| 1. |
- Browall, Maria, et al.
(författare)
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Development and Psychometric Evaluation of a New Short Version of the Swedish Frommelt Attitudes Toward Care of the Dying Scale
- 2021
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Ingår i: Cancer Nursing. - : Ovid Technologies (Wolters Kluwer Health). - 0162-220X .- 1538-9804. ; 44:4, s. 305-313
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Frommelt Attitudes Toward Care of the Dying (FATCOD) is widely used as a measure of attitudes toward care of dying patients. However, poor factor structure and item redundancy have been reported across the literature.OBJECTIVE: A short version of the questionnaire is needed, to facilitate effective assessments of the attitudes of those caring for dying patients. The purpose of this study was to develop a FATCOD-Short Form and to secure its psychometric properties.INTERVENTIONS/METHODS: Data gathered from 1000 nurses in previous studies were pooled and reanalyzed. Principal components analysis and confirmatory factor analysis were utilized to assess the factor structure of the FATCOD-30. A Rasch model was used to evaluate the measurement functioning of the scale.RESULTS: Of the original 30 items, 9 items of FATCOD were chosen for retention in the short form based on the principal components analysis, floor or ceiling effects, interitem correlations, and item-total correlation. All 9 items had good internal reliability. Both confirmatory factor analysis and Rasch analysis supported the unidimensionality of the FATCOD-Short Form.CONCLUSIONS: The 9-item FATCOD-Short Form demonstrates evidence of acceptable validity and reliability to identify nurses' attitudes toward caring for dying persons because of its brevity and comprehensive content.IMPLICATIONS FOR PRACTICE: When changing curricula in nursing education or implementing new procedures in nursing practice, it is important to have valid instruments to evaluate the results of the change. Such instruments should not be too lengthy or complicated. FATCOD-Short Form is a brief and valid instrument that can be easily used.
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| 4. |
- Franks, P. W., et al.
(författare)
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Technological readiness and implementation of genomic-driven precision medicine for complex diseases
- 2021
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 290:3, s. 602-620
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Forskningsöversikt (refereegranskat)abstract
- The fields of human genetics and genomics have generated considerable knowledge about the mechanistic basis of many diseases. Genomic approaches to diagnosis, prognostication, prevention and treatment - genomic-driven precision medicine (GDPM) - may help optimize medical practice. Here, we provide a comprehensive review of GDPM of complex diseases across major medical specialties. We focus on technological readiness: how rapidly a test can be implemented into health care. Although these areas of medicine are diverse, key similarities exist across almost all areas. Many medical areas have, within their standards of care, at least one GDPM test for a genetic variant of strong effect that aids the identification/diagnosis of a more homogeneous subset within a larger disease group or identifies a subset with different therapeutic requirements. However, for almost all complex diseases, the majority of patients do not carry established single-gene mutations with large effects. Thus, research is underway that seeks to determine the polygenic basis of many complex diseases. Nevertheless, most complex diseases are caused by the interplay of genetic, behavioural and environmental risk factors, which will likely necessitate models for prediction and diagnosis that incorporate genetic and non-genetic data.
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| 5. |
- Fristedt, Sofi, 1969-, et al.
(författare)
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Registered nurses and undergraduate nursing students' attitudes to performing end-of-life care
- 2021
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Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 98
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Tidskriftsartikel (refereegranskat)abstract
- Registered Nurses (RNs) are in the immediate position to provide End-of-life (EOL) care and counselling for patients and families in various settings. However, EOL-care often creates feelings of uncertainty and inadequacy linked to inexperience, lack of education, and attitude. To identify and describe factors associated with RNs' attitudes towards EOL-care, and to identify whether and how these attitudes differ from undergraduate nursing students' (UNSs) attitudes, a descriptive and comparative, quantitative study was performed. The FATCOD-instrument, focusing on attitude towards EOL-care, was used and the results analysed with descriptive and nonparametric statistics. In total, 287 RNs in 14 different specialist programmes, and 124 UNSs participated. A statistically significant difference (p = 0.032) was found in attitude towards EOL-care based on clinical experience. RNs in “Acute Care” and “Paediatric & Psychiatry Care” specialist programmes had a less positive attitude towards EOL-care (compared to RNs in other specialist programmes), while RNs attending the Palliative Care programme had the most positive attitudes. RNs and UNSs' scores differed statistically significantly in 17 out of 30 FATCOD variables. Finally, the results imply that there is a need for greater emphasis on further continuing education within EOL care for RNs working in all types of clinical specialities to encourage RNs talking about death and to enhance attitudes towards EOL care. © 2021 Elsevier Ltd
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| 6. |
- Granrud, Marie Dahlen, et al.
