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Sökning: WFRF:(Lundman Berit)

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1.
  • Boström, Eva, 1966-, et al. (författare)
  • Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes
  • 2014
  • Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 94:2, s. 187-192
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management. Methods: Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis. Results: The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions. Conclusion: It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients' self-management, and also may strengthen the DSNs in their professional performance. Practice implications: Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
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2.
  • Hällgren Graneheim, Ulla, 1947-, et al. (författare)
  • Methodological challenges in qualitative content analysis : A discussion paper.
  • 2017
  • Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 56, s. 29-34
  • Tidskriftsartikel (refereegranskat)abstract
    • This discussion paper is aimed to map content analysis in the qualitative paradigm and explore common methodological challenges. We discuss phenomenological descriptions of manifest content and hermeneutical interpretations of latent content. We demonstrate inductive, deductive, and abductive approaches to qualitative content analysis, and elaborate on the level of abstraction and degree of interpretation used in constructing categories, descriptive themes, and themes of meaning. With increased abstraction and interpretation comes an increased challenge to demonstrate the credibility and authenticity of the analysis. A key issue is to show the logic in how categories and themes are abstracted, interpreted, and connected to the aim and to each other. Qualitative content analysis is an autonomous method and can be used at varying levels of abstraction and interpretation.
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3.
  • Lundgren, Berit, et al. (författare)
  • The meaning of living with skin disease
  • 2004
  • Ingår i: Workgroup of European nurse researchers. Biennial conference (12 : Lisboa : 2004). - : WENR. ; , s. 92-
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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4.
  • Aléx, Lena, et al. (författare)
  • Balancing within various discourses--the art of being old and living as a Sami woman.
  • 2006
  • Ingår i: Health Care for Women International. - : Informa UK Limited. - 0739-9332 .- 1096-4665. ; 27:10, s. 873-92
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this part of the Umeå 85+ Study was to explore how indigenous women narrate their lives and their experience of being old as Sami women. Interviews with 9 old Sami women were analyzed using grounded theory. The categories identified were "reindeer as the basis of life," "longing for significant Sami values," "feeling valued as a Sami woman," and "changing for survival;" these evolved into the core category: "balancing within various discourses-the art of being old and living as a Sami woman." Knowing how to balance provided the ability to make use of available opportunities.
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5.
  • Alex, Lena, et al. (författare)
  • Beyond a Dichotomous View of the Concepts of 'Sex' and 'Gender' Focus Group Discussions among Gender Researchers at a Medical Faculty
  • 2012
  • Ingår i: PLOS ONE. - : Public library of science. - 1932-6203. ; 7:11, s. e50275-
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The concepts of 'sex' and 'gender' are both of vital importance in medicine and health sciences. However, the meaning of these concepts has seldom been discussed in the medical literature. The aim of this study was to explore what the concepts of 'sex' and 'gender' meant for gender researchers based in a medical faculty. Methods: Sixteen researchers took part in focus group discussions. The analysis was performed in several steps. The participating researchers read the text and discussed ideas for analysis in national and international workshops. The data were analysed using qualitative content analysis. The authors performed independent preliminary analyses, which were further developed and intensively discussed between the authors. Results: The analysis of meanings of the concepts of 'sex' and 'gender' for gender researchers based in a medical faculty resulted in three categories; "Sex as more than biology", with the subcategories 'sex' is not simply biological, 'sex' as classification, and 'sex' as fluid and changeable; "Gender as a multiplicity of power-related constructions", with the subcategories: 'gender' as constructions, 'gender' power dimensions, and 'gender' as doing femininities and masculinities; "'Sex and gender as interwoven", with the subcategories: 'sex' and 'gender' as inseparable and embodying 'sex' and 'gender'. Conclusions: Gender researchers within medicine pointed out the importance of looking beyond a dichotomous view of the concepts of 'sex' and 'gender'. The perception of the concepts was that 'sex' and 'gender' were intertwined. Further research is needed to explore how 'sex' and 'gender' interact.
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6.
  • Aléx, Lena, 1948-, et al. (författare)
  • Construction of masculinities among men aged 85 and older in the north of Sweden.
  • 2008
  • Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 17:4, s. 451-9
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: The aim was to analyse the construction of masculinities among men aged 85 and older. BACKGROUND: All societies have a gender order, constructed from multiple ideas of what is seen as feminine and masculine. As the group of men aged 85 and older is increasing in size and their demand for care will increase, we must recognize the importance of studying these men and various discourses of masculinities. DESIGN: Qualitative explorative. METHODS: Qualitative content analysis was used to analyse thematic narratives. Masculinity theories provided the point of departure for the analysis. RESULTS: The analysis coalesced into three masculinities. 'Being in the male centre', developed from subthemes as: taking pride in one's work and economic situation; being in the centre in relation to others; regarding women as sexual objects; and belonging to a select group. 'Striving to maintain the male facade' developed from subthemes as: emphasizing 'important' connections; having feelings of loss; striving to maintain old norms and rejecting the fact of being old. 'Being related' was formulated from subthemes as: feeling at home with domestic duties; being concerned; accepting one's own aging; and reflecting on life. CONCLUSIONS: Our study indicates the importance of being aware of the existence of multiple masculinities, in contrast to the generally unproblematic and unsubtle particular healthcare approaches which consider men as simply belonging to one masculinity. Relevance to clinical practice. Diverse masculinities probably affect encounters between men and healthcare providers and others who work with an older population and therefore our results are of importance in a caring context.
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7.
  • Aléx, Lena, et al. (författare)
  • Constructions of various femininities among the oldest old women.
  • 2006
  • Ingår i: Health Care for Women International. - Washington, D.C. : Informa UK Limited. - 0739-9332 .- 1096-4665. ; 27:10, s. 853-72
  • Tidskriftsartikel (refereegranskat)abstract
    • This study forms part of the Umeå 85+ Study, and the aim was to explore various gendered constructions of femininities among the oldest old women. Femininities are seen as various ways of shaping oneself as a woman in relation to the impact of historical, social, and cultural circumstances. Thematic narratives were analyzed using qualitative content analysis. Through interpreting these narratives in the light of gender theories, we were able to discern four femininities: "being connected," "being an actor," "living in the shadow of others," and "being alienated." The oldest old women displayed complex outlooks on femininities, and no femininity was interpreted as being in the center related to the other femininities. Further research is needed in order to disclose the complexity of femininities related to factors such as social class, ethnicity, and financial situation among the oldest old, and to acquire a greater knowledge of various femininities.
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8.
  • Aléx, Lena, et al. (författare)
  • Lack of resilience among very old men and women : a qualitative gender analysis
  • 2011
  • Ingår i: Research and Theory for Nursing Practice. - : Springer Publishing Company. - 1541-6577 .- 1945-7286. ; 25:4, s. 302-316
  • Tidskriftsartikel (refereegranskat)abstract
    • High degree of resilience has been described as an enduring positive view of life despite difficult circumstances during the aging process. How to become old and being old with low resilience have not been studied. The aim of this study was to illuminate experiences about becoming old and being old among very old people with low resilience. Interviews from very old women and men were analyzed using content analysis with the following themes identified: being out of it, emphasizing life experiences from the past, religious doubting, and accepting age. Except for religious doubting, the themes contained both similarities and variations between women and men. Our study showed that in spite of scoring low on the Resilience Scale (RS), very old persons can experience integration and well-being. However, the women seemed to be more vulnerable compared to men, and for them, it is important to strengthen social and relational possibilities for contributing to resilience.
