| 51. |
- Ekman, Inger, 1952, et al.
(författare)
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The person-centred approach to an ageing society
- 2013
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Ingår i: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5656 .- 2052-5648. ; 1:1, s. 132-137
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Tidskriftsartikel (refereegranskat)abstract
- Modern care is often based on investigations such as laboratory markers and imaging - for example, x-ray or ultrasound. The results contribute to a diagnosis and, if judged necessary, treatment is initiated. This diseased-oriented approach is the prevailing mode of management in modern medicine. In contrast, person-centered care (PCC) takes the point of departure from each person´s subjective experience of illness and its impact on daily life. A patient is considered as a person with emotions and feelings. PCC is considered present within clinical care according to a definition articulated by the Centre for Person Centred Care at the University of Gothenburg (GPCC) when three core components are present: elicitation of a detailed patient narrative; formulated partnership between caregiver and patient and documentation of the partnership in the patient record. Accordingly, when there is an illness requiring care and the person is attended using these components, PCC is being applied. In most situations today, PCC is not applied as the narrative is not fully elicited or the partnership and/or the documentation are not included. It is proposed that the challenge to Society arising from changing demographics can be addressed by implementing PCC and creating an alternative to existing healthcare. The importance and benefits of such an approach on a wider scale is not yet clear as research has been limited to date. Studies in selected patient populations (heart failure and hip fractures), however, have shown promising results. As the population ages, there will be a dramatic increase in healthcare consumption. Even with technological developments, there will be a need for tremendous resources to be dedicated to care. A new organization and attitude from healthcare policymakers and providers above and beyond the present model appears required in order to respond to this demand. As part of such change, person-centred care, with the interaction between healthcare providers and the person of the patient, can facilitate, compensate and develop more effective healthcare services for the future.
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| 52. |
- Englund, Ann-Charlotte, et al.
(författare)
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Being the parent of a child with asthma
- 2001
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Ingår i: Pediatric Nursing. - : Jannetti Publications, Inc.. - 0097-9805. ; 27:4, s. 365-373
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to describe what it means to be parents of a child with asthma. Unstructured interviews were carried out with 12 mothers and 12 fathers of children with asthma living in Sweden. The parents' accounts were analyzed using a phenomenological-hermeneutic approach. The results revealed that parents were living a strenuous life and their actions involved both protecting and liberating. Parents also reported feelings of sadness and acceptance. In most cases, mothers acted in a protecting manner and expressed feelings of sadness; fathers acted in a liberating manner and expressed feelings of acceptance. To gain a deeper understanding of the parents' actions and feelings, study results were interpreted through philosophical perspectives described by Ruddick (1989), Mayeroff (1965), and Hegel (1975). These interpretations show that the feelings and actions of these parents exist in a dialectical relation with one another. Results emphasize the importance of a good partnership between the parents and the nurse, where the nurse shows consideration for the parents' unique actions and feelings and understands and supports parents in the care of their child with asthma.
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| 53. |
- Ericson-Lidman, Eva, et al.
(författare)
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Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD
- 2014
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 28:2, s. 337-346
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Tidskriftsartikel (refereegranskat)abstract
- Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health.
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| 54. |
- Ericson-Lidman, Eva, et al.
(författare)
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Healthcare personnel's experiences of situations in municipal elderly care that generate troubled conscience
- 2013
-
Ingår i: Scandinavian Journal of Caring Sciences. - Hoboken, NJ, USA : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 27:2, s. 215-223
-
Tidskriftsartikel (refereegranskat)abstract
- Healthcare personnel may perceive troubled conscience when feeling inadequate and powerless. It is important to further explore healthcare personnel's descriptions of situations in daily work, which generate troubled conscience to increase the awareness of such situations. This study aimed to describe health care personnel's experiences of situations in municipal elderly care that generate troubled conscience. In this qualitative study, interviews were conducted with Registered and Enrolled nurses and nursing assistants (n = 20) working in municipal elderly care. The interviews were tape-recorded, transcribed verbatim and analysed with content analysis. Situations that generated troubled conscience was (i) Being caught between different demands, comprising being forced to prioritize between different residents' needs, being torn between residents'-/relatives'-/and co-workers' needs and expectations' and between work and private life, (ii) Being torn away from residents to other 'must do's', comprising stealing time from residents' to do housekeeping chore' and to 'obey' rules and recommendations, (iii) Feeling unable to relieve suffering, comprising falling short when striving to help, lacking knowledge, advice and support and time to ease residents' suffering and finally, (iv) Being part of providing care that is or feels wrong, comprising providing poor care and/or witnessing co-workers providing poor care, and being forced to give care that feels wrong. These findings identify important factors that generate stress of conscience (stress caused by troubled conscience), including difficulties with balancing priorities and following rules and recommendations that seem contrary to best care, and the need for interdisciplinary teamwork. Findings point to that sharing what conscience tells in the work team opens up possibilities for healthcare personnel to constructively deal with troubled conscience. Intervention studies are needed to explore whether such measures contribute to relieve the burden of troubled conscience and increase possibilities to provide high quality care.
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| 55. |
- Ericson-Lidman, Eva, et al.
(författare)
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Meanings of being a female co-worker to a person developing burnout
- 2007
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell Publishing Inc.. - 0283-9318 .- 1471-6712. ; 21:2, s. 155-162
-
Tidskriftsartikel (refereegranskat)abstract
- Burnout is dramatically increasing in many industrialised countries. Burnout is mainly studied from the perspective of the burnout person although it has been confirmed to affect co-workers as well. This study aimed to illuminate meanings of being a female co-worker to a person developing burnout. Fifteen interviews with nursing and medical staff were performed, tape-recorded and transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. One meaning of being a female co-worker is struggling, on the one hand to understand and help the person developing burnout and on the other hand to manage their work and survive oneself. This means to be torn between helping the workmate and managing their work. Co-workers are filled with contradictory feelings, from deep concern to aversion and when the workmate finally goes on sick leave, co-workers' feelings of shortcomings and failure emerge, along with troubled conscience. This study reveals a picture of the difficulties of being a female co-worker to a person developing burnout that it is crucial to be aware of.
