| 1. |
- Johansson, Karin C, et al.
(författare)
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Narratives of care providers concerning picking behavior among institutionalized dementia sufferers
- 1999
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Ingår i: Geriatric Nursing. - 0197-4572 .- 1528-3984. ; 20:1, s. 29-32
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Tidskriftsartikel (refereegranskat)abstract
- To illuminate the meaning of picking behavior in institutionalized people with dementia, the narratives of 15 care providers were interpreted using a method inspired by Ricoeur's phenomenologic hermeneutics. The care providers saw the behavior as a form of meaningful communication. The behavior was described as occurring in combination with wandering and in connection with restlessness and stress related to fatigue, difficulty communicating, and lack of occupation. The behavior also was seen as an attempt to engage in meaningful activities. Some care providers reported that the picking behavior caused them strain, whereas others reported a more positive reaction because the behavior made the ward more alive. Most care providers perceived the meaning of the picking behavior relative to the dementia sufferer's previous life and said they reacted by diverting, allowing, or understanding the picking.
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| 2. |
- Karlsson, Eva, et al.
(författare)
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Aspects of Self and Identity in Narrations About Recent Events : Communication With Individuals With Alzheimer's Disease Enabled by a Digital Photograph Diary
- 2017
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Ingår i: Journal of Gerontological Nursing. - : SLACK. - 0098-9134 .- 1938-243X. ; 43:6, s. 25-31
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Tidskriftsartikel (refereegranskat)abstract
- The ability to narrate autobiographical memories is important for maintaining the identity of individuals with Alzheimer's disease (AD). The current study explored how the sense of self is manifested in narrations about recent events, enabled via a digital photograph diary. Use of a digital photograph diary was tested with seven individuals with AD and their household members. Narrative analysis was used to analyze audiorecordings of the pairs' communication about recent events shown in the photographs. The results show how individuals with AD understand events illustrated in recent photographs in relation to their sense of self and associated skills and abilities that are facets of their selfhood. This type of digital photograph diary has the potential to support individuals with AD to maintain their sense of self and participation in everyday life, and strengthen their relationships with household members; it could be an important tool in person-centered care.
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| 3. |
- Karlsson, Eva, et al.
(författare)
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"Carpe Diem" : Supporting conversations between individuals with dementia and their family members
- 2014
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Ingår i: Journal of Gerontological Nursing. - : SLACK, Inc.. - 0098-9134 .- 1938-243X. ; 40:2, s. 38-46
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Tidskriftsartikel (refereegranskat)abstract
- Remembrance of recent events is a major problem for individuals with dementia. Consequently, this article explores the process of acceptance and integration of a digital photograph diary (DPD) as a tool for remembrance of and conversations about daily life events. A design for multiple case studies was used. Seven couples, in which one individual in the couple had Alzheimer's disease, tested the DPD for 6 months. Data were collected in three sequences with interviews, observations, and screening instruments. In the analysis, all data were integrated to find common patterns of content. Some couples became regular users, while others used the DPD more sporadically. Factors contributing to regular use were how the DPD matched expectations, actual use, support, experienced usefulness, and reactions from family and friends. For those couples who became regular users, the DPD facilitated their conversation about recent daily activities
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| 4. |
- Karlsson, Eva, et al.
(författare)
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Stories about life narrated by people with Alzheimer's disease
- 2014
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 70:12, s. 2791-2799
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Tidskriftsartikel (refereegranskat)abstract
- AimTo explore how people with Alzheimer's disease present their life story.BackgroundLife story work is a key concept in a person-centred care. An important aspect in understanding the subjective experience and supporting the identity of people with dementia is to listen to their life stories.DesignA narrative design with interviews was used.MethodNine participants with Alzheimer's disease were encouraged to tell about their lives from childhood, adult life, to present life and about their thoughts on the future. The interviews were conducted between September 2010–March 2011 in the participants' homes, with their spouses present and were analysed with a method for analysis of narratives.FindingsContentment, Connectedness, Self-reliance and Personal growth were identified as core dimensions in the participants' life stories and shown like threads throughout life, from childhood, adult life to present life. All participants expressed an overall contentment with life, and connectedness was related to their relation with significant persons and to be included in the local community. Self-reliance was expressed as a strong confidence in the own ability and an overall curiosity throughout life as a sustained quest for personal growth.ConclusionsIt is important for healthcare professionals, who work with people with dementia, to understand that people with Alzheimer's disease can maintain an overall trusting and hopeful approach to life. It is also important to use life story work to enhance feelings of being connected to the world and thereby support their identity and sense of self.
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| 5. |
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| 6. |
- Karlsson, Eva, et al.
(författare)
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The challenge of coming to terms with the use of a new digital assistive device : a case Study of two persons with mild dementia
- 2011
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Ingår i: Open Nursing Journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; 5, s. 102-110
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Tidskriftsartikel (refereegranskat)abstract
- There is an increased interest in supporting persons with dementia with technical services in daily life. The aim of this case study was to explore the complex issues involved in the process from a user driven development to the acceptance and usage of a new digital assistive device for persons with mild dementia. Even though it was developed in a user driven process and personalized to meet their individual needs they rarely used it. To deepening the understanding of this disparity between actual usage and perceived usefulness, the participants were studied whilst performing daily life activities through participant observations and interviews. Their partners were interviewed two years after the first observations to clarify the change in needs over time. The results show that the participant needs encompassed occupation, safety, social interaction, and memory support together with the receipt of general support. The overriding requirement for both participants was a need to maintain their self-image. When the digital assistive device did not correspond with the participants’ expectations or view of themselves, their interest in using it faded, since the digital assistive device failed to support their self-image. The acceptance of a digital assistive device by a person with dementia is a process that begins with identifying and personalizing the functions of the device according to individual needs, and then supporting the usage and the gradual integration of the device into daily life. During this process, the person’s selfimage must be taken into consideration and supported
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| 7. |
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| 8. |
- Sjögren, Karin, et al.
(författare)
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Organisational and environmental characteristics of residential aged care units providing highly person-centred care : a cross sectional study
- 2017
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics.METHODS: A cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi(2) test, Eta Squared and Phi coefficient were used to analyse data.RESULTS: Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care.CONCLUSIONS: It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.
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| 9. |
- Sjögren, Karin, et al.
(författare)
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Person-centredness and its association with resident well-being in dementia care units
- 2013
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Ingår i: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 69:10, s. 2196-2205
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To report a study of the relationship between person-centred care and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours among residents with dementia in residential care facilities.Background: Standardized measurements of person-centred care have not previously been used to investigate the relationship between person-centred care and well-being for residents with dementia in residential aged care units.Design: This study had a cross-sectional design.Method: Staff and resident surveys were used in a sample of 1261 residents with dementia and 1169 staff from 151 residential care units throughout Sweden. Valid and reliable scales were used to measure person-centredness and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours in residents. All data were collected in May 2010.Findings: Person-centred care was correlated with residents' ability to perform activities of daily living. Furthermore, residents in units with higher levels of person-centred care were rated as having higher quality of life and better ability to perform activities of daily living compared with residents in units with lower levels of person-centred care.Conclusions: There seems to be a relationship between person-centredness, residents' ability to perform activities of daily living, and residents' quality of life. Further studies are needed to explain the variation of person-centredness between units and the extent and ways this might impact on the quality of life and well-being of frail older residents with cognitive impairments in clinical practice.
