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  • 1.
    Asplund, Kenneth
    Mittuniversitetet.
    Demensvård förr, nu och i framtiden (Dementia care in the past, now and in the future)1998In: Vård : utbildning, utveckling, forskning, ISSN 0281-921X, no 2, p. 2-8Article in journal (Other academic)
  • 2.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Omvårdnad: ett i grunden omstritt begrepp (Nursing : a fundamentally controversial concept)1994In: Omvårdaren, ISSN 0280-4123, Vol. 41, no 4, p. 4-5Article in journal (Other academic)
  • 3. Asplund, Kenneth
    et al.
    Adolfsson, R
    Lundgren, K
    Rönnbäck, E
    Sandman, P-O
    Wimo, A
    Åström, S
    Gruppboende för åldersdementa: erfarenheter efter två år1988In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 85, no 9, p. 734-737Article in journal (Other academic)
  • 4.
    Asplund, Kenneth
    et al.
    University of Tromsø, Norway.
    Jansson, Lilian
    Umeå universitet.
    Norberg, Astrid
    Umeå universitet.
    Facial Expressions of Patients With Dementia: A Comparison of Two Methods of Interpretation1995In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 7, no 4, p. 527-534Article in journal (Refereed)
    Abstract [en]

    Two methods of interpreting the videotaped facial expressions of four patients with severe dementia of the Alzheimer type were compared. Interpretations of facial expressions performed by means of unstructured naturalistic judgements revealed episodes when the four patients exhibited anger, disgust, happiness, sadness, and surprise. When these episodes were assessed by use of modified version of the Facial Action Coding System, there was, in total, 48% agreement between the two methods. The highest agreement, 98%, occurred for happiness shown by one patient. It was concluded that more emotions could be judged by means of the unstructured naturalistic method, which is based on an awareness of the total situation that facilitates imputing meaning into the patients' cues. It is a difficult task to find a balance between imputing too much meaning into the severely demented patients' sparse and unclear cues and ignoring the possibility that there is some meaning to be interpreted.

  • 5.
    Asplund, Kenneth
    et al.
    University of Tromsø, Norway.
    Norberg, Astrid
    Umeå universitet.
    Caregivers' Reactions to the Physical Appearance of a Person in the Final Stage of Dementia as Measured by Semantic Differentials1993In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 37, no 3, p. 205-215Article in journal (Refereed)
    Abstract [en]

    The semantic differential (SeD) technique was applied to 158 caregivers from a nursing home in the northern part of Sweden. The questionnaire contained fifty-eight bipolar scales of adjective pairs and the interviewees indicated then-reactions to a described picture of a severely demented person: A factor analysis revealed three dimensions; an ethical one, an esthetical one, and one about the person's own feelings. The fifty-eight scales were mostly rated toward the negative poles. The severely demented person was rated as painful, apathetic, suffering, weak, afraid, sad, cold, dark, rough, and ugly.

    Four years later a comparable group of caregivers (n = 93) answered a revised questionnaire containing the 26 SeD scales with factor loadings > .50 for the picture of the severely demented person. The result was nearly identical and alternative interpretations are discussed.

  • 6.
    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.

  • 7. Asplund, Kenneth
    et al.
    Norberg, Astrid
    Adolfsson, Rolf
    Waxman, Howard M.
    Facial expressions in severely demented patients: a stimulus-response study of four patients with dementia of the Alzheimer type1991In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 6, no 8, p. 599-606Article in journal (Refereed)
    Abstract [en]

    The ability to exhibit facial expressions was studied in four patients with severe dementia of the Alzheimer type (SDAT), by means of the Facial Action Coding System (FACS) and physiological responses (heart rate, respiration, skin temperature) under pleasant and unpleasant stimulus conditions. Complex facial expressions that could be interpreted as expressions of emotions were not seen. An increase in the number of facial movements and changes in the physiological responses were seen most markedly under the unpleasant stimulus condition. The patients' reactions during the assumed pleasant stimulus conditions indicated comfort. Different reactions were obtained among the patients. The importance of developing further methods to identify and interpret facial movements in nurse-patient relationships is emphasized.

  • 8.
    Asplund, Kenneth
    et al.
    Umeå universitet.
    Wimo, Anders
    Lundgren, Kjerstin
    Aggressivitet och motoriska problem tvingar dementa lämna gruppboende1990In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 87, no 18, p. 1555-1556Article in journal (Other academic)
  • 9.
    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.

  • 10.
    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.

