| 1. |
- Frank, Catharina, 1961-, et al.
(författare)
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Ethics rounds in the ambulance service: a qualitative evaluation
- 2024
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Ingår i: BMC Medical Ethics. - : Springer Nature. - 1472-6939. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIt is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians’ ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance service context. Thus, the aim of this study was to describe ambulance clinicians’ experiences of participating in ethics rounds.MethodsThis was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis.ResultsTwo themes describe the participants’ experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue.ConclusionIncorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service.
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| 2. |
- Godskesen, Tove, et al.
(författare)
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Barriers to and facilitators of ethical encounters at the end of life in a nursing home : an ethnigraphic study
- 2024
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Ingår i: The 5th International NCCS & EACS Conference, University of Stavanger, Norway: Caring cience - the heart of multi-professional care. ; , s. 6-6
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Konferensbidrag (refereegranskat)abstract
- Background: This study explored the dynamics of ethical encounters between frail older residents and assistant nurses during assisted bodily care at the end of life within nursing homes. While personalized palliative care is recognized as crucial for this demographic, little is known about the ethical dimensions of daily care practices in this setting. Design: Focused ethnography. Methods: Data consisted of 170 hours of fieldwork in an urban Swedish nursing home. This involved participant observation and interviews. Thematic analysis was used, with input from five public community stakeholders during a focus group. Results: Our findings uncover barriers to achieving ethical encounters in assisted bodily care within the nursing home, primarily linked to communication, relationships, and care quality. These obstacles stem from resource limitations, ineffective communication, and misaligned work values. However, ethical encounters can be facilitated through the promotion of moral sensitivity, genuine resident engagement, and collaborative practices, essential for person-centered care. Personnel, particularly assistant nurses, must recognize their responsibility in addressing resident vulnerability. Conclusion: We advocate for continuous moral reflection on communication, compassion, decision-making, and behavior, with a strong focus on the care relationship. To improve care quality, organizations should allocate resources for relationship-building and provide assistant nurses with adequate post-shift recovery time. Additionally, we recommend further research, including the implementation of ethically grounded palliative care, to continuously enhance care practices in nursing homes.Ethical issues and approvals: The study followed ethical standards stated by the Declaration of Helsinki, approved by The Regional Ethics Board of Stockholm (Dnr 2017/8-31/1).
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| 3. |
- Godskesen, Tove, et al.
(författare)
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How do journals publishing palliative and end‐of‐life care research report ethical approval and informed consent?
- 2023
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Ingår i: Learned Publishing. - : John Wiley & Sons. - 0953-1513 .- 1741-4857. ; 36:4, s. 554-563
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Tidskriftsartikel (refereegranskat)abstract
- This study explores how papers published in internationaljournals in palliative and end-of-life care report ethical approval andinformed consent. A literature search following PRISMA guidelines wasconducted in PubMed, the Web of Science Core Collection, Scopus, theProQuest Social Science Premium Collection, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). A total of169 empirical studies from 101 journals were deductively coded andanalysed. The results showed that 5% of publications provided no information on ethical approval, 12% reported minimal information, 56%reported rudimentary information, and 27% reported comprehensivedetails. We also found that 13% did not report any information oninformed consent, 17% reported minimal information, 50% reported rudimentary information, and 19% reported comprehensive details. The prevalence of missing and incomplete ethical statements and inadequatereporting of informed consent processes in recent publications raises concerns and highlights the need for improvement. We suggest that journalsadvocate high reporting standards and potentially reject papers that donot meet ethical requirements, as this is the quickest path toimprovement.
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| 4. |
- Henoch, Ingela, et al.
(författare)
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De 6 S:n : Personcentrerad palliativ vård för alla åldrar
- 2022
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Konferensbidrag (populärvet., debatt m.m.)abstract
- De 6 S:n, självbild, symtomlindring, sociala relationer, sammanhang, strategier och självbestämmande, haranvänts för att bidra till personcentrerad palliativ vård i Sverige sedan 1990-talet. De 6 S:n har traditionellt använts inom specialiserad palliativ vård, men passar också för allmän palliativ vårdunder hela livsspannet. Palliativ vård av barn ställer stora krav. Ett projekt där De 6 S:n används för att bidra tillpersoncentrerad palliativ vård av barn kommer att presenteras. Inom äldreomsorg ställs stora krav på attbevara integritet och personcentrering när funktion, kognition och möjlighet till självbestämmande börjar avta.Vi presenterar forskning om hur kroppslig omvårdnad inom äldreomsorg kan bli mer personcentrerad och enmodell för att förbättra självbestämmande och därmed bidra till en personcentrerad palliativ vård inomäldreomsorgen.De 6S:n har diskuterats, preciserats och utvecklats av det nationella 6S-nätverket för att beskriva det teoretiskainnehållet och för att utveckla den praktiska användbarheten. Diskussionen är levande och ständigt fortgåendeför att förbättra personcentrerad palliativ vård för personer i olika åldrar och olika vårdkontext.
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| 5. |
- 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
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Ingår i: Presented at IAGG-ER 2019 - 9th International Association of Gerontology and Geriatrics European Region Congress, Gothenburg, May 23-25, 2019.
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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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| 6. |
- Holmberg, Bodil, 1970-, et al.
(författare)
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Assenting to exposedness : meanings of receiving assisted bodily care in a nursing home as narrated by older persons
- 2019
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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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| 7. |
- Holmberg, Bodil, et al.
(författare)
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Barriers to and facilitators of ethical encounters at the end of life in a nursing home : An ethnographic study
- 2022
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Ingår i: BMC Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Among a growing population of older persons, many affected by multiple diseases and complex needs, are cared for in nursing homes. Previous studies of nursing homes have highlighted the importance of personalised palliative care. Nevertheless, we know little about whether everyday care practice involving assistant nurses and frail older persons accomplishes ethical encounters, especially in assisted bodily care. Therefore, the aim of this study was to understand and conceptualize the encounter between residents and assistant nurses in bodily care-situations at the end of life in a nursing home.METHODS: Focused ethnographic design was used. Residents and assistant nurses from one nursing home in an urban Swedish area participated in this study. Data were collected for 6 months and consisted of 170 h of fieldwork, including participant observation and interviews. Observations and digitally recorded interviews were analysed thematically. Five public community stakeholders contributed to the analysis by discussing preliminary results and clinical implications in a focus group.RESULTS: Four themes, each encompassing both barriers to and facilitators of ethical encounters in assisted bodily care, were identified: Coping with the impact of workplace demands; Interacting in dialogue and communication; Experiencing involvement in the provision of assisted bodily care; and Adapting to good care and comfort.CONCLUSIONS: The findings suggest that accomplishing ethical encounters in assisted bodily care practice in a nursing home context has many barriers that are related to communication, relationships, and quality of care. Barriers included lack of resources, ineffective communication, and work values, which hinder ethical encounters. Nevertheless, moral sensitivity, genuine interest in resident engagement, and collaborative practices facilitated ethical encounters and are thus central to person-centred care. Uniquely, assistant nurses must be aware of their responsibility for performing their tasks in response to residents' vulnerability. We therefore suggest that moral deliberation over issues of communication, compassion, decision-making, and behavior, with particular consideration for the care relationship. To further improve the quality of care, organisations must provide resources for the building of relationships, as well as time for assistant nurses to recover after long shifts. Additional research is warranted, including implementation of ethically grounded palliative care.
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| 8. |
- Holmberg, Bodil, 1970-, et al.
(författare)
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Being a companion at a natural pathway towards death
- 2017
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Ingår i: EAPC 2017 - 15th World Congress of the European Association for Palliative Care : Progressing Palliative Care. - Newmarket : Hayward Medical Communications. ; , s. 1091-1091
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Konferensbidrag (refereegranskat)abstract
- Background: Dying in old age tends to be slow and characterized by frailty and bodily needs. In Sweden a large proportion of deaths occur in nursing homes where bodily care is foremost provided by assistant nurses (ANs) who have high school education. Due to lack of places, admission to a nursing home is seldom granted until the older person has complex care needs, meeting death within a year.Aim: The aim of the study was to describe ANs experiences of providing bodily care to older persons during the last time of their lives in a nursing home.Method: The study had a qualitative design. Data was collected by individual interviews with ANs (n=7). The transcribed interviews were analyzed using an inductive qualitative content analysis.Results: In the analysis one main theme emerged; “Being a companion at a natural pathway towards death”. The ANs perceived dying at old age expected as a natural end to a long life. This meant not to hinder what happened, but to be pliable to bodily signs of gradual deterioration of the older person, using intuition, experience and teamwork. The bodily care strived to relieve oppressive symptoms and increase quality of life. This was made possible by teamwork with a holistic approach meaning that bodily care was not only to care for the body, but the whole person. Thus, ANs also described a wish to bring a sense of security and well-being to the older person by being present, creating an atmosphere of closeness outgoing from a companionship built upon a mutual and familiar relationship. Conclusion: ANs strived to supply a bodily care aimed to strengthen the older persons self-image. This goal was closely linked to a person-centred palliative care that highlights self-image as fundamental to health, wellbeing and a good death. This may indicate a need of further education in palliative care in order to strengthen the ANs as professionals but also to develop an evidence-based bodily care.
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| 9. |
- Holmberg, Bodil, et al.
(författare)
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Being a spectator in ambiguity : Family members' perceptions of assisted bodily care in a nursing home
- 2019
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Ingår i: International Journal of Older People Nursing. - : Wiley. - 1748-3735 .- 1748-3743. ; 15:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to explore family members' perceptions of assisted bodily care in a nursing home.BACKGROUND: Many older people living in nursing homes need assisted bodily care, provided by assistant nurses. This means exposedness, as the assistance is often provided under stress, but also brings pleasure. Family members, who may wish to and often benefit from continuing to provide assisted bodily care, are perceived as visitors and are expected to relinquish the assisted bodily care to the assistant nurses.DESIGN: This study has a qualitative design with a phenomenographic approach.METHODS: Data were collected through semi-structured interviews (n = 13) with family members of older people who were aged > 80, permanently living in a nursing home, suffering from multimorbidity, and in daily need of assisted bodily care. The data were analysed using a phenomenographic method.RESULTS: Three categories of description presenting an increasing complexity were identified. The family members perceived that assisted bodily care is built upon a respect for the older person's self-determination, practically supported by assistant nurses, and complemented by family members.CONCLUSIONS: In the family members' perceptions, assisted bodily care signifies ambiguity, as they find themselves balancing between the older persons' need for self-determination and need for help, and, further, between their trust in the assistant nurses' skills and their own perceived inadequacies in intimate assisted bodily care.IMPLICATIONS FOR PRACTICE: Policies that address the family members' role in nursing homes are needed. Furthermore, time for collaboration is needed for assistant nurses to inform and explain care decisions, become aware of the family members' perceptions of their situation and learn from them.
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| 10. |
- Holmberg, Bodil, 1970-, et al.
(författare)
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Caring for older patients with reduced decision-making capacity : a deductive exploratory study of ambulance clinicians’ ethical competence
- 2023
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Ingår i: BMC Medical Ethics. - : BioMed Central (BMC). - 1472-6939. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- Background: As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complexand difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability.Methods: A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis.Results: Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting.Conclusions: Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values
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