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| 10. |
- Sjögren, Karin, 1953-
(författare)
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Personcentrerad vård i särskilda boenden för äldre
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Andelen äldre i befolkningen ökar nationellt och internationellt, och med ökande ålder ökar både fysisk och psykisk ohälsa. Äldre personer med ohälsa i form av kognitiv svikt (oftast demenssjukdom) kan bli beroende av vård och omsorg i särskilda boenden för äldre för att kunna känna trygghet och välbefinnande samt ha ett gott liv, i gemenskap med andra. Dock visar utvärderingar av särskilda boenden för äldre att vården ofta kan vara uppgiftscentrerad och inte motsvara de äldres individuella behov och önskemål. Personcentrerad vård är en vårdmodell som beskrivs kunna tillgodose äldre personers multidimensionella behov och önskemål, genom att personens livshistoria, personlighet, kapacitet och perspektiv uppmärksammas, respekteras och inkluderas i vården. Den vetenskapliga litteraturen inom området visar dock att det finns begränsad kunskap om förekomsten av personcentrerad vård i särskilda boenden för äldre i Sverige och internationellt, liksom om vilka faktorer som är mest betydelsefulla för att särskilda boenden för äldre ska bedriva en personcentrerad vård.Syfte: Syftet med denna avhandling var att beskriva faktorer som samvarierar med förekomst av personcentrerad vård i särskilda boenden för äldre i Sverige.Metod: Samtliga delstudier var tvärsnittstudier och data samlades in genom enkäter till äldre med kognitiv svikt och personal i särskilda boenden för äldre i Sverige. I studie I bestod insamlad data av skattningar av personcentrerad vård från vårdpersonal (n=1465) i 182 särskilda boendeenheter. I studie II insamlades data i form av vårdpersonalens (n=1169) skattningar av personcentrerad vård och proxyskattningar av de äldres (n=1261) livskvalitet, ADL-förmågor, smärta, depressiva symtom och agitation i 151 särskilda boendeenheter. Delstudie III baserades på data i form av personalskattningar (n=1169) av personcentrerad vård, tillfredställelse med arbete och vård, samvetsstress, arbetsbelastning och psykosocialt klimat i samma 151 särskilda boendeenheter. Även delstudie IV baserades på data från de 151 särskilda boendeenheterna och inkluderade skattningar av de äldre och vårdpersonal, men också skattningar av organisation och miljö vid dessa enheter (n=151). Samtliga studiernas data analyserades med hjälp av statistiska analyser, beskrivande, bivariata och multivariata analysmetoder.Resultat: Studie I visade att enkätinstrumentet The Person-Centred Care Assessment Tool (P-CAT) har tillfredställande psykometriska egenskaper för intern konsistens och test-retest-reliabilitet. Instrumentet består av två subskalor: Individualisering av vården och Stöd från organisation och miljö. Delstudie II visade att de boendes ADL-förmågor och livskvalitet skattades bättre vid enheter som kan beskrivas som mer personcentrerade. Delstudie III visade att en mer personcentrerad vård har samband med att personalen upplever ett positivt psykosocialt klimat, mindre samvetsstress, lägre arbetsbelastning samt högre tillfredställelse med vård och arbete. Studien visade också att personcentrerad vård var positivt relaterat till i vilken omfattning vårdarna hade vidareutbildning i demensvård. Delstudie IV visade att vårdmiljön var mest betydelsefull för förekomsten av personcentrerad vård vid boendeenheterna och att en gynnsam vårdmiljö innebar att personal upplevde att det var ett positivt psykosocialt klimat på enheten, att de hade tid att prata med eller bara vara med de boende samt att de upplevde sig ha en gemensam värdegrund, låg arbetsbelastning och en fysisk miljö som var anpassad till de boendes behov.Slutsatser: Resultaten i avhandlingen visar att den svenska versionen av P-CAT kan användas för valida och reliabla utvärderingar av personcentrerad vård samt att den kan rekommenderas för fortsatt forskning och vårdutveckling inom särskilda boenden för äldre. Resultatet visar också att den vård- och arbetsmiljö som omger de äldre och vårdpersonal i särskilda boenden för äldre är betydelsefull för förekomsten av personcentrerad vård. Dessa aspekter behöver fokuseras ytterligare för att kunna erbjuda en personcentrerad vård. Vidare är det psykosociala klimatet och förekomsten av en upplevd gemensam värdegrund viktig att förstå och prioritera om vården ska utvecklas mot en ökad personcentrering. Fortsatt forskning och kliniskt utvecklingsarbete behövs för att operationalisera och implementera de komponenter som bidrar till ett positivt psykosocialt klimat och en personcentrerad värdegrund på särskilda boenden för äldre. Dessutom behövs en ökad förståelse för hur en sådan värdegrund kan omsättas i personcentrerade interaktioner, handlingar, aktiviteter och prioriteringar. Det vore alltså önskvärt att äldrevården utvecklades mot ett mer personcentrat förhållningssätt, eftersom avhandlingens resultat visar att högre grad av personcentrerad vård i särskilda boenden för äldre var positivt relaterat till välbefinnande och tillfredställelse för såväl de äldre som för vårdpersonal.
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| 11. |
- Sjögren, Karin, et al.
(författare)
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Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT)
- 2012
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Ingår i: International psychogeriatrics. - : Cambridge University Press. - 1041-6102 .- 1741-203X. ; 24:3, s. 406-415
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Tidskriftsartikel (refereegranskat)abstract
- Background: Person-centered care is a multidimensional concept describing good care, especially within aged care and care for people with dementia. Research studies evaluating person-centered care interventions seldom use direct measurement of levels of person-centeredness. Existing scales that measure person-centeredness need further testing. This study evaluated the psychometric properties of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT).Methods: A cross-sectional sample of 1465 staff from 195 residential care units for older people in Sweden participated in the study. Validity, reliability, and discrimination ability of the scale were evaluated.Results: Confirmatory factor analysis, parallel analysis and exploratory factor analysis supported the construct validity of a two-factor solution. Reliability and homogeneity were satisfactory for the whole P-CAT as demonstrated by a Cronbach's α of 0.75. Test-retest reliability showed temporal stability of the scale, and the discrimination ability of the scale was satisfactory.Conclusion: The Swedish version of the P-CAT was found to be valid, reliable, and applicable for further use. Two subscales are recommended for the Swedish version.
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| 12. |
- Sjögren, Karin, et al.