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| 56. |
- Ericson-Lidman, Eva, 1960-
(författare)
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The complicated struggle to be a support : meanings of being a co-worker, supervisor and closely connected to a person developing burnout
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to illuminate meanings of being a co-worker, supervisor and closely connected to a person developing burnout, and to describe perceptions of signs preceding burnout. The thesis comprises four papers and is based on qualitative data. In papers I and II, the data material consisted of interviews with 15 female coworkers of a person developing burnout, in paper III, interviews with 12 supervisors to care providers suffering from burnout, and in paper IV, interviews on two occasions with 5 people closely connected to a person developing burnout. Thematic content analysis (I) and phenomenological-hermeneutic method (II, III, IV) was used to analyse/interpret the interview text. The findings show that the coworkers retrospectively recalled different signs preceding their workmate’s burnout. They describe that their workmate was struggling to manage alone and was showing self-sacrifice. Co-workers also describe that their workmates were struggling to achieve unattainable goals and were becoming distanced and isolated. Finally, the co-workers describe that their workmates were showing signs of falling apart (I). Meanings of being a female co-worker to a person developing burnout are struggling, on the one hand to understand and help the person with symptoms of burnout, and on the other to manage one’s own work. This burdensome situation means that the co-workers are filled with contradictory and frustrating feelings and when the workmate is finally sick-listed, troubled conscience arise in the coworkers (II). Meanings of being a supervisor for care providers suffering from burnout are struggling to help the care provider continue to work, but being responsible for the unit, the supervisors are forced to ensure that the work is carried out. As the situation proceeds, supervisors are trapped in a predicament, unable to help and feeling inadequate. When the care provider is sick-listed, feelings of self-blame arise. When the time comes for rehabilitation the supervisors are once again caught between conflicting demands in a seemingly impossible mission (III). Meanings of being closely connected to a person suffering from burnout are putting one’s life on hold in order to help the person, striving to stand by to the person developing burnout, regardless of one’s own needs. Those closely connected are saving the face of the person developing burnout in order to protect them from stress. As the situation proceeds, those closely connected carry the burden alone in this strained situation and sometimes they are treated with disrespect by the person developing burnout, a situation which reveals their own suffering. Striving to find recuperation engenders troubled conscience. This situation reveals a huge need for support for those closely connected to a person developing burnout (IV). The comprehensive understanding is that meanings of being a co-worker, supervisor and closely connected to a person developing burnout are, on the one hand, a complicated struggle to support the person and on the other to shoulder a heavy burden. They try to do everything they can to help and support the person developing burnout (II-IV), these attempts, however, do not seem to reach through (I-IV). Co-workers describe signs that something is the matter (I), but they (co-workers, supervisors and those closely connected) do not understand what is happening (IIIV). This burdensome situation is full of conflict for those involved, torn between the complicated struggle to support the person developing burnout and to manage this burdensome situation. Faced with their own shortcomings, troubled conscience arises. The comprehensive understanding of the four papers (I-IV) are discussed and reflected on with the help of social support theories and the ideas of the Danish philosopher Lögstrup’s thoughts about the ethical demand.
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| 57. |
- Fagerberg, Ingegerd, et al.
(författare)
-
"Learning by doing" : or how to reach an understanding of the research method phenomenological hermeneutics
- 2009
-
Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 29:7, s. 735-739
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Tidskriftsartikel (refereegranskat)abstract
- One problem addressed in teaching graduate students qualitative research methods is practising the cognitive and conative skills that students need to generate both rich data and meaningful analysis. The aim of the study was to illuminate development in a group of pre-doctoral and doctoral students as they learnt the phenomenological hermeneutics research method. In a course comprising 18 doctoral students we used the "guided path" pedagogical approach and decided to use a subject of which everyone has lived experience, "troubled conscience", for the phenomenological hermeneutic analysis conducted with the students. As the students progressed in their learning experience of the research method, they analysed their data according to the steps in the method, and we as teachers conducted separate analyses of the same data. The results point in the same direction as previous studies in the field. This is discussed in terms of strength of the pedagogical approach and the students' learning, since despite the fact that their data are limited and not very detailed they were able to come up with results that were in line with previous research.
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| 58. |
- Fischer, Regina Santamäki, et al.
(författare)
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Embracing opposites : meanings of growing old as narrated by people aged 85
- 2008
-
Ingår i: The International Journal of Aging & Human Development. - Farmingdale, N.Y. : Baywood. - 0091-4150 .- 1541-3535. ; 67:3, s. 259-71
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Tidskriftsartikel (refereegranskat)abstract
- Many old people suffer from prolonged and multiple bodily ailments, new diseases, and increased risk for disadvantages and losses in life. Aging also means becoming mature and wise. This study illuminates the meaning of the lived experience with respect to changes in late life. Using a phenomenological hermeneutic method, this study analyzes transcribed interviews of 15 85-year-old people. Four themes were formulated: embracing weakness and strength, embracing slowness and swiftness of time, embracing reconciliation and regret, and embracing connectedness and loneliness. From these analyses, growing old was described as--maintaining one's identity in spite of the changes that come with aging and, embracing opposites--being changed and feeling being the same.
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| 59. |
- Fischer, Regina Santamäki, et al.
(författare)
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Living Amidst Consolation in the Presence of God Perceptions of Consolation Among the Oldest Old : The Umeå 85+ Study.
- 2007
-
Ingår i: Journal of Religion, Spirituality & Aging. - 1552-8030. ; 19:3, s. 3-20
-
Tidskriftsartikel (refereegranskat)abstract
- This study describes how 90-year-olds and older people perceive consolation. Qualitative Content analysis of 49 interviews revealed four categories: consolation by God; consolation from others; consolation from self; and consolation from things, which were present in two themes. The theme "Living amidst consolation in the presence of God" was a core theme and expresses consolation as self-evident and based on a relation to God, others, self, and things. The theme "Seeking consolation," expresses consolation from self, others, things, or God. Interviewees in some cases regretted that they had no religious faith. Reasonably, most interviewees referred to religious consolation, as religion had been so closely connected with the word "consolation" all their lives. [ABSTRACT FROM AUTHOR]
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| 60. |
- Fjelltun, Aud-Mari, et al.
(författare)
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Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents : a comparative study.
- 2009
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:4, s. 736-747
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses' physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly's functional levels may illuminate the extent of the carers' workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi-Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly's need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.
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| 61. |
- Fjelltun, Aud-Mari Sohini, et al.
(författare)
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Carers' and nurses' appraisals of needs of nursing home placement for frail older in Norway
- 2009
-
Ingår i: Journal of Clinical Nursing. - Malden : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 18:22, s. 3079-3088
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The aim of this paper was to explore carers' and nurses' appraisals concerning if and when nursing home placement for frail older people awaiting placement was needed and to illuminate ethical issues involved in decisions regarding nursing home placement.Background. Requesting nursing home placement can be a complicated decision for carers, causing feelings of failure, anxiety and guilt. After the necessity of nursing home care is determined, the names of the older people are put on waiting lists. While waiting, home health care provides support services. Even with this care, many of the older people and their carers face difficult life situations.Design. This is a descriptive and comparative cross-sectional study using qualitative methods.Methods. The convenience sample (n = 36) comprised 11 carers of older people on a nursing home placement waiting list in Norway and 11 nurses caring for these older people. Every one willingly participated in interviews that were transcribed and analysed by qualitative content analysis.Results. Various similarities and differences between nurses' and carers' appraisals were found. Complex ethical issues of justice, equality, autonomy, beneficence and justifiability in nursing were involved in decision making concerning nursing home placement. Four categories constructed were: 'appraising nursing home to be the level of care needed', 'appraising the older people as able to continue living at home', 'being ambivalent about nursing home placement' and 'being sceptical about use of coercion regarding nursing home placement'.Conclusions. Not all of the older people awaiting nursing home placements could be placed in nursing homes when beds became available. The situations were complex and involved ethical issues. Relevance to clinical practice. Despite insufficient resources in home health care, providing appropriate support for older people and their carers means that nurses have to consider individual concerns in each situation, cooperate with carers, respect their appraisals of needs and argue for the timely nursing home placement of older people.
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| 62. |
- Fjelltun, Aud-Mari Sohini, et al.
