| 11. |
- Gransjön Craftman, Åsa, et al.
(author)
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Caring for older people with dementia reliving past trauma
- 2020
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In: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 27:2, s. 621-633
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Journal article (peer-reviewed)abstract
- Background: The occurrence of behavioural changes and problems, and degree of paranoid thoughts, are significantly higher among people who have experienced extreme trauma such as during the Holocaust. People with dementia and traumatic past experiences may have flashbacks reminding them of these experiences, which is of relevance in caring situations. In nursing homes for people with dementia, nursing assistants are often the group of staff who provide help with personal needs. They have firsthand experience of care and managing the devastating outcomes of inadequate understanding of a person's past experiences.Aim: The aim was to describe nursing assistants' experiences of caring for older people with dementia who have experienced Holocaust trauma.Research design: A qualitative descriptive and inductive approach was used, including qualitative interviews and content analysis.Participants and research context: Nine nursing assistants from a Jewish nursing home were interviewed. Ethical considerations: The study was approved by the Regional Ethical Review Board, Stockholm.Findings: The theme 'Adapting and following the survivors' expression of their situation' was built on two categories: Knowing the life story enables adjustments in the care and Need for flexibility in managing emotional expressions.Discussion and conclusion: The world still witnesses genocidal violence and such traumatic experiences will therefore be reflected in different ways when caring for survivors with dementia in the future. Person-centred care and an awareness of the meaning of being a survivor of severe trauma make it possible to avoid negative triggers, and confirm emotions and comfort people during negative flashbacks in caring situations and environments. Nursing assistants' patience and empathy were supported by a wider understanding of the behaviour of people with dementia who have survived trauma.
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| 12. |
- Gransjön Craftman, Åsa, et al.
(author)
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Experiences of home care assistants providing social care to older people : A context in transition
- 2018
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In: International Journal of Older People Nursing. - : Wiley. - 1748-3735 .- 1748-3743. ; 13:4
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Journal article (peer-reviewed)abstract
- AIM: The aim was to describe home care assistants' (HCA) experiences of providing social care in older people's own homes.BACKGROUND: With the increase in average life expectancy and related growth of the elder population, addressing geriatric care needs has become an increasingly vital issue. However, the frontline workforce faces major challenges in meeting these needs, including a lack of trained professionals entering the field.DESIGN: A qualitative inductive design was used.METHODS: A descriptive, qualitative study using focus group interviews and content analysis.FINDINGS: The findings revealed that HCAs are active in an area facing challenges due to an older home-dwelling generation. Transfer of tasks should be reviewed considering changes to the workforce's skill mix brought on by task shifting.CONCLUSIONS: Certain prerequisites are needed to enable unlicensed assistive personnel to perform a good job; they also need to receive affirmation that they are a crucial workforce carrying out multifaceted tasks. To improve and maintain the pull factors of social care work, it is crucial to clarify how older people's requirements influence the daily care relation.IMPLICATIONS FOR PRACTICE: The findings highlight HCAs' blurred responsibility when providing nursing and care to older people with multiple chronic conditions and functional disabilities. Increasing expectations are placed upon HCAs to cope with practical situations that are theoretically outside the bounds of social care. The findings contribute knowledge to further development of collaboration between social and health care providers as well as the important affirmation of this unlicensed personnel group in transition. A long-term plan is therefore needed to provide HCAs with the skills and tools they need to deliver care and support to older people with a variety of needs.
