| 1. |
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| 2. |
- Falk Johansson, Marcus, et al.
(författare)
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A comparison of spouse and non-spouse carers of people with dementia : a descriptive analysis of Swedish national survey data
- 2021
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundBeing an informal carer of a person with dementia (PwD) can have a negative effect on the carer's health and quality of life, and spouse carers have been found to be especially vulnerable. Yet relatively little is known about the care provided and support received by spouse carers. This study compares spouse carers to other informal carers of PwDs regarding their care provision, the support received and the psychosocial impact of care.MethodsThe study was a cross-sectional questionnaire-based survey of a stratified random sample of the Swedish population aged 18 or over. The questionnaire explored how much care the respondent provided, the support received, and the psychosocial impact of providing care. Of 30,009 people sampled, 11,168 (37.7%) responded, of whom 330 (2.95%) were informal carers of a PwD.ResultsIn comparison to non-spouse carers, spouse carers provided more care more frequently, did so with less support from family or the local authority, while more frequently experiencing negative impacts on their social life and psychological and physical health. Spouse carers also received more carer support and more frequently experienced a closeness in their relationship with the care-recipient.ConclusionsSpouse carers of PwD differed from non-spouse carers on virtually all aspects of their care situation. Policy and practice must be more sensitive to how the carer-care-recipient relationship shapes the experience of care, so that support is based on an understanding of the individual carer's actual needs and preferences rather than on preconceptions drawn from a generalised support model.
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| 3. |
- Falk Johansson, Marcus
(författare)
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For better and for worse, till death do us part : Support needs of persons caring for a co-habitant spouse or partner with dementia
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Caring for a partner with dementia is typically stressful and challenging. Such carers can become overwhelmed by their responsibilities, neglecting their personal needs as well as their need for support as a carer. Receipt of support is low among spouse carers, while the support received may not be appropriate for their needs. More research is required to develop effective support for this important group of carers. Overall aim: To explore the life- and caring situation of spouses caring for a partner with dementia and to increase the understanding of their needs and experiences of support. Methods: This thesis consists of four papers (I-IV): I, Analysis of data on informal carers of persons with dementia (n=330) from a cross-sectional survey of a stratified random probability sample of adults in Sweden (N=30 009); II and III, a cross-sectional survey of a convenience sample of people aged 65 years or older caring for a partner with dementia (N=175). Hierarchal regression models explored positive and negative aspects of caring (II), and principal component analysis examined carers’ perceptions of support (III); IV, a thematic analysis of semi-structured telephone interviews with 24 spouse carers, exploring their caring experiences. Results: Compared to other carers, spouses of persons with dementia received less support from family or local authorities, while experiencing more negative impact from caring (I). Negative impact from, and positive value of, caring among spouses, were associated with different aspects of their situation (II). Support was perceived as important, yet spouses may not perceive support to themselves as more important than support to their partner (III). Spouse carers experienced a loss of self and felt confined in their situation, finding it hard to distinguish between their needs and those of their partner (IV). Conclusion: Compared to other carers, spouses are more exposed to the negative aspects of caring, while being less supported. Support to spouse carers should focus on strengthening the positive aspects of caring to mitigate the negative aspects. As a spouse’s needs are conditioned by their partner’s, support should focus on spouses’ personal needs and their partners’ care needs.
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| 4. |
- Falk Johansson, Marcus, et al.
(författare)
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Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons With Dementia in Sweden
- 2021
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Ingår i: Family Caregiving and Persons with Dementia. - : Oxford University Press (OUP). ; , s. 154-
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Konferensbidrag (refereegranskat)abstract
- As welfare providers struggle to meet the care needs of persons with dementia (PwDs), most of their needs are being met by a family carers, most often a spouse. The situation for spouse carers is unique, e.g., with grief, loneliness and loss of intimacy combining with stress and poor health. Research is needed to develop adequate support for spouse carers based on evidence of what influences negative and positive outcomes of care. The present study investigated psychosocial correlates of spouse carers’ (i) negative impact and (ii) positive value of caring. Data from a cross-sectional survey of 165 spouse carers community-resident in Sweden was analysed in two hierarchical regression models to predict negative impact and positive value of caring. Results found that negative impact and positive value were explained by different variables, significant predictors for negative impact included carer stress, health, and emotional loneliness, and change in intimacy with the care-recipient, while positive value was predicted by mutuality, change in closeness to the care-recipient and quality of support. Negative impact and positive value shared variance of only 17.2%. Thus, negative impact and positive value represent different aspects of the carer situation. Consequently, support needs to target several aspects in carers’ life, aiming to; facilitate for spouses to manage PwD’s impairment, increase emotional support while also strengthening the relationship between carer and PwD to reduce negative impact while increasing positive value.
