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Rasoal, D., Kihlgren, A. & Skovdahl, K. (2018). Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach. BMC Geriatrics, 18(1), Article ID 312.
Open this publication in new window or tab >>Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach
2018 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, no 1, article id 312Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services.

METHOD: This study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis.

RESULTS: The inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues.

CONCLUSIONS: This study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Community home health care services, Ethically difficult situations, Ethnography, Healthcare professional
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Geriatrics
Identifiers
urn:nbn:se:oru:diva-70801 (URN)10.1186/s12877-018-0996-8 (DOI)000453237500001 ()30547755 (PubMedID)2-s2.0-85058603986 (Scopus ID)
Note

Funding Agency:

Stiftelsen Olle Engkvist Byggmästare  CF 71-485/2008

Available from: 2018-12-18 Created: 2018-12-18 Last updated: 2019-01-08Bibliographically approved
Frost, E., Kihlgren, A. & Jaensson, M. (2018). Experience of physician and nurse specialists in Sweden undertaking long distance aeromedical transportation of critically ill patients: A qualitative study. International Emergency Nursing
Open this publication in new window or tab >>Experience of physician and nurse specialists in Sweden undertaking long distance aeromedical transportation of critically ill patients: A qualitative study
2018 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: Transportation of critically ill patients, intra- or inter-hospital, always involves risks when resources are limited. With aeromedical transports, additional risk factors are incurred. The physiological effects of altitude, when both pressure and density decline, can lead to hypobaric hypoxia and gases trapped in body cavities will expand and cause stress on biological tissue.

AIM: The aim of this study was to explore the experiences of nurse and physician specialists in Sweden undertaking long distance aeromedical transport of critically ill patients, with a flight time of more than two hours.

METHOD: A qualitative approach with a descriptive design. Thirteen recorded semi-structured interviews with physician and nurse specialists were analyzed using inductive qualitative content analysis.

RESULTS: One overall theme emerged, To be one step ahead to ensure patient safety in the air; with three categories 1) With the patient in focus, 2) To be part of a team and concerned about patient safety and 3) To be in need of recovery.

CONCLUSION: This study demonstrates the challenges with long distance aeromedical transport of critically ill patients. The healthcare personnel make decisions and actions to be one step ahead to ensure patient safety. This isolated work is improved with experience, education, training and good communication skills.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Aeromedical transport, Communication, Content analysis, Crew resource management, Critical care, Patient safety, Qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-71190 (URN)10.1016/j.ienj.2018.11.004 (DOI)30583952 (PubMedID)
Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-08Bibliographically approved
Göransson, C., Eriksson, I., Ziegert, K., Wengström, Y., Langius-Eklöf, A., Brovall, M., . . . Blomberg, K. (2018). Testing an app for reporting health concerns: Experiences from older people and home care nurses. International Journal of Older People Nursing, 13(2), Article ID e12181.
Open this publication in new window or tab >>Testing an app for reporting health concerns: Experiences from older people and home care nurses
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2018 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, no 2, article id e12181Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To explore the experiences of using an app among older people with home-based health care and their nurses.

BACKGROUND: Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed.

DESIGN: Explorative qualitative design.

METHODS: For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis.

RESULTS: The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement.

CONCLUSIONS: The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future.

IMPLICATIONS FOR PRACTICE: The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
App, health concerns, older people, security, self-confidence, thematic analysis
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:oru:diva-63300 (URN)10.1111/opn.12181 (DOI)000434118100005 ()29210218 (PubMedID)2-s2.0-85037995107 (Scopus ID)
Note

Funding Agencies:

Faculty of Medicine and Health, School of Health Sciences, Örebro University  

School of Health and Welfare, Halmstad University  

Karolinska Institutet 

Available from: 2017-12-11 Created: 2017-12-11 Last updated: 2018-07-24Bibliographically approved
Algilani, S., Langius-Eklöf, A., Kihlgren, A. & Blomberg, K. (2017). An interactive ICT-platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing: development and feasibility. Journal of Clinical Nursing, 26(11-12), 1575-1583
Open this publication in new window or tab >>An interactive ICT-platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing: development and feasibility
2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 11-12, p. 1575-1583Article in journal (Refereed) Published
Abstract [en]

Aim and objectives: To develop and test feasibility and acceptability of an interactive ICT-platform integrated in a tablet for collecting and managing patient reported concerns of older adults in home care.