     

  • 11.
    Athlin, Elsy
    et al.
    Umeå universitet.
    Norberg, Astrid
    Umeå universitet.
    Asplund, Kenneth
    Umeå universitet.
    Jansson, Lilian
    Probleme des Essenseingebens bei schwer dementen Patientinnen unter den Aspekten "Verrichtung" und "Beziehung"1993In: Pflege, Die wissenschaftliche Zeitschrift für Pflegeberufe, ISSN 1012-5302, E-ISSN 1664-283X, Vol. 6, no 2, p. 120-128Article in journal (Refereed)
  • 12.
    Audulv, Åsa
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Norbergh, Karl-Gustaf
    Mittuniversitetet.
    Being free of symptoms or experiencing mental wellbeing – different ways of understanding wellness among people living with chronic illness2009Conference paper (Refereed)
  • 13.
    Audulv, Åsa
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Norbergh, Karl-Gustaf
    Mittuniversitetet, Institutionen för hälsovetenskap.
    The impact of illness - Various ways of perceiving illness influences on self-management among people living with chronic disease2010In: The impact of illness - Various ways of perceiving illness influences on self-management among people living with chronic disease, 2010Conference paper (Refereed)
  • 14.
    Audulv, Åsa
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet, Universitetet i Tromsø, Norge.
    Norbergh, Karl-Gustaf
    Mittuniversitetet.
    The influence of illness perspectives on self-management of chronic disease2011In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 3, no 2, p. 109-118Article in journal (Refereed)
    Abstract [en]

    Aim: To explore people’s illness perspectives and related self-management of chronic disease.

    Background: Individuals’ illness beliefs and perspectives have been suggested to influence their self-management behaviour. However, research that has examined the influence of illness perspectives on chronic disease self-management has been largely quantitative and has focused on selected elements of self-management. How individuals’ illness perspectives influence their whole of self-management has not been investigated in depth.

    Method: The phenomenographic research study entailed 26 narrative interviews with Swedish adults with a variety of chronic diseases. Data were collected mostly during 2006.

    Results: The participants described two illness perspectives; being life-oriented meant to focus upon how to live a good life with disease, whereas a diseaseoriented illness perspective emphasised the medical and physiological aspects of disease. The participants attested to one of the two illness perspectives as a main perspective, although they shifted between the perspectives depending of context and illness experience. The participants’ illness perspectives were reflected in their understandings of self-management. Participants with a dominant life-oriented illness perspective performed self-management in order to continue living a ‘normal’ life (e.g. facilitate activity and mental well-being). When holding a disease-oriented illness perspective, self-management was focused upon controlling disease (e.g. symptom management and avoiding disease related complications).

    Conclusions: People with chronic illness hold a dominant illness perspective that determines how they understand and enact self-management. These perspectives 2011 Blackwell Publishing Ltd 109 are not static; instead individuals tend to shift between the perspectives under specific circumstances.

    Relevance to clinical practice: Health-care providers shall acknowledge that individuals’ with chronic illness shift between a life-oriented and a disease-oriented illness perspective. The results of the current study can be used by health-care providers in order to launch a dialogue in order to support individuals’ self-management.

  • 15.
    Audulv, Åsa
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Norbergh, Karl-Gustaf
    Mittuniversitetet.
    The integration of chronic illness self-management2012In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 22, no 3, p. 332-345Article in journal (Refereed)
    Abstract [en]

    Self-management is crucial for people living with chronic diseases, but the actual process of integrating self-management has not been explored in depth. In this article, we investigate the integration of self-management into the lives of people with chronic illness. In this longitudinal study, we used an interpretive description approach. Twenty-one individuals were interviewed regularly during the first 3 years after they were diagnosed with a chronic condition. We found self-management integration to be an ongoing process that included four phases: seeking effective self-management strategies, considering costs and benefits, creating routines and plans of action, and negotiating self-management that fits one's life. The participants managed the phases according to their context, e.g., illness experience, life situation, personal beliefs, and social support. Health care providers should therefore facilitate self-management integration by providing support that is adjusted to the person's phase of self-management integration and life context.

  • 16.
    Audulv, Åsa
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet, Universitetet i Tromsö, Norge.
    Norbergh, Karl-Gustaf
    Länssjukhuset i Sundsvall.
    Who's in charge? The role of responsibility attribution in self-management among people with chronic illness2010In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 81, no 1, p. 94-100Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore how responsibility attribution influences self-management regimens among people with chronic illness.

    METHODS: This qualitative content analysis included 26 interviews with people living with chronic illness.

    RESULTS: The participants attributed responsibility to internal, external or a combination of these factors, meaning that they either assumed responsibility for self-management or considered other people or factors responsible. Internal responsibility was associated with a multifaceted self-management regimen, whereas external responsibility was related to "conventional" self-management such as taking medication, managing symptoms and lifestyle changes.

    CONCLUSION: How responsibility is attributed is vital for the way in which individuals perform self-management. In this study, those who attributed responsibility to external factors mainly performed recommended behaviours to control their illness. In contrast, to take charge of their illness and be an active participant in the care, individuals must take responsibility for themselves, i.e. internal responsibility.

    PRACTICE IMPLICATIONS: Health-care providers should acknowledge and support individuals' wishes about various levels of responsibility as well as different kinds of patient-provider relationships.