(författare)
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Health Care Personnel's Perspectives on Quality of Palliative Care During the COVID-19 Pandemic - A Cross-Sectional
- 2023
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Ingår i: Journal of Multidisciplinary Healthcare. - : Dove Medical Press. - 1178-2390. ; 16, s. 2893-2903
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The provision of high-quality palliative care is challenging, especially during a pandemic like COVID-19. The latter entailed major consequences for health care systems and health care personnel (HCP) in both specialist and community health care services, in Norway and worldwide. The aim of this study was to explore how the HCP perceived the quality of palliative care in nursing homes, medical care units, and intensive care units during the COVID-19 pandemic. Methods: This study had a cross-sectional design. A total of 290 HCP from Norway participated in the study (RR = 25.8%) between October and December 2021. The questionnaire comprised items concerning respondents' demographics and quality of care, the latter measured by the short form of the Quality from the Patient's Perspective-Palliative Care instrument, adapted for HCP. The STROBE checklist was used. Results: This study shows that the HCP scored subjective importance as higher in all dimensions, items and single items than their perception of the actual care received. This could indicate a need for improvement in all areas. Information about medication, opportunity to participate in decisions about medical and nursing care and continuity regarding receiving help from the same physician and nurse are examples of areas for improvement. Conclusion: Study results indicate that HCP from nursing homes, medical care units, and intensive care units perceived that quality of palliative care provided was not in line with what they perceived to be important for the patient. This indicate that it was challenging to provide high-quality palliative care during the COVID-19 pandemic.
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| 7. |
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| 8. |
- Granrud, MD, et al.
(författare)
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Health Care Personnel's Perspectives on Quality of Palliative Care During the COVID-19 Pandemic : A Cross-Sectional Study
- 2023
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Ingår i: Journal of Multidisciplinary Healthcare. - : Dove Medical Press. - 1178-2390. ; 16, s. 2893-2903
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The provision of high-quality palliative care is challenging, especially during a pandemic like COVID-19. The latter entailed major consequences for health care systems and health care personnel (HCP) in both specialist and community health care services, in Norway and worldwide. The aim of this study was to explore how the HCP perceived the quality of palliative care in nursing homes, medical care units, and intensive care units during the COVID-19 pandemic. Methods: This study had a cross-sectional design. A total of 290 HCP from Norway participated in the study (RR = 25.8%) between October and December 2021. The questionnaire comprised items concerning respondents' demographics and quality of care, the latter measured by the short form of the Quality from the Patient's Perspective-Palliative Care instrument, adapted for HCP. The STROBE checklist was used. Results: This study shows that the HCP scored subjective importance as higher in all dimensions, items and single items than their perception of the actual care received. This could indicate a need for improvement in all areas. Information about medication, opportunity to participate in decisions about medical and nursing care and continuity regarding receiving help from the same physician and nurse are examples of areas for improvement. Conclusion: Study results indicate that HCP from nursing homes, medical care units, and intensive care units perceived that quality of palliative care provided was not in line with what they perceived to be important for the patient. This indicate that it was challenging to provide high-quality palliative care during the COVID-19 pandemic.
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| 11. |
- Lundh Hagelin, Carina, et al.
(författare)
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Teaching about death and dying : A national mixed-methods survey of palliative care education provision in Swedish undergraduate nursing programmes
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 36:2, s. 545-557
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Tidskriftsartikel (refereegranskat)abstract
- Background: In coming decades, the number of people affected by illnesses who need palliative care will rise worldwide. Registered Nurses are in a central position in providing this care, and education is one of the necessary components for meeting coming requirements. However, there is a lack of knowledge about palliative care in undergraduate nursing education curricula, including the extent of the education provided and the related pedagogical methods. Aim: The aim was to investigate the extent, content and pedagogical methods used and to explore lecturers’ experiences of being responsible for teaching and learning about palliative care for undergraduate nursing students on nursing programmes at Swedish universities. Setting: All 24 universities responsible for providing undergraduate nursing education in Sweden participated. Participants: One lecturer with in-depth knowledge about palliative care or end-of-life care education participated in the quantitative (n = 24) and qualitative (n = 22) parts of the study. Method: A mixed-method research study with an explorative design was used. Descriptive statistics were used to analyse quantitative data, and content analysis for qualitative, with both also analysed integratively. Results: Few undergraduate nursing programmes included a specific course about palliative care in their curricula, however, all universities incorporated education about palliative care in some way. Most of the palliative care education was theoretical, and lecturers used a variety of pedagogical strategies and their own professional and personal experience to support students to understand the palliative care approach. Topics such as life and death were difficult to both learn and teach about. Conclusions: There is a need for substantial education about palliative care. Lecturers strive on their own to develop students’ understanding and increase the extent of palliative care education with innovative teaching strategies, but must compete with other topics. Palliative care teaching must be prioritised, not only by the universities, but also by the national authority.
