Context in Sweden
- 2021
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 30:15-16, s. 2258-2269
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To examine how gendered discursive norms and notions of masculinity and femininity were (re)produced in professional conversations about users of long-term municipality psychiatric care. Focus is on the staff's use of language in relation to gender constructions.BACKGROUND: Psychiatric care in Sweden has undergone tremendous changes in recent decades from custodian care in large hospitals to a care mainly located in a municipal context. People who need psychiatric care services often live in supporting houses. In municipal psychiatric care, staff conduct weekly professional meetings to discuss daily matters and the users' needs. Official reports of the Swedish government have shown that staff in municipal care services treat disabled women and men differently. Studies exploring gender in relation to users of long-term psychiatric care in municipalities have problematised the care and how staff, through language, construct users' gender. Therefore, language used by staff is a central tool for ascribing different gender identities of users.DESIGN: The content of speech derived from audio recordings were analysed using Foucauldian discursive analysis. The COREQ checklist was used in this article.RESULTS: The results indicate that by relying on gender discourses, staff create a conditional care related to how the users should demonstrate good conduct. In line with that, an overall discourse was created: Disciplined into good conduct. It was underpinned by three discourses inherent therein: The unreliable drinker and the confession, Threatened dignity, Doing different femininities.CONCLUSION: The community psychiatric context generates a discourse of conduct in which staff, via spoken language (re)produces gendered patterns and power imbalances as a means to manage daily work routines. Such practices of care, in which constant, nearly panoptic, control despite the intention to promote autonomy, urgently require problematising current definitions of good conduct and normality.
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| 16. |
- Eivergård, Kristina
(författare)
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Språkets makt : en studie av vårdpersonals tal om psykiatriska patienter och brukare
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this dissertation was to critically examine, based on three selected psychiatric care environments, how healthcare staff talk about patients and users with a focus on how notions of gender are produced and reproduced during rounds and in reportings.Reportings and rounds are daily activities in almost all healthcare practices. It takes place three to four times a day and is ideally aimed at creating continuity and alignment in the care. In psychiatric contexts, the reportings and rounds constitute important tools in assessing which approach and treatment are most appropriate. Studies on verbal reporting have mainly been carried out in somatic care and have been focused on the reportings’ content, type, cost and time required. Research also suggests that healthcare staff find it difficult to move away from a strictly medical perspective and that reporting and rounds take place in a ritualized way where the staff are socialized into what is valid information to pass on. The reportings can also serve as a way for healthcare staff to support each other in their work. The research also applies in psychiatric care contexts where different power structures also become apparent in the use of language. However, how psychiatric care staff talk about patients and users in reportings and on rounds based from a gender perspective has not been studied to any great extent.The dissertation is based on four sub-studies, all with qualitative research design. The empirical material in all sub-studies consisted of sound recordings from rounds and reports in three different psychiatric care contexts; general psychiatry, forensic psychiatry and municipal psychiatry. In sub-study I and II, content analysis was employed and in sub-study III and IV, discourse analysis was employed. Sub-study I showed how the healthcare staff used everyday words and concepts in both reports as in the rounds. The words and concepts formed the basis for assessing the patient's behaviour and mental condition and decisions about nursing and treatment. Sub-study II showed that the language discourse of the healthcare staff reproduced a gender order in which the female patients were expected to behave according to feminine norms in order to be acceptable as women and, as patients. In sub-study III, the statements studied showed a family oriented caring practice and how power techniques in terms of discursive norms around masculinity contributed to the subordination of men cared for in. The results also revealed how the healthcare staff reproduced a heteronormativity gender order through the language used. In sub-study IV, the statements showed a discourse of care where various techniques of power such as intimacy and confession were used to persuade the users to behave according to feminine or masculine norms. The statements also showed a heteronormative and heterosexual order in which the paradox between the need for support and maintaining one's dignity was clarified.The conclusion of the sub-studies together was that the reports and rounds was a scene for which everyday words and concepts were used to describe and assess patients and users. These everyday words and concepts reproduced power orders in which different disciplining power techniques were displayed. The language also reproduced a heteronormative gender order in which notions of femininity and masculinity participated in the assessments of patients and users´ mental states. Because the patients were not involved in the conversations about themselves, healthcare staff were given the possibility to describe and position the patients and users in ways that they themselves were not aware of. In order to create opportunities to break with stereotypical gender patterns as well as patterns of dominance and subordination in psychiatric nursing and care, students, as well as healthcare staff, should work with awareness and critical reflection on discursive norms and how language constructs the patient and user.
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| 17. |
- Eivergård, Kristina, et al.
(författare)
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Subordinated masculinities : a critical inquiry into reproduction of gender norms in handovers and rounds in a forensic psychiatric care
- 2020
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 29:21-22, s. 4227-4238
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: To examine how gendered discursive norms and notions of masculinity are (re)produced in professional conversations about men cared for as patients in forensic psychiatric care, with a particular focus on the centrality of language and gender.Background: During verbal handovers and ward rounds, care staff converse to share information about patients and make decisions about their mental status. Spoken language is thus a pivotal tool in verbal handovers and ward rounds, one able to reproduce discourses and gender norms.Design: Qualitative. Data collected from audio recordings of verbal handovers and ward rounds in a forensic psychiatric clinic were subjected to discourse analysis. The COREQ checklist was used.Results: While discussing patients, staff subordinated them by reproducing a discourse typical of heteronormative, family‐oriented care. The overarching discourse, which we labelled subordinated masculinities, was supported by three other discourses: being unable to take responsibility, being drug‐addicted and performing masculinity. Such discourse was identified as a disciplining practice that subordinate's patients as a means to maintain order, rules and gender norms.Conclusion: The study reveals a caring practice that position male patients as children or disabled individuals and, in that way, as subordinated other men within a context were staff reproduces a heteronormative family structured care. The process also reveals a practice were downplaying aggressive and deviant behaviour could disempower and reduce patients' responsibility for personal actions and their possibilities to participate in their care. That finding especially seems to contradict previous findings that patients want to be able to act responsibly and, to that end, want care staff to help them.Relevance to clinical practice: Nurses need to deepen their understanding of how language (re)produces discursive norms of gender and masculinity in forensic care and that process's consequences for such care.
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| 18. |
- Eivergård, Kristina, et al.
