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  • 2301.
    Årestedt, Kristofer
    et al.
    Ersta Sköndal University College, Palliative Research Centre, PRC.
    Carlander (Goliath), Ida
    Ersta Sköndal University College, Palliative Research Centre, PRC.
    Henriksson (Alvariza), Anette
    Ersta Sköndal University College, Palliative Research Centre, PRC.
    Factors Associated with Feelings of Reward during Ongoing Palliative Family Caregiving2014In: Palliative Medicine, Sage Publications, 2014, p. 699-699Conference paper (Refereed)
    Abstract [en]

    Objectives: Of the few studies that have paid attention to feelings of reward in palliative family caregiving, most are retrospective and examine the experiences of bereaved family caregivers. Although feeling rewarded has been described as an influence that may facilitate the way family caregivers handle the caregiving situation, no study has sought to identify factors associated with feelings of reward while providing ongoing family palliative care. The aim of this study, therefore, was to identify influential factors in feelings of reward in family palliative caregivers. Methods: The study had a correlational cross-sectional design. Family caregivers (n = 125) of patients receiving specialized palliative care were consecutively recruited from four settings. These caregivers answered a questionnaire including the Rewards of Caregiving Scale (RCS). The questionnaire also included questions about demographic background and scales to measure preparedness for caregiving, feelings of hope, perceived health, and symptoms of anxiety and depression. Correlation and regression analyses were conducted to identify factors associated with rewards. Results: The results showed that more prepared caregivers with higher levels of hope felt more rewarded, while caregivers with higher levels of anxiety and those in a spousal relationship to the patient felt less rewarded by caregiving. Significance of results: It seems reasonable that feeling rewarded can significant to the overall experience of providing ongoing palliative care. The situation of family caregivers has been shown to be multifaceted and complex, and co-varying factors such as preparedness, anxiety, hope, and being in a spousal relationship with the patient influence the experience.

  • 2302.
    Årestedt, Kristofer
    et al.
    Ersta Sköndal University College, Palliative Research Centre, PRC.
    Strömberg, A
    Jaarsma, T
    Öhlén, Joakim
    Ersta Sköndal University College, Palliative Research Centre, PRC.
    Henriksson (Alvariza), Anette
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Ersta sjukhus.
    Palliative Care Needs in Terms of Signs, Symptoms and Health Related Quality of Life (HRQoL) among Patients with Advanced Chronic Heart Failure2014In: Palliative Medicine, Sage Publications, 2014, p. 697-697Conference paper (Refereed)
    Abstract [en]

    Purpose: Despite that chronic heart failure is associated with a poor prognosis, only few patients receive palliative care. Among patients with advanced stages of heart failure, previous studies have mainly focused on solitary specific signs or symptoms and few have described the patients’ situation from a more comprehensive perspective. The aim was therefore to undertake a comprehensive description of potential palliative care needs in terms of signs, symptoms and health related quality of life (HRQoL) among patients with advanced chronic heart failure. Methods: The study included 72 patients with advanced chronic heart failure (NYHA III and IV), taken from a larger multi-centre study. The study variables included demographic data, medical and nutritional status, sleeping disordered breathing, physical activity, self-perceived symptoms and HRQoL, and cognitive function. Results: A large number of the patients scored appetite levels at increased risk for weight loss (53%), scored mild or worse depressive symptoms (47%), was short of breath in rest (43%), and had moderate or worse pain (82%). Mobility problems were common ( 72%) as well as problems conducting usual activities (33%). Problems with low physical activity according to average number of steps (2691±2022) and METs (1.0±0.2), insomnia (64%), daytime sleepiness (44%) and sleep disordered breathing (AHI ≥ 15, 56%) were common. The mean BMI was high (30.2±5.7) and 18% had albumin levels ≤ 35 (mean 38.8±3.7). Impaired cognitive functioning was also common (MMSE ≤ 27, 54%). HRQoL was in general low, but with a great individual variance (EQ-index 0.65±0.22; EQ-VAS 50.8±17.6). Conclusion: Despite that none of the participants received palliative care, this comprehensive description shows that these patients with heart failure have complex health care needs. Therefore, health professional should focus on palliative care needs earlier in the disease trajectory.

