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  • 1.
    Andershed, Birgitta
    et al.
    Ersta Sköndal University College, Department of palliative care research.
    Olsson, Kristina
    Review of research related to Kristen Swanson's middle-range theory of caring.2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 3, p. 598-610Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify and describe how Kristen Swanson's middle-range theory has been used in nursing practice/research presented in international journals. A total of 120 studies were included in the review and 23 were analysed further. An overview of the studies is presented, followed by four categories of how the theory has been used: referring to the theory (97 papers), applications of the theory to practice/research and/or theoretical discussions (nine papers), relating findings to and/or validation of the theory (eight papers), and development of measurements from and/or testing of the theory (six papers). The use of the theory and conclusions of the studies related to criteria for evaluation of theories were discussed.

  • 2. Andershed, Birgitta
    et al.
    Ternestedt, Britt-Marie
    Patterns of care for patients with cancer before and after the establishment of a hospice ward1997In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 11, no 1, p. 44-52Article in journal (Refereed)
  • 3. Asp, Margareta
    et al.
    Fagerberg, Ingegerd
    Mälardalens högskola.
    The woven fabric – a metaphor of nursing care: the major subject in nursing education2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 2, p. 115-121Article in journal (Refereed)
    Abstract [en]

    Society’s future needs regarding health care present challenges to traditional nursing education. Today, the ambition is to create a nursing role that is appropriate to people’s health care needs rather than the needs of the health care system. In nursing education, the major subject – nursing care – is central. Accordingly, there is a need for a consistent and clear articulation of this subject as well as the nursing profession. The aim of the present study was to interpret and describe the major subject, its content and structure in the nursing programme at Mälardalen University. With a hermeneutic approach an interpretation and application emerged as a metaphor of nursing care – the woven fabric. In this structure concepts function as bridges linking theory and practice, whereby it is possible to integrate different aspects of knowledge in order to think, feel and act nursing care.

  • 4.
    Asplund, Kenneth
    et al.
    Umeå universitet.
    Norberg, Astrid
    Adolfsson, Rolf
    The Sucking Behaviour of Two Patients in the Final Stage of Dementia of the Alzheimer Type1991In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 5, no 3, p. 141-147Article in journal (Refereed)
    Abstract [en]

    Two patients in the final stage of dementia of the Alzheimer type (DAT), who could no longer be given nutrition by assisted feeding, were given fluids by means of the sucking ability they still retained. They sucked more slowly under nutritive than under non-nutritive sucking conditions. The sucking efficiency of one of them improved during training. The status of the patients in the final stage of their dementia differed from one another, which might explain the difference in outcome. It is therefore suggested, that the use of the patients' sucking ability could serve as a complement and/or an alternative feeding technique when assisted spoon-feeding becomes extremely difficult or impossible. It is considered to be more gentle and natural than the present feeding techniques.

  • 5.
    Aström, Sture
    et al.
    Umeå universitet.
    Karlsson, Stig
    Umeå universitet.
    Sandvide, Asa
    Umeå universitet.
    Bucht, Gösta
    Umeå universitet.
    Eisemann, Martin
    University of Tromsoe.
    Norberg, Astrid
    Umeå universitet.
    Saveman, Britt-Inger
    Staff's experience of and the management of violent incidents in elderly care2004In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 4, p. 410-416Article in journal (Refereed)
    Abstract [en]

    Violence towards staff has become an important issue, since it has been reported to be common in various health care settings. This study aimed to describe emotional reactions among staff being exposed to violence in residential community care for the elderly: to investigate consequences from violent incidents and to describe the management of violent incidents. Data were collected by telephone interviews with nursing staff reporting incidents of violence. During the period of investigation, 97 of 848 staff (11.4%) reported that they had been exposed to violence. More than one-third of them reported subsequent wound and bruises from the incident and two of the exposed staff consulted a doctor because of the violent incident. The most frequently reported reactions among the staff were aggression, astonishment, and antipathy against the perpetrating care recipient, as well as insufficiency, powerlessness, insult and fear. A majority of the incidents were judged as intentionally perpetuating from the care recipient. Most of the violent incidents were managed by informal discussions in the working team. A low number of the reported incidents of violence involved formal discussions with nurse managers.

  • 6.
    Athlin, Elsy
    et al.
    Umeå universitet.
    Norberg, Astrid
    Umeå universitet.
    Asplund, Kenneth
    Umeå universitet.
    Caregivers' perceptions and interpretations of severely demented patients during feeding in a task assignment system.1990In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 4, no 4, p. 147-155Article in journal (Refereed)
    Abstract [en]

    Ninety-one focused interviews concerning the feeding of 23 severely demented patients were performed with 62 caregivers who fed the patients in a task assignment system. The aim was to increase the understanding about how caregivers perceive and interpret severely demented patients' behaviour and experiences during feeding. Content analysis showed that the caregivers' commitment or lack of commitment constituted a superior level that determined whether the patient was seen as a subject or as an object. Subcategories that were found were knowledge of the patient's disease and personal history, intuition, identification, empathy, generalisation and routinisation.

  • 7.
    Athlin, Elsy
    et al.
    Umeå universitet.
    Norberg, Astrid
    Umeå universitet.
    Asplund, Kenneth
    Umeå universitet.
    Jansson, Lilian
    Feeding problems in severely demented patients seen from task and relationship aspects1989In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 3, no 3, p. 113-121Article in journal (Refereed)
    Abstract [en]

    This study aimed at increasing the understanding of feeding problems in severely demented patients cared for in a task assignment system. Twenty-three video-recordings made during the feeding of 15 severely demented patients and 55 focused interviews with 45 caregivers, who fed the 15 patients during that period were analysed regarding the feeding problems seen from a task aspect and from a relationship aspect. The result indicated that the problems were partly of a more constant nature and partly fluctuated from meal to meal. Feeding problems regarding the task aspect were mentioned first by the caregivers in the interviews in spite of the fact that the patients had severe communication problems which could be expected to cause great problems in the relationship between the patient and his caregiver. Reasons for these findings are suggested.

     

  • 8.
    Axelsson, Lena
    et al.
    Sophiahemmet högskola, Karolinska institutet.
    Klang, Birgitta
    Karolinska institutet.
    Lundh Hagelin, Carina
    Sophiahemmet högskola, Karolinska institutet, Stiftelsen Stockholms sjukhem.
    Jacobson, Stefan H
    Karolinska institutet, Danderyds sjukhus.
    Gleissman, Sissel Andreassen
    Sophiahemmet högskola, Karolinska institutet, Danderyds sjukhus.
    End of life of patients treated with haemodialysis as narrated by their close relatives.2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 776-84Article in journal (Refereed)
    Abstract [en]

    AIM: The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives.

    INTRODUCTION: Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation.

    DESIGN: Qualitative and descriptive.

    METHODS: Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved.

    FINDINGS: In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal.

    CONCLUSIONS: Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care.

  • 9.
    Bullington, Jennifer
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Cronqvist, Agneta
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Group supervision for healthcare professionals within primary care for patients with psychosomatic health problems: A pilot intervention study2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In primary health care, efficacious treatment strategies are lacking for these patients, although the most prominent symptoms accounting for consultation in primary care often cannot be related to any biological causes.

    AIM: The aim was to explore whether group supervision from a specific phenomenological theory of psychosomatics could provide healthcare professionals treating patients with psychosomatichealth issues within primary care a deeper understanding of these conditions and stimulate profession-specific treatment strategies. Our research questions were as follows: (i) What is the healthcare professionals' understanding of psychosomatics before and after the intervention? (ii) What are the treatment strategies for this group of patients before and after the intervention?

    METHODS: The study was an explorative qualitative intervention pilot study. The six participants from a primary healthcare setting in a medium-sized city in Sweden participated in the study. A supervision group was formed, based on a mix of professions, age, gender and years of clinical experience. Supervision consisted of one 75-minutes meeting every month during the course of 6 months. Participants were interviewed before and after the supervision intervention.