(författare)
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The Importance of Being Acceptable - Psychiatric Staffs' Talk about Women Patients in Forensic Care
- 2019
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Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 40:2, s. 124-132
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Tidskriftsartikel (refereegranskat)abstract
- Currently, women comprise about ten percent of those sentenced to psychiatric forensic clinics in Sweden. Those who are sentenced to forensic care because of offending and violent behaviour have already taken a step away from the usually expected female behaviour. On the other hand, there are many women in forensic care who have not committed crimes, but who instead self-harm. Studies have identified a gender bias in diagnosing and care in psychiatric settings, but there are few studies conducted on women in forensic care. The present study therefore examined how the situation of women patients and female norms are expressed in the staff's talk about these women during verbal handovers and ward rounds at a forensic clinic in Sweden. The aim was to explore how psychiatric staff, in a context of verbal handovers and ward rounds, talk about women who have been committed to forensic psychiatric care, and what consequences this might have for the care of the patients. The content of speech was examined using audio recordings and a method of analysis that was inspired by thematic analysis. The analysis identified that the staff talked about the women in a way that indicates that they expected the women to follow the rules and take responsibility for their bodies in order to be regarded as acceptable patients.
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| 19. |
- Enarsson, Per, 1962-, et al.
(författare)
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'There should be something gained' : Carers’ ethical reasoning about using a common staff approach in psychiatric in-care
- 2017
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Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 37:4, s. 217-225
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Tidskriftsartikel (refereegranskat)abstract
- Thirteen carers were interviewed about their ethical reasoning when using a common staff approach to restricting smoking for a psychiatric in-patient. A constructed case structure and a vignette method were used in the interviews, and manifest content analysis of the texts exposed five ethical positions adopted by the carers: ‘best for the person’, ‘best for the patient’, ‘best for others involved with the person/patient’, ‘best for me as a carer’, and ‘best according to rules and regulations’. A second manifest content analysis of language showed terms that expressed value judgments in regard to the carers’ personal experiences. Some carers argued at first from one ethical position, but when the question was changed, they argued from an opposite ethical position. Results may be understood in light of dialog philosophy; ethical reasoning during use of a common staff approach tends to focus either on relations with others or with oneself.
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| 20. |
- Hammarström, Lars, et al.
(författare)
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Controlling emotions : nurses’ lived experiences caring for patients in forensic psychiatry
- 2019
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Nurses working in forensic psychiatry often encounter offenders who have a severe mental illness, which may cause ethical challenges and influence nurses’ daily work. This study was conducted to illuminate the meaning of nurses’ lived experiences of encounters with patients with mental illnesses in forensic inpatient care. Methods: This qualitative study employed narrative interviews with 13 nurses. Interviews were audiotaped and transcribed verbatim and analysed following a phenomenological-hermeneutic approach. Results: Four key themes were revealed: “Being frustrated” (subthemes included “Fighting resignation” and “Being disappointed”), “Protecting oneself” (subthemes included “To shy away,” “Being on your guard,” and “Being disclosed”), “Being open-minded” (subthemes included “Being confirmed,” “Developing trust,” and “Developing compassion”), and “Striving for control” (subthemes included “Sensing mutual vulnerability” and “Regulating oneself”). Further, working in forensic psychiatry challenged nurses’ identity as healthcare professionals because of being in a stressful context. Conclusions: Dealing with aggressive patients with severe mental illnesses threatens nurses’ professional identity. Nurses must attempt to empathize with patients’ experiences and respond accordingly. Utilizing strategies rooted in compassion such as self-reflection, emotional regulation, and distancing themselves when necessary may enable nurses to more effectively respond to patients’ needs. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 21. |
- Hammarström, Lars
(författare)
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Encounters with patients in forensic inpatient care : Nurses lived experiences of patient encounters and compassion in forensic inpatient care
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Forensic psychiatry is characterised by compulsory care and long hospital stays, where nurses care for patients with severe mental illness, who often have committed crimes. The main objective is to rehabilitate the patient to once again become a part of society by improving mental health and decreasing the risk of criminal relapse. This is mainly achieved through encounters with the patients. Encountering patients in forensic psychiatry means coming face to face with suffering and the duality of caring, doing what is best for the patient and protecting society.Aim: The purpose of the study was to obtain a deeper understanding of encounters with patients with mental illness in forensic inpatient care as experienced by nurses.Method: This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design. A total of 13 nurses working at a forensic psychiatric hospital in Sweden were recruited through a purposive sample to participate in the studies through narrative interviews. Study I was analysed with phenomenological hermeneutics in line with Lindseth and Norbergh (2004) in order to illuminate the lived experience of nurses’ encounters. Study II was a secondary supplementary analysis, which applied hermeneutics in line with Fleming, Gaidys, and Robb (2003) to gain a deeper understanding of nurses’ compassion in forensic psychiatry. The two studies were merged to provide a comprehensive understanding in this licentiate thesis.Findings: Study I illuminated the meaning of nurses’ lived experiences of encounters with patients with mental illnesses in forensic inpatient care, that is the nurses’ desire to do good despite being confronted with their own emotions as fear, humiliation, and disappointment. Encounters were also occasionally perceived as positive, awakening emotions of compassion, competence, pride, trust, satisfaction, and gratification regarding the patient’s recovery. However, a source of conflict was the struggle between doing what was best for the patient and protecting society. The study comprised of four themes: being frustrated, protecting oneself, being open-minded, and striving for control. Study II aimed to gain a deeper understanding of nurses’ compassion in providing forensic psychiatric inpatient care with three themes: recognising suffering and need for support, responding to patient suffering, and reacting to one’s own vulnerability. Abstracting to a main theme of being compassionate in forensic psychiatry which is described as an emotional journey, an ongoing inner negotiation between own vulnerability and expressions of suffering. This inner negotiation of making sense of patients’ plea and how they were perceived was crucial for determining the development of compassion rather than turning to control and rules as a means to protect oneself.Discussion: A interpretation of the studies (I, II) revealed two topics, being sensitive and responsive and keeping distance, which were reflected upon against the theoretical framework of Kari Martinsen. The studies showed that nurses faced a variety of encounters that forced them to face their own vulnerability and that trust could reduce power imbalances as well as help deal with societal, man-made constructs. The nurses’ encounters with incomprehensible expressions of suffering also show that nurses need to find a way to make room for “expressions of life”– taking a step back and turning their gaze inwards – in order to regulate their own emotions. This may better equip nurses to encounter patients with compassion and kindness rather than turning to norms and rules to protect themselves and guard their own vulnerability. Rather than distancing themselves from the patients, nurses can instead take a step back to come closer to their patients.
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| 22. |
- Hammarström, Lars, et al.
(författare)
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‘Fleeing’ as a Strategy for Navigating Resistance in Patient Encounters within Forensic Care
- 2023
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Ingår i: Healthcare. - : MDPI AG. - 2227-9032. ; 11:21
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the phenomenon of “fleeing the encounter when facing resistance” as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one’s emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers’ self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient’s lifeworld but also their own.
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| 23. |
- Hammarström, Lars, et al.