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| 12. |
- Lundh Hagelin, Carina, et al.
(författare)
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Undervisning om döende och död : En nationell kartläggning av palliativ vård i svenska sjuksköterskeprogram
- 2022
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Antalet människor som drabbas av sjukdomar och behöver palliativ vård kommer öka världen över. Sjuksköterskor är i position för avgörande insatser riktade för både patient och närstående. Kunskap finns om stora variationer i utbildning om palliativ vård i sjuksköterskeutbildningar i Sverige medan kunskap om hur palliativ vård ingår i utbildningsplaner och hur undervisningen utformas är bristfällig.Syfte: Att undersöka omfattning och innehåll, samt vilka pedagogiska strategier som används för utbildning om palliativ vård i sjuksköterskeprogram i Sverige. Dessutom att utforska erfarenheterna hos lärare om att undervisa om palliativ vård.Metod: En studie med mixad design genomföres. Alla 24 universitet som ansvarar för att tillhandahålla sjuksköterskeutbildning i Sverige deltog genom en lärare med kunskap om utbildningens innehåll. Beskrivande statistik användes för att analysera kvantitativa data och innehållsanalys för kvalitativa data.Resultat: Endast ett fåtal sjuksköterskeprogram i Sverige inkluderade en specifik kurs om palliativ vård i sina utbildningsplaner. Lärare upplevde sig tvungna att konkurrera med andra områden inom utbildningen för att undervisa om palliativ vård. Utbildningen som gavs om palliativ vård var främst teoretisk och lärare använde olika pedagogiska strategier och den egna yrkesmässiga och personliga erfarenheter för att stödja studenterna att förstå palliativ vård. Vissa områden, som döende och död var svåra ämnen att lära ut.Betydelse: Utbildning om palliativ vård är viktig för att klara kommande behov. Studien visar att lärare ofta strävar på egen hand för att utveckla studenters förståelse genom olika undervisningsstrategier och måste också konkurrera med andra områden inom utbildningen. Kartläggningen kan vara ett stöd för enskilda lärare och lärosäten för att möjliggöra utbildning om palliativ vård. Utbildning om palliativ vård måste prioriteras inte bara av enskilda lärosäten utan också på nationell nivå.
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| 13. |
- Melin-Johansson, Christina, 1956-, et al.
(författare)
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A third of dying patients do not have end-of-life discussions with a physician : A nationwide registry study
- 2022
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Ingår i: Palliative & Supportive Care. - : Cambridge University Press (CUP). - 1478-9515 .- 1478-9523. ; 20:3, s. 357-362
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of the study was to explore the proportion of adult patients and next-of-kin who had end-of-life (EOL) discussions and associated factors. Method A retrospective nationwide registry study was reported with data from the Swedish Register of Palliative Care. All patients in Sweden in hospitals, nursing homes, own homes, community, and palliative care units during 2015-2017 and their next-of-kin were included. Data were reported to the register by healthcare staff, based on diseased patients' records regarding their last days of life, and were voluntary. Descriptive statistics illustrated the proportion of patients/next-of-kin who had EOL discussions and logistic regressions were used to examine associated factors. Results About half of the patients (46%) did have an EOL discussion, but a third (32%) did not. Associated factors of those who did not have an EOL discussion were dementia (48.5%) or stroke (47.5%), older age (38.4%), being female (33.6%), being cared for in a nursing home (41.3%), or hospital (40.3%), having lost decision-making ability months before death (58.9%), and not having a documented decision to shift to EOL care (82.7%). Younger patients diagnosed with cancer and cared for at a palliative unit were more likely to have EOL discussions. The regression analysis showed similar results for next-of-kin. Significance of results The result shows that not all patients with palliative care needs have equal access to EOL discussions, despite efforts at a national level and the recognized benefits of timely communication about the EOL care. Further efforts must be made to achieve EOL discussions for all patients.
