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  • 1.
    Hellzén, Ove
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Umeå universitet.
    Being in a fragmented and isolated world: Iinterviews with carers working with a person with severely autistic disorder2002In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 37, no 4, p. 346-354Article in journal (Refereed)
    Abstract [en]

    Aim: To illuminate the meaning of being a carer for a person having a severe autistic disorder. Background: Carers working with people with severe autim are occasionally exposed to residents’ self-injurious behaviours and violent actions and at time residents appear resistant to all forms of treatment. Design/Method: A qualitative case study was conducted. Six Swedish carers (ENs), working at a special ward on a nursing home were interviewed about their lived experiences when caring for an individual having a severe autistic disorder. Narrative interviews were conducted and interpreted using a phenomenological-hermeneutic method inspired by Paul Ricoeur. Findings: Two themes were formulated which describe the carers’ reality and their dream of an ideal, which described carers’ experiences of being trapped in a segmented and isolated care reality and thier longing to achieve a sense of wholeness. The findings were interpreted and reflected on in the light of a framework inspired by the German philosopher Karl Jaspers in order to achieve a deeper understanding of the text. Concusions: In their desperation the carers used their empirical knowledge based on scientific knowledge, which could be understood as a substitute for their vision of a consolating wholeness. This paper shows that searching for a substitute to consolation seems to be an important aspect of the meaning of being a carer for a person with severe autistic disorder.

  • 2.
    Hellzén, Ove
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Nurses' narratives about their residents when caring for people with long-term mental illness in municipal group dwellings2006In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 15, no 1, p. 60-69Article in journal (Refereed)
    Abstract [en]

    Nurses working in community psychiatric care are expected to spend time with the residents, in a genuine, professional way, irrespective of their own feelings towards them. Fourteen nurses at two group dwellings in Sweden were interviewed about their experiences when caring for people with long-term mental illness. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. The analyses were performed in two steps: the first shows that residents could be divided into four different typologies or patterns--the good, the disabled, the invisible, and the bad residents, of which the nurses liked the first two and disliked the last two. In the second analysis, two themes were formulated to describe the nurses' experiences of 'replenishing one's self-worth and self-esteem' and 'giving up the caring role'. These results were interpreted and reflected on in the light of a theoretical framework in order to obtain a deeper understanding of the text. The study indicates that the question of whether nurses liked or disliked the residents appears to be closely related to whether or not the individual resident confirmed the nurse. Residents who confirmed nurses were liked and given attention, whereas those who did not were disliked and given a minimum of time together with the nurse.

  • 3.
    Hellzén, Ove
    et al.
    Mittuniversitetet & Umeå universitet.
    Asplund, Kenneth
    Mittuniversitetet & University of Tromsø, Norway.
    Gilje, Fredricka
    Umeå universitet & University of North Dakota, Grand Forks, ND, USA.
    Sandman, Per-Olof
    Umeå universitet.
    Norbergh, Astrid
    Umeå universitet.
    From optimism to pessimism: A case study of a psychiatric patient1998In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 7, no 4, p. 360-370Article in journal (Refereed)
    Abstract [en]

    This article focuses on the results of a single case study which illuminates an understanding of phases in nursing care for a patient in a psychiatric setting in Sweden. The focus of this study is a fifty year old man who showed progressive deterioration from increased motor activity to oral, sexual, destructive and aggressive actions. The data collection using five methods occurred during a 21 months period. Results of the content analyses processes identified four distinct but indiscreet phases of the patient’s complex condition. The medical and nursing care was categorised in three approaches: optimistic, strategic and resigned. The results raise the question whether there is action that is without any meaning as an expression of the patient´s wishes, thoughts and feelings. It seems clear that the patient in this study felt really angry and in despair. However, during moments of lucidity, he also indicated that he felt this was not an authentic expression of his "real" self. His experience was that of a splintered world.

  • 4.
    Hellzén, Ove
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Sandman, Per-Olof
    Umeå universitet.
    Norberg, Astrid
    Umeå universitet.
    Unwillingness to be violated: Carers' experiences of caring for a person acting in a disturbing manner. An interview study1999In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 8, no 6, p. 653-662Article in journal (Refereed)
    Abstract [en]

    Carers working in psychiatric care are sometimes exposed to insane, unpredictable and violent actions. In rare cases a patient appears to be resistant to all forms of pharmacological treatment. · Fifteen carers (4 RNs, 11 ENs) on a psychiatric ward in Sweden were interviewed about their experiences when caring for a person who acted in a disturbing manner. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. · Four themes were formulated which describe the carers’ uncertainty about the future, their inability to interpret the patient’s disturbing behaviour and their own overall feeling of meaninglessness. · Carers believed that the patient had power and ruled the ward, which led to them feeling they were subjugated victims. Interviews also revealed the carers’ recognition of forbidden feelings and actions and own unknown negative sides. · These results were interpreted and reflected on in the light of an ethical framework in order to achieve a deeper understanding of the text. · This paper shows that an ethical perspective is important when searching for the meaning of caring for patients acting in a disturbing manner. The study raises the question: ‘Is it possible to establish good when evil has dominion?

  • 5.
    Hellzén, Ove
    et al.
    Mittuniversitetet.
    Kristiansen, Lisbeth
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    En studie i kvantitetssäkring av omvårdnad: En möjlig metod att fokusera kvaliteten?2003In: Incitament : för en hälso- & sjukvård i förvandling, ISSN 1103-503X, Vol. 12, no 7, p. 638-640Article in journal (Other academic)
  • 6.
    Kristiansen, Lisbeth
    et al.
    Mittuniversitetet.
    Dahl, Annika
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Hellzén, Ove
    Mittuniversitetet.
    The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients2005In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 12, no 6, p. 719-727Article in journal (Refereed)
    Abstract [en]

    The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients For people afflicted with different kinds of psychiatric disorder, suffering is a common denominator. The time the nurses spend with psychiatric clients may mirror their attitudes towards and feelings for these clients. The aim of this study was to investigate the connections between the time spent together and the nurses' opinion of client behaviour and social functioning in community-based psychiatry. In this quantitative study, 29 clients were assessed by 30 nurses, who answered the Global Assessment of Functioning Scale (GAF) and the Positive and Negative Syndrome Scale (PANSS). At the same time, 11,200 non-participant observations of clients were registered using the Patient Activity Classification (PAC) to investigate how they spent their time at two psychiatric group dwellings. The PAC instrument revealed that clients spent an average of 60.8% of time alone, while only 20% of their daily time was spent with the nurses. Based on a factor analysis, indices were made by setting cut-off points for the PANSS and the GAF scores, and four small groups of clients were generated: a relatively high level of social functioning and a low degree of psychiatric symptoms (A); a relatively high level of social functioning and a high degree of psychiatric symptoms (B); a low level of social functioning and a low degree of psychiatric symptoms (C); and, finally, a low level of social functioning and a high degree of psychiatric symptoms (D). The clients judged as having a low level of social functioning in combination with high degrees of psychiatric symptoms, that is, the most vulnerable and dependent individuals, receive less staff attention (18%) and are the clients who spend the most time alone (71.4%). It might be possible to interpret the results of this study in the light of a process of dehumanization.

  • 7.
    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.

  • 8.
    Kristiansen, Lisbeth
    et al.
    Mittuniversitetet & Karolinska institutet.
    Hellzén, Ove
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Swedish assistant nurses´experiences of job satisfaction when caring for persons suffering from dementia and behavioural disturbances: An interview study2006In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 1, no 4, p. 245-256Article in journal (Refereed)
    Abstract [en]

    Job satisfaction is complex and is an important component in facilitating high quality nursing care. Behavioural and psychological symptoms of dementia (BPSD) can be clustered into one of five syndromes: psychosis, aggression, psychomotor agitation, depression and apathy, and comprise signs and symptoms of disturbed perception, thought content, mood or behaviour that frequently occur in patients with dementia. BPSD can cause tremendous distress both for the patients and for their caregivers and they have been seen as the most stressful aspect of care giving. Two registered nurses, 16 assistant nurses and two nursing assistants in Sweden talked about their job satisfaction when caring for residents suffering from dementia and BPSD. Thematic content analysis was conducted. The nurses' narrations indicate exposure, insufficiency, not being valued and doubt, as well as respect and importance and devotion towards the residents. One core theme was formulated: "Job satisfaction as a process moving between breaking down and occasionally building up the working person". A positive relationship with colleagues was the primary reason for nurses continuing to work at the group dwellings. The organization and resident behaviours were seen as very negative. Some nurses described insecurity in terms of how long they could continue to take rudeness, being spat at, being scratched or physically hit by residents, without "hitting back". In order to increase the well-being of the nurses, the pressure on them needs to be relieved. The development of leadership, education, supervision and reflection might be one possible way of reducing the prevalence of BPSD-related violence, enhancing job satisfaction and handling moral stress.