(författare)
-
Carers' experiences with overnight respitecare : a qualitative study
- 2009
-
Ingår i: Vård i Norden. - 0107-4083 .- 1890-4238. ; 29:3, s. 23-27
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to explore experiences with overnight respite care (ORC) of Norwegian carers who provided care to frail elderly awaiting nursing home placement. Background In many Western countries respite care has become part of health care service provision, and various types of respite care are available. The intent with respite care can be twofold; caring for the care receiver and supporting the carer. Methods This was a descriptive qualitative study. Interviews were conducted with 15 carers, transcribed and analysed by qualitative content analysis. Findings The carers described various experiences with ORC. If ORC supported the family unit, it was welcomed by carers and experienced as supportive. If ORC did not support the family unit, many carers rejected ORC, and it was experienced as non-supportive. Two categories were constructed: 'experiencing ORC as supportive for the family as a unit' and 'not experiencing ORC as supportive for the family as a unit'. Conclusion To support more carers, nurses have to listen to carers’ experiences about ORC. Nurses need to take responsibility for the family as a unit and provide more flexible ORC services based on both carers’ and elderly’s needs.
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| 63. |
- Fjelltun, Aud-Mari Sohini, et al.
(författare)
-
Nurses' and carers' appraisals of workload in care of frail elderly awaiting nursing home placement.
- 2009
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:1, s. 57-66
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study is to describe carers' and nurses' appraisals of workload in care of frail elderly awaiting nursing home (NH) placement. BACKGROUND: Carers' workload of care for frail elderly awaiting NH placement has been studied separately from that of nurses' workload. The literature neither addressed a comparison of carers' and nurses' appraisals of psychological and physical workloads nor the most strenuous factors common to the workloads of both nurses and carers in care of the same elderly person. The terms 'carers' and 'nurses' in this paper refer to informal caregivers and to both enrolled nurses and Registered Nurses respectively, when no particular one is stated. METHOD: The sample comprised 11 nurses and 11 carers paired based on care provided to the same elderly person awaiting NH placement in Norway. Data collected by a workload-scale was analyzed by descriptive statistics. Data collected by individual interviews were analyzed by qualitative content analysis. Carers' and nurses' appraisals of workload were compared and contrasted and most strenuous factors described. FINDINGS: The findings show that both carers and nurses rated workload levels maximum. Carers' highest ratings concerned psychological workload, while nurses' highest ratings concerned physical workload. The workload ratings concerning elderly with advanced dementia disease were most similarly aligned. Qualitative content analysis showed three categories that describe the most strenuous factors common to the workloads of both carers and nurses. These were feeling responsible, burdened and ambivalent. CONCLUSION: This study reports carers' and nurses' appraisals of workload in care of frail elderly awaiting NH placement. The results show many similarities and some differences. These results may help guide policy development to address resource allocations to elderly care. Further research is needed to address workloads of care for elderly awaiting NH placement.
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| 64. |
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| 65. |
- Glasberg, Ann-Louise, et al.
(författare)
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Burnout and 'stress of conscience' among healthcare personnel
- 2007
-
Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 57:4, s. 392-403
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper reports a study examining factors that may contribute to burnout among healthcare personnel.Background: The impact on burnout of factors such as workload and interpersonal conflicts is well‐documented. However, although health care is a moral endeavour, little is known about the impact of moral strain. Interviews reveal that healthcare personnel experience a troubled conscience when they feel that they cannot provide the good care that they wish – and believe it is their duty – to give.Methods: In this cross‐sectional study, conducted in 2003, a sample of 423 healthcare personnel in Sweden completed a battery of questionnaires comprising the Maslach Burnout Inventory, Perception of Conscience Questionnaire, Stress of Conscience Questionnaire, Social Interactions Scale, Resilience Scale and a personal/work demographic form.Results: Regression analysis resulted in a model that explained approximately 59% of the total variation in emotional exhaustion. Factors associated with emotional exhaustion were ‘having to deaden one's conscience’, and ‘stress of conscience’ from lacking the time to provide the care needed, work being so demanding that it influences one's home life, and not being able to live up to others’ expectations. Several additional variables were associated with emotional exhaustion. Factors contributing to depersonalization were ‘having to deaden one's conscience’, ‘stress of conscience’ from not being able to live up to others’ expectations and from having to lower one's aspirations to provide good care, deficient social support from co‐workers, and being a physician; however, the percentage of variation explained was smaller (30%).Conclusion: Being attentive to our own and others’ feelings of troubled conscience is important in preventing burnout in health care, and staff need opportunities to reflect on their troubled conscience. Further research is needed into how a troubled conscience can be eased, particularly focusing on the working environment.
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| 66. |
- Glasberg, Ann-Louise, et al.
(författare)
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Development and initial validation of the Stress of Conscience Questionnaire.
- 2006
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 13:6, s. 633-48
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Tidskriftsartikel (refereegranskat)abstract
- Stress in health care is affected by moral factors. When people are prevented from doing 'good' they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach's alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: 'internal demands' and 'external demands and restrictions'. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.
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| 67. |
- Glasberg, Ann-Louise, et al.
(författare)
-
Factors associated with 'stress of conscience' in healthcare.
- 2008
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 22:2, s. 249-58
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The main purpose of this study was to examine factors related to 'stress of conscience' i.e. stress related to a troubled conscience in healthcare. METHODS: A series of questionnaires was completed by 423 healthcare employees in northern Sweden as part of this cross-sectional study. The series of questionnaires comprised the 'Stress of Conscience Questionnaire', 'Perception of Conscience Questionnaire', 'Revised Moral Sensitivity Questionnaire', Social Interactions Scale, Resilience Scale and a Personal/Work Demographic form. RESULTS: Nonautomatic stepwise regression analysis with forward inclusion resulted in a model that explained approximately 39.6% of the total variation in stress of conscience. Individual items associated with stress of conscience were; perceiving that conscience warns us against hurting others while at the same time not being able to follow one's conscience at work and having to deaden one's conscience to keep working in healthcare. In addition moral sensitivity items belonging to the factor 'sense of moral burden' were; one's ability to sense patient's needs means that one is doing more than one has strength for, having difficulty to deal with feelings aroused when a patient is suffering and one's ability to sense patient's needs means feeling inadequate all added significantly to the model. In addition, deficient social support from superiors, low levels of resilience and working in internal medicine wards were all associated with stress of conscience. CONCLUSION: Healthcare employees seem to experience stress of conscience in their everyday practise. Particular contributing factors are not being able to follow one's conscience at work, and the 'negative' dimension of moral sensitivity - moral burden - which is an inability to deal with moral problems. Thus, in order for conscience and moral sensitivity to become an asset instead of a burden, healthcare employees need to be able to express their moral concerns.
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| 68. |
- Glasberg, Ann-Louise, et al.