  • 17.
    Audulv, Åsa
    et al.
    Mittuniversitetet.
    Norbergh, Karl-Gustaf
    Sundsvalls sjukhus.
    Asplund, Kenneth
    Mittuniversitetet; Universitetet i Tromsø, Norge.
    Hörnsten, Åsa
    Umeå universitet .
    An ongoing inner negotiation process: a Grounded Theory study concerning self-management among people living with chronic illness2009Conference paper (Refereed)
  • 18.
    Audulv, Åsa
    et al.
    Mittuniversitetet.
    Norbergh, Karl-Gustaf
    Sundsvalls sjukhus.
    Asplund, Kenneth
    Mittuniversitetet, Universitetet i Tromsø.
    Hörnsten, Åsa
    Umeå universitet.
    An ongoing process of inner negotiation – a Grounded Theory study of self-management among people living with chronic illness2009In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 1, no 4, p. 283-293Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to better understand the main concern of self-management processes among people with chronic illness.

    Background: One aspect of living with chronic illness is self-management that can reduce the illness impact on daily life and promote future health. Although factors that influence self-management have been identified in previous research, little attention has been brought to the process of making self-management decisions. In clinical settings, use of a theory could facilitate patient-empowering approaches.

    Method: The data collection for this Grounded Theory was mostly conducted in 2006. Data were collected by interviews with 26 adults with a variety of chronic illnesses, including rheumatoid arthritis, diabetes mellitus, inflammatory bowel syndrome, multiple sclerosis, ischaemic heart disease and chronic kidney failure.

    Results: Individuals are conflicted by competing preferences when taking decisions about self-management. Consequently, the decision-making process can be understood as an ongoing inner negotiation between different incompatible perspectives, e.g. social needs vs. medical needs. The process of negotiating self-management starts with the individual’s considering beliefs about health and illness, which make the individual face illness threats and the need for self-management. Several aspects influence negotiating self-management namely, assessing effects of self-management; evaluating own capacity; perceiving normality or stigmatisation; and experiencing support and external resources. The process has been demonstrated in a model.

    Conclusions: The process of negotiating self-management is an ongoing inner debate rather than a one-time decision. This opens up new ways of understanding, and communicating with, patients. The described model also links behavioural theories and research findings in a comprehensive understanding.

    Relevance to clinical practice: This model could be applicable as a communication tool for health-care providers in identifying barriers to, and resources in, self-management behaviour among individuals with chronic illness.

  • 19.
    Augutis, Marika
    et al.
    Karolinska institutet, Länssjukhuset i Sundsvall.
    Levi, Richard
    Karolinska institutet, Rehab station Stockholm.
    Asplund, Kenneth
    Mittuniversitetet.
    Berg-Kelly, Kristina
    Göteborgs universitet.
    Psychosocial aspects of traumatic spinal cord injury with onset during adolescence: A qualitative study2007In: Journal of Spinal Cord Medicine (JSCM), ISSN 1079-0268, E-ISSN 2045-7723, Vol. 30, no Suppl1, p. 55-64Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVE: Spinal cord injury (SCI) occurring during adolescence poses additional challenges because of the concurrent age-specific bio-psychosocial development. Full understanding of the psychosocial dimensions of rehabilitation requires exploration of the patient perspective. The objective of this study was to focus on psychosocial factors from the patient perspective in persons who had previously sustained a SCI during early and mid-adolescence (11-15 years of age).

    METHODS: Twenty-four of the 28 persons who had sustained a SCI in Sweden from 1985 to 1996 participated in the study. Semistructured interviews were made an average of 10 years after injury. Narratives were analyzed qualitatively according to content analysis.

    RESULTS: Parents and peers were found to have formed a crucial network. Parents frequently acted as advocates in interactions with health care providers, as supporters, and as containers of sorrow, frustration, and anger. Peers acted as promoters of activity and identity development. However, health care providers were perceived as not making sufficient use of this network.

    CONCLUSIONS: Rehabilitation professionals might be encouraged to increase their knowledge of adolescence medicine to better meet the specific needs and demands of persons in this age group. It is further suggested that parents and peers be considered important partners in the joint rehabilitation effort.

  • 20.
    Björkman Randström, Kerstin
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Svedlund, Marianne
    Mittuniversitetet.
    "I have to be patient" - A longitudinal case study of an older man's rehabilitation experience after a hip replacement surgery2013In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 8, p. 160-169Article in journal (Refereed)
    Abstract [en]

    Background: Aging can bring about an increased risk of disability. Following illness or injures, rehabilitation is essentialif the individual affected is to attain and maintain independence. Performing rehabilitation with a person-centeredapproach is vital for positive outcomes. Health providers are increasingly interested in developing rehabilitation servicesin outpatient settings for older people in their own homes.

    Aim: The aim of this study was to describe an older man’s rehabilitation experience after a hip replacement surgery.

    Design: A longitudinal qualitative descriptive single case study.

    Methods: Interviews were conducted on four occasions with the participant in his own home. The interviews wereconducted one month, seven months, one year, and five years after the patient was discharged from the hospital. The datawere analyzed using qualitative content analysis.

    Results: Three categories emerged: (i) having feelings of despair, (ii) being in charge, and (iii) having rehabilitative support. The results demonstrate the participant’s decreased ability to walk after a complicated hip surgery, and his physical and psychological struggle for well-being in everyday life. A strong motivation to return to as normal a life aspossible facilitated the rehabilitation. Also, a supportive family and accessible health care professionals were essential tothe positive outcome of the home rehabilitation.

