| 1. |
- Andersson, Jenny, et al.
(författare)
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Decision‐Making in Seeking Emergency Care for Stroke Symptoms
- 2022
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Ingår i: Stroke: Vascular and Interventional Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 2694-5746. ; 2:6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious studies have shown that rapid treatment for stroke, especially ischemic stroke, reduces mortality and disability. The focus has mainly been on reducing time from arrival at hospital to start of treatment. However, the main reason for delay is often time from symptom onset to arrival at hospital. This study therefore aimed to explore decision‐making processes after the onset of stroke symptoms in patients experiencing a first‐time stroke.MethodsWe included 36 patients aged 18 and older, all of whom were hospitalized with a first‐time stroke between October 2018 and April 2020. All patients were interviewed once within 4 weeks of symptom onset and before hospital discharge. Eligible patients were identified retrospectively through a targeted review of medical records. The data were collected and analyzed according to the grounded theory methodology.ResultsIn total, 43 potential patients were identified and asked to participate. Overall, 36 patients were included in the study: 17 women (median age 77.0 years, interquartile range 17.5) and 19 men (median age 65.7 years, interquartile range 17.2). All interviewees felt fear, and this affected their decision to seek emergency care. The decision‐making processes were described by the core category of “Acting on fear.” The reason for feeling frightened determined the actions taken. The reasons were sorted into 3 main categories: (1) “seeking care”–recognized stroke symptoms and acted immediately; (2) “pending and reluctance”–suspected stroke but awaited to seek care; and (3) “seeking an explanation”–confused by symptoms.ConclusionWe found that decision‐making when experiencing stroke symptoms was complex. All patients felt fear, which determined their actions. Some patients knew about stroke symptoms and acted immediately. Others suspected stroke but still chose to wait, whereas others were confused and tried to find answers. These results could contribute to form future awareness campaigns.
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| 2. |
- Andersson, Jenny, et al.
(författare)
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Patient´s description of onset stroke symptoms : Oral Presentations. ESOC 2023 Abstract Book
- 2023
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Ingår i: European Stroke Journal. - : Sage Publications. - 2396-9873 .- 2396-9881. ; 8:2, s. 427-427
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Stroke symptoms vary and could be hard to recognize. In addition, stroke severity has decreased according to the National Institutes of Health Stroke Scale (NISSH), with less pronounced symptoms expression. Knowledge on the patient’s description of stroke symptoms is therefore needed. The aim was to describe patient’s symptoms at stroke onset.Methods: A qualitative content analysis was used. Data were collected through individual interviews with 27 patients (16 men and 11 women, median age 70.4 years). All patients were hospitalized with a first-time stroke. The interviews were conducted within 4 weeks of symptoms onset and before hospital discharge.Results: All patients had symptoms that affected their daily life. Some patients described having multiple symptoms at the same time, others had symptoms that began insidiously and worsened over time. Symptoms such as overwhelming fatigue or nausea were described as Premonition of becoming ill, feeling unwell or that something was wrong. Motoric bodily changes were multifaceted as slurred speech or dizziness, balance difficulties and losing control of the body or motor dysfunction. But also, that the surroundings were distorted, and solid objects moved around. Symptoms of Dazed and affected senses included confusion and visual impairment or headache.Conclusions: Stroke is a complex disease with several different symptoms’ expressions and could be difficult to recognize, especially when symptoms are less typical or perceived as not serious. Increased awareness of stroke symptoms among caregivers and among members of the community is important and needed.
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| 3. |
- Andersson, Jenny, et al.
(författare)
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Symptoms at stroke onset as described by patients: a qualitative study
- 2024
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Ingår i: BMC Neurology. - : Springer Nature. - 1471-2377. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke.Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level.Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another.Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this.
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| 4. |
- Berndtsson, Ina, 1953-, et al.
(författare)
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Nursing students' attitudes toward care of dying patients : A pre- and post-palliative course study
- 2019
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Ingår i: Heliyon. - : Elsevier. - 2405-8440. ; 5:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many nursing students are not prepared to encounter death and care for patients who are at the end of life as newly educated nurses. The Frommelt Attitude Toward Care of Dying Scale (FATCOD) has been used to assess nursing students' attitudes during their education and changes have been noted.Objective: To examine nursing students' attitudes towards care of dying patients before and after a course in palliative care.Design: A descriptive study with a pre and post design.Settings & participants: Nursing students (n = 73) enrolled in a mandatory palliative course in the nursing programme at a Swedish university.Methods: Data were collected before and after a palliative care course using FATCOD and qualitative open-ended questions. Data from FATCOD were analysed using descriptive and analytical statistics. The open-ended questions were analysed with qualitative content analysis.Results: The students' mean scores showed a statistically significant change toward a more positive attitude toward care of dying. Students with the lowest pre-course scores showed the highest mean change. The qualitative analysis showed that the students had gained additional knowledge, deepened understanding, and increased feelings of security through the course.Conclusions: A course in palliative care could help to change nursing students' attitudes towards care of patients who are dying and their relatives, in a positive direction. A course in palliative care is suggested to be mandatory in nursing education, and in addition to theoretical lectures include learning activities such as reflection in small groups, simulation training and taking care of the dead body.
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| 5. |
- Bjalkefur, K., et al.
(författare)
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Self-rated health over the first five years after stroke
- 2020
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Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Self-rated health (SRH) focuses on the patient's own perception, and represents an important patient-reported outcome. The aim was to investigate SRH one to 5 years after stroke, follow the development over time and search for factors associated with SRH. Methods Consecutive stroke patients admitted to Stroke Units at the Skaraborg Hospital, Sweden were included 2007-2009 (n = 2190). Patient-reported outcomes were collected annually over 5 years using a postal questionnaire. SRH was assessed by the question about general health from SF-36. Factors associated with SRH were investigated by multiple logistic regression analysis. Results Response-rate was > 90% at all time points. Overall, 40.2, 41.9, 40.7, 45.0 and 46.3% of the patients reported good SRH, 1 to 5 years after stroke. Performance in activities of daily living (ADL) was strongly associated with good SRH; 49.8 and 14.7% after 1 year in independent and dependent survivors respectively, p < 0.001. In independent survivors 1 year after stroke, good SRH was positively associated with female sex (OR = 2.0; p = < 0,001), physical activity (OR = 2.14; p = < 0,001), car driving (OR = 2.25; p = < 0,001), and negatively associated with age (OR = 0.99; p = < 0,001), pain (OR = 0.49; p = < 0,001), depression (OR = 0.30; p = < 0,001), and self-perceived unmet care needs (OR = 0.39; p = < 0,001). In dependent survivors, depression (OR = 0.23; p = < 0,001) and age (OR = 0.96; p = < 0,05), were negatively associated with good SRH 1 year after stroke. Similar patterns were observed throughout the follow-up. Conclusion The proportion stroke survivors reporting their health as good is slightly increasing over time. After stroke, SRH is associated with pain, depression, ability to perform activities and self-perceived unmet care needs, indicating that efforts to support stroke survivors in the chronic phase after stroke should concentrate on targeting these factors.
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| 6. |
- Eriksson, K., et al.
(författare)
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Stroke
- 2023
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Ingår i: Teamarbete i neurologisk vård. - Lund : Studentlitteratur AB. - 9789144158174 ; , s. 73-114
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 7. |
- Forsgren Gebring, Susanne, 1961-, et al.
(författare)
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To Attend or Not : The Reasoning Behind Nursing Students' Attendance at Lectures : A Qualitative Study
- 2021
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Ingår i: Scandinavian Journal of Educational Research. - : Informa UK Limited. - 0031-3831 .- 1470-1170. ; 65:3, s. 500-509
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Tidskriftsartikel (refereegranskat)abstract
- There is a rising tendency for students in higher education not to attend lectures. Therefore, the aim of the study was to describe the reasoning behind nursing students’ decisions on whether or not to attend lectures. This qualitative study was performed in a nursing education programme at a Swedish University. One hundred and thirty-one students participated. Data were collected through a questionnaire comprising open-ended questions. Qualitative content analysis was performed. The results are presented in eight categories: four concerning reasons for attending lectures and four concerning reasons for not attending lectures. Decisions, both to attend and to not attend lectures, were based on conscious choices guided by the students’ self-governing of their own personal needs for learning. © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 8. |
- Godskesen, Tove, et al.
(författare)
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Etik i samverkan
- 2023
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Ingår i: Samverkan i vården. - Stockholm : Liber. - 9789147145416 ; , s. 93-112
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Gustafsson, Anna, et al.
(författare)
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Oral health plays second fiddle in palliative care: an interview study with registered nurses in home healthcare
- 2021
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Ingår i: BMC Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Oral health is crucial to the experience of well-being, and symptoms from the mouth are common at the end of life. Palliative care aims to identify and treat symptoms early to avoid unnecessary suffering and is thus an important part of nursing in home healthcare. The aim of this study was to illustrate the professional reflections of registered nurses about oral health amongst patients in palliative care, who are being cared for in a home healthcare setting.Results: The results showed oral health in end-of-life care, to be an area marked by responsibility and ethical considerations. This was seen in all four partly overlapping themes that emerged through the analysis: Oral health is easily overlooked in palliative care, Oral health is everybody’s but in reality nobody’s responsibility, Patient integrity can be an obstacle for oral health, and Focus on oral health is urgently needed. The mouth is often not included as part of the daily basic care routine, by the registered nurses and the home healthcare staff, until the patient is near end of life. Moreover, neither does the patient tell about symptoms from the mouth. The interpreted whole indicates that the registered nurses had a bad conscience about not doing what they are actually responsible for and ought to do.Conclusion: The oral health of patients at the end of life risks being forgotten or falling between the cracks, due to the nurses’ scattered tasks and unclear delimitations between their, and other professionals’ responsibilities. The responsibilities of registered nurses are also ethically demanding, since their intent to respect the patient’s integrity could mean that in some cases the patients does not allow them to help with oral health. To reduce the risk that oral health is overlooked, clearer demarcation and guidelines on the division of responsibilities are required. Routines that clearly implement early and recurring oral health assessments in home healthcare as well as continuing education updates on oral health and oral care are also needed.
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| 10. |
- Palmryd, Lena, Doktorand, et al.
(författare)
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Integrity at end of life in the intensive care unit : a qualitative study of nurses' views.
- 2021
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Ingår i: Annals of Intensive Care. - : Springer Science and Business Media LLC. - 2110-5820. ; 11:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Integrity is a core value for delivering ethical health care. However, there is a lack of precision in defining what integrity is and how nurses understand it. In the setting of nurses caring for critically ill and dying patients in intensive care units (ICUs), integrity has not received much attention. Therefore, the aim of this study was to explore how nurses perceive and maintain the integrity of patients during end-of-life care in the ICU setting.METHODS: This study had a qualitative descriptive design. Data were collected using individual semi-structured interviews with 16 intensive care nurses working at ICUs in four Swedish hospitals. The data were analysed by applying qualitative content analysis.RESULTS: Five overall categories were explored: seeing the unique individual; sensitive to patient vulnerability; observant of patients' physical and mental sphere; perceptive of patients' religion and culture; and being respectful during patient encounters. Many nurses found it difficult to define integrity and to explain what respecting integrity entails in the daily care of dying patients. They often used notions associated with respect and patient-centred attitudes, such as listening and being sensitive or by trying to describe good care. Integrity was nonetheless seen as a central value for their clinical work and a precondition for ethical nursing practice. Some nurses were concerned about patient integrity, which is at risk of being "wiped out" due to the patient's illness/injury, unfamiliarity with the ICU environment and utter dependence on others for care. Protecting patients from harm and reducing patient vulnerability were also seen as important and a way to maintain the integrity of patients.CONCLUSIONS: The study results show that even though integrity is a fundamental ethical concept and a core value in nursing, ethical codes and guidelines are not always helpful in clinical situations in the end-of-life care of ICU patients. Hence, opportunities must regularly be made available for ICU nurses to reflect on and discuss ethical issues in terms of their decision-making and behaviour.
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| 11. |
- Rejnö, Åsa, 1970
(författare)
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Bråd död när patienten drabbats av stroke - Vårdares och närståendes upplevelser.
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract A large number of people die from stroke every year, many of them suddenly and unexpectedly as a result of acute stroke. Sudden and unexpected death influences the next of kin and carers as well as the care given to the patients but has not previous been studied within the context of stroke. Aim: The overall aim of the thesis was to describe how carers and next of kin experience patients’ death when the patient has been afflicted by stroke. Methods: In the thesis an interpretive qualitative approach has mainly been used. The studies (I-V) have emerged from one another as in a hermeneutic design. An inductive design (I, II, IV, V) and a deductive design (III) have been used. Data were collected with individual interviews (I, III, IV) and individual interviews together with a form (III). Focus group interviews have also been used (II). Participants have been carers on stroke units; ten registered nurses (I) and nineteen respective fifteen members of stroke teams; physicians, registered nurses and enrolled nurses (II, III) together with twelve next of kin to eight patients (IV, V). For analysis of data mainly interpretive methods were utilized; hermeneutic textual interpretation (I), interpretive content analysis (II) and a combined qualitative and quantitative content analysis (III). In addition narrative thematic analysis (IV) and narrative structural analysis (V) were also used. Results: Unexpected sudden death when the patient has been afflicted by stroke can be understood as the unexpected force that intervenes without the patient, the next of kin or the carers being prepared (I). The sudden onset puts the carers in ethically demanding situations through the demands of immediate caring for the patient and also the support the next of kin needs, required by the urgent incident (I - III). The ethical problems became most evident in information, decisions about care and caring, together with support for the next of kin (II). The carers did not use ways of handling ethically problematic situations in the same way as they would have preferred. Mutual trust, both within the teams and with the next of kin constitutes the core for the carers ways of handling the urgent situation and the ethical problems guided by putting what’s best for the patients first (III). The studies with the next of kin reveal how complex and elusive the situation might be perceived. The next of kin’s experiences of the unexpected sudden death were marked by the uncertainty in the situation and to be left to the mercy of the unexpected (IV). The attention of the next of kin was clearly directed to the patient to the extent that they even forgot themselves and their own needs. The urgency shows itself as influencing the way the next of kin experienced time, how their attention was directed during vigil but it also affected their memory so it behaved in a betraying and contradictory way (IV). Conclusion: Through the results death caused by acute stroke emerge as unexpected sudden death. Unexpected sudden death shows as death calling for urgent actions, brings a potential power to violate the dignity of the afflicted, creating ethical problems that the carers have to deal with and have the power to completely invade the next of kin’s present life. The unexpected sudden death brings with it an element of uncertainty that all involved in the situation, the patient, their next of kin and the carers have to address themselves to. Bereavement counselling could be a way to support the next of kin. The methods of this thesis have given knowledge of narrative structure and how it can be utilized to develop stories could be used as a tool for caregivers support the next of kin. Keywords: carers, combined qualitative and quantitative content analysis, content analysis, dignity, hermeneutic textual analysis, narratives, next of kin, qualitative methods, sudden and unexpected death, uncertainty, stroke, stroke team
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| 12. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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Changes in functional outcome over five years after stroke
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Data on the long-term time course of poststroke functional outcome is limited. We investigated changes in functional outcome over 5 years after stroke in a hospital based cohort. Materials and Methods Consecutive patients who were independent in activities of daily living (ADL) and admitted to a Stroke Unit at Skaraborg Hospital, Sweden for a first acute stroke from 2007 to 2009 (n = 1,421) were followed-up after 3 months and thereafter annually over 5 years using a postal questionnaire. Clinical variables at acute stroke and 3 months post stroke were obtained from the Swedish Stroke Register. ADL dependency was defined as dependence in dressing, toileting or indoor mobility. Results The proportions of survivors who reported ADL dependency remained stable throughout follow-up (19%-22%). However, among survivors who were ADL independent at 3 months, about 3% deteriorated to dependency each year. Deterioration was predicted by age (HR 1.11; 95% CI 1.08-1.13), diabetes (HR 1.65; 95% CI 1.12-2.44), NIHSS score (HR 1.07; 95% CI 1.04-1.10), and self-perceived unmet care needs one year post stroke (HR 2.01; 95% CI 1.44-2.81). Transitions from ADL dependency to independence occurred mainly during the first year post stroke. Improvement was negatively predicted by living alone before stroke (HR 0.41 95% CI 0.19-0.91), NIHSS score (HR 0.90; 95% CI 0.86-0.95) and ischemic stroke (vs. hemorrhagic stroke), HR 0.39; 95% CI 0.17-0.89. Conclusion Transitions between ADL independence and dependency occur up to 5 years after stroke. Some of the factors predicting these transitions are potentially modifiable.
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| 13. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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Combining Qualitative and Quantitative Content Analysis : A Way to Utilize Different Types of Data in Research of Ethical Problems in Acute Stroke Care
- 2017
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Ingår i: Sage Research Methods. - 1 Oliver's Yard, 55 City Road, London EC1Y 1SP United Kingdom : Sage Publications. - 9781526424877
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Annan publikation (refereegranskat)abstract
- Most people who experience an acute stroke survive, but a substantial number die as a result of it. Stroke is, according to the World Health Organization, the second leading cause of death globally. Research in the area of stroke has previously been less focused on situations when patients die due to an acute stroke in favor of research on medical treatments, rehabilitation, and living with the aftermath of stroke. Research focusing on ethical problems in the care of dying patients can be found both in general and in specific care contexts such as palliative, intensive, and non-hospital care, but knowledge concerning ethical problems in the area of stroke, or arising as a result of acute stroke, was lacking. Both these subjects, death due to acute stroke and ethical problems, were combined for the first author's (Å. R.) thesis. Individual interviews with stroke team members were performed guided by their answers in a three-part form filled out before the interviews. This case study provides an account of how qualitative and quantitative content analysis was used in combination to deepen the results from the study utilizing data obtained from both the three-part forms and the interviews performed. The case highlights some challenges faced when combining the two different types of data. It also gives examples of how the analysis was performed when combining qualitative and quantitative content analysis to support and further explore data.
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| 14. |
- Rejnö, Åsa, 1970, et al.
(författare)
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Communication as a key in creating dignified encounters in unexpected sudden death by stroke
- 2018
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Ingår i: Palliative Medicine : A Multiprofessional Journal. Vol. 32, Suppl. 1. Abstract P253. - : SAGE Publications. - 0269-2163 .- 1477-030X.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Communication is present in all encounters in care and of importance to create a caring relation. A good relation between patients, next of kin and health care staff is crucial, not least in times of rapid changes in health and when questions about life and death are at stake such as in palliative care. The aim of this study was to illuminate communication and its meaning in unexpected sudden death with stroke as example, as experienced by next of kin and stroke team members. The design of the study is a secondary analysis of qualitative data as proposed by Heaton, from a project on unexpected sudden death by stroke. Material from four interview studies from the project with all in all twelve next of kin of patients who had died due to the acute stroke during hospital stay and twenty-seven stroke team members from stroke units were utilized. Data were analysed with qualitative content analysis according to Krippendorf and Baxter. The analysis reveals communication as the foundation for care and caring. The overarching theme foundation for dignified encounters in care is built up by six themes illuminating the meaning of communication in unexpected sudden death by stroke; creating relationship, information enabling understanding, giving ground for unanimity, personalizing the patient, preconditioning for decisions and giving and experiencing support. Communication and its meaning in unexpected sudden death as experienced by next of kin and stroke team members enables dignified encounters in care. Through the next of kin knowledge about the severely ill patient, possibility to preserve and uphold absolute dignity and dignity of identity is given, expressed through respect for the patient’s will and desire and derived through talks between carers and next of kin. Communication is one key to create dignified encounters in palliative care when unexpected sudden death occurs. It gives ground for unanimity about care and possibility to maintain and uphold dignity in care when acknowledging the next of kin familiarity with the patient. This gives ground for a person centeredness in palliative care despite the patients sever illness.