(författare)
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Sources of burnout among healthcare employees as perceived by managers
- 2007
-
Ingår i: Journal of Advanced Nursing. - : Blackwell Verlag. - 0309-2402 .- 1365-2648. ; 60:1, s. 10-19
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This paper is a report of a study to investigate healthcare managers’ perspectives on factors contributing to the increase of healthcare employees on sick leave for burnout symptoms.Background: Current turbulent healthcare reorganization has resulted in structural instability, role conflicts and vague responsibility commitments, all of which contribute to increasing numbers of sick days caused by burnout symptoms. Managers’ perceptions of burnout sources are important as these perceptions guide the actions taken to prevent burnout.Method: Interviews were carried out with 30 healthcare managers, with different occupational backgrounds and from different units. The data were collected in Sweden in 2003 and analysed using thematic qualitative content analysis.Findings: According to the healthcare managers, continuous reorganization and downsizing of healthcare services has reduced resources and increased demands and responsibilities. These problems are compounded by high ideals and expectations, making staff question their own abilities and worth as well as making them feel less confirmed and less valued as people. The main finding indicates that healthcare employees are thrown into a spiralling sense of inadequacy and an emerging sense of pessimism and powerlessness.Conclusion: To understand and influence people’s actions, one has to understand their perceptions and thoughts – their explanatory models. This study shows the complexity and interconnection between sources of burnout as perceived by healthcare managers, and highlights the encouragement of realism without the destruction of enthusiasm as an important factor in management and healthcare practice.
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| 69. |
- Gustafson, Yngve, et al.
(författare)
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A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures
- 1991
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 39:7, s. 655-662
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the effect of a geriatric-anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre- and post-operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri-operative blood pressure falls and treatment of post-operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P less than 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post-operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P less than 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay
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| 70. |
- Gustafson, Yngve, et al.
(författare)
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Acute confusional states in elderly patients treated for femoral neck fracture
- 1988
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 36:6, s. 525-530
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to estimate the incidence of acute confusional state (ACS), its predisposing factors and consequences in 111 consecutive patients operated for fractured neck of the femur. The incidence of ACS was 61 percent and the predicting factors were old age and dementia. Drugs with anticholinergic effect, depression, and previous stroke were factors that seemed to be associated with the development of ACS. Ninety-two percent of the patients who had severe perioperative blood pressure drops developed ACS. The consequences of ACS were prolonged ward-stay at the orthopedic department, a greater need for long-term care after discharge, and poor walking ability at discharge and six months after surgery. The confused patients also had more complications, such as urinary problems, feeding problems and decubital ulcers, as compared with the nonconfused patients.
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| 71. |
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| 72. |
- Gustafson, Yngve, et al.
(författare)
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Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients
- 1991
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 39:8, s. 760-765
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: To determine the accuracy of diagnosis and documentation of acute confusional states (ACS) in the medical records of patients with hip fracture. DESIGN: The diagnosis of ACS in two prospective clinical studies was compared to its diagnosis in the medical records of the same patients on the same hospitalization. In order to determine if the simultaneous prospective study influences the diagnostic and documentary practices evidenced in the medical records, a further comparison was done by reviewing medical records of two series of patients seen some years prior to the prospective studies. SETTING: Patients with femoral neck fractures treated at a department of orthopedic surgery in a university hospital and one retrospective control sample from a department of general surgery in a county hospital. SUBJECTS: Two prospective samples of patients 65 years and older treated for femoral neck fractures (n = 111 and n = 57, respectively) and two earlier retrospective samples (n = 66 and n = 68, respectively). MEASUREMENTS AND MAIN RESULTS: All comparisons showed that both physicians and nurses diagnosed ACS unsatisfactorily and documented the patients' mental status poorly. The analysis of the two retrospective medical record control samples gave the same results. Neither the physicians nor the nurses used any kind of diagnostic instrument to detect cognitive disorders in the patients. CONCLUSIONS: ACS is a common and severe complication in elderly people treated for femoral neck fractures. Acute confusional states have, by definition, one or more causes that can often be identified and treated. Poor assessment and documentation is a threat to the patients as a correct diagnosis of ACS is a prerequisite for further assessment of its underlying causes and the consequent necessary medical and nursing care.
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| 73. |
- Gustafsson, Gabriella, et al.
(författare)
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Burnout and perceptions of conscience among health care personnel : a pilot study.
- 2010
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 17:1, s. 23-38
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Tidskriftsartikel (refereegranskat)abstract
- Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one's conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group.
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| 74. |
- Gustafsson, Gabriella, 1951-, et al.
(författare)
-
Meanings of becoming and being burnout : phenomenological-hermeneutic interpretation of female healthcare personnel's narratives
- 2008
-
Ingår i: Scandinavian Journal of Caring Sciences. - Umeå : Institutione för omvårdnad. - 0283-9318 .- 1471-6712. ; 22:4, s. 520-528
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of burnout has increased in many industrialized countries. Burnout is mainly studied among people still at work and with quantitative methods. The present study aimed to illuminate the meanings of becoming and being burnout as narrated by healthcare personnel on sick leave because of symptoms of burnout. Interviews with 20 female healthcare personnel were performed, tape-recorded and transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. The result shows that the meanings of becoming and being burnout are to be torn between what one wants to be and what one manages. It is as one's ideals have become more like demands and no matter the circumstances, one must be and show oneself as being capable and independent. It is also to be dissatisfied with oneself for not living up to one's ideals as well as disappointed with other people for not giving the confirmation one strives for. Feelings of being a victim of circumstances emerge. Thus, becoming and being burnout is leading a futile struggle to live up to one's ideal, failing to unite one's ideal picture with one's reality and experiencing an overwhelming feebleness. This is interpreted in the light of Buber's philosophy as well as relevant empirical studies about burnout. One conclusion is that it seems important to reflect on as well as discuss between one another about our everyday reality; what are reasonable vs. unreasonable demands. Hopefully, such reflections will increase our tolerance of ourselves and others and our insightfulness of what is possible to achieve in work as well as in private life. This study is ethically approved.
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| 75. |
- Gustafsson, Gabriella, et al.
(författare)
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Personality traits among burnt out and non-burnt out health-care personnel at the same workplaces : a pilot study
- 2009
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Ingår i: International Journal of Mental Health Nursing. - : John Wiley & Sons. - 1445-8330 .- 1447-0349. ; 18:5, s. 336-348
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Tidskriftsartikel (refereegranskat)abstract
- Stress-related illnesses, such as burnout, have increased over the last decade, but not everyone at the same workplace develops burnout, suggesting that individual factors may contribute to this phenomenon. The aim of this study was to describe patterns of personality traits among two groups of health-care personnel from the same workplaces, one group on sick leave due to medically-assessed burnout, and one group with no indication of burnout, respectively. Fourteen psychiatric- (n = 7) and elderly (n = 7)-care units, located in one specific area in a municipality in northern Sweden, participated in this questionnaire-based study. The participants (n = 40), on sick leave due to medically-assessed burnout (n = 20), and those with no indication of burnout (n = 20), respectively, completed Cattell's 16 Personality Factors Questionnaire between February and December 2004. Conventional statistical methods and partial least square regression were used to analyze data. The results showed that the burnout group had lower scores regarding emotional stability and higher scores regarding anxiety than the non-burnout group, but the results also showed a wide variation of personality traits within groups. The most important indicators for belonging to the burnout group were 'openness to changes' and 'anxiety', and for belonging to the non-burnout group, 'emotional stability', 'liveliness', 'privateness' (i.e. forthright or discreet), and 'tension'. The result indicates complex interactions between personality traits and the context in which the individual lives. It seems to be important to increase our awareness of when personality traits may constitute opportunities versus risks in dealing with one's existing circumstances.
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| 76. |
- Hajdarevic, Senada, et al.
