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Östlund, U., Blomberg, K., Söderman, A. & Werkander Harstäde, C. (2019). How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care. BMC Palliative Care, 18(1), Article ID 10.
Open this publication in new window or tab >>How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care
2019 (English)In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 18, no 1, article id 10Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: An essential aspect of palliative care nursing is to conserve the dignity of the patient. A Dignity Care Intervention (DCI) has been developed in Scotland to facilitate this role for nurses. The DCI is now being adapted to a Swedish context (DCI-SWE) and a central step is to identify culturally relevant, dignity-conserving care actions. These care actions will be incorporated into the DCI-SWE. Therefore, the aim of this study was to suggest care actions for conserving dignity in palliative care from the perspectives of the patients, significant others (SOs), and health care professionals (HPs) in municipality care in Sweden.

METHODS: This study used a descriptive design with a qualitative approach. Data from 20 participants were collected through semi-structured individual interviews with patients (n = 3), SOs (n = 4), two focus groups with nurses (n = 9) and one focus group with physicians (n = 4) in two Swedish municipalities. These data were deductively analysed using qualitative content analysis with the Chochinov model of dignity as framework.

RESULTS: With the Chochinov model of dignity as a framework, care actions based on suggestions from the participants were identified and presented under three themes: Illness related concerns, Dignity conserving repertoire, and Social dignity inventory. The study found both specific concrete care actions and more general approaches. Such general approaches were found to be relevant for several dignity related issues as all-embracing attitudes and behaviours. However, these general approaches could also be relevant as specific care actions to conserve dignity in relation to certain issues. Care actions were also found to be linked to each other, showing the importance of a holistic perspective in conserving dignity.

CONCLUSIONS: As part of the adaption of the DCI from a Scottish to a Swedish context, this study added relevant care actions for collaborative planning of individualised care in mutual dialogues between nurses and those they care for. The adapted intervention, DCI-SWE, has the potential to help the nurses in providing palliative care of evidence-based quality.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Care actions, Community nursing, DCI-SWE, Dignity, Dignity care intervention, End of life care, Palliative care, Person centred, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-71849 (URN)10.1186/s12904-019-0393-x (DOI)000457121700002 ()30678669 (PubMedID)2-s2.0-85060556337 (Scopus ID)
Funder
The Kamprad Family Foundation, 20152002
Note

Funding Agencies:

Ulrika Crones Foundation from the Swedish Society of Nursing 

Faculty of Medicine and Health, Örebro University 

Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-03-26Bibliographically approved
Blomberg, K., Lindqvist, O., Harstäde, C. W., Söderman, A. & Östlund, U. (2019). Translating the Patient Dignity Inventory. International Journal of Palliative Nursing, 25(7), 334-343
Open this publication in new window or tab >>Translating the Patient Dignity Inventory
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2019 (English)In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 25, no 7, p. 334-343Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Patient Dignity Inventory (PDI) is based on an empirically-driven dignity model that has been developed and used for clinically assessing the various sources of dignity-related distress. In a recent review, it received the highest score as a useful instrument in both practice and research in palliative care. The PDI has been adapted to and validated for use in various countries, but not yet Sweden.

AIMS: To translate the PDI into Swedish, including cultural adaptation for clinical use.

METHODS: A multi-step process of translation, negotiated consensus, expert group discussion (n=7: four invited experts and three researchers) and cognitive interviewing (n=7: persons with palliative care needs).

FINDINGS: Discussion, by the expert reviewers, of both linguistic and cultural issues regarding the content and readability of the translated Swedish version resulted in revisions of items and response alternatives, focusing mainly on semantic, conceptual, and experiential equivalence. A pilot version for cognitive interviews was produced. The analysis of data showed that most of the items were judged to be relevant by the persons with palliative care needs.

CONCLUSION: The process of translation and adaptation added clarity and consistency. The Swedish version of the PDI can be used in assessing dignity-related distress. The next step will be to test this Swedish version for psychometric properties in a larger group of patients with palliative care needs before use in research.