(författare)
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To what extent is the work environment of staff related to person-cented care? A cross-sectional study of residential aged care.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background Person-centred care is often described as the model of choice in residential aged care and in the care of persons with dementia. Few empirical studies have reported on the relationship between person-centred care and how staff experience different aspects of their work.Aim To explore the relationship between person-centred care, staff characteristics and perceived work environment in residential aged care units.Method A cross sectional quantitative design was used. Staff in 151 residential aged care units in Sweden (n=1169) completed surveys which included questions about staff characteristics, valid and reliable measures of person-centred care, satisfaction with work and care, job strain, stress of conscience and psychosocial unit climate. Statistical analyses of correlations, group differences, and explanatory regression models were conducted.Results Higher levels of person-centred care was associated with higher levels of staff satisfaction, lower levels of job strain, lower levels of stress of conscience, higher levels of a supportive psychosocial unit climate, and a higher proportion of staff who had received continuing education in dementia care. A supportive psychosocial climate, i.e., where residents and staff experience safety, everydayness and community, explained most of the variation in person-centred care in the regression model.Conclusions This study shows that the work environment and psychosocial climate as perceived by staff, are associated with the extent to which staff perceive the care as being person-centred in residential aged care. These empirical findings support the theoretical postulation that the environment is an important aspect of person-centred care. Thus, promoting a positive and supportive psychosocial environment to enable person-centred care practice seems to be an important implication for managers and leaders in residential aged care.Keywords: Conscience, Cross sectional study, Environment, Job satisfaction, Nursing staff, Patient-centred care, Psychological stress, Residential facilities
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| 13. |
- Sjögren, Karin, et al.
(författare)
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To what extent is the work environment of staff related to person-centred care? : A cross-sectional study of residential aged care
- 2015
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 24:9-10, s. 1310-1319
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To explore the relationship between staff characteristics, perceived work environment and person-centred care in residential aged care units.BACKGROUND: Person-centred care is often described as the model of choice in residential aged care and in the care of persons with dementia. Few empirical studies have reported on the relationship between how staff experience different aspects of their work and person-centred care.DESIGN: The study had a cross-sectional quantitative design.METHODS: Staff in 151 residential aged care units in Sweden (n = 1169) completed surveys which included questions about staff characteristics, valid and reliable measures of person-centred care, satisfaction with work and care, job strain, stress of conscience and psychosocial unit climate. Statistical analyses of correlations, group differences and multiple linear regression analysis estimated with generalised estimating equation were conducted.RESULTS: Higher levels of staff satisfaction, lower levels of job strain, lower levels of stress of conscience, higher levels of a supportive psychosocial unit climate and a higher proportion of staff with continuing education in dementia care were associated with higher levels of person-centred care. Job strain and a supportive psychosocial climate, explained most of the variation in person-centred care.CONCLUSIONS: This study shows that the work environment as perceived by staff is associated with the extent to which staff perceive the care as being person-centred in residential aged care. These empirical findings support the theoretical postulation that the work environment is an important aspect of person-centred care.RELEVANCE TO CLINICAL PRACTICE: Promoting a positive and supportive psychosocial climate and a work environment where staff experience balance between demands and control in their work, to enable person-centred care practice, seems to be important implications for managers and leaders in residential aged care.
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| 14. |
- Ahlin, Karin, 1963-, et al.
(författare)
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A Transition Towards Digital Home Visits in Social Care and Home Health Care During the Corona Pandemic
- 2021
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Ingår i: GLOBAL HEALTH 2021, The Tenth International Conference on Global Health Challenges. - : International Academy, Research and Industry Association (IARIA). - 9781612088921
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Konferensbidrag (refereegranskat)abstract
- During the pandemic, physical meetings were supposed to decrease as much as possible to avoid the virus to spread. Before the pandemic, the physical meeting favoured social care and home health care in Sweden. One solution was to digitize as many of these meetings as possible. Therefore, we investigated this transition in a web survey, including questions with predetermined and open-ended answers. The web-survey was sent to co-workers in home health care and social care in a middle-seized municipality in Sweden. The results showed that not all meetings could be transformed, like meetings with citizens with hearing or cognitive impairments. Challenges related to the transformation were instability in technical equipment, the professionals’ and citizens’ knowledge of handling technical equipment, and access to technical equipment support. Despite this did the co-workers digitize meetings whenever possible, adding operational and problem-solving attitude to the transformation. Due to this study’s limitation, like respondents from one municipality and the pandemic’s length, we intend to investigate further and understand the development of the transformation and how knowledge in the area increases.
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| 15. |
- Almevall, Albin Dahlin, et al.
(författare)
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Accepting the inevitable : A mixed method approach with assessment and perceptions of well-being in very old persons within the northern Sweden Silver-MONICA study
- 2021
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 92
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAs the group of very old persons will form an increasing part of society, the study of how well-being is described and affected by specific factors will be of importance to meet the future needs of these persons. The aim of the study was to increase knowledge of well-being in very old persons by combining assessments and perceptions using the Philadelphia Geriatric Morale Scale (PGCMS).MethodIn a mixed method, convergent parallel design, 52 persons 80 years or older were assessed and interviewed using the PGCMS to combine assessment of morale and descriptions of perceptions of well-being using a mixed method approach.ResultsQuantitative and qualitative results converged in four areas: not feeling lonely and being included, rating and perceiving health as good, high physical function/ability and being physically active, living in own house and feeling at home. Areas perceived as important to well-being captured only in qualitative analysis were having freedom and engagement. An example of insights not achievable from the quantitative or qualitative analysis alone was that individuals with high morale expressed anxiety about losing their health due to potential ageing-related threats and that individuals with low morale struggled with acceptance. Acceptance was the key strategy for handling adverse consequences of ageing in all described areas.ConclusionWhen using standardized assessment scales in clinical practice, it could be useful to combine quantitative and qualitative data. Acceptance was key for well-being; however, acceptance could be resigned or reorienting in nature.
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| 16. |
- Almevall, Albin Dahlin, et al.
(författare)
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Associations between everyday physical activity and morale in older adults
- 2022
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Ingår i: Geriatric Nursing. - : Elsevier. - 0197-4572 .- 1528-3984. ; 48, s. 37-42
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Tidskriftsartikel (refereegranskat)abstract
- Studies that objectively investigate patterns of everyday physical activity in relation to well-being and that use measures specific to older adults are scarce. This study aimed to explore objectively measured everyday physical activity and sedentary behavior in relation to a morale measure specifically constructed for older adults. A total of 77 persons (42 women, 35 men) aged 80 years or older (84.3 ± 3.8) wore an accelerometer device for at least 5 days. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS scores were significantly positively associated with number of steps, time spent stepping, and time spent stepping at >75 steps per minute. Sedentary behavior did not associate with PGCMS. Promoting PA in the form of walking at any intensity–or even spending time in an upright position—and in any quantity may be important for morale, or vice versa, or the influence may be bidirectional.
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| 17. |
- Almevall, Albin, et al.