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9.
  • Aléx, Lena, et al. (författare)
  • Reflections of men and women in advanced old age on being the other sex
  • 2010
  • Ingår i: Ageing & Society. - 0144-686X .- 1469-1779. ; 30:2, s. 193-206
  • Tidskriftsartikel (refereegranskat)abstract
    • The study reported in this paper is part of the Umeå 85+ project in Sweden. The aim was to investigate gender perspectives among ‘the oldest old’, by asking men and women in advanced old age living in a sparsely populated area of northern Sweden to reflect on how life might have been if they had been born the other sex. Thematic narratives from nine men and seven women were analysed using qualitative content analysis. The content of these narratives was resolved into eight categories in two domains, respectively men's and women's reflections about being born the opposite sex. The narratives of both the men and women indicated that they were satisfied with their actual birth sex. The men were aware that if they had been born female, they would probably have experienced more hard work and had a more restricted life, and they were conscious of both women's relative powerlessness and their greater ability to manage and organise work within the home. The women's narratives described a femininity characterised by longing for a state of being unconcerned when young, and their narratives also displayed awareness of women's physical strength and that men's lives had also been hard.
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13.
  • Bolse, Kärstin (författare)
  • Caring for Patients with an Implantable Cardioverter Defibrillator Experiences of Patients and Healthcare Professionals
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: An Implantable Cardioverter Defibrillator (ICD) is a technical device used in the treatment of ventricular arrhythmias. After the implantation of an ICD the entire life situation can be affected with psychological and social consequences for the patient and his/her next of kin. The healthcare professionals play a vital role in providing educational information, support, and technical follow-up of the device. During recent years more and more hospitals have introduced a more team based organisation where the physicians collaborate with specialised ICD nurses. Aim: The overall aim of the thesis was to explore how patients with an ICD experienced their life situation and howhealthcare professionals described their experiences of delivering care to ICD patients. Methods: The design was descriptive, combining both quantitative and qualitative approaches, and the data was collected from Sweden and the USA. The Uncertainty of Illness Scale (MUIS-C) and Quality of life Index (QLI) instruments were used to determine the level of uncertainty and satisfaction with life (I), in-depth interviews with a phenomenographic approach was used to describe how Swedish and US patients living with an ICD conceived their life situation (II, III) and how healthcare professionals’ experienced delivering care to patients with an ICD, (IV). Finally, to explore clinical aspects of ICD care in Sweden, the Delivery of ICD Questionnaire (DOIQ) was used to describe the healthcare professionals’ experiences and a content analysis was used to describe the written educational information material provided to patients (V). Results: There were no differences in uncertainty between pre and post ICD implantation either in Swedish or the US patients. Satisfaction with life was significantly higher among US patients compared to Swedish patients both before and after ICD implantation within the health-functioning, socio-economic and psychological-spiritual domains. The Swedish ICD patients experienced a significantly higher satisfaction with life within the socioeconomic domain after 3 months. (I). The patients felt safe in having an ICD implanted, but the conceptions varied from seeing the device as a life saver to being worried about what could happen. Gratitude at having an ICD varied from happiness at being alive to something that was alien and disturbed the patient. Being more or less dependent included how patient experienced feelings from well-being to grief. Having a network varied from having sufficient support to loneliness. Having a belief in the future ranged from having confidence to look forward to resignation. Gaining awareness described patients’ adaptation to living with an ICD and limitations due to the ICD (II). The patients also underwent a transition from becoming aware of the restriction in the life situation through a process of adaption and having trust in the ICD. This phase was followed by a reorientation phase where they adapted to their life situation and the patient and his/her family regained of their lives (III). The healthcare professionals strove to provide competent and individualised care and infuse confirmation to the patients in form of information, education and support. They gave the patients tools to handle their life situation, through existential support and mediating security (IV). Half of the hospitals had nurse-based clinic and others planned to introduce them. Three hospitals performed follow-up in the form of remote home monitoring. The nurse had specific ICD education from ICD companies and/or various university courses. In the educational information material the biophysical dimensions dominated while the emotional dimension was scarcely described, and the spiritual-existential was not referred to at all (V). Conclusions: This thesis offers a further contribution to the scholarly discussion about the relationship between technology and human existence and how to cope with this transition. Our studies revealed that the embodiment of the ICD reflects a merger of experiences about its presence and potential from both patients’ and healthcare professionals’ perspective. This research hopefully encourages healthcare professionals to carefully reflect on what it is like to live with an ICD and to consider practice improvement for the patients’ and the next of kin.
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14.
  • Boman, Erika, et al. (författare)
  • Identifying variables in relation to health-related quality of life among community-dwelling older women : knowledgebase for health-promoting activities
  • 2016
  • Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 36:1, s. 20-26
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the present study was to explore health-related quality of life (HRQoL) and associated variables among all community-dwelling older women (565 years) (n¼2724) on A ° land, a Finnish self-governing island community. A total of 1023 women participated (mean age 72.96.8 years). Absence of depression, absence of diagnosed disease(s), having the opportunity to engage in meaningful leisure activities, and never or seldom feeling lonely explained, together with socioeconomic control variables (i.e. age, education and economic situation), 34.4% of the variation in physical health. Absence of depression, strong inner strength, and never or seldom feeling lonely explained, together with socio-economic control variables, 27.7% of the variation in mental health. HRQoL was rated as relatively good, although special attention should be paid to women aged 80þ years. To promote HRQoL, interventions aimed at preventing, detecting and treating depression should be prioritised. In addition, interventions aimed at reducing feelings of loneliness are also recommended in order to enhance overall HRQoL.
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15.
  • Boman, Erika, et al. (författare)
  • Inner strength and its relationship to health threats in ageing : A cross-sectional study among community-dwelling older women
  • 2017
  • Ingår i: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 73:11, s. 2720-2729
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To explore the relationship between inner strength and health threats among community-dwelling older women. Background: Inner strength is described as a resource that promotes experiences of health, despite adversities. Inner strength and its dimensions (i.e. connectedness, creativity, firmness and flexibility) can be assessed using the Inner Strength Scale (ISS). Exploring attributes of weaker inner strength may yield valuable information about areas to focus on in enhancing a person's inner strength and may ultimately lead to the perception of better health. Design: Cross-sectional questionnaire survey. Methods: The study is based on responses from 1270 community-dwelling older women aged 65 years and older; these were collected in the year 2010 and describe the situation that still exists today for older women. The questionnaire included the ISS, background characteristics and explanatory variables known to be health threats in ageing. Data were analysed using descriptive and inferential statistics. Results: Poorer mental health was related to weaker inner strength in total and in all the dimensions. Symptoms of depressive disorders and feeling lonely were related to three of the dimensions, except firmness and creativity respectively. Furthermore, poor physical health was associated with the dimensions firmness and flexibility. Other health threats were significantly related to only one of the dimensions, or not associated at all. Conclusion: Mental ill health has overall the strongest association with weaker inner strength. Longitudinal studies are recommended to confirm the results. However, the ISS does not only estimate inner strength but can also be a tool for discovering where (i.e. dimension) interventions may be most profitable.
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16.