Place, publisher, year, edition, pages
Pensord Press Ltd., 2019
Keywords
Dignity, End-of-life care, Patient Dignity Inventory, Patient-reported outcomes
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-75340 (URN)10.12968/ijpn.2019.25.7.334 (DOI)000476486800004 ()31339819 (PubMedID)2-s2.0-85069683349 (Scopus ID)
Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-08-12Bibliographically approved
Söderman, A., Östlund, U., Werkander Harstäde, C. & Blomberg, K. (2018). En intervention för att bevara sköra äldre personers värdighet: utveckling och anpassning till en svensk kontext . In: Forskningen och utvecklingens dag, 2018: . Paper presented at Forskningen och utvecklingens dag, Örebro, Sweden, 12 April, 2018. Örebro
Open this publication in new window or tab >>En intervention för att bevara sköra äldre personers värdighet: utveckling och anpassning till en svensk kontext
2018 (Swedish)In: Forskningen och utvecklingens dag, 2018, Örebro, 2018Conference paper, Oral presentation only (Other academic)
Abstract [sv]

Bakgrund: Utvärdering av palliativ vård i Sverige har visat att vården är ojämlik och att äldre personer får sämre palliativ vård. För att främja äldre personers livskvalitet den sista tiden i livet är bevarande av värdighet grundläggande. Förlust av värdighet kan innebära förtvivlan, en känsla av att vara en börda för andra och en önskan om att få dö, vanliga upplevelser hos sköra äldre personer. Konkreta arbetssätt behöver därför utvecklas för att bevara äldre personers värdighet, vilket idag saknas inom svensk palliativ vård. En värdighetsbevarande intervention (DCI) har utvecklats och prövats i Skottland och Irland. Interventionen består av ett formulär för kartläggning av värdighet, reflekterande frågor samt evidensbaserade vårdhandlingar.

Syfte: Syftet var att utveckla och anpassa DCI till en svensk kontext.

Metod: Utveckling och kulturanpassning skedde genom 1) översättning och anpassning av formuläret till svensk kontext via en expertpanel och via kognitiva intervjuer med äldre personer 2) identifiering av värdighetsbevarande vårdhandlingar relevanta för en svensk kontext, utifrån en litteraturgenomgång samt via intervjuer med äldre personer, deras närstående och vårdpersonal.

Resultat: Mindre revideringar av formuläret genomfördes, men överlag accepterades det av de äldre personerna. Identifierade värdighetsbevarande vårdhandlingar speglade mestadels de redan angivna i originalversionen DCI. Dock framkom fler vårdhandlingar än i originalet vid några av kategorierna i den svenska DCI (DCI-SWE) som t.ex. ”socialt stöd”, medan det framkom färre vårdhandlingar än originalet vid t.ex. ”dödens följder för andra”. I DCI-SWE konkretiserades generella vårdhandlingar som t.ex. att lyssna och visa respekt, till skillnad från originalet.

Konklusion: DCI-SWE har möjlighet att främja sköra äldre personers värdighet, och prövas nu av sjuksköterskor i en genomförbarhetsstudie inom hemsjukvården.

Place, publisher, year, edition, pages
Örebro: , 2018
Keywords
Värdighet, palliativ vård
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-67361 (URN)
Conference
Forskningen och utvecklingens dag, Örebro, Sweden, 12 April, 2018
Projects
Dignity Care Project
Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2019-03-26Bibliographically approved
Söderman, A., Östlund, U., Werkander Harstäde, C. & Blomberg, K. (2018). Enhancing dignity in older persons in Sweden: adaptation of the Dignity Care Intervention. In: 24th Nordic Congress of Gerontology: . Paper presented at 24th Nordic Congress of Gerontology, Oslo, Norway, 2-4 May, 2018.
Open this publication in new window or tab >>Enhancing dignity in older persons in Sweden: adaptation of the Dignity Care Intervention
2018 (English)In: 24th Nordic Congress of Gerontology, 2018Conference paper, Oral presentation only (Other academic)
Abstract [en]

Background : In end of life, the older persons´ experiences of dignity can be affected due to serious illness and life changes, derived from physical, psychological, social and existential dimension. Loss of dignity impact the persons´ will to live. The Dignity Care Intervention (DCI) was developed and tested in Scotland and Ireland, to enhance dignity of older persons with palliative care needs, by nurses in municipality care. DCI consists a patient dignity inventory, reflective questions and examples of evidence-based care actions.

The aim was to develop and adapt the DCI to a Swedish context.

Methods: The patient dignity inventory was overall accepted by older persons in home care, however some changes in the wording were performed. The Swedish care actions reflected mostly earlier care actions described in the original version. However some more care actions derived in some of the categories in the Swedish DCI (DCI-SWE) e.g. “social support”, and some less care actions derived for example in the category “aftermath concerns”.  In DCI-SWE general care actions like e.g. to show respect were concretized unlike the original DCI.

