| 1. |
- Frank, Catharina, 1961-
(författare)
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Tillfället gör delaktighet : Patienters och vårdares erfarenheter av patientdelaktighet på akutmottagning. En deskriptiv, metodutvecklande och utvärderande studie
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the present thesis was to examine, develop and evaluate patient participation in emergency department (ED) for promoting the relief of suffering for patients in care relations, from the perspective of patients and caregivers.Method: The explorative studies (I, II) were based on reflective lifeworld approach and analyzed by phenomenographic method. Data were collected from interviews by patients (9) and caregivers (11) about their conception of patient participation in ED. The methodological study (III) performed analyses and were tested for content, construct and criterion validity as well as homogeneity and stability reliability. The sample for study (III, IV) consisted of 356 patients consecutively cared for in EDs in Sweden. In the evaluating study (IV) the questionnaire Patient Participation Emergency Department (PPED) was used. The statistical methods handled were Student’s t-test, one-way ANOVA and Spearman correlation.Findings: The patients’ conception of patient participation means: being acknowledged; struggling to become involved; and having a clear space (I). The caregivers’ conceptions of patient participation can be divided into three different descriptive categories: Caregivers offer the opportunity for participation, Patients demand participation and Mutual participation (II). A 17- item questionnaire was developed. Two separate factor analyses revealed a distinct four- factor solution which was labelled: Fight for participation, Requirement for participation, Mutual participation and Participating in getting basic needs satisfied. Criterion validity presented showed 9 out of 20 correlations equal or above 0.30. Cronbach’s alpha coefficient ranged from 0.63 - 0.84 and test- retest varied between 0.59 and 0.93(III).The results show that patient participation is low in two dimensions (Fight for participation, Participation in getting basic needs satisfied), reasonable in one dimension (Mutual participation), and high in one dimension, Requirement for participation (IV).Conclusions: Participation does occur on occasion when the circumstances are right despite international and national guidelines that lay down the need for patient participation. Patient participation in EDs is perceived when patients are in contact with caregivers and there is space for collaboration in situations of consistency. However, patient participation cannot be offered in a one-sided caring action. In collaboration patient participation contributes to the relief of suffering in the process of health and patients participate when they are allowed to be the point of departure for caring. However, the results point to a lack of strategy for patient participation and for increased patient participation to take place improvements in external organization requirements are required. The results indicate an amplified clarity in how patient participation can be understood for EDs, in education and community and a scientific tested instrument has made it possible to evaluate patient participation.
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| 2. |
- Gross, Mechthild M., et al.
(författare)
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Women's experiences on VBAC: results of a metasynthesis
- 2014
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Ingår i: Optimising Childbirth Across Europe, 9-10 April 2014. Brussels, Belgium..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: More and more women experience a caesarean section with their first, or later, birth. During a subsequent pregnancy they experience a challenging period of decision making on the mode of birth. Vaginal birth after caesarean section (VBAC) is a relevant option for a large number of women. Despite lots of quantitative studies on VBAC there is a lack of studies that report the experiences of women. Aim of review: To report the main themes of women’s experiences of VBAC. Search strategy: The following databases were searched: CINAHL, EBSCO, Journals@ OVID, Pubmed, PSYCHINFO, using the keywords VBAC, vaginal birth after caesarean section, qualitative study, experiences, qualitative and women´s experiences in various combinations. Review methodology: In total, 1981 papers were identified; of these, 1959 had to be excluded. From the remaining 22 papers eleven were excluded at this stage, as not focusing on women´s experiences, or only focusing on experiences of CS in relation to VBAC. A metasynthesis based on the interpretative meta ethnography method was conducted. Main findings: Four final themes became obvious: ‘to be involved in decision about mode of delivery is difficult but important,’ ‘vaginal birth has several positive aspects mainly described by women,’ ‘vaginal birth after CS is a risky project,’ and ‘own strong responsibility for giving birth vaginally’. The papers discussed issues such as the women´s experience in relation to different aspects of VBAC, decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. Conclusion: It became obvious that women may feel as though they are in a fog when preparing for a VBAC. Women need evidence-based information not only about the risks involved but also about positive aspects of VBAC.
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| 3. |
- Larsson, Åsa, et al.
(författare)
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Fördjupad hälsa – kvinnors upplevelse av att planera och föda sitt barn hemma
- 2014
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Ingår i: HOITOTIEDE. - 0786-5686. ; 26:1, s. 2-10
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Tidskriftsartikel (refereegranskat)abstract
- In Finland, 12 planned and 81 unplanned homebirths took place according to the official Health Statistics 2012. In a Nordic neighbor country, Sweden, like in many high-income countries almost all women give birth at hospital, and only about 100–200 women each year choose to plan and give birth at home. It is a controversial decision because it is often associated with risks, and not supported by the public health care system. The aim of this study was to describe Swedish women’s experience of planning and giving birth at home. Ten women who have had between one to three homebirths were interviewed. The data were analyzed with a phenomenological hermeneutical method. Five themes were identified, and an overall interpretation was discussed in relation to an ontological theory of health. Findings show that women who choose homebirth are aware of their needs and have the strength to go through with their decision in spite of resistance. Childbirth at home was for the women an opportunity for enrichment and health, and a new experience of wholeness as a person.