    Conclusion: Rehabilitation can extend over a long period to maintain and improve mobility. Also, living with a disability causes feelings of despair. The home can be a source of energy but also a place of challenges during rehabilitation. To support older people in achieving their rehabilitation goals and engaging in meaningful activities, professionals should focus on personal factors, psychosocial support and on influential factors in the home environment and in society in general.

  • 21.
    Björkman Randström, Kerstin
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Svedlund, Marianne
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Impact of environmental factors in home rehabilitation: A qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 9, p. 779-787Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation.

    Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category.

    Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services.

    Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.

  • 22.
    Björkman Randström, Kerstin
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Svedlund, Marianne
    Mittuniversitetet.
    Paulson, Margareta
    Mittuniversitetet.
    Activity and participation in home rehabilitation: Older people's and family members perspectives2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 2, p. 211-216Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the experiences of older people and their supporting family members in relation to home rehabilitation, with a focus on activity and participation.

    Methods: Qualitative interviews were carried out with 6 older people and 6 family members at 1 and 6 months after the older person’s discharge to their home. Qualitative content analysis of the data was carried out. The International Classification of Functioning, Disability and Health provides a guiding framework for rehabilitation.

    Results: Informants’ experiences of home rehabilitation contributed to the formation of 6 categories: (i) living with a frail body; (ii) striving for well-being in daily life; (iii) being close at hand; (iv) feeling dependent in daily life; (v) struggling to carry on; and (vi) striving to be at home.

    Conclusion: Older people’s goals were to return to daily routines and to perform meaningful activities without feeling dependent on other people. Family members’ participation was crucial. Psychosocial support and autonomy were essential for facilitating activity and participation. Healthcare professionals should consider each individual’s unique experiences along with the significance of being at home.

  • 23.
    Björkman Randström, Kerstin
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Svedlund, Marianne
    Mittuniversitetet.
    Paulson, Margareta
    Mittuniversitetet.
    Activity and participation in home rehabilitation: older people's and family members' perspectives2010In: Journal of Clinical Nursing. Suppl 1, 2010, p. 85-85Conference paper (Refereed)
  • 24.
    Björkman Randström, Kerstin
    et al.
    Mittuniversitetet.
    Wengler, Yvonne
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Svedlund, Marianne
    Mittuniversitetet.
    Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people2014In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 9, no 1, p. 25-33Article in journal (Refereed)
    Abstract [en]

    Background: There is a move towards the provision of rehabilitation for older people in their homes. It is essential to ensure that rehabilitation services promote independence of older people.

    Aim: The aim of the study was to explore multidisciplinary teams' experiences of home rehabilitation for older people.

    Methods: Five focus groups were conducted with multidisciplinary teams based in a municipality in Sweden, covering seven different professions. In total, 28 participants volunteered to participate in these interviews. Interviews were transcribed verbatim and analysed according to content analysis.

    Results: Two main categories, as well as four subcategories, emerged. The first main category, having a rehabilitative approach in everyday life, consisted of the subcategories: ‘giving ‘hands-off’ support’ and ‘being in a home environment’. The second main category, working across professional boundaries, consisted of the subcategories: ‘coordinating resources’ and ‘learning from each other’.

    Conclusion: Common goals, communication skills and role understanding contributed to facilitating the teams' performances of rehabilitation. A potential benefit of home rehabilitation, because the older person is in a familiar environment, is to work a rehabilitative approach into each individual's activity in their everyday life in order to meet their specific needs. At an organisational level, there is a need for developing services to further support older people's psychosocial needs during rehabilitation.

    Implications for practice: Team performance towards an individual's rehabilitation should come from an emerged whole and not only from the performance of a specific professional approach depending on the traditional role of each profession. A rehabilitative approach is based on ‘hands-off’ support in order to incorporate an individual's everyday activities as a part of their rehabilitation.

  • 25.
    Björkman Randström, Yvonne
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Wengler, Yvonne
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Svedlund, Marianne
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Multidisciplinary team's promoting a rehabilitative approach among older people in home care: Meeting abstract2010In: Journal of clinical nursing, Vol 19 Suppl 1, Wiley-Blackwell , 2010, p. 85-86Conference paper (Refereed)
  • 26.
    Blusi, Madeleine
    et al.
    Mittuniversitetet, Landstinget Västernorrland.
    Asplund, Kenneth
    Mittuniversitetet.
    Jong, Mats
    Mittuniversitetet.
    Older family carers in rural areas: Experiences from using caregiver support services based on Information and Communication Technology (ICT)2013In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 10, no 3, p. 191-199Article in journal (Refereed)
    Abstract [en]

