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  • 1.
    Algilani, Samal
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Karolinska Institutet, Stockholm, Sweden.
    Individualised care with modern technology: Usability and Feasibility of an E-health platform including a Health measure, Self-Care advices and Alarms2013Conference paper (Refereed)
  • 2.
    Algilani, Samal
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Experiencing Participation in Health Care: “Through the Eyes of Older Adults”2016In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 6, no 1, p. 62-77Article in journal (Refereed)
    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.

  • 3.
    Algilani, Samal
    et al.
    Örebro University, School of Health Sciences.
    Langius-Ekelöf, Ann
    Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    An interactive ICT-platform for early assessment and management of patient-reported concerns among older adults living in Ordinary Housing: Development and FeasibilityManuscript (preprint) (Other academic)
  • 4.
    Algilani, Samal
    et al.
    Örebro University, School of Health Sciences.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    An interactive ICT-platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing: development and feasibility2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 11-12, p. 1575-1583Article in journal (Refereed)
    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.

  • 5.
    Algilani, Samal
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langius-Eklöf, Ann
    Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Can assessment of health on a ICT-platform improve optimal functionality and lead to participatory care among older adults?2014In: eTELEMED 2014, The Sixth International Conference on eHealth, Telemedicine and Social Medicine, Wilmington DE: International Academy, Research and Industry Association (IARIA), 2014, p. 201-204Conference paper (Refereed)
    Abstract [en]

    The number of people reaching old age is increasing rapidly, challenging the society and healthcare to promote healthy and meaningful aging. There is, and has been for a few years, a big interest in collecting patient reported outcomes (PROs) as a base for clinical management. Information and communication technology (ICT) and assistive technology in elderly care increase and may facilitate the care of older adults as they are moved from nursing homes to private homes. An ICT-platform for reporting health issues with immediate access to self-care advice and direct communication with healthcare professionals has been developed. The overall aim of this project is to evaluate the effects of the interactive ICT-platform regarding optimal functionality and participatory care. The project will be conducted in three phases: development of the ICT-platform, evaluating feasibility and evaluation of effects. The platform is unique by integrating interactive components for direct clinical management and needs to be thoroughly evaluated before implementation in daily practice. It is hypothesized that by using an interactive ICT-platform, it will promote participatory care and enhance the communication between older adults and their professional carers. The platform will be further developed, as well as test in a full-scale study.

  • 6.
    Algilani, Samal
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Östlund-Lagerström, Lina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Brummer, Robert Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Schoultz, Ida
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Exploring the concept of optimal functionality in old age2014In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 7, p. 69-79Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Aging is characterized by loss of function and represents a perspective that puts the focus on the negative aspects of aging. Thus, it is fundamental to shift the focus from loss of function to maintaining good health and personal satisfaction through life; in other words, to promote optimal functionality at a level appropriate for older adults. However, it is not yet known what constitutes optimal functionality from the older adult's own perspective.

    OBJECTIVE: To explore the concept of optimal functionality in old age from the older adult's perspective (ie, people over 65 years of age) in industrialized Western countries.

    METHODS: We undertook a scoping review and searched two electronic databases (PubMed and the Cumulative Index to Nursing and Allied Health Literature [CINAHL]) from January 2002 to July 2013 for scientific studies, using the key search term personal satisfaction. In total, 25 scientific studies were analyzed.

    RESULTS: Only six of the included articles applied a qualitative methodology. By analyzing the results of these articles, three major themes were identified as cornerstones in the concept of optimal functionality at old age: 1) self-related factors (eg, mental well-being); 2) body-related factors (eg, physical well-being); and 3) external factors equal to demographic and environmental factors.

    CONCLUSION: There is a lack of qualitative studies in the current literature, and hence of what constitutes optimal functionality from the older adult's perspective. The results outlined in this review identify three cornerstones (self-related factors, body-related factors, and external factors) of what constitutes optimal functionality at old age. However, it is vital that these findings are taken further and are evaluated through qualitative studies to reflect older adults' opinions.

  • 7.
    Algilani, Samal
    et al.
    Örebro University, School of Health Sciences.
    Östlund-Lagerström, Lina
    Örebro University, School of Medical Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Schoultz, Ida
    Örebro University, School of Medical Sciences.
    Schröder, Agneta
    Örebro University, School of Health Sciences.
    Mental health as a prerequisite for functioning as optimally as possible in old age: a phenomenological approachManuscript (preprint) (Other academic)
  • 8.
    Algilani, Samal
    et al.
    Örebro University, School of Health Sciences.
    Östlund-Lagerström, Lina
    Örebro University, School of Medical Sciences.
    Schoultz, Ida
    Örebro University, School of Medical Sciences.
    Brummer, Robert J.
    Örebro University, School of Medical Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Increasing the qualitative understanding of optimal functionality in older adults: a focus group based study2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, article id 70Article in journal (Refereed)
    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.

  • 9.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, School of Health and Medical Sciences.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences.
    Sörlie, Venke
    Högskolan i Bodö.
    Embodied suffering: experiences of fear in adolescent girls with cancer2008In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 12, no 2, p. 129-143Article in journal (Refereed)
    Abstract [en]

    Previously, fear in adolescents with cancer has been sparsely described from an emic perspective. The aim of this study was to illuminate fear in adolescents with personal experience of cancer. The participants were six adolescent girls between the age of 14 and 16 years who were no longer under active treatment for cancer but still went for regular check-ups. Open interviews were conducted. Data were analysed according to the phenomenological hermeneutic method. In the result one main theme was identified: `an embodied fear — a threat to the personal self'. This theme was built up by three separate but intertwined themes: `experiencing fear related to the physical body', `experiencing existential fear' and `experiencing fear related to the social self'. In the comprehensive understanding the fear was interpreted from youth cultural aspects as well as a holistic perspective. The importance of professionals taking the whole person and their situation into account when meeting the fear is underlined.

  • 10.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Sörlie, Venke
    Lovisenberg Deaconal University College, Oslo, Norway.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dealing with fear: from the perspective of adolescent girls with cancer2012In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 16, no 3, p. 286-292Article in journal (Refereed)
    Abstract [en]

    Background: Previously fears in adolescents with cancer has been identified in relation to medical procedures, death, altered appearance and as having an overall influence on life, but to our knowledge young people's perspectives on dealing with fear have not been previously investigated.

    Purpose: To examine adolescents' perspectives on dealing with cancer related fear.

    Methods and sample: Six girls participated in qualitative interviews focussing on their fear and and how they dealt with it. Data were analysed by means of qualitative content analysis.

    Results: The results revealed two perspectives. First, the adolescents' own personal battle with fear. Second, they reported that they were not alone with their fear, as they shared it with significant others. An environment characterized by emotional presence helped them to deal with their fear, as well as prevented it from occurring.

    Conclusions: There is a need for staff and parents to be vigilant to the adolescents' need to feel cared for and allow them the opportunity to deal with their own fear, as at times they want to manage in their own way. Young patients have resources to cope with their fears and therefore should not be viewed as victims, but as young people with a great amount of competence, who benefit from a supportive environment.

  • 11.
    Blomberg, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Meanings over time of working as a nurse in elderly care2013In: The open nursing journal, ISSN 1874-4346, Vol. 7, p. 107-113Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as "low status" in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time.

    AIM: The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs.

    METHOD: We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description.

    RESULTS: The results show similarities and differences over time in the RNs' reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities.

    CONCLUSION: An RN's intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.

  • 12.
    Blomberg, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ohlsson, Ulla
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Views on leadership and competence among formal leaders in care of older adults: differences over time2013In: Journal of General Practice, ISSN 2329-9126, Vol. 1, no 4Article in journal (Refereed)
    Abstract [en]

    Background: Leaders play an essential role in the health care of older adults. The leadership role has changed over the years because of new demands in providing care for older adults with multiple chronic conditions, as well as a lack of resources.