    FINDINGS:The study showed two distinct categories emerged from the data. One category of healthcare professionals espoused a psycho-educative approach, while the other lacked a cohesive approach. The supervision improved the second category of healthcare professionals' understanding of psychosomatics. The psycho-educative group did not change their understanding of psychosomatics, although they felt strengthened in their approach by the supervision. Profession-specific strategies were not developed.

    IMPLICATIONS: This pilot study indicates that a relatively short supervision intervention can aid clinicians in their clinical encounters with these patients; however, further research is necessary to ascertain the value of the specific phenomenologically based supervision intervention.

  • 10.
    Bullington, Jennifer
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Fagerberg, Ingegerd
    Ersta Sköndal University College, Department of Health Care Sciences.
    The fuzzy concept of 'holistic care': a critical examination2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 493-494Article in journal (Refereed)
  • 11.
    Bullington, Jennifer
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Nordemar, Rolf
    S:t Görans sjukhus, Stockholm, Karolinska institutet.
    Nordemar, Kristina
    S:t Görans sjukhus, Stockholm.
    Sjöström-Flanagan, Charlotte
    S:t Görans sjukhus, Stockholm.
    Meaning out of chaos: a way to understand chronic pain2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 4, p. 325-331Article in journal (Refereed)
    Abstract [en]

    Pain is a multidimensional phenomenon lying at the intersection between biology and culture. The modern understanding of pain takes into account emotional, psychological, socio-political and existential aspects of pain as well as physiological, anatomical factors. Our aim in this study was to deepen the understanding of psychosocial, existential aspects of pain and to discuss how clinicians can better understand and treat patients with chronic pain. A focus group was formed consisting of a researcher and a group of clinicians (n = 3) with various backgrounds working at a specialized pain clinic. The group met once a month during a 6-month period. Questions concerning the life-world of the pain patient as well as inquiries into the conditions for 'the good clinical encounter' were investigated. The results of this study consist of a systematization of the data (focus group meetings) collected and analysed in a collaborative effort between the researcher and group participants. The findings are presented in terms of themes. The main metaphor used to describe the path from the seeking of medical help to successful rehabilitation was order out of chaos. Ordering chaos was a process moving from diagnosis through a phase of heightened self-awareness towards responsibility-taking on the part of the patient. Related themes presented, illustrated and discussed in the paper concern problems of linkage, the role of flexibility and creativity in the healing process and the kind of clinical encounter conducive for the journey from chaos to the creation of new meaning.

  • 12.
    Cronfalk, Berit Seiger
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Karolinska institutet, Høgskolen Stord/Haugesund.
    Norberg, Astrid
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Umeå universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC.
    They are still the same: Family members' stories about their relatives with dementia disorders as residents in a nursing home.2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 168-176Article in journal (Refereed)
    Abstract [en]

    In order to better understand the context of suffering from dementia disorders, greater efforts should be made to understand and identify what persons with such disorders experience when living in a nursing home. The aim of this qualitative study was to gain further understanding of how persons with dementia disorders experienced and coped with their changed life situation after being relocated to a nursing home as described by their family members' perceptions. Qualitative data were collected from ten interviews with family members and evaluated using content analysis. The main findings suggest that residents with dementia disorders largely maintained their personality intact throughout the trajectory of illness as they were able to keep their habits and interests. The local environment of the nursing home and the residents' relationships to staff were important in order to feel accepted. Four categories were discerned during the analysis: living in limbo; coming to peace; keeping old habits and relationships; and thoughts about impending death. It is reasonable to believe that old habits and interests may be preserved as the embodiment of such habits are deeply rooted and connected to a person's identity even when going through various changes and transitions in life. Therefore, to be accepted as the person you are requires care and services to specific needs, i.e. person-centeredness. Lack of understanding from staff may therefore have an adverse effect on a person's self-respect and identity. For that reason, staff needs to reflect on their attitudes and relationships as well as extending their knowledge about how to address sensitive topics such as the residents' impending death. To achieve this support from managers is pivotal. Future research should focus on support to nursing staff to further knowledge and understanding about the individual changes resident go through near the end of life.

  • 13. Emami, Azita
    et al.
    Momeni, Pardis
    Karolinska institutet.
    Hossein, Malek Afzali Ardakan
    Maddah, Sadat Seyed
    Developing a questionnaire for conducting cross-national studies: 'Self-reported health and needs among elderly Iranians and Swedes'2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, p. 372-9Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This paper describes the process of developing and validating a questionnaire to investigate self-reported health and care needs of elders in Iran and Sweden.

    BACKGROUND: Both developing and developed countries face dilemmas under the current condition of increasing mental and physical health morbidity globally. In order to fully assess and understand the extent of these dilemmas and the global and local factors that alleviate or worsen them, a comparison of the self-reported health and care needs in a developed and a developing country is required. To these ends, two research teams within a joint international project worked together to construct a questionnaire to measure self-reported health in elders in Sweden and Iran.

    METHODS: The questionnaire was developed according to a multiphase process, during which the researchers tested the validity and reliability of the questionnaire using various methods and modified it based on the test results. First, the concepts to be used were agreed upon and a literature review was conducted. Thereafter, face and content validity was measured in Iran, looking at the initial items that were developed. The questionnaire was then translated and back-translated. Finally, both teams conducted a test of content validity using target groups in Iran and Sweden, respectively.

    RESULTS: Validity was established by testing face and content validity with the use of expert groups. Reliability was also determined according to two different dimensions, stability and internal consistency. Both methods gave satisfactory results, indicating that the instrument was reliable.

    CONCLUSION: The questionnaire was thereby developed and titled, 'Self-reported health and health-care needs'. The results confirm validity and reliability of the final version of the questionnaire.

  • 14.
    Erdner, Anette
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Magnusson, Annabella
    Karolinska institutet.
    Nyström, Maria
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Ersta Sköndal University College, Department of Health Care Sciences.
    Social and existential alienation experienced by people with long-term mental illness2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 4, p. 373-380Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore how people suffering from long-term mental illness and who live in the community experience their daily lives. The study was based on an ethnographic framework involving participant observations with 23 individuals from two rehabilitation centres and interviews with six women and two men. The observational notes and interviews were recorded, transcribed into the data and analysed based on the phases of hermeneutic interpretation. The process consisted of identifying tentative interpretations that highlighted various impediments that prevent people with long-term mental illness from having an active life. The impediments can also be interpreted as a form of alienation, an interpersonal phenomenon and a consequence due to of the lack of social acceptance towards mental illness. The participants expressed concern about the future and lack of hope. Viewing themselves as being ‘odd’ is not a symptom of mental illness, but rather evidence of experiencing existential and social alienation not only as a consequence of other people's reactions but also their own negative attitudes towards mental illness and effects of their cognitive dysfunction.

  • 15.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet.
    Franklin Larsson, Lise-Lotte
    Ersta Sköndal University College, Palliative Reserch Centre, PRC. Sophiahemmet.
    Norberg, Astrid
    Ersta Sköndal University College, Palliative Reserch Centre, PRC. Umeå universitet.
    Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 337-346Article in journal (Refereed)
    Abstract [en]

    Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health.

  • 16.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet.
    Norberg, Astrid
    Ersta Sköndal University College, Palliative Reserch Centre, PRC. Umeå universitet.
    Persson, Birgitta
    Umeå universitet.
    Strandberg, Gunilla
    Umeå universitet.
    Healthcare personnel's experiences of situations in municipal elderly care that generate troubled conscience2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 215-223Article in journal (Refereed)
    Abstract [en]

    Healthcare personnel may perceive troubled conscience when feeling inadequate and powerless. It is important to further explore healthcare personnel’s descriptions of situations in daily work, which generate troubled conscience to increase the awareness of such situations. This study aimed to describe health care personnel's experiences of situations in municipal elderly care that generate troubled conscience. In this qualitative study, interviews were conducted with Registered and Enrolled nurses and nursing assistants (n = 20) working in municipal elderly care. The interviews were tape-recorded, transcribed verbatim and analysed with content analysis. Situations that generated troubled conscience was (i) Being caught between different demands, comprising being forced to prioritize between different residents’ needs, being torn between residents’-/relatives’-/and co-workers’ needs and expectations’ and between work and private life, (ii) Being torn away from residents to other ‘must do’s’, comprising stealing time from residents’ to do housekeeping chore’ and to ‘obey’ rules and recommendations, (iii) Feeling unable to relieve suffering, comprising falling short when striving to help, lacking knowledge, advice and support and time to ease residents’ suffering and finally, (iv) Being part of providing care that is or feels wrong, comprising providing poor care and/or witnessing co-workers providing poor care, and being forced to give care that feels wrong. These findings identify important factors that generate stress of conscience (stress caused by troubled conscience), including difficulties with balancing priorities and following rules and recommendations that seem contrary to best care, and the need for interdisciplinary teamwork. Findings point to that sharing what conscience tells in the work team opens up possibilities for healthcare personnel to constructively deal with troubled conscience. Intervention studies are needed to explore whether such measures contribute to relieve the burden of troubled conscience and increase possibilities to provide high quality care.