  • Boman, Erika, 1975- (författare)
  • Inner strength as a health resource among older women
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background Long life does not inevitably mean more healthy years; older women have an increased risk of disabilities, diseases and adverse life events. Nevertheless, many older women experience health. This may be explained by possessing resources that promote health, despite adversities. Inner strength is seen as a resource as such. In this thesis inner strength is interpreted according to a theoretical model where inner strength comprises four interrelated and interacting dimensions: connectedness, creativity, flexibility and firmness, and being rated by the Inner Strength Scale (ISS).Aim and methods The overall purpose of this thesis was to explore inner strength as a health resource among older women. In study I six focus group interviews were performed with older women (66-84 years; n = 29) and the interviews were analysed by a concept driven approach and by means of qualitative content analysis. Studies II–IV had a quantitative, cross-sectional design. A questionnaire was sent to all older women (65 years and older) living in Åland, an autonomous island community in the Baltic Sea, and 1555 (57%) women responded. The data was analysed using descriptive and inferential statistics.Results In study I, exploring how inner strength and its dimensions can be identified in narratives of older women, connectedness was interpreted as a striving to be in communion, creativity as the ability to make the best of the situation, firmness as having a spirit of determination – “it is all up to you”, and flexibility as a balancing act. The results of study II showed that strong inner strength was associated with better mental health, but not physical health. In exploring factors associated with health-related quality of life, fewer symptoms of depressive disorders was the strongest explanatory variable, and together with not feeling lonely associated with better both physical health and mental health. Better physical health was also explained by not having a diagnosed disease, being of lower age and the opportunity to engage in meaningful leisure activities. Better mental health was additionally explained by having enough money for personal needs. In study III the result showed that non-depressed women were likely to have a strong inner strength, as well as never or seldom feeling lonely, taking fewer prescribed drugs, feeling needed and having the opportunity to engage in meaningful leisure activities. In study IV poorer mental health was associated with weaker inner strength in total, and in all four dimensions of inner strength. Symptoms of depressive disorders and feeling lonely were related to lower scores in three of the dimensions (except firmness and creativity, respectively) and poorer physical health was associated with lower scores in two of the dimensions (firmness and flexibility). Some other health threats were significantly associated with only one of the dimensions (connectedness or creativity), and others were not significantly associated at all.Conclusion The results add nuance to the notion of inner strength and deepen empirical knowledge about the phenomenon. It is elucidated that the ISS can be used not only to rate inner strength but also to offer guidance as to the areas (i.e. dimensions) in which interventions may be profitable. It is further shown that inner strengths can be identified in narratives of older women. Mental ill health has shown to have overall the strongest association with weakened inner strength among community-dwelling older women. The causality can, though, not be studied due to the cross-sectional design; therefore, longitudinal studies are recommended. Notwithstanding that limitation, the findings can be used as a knowledge base in further research within this field.
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17.
  • Boman, Erika, et al. (författare)
  • Inner Strength as Identified in Narratives of Elderly Women A Focus Group Interview Study
  • 2015
  • Ingår i: Advances in Nursing Science. - 0161-9268 .- 1550-5014. ; 38:1, s. 7-19
  • Tidskriftsartikel (refereegranskat)abstract
    • By identifying sources of inner strength, health care personnel can be given valuable information about elderly people's capacities regardless of frailty. The focus of this interview-based study was to explore how inner strength and its dimensions can be identified in narratives of elderly women. The analysis was based on a theoretical model where inner strength is composed of 4 interacting dimensions of connectedness, creativity, firmness, and flexibility. Our findings add nuance to the notion of inner strength and deepen empirical knowledge about the concept.
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18.
  • Boström, Eva, et al. (författare)
  • Diabetes specialist nurses' perceptions of their multifaceted role
  • 2012
  • Ingår i: European Diabetes Nursing. - : Maney Publishing. - 1551-7853 .- 1551-7861. ; 9:2, s. 39-44
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to explore diabetes specialist nurses' (DSNs') perceptions of their professional role in diabetes care.Exploratory interviews were used to elicit DSNs' perceptions of their professional role. Twenty-nine DSNs working in 23 primary health care centres in northern Sweden were interviewed in focus groups. Data were analysed using qualitative content analysis.The DSNs described their profession as encompassing five major roles: ‘expert’, ‘fosterer’, ‘executive’, ‘leader’, and ‘role model’. Challenges interpreted as role ambiguities included feeling uninformed, fragmented, resigned, pressed for time, and self-reproachful.The profession of DSN was interpreted as multifaceted, with various roles and role ambiguities. Patient-centred care and empowerment, which are recommended in diabetes care, can be difficult to achieve when DSNs experience role ambiguity.Lack of clarity about role demands and difficulty in reconciling different roles may have a negative impact on DSNs' attitudes in clinical encounters and could inhibit patient-centred care. The development of the DSN profession requires improved awareness of the DSN's professional role in the clinical encounter, not only to improve the care of patients with diabetes, but also to retain these professionals.
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19.
  • Boström, Eva, et al. (författare)
  • Patient-centred care in type 2 diabetes : an altered professional role for diabetes specialist nurses
  • 2014
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 28:4, s. 675-682
  • Tidskriftsartikel (refereegranskat)abstract
    • Little research has been done to try to understand how patient-centred care is understood and practised by healthcare professionals specialising in patients with diabetes. Experiences from patient-centred practices need to be highlighted as a way of motivating diabetes specialist nurses to take a patient-centred approach. The aim of this study was to describe diabetes specialist nurses' experiences of practising patient-centred care in the context of a type 2 diabetes intervention. The study design was descriptive and used qualitative methods. Focus group interviews complemented by individual semi-structured interviews were analysed by qualitative content analysis. The main theme of the diabetes specialist nurses' experiences of practising patient-centred care was an altered professional role. The main theme was based on two themes: ambivalence towards practising patient-centred care and enriched relationships with the patients. The ambivalence towards practising patient-centred care was based on the three subthemes: a position of withdrawn expertise, inconvenience of changing routines and insights that patient-centred care is difficult but possible. Their experiences of enriched relationships with patients were based on the two subthemes: courage to discuss the severity of diabetes and increased engagement in patients' daily lives. The diabetes specialist nurses' experiences with practising patient-centred care included doubts about their ability to practise in such a way and about the feasibility of such care. At the same time, their enriched relationships with patients were seen as an opportunity to engage in patients' lives. Training and support for practising patient-centred care may improve diabetes specialist nurses skills in patient-centred care and self-management support in type 2 diabetes.
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20.
  • Boström, Eva, 1966- (författare)
  • Proximity and distance : challenges in person-centred care for diabetes specialist nurses in primary health care
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background Type 2 diabetes demands self-management over time, to maintain health and reduce the risk for diabetes complications. However, despite efforts, many persons with type 2 diabetes are not reaching the treatment targets. In diabetes, person-centred care and group education are recommended. Diabetes specialist nurses (DSNs) working in primary healthcare have an important role in supporting patients with type 2 diabetes in their self-management to adapt to the demands of the disease in everyday life. Therefore, it is important to explore the DSNs’ professional role and their experiences of practising person-centred care. The overall aim of the thesis was to explore the professional role of DSNs in primary healthcare, and to describe their experiences of person-centred diabetes care.Methods The thesis includes three studies with qualitative, and one with a quantitative, approach. Data collection consisted of focus group interviews, individual interviews, observations, and questionnaires. Qualitative content analysis and statistics were used in the analysis. In studies I and II, 29 and 31 DSNs participated, respectively. In study III, 10 DSNs and 44 persons with type 2 diabetes participated. Lastly, in study IV, 10 DSNs participated.Results The results in the thesis showed that DSNs have a complex and multifaceted professional role that entails striving to be an expert, a fosterer, a leader, an executive, and a role model, which they found challenging. The DSNs perceived high job demands, such as decision-making and learning. The thesis also showed that the interaction between DSNs and persons with type 2 diabetes shifted from empowerment to authority struggles during group support sessions based on person-centred care. The experience of person-centred care was described as enriching, but DSNs also expressed ambivalence, related to an altered professional role.Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. Even though person-centred care is recommended in healthcare, and despite DSNs’ efforts to practise PCC, the result of this thesis shows that it also implies an altered professional role for DSNs that has to be addressed.