    Aim: The aim of this study was to describe formal leaders’ views over time on their leadership and the competence among staff in care of older adults.Method: Individual interviews and focus group discussions with leaders in care of older adults were conducted with a total of 46 formal leaders in 2000 (n=20) and 2011 (n=26). The analysis took a qualitative approach, using interpretative description.

    Results: The leaders’ descriptions of leadership encompassed two different views on leadership over time, from “I as a leader” to “We together”. The leaders interviewed in 2011 saw practical wisdom (phronesis) as a central aspect of staff competence. Throughout the interviews, a greater focus on personal characteristics was seen over time.

    Conclusions: Differences over time in views of the leaders’ role and staff competence, especially the increased focus on personal characteristics, may have an impact on the health care provided to older adults. This is particularly true if formal education is not prioritized. Strategies within organizations and continuing development and education must take these changes into consideration

  • 13. Flackman, Birgitta
    et al.
    Fagerberg, Ingegerd
    Haggstrom, Elisabeth
    Kihlgren, Annica
    Örebro University, Department of Nursing and Caring Sciences.
    Kihlgren, Mona
    Despite shattered expectations a willingness to care for elders remains with education and clinical supervision2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 3, p. 379-389Article in journal (Refereed)
    Abstract [en]

    The aim was to describe nursing home (NH) caregivers' work experiences while receiving education and clinical supervision for 2 years. Working in elder care seems to be losing its attraction especially with organizational changes, cutbacks and changes in work place conditions. Clinical supervision has been reported to increase job satisfaction and creativity. Semi-structured interviews from caregivers working at an NH in Sweden were conducted, at the start and again at 12 and 24 months. At about 12 months the caregivers were informed of planned cutbacks. Content analysis was the method used to analyse the interviews from seven caregivers who participated throughout the entire period. Findings show that the value of a caring milieu was one category generated by the subcategories: experiences related to work activities and changes, and experiences related to relationships. The value of knowledge was the other category that was influenced by the experiences related to the different backgrounds and the experiences related to increased knowledge gained from the support through education and clinical supervision. The categories contained positive as well as negative influences on care. The initial focus on practical duties associated with the opening of the NH shifted towards caregiver activities with the elders they spoke warmly about. After 2 years the caregivers' willingness to care continued despite their disappointment in the worsened working conditions. The main theme that resulted was: Despite shattered expectations a willingness to care for elders remained. Continued education and clinical supervision seems to be one factor behind the retained willingness. These findings demonstrate that support and caregiver involvement in educational programmes are important during times of change and when disappointments arise in the workplace.

  • 14. Flackman, Birgitta
    et al.
    Hansebo, Gorel
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences.
    Struggling to adapt: caring for older persons while under threat of organizational change and termination notice2009In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 16, no 1, p. 82-91Article in journal (Refereed)
    Abstract [en]

    FLACKMAN B, HANSEBO G and KIHLGREN A. Nursing Inquiry 2009; 16: 82-91 Struggling to adapt: caring for older persons while under threat of organizational change and termination notice Organizational changes are common in elder care today. Such changes affect caregivers, who are essential to providing good quality care. The aim of the present study was to illuminate caregivers' experiences of working in elder care while under threat of organizational change and termination notice. Qualitative content analysis was used to examine interview data from 11 caregivers. Interviews were conducted at three occasions during a two-year period. The findings show a transition in their experiences from 'having a professional identity and self-confidence', to 'being a professional in a threatening situation caused by someone else' and to 'struggling to adapt to a changed working environment as a person and a professional'. The caregivers experienced a loss of pride and satisfaction. Previous literature indicates that this may have consequences for the quality of care and that employees may be at risk of negative health effects. However, the caregivers continued to struggle, doing their best to complete their duties. The study has implications for high-level decision-makers, managers and caregivers in similar work-life situations in that it deals with factors that facilitate or impede similar transitions.

  • 15.
    Fläckman, Birgitta
    et al.
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Skovdahl, Kirsti
    Faculty for Health Sciences, Buskerud and Vestfold University College, Drammen, Norway.
    Fagerberg, Ingegerd
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden; Faculty for Health Sciences, Buskerud and Vestfold University College, Drammen, Norway.
    Kihlgen, Mona
    Centre for Caring Sciences, Örebro University Hospital, Örebro, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Consequences of working in eldercare during organizational changes and cut backs while education and clinical supervision was provided: a mixed methods study2015In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 5, no 9, p. 813-827, article id 1440527Article, review/survey (Refereed)
    Abstract [en]

    Background: Reorganization and downsizing can disrupt a competent staff and conflicts can arise between what the employee is being asked to do and their knowledge and competences. Reduced job satisfaction among nursing home staff with increased workload and strain can occur.                                                                                                   

    Aim and Objectives: The aim was to investigate the organizational climate and prevalence of burnout symptoms among caregivers over time in three Swedish nursing homes (NH I-III) undergoing organizational changes, while education and clinical supervision were provided. Design: The study design combines qualitative and quantitative methods in a longitudinal two-year follow-up project in NH I-III.                                                                   

    Methods: Support through education and clinical supervision was provided for caregivers only at NH I and NH II. At NH I-III caregiver self-assessments and interviews were completed and analysed three different times. Results: NH I revealed improvement and increased innovation over time, while NH II showed a decline with no ability to implement new knowledge. NH III retained a more status quo.                                                                             

    Conclusions: Organizational changes and cutbacks, occurring at different times, appeared to cause major stress and frustration among the three personnel groups. They felt guilty about not meeting their perceived obligations, seemed to have lost pride in their work but kept struggling. The changes seemed to over-shadow attempts to improve working conditions through education and clinical supervision initially.                                               

    Implications for practice: It will be important to learn from reorganizations and the consequences they will have for the staff and quality of care. Important topics for future research are to study financial cutbacks and changes in organizational processes in care of older people to be able to develop a more person centered care for older people.

  • 16.
    Forslund, Kerstin
    et al.
    Örebro University, Department of Nursing and Caring Sciences. Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden.
    Kihlgren, Annica
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; CECAR, Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Mona
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; CECAR, Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    Operators' experiences of emergency calls2004In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 10, no 5, p. 290-7Article in journal (Refereed)
    Abstract [en]

    In Sweden, the operators at emergency dispatch centres are responsible for allocating resources (e.g. ambulances, fire brigade, police) in response to calls. We analysed situations that the emergency operators experienced as difficult and their reflections on how they managed them. Interviews were conducted with all 16 emergency operators at a centre that serves a population of 275,000 and receives about 700,000 emergency calls annually. A phenomenological-hermeneutic approach was used for the analysis. Situations that operators experienced as difficult were characterized by uncertainty, communication difficulties and insufficient resources. Skills, knowledge and experience were regarded as important in the management of these situations, as were personal qualities such as sensitivity, insight, empathy and intuition. The emergency operators stated that they needed more guidance, feedback and education in their work. This would lead to an increased sense of certainty, which would lead to decreased stress and a better outcome for those in need.

  • 17.
    Frost, Elisabeth
    et al.
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden; Karolinska University Hospital, Solna, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Experience of physician and nurse specialists in Sweden undertaking long distance aeromedical transportation of critically ill patients: A qualitative study2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013XArticle in journal (Refereed)
    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.