  • 17. Ericson-Lidman, Eva
    et al.
    Norberg, Astrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Strandberg, Gunilla
    Meanings of being a female co-worker to a person developing burnout.2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 2, p. 155-62Article in journal (Refereed)
    Abstract [en]

    Burnout is dramatically increasing in many industrialised countries. Burnout is mainly studied from the perspective of the burnout person although it has been confirmed to affect co-workers as well. This study aimed to illuminate meanings of being a female co-worker to a person developing burnout. Fifteen interviews with nursing and medical staff were performed, tape-recorded and transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. One meaning of being a female co-worker is struggling, on the one hand to understand and help the person developing burnout and on the other hand to manage their work and survive oneself. This means to be torn between helping the workmate and managing their work. Co-workers are filled with contradictory feelings, from deep concern to aversion and when the workmate finally goes on sick leave, co-workers' feelings of shortcomings and failure emerge, along with troubled conscience. This study reveals a picture of the difficulties of being a female co-worker to a person developing burnout that it is crucial to be aware of.

  • 18.
    Eriksson, Monica
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Hochwälder, Jacek
    Mälardalens högskola.
    Svedlund, Marianne
    Mittuniversitetet.
    Changes in hope and health-related quality of life in couples following acute myocardial infarction: A quantitative longitudinal study2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 295-302Article in journal (Refereed)
    Abstract [en]

    Background:  Acute myocardial infarction (AMI) is a life-changing event that affects both the patient and the family and can have an influence on hope as well as HRQoL during the recovery period.

    Aims:  To compare self-rated scores of hope and health-related quality of life (HRQoL) 1, 7, 13 and 25 months, after an AMI with regard to (i) differences across time, and (ii) differences between patients and their partners.

    Design:  Explorative and longitudinal study.

    Methods:  In this nonrandomized study, Short Form 36 Health Questionnaire (SF-36) and Herth Hope Index-Swedish (HHI-S) questionnaires were completed by thirteen post-AMI patients and their partners. Data were collected on four occasions.

    Results:  In general, hope as well as HRQoL scores increased over time. A 2 (groups) × 4 (times) anova for mixed design showed significant changes in mental as well as in physical health over time but no significant effect of group on mental or physical health. Calculation of the minimum detectable change (MDC-index) for HHI-S and SF-36 revealed that scores between data collection points were not stable.

    Conclusion:  Our results show that although hope and HRQoL scores increased, only a few of the changes were statistically significant. Neither HHI-S nor SF-36 seems to measure stable states. Changes in hope and HRQoL levels may be due to participants striving to adapt to the current situation.

    Relevance to clinical practice:  These results can be used in the training of nursing staff to enhance their understanding of the significance of a family-centred approach after an AMI.

  • 19.
    Fagerberg, Ingegerd
    et al.
    Karolinska Institutet.
    Ekman, Sirkka-Liisa
    Heyman, Inga
    Nursing students' reasoning about two fictitious elderly patient cases.1999In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 13, no 4, p. 247-53Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine and describe how nursing students developed their reasoning and knowledge about the state of health of, and their possible actions regarding, two fictitious elderly patient case histories during their three-year education. The descriptions were audiotaped, transcribed verbatim and analysed by content analysis. The findings show a development in the students' reasoning concerning the more acute case, but no development in reasoning regarding the case of a confused person. This could be due either to a lack of education in gerontology and geriatrics, or to the students receiving limited guidance during their education on how to reason about and reflect upon different ways of approaching emerging problems. The findings could also be understood in the light of traditions and history in nursing education.

  • 20.
    Fjelltun, Aud-Mari
    et al.
    University of Tromsø, Norway.
    Henriksen, Nils
    University of Tromsø, Norway.
    Norberg, Astrid
    Ersta Sköndal University College, Palliative Research Centre, PRC. University of Tromsø, Norway & Umeå universitet.
    Gilje, Fredricka
    School of Nursing, University of Alaska Anchorage, Anchorage, AK, USA.
    Normann, Hans Ketil
    University of Tromsø, Norway.
    Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents: a comparative study2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 4, p. 736-747Article in journal (Refereed)
    Abstract [en]

    The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses' physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly's functional levels may illuminate the extent of the carers' workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi-Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly's need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.

  • 21. Fjelltun, Aud-Mari Sohini
    et al.
    Henriksen, Nils
    Norberg, Astrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Gilje, Fredricka
    Normann, Hans Ketil
    Nurses' and carers' appraisals of workload in care of frail elderly awaiting nursing home placement.2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 1, p. 57-66Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study is to describe carers' and nurses' appraisals of workload in care of frail elderly awaiting nursing home (NH) placement. BACKGROUND: Carers' workload of care for frail elderly awaiting NH placement has been studied separately from that of nurses' workload. The literature neither addressed a comparison of carers' and nurses' appraisals of psychological and physical workloads nor the most strenuous factors common to the workloads of both nurses and carers in care of the same elderly person. The terms 'carers' and 'nurses' in this paper refer to informal caregivers and to both enrolled nurses and Registered Nurses respectively, when no particular one is stated. METHOD: The sample comprised 11 nurses and 11 carers paired based on care provided to the same elderly person awaiting NH placement in Norway. Data collected by a workload-scale was analyzed by descriptive statistics. Data collected by individual interviews were analyzed by qualitative content analysis. Carers' and nurses' appraisals of workload were compared and contrasted and most strenuous factors described. FINDINGS: The findings show that both carers and nurses rated workload levels maximum. Carers' highest ratings concerned psychological workload, while nurses' highest ratings concerned physical workload. The workload ratings concerning elderly with advanced dementia disease were most similarly aligned. Qualitative content analysis showed three categories that describe the most strenuous factors common to the workloads of both carers and nurses. These were feeling responsible, burdened and ambivalent. CONCLUSION: This study reports carers' and nurses' appraisals of workload in care of frail elderly awaiting NH placement. The results show many similarities and some differences. These results may help guide policy development to address resource allocations to elderly care. Further research is needed to address workloads of care for elderly awaiting NH placement.

  • 22.
    Fläckman, Birgitta
    et al.
    Högskolan i Gävle & Karolinska institutet.
    Fagerberg, Ingegerd
    Mälardalens högskola & Karolinska institutet.
    Häggström, Elisabeth
    Högskolan i Gävle & Karolinska institutet.
    Kihlgren, Annica
    Örebro universitet & Karolinska institutet.
    Kihlgren, Mona
    Örebro universitet & Karolinska universitetet.
    Despite shattered expectations a willingness to care for elders remains with education and clinical supervision2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 3, p. 379-389Article in journal (Refereed)
    Abstract [en]

    The aim was to describe nursing home (NH) caregivers' work experiences while receiving education and clinical supervision for 2 years. Working in elder care seems to be losing its attraction especially with organizational changes, cutbacks and changes in work place conditions. Clinical supervision has been reported to increase job satisfaction and creativity. Semi-structured interviews from caregivers working at an NH in Sweden were conducted, at the start and again at 12 and 24 months. At about 12 months the caregivers were informed of planned cutbacks. Content analysis was the method used to analyse the interviews from seven caregivers who participated throughout the entire period. Findings show that the value of a caring milieu was one category generated by the subcategories: experiences related to work activities and changes, and experiences related to relationships. The value of knowledge was the other category that was influenced by the experiences related to the different backgrounds and the experiences related to increased knowledge gained from the support through education and clinical supervision. The categories contained positive as well as negative influences on care. The initial focus on practical duties associated with the opening of the NH shifted towards caregiver activities with the elders they spoke warmly about. After 2 years the caregivers' willingness to care continued despite their disappointment in the worsened working conditions. The main theme that resulted was: Despite shattered expectations a willingness to care for elders remained. Continued education and clinical supervision seems to be one factor behind the retained willingness. These findings demonstrate that support and caregiver involvement in educational programmes are important during times of change and when disappointments arise in the workplace.