(författare)
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Meanings of carers’ lived experience of “regulating oneself” in forensic psychiatry
- 2022
-
Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE This study aimed to illuminate the essential meanings of carers’ lived experience of regulating themselves when caring for patients with mental illnesses in forensic inpatient care.METHODS Qualitative analysis was used to analyse data from narrative interviews with open-ended questions conducted with nine carers, which were analysed using a phenomenological-hermeneutic approach.RESULTS Findings revealed three themes, “preserving oneself as a carer,” “building an alliance with the patient” and “maintaining stability in the community.” Carers not only regulated emotions related to patients but also the ward to facilitate a caring climate. For carers, encounters with patients meant facing expressions of suffering that evoked unwanted emotions. Regulating one’s emotions also meant being emotionally touched and facing one’s vulnerability.CONCLUSION Regulating oneself was a strategy used by carers to get closer to the patient and establishing a trusting relationship. Regulating oneself meant becoming aware of one’s shortcomings, not projecting them onto others, which may impair establishing relationships with patients and fulfilling the aim and caring task of forensic psychiatry. This study stresses the importance of carers being guided to manage their conflicting emotions and vulnerabilities and finding courage and an approach that allows a permissive climate of self-reflection.
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| 24. |
- Hammarström, Lars, et al.
(författare)
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The path of compassion in forensic psychiatry
- 2020
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Ingår i: Archives of Psychiatric Nursing. - : Elsevier BV. - 0883-9417 .- 1532-8228. ; 34:6, s. 435-441
-
Tidskriftsartikel (refereegranskat)abstract
- We aimed to deepen our understanding of the concept of compassion in caring for patients with mental illness in forensic psychiatric inpatient care settings. Qualitative analysis was used to illuminate themes from interviews conducted with 13 nurses in a prior study. The audiotaped interviews, which had been transcribed verbatim, were analyzed following a hermeneutic approach. Results revealed the main theme of “being compassionate in forensic psychiatry is an emotional journey” and three themes. Overall, compassion was seen as a changeable asset, but also an obstacle when absent; sensitivity to one's own vulnerability is necessary to overcome that obstacle.
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| 25. |
- Hammarström, Lars, 1983-
(författare)
-
“To see the person behind the crime, through the eyes of the person behind the keychain” : - Carers lived experiences of patient encounters in forensic inpatient care.
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Forensic psychiatric care (FPC) encompasses involuntary care and treatment of those who have committed a crime. On the one hand, FPC is constructed regarding the respect for the individual’s freedom and autonomy, and on the other hand, it is constructed on societal protection. Being a carer in FPC is intertwined with being faced with a distinct ethical dimension of care, as it involves caring for patients who are deprived of their freedom, meaning dealing with the tension of care and custody. Caring means often finding oneself in encounters with individuals with inevitable elements of rules, coercion, threats, and violence. In this complex environment, a caring relationship is to be established, which is intended to be built on trust, as a forensic nurse’s main purpose is creating wellbeing and care, based on the patient’s perspective. It is in the everyday encounters that occur often spontaneously that the carer–patient relationship should be established. It is in these encounters that the carer is given the opportunity to relive suffering. The encounter becomes the focal point where the lifeworlds of the carer and patient meet. Dealing with the duality of FPC and contradictory emotions requires a deeper understanding, which encourages to self reflect the meaning of these encounters and oneself as a carer. Aim: The overarching purpose of the thesis was to obtain a deeper understanding of carers’ lived experience of encounters with patients with mental illness in forensic inpatient care. Method: The thesis consists of four studies (I, II, III, IV) with qualitative design, based on ontological and epistemological reasonings of phenomenology and hermeneutics. The studies illuminated the lived experience and are conducted with phenomenological hermeneutics (I, III), hermeneutics (II), and reflective lifeworld research (IV). Findings: Encounters with patients are characterised with the duality of acting upon the patients’ needs and managing rules and norms stipulated in laws and regulations that govern FPC and societal protection. Encounters in FPC and being a carer is intertwined with being put in a position of power, where the carer also must be allowedviito be fragile and deal with vulnerabilities and not play a role. The encounter means being in a duality and having the insight of the tension of impressions of expressions of suffering, being in the “space in-between”. In this space, there is room and a possibility for carer’s personal growth, and achieving a phenomenological attitude and to truly embrace the patients’ lifeworld. Discussion: A comprehension of the studies (I, II, III, IV) revealed four topics, having trust or feeling distrust, being compassionate or being indifferent, having courage or being afraid, and being genuine or pretending. These were reflected upon against the theoretical framework of K. E. Lögstrup. The duality of FPC and the space in-between that arises in the encounter suggests that the carer is forced to be confronted with existential phenomena that constitutes one’s world. By being active in the space in-between and reflecting upon openness, the carer moves between this duality that exists in the continuum that the opposite phenomenon contains. The space in-between may become a place and a possibility for personal growth by being active and obtaining a phenomenological approach. This is obtained by an openness and consciousness to the impression by self-reflection to convey its meaning. If carers can do this by openness and compliance, there is a possibility for the encounter to become a place for personal growth, that encourages the sovereign utterances of life, and carers may to a greater extent understand themselves as well as patients’ expressions of suffering.
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| 26. |
- Hammarström, Lars, et al.
(författare)
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"You Know Where the Boundary Is When You Cross It"-A Phenomenological Understanding of Vulnerability as Experienced by Carers in Forensic Inpatient Care
- 2022
-
Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 43:8, s. 712-720
-
Tidskriftsartikel (refereegranskat)abstract
- In forensic nursing, carers must balance caring and limiting actions in encounters with patients. Interpreting suffering in others raises awareness of one's own vulnerability. Hence, the aim of this study was to describe the phenomenon of vulnerability as experienced by carers in forensic inpatient care. Nine participants were recruited at a major forensic hospital, and their narratives were analysed with a reflective lifeworld approach. The findings revealed that vulnerability was both a strength and a burden. Vulnerability comprised becoming aware of one's boundaries, being genuine and protecting oneself. Dealing with vulnerability enables carers to open up to patients.
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| 27. |
- Hellzén, Ove, 1954-, et al.
(författare)
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A Meta-Ethnographic Review of Forensic Psychiatry Inpatient Care. Nursing Staff Experiences of the Nurse-Patient Encounter
- 2023
-
Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 44:12, s. 1226-1236
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this review was to synthesise qualitative research into how nurses perceive and experience encountering patients in forensic inpatient care. Review method This review followed the steps of meta-ethnography developed by Noblit and Hare. Data sources Twelve studies, published from 2011 to 2021, were identified through a search of relevant databases in December 2021. Findings The synthesis revealed three third-order and 10 second-order constructs during the translation of concepts in the studies. These are: Adopting the patient’s perspective (liberation, comprehension and resistance), Action (security, trust, flexibility and predictability) and Activation (afraid or safe, involved or indifferent and boundaries). Further, a line of argument was developed which indicates that in forensic psychiatry inpatient care, nurses experience having to deal with internal and external resistance that affects their freedom of choice in the creation of a caring relationship. Conclusion The encounter is experienced as a continuous process in which the foundation is laid for the encounter (approach), the encounter unfolds and develops (action) and the nurse experiences the encounter (activation). The process is intertwined with and takes place in a context where care is influenced by the duality of the task (task), the culture of care (context), the patient’s expression (patient) and the nurse’s own impression of the patient’s expression (oneself). Implications Professional communities should support initiatives that can strengthen nurses’ self-awareness and provide opportunities for reflection on practice, which will both benefit the resilience of the nursing staff and the quality of care for patients in this setting.