Conclusions: The DCI-SWE has prospects to enhance older persons´ dignity, and is now tested in a feasibility study by twelve nurses in home care.

Keywords
Dignity, End of life care, Palliative Care
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-67366 (URN)
Conference
24th Nordic Congress of Gerontology, Oslo, Norway, 2-4 May, 2018
Projects
Dignity Care Project
Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2019-03-26Bibliographically approved
Alexopoulou, S., Fart, F., Jonsson, A.-S., Karni, L., Kenalemang, L. M., Krishna, S., . . . Widell, B. (2018). Successful ageing in an interdisciplinary context: popular science presentations. Örebro: Örebro University
Open this publication in new window or tab >>Successful ageing in an interdisciplinary context: popular science presentations
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2018 (English)Book (Other (popular science, discussion, etc.))
Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 127
National Category
Gerontology, specialising in Medical and Health Sciences Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:oru:diva-66306 (URN)978-91-87789-18-2 (ISBN)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2019-03-26Bibliographically approved
Söderman, A., Östlund, U., Werkander Harstäde, C. & Blomberg, K. (2018). The adaptation of the Dignity Care Intervention to a Swedish context. In: Nordic Conference in Nursing Research - Methods and Networks for the future, 2018: . Paper presented at Nordic Conference in Nursing Research - Methods and Networks for the future, Oslo, Norway, 13-15 June, 2018.
Open this publication in new window or tab >>The adaptation of the Dignity Care Intervention to a Swedish context
2018 (English)In: Nordic Conference in Nursing Research - Methods and Networks for the future, 2018, 2018Conference paper, Oral presentation only (Other academic)
Abstract [en]

Background: The Dignity Care Intervention (DCI) was developed in Scotland by Johnston and co-workers for nurses in municipality care, to enhance dignity in persons with palliative care needs. DCI includes a questionnaire, examples of reflective questions and suggests care actions. DCI has been tested in Ireland, and is now adapted to Swedish.

Objective: To translate and adapt the DCI to a Swedish palliative context.

Method: The questionnaire was translated and adapted into Swedish and reviewed by an expert group, before validated in cognitive interviews (N=7) with older persons. To update evidence concerning care actions from a Swedish context, a review of Swedish research literature and interviews with older persons, relatives and health care professionals were carried out. This gathered knowledge has been integrated into the Swedish DCI (DCI-SWE) and a feasibility study now takes place in one municipality in home care, Sweden. Included nurses got repeated information and participated in a shorter DCI-education, and will use the DCI in their everyday work for three months. Follow-up interviews will be conducted and analysed with qualitative content analysis.

Results: The Swedish version of the questionnaire was experienced relevant for older persons, and both the Swedish review and the interviews gave culturally relevant proposals about dignity care actions. Further, a feasibility study will contribute to the ongoing development of the Swedish DCI-version.

Conclusion and implication for practice: Implementing DCI in Sweden can enhance dignity in persons with palliative care needs and facilitate for a person-centered care.