  • 9.
    Norbergh, Karl-Gustaf
    et al.
    Mittuniversitetet.
    Helin, Yvonne
    Department of Social Services, Sundsvall.
    Dahl, Annika
    Mittuniversitetet.
    Hellzén, Ove
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Nurses' attitudes towards people with dementia: the semantic differential technique2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 3, p. 264-274Article in journal (Refereed)
    Abstract [en]

    One important aspect of the nurse-patient relationship is the nurses' attitudes towards their patients. Nurses' attitudes towards people with dementia have been studied from a wide range of approaches, but few of them have focused on the structure in nurses' attitudes. This study aimed to identify a structure in licensed practical nurses' attitudes towards people with dementia. Twenty-one group dwelling units for people with dementia at eleven nursing homes participated in the study. In all, 1,577 assessments of 178 patients were sent out to 181 respondents and 1,237 answers were returned. The semantic differential technique was used. The scale has 57 bipolar pairs of adjectives, which estimate an unknown number of dimensions of nurses' attitudes towards an identified patient. The assessments were analysed using entropy-based measures of association combined with structural plots. The analysis revealed four dimensions. These four dimensions related to licensed practical nurses' opinion of the patients; from an ethical and aesthetic dimension; their ability to understand; their ability to experience; their ability for social interaction. The study indicates that, on the positive to negative attitude continuum, attitudes fall at the positive to neutral end of the continuum. This is an important finding due to the personhood perspective. From this perspective, it is reasonable to assume that with a more positive attitude to people with dementia, the prerequisites for person-centred care will improve.

  • 10.
    Norbergh, Karl-Gustaf
    et al.
    Mittuniversitetet & Umeå universitet.
    Hellzén, Ove
    Mittuniversitetet.
    Sandman, Per-Olaf
    Umeå universitet.
    Asplund, Kenneth
    Mittuniversitetet & University of Tromsø, Norway.
    The relationship between organisational climate and the content of daily life for people with dementia living in group-dwelling2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 2, p. 237-246Article in journal (Refereed)
    Abstract [en]

    One factor influencing the outcome of care may be nursing staff's experience of the organizational work climate. The aim of the study was to investigate how people with dementia spend their time in group-dwelling units (GD) with either a creative or less creative organizational climate. 2. For the study, two GD units assessed as having a creative organizational climate and two units assessed as having a less creative climate were selected. Eighteen residents living in the units assessed as creative and 20 residents living in the units assessed as less creative participated in the study. 3. For measuring the organizational climate the Creative Climate Questionnaire was used. Observations of residents' activities were classified according to the Patient Activity Classification. For measuring residents' functional ability the Multi-Dimensional Dementia Assessment Scale was used. Their cognitive capacity was measured with the Mini Mental State Examination. 4. Residents living in the units assessed as having a creative organizational climate spent 45.2% of the time with nursing staff, while those in the less creative climate spent 25.6% (P < 0.001). Time spent with fellow residents in the creative climate was 13.9% and in the less creative climate 31.3% (P < 0.001). There was no significant difference between the units according time spent with relatives and time spent alone. 5. Since the purpose of GD is to offer care adapted to the abilities and psychosocial needs of people suffering from dementia, a less creative climate can be a threat to the aims of GD. In order to maintain these, it is important for managers to be aware of the work climate and its impact on care for people with dementia.

  • 11.
    Sjöling, Mats
    et al.
    Mittuniversitetet, Umeå universitet.
    Ågren, Ylva
    Länssjukhuset i Sundsvall.
    Olofsson, Niclas
    Landstingen Västernorrland.
    Hellzén, Ove
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet, Universitetet i Tromsø. Norge.
    Waiting for surgery; living a life on hold: A continuous struggle against a faceless system2005In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 42, no 5, p. 539-547Article in journal (Refereed)
    Abstract [en]

    This interpretive-phenomenological study examined the lived experience of being on the waiting list for arthroplastic surgery of the knee or hip and its impact on daily life. The interviews reveal that respondents experience suffering from different points of view; illness-, caring- and life- suffering. Suffering leads to a struggle in order to have their caring needs met and the struggle is often fruitless - against a faceless enemy - "the system". No one is there to answer their plea or to address the frustration that then arises and, in combination with their present life situation, this may lead to a disrupted self-image. Finding or creating meaning in suffering appears to be a crucial issue in the struggling process. Respondents who are able to preserve or create meaning in life may find it easier to accept the waiting times and wait for their turn in the queue. They are able to reformulate their life-world and live a full life, in spite of severe pain and disability.

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