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| 15. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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Communication, the Key in Creating Dignified Encounters in Unexpected Sudden Death - With Stroke as Example
- 2019
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Ingår i: Indian Journal of Palliative Care. - 0973-1075 .- 1998-3735. ; 25:1, s. 9-17
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to illuminate the communication and its meaning in unexpected sudden death with stroke as example, as experienced by stroke team members and next of kin. Subject and Methods: The study has a qualitative design. Secondary analysis of data from four previous interview studies with stroke team members; physicians, registered nurses, and enrolled nurses from the stroke units (SU) and next of kin of patients who had died due to acute stroke during hospital stay were utilized. Results: Communication is revealed as the foundation for care and caring with the overarching theme foundation for dignified encounters in care built-up by six themes illuminating the meaning of communication in unexpected sudden death by stroke. Conclusion: Communication shown as the foundation for dignified encounters in care as experienced by stroke team members and next of kin enables the patient to come forth as a unique person and uphold absolute dignity in care. Acknowledging the next of kin's familiarity with the severely ill patient will contribute to personalizing the patient and in this way be the ground for a person centeredness in care despite the patients' inability to defend their own interests. Through knowledge about the patient as a person, the foundation for dignified care is given, expressed through respect for the patient's will and desires and derived through conversations between carers and next of kin.
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| 16. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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Creating dignified encounters in unexpected sudden death by stroke : communication as the key
- 2018
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Ingår i: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 3:1_suppl., s. -292
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background and Aims: Communication is present in all encounters in stroke care and of importance to create a caring relation. A good relation between patients, next of kin and health care staff is crucial, not least in unexpected sudden death by stroke. The aim of the study was to illuminate communication and its meaning in unexpected sudden death by stroke, as experienced by next of kin and stroke team members. Method: The design is a secondary analysis of qualitative data from a project on unexpected sudden death by stroke. Material from four interview studies from the project with all in all twelve next of kin of patients who had died due to the acute stroke during hospital stay and twentyseven stroke team members from stroke units were utilized. Data were analysed with qualitative content analysis. Results: The analysis reveals communication as the foundation for care and caring in acute stroke care. The overarching theme foundation for dignified encounters in care is built up by six themes illuminating the meaning of communication in unexpected sudden death by stroke. Conclusion: Communication and its meaning in unexpected sudden death by stroke as experienced by next of kin and stroke team members is one key to create dignified encounters in care when unexpected sudden death by stroke occurs. It gives ground for unanimity about care and possibility to maintain and uphold dignity in care when acknowledging the next of kin familiarity with the patient, giving ground for a person centeredness despite the patients sever illness.
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| 17. |
- Rejnö, Åsa, 1970, et al.
(författare)
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Creating dignified encounters in unexpected sudden death by stroke –communication as a key
- 2018
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Ingår i: 4th European Stroke Conference ESOC in Gothenburg, 16-18 May. Poster presentation.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Communication is present in all encounters in stroke care and of importance to create a caring relation. A good relation between patients, next of kin and health care staff is crucial, not least in unexpected sudden death by stroke. The aim of the study was to illuminate communication and its meaning in unexpected sudden death by stroke, as experienced by next of kin and stroke team members. The design is a secondary analysis of qualitative data from a project on unexpected sudden death by stroke. Material from four interview studies from the project with all in all twelve next of kin of patients who had died due to the acute stroke during hospital stay and twenty-seven stroke team members from stroke units were utilized. Data were analysed with qualitative content analysis. The analysis reveals communication as the foundation for care and caring in acute stroke care. The overarching themefoundation fordignified encounters in careis built up by six themes illuminating the meaning of communication in unexpected sudden death by stroke.