Keywords
Dignity, End of Life, Palliative Care
National Category
Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-67367 (URN)
Conference
Nordic Conference in Nursing Research - Methods and Networks for the future, Oslo, Norway, 13-15 June, 2018
Projects
Dignity Care Project
Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2019-03-26Bibliographically approved
Werkander Harstäde, C., Blomberg, K., Söderman, A., Benzein, E. & Östlund, U. (2016). Anpassning av “the Dignity Care Intervention” till svenska förhållanden. In: : . Paper presented at 4:e Nationella konferensen i palliativ vård, Malmö, Sweden, 15-16 mars, 2016.
Open this publication in new window or tab >>Anpassning av “the Dignity Care Intervention” till svenska förhållanden
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2016 (Swedish)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-54280 (URN)
Conference
4:e Nationella konferensen i palliativ vård, Malmö, Sweden, 15-16 mars, 2016
Available from: 2017-01-04 Created: 2017-01-04 Last updated: 2019-03-26Bibliographically approved
Werkander Harstäde, C., Blomberg, K., Söderman, A. & Östlund, U. (2015). Adapting the Dignity Care Intervention to a Swedish Context. In: 978-0-9542022-3-1: . Paper presented at 14th Congress of the European Association for Palliative Care, Copenhagen, Denmark, 8-10 May, 2015.
Open this publication in new window or tab >>Adapting the Dignity Care Intervention to a Swedish Context
2015 (English)In: 978-0-9542022-3-1, 2015Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Abstract number: P1-212 Abstract type: Poster Adapting the Dignity Care Intervention to a Swedish Context WerkanderHarstäde C. 1 , Blomberg K. 2 , Söderman A. 2 ,ÖstlundU. 1 1 Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Kalmar, Sweden, 2 Örebro University, School of Health and Medical Sciences, Örebro, Sweden Presenting author email address: ulrika.ostlund@lnu.se Aims: The Dignity Care Intervention (DCI) was developed in Scotland to be used by community nurses caring for patients with palliative care needs, with an aim to conserve patients’sense of dignity. The DCI includesthe Patient Dignity Inventory (PDI) that is used to identify dignity related concerns. In a dialogue with the patient, the nurse discussidentified concerns and waysto addressthem by using reflective questions and evidence based care actions provided in the DCI. The DCI is now translated and adapted for implementation in Swedish palliative care. Design, method, and approach: DCI is based on Chochinovs model of dignity and the PDI is one key component. Two researchersindependently translated the model and the inventory from English to Swedish and the research group examined the translationstogether with the original versions. An expert review focusing on items and response alternatives was accomplished followed by cognitive interviews with patients answering the preliminary Swedish version of the PDI. Evidence based care actions were updated with Swedish publicationssuch astheses, clinical guidelines and governmental publications. Results: Swedish versions of the model of dignity and the PDI were produced, the process of translation and adaptation added clarity and consistency. From the review of Swedish publications, care actions were adapted and updated. Conclusions: The focus has been on achieving cultural relevance which might have affected equivalence to the original model of dignity and the PDI. To get local context evidence for care actions, focus group interviews will be conducted with nurses, physicians, patients and family members. After the process of adapting the DCI it will be implemented and evaluated in clinicalsettings. Two clinicalsettings have agreed to collaborate in this phase. Implementing the culturally adapted DCI will be a way for nursesto provide evidence based and person centred palliative care.

National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-47062 (URN)
Conference
14th Congress of the European Association for Palliative Care, Copenhagen, Denmark, 8-10 May, 2015
Available from: 2015-12-11 Created: 2015-12-11 Last updated: 2019-03-26Bibliographically approved
Söderman, A. & Jackson, K. (2011). Barn som far illa i sin hemmiljö: BVC-sjuksköterskors upplevelser av att möta och hjälpa barnen.. Vård i Norden, 31(4), 38-42
Open this publication in new window or tab >>Barn som far illa i sin hemmiljö: BVC-sjuksköterskors upplevelser av att möta och hjälpa barnen.
2011 (Swedish)In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 31, no 4, p. 38-42Article in journal (Refereed) Published
Abstract [en]

ABSTRACT

Aim: The aim of this study was to describe child health nurses (CHN´s) experiences of meeting and helping the children exposed to child abuse in the home environment.

Background: CHN´s have the opportunity to come close to families and support them. This support may strengthen the parental role which can improve the child's environment and provide help to children exposed to child abuse.

Methods: A descriptive design with a qualitative approach (content analysis) was used. Six CHN´s were interviewed.

Findings: The experience of to obtain an insight into the child maltreatment was described. The CHN´s experienced their meeting with child abuse as a difficult task e.g. to take a decision to notify the social services and the CHN as the child´ s agent. The CHN´s also had experiences of both providing and receiving support.

Conclusions: CHN´s have a number of difficult tasks like meeting abused children. Through experience and support from colleges the CHN´s can reach a higher confidence in their own capacity of helping the children. This can affect how fast the CHN take the necessary decision to report to social services when a child is abused.

KEYWORDS: Child abuse, Care failure, Child health care, Child health nurse, Failure to thrive.

Place, publisher, year, edition, pages
Oslo: , 2011
Keywords
Child abuse, Care failure, Child health care, Child health nurse, Failure to thrive
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-29709 (URN)
Note

VÅRD I NORDEN 4/2011. PUBL. NO. 102 VOL. 31 NO. 1 PP 38–42

Available from: 2013-06-24 Created: 2013-06-24 Last updated: 2019-03-26Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8661-004x

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