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  • 1.
    Algilani, Samal
    Örebro University, School of Health Sciences.
    To be at one's best: The evolution of Optimal Functionality and its possible implementation in an ICT-platform2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    At the Nutrition and Physical Activity Research Centre for Optimal Health and Functionality through Life (NUPARC), a research gap was uncovered regarding the concept optimal functionality based on the older adult’s own perspective. The overall aim was to explore the concept of optimal functionality among older adults and the possibility of creating and developing an ICT-platform to measure it. Method: An existing cohort from NUPARC was used for recruitment in studies I-III and to some extent study IV. A scoping study design and framework was adopted for the inclusion of the articles in Study I. Study II had a descriptive design. Six focus group discussions were conducted and analysed using qualitative deductive content analysis to extend the qualitative understanding. Study III used a phenomenological approach describing the experience of mental health and its impact on the ability to function as optimally as possible. Six interviews were analysed using Giorgi’s phenomenological approach. Study IV was a feasibility study and included 8 older adults using an ICTplatform for a period of four weeks. Results: Optimal Functionality comprises three major corner stones: Body-related factors, Self-related factors and External factors (I) accompanied by nine aspects, and according to older adults it is a matter of functioning as optimally as possible (II). The three major cornerstones are intricately linked and all but the mental aspects were included in the discussions (II). Life situations affecting mental health, consequences of mental health and strategies for maintaining good mental health were described by older adults as having an impact on mental health and affecting their ability to function as optimally as possible (III). The older adults managed the usage of an ICT-tool well and it was perceived as meaningful (IV). Conclusion: Optimal functionality is holistic, subjective, dynamic and applicable to all older adults. Identification of the factors involved can help the older adults on their path to health. An ICT-platform can facilitate the identification of the factors for optimal functionality and the eventual measurement of it.

    List of papers
    1. Exploring the concept of optimal functionality in old age
    Open this publication in new window or tab >>Exploring the concept of optimal functionality in old age
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    2014 (English)In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 7, p. 69-79Article, review/survey (Refereed) Published
    Abstract [en]

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

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

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

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

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

    Place, publisher, year, edition, pages
    Dove Medical Press, 2014
    Keywords
    optimal functionality, aging, personal satisfaction
    National Category
    Nursing
    Research subject
    Medicine; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-33866 (URN)10.2147/JMDH.S55178 (DOI)24516333 (PubMedID)2-s2.0-84893293812 (Scopus ID)
    Available from: 2014-02-20 Created: 2014-02-20 Last updated: 2018-06-05Bibliographically approved
    2. Increasing the qualitative understanding of optimal functionality in older adults: a focus group based study
    Open this publication in new window or tab >>Increasing the qualitative understanding of optimal functionality in older adults: a focus group based study
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    2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, no 1, article id 70Article in journal (Refereed) Published
    Abstract [en]

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

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

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

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

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

    Funding Agencies:

    Olle Engkvist Byggmästare Foundation

    Faculty of Medicine and Health at Örebro University

    Available from: 2016-04-02 Created: 2016-04-02 Last updated: 2018-04-27Bibliographically approved
    3. Mental health as a prerequisite for functioning as optimally as possible in old age: a phenomenological approach
    Open this publication in new window or tab >>Mental health as a prerequisite for functioning as optimally as possible in old age: a phenomenological approach
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-50048 (URN)
    Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2017-10-17Bibliographically approved
    4. An interactive ICT-platform for early assessment and management of patient-reported concerns among older adults living in Ordinary Housing: Development and Feasibility
    Open this publication in new window or tab >>An interactive ICT-platform for early assessment and management of patient-reported concerns among older adults living in Ordinary Housing: Development and Feasibility
    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-50049 (URN)
    Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2017-10-17Bibliographically approved
  • 2.
    Anita, Johansson
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ändlös omsorg och utmätt hälsa: Föräldraskapets paradoxer när ett vuxet barn har långvarig psykisk sjukdom2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to deepen knowledge of what it means to be a parent of an adult child who suffers from long-term mental illness. Data collection in studies I-III consisted of qualitative interviews with 26 parents. In study I, 16 mothers and, in study II, 10 fathers were interviewed about the way in which their everyday life was affected when an adult child suffers from long-term mental illness. Data were analysed using qualitative content analysis. In study III, the same 26 parents participated as in studies I-II. The aim of the study was to investigate parents’ conceptions of the mental health care. Data were analysed by means of the phenomenographic method. Study IV is based on questionnaires completed by 151 parents. The aim was to investigate mothers’ and fathers’ health related quality of life (HRQOL) focusing on self-rated symptoms of anxiety, depression and burden as well as their experiences of encounters with the mental health services. Data were analysed for the most part by means of non-parametric method.