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| 14. |
- Melin-Johansson, Christina, 1956-, et al.
(författare)
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Mening
- 2020. - 2
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Ingår i: Palliativ vård. - : Studentlitteratur AB. - 9789144131078 ; , s. 353-367
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 19. |
- Melin-Johansson, Christina, 1956-, et al.
(författare)
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Talk for life - conversations in palliative care : Establishing a Trusting Relation: Interdisciplinary Strategies
- 2023
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Ingår i: Palliative Medicine. - : Sage Publications. - 0269-2163 .- 1477-030X. ; 37:1 Supplement
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Tidskriftsartikel (refereegranskat)abstract
- Background/aims: In Sweden, palliative care, is an interdisciplinary approach including e.g. doctors, nurses, hospital social workers, physiotherapists and occupational therapists, having knowledge about the patient’s physical and medical status. Communication about existential issues as life and death, and meaning, contribute to relieve symptoms for patients and support their next-of-kin. Today, these conversations are not provided on equal terms to all patients in palliative care. Therefore, there is a need for deeper knowledge about healthcare professionals’ experiences of existential conversations with patients and their next-of-kin in palliative care, and investigate their main concerns to initiate and implement these conversations.Aim:To deepen the understanding of healthcare professionals’ communication strategies and main concerns in conversations with patients having palliative care needs and their next-of kin.Methods: Design: A qualitative approach using grounded theory method for data collection and analysis with a focus on communication processes in the participants’ natural settings. Seven focus group interviews with assistant and registered nurses, psysiotherapists and occupational therapists were conducted. The analysis is in progress and final results will presented at the conference.Results: Preliminary results: Professionals’ main concerns involved “Establishing a trusting relationship” which they solved by “Maintaining presence” despite challenges. These challenges affected how they handled their main concern and are represented in the categories “Talking about death” “Capturing wishes and needs” and “Guiding the patient and next-of-kin”.Conclusions: A theory based on the professional’s main concerns and challenges will be developed when all data have been analyzed.
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| 24. |
- Ozanne, Anneli, 1978, et al.
(författare)
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Impact of an education program to facilitate nurses' discussions of existential issues in neurological care
- 2022
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Ingår i: Palliative & Supportive Care. - : Cambridge University Press. - 1478-9515 .- 1478-9523. ; 20:5, s. 630-636
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Discussing existential issues is integral to caring for people with acute, progressive, or life-limiting neurological illness, but there is a lack of research examining how nurses approach existential issues with this patient group and their family members. The purpose was to examine the experiential impact of an educational program for nurses designed to facilitate discussions of existential issues with patients and family members in neurological wards. Method Nurses in inpatient and outpatient care at a neurological clinic in Sweden were invited to participate in an education program about discussing existential issues with patients and their family members as related to neurological conditions. The evaluation of the program and of the nurses' view of discussing existential issues was conducted through focus groups before and after participation. The data were analyzed by qualitative content analysis. Results The program gave nurses a deeper understanding of existential issues and how to manage these conversations with patients and their family members. Both internal and external barriers remained after education, with nurses experiencing insecurity and fear, and a sense of being inhibited by the environment. However, they were more aware of the barriers after the education, and it was easier to find strategies to manage the conversations. They demonstrated support for each other in the team both before and after participating in the program. Significance of results The educational program gave nurses strategies for discussing existential issues with patients and family members. The knowledge that internal and external barriers impede communication should compel organizations to work on making conditions more conducive, for example, by supporting nurses to learn strategies to more easily manage conversations about existential issues and by reviewing the physical environment and the context in which they are conducted.
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| 26. |
- Rönnberg, Linda, 1979-, et al.
(författare)
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Beyond the monitors : Anaesthesiologists' experiences of the process of extubation
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 36:4, s. 988-996
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although extubation is a high-risk phase associated with risk of severe complications for patients undergoing general anaesthesia, there is a lack of research about this phenomenon from the perspective of anaesthesiologists' experiences of the process of extubation in the anaesthesia setting.AIM: To describe Swedish anaesthesiologists' experiences of the extubation process in the anaesthesia setting.METHODS: A qualitative descriptive design study with individual semi-structured interviews was conducted in three hospitals in Sweden with a total of 17 anaesthesiologists. A qualitative manifest content analysis method was used to analyse the data.RESULTS: The anaesthesiologists' experiences were described in two categories: To assemble sensibilities, where the anaesthesiologists are receptive to inputs, create tailored plans, are guided by emotions and experiences, and sense the atmosphere in the process of extubation; and To stay focused, where they understand the importance of preparation and being prepared, and of being calm and strategic, and of needing to trust the registered nurse anaesthetist in the process of extubation.CONCLUSIONS: Decision-making regarding the process of extubation does not rely solely on monitoring signs; rather, the anaesthesiologists described how, by looking beyond the monitors and by being receptive to inputs from the patient and other professionals, their experience and intuition guides them through the process of extubation.
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| 27. |
- Rönnberg, Linda, 1979-, et al.
(författare)
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Safeguarding the patient : a grounded theory study of registered nurse anesthetists' main concerns in the process of extubation in the anesthesia setting
- 2022
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The process of extubation is complex as it takes place in the technical and challenging environment of the operating room. The extubation is related to complications of varying severity and a critical moment for the patient, who is in a vulnerable condition when emerging from anesthesia. Registered Nurse Anesthetists (RNAs) in Sweden have specialist training and performs extubations independently or in collaboration with an anesthesiologist.AIM: To obtain a deeper understanding of Registered Nurse Anesthetists' main concerns and how they resolve these in the process of extubation when caring for a patient during general anesthesia.PARTICIPANTS: A total of 17 RNAs, eight male and nine female, were included in the study. Twelve RNAs in the first step of data collection (I); and five RNAs the second step of data collection (II).METHOD: A classic grounded theory approach with a qualitative design was used for this study.FINDINGS: The RNAs' main concern in the process of extubation were Safeguarding the patient in a highly technological environment, which the solved by Maintaining adaptability. Facilitators as well as challenges affected how the RNAs solved their main concern and represented the categories: 'Having a back-up plan', 'Getting into the right frame of mind', 'Evaluating the patient's reactions', 'Using one's own experience', 'Dealing with uncertainty', 'Pressure from others', and 'Being interrupted'. The theory, Safeguarding the patient in the process of extubation, emerged.CONCLUSION: To be able to safeguard the patient in a highly technological environment, the RNAs must oscillate between facilitators and challenges. By maintaining adaptability, the RNAs resolved the difficulties of oscillating, indicating a need for finding a balance between maintaining attentiveness on what is important to keep the patient safe in the process of extubation and all of the disturbances present in the OR.
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| 28. |
- Rönnberg, Linda, 1979-
(författare)
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Tracheal Extubation of Patients Cared for in the Anesthesia Setting : Experiences Described by Registered Nurse Anesthetists and Anesthesiologists
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background In Sweden, extubation is an interdisciplinary process involving teamwork between Registered Nurse Anesthetists (RNA) and Anesthesiologists, and comprehensive demands are placed on the professionals providing anesthesia. The extubation of the endotracheal tube after General Anesthesia (GA) is a critical moment for the patient. In that moment, the patient is in a vulnerable state and at risk of suffering severe complications, such as hypoxia, laryngospasm, aspiration, and hypertension. Anesthesia deals with identifying options, making risk assessments and reconsiderations. Clinical decision-making in anesthesia includes making decisions quickly and sometimes re-evaluating these just as quickly. In the often brief meeting prior to anesthesia, a relationship with the patient emerges and an unspoken demand arises: to care for the life that is placed in the hands of the anesthetists.Aim The overall aim was to gain an understanding of the Registered Nurse Anesthetists’ and Anesthesiologists’ experiences of their decision-making practices in the process of extubation of the endotracheal tube in the anesthesia setting with patients undergoing general anesthesia.Method This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design using focus-group interviews (I) and Individual interviews (II) to collect data. A total of 20 RNAs from two hospitals and 17 Anesthesiologists from three hospitals were included, using a consecutive sampling strategy. Both studies were analyzed with qualitative content analysis and adopted an inductive approach to seek a deeper understanding of the phenomena, using manifest content analysis. In order to explore how the RNAs and Anesthesiologists experience the process of extubation and to identify nuances between them, the two studies were merged together in this licentiate thesis.Results When merging these studies (I, II) together by combining subcategories from both, six themes emerged. The theme, Assembling unique decisions, deals with the how the RNAs (I) and Anesthesiologists (II) assess, prepare, prevent and reconsider when planning for the extubation. Acting upon sensibilities consists of them recognizing patterns, leaning on their experience, and being receptive to different inputs from the patient and other professionals. The third theme, Being guided by intuition, included how