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  • 1.
    Alnes, Rigmor Einang
    et al.
    Department of Health Science, Aalesund University College, Aalesund ,Norway.
    Kirkevold, Marit
    Institute of Health and Society, Department of Nursing Science, University of Oslo, Oslo, Norway; Institute of Public Health, Aarhus University, Aarhus, Denmark.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences.
    Marte meo counselling: a promising tool to support positive interactions between residents with dementia and nurses in nursing homes2011In: Journal of Research in Nursing, ISSN 1744-9871, E-ISSN 1744-988X, Vol. 16, no 5, p. 415-433Article in journal (Refereed)
    Abstract [en]

    Marte Meo Counselling (MMC) is an educational video-based counselling method developed to improve interactions between persons. This study aimed at investigating whether changes could be identified in the interactions between people with dementia and their nurses during morning care, following MMC. An intervention study based on video recordings before and after a MMC intervention was used. Thirteen nurses and 10 residents from six dementia-specific care units at six different institutions in Norway participated. Data were collected through video recording of six pairs (nurse and resident) in interaction before and after the staff received MMC. Four pairs participated as controls. The findings suggest that nurses who received MMC succeeded, to a greater degree than did the comparison nurses, in providing care consistent with promoting positive interactions. We found clearer indications of increased positive interactions and a reduction in inappropriate interactions in the intervention group. In the control group, the variation was greater, with both good and poor interactions present in the same cases.

    This study indicates that MMC can serve as a facilitator for positive interactions and can also lead to a reduction in inappropriate interactions. Further research is needed to evaluate the effect of MMC.

  • 2.
    Alnes, Rigmor Einang
    et al.
    Department of Health Science, Aalesund University College, Aalesund, Norway; Center for Care Research, Steinkjer, Norway.
    Kirkevold, Marit
    Institute of Health and Society, Department of Nursing Science, University of Oslo, Oslo, Norway; Institute of Public Health, Aarhus University, Aarhus, Denmark.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Health Science, Aalesund University College, Aalesund, Norway.
    The influence of the learning climate on learning outcomes from Marte Meo counselling in dementia care2013In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 21, no 1, p. 130-140Article in journal (Refereed)
    Abstract [en]

    AIM:   To identify factors that affected the learning outcomes from Marte Meo counselling (MMC).

    BACKGROUND:   Although MMC has shown promising results regarding learning outcomes for staff working in dementia-specific care units, the outcomes differ.

    METHOD:   Twelve individual interviews and four focus group interviews with staff who had participated in MMC were analysed through a qualitative content analysis.

    RESULTS:   The learning climate has considerable significance for the experienced benefit of MMC and indicate that this learning climate depends on three conditions: establishing a common understanding of the content and form of MMC, ensuring staff's willingness to participate and the opportunity to do so, and securing an arena in the unit for discussion and interactions.

    CONCLUSION:   Learning outcomes from MMC in dementia-specific care units appear to depend on the learning climate in the unit. Implication for nursing management  The learning climate needs attention from the nursing management when establishing Marte Meo intervention in nursing homes. The learning climate can be facilitated through building common understandings in the units regarding why and how this intervention should take place, and by ensuring clarity in the relationship between the intervention and the organization's objectives.

  • 3.
    Dahlkvist, Eva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Faculty of Health and Occupational Studies, Department of Health and Caring Sciences , University of Gävle, Gävle, Sweden.
    Nilsson, Annika
    Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Faculty of Health Sciences, Buskerud University College, Kongsberg, Norway.
    Engström, Maria
    Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Is there a caring perspective in garden/patio design in elderly care?: a description and a comparison of residents' and staff members' perceptions of these outdoor spaces2014In: Journal of Housing for the Elderly, ISSN 0276-3893, E-ISSN 1540-353X, Vol. 28, no 1, p. 85-106Article in journal (Refereed)
    Abstract [en]

    This article aims to describe the characteristics of and design elements in gardens/patios at 87 residential living homes for older people and to describe and compare residents’ and staff members’ perceptions of outdoor spaces. The aim was also to investigate factors related to residents' satisfaction with and stays in the garden/patio. The result showed that many gardens/patios had several recommended design elements and, at the same time, obvious deficiencies. The residents (n = 415) valued various aspects of the garden/patio more highly than did the staff (n = 667). Managers responsible for residential living homes for elderly people should take measures to ameliorate deficiencies and deficient elements in design and accessibility that are lacking so that the garden/patio can be used as an important health promotion resource in the care of elderly people. Residents and staff are important actors in such development work.