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| 5. |
- Falk Johansson, Marcus, et al.
(författare)
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Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:3
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Tidskriftsartikel (refereegranskat)abstract
- (1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse car-ers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.
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| 6. |
- Falk Johansson, Marcus, et al.
(författare)
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Spouse’s supported and unsupported care of persons with dementia : Home care and the informal caregiver’s perspective
- 2021
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Konferensbidrag (refereegranskat)abstract
- Introduction. Caring for a person with dementia (PWD) can negatively affect the quality of life of informal carers, and research suggests spouse carers, often being older, are particularly vulnerable and requiring of support. Yet the formal support offered is rarely tailored to meet the needs of spouse carers of PWDs. The aim of the present study was to compare spouse carers to other carers of PWDs on a range of factors, as a foundation for a better understanding of their support needs. Material and methods. Cross-sectional survey. In late 2018 a random stratified sample was taken of the Swedish population aged 18 and older. Of 30,009 people contacted, 11,168 completed and returned a questionnaire or completed a web-based version, a response rate of 37.3%. The questionnaire contained questions on whether the respondent was an informal carer for another person, the extent of care provided, contact with and support received from formal services, and impacts of care.Results. Of the respondents, 378 (3.38%) were carers of PWDs, of whom 107 (28.3%) were spouse carers. Spouse carers compared to other carers of PWD provide care more intenselyand are more informed on their right to support from local authorities. While more often being offered formal support in their carer role, they are less supported in providing care and report a higher negative impact (for all p<.05). Conclusions. Formal support is offered to spouse carers in their carer role, but might not be tailored to their specific needs of support.
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| 7. |
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| 8. |
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| 9. |
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| 10. |
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| 11. |
- Håkansson Eklund, Jakob, 1971-, et al.
(författare)
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Same same or different? A review of reviews of person-centred and patient-centred care.
- 2019
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; :1, s. 3-11
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts.MethodsA synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis.ResultsThe analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life.ConclusionsWhile there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals.Practice implicationsClarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.
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| 12. |
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| 13. |
- Håkansson Eklund, Jakob, et al.
(författare)
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Toward a consensus on the nature of empathy : A review of reviews
- 2021
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 104:2, s. 300-307
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Forskningsöversikt (refereegranskat)abstract
- Objective: The objective was to provide a synthesis of already synthesized literature on empathy in order to identify similarities and differences among conceptualizations.Methods: A review of reviews was conducted to locate synthesized literature published between January 1980 and December 2019. Two authors screened and extracted data, and quality-appraised the sources. A total of 52 articles deemed relevant to this overview were synthesized using thematic analysis.Results: The analysis resulted in four themes found in most empathy conceptualizations. In empathy, the empathizer (1) understands, (2) feels, and (3) shares another person’s world (4) with self-other differentiation.Conclusions: Most writings about empathy begin by claiming that there is far from a consensus on how empathy should be defined. This article shows a developing consensus among neuroscientists, psychologists, medical scientists, nursing scientists, philosophers, and others that empathy involves understanding, feeling, sharing, and self-other differentiation.Practice implications: A clarification of the content of empathy may assist practitioners and researchers in avoiding confusion regarding the meaning of the concept, as well as in developing and measuring the relevant aspects of the concept.
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| 14. |
- Lovenmark, Annica, et al.
(författare)
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That Mr. Alzheimer ... you never know what he's up to, but what about me? : A discourse analysis of how Swedish spouse cargivers can make their subject positions understandable and meaningful
- 2018
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs.
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| 15. |
- Marmstål Hammar, Lena, 1979-, et al.
(författare)
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Being ‘alone’ striving for belonging and adaption in a new reality : The experiences of spouse carers of persons with dementia
- 2021
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Ingår i: Dementia. - : Sage Publications. - 1471-3012 .- 1741-2684. ; 20:1, s. 273-290
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Tidskriftsartikel (refereegranskat)abstract
- Background and aimSpouse carers of a person with dementia report feeling lonely and trapped in their role, lacking support and having no time to take care of their own health. In Sweden, the support available for family carers is not specialised to meet the needs of spouse carers of people with dementia. The aim of the study described in this paper was to explore spouse carers’ experiences of caring for a partner with dementia, their everyday life as a couple and their support needs.MethodsNine spouse carers of a partner with dementia living at home were recruited through a memory clinic and a dementia organisation. Semi-structured interviews were conducted with the participants, focusing on their experiences of providing care, their support needs in relation to their caring situation, their personal well-being and their marital relationship. The interviews were transcribed and underwent qualitative content analysis.ResultsThe analysis resulted in one overall theme Being ‘alone’ striving for belonging and adaption in a new reality, synthesized from four sub-themes: (1) Being in an unknown country; (2) Longing for a place for me and us; (3) Being a carer first and a person second; and (4) Being alone in a relationship.ConclusionsThe training of care professionals regarding the unique needs of spouse carers of people with dementia needs improvement, with education, in particular, focusing on their need to be considered as a person separate from being a carer and on the significance of the couple’s relationship for their mutual well-being.