(författare)
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Becoming whole again-Caring for the self in chronic illness-A narrative review of qualitative empirical studies
- 2024
-
Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702.
-
Tidskriftsartikel (refereegranskat)abstract
- AIM AND OBJECTIVES: To explore how chronic illness transforms the self when living with and managing chronic illness and what this means for their self and identity. We also discuss how people with chronic conditions could be supported by healthcare professionals to manage illness in daily life.BACKGROUND: Self-management recommendations from health care are commonly based on a biomedical understanding of the disease. People's experiences of how a condition affects them and adequate support are crucial for their outcomes in daily self-management.DESIGN: A narrative review.METHODS: A systematic search was undertaken during January 2021 across the databases MEDLINE, CINAHL, PsycINFO, Soc INDEX and Philosopher's Index. A quality appraisal of articles was performed. Our analysis was inspired by qualitative content analysis. The PRISMA Checklist 2020/EQUATOR guidelines was used to report the study.RESULTS: Twenty-eight peer-reviewed qualitative empirical articles focusing on self in a variety of chronic illnesses with relevance to nursing published from January 2010 to December 2020 were included. The main theme, Developing from an uncertain existence to meaning and wholeness, was built up by the five themes: Walking on an unstable ground; Being stalemated; Being involved with others for better or worse; Searching for meaning; and lastly, Modifying self and integrating a new way of living.CONCLUSIONS: The results illuminate experiences that seldom are prioritized but need to be addressed by health professionals. Such experiences are oriented more towards the existential self rather than medical issues, why it is important to go beyond the medical lens.RELEVANCE TO CLINICAL PRACTICE: This is important knowledge for nurses aiming to support people with chronic illnesses. Nurses supporting people in self-management need to be aware that by teaching and encouraging people to revise their daily habits, they also work on the boundaries of their self-concept.PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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| 77. |
- Hammarström, Anne, et al.
(författare)
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The importance of having a paid job : Gendered experiences of health and ill-health in daily life among middle-aged women and men
- 2021
-
Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: More gender-theoretical studies are needed to gain a deeper understanding of what life circumstances make people sick or improve their health. The aim of the study was to gain a deeper understanding of social determinants of health by exploring gendered experiences in daily life among middle-aged women and men using the theory of gender relations.Methods: Individual interviews with nine men and women were performed, focusing on what made them feel good or bad. Qualitative content analysis was used to analyse the data.Results: A major theme in our interviews was the gendered health-promoting experiences related to having a job, which involved becoming someone, feeling appreciated at work and having control over work. Having good family relations was also health-promoting, in terms of supportive relations and becoming a parent. Ill-health was related to gendered adverse conditions at work (accidents, monotonous and stressful work tasks, being bullied) and in domestic life (demands, destructive partner relations, having children with problems).Conclusions: Gendered determinants of health and ill-health were identified in both working and domestic life. Public health policy needs to challenge the gender order in society, which defines the gendered structure of the labour market as well as the gendered relations in domestic life.
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| 78. |
- Hedman, Ragnhild, et al.
(författare)
-
Agency and communion in people with Alzheimer’s disease, as described by themselves and their spousal carers
- 2019
-
Ingår i: Dementia. - : Sage Publications. - 1471-3012 .- 1741-2684. ; 8:4
-
Tidskriftsartikel (refereegranskat)abstract
- Agency (individuality) and communion (togetherness) are vital to a positive sense of self. People with Alzheimer’s disease are at risk of experiencing diminished agency and decreased communion. Their family members’, especially their partner’s, view on their agency and communion is also likely to influence their sense of agency, communion, and self. In the present study, individual interviews with 10 people with Alzheimer’s disease and their spousal carers were qualitatively analysed to describe how in each couple the two spouses viewed the agency and communion of the person with Alzheimer’s disease from an individual perspective. The findings show that the carers generally described the agency of the person with Alzheimer’s disease as slightly weaker compared with the persons with Alzheimer’s disease themselves. The carers also appeared to have poor knowledge of what supported and threatened the sense of communion of the person with Alzheimer’s disease.
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| 79. |
- Hedman, Ragnhild, et al.
(författare)
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Expressed Sense of Self by People With Alzheimer’s Disease in a Support Group Interpreted in Terms of Agency and Communion
- 2016
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Ingår i: Journal of Applied Gerontology. - : SAGE Publications. - 0733-4648 .- 1552-4523. ; 35:4, s. 421-443
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Tidskriftsartikel (refereegranskat)abstract
- The self is constructed in cooperation with other people and social context influences how people perceive and express it. People with Alzheimer’s disease (AD) often receive insufficient support in constructing their preferred selves, but little is known about how they express themselves together with other people with AD. In accordance with Harré’s social constructionist theory of self, this study aimed to describe how five people with mild and moderate AD express their Self 2 (i.e., their personal attributes and life histories) in a support group with a facilitator experienced in communicating with people with AD. The participants’ expressions of their Self 2 were analyzed with qualitative abductive content analysis and interpreted in terms of agency and communion and a lack of agency and communion. The findings highlight the importance of supporting a sense of agency and communion when assisting people with AD in constructing their self.
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| 80. |
- Hedman, Ragnhild, 1962-, et al.
(författare)
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How people with Alzheimer's disease express their sense of self : analysis using Rom Harré's theory of selfhood
- 2013
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Ingår i: Dementia. - : SAGE Publications. - 1471-3012 .- 1741-2684. ; 12:6, s. 713-733
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to use Harré's social constructionist theory of selfhood to describe how people with mild and moderate Alzheimer's disease (AD) express their sense of self. The findings show that Self 1, the embodied sense of being a person, was expressed fluently by participants through the use of first-person indexicals. Self 2, the experienced personal attributes and life narrative, had undergone changes. Those changes were not entirely for the worse; participants had also developed new skills in managing life with AD. In a lifetime perspective, those changes were minor and participants perceived themselves to be basically the same people that they were before having AD. When constructing Self 3, the social personae, participants usually described being supported by others, but sometimes described being exposed to malignant positioning. They also feared that they might become more exposed to negative attitudes as their AD progressed. However, participants were understanding towards the offensive behaviours of others.
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| 81. |
- Hedman, Ragnhild, 1962-, et al.
(författare)
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Sense of Self in Alzheimer’s Research Participants
- 2018
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Ingår i: Clinical Nursing Research. - : SAGE Publications. - 1054-7738 .- 1552-3799. ; 27:2, s. 191-212
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Tidskriftsartikel (refereegranskat)abstract
- The sense of self is vulnerable in people with Alzheimer's disease (AD), and might be positively and negatively influenced by research participation. The purpose of this study was to describe how people with AD express their experience of being a research participant with respect to their sense of self. Interviews and support group conversations involving 13 people with mild and moderate AD were analyzed using qualitative content analysis. Three themes were constructed: contributing to an important cause, gaining from participating, and experiencing risks and drawbacks. Participants described contributing to research as being in line with their lifelong values and lifestyles. They expressed contentment and pride about being research participants, emphasized their positive relationships with the researchers, and described participation as a meaningful activity. When research procedures threatened their sense of self, they were able to reason about risks and decline participation.