  • 23. Friberg, F
    et al.
    Dahlberg, K
    Nyström Pettersson, M
    Öhlén, Joakim
    Göteborgs universitet.
    Context and methodological decontextualisation in nursing rsearch with examples from phenomenography2000In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 14, p. 37-43Article in journal (Refereed)
  • 24.
    Fridh, Isabell
    et al.
    Högskolan i Borås, Göteborgs universitet.
    Kenne Sarenmalm, Elisabeth
    Ersta Sköndal University College, Palliative Research Centre, PRC. Skaraborgs sjukhus.
    Falk, Kristin
    Göteborgs universitet.
    Henoch, Ingela
    Göteborgs universitet.
    Öhlen, Joakim
    Ersta Sköndal University College, Palliative Research Centre, PRC. Göteborgs universitet.
    Ozanne, Anneli
    Göteborgs universitet.
    Jakobsson Ung, Eva
    Göteborgs universitet.
    Extensive human suffering: a point prevalence survey of patients' most distressing concerns during inpatient care2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, p. 444-453Article in journal (Refereed)
    Abstract [en]

    AIM: To explore patients' most distressing concerns during a hospital stay.

    BACKGROUND: The characteristics of hospitalised patients have changed. Care is provided at a higher age, lengths of stay have fallen and the nursing workload is increasing. It is presumed that hospitalised patients are more seriously ill and have more palliative needs than previously. Studies show that inpatients suffer from more distress than similar outpatients although there is a lack of overall knowledge about inpatients' distress and major concerns, regardless of age, diagnosis or care setting.

    METHODS: This study was part of a point prevalence survey (PPS) concerning symptom prevalence. Of the 710 patients who participated in the PPS, 678 (95%) answered an open-ended question in a questionnaire: What is your main concern or what is most distressing or troublesome for you at present? Using a life-world approach, the text was analysed qualitatively and patients' concerns were interpreted in two main dimensions, an intersubjective dimension and a temporal dimension.

    FINDINGS: The patients reported extensive suffering due to illness, symptoms and failing health. Patients were concerned about family members, existential issues and the future. Three aspects of the patients' most distressing concerns were interpreted: The suffering self, The suffering person in close relations and The suffering person in a threatening world.

    CONCLUSION: Hospitalised patients are affected by severe illness, distressing symptoms and existential quandaries, revealing extensive human suffering in the midst of the demanding activities that take place during an ordinary day in a hospital. To support patients and alleviate suffering, hospital staff need to be more sensitive to patients' most distressing concerns. This presupposes a hospital environment in which the value system supports caring and comforting behaviour.

  • 25. Glasberg, Ann-Louise
    et al.
    Eriksson, Sture
    Norberg, Astrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Factors associated with 'stress of conscience' in healthcare.2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 2, p. 249-58Article in journal (Refereed)
    Abstract [en]

    AIM: The main purpose of this study was to examine factors related to 'stress of conscience' i.e. stress related to a troubled conscience in healthcare. METHODS: A series of questionnaires was completed by 423 healthcare employees in northern Sweden as part of this cross-sectional study. The series of questionnaires comprised the 'Stress of Conscience Questionnaire', 'Perception of Conscience Questionnaire', 'Revised Moral Sensitivity Questionnaire', Social Interactions Scale, Resilience Scale and a Personal/Work Demographic form. RESULTS: Nonautomatic stepwise regression analysis with forward inclusion resulted in a model that explained approximately 39.6% of the total variation in stress of conscience. Individual items associated with stress of conscience were; perceiving that conscience warns us against hurting others while at the same time not being able to follow one's conscience at work and having to deaden one's conscience to keep working in healthcare. In addition moral sensitivity items belonging to the factor 'sense of moral burden' were; one's ability to sense patient's needs means that one is doing more than one has strength for, having difficulty to deal with feelings aroused when a patient is suffering and one's ability to sense patient's needs means feeling inadequate all added significantly to the model. In addition, deficient social support from superiors, low levels of resilience and working in internal medicine wards were all associated with stress of conscience. CONCLUSION: Healthcare employees seem to experience stress of conscience in their everyday practise. Particular contributing factors are not being able to follow one's conscience at work, and the 'negative' dimension of moral sensitivity - moral burden - which is an inability to deal with moral problems. Thus, in order for conscience and moral sensitivity to become an asset instead of a burden, healthcare employees need to be able to express their moral concerns.

  • 26. Gustafsson, Christine
    et al.
    Fagerberg, Ingegerd
    Ersta Sköndal University College, Department of Health Care Sciences.
    Asp, Margareta
    Dependency in autonomous caring - night nurses' working conditions for caring in nursing2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2Article in journal (Refereed)
    Abstract [en]

    Few research studies have focused on nurses' working conditions for caring provided at night, and these studies have mainly described nurses' work in hospital settings, not in a municipal, social-care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses' caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses' experiences of their working conditions for caring in nursing. All municipal night-duty nurses (n = 7) in a medium-sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses' role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed-side caring, which makes it easier for them to find time for caring in situations that arise when nurses' skills, expertise and authority are called upon. Conversely the consultancy function entails short-term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses' possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.

  • 27. Gustafsson, Gabriella
    et al.
    Norberg, Astrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Strandberg, Gunilla
    Meanings of becoming and being burnout--phenomenological-hermeneutic interpretation of female healthcare personnel's narratives.2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 4, p. 520-8Article in journal (Refereed)
    Abstract [en]

    The incidence of burnout has increased in many industrialized countries. Burnout is mainly studied among people still at work and with quantitative methods. The present study aimed to illuminate the meanings of becoming and being burnout as narrated by healthcare personnel on sick leave because of symptoms of burnout. Interviews with 20 female healthcare personnel were performed, tape-recorded and transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. The result shows that the meanings of becoming and being burnout are to be torn between what one wants to be and what one manages. It is as one's ideals have become more like demands and no matter the circumstances, one must be and show oneself as being capable and independent. It is also to be dissatisfied with oneself for not living up to one's ideals as well as disappointed with other people for not giving the confirmation one strives for. Feelings of being a victim of circumstances emerge. Thus, becoming and being burnout is leading a futile struggle to live up to one's ideal, failing to unite one's ideal picture with one's reality and experiencing an overwhelming feebleness. This is interpreted in the light of Buber's philosophy as well as relevant empirical studies about burnout. One conclusion is that it seems important to reflect on as well as discuss between one another about our everyday reality; what are reasonable vs. unreasonable demands. Hopefully, such reflections will increase our tolerance of ourselves and others and our insightfulness of what is possible to achieve in work as well as in private life. This study is ethically approved.

  • 28.
    Gustafsson, Lena-Karin
    et al.
    Mälardalens högskola.
    Mattsson, Karin
    Mälardalens högskola.
    Dubbelman, Kerstin
    Mälardalens högskola.
    Snöljung, Åsa
    Mälardalens högskola.
    Aspects of nursing with evidence-base when nursing frail older adults: a phenomenographic analysis of interviews with nurses in municipal care2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 793-801Article in journal (Refereed)
    Abstract [en]

    In earlier research as well as in political discussion and documents, the topic of evidence has been highlighted as one of the most important concerns in nursing care. This study focuses on understanding what lies behind nurses' ways of acting regarding evidence-based nursing through an illumination of the way they perceive the phenomena.

    AIM: The aim was to identify and describe the different ways municipal care nurses perceive aspects of working with evidence when nursing frail older adults.