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| 16. |
- Marmstål Hammar, Lena, et al.
(författare)
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Ethical aspects of caregivers' experience with persons with dementia at mealtimes
- 2016
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Ingår i: Nursing Ethics. - : Hodder Education. - 0969-7330 .- 1477-0989. ; 23:6, s. 624-635
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Persons with dementia are at risk of malnutrition and thus in need of assistance during mealtimes. Research suggest interventions for caregivers to learn how to facilitate mealtimes and eating, while other suggest a working environment enabling the encounter needed to provide high-quality care. However, the phenomenon of caring for this unique population needs to be elucidated from several perspectives before suggesting suitable implications that ensure their optimal health.OBJECTIVES: To illustrate the meanings within caregivers' experiences of caring for persons with dementia during mealtime situations. We also measured weight and food intake among individuals with dementia to explain better the phenomenon of caring for them during mealtimes.METHODS: Mixed method including focus group interviews with seven caregivers analyzed using phenomenological hermeneutics. In addition, for nine persons with dementia, weight and food intake were collected and descriptive statistics were calculated.ETHICAL CONSIDERATIONS: Ethical review was obtained from an ethics committee, and all caregivers signed a consent form after being informed on the issue of research ethics. Relatives for persons with dementia were informed and signed the consent. In addition, throughout the study, the persons' expressions were observed aiming to respect their vulnerability, integrity, and dignity.FINDINGS: One theme emerged from interviews (struggling between having the knowledge and not the opportunity), which was built upon three subthemes (being engaged and trying; feeling abandoned and insufficient; being concerned and feeling guilty). Seven of nine persons with dementia lost a minimum of 1.3 kg of weight and ate a maximum of 49.7% of the food served.CONCLUSION: Caregivers struggle because they have knowledge about how to provide high-quality care but are unable to provide this care due to organizational structures. The weight loss and insufficient eating among the persons with dementia may support this conclusion. Sufficient time for adequate care should be provided.
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| 17. |
- Marmstål Hammar, Lena, 1979-, et al.
(författare)
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Exhausted and trapped in isolation. Caring for a spouse with dementia during the Covid-19 pandemic
- 2021
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Ingår i: Family Caregiving (HS Poster). - : Oxford University Press (OUP). ; , s. 800-801
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Konferensbidrag (refereegranskat)abstract
- Even before the Covid-19 pandemic, spouse carers of persons with dementia (PwDs) found their care responsibilities overwhelming and had little time to focus on their own lives. To minimize the risk of being infected with Covid-19, older persons are recommended to self-isolate in their homes, while formal support such as respite care and day care centers are withdrawn. This study involved semi-structured interviews with 24 spouse carers of community-living PwDs, with the aim of describing their situation during the pandemic. The interviews were analyzed with qualitative content analysis. Results revealed that they commonly declined help because of the perceived risk of their spouse being infected with Covid-19 and thus also possibly causing their death. They described feelings of being trapped in their situation, as they experienced having no choice than take all responsibility for the care of their partner themselves, with cost of being unable to take necessary breaks. This was described as making an already strained situation almost unbearable, which led to conflicts with their partner. However, the spouses also described positive aspects due to strategic changes in health and social care provision to prevent the spread of the virus, such as greater staff continuity in home care services, and patient transportation service. These made the PwD less stressed and influenced their everyday life positively. It could be concluded that the extent burden during the Covid-19 pandemic calls for extensive development of tailored support to better tackle the rapid changes that can occur in a society.
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| 18. |
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| 19. |
- Marmstål Hammar, Lena, et al.
(författare)
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The care of and communication with older people from the perspective of student nurses. A mixed method study.
- 2017
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Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 52, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people.OBJECTIVE: The aim of this study was to investigate student nurses' views on the care of and communication with older people.DESIGN: A descriptive study with a mixed-method approach was conducted.METHODS: Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015.RESULTS: The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites.CONCLUSIONS: Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed.
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| 20. |
- Martina, Summer Meranius, 1971-, et al.