    The mothers’ everyday life was characterized by constant preparedness to adapt their life situation to the needs of their child (I). The fathers’ inherent ongoing struggle to ensure the child’s well-being required both strength and courage. Fathers attempted to maintain a good balance in life; this balancing act depended on collaboration between those involved in the child’s life, the family, the healthcare services and other authorities (II). The parents described feeling excluded from professional care and questioned its quality and accessibility (III). Mothers’ self-rated HRQOL was lower and they were also affected by burden and mental ill health to a greater extent than the fathers (IV).

    The results highlight shortcomings in the interaction between parents and mental health professionals. This highlights the importance of interventions that support and strengthen cooperation between parents and mental health professionals in the care of children who suffer from mental illness.

    List of papers
    1. Mothers' Everyday Experiences of Having an Adult Child Who Suffers from Long-Term Mental Illness
    Open this publication in new window or tab >>Mothers' Everyday Experiences of Having an Adult Child Who Suffers from Long-Term Mental Illness
    2010 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 31, no 11, p. 692-699Article in journal (Refereed) Published
    Abstract [en]

    This paper aims to describe everyday life experiences of mothers who have an adult child with a long-term mental illness. Sixteen mothers were interviewed. A content analysis resulted in one main theme: My adult child who is struggling with mental illness is always on my mind, and three subthemes: (1) living a life under constant strain, (2) living with an emotional burden, and (3) seeing light in the darkness despite difficulties. Knowledge of mothers’ everyday life experiences is of great importance in order to support them and thereby increase the possibility of these mothers being a source of strength for their child.

    National Category
    Humanities
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-27597 (URN)10.3109/01612840.2010.515768 (DOI)20936890 (PubMedID)2-s2.0-77958097228 (Scopus ID)
    Available from: 2013-03-22 Created: 2013-02-16 Last updated: 2018-04-24Bibliographically approved
    2. Fathers’ everyday experiences of having an adult child who suffers from long-term mental illness
    Open this publication in new window or tab >>Fathers’ everyday experiences of having an adult child who suffers from long-term mental illness
    2012 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 3, no 2, p. 109-117Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study is to describe the everyday life experiences of fathers of adult children who have various forms of long-term mental illness. Ten fathers were interviewed. Content analysis revealed one main theme: Maintaining a strong façade while balancing on a thin line, and two sub-themes: (1) A constant struggle and (2) A feeling of powerlessness. The fathers demonstrated great engagement and good will to participate in their child's life. A sense of powerlessness and frustration at not having or being allowed freedom of action emerged. Cooperation between children, parents, the care service providers, and the authorities could increase the parents’ abilities to provide adequate support to the child as well as helping them to understand and make the incomprehensible manageable.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Taylor & Francis, 2012
    National Category
    Medical and Health Sciences Nursing
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-27598 (URN)10.3109/01612840.2011.627106 (DOI)22273345 (PubMedID)2-s2.0-84856368647 (Scopus ID)
    Available from: 2013-03-22 Created: 2013-02-16 Last updated: 2018-05-12Bibliographically approved
    3. Conceptions of mental health care: from the perspective of parents’ of adult children suffering from mental illness
    Open this publication in new window or tab >>Conceptions of mental health care: from the perspective of parents’ of adult children suffering from mental illness
    2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 496-504Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to describe parents' conceptions of the mental health care provided to adult children suffering from mental illness. Data were collected using qualitative research interviews with a purposive sample of sixteen mothers and ten fathers. Phenomenographic analysis was used to identify conceptions and formulate descriptive categories. The first category, questioning the availability of care, describes mental health care as being unequal in terms of accessibility and lacking in continuity. The second category, disapproval of parental exclusion, illustrates conceptions that mental healthcare professionals disregard parents and do not provide them with adequate information. The third category, questioning the quality of care, encompasses conceptions of lack of trust in the professionals' competence, an unsatisfactory environment as well as inadequate cooperation with other healthcare providers and authorities. Positive aspects, such as being seen and confirmed, were mentioned as valuable by the parents.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2014
    Keywords
    mother, father, parent, adult child, mental illness, mental health care, phenomenography.
    National Category
    Nursing
    Research subject
    Health and Medical Care Research; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-34617 (URN)10.1111/scs.12074 (DOI)000340288100009 ()23980612 (PubMedID)2-s2.0-84904999092 (Scopus ID)
    Note