    The aim of this intervention study was to illuminate the meaning of ICT-basedcaregiver support as experienced by older family carers living in vast ruralareas, caring for a spouse at home. In order to access the support serviceparticipants were provided with a computer and high speed Internet in theirhomes. Semi structured webcam-interviews were carried out with 31 familycarers. A strategy for webcam interviewing was developed in order to ensurequality and create a comfortable interview situation for the family carers.Interviews were analyzed using content analyses, resulting in the themes: Adoptingnew technology with help from others and Regaining social inclusion.The results indicate that ICT-based support can be valuable for older familycarers in rural areas as it contributes to improve quality in daily life in anumber of ways. In order to fully experience the benefits, family carers needto be frequent users of the provided support. Adequate training andencouragement from others were essential in motivating family carers to use thesupport service. Access to Internet and webcamera contributed to reducingloneliness and isolation, strengthening relationships with relatives living faraway and enabled access to services no longer available in the area. Use of theICT-service had a positive influence on the relationship between the oldercarer and adult grandchildren. It also contributed to carer competence andpromote feelings of regaining independence and a societal role.

  • 27.
    Bäckström, Britt
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet; Universitetet i Tromsø, Norge.
    Sundin, Karin
    Umeå universitet .
    The meaning of middle-aged female spouses' lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischarge2010In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 17, no 3, p. 257-268Article in journal (Refereed)
    Abstract [en]

    Stroke consequences present a great long-term challenge to the spouses of the stroke sufferer. A longitudinal study with a phenomenological hermeneutic approach was used to illuminate the meanings of middle-aged female spouses' lived experience of their relationship with a partner who has suffered a stroke, during the first year postdischarge. Four middle-aged female spouses of stroke sufferers participated in the study. Narrative interviews were conducted 1, 6 and 12 month postdischarge (total of 12 interviews), audio-taped and transcribed verbatim to a text and interpreted by a phenomenological hermeneutic method inspired by Ricoeur. The findings showed a process over time during which spouses come to know, recognize and acknowledge the residual changes in their partners' cognitive and emotional conditions and the impact on their relationship. Spouses showed grief due to the loss of the marital relationship they once had and anxiety that they would not be able to continue in an undesired relationship in the future. Even if the partner is still alive, there is a loss to grieve and to be understood, an important meaning of the transition process in the relationship during the first year after the partner's discharge.

  • 28.
    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.

  • 29.
    Eriksson, Monica
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Svedlund, Marianne
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Couples' experiences of their relationship over a two year period following an acute myocardial infarction: A longitudinal qualitative studyIn: Article in journal (Refereed)
  • 30.
    Eriksson, Monica
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Svedlund, Marianne
    Mittuniversitetet.
    Couples' thoughts about and expectations of their future life after the patient's hospital discharge following acute myocardial infarction2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 23-24, p. 3485-3493Article in journal (Refereed)
    Abstract [en]

    Aim: To describe and interpret couples’ thoughts and expectations about their future life after the patient’s discharge following acute myocardial infarction [AMI].

    Background: An AMI is a challenge for both the patient and his/her partner, as it can disrupt family functioning and dynamics. Earlier research has generally focused on either the patient or the partner and few studies have explored the experiences of the couple.   

    Design: Qualitative descriptive and interpretative.

    Methods: 15 couples took part in individual interviews, 4-8 weeks after discharge. Data were analysed in two phases using qualitative content analysis.

    Results: The first phase of the analysis revealed two categories: ‘an active approach to the future’ and ‘a wait-and-see approach to the future’, both of which described the participants’ thoughts about the future. In the second phase, the couples’ stories were interpreted and grouped into four positions: ‘the life companions’, ‘the tightrope walkers’, ‘the pathfinders’ and ‘the observers’, which illustrated their visions of the future.

    Conclusions: Our results reveal differences in the couples’ thoughts about and expectations of their future life, most of them managed the situation by having a positive attitude to life and their future. The couples discovered their resources and compensated for or balanced each other in the early recovery period.

    Relevance to clinical practice: The results indicate the importance of giving both partners the opportunity to express their views of the situation, as this increases nurses’ understanding of the impact of the illness on their life and relationship. However, the results also highlight the significance of seeing the couple and showing them consideration both as individuals and as a unit.

  • 31.
    Eriksson, Monica
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Svedlund, Marianne
    Mittuniversitetet.
    Patients´and their partners´experiences of returning home after hospital discharge following acute myocardial infarction2009In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 8, no 4, p. 267-273Article in journal (Refereed)
    Abstract [en]

    Background: Returning home from hospital after an acute myocardial infarction [AMI] can be a period of vulnerability both for the patient and his/her partner. This study focuses on the time immediately after discharge.

    Aims: The aim of this study was to describe the patient’s and his/her partner’s experiences after hospital discharge following AMI.

    Methods: 15 couples took part in individual interviews, 4- 8 weeks after discharge. Data were analysed using qualitative content analysis.

    Results: The results are presented by means of three themes, ´ at home in one’s own home`, ´ at home within oneself ` and ´having normality in sight`, comprising ten categories that describe the experiences of both the patient and his/her partner.

    Conclusions: The patients as well as partners described the period after discharge from hospital comprising ambitions of feeling safety in their home, an inner sense of security and seeking normalisation.The results of this study could be useful for nurses when planning for patient discharge. During hospitalization nurses can prepare both the patient and their partner for what to expect when the patient returns home.