  • 4.
    Einang Alnes, Rigmor
    et al.
    Department of Health Sciences, Aalesund University College, Aalesund, Norway.
    Kirkevold, Marit
    Department of Nursing and Health Sciences, Oslo University, Oslo, Norway; School of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Insights gained through Marte Meo counselling: experiences of nurses in dementia specific care units2011In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 6, no 2, p. 123-32Article in journal (Refereed)
    Abstract [en]

    AIM: This study sought to uncover what nurses perceived to have learned, during their participation in video supported counselling, based on Marte Meo principles, in four dementia specific care units.

    METHODS: This was a descriptive qualitative study. Data were collected through 12 individual and four focus group interviews. In addition, supplementary data from two video recordings and one written log were included. Findings emerged through content analysis and re-examination of the text based on the initial analysis.

    RESULTS: The nurses experienced that they acquired new knowledge about the residents through Marte Meo Counselling (MMC), resulting in improved capability to interpret the residents` expressions, and increased awareness of the residents' competence. New knowledge about themselves as nurses also emerged; they recognised how their actions entailed consequences for the interaction, in turn making them conscious of the usefulness of taking time, pacing their interactions, maintaining eye contact and describing the situation in words when the interaction took place. This appeared to increase the resident's perception of being able to cope.

    CONCLUSIONS: This study indicates that MMC helped the nurses to gain knowledge about how to improve interactions with residents suffering from dementia. Further research is warranted into the effectiveness of MMC.

  • 5.
    Finnbakk, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Lovisenberg Diaconal University College, Oslo, Norway.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blix, Ellen Störe
    Faculty of Professional Studies, University of Nordland, Bodø, Norway.
    Fagerström, Lisbeth
    Faculty of Health Sciences, Buskerud University College, Drammen, Norway; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Top-level managers' and politicians' worries about future care for older people with complex and acute illnesses: a Nordic study2012In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 7, no 2, p. 163-72Article in journal (Refereed)
    Abstract [en]

    Background: The growing aging population, with its associated complex needs and illnesses, will in the future become an even more important challenge for the Nordic countries.

    Aim: The aim of the study was to describe and explore the perceptions and views of top-level managers and politicians in regard to an optimal future care for older people during the next decade.

    Design: The study has a qualitative, descriptive design.

    Methods: Top-level managers (n = 11) and politicians (n = 8) were interviewed in Sweden, Finland, Denmark and Norway in 2009. The data material was analysed through manifest and latent content analyses.

    Results: Future care should substantially focus on the individual needs and dignity of older people. The respondents also recommended a preventive perspective on future care. They anticipate that older people's needs will be complex, requiring nursing competence on an advanced level within home care and nursing homes, and point to the importance of leadership abilities and workplace image. Limited resources and the use of health technology will be dominant issues, entailing the need for open-mindedness to reorganise future care. The latent theme expressed was 'A creative willingness to act - but with an underlying worry about the future'.

    Conclusions: The findings reveal a multifaceted scenario of optimal future care; older people will have significant, acute and complex needs but resources will be limited. In the near future, medical treatment and nursing care for older people at advanced and specialised levels within primary health care will be needed.

    Implications for practice: To meet demands, a clear need exists for the advanced clinical competence of nurses. There is also a clear need to reorganise health care services for older people, develop the leadership abilities of nurse managers and make workplaces more attractive.

  • 6.
    Finnbakk, Elisabeth
    et al.
    Lovisenberg Deaconal Univ Coll, Oslo, Norway .
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fagerström, Lisbeth
    Høgskolen i Buskerud, Kongsberg, Norway.
    Olesen, Mette Anne
    VIA, Univ Coll, Aarhus, Denmark .
    Store, Ellen Blix
    Bodö Univ Coll, Bodö, Norway .
    Larsen, Reidun
    Lovisenberg Deaconal Univ Coll, Oslo, Norway.
    Kulla, Gunilla
    Appl Sci, Novia Univ, Vaasa, Finland.
    Ahonen, Pia
    Appl Sci, Turku Univ, Turku, Finland.
    An optimal future care for older people in the Nordic countries2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no Suppl. 1, p. 127-127Article in journal (Other academic)
  • 7.
    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.