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| 4. |
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| 5. |
- Lindberg, Elisabeth, et al.
(författare)
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'The responsibility of someone else' : a focus group study of collaboration between a university and a hospital regarding the integration of caring science in practice.
- 2012
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell Publishing Ltd.. - 0283-9318 .- 1471-6712. ; 26:3, s. 579-86
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of the study was to develop insights into how nurses, senior preceptors and head nurses experience the integration of caring science in practice and how they value the contributions of nursing students to the integration of caring science in practice. BACKGROUND: Research still reveals differences between theory and practice by nursing students. In Sweden, clinical education units have become one way of creating consistency between university and health care practices on values of caring. METHOD: The study is hermeneutic in design comprising data from three focus group interviews. The participants include registered nurses, senior preceptors and head nurses. RESULT: The study shows that roles and mandates are not clearly defined between the different actors. The university and hospital collaboration in caring science integration was regarded as 'someone else's responsibility'. Research and development seemed excluded from the everyday life of the hospital units. The students seemed to fall somewhere between the hospital 'practice and concrete world of production' and the university 'theory world of education and research'. Three themes emerge: 'integration--someone else's responsibility', 'the hospital--a culture of production' and 'the hospital and the university--different realities'. DISCUSSION: The results suggest the need for professionals within health care and university to reflect on their responsibilities in terms of research and development. The ethos of caring science implies the alleviation of suffering and caring for vulnerable patients including research and development.
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| 6. |
- Lundgren, Ingela, 1957, et al.
(författare)
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'Groping through the fog': a metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section)
- 2012
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vaginal birth after Caesarean section (VBAC) is a relevant question for a large number of women due to the internationally rising Caesarean section (CS) rate. There is a great deal of research based on quantitative studies but few qualitative studies about women's experiences. Aim: To integrate qualitative findings and deepen the understanding of women's experiences of VBAC. Method: A metasynthesis based on the interpretative meta ethnography method was conducted. The inclusion criterion was peer-review qualitative articles from different disciplines about women's experiences of VBAC. Eleven articles were checked for quality, and eight articles were included in the synthesis. Results: The included studies were from Australia (four), UK (three), and US (one), and studied women's experience in relation to different aspects of VBAC; decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. The main results are presented with the metaphor groping through the fog; for the women the issue of VBAC is like being in a fog, where decision-making and information from the health care system and professionals, both during pregnancy and the birth, is unclear and contrasting. The results are further presented with four themes: 'to be involved in decision about mode of delivery is difficult but important,' 'vaginal birth has several positive aspects mainly described by women,' 'vaginal birth after CS is a risky project,' and 'own strong responsibility for giving birth vaginally'. Conclusion: In order to promote VBAC, more studies are needed from different maternity settings and countries about women's experiences. Women need evidence-based information not only about the risks involved but also positive aspects of VBAC.
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| 7. |
- Nilsson, Christina, 1959-
(författare)
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Förlossningsrädsla : med fokus på kvinnors upplevelser av att föda barn
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this study is to describe experiences of, and the association between, fear of childbirth and birth experiences of women with fear ofchildbirth.Methods: In studies I, II, and IV, a reflective lifeworld approach based on phenomenological philosophy was used to describe women’s experiences of fear of childbirth (I), previous birth experiences (II), and fear of childbirth and of birth experience in a long-term perspective (IV). In study III, differences between women who reported fear of childbirth and those who did not were calculated using risk ratios with a 95 % confidence interval and multivariate logistic regression analysis. Data were collected from interviews with eight (I) and nine (II) pregnant women with intense fear of childbirth, and with six women who had sought care for intense fear of childbirth 7 to 11 years prior to the interview (IV), and via questionnaire from a sample of 763 women during pregnancy and again one year following birth (III).Findings: Fear of childbirth was described as “to lose oneself as a woman into loneliness” (I). Previous birth experience was described as “a sense of not being present in the delivery room and an incomplete childbirth experience” (II). Fear of childbirth was associated with a previous negative birth experience and a previous emergency caesarean section (III). From a long-term perspective, fear of childbirth and birth experience was described as “an effort to make all the pieces come together” (IV).Conclusions: This thesis generates evidence on the importance of previous birth experience for women with fear of childbirth, from both qualitative and quantitative perspectives. These perspectives illustrate the complexity where women´s experiences in the delivery room are central. To avoid creating fear of childbirth, it is important that maternity care services focus on women’s birth experiences and critically evaluate care in relation to childbirth.
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| 8. |
- Nilsson, Christina, et al.