(författare)
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Complexity in Daily Living of Older Adults with Multimorbidity : Health, Social and Informal Care Utilization and Costs
- 2018
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Ingår i: HSOA Journal of Gerontology & Geriatric Medicine. - 2381-8662. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of the study was to describe health, social and informal care utilization and costs for older adults with multimorbidity. The design was descriptive and retrospective.Methods: The setting was a medium-sized town in an urban area of Sweden and included 10 health centers. Data were collected during 2011 using individual, structured interviews with the informal carers of 20 older adults with multimorbidity. Retrospectively, for a period of 18 months, data were also collected from the older adults’ patient registers and records, as data regarding the costs of their health and social care, in- and out-patient care and municipal care including home services.Results: The primary result was that older adults with multimorbidity utilize health and social care from different principals, through different contacts. The results also provide insight into the complexity of these older adults’ daily living. Their 18-month health and social care costs varied between 12,084 and 137,187 Euros. For 12 older adults who utilized informal care, their calculated costs varied between 2,092 and 70,590 Euros.Conclusion: The conclusion is that the increasing number of older adults with multimorbidity and their health and social care utilization and costs should be taken into account in healthcare policy and the organization of health and social care.
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| 21. |
- Narkbubpha, Rapeepan, et al.
(författare)
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Experiences of Teenagers withUnplanned Pregnanciesin Phetchaburi Province, Thailand
- 2012
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Ingår i: Philippine journal of nursing. - Filippinerna. - 0048-3818. ; 82, s. 57-63
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study is for readers tounderstand the various experiences teenageparents endure within the Phetchaburi Province ofThailand. Using a qualitative research design, ten (10)pregnant teenagers between the ages of 15-19 years oldwere interviewed. A semi-structured, in-depth interviewwas used as the primary means of data collection. Inaddition, data were analyzed using the process ofmanifest content analysis. The four main themes thatemerged were: (1) circumstances leading to pregnancywas due to the failure of contraception and lack ofknowledge regarding proper sexual education, (2)recognition of pregnancy was late because the teenagershave neither experienced pregnancy nor did they haveknowledge of self-monitoring during pregnancy, (3) thereactions towards the pregnancies were typicallynegative reactions from girls, boyfriends, and parents (4)life changes after the pregnancy were due to the strongconcerns about dropping out of school and beingostracized by the community. The findings implied animprovement for healthcare services. For instance,teenagers should participate in sexual education classesthat offer precautionary lessons towards pregnancy.Moreover, educational programs (specifically meeting theTSend correspondence to: Rapeepan Narkbubpha, RN, M.N.S., Phachomklao College of Nursing, Phetchaburi Province 203 Moo 2 Thongchai District,Amphoe Muang, Phetchaburi Province, Thailand 76000 Tel+66-8990-86672, Fax+66-3240-0573, E-mail address: rapeepan2549@gmail.com orMartina Summer Meranius, RN, PhD. A Senior Lecturer, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna - Västerås,Sweden, E-mail address: martina.summer.meranius@mdh.seMartina Summer Meranius, PhD, RNphysical and emotional needs of pregnant teenagers)should be established so that pregnant teenagers cancontinue their pregnancy without quitting school.
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| 22. |
- Nilsson, Christina, et al.
(författare)
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Varför vårdvetenskap?
- 2008
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Ingår i: Vårdvetenskapliga vägskäl. - Växjö : Växjö universitet. ; , s. 49-60
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Rapport (övrigt vetenskapligt/konstnärligt)
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| 23. |
- Pavedahl, Veronica, 1980-, et al.
(författare)
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Fundamentals of care in the emergency room – An ethnographic observational study
- 2021
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 58
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a strong biomedical focus within emergency care. However, while failure to meet patients’ fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients. Aim: This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms. Methods: Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics. Results: Observations showed that registered nurses (RN) identified patients’ fundamental care needs and provided nursing care. However, the RNs’ focus on the patient decreased over time. When the RN communicated with the patient, the patients’ physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs’ ability to meet patients’ fundamental care needs. Conclusion: Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient–nurse relationship to meet the patient's physical, psychosocial, and relational needs.