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| 18. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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Dignity at stake : Caring for persons with impaired autonomy
- 2020
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 27:1, s. 104-115
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Tidskriftsartikel (refereegranskat)abstract
- Dignity, usually considered an essential ethical value in healthcare, is a relatively complex, multifaceted concept. However, healthcare professionals often have only a vague idea of what it means to respect dignity when providing care, especially for persons with impaired autonomy. This article focuses on two concepts of dignity, human dignity and dignity of identity, and aims to analyse how these concepts can be applied in the care for persons with impaired autonomy and in furthering the practice of respect and protection from harm. Three vignettes were designed to illustrate typical caring situations involving patients with mild to severely impaired autonomy, including patients with cognitive impairments. In situations like these, there is a risk of the patient's dignity being disrespected and violated. The vignettes were then analysed with respect to the two concepts of dignity to find out whether this approach can illuminate what is at stake in these situations and to provide an understanding of which measures could safeguard the dignity of these patients. The analysis showed that there are profound ethical challenges in the daily care of persons with impaired autonomy. We suggest that these two concepts of human dignity could help guide healthcare professionals to develop practical skills in person-centred, ethically grounded care, where the patient's wishes and needs are the starting point.
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| 19. |
- Rejnö, Åsa, 1970, et al.
(författare)
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Ethical problems: In the face of sudden and unexpected death.
- 2012
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Ingår i: Nursing Ethics. - London : SAGE Publications. - 0969-7330 .- 1477-0989. ; 19:5, s. 642-653
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Tidskriftsartikel (refereegranskat)abstract
- When people die suddenly and unexpectedly ethical issues often come to the fore. The aim of the study was to describe experiences of members of stroke teams in stroke units of ethical problems and how the teams manage the situation when caring for patients faced with sudden and unexpected death from stroke. Data were collected through four focus group interviews with 19 team members in stroke-unit teams, and analysed using interpretive content analysis. Three themes emerged from the analysis characterized by information, decisions about care and support for the next-of-kin in the changing and uncertain situation, with mutual trust as the core. Mutual trust, both within the stroke team and with next-of-kin was seen by the stroke-team members as a way of handling ethical problems by administering care with the patient's best interest at heart.
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| 20. |
- Rejnö, Åsa, 1970, et al.
(författare)
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Kommunikation, nyckeln till att skapa värdiga möten vid bråd död-med stroke som exempel.
- 2018
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Ingår i: 5:e nationella konferensen för palliativ vård i Stockholm 21-22 mars. Poster presentation..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Kommunikation är närvarande i alla vårdmöten och av vikt för att skapa en vårdande relation. En god relation mellan patienter, närstående och vårdpersonal är viktig, inte minst vid hastiga förändringar i hälsan eller när livet står på spel som vid palliativ vård. Syftet med studien var att belysa kommunikationens betydelse vid bråd död med stroke som exempel, så som det upplevs av närstående och stroketeamets medlemmar. Data från fyra tidigare studier med tolv närstående till patienter som dött en bråd död till följd av stroke och sammanlagt tjugosju stroketeammedlemmar användes för sekundäranalys och analyserades med kvalitativ innehållsanalys. Kommunikation stiger fram som vårdens och vårdandets fundament vid bråd död. Det övergripande temat ”fundamentet för värdiga möten i vården” byggs upp av sex teman som belyser kommunikationens betydelse vid bråd död vid stroke; att skapa en relation, information möjliggör förståelse, ge grund för enighet, gör patienten till person, förutsättning för beslut och ge och känna stöd.
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| 21. |
- Rejnö, Åsa, 1970, et al.
(författare)
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Next of kin's experiences of sudden and unexpected death from stroke - a study of narratives.
- 2013
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Ingår i: BMC nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Death always evokes feelings in those close to the afflicted person. When death comes suddenly the time for preparation is minimal and the next of kin have to cope with the situation despite their own sorrow. The suddenness is found to be stressful for the next of kin and communication both with healthcare professionals and information about what has happened has been found helpful. The aim of this study was to illuminate the experiences of next of kin from the sudden and unexpected death of a relative from acute stroke.
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| 22. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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Reasoning about truth-telling in end-of-life care of patients with acute stroke
- 2017
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 24:1, s. 100-110
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as 'incompetent' decision makers regarding their own care. OBJECTIVE: The aim of the study was to deepen the understanding of stroke team members' reasoning about truth-telling in end-of-life care due to acute stroke. RESEARCH DESIGN: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. PARTICIPANTS AND RESEARCH CONTEXT: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. FINDINGS: The main findings were the team members' dynamic movement between the categories 'Truth above all' and 'Hide truth to protect'. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. DISCUSSION: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient's best interest first. CONCLUSION: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.
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| 23. |
- Rejnö, Åsa, 1970, et al.
(författare)
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Strategies for handling ethical problems in end of life care: obstacles and possibilities
- 2015
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 22:7, s. 778-789
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Tidskriftsartikel (refereegranskat)abstract
- Background: In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members' experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. Objective: The aim of the study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. Research design: A qualitative method with combined deductive and inductive content analysis was utilized. Participants and research context: Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. Findings: All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept the patient's best interests as a starting point for the carers' ethical reasoning. Conclusion: The concept the patient's best interests used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions.