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| 82. |
|
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| 83. |
- Hedman, Ragnhild, 1962-
(författare)
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Striving to be able and included : Expressions of sense of self in people with Alzheimer's disease
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- According to research applying a social constructionist perspective, the sense of self is not lost in people with Alzheimer’s disease (AD). It is, however, greatly influenced by the symptoms and by how they are treated by other people. Without support, it is difficult to preserve a positive sense of self, when living with progressing cognitive impairments. The stigma associated with cognitive impairment also threatens their sense of self. Harré’s social constructionist theories of self and positioning have been used to study how people with AD express their sense of self. As there is a need to expand the previous research by involving additional participants and research contexts, the aim of the present thesis was to describe, in accordance with Harré’s theories of self and positioning, how people with AD expressed their sense of self in personal interviews and in support groups with other people with AD. The research consists of four substudies (I–IV), and has a qualitative, descriptive, and theory-testing approach. Thirteen people with mild and moderate AD were included, 11 of whom had the early onset form of the disease. Two support groups were formed, led by facilitators who supported the communication and the participants’ expressions of self. Each group met 10 times during an eight-month period. Topics were not predetermined, and introduced by both facilitators and participants. Semistructured interviews were conducted before the groups started and after they ended. The interviews and support group conversations were audio-recoded and analysed with qualitative content analysis, guided by Harré’s theories. In substudy I, the initial interviews were deductively analysed. The findings showed that Self 1 (the sense of being a singular, embodied person) was expressed by the participants without difficulties. Self 2 (the perception of one’s personal attributes and life history) was expressed as feeling mainly the same person. While some abilities had been lost, other had been developed. Self 3 (the socially constructed self) was described as mostly supported, but sometimes threatened in interactions with other people (I). In substudy II, support group conversations were analysed abductively with respect to expressions of Self 2. It was found that participants expressed Self 2 in terms of agency and communion, and a lack of agency and communion (II).In substudy III, a secondary analysis of the data from substudy II was performed inductively with the aim of describing how Self 3 was constructed in the interaction of the support group. Five first-order positions, generating lively interaction, were described: the project manager, the storyteller, the moral agent, the person burdened with AD, and the coping person (III). In substudy IV, all the collected data were reanalysed inductively, focusing on how participants expressed the experience of being research participants. Three themes were constructed: contributing to an important cause, gaining from participating, and experiencing risks and drawbacks (IV). In conclusion, it was found that participants constructed positive social selves through the support from each other, the facilitator, and researchers in the support group (III), and as research participants (IV). Agency and communion were central to Self 2, and decreased with the progression of AD (II). In spite of change, participants perceived themselves as basically the same people, with a potential to learn and develop as persons (I).
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| 84. |
- Hellzén, Ove, et al.
(författare)
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From optimism to pessimism : A case study of a psychiatric patient
- 1998
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 7:4, s. 360-370
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Tidskriftsartikel (refereegranskat)abstract
- This article focuses on the results of a single case study which illuminates an understanding of phases in nursing care for a patient in a psychiatric setting in Sweden. The focus of this study is a fifty year old man who showed progressive deterioration from increased motor activity to oral, sexual, destructive and aggressive actions. The data collection using five methods occurred during a 21 months period. Results of the content analyses processes identified four distinct but indiscreet phases of the patient’s complex condition. The medical and nursing care was categorised in three approaches: optimistic, strategic and resigned. The results raise the question whether there is action that is without any meaning as an expression of the patient´s wishes, thoughts and feelings. It seems clear that the patient in this study felt really angry and in despair. However, during moments of lucidity, he also indicated that he felt this was not an authentic expression of his "real" self. His experience was that of a splintered world.
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| 85. |
|
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| 86. |
- Hellzén, Ove, et al.
(författare)
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Unwillingness to be violated : Carers' experiences of caring for a person acting in a disturbing manner. An interview study
- 1999
-
Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 8:6, s. 653-662
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Tidskriftsartikel (refereegranskat)abstract
- Carers working in psychiatric care are sometimes exposed to insane, unpredictable and violent actions. In rare cases a patient appears to be resistant to all forms of pharmacological treatment. · Fifteen carers (4 RNs, 11 ENs) on a psychiatric ward in Sweden were interviewed about their experiences when caring for a person who acted in a disturbing manner. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. · Four themes were formulated which describe the carers’ uncertainty about the future, their inability to interpret the patient’s disturbing behaviour and their own overall feeling of meaninglessness. · Carers believed that the patient had power and ruled the ward, which led to them feeling they were subjugated victims. Interviews also revealed the carers’ recognition of forbidden feelings and actions and own unknown negative sides. · These results were interpreted and reflected on in the light of an ethical framework in order to achieve a deeper understanding of the text. · This paper shows that an ethical perspective is important when searching for the meaning of caring for patients acting in a disturbing manner. The study raises the question: ‘Is it possible to establish good when evil has dominion?
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| 87. |
- Henriksen, Nils, et al.
(författare)
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Nursing home placement in Norway : characteristics of older people assigned to placement
- 2015
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Ingår i: Nordisk sygeplejeforskning. - : Universitetsforlaget. - 1892-2678 .- 1892-2686. ; 5:2, s. 133-150
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Tidskriftsartikel (refereegranskat)abstract
- To determine the characteristics of older people assigned to nursing home placement and to illuminate the factors emphasised in the assignments, thirty-two home health care leaders in a Norwegian municipality completed a questionnaire regarding their assessment of the levels of functioning of the assigned individuals. These assessments were compared with assessments of individuals who had been placed on a waiting list to receive an assignment and of residents who had already been admitted to a nursing home. The individuals who had received assignments had higher rates of cognitive impairment, memory disturbances, disorientation and psychiatric symptoms compared with the individuals awaiting placement. The individuals with assignments had better motor function and a greater ability to accomplish daily activities without assistance than those in the other two groups. The physical workloads were the lowest for the carers of older people assigned to placement. Individuals without cognitive impairment and with low/worse motor function had to wait longer for nursing home placement than individuals with cognitive impairment. Older people with low/worse motor function required more assistance with their daily activities from informal carers. The implications for nursing are to recognise the physical workloads of carers and the necessity of offering them respite and support.
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| 88. |
- Holmberg, Bodil, 1970-, et al.
(författare)
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Assenting to exposedness : meanings of receiving assisted bodily care (RABC) in a nursing home as narrated by older persons
- 2019
-
Ingår i: Presented at IAGG-ER 2019 - 9th International Association of Gerontology and Geriatrics European Region Congress, Gothenburg, May 23-25, 2019.