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| 28. |
- Hellzen, Ove, 1954-, et al.
(författare)
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“I screamed for help” : A single case study of one sister’s experiences with formal psychiatric care when her brother became mentally ill
- 2013
-
Ingår i: Health. - : Scientific Research Publishing, Inc.. - 1949-5005 .- 1949-4998. ; 5:3, s. 417-425
-
Tidskriftsartikel (refereegranskat)abstract
- Studies have shown that the quality of the relationship between siblings has great significance for the mentally ill sibling’s overall quality of life. Sibling relationships may be particularly impor- tant because few adults with severe mental illness have children. As parents grow older, adult children are expected to support their sibling with mental illness when their parents are no longer able to do so. The sibling relationship has the potential to be one of the most significant relationships for adults with schizophrenia. The aim of this paper is to present a case study of a sister’s experiences and needs in her contact with psychiatric care. This single case study was designed and the informant was recruited be- cause of her value in maximizing what we can learn about being a sibling to a person with mental illness. Data were collected through four in-depth, semi-structured, repeated interviews during a two-year period, and were interpreted and analyzed through content analysis. Three major topics were discussed: 1) Anna’s brother’s time with formal psychiatric care; 2) Anna’s feel- ings and emotions; and 3) Anna’s view of her contact with psychiatric care. The findings indicated a sibling’s need for attention, support, and understanding from the formal caregivers. Participation in our study was one of the first opportunities she had to talk about her relationship with formal psychiatric care. An open dialogue may help siblings to manage their situations.
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| 29. |
- Hellzén, Ove, 1954-, et al.
(författare)
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‘It’s my home and your work’ : the views of a filmed vignette describing a challenging everyday situation from the perspective of people with intellectual disabilities
- 2018
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 13:1
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Forskningsöversikt (refereegranskat)abstract
- Purpose: Examining everyday challenges in the interactions between people with intellectual disabilities and their staff, as seen from the user’s perspective, is an important perspective in health care research. Involving people with intellectual disabilities as so-called co-researchers is a relatively unexplored research strategy. In this paper, co-researchers participated in all the steps of the research process, from planning to reporting, in addition to the written reporting of the findings. The aim of this study was to explore how people with intellectual disabilities experienced a filmed vignette of an everyday situation. Method: Based on audio-recorded and transcribed individual and focus-group interviews with people with intellectual disabilities,performed by co-researchers with intellectual disabilities together with researchers,qualitative content analysis was used. Results: The analysis reveals three themes: “being emotionally touched”, “being aware of the other”, and “being unclear”. Conclusions: The results are discussed in light of normalization and participation in society with independence and one’s own decision-making. Regarding the care of people with intellectual disabilities, the main finding is the need to focus not only on greater involvement of this population in their own daily lives, but also to teach self-determination skills. Another finding is the importance of involving people with intellectual impairment as co-researchers.
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| 30. |
- Hellzen, Ove, 1954-
(författare)
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Omvårdnad vid psykisk ohälsa
- 2014. - första
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Ingår i: När omvårdnad blev vetenskap. - Stockholm : Liber. - 9789147114047 ; , s. 184-188
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 31. |
- Hellzén, Ove, 1954-, et al.
(författare)
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Primary Healthcare Nurses’ Views on Digital Healthcare Communication and Continuity of Care : A Deductive and Inductive Content Analysis
- 2022
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Ingår i: Nursing Reports. - : MDPI AG. - 2039-439X .- 2039-4403. ; 12:4, s. 945-957
-
Tidskriftsartikel (refereegranskat)abstract
- Primary healthcare in the Western world faces significant functional challenges, resulting in the implementation of digital communication tools. Nurses are key professionals in primary care and focusing on the impact of digital communication and continuity of care in primary care organisations is important. This qualitative descriptive study explores digital communication and continuity of care from primary healthcare nurses’ perspective. Data from individual semi-structured interviews with 12 nurses were collected; deductive and inductive content analyses were performed. Three descriptive categories emerged from the deductive (digital communication as interpersonal, information, and management continuities) and inductive (‘digital care does not suit everyone’, ‘new technology is contextually intertwined with daily work’, and ‘patient-positive aspects of digital information’) phases. Additionally, a structural risk of obscuration of patients’ needs by the contextual conditions emerged. To ensure digital communication-aligned continuity of care, compatible information technology systems should be developed. Allowing nurses to provide high-quality care based on their own values would enhance person-centred patient care.
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| 32. |
- Hellzén, Ove, 1954-, et al.
(författare)
-
Psykisk ohälsa hos äldre
- 2013. - första
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Ingår i: Omvårdnad på avancerad nivå. - Lund : Studentlitteratur AB. - 9789144071459 ; , s. webb-
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 33. |
- Hellzen, Ove, 1954-, et al.
(författare)
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Undervisning og veiledning for hjemmeboende eldre
- 2011. - första
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Ingår i: Sykepleiepedagogisk praksis. - Oslo : Gyldendal Akademisk. - 9788205399990 ; , s. 136-156
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 34. |
- Hellzen, Ove, 1954-, et al.
(författare)
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Vårdares attityder och stigmatisering
- 2010. - 1:1
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Ingår i: Omvårdnad vid psykisk ohälsa. - Lund : Studentlitteratur AB. - 9789144056463 ; , s. 383-400
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 35. |
- Kjällman Alm, Annika, 1963-, et al.
(författare)
-
Creating a Dementia-Friendly Community
- 2023
-
Ingår i: World Academy of Science, Engineering and Technology.