  • 8.
    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.

  • 9.
    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.

  • 10.
    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.

  • 11.
    Kihlgren, Mona
    et al.
    Örebro University, School of Health and Medical Sciences.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences.
    Vårdinsatser vid BPSD: förhållningssätt och behandling2008In: Information från Läkemedelsverket, ISSN 1101-7104, Vol. 19, no 5, p. 28-33Article in journal (Other academic)
  • 12.
    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.

  • 13.
    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.

  • 14.
    Olsson, Annakarin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Engström, Maria
    Lampic, Claudia
    Skovdahl, Kirsti
    A passive positioning alarm used by persons with dementia and their spouses: a qualitative intervention study2013In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 13, no 11, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background

    Increasingly, information and communication technology is being used to support persons with dementia living at home and their relatives. The aim of the present intervention study was to describe and explore the use and experiences of using a passive positioning alarm, over time, in daily life among persons with dementia and their spouses.

    Methods

    Using an ethnographically inspired approach, five couples, each including a person with Alzheimer's disease and his/her spouse living in their own home, were repeatedly observed and interviewed regarding their experiences of using a passive positioning alarm. Interview text transcripts and field notes were analyzed using qualitative content analysis.

    Results

    The main findings show changes over time, where testing and checking the passive positioning alarm successively led to trust in the alarm and in one own's ability to use it. These components were a prerequisite for the couples to perceive the value of the alarm.

    Conclusions

    A passive positioning alarm for persons with dementia and their spouses needs to be packaged as a "service" with flexibility for each user and based on user needs, abilities, knowledge and skills. Using a passive positioning alarm can be a valuable support that allows persons with dementia to be alone outdoors and can increase safety and security for them and their spouses. The present study contributes to our understanding of what prerequisites need to be in place and what barriers need to be dealt with before successful implementation can occur.

  • 15.
    Olsson, Annakarin
    et al.
    Örebro University, School of Health and Medical Sciences. Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Engström, Maria
    Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences.
    Lampic, Claudia
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    My, your and our needs for safety and security: relatives' reflections on using information and communication technology in dementia care2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, p. 104-112Article in journal (Refereed)
    Abstract [en]

    Aim: The present paper reports on a study aimed at describing relatives' reflections on different kinds of information and communication technology (ICT) devices that are used or can be used in the daily care of persons with dementia.

    Background: Many persons with dementia continue living in their own homes, which requires the support of their relatives. One way to meet the needs of relatives and persons with dementia is to use ICT.

    Methods: An interview study was conducted in Sweden (2007-2008) with a purposive sample of 14 spouses of a person with dementia. Qualitative content analysis was used to identify categories and themes in the data.

    Findings: Relatives' reflections on the use of ICT were described as ICT - a support in daily life, ICT - internal and external conditions and ICT - the decision to use or not use. Based on these categories, a theme was revealed: shifting between different perspectives: my, your and our needs for safety and security.

    Conclusion: Relatives struggle to create a situation of safety and security in daily life for themselves and the persons with dementia. ICT devices with the right functionality and used at the right time are regarded as useful in solving everyday problems. In the decision to use or not use ICT, the opportunity to create a safe and secure environment overshadows potential ethical problems. Providing early information about ICT to persons with dementia and their relatives could facilitate joint decision-making regarding use of ICT.

  • 16.
    Olsson, Annakarin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Engström, Maria
    Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Åsenlöf, Pernilla
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Faculty of Health Sciences, Buskerud University College, Drammen, Norway.
    Lampic, Claudia
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
    Effects of tracking technology on daily life of persons with dementia: three experimental single-case studies2015In: American Journal of Alzheimer’s Disease and Other Dementia, ISSN 1533-3175, E-ISSN 1938-2731, Vol. 30, no 1, p. 29-40Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the effects of using tracking technology on independent outdoor activities and psychological well-being in 3 persons with dementia (PwDs) and their spouses.

    Methods: Three experimental single-case studies with an A1B1A2B2 design. The intervention entailed access to a passive positioning alarm and technical support. Continual daily measures of independent outdoor activities among PwDs' and spouses' worries about these activities were made during all phases.

    Results: Access to a tracking technology consistently increased the independent outdoor activities of 2 PwDs. One of the spouses consistently reported decreased worry during B phases, another's worry decreased only in B2, and the third showed little variability in worrying across all phases.