  • 2303. Åsberg, Marie
    et al.
    Nygren, Åke
    Leopardi, Rosario
    Rylander, Gunnar
    Peterson, Ulla
    Wilczek, Lukas
    Källmén, Håkan
    Ekstedt, Mirjam
    Åkerstedt, Torbjörn
    Lekander, Mats
    Ekman, Rolf
    Novel biochemical markers of psychosocial stress in women.2009In: PloS one, ISSN 1932-6203, Vol. 4, no 1, p. e3590-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Prolonged psychosocial stress is a condition assessed through self-reports. Here we aimed to identify biochemical markers for screening and early intervention in women. METHODS: Plasma concentrations of interleukin (IL) 1-alpha, IL1-beta, IL-2, IL-4, IL-6, IL-8, IL-10, interferon-gamma (INF-gamma), tumor necrosis factor-alpha (TNF-alpha), monocyte chemotactic protein-1 (MCP-1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), thyroid stimulating hormone (TSH), total tri-iodothyronine (TT3), total thyroxine (TT4), prolactin, and testosterone were measured in: 195 women on long-term sick-leave for a stress-related affective disorder, 45 women at risk for professional burnout, and 84 healthy women. RESULTS: We found significantly increased levels of MCP-1, VEGF and EGF in women exposed to prolonged psychosocial stress. Statistical analysis indicates that they independently associate with a significant risk for being classified as ill. CONCLUSIONS: MCP-1, EGF, and VEGF are potential markers for screening and early intervention in women under prolonged psychosocial stress.

  • 2304.
    Åström, Cecilia
    Ersta Sköndal University College, Department of Health Care Sciences.
    Smak- och luktförändringar hos patienter inom specialiserad palliativ vård2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Många patienter i palliativ vård rapporterar en minskad, eller förändrad, förmåga att känna smak och lukt. Smak-och luktförändringar (SoL-förändringar) kan innebära lidanden för den enskilde patienten, men kan även påverka näringsintag samt få negativa följder i det dagliga livet.

    Syfte: Syftet var att rapportera om cancerpatienters erfarenheter av smak- och luktförändringar och påverkan och hantering av dessa i det dagliga livet när de är i palliativ fas.

    Metod: Kvantitativ data samlades in från åtta deltagare, under tre mättillfällen per deltagare, via ett frågeformulär. Kvalitativ data beståendes av kommentarer till frågorna, redovisades som citat.

    Resultat: Det var fem huvudfynd som framkom i resultatet. Ett övergripande tema som kunde urskiljas var sårbarheten och lidandet i samband med SoL-förändringar.  Vidare framkom att SoL-förändringar rapporterades av samtliga deltagare, dock inte vid alla mättillfällen. En definitionssvårighet av SoL-förändringar uppmärksammades också bland svaren. Ytterligare var aptitnedsättningar lågt rapporterade bland deltagarna. Detta stod i kontrast till illamående som rapporterades av samtliga deltagare.

    Diskussion: Sårbarheten och lidandet som uppkom i samband med Sol-förändringar kunde ge en negativ påverkan på det dagliga livet. Drivkraften att tillgodogöra sig föda för sin överlevnad återges med insikten att det ofta inte är för njutningens skull som måltider intas.  Resultatet visade på vikten av att SoL-förändringar uppmärksammas inom den palliativa sjukvården.

     

     

     

     

  • 2305.
    Åström, Liselotte
    Ersta Sköndal University College, Department of Health Care Sciences.
    Utevistelsens betydelse för personer med demenshandikapp - vårdarens perspektiv2003Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 2306.
    Öhlen, Joakim
    Ersta Sköndal University College, Palliative Reserch Centre, PRC.
    Do inequalities in end of life care matter?2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 2, p. 105-107Article in journal (Refereed)
  • 2307.
    Öhlen, Joakim
    et al.
    Karolinska institutet.
    Andershed, Birgitta
    Ersta Sköndal University College, Department of palliative care research.
    Berg, Christina
    Frid, Ingvar
    Palm, Carl-Axel
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Department of Health Care Sciences. Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Segesten, Kerstin
    Relatives in end-of-life care--part 2: a theory for enabling safety2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 2, p. 382-390Article in journal (Refereed)
    Abstract [en]

    AIM: To develop a goal-oriented praxis theory for enabling safety for relatives when an adult or older patient is close to end-of-life.BACKGROUND: This is the second part of a project focusing on the situation and needs of relatives in end-of-life care. Our interpretation of the existing corpus of knowledge pertaining to the needs of close relatives in this situation showed the significance of relatives' need for safety.