    METHODS: An explorative design with a phenomenographic approach based on interviews with nurses working with home-based care within the municipality was used in order to gain understanding of nurse's perceptions of the phenomena.

    RESULTS: Findings revealed that the nurses perceived a variety of aspects when working with evidence when nursing frail older people. Aspects with a spectra of different perceptions shown in the analysis were as follows: Evidence-based nursing as a desired intention/mission, lack of practical supporting structures to apply evidence, lack of confidence in own capacity to apply evidence and a belief that it will work anyway.

    CONCLUSIONS: Findings reveal that it is a challenge to implement research both on an individual as well as on an organisational level. Understanding the contextual perceptions of evidence by nurses can cast light on the barriers as well as the prerequisites of working with evidence while caring for frail older adults in municipal care.

  • 29.
    Hellström, Ingrid
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Linköpings universitet.
    Håkanson, Cecilia
    Ersta Sköndal University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Karolinska institutet.
    Eriksson, Henrik
    Röda korsets högskola.
    Sandberg, Jonas
    Jönköpings universitet.
    Development of older men's caregiving roles for wives with dementia.2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 4, p. 957-964Article in journal (Refereed)
    Abstract [en]

    This secondary analysis of qualitative interviews describes how older Swedish men approach the caregiver role for a wife with dementia, over time. An increasing number of male caregivers will become primary caregivers for partners living with dementia at home, and they will likely be caregivers for an extended period of time. It has been stated that caregiving experiences influence how older men think of themselves. The theoretical starting point is a constructivist position, offering an understanding of older caregiving men's constructions and reconstructions of themselves and their caregiver roles. Seven men, who were cohabiting with their wives, were interviewed on up to five occasions at home during a 5- to 6-year period. The findings comprise three themes; me and it, me despite it, it is me, depict how these men gradually take on and normalise the caregiving tasks, and how they develop and internalise a language based on their caring activities. The results provide understanding about the relationship between men as caregivers and how this influences them as individuals. By careful attention to each caregiving man's individual needs rather than making gendered assumptions about men and caring, the aim of the caregiver support for men might best target men's own meaning to the caring in their the everyday practices.

  • 30.
    Hellzen, Ove
    et al.
    Mitthögskolan.
    Asplund, Kenneth
    Mitthögskolan.
    Sandman, Per-Olof
    Umeå universitet.
    Norberg, Astrid
    Umeå universitet.
    The meaning of caring as described by nurses caring for a person who acts provokingly: an interview study.2004In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 1, p. 3-11Article in journal (Refereed)
    Abstract [en]

    Nurses working with people with learning disabilities are sometimes exposed to provoking behaviour such as unpredictable and violent actions, spitting and sexual harassment. Eight nurses at a group dwelling in Sweden were interviewed about their experiences when caring for a person who acts provokingly. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. Three themes were formulated which describe nurses' feelings of being tormented, disrupted and helpless. Nurses describe themselves as being deeply humiliated by physical violence, spittle, sexual invective and actions on the part of the patient. They respond more to being spat on and the sexual invective than to the patient's physical violence. The frequent humiliations could be seen as a symbolic language connected to defilement and 'evil' and therefore as having a deep symbolic meaning for the nurses. These results were interpreted and reflected on in the light of a theoretical framework from an affliction perspective in order to achieve a deeper understanding of the text. This paper shows that an affliction perspective is important when searching for the meaning of caring for a patient who acts provokingly. The study indicates that the goal in a provoking care situation must be to see the provoking patient, as he appears to the nurses in order to glimpse the goodness concealed behind the provoking facade.

  • 31.
    Holmberg, Mats
    et al.
    Karolinska institutet.
    Forslund, Kerstin
    Örebro universitet.
    Wahlberg, Anna Carin
    Karolinska institutet.
    Fagerberg, Ingegerd
    Ersta Sköndal University College, Department of Health Care Sciences.
    To surrender in dependence of another: the relationship with the ambulance clinicians as experienced by patients2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 544-551Article in journal (Refereed)
    Abstract [en]

    Historically, the ambulance care has focused on acute transports and medical treatment, although ambulance care has also been reported as complex, encompassing more than just medical treatment and transports. Previous studies, on ambulance clinicians, have pointed out the importance of interpersonal caring activities complementary to the medical treatment. Those activities can be understood as taking part in the relationship between patients and ambulance clinicians, earlier described as essential and a core component of care. The aim of this study was to elucidate the meaning of the relationship with the ambulance clinicians as experienced by patients. Twenty ambulance patients were interviewed in the study. The interviews were transcribed verbatim and analysed with a phenomenological hermeneutical method to grasp meanings in the patients' experiences. The regional ethical committee approved the study. In the result emerged one main theme: To surrender in dependence of another. The main theme includes four themes: Being in the hands of another, Being in a caring temporary presence, Being important while involved and Being powerless while insignificant, and the themes comprise eleven subthemes. The main theme meant to have no other option than to surrender and to put their life into the hand of another. This surrender also meant to adapt to the clinicians' views even if not shared. This is experienced as excessive care. Summarised, the patients' experiences were both positive and negative and the findings provide a complex understanding of the relationship between the patient and the ambulance clinicians. Overall, the relationship embraces the whole person without reducing the patient to be a recipient of an objectified ambulance care.

  • 32.
    Häggström, Marie
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Kristiansen, Lisbeth
    Mittuniversitetet.
    To reduce technology prior discharge from intensive care – important but difficult?: A grounded theory2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 506-515Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to provide a deeperunderstanding of the experience of intensive care staffregarding the reduction in the use of medical technologyprior to patients’ transfer from the ICU.Background: The goal of ICU transitional care, provided forintensive care patients before, during and after the transferfrom the ICU to another care unit, is to ensure minimaldisruption and optimal continuity of care for the patient.To smooth this transition, there is a need to prepare for aless technological environment and therefore also a needfor a gradual reduction in the use of monitoring equipment.Method: Group interviews and individual interviews, togetherwith participant observations, were conducted withICU staff in two hospitals in Sweden. The data wereanalysed using classic grounded theory.Results: The main concern was the ICU staff’s ambiguityregarding whether and how to reduce the use of medicaltechnology devices. Insecurity about weaning patientsfrom medical equipment combined with a lack of standardizedroutines made it difficult for staff to reduce thetechnical support. The core category describes how theambiguity was solved primarily by ’prioritizing control’.However, this often caused the ICU staff to use advancedtechnology while the patients were in the ICU until theward staff arrived, even if this should have been handledotherwise. Why and how the ICU staff used the strategy of’prioritizing control’ is further explained in the categories’being affected by cultural/contextual aspects’, ’searching forguidance and a shared understanding’ and ’weighing advantageswith more v s less technology’.Conclusion: It is important to consider ICU staff ambiguityconcerning the reduction in technology and to establishstrategies for a safe and structured transitional phase withstep-down procedures in which technology and monitoringis gradually reduced prior to transfer from ICU.

  • 33. Häggström-Nordin, Elisabet
    et al.
    Sandberg, Jonas
    Mälardalens högskola.
    Hanson, Ulf
    Tydén, Tanja
    'It's everywhere!' young Swedish people's thoughts and reflections about pornography.2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 4, p. 386-93Article in journal (Refereed)
    Abstract [en]

    Pornography is one of the most sought-after topics on the Internet, and is easily available for anyone, including children and adolescents. At youth centres, nurse-midwives have noticed that young people have different kinds of questions about sexual practices compared with a few years ago. The aim of this study was to gain an understanding of thoughts and reflections about pornography consumption, and its possible influence on sexual practices, among young women and men. The staff at a youth centre in a city in central Sweden asked the visitors if they had seen pornography and if they wanted to be interviewed about their experiences. Ten young women and eight men, aged 16-23 years, participated. In-depth interviews were performed and open-ended questions about pornography and sexuality were posed. The interviews were tape-recorded and transcribed verbatim. Data were analysed according to grounded theory. The core category 'Living with the current sexual norm' depicted how pornography created sexual expectations and demands, for instance, to perform certain sexual acts. The informants expressed contradictory feelings towards pornography and felt that sexuality was separated from intimacy. A moral attitude was described and examples of stereotypic gender roles were given. To deal with the current sexual norm, informants had different individual handling strategies and attitudes to pornography, namely liberal, normalization, distance, feminist or conservative. Limitations of this study were the small sample size and that results from a qualitative research study cannot be generalized. The results contribute to an understanding of how pornographic material can influence young peoples' thoughts, reflections and sexual behaviour. This indicates the importance, for personnel at youth centres and schools, to discuss sexual behaviour and how sexuality is portrayed in pornographic material with young people.

