34567896 of 21
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
När kroppen inte räcker till: Assisterad kroppslig omvårdnad i livets slut på vård- och omsorgsboende
Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC.ORCID iD: 0000-0002-8912-8101
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Det övergripande syftet med denna avhandling var att belysa vård i livets slut på vård- och omsorgsboende, med inriktning mot den kroppsliga omvårdnaden, utifrån äldre personers, undersköterskors och anhörigas perspektiv. Avhandlingen bygger på fyra delstudier. Tre analysmetoder användes;innehållsanalys (I & III), fenomenologisk hermeneutik (II) och fenomenografi(IV). Datainsamlingen omfattade individuella intervjuer (I, II & IV) och observation (III). Fynden visar att; (I) undersköterskor känner de äldre personerna och värnar deras självbestämmande, välbefinnande och värdighet. I sitt arbete fokuserar de främst på kroppslig omvårdnad. Äldre personer (II) upplever kroppslig omvårdnad som en assistans, växelvis i form av ett fängelse eller som en njutning. De värnar sitt självbestämmande, men anpassar sig efter de omständigheter som bestäms av andra. Det är främst undersköterskor som utför assisterad kroppslig omvårdnad (III), medan äldre tar del i det de kan, trots nedsatt kroppslig förmåga. Anhöriga räknar med att äldre personer utövar fullt självbestämmande gällande assisterad kroppslig omvårdnad (IV). Själva bidrar de med en assisterad kroppslig omvårdnad som inte innefattar intimhygien, medan de förblir observanta på undersköterskors arbete. Avhandlingen belyser att assisterad kroppslig omvårdnad kan överbrygga äldres kroppsliga begränsningar och leda till välbefinnande när självbestämmandet främjas. Sådan assisterad kroppslig omvårdnad kan utgöra en väsentlig del av en palliativ omvårdnad för äldre personer på vård- och omsorgsboende i livets slut.

Place, publisher, year, edition, pages
Stockholm: Ersta Sköndal Bräcke högskola , 2020. , p. 135
Series
Avhandlingsserie inom området Människan i välfärdssamhället, ISSN 2003-3699 ; 4
Keywords [sv]
Anhöriga, Autonomi, Äldre personer, Kroppslig omvårdnad, Palliativ vård, Undersköterskor, Vård- och omsorgsboende, Välfärd, Värdighet
National Category
Nursing
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
URN: urn:nbn:se:esh:diva-8055Libris ID: 0bgsfjtqxxcvdd0gISBN: 978-91-985808-4-6 (print)OAI: oai:DiVA.org:esh-8055DiVA, id: diva2:1423618
Public defence
2020-05-15, 09:00
Opponent
Supervisors
Available from: 2020-04-15 Created: 2020-04-15 Last updated: 2020-05-25Bibliographically approved
List of papers
1. End-of-life care in a nursing home: Assistant nurses' perspectives.
Open this publication in new window or tab >>End-of-life care in a nursing home: Assistant nurses' perspectives.
2018 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, article id 969733018779199Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in.

OBJECTIVE: To describe assistant nurses' perspectives of providing care to older persons at the end of life in a nursing home.

RESEARCH DESIGN: Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee.

RESULTS: Three main categories emerged; "Death a natural part of life"; "The older person's well-being"; and "Care in the moment of death"; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons' dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions.

DISCUSSION: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded.

CONCLUSION: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development.

Keywords
Assistant nurse, Dignity, End-of-life care, Ethics, Intuitive knowledge, Nursing home, Older person, Palliative care, Qualitative content analysis
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-6923 (URN)10.1177/0969733018779199 (DOI)29950147 (PubMedID)
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2020-04-15Bibliographically approved
2. Assenting to exposedness - meanings of receiving assisted bodily care in a nursing home as narrated by older persons.
Open this publication in new window or tab >>Assenting to exposedness - meanings of receiving assisted bodily care in a nursing home as narrated by older persons.
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

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.

Keywords
assent; assisted bodily care; exposedness; hermeneutics; lifeworld; lived body; nursing home; older persons; phenomenology; self-determination
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7361 (URN)10.1111/scs.12683 (DOI)30888087 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2020-04-15Bibliographically approved
3. Elements of assisted bodily care: Ethical aspects
Open this publication in new window or tab >>Elements of assisted bodily care: Ethical aspects
2020 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed) Accepted
Abstract [en]

Background: Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy, and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim having exposedness to assistant nurses’ routines. The provider-receiverin congruence revealed here warrants investigation.

Aim: To describe the elements of assisted bodily care, as performed in a nursing home.

Research design: Data were collected through thirty-nine observations of assisted bodily care, analyzed with qualitative content analysis.

Participants and research context: Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home.

Ethical considerations: The research was conducted in line with the Declaration of Helsinki,further approved by the regional ethics committee.

Findings: Findings show, that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Still, assistant nurses attempt to adapt this work to older persons’wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care.

Discussion: Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. On the contrary, they seem to know older persons well enough to adapt assisted bodily care according to their preferences and support self-determination. This indicates that openness to older persons’ life-worlds may be more important than the amount of time available.

Conclusions: Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could prepare agreement on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all.

Keywords
Areas of practice, assisted bodily care, autonomy, care of the older person, dignity in care, empirical approaches, ethics of care/care ethics, nursing home, palliative care assistant nurse, qualitative research, self-determination, theory/philosophical perspectives, topic areas
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
urn:nbn:se:esh:diva-8053 (URN)
Available from: 2020-04-15 Created: 2020-04-15 Last updated: 2020-04-15Bibliographically approved
4. Being a spectator in ambiguity: Family members' perceptions of assisted bodily care in a nursing home
Open this publication in new window or tab >>Being a spectator in ambiguity: Family members' perceptions of assisted bodily care in a nursing home
2019 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 15, no 1, p. 1-10, article id e12289Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
assisted bodily care, ethics, family, nursing home care, phenomenography, qualitative methods, self-determination
National Category
Nursing
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
urn:nbn:se:esh:diva-8054 (URN)10.1111/opn.12289 (DOI)31763780 (PubMedID)
Available from: 2020-04-15 Created: 2020-04-15 Last updated: 2020-04-15Bibliographically approved

Open Access in DiVA

spikblad(44 kB)17 downloads
File information
File name SPIKBLAD01.pdfFile size 44 kBChecksum SHA-512
2baae5a437b8655420012dac9cac757c02bbca0030f5bc88a2a60bf990b563d9486afffcce654d5a205b7135f294d45d6129127116660a86a58dd909c794ebfc
Type spikbladMimetype application/pdf
Doktorsavhandling(957 kB)61 downloads
File information
File name FULLTEXT02.pdfFile size 957 kBChecksum SHA-512
641d9d3bfbbcf84cc744a8fb24fc2377e1cddf7684a36f7ae73a7da33d60ae8ab999b72ba7d82fa91cbb9aea9093d358c13c06bca10e98e0aefbbb3d31543d70
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Holmberg, Bodil
By organisation
Palliative Research Centre, PRC
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 182 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 589 hits
34567896 of 21
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf