| 1. |
- Ahlström, Gerd, et al.
(författare)
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Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design : a study protocol
- 2018
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Ingår i: BMC Palliative Care. - : BioMed Central. - 1472-684X. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: The demography of the world is changing as the population is ageing. Because of this change to a higher proportion of older people, the WHO has called for improved palliative care for older persons. A large number of all deaths in the industrialised world occur while older people are living in nursing homes and therefore a key question becomes how the principles of palliative care can be implemented in that context. The aims of this study are: a) to describe a model of an educational intervention with the goal of implementing knowledge-based palliative care in nursing homes, and b) to describe the design of the evaluation of the effectiveness regarding the implementation of knowledge-based palliative care. Methods/design: A complex intervention is evaluated by means of a cross-over design. An educational intervention concerning palliative care consisting of five seminars during 6 months for staff and managers has been developed and conducted in 20 nursing homes in two counties. Before the intervention started, the feasibility was tested in a pilot study conducted in nursing homes not included in the main study. The intervention is evaluated through a non-randomized experimental design with intervention and control groups and pre- and post-assessments. The evaluation includes older persons living in nursing homes, next-of-kin, staff and managers. Data collection consists of quantitative methods such as questionnaires and register data and qualitative methods in the form of individual interviews, focus-group interviews and participant observations. Discussion: The research will contribute to new knowledge about how to implement knowledge-based palliative care in a nursing home setting. A strength of this project is that the Medical Research Council framework of complex intervention is applied. The four recommended stages, Development, Feasibility and piloting, Evaluation and Implementation, are combined for the educational intervention, which functions as a strategy to achieve knowledge-based palliative care in the nursing homes. Implementation is always a question of change and a good theoretical understanding is needed for drawing valid conclusions about the causal mechanisms of change. The topic is highly relevant considering the world's ageing population. The data collection is completed and the analysis is ongoing.
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| 2. |
- Alftberg, Åsa, et al.
(författare)
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Conversations about Death and Dying with Older People : An Ethnographic Study in Nursing Homes
- 2018
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Ingår i: Healthcare. - : MDPI. - 2227-9032. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- Nursing homes are often places where older persons “come to die.” Despite this, death and dying are seldom articulated or talked about. The aim of this study was to explore assistant nurses’ experiences of conversations about death and dying with nursing home residents. This study is part of an implementation project through a knowledge-based educational intervention based on palliative care principles. An ethnographic study design was applied in seven nursing homes, where eight assistant nurses were interviewed and followed in their daily assignments through participant observations. The assistant nurses stated that they had the knowledge and tools to conduct such conversations, even though they lacked the time and felt that emotional strain could be a hinder for conversations about death and dying. The assistant nurses used the strategies of distracting, comforting, and disregarding either when they perceived that residents’ reflections on death and dying were part of their illness and disease or when there was a lack of alignment between the residents’ contemplations and the concept of dying well. They indicated that ambivalence and ambiguity toward conversations about death and dying should be taken into consideration in future implementations of knowledge-based palliative care that take place in nursing homes after this project is finalized.
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| 3. |
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| 4. |
- Axelsson, Lena, et al.
(författare)
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End-of-life and palliative care of patients on maintenance hemodialysis treatment : a focus group study
- 2019
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Ingår i: BMC Palliative Care. - : BioMed Central. - 1472-684X. ; 18:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite complex illness trajectories and a high symptom burden, palliative care has been sub-optimal for patients with end-stage kidney disease and hemodialysis treatment who have a high rate of hospitalization and intensive care towards end of life. There is a growing awareness that further development of palliative care is required to meet the needs of these patients and their family members. In this process, it is important to explore healthcare professionals' views on provision of care. The aim of this study was therefore to describe nurses' and physicians' perspectives on end-of-life and palliative care of patients treated with maintenance hemodialysis. Methods: Four focus group interviews were conducted with renal nurses (17) and physicians (5) in Sweden. Qualitative content analysis was used to analyze data. Results: Participants were committed to giving the best possible care to their patients, but there were challenges and barriers to providing quality palliative care in nephrology settings. Professionals described palliative care as end-of-life care associated with hemodialysis withdrawal or palliative dialysis, but also identified care needs and possibilities that are in line with an earlier integrated palliative approach. This was perceived as complex from an organizational point of view. Participants identified challenges related to coordination of care and different perspectives on care responsibilities that impacted symptom management and patients' quality of life. Communication issues relating to the provision of palliative care were revealed where the hemodialysis setting was regarded as an impediment, and personal and professional experiences, beliefs and knowledge were considered of major importance. Conclusions: Nurses and physicians identified a need for the improvement of both late and earlier palliative care approaches. The results highlighted a requirement for and possibilities of training, counselling and support of health care professionals in the dialysis context. Further, multi-professional palliative care collaborations should be developed to improve the coordination and organization of end-of-life and palliative care of patients and their family members. A climate allowing conversations about advance care planning throughout the illness trajectory may facilitate the gradual integration of palliative care alongside life-prolonging treatment for improved support of patients and families.
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| 5. |
- Benzein, Eva, 1951-, et al.
(författare)
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Hälsostödjande familjesamtal
- 2017. - 2
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Ingår i: Att möta familjer inom vård och omsorg. - Lund : Studentlitteratur AB. - 9789144115870 ; , s. 65-86
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Benzein, Eva, 1951-, et al.
(författare)
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Metoder inom familjecentrerad forskning
- 2017. - 2
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Ingår i: Att möta familjer inom vård och omsorg. - Lund : Studentlitteratur AB. - 9789144115870 ; , s. 107-122
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 7. |
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| 8. |
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| 9. |
- Benzein, Eva, 1951-, et al.
(författare)
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Varför ska familjen ses som en enhet?
- 2017. - 2
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Ingår i: Att möta familjer inom vård och omsorg. - Lund : Studentlitteratur AB. - 9789144115870 ; , s. 27-32
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Benzein, Eva, et al.
(författare)
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‘You put it all together’ : families' evaluation of participating in family health conversations
- 2015
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 29:1, s. 136-144
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectivesTo evaluate the Family Health Conversations from the perspective of families living with chronic illness.Methodological design and justificationThis study has a descriptive qualitative design using semi-structured evaluative family interviews and conventional content analysis.Ethical issues and approvalThe study was approved by a Regional Ethical Review Board.Research methodsFamily Health Conversations were used as an intervention with 14 families living with chronic illness. The outcome measures consisted of evaluative family interviews.ResultsFamilies' experiences of the conversations embraced their structure and the interactions with the conversation leaders. All families were satisfied with the conversations, pointing to the importance of having them early in the illness process. The opportunity to talk with someone outside the family was strongly emphasised as promoting well-being. The experienced significance of the conversations was captured in four categories: creating a whole picture, that is, being given the opportunity to listen to other family members' experiences and fill in potential memory gaps; making the situation manageable, that is, receiving support from other participants in order to handle problems and gain control; facilitating healing, that is, being able to tell their story about what had previously been ‘the unspeakable’; and strengthened family cohesion, that is, increased understanding for each other's experiences, thus bringing family members closer together.Study limitationsMost families were partners, which could possibly limit transferability of the findings to families constituted by couples.ConclusionsFamily Health Conversations should be offered as a part of standard care shortly after diagnosis and at various transitions in life.
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