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  • 1.
    Hedman, Ragnhild
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Det enda alternativet: gamla personers upplevelser av att bo på sjukhem2003Självständigt arbete på avancerad nivå (magisterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 2.
    Hedman, Ragnhild
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska Institutet.
    Striving to be able and included: Expressions of sense of self in people with Alzheimer's disease2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    According to research applying a social constructionist perspective, the sense of self is not lost in people with Alzheimer’s disease (AD). It is, however, greatly influenced by the symptoms and by how they are treated by other people. Without support, it is difficult to preserve a positive sense of self, when living with progressing cognitive impairments. The stigma associated with cognitive impairment also threatens their sense of self. Harré’s social constructionist theories of self and positioning have been used to study how people with AD express their sense of self. As there is a need to expand the previous research by involving additional participants and research contexts, the aim of the present thesis was to describe, in accordance with Harré’s theories of self and positioning, how people with AD expressed their sense of self in personal interviews and in support groups with other people with AD. The research consists of four substudies (I–IV), and has a qualitative, descriptive, and theory-testing approach. Thirteen people with mild and moderate AD were included, 11 of whom had the early onset form of the disease. Two support groups were formed, led by facilitators who supported the communication and the participants’ expressions of self. Each group met 10 times during an eight-month period. Topics were not predetermined, and introduced by both facilitators and participants. Semistructured interviews were conducted before the groups started and after they ended. The interviews and support group conversations were audio-recoded and analysed with qualitative content analysis, guided by Harré’s theories. In substudy I, the initial interviews were deductively analysed. The findings showed that Self 1 (the sense of being a singular, embodied person) was expressed by the participants without difficulties. Self 2 (the perception of one’s personal attributes and life history) was expressed as feeling mainly the same person. While some abilities had been lost, other had been developed. Self 3 (the socially constructed self) was described as mostly supported, but sometimes threatened in interactions with other people (I). In substudy II, support group conversations were analysed abductively with respect to expressions of Self 2. It was found that participants expressed Self 2 in terms of agency and communion, and a lack of agency and communion (II).In substudy III, a secondary analysis of the data from substudy II was performed inductively with the aim of describing how Self 3 was constructed in the interaction of the support group. Five first-order positions, generating lively interaction, were described: the project manager, the storyteller, the moral agent, the person burdened with AD, and the coping person (III). In substudy IV, all the collected data were reanalysed inductively, focusing on how participants expressed the experience of being research participants. Three themes were constructed: contributing to an important cause, gaining from participating, and experiencing risks and drawbacks (IV). In conclusion, it was found that participants constructed positive social selves through the support from each other, the facilitator, and researchers in the support group (III), and as research participants (IV). Agency and communion were central to Self 2, and decreased with the progression of AD (II). In spite of change, participants perceived themselves as basically the same people, with a potential to learn and develop as persons (I).

  • 3.
    Hedman, Ragnhild
    et al.
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska institutet.
    Hansebo, Görel
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska institutet.
    Ternestedt, Britt-Marie
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Karolinska institutet.
    Hellström, Ingrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Linköpings universitet.
    Norberg, Astrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Umeå universitet.
    Expressed Sense of Self by People With Alzheimer’s Disease in a Support Group Interpreted in Terms of Agency and Communion2016Ingår i: Journal of Applied Gerontology, ISSN 0733-4648, Vol. 35, nr 4, s. 421-443Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The self is constructed in cooperation with other people and social context influences how people perceive and express it. People with Alzheimer’s disease (AD) often receive insufficient support in constructing their preferred selves, but little is known about how they express themselves together with other people with AD. In accordance with Harré’s social constructionist theory of self, this study aimed to describe how five people with mild and moderate AD express their Self 2 (i.e., their personal attributes and life histories) in a support group with a facilitator experienced in communicating with people with AD. The participants’ expressions of their Self 2 were analyzed with qualitative abductive content analysis and interpreted in terms of agency and communion and a lack of agency and communion. The findings highlight the importance of supporting a sense of agency and communion when assisting people with AD in constructing their self.

  • 4.
    Hedman, Ragnhild
    et al.
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Ersta Sköndal högskola, Enheten för forskning i palliativ vård.
    Hansebo, Görel
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Ternestedt, Britt-Marie
    Ersta Sköndal högskola, Enheten för forskning i palliativ vård.
    Hellström, Ingrid
    Linköpings universitet.
    Norberg, Astrid
    Ersta Sköndal högskola, Enheten för forskning i palliativ vård.
    How people with Alzheimer's disease express their sense of self: Analysis using Rom Harré's theory of selfhood2013Ingår i: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 12, nr 6, s. 713-733Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to use Harré’s social constructionist theory of selfhood to describe how people with mild and moderate Alzheimer’s disease (AD) express their sense of self. The findings show that Self 1, the embodied sense of being a person, was expressed fluently by participants through the use of first-person indexicals. Self 2, the experienced personal attributes and life narrative, had undergone changes. Those changes were not entirely for the worse; participants had also developed new skills in managing life with AD. In a lifetime perspective, those changes were minor and participants perceived themselves to be basically the same people that they were before having AD. When constructing Self 3, the social personae, participants usually described being supported by others, but sometimes described being exposed to malignant positioning. They also feared that they might become more exposed to negative attitudes as their AD progressed. However, participants were understanding towards the offensive behaviours of others.