    Conclusion: Tracking technology may support PwDs to engage in independent outdoor activities and decrease spouses' worries; however, randomized controlled group studies are needed to investigate whether these results can be replicated on a group level.

  • 17.
    Olsson, Annakarin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lampic, Claudia
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Engström, Maria
    Persons with early-stage dementia reflect on being outdoors: a repeated interview study2013In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 17, no 7, p. 793-800Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to describe how persons with early-stage dementia reflect on being outdoors. Method: Data were collected through repeated interviews with a purposive sample of 11 persons with early-stage dementia in Sweden during the period 2009-2010 and were analysed using qualitative content analysis. Results: Informants described being outdoors as a confirmation of the self. Confirmation of their ability to maintain desired activities, despite the dementia disease, was important to the informants. However, some confirmations were not positive; the realisation that one could no longer perform certain activities could be devastating. Two sub-themes emerged: shifting between still being part of it all' and a sense of grief and loss and striving to keep on despite perceived barriers. Past, but no longer possible, outdoor activities were greatly missed and the informants longed to be able to perform these activities once again. To resolve possible difficulties associated with being outdoors, the informants used various adaptation strategies. Despite the described barriers, being outdoors was of great value to them. Conclusion: Independent outdoor activities seem to contribute to the well-being and feelings of self-worth among persons with early-stage dementia who want to be and are able to be outdoors. If a person with dementia, despite cognitive limitations, wants and is able to engage in outdoor activities, it is important for relatives and health-care staff to encourage and facilitate this, for example, by discussing adaptation strategies to deal with orientation problems.

  • 18.
    Pajalic, Zada
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. The School of Health and Society, The PROCARE Group & The Network for Eating and Nutrition, Kristianstad, Sweden.
    Persson, Lena
    The School of Health and Society, The PROCARE Group & The Network for Eating and Nutrition, Kristianstad, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Westergren, Albert
    The School of Health and Society, The PROCARE Group & The Network for Eating and Nutrition, Kristianstad, Sweden.
    Facilitating change, the decision-maker’s views of municipality organized food distribution to elderly people living at home and suggestions for development: a participatory action research study2012In: Public Administration Research, ISSN 1927-517X, E-ISSN 1927-5188, Vol. 1, no 1, p. 14-23Article in journal (Refereed)
    Abstract [en]

    This study is the final part of a larger project with an action research approach focusing on food distribution (FD) within municipal service and care for elderly persons, living at home  (≥ 65 years), from various perspectives. The aim was to describe the decision-makers’ the politicians and top level administrative manager’s views on the FD service, and to give feedback from the results of earlier studies based on information given by FD receivers, the perspectives of involved professionals, and the results of an intervention study and further to report the decision-makers suggestions for which areas should be taken into consideration as starting points to improve the FD process and practice. Data was gathered in two steps: step 1, through individual interviews (n=12) with the decision-makers during the spring of 2009, step 2a through feedback from previous studies, received during the autumn of 2011 and step 2b from discussions based on the feedback. The interview data was analysed using qualitative content analysis. The findings indicated a discrepancy between the reality and the political visions. It was shown that decision-maker’s needed to make decisions despite their uncertain knowledge of the complexity of the FD programme. They considered what has been, what is, and will be, when setting goals. Their goal was that elderly person’s rights and needs should be fulfilled. This included freedom of choice and individual consideration. In addition, it meant, meeting elderly people’s medical and social needs. Three areas were found to require facilitation for change related to FD: 1) the monitoring of the elderly’s health and wellbeing while providing FD, 2) the increasing of professional competence, and 3) the creation of a forum for inter-professional communication. The findings in this study have implications for nursing, gerontology and public administration.

  • 19.
    Pajalic, Zada
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Persson, Lena
    School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Westergren, Albert
    School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Berggren, Vanja
    School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The experiences of elderly people living at home related to their receiving meals distributed by a municipality in Sweden2012In: Journal of Food Research, ISSN 1927-0887, E-ISSN 1927-0895, Journal of Food Research, ISSN 1927-0887, Vol. 1, no 1, p. 68-78Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to describe the experiences of elderly people, living at home who receive hot meals that are distributed by their municipality. Qualitative content analysis was used to analyse the (n=13) interviews. The results showed that feelings of dependency, loneliness and gratitude were expressed by the participants in the study related to their meals being delivered home. Dependency was expressed as not having influence over the food products the meals were made from. Loneliness was expressed as being isolated and being confined at home alone due to difficulties getting out of the house, which was associated with the costs of taxis transportation. Gratitude was expressed by the sincere thanks for the possibility of receiving traditional meals delivered daily.