  • 34.
    Håkanson, Cecilia
    et al.
    Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Sahlberg-Blom, Eva
    Örebro universitet.
    Nyhlin, Henry
    Karolinska universitetssjukhuset Huddinge.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Learning to live with irritable bowel syndrome.: The influence of a group-based patient education programme on peoples’ ability to manage illness in everyday life.2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, p. 491-498Article in journal (Refereed)
    Abstract [en]

    Background: Living with chronic irritable bowel syndrome sets limitations in peoples’ everyday lives. This is due to bad health and the difficulty to find strategies that will manage their problem. In encounters with health care providers, these people feel that they are not getting the appropriate support to manage their illness-related troubles, and they perceive themselves to be insufficiently informed about the disease.

    Aim: To evaluate the influence of a group-based patient education programme about irritable bowel syndrome, on people’s ability to manage their illness in everyday life.

    Methods: The study used an evaluative research design. Fifty-one individuals with irritable bowel syndrome completed the ways of coping questionnaire, and the irritable bowel syndrome severity scoring system, before and after participating in a multidisciplinary group-based patient education programme.

    Results: In the participants’ self assessments, statistical significances (p > 0.05) were found for the mean frequency of efforts used on the coping strategies distancing and escape-avoidance. Distancing was used more often after the education programme, while escape-avoidance, was used more seldom. The proportional use of the strategy self-controlling (relative score) was enhanced after the education programme. The participants’ overall severity of symptoms was significantly reduced after the education programme. The individuals with a clinically noteworthy improvement in symptom severity (decrease £ 50) had greater changes in relative score values than those that showed a lesser improvement in symptom severity.

    Conclusion: Coping patterns were changed and symptoms were scored significantly less severe among the participants who participated in the education programme. Controlled studies following individuals over a longer period are suggested to establish the validity and sustainability of these changes, and qualitative interview studies would provide additional understanding about the significance of the separate parts of the education programme, and about the meaning of the programme to peoples’ everyday lives as a whole.

  • 35.
    Håkanson, Cecilia
    et al.
    Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Sahlberg-Blom, Eva
    Örebro universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Nyhlin, Henry
    Karolinska Institutet.
    Learning about oneself through others: experiences of a groupbased patient education programme about irritable bowel syndrome2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 4, p. 738-46Article in journal (Refereed)
    Abstract [en]

    Background: People with irritable bowel syndrome (IBS) often experience severe illness-related troubles in their everyday lives. Many persons also perceive their disease-related knowledge to be insufficient, and they feel dissatisfied with their inability to improve well-being. Previous research about patient education and IBS has emphasized biomedical outcomes of symptoms,health-promoting behaviours, coping and health-related quality of life, rather than people’s experiences.

    Aim: To explore people’s experiences of participating in a multidisciplinary group-based patient education programme about IBS and of the influence of this programme on everyday life with illness.

    Methods: Focus group interviews were performed with 31

    persons after their participation in the patient education programme. Interpretive description guided the inductive analysis of data. The study was approved by the local research ethics committee.

    Findings: The analysis revealed four patterns; being part of a safe community, learning about oneself through others, understanding and controlling the body and illness as awhole, and being outside of the community. The pattern of learning about oneself through others can be described as a reciprocal activity of learning by listening to, telling andobserving others. Being among similar others had created feelings among most of the focus group participants of being part of a safe community where taboo subjects related to IBS-symptoms could be outspoken. Understanding the body and illness as a whole had enhanced their ability to interpret bodily signals and to handle trouble some situations with greater self-confidence, and this regained their access to the social everyday world.

    Conclusion: The combination of reciprocal sharing of experiences and the provision of professional scientific knowledge during the patient education programme together contributed to a growing readiness to improve well-being in everyday life, for most of the participating individuals. This was based on new understandings of the body and illness as a whole and of new abilities to make knowledgebased decisions about what strategies to use in overcoming illness-related troubles.

  • 36.
    Ivarsson, Ann-Britt
    et al.
    Uppsala universitet.
    Söderback, Ingrid
    Uppsala universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Department of Health Care Sciences.
    The meaning and form of occupational therapy as experienced by women with psychoses: A phenomenological study2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 1, p. 103-110Article in journal (Refereed)
    Abstract [en]

    The meaning and form of occupational therapy as experienced by women with psychoses: a phenomenological study The aim of this study was to illuminate the experiences of occupational therapy interventions in individuals with psychoses. Repeated tape-recorded narrative interviews were conducted with six women participating in occupational therapy immediately after an intervention. The subsequent analyses followed a phenomenological approach. Key constituents integrated in two structures, are the main findings. The meaning of occupational therapy as expressed in the key constituents relief, self-knowledge, belief in the future, capability, resistance and satisfaction formed one structure. The form of occupational therapy as expressed in the key constituents time, environment, guidance, voluntariness and collaboration represented the other structure. These findings confirm and give empirical support to beliefs and assumptions expressed in occupational therapy literature. The results form a conceptual base for developing an evaluative assessment instrument for individuals with psychoses participating in occupational therapy.

  • 37.
    Junehag, Lena
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Svedlund, Marianne
    Mittuniversitetet.
    Perceptions of illness, lifestyle and support after an acute myocardial infarction2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 289-296Article in journal (Refereed)
    Abstract [en]

    After an acute myocardial infarction (AMI), people are encouraged to adopt a healthy lifestyle. But they are not always motivated to maintain the necessary lifestyle changes and need the right support to do it. In sparsely populated areas, people afflicted by an AMI have difficulty in finding standard rehabilitation programmes near their homes during the recovery, so they need alternative forms of support. The aim was to describe individual perceptions of their lifestyle and support, 1year after an AMI, with or without mentorship. This study has a qualitative, descriptive design with data collected in individual interviews. Twenty men and women were interviewed 1year after their first AMI, and 11 had been offered contact with mentors who had had an AMI. Content analysis was used to analyse the data. Those with and without mentors had similarities and tendencies to variation in their perceptions, with both a positive and negative view of life. The participants were aware of the necessity of living a healthy lifestyle but some resisted doing so. They wished to live as before, and all saw the future positively. Having a mentor with the same experience could be valuable for some people, but more research is needed to understand the lack of motivation to make beneficial lifestyle changes after a serious health event as AMI.

  • 38. Karlsson, Inga Lill Källström
    et al.
    Ehnfors, Margareta
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Department of Health Care Sciences. Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Patient characteristics of women and men cared for during the first 10 years at an inpatient hospice ward in Sweden.2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 2, p. 113-21Article in journal (Refereed)
    Abstract [en]

    The hospice philosophy with focus on the patient's autonomy and the ideal of a good death are the overall objectives of palliative care. Often-raised questions, when discussing hospice, are for which of the incurable ill inpatient hospice is the most optimal care alternative together with who are making use of hospice. The aim of the present study was to describe patient characteristics such as age, marital status, diagnosis, referral source and length of stay (LoS) in relation to gender, during the first decade at an inpatient hospice ward (1992-2001). Data, obtained from medical register, were analysed by using descriptive statistics and the chi-square test. The number of patients was 666 women and 555 men, and most of them were elderly. In some respects significant differences were observed between women and men. More women than men were single, had cancer with relatively rapid trajectory and were referred from the oncology department. Men, more often than women, were diagnosed with cancers with a somewhat longer trajectory. Despite the longer trajectory, the LoS was shorter for men (median =13 days) than for women (median = 17 days). The most frequent referral source was hospital, though men, younger men in particular, were more often referred from home-based hospice care than women. During the last 3 years self-referrals were documented. Self-referrals can be seen as one distinct expression from a standpoint of one's own active choice compared with other referrals. Altogether, self-referrals were less frequent among women than men but in relation to age, self-referrals were more common among the youngest (<60 years) and the oldest women (>85 years) than men in the same age groups. Further studies illuminating a gender perspective can broaden the understanding of what these differences may imply for women and men.