  • 32.
    Eriksson, Ulrika
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Sellström, Eva
    Mittuniversitetet.
    Growing up in rural community: children's experiences of social capital from perspectives of wellbeing2010In: Rural and remote health, ISSN 1445-6354, Vol. 10, no 3, article id 1322Article in journal (Refereed)
    Abstract [en]

    Introduction: People are influenced by the neighborhood in which they live. The neighborhood may be particularly important for children’s wellbeing because of the constraints it imposes on their patterns of daily activities. Furthermore, the neighborhood is a central context for social development, being a place where children form networks and learn social skills and values. The aim of this study was to describe how social capital in the neighborhood is perceived by children living in rural areas, and to reveal what this adds to their sense of wellbeing.

    Methods: The study had a descriptive research design with a qualitative approach. Seven single-sex focus group interviews were conducted with children the in 6th grade (aged 11–12 years). Data were analyzed using deductive content analysis.

    Results: The children perceived a lack of social capital due to environmental and social constraints in their everyday lives. However, their wellbeing was enhanced by strong cohesion in the neighborhood. In addition, settings such as the school, the natural environment, and sporting associations were highly valued and emerged as crucial factors for enhancing the children’s wellbeing. The spatial isolation that characterizes rural areas created a special context of social network structures, cohesion and trust, but was also a breeding ground for exclusion and social control. The stories revealed paradoxical feelings of living in a good and safe area that simultaneously felt isolated and restricted.

    Conclusions: From a rural perspective, this study reveals the complexity of the children’s perceptions of their social environment, and the ways in which these perceptions have both positive and negative effects on wellbeing. The results highlight how important it is for health professionals in rural areas to consider the complex influence of bonding social capital on children’s wellbeing, and to be aware that it can promote exclusion as well as cohesion.

  • 33.
    Ervik, Bente
    et al.
    University of Tromsø.
    Asplund, Kenneth
    University of Tromsø, Mittuniversitetet.
    Dealing with a troublesome body: A qualitative interview study of men’s experiences living with prostate cancer treated with endocrine therapy2012In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 16, no 2, p. 103-108Article in journal (Refereed)
    Abstract [en]

    Purpose: Endocrine therapy for prostate cancer causes substantial side effects, and previous studies have focused on the impacts on sexuality and masculinity. Little is known about how men experience bodily alterations in everyday life through the course of the prostate cancer and treatment. The aim of this study was to show how men with prostate cancer experience bodily changes and how these alterations influence daily life.

    Method: The study was conducted via qualitative interviews with a phenomenological hermeneutic approach. We interviewed ten men (aged 58-83) with prostate cancer who received endocrine therapy as the primary treatment method.

    Results: The results showed that five themes were important for the men’s experiences of their bodily alterations throughout the course of the illness: "something is ’wrong’", "when the body becomes troublesome", "to be well or to be ill", "dealing with the alterations" and "to talk about cancer and the intimate details" Initially, the shock of receiving a cancer diagnosis and the physical changes in their bodies were at the forefront of many patients’ minds. Eventually, the impact of the side effects became more evident, which caused problems in everyday life. Yet, the men were able to reflect on the impact of treatment on their everyday lives.

    Conclusion: This study showed that hormone treatment has a significant influence, both directly and indirectly, on the bodies of prostate cancer patients. The experiences of men with prostate cancer may lead to feelings of loss of identity on an existential level. © 2011 Elsevier Ltd.

  • 34.
    Ervik, Bente
    et al.
    University of Tromso.
    Nordoy, Tone
    University of Tromso.
    Asplund, Kenneth
    Mittuniversitetet, University of Tromso, .
    Hit by Waves: Living With Local Advanced or Localized Prostate Cancer Treated With Endocrine Therapy or Under Active Surveillance2010In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 33, no 5, p. 382-389Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies of living with prostate cancer have shown that the illness and the treatment cause physical as well as psychosocial problems.

    Objective: The aim of this study was to illuminate men's experiences living with localized or local advanced prostate cancer when curative treatment such as surgery or radiation therapy is not an option at the time of diagnosis.

    Methods: The study was conducted via qualitative interviews, using a phenomenological hermeneutic approach. Ten men treated with endocrine therapy or under active surveillance were interviewed.

    Results: Being diagnosed with prostate cancer was described as a shock, with different aspects of the illness revealed gradually. The limited amount of time available for meeting with health care providers contributed to patients' feelings of being left alone with difficulty getting information and help. Sexual and urinary problems were perceived as a threat to their manhood. The spouses provided the closest everyday support.

    Conclusion: The life situation of these patients can be understood as living in a "state of readiness," expecting something to happen regarding their illness, and not always knowing where to get help. Implications for Practice: The results confirm existing knowledge of patient's experiences in living with prostate cancer regarding the initial shock perceived by the patients, the bodily alterations, and the important role of their spouses. Nurses, as well as general practitioners, must play a more active role in follow-up to ensure that the men and their spouses receive better help and support.