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21.
  • Boström, Eva, et al. (författare)
  • Role clarity and role conflict among Swedish diabetes specialist nurses
  • 2013
  • Ingår i: Primary care diabetes. - : Elsevier. - 1878-0210 .- 1751-9918. ; 7:3, s. 207-212
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To explore diabetes specialist nurses (DSNs)' perceptions of their role in terms of clarity, conflict and other psychosocial work aspects.METHODS: A cross-sectional study was conducted among DSNs in a county in northern Sweden. The DSNs answered the Nordic Questionnaire of Psychological and Social Factors at Work (QPS Nordic) about psychosocial aspects of their work. Statistical analysis compared DSNs with a reference group of different health professionals. Correlations between role clarity, role conflict, and other variables were analysed.RESULTS: The DSNs perceived more, and higher, job demands, including quantitative, decision-making and learning demands, but also more positive challenges at work compared with the reference group. Role clarity correlated with experiences of health promotion, perception of mastery, co-worker support, and empowering leadership, while role conflict correlated with quantitative and learning demands.CONCLUSIONS: The DSNs perceived high demands but also positive challenges in their work. Their role expectations correlated with several psychosocial work aspects. It is important that DSNs should be presented with positive challenges as meaningful incentives for further role development and enhanced mastery of their work.
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22.
  • Choowattanapakorn, Tassana, et al. (författare)
  • Resilience among women and men aged 60 years and over in Sweden and in Thailand
  • 2010
  • Ingår i: Nursing and Health Sciences. - : Wiley. - 1441-0745 .- 1442-2018. ; 12:3, s. 329-335
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to compare the level of resilience of people aged > or = 60 years in Sweden and Thailand. In a randomized sample of 422 people in Sweden and a convenience sample of 200 people in Thailand, the level of resilience was measured by using the Resilience Scale. A chi(2)-analysis was used for the differences between proportions. The relationships between the background variables and the resilience scores were analyzed by using stepwise multiple linear regression. The mean scores of resilience were 144 for the Swedish participants and 146 for the Thai participants. The two samples differed in their background characteristics. The Thai participants were more likely to be women, to be widowed, and to have more children, while among the Swedish participants, more women were married and more participants were aged > or = 80 years. Despite different background characteristics, the Swedish and the Thai participants' scores were almost the same on the Resilience Scale. More studies are necessary to address aspects of gender and ethnicity in relation to resilience.
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23.
  • Christianson, Monica, et al. (författare)
  • Sex and gender traps and springboards : a focus group study among gender researchers in medicine and health sciences
  • 2012
  • Ingår i: Health Care for Women International. - : Taylor & Francis Group. - 0739-9332 .- 1096-4665. ; 33:8, s. 739-755
  • Tidskriftsartikel (refereegranskat)abstract
    • We explored the difficulties that gender researchers encounter in their research and the strategies they use for solving these problems. Sixteen Swedish researchers, all women, took part in focus group discussions; the data were analyzed using qualitative content analysis. The problems reported fell into four main categories: the ambiguity of the concepts of sex and gender; traps associated with dichotomization; difficulties with communication; and issues around publication. Categories of suggested problem-solving strategies were adaptation, pragmatism, addressing the complexities, and definition of terms. Here the specific views of gender researchers in medicine and health sciences-"medical insiders"-bring new challenges into focus.
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24.
  • Det goda åldrandet
  • 2012. - 1
  • Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
    • Boken syftar till att belysa ett gott åldrande och hot mot ett gott åldrande ur ett salutogent perspektiv samt till att spegla komplexiteten i åldrandet.Huvudbudskapet är att många äldre personer har det bra under åldrandet, men att det är möjligt att främja upplevelse av hälsa även hos de som lever med olika former av illabefinnande i samband med förluster, ohälsa eller under den sista tiden i livet. Att främja hälsa handlar om att ta tillvara yttre och inre resurser hos äldre personer, hos deras närmaste och i samhället samt att ge adekvat vård och omsorg, medicinsk behandling och rehabilitering.I boken medverkar 13 forskare inom arbetsterapi, geriatrik, omvårdnad och sjukgymnastik. Alla har omfattande erfarenhet av forskning om äldre personer. De olika perspektiven ger en bild av aktuell forskning om äldre personers situation.Boken är i första hand avsedd för studenter på grundläggande nivå och för vidareutbildning av personal inom vård och omsorg, men den är också lämplig att använda inom praktisk verksamhet.
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25.
  • Egberg, Louise (författare)
  • Life situation in people with peripheral arterial disease and their family members
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Life with peripheral arterial disease and the resulting impaired walking ability leads to major limitations in daily life and a decreased quality of life. The overall aim of this thesis was to generate understanding about the life situation among people living with peripheral arterial disease and their family members. The outcomes after percutaneous transluminal angioplasty interventions both proximal and distal to the inguinal ligament were assessed by collecting data by means of chart review using a study specific protocol. The results show a connection between proximal intervention and age as well as proximal intervention and smoking. Patients in the proximal group were younger and more frequent smokers or former smokers and hematomas/bruises as a complication were more common among non-diabetic patients (Paper I). Health related quality of life in patients with peripheral arterial disease undergoing percutaneous transluminal angioplasty intervention was investigated using a general questionnaire (EQ5D) as well as a disease-specific questionnaire (CLAU-S) translated into Swedish for this study. The health related quality of life was improved both one month and one year after the percutaneous transluminal angioplasty compared to before the intervention (Paper II). The experiences of living with intermittent claudication were studied through qualitative interviews with individuals suffering from peripheral arterial disease. The interviews were analyzed by thematic content analysis and six themes together founded a main theme concerning adjusting to a restricted life when living with intermittent claudication (Paper III). Spouses and cohabitants were interviewed about their experiences of living together with a person suffering from intermittent claudication. The overall theme was about living a demanding life when living together with someone with intermittent claudication. The findings of this study give insight into the complexities and the difficulties of ageing and living together with someone suffering from intermittent claudication (Paper IV). In conclusion, living with intermittent claudication has a major impact on daily life and demands adjustment to a restricted life. Percutaneous transluminal angioplasty improves health related quality of life among individuals suffering from peripheral arterial disease and the effect is sustainable over time up to one year after the intervention. People who had undergone percutaneous transluminal angioplasty were younger in the proximal group and hematomas/bruises were more common among nondiabetic patients. Ageing and intermittent claudication have great impact on both the spouse’s and the ill person’s life situation
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26.
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27.