    METHOD: The theory was developed step-by-step, through triangulation of critical review of empirical research in the field, our own clinical experiences from end-of-life care, renewed literature searches and theoretical reasoning.

    THEORY: The foundation for the theory is taken from the ethical intention of the philosopher Paul Ricoeur. From this, the theory focuses on relatives in the context of end-of-life care with the goal of enabling safety. This is proposed by four aphorisms functioning as safety enablers and these are directed towards the professional's approach and attitude, the relative's concern for the patient, the specific situation for the relative and the patient's end-of-life period as a period in the life of the relative.

    RELEVANCE TO CLINICAL PRACTICE: Implications for end-of-life practice are considered and include aspects for promotion of just institutions in end-of-life care, the significance of negotiated partnership in end-of-life care, enabling safety for relatives living in existential and practical uncertainty in connection with end-of-life care and diversity of relatives' preferences as they live through this particular period.

  • 2308.
    Öhlen, Joakim
    et al.
    Ersta Sköndal University College, Palliative Reserch Centre, PRC.
    Ekman, Inger
    Zingmark, Karin
    Bolmsjö, Ingrid
    Benzein, Eva
    Conceptual development of "at-homeness" despite illness and disease: a review.2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, p. 23677-Article in journal (Refereed)
    Abstract [en]

    Only one empirical study, the one by Zingmark, Norberg and Sandman published in 1995, explicitly focuses on at-homeness, the feeling of being metaphorically at-home, as a particular aspect of wellness. However, other studies reveal aspects of at-homeness, but if or how such aspects of at-homeness are related to each other is unclear. For this reason, the aim was to review Scandinavian nursing research related to at-homeness in the context of wellness-illness in severe and long-term conditions in order to take a step towards conceptual clarification of "at-homeness." The review included interpretive studies related to severe and long-term illness conducted in Sweden: 10 original articles and 5 doctoral theses. "At-homeness" was found to be a contextually related meaning of wellness despite illness and disease embedded in the continuum of being metaphorically at-home and metaphorically homeless. This was characterized by three interrelated aspects and four processes: being safe through expanding-limiting experiences of illness and time, being connected through reunifying-detaching ways of relating, and being centred through recognition-non-recognition of oneself in the experience and others giving-withdrawing a place for oneself. This conceptualization is to be regarded as a step in conceptual clarification. Further empirical investigation and theoretical development of "at-homeness" are needed. The conceptualization will be a step of plausible significance for the evaluation of interventions aimed at enhancing wellness for people with severe long-term illness, such as the frail elderly, and people with chronic illness or palliative care needs.

  • 2309.
    Öhlén, Joakim
    Institutionen för vårdpedagogik Göteborgs universitet.
    Att vara i en fristad: berättelser om lindrat lidande inom palliativ vård2000Doctoral thesis, monograph (Other academic)
  • 2310.
    Öhlén, Joakim
    Ersta Sköndal University College, Palliative Research Centre, PRC.
    Perspektiv på lidande2013In: Palliativ vård: begrepp & perspektiv i teori och praktik / [ed] Birgitta Andershed, Britt-Marie Ternestedt, Cecilia Håkanson, Lund: Studentlitteratur AB, 2013, 1, p. 137-150Chapter in book (Other academic)
  • 2311.
    Öhlén, Joakim
    et al.
    Göteborgs universitet.
    Furåker, Carina
    Jakobsson, Eva
    Idéhn, Lydia
    Hermansson, Evelyn
    Huvudområdet i landets sjuksköterske- och specialistsjuksköterskeprogram efter högskolereformen 1 juli 20072009In: Omvårdnad som akademiskt ämne: rapport från arbetande konferens / [ed] Gerthrud Östlinder, Siv Söderberg, Joakim Öhlén, Stockholm: Svensk sjuksköterskeförening , 2009, p. 61-73Conference paper (Other academic)
  • 2312.
    Öhlén, Joakim
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Göteborgs universitet.
    Russell, Lara
    Kanada.
    Håkanson, Cecilia
    Ersta Sköndal University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Lunds universitet, Karolinska institutet .
    Alvariza, Anette
    Ersta Sköndal University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Lunds universitet, Karolinska institutet .
    Fürst, Carl Johan
    Lunds universitet, Karolinska institutet .
    Årestedt, Kristofer
    Linnéuniversitetet, Linköpings universitet.
    Sawatzky, Richard
    Kanada.
    Variations in care quality outcomes of dying people: Latent class analysis of an adult national register population.2017In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 53, no 1, p. 13-24Article in journal (Refereed)
    Abstract [en]

    CONTEXT: Symptom relief is a key goal of palliative care. There is a need to consider complexities in symptom relief patterns for groups of people in order to understand and evaluate symptom relief as an indicator of quality of care at end of life.