(författare)
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Experiences of home as an aspect of well-being in people over 80 years : A mixed method study
- 2022
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 78:1, s. 252-263
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Tidskriftsartikel (refereegranskat)abstract
- Aims To (1) describe experiences of home from a well-being perspective, (2) describe participant characteristics and well-being measures in relation to housing type (3) and how the aforementioned aspects may affect well-being in very old persons. Design Cross-sectional, convergent parallel-results mixed method design with semi-structured interviews analysed by qualitative content analysis, in relation to descriptive statistics and specific well-being outcome measures related to home. Methods A total of 50 persons 80 years or older living in ordinary housing were interviewed (July 2017 to November 2018) about home in relation to well-being, along with collection of participant characteristics and well-being measures related to home. Results Participants described how home had become increasingly important as it provided autonomy and acted as a social and occupational hub. However, autonomy was not unconditional, and home could also be perceived as a place of inactive solitude. Results were interpreted as relating to being in the margins of home and had a major impact on well-being. Housing type seemed of importance with higher measures of well-being for participants in single-living housing compared with those living in apartment. Conclusion Home is increasingly central to well-being in old age; however, very old persons also have to relate to being physically and mentally in the margins of being able to remain in the home. These aspects of home potentially have a major impact on well-being. Impact As very old persons living in ordinary housing will constitute a larger segment of society in coming years, aspects of home can potentially have a considerable impact on well-being for this age-group. This study describes aspects of home that contribute to, or has adverse impact on well-being. These aspects need thorough consideration in policy-making and planning of health care that can affect experiences of home.
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| 18. |
- Almevall, Ariel, et al.
(författare)
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Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study
- 2024
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Studies of older women’s life transitions is rare but gains relevance as the aging population, with older women as the majority, expands.Purpose: To explore the meaning of a good life for older widows with extensive home care needs.Materials and methods: Semi-structured interviews were carried out with eleven women, aged 80 and over (82–95 years, mean 90) residing at home with extensive care needs (≥4 daily sessions, averaging 2.5–6 hours, mean 3). Data were analysed by reflexive thematic analysis.Results: The theme “This Day in My Home, the frame of my life” reflects the women’s experience of a good life. A good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. However, there were moments when life was merely about navigating daily challenges. During such days, the women felt trapped in time, unsafe and lonely.Conclusion: A day at home may seem static, yet it mirrors life’s dynamism, evolving with shifting circumstances. Older widows navigate challenges while maintaining their sense of self, independence, and connection to home. These findings have implications for aged care, recognizing the multifaceted aspects of life and the centrality of home.
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| 19. |
- Almevall, Ariel
(författare)
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Health in later life: A nursing perspective
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The ongoing demographic shift towards an older population calls for a corresponding shift to a proactive approach, aiming for health and well-being in old age. This dissertation addresses the need for increased knowledge about health in the context of aging at home. It explores the roles of relationships, home, health, and well-being while examining the various factors influencing health. The disseration also explores how key stakeholders in home care organizations percive a good life for older persons. From a nursing perspective, the disseration explores pathways of change and experiences related to health, guided by the caritative caring theory, which underscores health as wholeness and holiness. By thoroughly examining self-rated health, relationships, and the experiences of older persons receiving home support, along with key stakeholders' perceptions, the dissertation aims to provide valuable insights for nursing practices and the promotion of health in later life.This dissertation aims to explore health in later life, specifically concentrating on widowed women living alone with extensive home care needs. This exploration encompasses both the perspective of older widows and that of key stakeholders. For a comprehensive understanding health, the disseration also study self-rated health among older persons over a 20-year period, exploring its associations to health and well-being factors, including survival. Additionally, the dissertation explores the shared relationship between older women and nurses.This dissertation comprises one quantitative and three qualitative studies, all centred around older persons aged 80 years and older. Paper I is a quantitative, longitudinal study investigating changes in Self-Rated Health (SRH) across the aging spectrum. The study included 1595 participants initially (aged 59-79) and 541 participants at follow-up (age 80-96). Most participants rated their health as "Quite good" (54.5%) at baseline. Over the study period, 42.6% had stable SRH, 40.6% had declined, and 16.8% had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p<0.05). Paper II is a qualitative study about the concept of a good life for single-living older women with extensive care needs. This involved individual interviews with 11 participants aged 82-95, analysed through reflexive thematic analysis. Paper III is a qualitative description of key stakeholders' perceptions regarding a good life for the oldest old persons living at home with extensive care needs. The study utilized qualitative focus groups with 28 participants aged 31-69 (1 man, 27 women), analysed through qualitative content analysis. Paper IV is a qualitative study that aim to explore the meaning of relationship between older women and registered nurses in home care. The research employed qualitative methods, including focus groups and individual interviews, with 11 older women (aged 82-95) and 5 registered nurses (aged 35-47), analysed using qualitative content analysis. In conclusion, health in later life is not merely about avoiding a decline in health; rather, it involves integrating existing aspects into an ever-changing situation. However, challenges such as living alone, experiencing depressive symptoms, and coping with illness and/or functional disability can pose threats, risking overall health and survival. In contrast, for those living with disabilities and illnesses with extensive care needs, the significance of daily life becomes paramount. Simultaneously, the relationship between older women and registered nurse emerges as a recurring connection with the potential not only to enhance daily life but also to serve as a consistent and supportive presence in the home.
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| 20. |
- Almevall, Ariel, et al.
(författare)
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Perceptions of a good life for the oldest old living at home
- 2022
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Ingår i: International Journal of Ageing and Later Life. - : Linköping University Electronic Press. - 1652-8670. ; 16:1, s. 25-48
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Tidskriftsartikel (refereegranskat)abstract
- An increasing number of people are growing older and living longer in their homes. This study aims to describe key stakeholders’ (politicians, managers, and professionals) perceptions of a good life for single-living oldest old persons living at home with extensive needs for support. Interviews with stakeholders were analysed with content analysis. The analysis resulted in the theme: An incongruence between intentions and actions in promoting a good life for the oldest old. Our findings show a gap between intentions and actions, which caused feelings of powerlessness in the key stakeholders. To promote a good life for the oldest old persons, a congruence is needed between individual awareness and the prerequisite of promoting a good life. Developing methods that identify and bridge gaps between intentions and actions could support the abilities of organisations to promote a good life for the oldest old persons with extensive needs for support.
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| 21. |
- Almevall, Ariel, et al.
(författare)
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Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort
- 2024
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 122
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population.Aim: To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival.Methods: All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests.Findings: Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05).Conclusion: This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.
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| 22. |
- Brodén, Karin, 1963-, et al.
