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  • 1.
    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.

  • 2.
    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.

  • 3.
    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

  • 4.
    Henoch, Ingela
    et al.
    Institute of Health and Care Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    Carlander, Ida
    Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden; Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Holm, Maja
    Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kenne-Sarenmalm, Elisabeth
    Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden; Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Lundh-Hagelin, Carina
    Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University, Stockholm, Sweden; Research and Development Unit in Palliative care, Stockholms Sjukhem Foundation, Stockholm, Sweden.
    Lindh, Susanne
    Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Sandgren, Anna
    School of Health Sciences, Jönköping University, Jönköping, Sweden; Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linneaus University, Kalmar/Växjö, Sweden.
    Öhlén, Joakim
    Institute of Health and Care Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
    Palliative Care Research: A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 20122016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 1, p. 5-25Article, review/survey (Refereed)
    Abstract [en]

    Background: In 2007, a literature review was undertaken of palliative care research from Sweden during the 1970s-2006, paving the way for a follow-up study to explore the recent developments. The aim was to systematically examine palliative care research from Sweden between 2007 and 2012, with special attention to methods, designs and research foci.

    Methods: A literature review was undertaken. The databases Academic search elite, Age line, Ahmed, Cinahl, PsychInfo, PubMed, Scopus, Soc abstracts, Web of science and Libris were reviewed for Swedish palliative care research studies published from 2007 to 2012, applying the search criteria 'palliative care OR palliative medicine OR end-of-life care OR terminal care OR hospice care OR dying OR death'.

    Results: A total of 263 papers met the inclusion criteria, indicating an increased volume of research compared to the 133 articles identified in the previous review. Common study foci were symptom assessment and management, experiences of illness and care planning. Targeting non-cancer-specific populations and utilisation of population-based register studies were identified as new features. There was continued domination of cross-sectional, qualitative and mono-disciplinary studies, not including ethnic minority groups, nonverbally communicable people or children <18 years of age.

    Conclusions: The trend is that Swedish palliative care research has expanded in volume from 2007 to 2012 compared to during the 1970s to 2006, with increasing participation of non-cancer-specific populations. A domination of qualitative approaches and small, cross-sectional studies with few interventions is still characteristic. Still more strategies are needed to expand the knowledge development of palliative care to respond to demographical, epidemiological, therapeutic and healthcare structure changes.

  • 5.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Att bygga kunskap vid vård i livets slut2013In: Palliativ vård: begrepp & perspektiv i teori och praktik / [ed] Birgitta Andershed, Britt-Marie Ternestedt, Cecilia Håkansson, Lund: Studentlitteratur AB, 2013, 1, p. 417-430Chapter in book (Other academic)
  • 6.
    James, Inger
    Örebro University, School of Health and Medical Sciences.
    Bakom rutinerna: kunskap och omvårdnadspraxis i mänskliga gränssituationer2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to study how family members, next of kin, and healthcare professionals construct and use knowledge in nursing praxis in human boundarysituations.The study was carried out on a surgical ward at a university hospital in Sweden.Methodology: Study I: A case study; data concerning a family with six familymembers were collected over 10 months using interviews, conversations, and diary notations.Study II: A hermeneutic approach; interviews with 27 family carers were conductedsix to eight months after a family member’s death. Studies III, IV: a combinedethnographic and hermeneutic approach; participant observations (285 hours), informalconversations (190), and interviews (25) were conducted with 25 nurses and 18 assistant nurses.

    The main findings were: (I) The family members used beliefs to explain and understandcancer, dying and death. The beliefs were aggregated into eight main beliefs and fourthemes: cancer is a deadly threat/death is a liberator; death can be held at bay/death canbe lived near; dying is done alone/dying should not be done alone; and life has anend/life is endless. These beliefs appear to oscillate between seemingly contrastingpoles. (II) The family carers made their own assessment of their loved one’s conditionand situation. Their actions were characterized by struggling to get treatment, being leftbehind, being partners, keeping the illness at a distance, hovering beside their loved one,waiting for death, and being experts and protectors. The family carers used practicalwisdom, phronesis, regarding what care was the best, or least harmful, for their lovedone in the encounter with professional care. (III) The nurses constructed knowledgethrough greeting the patient, and reading the patient. By being sensitive, using humor,and emotional involvement, understanding was deepened. By being suspicious and selfcritical,interaction was sought with nurse colleagues, the patient, relatives, and the doctor,and additional knowledge was obtained. They strived to be one step ahead in theirefforts to attain an understanding of the patient´s situation. The knowledge nurses makeuse of can be related to the intertwined and embodied forms of theoretical knowledge,i.e., episteme, practical professional knowledge, i.e., techne, and practical wisdom i.e.,phronesis. (IV) The nurses created and used emotional knowing that could be interpretedin relation to various rooms of emotions, thoughts and actions. They strived to dothings correctly in the normative room; created a safe, secure milieu for patients andnext of kin in the safety-security room; and questioned their actions in the critical room.They created an affinity for co-operation that was of benefit in encounters with patientsin the nurses’ affinity room. And they demonstrated compassion for patients and next ofkin; this compassion was particularly evident in the closeness room.Conclusion: In praxis, construction and use of knowledge occurs that often takes placebehind the routines. This knowledge constitutes an important content in nursing. Thehermeneutic spiral can serve a pedagogic purpose in elucidating nursing and its differentforms of knowledge.