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| 24. |
- Rejnö, Åsa, 1970, et al.
(författare)
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Strategies for handling ethical problems in sudden and unexpected death
- 2013
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 20:6, s. 708-722
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Tidskriftsartikel (refereegranskat)abstract
- How ethical praxis is shaped by different contexts and situations has not been widely studied. We performed a follow-up study on stroke team members' experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. A number of ways for handling ethical problems emerged, which we have now explored further. Data were collected through a three-part form used as base for individual interviews with 15 stroke team members and analyzed using both quantitative and qualitative content analysis. In the analysis, the approaches in the form were condensed into strategies, and the two different ways those strategies were preferred and used by the team members were shown. Hindrances perceived by the team members to impede them from working the preferred way were also revealed and grouped into eight categories.
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| 25. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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Strokerehabilitering ur ett vårdkedjeperspektiv
- 2023
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 120
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Rehabilitation is a key aspect of the treatment of stroke patients, both acute and in later phases. The patients' needs varies between individuals and over time. Several skills and methods and different professionals working together in teams, as well as coordination along the entire chain of care, are required in order to meet those different needs. Early supported discharge, ESD, is recommended for patients with mild to moderate stroke. Stroke is a chronic disease requiring lifelong structured follow-up focusing not only on medical treatment but also on lifestyle, mental and physical well-being and activity and participation.
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| 26. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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"StrokeSverige" lär i webbaserad kompetensutbildning
- 2018
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Ingår i: VILÄR Abstraktbok. - Trollhättan : Högskolan Väst. - 9789187531460 - 9789187531477 ; , s. 4-5
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BakgrundVerksamhetsintegrerat lärande omfattar lärande som sker integrerat mellan akademi och arbetsliv. Ofta är integrationen sådan att arbetslivet integreras i akademin. Det omvända är inte lika vanligt. Strokeenhetsvård är sedan 1980-talet ett internationellt evidensbaserat vårdkoncept som minskar mortalitet, institutionsboende och beroende i ADL efter stroke. För att en verksamhet ska få kalla sig strokeenhet ingår att vården ska bedrivas av ett multidisciplinärt team med expertkunnande inom stroke och rehabilitering. Strokekompetensutbildning med både teoretiska och praktiska moment som ger detta expertkunnande ges sedan av STROKE Riksförbundet och drivs lokalt. Antalet som genomgår utbildningen minskar på grund av vårdens pressadef örhållanden vilket gett svårigheter att organisera och driva utbildningen lokalt. Från centralt håll har oro uttryckts då strokekompetensen genom detta minskar vilket potentiellt leder till sämre vård. Syftet med presentationen är att visa hur lokalt drivna utbildningar i arbetslivet kan webbaseras i samarbete med akademin för att möjliggöra personalgruppers möjlighet till kompetenshöjning.MetodUtbildningen har digitaliserats för att ge förutsättningar för jämlik vård. Alla teoretiska moment har gjorts som filmade föreläsningar av personer med spetskompetens inom sitt område och en tredelad examination har tagits fram som säkerställer att utbildningen ger jämn och hög kvalitet.ResultatUtbildningen som använder det flippade klassrummet som teoretisk modell är nu en poänggivande högskoleutbildning som ges av Umeå universitet där teambased learning och constructive alignment varit ledord för uppbyggnaden. Utbildningen omfattar filmade föreläsningar, quiz och webbaserad examination som genomförs via lärplattformen, samt material för träffar där praktiska moment ingår som ordnas lokalt av respektive verksamhet, liksom material för såväl individuell examination som gruppexamination. Utöver detta finns länkar till referensmaterial samt fördjupningsmaterial.DiskussionMed noggrann planering, förankring och tydliga pedagogiska utgångspunkter kan utbildning utvecklas i samarbete mellan offentlig sektor och universitet/högskolor. Utbildningen är exempel på ett initiativ från arbetslivet där akademin är tydligt integrerad för att möjliggöra lärande för personer i arbetslivet. Genom digitaliseringen ges möjlighet för verksamheter att erbjuda personal utbildning inommer flexibla ramar och på tider som passar dem jämfört med traditionella kurser inom högre utbildning. Konceptet kan potentiellt användas för många verksamheter och visar på möjligheterna med digitalisering av högre utbildning för att nå ut till arbetslivet
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| 27. |
- Rejnö, Åsa, 1970, et al.