(författare)
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Determining Value in Welfare-Technology : The Need for a Multi-Perspective Framework
- 2023
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Ingår i: International Journal of Health Economics and Policy. - : Science Publishing Group. - 2578-9295 .- 2578-9309. ; 8:4, s. 76-88
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stakeholders in health and social care are implementing digital solutions to facilitate person-centred care for citizens. One problem is choosing which digital solution to implement. Ordinary cost-benefit analysis implicates the measurable parts of the value, leaving the immeasurable without any trace in an analysis. Results: We used design thinking to design a framework that implicates what to add as valuable factors on individual, organisational, and governmental levels. The design is based on empirical material from workshops and literature reviews on systems thinking, quality management, and value factors. The valuable factors at an individual level could include independence, autonomy, and empowerment, and the factors at the organisational level accessibility, competence, and independence. On a central level, the factors are related to person-centred care and its value proposals, such as autonomy and independence. Conclusions: While conducting a cost-benefit analysis, focusing on a standard definition of the value concept is essential. The designed framework needs to be dynamic due to the broad range of welfare technology. The created rubrics cube model, including strategic, organisational-operational and individual levels, should be used by decision-making groups as a flexible foundation. Forthcoming research will test this framework, including the proposed scale for measurement and focusing on welfare technology for older citizens.
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| 23. |
- Brännström, Margareta, et al.
(författare)
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Meeting in a 'free-zone' : Clinical ethical support in integrated heart-failure and palliative care
- 2019
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 18:7, s. 577-583
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Tidskriftsartikel (refereegranskat)abstract
- Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams.Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare.Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis.Results: The CES was found to offer possibilities for meeting in an ethical ‘free-zone’ where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints.Conclusion: Participating in CES was experienced as meeting in an ethical ‘free-zone’ and seemed to be a means of facilitating integration of palliative and heart-failure care.
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| 24. |
- Dahlin Almevall, Albin, 1984-
(författare)
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Healthy Ageing and Well-Being in Old Age
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the decades to come, Sweden will be facing an unprecedented increase in the proportion of inhabitants aged 80 years or older. This age group is characterised by large heterogeneity; however ageing also poses challenges for health and well-being. These challenges apply not only to the individual, but also to the health care systems. Care of this older age group employs much of the nursing resources, affecting society as a whole. Healthy ageing can and should, therefore, be promoted in the decades prior to reaching old age, and once having reached old age, well-being should be a continued focus of health care and society. In this way older adults can continue perceiving good health and well-being. The overall aim of this thesis was to explore and describe areas of importance to healthy ageing and well-being in old age. Predictors of healthy ageing were prospectively studied as part of the northern Sweden Silver-MONICA project, from baseline in 1999 (n=1595) to follow-up 20 years later (n=541). For the healthy ageing outcome, a composite outcome comprised of measures of cognition (MMSE), 2.4 metre walking speed, personal independence in everyday life (Katz P-ADL) and depression (GDS15) was constructed. To study perceptions of general well-being in old age, a subsample (n=52) age > 80 was analysed as a cross-section using mixed method with open-ended interviews and the PGCMS well-being measure. A similar approach was used (n=50) to investigate specific aspects of well-being in relation to home. To study the relationship between well-being and objectively measure everyday physical activity, an accelerometer was worn 24 hours per day for at least 5 consecutive days (n=77) and analysed for associations with the PGCMS and its subscales. The five top ranking predictors determined by the healthy ageing index, comprising the total baseline cohort including those who passed away before possible follow-up were smoking status, NT-proBNP, waist circumference, leisure time physical activity level and HbA1c. For those who participated in the Silver-MONICA follow-up, the top five ranking predictors as determined by the healthy ageing index were leisure time physical activity, HbA1c, BMI, waist circumference and high sensitivity Troponin I. In interviews of general well-being, six areas were described that related to social context, health, physical activity, home, engagement and freedom. In regression analysis independence in activities of everyday living along with age were significantly associated with well-being. Acceptance was key for handling consequences of ageing that impacted well-being. Home was perceived as a central aspect of well-being; however, participants described being in the margins of home. Morale was higher among persons living in single-dwelling housing compared to those living in apartments. In activity measures, well-being was associated with the number of steps, time spent stepping and time spent stepping at >75 steps/minute.In conclusion, the combination of qualitative, quantitative and mixed methodology utilised in this thesis to study healthy ageing allowed for the possibility to nuance conclusions and to describe the subject from different points of view. Based on the findings, this thesis suggests that physical ability in old age is the basis for being able to engage in and experience the important factors of well-being described above. However, support from others, often family, can compensate for the lack of physical ability. The support is positive to well-being as long as it does not create feelings of being a burden. As consequences of ageing affect the areas most crucial to well-being, it seems that the extent and way these changed conditions are accepted has an important role in the maintaining of well-being in old age.
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| 25. |
- Darehed, David, et al.
(författare)
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Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce : a Swedish multicenter register study
- 2017
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Ingår i: European Stroke Journal. - : Sage Publications. - 2396-9873 .- 2396-9881. ; 2:2, s. 178-186
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome.Patients and methods: This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011-2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission.Results: A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio = 0.985, 95% confidence interval = 0.978-0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval = 2.6-5.5) for direct admission to a stroke unit versus the reference hospital.Discussion and conclusion: We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.
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| 26. |
- Ejneborn-Looi, Git-Marie, et al.
(författare)
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Solving the Staff's Problem or Meeting the Patients’ Needs : Staff Members’ Reasoning about Choice of Action in Challenging Situations in Psychiatric Inpatient Care
- 2014
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Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 35:6, s. 470-479
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Tidskriftsartikel (refereegranskat)abstract
- Coercion in challenging situations is often seen as a necessary component of psychiatric care. This study aims to describe staff members’ reasoning about their choice of action in challenging situations in inpatient psychiatric care. Focus group interviews with 26 staff members were analyzed using qualitative content analysis. The results provide an overview of the integrated structure of participants’ reasoning and suggest that staff members’ reasoning about choice of action can be described as a matter of either solving the staff's problems or meeting the patients’ needs. These results can be of use in further research, educational interventions, and staff development activities.
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| 27. |
- Fischer Grönlund, Catarina, 1962-, et al.
(författare)
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Communicative and organizational aspects of clinical ethics support
- 2019
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 33:6, s. 724-733
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Tidskriftsartikel (refereegranskat)abstract
- Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.
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| 28. |
- Fischer Grönlund, Catarina, et al.
(författare)
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Ethically difficult situations in hemodialysis care : nurses' narratives
- 2015
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 22:6, s. 711-722
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.RESEARCH QUESTION: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses' experiences of being in ethically difficult situations that give rise to a troubled conscience.RESEARCH DESIGN: This study has a phenomenological hermeneutic approach.PARTICIPANTS: Narrative interviews were carried out with 10 registered nurses working in dialysis care.ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.RESULTS: One theme, 'Calling for a deliberative dialogue', and six sub-themes emerged: 'Dealing with patients' ambiguity', 'Responding to patients' reluctance', 'Acting against patients' will', 'Acting against one's moral convictions', 'Lacking involvement with patients and relatives' and 'Being trapped in feelings of guilt'.DISCUSSION: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.CONCLUSION: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.