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| 13. |
- Gransjön Craftman, Åsa
(author)
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Hantering av läkemedel i hemmet
- 2019
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In: Hemsjukvård. - Stockholm : Liber. - 9789147112777 ; , s. 253-260
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Book chapter (other academic/artistic)
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| 14. |
- Gransjön Craftman, Åsa
(author)
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Medicine management in municipal home care : delegating, administrating and receiving
- 2015
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Doctoral thesis (other academic/artistic)abstract
- The general aim of this thesis was to investigate how delegation of medication is handled in municipal home care. Specific aims were to 1) explore the prevalence of medication use in older adults over time; 2) describe district nurses’ experiences of the delegation of medication management to municipal home care personnel; 3) explore and describe how home care assistants experience receiving the actual delegation of the responsibility of medication administration; and 4) to describe how older adults, living at home, perceive receiving assistance from home care assistants to manage their own medication. Study I: Changes were explored in medication use over a period of 20 years among three cohorts of older adults aged 78+ years and living in Stockholm, Sweden (1517 participated in 1987; 1581 in 2001; and 1206 in 2007). All were included, whether living at home or in an institution. Univariate analysis was carried out, as well as multivariate logistic regression models. The mean number of drugs increased for both genders in all age groups: from 2.8 in 1987 to 5.8 in 2007 for those aged 78+ years, the corresponding figures for 96+ years was 3.6 and 7.7. Overall (1987, 2001 and 2007), drugs for the cardiovascular system were most frequent (53.1%, 60.8% and 68.7% respectively). Prevalence of polypharmacy (concurrent use of five drugs or more) increased from 27.0% (1987) to 53.9% (2001), and 65.3% (2007). Adjusting for age, gender, education and cognition, the odds of using analgesics and psychotropics were significantly higher in 2007 compared to 1987; OR (95% CI) of 3.3 (2.8-4.0) and 1.3 (1.1-1.6) respectively. Cognitively intact elderly primarily used hypnotics, whereas cognitively impaired elderly used hypnotics, sedatives and antidepressants. People living at home used fewer drugs. For those living in institutions, polypharmacy increased from 24.4% in 1987 to 95.3% in 2007. Corresponding figures for those living in service buildings were 44.6% to 82.4%. Study II: District nurses’ (DNs) perceptions of the concept of delegating the administration of medication to unlicensed personnel (home care aides, HCAs) working in municipal social care were described. Twenty DNs were interviewed and the interviews were audio taped. Data were collected from April 2009 to August 2010 and analysed using content analysis. Findings revealed that the statutes of delegation were outdated and appeared to be incompatible with day to day practice. Communication between DNs and HCAs, as well as tutoring, was regarded as important. The DNs found it imperative to be available to the HCAs and made an effort to create a trusting atmosphere. Delegation of administration of medication to a person, who lacked knowledge of medication, for example when it is proper to mix pills or blend them in a thick liquid, was reported by the DN as being stressful. This was explained by various responsible authorities and the growing number of social service groups. Despite this, the DNs did not see any major problems with the fact that the HCAs work for a separate authority (the county council vs. the municipality). Study III: The purpose was to explore and describe how HCAs experience receiving the delegation of medicine management, and how they handle the responsibility that comes with the delegation. Four focus groups consisting of 19 HCAs were conducted. Data were analysed using qualitative content analysis. According to the HCAs, health and social care depends on delegation arrangements to function effectively, but mainly it relieves a burden for DNs. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among HCAs of the content of the statutes of delegation. Accepting delegation to administer medication was an inevitable and a routine fact, regarded as a mandatory task that had become an implicit prerequisite for social care work in the municipality. Study IV: Finally, we wanted to describe how older people, living at home, experience the use and assistance of administration of medicines in the context of social care. Ten older adults, aged 68 to 94 years, were interviewed in their own homes. Latent content analysis was used. There were divided feelings about being dependent on assistance in handling medication, since it interfered with their autonomy at a time of health transition. On the other hand, the assistance eases daily life with regard to practical matters and improves adherence to a medicine regimen. Participants were balancing empowerment and a dubious perception of the home care assistants’ knowledge of medicine and safety. The trust in the physicians’ and DNs’ knowledge about medication routines was seen as a guarantee with regard to medicines in general and the medicine regimen in particular. The perceived strained work situation for HCAs risks placing older people in an adverse position in relation to HCAs with their heavy workload and limited schedules. This may negatively influence the care relationship and patient safety. Conclusions: This thesis reports: 1) A dramatic increase in medication use in older adults from the late 1980s to the mid- 2000s in central Stockholm, Sweden; 2) DNs cannot manage their workload without delegating the administration of medication to unlicensed personnel (HCAs) in the present organisational model of health- and social care; 3) Accepting the delegation to administer medication was inevitable and had become routine to meet the needs of a growing number of older home care recipients; and 4) Assistance with handling medication eases daily life and medicine regimen adherence. Dependence on assistance may affect older adults’ sense of autonomy. Perceived safety varied relating to HCAs’ knowledge of medicine. We believe our results may contribute to a better understanding of how health and social care, two fields spanning sociology and nursing, perceive and adjust to the given frames; in the first place by indicating how delegated administration of medication to older people living at home is perceived by the care recipients, DNs, and HCAs and also by illustrating how the possibility of delegating medical chores can give temporary tasks a manifest transition from licensed to unlicensed personnel.
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| 15. |
- Gransjön Craftman, Åsa, et al.