    Accepterad juli 2013.

    In thesis named "Parents’ conceptions of adult mental health care: aphenomenographic study"

    Available from: 2014-04-08 Created: 2014-04-08 Last updated: 2018-08-27Bibliographically approved
    4. Health-Related Quality of Life: from the perspective of mothers and fathers of adult children suffering from longterm mental disorders
    Open this publication in new window or tab >>Health-Related Quality of Life: from the perspective of mothers and fathers of adult children suffering from longterm mental disorders
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    2015 (English)In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 9, no 3, p. 180-185Article in journal (Refereed) Published
    Abstract [en]

    There is a lack of studies on mothers' and fathers' experiences of Health-Related Quality of Life (HRQOL) associated with caregiving of adult children suffering from mental disorder. A cross-sectional study was therefore carried out with 108 mothers and 43 fathers. Data were collected by means of the Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Family Involvement and Alienation Questionnaire (FIAQ) and the Burden Assessment Scale (BAS). Mothers' HRQOL was affected more than fathers' and lower compared to Swedish age related norms. HRQOL was predominantly related to ratings on HADS and BAS.

    Place, publisher, year, edition, pages
    Saunders Elsevier, 2015
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-34618 (URN)10.1016/j.apnu.2015.02.002 (DOI)000355642600010 ()26001718 (PubMedID)2-s2.0-84929701991 (Scopus ID)
    Note

    Funding agencies:

    Division of Psychiatry, Skaraborg Hospital  

    Research Fund at Skaraborg Hospital  

    Skaraborg Research and Development Council 

     Skaraborg Institute for Research and Development  

    Research Committee, Orebro County Council 

    Available from: 2014-04-08 Created: 2014-04-08 Last updated: 2019-03-26Bibliographically approved
  • 3.
    Arvidsson Lindvall, Mialinn
    Örebro University, School of Health Sciences.
    Physiotherapeutic perspectives on balance control after stroke: exercises, experiences and measures2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to investigate physiotherapeutic perspectives on balance after stroke, in terms of exercises, experiences and measurements. Study I was a pilot randomized controlled trial with 46 persons who had had a stroke, 24 of whom were included in the intervention group and 22 who were included in the control group. The intervention consisted of 8 weeks of body awareness therapy (BAT). There were no significant differences over time between the groups in the outcome measures of balance, walking, self-reported balance confidence and quality of life. Study II had a qualitative design using content analysis. Participants in the intervention group from Study I and the four physiotherapists who had been in charge of the BAT were interviewed. One overall theme emerged: "Simple yet challenging", which was based on six categories. Study III investigated the validity and test-retest reliability of the Six-Spot Step test (SSST), an instrument used to assess the ability to take load on each leg. A cross-sectional design with 81 persons who had had stroke was performed. The convergent validity was strong to moderate, and the test-retest reliability was good. In Study IV a mixed method design including both qualitative and quantitative data collection was used. The participants’ experiences of balance and its influence in everyday life were presented in two themes: "Feeling dizzy and unstable is a continuous challenge" and "Feeling trust and confidence despite dizziness and unsteadiness". Taken together, the different data sets provided complementary and confirmatory information about balance. All participants experienced the balance limitations as a continuous challenge in everyday life, yet they also felt trust and confidence.