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| 24. |
- Pavedahl, Veronica, 1980-
(författare)
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Person-centered fundamental care in the emergency room : Patient and registered nurse perspectives
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients who suffer from life-threatening illness or injury – experiencing conditions such as cardiac arrest, breathing problems, or trauma – are cared for at designated emergency rooms within the emergency department. In the emergency room, the registered nurse is responsible for those who are exposed and vulnerable and have complex needs. In these rooms, the biomedical focus may reinforce a culture that values the medical-technical aspects of nursing. Meeting patients’ fundamental care needs, such as respect, information, and toileting, in a person-centered way seems challenging in emergency rooms. When care is not provided correctly, the consequences for the patient’s health can be serious, for instance resulting in physical complications in the form of pressure injuries from breathing masks and spine boards or psychological complications such as worry, anxiety, or post-traumatic stress syndrome. Little is known about how person-centered fundamental care is made visible and valued both for and by patients in emergency rooms. In this thesis the understanding of fundamental care is guided by the Fundamentals of Care framework, in order to maintain an optimal person-centered care that considers the patient’s fundamental care needs with a holistic view of the patient. The overall aim of this thesis is to explore how person-centered fundamental care needs are met for life-threateningly ill patients in emergency rooms, from both patient and registered nurse perspectives.Study I explored how fundamental care needs of life-threateningly ill or injured patients were met by observing the daily activities of registered nurses in the emergency room, through 108 observations. The results showed that registered nurses were initially engaged and active in meeting patients’ needs, but that this decreased over the duration of the care. Registered nurses met the patients’ physical needs to a greater extent than their psychosocial and relational ones. The environment affected the registered nurses’ ability to meet the patients’ fundamental care needs.To describe fundamental care needs in the emergency room, based on life-threateningly ill patients’ experiences, an interview study (Study II) was conducted with 15 persons who had been cared for in an emergency room. The interviews were analyzed using deductive content analysis based on the Fundamentals of Care framework. The results showed that relationship, timely and personalized information, and existential needs were identified as essential fundamental care needs, which were not (or only partly) met. The physical environment limited patients in having their fundamental care needs met, and they adopted a “patient role” to avoid adding to healthcare professionals’ stress.Study III described registered nurses’ work approach and prerequisites for meeting life-threateningly ill patients’ care needs from the perspective of a person-centered fundamental care framework, through 14 interviews. The results revealed that registered nurses structure their work approach in meeting patients’ fundamental care needs based on prevailing organizational and personal prerequisites.In Study IV the content of guidelines governing the registered nurses’ work in the emergency room was investigated. The results revealed that the registered nurses’ work in Swedish emergency rooms was guided by an instrumental and task-oriented approach to care. The guidelines lacked guidance in providing for patients’ fundamental care needs, and did not support the registered nurses in conducting holistic, comprehensive patient assessments and interventions.The organizational prerequisites contribute to a task-oriented and instrumental way of working, and patients are not having their fundamental care needs fully met. Fundamental care is not being promoted or prioritized, as the organization and responsibilities for providing person-centered fundamental care are unclear, unspecified, and lacking in direction for how it is to be performed – neither the organization nor the culture supports the registered nurses’ work and profession.
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| 25. |
- Pavedahl, Veronica, 1980-, et al.
(författare)
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Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room : An interview study with registered nurses
- 2022
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 78:7, s. 2165-2174
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Tidskriftsartikel (refereegranskat)abstract
- Aim To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life-threateningly ill patients' care needs from the perspective of a person-centred fundamental care framework. Design A descriptive, qualitative interview study. Method Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. Results Three themes were identified: Task-oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person-centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. Conclusion From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person-centred care. Impact To date, little is known about registered nurses' work approach and prerequisites in meeting life-threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person-centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person-centred fundamental care and thereby avoid fundamental care being missed.
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| 26. |
- Summer Meranius, Martina, 1971-
(författare)
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"Era delar är min helhet" : En studie om att vara äldre och multisjuk
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to describe what it means to be old and live with multimorbidity. An additional aim is to examine and describe the contextual meaning of the phenomenon in ordinary housing and nursing homes, and a third aim is to deepen our understanding of the situation for old people who also are ill. The thesis uses a caring science perspective and a reflective lifeworld approach founded on phenomenological philosophy. This approach searches for and describes the meaning of a phenomenon, its variations and its essential meaning structure. Interviews were used for data collection and data were analyzed for meaning, searching for the essence of the phenomenon. The findings are presented in two empirical studies and one philosophical excursion. The empirical studies have been further thematized with the essential meanings from the empirical studies. The philosophical excursion is the result of a more profound understanding of the thematized meanings.The essential meaning of being old and living with multimorbidity in ordinary housing is described as a struggle to maintain identity in a life situation that changes. Multimorbidity and aging pose existential barriers at the same time as the possibility of living an independent life and being oneself is hindered. Ordinary housing is experienced as a place where the old can be themselves, and a place that is associated with independence. On the other hand, multimorbidity threatens the possibility of continuing to live in their private homes, as does the failure of others to meet the old as individuals.The essential meaning of being old and living with multimorbidity in nursing homes is described as striving for independence which brings with it a zest for life and a feeling of security. The older’s degree of independence can change due to the fragile health situation, and is characterized by the experience of not being a burden for the busy caregivers and relatives. Independence can change to insecurity, vulnerability and helplessness.The themes of essential meaning that have been extracted from the empirical studies suggest that the experiences of frailty and loneliness differ more between those living in ordinary housing and in nursing homes than the experiences of trust and independence differ.The philosophical excursion illuminates how older people with multimorbidity experience their lives as an ability to manage their daily lives and not merely an absence of disease symptoms. A person is “just” sick, independently of the objective quantity of diseases s/he may suffer from. Health and wellbeing occur from the ability to live in existential coherence, which is encouraged when the older people are allowed to retain their habits, the ability to be oneself, individual’s life story and by social relationships, as well as by continuity among the caregivers.