    The major conclusion of the study was the indication that greater attention should be paid to meet both the practical and psychological needs of elderly people.

  • 20.
    Pajalic, Zada
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Persson, Lena
    Westergren, Albert
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Evaluation for change, the decision maker’s involvement in the development of food distribution to home living elderly people2012Conference paper (Refereed)
  • 21.
    Pajalic, Zada
    et al.
    Örebro University, School of Health and Medical Sciences.
    Persson, Lena
    Westergren, Albert
    Skovdahl, Kirsti
    Food distribution within a municipality from different perspectives - older people, decision makers and professionals: an action research study2011Conference paper (Refereed)
  • 22.
    Pajalic, Zada
    et al.
    School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Persson, Lena
    School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Westergren, Albert
    School of Health and Society, Kristianstad University, Kristianstad, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Public home care professionals’ experiences of being involved in food distribution to home-living elderly people in Sweden: a qualitative study with an action research approach2012In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 2, no 2, p. 41-51Article in journal (Refereed)
    Abstract [en]

    Background: Research focusing on Food Distribution (FD) from various professionals’ and organisational perspectivesare lacking. The aim of this study was therefore to explore various professionals’ experiences of involvement in FD inorder to get comprehensive understanding of the organisation, responsibilities and roles.

    Methods: This qualitative study is a part of a larger project with an action research approach focusing on FD in themunicipal home service and care for home-living elderly persons in a municipality in southern Sweden. The data wascollected through participatory observations (n=90 occasions and in total 480 hours), repeated focus group interviews (n =4) with different professionals (n =10) involved in the FD process and one individual interview. The material was analysedby qualitative manifest and latent content analysis.

    Results: The study indicates that Food Distribution is a fragmentary intervention where a comprehensive perspective andclear roles of responsibility are lacking. The FD organisation seemed to be strictly divided and limited by constraintsregarding time and money. The fragmented organisation led partly to staff only taking responsibility for their part of thechain and no one having the full picture of and responsibility for the FD process, but also to some professionals takingmore responsibility than they were supposed to.

    Conclusions: The aim of the study was met by using an action research approach. The study was however limited by thatno home help officers were represented. The FD appeared as an extremely complex chain of different but connectedactivities. It is not merely the distribution of a product, i.e. the meal box. The fragmentation of FD means that staff onlytakes responsibility for their part of the chain, and that no one has the full picture of or responsibility for the FD process.Consequently, there is a need for an outline of responsibilities. The findings have implications for nursing, gerontology,and in the care for the elderly.

  • 23.
    Pajalic, Zada
    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.
    Westergren, Albert
    The School of Health and Society, The PROCARE Group & The Network for Eating and Nutrition, Kristianstad University, Kristianstad, Sweden.
    Persson, Lena
    The School of Health and Society, The PROCARE Group & The Network for Eating and Nutrition, Kristianstad University, Kristianstad, Sweden.
    How the professionals can identify needs for improvement and improve Food Distribution service for the home-living elderly people in Sweden: an action research project2013In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 8, p. 29-40Article in journal (Refereed)
    Abstract [en]

    Background: Making changes to municipal social care and service has been found to be challenging to realise and highly multifaceted. The aim of this study was to describe how the professionals can identify needs for improvement and improve Food Distribution (FD) service for the home-living elderly people in Sweden.

    Methods: This study is part of a larger project with an action research approach focusing on to municipal FD to older people living in their own home in Sweden. The professionals involved in FD invited the first author to assist them in this process. The study participants were comprised of the following groups: “The Identification focus group” that identified need for improvement of FD (n= 5); “The Action focus group” that planned and choose suitable ‘action’ for improvement (n=5); “The First Evaluation group” (n=4) that evaluated the content of planned improvement and finally “The Second Evaluation group” (n=29) that evaluated the changes following improvement. The data was gathered and analysed by Story Dialogue Method.

