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- Kihlgren, Mona, 1938-
(författare)
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Integrity promoting care of demented patients
- 1992
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of the thesis was to investigate if integrity promoting care improves functions in demented patients over time. The Erikson (1982) theory of ”eight stages of man” was used as a basis for training of staff in a three-month intervention study (I-VI) at a nursing home ward. A collective living unit where staff had had support in the performance of the delivery of care was also evaluated and compared with a nursing home in a long-term study (VII). Patients, relatives, staff, and the environments were investigated. Cerebrospinal fluid concentrations of somatostatin increased, and reduction of distractability, anxiety and confusion was seen in the intervention group (I) in contrast to controls. In the collective living group (VII) EEG activities indicated a reduction of supposed dementia induced changes. Better motor and social ability, some improved intellectual ability, more alertness and reduced signs of depression were seen (I, II, VII). Patients expressed more autonomy (IV, VII) and initiatives (II-VII) and showed a lot of competence (V) in conversations. Five patients (V) showed patterns of behaviour which seemed to reflect life-long characteristics in spite of their severe dementia. The improvement in the patients' functions can be attributed to the physical environment and the integrity promoting care, since the medical treatment of the patients remained unchanged. In the thesis medical, psychological, and nursing sciences were connected in a complementary process. The results were congruent, and indicate that patients in the care of staff who had had training and support, declined less than controls.
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| 2. |
- Saveman, Britt-Inger, 1950-
(författare)
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Formal carers in health care and the social services witnessing abuse of the elderly in their homes
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose was to elucidate the reactions of formal carers as witnesses and helpers in situations of elder abuse, to illuminate abusive situations and to reflect on the findings from an ethical point of view. Twenty-one district nurses from one county council were interviewed (I, II, III, IV). They described the problems they had when dealing with cases of elder abuse, the uncertainty they felt when they approached the family, identified the abuse and intervened (I). They used no distinct definition of elder abuse but described it as ’overstepping the boundaries of a person’s integrity/autonomy’ (II). In the 44 cases narrated the elderly people were mostly physically and/or psychologically impaired, the person abused could either be the impaired elderly person, the informal carer or both. Abuse was related to the inability of one party to meet the demands made on him/herself, the other person, or to a history of violence (III). The cases narrated were analysed for reliability and were considered reliable (IV). Questionnaires submitted to 163 district nurses revealed 33 cases of elder abuse (V) and to home service assistants 97 cases (VI). The abused elderly people were often very old women, mostly healthy or unhealthy in equal proportions. The perpetrators were mostly close relatives, responsible or not responsible for the caring. The abusive acts often involved a combination of psychological, physical, and financial abuse and neglect. Mental disturbance and alcohol abuse, as well as financial reasons were reported as contributing to the abuse (V, VI). The attitudes of general practitioners, district nurses and home service assistants towards elder abuse and the interventions suggested in hypothetical cases of elder abuse were investigated (VII). All groups were uncertain about their attitudes towards elder abuse. Their suggested interventions were amalgamated into three groups; sparse and of the social type, more specific and of the health care and voluntary type, or overall types of intervention. The situation, profession and organization seemed to result in different interventions (VII). The findings were reflected on using Lögstrup’s ethic as a framework, and the conclusion was that in order to be able to intervene successfully formal carers need to find solutions on a meta-level. Conventions and norms must be developed and public responsibility is needed.
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| 3. |
- Lundman, Berit, 1942-
(författare)
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Daily living and coping strategies in insulin-dependent diabetics : diagnostic reasoning in nursing
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Within a defined geographical area, all patients, 192 in total, with insulin- dependent diabetes of at least 2 years' duration and free from long-term diabetic complications were identified. Their experiences of the influence of the disease on daily living, tedium, and smoking habits were evaluated using a questionnaire and related to metabolic control. A case-referent study concerning smoking habits among 25 patients with good, and 25 with poor metabolic control was performed. The influence of mentruation on metabolic control was studied among 20 diabetic women and 20 healthy controls. Coping strategies and their outcomes were studied among 20 patients, using the interview technique. Among those with unsatifactory metabolic and/or emotional outcomes, plans for nursing intervention were agreed on, using diagnostic reasoning. Only a minority of the patients reported that the disease caused them considerable problems in their daily lives. The greatest problems occurred in connection with regularity in daily life, diet management, and exercise. Patients with good metabolic control (HbAic<6.7) had a higher number of hypo-glycemic cornata (7 vs 1, p<0.001). Patients with poor metabolic control (HbAic>9.0) reported more often that they were smokers (pcO.Ol) and the women fertile aged in this group more often reported problems with metabolic control during menstruation (p<0.05). Twenty-nine (18%) were defined as suffering from tedium. There was a higher proportion (NS) of high tedium scores among patients in both good and poor metabolic control groups than in those with intermediate metabolic control. Sixty (31%) of the patients were smokers, prevalence of smoking increased significantly with increasing HbAic- levels (17.5% among patients with the best metabolic control, 47.5% among those with the worst metabolic control). In the case referent study exposure to smoking was found to be significantly more common among those with poor control (odds ratio 6.0). No systematic change in metabolic control during the menstrual cycle could be found. Problem-solving coping strategy based on the monitoring of blood glucose in combination with sensitivity to signs of actual blood glucose level and logical reasoning, was found to have the best coping outcome, both regarding metabolic control and well-being. The results are summarized in a model for diagnostic reasoning in nursing.
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| 4. |
- Rahm Hallberg, Ingalill, 1944-
(författare)
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Vocally disruptive behaviour in severely demented patients in relation to institutional care provided
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Thirty-seven patients identified as vocally disruptive and a control group, selected from 264 patients at psychogeriatric wards were studied. Tape-recordings of their vocal behaviour, ratings of their functional performance and symptoms related to dementia, observations of their behaviour, activities and interaction with caregivers were performed. Seventeen plus sixteen caregivers were interviewed to give their interpretation of the experience behind the behaviour and describe their own experience of it. The severely demented vocally disruptive patients were found to be significantly more physically dependant, disorientated at the ward and prone to confusional reactions but they had a more preserved speech performance than the controls. The vocal activity expressed such as helplessness, pain, fear and protest. Some were emotionally indifferent and a few expressed positive emotions. Caregivers interpreted the behaviour as an expression of anxiety related to such as abandonment, dissolution and loss of autonomy. They also expressed a strong wish to comfort the patients but felt unable to do so. The patients' daily life was characterized by idleness and solitude. Caring activities and interactions were dominated by physical procedures performed in a fragmentary and rapid way. Two hypotheses are generated. 1. Vocally disruptive behaviour develops influenced by sensory deprivation and the brain damage. 2. The care provided is influenced by caregivers experiencing anxiety in the patients as well as experiencing a conflict between the care they would like to provide and the care they actually provide. This evokes anxiety in them which elicits defence mechanisms leading to emotional withdrawal from the patients and task oriented care. The results are discussed in a nursing perspective based on existential thoughts, psychoanalytic and psychosocial theory.
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