  • Ellberg, Lotta, et al. (författare)
  • Maternity care options influences readmission of newborns
  • 2008
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 97:5, s. 579-583
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To analyse morbidity and mortality in healthy newborn infants in relation to various routines of post-natal follow-up. Design: cross-sectional study. Setting: maternity care in Sweden. Population: healthy infants born at term between 1999 and 2002 (n = 197 898).Methods: Assessment of post-natal follow-up routines after uncomplicated childbirth in 48 hospitals and data collected from the Swedish Medical Birth Register, Hospital Discharge Register and Cause-of-Death Register. Main outcome measure: neonatal mortality and readmission as proxy for morbidity.Results: During the first 28 days, 2.1% of the infants were readmitted generally because of infections, jaundice and feeding-related problems. Infants born in hospitals with a routine neonatal examination before 48 h and a home care programme had a readmission rate [OR, 1.3 (95% CI, 1.16–1.48)] higher than infants born in hospitals with routine neonatal examination after 48 h and 24-h care. There were 26 neonatal deaths.Conclusion: Post-delivery care options and routines influence neonatal morbidity as measured by hospital readmission rate. A final infant examination at 49–72 h and an active follow-up programme may reduce the risk of readmission.
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28.
  • Ellberg, Lotta, et al. (författare)
  • Satisfying parents' preferences with regard to various models of postnatal care is cost-minimizing
  • 2006
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 85:2, s. 175-181
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: This study describes three options for postnatal care in Sweden and contains a cost analysis of the options in various combinations. The aim of the study was to calculate the cost of a postnatal care model according to new parents' preferences. METHODS: Staff costs were calculated for various models of postnatal care, comprising the maternity ward, the family suite, and/or the early discharge program. One of the models was based on answers from 342 parents who specified their preferences with regard to postnatal care in the event of another birth. RESULTS: Comparing costs for five different models of postnatal care showed that the proportion of mothers receiving care at the maternity ward crucially influences the total costs. The staff costs differed significantly between the models, ranging from US$448 000 to US$778 000 per 1500 mother-child dyads. MAIN OUTCOME MEASURES: Cost calculation of various care models and parents' preferences for postnatal care. CONCLUSIONS: Because the parents' preferences with regard to postnatal care created one of the most cost-minimizing care models in the study, it would be possible to better meet parent's desires and, at the same time, reduce costs, without increasing risks in comparison with the early discharge program.
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29.
  • Fischer, Regina Santamäki, et al. (författare)
  • Embracing opposites : meanings of growing old as narrated by people aged 85
  • 2008
  • Ingår i: The International Journal of Aging & Human Development. - Farmingdale, N.Y. : Baywood. - 0091-4150 .- 1541-3535. ; 67:3, s. 259-71
  • Tidskriftsartikel (refereegranskat)abstract
    • Many old people suffer from prolonged and multiple bodily ailments, new diseases, and increased risk for disadvantages and losses in life. Aging also means becoming mature and wise. This study illuminates the meaning of the lived experience with respect to changes in late life. Using a phenomenological hermeneutic method, this study analyzes transcribed interviews of 15 85-year-old people. Four themes were formulated: embracing weakness and strength, embracing slowness and swiftness of time, embracing reconciliation and regret, and embracing connectedness and loneliness. From these analyses, growing old was described as--maintaining one's identity in spite of the changes that come with aging and, embracing opposites--being changed and feeling being the same.
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30.
  • Fischer, Regina Santamäki, et al. (författare)
  • Living Amidst Consolation in the Presence of God Perceptions of Consolation Among the Oldest Old : The Umeå 85+ Study.
  • 2007
  • Ingår i: Journal of Religion, Spirituality & Aging. - 1552-8030. ; 19:3, s. 3-20
  • Tidskriftsartikel (refereegranskat)abstract
    • This study describes how 90-year-olds and older people perceive consolation. Qualitative Content analysis of 49 interviews revealed four categories: consolation by God; consolation from others; consolation from self; and consolation from things, which were present in two themes. The theme "Living amidst consolation in the presence of God" was a core theme and expresses consolation as self-evident and based on a relation to God, others, self, and things. The theme "Seeking consolation," expresses consolation from self, others, things, or God. Interviewees in some cases regretted that they had no religious faith. Reasonably, most interviewees referred to religious consolation, as religion had been so closely connected with the word "consolation" all their lives. [ABSTRACT FROM AUTHOR]
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31.
  • From, Ingrid, 1953- (författare)
  • Health and quality of care from older peoples' and formal caregivers' perspective
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.
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32.
  • Graneheim, Ulla Hällgren, et al. (författare)
  • Experiences of loneliness among the very old : the Umeå 85+ project.
  • 2010
  • Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 14:4, s. 433-438
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: This study aims to elucidate experiences of loneliness among the very old, who live alone. METHOD: Twenty-three women and seven men, aged 85-103 years, were interviewed about their experiences of loneliness. The text was subjected to qualitative content analysis. RESULT: The descriptions of loneliness were twofold: on the one hand, living with losses and feeling abandoned represented the limitations imposed by loneliness; and on the other, living in confidence and feeling free represented the opportunities of loneliness. The findings indicate that experiences of loneliness among the very old are complex, and concern their relations in the past, the present, and the future. CONCLUSION: Experiences of loneliness among the very old can be devastating or enriching, depending upon life circumstances and outlook on life and death. We interpreted these two aspects of loneliness as feelings of homelessness and at-homeness.
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33.
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34.
  • Hajdarevic, Senada, et al. (författare)
  • Becoming whole again-Caring for the self in chronic illness-A narrative review of qualitative empirical studies
  • 2024
  • Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702.
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM AND OBJECTIVES: To explore how chronic illness transforms the self when living with and managing chronic illness and what this means for their self and identity. We also discuss how people with chronic conditions could be supported by healthcare professionals to manage illness in daily life.BACKGROUND: Self-management recommendations from health care are commonly based on a biomedical understanding of the disease. People's experiences of how a condition affects them and adequate support are crucial for their outcomes in daily self-management.DESIGN: A narrative review.METHODS: A systematic search was undertaken during January 2021 across the databases MEDLINE, CINAHL, PsycINFO, Soc INDEX and Philosopher's Index. A quality appraisal of articles was performed. Our analysis was inspired by qualitative content analysis. The PRISMA Checklist 2020/EQUATOR guidelines was used to report the study.RESULTS: Twenty-eight peer-reviewed qualitative empirical articles focusing on self in a variety of chronic illnesses with relevance to nursing published from January 2010 to December 2020 were included. The main theme, Developing from an uncertain existence to meaning and wholeness, was built up by the five themes: Walking on an unstable ground; Being stalemated; Being involved with others for better or worse; Searching for meaning; and lastly, Modifying self and integrating a new way of living.CONCLUSIONS: The results illuminate experiences that seldom are prioritized but need to be addressed by health professionals. Such experiences are oriented more towards the existential self rather than medical issues, why it is important to go beyond the medical lens.RELEVANCE TO CLINICAL PRACTICE: This is important knowledge for nurses aiming to support people with chronic illnesses. Nurses supporting people in self-management need to be aware that by teaching and encouraging people to revise their daily habits, they also work on the boundaries of their self-concept.PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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35.