Background: Using different ICT-applications, e.g. interactive tablets for self-assessment of health and health issues, based on health monitoring as well as other somatic and psychiatric monitoring systems may improve quality of life, staff and patient communication and feelings of being reassured. The European Commission hypothesize that introduction of ICT-applications to the older population will enable improved health. However, evidence-based and user-based applications are scarce.

Design: The design is underpinned by the Medical Research Council's complex intervention evaluation framework. A mixed-method approach was used combining interviews with older adults and healthcare professionals, and logged quantitative data.

Methods: In cooperation with a health management company, a platform operated by an interactive application for reporting and managing health related problems in real time was developed. Eight older adults receiving home care were recruited to test feasibility. They were equipped with the application and reported three times weekly over four weeks, and afterwards interviewed about their experiences. Three nurses caring for them were interviewed. The logged data was extracted as a coded file.

Results: The older adults reported as instructed, in total 107 reports (mean 13). The most frequent concerns were pain, fatigue and dizziness. The older adults experienced the application as meaningful with overall positive effects as well as potential benefits for the nurses involved.

Conclusions The overall findings in this study indicated high feasibility among older adults using the ICT-platform. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations.

Relevance to practice: An ICT-platform increased the older adults' perception of involvement and facilitated communication between the patient and nurses.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2017
Keywords
Information and communication technology (ICT), nursing care, older adults, patient reported outcomes
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-51489 (URN)10.1111/jocn.13468 (DOI)000400992400014 ()27381423 (PubMedID)2-s2.0-85017395310 (Scopus ID)
Note

Funding Agencies:

Örebro University  

Karolinska Institutet 

Available from: 2016-08-05 Created: 2016-08-02 Last updated: 2017-09-05Bibliographically approved
Rasoal, D., Skovdahl, K., Gifford, M. & Kihlgren, A. (2017). Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review. HEC Forum, 29(4), 313-346
Open this publication in new window or tab >>Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review
2017 (English)In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498, Vol. 29, no 4, p. 313-346Article, review/survey (Refereed) Published
Abstract [en]

This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different coun-tries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a ‘‘bot-tom-up’’ perspective might give healthcare personnel opportunities to think and reflect more than a ‘‘top-down’’ perspective. A ‘‘bottom-up’’ approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a ‘‘top-down’’ approach risks removing such moral responsibility.

Place, publisher, year, edition, pages
Dordrecht, Netherlands: Springer, 2017
Keywords
Ethics, health personnel, moral case deliberation, ethics consultation, ethics committees, ethics rounds, ethical reflection
National Category
Medical and Health Sciences Medical Ethics
Identifiers
urn:nbn:se:oru:diva-64288 (URN)10.1007/s10730-017-9325-4 (DOI)000415616200004 ()28600658 (PubMedID)2-s2.0-85020624322 (Scopus ID)
Funder
Stiftelsen Olle Engkvist Byggmästare
Note

Funding Agency:

Örebro University

Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-11-29Bibliographically approved
Rasoal, D., Kihlgren, A. & Svantesson, M. (2017). ‘It’s like sailing’: experiences of the role as facilitator during moral case deliberation. Clinical Ethics, 12(3), 1-8
Open this publication in new window or tab >>‘It’s like sailing’: experiences of the role as facilitator during moral case deliberation
2017 (English)In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 3, p. 1-8Article in journal (Refereed) Published
Abstract [en]

Moral case deliberation is one form of clinical ethics support, and there seems to be different ways of facilitating thedialogue. This paper aimed to explore the personal experiences of Swedish facilitators of their role in moral casedeliberations. Being a facilitator was understood through the metaphor of sailing: against the wind or with it. Therole was likened to a sailor’s set of skills: to promote security and well-being of the crew, to help crew navigate theirmoral reflections, to sail a course into the wind against homogeneity, to accommodate the crew’s needs and just sail withthe wind, and to steer towards a harbour with authority and expertise. Balancing the disparate roles of being accom-modative and challenging may create a free space for emotions and ideas, including self-reflection and consideration ofmoral demands. This research opens the question of whether all these skills can be taught through systematic training orwhether facilitators need to possess the characteristics of being therapeutic, pedagogical, provocative, sensitive andauthoritarian.