-
Konferensbidrag (refereegranskat)abstract
- The concept of dementia‐friendly communities focuses on the lived experience of people who have dementia and is most relevant to addressing their needs and the needs of those people who live with and provide support for them. The goal of communities becoming dementia‐friendly is for dementia to be normalized and recognized as a disabling condition. People with dementia find being connected to self, to others, and to the environment by meaningful activities as important. According to the concept underlying dementia-friendly communities, people with dementia or cognitive decline can continue to live in the community if their residential community has sufficiently strong social capital. The aim of this study is to explore staff and leaders’ experiences in implementing interventions to enhance a more inclusive dementia-friendly community. A municipality in northern Sweden with a population of approx. 100 000 inhabitants decided to create a dementia friendly municipality. As part of the initiative, a Centre for support was established. The Centre offered support for both individuals and groups, did home visits, and provided information about Dementia. Interviews were conducted with staff who had undergone training in a structured form of multidimensional support, the PER-model®, and worked at the Centre for support. The staff consisted of registered nurses, occupational therapists, and specialized nurses who had worked there for more than five years, and all had training in dementia. All interviews were audio-recorded and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis. Results suggest that implementing the PER-model® of support for persons in the early stages of dementia and their next of kin added a much-needed form of support and perceived possibilities to enhance daily life in the early stages of dementia. The staff appreciated that the structure of PER-model® was evidenced based. They also realized that they never even considered that the person with dementia also needed support in the early stages but that they now had tools for that as well. Creating a dementia friendly municipality offering different kinds of support for all stages of dementia is a challenge. However, evidence-based tools and a broad spectrum of different types of support, whether individual or group, are needed to tailor to everyone’s needs. A conviction that all citizens are equal and should all be involved in the community is a strong motivator.
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| 36. |
- Kjällman Alm, Annika, 1963-, et al.
(författare)
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Sense of Involvement and Support in Persons with Cognitive Decline in Ordinary Dwelling
- 2023
-
Ingår i: World Academy of Science, Engineering and Technology.
-
Konferensbidrag (refereegranskat)abstract
- Worldwide, the number of people who are living with dementia is increasing because of an aging population, which leads to increased financial and social costs, including reduced quality of life for people with dementia and their care partners. Most people who have dementia reside in the community. Aging in place could be described as having the health and social supports and services you need to live safely and independently in your home or your society for as long as you wish and are able. People with dementia are not different than people without dementia where they want to remain at home, if possible, with a sense of familiarity and engagement in typical everyday activities. So how do persons with dementia or cognitive decline see their possibilities to be socially involved and experience support? The aim of this study was to explore persons with cognitive decline's sense of involvement and support living in the ordinary dwelling. The study was approved by the Ethical Review Authority in Sweden prior to the interviews. Interviews were conducted with 20 persons living at home, either alone or in a relationship. The persons had perceived cognitive decline; some were under investigation or already had a diagnose of early dementia. Thematic analysis was used to identify, analyze, and report patterns within the data. Researchers extracted three main themes through participants’ interviews: a) Importance of social involvement with family and friends. b) Hindrances for social involvement. c) Struggling mentally with a new life situation. Results found that going to activity centers, staying involved, and meeting friends and family enhanced the sense of involvement and support. There were also hindrances to a sense of involvement and support as they struggled with the diagnose and the changes in daily life, such as physical problems, mental problems, or economic issues. The mental struggle of accepting the cognitive decline and the changes in daily life it brought was also an issue for some of the participants. A multidimensional support should be provided by the community to enable persons with cognitive decline to stay involved in family and community in the comfort of their own homes.
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| 37. |
- Larsson Gerdin, Anna, et al.
(författare)
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Encountering patients in their homes : A qualitative study of home care nurses’ experiences
- 2023
-
Ingår i: Nordic journal of nursing research. - : SAGE Publications. - 2057-1585 .- 2057-1593. ; 43:1
-
Tidskriftsartikel (refereegranskat)abstract
- Many ill people want to be cared for at home, and home care nurses face an infinite number of encounters when providing that service. Despite the rising prominence of home care organizations worldwide, little research has been conducted on the encounters between home care nurses and patients and how encounters influence the nursing care provided. The aim of the present study was to describe home care nurses’ experiences of encounters with patients in their homes. In total, 11 home care nurses were selected through purposive sampling. The data consisted of individual interviews, which were analyzed through qualitative content analysis, and reported using COREQ reporting guidelines. The results were based on two categories describing the importance of adapting to each patient's needs and collaborating with the person being cared for. Implementing the findings could enable nurses to care for the patients without reducing them to recipients of objectified care.
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| 38. |
- Larsson Gerdin, Anna
(författare)
-
Experiences of care encounters in Swedish home care setting: perspectives from older persons and home care nurses
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The Swedish healthcare organisation for older persons has shifted its focus towards home care. Receiving care at home offers comfort and security, allowing older persons to remain in familiar surroundings. The care encounter in home care is the core of everyday care practice. However, what happens during these care encounters is often unknown due to its private nature and is sparsely researched. Aim: The overall aim of this doctoral thesis was to explore, describe, and gain a deeper understanding of the lived experiences of care encounters in home care, as perceived by older persons and home care nurses, to generate knowledge for nursing practice. Method: The design is qualitative, and data has been collected through interviews at both descriptive (I, III) and in-depth narrative levels (II, IV). Participants were purposefully sampled to ensure a diverse range of perspectives and experiences relevant to the research aim. The interview text has been analysed through Qualitative content analysis (I, III), Hermeneutic interpretation (II), and Phenomenological hermeneutic interpretation (IV). Findings: While older persons appreciated the convenience of receiving care at home, the findings revealed challenges such as nursing routines conflicting with everyday life routines (I, II), unclear communication, and being dependent on support (I). Although receiving vital support, older persons strove to uphold independence (II) but were subordinate to their home care nurses which posed a challenge in this regard (I, II). Home care nurses encountered a wide range of patient needs, which spanned from medical requirements to emotional support (III). Each of their patients brought unique challenges and circumstances, necessitating home care nurses to flexibly adjust their approaches (IV). However, they struggled with balancing their expectations and desires related to the quality and extent of care they intended to provide to their patients, against what was realistically achievable given the constraints of time, legislative requirements, and organisational demands (III, IV). Conclusion: An examination of the findings alongside the overall aim of this doctoral thesis, relevant literature, and Kari Martinsen’s philosophy of caring, reveal the complexity of care encounters in this context. For example, the quality of these care encounters varies based on the assigned home care nurse, affecting the equality and effectiveness of care. Older persons lacked involvement in their care decisions, impacting the person-centred approach. Dependency on home care nurses complicates matters, as it can lead to a loss of autonomy and dignity. Additionally, tight schedules limit home care nurses’ time with each of their patients, reducing opportunities for meaningful interactions. The unique nature of care at home blurs personal and professional boundaries. Providing relational, moral, and practical care enhances dignity and empowerment for older persons. Effective implementation of this approach requires adequate time and resources for home care nurses.
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| 39. |
- Larsson Gerdin, Anna, et al.
