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- Ahlström, Gerd, et al.
(författare)
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A comprehensive rehabilitation programme tailored to the needs of adults with muscular dystrophy.
- 2006
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 20:2, s. 132-141
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess if activities of daily living (ADL), coping and quality of life could be improved in adults with muscular dystrophy through a comprehensive rehabilitation programme. DESIGN: Quasi-experimental, controlled clinical study comparing patients with similar age and disease aspects. SETTING: Two different counties in Sweden, being either study or control setting. SUBJECTS: The study group comprised 37 adults (21 women, 16 men; mean age 50 years), while the control group comprised 39 people (25 women, 14 men; mean age 46 years). INTERVENTIONS: Four rehabilitation sessions tailored to different medical, physical and psychosocial needs of the patients, comprising a total of 10 days over a period of 18 months. MAIN MEASURES: ADL, the Mental Adjustment to Cancer Scale measuring coping strategies, the Sickness Impact Profile measuring health-related quality of life, the Hospital Anxiety and Depression Scale, and the Psychosocial Well-being Questionnaire. RESULTS: No significant differences were found between groups with regard to the outcome measures. There was increased dependence on others in ADL after 18 months in both groups, but it was more pronounced in the control group. Furthermore, a clear trend was observed in the data with regard to coping patterns, the control group using more coping strategies such as 'Helplessness/hopelessness' (P= 0.057), 'Anxious preoccupation' (P = 0.085) and 'Fatalistic' (P= 0.073) when being compared to the study group. CONCLUSIONS: No apparent effects on ADL were found from the rehabilitation programme, although there was a tendency of reduction of maladaptive coping patterns in the study group. This initial study may provide the rationale and basis for a randomized controlled trial.
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- Ahlström, Gerd
(författare)
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Coping with Neuromuscular disease and the Implications for Interventions
- 2008
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Ingår i: The First International Symposium on Psychosocial Aspects of Neuromuscular Disorders. - Bilbao, June 20-21 2008 : University of Deusto, Bilbao. ; , s. 1-
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Konferensbidrag (refereegranskat)abstract
- Coping with Neuromuscular disease and the Implications for Interventions The lecture is based on results from three theses and about 25 scientifically articles about the plight of the patient with muscular dystrophy (MD), and the patients’ ways of coping with illness-related problems from a psychosocial perspective. MD is a group of inherited disorders characterised by muscular weakness caused by muscle wasting. Three subgroups are distinguished in our research: one group with different types of proximal MD and the other two groups characterized chiefly by distal weakness. The research was to elucidate how persons with muscular dystrophy experience their everyday life over a ten years period. The research includes four data collections with qualitative and quantitative methods. The data was selected in three different county councils in Sweden. The persons with MD described the change from being independent to being an individual in need of assistive devices and/or personal support to manage activities of every day life. Besides muscular weakness the persons have the strain it means to have a hereditary disease. The deterioration in a decennium was mainly with regard to ambulation. The number of persons walking without assistive devices and working has almost been halved. They experienced periods of sorrow due to losses of independence, control, status and social roles and the loss of one’s identity as a healthy person. The sorrow connecting with repeated losses are in the literature designate as chronic or episodic sorrow. Also, in the lecture the patients’ illness trajectory were described by a model of Sullivan (1994) into four dimensions in order to increase the understanding of what it means to live with muscular dystrophy. The aim of interventions is to support the patient’s appropriate ways of coping as Problem-focused coping/Searching for a solution, Fighting spirit/Struggling, Re-appraising of life values, Maintaining hope, Social comparison, Laughing and joking and Caring about self.
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- Ahlström, Gerd
(författare)
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Experiences of loss and chronic sorrow in persons with severe chronic illness
- 2007
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Ingår i: Journal of Clinical Nursing. - 0962-1067 .- 1365-2702. ; 16:3A, s. 76-83
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The aims of the present study were to describe losses narrated by persons afflicted with severe chronic physical illness and to identify the concomitant occurrence of chronic sorrow. Background. Reactions connected with repeated losses are referred to in the literature as chronic sorrow, which has recently been described in conjunction with chronic illness. Design. A qualitative study with an abductive approach of analysis, including both inductive and deductive interpretations. Method. The study is based on 30 persons of working age with average disease duration of 18 years. The average age was 51 years. All of the persons had personal assistance for at least three months because of considerable need for help in daily life due to physical disability. Each person was interviewed twice. There was also an independent assessment of the deductive results concerning chronic sorrow. Results. The inductive findings show that all persons had experienced repeated physical, emotional and social losses. Most common were 'Loss of bodily function', 'Loss of relationship', 'Loss of autonomous life' and 'Loss of the life imagined'. 'Loss of identity' included the loss of human worth, dignity and a changed self-image. In addition, the deductive findings suggest that chronic sorrow exists in the study population. Sixteen of 30 participating subjects were assessed by both assessors to be in a state of chronic sorrow and there was an especially high agreement with respect to one criterion of chronic sorrow 'Loss experience, ongoing or single event' (28 of 30 subjects). Conclusions. This study shows that persons with severe chronic illness often experience recurring losses. These experiences are consistent with the phenomenon of chronic sorrow. Relevance to clinical practice. Knowledge of the existence of chronic sorrow in persons with chronic illness will enable nurses to support these persons in a more sensitive and appropriate way.