    In summary, BAT can be a complement in physiotherapeutic stroke rehabilitation and the SSST can be used as a measuring instrument of walking balance in persons with stroke. Living with balance limitations was experienced as a challenge but the participants were still able to manage their everyday life and activities.

    List of papers
    1. Body awareness therapy in persons with stroke: a pilot randomised controlled trial
    Open this publication in new window or tab >>Body awareness therapy in persons with stroke: a pilot randomised controlled trial
    2014 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, no 12, p. 1180-1188Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate the effects of body awareness therapy on balance, mobility, balance confidence, and subjective health status in persons with stroke.

    Design: A pilot randomized controlled study with follow-up at one and 4–6 weeks after the intervention period.

    Setting: Four primary healthcare centres in Örebro County Council.

    Subjects: Persons more than six months post stroke, with walking ability of 100 metres.

    Intervention: The experimental intervention was body awareness therapy in groups once a week for eight weeks. The controls were instructed to continue their usual daily activities.

    Main measures: Berg Balance Scale, Timed Up and Go Test, Timed Up and Go Test with a cognitive component, 6-minute walk test, and Timed-Stands Test. Self-rated balance confidence was assessed using the Activities-specific Balance Confidence Scale, and subjective health status using the Short Form 36 (SF-36) questionnaire.

    Results: A total of 46 participants were included (mean age 64 years); 24 in the experimental intervention group and 22 in the control group. No significant differences in changed scores over time were found between the groups. Within the experimental intervention group, significant improvements over time was found for the tests Berg Balance Scale, Timed Up and Go cognitive, and 6-minute walk test. Within the control group, significant improvements over time were found for the Timed Up and Go Cognitive, and the Timed-Stands Test.

    Conclusion: In comparison to no intervention, no effects were seen on balance, mobility, balance confidence, and subjective health status after eight weeks of body awareness therapy.

    Place, publisher, year, edition, pages
    Sage Publications, 2014
    Keywords
    Body awareness therapy, postural control, physiotherapy, stroke
    National Category
    Health Sciences Nursing
    Research subject
    Health and Medical Care Research; Rehabilitation Medicine
    Identifiers
    urn:nbn:se:oru:diva-35843 (URN)10.1177/0269215514527994 (DOI)000347118700004 ()24668360 (PubMedID)2-s2.0-84921668455 (Scopus ID)
    Note

    Funding Agencies:

    Swedish Stroke Association

    Norrbacka Eugenia Foundation 803-11

    Research Committee Orebro County Council OLL-227701

    Available from: 2014-08-04 Created: 2014-08-04 Last updated: 2018-05-09Bibliographically approved
    2. Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists
    Open this publication in new window or tab >>Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists
    2016 (English)In: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 20, no 1, p. 83-89Article in journal (Refereed) Published
    Abstract [en]

    Background: After a stroke many patients have muscle weakness, spasticity and compromised sensation leading to decreased postural stability. Basic Body Awareness Therapy includes slow movements that challenge postural control.

    Aim: The aim was to describe experiences of 8 weeks of Basic Body Awareness Therapy from the perspective of both patients with stroke and physiotherapists.

    Method: This study had a qualitative design. Twenty-one patients and four physiotherapists were interviewed. The interviews were analysed using manifest and latent content analysis.