  • Hammarström, Anne, et al. (författare)
  • Health and masculinities shaped by agency within structures among young unemployed men in a northern Swedish context
  • 2015
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5, s. 1-18
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of our paper was to explore expressions of life choices and life chances (aspects of agency within structures) related to power and experiences of health among early unemployed adolescent young men during the transition period to adulthood. These expressions of agency within structure were interpreted in the light of Cockerham’s Health Lifestyles Theory. Furthermore, social constructions of masculinities were addressed in our analysis.Repeated interviews with ten young men in a cohort of school leavers were analyzed with qualitative content analysis.Cockerham’s model was useful for interpreting our findings and we found disposition to act to be a crucial theoretical tool to capture the will and intentions of participants in relation to health. We developed the model in the following ways: structure and socialization were visualized as surrounding the whole model. Analyses of what enhances or restricts power are important. In addition to practices of health lifestyles, we added experiences of health as outcome as well as emotional aspects in disposition to act. We interpret our findings as constructions of masculinities within certain structures, in relation to choices, habitus and practices.Qualitative research could contribute to develop the understanding of the agency within structure relationships. Future studies need to pay attention to experiences of health among young people at the margin of the labor market in various milieus – and to analyze these in relation to gender constructions and within the frame-work of agency within structure.
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36.
  • Hammarström, Anne, et al. (författare)
  • The importance of having a paid job : Gendered experiences of health and ill-health in daily life among middle-aged women and men
  • 2021
  • Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: More gender-theoretical studies are needed to gain a deeper understanding of what life circumstances make people sick or improve their health. The aim of the study was to gain a deeper understanding of social determinants of health by exploring gendered experiences in daily life among middle-aged women and men using the theory of gender relations.Methods: Individual interviews with nine men and women were performed, focusing on what made them feel good or bad. Qualitative content analysis was used to analyse the data.Results: A major theme in our interviews was the gendered health-promoting experiences related to having a job, which involved becoming someone, feeling appreciated at work and having control over work. Having good family relations was also health-promoting, in terms of supportive relations and becoming a parent. Ill-health was related to gendered adverse conditions at work (accidents, monotonous and stressful work tasks, being bullied) and in domestic life (demands, destructive partner relations, having children with problems).Conclusions: Gendered determinants of health and ill-health were identified in both working and domestic life. Public health policy needs to challenge the gender order in society, which defines the gendered structure of the labour market as well as the gendered relations in domestic life.
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37.
  • Hansson, Anna (författare)
  • Subjective Well-being in an Adult Swedish Population : Findings from a Population-based Study
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This doctoral thesis examines various factors associated with subjective well-being (SWB) in an adult Swedish population, aged 20-64 years, using cross-sectional and longitudinal data. The thesis includes four studies based on the PART study, a current population-based study on mental health, work, and relations in Stockholm County, Sweden. Research has shown that there is a relationship between mental health problems such as depression and low well-being. It is therefore of great interest to investigate various factors associated with SWB in order to promote or increase mental health. We also examined if the well-being scale used in all studies could be used as a screening instrument for depression.The specific aim of Study I was to examine if age, gender, foreign background (i.e. not born in Sweden), cohabitation, education, financial strain, social support, childhood conditions and negative life events and their associations with SWB could be replicated in our data. In Study II we investigated strategies people chose to employ in order to improve or maintain their well-being and whether these were associated with SWB. Study III examined if changes in cohabiting, social support or the financial situation influenced SWB, after controlling for neuroticism at a 3-year follow-up. The change in the study sample’s SWB was also studied during the same time period. In Study IV the aim was to investigate whether the well-being scale, the (WHO) Ten Well-being index, could be used as a screening instrument for depression.Results from Study I showed that men had higher SWB than women, and that positive childhood conditions, cohabiting, greater age, sound financial situation, absence of negative life events, and support from friends were all positively associated with SWB. Social support had the strongest relationship. Together, these factors explained 20 % of the variance in SWB and the findings replicated earlier research. The strategies reported in Study II were physical exercise, physical health,engaging in pleasurable activities, relaxation, plan/set limits, social support, professional contacts, positive thinking, and work. Of these, social support, relaxation, physical exercise and physical health were associated with higher SWB. Social support showed the strongest association. In Study III changes in financial situation, social support, or cohabiting influenced SWB after controlling for neuroticism. The results also suggested that SWB was relatively stable over a period of three years. Preliminary findings from Study IV indicate that the (WHO) Ten Well-being index can work as a screening instrument for depression in populationbased samples.In summary, the findings suggest that demographics and psychosocial factors explain only a small part of the variance in SWB, replicating previous data. Certain self-care strategies are positively associated with SWB. In addition, changes in life circumstances influence SWB, even after controlling for neuroticism over a period of three years despite the stability of SWB. Furthermore, the preliminary findings indicate that the well-being scale can work as a screening instrument for depression in a population-based sample. The overall conclusion from the results of this thesis suggests that it is important for the health care services to be aware that negative life events/circumstances may affect people’s SWB over several years. Furthermore, selfhelp interventions might be important in order to maintain or increase SWB.
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38.
  • Hägglund, Lena, et al. (författare)
  • Depression among elderly people with and without heart failure, managed in a primary healthcare setting.
  • 2008
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 22:3, s. 376-382
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND RESEARCH OBJECTIVES: Depression is common among patients with heart failure (HF) and among elderly in general. Problems in diagnosing and care planning can arise as symptoms of HF, dyspnoea and especially fatigue, are nonspecific and also overlap with symptoms of depression. The objective of this study was to describe the prevalence and compare degrees of depression among patients with confirmed HF, patients with symptoms similar to HF (no heart failure, NHF) and a reference group in one primary healthcare centre (PHC), after adjusting for background characteristics and fatigue. SUBJECTS AND METHODS: A descriptive case-reference study was conducted in one PHC in a middle-sized city. Participants were 49 patients with confirmed HF, 59 patients with symptoms similar to HF (NHF) and 40 people in a reference group. After informed consent data were collected by structured interviews using the Geriatric Depression Scale and the Multidimensional Fatigue Inventory-20. Odds ratios for the outcomes HF vs. NHF, HF vs. reference group, and NHF vs. reference group were calculated. RESULTS: The HF and NHF groups had similar degrees of depression which were significantly higher than for the reference group. This difference between the groups did not remain significant when adjusting for physical fatigue. More patients in the NHF than in the HF group were living alone and there were more women in the NHF than in the reference group. CONCLUSIONS: Prevalence of depression and degrees of fatigue were higher among elderly from a PHC who experienced HF symptoms, independent of objectively measured heart function, compared with elderly without such symptoms. When comparing degrees of depression between the three groups and adjusting for fatigue, the physical dimension of fatigue was of greater importance in explaining group differences.
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39.
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40.
  • Hägglund, Lena, 1954- (författare)
  • Man måste vila emellanåt : patienters självskattade och berättade erfarenheter av att leva med kronisk hjärtsvikt
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall purpose was to explore the experience of living with chronic heart failure among patients in primary healthcare. Comparisons were made between patients with confirmed heart failure (HF, n=49), patients with symptoms indicating HF but with no HF (NHF, n=59), and a reference group (n=40). The mean age was 77 years. Patients in the HF and NHF groups had more general and physical fatigue, more reduced activity, worse physical quality of life and higher degree of depression compared with the reference group. The HF group had also higher degree of physical fatigue and worse physical quality of life than the NHF group. When comparing degrees of depression between the three groups and adjusting for fatigue, the physical dimension of fatigue was of greater importance in explaining group differences. In the HF group general fatigue was more closely related to limitations in role functioning for physical reasons than to reduced physical function per se. Women experienced more fatigue than men. Narrative interviews were conducted with ten women with confirmed heart failure, aged 73-89 years, with special reference to fatigue. The findings were presented in two themes, ‘living with the loss of physical energy’, and ‘striving for independence while being aware of deteriorating health’. The conclusion in study IV was in accordance with the results in the quantitative studies, indicating that the experience of HF or symptoms similar to HF had the greatest impact on the physical dimensions of fatigue and health-related quality of life. From a clinical perspective the findings in this thesis emphasize the importance of careful investigation of each patients experienced problems. In particular symptoms of depression and different dimensions of fatigue need to be analysed. Interventions aimed at reducing fatigue needs to be developed, and its further impact on health-related quality of life should be investigated.