    List of papers
    1. A family's beliefs about cancer, dying, and death in the end of life
    Open this publication in new window or tab >>A family's beliefs about cancer, dying, and death in the end of life
    2007 (English)In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 13, no 2, p. 226-252Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this case study was to describe the beliefs over time of a Swedish family and individual family members about cancer and death and how these beliefs affected their daily lives. Data were collected over 10 months using interviews, conversations, and diary notations. The beliefs were aggregated into eight main beliefs and four themes: Cancer is a deadly threat/death is a liberator, death can be held at bay/death can be lived near, dying is done alone/dying should not be done alone, and life has an end/life is endless. These beliefs appear to oscillate between seemingly contrasting poles. Some beliefs were shared by all family members, whereas others were described by only one or more members of the family. The complexity of daily life in families experiencing life-shortening illness underscores the need of individualized nursing care with openness to difference and collaboration as guiding principles.

    Keywords
    Adult, Aged, Attitude to Death, Decision Making, Family/*psychology, Female, Gastrointestinal Neoplasms/*psychology, Humans, Interviews as Topic, Middle Aged, Sweden, Terminal Care
    National Category
    Medical and Health Sciences Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-4422 (URN)10.1177/1074840707300849 (DOI)17452604 (PubMedID)
    Available from: 2008-03-11 Created: 2008-03-11 Last updated: 2017-12-14Bibliographically approved
    2. The encounter between informal and professional care at the end of life
    Open this publication in new window or tab >>The encounter between informal and professional care at the end of life
    2009 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 2, p. 258-271Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study was to obtain and describe in-depth knowledge about family carers' experiences of the encounter, in a hospital, between informal and professional care at the end of life. A hermeneutic approach was chosen, and we conducted interviews with 27 family carers 6 to 8 months after their loved one's death. In the encounter, the family carers made their own assessment of their loved one's condition and situation. The professionals' attitudes could both promote and impede the interaction between the two forms of care. Family carers' care actions were characterized by struggling to get treatment, being left behind, being partners, keeping the illness at a distance, hovering beside their loved one, waiting for death, and being experts and protectors. The main interpretation of the findings is that family carers possess practical knowledge about what care is the best, or least harmful, for their loved one. This can be linked to what Aristotle called phronesis.

    Place, publisher, year, edition, pages
    London: SAGE, 2009
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-9539 (URN)10.1177/1049732308329309 (DOI)000262612500009 ()19092139 (PubMedID)
    Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2017-12-12Bibliographically approved
    3. Knowledge constructions in nursing practice: Understanding and integrating different forms of knowledge
    Open this publication in new window or tab >>Knowledge constructions in nursing practice: Understanding and integrating different forms of knowledge
    2010 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 20, no 11, p. 1500-1518Article in journal (Refereed) Published
    Abstract [en]

    In this combined ethnographic and hermeneutic study we examined which forms of knowledge nurses make use of and how they construct knowledge. We collected data using participant observations, informal conversations, and interviews. Nurses' knowledge construction took the form of a hermeneutic spiral, a journey in which the nurses moved up and down and horizontally, and in which they created understanding. The nurses constructed knowledge from reading the patient's record, the brief oral handover report, greeting the patient, and reading the patient. By being sensitive, using humor, and emotional involvement, they deepened their understanding. By being suspicious and self-critical, they sought interaction with nurse colleagues, the patient, doctor, and relatives, and obtained additional knowledge. They strove throughout the journey to be one step ahead in their efforts to attain an understanding of the patient's situation. We can relate the knowledge nurses make use of to intertwined forms of episteme, techne, and phronesis

    Place, publisher, year, edition, pages
    London: Sage, 2010
    Keywords
    ethnography, Gadamer, hermeneutics, knowledge construction, nurse practitioners, nursing, Ricoeur
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-9540 (URN)10.1177/1049732310374042 (DOI)000283250900008 ()
    Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2018-04-19Bibliographically approved
    4. Emotional knowing in nursing practice: in the encounter between life and death
    Open this publication in new window or tab >>Emotional knowing in nursing practice: in the encounter between life and death
    2010 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 2, article id 5367Article in journal (Refereed) Published
    Abstract [en]