the RNAs and Anesthesiologists relied on their feelings and were guided by emotions when deciding when to extubate. Safeguarding the patient deals with them protecting and acting as an advocate for the patient and how they focus on and are humble in the process of extubation. In the fifth theme, Being in a vulnerable position, the RNAs (I) felt they were on their own when making the decision on when to extubate, while the Anesthesiologists (II) felt as if they were one of the team. Using their own receptivity included how they established a connection with the patient and sensed the atmosphere.Discussion In their first encounter with the patient, or when obtaining knowledge about the patient, the RNAs and Anesthesiologists had already started to tailor a mental plan of the extubation unique to each patient. The plan consisted of small pieces of information being gathered and assembled together during the anesthesia, and this information is then combined with their experience of similar situations and with their intuition with the aim of safeguarding the patient. RNAs and Anesthesiologists act upon sensibilities when deciding on when to extubate. These strategies align with the concept of phronesis, a form of knowledge understood as practical wisdom that facilitates good clinical judgement in being rational, which is based on pre-understanding, experience, and interpersonal relationships and which is difficult to teach to someone else.
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| 29. |
- Schenell, R., et al.
(författare)
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Teaching to prepare undergraduate nursing students for palliative care : nurse educators’ perspectives
- 2023
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Ingår i: BMC Nursing. - : Springer Nature. - 1472-6955. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Education in palliative care for undergraduate nursing students is important for the competence of general nurses. Newly graduated nurses have reported challenges in coping with their own emotions when encountering dying persons. They express a wish for more education before they graduate, particularly in psychosocial and existential areas, such as having difficult conversations and supporting grieving persons. Despite awareness of the importance of palliative care education for nurses, there is a lack of knowledge on how to effectively convey this knowledge to students. The aim of the present study was to explore how teaching to prepare undergraduate nursing students for palliative care practice is conducted in Sweden. Methods: Educators from 22 Bachelor of Science nursing programmes in Sweden were interviewed about how they conducted palliative care education, with a focus on teaching situations that have been successful or less successful. The interviews were transcribed and analysed using qualitative inductive content analysis. Results: Educators described that they play a crucial role in preparing undergraduate nursing students to face death and dying and to care for persons at the end of life. In the main theme, “Transforming person-centred palliative care into student-centred education”, educators described how they incorporated the person-centred palliative approach into their teaching. Educators used a dynamic style of teaching where they let the students’ stories form the basis in a co-constructed learning process. The educators trusted the students to be active partners in their own learning but at the same time they were prepared to use their expert knowledge and guide the students when necessary. Discussion and reflection in small groups was described as being essential for the students to achieve a deeper understanding of palliative care and to process personal emotions related to encountering dying and grieving individuals. Conclusions: This study suggests that palliative care education for undergraduate nursing students benefits from teaching in smaller groups with room for discussion and reflection. Furthermore, gains are described relating to educators taking the role of facilitators rather than traditional lecturers, being flexible and ready to address students’ emotions. Educators also draw on their experiences as palliative care nurses in their teaching practices.
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| 30. |
- Stenman, Tove, 1975-, et al.
(författare)
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“Daring to deal with the difficult and unexpected” registered nurses’ confidential conversations with patients with palliative care needs : a qualitative interview study
- 2023
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Ingår i: BMC Palliative Care. - : Springer Nature. - 1472-684X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn palliative care, registered nurses provide advanced nursing care to relieve patients’ symptoms and increase their quality of life based on physical, mental, social and existential dimensions. Conversations, often about existential issues, are an important part of nursing and can affect quality of life positively. Confidential conversations between patients and nurses occur naturally while other nursing activities are being performed. Despite their great importance for palliative care these are rarely described.AimTo gain a deeper understanding of how nurses in palliative care experience and describe confidential conversations with patients.MethodSecondary analysis of data from 17 open-ended face-to-face interviews with registered nurses in palliative care was conducted. Qualitative content analysis using an inductive approach was used to gain a deeper understanding and analyse the latent content.ResultsThe confidential conversation was considered an important part of palliative care and is the nurse’s responsibility. This responsibility was described as complex and placed various demands on the nurses, both personal and professional. A prerequisite for the conversation was the interpersonal relationship. The conversation allowed the patient to process important matters not previously addressed or put into words. It had no predetermined content, was unplanned and entirely on the patient’s terms. For nurses the conversation could be experienced both as draining and a source of power and strength. The nurses also described safeguarding the patient through the conversation.ConclusionNurses’ confidential conversations with patients are essential in palliative care and must be highlighted more to increase the quality of palliative care. The confidential conversations often have an existential content and are challenging for the nurses. Therefore, nurses need time, knowledge, and supervision to increase their conversation skills.