(author)
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Registered nurses' experience of delegating the administration of medicine to unlicensed personnel in residential care homes
- 2016
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In: Journal of Clinical Nursing. - Oxford : Blackwell Scientific Publications. - 0962-1067 .- 1365-2702. ; 25:21-22, s. 3189-3198
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Journal article (peer-reviewed)abstract
- AIMS AND OBJECTIVE: The aim was to describe registered nurses' experience in the context of delegating the administration of medication to unlicensed personnel in residential care homes.BACKGROUND: The residents in residential care homes have a need for extensive care and nursing, and large amounts of medicines are common practice. Registered nurses' workload and difficulties in fulfilling their duties, such as administration of medicines, have led to frequent delegation of this task between the registered nurses and unlicensed assisting personnel. It is, of course, a great responsibility to ensure that the care of the older people remains safe while maintaining quality in the prevailing situation.DESIGN: A qualitative inductive descriptive study.METHODS: Data were collected using audio-recorded semistructured interviews with a purposive sample of 18 registered nurses and interpreted using manifest content analysis. The study was approved by the ethical research committee.RESULTS: Registered nurses found the organisation unsupportive with regard to nursing interventions. The delegation context was experienced as a grey zone; the rules and regulations were not in line with the unspoken expectation to delegate the administration of medicine to unlicensed personnel, in order to be able to manage their daily work.CONCLUSIONS: The slimmed organisation of residential care homes relies upon registered nurses' use of delegation of medicine administration to unlicensed assistant personnel. It becomes an inevitable assignment entailing a challenging responsibility for patient safety and the quality of care.RELEVANCE TO CLINICAL PRACTICE: The results of this study may contribute to a better understanding of the complexity of caring for older people in residential care homes and to improving the work environment of all healthcare personnel.
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| 16. |
- Gransjön Craftman, Åsa, et al.
(author)
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Time trends in 20 years of medication use in older adults : Findings from three elderly cohorts in Stockholm, Sweden.
- 2015
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In: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 63, s. 28-35
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Journal article (peer-reviewed)abstract
- New drugs and expanded drug indications are constantly being introduced. Welfare states strive to provide equity in drug treatment for all of its citizens and todaýs healthcare systems spend financial resources on drugs for the elderly in a higher rate than for any other age group. Drug utilization in elderly persons has an impact in health and wellbeing in older people.THE PURPOSE OF THE RESEARCH: It was to describe the changes in medication use including people aged 78 years and over regardless of residence and other characteristics over 20 years.MATERIALS AND METHODS: The study population consisted of 4304 participants in three population-based cross-sectional surveys conducted in the Kungsholmen area of central Stockholm, Sweden. The participant's current drug utilization was reviewed by physicians following standardized protocols. Data were statistical analyzed. Logistic regression models was used to estimate odds ratios and 95% confidence intervals for use of analgesics and psychotropic drugs in the cohorts of 2001 and 2007, controlling for age, gender, education and cognition.THE PRINCIPAL RESULTS AND MAJOR CONCLUSIONS: Results shows that the prevalence of medication use and polypharmacy in older adults has increased dramatically the late 1980s to the 2000s in central Stockholm, Sweden. In particular, the use of analgesics increased significantly, while some drug groups decreased, i.e., antipsychotics. Women used more medication than men in all three cohorts. Older adults living in service buildings used the largest amount of drugs in 1987, whereas those living in institutions were the most frequent users in 2001 and 2007.
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| 17. |
- Grundberg, Åke, et al.
(author)
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Childrens' and young adults' perspectives of having a parent with dementia diagnosis : A scoping review
- 2021
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In: Dementia. - : SAGE Publications. - 1471-3012 .- 1741-2684. ; 20:8, s. 2933-2956
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Research review (peer-reviewed)abstract
- BACKGROUND: Dementia is a key health issue worldwide. In Sweden, as in other European countries, most persons with dementia live in domestic settings and are often cared for by their family members. This scoping review aims to describe the perspectives of children and young adults with a parent diagnosed with dementia. Young family members may be alone and without support despite their high level of care burden.DESIGN AND METHODS: Three electronic databases (PubMed, Web of Science and PsycINFO) were used to search for English-language articles focusing on children and young adults between the ages of 6 and 34 who have a parent diagnosed with dementia. A thematic synthesis of the included articles was performed.FINDINGS: Sixteen original published qualitative studies were identified. These studies were categorised based on information about the authors, year of publication, study location, participants, aim of the study, data collection, analysis and main findings. Five main analytical themes were identified: (1) children and young adults identify changes in their parents' behaviour and personality, (2) children and young adults experience changed roles and relationships within the family, (3) children and young adults need to cope with an uncertain future, (4) children and young adults relate changes in their parent to their own mixed emotions and (5) children and young adults need help and seek it out but experience inadequate support.CONCLUSIONS: The children and young adults in the included studies seem to provide significant levels of care and support to their affected parent, which may affect their own health, social relations, community participation, employment, education, finances and sense of security. This means that it is important for health care systems and social services to identify barriers to these young family members' access to relevant care and support for themselves.
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| 18. |
- Kabir, Zarina Nahar, et al.