    OBJECTIVES: The aims of this study were to distinguish classes of patients who have different symptom relief patterns during the last week of life and to identify predictors of these classes in an adult register population.

    METHODS: In a cross-sectional retrospective design, data was used from 87,026 decedents with expected deaths registered in the Swedish Register of Palliative Care in 2011 and 2012. Study variables were structured into patient characteristics, and processes and outcomes of quality of care. A latent class analysis was used to identify symptom relief patterns. Multivariate multinomial regression analyses were used to identify predictors of class membership.

    RESULTS: Five latent classes were generated: "relieved pain", "relieved pain and rattles", "relieved pain and anxiety", "partly relieved shortness of breath, rattles and anxiety" and "partly relieved pain, anxiety and confusion". Important predictors of class membership were age, sex, cause of death, and having someone present at death, individual PRN prescriptions and expert consultations.

    CONCLUSION: Inter-individual variability and complexity in symptom relief patterns may inform quality of care and its evaluation for dying people across care settings.

  • 2313.
    Öhlén, Joakim
    et al.
    Ersta Sköndal University College, Palliative Research Centre, PRC.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Palliative Research Centre, PRC. Karolinska institutet.
    Palliativt forskningscentrum vid Ersta Sköndal högskola och Ersta sjukhus i Stockholm2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 1, p. 92-96Article in journal (Other academic)
    Abstract [sv]

    I denna artikel presenteras ett nystartat Palliativt forskningscentrum i Stockholm. Först ger vi en bakgrund till den forskning som bedrivits vid den tidigare enhet som möjliggjort det nya centrumet. Detta följs av några exempel på överväganden vi gjort vid utvecklingen av forskningsprogrammet. Slutligen presenterar vi några utmärkande drag för den planerade fortsatta forskningen. Vi avser även fortsättningsvis beforska frågor om döende och sorg ur patienters och familjers perspektiv och bidra till kunskapsutvecklingen om erfarenhetsmässiga och existentiella aspekter på palliativ vård. Detta kommer att kompletteras med palliativa teams perspektiv på vård och på genomförande av palliativ vård och implementering av ny kunskap samt organisation och policy för palliativ vård utifrån samhällets och befolkningens perspektiv

  • 2314.
    Ölmebäck Nilsson, Ida
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Ångbäck, Maria
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Vuxna i onkologisk vård: kommunikation med vårdpersonal om sexualitet: en litteraturöversikt2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Throughout the ages sexuality has been a taboo subject. Today, knowledge is more extensive and the view on sexuality has developed into being less of a taboo but nonetheless, sexuality is fairly new and unexplored in care situations. One of the nurse’s primary tasks is to promote health and to prevent illness and to that the sexual aspect of health is also included. Research has shown that a large proportion of people who are cared for because of cancer, encounter obstacles or issues of sexuality or sexual dysfunction. Studies have shown that information regarding possible side effects on sexuality stemming from treatments and medications used against cancer, is scarce.

    Aim: The aim with this review was to illuminate the communication between health care professionals and adults in oncology care about sexuality.

    Method: This literature review was compiled by collection of material from previous studies and other scientific literature for the chosen field of health sciences. The basis for the outcome consists of ten scientific articles on cancer, sexuality and communication. The articles were found in the databases CINAHL Complete and PubMed. The material was examined and analyzed according to Friberg's method. The result was summarized in two main themes with two subthemes respectively.

    Results: The result shows that people who have been diagnosed with cancer rarely had talked to healthcare professionals about, or been given insufficient information about, treatment and pharmaceuticals and what consequences for the sexuality these and the disease itself may imply. Both healthcare professionals and patients state that it can be difficult to talk about sexuality as there are barriers or factors that can prevent such conversations. An often mentioned barrier was time, where patients did not want to spend precious time for the staff with their "trivial" problems or that the healthcare staff themselves blamed it on a lack of time. The results also show that information on sexuality was a priority for those who suffered from sexuality related cancers despite the fact that sexuality-related problems can be experienced regardless of the type of cancer or treatment.