  • 18.
    Graaf [Olsson-Graaf], Tyra
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annika
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Communication patterns in coordinated care planning conferences with older patients2013In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 10, p. 35-49Article in journal (Refereed)
    Abstract [en]

    Background: When an older patient is discharged from a hospital in Sweden, a care plan in cooperation with the patient should be made through coordinated care planning (COCP). Previous research has described difficulties in the discharge process; consequently, it is important to develop additional knowledge and investigate both whether and how patients are given the opportunity to participate in COCP. The aim of the present study was to determine if older patients are given the opportunity to participate in COCP meetings, and if so, what characterizes these meetings.

    Method: This qualitative, descriptive study is based on non-participant observation of interactions between older patients and care staff at six COCP meetings. The data collected were analyzed using directed content analysis and critical discourse analysis (CDA).

    Results: The main findings indicate a lack of patient participation in all the COCP meetings held at the hospital. The dialogues in that context were less information intensive, and a professional perspective dominated. The situation in advanced home care (AHC) was the opposite; already from the outset, it was evident that the patient was the chief informant and that the patient’s perspective predominated during the dialogues.

    Conclusions: General differences in the way the dialogues were initiated and in how they progressed were observed between the hospital and AHC. Due to both shortage of time in health care today and financial issues, it is important to find solutions that incorporate the older patient’s experiences as well as professional knowledge.

  • 19.
    Göransson, Carina
    et al.
    Örebro University, School of Health Sciences. School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Eriksson, Irene
    School of Health and Education, University of Skövde, Skövde, Sweden.
    Ziegert, Kristina
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Wengström, Yvonne
    Cancer Theme, Karolinska University Hospital, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Langius-Eklöf, Ann
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Brovall, Maria
    School of Health and Education, University of Skövde, Skövde, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Testing an app for reporting health concerns: Experiences from older people and home care nurses2018In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, no 2, article id e12181Article in journal (Refereed)
    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.

  • 20.
    Göransson, Carina
    et al.
    Örebro University, School of Health Sciences. School of Health and Welfare, Halmstad University, Halmstad, Sweden .
    Wengström, Yvonne
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
    Ziegert, Kristina
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Langius-Eklöf, Ann
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Irene
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Perspectives of health and self-care among older persons: to be implemented in an interactive interactive information and communication technology-platform2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4745-4755Article in journal (Refereed)
    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.

  • 21.
    Göransson, Carina
    et al.
    School Of Social And Health Sciences, Halmstad university, Halmstad, Sweden.
    Ziegert, Kristina
    School Of Social And Health Sciences, Halmstad university, Halmstad, Sweden.
    Wengström, Yvonne
    Department Of Neurobiology, Care Science And Society, Karolinska institutet, Huddinge, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Feasibility and acceptability of an interactive ICT-platform in older adults for participatory care2015Conference paper (Refereed)
    Abstract [en]

    Background: The increasing ageing population puts demands on society and particularly on health care system to promote a health related quality of life. Thus, it is necessary to develop strategies that promote self-care among older adults that enable them to live in their own homes as long as possible and to make them feel safe and involved in their care. In order to encourage their participation in their care, new innovative solutions are needed. The market of information-and communication technology (ICT)-based platforms directed to the health care arena has exploded during recent years. Despite the large range of products few are developed with interactive components. In collaboration within a multicenter research group and a Swedish health care company (Health Navigator) an ICT-platform is developed for use in a mobile phone or tablet that includes an interactive mobile application for reporting problems and concerns. This platform is unique through the real-time communication enabling rapid management of earlydetected problems.

    Aim: The aim with the project is to evaluate an ICT-platform by older adults living in own homes with assistance from home care nurses in a community in Sweden.

    Method: The study is prospective and has a mixed methods approach advocated for the evaluation of new technologies within healthcare. This includes a quantitative approach to evaluate effects, qualitative methods such as interviews and focus group discussions to evaluate how patients and health care professionals perceive the intervention. The design is underpinned by the Medical Research Council’s complex intervention evaluation framework. Thirty older adults >65 years or above, living in their own homes, with assistance from home care nurses have through an application in a tablet reported health status twice a week and when needed during three months. They have continuous access to evidence based self-care advice directly related to their reported problems and concerns. The risk assessment model sends alarms to involved nurses via text messaging (SMS). This initiates an interaction between the nurse and the older adult who is contacted by telephone to discuss the reported problems. Furthermore, the nurses in charge can also log into a web-interface and view the reports of the participants. Individually interviews with the older adults and focus groups interviews with nurses are conducted after the study period. Questionnaires are given to the older adults before intervention, after the study´s completed and after six months with primarily main outcomes as self-care, health literacy and well-being. A control group with older adults 65 years and above is used as a comparison.

    Results: Preliminary results will be presented with focus on feasibility, acceptability and benefit of the ICT-platform from the perspective of older adults and home care nurses. Additional logged data on the frequency of symptom reports, alerts, and page views will also be presented.

    Summary: An interactive ICT-platform is developed and used by older adults to report problems and concerns which enabling rapid management of early-detected problems. This study aims to evaluate the ICT-platform by thirty older adults living in own home with assistance from home care nurses.

  • 22.
    Göransson, Carina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ziegert, Kristina
    Wengström, Yvonne
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The elderly persons´ experiences of reporting health status in an ICT-platform2015Conference paper (Refereed)
  • 23.
    Haggstrom, Elisabeth
    et al.
    Dept Caring Sci & Sociol, Univ Gavle, Gavle, Sweden.
    Mamhidir, Anna-Greta
    Dept Caring Sci & Sociol, Univ Gavle, Gavle, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences.
    Caregivers' strong commitment to their relationship with older people2010In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 16, no 2, p. 99-105Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to describe caregivers' good as well as bad experiences of working with older people. The study was based on five focus group interviews. One theme emerged from a latent content analysis: strong commitment to the relationship. This theme functioned as a thread of underlying meaning throughout the entire interpretative process of 48 caregivers' experiences of work. A delicate relationship existed that could be vulnerable and could reveal itself in feelings of lack of knowledge, guilt and fear. The caregivers' committed relationship to the older adults created independency in the ways in which they protected the older people's needs. Further studies are needed that focus on caregivers' transition from dependency to independency. The findings highlight the importance of clinical supervision to personal development and identity, and to promoting caregivers' self-esteem and maintaining a committed relationship. Commitment is a deep human feeling, and it should be promoted in order to maintain and further develop quality care for older adults.

  • 24. Häggstrom, Elisabeth
    et al.
    Kihlgren, Annica
    Örebro University, Department of Nursing and Caring Sciences.
    Experiences of caregivers, and relatives in public nursing homes2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 5, p. 691-701Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was, by means of discussion highlighting ethical questions and moral reasonings, to increase understanding of the situations of caregivers and relatives of older persons living in a public nursing home in Sweden. The findings show that these circumstances can be better understood by considering two different perspectives: an individual perspective, which focuses on the direct contact that occurs among older people, caregivers and relatives; and a societal perspective, which focuses on the norms, values, rules and laws that govern a society. Relatives and caregivers thought that the politicians were sending out mixed messages: they were praising caregivers and relatives for their efforts, but at the same time the public health care sector was subjected to significant cutbacks in resources. Both caregivers and relatives were dissatisfied and frustrated with the present situation regarding the care of older persons in public nursing homes.

  • 25.
    Häggström, Elisabeth
    et al.
    Senior Lecturer, University of Gävle, V-institutionen, Gavle, Sweden; Neurotec-Department, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annica
    Senior Lecturer, Neurotec-Department, Karolinska Institutet, Stockholm, Sweden; Centre of Nursing Science, University Hospital, Orebro, Sweden.
    Kihlgren, Mona
    Professor, Neurotec-Department, Karolinska Institutet, Stockholm, Sweden; Centre of Nursing Science, University Hospital, Orebro, Sweden.
    Sörlie, Venke
    Associate Professor, Centre of Nursing Science, University Hospital, Orebro, Sweden; Institute of Nursing and Health Sciences, University of Oslo, Oslo, Norway.
    Relatives' struggle for an improved and more just care for older people in community care2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 9, p. 1749-57Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of the present study was to describe the relatives' experience concerning older family members living in special housing facilities.