(författare)
-
Nurses’ experiences of encounters in home care : a phenomenological hermeneutic study
- 2021
-
Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 16:1
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: nurses working in home care often encounter patients with multiple diagnoses in unpredictable environments. This may cause ethical and emotional challenges and influence nurses’ daily work. The aim of this study was to illuminate the meaning of nurses’ lived experiences of encountering patients in home care. Methods: narrative interviews were conducted with 11 nurses. These interviews were audiotaped and transcribed verbatim and analysed using a phenomenological hermeneutic approach. Findings: the findings are presented under three main themes: (1)”Being receptive to the other” (with subthemes “Caring about the encounter,” and “Establishing trusting relationships”). (2) “Need to handle Handling the unpredictable” (with subthemes “Being alone in the encounter” and “Being experienced and competent”). (3) “Managing frustration” (with subthemes “Feeling insufficient” and “Feeling restricted”. Having overall nursing responsibility challenged the nurse’s self-confidence in providing care trustfully. Conclusions: encountering patients in home care means relating to the other unconditionally, which aim to highlight patients’ needs. Being a nurse in home care is both emotionally demanding and rewarding. Having the courage to face their own and the patients’ vulnerabilities will entail the promotion of natural receptivity and responsiveness to patients’ needs.
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| 40. |
- Larsson Gerdin, Anna, et al.
(författare)
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Nurses’ experiences of encounters in home care : a phenomenological hermeneutic study
- 2023
-
Ingår i: Abstraktkatalog. ; , s. 48-
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Nurses working in home care often encounter patients with multiple diagnoses in an unpredictable environment, which can cause ethical and emotional challenges and affect their daily work. However, research about encounters in home care is sparse.Aim: To illuminate the meaning of nurses’ lived experiences of encountering patients in home care.Method: The study has a qualitative design and adopts a phenomenological hermeneutic approach. This approach was chosen to shed light on the meaning of the nurses’ everyday experiences by interpreting texts transcribed from lived narrations. After obtaining ethical approval participants (n=11) were recruited through purposive sampling.Findings: The findings are presented under three main themes:1) “Being receptive to the other”, which illustrates the meaning of being open-minded and taking the time to acknowledge the patient.2) “Handling the unpredictable”, which illustrates the meaning of encountering the unknown in the patient’s home.3) “Managing frustration”, which illustrates the meaning of managing your emotions to highlight the needs of the patients. The variety of encounters made different impressions on the nurses which affected the provided care.Discussion: During unpredictable encounters, it was sometimes hard to determine and assess the best care for the patients. The findings highlight that misinterpreting the patients’ needs worried the nurses and caused their consciences to be troubled. Nurses must manage their own and their patients’ vulnerability in order to be receptive to what the patients conveyed. When doing so, nurses will discover a genuine interest in the other and counteract the risk of overlooking the patients. The unilateral ethical demand requires the nurses to take care of the patients’ lives selflessly. We are all in each other’s power because our vulnerability and loneliness will facilitate a natural trust. A trust that we hope will be answered and fulfilled by measures that touch and show care and affection.Conclusions: Although encountering patients in home care means relating to the other unconditionally, it is sometimes hard to perceive the wishes and needs of the patient and to respond to the ethical demand. However, this was facilitated by shifting the focus from problem-solving an deficiency to get to know the person. Additionally, management of vulnerability will also increase the ability of the nurse to encounter the patient in home care more perceptively.
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| 41. |
- Larsson Gerdin, Anna, et al.
(författare)
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Older persons' experiences of care encounters in their home : A multiple-case study
- 2024
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 33:6, s. 2287-2297
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Tidskriftsartikel (refereegranskat)abstract
- AimTo explore and describe older persons' unique experiences of care encounters with home care nurses in a real-life context.BackgroundThe increasing number of older persons in society contributes to increases in age-related impairments compromising their quality of life. Future care consists of “hospitals at home” where care encounters occur in a person's private domain, partly becoming a clinical workplace. Scant research has focused on how older persons experience care encounters with home care nurses and needs to be highlighted.DesignMultiple-case study.MethodsThe cases relied on replication logic and five purposive sampled older persons were interviewed. Data were analysed using qualitative content analysis and differences within and between cases were explored and findings across the cases were replicated.FindingsThe cross-analysis emerged in three categories: “Nursing routine rules the care encounters”, “Lack of knowledge and information” and “Dependency on support from others”.ConclusionsOur research has found that older persons face challenges while receiving home care, including limited engagement in their care and the need for enhanced support. Implementing person-centred care in homes poses ethical challenges that require careful consideration. Home care nurses should prioritise understanding each patient individually, recognising them beyond their patient role, which necessitates more thorough and time-sensitive care encounters.Reporting MethodFindings were reported using COREQ guidelines.Patient or Public ContributionPatients were interviewed and contributed with data for this study.Implications for the Profession and Patient CareThis study emphasises the need to prioritise individualised care in home settings and listen to the voices of older individuals to enhance quality.
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| 42. |
- Norbergh, Karl-Gustaf, 1950-, et al.
(författare)
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Omvårdnad på avancerad nivå : kärnkompetenser inom sjuksköterskans specialistområden
- 2013
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Ingår i: Omvårdnad på avancerad nivå. - Lund : Studentlitteratur. - 9789144071459 ; , s. webb artiklar-
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Denna bok och webb är den efterfrågade och fristående fortsättningen på Omvårdnadens grunder. Redan före sin publicering har Omvårdnad på avancerad nivå varit känd för många under det lekfulla arbetsnamnet Omvårdnadens höjder. Innehållet är två sammanflätade delar: en tryckt bokdel och en digital webbdel. Den senare är helt unik i sitt slag. Ett åttiotal forskande och/eller kliniskt verksamma sjuksköterskor har skapat en digital artikelsamling som beskriver tillämpningen av avancerad omvårdnad inom respektive specialistområde. Webbmaterialet innehåller även sammanfattande ljudklipp, frågor samt den tryckta boken i sin helhet så att den kan läsas på exempelvis iPad. Detta är det första bokverket i Sverige som beskriver huvudområdet omvårdnad på avancerad nivå. Utgångspunkten är de sex kärnkompetenser som är gemensamma för alla professioner inom hälso- och sjukvården och som Svensk sjuksköterskeförening rekommenderar bör utgöra en röd tråd med progression genom utbildningarnas nivåer: Personcentrerad vård Samverkan i team Evidensbaserad vård Förbättringskunskap för kvalitetsutveckling Säker vård Informations- och kommunikationsteknologi Tillsammans bildar bok och webb ett gemensamt och mångfaldigt innehåll för specialistsjuksköterskeutbildningarna. Avsikten är att skapa en grund för dessa utbildningar och deras motsvarigheter där omvårdnad på avancerad nivå kan beskrivas och problematiseras. Instruktioner för hur du kommer åt det digitala materialet finns på omslagets insida.
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| 43. |
- Rasmussen, Hege, et al.