    Discussion: The conclusion is that using the right methods and materials, communication on sexuality can be facilitated to a large extent. BETTER and PLISSIT are two models that, with the right application, also can help patients to address issues related to sexuality themselves.

  • 2315.
    Öresland, Stina
    et al.
    Umeå universitet.
    Määttä, Sylvia
    Göteborgs universitet.
    Norberg, Astrid
    Ersta Sköndal University College, Palliative Reserch Centre, PRC. Umeå universitet.
    Lützén, Kim
    Karolinska institutet.
    Home-based nursing: an endless journey.2011In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, no 3, p. 408-417Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore metaphors for discovering values and norms held by nurses in home-based nursing care. Ten interviews were analysed and interpreted in accordance with a metaphor analytical method. In the analysis, metaphoric linguistic expressions and two entailments emerged, grounded in the conceptual metaphor 'home-based nursing care is an endless journey', which were created in a cross-domain mapping between the two conceptual domains of home-based nursing care and travel. The metaphor exposed home-based nursing care as being in constant motion, thereby requiring nurses to adjust to circumstances that demand ethical maturity. The study focuses on the importance of developing further theories supporting nurses' expressions of their experiences of everyday ethical issues.

  • 2316.
    Örnbrand, Yasmine
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Örnelid, Lina
    Ersta Sköndal University College, Department of Health Care Sciences.
    Upplevelser av att leva med stomi: ur ett patientperspektiv2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2317.
    Örsell, Susanna
    Ersta Sköndal University College, Department of Health Care Sciences.
    Medberoende eller god omvårdnad: en kvalitativ intervjustudie med sjuksköterskor inom beroendevården med fokus på substansbrukssyndrom2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The background describes aspects of the nurse’s profession and care responsibility within both general care and in dependent care. Furthermore, it describes the patient group with its problems, the concept of co-dependency and how it can impact the choice of nursing.  

    Aim: The aim of this study has been to explore nurses’ view of what characterizes good care and co-dependency within the closed depending care.

    Method: This study has a qualitative design with an inductive approach. Seven nurses at a   depending care unit in Stockholm were interviewed using an unstructured method. The material was then analyzed using qualitative content analysis.

    Results: The result from the interviews developed into three categories: The nurse’s view of what   constitutes good care within depending care, The view of the phenomenon of co-dependency within depending care and finally, The nurse’s perception of what differentiates good care and co-dependency. The result reveals, among   other things, the fact that while the nurse, intellectually, had no major problems in separating the concepts of good care and co-dependency, in practice it proved to be harder to implement.

    Discussions: The results are discussed in the context of previous research, other relevant literature and from Ida Jean Orlando’s interaction theory. In the discussion it reveals, among other things, how the nurses responsibility of care can develop into co-dependency.

  • 2318.
    Örtenholm, Eva
    Ersta Sköndal University College, Department of Health Care Sciences.
    Patienters erfarenheter att leva med övervikt eller fetma2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2319.
    Österberg, Emma
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    El messaoudi, Yasmin
    Ersta Sköndal University College, Department of Health Care Sciences.
    Humors betydelse för sjuksköterske- och patientrelationen i cancervården: En litteraturöversikt2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Humor är ett komplex begrepp som färgas av den subjektiva upplevelsen och är föränderlig över tid. Tidigare forskning visar på att humor har använts som en copingmekanism för patienter med cancer, för att distansera sig från sin tillvaro och diagnos. Även sjuksköterskor har använt sig av humor för att skapa relation med patienten. Humor har använts för att hjälpa patienterna att hålla humöret upp genom att skifta deras fokus.

    Syfte: Syftet med denna litteraturöversikt var att belysa humor i sjuksköterske- och patientrelationen inom cancervården.

    Metod: Denna uppsats är en litteraturöversikt där innehållet av sju kvalitativa och tre kvantitativa vetenskapliga artiklar analyserades.

    Resultat: Tio artiklar analyserades där tre huvudteman framkom: Humor i sjuksköterske- och patientrelationen belyser att en relation mellan parterna bör finnas innan humor introduceras. Humor som ett omvårdnadsmässigt dilemma belyser när humor är tillämpbart och när det inte är accepterat. Positiv attityd och humor belyser vikten av en positiv attityd hos patienten för att kunna uppskatta och vara humoristisk.