    Patients, next of kin and nurses in surgical wards often raise existential questions in the encounter between life and death. Nurses' emotional knowing at this encounter is crucial. Consequently, this study's purpose was to analyse and describe nurses' emotional knowing to reveal (a) how this knowing is expressed in daily work and (b) what emotions, thoughts and actions this knowing includes. This study used combined ethnographic and hermeneutic methodologies. Data were collected using participant observations, informal conversations and interviews. We found that nurses' emotional knowing could be interpreted in relation to various rooms of emotions, thoughts and actions. Nurses' judgements formed these rooms. They strived to do things correctly in the normative room; created a safe, secure milieu for patients and next of kin in the safety–security room; and questioned their actions in the critical room. They created affinity for co-operation that benefitted encounters with patients in their affinity room. And they demonstrated sensitivity and compassion to patients and next of kin; sensitivity and compassion were particularly evident in the closeness room. In our main interpretation, we found that nurses' judgements in various rooms (emotional knowing) constitute an expression of practical wisdom (phronesis) in nursing practice.

    Place, publisher, year, edition, pages
    Järfälla, Sweden: Co-Action Publishing, 2010
    Keywords
    Emotional knowing, ethnography, critical hermeneutics, nurses, assistant nurses, nursing practice, phronesis
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-9541 (URN)10.3402/qhw.v5i2.5367 (DOI)000281886700013 ()20640014 (PubMedID)2-s2.0-84873993867 (Scopus ID)
    Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2018-04-19Bibliographically approved
  • 7.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    En familjs vardag vid livets slut2012In: Att möta familjer inom vård och omsorg / [ed] Eva Benzein, Margaretha Hagberg, Britt-Inger Saveman, Lund: Studentlitteratur AB, 2012, 1, p. 207-220Chapter in book (Other academic)
  • 8.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences.
    Andershed, Birgitta
    Örebro University, School of Health and Medical Sciences. Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden.
    Gustavsson, Bernt
    Örebro University, School of Humanities, Education and Social Sciences. South African Chair for Education and Development, University of South Africa, Pretoria, South Africa; Centre for Adult and Continuing Education, University of the Western Cape, Cape Town, South Africa.
    Ternestedt, Britt-Marie
    Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden; Stockholms Sjukhem Foundation, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Emotional knowing in nursing practice: in the encounter between life and death2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 2, article id 5367Article in journal (Refereed)
    Abstract [en]

    Patients, next of kin and nurses in surgical wards often raise existential questions in the encounter between life and death. Nurses' emotional knowing at this encounter is crucial. Consequently, this study's purpose was to analyse and describe nurses' emotional knowing to reveal (a) how this knowing is expressed in daily work and (b) what emotions, thoughts and actions this knowing includes. This study used combined ethnographic and hermeneutic methodologies. Data were collected using participant observations, informal conversations and interviews. We found that nurses' emotional knowing could be interpreted in relation to various rooms of emotions, thoughts and actions. Nurses' judgements formed these rooms. They strived to do things correctly in the normative room; created a safe, secure milieu for patients and next of kin in the safety–security room; and questioned their actions in the critical room. They created affinity for co-operation that benefitted encounters with patients in their affinity room. And they demonstrated sensitivity and compassion to patients and next of kin; sensitivity and compassion were particularly evident in the closeness room. In our main interpretation, we found that nurses' judgements in various rooms (emotional knowing) constitute an expression of practical wisdom (phronesis) in nursing practice.

  • 9.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences.
    Andershed, Birgitta
    Örebro University, School of Health and Medical Sciences.
    Gustavsson, Bernt
    Örebro University, School of Humanities, Education and Social Sciences.
    Ternestedt, Britt-Marie
    Dept Palliat Care Res, Ersta Skondal Univ Coll, Stockholm, Sweden.
    Knowledge constructions in nursing practice: Understanding and integrating different forms of knowledge2010In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 20, no 11, p. 1500-1518Article in journal (Refereed)
    Abstract [en]

    In this combined ethnographic and hermeneutic study we examined which forms of knowledge nurses make use of and how they construct knowledge. We collected data using participant observations, informal conversations, and interviews. Nurses' knowledge construction took the form of a hermeneutic spiral, a journey in which the nurses moved up and down and horizontally, and in which they created understanding. The nurses constructed knowledge from reading the patient's record, the brief oral handover report, greeting the patient, and reading the patient. By being sensitive, using humor, and emotional involvement, they deepened their understanding. By being suspicious and self-critical, they sought interaction with nurse colleagues, the patient, doctor, and relatives, and obtained additional knowledge. They strove throughout the journey to be one step ahead in their efforts to attain an understanding of the patient's situation. We can relate the knowledge nurses make use of to intertwined forms of episteme, techne, and phronesis