    BACKGROUND: During the 21st century, the relatives of older people and their efforts related to the care and nursing of older people have been observed. The interest in these relatives is because of factors such as demographic changes, where the number of older people has increased and the increasing gap between the resources that are available for geriatric care and the care needed for older people.

    DESIGN: The present study has a descriptive design and is part of a project including 24 specific residences, called special housing facilities.

    METHOD: The study focused on the narratives supplied by the relatives that were analysed using qualitative latent content analysis, an interpretative process where the researcher considers the content of the text.

    RESULTS: The relatives' experience of having an older person in a special housing facility that emerged from the study, was expressed in one main theme: The relatives' struggle for an improved and just care for older people and four sub-themes: (i)'To trust in caregivers'; (ii) 'To be confirmed'; (iii) 'To trust in care'; (iv) 'To receive the kind of care that one considers one has the right to receive'.

    CONCLUSIONS: The study shows that the relatives need more support and more opportunities, so that they can participate in the care. The study shows the relatives engagement in working for a just society's obligation towards the protection of older peoples rights and the staff's working conditions.

    RELEVANCE TO CLINICAL PRACTICE: It is important that caregivers and management working with older people realize that they, together with them and their relatives, are a part of society and that all individuals are influenced by the discourse of that society.

  • 26.
    Häggström, Elisabeth
    et al.
    University of Gävle, Gävle, Sweden; Neurotec-Department, Karolinska Institutet, Stockholm, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Neurotec-Department, Karolinska Institutet, Stockholm,Sweden; Centre of Nursing Science, Örebro University Hospital, Örebro, Sweden.
    Fläckman, Birgitta
    University of Gävle, Gävle, Sweden; Neurotec-Department, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annica Larsson
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Neurotec-Department, Karolinska Institutet, Stockholm, Sweden; Centre of Nursing Science, Örebro University Hospital, Örebro, Sweden.
    Kihlgren, Mona
    Örebro University, Department of Nursing and Caring Sciences. Neurotec-Department, Karolinska Institutet, Stockholm, Sweden: Centre of Nursing Science, Örebro University Hospital, Örebro, Sweden.
    To feel betrayed and to feel that you are betraying the older residents: caregivers' experiences at a newly opened nursing home2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 6, p. 687-696Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Sweden and internationally, little research has focused on the working situation of Enrolled Nurses and Nurses' Aides who form the majority of workers in geriatric care today. With this in mind, it is important to focus on how these occupational groups experience their working situation with older residents in municipal care.

    AIMS AND OBJECTIVES: The aim of the study was to investigate the deeper meaning of work satisfaction and work dissatisfaction at a newly opened nursing home for older residents. The study focused on the narratives supplied by the caregivers at the nursing home. The participants included: one Registered Nurse, sixteen Enrolled Nurses, and three Nurses' Aides. All were directly involved in patient care.

    DESIGN: The present study is part of a larger longitudinal study within the municipal geriatric care system in Sweden, with a quasi-experimental design.

    METHOD: The interviews were analysed with a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur.

    RESULT: The caregivers experiences of work satisfaction and work dissatisfaction was expressed in four themes: (i) 'Experience of betrayal' describes how the staff felt let down in several ways; (ii) 'Experience of failing others' describes how the staff felt that they did not pay enough attention to older people, in several different ways; (iii) 'Experience of insufficiency' describes how the staff encountered overwhelming demands from several directions; (iv) 'Experience of work satisfaction' describes how the staff felt that they were given support in various ways. Each theme emerged from several subthemes that originated from the caregivers' narratives.

    CONCLUSIONS: The study shows that the caregivers' experience of work dissatisfaction overshadows their experience of work satisfaction. It also suggests that their feelings of failing the older residents are connected to their own experiences of feeling betrayed.

    RELEVANCE TO CLINICAL PRACTICE: The findings can be used when other nursing homes in municipal care are opened, as a means of preventing work dissatisfaction and increasing work satisfaction among future employees.

  • 27.
    Häggström, Elisabeth
    et al.
    University of Gävle, Gävle, Sweden; Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm.
    Fläckman, Birgitta
    University of Gävle, Gävle, Sweden; Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annika L
    Örebro University, Department of Nursing and Caring Sciences. Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm.
    Kihlgren, Mona
    Örebro University, Department of Nursing and Caring Sciences. Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm.
    Work satisfaction and dissatisfaction: caregivers' experiences after a two-year intervention in a newly opened nursing home2005In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 1, p. 9-19Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of the study was to investigate, from the narratives of nine enrolled nurses and one nurses' aide directly involved in patient care, the deeper meaning of work satisfaction and dissatisfaction when working with the older people.

    BACKGROUND: Both nationally and internationally, there is little research documented regarding the working situation of the enrolled nurses and nurses' aides who make up the majority of care for older people today. With this in mind, it is important to focus on how these occupational groups experience their work with the older residents in municipal care, following a two-year intervention.

    DESIGN: The study is part of a larger longitudinal study, with a quasi-experimental design within the municipal system of care for older people in Sweden. The investigation was carried out following a two-year intervention, which included: education, support and clinical supervision.

    METHOD: The interviews were performed 12 and 24 months after start of the intervention and were analysed with a phenomenological-hermeneutic method inspired by Ricoeur's philosophy.

    RESULTS: The findings from these narratives illustrated a change compared with the findings from the first interviews, when the nursing home had just opened. There was a shift from a dominance of dissatisfaction with work, to a dominance of work satisfaction and this was expressed in the following themes: experience of a changed perspective, experience of open doors, and experience of closed doors. Each theme emerged from several different subthemes and each subtheme that had been expressed in the caregivers' narratives was interpreted.

    CONCLUSIONS: The study shows that the caregivers' experience of work satisfaction in the workplace exceeded their experience of dissatisfaction and that the intervention, consisting of: education, support, and supervision might have facilitated this positive development where the older residents were prioritized. It also shows that communication and understanding between management and staff had increased as the nursing home had opened.

    RELEVANCE TO CLINICAL PRACTICE: The findings can be used to help to prevent work dissatisfaction, and thereby increase work satisfaction for caregivers working in nursing homes.

  • 28.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ardeman- Merten, Rebecka
    Healthcare and Social Services, Örebro Municipallity, Örebro, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ontological Security in Nursing Homes for Older Persons: Person-Centred Care is the Power of Balance2014In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 8, p. 79-87Article in journal (Refereed)
    Abstract [en]

    Introduction: The Swedish national guidelines for elderly care describe how older persons should be able to trust that their care is permeated with security. Different theoretical perspectives can be found that describe what creates security. Many studies have been done about security. However, few studies have explicitly asked older persons what security in nursing homes means to them.

    Aim: The aim of the study was to describe how older persons in nursing homes talked and reflected about security in their daily lives.

    Method: Nine older persons were interviewed in, in-depth interviews one to three times and the resulting data was analysed using content analysis.

    Results: The older persons adapted to having their own needs and those of the other older persons met and to the staff routines which created a sense of security. At the same time, they longed for security in which they could trust themselves and create their own daily life. Further to have a sense of belonging and of being liked for created an internal, interpersonal and external security. This can be linked to an ontological security which means having a sense of confidence in the continuity of self-identity and order in events, a being in the world.

    Conclusion: Person-centred instead of institution- centred care can provide the balance of power that allows the older person to obtain ontological security in which the staff's ability to create a relationship with the older persons becomes crucial.