    Diskussion: Diskussionen baseras på litteraturöversiktens resultat där det framkom att en etablerad relation mellan sjuksköterskan och patienten bör finnas innan humor kan användas. Oftast är det patienten som initierar humorn i relationen och det kan ses som en indikator på när humor kan användas. Åsikterna går isär kring huruvida om det är humor som skapar en positiv attityd eller tvärtom. Utifrån Katie Erikssons teori diskuteras relationsbildning som ansning, humor som lek och hur leken sedan utmynnar i lärande.

     

     

  • 2320.
    Österholm, Anna
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Sörholm, Eva
    Ersta Sköndal University College, Department of Health Care Sciences.
    Sjuksköterskans bemötande av personer med alkoholberoende2003Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2321.
    Österlind, Jane
    Ersta Sköndal University College, Department of Health Care Sciences.
    Hemmet på hemmet: att vårdas och vårda inom särskilda boendeformer för äldre. En beskrivning om livets sista tid på sjukhem och ålderdomshem ur ett personalperspektiv2002Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 2322.
    Österlind, Jane
    Ersta Sköndal University College, Department of palliative care research.
    När livsrummet krymper: vård och omsorg av äldre personer i livets slutskede2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This research focused on the life situation of older people, who had moved to a nursing home at the end of life, from the perspectives of the older people themselves, care managers and nursing staff. The thesis is based on an analysis of 446 care manager assessments and decisions, interviews with seven care managers, six older people and 28 nursing staff. The main fi ndings are: (I); that there was a statistically signifi cantly shorter waiting time for a move to a nursing home for older people who were in hospital compared to those who were living in their own home at the time of the decision. Seventy percent of the decisions made by care managers’ concerned women. The waiting period for men was fi ve days shorter compared to women. (II); that the care managers’ descriptions revealed that their assessments of the needs and wishes of the older people were infl uenced by whether or not it was clear that the older person had only a limited time left to live. The care managers’ way of reasoning has been conceptualised as two approaches, the medical and the natural path to death, where the former was characterised as fl exible and collaborative, whereas the latter was governed to a greater extent by a “wait and see attitude”. (III); that the older people’s experiences of living in a nursing home have been conceptualised into three themes: feeling like a stranger in an unfamiliar culture, being excluded from life, and living while waiting for death. The latter involved a deep insight that life would soon come to an end; a fact the staff appeared to take into account to only a minor extent. (IV); that dying and death was characterised by a discourse of silence, with tension between avoidance of and a confrontation with death. Staff members who expressed a fear of death held it at a distance by concentrating on practical tasks and avoiding close contact with older people who were dying. The thesis highlights the fact that the dying and death of older persons was characterised by a discourse of silence and several transitions. Death was not a topic that the staff members or older people generally talked about, and care in the fi nal phase of life was not actively or explicitly planned. In terms of access to a nursing home bed, only older people with an extensive need for care obtained such a place. These fi ndings imply that all older people can be said to be in need of palliative care. The older people in our study were in a liminal phase, and waiting for death. Feelings of social and existential loneliness and that their living space was shrinking were evident. It was also clear that the older people and staff members inhabit the same place but appear to be in two different sub-cultures, where the norms and values that guided the staff members’ attitudes were dominant. Keywords: transition, older people, end of life care, palliative care, nursing home, caring, care manager and staff

  • 2323.
    Österlind, Jane
    Ersta Sköndal University College, Department of palliative care research.
    Omvårdnadsbehov i livets slutskede2001In: Palliativ vård / [ed] Inger Fridegren, Susanne Lyckander, Stockholm: Liber, 2001, 1, p. 92-101Chapter in book (Other academic)
  • 2324.
    Österlind, Jane
    Ersta Sköndal University College, Department of palliative care research.
    Vårdkultur och självbestämmande i sjukhemsmiljö2007In: Hemmets vårdetik: om vård av äldre i livets slutskede / [ed] Gunilla Silfverberg, Lund: Studentlitteratur , 2007, p. 235-247Chapter in book (Other academic)
  • 2325.
    Österlind, Jane
    et al.
    Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Hansebo, Görel
    Ersta Sköndal University College, Department of Health Care Sciences.
    Andersson, Janicke
    Institutionen för samhälls- och välfärdsstudier, LInköpings universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Enheten för forskning i palliativ vård. Ersta Sköndal University College, Department of Health Care Sciences.
    Hellström, Ingrid
    Institutionen för samhälls- och välfärdsstudier, Linköpings universitet.
    A discourse of silence: professional carers resoning of death and dying in nursing homes2011In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 31, no 4, p. 529-544Article in journal (Other academic)
    Abstract [en]