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41.
  • Hägglund, Lena, et al. (författare)
  • The experience of fatigue among elderly women with chronic heart failure.
  • 2008
  • Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7:4, s. 290-295
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Fatigue is a common and distressing symptom in chronic heart failure (CHF). Most of the current methods for evaluating patients' symptoms fail to consider the meaning or importance that these symptoms have for the patient. AIM: To illuminate the lived experience of fatigue among elderly women with CHF. METHOD: Narrative interviews were conducted with 10 women with CHF, aged 73-89 years. Interviews were analysed with qualitative content analysis. RESULTS: The findings are presented in two themes and five subthemes. The first theme, 'living with the loss of physical energy', was based on three subthemes describing the experience of fatigue: 'experiencing a substantial presence of feebleness and unfamiliar bodily sensations', 'experiencing unpredictable variations in physical ability', and 'needing help from others in daily life'. The second theme, 'striving for independence while being aware of deteriorating health', describes how the women managed their life situation; it was based on two subthemes: 'acknowledging one's remaining abilities', and 'being forced to adjust and struggle for independence'. CONCLUSIONS: Fatigue was experienced as loss of physical energy, leading to discrepancies between intention and capacity. The will to reduce dependency on others involved a daily struggle against fatigue.
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42.
  • Hällgren Graneheim, Ulla, et al. (författare)
  • Kvalitativ innehållsanalys
  • 2023. - 3
  • Ingår i: Vetenskaplig teori och metod. - Lund : Studentlitteratur AB. - 9789144161389 ; , s. 295-312
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)
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43.
  • Hörnsten, Åsa, et al. (författare)
  • A model of integration of illness and self-management in type 2 diabetes
  • 2011
  • Ingår i: Journal of Nursing and Healthcare of Chronic Illness. - Singapore : Wiley-Blackwell. - 1752-9816 .- 1752-9824. ; 3:1, s. 41-51
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim. To describe the process of illness integration and self-management among people with type 2 diabetes.Background. Integration of illness is a developmental process referring to the emotional and existential aspects of being ill. It is an overarching concept that describes the process that a person undergoes in living with a chronic disease, from prediagnosis to adaptation to illness as a natural part of life. Despite the common use of terms such as illness integration and self-management, there exists little research that investigates how these concepts relate to one another.Methods. A narrative interview study applying qualitative content analysis was conducted with people diagnosed with type 2 diabetes. The study focused on their personal understandings of illness, and particularly, the relationship of the participants’ illness integration to self-management of the disease. Data were collected in 2002.Results. In the trajectory from prediagnosis to adaptation, there is a turning point when people seem to integrate the illness emotionally and existentially, and in relation to their self-management practice. The trajectory includes the phases of suspecting illness/being diagnosed, understanding and explaining the illness, and negotiating illness and taking stands about self-management. These phases in turn are influenced by perceptions of the seriousness and threat of the disease; the intensity and nature of the ill person’s emotional response to the disease and its management; goals and expectations for living with the disease and for living in general; and lastly, perceptions of the outcomes and impacts of self-management.Conclusion. Illness integration and self-management processes develop simultaneously. In some cases, a turning point occurs that causes the person to view self-management as both necessary and feasible.Relevance to clinical practice. Nurses may influence the illness integration trajectory and assist people with type 2 diabetes to integrate the disease and its management more readily.
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44.
  • Hörnsten, Åsa, 1963- (författare)
  • Experiences of diabetes care - patients' and nurses' perspectives
  • 2004
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: In order to provide good diabetes care it is important for the health care professionals to share patients’ personal understanding of living with diabetes, which differs from a professional understanding of the illness. Patients’ beliefs about health, illness, control and cure are predictive of the outcome of lifestyle changes and pharmacological treatment. Narratives about illness could be used to elucidate what people believe to be central to their experience of an illness and its management. The overall aim of this thesis was to investigate experiences of diabetes and diabetes care among people with type 2 diabetes and district nurses responsible for diabetes care within primary health care. Methods: Forty-four patients diagnosed with diabetes during the previous 2 years were interviewed about their personal understanding of illness and experiences of care. They also participated in an intervention study consisting of group sessions during 9 months. The intervention focused on the patients’ understanding of living with diabetes and was directed at the patients and their nurses (n = 5). The outcome variables haemoglobin A1c (HbA1c), lipids, blood pressure (BP) and body mass index (BMI) as well as well-being, treatment satisfaction and diabetes symptoms of the intervention group were compared with those in a control group (n = 60). Another ten patients were interviewed about their views of their lives. Seventeen nurses in diabetes care were interviewed about their views of their work with patients. The narrative, thematic interviews and focus group interviews were analysed using qualitative content analysis. Findings: Patients’ personal understanding of illness included the categories “image of the disease”; “meaning of the diagnosis”; “integration of the illness”; “space for the illness”; “responsibility for care”; and “future prospects”. Patients’ narratives about their lives included views of knowledge, and capacity, motivation and courage, aspects important for effective self-management. Patients’ views on clinical encounters in diabetes care, interpreted as satisfying or not, included the themes “being in agreement v. in disagreement about the goals”; “being autonomous and equal v. being forced into adaptation and submission”; “feeling worthy as a person v. feeling worthless”; “being attended to and feeling welcome v. being ignored”; and “feeling safe and confident v. feeling unsafe and lacking confidence”. The results of the intervention study with group sessions showed improvements in metabolic balance and treatment satisfaction in the intervention group. At the 1-year follow-up the mean difference between groups in HbA1c was 0.94% (95% confidence interval (CI) 0.58–1.29). Nurses’ views of their work included the themes “Perspectives on illness and caring are not easily integrated into views of disease and its treatment”; “Nurses view their knowledge as more important than the patients’ knowledge”; Nurses’ conscience is challenged by some of their nursing decisions”; “The individuality of each patient is undermined when patients are regarded as a collective group”; and “Nurses are confirmed in their role of nurses by patients who assume a traditional patient role”. Conclusion: These results demonstrate that the understanding of illness and care differs between patients and nurses working in diabetes care; furthermore, that an intervention involving patients and their nurses based on patients’ personal understanding of illness is effective with regard to metabolic control and treatment satisfaction. The cost of the intervention is moderate. Also, we believe that it is possible to clinically implement this intervention within the existing resources for primary health care.
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45.