Place, publisher, year, edition, pages
United Kingdom: Royal Society of Medicine Press, 2017
Keywords
Ethics, clinical ethics, ethics consultation, moral case deliberation, healthcare professionals
National Category
Medical and Health Sciences Medical Ethics
Research subject
Health and Medical Care Research
Identifiers
urn:nbn:se:oru:diva-64287 (URN)DOI: 10.1177/1477750917710882 (DOI)2-s2.0-85029502486 (Scopus ID)
Projects
NUPARC
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-08-13Bibliographically approved
Göransson, C., Wengström, Y., Ziegert, K., Langius-Eklöf, A., Eriksson, I., Kihlgren, A. & Blomberg, K. (2017). Perspectives of health and self-care among older persons: to be implemented in an interactive interactive information and communication technology-platform. Journal of Clinical Nursing, 26(23-24), 4745-4755
Open this publication in new window or tab >>Perspectives of health and self-care among older persons: to be implemented in an interactive interactive information and communication technology-platform
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2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4745-4755Article in journal (Refereed) Published
Abstract [en]

AIM AND OBJECTIVES: To acquire knowledge regarding the contents to be implemented in an interactive ICT-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves.

BACKGROUND: The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform (ICT-platform) could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals.

DESIGN: Descriptive qualitative design.

METHODS: This study was based on three samplings: a scoping review of the literature (n=20 articles), interviews with healthcare professionals (n=5), and a secondary analysis of interviews with older persons (n=8) and nursing assistants (n=7). The data were analysed using qualitative content analysis.

RESULTS: Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons.

CONCLUSIONS: The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive ICT-platform for use in regular daily care assessments. Descriptions of self-care was limited indicating a possible gap in knowledge that requires further research.

RELEVANCE TO CLINICAL PRACTICE: Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Health status, information-communication technology, nursing care, older persons, qualitative content analysis, self-care
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-56862 (URN)10.1111/jocn.13827 (DOI)000416319600087 ()28334519 (PubMedID)
Note

Funding Agencies:

Faculty of Medicine and Health, School of Health Sciences, Örebro University  

School of Health and Welfare, Halmstad University 

Available from: 2017-03-28 Created: 2017-03-28 Last updated: 2017-12-19Bibliographically approved
Kihlgren, A., Svensson, F., Lövbrand, C., Gifford, M. & Adolfsson, A. (2016). A Decision support system (DSS) for municipal nurses encountering health deterioration among older people. BMC Nursing, 15, Article ID 63.
Open this publication in new window or tab >>A Decision support system (DSS) for municipal nurses encountering health deterioration among older people
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2016 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, article id 63Article in journal (Refereed) Published
Abstract [en]

Backgrund: This study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver.

Methods: This study has an explanatory approach, commencing with quantitative data collection phase followed by qualitative data arising from focus group discussions over the RNs professional experience using the Decision Support system. Focus group discussions were performed to complement the quantitative data to get a more holistic view of the decision support system.

Results: Using elements of the decision support system (vital parameters for saturation, pain and affected general health) together with the nurses' decision showed that 94 % of the older persons referred to hospital were ultimately hospitalized. Nurses felt that they worked more systematically, communicated more effectively with others and felt more professional when using the decision support system.

Conclusions: The results of this study showed that, with the help of a decision support system, the correct patients are sent to the Emergency Department from municipal home care. Unnecessary referrals of older patients that might lead to poorer health, decreased well-being and confusion can thus be avoided. Using the decision support system means that healthcare co-workers (nurses, ambulance/emergency department/district doctor/SOS alarm) begin to communicate more optimally. There is increased understanding leading to the risk of misinterpretation being reduced and the relationship between healthcare co-workers is improved. However, the decision support system requires more extensive testing in order to enhance the evidence base relating to the vital parameters among older people and the use of the decision support system.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2016
Keywords
Elderly, Emergency care, Decision-making, Nursing homes and referral
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-53490 (URN)10.1186/s12912-016-0184-0 (DOI)000387609500001 ()27833455 (PubMedID)2-s2.0-84994497582 (Scopus ID)
Note

This paper present independent researcher funded by the Region Örebro lanand ViSam project, Örebro municipal and The Faculty of Medicine at Örebro University.

Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2018-07-17Bibliographically approved
Algilani, S., James, I. & Kihlgren, A. (2016). Experiencing Participation in Health Care: “Through the Eyes of Older Adults”. Open Journal of Nursing, 6(1), 62-77
Open this publication in new window or tab >>Experiencing Participation in Health Care: “Through the Eyes of Older Adults”
2016 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 6, no 1, p. 62-77Article in journal (Refereed) Published
Abstract [en]

Background: Patient participation is well understood by health care professionals but not many studies have focused on the older adults and their perceptions of patient participation.

Aim and Objectives: To report an analysis of the concept of participation from the perspective of the older adult. Design: Concept analysis.

Methods: An integrative review approach was undertaken and the searches were limited from January 2003 to December 2014, guiding question was; “what constitutes patient participation according to the older adult?”

Results: Through the eyes of the older adults, a two-way communication should be initiated by the staff. Equality and sharing power between older adults and staffs was perceived as a precondition. Been given time was an essential issue, implying that older adults wished to have enough time from staffs and be in the right context surrounded by the appropriate environment in order to experience participation.

Conclusion: In order to experience participation for older adults, it is important that the health care professionals are aware of how and in what ways they can contribute to participation among older adults. The need or wish to create participation is not enough; the health care professional needs to see and understand participation through the older adult’s eyes. Thus, a person-centered nursing approach is relevant for the health care professional in order to both give and maintain the experience of participation to the older adult.

Place, publisher, year, edition, pages
Irvine, USA: Scientific Research Publishing, 2016
Keywords
Concept Analysis, Patient Participation, Older Adults’ Perspective, Nursing
National Category
Medical and Health Sciences Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-48458 (URN)10.4236/ojn.2016.61007 (DOI)
Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2017-11-30Bibliographically approved
Algilani, S., Östlund-Lagerström, L., Schoultz, I., Brummer, R. J. & Kihlgren, A. (2016). Increasing the qualitative understanding of optimal functionality in older adults: a focus group based study. BMC Geriatrics, 16(1), Article ID 70.
Open this publication in new window or tab >>Increasing the qualitative understanding of optimal functionality in older adults: a focus group based study
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2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, article id 70Article in journal (Refereed) Published
Abstract [en]

Background: Decreased independence and loss of functional ability are issues regarded as inevitably connected to old age. This ageism may have negative influences on older adults' beliefs about aging, making it difficult for them to focus on their current ability to maintain a good health. It is therefore important to change focus towards promoting Optimal Functionality (OF). OF is a concept putting the older adult's perspective on health and function in focus, however, the concept is still under development. Hence, the aim was to extend the concept of optimal functionality in various groups of older adults.

Methods: A qualitative study was conducted based on focus group discussions (FGD). In total 6 FGDs were performed, including 37 older adults from three different groups: group 1) senior athletes, group 2) free living older adults, group 3) older adults living in senior living homes. All data was transcribed verbatim and analyzed following the process of deductive content analysis.

Results: The principal outcome of the analysis was "to function as optimally as you possibly can", which was perceived as the core of the concept. Further, the concept of OF was described as multifactorial and several new factors could be added to the original model of OF. Additionally the findings of the study support that all three cornerstones comprising OF have to occur simultaneously in order for the older adult to function as optimal as possible.

Conclusions: OF is a multifaceted and subjective concept, which should be individually defined by the older adult. This study further makes evident that older adults as a group are heterogeneous in terms of their preferences and views on health and should thus be approached as such in the health care setting. Therefore it is important to promote an individualized approach as a base when caring for older adults.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2016
Keywords
Older adults, optimal functionality, person centered care, focus group discussions
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:oru:diva-49605 (URN)10.1186/s12877-016-0244-z (DOI)000372822200002 ()27007861 (PubMedID)
Funder
Knowledge Foundation, 20110225
Note

Funding Agencies:

Olle Engkvist Byggmästare Foundation

Faculty of Medicine and Health at Örebro University

Available from: 2016-04-02 Created: 2016-04-02 Last updated: 2018-04-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2873-4247

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