    Nursing homes are a setting in which death and dying is common. How death and dying is articulated and the actions that take place in a nursing home constitute adiscourse that guides the staff in their work. The aim of this studywas to explore thediscourse of death and dying in nursing homes from the perspective and understandingof the staff. The study draws on Foucault’s discourse analysis. Data arefrom fivefocus-group discussions held with 28 staff of four different nursing homes in Sweden. The findings show that the discourse had three characteristics :(a) dying was silent and silenced, (b) emotions were pushed into the background,and (c) attentiveness to death arose after the moment of the elderly person’s death. The structure of the discourse was characterised by a movement between twopositions, avoiding and confronting death, themain focus being on avoidance. Thearticulation and practices of silence highlight a need to regard dying as a processthat requires attention. One way to ensure appropriate attention could be to instil the philosophy of palliative care in nursing homes, including training and supportfor the staff in their work. The study demonstrates that nursing-home staff needmore knowledge and support to enable them to feel that they do a good job.

  • 2326.
    Österlind, Jane
    et al.
    Ersta Sköndal University College, Department of palliative care research.
    Hansebo, Görel
    Ersta Sköndal University College, Department of Health Care Sciences.
    Lantz, Göran
    Ersta Sköndal University College, Department of Health Care Sciences.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Department of Health Care Sciences. Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Pathways in end-of-life care for older people: care managers' reasoning.2008In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 14, no 9, p. 420-5Article in journal (Refereed)
    Abstract [en]

    Seven care managers employed by a large municipality in Sweden were interviewed concerning their reasoning regarding end-of-life care for older people. Data were analyzed using a hermeneutic approach. The results showed that end-of-life care was considered to constitute a small part of the care managers' work and was something they did not focus on in general when assessing care needs. Two different pathways to death--the natural and the medical--were identified. In the natural pathway, death was invisible and the care was more routine-oriented. In the medical pathway, death was visualised and the care more individualised. Neither of the pathways paid attention to communication or existential needs. Thus, there is a need for a palliative pathway to death based on the philosophy of palliative care, which could provide guidance for care managers and promote opportunities for older people to achieve a dignified dying and death.

  • 2327.
    Österlind, Jane
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC.
    Prahl, Charlotte
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC.
    Westin, Lars
    Högskolan i Skövde.
    Strang, Susann
    Göteborgs universitet, Angereds närsjukhus.
    Bergh, Ingrid
    Högskolan i Skövde.
    Henoch, Ingela
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Angereds närsjukhus, Göteborgs universitet.
    Hammarlund, Kina
    Högskolan i Skövde.
    Ek, Kristina
    Högskolan i Skövde.
    Nursing students' perceptions of caring for dying people, after one year in nursing school.2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 41, p. 12-16, article id S0260-6917(16)00122-2Article in journal (Refereed)
    Abstract [en]

    AIM: To describe Swedish nursing students' perceptions of caring for dying people after the first year of a three year in a nursing programme at three university nursing schools in Sweden.

    METHODS: Interviews (n=17) were undertaken with nursing students at the end of their first year. A phenomenographic approach was used to design and structure the analysis of the nursing students' perceptions.

    RESULTS: The analysis resulted in five categories: 1) from abstract to reality, 2) from scary to natural, 3) increased knowledge can give bad conscience, 4) time limits versus fear of end-of-life conversations, and 5) meeting with relatives.

    CONCLUSION: Nursing students need to be prepared both theoretically and within practice to encounter death and dying and to care for dying persons. By combining their theoretical knowledge of dying and death with their own encounters of death and dying people in practice, the students can be supported to develop an understanding of dying and death as a natural part of life rather than something frightening.

  • 2328.
    Österlind, Jane
    et al.
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Department of Health Care Sciences. Ersta Sköndal University College, Enheten för forskning i palliativ vård. Karolinska institutet.
    Hansebo, Görel
    Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
    Hellström, Ingrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences. Linköpings universitet.
    Feeling lonely in an unfamiliar place: older peoples experiences of life close to death in a nursing home2017In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 12, no 1, p. 1-8, article id e12129Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to deepen the understanding of how older persons living in a nursing home experience life close to death.