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- Ahlström, Gerd
(författare)
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Integrating improvement learning into health professional educational curricula
- 2008
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Ingår i: International Forum on Quality Improvement in Healthcare. - France, April 24 2008 : International Forum on QI. ; , s. 1-
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Konferensbidrag (refereegranskat)abstract
- We all need to start where we are and also wanting to go further all the time. This is the essence in quality improvement. The leader and the teachers must own this attitude themselves in order to have the ability to be trustworthy for the students. There is evidence in the literature about the impact of education on the professional attitude and role. This means that it is important to work with better professional development for better outcomes in the faculty. One starting point for us in the planning of our different programs are that improvement knowledge will be a streak through the whole education in order to establish a professional attitude of daily inspiration to produce the best practise. We have applied all curricula to Boologna declaration and in this system progression in learning is a key point. We have four levels in the basic education (3-years education which lead to Bachelor degree) where we start to introduce 1) Concepts and models in health improvement. Then let our students make a 2) Personal improvement in their everyday life. Later in the education we teach about 3) Evidence practise and systematic literature reviews. Finally the students are 4) Making health improvements in collaboration with the staff during one clinical education. All educational programmes on basic level since 2007 include aim descriptions about quality improvement. The aim of the learning is to have the competence to initiate and participate in work about health care improvements. Finally, besides the mentions aspects in improvement education there are some other factors that needs for better system performance.
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- Ahlström, Gerd
(författare)
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Intentional Partnerships—Creating New Partnerships : A national and international model
- 2008
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Ingår i: Quality and Safety in Nursing Education. - Chicago, USA : The Joint Comission. ; , s. 6-
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Konferensbidrag (refereegranskat)abstract
- Since one of the aims of this meeting is to create a strategy for the participants to connect and share experiences post-conference I will start by giving a very brief account of Jönköping University and the School of Health Sciences, this in order to give you a sense of the school as a possible partner for collaboration. Then I will describe how teachers work to increase knowledge with regard to health care improvement within the nursing program. Thereafter I will talk about a research project and relate this to what we can learn about interprofessional education. The basic values regarding health care improvement described by Paul Batalden and his colleagues are central to our present development. We share the theoretical assumptions concerning the Clinical Microsystem and the view of redesigning health care education in order to produce the best care for the patient and his/her family. So within our organization both teachers and students — like nurses — have two jobs, one of which is to bring about improvement. So we have started the process where the educators need to change their teaching for the sake of better patient outcomes, better system performance, and better professional development. This means communicating not only the existing evidence-based knowledge but also improvement knowledge which involves a substantial shift in our idea of the work of health care — a challenging task that can benefit from the use of a wide variety of tools and methods. A key concern for us in the planning of our different programs is that the improvement of knowledge shall permeate the education and contribute to establishing a professional attitude marked by daily inspiration to produce the best care. The basic education involves four stages. First there is an introduction to concepts and models in health care improvement. This content is in the first semester. Second the students’ are making a personal improvement in their everyday life. The students apply PDSA-cycle for improvement of an issue, commonly their time-table for studies, time spending for eating breakfast in the morning or eating habits in general. The third stage involves evidence-based nursing and systematic literature reviews and in the fourth stage, the students make health care improvements in collaboration with the staff during a clinical training period. The nurses at the clinic formulate the area of improvement. Then the students work systematically in pairs to collect data and the results are reported to the nurses. The latter stage is a new content in nursing education but we know from occupational therapy that the staff appreciated these works and the results were in most cases used by the staff in their job. The overall aim of the research project “Bridging the gaps” is to generate evidence about the process and outcome of clinical work within the area of quality improvement. The project contributes to an advanced environment for learning and innovation, research and development in the field of health-care management and improvement. There are 14 doctoral students at the research school, who takes part in the research project. Three of them are nurses and doctoral students at the School of Health Sciences. All PhD students have to take two compulsory courses, one is named “Bridging the gaps — a multidisciplinary research field” and the other is named “Interactive Research Methodology”. The Microsystem as a theoretical model is included in the mention research course “Bridging the gaps” and in each doctoral student’s research proposal. The PhD students shall work together with health-care staff by way of an interactive research method. This means that there is an integration of research and practice. The PhD students and the health-care staff are working together throughout the project. The staff is involved at every stage, from designing the improvement work, formulating the research questions to reporting the results. Research with this methodology generates knowledge of great relevance for clinical practice.
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- Ahlström, Gerd
(författare)
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Personal assistance for patients living with a severe neurological disorder.
- 2006
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Ingår i: Journal of Neuroscience Nursing. - 0888-0395. ; 38:3, s. 183-193
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Tidskriftsartikel (refereegranskat)abstract
- Patients with neurological diseases increasingly are being cared for at home. The purpose of this study was to describe stressful everyday experiences in connection with neurological disorders, to learn how people cope with such experiences, and gain knowledge about coping resources. Twenty-seven persons receiving personal assistance were interviewed twice at home. The 54 interviews were subjected to inductive content analysis. The persons encountered many problems in everyday life and usually handled them by means of acceptance, avoidance, practical problem solving, and reappraisal. Dependence on personal assistance gave rise to a sense of helplessness, but it was also the major coping resource. Nurses can improve home care by giving instruction and guidance to persons working as personal assistants.
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- Ahlström, Gerd
(författare)
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Research Outcomes about Coping in Swedish populations : the Ways of Coping Questionnaire (WCQ)
- 2009
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Konferensbidrag (refereegranskat)abstract
- The lecture will present an overview of the development and results from the Swedish version of the WCQ. The process of translation of the original questionnaire into Swedish is described as well as the results of the first Swedish study about coping with illness-related problems in persons with chronic diseases compared with a group healthy subjects. The first findings indicated the importance of further testing of the psychometric properties of the WCQ. Further psychometric evaluation of the WCQ included 510 subjects (patients, their next of kin and students). The result indicated modest support for the 8-factor model and deviation from equality of factor structures among the sub-samples. The 8-factor model was more adequate in describing clinical than non-clinical samples. A modification of the WCQ with a version of 45 items was made based on the results, which is now current in several studies.
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