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| 29. |
- Fischer Grönlund, Catarina, 1962-
(författare)
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Experiences of being in ethically difficult care situations and an intervention with clinical ethics support
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Studies show that healthcare professionals often experience ethical difficulties in their relations with patients, relatives, and other professionals and in relation to organisational issues, and these can sometimes be difficult to handle. Failing to act or to relate in accordance with one’s values for what is good and right might cause a troubled conscience that is connected to feelings of guilt and ill-being. Ethical issues related to the care of patients with end-stage renal disease have been described, but no studies in this context have been found that explore registered nurses’ (RNs’) and physicians’ experiences of being in ethically difficult situations that give rise to a troubled conscience. The importance of communicating ethical issues in order to understand and handle ethically difficult care situations has been emphasized. Various forms of clinical ethics support (CES) have been described and evaluated, but studies on the communication processes and the organisation of CES interventions are sparse and no study describing a CES intervention based on Habermas’ theory of communicative action has been found.Aim: The overall aim was to increase our understanding about being in ethically difficult care situations and about how communication concerning ethical issues in healthcare can be promoted. More specifically, the aim of studies I and II was to illuminate experiences of being in ethically difficult situations giving rise to a troubled conscience among RNs and physicians, while studies III and IV aimed to describe the communication of value conflicts (III) and the organisation and performance of a CES intervention (IV).Methods: In studies I and II narrative interviews with ten RNs (I) and five physicians (II), were performed in a dialysis care context. The interviews were analysed using a phenomenological hermeneutic approach. In studies III and IV, eight audio- and video-recorded and two audio-recorded sessions of the CES intervention, were conducted and sorted by the data tool Transana and analysed in accordance with a qualitative content analysis (III) and a qualitative concept- and data-driven content analysis (IV).Results: The RNs’ narratives (I) resulted in the theme ‘Calling for a deliberative dialogue’. Their narratives expressed feelings of uncertainty, solitude, abandonment, and guilt in complex and ambiguous ethically difficult situations. The narratives concerned the value conflict between preserving life by all means and preserving life with dignity. The physicians’ narratives (II) resulted in the themes ‘Feeling trapped in irresolution’ and ‘Being torn by conflicting demands’. Their narratives expressed feelings of uncertainty, solitude, abandonment and guilt related to the obligation to make crucial decisions and in situations when their ideals and the reality iii clashed. The analysis of the communication of value conflicts during the CES intervention inspired by Habermas’ theory of communicative action (study III) revealed a process of five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, revelation of the value conflict, enhancing realistic expectations of the patients and relatives, and seeing opportunities to change the situation instead of obstacles. The CES intervention (study IV) was organised as a framework with a given structure and an openness for variations to facilitate communicative action. Three courses of actions to reach a communicative agreement were identified and concerned the approach to achieve a permissive communication, opening up for extended views, and enhancing mutual understanding (IV).Conclusion: The results show that both RNs and physicians expressed feelings of uncertainty abandonment and loneliness in similar ethically difficult situations but from different points of view. They struggled with the same value conflicts and feelings, but they did not share their struggles with each other. The lack of communication and confirmation led to distrust and increased feelings of uncertainty. The CES intervention, inspired by Habermas’ theory of communicative action, offered the possibility of dealing with experiences of ethically difficult care situations. In the permissive atmosphere, the professionals helped each other to balance their ambiguity, frustrations, and powerlessness and came to an agreement about how to handle the value conflicts and how to act. The findings from this CES intervention constitute a step towards a CES method that is clearly described so that leaders can be educated and extended intervention studies with different kinds of data can be conducted in order to further develop knowledge about how to promote an inter-professional dialogue about ethical difficulties.
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| 30. |
- Fischer Grönlund, Catarina, et al.
(författare)
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Managing Ethical Difficulties in Healthcare : Communicating in Inter-professional Clinical Ethics Support Sessions
- 2016
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Ingår i: HEC Forum. - : Springer Science and Business Media LLC. - 0956-2737 .- 1572-8498. ; 28:4, s. 321-338
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Tidskriftsartikel (refereegranskat)abstract
- Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) inspired by Habermas' theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved.
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| 31. |
- Fischer-Grönlund, Catarina, 1962-, et al.
(författare)
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The ‘one to five’ method - A tool for ethical communication in groups among healthcare professionals
- 2021
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Ingår i: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 51
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Tidskriftsartikel (refereegranskat)abstract
- Healthcare professionals have expressed a wish for facilitated inter-professional communications about ethical difficulties experienced in clinical practice. The introduction of an easily accessible method for facilitating ethical communication in groups may promote its implementation in everyday clinical practice. The aim of this paper was to draw on previous studies and available knowledge in order to develop and describe a method that enables systematic implementation of inter-professional ethical communication in groups. The ‘one-to-five method’ for facilitated ethical communication in groups is theoretically inspired by Habermas's theory of communicative actions and base on previous studies that accords with the Helsinki Declaration (2013). The ‘one to five method’ supports guidance of ethical communication in five steps: telling the story about the situation; reflections and dialogue concerning the emotions involved; formulation of the problem/dilemma; analysis of the situation and the dilemma; and searching for a choice of action or approach. It offers an easily accessible method for teaching healthcare professionals how to facilitate ethics communication groups. Educating facilitators closely connected to clinical work may lead to ethical dialogue becoming a natural part of clinical practice for healthcare professionals.
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| 32. |
- Forslund, Ann-Sofie, et al.
(författare)
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Meanings of people's lived experiences of surviving an out-of-hospital cardiac arrest, 1 month after the event
- 2014
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Ingår i: Journal of Cardiovascular Nursing. - 0889-4655 .- 1550-5049. ; 29:5, s. 464-471
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Tidskriftsartikel (refereegranskat)abstract
- Background: The out-of-hospital cardiac arrest (OHCA) survival rate has been poor and stable for a long time, but more recent studies describe its increase. However, there are few studies in which people narrate their experiences from surviving. Objective: The aim of this study was to elucidate meanings of people's lived experiences of surviving an OHCA with validated myocardial infarction (MI) etiology, 1 month after the event. Methods: A purposive sample of 2 women and 9 men was interviewed between February 2011 and May 2012. A phenomenological hermeneutical method was used for analysis, which involved 3 steps: naive reading and understanding, structural analysis, and comprehensive understanding. Results: There were 2 themes, (1) returning to life and (2) revaluing life, and five subthemes, (1a) waking up and missing the whole picture, (1b) realizing it was not time to die, (2a) wondering why and seeking explanations, (2b) feeling ambiguous in relations, and (2c) wondering whether life will be the same. All were constructed from the analysis. Conclusions: Surviving an OHCA with validated MI etiology meant waking up and realizing that one had experienced a cardiac arrest and had been resuscitated. These survivors had memory loss and a need to know what had happened during the time they were dead/unconscious. They searched for a reason why they experienced an MI and cardiac arrest and had gone from being "heart-healthy'' to having a lifelong illness. They all had the experience of passing from life to death and back to life again. For the participants, these differences led to a revaluation of what is important in life.