    Results: One overall theme emerged "Simple yet challenging" which was based on six categories: "Facing one's limitations", "Individualized movements", "A feeling of harmony", "Improved balance", "Integrated knowledge" and "Frustration and doubt". The patients described improvement in balance and stability, as well as increased wellbeing.

    Conclusion: The patients and physiotherapists related that Basic Body Awareness Therapy challenges balance but also provides an opportunity to reflect on the body.

    Place, publisher, year, edition, pages
    Elsevier, 2016
    Keywords
    Basic Body Awareness Therapy, Physiotherapy, Qualitative study, Stroke
    National Category
    Nursing
    Research subject
    Rehabilitation Medicine
    Identifiers
    urn:nbn:se:oru:diva-52163 (URN)10.1016/j.jbmt.2015.06.004 (DOI)000381689000012 ()26891641 (PubMedID)2-s2.0-84958039596 (Scopus ID)
    Available from: 2016-09-14 Created: 2016-09-14 Last updated: 2019-01-18Bibliographically approved
    3. Validity and test-retest reliability of the Six-Spot Step Test in persons after stroke
    Open this publication in new window or tab >>Validity and test-retest reliability of the Six-Spot Step Test in persons after stroke
    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-66907 (URN)
    Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-05-09Bibliographically approved
    4. "I can still manage": a mixed-method study of balance after stroke
    Open this publication in new window or tab >>"I can still manage": a mixed-method study of balance after stroke
    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-66909 (URN)
    Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-05-09Bibliographically approved
  • 4.
    Barzangi, Jir
    Örebro University, School of Health Sciences.
    Infant Dental Enucleation in Sweden: Perspectives on a Practice among Residents of Eastern African Origin2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Infant dental enucleation (IDE) is a practice consisting of the removal of deciduous canine tooth buds in infants. Practiced mainly in Eastern Africa, the purpose is to treat or to prevent bodily symptoms and diseases. IDE can cause both general and oral complications. The occurrence of IDE among Eastern African immigrants in a few European countries has been reported. However, knowledge surrounding the practice in Sweden was poor. The overall aim of this work was to explore IDE in the Swedish context. Four studies were conducted. Paper I presents a review of scientific publications. An overview of IDE was gained, and some knowledge gaps were identified. Paper II describes a cross-sectional study to determine the prevalence of IDE in small children. Dental records of 1133 children (mean age 4.6 years, SD 1.4) from a multi-ethnic area were studied. Missing deciduous canines without any registered reason were documented. One or more deciduous canines were missing in 21% of the children with known Eastern African origin (n=101), compared to only three children in the rest of the population (n=1032). Six adults of Somali origin were interviewed to explore their experiences and perceptions of IDE (paper III). These experiences and perceptions were categorised in four essentially different ways: an effective and necessary treatment, a disputed tradition, an option to failure and a desperate measure. Their experiences and perceptions were found to be highly influenced by contexts. In the final study (paper IV), the knowledge, experiences and attitudes among dental and health care personnel were examined. Questionnaires were sent to licensed personnel working in emergency departments, midwifery and child health centres, school health services and public dental health services in ten municipalities. Less than 20% had any knowledge of IDE, while 12.5% of the respondents encountering children had seen at least one patient subjected to IDE. Different attitudes were reported between clinical settings regarding responsibilities and possibilities concerning the management and prevention of IDE. From the findings presented in this thesis, it was concluded that there is a need for initiatives to increase awareness of and knowledge on IDE among dental and health care professionals. Legally obligated responsibilities in these professions regarding IDE need to be clarified, and initiatives should include guidelines regarding both the management of IDE and its prevention in Sweden. Educational programmes should also be produced for residents of Eastern African origin to change their perceptions of IDE, and a culturally sensitive approach should be adopted to ensure that such programmes are effective.