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| 27. |
- Summer Meranius, Martina, et al.
(författare)
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Experience of self-management of medications among older people with multimorbidity
- 2015
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:19-20, s. 2757-2764
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. To explore the experience of self-managing medication among older people with multimorbidity. Background. Older people with multimorbidity are now more likely to live at home and to self-medicate. Reduced assistance from professional caregivers is associated with medical errors. Design. Face-to-face interviews were conducted with older people with multimorbidity. Methods. Participants aged >= 75 years with >= 2 medical diagnoses and living at home or in special accommodation were interviewed. Twenty-eight men and women (mean age 84 years) participated. Interviews lasted from 45 minutes-2 hours and were transcribed verbatim. A lifeworld-based phenomenological method was used for analysis. Results. Uncertainty among the participants increased with their experience of side effects and concern that the medication might be harmful. These uncertainties were reinforced by a fear of malpractice when several physicians were involved. This meant living with ambivalence when taking the medication, which required a trade-off between symptom relief and reducing side effects. A lack of continuity with physicians and nurses led to uncertainty in maintaining an overview of the medications. By contrast, when the relationships were supportive and caring, the uncertainties diminished. Four concepts were used to describe the various meanings of this experience: adapting to a new lifestyle; ambivalence towards medicine; experience of side effects and concerns about medical errors; and relationships as sources of feeling secure. Conclusions. Medications can cause side effects, and unclear benefits increase the uncertainty for older people with multimorbidity. Health care professionals need to develop an understanding of each patient's experience of such uncertainty. Relevance to clinical practice. Health care professionals can give support and show understanding for older people's existential uncertainty by creating good relationships and continuity in care, and offering appropriate information. Regular visits should be scheduled to manage any problems patients might have when self-medicating.
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| 28. |
- Summer Meranius, Martina, 1971-, et al.
(författare)
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Health and social care management for older adults with multimorbidity: a multi-perspective approach
- 2017
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; :31, s. 96-103
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Tidskriftsartikel (refereegranskat)abstract
- Multimorbidity, a condition common among olderadults, may be regarded as a failure of a complex system.The aim of this study was to describe the corecomponents in health and social care management forolder adults with multimorbidity. A cross-sectionaldesign included two methods: individual interviews andgroup discussions. A total of 105 participants includedolder adults with multimorbidity and their relatives,care staff and healthcare policymakers. Data were analysedusing content analysis. The results show thatseven core components comprise a multiperspective view of health and social care management for olderadults with multimorbidity: political steering, leadership,cooperation, competence, support for relatives, availabilityand continuity. Steps should be taken to ensure thatevery older adult with multimorbidity has a treatmentplan according to a multiperspective view to preventfragmentation of their health care. This study providesrelevant evidence developing a multiperspective modelof health and social care management for older adultswith multimorbidity.
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| 29. |
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| 30. |
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| 31. |
- Summer Meranius, Martina, 1971-, et al.
(författare)
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How does the healthcare system affect medication self-management among older adults with multimorbidity?
- 2016
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 30:1, s. 91-98
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Tidskriftsartikel (refereegranskat)abstract
- Individuals with multimorbidity commonly have several concurrent prescriptions and experience healthcare obstacles related to managing different diagnoses and medications. This study aimed to provide a deeper understanding of how older adults with multimorbidity experience medication self-management and how this is affected by the healthcare system. The National Board of Research Ethics approved the study, and 20 older adults with multimorbidity participated in in-depth interviews that were analysed using a hermeneutic approach. Three levels of interpretation emerged. At the first level, lack of participation in healthcare communication hinders adherence and safety, and feeling abandoned to self-care leads to health risk-taking. At the second level, the healthcare organisation is seen as an obstacle to medication self-management. The overall interpretation was a system of repairing ‘parts’ but not enabling the experience of health. This study shows that the healthcare system is able to treat and relieve an individual's symptoms, but seems unable to help them achieve and promote good health, or to provide the support they need to function in everyday life.