  • 39. Karlsson, Inger
    et al.
    Ekman, Sirkka-Liisa
    Fagerberg, Ingegerd
    Karolinska institutet.
    A difficult mission to work as a nurse in a residential care home – some registered nurses’ experiences of their work situation2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 2, p. 265-273Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe Registered Nurses’ (RNs) experiences of their work environment in residential care homes for older persons. Twelve RNs were interviewed and latent content analysis was used for analysing the data. The data were collected in the spring of 2006. The findings revealed that these RNs experienced a paradoxical work environment: feeling appreciated and valuable, whilst at the same time feeling underestimated and frustrated. They felt appreciated and valuable when they provided nursing care and trust and support to others. The RNs experienced a positive work environment when the border between social and nursing care were clear. They also felt frustrated when they were expected to ‘be everywhere and to know everything’, but at the same time they felt invisible and underestimated. They experienced themselves as ‘lonely fixers’, having the ability to solve practical problems when the older persons were discharged from hospital and expected to be able to provide specialist nursing care without having specialised competence and specialist staff team members. In conclusion, it is important that the RNs can identify the border for nursing care. When these are clear, the nursing care objectives are apparent and the RNs become more autonomous, visible and listened to. The manager should listen to and support the RNs, with continuous supervision and competence development being mandatory elements. It is a difficult task for RNs working in residential care homes to meet all of the expectations placed on them, resulting in a risk of moral distress, making mistakes and developing illnesses caused by stress.

  • 40.
    Karlstedt, Mikaela
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Wadensten, Barbro
    Uppsala universitet.
    Fagerberg, Ingegerd
    Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
    Pöder, Ulrika
    Uppsala universitet.
    Is the competence of Swedish Registered Nurses working in municipal care of older people merely a question of age and postgraduate education?2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 307-316Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Previous studies suggest that not only education but also personal aspects such as experience of working as a registered nurse (RN) and age can influence competence. The objective was to explore the educational and self-rated competence of RNs and their duties within the care of older people.

    METHODS: A cross-sectional descriptive design was used. All RNs in two counties in Sweden were asked to complete a written questionnaire: a study specific questionnaire with educational and work related questions using the Nurse Competence Scale. The response rate was 61% (n 344).

    RESULTS: Higher self-rated satisfaction with own professional competence was related to older age, more years after nursing education and possessing at least one postgraduate education in specialist nursing. Educational needs were related to younger age and fewer years since nursing graduation. Education within elder care, including education about drugs was rated the most urgently needed area of education. The most frequently reported tasks were found in the domain helping role, whereas ensuring quality was less present in their daily work.

    CONCLUSIONS:Educational level, age and years of experience had an impact on RNs' self-perceived competence, which is in accordance with previous descriptions of the concept competence. It seems imperative that RNs working in care of the old and with the demands placed on them are given the opportunity to take a postgraduate specialist education in order to gain a competence level in their desired area of work. It is also important that RNs working in care of the old get tailored education in line with the requirements the organisation places on them.

  • 41. Kelvered, M
    et al.
    Öhlén, Joakim
    Göteborgs universitet.
    Åkesdotter Gustafsson, B
    Operating theatre nurses' experience of patient-related, intraoperative nursing care2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 3, no 3, p. 449-457Article in journal (Refereed)
  • 42. Klang, B
    et al.
    Björvell, H
    Cronqvist, Agneta
    Patients with chronic renal failure and their ability to cope.1996In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 10, no 2, p. 89-95Article in journal (Refereed)
    Abstract [en]

    The subject studied in this paper, describing uremic patients' use of coping strategies and their sense of coherence, was 48 consecutively selected patients with chronic renal failure at a Swedish hospital. The questionnaires used were the Jalowiec Coping Scale (JCS-40) and the Sense of Coherence Scale (SOC). The results showed that the patients used a variety of coping strategies, such as maintaining control, finding out more about the situation and hoping. In the use of coping styles, the confrontational style was the most favoured one, compared with the palliative and the emotive styles. There was a significant distinction between the predialysis patients and those on dialysis treatment concerning the use of strategies and coping styles. Patients on dialysis treatment showed significantly higher scores in overall strategies and in confrontational and palliative coping styles. The results revealed significant correlations between the JCS and the SOC scores, age and duration of kidney disease. Knowledge of the patients' commonly used coping strategies and sense of coherence is important when nursing care is being planned for the patient.

  • 43.
    Kneck, Åsa
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Klang, Birgitta
    Karolinska institutet.
    Fagerberg, Ingegerd
    Ersta Sköndal University College, Department of Health Care Sciences.
    Learning to live with illness: experiences of persons with recent diagnoses of diabetes mellitus2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, p. 558-566Article in journal (Refereed)
    Abstract [en]

    Background: The process of learning to live with an illness is complex. By better understanding the learning process for persons with diabetes in the early stage of the illness, the role of the health care can be shown.

    Aim: To reach an understanding of how learning to live with diabetes is experienced in the first 2 months after diagnosis.

    Method: A qualitative descriptive design was used, and interviews were conducted. Thirteen participants with a recent diagnosis of diabetes were included and asked to narrate about their experience of living with diabetes. Qualitative inductive content analysis was used.

    Findings: Four themes emerged: ‘taken over by a new reality’, ‘the body plays a role in life’, ‘different ways of learning’ and ‘the healthcare service as a necessary partner’.

    Conclusion: People with short-term experience of the illness gained knowledge through personal resources such as their own experience and self-reflection. The learning process includes an inner dialogue between the self, the body and the life. Participants were concerned with grasping a new reality and understanding a different self and body where lifestyle changes and uncertainty were present. When health care was accessible and sensitive to their needs, those with short-term experience of diabetes chose the staff as key players in the early stages of their life with diabetes.

  • 44.
    Kristiansen, Lisbeth
    et al.
    Mittuniversitetet; Karolinska institutet.
    Hellzén, Ove
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Left alone - Swedish nurses' and mental health workers' experiences of being care providers in a social psychiatric dwelling context in the post-health-care-restructuring era: A focus-group interview study2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 3, p. 427-435Article in journal (Refereed)
    Abstract [en]

    The professional role of nurses and mental health workers in social psychiatry is being re-defined towards a recovery, client-focused perspective. Approximately 0.7 percent of the adult population in Sweden suffers from severe mental illness leading to a need for community services. The primary aims of the Mental Health Reform in 1995 in Sweden were to improve the quality of life for people with severe, long-term mental illness and, through normalization and integration, enhancing their opportunities to communicate with and participate in society. This study examines nurses' and mental health workers' views and experiences of being care providers in a municipal psychiatric group dwelling context when caring for clients suffering from severe mental illness. Three focus group interviews were made and thematic content analysis was conducted. Four themes were formulated: 'Being a general human factotum not unlike the role of parents', 'Having a complex and ambiguous view of clients', 'Working in a mainly 'strangled' situation', and 'Feeling overwhelming frustration'. The staff, for instance, experienced a heavy workload that highly involved themselves as persons and restricted organization. The individual relational aspects of the nursing role, the risk of instrumentalizing the staff due to an organizational economical teleopathy (meaning a pathological desire to react goals), and the high societal demands on accomplishing the Mental Health Reform goals are discussed. To redefine the professional role of nurses and mental health workers in the community, in Sweden known as municipality, they need support in the form of continuously education, supervision, and dialogue with politicians as well as the public in general.