    Results: The need to update and increase the FD recipient’s knowledge in nutrition by sending them informative letters was found to be an important area to focus on. The information letters (n=1700) were distributed to the all FD recipients in six municipalities in southern Sweden during April 2011. The results were evaluated during May 2011. The overall general estimation was that the content of the letters indicated that this was a suitable method for gaining information to make a nutrition competence update. Following this, “The Action focus group” decided: firstly, to continue preparing and distributing information letters to all FD recipients to be sent out twice a year, and secondly: to make the information letters accessible on the websites of the six municipalities and county councils involved.

    Conclusions: This study showed that systematic work inspired by an action research approach with motivated and involved participants can be beneficial and a starting point for the process of change in municipal service and care practice. The major conclusion of the study was that systematic reflection over everyday practice can be the vehicle for the future change of practice. The research process and the findings have implications for nursing, care of the elderly and gerontology.

  • 24.
    Pajalic, Zada
    et al.
    Örebro University, School of Health and Medical Sciences.
    Westergren, Albert
    Persson, Lena
    Skovdahl, Kirsti
    Matdistribution från olika prespektiv: professioner, beslutsfattare och från äldre personer - en aktionsforskningsstudie2011Conference paper (Refereed)
  • 25.
    Quell, Robin
    et al.
    Center of Nursing Science, Örebro University Hospital.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences.
    Kihlgren, Mona
    Center of Nursing Science, Örebro University Hospital.
    Lökk, Johan
    Intitution of Neurobiology, Caring Science adn Society, Karolinska Institutet.
    Using tactile stimulation in a dementia care facility with plasma prolactine as an outcome measure: a pilot study2008In: Archives: the international journal of medicine, ISSN 1791-4000, Vol. I, no 3, p. 123-129Article in journal (Refereed)
    Abstract [en]

    BackgroundThere is poor scientific documentation supporting tactile stimulations’ benefit as a nursing intervention. It has been theorized that older adults with dementia experience high anxiety and stress levels. High prolactin levels are associated with psychosomatic reactions and have been used to measure stress levels in adults.AimTo evaluate tactile stimulation’s effectiveness on anxiety and stress in older adults, with dementia diagnosis or signs of dementia and living in a dementia care facility, as manifested by plasma prolactin levels.Materials and MethodsTactile stimulation was given weekly by trained staff members to half the residents of a Swedish dementia care facility.The subjects were randomly selected (n=20) and were tracked in the study for a minimum of 28 weeks. The remaining half elders made up the control team (n=20). Diagnostic groups were formed according the severity of dementia. Plasma prolactin levels were drawn at baseline and post intervention. Medications caused the exclusion of 12 residents and seven dropped out due to other causes. ResultsThere was no difference in plasma prolactin levels between the intervention (n=11) and control (n=12) group. A significant main effect between the diagnostic groups was found as well as a trend towards a positive correlation between age and plasma prolactin levels. There was no gender difference in plasma prolactin levels.ConclusionsOur hypothesis that reduced plasma prolactin levels could be detected in elders treated with tactile stimulation, indicating alleviated stress, was not supported by the preliminary results of the present study. Further evaluation of tactile stimulation with larger study groups and a better understanding of prolactin’s sensitivity, complexity and interaction with medications could contribute to the outcome and problems of the study. The use of neuropsychological assessment could enrich the research data and help the evaluation.

  • 26.
    Skovdahl, Kirsti
    et al.
    Örebro University, School of Health and Medical Sciences.
    Fahlström, Gunilla
    Regionförbundet i Örebro län.
    Horttana, Britt-Marie
    Örebro University, School of Health and Medical Sciences.
    Winblad, Bengt
    Kihlgren, Mona
    Centre for Nursing Science, Örebro University Hospital.
    Demanding behaviours and workload in elderly care in Sweden: occurrence at two time points within a decade2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 3, p. 323-330Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the occurrence of demanding behaviours in persons ‡65 years receiving home care or living in sheltered accommodation at two points in time, 1993 and 2002. Another aim was to investigate whether the perceived workload in staff had changed during this period. All persons ‡65 years living at home and utilizing home care services or those who lived in some form of sheltered housing were included and assessed by staff using a three-part questionnaire, in two cross-sectional studies. The study group comprised 1187 and 1017 participants which equals 77% and 99% respectively. Symptoms and degree of behavioural and psychiatric symptoms common in dementia that were assessed with a subscale in The Gottfries-Bra°ne-Steen Scale, demonstrated an all over increase from 1993 to 2002. Items from The Multi Dimensional Dementia Assessment Scale (MDDAS) measured a decrease in ‘daily’ occurrences of dementia symptoms but an increase in ‘sometimes per week’. A mixed pattern was seen concerning behaviours where increases as well as decreases were found. The behaviours ‘constantly seeking attention’ and ‘shrieking continuously’ increased significantly. The number of individuals showing restless, aggressive or shrieking behaviours increased significantly over the decade. Two items from the MDDAS were used to measure the workload. The physical workload increased significantly over the decade whereas the rising tendencies of the psychological workload were not statistically significant. The mean age over the decade had increased from 83 to 86 years, which together with the findings make the recipients of home care and sheltered housing a very vulnerable group. The demanding problems place considerable pressure on staff.