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| 31. |
- Stenman, Tove, 1975-, et al.
(författare)
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Förtroliga samtal i palliativ vård - Personalens och patienters erfarenheter
- 2022
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: I palliativ omvårdnad identifierar, bedömer och bemöter sjuksköterskan fysisk, social, psykisk och existentiell hälsa för såväl patient som närstående samt planerar, genomför och utvärderar åtgärder. Samtal är en viktig omvårdnadshandling med syfte att förbättra patienternas livskvalitet och möjliggöra en värdig död. Samtalen om existentiella frågor har positiva effekter på livskvalitet och samtalet erbjuder existentiellt stöd i olika åldrar och sjukdomsgrupper vid obotlig sjukdom som exempelvis cancer, organsvikt, demenssjukdom. Det finns olika former av samtal i palliativ vård. Sjuksköterskans förtroliga samtal som ofta sker spontant vet vi lite om Det förtroliga samtalet finns inte heller explicit beskrivet som begrepp i vårdvetenskaplig forskning. Syfte: Att få en djupare förståelse för innebörden av förtroliga samtal i palliativ vård utifrån sjuksköterskors och patienters perspektiv. Metod: Kvalitativ ansats med sjuksköterskor och patienter som i intervjuer beskriver sina erfarenheter av förtroliga samtal. Resultat: Analys av insamlade data med sjuksköterskor pågår och beräknas avslutas hösten 2022. Rekrytering och insamling av data med patienter beräknas påbörjas hösten 2022. Preliminära resultat i delstudie I visar att samtalen är en viktig del i den palliativa omvårdanden och sjuksköterskans självklara ansvar. Såväl ansvaret som samtalet i sig beskrivs som komplext och ställer olika typer av krav på sjuksköterskan. I samtalet kan patienten med palliativ vårdbehov få möjlighet att bearbeta saker som inte tidigare bearbetats och sätta ord på det som behöver sättas ord på. Samtalet inte har något förutbestämt innehåll, sker ofta i anslutning till någon annan omvårdnadssituation och sker helt på patientens villkor då det är patienten somhåller i taktpinnen. Betydelse: Samtal är mycket viktig del av omvårdnaden, trots det upplever vårdpersonal av olika skälutmaningar i att genomföra samtal. Personalens vilja att hjälpa, lindra symtom och plågor samt att främja en värdig död är ofta en stark drivkraft. I förtroliga samtal med en sjuksköterska får patienter möjlighet att hantera sin situation, sin sjukdom, sina förluster, sitt beroende av hjälp och stöd samt sin livssituation vilket kan leda till ökad livskvalitet och känsla av oberoende och värdighet. Kontexten palliativ vård är viktig i det förtroliga samtalet, där livets sista tid, döendet och döden är närvarande. Studien med patienter kommer att ligga till grund för en digital interaktiv utbildningsintervention om existentiella samtal riktad till vårdpersonal. Det är centralt att medarbetare i teamet runt patienter med palliativ vårdbehov har kunskaper, förmåga och mod att initiera och samtala kring patienters existentiella tankar och funderingar vid obotlig sjukdom.
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| 32. |
- Stenman, Tove, 1975-, et al.
(författare)
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“Unless someone sees and hears you, how do you know you exist?” Meanings of confidential conversations – a hermeneutic study of the experiences of patients with palliative care needs
- 2024
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Ingår i: BMC Nursing. - : Springer Nature. - 1472-6955. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs. Methods: In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations. Results: The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life’s challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences. Conclusions: Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients’ suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients’ varying preferences.
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| 33. |
- Sundelöf, Johan, et al.