  • 35.
    Ervik, Bente
    et al.
    Norge.
    Nordøy, Tone
    Norge.
    Asplund, Kenneth
    Mittuniversitetet.
    In the middle and on the sideline: The experience of spouses of men with prostate cancer2013In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 36, no 3, p. 7-14Article in journal (Refereed)
    Abstract [en]

    Background: Spouses play an important role in how well patients with prostate cancer manage their illness. Whereas earlier studies mostly included both patients and spouses, this study focuses on the spouses' experiences during the course of the illness.

    Objective: The objective of this study was to explore how the daily life of female spouses is affected by their husband's prostate cancer.

    Methods: Qualitative interviews were conducted with 9 spouses of men receiving potential curative treatment for prostate cancer.

    Results: Prostate cancer in men had significant impact on spouses' everyday life. The results showed that spouses strived to achieve a balance between focusing on their own needs and meeting their husbands' needs along the course of the illness. Four themes emerged: strong and optimistic versus vulnerable and overstrained, maintaining the partner's sense of manhood, being on the sideline, and the need for relationships outside the immediate family.

    Conclusion: Being a spouse to a man with prostate cancer is emotionally and practically demanding. There is a danger of the spouses suppressing their own needs in the process of supporting their husbands. Those spouses living in the situation over a period of years expressed fatigue and a shift in focus from their husbands' needs to their own needs for support.

    Implications för practice: Healthcare providers should provide support for spouses during the course of the illness, encourage spouses to participate in seminars for couples living with prostate cancer, and be aware of the potential for situational fatigue in spouses many years after the diagnosis.

  • 36.
    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.

  • 37.
    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.

  • 38.
    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.

  • 39.
    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?

  • 40.
    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)
  • 41.
    Häggström, Marie
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Kristiansen, Lisbeth
    Mittuniversitetet.
    How can nurses facilitate patient's transitions from intensive care?: A grounded theory of nursing2012In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 28, no 4, p. 224-233Article in journal (Refereed)
    Abstract [en]

    Objectives: Intensive care patients often experience feelings of powerlessness and vulnerability when being transferred from an intensive care unit to a general ward. The aim of this study was to develop a grounded theory of nurses care for patients in the ICU transitional care process. Methods: Group interviews, individual interviews and participant observations were conducted with nurses in two hospitals in Sweden and were analysed using grounded theory. Result: The substantive theory shows the process of nursing care activities — from the contexts of the ICU and the general ward. The main concern was to achieve a coordinated, strengthening, person-centered standard of care to facilitate patient transitions. The core category ‘‘being perceptive and adjustable’’ was a strategy to individualise, that was related to the other categories; ‘‘preparing for a change’’ and ‘‘promoting the recovery’’. However, the nurses were forced to ‘‘balance between patient needs and the caregivers’ resources’’ and consequently were compromising their care. Conclusions: To facilitate an ICU-patient’s transition, individual care planning is needed. It is also essential that the patients are adequately prepared for the change to facilitate the transitional care. Knowledge about transitional needs, empowerment and patient-education seems to be important issues for facilitating transitions.

  • 42.
    Häggström, Marie
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Kristiansen, Lisbeth
    Mittuniversitetet.
    Important quality aspects in the transfer process2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 2, p. 123-139Article in journal (Refereed)
    Abstract [en]

    Purpose: Admission to and transfer from an intensive care unit affects not only the patient but also his or her relatives. The authors aimed to investigate relatives' perceptions of quality of care during a patient's transfer process from an intensive care unit to a general ward.

    Design/methodology/approach: The study had a mixed method design that included quantitative data and answers to open questions. The participants were 65 relatives of patients who received care in an ICU. They were recruited from two hospitals in Sweden.

    Findings: A majority perceived the transfer process as important, but analysis also showed that the participants rated it as an area for improvements. The relatives wanted participation, personal insight and control, respectful encounters, proximity, reassurance, continuous quality, reconnection and feedback. The relatives' participation in the transfer process was perceived as inadequate by 61 per cent, and the support that was received after the ICU discharge was perceived as inadequate by 53 per cent. The patients' length of stay in the ICU affected the relatives' perceptions of the quality of care. Overall, the relatives seemed to desire that the transfer process includes a continuous care, a competent staff, available information throughout the transfer process and personal involvement in the care, both before and after the transfer from the ICU.

    Research limitations/implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality.

    Practical implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality.

    Originality/value: The findings have important implications for nursing and nursing management. A relative's perception of the quality of care before and after transfer from ICU may be a valuable source to evaluate the ICU transitional care.

  • 43.
    Häggström, Marie
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Kristiansen, Lisbeth
    Mittuniversitetet.
    Struggle with a gap between intensive care units and general wards2009In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 4, no 3, p. 181-192Article in journal (Refereed)
    Abstract [en]

    Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process-the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses' "struggling with a gap." The "gap" was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: Sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients' ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.

  • 44.
    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.