  • 29.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    A meaningful daily life in nursing homes - a place of shelter and a space of freedom: a participatory appreciative action reflection study2014In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 13, no 19Article in journal (Refereed)
    Abstract [en]

    Background

    Shortcomings in elderly care have been reported in many parts of the world, including Sweden. However, national guidelines for elderly care have been introduced in Sweden, which contain core values and local guarantees of dignity. These highlight the need for dignity and well-being, and organising the older person’s daily life so that they perceive it as meaningful. Therefore, the aim of the present study was to describe older persons’ experience and knowledge about obstacles, opportunities and solutions to developing a meaningful daily life for those living in nursing homes.

    Methods

    This study combined the Participatory Appreciative Action Reflection (PAAR) and hermeneutic approaches. Twenty-five older persons participated and persons with dementia or cognitive impairments were included. Repeated interviews were carried out as reflective conversations, leaving 50 interviews in total, wherein the older persons provided their analyses and reflections on a meaningful daily life. Finally, an analysis of the data was completed based on a life-world hermeneutic approach.

    Results

    We identified five tentative interpretations that describe obstacles, opportunities and solutions for a meaningful daily life. Themes 2 and 4 outline obstacles for a meaningful daily life, and Themes 1, 3 and 5 describe opportunities and solutions for a meaningful daily life: (1) Having space to be yourself; (2) No space to be yourself; (3) Belonging and security; (4) A feeling of insecurity; and (5) Longing for something to happen. In the main interpretation, we found that the five tentative interpretations are related to Tuan’s concepts of space and place, where place can be described as security and stableness, and space as freedom and openness.

    Conclusions

    The reciprocal relationship is a solution for a meaningful daily life and occurs in the interaction between staff and older persons in nursing homes. It is the balance of power, and constitutes a place of shelter and a space of freedom for a meaningful daily life. The older person must have balance between shelter and freedom to have a meaningful daily life.

  • 30.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Liljekvist, Elisabeth
    Örebro township, Örebro. Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    A Meaningful Day For Older Persons In Municipal Care: Guidelines For The Care2013Conference paper (Refereed)
  • 31.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Liljekvist, Elisabeth
    Health Care and Social Services, Örebro Municipality, Örebro, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Working together for a meaningful daily life for older persons: A participatory and appreciative action and reflection project—The lessons we learned2015In: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 13, no 4, p. 336-353Article in journal (Refereed)
    Abstract [en]

    This interdisciplinary action research project has its background in the Swedish government’s introduction of national guidelines to address deficiencies in elderly care, wherein it gave each municipality the responsibility to formulate its own guidelines. The main purpose is how we successfully involved stakeholders to create and agree on core values and local guarantees of dignity with regard to elderly care. This paper focuses on the choices we made that led to the politicians adopting the guidelines, and we discuss the lessons learned. This project is based on a participatory and appreciative action and reflection approach. We worked with stakeholders, including managers, politicians, older persons, relatives, nurse assistants, nurses, occupational therapists, and organizations for retired persons (n ∼ 386) in elderly care in three phases from 2010 to 2013. Firstly, we cocreated practical knowledge via interviews, focus group discussions, and participated in nurse assistants’ work. Secondly, we trained managers who formulated preliminary core values and guarantees of dignity. Thirdly, we returned to the stakeholders for a critical review. We learned it is possible to manage a project and involve stakeholders in an action research project by having access to scheduled meetings, providing training to managers, and using appreciative intelligence and technical aids.

  • 32.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sjöman, Lena
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    En meningsfull vardag för äldre personer i äldreomsorgen?: Litteraturöversikt2013Book (Other (popular science, discussion, etc.))
  • 33.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fredriksson, Carin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wahlström, Catrin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Making Each Other’s Daily Life: Nurse Assistants’ Experiences and Knowledge on Developing a Meaningful Daily Life in Nursing Homes2014In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 8, p. 34-42Article in journal (Refereed)
    Abstract [en]

    Background: In a larger action research project, guidelines were generated for how a meaningful daily life could be developed for older persons. In this study, we focused on the nurse assistants’ (NAs) perspectives, as their knowledge is essential for a well-functioning team and quality of care. The aim was to learn from NAs’ experiences and knowledge about how to develop a meaningful daily life for older persons in nursing homes and the meaning NAs ascribe to their work. Methods: The project is based on Participatory and Appreciative Action and Reflection. Data were generated through interviews,participating observations and informal conversations with 27 NAs working in nursing homes in Sweden, and a thematic analysis was used.

    Result: NAs developed a meaningful daily life by sensing and finding the “right” way of being (Theme 1). They sense and read the older person in order to judge how the person was feeling (Theme 2). They adapt to the older person (Theme 3) and share their daily life (Theme 4). NAs use emotional involvement to develop a meaningful daily life for the older person and meaning in their own work (Theme 5), ultimately making each other’s daily lives meaningful.

    Conclusion: It was obvious that NAs based the development of a meaningful daily life on different forms of knowledge: theoretical and practical knowledge, and practical wisdom, all of which are intertwined. These results could be used within the team to constitute a meaningful daily life for older persons in nursing homes.

  • 34.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    A meaningful life for older persons receiving municipal care: unit leaders’ perspectives2015In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 5, no 11, p. 1233-1241Article in journal (Refereed)
    Abstract [en]

    Introduction:  In Sweden new national guidelines for elderly care have been introduced containing core values and local guarantees of dignity that highlight the need for dignity, well-being and the organisation of the older person’s daily life so it is perceived as meaningful. Unit leaders play a crucial role in health care organisations when guidelines are to be implemented.

    Aim: The aim was therefore to describe unit leaders’ experiences about what constitutes a meaningful daily life for older persons receiving municipal care and the opportunities and obstacles that may exist.

    Method: Repeated interviews using reflective conversations with nine leaders were performed and analysed with qualitative content analysis.

    Results: Unit leaders felt a shared vision regarding a meaningful life was needed. Daily routines and habits that promote independence, a feeling of community together with familiarity with the job, and that little extra from knowledgeable staff was important. The historical collective paradigm in elderly care needed to be abandoned in favour of one promoting more individualism. Fundamental was the courage to ask the older person what is important and dare to follow through “Give power to the older person to decide what care to be given”.

    Conclusion: Organisational conditions affect unit leaders ability to succeed in the implementation of the work. Further studies are required regarding the nature of the support the unit leaders need to succeed in their work. 

  • 35.
    Kihlgren, Annica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    A reciprocal relationship - an opportunity and a solution for a meaningful daily life in home care: the older person’s perspective2015In: Clinical Nursing Studies, ISSN 2324-7940, E-ISSN 2324-7959, Vol. 3, no 1, p. 71-81Article in journal (Refereed)
    Abstract [en]

    Background: Shortcomings in elderly care have been reported in many parts of the world, including Sweden. National guidelines for elderly care have been introduced in Sweden, which contain core values and local guarantees of dignity. These highlight the need for dignity and well-being and organizing the older person’s daily life so that she/he perceives it as meaningful. Therefore, the aim of the present study was to explore opportunities, obstacles and search for solutions as described by the older person in order to create a meaningful daily life.

    Methods: The design is based on the underpinning view of seeing the older persons as narrators of their own stories and interpreters of their own lives. Participatory Appreciative Action Reflection (PAAR) was used when collecting the data. Fifteen older persons participated, and repeated interviews were carried out as reflective conversations, in total 30 interviews. The older persons provided their analyses and reflections on what had been said regarding a meaningful daily life. Finally, an analysis of the data was done, based on interpretative description, and an inductive approach built on the key axioms of naturalistic inquiry.