(författare)
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Family caregivers experiences of the pre-diagnostic stage in frontotemporal dementia
- 2019
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Ingår i: Geriatric Nursing. - : Elsevier. - 0197-4572 .- 1528-3984. ; 40:3, s. 246-251
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Tidskriftsartikel (refereegranskat)abstract
- Frontotemporal dementia (FTD) is a neurodegenerative disease with symptoms that differs from other dementias. Commonly early symptoms in FTD are changes in personality and behavior, which can be interpreted as psychiatric disease. The delay in FTD diagnosis contributes to the burden of family caregivers. Therefore, it is important to have more knowledge about the pre-diagnostic stage. In this qualitative interview study, we explored fourteen family caregiver's experiences of the pre-diagnostic stage of frontotemporal dementia (FTD). Our findings suggest that the family caregivers experienced the pre-diagnostic stage of FTD as changes in the interpersonal relationship with their loved one. These changes were often subtle and difficult for family caregivers to explain to others. The findings from our study illuminate the importance of medical staff paying attention when a next of kin is concerned about subtle changes in a loved one. The findings also illuminate that awareness of FTD should be raised.
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| 44. |
- Rygg, Lisbeth, et al.
(författare)
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Lifestyle Changes in Diet and Physical Activities after Group Education for Type 2 Diabetes : The Active Ingredient in the Education. A Qualitative Study
- 2017
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 7:10, s. 1181-1195
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Tidskriftsartikel (refereegranskat)abstract
- Background: Diabetes self-management education (DSME) for patients withtype 2 diabetes requires efficient teaching methods that make patients want tochange lifestyle in terms of their diabetes. The study looks at what may be theactive ingredient in this DSME. Objective: To explore how participants inDSME, with an interactive learning method, experienced changes in relationto diet and physical activity. Method: We studied possible changes in diet andphysical activity by semi-structured individual interviews of 16 participantsattending DSME. Results: Before the DSME, the participants felt insecureabout what to eat, and they expressed little interest in changing their physicalactivity. Just after the DSME, they were more optimistic about diet becausethey had learned how to interpret food labels and compose their meals. Furthermore,they had experienced the benefit of physical activity in relation totheir blood glucose levels. Behavior changes appeared to persist the followinghalf year. We discuss the findings in light of the principles of interactivelearning. The participants experienced an effect of their behavior changes, andblood glucose measurement was used as a tool to gain control and reach astate of well-being. Conclusion: From being insecure about what to eat, thepatients acquired knowledge to handle their diet through the DSME. Theylearned how to compose their meals and use physical activity to regulate theirblood glucose. We suggest that the interactive learning used in the DSME wasan active ingredient that led to changes in behavior and should be consideredas an educational method in DSME for patient with type 2 diabetes.
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| 45. |
- Rönnberg, Linda, 1979-, et al.
(författare)
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Beyond the monitors : Anaesthesiologists' experiences of the process of extubation
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 36:4, s. 988-996
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although extubation is a high-risk phase associated with risk of severe complications for patients undergoing general anaesthesia, there is a lack of research about this phenomenon from the perspective of anaesthesiologists' experiences of the process of extubation in the anaesthesia setting.AIM: To describe Swedish anaesthesiologists' experiences of the extubation process in the anaesthesia setting.METHODS: A qualitative descriptive design study with individual semi-structured interviews was conducted in three hospitals in Sweden with a total of 17 anaesthesiologists. A qualitative manifest content analysis method was used to analyse the data.RESULTS: The anaesthesiologists' experiences were described in two categories: To assemble sensibilities, where the anaesthesiologists are receptive to inputs, create tailored plans, are guided by emotions and experiences, and sense the atmosphere in the process of extubation; and To stay focused, where they understand the importance of preparation and being prepared, and of being calm and strategic, and of needing to trust the registered nurse anaesthetist in the process of extubation.CONCLUSIONS: Decision-making regarding the process of extubation does not rely solely on monitoring signs; rather, the anaesthesiologists described how, by looking beyond the monitors and by being receptive to inputs from the patient and other professionals, their experience and intuition guides them through the process of extubation.
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| 46. |
- Rönnberg, Linda, 1979-, et al.
(författare)
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Safeguarding the patient : a grounded theory study of registered nurse anesthetists' main concerns in the process of extubation in the anesthesia setting
- 2022
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The process of extubation is complex as it takes place in the technical and challenging environment of the operating room. The extubation is related to complications of varying severity and a critical moment for the patient, who is in a vulnerable condition when emerging from anesthesia. Registered Nurse Anesthetists (RNAs) in Sweden have specialist training and performs extubations independently or in collaboration with an anesthesiologist.AIM: To obtain a deeper understanding of Registered Nurse Anesthetists' main concerns and how they resolve these in the process of extubation when caring for a patient during general anesthesia.PARTICIPANTS: A total of 17 RNAs, eight male and nine female, were included in the study. Twelve RNAs in the first step of data collection (I); and five RNAs the second step of data collection (II).METHOD: A classic grounded theory approach with a qualitative design was used for this study.FINDINGS: The RNAs' main concern in the process of extubation were Safeguarding the patient in a highly technological environment, which the solved by Maintaining adaptability. Facilitators as well as challenges affected how the RNAs solved their main concern and represented the categories: 'Having a back-up plan', 'Getting into the right frame of mind', 'Evaluating the patient's reactions', 'Using one's own experience', 'Dealing with uncertainty', 'Pressure from others', and 'Being interrupted'. The theory, Safeguarding the patient in the process of extubation, emerged.CONCLUSION: To be able to safeguard the patient in a highly technological environment, the RNAs must oscillate between facilitators and challenges. By maintaining adaptability, the RNAs resolved the difficulties of oscillating, indicating a need for finding a balance between maintaining attentiveness on what is important to keep the patient safe in the process of extubation and all of the disturbances present in the OR.
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| 47. |
- Rönnberg, Linda, 1979-, et al.
(författare)
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The Art Is to Extubate, Not to Intubate-Swedish Registered Nurse Anesthetists' Experiences of the Process of Extubation After General Anesthesia
- 2019
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier BV. - 1089-9472 .- 1532-8473. ; 34:4, s. 789-800
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To describe Registered Nurse Anesthetists' (RNA's) experiences of the process of extubation of the endotracheal tube in patients undergoing general anesthesia. Design: A descriptive qualitative design. Methods: This study was conducted in two hospitals with 20 RNAs in total. Data were generated from focus group interviews. Content analysis was used to analyze data. Findings: The RNAs' experiences were described within four categories and eight subcategories. The category To be a step ahead includes assessment and preparation, and To be on my toes, their ability to recognize patterns and build a connection. To use situation awareness relates to their use of experience and feelings, and To be alone in a critical moment, to feeling alone in the team and protecting the patient. Conclusions: The RNAs make decisions when to extubate by combining theoretical knowledge, clinical experience, and intuition with the uniqueness of each patient.