(författare)
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H.O.P.E : Ett frågeformulär på svenska för att identifiera religiösa, andliga och existentiella behov
- 2022
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Ingår i: Palliativ vår - det gäller livet. ; , s. 7-8
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Enligt WHO kännetecknas palliativ vård av helhetssyn med mål att möta fysiska, psykiska, sociala liksom religiösa, andliga och existentiella behov. Att möta existentiella behov förbättrar livskvaliteten men forskningen visar att många patienter i palliativ vård har otillräckligt mötta existentiella behov. Det saknas frågeformulär på svenska för att identifiera och möta existentiella behov i palliativ vård.Syfte: Att utvärdera patienters och personals erfarenheter av att använda en svensk översättning avfrågeformuläret H.O.P.E (Hope, Organized Religion, Personal practices, Effects on medical care) vid en palliativ slutenvårdsenhet.Metod: H.O.P.E översattes från engelska till svenska genom ”double back translation”. Sex patienter, en sjuksköterska, en läkare och en kurator deltog i djupintervjuer om erfarenheter av att använda H.O.P.E i samtal med patienter. Intervjuerna spelades in digitalt, transkriberades och analyserades med hermeneutisk ansats.Resultat: Patienter och personal upplevde att H.O.P.E var applicerbart, uppskattat och relevant att använda vidsamtal om religiösa, andliga och existentiella behov. H.O.P.E associerades med känslor av att ”känna sig sedd” och bidrog till att identifiera coping strategier hos patienterna. I samtalen identifierades och adresserades existentiella frågor som mening, hopp, skuld och ånger som följdes upp vid behov. Modifieringar föreslogs av språk som ibland kändes akademiska. Separering föreslogs av vissa frågor. Aspekter av existentiella behov som hopp/hopplöshet, mening/meningslöshet, skuld och ansvar skulle kunna adresseras ytterligare för att bättre möta en sekulär kontext.Betydelse: Studiens resultat visade att den svenska versionen av H.O.P.E är användbart, uppskattat och relevant vid samtal med patienter i palliativ vård om religiösa, andliga och existentiella behov. Modifiering avspråk, uppdelning i flera frågor och tillägg av fler frågor utifrån en sekulär kontext skulle ytterligare förbättra formuläret. Framtida studier behövs för utveckling och validering av formuläret.
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| 34. |
- Österlind, Jane, 1959-, et al.
(författare)
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6 S-modellen för personcentrerad palliativ vård : En undersökning av personalens uppfattningar på vård-och omsorgsboende och i hemtjänst
- 2023
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Palliativ vård innebär en holistisk vård av personer i alla åldrar. Syftet är att lindra lidande av fysisk, psykologisk, social eller existentiell/andlig natur. Döendet och döden är ofta omgärdade av tystnad, både i samhället i stort och bland vårdpersonal. Vårdpersonal kan känna sig obekväma vid tanken på döden. Djupare existentiella frågor undviks ofta genom att äldre personer inom hälso- och sjukvården avleds genom att prata om mer lättsamma samtalsämnen. Framtidens palliativa vård äger till stor del rum i hemmen och inom äldreomsorgen. Frågeställning: Studien är en del av en större interventionsstudie, EDUC-PC studien, och omfattar baslinjedata från 6S-enkäten med fokus på hur personal inom äldreomsorgen uppfattar att de arbetar enligt ett personcentrerat palliativt förhållningssätt. Metod: En kvantitativ ansats antogs. Enkäten som innehåller nio frågor skickades till 266 anställda varav 136 svarade. Resultaten redovisas som deskriptiv statistik i form av antal, procenttal, med median (md) som centralt mått. Resultat: Resultaten visar att den vård som ges uppfattas som bra eller mycket bra av personalen men att uppfattningarna varierar mellan olika yrkesgrupper. Innehållet i självbild, självbestämmande, sociala relationer och symtomlindring får alla höga poäng, medan de två existentiellt inriktade S:en; syntes och strategier, visar en större spridning mot lägre poäng. Konklusion: Obalansen mellan de olika innehållen i 6S omvårdnadsmodellen visar att det finns brister i den palliativa omvårdnaden inom äldreomsorgen. Detta är tydligast när de två S:en symtomlindring och strategier jämförs. Resultaten visar på ett behov av fortsatt fokus på äldre personers existentiella frågor inom äldreomsorgen.
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