  • 27.
    Skovdahl, Kirsti
    et al.
    Centre for Nursing Science , Örebro University Hospital , Örebro, Sweden.
    Kihlgren, Annica Larsson
    Centre for Nursing Science , Örebro University Hospital , Örebro, Sweden.
    Kihlgren, Mona
    Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research , Karolinska Institutet , Stockholm, Sweden.
    Different attitudes when handling aggressive behaviour in dementia: narratives from two caregiver groups.2003In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 7, no 4, p. 277-286Article in journal (Refereed)
    Abstract [en]

    This study highlights the experiences of 15 formal caregivers, during interactions with elderly residents suffering from dementia disease and showing aggressive behaviour. The purpose was to study caregivers' reflections about and attitudes to behavioural and psychiatric symptoms of dementia (BPSD) and how they dealt with the symptoms. This was done by comparing care units with high or low levels of aggressive behaviour in residents. A phenomenological-hermeneutic approach was used for the analysis of the interviews. The main themes that emerged were: a need for balance between demands and competence; and a need for support. The findings indicated the importance of a balance for the residents as well as for the caregivers, if a positive relationship was to develop. Furthermore, caregivers stated that support was crucial, not only for the residents but also for themselves, if they were expected to cope with demanding situations. Different types of support were necessary and included: confirmation, feedback, and supervision. Residents who feel appreciated and respected may be less likely to act out their frustrations in an inappropriate manner. Caregivers who strive to understand the meaning behind a resident's behaviour and who master the necessary care-giving skills, and their implementation, could be more successful at curbing distressing behaviour, than caregivers who act merely in a custodial role.

  • 28.
    Skovdahl, Kirsti
    et al.
    Doctoral Student, Centre for Nursing Science, Örebro University Hospital, Örebro; Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.
    Kihlgren, Annica Larsson
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Doctoral Student, Centre for Nursing Science, Örebro University Hospital, Örebro; Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Mona
    Centre for Nursing Science, Ö University Hospital, Örebro, Sweden; Centre of Excellence in Elderly Care Research, Neurotec Department, Karolinska Institute, Stockholm, Sweden.
    Dementia and aggressiveness: video recorded morning care from different care units2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 6, p. 888-898Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to illuminate, from video recorded sequences, interactions between individuals with dementia and aggressive behaviour and caregivers who reported problems dealing with such behaviour and caregivers who did not. Nine caregivers and two residents participated.

    The video recordings were later transcribed into text and analysed by using a phenomenological hermeneutic approach, inspired by Ricoeur's philosophy.

    The main themes that emerged from the analysis were 'Being involved and developing a positive interaction' and 'Being confined to routines and remaining in negative interaction'.

    The findings indicated the interactions either to be in a positive or negative spiral. Caregivers who had reported problems dealing with behavioural and psychiatric symptoms in dementia focused on accomplishing the task, where the main focus was on 'the goal itself'. In other sequences with caregivers who had been satisfied with their capability the focus was placed on 'how' the caregivers could reach their goal.

    Power was central in the material, in different ways, either as a possible way to handle the situation or as a possible way of defending oneself. Parts of Kitwood's framework and Fromm's theory about power 'over' and power 'to', has been used in the comprehensive understanding. Our conclusion is that caregivers should use power 'to' when they have to help persons with dementia and aggressive behaviour, as a part of behavioural and psychiatric symptoms of dementia, for being able to give help in the best possible way. They should also act in a sensitive and reflective manner, with the individual in focus.