(author)
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mHealth based intervention by social care professionals to support family caregivers to persons with dementia living at home in Sweden (Caregiver Connect) : A randomized controlled trial
- 2024
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In: BMC Geriatrics. - 1471-2318. ; 24
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Journal article (peer-reviewed)abstract
- BACKGROUND: The majority of persons with dementia in Sweden reside in their own homes with support from family members. Approximately, 12% of persons with dementia have immigrant background. Within the next 20 years, the number of persons with dementia who are non-ethnic Swedes is said to double. Family caregivers with immigrant backgrounds are noted to receive less support in the community than ethnic Swedes and rate their health status lower than ethnic Swedish peers. The Swedish National Board of Health and Welfare have highlighted the importance of follow-up support for family caregivers with immigrant backgrounds as there is a recognized gap in research and available information tailored to meet the needs of this group.PURPOSE OF THE STUDY: The purpose of the study is to test effectiveness of an mHealth based intervention through which community social workers can improve caregiving competence of non-European immigrant family caregivers of people with dementia living at home in Sweden. The overarching aim is to reduce caregiver burden and depressive symptoms, and improve quality of life.METHODS: A randomized controlled trial (RCT) including wait list control group will be performed consisting of an intervention group (A, n = 44) and a wait list control group (B, n = 44), totaling a sample size of 88. On completion of the 10-weeks long intervention in the intervention group, the intervention will be delivered to group B. Effect of the intervention will be analyzed between and within groups over time. The content of the educational component of the intervention is inspired by the iSupport manual developed by the World Health Organization. The contents, in the form of a booklet, aims to equip the family caregivers with structured information on understanding dementia as a condition and its management at home, including self-care guidance designed specifically for family caregivers themselves.DISCUSSION: Similar telephone-delivered intervention studies targeted for family caregivers to persons with dementia are ongoing in Malaysia and will start in India using the same booklet adapted to the local context. These studies will provide evidence on the effectiveness of using digital technologies to deliver support to those who may not be reached or adequately served by the traditional healthcare system.TRIAL REGISTRATION: ISRCTN registry, Registration number ISRCTN64235563.
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| 19. |
- Omerov, Pernilla, et al.
(author)
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Homeless persons' experiences of health- and social care : A systematic integrative review
- 2020
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In: Health & Social Care in the Community. - : Hindawi Limited. - 0966-0410 .- 1365-2524. ; 28:1, s. 1-11
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Research review (peer-reviewed)abstract
- Homelessness is associated with high risks of morbidity and premature death. Many interventions aimed to improve physical and mental health exist, but do not reach the population of persons experiencing homelessness. Despite the widely reported unmet healthcare needs, more information about the barriers and facilitators that affect access to care for persons experiencing homelessness is needed. A systematic integrative review was performed to explore experiences and needs of health- and social care for persons experiencing homelessness. The following databases were searched: AMED, ASSIA, Academic Search Complete, CINAHL, Cochrane library, Nursing and Allied Database, PsycInfo, PubMed, Scopus and Web of Science Core Collection. Twenty-two studies met the inclusion criteria of empirical studies with adult persons experiencing homelessness, English language, and published 2008-2018. Fifty percent of the studies were of qualitative and quantitative design, respectively. Most studies (73%) were conducted in the United States (n=11) and Canada (n=5). The analysis resulted in three themes Unmet basic human needs, Interpersonal dimensions of access to care, and Structural and organizational aspects to meet needs. The findings highlight that persons in homelessness often must prioritize provision for basic human needs, such as finding shelter and food, over getting health- and social care. Bureaucracy and rigid opening hours, as well as discrimination and stigma, hinder these persons' access to health- and social care.
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| 20. |
- Swall, Anna, 1977-, et al.
(author)
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Dog handlers' experiences of therapy dogs' impact on life near death for persons with dementia
- 2019
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In: International Journal of Palliative Nursing. - : Pensord Press Ltd.. - 1357-6321 .- 2052-286X. ; 25:2, s. 65-71
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Journal article (peer-reviewed)abstract
- BACKGROUND:: Persons with dementia may have severe physical and psychological symptoms at the end of life. A therapy dog used in their care can provide comfort and relieve their anxiety. The dog handler guides the dog during the interaction with the patient.AIM:: To describe the impact of therapy dogs on people with dementia in the final stages of life from the perspective of the dog handler.METHODS:: Interviews were conducted and analysed using qualitative content analysis.FINDINGS:: The dog provides comfort and relief through its presence and by responding to the physical and emotional expressions of the dying person.CONCLUSIONS:: Interactions with dogs were found to have a positive impact on persons with dementia and eased the symptoms associated with end of life according to the dog handlers.
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