    Background: A move to and a life in a nursing home while being close to death is a reality for many older people in Sweden. Being able to express thoughts and feelings about death has been described as both crucial for sustaining personhood as well as for establishing a meaningful existence at the end of life. Important are the experiences of older people living in nursing homes who are approaching death.

    Method: Six older people were interviewed on one to four occasions. A total of 16 interviews were conducted with the participants. An interpretative approach was chosen.

    Findings: The main interpretation, Feeling lonely in an unfamiliar place, is based on three themes (i) Waiting for death, with the subthemes death as a release and thinking of oneself as dead; (ii) Subordinate oneself to values and norms of the staff, with the subthemes feeling offended and feeling trapped; and (iii) Keep the courage up. The older people's lives were characterised by feelings of aloneness in an unfamiliar place which contributed to a sense of existential loneliness. They experienced few opportunities to discuss their thoughts of life and death, including preparations for passing away.

    Conclusion and implication for practice: It is of importance for professionals to be able to meet older people as they are and respect them as human beings in their transitions, before, during and after the move to a nursing home. It is important to find ways to support older people's wellbeing and identity near death.

  • 2329. Östlinder, Gerthrud
    et al.
    Söderberg, SivÖhlén, JoakimGöteborgs universitet.
    Omvårdnad som akademiskt ämne: Rapport från arbetande konferens2009Conference proceedings (editor) (Other academic)
  • 2330. Almqvist, E W (Contributor)
    A randomized, placebo-controlled trial of coenzyme Q10 and remacemide in Huntington's disease.2001In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 57, no 3, p. 397-404Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine whether chronic treatment with coenzyme Q10 or remacemide hydrochloride slows the functional decline of early Huntington's disease (HD).

    METHODS: The authors conducted a multicenter, parallel group, double-blind, 2 x 2 factorial, randomized clinical trial. Research participants with early HD (n = 347) were randomized to receive coenzyme Q10 300 mg twice daily, remacemide hydrochloride 200 mg three times daily, both, or neither treatment, and were evaluated every 4 to 5 months for a total of 30 months on assigned treatment. The prespecified primary measure of efficacy was the change in total functional capacity (TFC) between baseline and 30 months. Safety measures included the frequency of clinical adverse events.

    RESULTS: Neither intervention significantly altered the decline in TFC. Patients treated with coenzyme Q10 showed a trend toward slowing in TFC decline (13%) over 30 months (2.40- versus 2.74-point decline, p = 0.15), as well as beneficial trends in some secondary measures. There was increased frequency of nausea, vomiting, and dizziness with remacemide and increased frequency of stomach upset with coenzyme Q10.

    CONCLUSIONS: Neither remacemide nor coenzyme Q10, at the dosages studied, produced significant slowing in functional decline in early HD.

  • 2331. Almqvist, E W (Contributor)
    Dosage effects of riluzole in Huntington's disease: a multicenter placebo-controlled study.2003In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 61, no 11, p. 1551-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Riluzole retards striatal glutamate release and pathologic consequences in neurotoxic animal models of Huntington's disease (HD).

    OBJECTIVE: To determine the dosage-related impact of riluzole on chorea in HD.

    METHODS: An 8-week double-blind dose-ranging multicenter study of riluzole was conducted in 63 subjects (32 women, 31 men) with HD who were randomized to receive placebo, riluzole 100 mg/day, or riluzole 200 mg/day. The prespecified outcome measure was change in the total maximal chorea score of the Unified Huntington's Disease Rating Scale (UHDRS).

    RESULTS: Fifty-six (89%) subjects completed the study. A reduction (p < 0.01) in chorea at 8 weeks was found using a linear trend test with dose. Comparing the groups individually, the reduction in chorea for the riluzole 200-mg/day group (-2.2 +/- 3.3) was different (p = 0.01) from placebo (+0.7 +/- 3.4), but the riluzole 100-mg/day group (-0.2 +/- 2.9) was not. Riluzole did not improve other motor, cognitive, behavioral, or functional components of the UHDRS. Alanine aminotransferase was elevated in a dosage-dependent fashion (p = 0.01).

    CONCLUSIONS: Over 8 weeks of treatment, riluzole 200 mg/day ameliorated chorea intensity in HD without improving functional capacity or other clinical features of illness. Riluzole 200 mg/day was attended by reversible liver transaminase abnormalities that would require monitoring in long-term studies.

44454647 2301 - 2331 of 2331
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