  • 5.
    Hedman, Ragnhild
    et al.
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska Institutet.
    Hellström, Ingrid
    Linköpings universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC.
    Hansebo, Görel
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Norberg, Astrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC.
    Being a research participant with Alzheimer’s disease: Expressions of sense of selfArtikel i tidskrift (Refereegranskat)
  • 6.
    Hedman, Ragnhild
    et al.
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska institutet.
    Hellström, Ingrid
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Linköpings universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC. Karolinska institutet.
    Hansebo, Görel
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska instituet.
    Norberg, Astrid
    Ersta Sköndal högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC. Umeå universitet.
    Sense of Self in Alzheimer’s Research Participants2018Ingår i: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 27, nr 2, s. 191-212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The sense of self is vulnerable in people with Alzheimer’s disease (AD), and might be positively and negatively influenced by research participation. The purpose of this study was to describe how people with AD express their experience of being a research participant with respect to their sense of self. Interviews and support group conversations involving 13 people with mild and moderate AD were analyzed using qualitative content analysis. Three themes were constructed: contributing to an important cause, gaining from participating, and experiencing risks and drawbacks. Participants described contributing to research as being in line with their lifelong values and lifestyles. They expressed contentment and pride about being research participants, emphasized their positive relationships with the researchers, and described participation as a meaningful activity. When research procedures threatened their sense of self, they were able to reason about risks and decline participation.

  • 7.
    Hedman, Ragnhild
    et al.
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska Institutet.
    Hellström, Ingrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Linköpings universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Karolinska Institutet.
    Hansebo, Görel
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska Institutet.
    Norberg, Astrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Umeå universitet.
    Social positioning by people with Alzheimer's disease in a support group2014Ingår i: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 28, s. 11-21Artikel i tidskrift (Refereegranskat)
  • 8.
    Hedman, Ragnhild
    et al.
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC.
    Norberg, Astrid
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC. Umeå universitet.
    Hellström, Ingrid
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC. Linköpings universitet.
    Agency and communion in people with Alzheimer's disease, as described by themselves and their spousal carers.2017Ingår i: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, artikel-id 1471301217706268Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Agency (individuality) and communion (togetherness) are vital to a positive sense of self. People with Alzheimer's disease are at risk of experiencing diminished agency and decreased communion. Their family members', especially their partner's, view on their agency and communion is also likely to influence their sense of agency, communion, and self. In the present study, individual interviews with 10 people with Alzheimer's disease and their spousal carers were qualitatively analysed to describe how in each couple the two spouses viewed the agency and communion of the person with Alzheimer's disease from an individual perspective. The findings show that the carers generally described the agency of the person with Alzheimer's disease as slightly weaker compared with the persons with Alzheimer's disease themselves. The carers also appeared to have poor knowledge of what supported and threatened the sense of communion of the person with Alzheimer's disease.

  • 9.
    Saarnio, Lotta
    et al.
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap. Karolinska institutet.
    Boström, Anne-Marie
    Karolinska institutet, Danderyds sjukhus.
    Gustavsson, Petter
    Karolinska institutet.
    Hedman, Ragnhild
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Öhlén, Joakim
    Göteborgs universitet.
    Temporally and spatially shaped meanings of at-homeness among people 85 years and over with severe illness.2018Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of the study was to illuminate how meanings of at-homeness are temporally and spatially shaped by older people with severe illness.

    BACKGROUND: At-homeness can be understood as a feeling of being metaphorically at-home while experiencing well-being. The research field of at-homeness among older people with severe illness is under researched and knowledge about how at-homeness is shaped by time and place is limited.

    METHOD: Narrative interviews were conducted in Sweden with a total of twenty men and women who were aged 85 years or over and affected by severe illness. The narrative interviews were analysed based on a phenomenological hermeneutical method.

    RESULTS: Meanings of at-homeness that were shaped temporally and spatially were interpreted, where time and place were shaped individually by other aspects and also interwoven. Two main inter-related themes were constructed: shaping at-homeness through relying on a familiar place and shaping at-homeness through continuous balancing between the past, present and future.

    CONCLUSION AND IMPLICATIONS: At-homeness is temporally and spatially shaped in two ways: through a process over time, or momentarily, where older people's earlier experiences and expectations are interwoven with their experiences of place and the people around them. The results of this study would be applicable to similar societal contexts. For future research, it is important to continue to study how at-homeness can be promoted for severely ill older people, in specific situations and over time.

  • 10.
    Saarnio, Lotta
    et al.
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC. Karolinska institutet.
    Boström, Anne-Marie
    Karolinska institutet.
    Hedman, Ragnhild
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC.
    Gustavsson, Petter
    Karolinska institutet.
    Öhlén, Joakim
    Göteborgs universitet.
    Enabling at-homeness for residents living in a nursing home: Reflected experience of nursing home staff.2017Ingår i: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 43, s. 40-45, artikel-id S0890-4065(17)30226-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Older people are often living the last period of their lives in institutions such as nursing homes. Knowledge of this period, specifically related to at-homeness which can be described as wellbeing in spite of illness and has been regarded as one of the goals in palliative care, has been very little researched in the context of nursing homes and the experience of nursing home staff. The aim of this study was to explore the experiences of nursing home staff of how to enable at-homeness for residents. Qualitative interpretive description methodology guided the design. The data generation was conducted in winter 2014-2015, when seven repetitive reflective group discussions with staff in a nursing home were held. The results show five patterns for how healthcare staff enabled at-homeness for the residents: Striving to know the resident, Showing respect for the resident's integrity, Creating and working in family-like relationships, Helping to find a new ordinariness and Preparing and making plans to ensure continuity. Nursing home staff seem to have collegial knowledge of how to enable at-homeness for the residents in a nursing home. Close relationships with respect for the resident's integrity stand out as enabling at-homeness.

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