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| 48. |
- Rönnberg, Linda, 1979-
(författare)
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Tracheal Extubation of Patients Cared for in the Anesthesia Setting : Experiences Described by Registered Nurse Anesthetists and Anesthesiologists
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background In Sweden, extubation is an interdisciplinary process involving teamwork between Registered Nurse Anesthetists (RNA) and Anesthesiologists, and comprehensive demands are placed on the professionals providing anesthesia. The extubation of the endotracheal tube after General Anesthesia (GA) is a critical moment for the patient. In that moment, the patient is in a vulnerable state and at risk of suffering severe complications, such as hypoxia, laryngospasm, aspiration, and hypertension. Anesthesia deals with identifying options, making risk assessments and reconsiderations. Clinical decision-making in anesthesia includes making decisions quickly and sometimes re-evaluating these just as quickly. In the often brief meeting prior to anesthesia, a relationship with the patient emerges and an unspoken demand arises: to care for the life that is placed in the hands of the anesthetists.Aim The overall aim was to gain an understanding of the Registered Nurse Anesthetists’ and Anesthesiologists’ experiences of their decision-making practices in the process of extubation of the endotracheal tube in the anesthesia setting with patients undergoing general anesthesia.Method This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design using focus-group interviews (I) and Individual interviews (II) to collect data. A total of 20 RNAs from two hospitals and 17 Anesthesiologists from three hospitals were included, using a consecutive sampling strategy. Both studies were analyzed with qualitative content analysis and adopted an inductive approach to seek a deeper understanding of the phenomena, using manifest content analysis. In order to explore how the RNAs and Anesthesiologists experience the process of extubation and to identify nuances between them, the two studies were merged together in this licentiate thesis.Results When merging these studies (I, II) together by combining subcategories from both, six themes emerged. The theme, Assembling unique decisions, deals with the how the RNAs (I) and Anesthesiologists (II) assess, prepare, prevent and reconsider when planning for the extubation. Acting upon sensibilities consists of them recognizing patterns, leaning on their experience, and being receptive to different inputs from the patient and other professionals. The third theme, Being guided by intuition, included how the RNAs and Anesthesiologists relied on their feelings and were guided by emotions when deciding when to extubate. Safeguarding the patient deals with them protecting and acting as an advocate for the patient and how they focus on and are humble in the process of extubation. In the fifth theme, Being in a vulnerable position, the RNAs (I) felt they were on their own when making the decision on when to extubate, while the Anesthesiologists (II) felt as if they were one of the team. Using their own receptivity included how they established a connection with the patient and sensed the atmosphere.Discussion In their first encounter with the patient, or when obtaining knowledge about the patient, the RNAs and Anesthesiologists had already started to tailor a mental plan of the extubation unique to each patient. The plan consisted of small pieces of information being gathered and assembled together during the anesthesia, and this information is then combined with their experience of similar situations and with their intuition with the aim of safeguarding the patient. RNAs and Anesthesiologists act upon sensibilities when deciding on when to extubate. These strategies align with the concept of phronesis, a form of knowledge understood as practical wisdom that facilitates good clinical judgement in being rational, which is based on pre-understanding, experience, and interpersonal relationships and which is difficult to teach to someone else.
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| 49. |
- Solum Myren, Gunn Eva, et al.
(författare)
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“Being Free Like a Bird”―The Meaning of Being an Informal Caregiver for Persons with Dementia Who Are Receiving Day Care Services
- 2015
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 5:2, s. 109-119
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Tidskriftsartikel (refereegranskat)abstract
- Respite care in the form of day care is one of the several respite services that aims to provide temporary relief to informal caregivers from their responsibilities of caring for a person with dementia. The purpose of this study was to illuminate the meaning of being an informal caregiver for a person with dementia living at home and receiving day care services. Narrative interviews were conducted, and data were analyzed using the phenomenological hermeneutic method. Two main themes emerged: “Living with limitations in everyday life” and “Having a life besides being a caregiver”. The comprehensive understanding suggested living with a person with dementia, changes and influences the informal caregiver’s life through a set of new roles and a new way of living and thinking. The result is discussed in light of Goffman’s analysis of the structures of social encounters from the perspective of the dramatic performance.
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| 50. |
- Solum Myren, Gunn Eva
(författare)
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Dagaktivitetstilbud for personer med demens som bor hjemme : ”Dagen i dag den kan bli vår beste dag”
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis was to examine how persons with dementia in who live at home experience day care services and what the services mean to them, their relatives and care staff. For persons with dementia, everyday life often lacks social and sensory stimuli, and research has shown that their relatives experience a burden of care that strains their quality of life. In response, more knowledge is necessary about how municipal services in should be designed to ensure that persons with dementia can stay at home for as long as possible. From 2020, municipalities in Norway, will have a statutory duty to offer day care services to persons with dementia. The thesis is based on four qualitative studies. In study I, fieldwork comprised observations and informal conversations with persons with dementia (participants) who receive care from two day care services and staff. Study II involved semi-structured interviews and study III, narrative interviews with relatives, whereas study IV involved semi-structured interviews with care staff. In study I, results revealed that location and buildings affected the inclusion of participants in activities. Where as homey, familiar environments contributed to greater activity among participants, institutional environments contributed to greater passivity, at least from the perspective of participants and staff. In turn, the meaningfulness of participants’ everyday lives depended on staff adaptiveness in exercising person-centred care. In study II, relatives of persons with dementia reported that the pre- and post-diagnosis periods were challenging for them and that the day care services, especially the daily routines that they established, were thus exceptionally meaningful. The relatives reported not only that could they afford to rest on days when the persons with dementia received day care services but that the participants experienced those days to be meaningful as well. At the same time, they reported struggling with deciding for how long it would be reasonable for the persons with dementia to live at home. In study III, results revealed that living with persons with dementia affected the everyday lives of spouses and cohabitants, who had to assume new roles and adapt to living lives full of commitment, singularity, anxiety and oneliness. Spouses and cohabitants not only sought to optimally manage their domestic arrangements but also conceal from others how they felt or thought about their situations. To those ends, day care services therefore helped them to persevere in caring for and living with their loved ones, as well as afforded them time to pursue their personal interests. Being visited by day care staff prevented them from having to ask for help because staff members were there to offer it instead.…Last, during study IV, staff reported striving to implement person-centred care by ensuring the dignity of participants and their relatives and facilitating meaningful activities according to individual needs. However, staff also reported facing various barriers in realising person-centred care, including staff shortages, different levels of functioning among participants and limitations in the design of spaces and their location. When developing day care services, it is important to consider both the physical design and location of buildings in which care will be offered. Person-centred care can guide the organization of adequate, tailored day care services able to afford persons with dementia meaningful everyday lives.
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