  • Hörnsten, Åsa, et al. (författare)
  • Improvements in HbA1c remain after 5 years--a follow up of an educational intervention focusing on patients' personal understandings of type 2 diabetes
  • 2008
  • Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 81:1, s. 50-5
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper reports a 5-year follow-up from a study aimed at evaluating whether an intervention which focused on patients’ personal understanding of their illness was more effective than conventional diabetes care with regard to metabolic control among patients with type 2 diabetes mellitus (DM2). The study was conducted within Swedish primary health care and included 102 patients (mean age 63 years). At clinic level they were randomised into control or intervention groups. The intervention directed at patients consisted of ten two-hour group sessions over 9 months, focusing on patients’ own needs and questions. The mean HbA1c at baseline was 5.71% (S.D. 0.76) in the intervention group and 5.78% (S.D. 0.71) in the control group. At the 5-year follow-up, the mean HbA1c in the intervention group still was 5.71% (S.D. 0.85) while among the controls it had increased to 7.08% (S.D. 1.71). The adjusted difference was 1.37 (p < 0.0001). Treatment upgrade, BMI, total cholesterol, HDL, LDL and triglycerides at baseline did not influence the difference in HbA1c. These findings indicate that group sessions in patients with DM2 focusing on patients’ personal understanding of their illness are more effective than conventional diabetes care with regard to metabolic control.
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46.
  • Hörnsten, Åsa, et al. (författare)
  • Metabolic improvement after intervention focusing on personal understanding in type 2 diabetes.
  • 2005
  • Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 68:1, s. 65-74
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to evaluate, whether an educational intervention, focusing on patients' personal understanding of their illness, was more effective than care given according to national guidelines for diabetes care. METHODS: An intervention group (n = 44), with type 2 diabetes was compared with a control group (n = 60), with HbA1c as the primary outcome. The intervention included ten group sessions addressing themes related to the patients' personal understanding of their illness. The diabetes nurses involved were educated in theories about illness/wellness experiences and participated in group sessions where various caring strategies related to the patients' individual needs and understanding were reflected upon. RESULTS: At 1-year follow-up the intervention group showed lower HbA1c levels (mean difference 0.94%; P < 0.001), lower triglycerides (mean difference 0.52 mmol/l; P = 0.002) and higher high-density lipoprotein (mean difference 0.15 mmol/l; P = 0.029) and treatment satisfaction than did the control group. The differences remained when adjusting for age, gender, body mass index or changed treatment during the intervention period. Within the intervention group, BMI and treatment satisfaction were also improved. CONCLUSION: The intervention, which focused on patients' personal understanding of illness, was found to be effective in terms of metabolic control and treatment satisfaction.
  •  
47.
  • Hörnsten, Åsa, et al. (författare)
  • Nurses' experiences of conflicting encounters in diabetes care
  • 2008
  • Ingår i: European Diabetes Nursing. - : Informa UK Limited. - 1551-7853 .- 1551-7861. ; 5:2, s. 64-69
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To describe nurses' experiences of encounters with patients in diabetes care.Methods: Focus-group interviews with 17 nurses about their experiences of caring for patients with diabetes. Interviews were analysed by qualitative content analysis.Results: Four themes described conflicts in their encounters with patients, disclosing a complex professional role as a diabetes nurse. Implementing guidelines at the same time as being patient-centred was found to be problematic. Nurses further viewed medical knowledge as being more important than life experience of diabetes. The nurses' comments were distanced from, and judgemental about, patients as a collective. Finally, the nurses felt comfortable in expert roles, but not in equal and mutual relationships with patients.Conclusion: The interviews identified a feeling of frustration over conflicting demands between different goals and ideologies for diabetes care. These conflicts may also arise from the difficulty of integrating medical goals and patients' life experiences of illness.
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48.
  • Hörnsten, Åsa, et al. (författare)
  • Patient satisfaction with diabetes care
  • 2005
  • Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 51:6, s. 609-617
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim. The aim of this paper is to report the findings of a study that elucidated the experiences and reflections of people with type 2 diabetes about clinical encounters.Background. Several patient satisfaction surveys have focused on privacy, cheerfulness and amenities rather than on how the care was delivered. A great deal of research has also focused on communication and various consultation styles, particularly within health promotion and diabetes care, but how these factors tie up with patient satisfaction has rarely been discussed. This study was performed in order to elucidate patients' perspectives about clinical encounters in diabetes care.Method. Interviews were carried out during 2001 with 44 patients with diabetes. The transcribed interviews were analysed using qualitative content analysis.Results. Five themes were connected to patient satisfaction and dissatisfaction, namely 'being in agreement vs. in disagreement about the goals'; 'autonomy and equality vs. feeling forced into adaptation and submission'; 'feeling worthy as a person vs. feeling worthless'; 'being attended to and feeling welcome vs. ignored'; and, lastly, 'feeling safe and confident vs. feeling unsafe and lacking confidence'.Conclusion. Despite efforts to individualize diabetes care and find ways to communicate with patients, many people have experiences of clinical encounters that they find dissatisfying. Experiences of dissatisfying encounters have elements that may threaten their perception of self and identity, while elements included in satisfying encounters are those characterizing patient-centred care.
  •  
49.
  • Hörnsten, Åsa, et al. (författare)
  • Personal understandings of illness among people with type 2 diabetes
  • 2004
  • Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 47:2, s. 174-182
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Professionals and patients understand the experience of illness from different worlds. Professionals' explanatory models focus on aetiology, diagnosis, pathophysiology and treatment, while patients' explanatory models are more focused on consequences and influences on daily life. The differences between patients and professionals in their understanding often result in conflicting expectations about treatment, priorities and outcomes of care. Aim. The aim of this study was to describe personal understandings of illness among people with type 2 diabetes in Sweden. Method. A sample of 44 patients, 47–80 years, diagnosed with type 2 diabetes within the last 2 years, was recruited from four health care centres. Narrative thematic interviews were used covering the areas of developing, coping with and living with diabetes. Qualitative content analysis was performed. Findings. The findings were formulated into six categories: image of the disease, meaning of the diagnosis, integration of the illness, space for the illness, responsibility for care and future prospects. Conclusions. The findings demonstrate that patients' personal understanding of illness is an important complement to the traditional professional view of diabetes. They could serve as a foundation for development of health history interviewing, as well as development of systems of documentation. Patients' personal understandings of diabetes in their daily lives are considered to be an important shared source of information for planning meaningful care.
  •  
50.
  • Hörnsten, Åsa, et al. (författare)
  • Psychosocial maturity among people with diabetes mellitus
  • 2002
  • Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 11:6, s. 777-784
  • Tidskriftsartikel (refereegranskat)abstract
    • There is a relationship between coping with chronic illness and a person's psychosocial development. The aim of this study was to describe dimensions of psychosocial development based on results of a previous factor analysis of the Modified Erikson Psychosocial Stage Inventory among people with type 2 diabetes. Interviews were carried out with 10 people with diabetes. The transcribed interviews were analysed by qualitative content analysis into main categories, categories and themes. The categories were trust, lack of trust, positive identity, identity confusion, integrity and lack of integrity. Themes that permeated the categories in a positive way were 'activity' and 'involvement', while themes that permeated the categories in a negative way were 'passivity' and 'alienation'. Our interpretation is that the category 'trust' is the basis for 'identity', and together 'trust' and 'identity' are the basis for maturity and 'integrity'. A conclusion is that positive psychosocial maturity has to do with attaining trust, identity and integrity through activity and involvement. Qualities important for maturation through trust, identity and integrity are understanding, capacity, purposefulness and fortitude. Our interpretation of maturity is considered as being an important and interesting focus in nursing, while the above related qualities are closely connected to coping with diabetes.
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