  • 29.
    Skovdahl, Kirsti
    et al.
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; NEUROTEC Department, Ctr. Excellence in Elderly Care Res., Karolinska Institutet, Stockholm, Sweden .
    Larsson Kihlgren, Annica
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; NEUROTEC Department, Ctr. Excellence in Elderly Care Res., Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Mona
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; NEUROTEC Department, Ctr. Excellence in Elderly Care Res., Karolinska Institutet, Stockholm, Sweden.
    Dementia and aggressivenes: stimulated recall interveiws with care-givers after video-recorded interactions2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 4, p. 515-525Article, review/survey (Refereed)
    Abstract [en]

    Background: In a previous study, nine caregivers and two residents with dementia showing aggressive behaviour, were video recorded. Caregivers who reported problems when dealing with such behaviour and caregivers, who did not, were included in this study.

    Aim: The aim of the present study was to obtain insight into the reasoning of the caregivers who had reported problems when dealing with older people with dementia and aggressiveness and those who did not relative to their respective video-recorded interactions with these residents. A further aim was to gain insight by discussing their reasoning in relation to each other.

    Method: Stimulated recall interviews were carried out with all the caregivers who had been video taped in the previous study. The text was analysed by thematic content analysis.

    Findings: Two main ways of thinking and discussing the care situations emerged. The caregivers, who had reported problems in handling behavioural and psychiatric symptoms in dementia earlier, reasoned that they were more focused on their duties, this included being responsible for the resident receiving her weekly shower. For this group of caregivers, the well being of the resident was in focus, but their attention was concentrated on the resident's well being and comfort after their shower. However, these caregivers seemed therefore unwittingly to prevent a positive interaction with the resident. The other caregivers were able to reflect spontaneously and appeared to be self-critical. This caregiver group seemed to sustain a positive interaction with the resident both during and after the shower.

    Relevance to clinical practice: In this study a nurturing and supportive climate and competence seemed to be the conditions necessary to facilitate reflections and promote creativity in the caregivers such that they are able to develop possible ways of handling difficult situations like aggressiveness in residents with dementia.

  • 30.
    Skovdahl, Kirsti
    et al.
    Örebro University, School of Health and Medical Sciences.
    Palo-Bengtsson, Liisa
    Karolinska Institutet.
    Anttila, Sten
    Institutet för utveckling av metoder i socialt arbete, Socialstyrelsen.
    Höjgård, Ulla
    Socialstyrelsen.
    Fredriksson, Maja
    Socialstyrelsen.
    Jonsson, Ann-Kristin
    Socialstyrelsen.
    Glad, Johan
    Socialstyrelsen.
    Yngre personer med demenssjukdom och närstående till dessa personer: en kunskapssammanställning2007Report (Other academic)
  • 31.
    Skovdahl, Kirsti
    et al.
    Örebro University, School of Health and Medical Sciences.
    Sörlie, Venke
    Bodö University College, Norge.
    Kihlgren, Mona
    Vårdvetenskapligt forskningscenter, Örebro läns landsting.
    Tactile stimulation associated with nursing care to individuals with dementia showing aggressive or restless tendencies: an intervention study in dementia care2007In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 2, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Aim.  This study aimed to describe from documentation both the caregivers' experiences of giving tactile stimulation to five people with moderate-to-severe dementia and who showed aggressive or restless tendencies, and the changes seen in them. Background.  Clinical experiences indicate that tactile stimulation can contribute to a feeling of trust and confirmation as well as to improving communication, promoting relaxation and easing pain. There is, however, very little scientific documentation of the effects of touch massage for people with dementia. Design.  From caregivers' documentation (28 weeks) of experiences, the giving of tactile stimulation to five randomly selected people with dementia showing aggressive or restless tendencies and the subsequent changes noticed. Method.  The documentation was analysed by using qualitative content analysis. Results.  All residents displayed signs of positive feelings and relaxation. The caregivers stated that they felt able to interact with the residents in a more positive way and that they felt they had a warmer relationship with them. Conclusion.  Tactile stimulation can be seen as a valuable way to communicating non-verbally, of giving feedback, confirmation, consolation or a feeling of being valuable and taken care of. Relevance to clinical practice.  Tactile stimulation has to be administered with respect and care, and given from a relational ethics perspective. Otherwise, there is a risk that tactile stimulation will be used merely as a technique instead of as a part of an effort to achieve optimal good, warm nursing care.

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