(författare)
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Previous birth experience in women with intense fear of childbirth
- 2010
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Ingår i: Journal of Obstetric, Gynecologic and Neonatal Nursing. - : Wiley-Blackwell. - 0884-2175 .- 1552-6909. ; 39:3, s. 298-309
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the meaning of previous experiences of childbirth in pregnant women who have exhibited intense fear of childbirth such that it has an impact on their daily lives.Design: A descriptive phenomenological study. Setting: A maternity clinic for women with fear of childbirth in the western part of Sweden. Participants: Nine women with intense fear of childbirth who were pregnant with their second child and considered their previous birth experiences negative.Methods: Interviews that were transcribed verbatim and analyzed with a reflective life-world approach.Results: The essential meanings that emerged were a sense of not being present in the delivery room and an incomplete childbirth experience. The women felt as if they had no place there, that they were unable to take their place, and that even if the midwife was present, she did not provide support. The experience remained etched in the women’s minds and gave rise to feelings of fear, loneliness, and lack of faith in their ability to give birth and diminished trust in maternity care. These experiences contrasted with brief moments that made sense.Conclusions: Previous childbirth experiences for pregnant women with intense fear of childbirth have a deep influence and can be related to suffering and birth trauma. The implication is to provide maternity care where the nurse/ midwife is present and supports women during birth in a way that enables them to be present and take their place during birth.
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| 9. |
- Nyman, Viola, 1961, et al.
(författare)
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Midwives´ experiences of action research and the nature of the first encounter on a hospital based labour ward in Sweden
- 2014
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Ingår i: Optimizing childbirth across Europe - an intedisciplinary maternity care conference. 9-10 April 2014, Brussels. Part of COST Action IS0907: Childbirth Cultures, Concerns & Consequences: Creating a dynamic EU framework for Optimal maternity care..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: An Action research study was undertaken with midwives based on one Swedish labour ward, to improve the quality of the first encounter with women and their partners. Aim of presentation: To describe 1) the Ar process 2) midwives' responses to a changed approach in the initial labour ward encounter. Research methodology: An insider action research design included several planning meetings with the midwives, agreeing on change, implementing the changes together, and evaluating the effects. To meet the woman's and partner's need for support even in the first encounter the ambition was to stay with the woman and partner while the fetal heart monitoring was running. The researcher kept a research journal documenting thoughts, reactions, reflections and the development of the Ar process. Thirty seven out of 57 midwives working on the labour ward were interviewed about their experiences. Interviews were tape recorded, transcribed and analysed using interpretive description. Ethical approval Ethical approval was received Study findings: The Ar started 2010. Initially, midwives found it most difficult to change their routine of starting the fetal heart monitoring when women first arrived in labour, and then leaving to read the woman's medical record and notes. Through the debates in the Ar meetings, more midwives moved towards spending time in the room with the woman and partner, talking with them, thereby creating meaningful relationships from the outset. The midwives' reflexive responses in the interviews illuminate their initial reluctance to respond to the Ar process, but also, the value of reflecting beyond routines to build a lingering presence in the first labour encounter. Conclusions: Examination of the three years of insider Ar process through qualitatively analyse clinical documents, the researcher's journal including notes of observations and interviews revealed the complexity and the difficulty of providing time to manage reflection in a large organization. To a greater or lesser extent, midwives had integrated relatively impersonal system-wide technocratic norms of childbirth into their belief systems and behaviors. The Ar study design enabled midwives reflect on routines and start the transformation of tacit use-inaction to reflection-in-action.
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| 10. |
- Pajalic, Zada, 1967-
(författare)
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Matdistribution till hemmaboende äldre personer ur flera perspektiv
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this study was to gain insight into municipal food distribution from several perspectives: that of the clients, mainly elderly people, and also from the perspectives of different professionals and decision makers. An action research approach was chosen, as the characteristics of this method were deemed to be correct in relation to the basic aim of the study. This thesis is based on four empirical studies. Study I aimed to explore various professionals’ experiences of involvement in food distribution (FD) in order to get a comprehensive understanding of the organization, responsibilities and roles. The results showed that FD is a fragmentary intervention where a comprehensive perspective and clear roles of responsibility are lacking. Study II aimed to gain insight and to describe the experiences of home-living elderly people who receive hot meals distributed by their municipality. The results showed that there were feelings of dependency, and loneliness among the elderly participants, however they also expressed gratitude for the opportunity to have their meals delivered to their home. Study III aimed to describe how the professionals can identify needs for improvement and improve the municipal FD service to home living elderly people. The need to update and increase the FD recipient’s knowledge in nutrition by sending information letters was found to be an important area to focus on. Evaluation of letters resulted in the decision to continue preparing and distributing information letters to all FD recipients twice a year and to make the information letters assessable on the websites of the six municipalities and county councils involved. Study IV aimed to describe the decision maker’s views on FD and to report their suggestions for which areas reported from studies I-III should be taken into consideration as starting points to improve the municipal FD. The findings resulted in the decisions to monitor the elderly’s health and wellbeing while providing FD and to increase the professionals’ competence and to create a forum for inter-professional communication. In conclusion, this thesis illustrates that there is a necessity to identify the needs for general improvement of FD by involving the participants and to start out from their personal experiences and in their own context.
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