  • 45.
    Jansson, Lilian
    et al.
    Umeå universitet.
    Norberg, Astrid
    Umeå universitet.
    Sandman, Per-Olof
    Umeå universitet.
    Athlin, Elsy
    College of Health and Caring Sciences, Umeå, Sweden .
    Asplund, Kenneth
    University of Tromsö, Norway .
    Interpreting Facial Expressions in Patients in the Terminal Stage of the Alzheimer Disease1993In: Omega, ISSN 0030-2228, E-ISSN 1541-3764, Vol. 26, no 4, p. 309-324Article in journal (Refereed)
    Abstract [en]

    Videotaped interactions between each of two experienced caregivers and each of four patients in the terminal stage of the Alzheimer disease were interpreted. A hermeneutic approach was used to analyze the videotapes. It was possible to see the patients as capable of having experiences and of communicating them to their caregivers. The analysis made it possible to put together the observed communicative cues into a narrative for each patient. The study may contribute to the improvement of the care of severely demented patients by affecting caregivers' preunderstanding of these patients' experiences and communicative abilities.

  • 46.
    Junehag, Lena
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Svedlund, Marianne
    Mittuniversitetet.
    A qualitative study: Perceptions of the psychosocial consequences and access to support after an acute myocardial infarction2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 1, p. 22-30Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to describe individuals' perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event. Methods: The study included 20 participants (14 men and six women) who lived in rural areas and had experienced their first AMI. Eleven were offered contact with a mentor. The participants were interviewed one year after their AMI. Results: The findings are presented in three themes: having a different life, having to manage the situation and having access to support, with 11 subthemes. During their recovery, the participants experienced psychosocial consequences, consisting of anxiety and the fear of being afflicted again. Most mentees appreciated their mentor and some of those without mentors wished they had received organised support. Participants were often more dissatisfied than satisfied with the follow-up provided during recovery. Conclusions: After an AMI, follow-up is important during recovery, but the standardised information provided is inadequate. During recovery, people need help dealing with existential crises. After discharge, receiving peer support from lay people with similar experiences could be valuable. The knowledge gleaned from this study could be used in education at coronary care units and in health care outside the hospital setting. © 2013 Elsevier Ltd.

  • 47.
    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.

  • 48.
    Kitzmüller, Gabriele
    et al.
    Norge.
    Asplund, Kenneth
    Mittuniversitetet; University of Tromsø, Norway.
    Häggström, Terttu
    Norge.
    The Long-Term Experience of Family Life After Stroke2012In: Journal of Neuroscience Nursing, ISSN 0888-0395, E-ISSN 1945-2810, Vol. 44, no 1, p. E1-E13Article in journal (Refereed)
    Abstract [en]

    Stroke is a life-threatening and disabling illness known to have a significant impact on families. The purpose of this study was to illuminate the long-term experience of family life after stroke of stroke survivors and their spouses and children, particularly regarding marital and parent-child relationships. Thirty-seven narrative interviews were conducted with stroke survivors and their spouses and adult children who were minors at onset of the illness. A qualitative approach inspired by Gadamer's hermeneutic and van Manen's phenomenological understanding of lived experience was used. The analysis revealed four themes: the family as a lifebuoy, absent presence, broken foundations, and finding a new marital path. Lack of communication and altered roles and relationships endangered marital equilibrium and parent-child relationships after stroke. This study highlighted the need for professional family support as families were unprepared for the life changes that occurred. Nurses and other healthcare workers should examine family relationships and communication patterns and view the family as a unit composed of unique persons with different needs. Further research on the experiences of stroke survivors' children seems urgent.

  • 49.
    Kitzmüller, Gabriele
    et al.
    Norge.
    Häggström, Terttu
    Norge.
    Asplund, Kenneth
    University of Tromsø, Norway; Mittuniversitetet.
    Living an unfamiliar body: the significance of the long-term influence of bodily changes on the perception of self after stroke2013In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 16, no 1, p. 19-29Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to illuminate the significance of the long-term influence of bodily changes on the perception of self after stroke by means of narrative interviews with 23 stroke survivors. A phenomenological-hermeneutic approach inspired by the philosophy of Merleau-Ponty and Ricoeur is the methodological framework. Zahavi's understanding of the embodied self and Leder's concept of dys-appearance along with earlier research on identity guide the comprehensive understanding of the theme. The meaning of bodily changes after stroke can be understood as living with an altered perception of self. Stroke survivors perceive their bodies as fragile, unfamiliar and unreliable and tend to objectify them. The weak and discomforting body that 'cannot' demands constant, comprehensive awareness to keep itself in play. These long-term and often permanent consequences of bodily weakness may turn stroke survivors' intentionality inwards, away from external activities and projects and relationships with others. Negative judgements from others are added to lost roles and positions and threaten the vulnerable self. Stroke survivors try to regain familiarity with their body by their life-long project of testing its boundaries. Mastering important tasks helps them strengthen their self-concept. Health care workers should be aware of the embodied self and engage in long-term dialogues with stroke survivors to strengthen positive perceptions of body and self. More research is needed to understand destructive post-stroke phenomena such as fatigue and pain and to find effective methods to help stroke survivors regain wholeness of body and self.

  • 50.
    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.

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