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| 33. |
- Forslund, Ann-Sofie, et al.
(författare)
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Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about lifestyle
- 2013
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Ingår i: European Journal of Cardiovascular Nursing. - 1474-5151 .- 1873-1953. ; 12:Suppl. 1, s. S13-S14
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about lifestyle.Design: An explanatory mixed methods design was used.Methods: All people registered in the northern Sweden Monica myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n=71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis.Results: The quantitative results showed that about 60% of the people had no history of ischemic heart disease or hypertension before the out-of-hospital cardiac arrest whereas 25% and 17% had been diagnosed with myocardial infarction and diabetes mellitus, respectively. Eighty percent of the people had total cholesterol levels greater than 5.0 mmol/l and/or were taking lipid lowering medications. Almost half were smokers and overweight. The qualitative results are presented in three categories ‘descriptions of lifestyle after surviving’, ‘modifying the lifestyle to the new life situation’ and ‘a changed view on life’. The participants described that their lifestyle focused on the importance of being needed and meaning something to others, feeling well and doing things of their choice. They tried to find a reason why the cardiac arrest happened and make appropriate lifestyle changes although they made their own assessmnet of risk behaviours. The participants expressed being grateful for a second chance at life and tried to have a positive outlook on life.Conclusions: For most people in this study out-of-hospital cardiac arrest was the first symptom of coronary heart disease. In the interviews the participants expressed that they were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some of the patricipants chose to ignore this knowledge to some extent and preferred to live a ‘good life’. A life where risk factor treatment played a minor part. The results of this study indicates that health care workers and patients should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours and lifestyle changes linked to these things.
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| 34. |
- Forslund, Ann-Sofie, et al.
(författare)
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Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about what lifestyle means to them : a mixed methods study
- 2013
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261 .- 1471-2261. ; 13:August
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Tidskriftsartikel (refereegranskat)abstract
- Background The known risk factors for coronary heart disease among people prior suffering an out-of-hospital cardiac arrest with validated myocardial infarction aetiology and their thoughts about what lifestyle means to them after surviving have rarely been described. Therefore the aim of the study was to describe risk factors and lifestyle among survivors. Methods An explanatory mixed methods design was used. All people registered in the Northern Sweden MONICA myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n = 71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis. Results About 60 % of the people had no history of ischemic heart disease before the out-of-hospital cardiac arrest, but 20 % had three cardiovascular risk factors (i.e., hypertension, diabetes mellitus, total cholesterol of more or equal 5 mmol/l or taking lipid lowering medication, and current smoker). Three categories (i.e., significance of lifestyle, modifying the lifestyle to the new life situation and a changed view on life) and seven sub-categories emerged from the qualitative analysis. Conclusions For many people out-of-hospital cardiac arrest was the first symptom of coronary heart disease. Interview participants were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some chose to ignore this knowledge to some extent and preferred to live a "good life", where risk factor treatment played a minor part. The importance of the support of family members in terms of feeling happy and having fun was highlighted by the interview participants and expressed as being the meaning of lifestyle. Perhaps the person with illness together with health care workers should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours linked to these things.
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| 35. |
- Gabrielsson, Sebastian, et al.
(författare)
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Knowledge of the patient as decision-making power: staff members’ perceptions of interprofessional collaboration in challenging situations in psychiatric inpatient care
- 2014
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 28:4, s. 784-792
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Tidskriftsartikel (refereegranskat)abstract
- Challenging situations in psychiatric inpatient settings call for interprofessional collaboration, but the roles and responsibilities held by members of different professions is unclear. The aim of this study was to describe staff members' perceptions of interprofessional collaboration in the context of challenging situations in psychiatric inpatient care. Prior to the study taking place, ethical approval was granted. Focus group interviews were conducted with 26 physicians, ward managers, psychiatric nurses, and nursing assistants. These interviews were then transcribed and analysed using qualitative content analysis. Results described participants' perceptions of shared responsibilities, profession-specific responsibilities and professional approaches. In this, recognising knowledge of the patient as decision-making power was understood to be a recurring theme. This is a delimited qualitative study that reflects the specific working conditions of the participants at the time the study was conducted. The findings suggest that nursing assistants are the most influential professionals due to their closeness to and first-hand knowledge of patients. The results also point to the possibility of other professionals gaining influence by getting closer to patients and utilising their professional knowledge, thus contributing to a more person-centred care.
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| 36. |
- Gabrielsson, Sebastian, et al.
(författare)
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Person-centred care : Clarifying the concept in the context of inpatient psychiatry
- 2015
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 29:3, s. 555-562
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Tidskriftsartikel (refereegranskat)abstract
- This paper reports an analysis of the concept of person-centred care in the context of inpatient psychiatry. It has been suggested that person-centred care in inpatient psychiatry might differ from person-centred care in other contexts, indicating a need to clarify the concept in this specific context. Scholarly papers from health-related disciplines were identified following a systematic search of the electronic databases CINAHL, PUBMED and PsycINFO, covering records indexed up until March 2014. An evolutionary approach to concept analysis was applied, integrating principles for data extraction and analysis in integrative reviews. The concept of person-centred care was defined as cultural, relational and recovery-oriented. It aspires to improve care and calls for a transformation of inpatient psychiatry. The concept is closely related to the concepts of recovery and interpersonal nursing. The result is described in terms of attributes, antecedents, consequences and related concepts. It is concluded that the further development of the concept needs to consider the contexts of the concept at both conceptual and praxis levels. Further research should explore the nature of and relationships between context, culture, care practice and outcomes in inpatient psychiatry from a perspective of person-centred care. The results of this analysis can provide a framework for such research
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| 37. |
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| 38. |
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| 39. |
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| 40. |
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| 41. |
- Isaksson, Rose-Marie, et al.
(författare)
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Older women's prehospital experiences of their first myocardial infarction : a qualitative analysis from the Northern Sweden MONICA Study
- 2013
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Ingår i: Journal of Cardiovascular Nursing. - Philadelphia : Lippincott Williams & Wilkins. - 0889-4655 .- 1550-5049. ; 28:4, s. 360-369
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few qualitative studies have been conducted on older women’s experiences of myocardial infarction (MI) and, in particular, the time before they seek medical care.Objective: The aim of this study was to explore older women’s prehospital experiences of their first MI.Methods: Qualitative content analysis was performed on data from individual interviews with 20 women, aged 65 to 80 years (mean, 73.0 years). The participants were interviewed 3 days after admission to a hospital for a confirmed first MI.Results: The women perceived their symptoms as a strange and unfamiliar development from indistinct physical sensations to persistent and overwhelming chest pain. Throughout the prehospital phase, they used different strategies such as downplaying and neglecting the symptoms. The symptoms were seen as intrusions in their daily lives, against which the participants defended themselves to remain in control and to maintain social responsibilities. As their symptoms evolved into constant chest pain, the women began to realize the seriousness of their symptoms. When the pain became unbearable, the women took the decision to seek medical care.Conclusion: Understanding the complex experiences of older women in the prehospital phase is essential to reducing their patient decision times. The findings of this study should be incorporated into the education of professionals involved in the care of cardiac patients, including those who answer informational and emergency telephone lines.