    Results: The older persons’ experiences and knowledge of opportunities, obstacles and solutions to a meaningful daily life can be summarized into four themes: (1) to live as usual, (2) collaboration with the staff, (3) the relationship carries everyday life, and (4) belonging to something. In the discussion, we choose to further develop these four themes by using Buber’s philosophy of dialogue.

    Conclusions: An opportunity and a solution for meaningful daily life for the older person were seen in the relationship to oneself, to staff, to others, and the family. The reciprocal relationship, which occurred in the interaction between the staff and the older person, was the opportunity and solution for a meaningful daily life. It was the ongoing conversation between the older person and the staff who became "the glue" and formed the relationship. If the staff could support the older persons to maintain their habits and routines, these were solutions for creating a meaningful daily life. A meaningful daily life could be obtained in an I-Thou relation in a shared everyday life, where the relationship and the continuing dialogue becomes the power of balance. The relationship is also relevant for the staff and in line with Buber’s thoughts on how we are shaped by humans in the encounter with others.

  • 36.
    Kihlgren, Annica
    et al.
    Centre for Nursing Science, Örebro University Hospital, Örebro; Nuerotec Department, Division of Gerontological Caring Science, Karolinska Institutet, Stockholm.
    Forslund, Kerstin
    Örebro University, Department of Nursing and Caring Sciences. Centre for Nursing Science, Örebro University Hospital, Örebro.
    Managements' perception of community nurses' decision making processes when refering older patients to an emergency department2006In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 14, no 6, p. 428-436, article id PMID16919120Article, review/survey (Refereed)
    Abstract [en]

    In Sweden, older adults are living and being cared for under the responsibility of their respective community. Extensive reorganizations in the community led to management having different backgrounds, which may have caused uncertainty among community nurses, especially in decision-making processes. The aim was to understand how 10 nurses, 10 doctors and 10 home care assistants as leaders for the nurses conceptualized the decision-making processes of community nurses, when referring older persons to Emergency Departments, and whether perceptual differences and/or similarities exist. Narrative interviews and content analysis were performed. The managers had differing views, but all felt there was a need to feel secure in order to trust professional decisions as being correct, thus avoiding inappropriate referrals. Management could see nursesexposed position, but had varying solutions. This might lead to different messages being given regarding what is important and might explain why the nurses reported that the managers did not understand them.

  • 37.
    Kihlgren, Annica Larsson
    et al.
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden, and Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.
    Fagerberg, Ingegerd
    Senior Lecturer, Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden, and Department of Caring and Public Health Sciences, Mälardalen University, Västerås, Sweden.
    Skovdahl, Kirsti
    Doctoral Student, Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden, and Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.
    Kihlgren, Mona
    Head of Centre, Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.
    Referrals from home care to emergency hospital care: basis for decisions.2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    The Swedish government implemented a reform, the Adel reform, in the care of older citizens in 1992, so that the communities where older people live became responsible for their care and housing. Nurses were appointed to make sure that older people were given accurate care and to act as supervisors for nurses' aides. In this study, 10 Registered Nurses from community home care services and four consultant head physicians in primary care were interviewed in order to illuminate what they thought influenced nurses' decisions to refer patients for emergency treatment and what support they requested to facilitate the decision. Content analysis showed the necessity of feeling secure in one's role as a community nurse. The categories that developed were: own competence, knowledge about the patient and a supportive working environment. The main theme was To feel safe in one's role - a basis for decision-making. High demands were put on the nurses' competence and their burden of responsibility became too great. This influenced decision-making negatively, if nurses felt that they were lacking in their own personal competence. Training in documentation for the nurses was required, as well as the need for organizations to provide staff with sufficient time for accurate documentation. A greater input of nursing and medical care was required to make it possible for patients to be cared for at home if they so wished. Respondents described considerable deficiencies in their working environment and in co-workers' competence, and nurses' professional roles within the community were not made clear. If these problems were remedied, this would improve working conditions, increase understanding, and reduce feelings of uncertainty among decision-makers.

  • 38.
    Kihlgren, Annica Larsson
    et al.
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Margareta
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institutet, Stockholm, Sweden; Department of Health Care Sciences, Ersta Sköndal University College, Stockholm,Sweden.
    Skovdahl, Kirsti
    Örebro University, Department of Nursing and Caring Sciences. Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institutet, Stockholm, Sweden.
    Palmblad, Bert
    Centre for Nursing Science, Örebro University Hospital, Örebro,Sweden; Department of Primary Health Care, Psychiatry and Rehabilitation, Örebro County Council, Örebro, Sweden.
    Wimo, Anders
    Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institutet, Stockholm,Sweden; Department of Family Medicine, Bergsjö, Sweden.
    Older patients awaiting emergency department treatment2004In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 2, p. 169-176Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe, through observations and interviews with patients >/=75 years old and the relatives who accompanied them to the hospital, the conditions at the emergency department (ED) and the events that took place during the waiting period. Twenty older patients were studied, together with their relatives. A modification of a comparative design, the interpretative method 'grounded theory', was utilized. Open, nonparticipant observations were carried out; from the time patients were admitted until the time they were discharged. Patients were observed through all stages, for example, in the reception area, in the examination room, and in the X-ray department. The observations were supplemented with field notes and interviews with the older patients as they left the ED. The selective coding developed into six core-variables that were the focus of the material. These were: unpleasant waiting, unnecessary waiting, lack of good routines during the waiting stage, suffering during the waiting stage, bad feelings during the waiting stage and nursing care during the waiting stage. The way, in which nursing care was carried out, which in this context is discussed in terms of praxis and poieses, appeared to be of major importance for the older peoples' experiences when visiting the ED.

  • 39.
    Kihlgren, Annica Larsson
    et al.
    Centre for Nursing Science, Orebro University Hospital, Orebro, Sweden.
    Nilsson, Margaretha
    Sørlie, Venke
    Caring for older patients at an emergency department: emergency nurses' reasoning.2005In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 5, p. 601-8Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of the study was to use the experiences of emergency nurses to illuminate what constitutes good nursing care for patients 75 years or older transferred to emergency departments.

    BACKGROUND: Emergency departments have a medical technical character and the number of visits there increases dramatically as people age. Older patients require increased healthcare services in terms of nursing care, interventions and hospitalizations due to an increased complexity of their problems. For these reasons it is important to study what good nursing care of the older patients consists of at an emergency department from the emergency nurses' point of view.

    METHOD: Ten emergency nurses from a university hospital emergency department in Sweden were interviewed. A thematic content analysis was performed.

    RESULTS: The study showed that it was necessary to be knowledgeable, to be understanding of the older patients' situation and to take responsibility for them in order to be able to provide good nursing care. The emergency nurses shifted focus from describing the central aspect of good nursing care to describing what hinders the provision of it. Their experience was that prioritizing medical procedures, everyday tasks and routines threatens good nursing care of older patients in emergency departments. The emergency nurses held that the older patient is often sent to an emergency department where the level of care is not appropriate to their needs.

    CONCLUSIONS: The result can be seen as a challenge for the organization and the nurses in the future; to prioritize differently, thereby maintaining a balance between good nursing and medical/technical tasks when treating older patients.

    RELEVANCE TO CLINICAL PRACTICE: The present day healthcare system is not organized to appropriately meet the needs of the older patients. Nurses themselves hold they can better serve the older patient. By sharing their experiences, both can be accomplished.