(författare)
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The narrative structure as a way to gain insight into peoples' experiences : One methodological approach
- 2014
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 28:3, s. 618-626
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Tidskriftsartikel (refereegranskat)abstract
- The narrative method is used in healthcare research, mostly in data collection but also in the analysis. Narrative approaches draw attention to how people tell about and create meaning of experiences. The aim of the article was to examine the narrative structure, the elements in the structure and their function and how these can be used in research to gain insights into experiences. Examples are taken from a material of narratives from a study where next of kin were asked to narrate their experiences of sudden and unexpected death from stroke. The narratives had a clear beginning, midpoint and ending. In the beginning, orientation of the narrated events was given. The narrated events were told to have a turning point constituted of complicating actions that lead to a resolution that solved the narrated event. The narratives were built up by multiple recaps into the narrated events and also consisted of asides - side narratives and flashbacks - events back in time. Use of a narrative structure can contribute with valuable information that might be missed with other analysis. The analysis can be used on its own, as a complement to other narrative analysis or even as a complement to other qualitative analysis. © 2013 Nordic College of Caring Science.
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| 28. |
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| 29. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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WebbSKU – Nätbaserad nationell stroketeamutbildning
- 2020
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Konferensbidrag (refereegranskat)abstract
- Stroke är en folksjukdom som drabbar 25000 svenskar årligen. Vårdkedjan innefattar omhändertagande före ankomst till sjukhus, under sjukhusvistelse samt efter utskrivning och sköts av interdisciplinära team. En utmaning är det stora behovet av kunskap hos all personal, speciellt i senare skede. Hösten 2018 sjösattes därför en ny nationell utbildning utvecklad för alla strokevårdsteam i Sverige. Den tidigare utbildningen som genomfördes lokalt på många enheter var mycket resurskrävande, hade en trend av minskat deltagande och spretigt innehåll samt skilde sig avseende examinationen (Rejnö, 2016) Målbilden för utbildningen, benämnd WebbSKU (WebbStrokeKompetensUtbildning, 2020) som ges som uppdragsutbildning (3,0 hp) inom Umeå universitet, var att öka antalet deltagare, säkra kvaliteten samt göra utbildningen nationellt enhetlig. Utbildningen skulle även vara lättillgänglig och flexibel samt stärka teamkänslan. En nationell grupp bildades som enades om kursinnehåll och en mindre grupp som arbetade med genomförandet. Tydliga pedagogiska utgångspunkter var centralt. Med utgångspunkt i konstruktiv länkning har det flippade klassrummet använts genomgående. Utbildningen ska pågå under minst ett år och ske parallellt med arbete i den egna strokeverksamheten. De teoretiska delarna sker via nätet som förberedelse för kursens fyra obligatoriska teamträffar där teambaserat lärande är den pedagogiska utgångspunkten. Deltagarna ska komma förberedda och bearbeta olika problem gemensamt i teamet (Michaelsen & Sweet, 2008). För produktion av kursmaterial inbjöds expertis från hela strokekedjan. Totalt producerades 66 filmer omfattande totalt ca 700 minuter film med tillhörande flervalsfrågor som instuderings- och examinationsfrågor. För teamträffarna skapades case, diskussionsfrågor samt praktiska övningar. Examinationen består av tre delar. En del sker i form av ett individuellt test i kursens webbplattform. De två andra delarna sker under sista fysiska sammankomsten; individuell skriftlig examination samt teamexamination. Aktivt deltagande vid de fysiska teamträffarna krävs. Kursen har nu drygt 1000 deltagare från sjukhusens strokeenheter, primärvård och kommun spridda över landet och 300 har slutfört utbildningen. Utbildningens pedagogiska upplägg har utvärderats med gott resultat. Framgångsfaktorer har varit att innehåll, genomförande och pedagogiska utgångspunkter varit tydliga. Kanske mest centralt har varit att det funnits nyckelpersoner som drivit processen framåt och lyckats förankra arbetet i alla led. Svårigheterna var att enas om gemensamt innehåll passande för samtliga yrkeskategorier samt att skapa en struktur för hur materialet ska produceras på enhetligt sätt. Lärdomarna är att med bra förankring och planering samt tydliga pedagogiska utgångspunkter är det fullt möjligt att ta fram en helt ny flexibel nationell utbildning som bygger på en tydlig idé om arbetsintegrerat lärande både i framtagande och genomförande.
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| 30. |
- Seitl, Camilla, et al.
(författare)
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Marketing of educational programs : a study of Swedish universities through presented images
- 2022
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Ingår i: Journal of Marketing for Higher Education. - : Taylor & Francis Group. - 0884-1241 .- 1540-7144. ; , s. 1-19
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Tidskriftsartikel (refereegranskat)abstract
- Marketing of higher education through images sends a messageabout the targeted audience. Our aim was to investigate normsand representation in marketing images on the websites of higher education institutions. Critical visual methodology was used to study images from Swedish higher education programs in engineering, economics, and nursing. The results show are production of already existing notions on societal norms and educational structure, i.e. that typical male- and female-dominated programs are still cemented in their thinking about the students targeted. Present study show that there is a potentially untapped opportunity to influence future inequality in both the labor market and in higher education throughmarketing. Imaging in marketing of higher education should therefore be well thought through and permeated by the pursuit of diversity in visual representations, so that stereotypical and norm-preserving images are avoided. Images that are more inclusive and show a greater variety of motif are needed.
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