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| 42. |
- Isaksson, Rose-Marie, et al.
(författare)
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Prehospital experiences of older men with a first myocardial infarction : A qualitative analysis within the Northern Sweden MONICA Study
- 2011
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 25:4, s. 787-797
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore older men's prehospital experiences of their first myocardial infarction (MI). Background: The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in MI. The majority of people experiencing MI are men. But few studies have been conducted solely on men's experiences before seeking medical care for MI. The objective of this study was to explore older men's experiences of symptoms and their reasoning during the prehospital phase of their first MI. Method: Data collection was carried out through individual interviews with 20 men representing the age range 65-80 (mean 71)years. The participants were interviewed 3days after admission for a confirmed first MI. The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews. Findings: The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill-being to a cluster of alarming symptoms. The participants dealt with conceptions about MI symptoms. They were unsure about the cause of their symptoms, which did not correspond to their expectations about an MI, and whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction. Conclusions: Understanding older men's prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.
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| 43. |
- Isaksson, Rose-Marie, et al.
(författare)
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Prehospital experiences of older men with a first myocardial infarction : a qualitative analysis within the Northern Sweden MONICA Study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To explore older men’s prehospital experiences of their first MI.Background: The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in myocardial infarction (MI). The largest single component of the delay is the time it takes the person to respond to the symptoms by seeking care. The majority of people experiencing MI are men. But few studies have been conducted solely on men’s experiences before seeking medical care for MI. The objective of this study was to explore older men’s experiences of symptoms and their reasoning during the prehospital phase of their first MI.Method: Data collection was carried out through individual interviews with 20 men representing the age range 65–80 (mean 71) years. The participants were interviewed three days after admission for a confirmed first MI (with or without ST elevation). The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews. Findings: The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill-being to a cluster of alarming symptoms. During this journey the participants dealt with conceptions about MI symptoms. They were unsure both about the cause of their symptoms, which did not correspond to their expectations about an MI, and about whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce, or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction.Conclusions:Understanding older men’s prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life.
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| 44. |
- Isaksson, Rose-Marie, 1964-
(författare)
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Symptoms, prehospital delay and long-term survival in men vs. women with myocardial infarction : a combined register and qualitative study
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to study symptoms, prehospital delay and time trends in long-term survival in men and women with myocardial infarction (MI). The study was based on quantitative and qualitative data collections. Study I was based on The Northern Sweden MONICA Myocardial Infarction Registry, 1989-2003, including 5072 men and 1470 women with a confirmed MI. Symptoms and prehospital delay were described and trends over time according to sex and age were studied. Typical pain was present in 86% of the men and 81% of the women and typical symptoms were more common among younger persons than older persons. Up to the age of 65 no gender differences were seen in the prehospital delay. In the oldest age group (65–74 years) time to hospital was longer than among the younger group, especially among women. Study II was based on individual interviews with 20 men with a first confirmed MI, representing the age range 65-80 years, about their experiences during the prehospital phase. The interviews were analyzed using qualitative content analysis. The interviewed older men described how the symptoms developed from diffuse ill-being, to a cluster of severe symptoms. The men had difficulties to relate to the experienced symptoms, which did not correspond to their expectations about an MI, and about whether they should seek medical care. By using different strategies the participants initially tried to understand, reduce, or treat the symptoms by themselves, with a desire to maintain an ordinary life. As the symptoms evolved to a persistent and alarming chest pain, the men realized the seriousness in the perceived symptoms, that all strategies were inefficacious and they came to the decision to seek medical care. Study III was based on individual interviews with 20 women with a first confirmed MI, representing the age range 65-80 years, about their experiences during the prehospital phase. The interviews were analyzed using qualitative content analysis. The interviewed older women described how the symptoms were perceived as a stepwise evolvement from intangible and bodily sensations to a more distinct, persistent and finally overwhelming chest pain. The women struggled against the symptoms and used different strategies, by downplaying and neglecting the symptoms in order to maintain control over their ordinary lives and maintain the social responsibilities. As the symptoms evolved to a persistent and overwhelming chest pain the women realized the seriousness in the perceived symptoms, they were not able to struggle against them anymore and they came to the decision to seek medical care. Study IV was based on The Northern Sweden MONICA Myocardial Infarction Registry which was linked to The Swedish National Cause of Death Registry for 6762 men and 1868 women, 25 to 64 years of age, with a first MI during 1985-2006. Also deaths before admission to hospital were included. Follow-up ended on August 30, 2008. Between 1985 and 2006 long-term survival after a first MI increased in both men and women. Over the whole 23-year period women showed a 9 percent higher survival then men. This slight difference was due to lower risk for women to die before reaching hospital, and during the last period similar rates of long time survival were noted in men and women. In conclusion there were no major differences between men and women in symptoms, prehospital delay or long-term survival. However, older patients had fewer typical symptoms and longer prehospital delay, especially among women. The prehospital phase was found to be multifaceted with experiences difficult to interpret in both men and women, with a dynamic development of symptoms, conceptions and expectations while the participants strove to maintain the ordinary and familiar life. The symptoms experienced presented a more heterogeneous and complex picture in both men and women than is usually described in the literature. Women under the age of 65 have a slightly higher age-adjusted long-term survival than men. Over a 23-year period long-term survival has improved similarly in both men and women.
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| 45. |
- Karlsson, Margareta, et al.
(författare)
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Customer orientation in a Swedish county council
- 2016
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Ingår i: International Journal of Quality and Service Sciences. - 1756-669X .- 1756-6703. ; 8:1, s. 2-16
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe use of the customer concept and ways of interacting with customers in support functions are relatively new areas of interest for public organizations. The aim of this study is to describe the development towards a stronger customer orientation in a support function in a Swedish county council from a management team perspective.Design/methodology/approachA revision of plans and annual reports and individual interviews with the members of a management team was done. The interviews were examined using qualitative content analysis.FindingsThe results are presented in one overarching theme: the double-edged customer concept, and three themes: meeting the customer’s needs, being the customer’s specialist, and developing in collaboration with the customer. The development of a customer orientation is illustrated as a spiral involving the concepts of understanding, wanting, and acting.Originality/valueThe paper contributes to new understanding of how customer orientation develops in the context of public organizations’ support functions.
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| 46. |
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| 47. |
- Karlsson, Margareta, et al.
(författare)
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Organizing for sustainable inter-organizational collaboration in health care processes
- 2020
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 34:2, s. 241-250
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Tidskriftsartikel (refereegranskat)abstract
- Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care.
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| 48. |
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| 49. |
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