  • 40.
    Kihlgren, Annica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sunnvison, Helena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ziegert, Kristina
    Högskolan i Halmstad, Halmstad, Sweden.
    Mamhidir, Anna Greta
    Högskolan i Gävle, Gävle, Sweden.
    Referrals to Emergency departments- The processes and Factors That Influence Decision-Making among Community Nurses2014In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, no 5, p. 366-374Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe the basis on which municipal care registered nurses (RN) make decisions and their experiences when referring older persons from nursing homes to emergency departments (EDs). RNs in the community are to ensure that older adults receive good care quality in nursing home. This study used a descriptive design with a qualitative content analysis. The analysis of the data from the 13 interviews revealed one theme “Shared responsibilities in the best interests of the older person reduce feelings of insufficiency”. The content was formulated, which revealed the RNs’ feelings, reasoning and factors influencing them and their actions in the decision-making situation, before the patients were referred to an emergency department. Complex illnesses, non-adapted organizations, considerations about what was good and right in order to meet the older person’s needs, taking account of her/his life-world, health, well-being and best interests were reported. Co-worker competencies and open dialogues in the “inner circle” were crucial for the nurses’ confidence in the decision. Hesitation to refer was associated with previous negative reactions from ED professionals. The RN sometimes express that they lacked medical knowledge and were uncertain how to judge the acute illness or changes. Access to the “outer circle”, i.e. physicians and hospital colleagues, was necessary to counteract feelings of insecurity about referrals. When difficult decisions have to be made, not only medical facts but also relationships are of importance. To strengthen the RNs’ and staff members’ competence by means of education seems to be important for avoiding unnecessary referrals. Guidelines and work routine need to be more transparent and referrals due to the lack of resources are not only wasteful but can worsen the older persons’ health.

  • 41.
    Kihlgren, Annica
    et al.
    Örebro University, School of Health Sciences.
    Svensson, Fredrik
    Region Örebro Counties, Örebro, Sweden.
    Lövbrand, Conny
    Ambulance Department, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Health Örebro University, Örebro, Sweden.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences. The Centre of Women’s Health, Faculty of Health Science, Buskerud Vestfold University College, Kongsberg, Norway.
    A Decision support system (DSS) for municipal nurses encountering health deterioration among older people2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, article id 63Article in journal (Refereed)
    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.

  • 42.
    Kihlgren, Annica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wimo, Anders
    Department of Neurobiology, Caring Sciences and Society, KI-Alzheimer Disease Research Center (KI-ADRC), Karolinska Institute, Stockholm, Sweden.
    Mamhidir, Anna-Greta
    Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Older patients referred by community nurses to emergency departments - a descriptive cross-sectional follow-up study in a Swedish context2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 1, p. 97-103Article in journal (Refereed)
    Abstract [en]

    ObjectivesThe objective of this study was to examine on what extent nursing home (NH) older patients aged 75 or older, referred to hospitals by registered nurses (RNs) in the community, utilise the emergency department (ED) over a 1-year period and for what reason. A further objective was to identify factors that may explain these referrals. MethodsA cross-sectional follow-up study, examining older patients' disabilities, resources and needs, was carried out in a county in Sweden. Assessments were made using Residents Assessment Instrument/Minimum Data Set, among 719 individuals in 24 NHs and the RNs' documentation were followed. ResultsThe result showed that of 719 residents, 209 accounted for 314 referrals to an ED over the 1-year period. No gender differences were observed. The main reasons for referrals were falls (23%), cardiovascular problems (16%), gastrointestinal problems (12%) and infections (11%). Most of the referrals (65%) were made on weekdays during daytime hours. In 62% of the cases, there had been a consultation with a physician prior to the referral. The nursing documentation was poor in connection with the referral. ConclusionOlder patients with dementia diseases were significant less refereed and questions are raised whether this group is undetected and undertreated, and therefore, it is important with further investigation.

  • 43.
    Liedström, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Faculty of Health Sciences, Buskerud University College, Buskerud, Norway.
    Windahl, Jenny [Larsson]
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Being a Next of Kin: experiences of Burden and Quality of Life2014In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, no 4, p. 275-286Article in journal (Refereed)
    Abstract [en]

    Aim and Objectives: To increase the understanding of next of kin’s life situation in the context of supporting persons who are long term ill, disabled and/or older by describing their experienced burden and quality of life and also the relationship between QoL, burden and socioeconomic variables.

    Methods: Cross-sectional, descriptive and correlative design. Eighty-four next of kin answered two questionnaires: the Caregiver Burden Scale and the Subjective Quality of Life.

    Results: Next of kin experienced a high burden in their life situation although they, at the same time, experienced a good quality of life. In the results gender differences were found. Females next of kin to a higher extent were disappointed, more emotionally involved, and they also estimated their economic situation as more unsatisfactory than the males next of kin.

    Conclusion: Healthcare personnel meet next of kin, persons in need of care, within all healthcare and social care in society.Therefore it is important to have a general knowledge and ability to understand the next of kin’s life situation, thus making it possible to focus the nursing interventions on individual support regardless of the care receiver’s diagnosis.

  • 44.
    Liedström, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Faculty of Health Sciences, Buskerud University College, Kongsberg, Norway.
    Isaksson, Ann-Kristin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Windahl, Jenny [Larsson]
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Understanding the next of kin’s experience of their life situation in informal care giving of older persons2014In: Clinical Nursing Studies, ISSN 2324-7959, Vol. 2, no 1, p. 53-63Article in journal (Refereed)
    Abstract [en]

    The experience of their life situation of next of kin in informal caregiving needs to be followed as they may need support to maintain their own health and cope with continuing in their caregiving role. Many of these individuals, often the older person’s spouse, are elderly themselves. The aim of this study was to increase the understanding of the next of kin’s experience of their life situation in connection with their informal caregiving of older persons. The study had a qualitative approach, with an inductive explorative design. Informal conversational interviews were conducted. Twelve next of kin were interviewed, nine of them twice. In all, 21 interviews were performed, and subsequently subjected to latent content analysis. The theme that emerged from the data was “A balance or imbalance in next of kin’s daily life.” The three subthemes were: (1) Balance and imbalance in the relationship with the older person, other family members, and friends; (2) Balance and imbalance in the relationship with the staff from municipal care; and (3) Balance and imbalance in demands, affecting the caregiver’s own health. Communication with mutual respect was described as a tool for creating good relations. The results of this study highlight the strained life experiences of next of kin while caring for older persons. There is a need to give more attention to the next of kin’s life situation and to find the means to support them. To reduce worry and stress, health care staff need to understand the next of kin’s experience of their life situation, and good relations need to be created among all involved in the care.

  • 45. Lindh, Marianne
    et al.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Perseius, Kent-Inge
    Factors influencing compliance to hygiene routines in community care: the viewpoint of medically responsible nurses in Sweden2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 224-230Article in journal (Refereed)
    Abstract [en]

    Factors influencing compliance to hygiene routines in community care - the viewpoint of medically responsible nurses in Sweden Aims and objectives: The aim of the study was to describe factors influencing compliance to hygiene routines in community care in Swedish municipalities from the perspective of medically responsible nurses (MRN). Method: A web-based questionnaire was sent to all MRNs in Swedish municipalities, N=268. Beside demographical background data, the questionnaire contained two core open-ended questions generating free text data. Data were analysed with descriptive statistics and qualitative content analysis. Result: Four categories of factors were found: resources, management, staff and external factors. All four categories contained subcategories. Conclusion: To some extent, the challenges to uphold adequate compliance to hygiene routines seem different in community care than in hospitals. Resources regarding equipment and supplies seem as an uncertain asset and uneven distributed among municipalities. Home likeness was seen as a major obstacle for upholding adequate hygiene routines. To uphold sufficient hygiene routines in a person's home or in a home-like environment might be one of the major challenges for community health care in the future. The MRN's narratives suggest that Registered Nurses have a key role in upholding sufficient hygiene in community care. This report might contribute in providing them with more knowledge to take on this urgent task.