  • 10.
    James, Inger
    et al.
    Örebro University, Department of Health Sciences.
    Andershed, Birgitta
    Örebro University, Department of Health Sciences.
    Ternestedt, Britt-Marie
    Örebro University, Department of Health Sciences.
    A family's beliefs about cancer, dying, and death in the end of life2007In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 13, no 2, p. 226-252Article in journal (Refereed)
    Abstract [en]

    The purpose of this case study was to describe the beliefs over time of a Swedish family and individual family members about cancer and death and how these beliefs affected their daily lives. Data were collected over 10 months using interviews, conversations, and diary notations. The beliefs were aggregated into eight main beliefs and four themes: Cancer is a deadly threat/death is a liberator, death can be held at bay/death can be lived near, dying is done alone/dying should not be done alone, and life has an end/life is endless. These beliefs appear to oscillate between seemingly contrasting poles. Some beliefs were shared by all family members, whereas others were described by only one or more members of the family. The complexity of daily life in families experiencing life-shortening illness underscores the need of individualized nursing care with openness to difference and collaboration as guiding principles.

  • 11.
    James, Inger
    et al.
    Örebro University, School of Health and Medical Sciences.
    Andershed, Birgitta
    Örebro University, School of Health and Medical Sciences.
    Ternestedt, Britt-Marie
    Ersta Sköndal Högskola .
    The encounter between informal and professional care at the end of life2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 2, p. 258-271Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to obtain and describe in-depth knowledge about family carers' experiences of the encounter, in a hospital, between informal and professional care at the end of life. A hermeneutic approach was chosen, and we conducted interviews with 27 family carers 6 to 8 months after their loved one's death. In the encounter, the family carers made their own assessment of their loved one's condition and situation. The professionals' attitudes could both promote and impede the interaction between the two forms of care. Family carers' care actions were characterized by struggling to get treatment, being left behind, being partners, keeping the illness at a distance, hovering beside their loved one, waiting for death, and being experts and protectors. The main interpretation of the findings is that family carers possess practical knowledge about what care is the best, or least harmful, for their loved one. This can be linked to what Aristotle called phronesis.

  • 12.
    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.

  • 13.
    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.

  • 14.
    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)
  • 15.
    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, 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.

  • 16.
    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.))
  • 17.
    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.

  • 18.
    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.

  • 19.
    Rasoal, Dara
    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.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svantesson, Mia
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    What healthcare teams find ethically difficult: Captured in 70 moral case deliberations2016In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, no 8, p. 825-837Article in journal (Refereed)
    Abstract [en]

    Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss.

    Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation.

    Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis.

    Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation.

    Findings: Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient's/next-of-kin's emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient's autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have.

    Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders.

    Conclusion: MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.

  • 20.
    Svantesson, Mia
    et al.
    Örebro University, School of Health Sciences. University of Warwick, UK.
    Silén, Marit
    University of Gävle, Sweden; Uppsala University, Sweden.
    James, Inger
    Örebro University, School of Health Sciences.
    It's not all about moral reasoning: Understanding the content of Moral Case Deliberation2017In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, article id Jan 1:969733017700235Article in journal (Refereed)
    Abstract [en]

    Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain.

    Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces.

    Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority.

    Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation.

    Findings: Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%).

    Conclusion: The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

  • 21.
    Windahl, Jenny
    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.
    Liedström, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    To maintain older family members lifestyle and self-identity for a meaningful daily life in nursing homes and home care: The relatives’ perspective2014In: Clinical Nursing Studies, ISSN 2324-7959, Vol. 2, no 4, p. 129-142Article in journal (Refereed)
    Abstract [en]

    In Sweden, national guidelines have been introduced to ensure that older persons in need of health care and social services enjoy a meaningful daily life. When new guidelines are introduced in elderly care, the experience of the older persons or their relatives are seldom taken into account as the guidelines often are formulated from using a top-down approach. Therefore the aim was to describe relatives experience about obstacles and opportunities for a meaningful daily life for their older family member. The analysis was based on a qualitative content analysis. Five themes describe how a meaningful daily life can be created and one overall theme emerged that describe a meaningful daily life as “In partnership to maintain the family member’s routines and habits in an everyday rhythm filled with meaning, in a home like environment and in community with others”.

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