-
Konferensbidrag (refereegranskat)abstract
- Introduction: Most older people living in nursing homes need R-ABC (assistance while dressing, undressing, eating, maintaining personal hygiene and while being transferred). This conveys to be helped with things that most people prefer to do in private, turning the older person’s body into an area, accessible to others in ways that would be unacceptable in other contexts.Aim: The aim of the study was to elucidate meanings of receiving assisted bodily care, as narrated by older persons living in a nursing home.Method: The study used a lifeworld design, focusing upon how the older persons experienced their world. Narrative interviews with 12 older persons generated 28 interviews.The transcribed interviews were analyzed by use of a phenomenological hermeneutical method, inspired by the philosophy of Ricoeur.Results: The main theme ’Assenting to exposedness’ means to be exposed to others’ glances, touch and benevolence in an organisation that limits the conditions under which one lives. The overall meaning is to be exposed. Before that, one can do nothing but assent. The theme comprised five themes.To have hope in hopelessnessMeans to recognise remaining bodily assets and receive help to practice in order to increase self-determination, while simultaneously being aware that the life journey is nearing its end.To relinquish one’s body into others’ handsMeans pleasure when experienced as soft, calm, warm, skilled and caring touch while talking about other things, which mutes the care needs. It means suffering when your wishes are neglected and the body is treated ’like a package’.To be between power and powerlessnessMeans to be able, to preserve self-determination by keeping trying to manage on one’s own. It means powerlessness when being without say, or feeling abandoned while waiting.To oscillate between one’s own responsibility and demands Means to judge situations and assent to circumstances predicted by others, but it also means uttering complaints about shortages in R-ABC, caused by organisational economic priorities.To be in an ongoing interactionMeans having an equal and mutual fellowship with ANs, tinged by a joviality and closeness that normalises otherwise embarrassing situations. On the other hand, it means loneliness and alienation when R-ABC is percieved mechanical, not attending to personal wishes about the delivery of assisted bodily care.Conclusions: The meaning of R-ABC is to be exposed, but not passively. Rather, it means to be self-determinant for as long as possible, to perceive the body as lived and avoid objectification. Further, to take on responsibility for judging the ANs work-load before asking for help.
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| 89. |
- Holmberg, Bodil, 1970-, et al.
(författare)
-
Assenting to exposedness : meanings of receiving assisted bodily care in a nursing home as narrated by older persons
- 2019
-
Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 33:4, s. 868-877
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Tidskriftsartikel (refereegranskat)abstract
- Most older persons moving to a nursing home need to receive assisted bodily care, which means being in a position of vulnerability. However, few studies have explicitly focused on the meanings of receiving assisted bodily care from the older persons' perspective. This study aimed to elucidate meanings of receiving assisted bodily care, as narrated by older persons living in a nursing home. Twelve men and women, aged 80 or older, living in a Swedish nursing home, participated in the study. Data were generated by narrative interviews and analysed with a phenomenological-hermeneutical method. The regional ethics committee approved the study. In the analysis, one main theme emerged: 'Assenting to exposedness'. This theme comprised five themes, 'To have hope in hopelessness', 'To relinquish one's body into others' hands', 'To be between power and powerlessness', 'To oscillate between one's own responsibility and demands', 'To be in an ongoing interaction', and ten subthemes. In conclusion, receiving assisted bodily care means to be exposed, but not passively. Rather, it means to be self-determinant for as long as possible, to perceive the body as lived. When the body must be relinquished to others, it might be objectified, leading to care-suffering. To avoid this, the older persons use a certain competence, acquired through life, to decide when to take action or when to assent. However, this is but one of the several possible interpretations, which may be considered a limitation.
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| 90. |
- Håkanson, Cecilia, 1968-, et al.
(författare)
-
First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care
- 2014
-
Ingår i: Open Nursing Journal. - : Bentham open. - 1874-4346. ; 8, s. 71-78
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.
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| 91. |
- Håkansson, Cecilia, et al.
(författare)
-
First-line managers’ views on leadership and palliative care in Swedish nursing homes
- 2014
-
Ingår i: Open Nursing Journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; 8, s. 71-78
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.
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| 92. |
- Häggström, Terttu, et al.
(författare)
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Maternal thinking in dementia care
- 1996
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 24:3, s. 431-438
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Tidskriftsartikel (refereegranskat)abstract
- Carers of demented people living in a group dwelling were interviewed and observed individually and together. The aim of the study was to illuminate the thinking of pre-identified good dementia carers and to make explicit their means of understanding demented people. The tape-recorded and transcribed interviews were interpreted using a phenomenological hermeneutic method. The findings showed that these carers explicitly referred to the concept of mother, used when explaining their ability to understand demented people. They created a home-like atmosphere together with the inhabitants. The findings were interpreted metaphorically as maternal love, thinking and practice in creating an understanding relationship with the demented people they cared for. This metaphorical aptitude considered the fulfilment of life for these demented people and included partly unconscious tools that the carers used to compensate for the loss of abilities suffered by the demented people. The carers' attitudes towards the inhabitants of the ward and each other were based on respect as in a functioning family. Their ambition was interpreted as an attempt to create an atmosphere that functioned not only as an institution, but as an incubator for human lives, which had become dependent on others for their survival and the preservation of their human dignity throughout their physical existence
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| 93. |
- Häggström, Terttu, et al.
(författare)
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Patients', Relatives', and Nurses' Experience of Stroke in Northern Vietnam
- 1995
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Ingår i: Journal of Transcultural Nursing. - : SAGE Publications. - 1043-6596 .- 1552-7832. ; 7:1, s. 15-23
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Tidskriftsartikel (refereegranskat)abstract
- Transcriptions were made of interviews held in Vietnam with five nurses, five people affected by stroke (aged 28-60), and with one relative each. Their stories were analysed as texts by means of a phenomenological hermeneutic method. The role of the nurses in Vietnam appeared to differ from that usually ascribed to nurses in Western institutionalized care. In the former a relative was expected to carry out basic care during the acute stage and to assist socioeconomically thereafter. The interviewees spoke of family bonds in the past, present, and future tenses when narrating their experiences of stroke as nurses, patients, and relatives. This was interpreted as an indication of a consciousness of an essential relatedness. Nurses were aware of playing a temporary and secondary role mainly as assistants: firstly to the doctor by carrying out orders and reporting, secondly to the stroke patient and his or her family by carrying out advanced nursing procedures and giving support The advantages and disadvantages of involving the family in nursing care can be revealed by obtaining views from a different culture, which can provide a contrast against which constructive criticism of the Western nursing tradition can be made.
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| 94. |
- Häggström, Terttu, et al.
(författare)
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Skilled carers' ways of understanding people with Alzheimer's disease
- 1998
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Ingår i: Scholarly Inquiry for Nursing Practice. - 0889-7182. ; 12:3, s. 239-68
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Tidskriftsartikel (refereegranskat)abstract
- Five carers in a group dwelling for people with dementia were observed and interviewed concerning their interactions with five residents with Alzheimer's disease. The tape-recorded and transcribed data were analyzed as text. The carers' personal ways of achieving understanding were defined as: affect attunement; affect attunement and completing a puzzle through explanatory connections of observation, knowledge about the residents' life histories and behavior at the group dwelling; and affect attunement within the context of caring as an intrinsic end. Personal experience from childhood and motherhood, knowledge about the residents' life history and the nature of the disease, and personal talent seemed to form these carers' ways of achieving understanding
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| 95. |
- Häggström, Terttu, et al.
(författare)
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The experience of living with stroke sequelae illuminated by means of stories and metaphors
- 1994
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 4:3, s. 321-337
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Tidskriftsartikel (refereegranskat)abstract
- Twenty-nine persons 60 to 91 years old participated in a study concerning living with stroke sequelae. They narrated stories about two different photographs showing a person of the same age and gender as themselves being fed or eating independently. The stories were analyzed and interpreted by means of a phenomenological hermeneutic method. Some interviewees identified themselves with the actor and the action that took place in the photograph and others did not. Four themes were found: uncertainty; sadness and mourning; gratefulness, hope, and satisfaction; and isolation. The stories varied regarding completeness and expressed optimistic or pessimistic future expectations. The stories were condensed into four core stories. The emotional content of each core story was expressed by a metaphor. The tacit knowledge embedded in the interview texts, expressed through core stories and metaphors, is essential to nursing care.