  • 46.
    Mamhidir, A. G.
    et al.
    Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden and Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Wimo, A.
    KI Alzheimer’s Disease Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden .
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fewer referrals to Swedish emergency departments among nursing home patients with dementia, comprehensive cognitive decline and multicomorbidity2012In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 16, no 10, p. 891-7Article in journal (Refereed)
    Abstract [en]

    Objectives: The objective was to describe the extent to which nursing home patients had cognitive impairments and were diagnosed with dementia. Furthermore, to describe and compare multicomorbidity, health status and drug use in the three subgroups; dementia diagnosis/not referred, dementia diagnosis/referred and no dementia diagnosis/not referred to an emergency department (ED) over a one-year period.

    Methods: A cross-sectional follow-up study was carried out in Sweden. RAI/MDS assessments were conducted on 719 patients in 24 nursing homes, of whom 209 were referred to EDs during a one-year period, accounting for 314 visits. This study involved an extensive examination of the population.

    Results: The 719 patients were reported to suffer from comprehensive cognitive impairments, which not accorded with the dementia diagnoses, they were significantly fewer. Cognitive decline or dementia diagnosis contributed to a significant decrease of referrals to EDs. Patients with dementia diagnosis/not referred had difficulties understanding others, as well as impaired vision and hearing. Patients with dementia diagnosis/referred usually understood messages. Low BMI, daily pain, multicomorbidity and high drug consumption occurred in all groups. Patients with no dementia diagnosis/not referred had significantly less multicomorbidity. Neuroleptica was significantly more prevalent among those with dementia diagnosis.

    Conclusion: Dementia remains undetected. Patients with cognitive decline and dementia are probably as sick as or even worse than others but may, due to low priority be undertreated or referrals avoided with the objective to provide good care in the setting. Observational studies are needed to identify what is done and could be done in referral situations.

  • 47.
    Mamhidir, Anna-Greta
    et al.
    Högskolan i Gävle, Gävle, Sweden.
    Ljunggren, G
    Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Mona
    Örebro University, Department of Nursing and Caring Sciences.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wimo, A
    Karolinska Institutet, Stockholm, Sweden.
    Underweight, weight loss and related risk factors among older adults in sheltered housing: a Swedish follow-up study2006In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 10, no 4, p. 255-262Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Underweight and weight loss are important factors in detecting malnutrition.

    OBJECTIVE: To describe underweight, weight loss and related nutritional factors after 12 months among individuals 75 years or older and living in sheltered housing. A further aim was to identify possible risk factors associated with underweight and weight loss.

    DESIGN: This is a part of a cross-sectional follow-up study from a county in Sweden, examining the disabilities, resources and needs of 719 older adults in sheltered housing units. Data were collected twice, with a 12-month interval using the Resident Assessment Instrument.

    RESULTS: Among the 503 remaining chronically ill individuals with cognitive and functional disabilities, 35% were classified as underweight at the initial assessment and 38% at the second, a non-significant difference. A further analysis showed 39% had decreased weight, 27% remained stable and 28% gained weight. A weight loss of 5% occurred in 27% of the older adults and a loss of 10% occurred in 14%. Risk factors associated with being underweight and weight loss, using scales derived from the instrument were cognitive and functional decline. Dementia and Parkinson's disease, eating dependencies and constipation were the strongest risk factors when analyzed as single items.

    CONCLUSION: A high percentage was underweight or exhibited weight loss and several risk factors were identified. Ensuring adequate nutritional status in individuals with a variety of diseases and declining health status is challenging. Increased combined efforts using a wide range of measures, nutritional programs and routines need to be regularly implemented.

  • 48.
    Norell, Margaretha
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ziegert, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dealing with daily emotions: supportive activities for the elderly in a municipal care setting2012In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 7, article id 9510Article in journal (Refereed)
    Abstract [en]

    There are diverse descriptions of supportive activities in nursing to be found in the literature. What they have in common is their association with good care outcomes, but they may differ depending on the context in which the care is given. In a Swedish municipal elderly care setting, registered nurses (RNs) work in a consultative way and they describe a part of their tasks as comprising supportive activities, without specifying what kind of supportive activities they mean. The aim of the study was to explore the main concern of the support given by RNs to a group of patients in an elderly home care setting. The study was conducted using Grounded Theory. Data were collected using nonparticipant observations regarding the supportive activities of 12 RNs at the home of 36 patients between the ages of 80 and 102 years. Most of the home visit lasted about 40 min but some lasted for 90 min. The central category was about dealing with daily emotions. This was done by encouraging the situation and reducing the patient's limitations, but situations also occurred in which there was a gap of support. Support was about capturing the emotions that the patient expressed for a particular moment, but there were also situations in which RNs chose not to give support. To develop a holistic eldercare, more knowledge is needed about the factors causing the RNs to choose not to provide support on some occasions.

  • 49.
    Norell [Pejner], Margaretha
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ziegert, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Care priorities: registered Nurses' clinical daily work in municipal elderly care settings2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 388-95Article in journal (Refereed)
    Abstract [en]

    Care priorities- Registered Nurses' clinical daily work in municipal care settings Common in Swedish elderly home care is that Registered Nurses work independently, and lead the care team without being a part of it. People involved in the care of the patient can be social services, physician, Registered Nurse (RN), nurses in inpatient care and family. In according to current model for nursing documentation RNs interventions is described as participation, information/education, support, environment, general care, training, observation/surveillance, special care drug administration and coordination. Time pressure is perceived as high, but the nurses have the opportunity to influence their daily work situation and make priorities. The purpose of this study was to investigate how RNs prioritise interventions in municipal elderly care settings. A quantitative descriptive method was used for the study. Data were collected during the months of April and October 2004 - 2008, using a web-based form. The nurses filled in patient's type of housing, performed interventions, and if the interventions were delegated. Interventions were described as keywords and were attributed a certain amount of time, calculated in previous time studies. The inclusion criteria were: all patients 80 years of age and older, in a municipality in south-western Sweden, who received some form of health care from a RN, or performed by non-certified staff by delegation. Results indicate that differences in priority could be observed, depending on the patient's gender, or whether the patient was living in independent or sheltered housing. Drug administration was prioritised for female patients, while coordination became a priority for patients living in ordinary housing. Support received the highest priority, regardless if the patient lived in ordinary or sheltered housing. However, it is not entirely clear what support signifies in municipal health care settings, and this issue would therefore require further investigation.

  • 50.
    Norell Pejner, Margaretha
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ziegert, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Trying to cope with everyday life: emotional support in municipal elderly care setting2012In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 7, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Emotional support is considered to be important to older patients because it is a contributing factor to experiencing good health and it has been shown that it can prevent depression after a hip fracture. Opinions differ on whether emotional support falls within the field of nursing, and studies also show that nurses in an elderly home care setting fail when it comes to giving emotional support. The aim of this study was to explore reasons for registered nurses to give emotional support to older patients in a municipal home care setting. The study was conducted using Grounded Theory. Data collection was carried out through interviews with 16 registered nurses. The inclusion criteria were emotional support given to patients aged 80 years and above living in ordinary or sheltered housing and who were in need of help from both the home help service and registered nurses. The results show that the main concern of emotional support was "Trying to relieve the patient from their emotions so they are able to cope with everyday life." This core category illustrates how registered nurses tried to support the patients' own strength, so that they were able to move forward. Registered nurses consider that they could support the patients because they give them access to, or could create access to, their emotions, but there were also times when they felt helplessness and as a result, consciously opted out. The results also indicate that registered nurses were keen to give emotional support. To develop patient-centered elderly care, more knowledge of emotional support and the elderly's need for this support is required.

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