  • 45.
    Kvamme, Brita Odland
    et al.
    Norge.
    Asplund, Kenneth
    Mittuniversitetet.
    Bjerke, Trond Nergaard
    Norge.
    Drinking resumption: problematic alcohol use relapse after rehabilitation. A phenomenological hermeneutical perspective2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 716-723Article in journal (Refereed)
    Abstract [en]

    The majority of patients being treated for alcohol abuse disorders experience one or more relapses after treatment. The fact that people use this inebriant in a way leading to so much harm and suffering might seem a conundrum. Therapists, family and others might find the person's relapse to be dramatic and upsetting, and one might question whether the person has the sufficient will or motivation to change. However, few previous studies have explored relapse from the patient's perspective. The aim of this study was to illuminate the patient's lived experience of relapse and to develop a deeper understanding of this phenomenon. The study consisted of qualitative interviews using a phenomenological hermeneutical approach. Three main themes emerged from the analyses: 'craving', 'self-image' and 'time'. The findings were discussed in the context of phenomenological literature. Cravings could occur unpredictably; nevertheless, craving was a common experience for the patients and signified a risk of relapse. Bodily experiences of craving were frequently mentioned, and alcohol addiction could be understood as to be a disease or a learned habit. Self-image was, at times, adversely affected by relapse episodes. Therefore, feelings of shame, self-respect and recognition were significant concepts. This study found that the perception of time as past, present and future greatly influenced the participants' experiences of relapse and rehabilitation. Thus, relapse was an upsetting and dramatic experience that could cause great discomfort and sometimes life-threatening situations. However, relapse could also be viewed as a planned event. This study highlights important truth and reality about alcoholism and relapse grounded in people's lived experience.

  • 46.
    Lindh, Marianne
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Kihlgren, Annica
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Perseius, Kent-Inge
    Ersta Sköndal University College, Department of Health Care Sciences.
    Factors influencing compliance to hygiene routines in community care: the viewpoint of medically responsible nurses in Sweden2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 224-230Article in journal (Refereed)
    Abstract [en]

    Aims and objectives:  The aim of the study was to describe factors influencing compliance to hygiene routines in community care in Swedish municipalities from the perspective of medically responsible nurses (MRN).

    Method:  A web-based questionnaire was sent to all MRNs in Swedish municipalities, N = 268. Beside demographical background data, the questionnaire contained two core open-ended questions generating free text data. Data were analysed with descriptive statistics and qualitative content analysis.

    Result:  Four categories of factors were found: resources, management, staff and external factors. All four categories contained subcategories.

    Conclusion:  To some extent, the challenges to uphold adequate compliance to hygiene routines seem different in community care than in hospitals. Resources regarding equipment and supplies seem as an uncertain asset and uneven distributed among municipalities. Home likeness was seen as a major obstacle for upholding adequate hygiene routines. To uphold sufficient hygiene routines in a person’s home or in a home-like environment might be one of the major challenges for community health care in the future. The MRN’s narratives suggest that Registered Nurses have a key role in upholding sufficient hygiene in community care. This report might contribute in providing them with more knowledge to take on this urgent task.

  • 47.
    Lindseth, Anders
    et al.
    Bodø Regional University, Norway.
    Norberg, Astrid
    Umeå universitet.
    A phenomenological hermeneutical method for researching lived experience2004In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 2, p. 145-153Article in journal (Refereed)
    Abstract [en]

    This study describes a phenomenological hermeneutical method for interpreting interview texts inspired by the theory of interpretation presented by Paul Ricoeur. Narrative interviews are transcribed. A naïve understanding of the text is formulated from an initial reading. The text is then divided into meaning units that are condensed and abstracted to form sub-themes, themes and possibly main themes, which are compared with the naïve understanding for validation. Lastly the text is again read as a whole, the naïve understanding and the themes are reflected on in relation to the literature about the meaning of lived experience and a comprehensive understanding is formulated. The comprehensive understanding discloses new possibilities for being in the world. This world can be described as the prefigured life world of the interviewees as configured in the interview and refigured first in the researcher's interpretation and second in the interpretation of the readers of the research report. This may help the readers refigure their own life.

  • 48. Löfmark, A
    et al.
    Thorell-Ekstrand, I
    Evaluation by nurses and students of a new assessment form for clinical nursing education.2000In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 14, no 2, p. 89-96Article in journal (Refereed)
    Abstract [en]

    An assessment form was developed, based on Swedish higher education regulations and international guidelines for nursing education, to be used during clinical education regardless of the level of the programme or clinical specialty. Nurses who acted as supervisors for students used the form for continuous and formal assessment, and students used it for self-assessment. Once developed, the assessment form covered 18 professional and academic areas. After one semester nurses (n = 323) and students (n = 154) from two university colleges evaluated their experiences of using the form by answering a questionnaire. In addition, the completed assessment forms filled in by the nurses were reviewed and analysed. The evaluation showed that the nurses and the students considered the assessment form highly valuable. Both groups believed that the form highlighted the requirements for clinical education and was useful in assessing the students' development. Almost all 18 factors were found to be important to assess. Least important and most difficult to assess were 'the use of research and developmental work' and 'the ability to inform and teach co-workers and students'. Some areas that were regarded as difficult to assess were also marked by the nurses in the assessment form as 'not possible or relevant to assess'. The form was found to be useful in assessing students' development towards the goals of nursing education. The study also revealed that essential areas in nursing education have unclear educational demands for those involved.

  • 49.
    Magnusson, Annabella
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lützén, Kim
    Factors that influence collaboration between psychiatric care and CSSs: experiences of working together in the interest of persons with long-term mental illness living in the community2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 1, p. 140-145Article in journal (Refereed)
    Abstract [en]

    Background: Since de-institutionalization of psychiatric care (PC) took place in Sweden during the second half of the 20th century, the intended collaboration between the two organizations, PC and community social service (CSS) has been evaluated as inadequate in providing care for persons with long-term mental illness living in the community. Aim: The aim of this explorative study was to examine factors that influence interdisciplinary teamwork between PC and CSSs based on the experience of nursing staff within two separate organizations. Method: Five focus groups were selected as an appropriate method to collect data. Two of these groups were recruited from the PC and three from the CSSs. The focus groups consisted of psychiatric nurses and mental healthcare workers. A qualitative content analysis was used to identify major themes in the data. Findings: Two main themes were found, external organizational factors and interpersonal factors that deter or enhance collaboration between PC and CSS. Separate care plans, unclear times for meetings were found to be a plausible reason for communication failure. The focus groups representing each of the two organizations viewed themselves as ‘us and them’. Different ideologies and goals for caring and service and how to use each other’s competence seemed to be explanations as well as consequences of not finding ways to work together. Conclusion: The results of this study points to the need for the two organizations to find ways to work more effectively together to realize a joint responsibility for the patient/client.

  • 50.
    Mazaheri, Monir
    et al.
    Röda korsets högskola, Tehran University of Medical Sciences, Iran.
    Ericson-Lidman, Eva
    Umeå universitet.
    Joakim, Öhlén
    Göteborgs universitet.
    Norberg, Astrid
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Umeå universitet.
    Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden.2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 380-388Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: A feature of the healthcare system in Sweden, particularly in the care of older people, is its cultural diversity in terms of having considerable numbers of both caregivers and care recipients with an immigrant background. Considering the influence of culture in ethical decision-making processes, the idea of conscience and the adverse effects of a troubled conscience, it is important to study the concepts of conscience and troubled conscience in culturally diverse populations. There is no published study regarding troubled conscience among immigrant populations that includes enrolled nurses.

    AIM: To illuminate the meanings of troubled conscience and how to deal with it among enrolled nurses with Iranian backgrounds working in Swedish residential care for Persian-speaking people with dementia who have emigrated from Iran.

    METHOD: The study was conducted with a phenomenological hermeneutic design. Ten enrolled nurses with an Iranian background, with at least one year's experience of taking care of older people with dementia, were interviewed. The study was reviewed by the Regional Ethical Review Board for ethical vetting of research involving humans. Appropriate measures were taken to ensure confidentiality and voluntary participation.

    RESULTS: The meanings of having a troubled conscience for the participants comprise not being a good person, including being an uncaring person, not acting according to one's values and living in a state of unease. Dealing with a troubled conscience involves trying to compensate for the harm one has caused and trying to prevent similar situations by being a responsible caregiver.

    CONCLUSIONS: The enrolled nurses understood themselves as caring people and not only caregivers. They knew that they should hear their conscience and respond to it by trying to be a caring person and acting according to their values. The findings should be interpreted in the given specific context.

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