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| 32. |
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| 33. |
- Summer Meranius, Martina, 1971-
(författare)
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Kvalitativ uppföljning av multisjuka äldre
- 2011
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Rapport (populärvet., debatt m.m.)abstract
- Kvalitativa uppföljningar av multisjuka äldre är ett nationellt projekt under ledningen av Sveriges Kommuner och Landsting. Projektet syftar till att identifiera systembrister/hinder, hitta systemlösningar som ger den multisjuka äldre bättre vård- och omsorgskvalité. Syftet är även att öka den samhällsekonomiska nyttan av de resurser som finns samlade i vård- och omsorgssystemet kring den multisjuka äldre, samt utvärdera och vidareutveckla metoden för kontinuerlig användning. I projektet har 20 äldre, 11 män och 9 kvinnor med medianålder på 79 år, följts upp med intervjuer, registerdata, journaldata och läkemedelsdata inom slutenvården, öppna specialistvården, primärvården och kommunala omsorgen. Även 13 anhöriga har intervjuats om vården och omsorgen som har berört de äldre.Resultatet visar bland annat följande medianvärden under 18 månader för Västmanland: slutenvårdskonsumtion 19,5 dygn; antal akutmottagningsbesök 4. Antal besök hos läkare inom öppna specialistvården 6,5 hos primärvårdsläkare 5 och hos distriktssköterskan 6. Fyra äldre hade även fått hembesök av primärvårdsläkare och åtta av distriktssköterskan. Hälften av de äldre hade hemtjänst och sex i kommunalregi. Den totala redovisade tiden för hemtjänst hade ett medianvärde på 206 timmar medan motsvarande siffra för den totala tiden som redovisades hos kunden var 125 timmar. Troligen berodde detta på att de äldre sade ifrån sig insatsen eller inte utnyttjade den om de till exempel låg på sjukhus. Tretton anhöriga intervjuades varav fyra förvärvsarbetade och nio var pensionerade vid intervjutillfället. Tre av de fyra arbetande anhöriga hade tagit ledigt från sitt arbete för att hjälpa sin anhörig – en, tre och 12 timmar per månad.Av läkemedelsgranskningen framgår att äldre använde i snitt 10 läkemedel och de vanligaste läkemedelsrelaterade problemen var otillräcklig effekt, underbehandling, biverkningar samt för hög dos. Vidare framgår av journalläsningen att epikriser ofta kom sent till familjeläkarmottagningar och att de inte alltid var kompletta. Detta ställde till konkreta problem för flera av personerna i undersökningen. Positivt var att endast 20 % av de multisjuka i undersökningsgruppen stod på lugnande medel och/eller sömnmedel (att jämföra med t.ex. 50 % för motsvarande undersökningsgrupp i relativt närliggande Dalarna) och att ingen stod på långverkande bensodiazepin.Kostnader för de 20 individerna varierade under 18 månaders period mellan 122 927 kr till 1 034 827kr. Granskningen av fallbeskrivningarna visar att för lite fokus låg på att förstå och agera på äldres grundläggande behov. Däremot låg för mycket fokus på olika insatser, reaktioner på diagnos och uppstådda skador, för lite på symptom och situation. De 12 fallbeskrivningar som redovisas, visar mer i detalj, vilka problem och behov äldre har och hur dessa följs upp i vården och omsorgen.
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| 34. |
- Summer Meranius, Martina, 1971-
(författare)
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KVALITETSREGISTER INOM ÄLDREOMSORG - 10 framgångsfaktorer för lärande och kvalitetsutveckling
- 2015
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Rapport (populärvet., debatt m.m.)abstract
- SammanfattningProjektet Kvalitetsregister för lärande och kvalitetsutveckling genom- fördes i samverkan mellan Västerås stad, Eskilstuna kommun och akademin för Hälsa, vård och välfärd Mälardalens högskola inom ramen för Mälardalens Kompetenscentrum för Hälsa och Välfärd.Projektets syfte har varit att ta fram och undersöka en modell för kontinuerligt lärande och verksamhets- och kvalitetsutveckling inom kommunal vård och omsorg. Projektet omfattar kvalitetsregister Senior alert och BPSD-registret. Genom litteraturstudier, intervjuer med framgångsrika verksamheter som har använt dessa register, workshop med en expertgrupp med kunskaper om registren samt pilotförsök har en lärmodell utvecklats och prövats. Lärmodellen består av 10 framgångsfaktorer. Ledarskap Teamarbete Ansvar Personcentrerad vård/omsorg Värdegrund Stödjande strukturer Reflekterande kommunikation Målbild Kunskap om nuläget Resultat och uppföljningLärdomar av projektet är att organisationer behöver arbeta strategiskt och ta vara på sina egna framgångsrika verksamheter genom att skapa förutsättningar för lärande. Organisationer behöver skapa och behålla sina egna ”stödjande strukturer” för att stödja kvalitets- utveckling inom verksamheterna och på alla nivåer inom organisationen. Genom införandet av kvalitetsregister har kunskaps- behovet om preventivt arbetssätt och förbättringskunskap blivit tydligt. Verksamheter behöver ta vara på den kunskap som erbjuds via olika aktörer som arbetar med kvalitetsutveckling inom äldre- omsorgen, men utbildningsansvaret kan inte i längden, ligga på de enskilda verksamheterna. Aktörer för utbildning, vård och omsorg behöver diskutera hur kunskaper hos undersköterskorna kan in- hämtas. Utbildningsaktörer behöver ta sitt ansvar och organisationer behöver ge stöd till sina verksamheter för att arbeta preventivt utifrån kvalitetsregister.Projektets resultat visar tydligt vilka omfattande ansträngningar chefer lägger på att driva arbetet med kvalitetsregister. Det är därför viktigt att organisationer skapar lämpliga styrmedel för att belöna och uppmuntra ett långsiktigt hållbart arbete med att bedriva hög- kvalitativ och patientsäker vård och omsorg inom den kommunala vården och omsorgen.
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| 35. |
- Summer Meranius, Martina, 1971-, et al.
(författare)
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Management Practices Promoting Sustained Implementation of the Quality Register Senior Alert for Older Adults in Municipal Care in Sweden
- 2018
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Ingår i: The Open Nursing Journal. - : Bentham Open. - 1874-4346. ; 12, s. 215-224
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Tidskriftsartikel (refereegranskat)abstract
- Background:Senior Alert is a national quality register aimed at supporting a standardized, structured, and systematic preventive care process foradults aged 65 and over in the areas malnutrition, pressure ulcers, falls, problems with oral health and bladder dysfunction. Therefore, the quality register is particularly suitable for older adults with multimorbidity. Aim: The aim was to describe management practices that contributed to the sustained implementation of the quality register Senior Alert inmunicipal elderly care in Sweden. Methods: The design of this pilot study was descriptive and inductive. The sample of n = 12 included managers (n = 7) and care staff (n = 5) atseven municipal care homes for older adults in Sweden. The study was performed between April 2014 and June 2014 using twomethods: Individual interviews and nonparticipant unstructured observations. Data were analyzed using qualitative content analysis. Results: The analysis led to the following generic categories: leading teamwork, leading a preventive care process and leading a supportiveorganizational structure, and to one main category: management promoting learning and quality improvement. Conclusion: To be sustainable, Senior Alert implementations in municipal elderly care need management. Management, by leading teamwork, apreventive care process and a supportive organizational structure, is essential for achieving learning and quality improvement.
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| 36. |
- Summer Meranius, Martina, 1971-, et al.
(författare)
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Paradoxes of person‐centred care : A discussion paper
- 2020
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 7:5, s. 1321-1329
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Forskningsöversikt (refereegranskat)abstract
- AIM: Previous research has mainly focused on the advantages of PCC and less on its disadvantages. Hence, there is a need to further explore the recent research regard-ing PCC from both sides. Therefore, the aim of this paper is to elucidate the advan-tages and disadvantages of PCC.DESIGN: Discussion paper.METHODS: We searched relevant literature published January 2000–March 2018 in PubMed, Medline, CHINAL, Scopus and Web of Science.RESULTS: The results showed that PCC can contribute to improved health and well-being, improved mutual interaction in relationships, improved cost-effectiveness and im-proved work environment, while the disadvantages can involve increased personal and financial costs, exclusion of certain groups, increased personal and financial costs, exclu-sion of staff's personhood and unfairness due to empathy. An analysis of the existing literature on PCC showed paradoxes, which call for further investigation.
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| 37. |
- Summer Meranius, Martina, 1971-
(författare)
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Vad kan hälsa vara för multisjuka äldre?
- 2011
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Ingår i: Ä - En tidning för Riksföreningen för Sjuksköterkan inom Äldrevård. - Sigtuna : JLD & Kompani. - 2001-1164. ; 1:1, s. 6-10
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Tidskriftsartikel (populärvet., debatt m.m.)
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