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| 96. |
- Hällgren Graneheim, Ulla, et al.
(författare)
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Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and 'behavioural disturbances', and on her care providers
- 2001
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 36:2, s. 256-265
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The study aims to illuminate how one woman with severe dementia and so-called behavioural disturbances acts in relation to her care providers and how the care providers act in relation to her. METHODS: Fourteen participant observations, including one woman with dementia and six care providers, were performed. A reflective dialogue focusing on the interaction between the woman and her care providers followed each observation. The tape-recorded observational notes and reflective dialogues were fixed as a text, which was subjected to a thematic content analysis. FINDINGS: The main findings are that the interaction between a woman with severe dementia and "behavioural disturbances" and her care providers relates to privacy, identity, autonomy and security. The phenomena are intertwined and also in conflict with each other. Interaction is a complex dialectic process in which those who are engaged meet problems that can be solved and are involved in dilemmas that cannot be solved, only related to.
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| 97. |
- Hällgren Graneheim, Ulla, 1947-
(författare)
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Störande beteende i interaktionen mellan personer med demens och deras vårdare
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med avhandlingen var att belysa innebörden i interaktionen mellan personer med demens och så kallat störande beteende och deras vårdare. I delstudierna I och II deltog en kvinna med frontallobsdemens och störande beteende (Ruth) respektive en kvinna med schizofreni, demens och störande beteende (Alice) och deras vårdare. Fjorton respektive 30 deltagande observationer samt sex respektive sju reflekterande samtal med vårdare genomfördes. Texterna tolkades med hjälp av kvalitativ innehållsanalys. I delstudie III gjordes narrativa intervjuer med sex vårdare och i delstudie IV genomfördes 10 informella samtal med tre personer med demens och störande beteende. Dessa texter tolkades med hjälp av fenomenologisk hermeneutisk metod. Innebörden i interaktionen mellan personerna med demens och störande beteende och deras vårdare handlar om att befinna sig i kaos och pendla mellan motsatser: att känna sig hemlös och hemma och att ”vara herre ”och ”vara slav”. Vårdarna upplever konflikter mellan att göra gott för individen och/eller kollektivet samt mellan de demensdrabbades beroende och önskan om självbestämmande. Såväl personerna med demens och störande beteende som deras vårdare pendlar mellan att känna sig hemlösa och hemma. Ruth lever i en fragmenterad värld där hon slåss för att skydda sitt revir. Hon kämpar också för att bli bekräftad samtidigt som hon bekräftar andra. Vårdarna bekräftar henne genom att möta henne i hennes värld. Alice lever i en tudelad värld där hon pendlar mellan ”himmel och helvete”. Hon misstror vårdarnas avsikter och slåss för sitt liv men hon visar också sin uppskattning och bekräftar vårdarnas ansträngningar. Även vårdarna upplever en tudelad värld. Innebörden i att leva med demens och störande beteende på institution handlar om att vara omgiven av oordning, fångad av begränsningar, satt åt sidan men också räknad med. Vårdarna befinner sig också i kaos och förstår inte vad det störande beteendet betyder. De upplever att de är fråntagna initiativet och känner sig utmattade och hjälplösa. Då och då upplever de att de har kontroll och känner sig dugliga och accepterade. Vårdarna pendlar mellan att ”vara herre” och ”vara slav”. Dialektiken mellan herre och slav handlar om kampen för ömsesidig bekräftelse. När vårdaren möter den demensdrabbade i sin egen (vårdarens) värld reduceras personen med demens till ett objekt. Därmed objektifierar vårdaren också sig själv. När vårdaren möter personen med demens i hans eller hennes värld, betraktar vårdaren den demensdrabbade som en betydelsefull person vars existens är viktig att bekräfta. Därmed känner sig också vårdaren betydelsefull. I hemmastaddheten bekräftas både personen med demens och vårdaren och kampen mellan herre och slav övergår i en Jag- Du relation. Störande beteenden är beteenden som inte bekräftar den andre. När vårdarna inte blir bekräftade upplever de personerna med demens vara störande och när personerna med demens inte blir bekräftade upplever de vårdarna vara störande. Bekräftelse uppstår i interaktioner som präglas av hemmastaddhet medan störande beteende visar sig i interaktioner som kännetecknas av hemlöshet.
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| 98. |
- Hörnsten, Åsa, et al.
(författare)
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Psychosocial maturity among people with diabetes mellitus
- 2002
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 11:6, s. 777-784
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Tidskriftsartikel (refereegranskat)abstract
- There is a relationship between coping with chronic illness and a person's psychosocial development. The aim of this study was to describe dimensions of psychosocial development based on results of a previous factor analysis of the Modified Erikson Psychosocial Stage Inventory among people with type 2 diabetes. Interviews were carried out with 10 people with diabetes. The transcribed interviews were analysed by qualitative content analysis into main categories, categories and themes. The categories were trust, lack of trust, positive identity, identity confusion, integrity and lack of integrity. Themes that permeated the categories in a positive way were 'activity' and 'involvement', while themes that permeated the categories in a negative way were 'passivity' and 'alienation'. Our interpretation is that the category 'trust' is the basis for 'identity', and together 'trust' and 'identity' are the basis for maturity and 'integrity'. A conclusion is that positive psychosocial maturity has to do with attaining trust, identity and integrity through activity and involvement. Qualities important for maturation through trust, identity and integrity are understanding, capacity, purposefulness and fortitude. Our interpretation of maturity is considered as being an important and interesting focus in nursing, while the above related qualities are closely connected to coping with diabetes.
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| 99. |
- Jacobsson, Catrine, et al.
(författare)
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Eating despite severe difficulties : assessment of poststroke eating
- 1996
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 5:1, s. 23-31
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Tidskriftsartikel (refereegranskat)abstract
- A programme for the assessment and nursing diagnoses of eating difficulties among stroke patients was tested. The patients' experiences regarding eating were expressed in interviews and dialogues. Eating was observed during both a test meal and regular meals. The assessments included the prerequisites for eating as well as oral, pharyngeal and oesophageal functions. General and specific nursing diagnoses as well as life consequences (handicap) were established, based on assessment of disabilities and impairments, and interviewing the patients and their families, respectively. The general nursing diagnoses were formulated on admission after the test meal and these were reformulated to form specific nursing diagnoses after assessments of the functions. The programme presented proved to be useful in clinical practice. It is emphasized that many assessments must be co-ordinated for each individual
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| 100. |
- Jacobsson, Catrine, et al.
(författare)
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How people with stroke and healthy older people experience the eating process
- 2000
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 9:2, s. 255-264
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the process of eating, experiences of eating and oral functions. Participants consisted of 30 people with first stroke and localization of the damage verified by computer topography (CT), and 15 healthy older people. All were observed during test-meals, interviewed about eating, and oral functions were tested. The results demonstrated that most (21) people with stroke had some difficulties in eating and expressed feelings of fear and shame about eating and changed physical and social appearance, mainly related to difficulties in preparing and transporting food to the mouth as well as swallowing deficits.
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