    List of papers
    1. Infant dental enucleation: A literature review on a traditional remedial practice in East Africa
    Open this publication in new window or tab >>Infant dental enucleation: A literature review on a traditional remedial practice in East Africa
    2014 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 3, p. 168-178Article, review/survey (Refereed) Published
    Abstract [en]

    Objective. To summarize and review the literature on infant dental enucleation, a traditional remedial procedure prevalent mainly in East Africa.

    Materials and methods. Literature searches were made electronically using general and specialized search engines. The main search was performed through a systematic strategy in PubMed, comprising tabulated keywords, search codes, and translated and transliterated terms. Criteria for the selection of studies were designed to provide a general understanding of the procedure. The findings were synthesized into two sections: a summary of the population prevalence studies, and a thematic literature review.

    Results. An overview of the known prevalence and clinical specifications was established. Insight was gained into the purpose of the procedure and the factors influencing its performance. Diverging suggestions were seen with regard to the rationale for use of infant dental enucleation between different populations. Moreover, reports of complications and consequences involving the general health and the dentoalveolar structures of patients were examined.

    Conclusions. Prevalence, clinical features and risks of infant dental enucleation point to a need for greater awareness of the procedure. Further, there is a need for specific guidelines regarding management of suspected cases within dental and healthcare communities.

    Place, publisher, year, edition, pages
    London: Informa Healthcare, 2014
    Keywords
    African traditional medicine, attitude to health, cuspid, post-operative complications, tooth germ surgery
    National Category
    Dentistry
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-34848 (URN)10.3109/00016357.2013.817603 (DOI)000333047400002 ()
    Note

    Funding Agencies:

    Public Dental Health Organizations of the county of Västmanland, Sweden

    Public Dental Health Organizations of the county of Örebro, Sweden

    Available from: 2014-04-28 Created: 2014-04-25 Last updated: 2018-09-12Bibliographically approved
    2. Infant dental enucleation in an East African population in Sweden: a cross-sectional study on dental records
    Open this publication in new window or tab >>Infant dental enucleation in an East African population in Sweden: a cross-sectional study on dental records
    Show others...
    2014 (English)In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 24, no 3, p. 209-214Article in journal (Refereed) Published
    Abstract [en]

    Aim: To examine the prevalence of infant dental enucleation (IDE) of primary canines, an East African traditional remedial procedure, in a multiethnic population of children in Sweden.

    Design: A cross-sectional study was conducted of dental records of 1133 patients (mean age 4.6years, SD +/- 1.4) attending one public dental service clinic in Sweden. The clinic was located in an area with a large multiethnic community. All were born within the years 2002-2006 and had received a check-up in one of the years 2007-2009. A registry was made of missing primary canines where no reason could be found. In documented cases, information about ethnic origin was extracted. Statistical grouping was made according to known East African ethnicities.

    Results: At least 36 ethnicities were recorded. Twenty-four (2.1%) patients were missing one or more canines according to the criteria for IDE. Significant difference was seen when comparison was made between patients of known East African ethnicities, of whom 20.8% (21/101) manifested findings consistent with the criteria, and the rest of the population (3/1032; P<0.001).

    Conclusions: Prevalence of cases suggestive of IDE among patients of East African origin points to a need for increased awareness within dental and healthcare communities.

    Place, publisher, year, edition, pages
    Hoboken: Wiley-Blackwell, 2014
    Keywords
    NORTHERN UGANDA; WEST ETHIOPIA; CHILD HEALTH; MUTILATION; MORBIDITY; MORTALITY; MAASAI; SUDAN; EBINO; JUBA
    National Category
    Dentistry
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-34940 (URN)10.1111/ipd.12063 (DOI)000333828800007 ()
    Note

    Funding Agency:

    Public Dental Services of Västmanland and Örebro in Sweden

    Available from: 2014-05-05 Created: 2014-05-05 Last updated: 2018-06-05Bibliographically approved
    3. Experiences and perceptions of infant dental enucleation among Somali immigrants in Sweden: A phenomenographic study
    Open this publication in new window or tab >>Experiences and perceptions of infant dental enucleation among Somali immigrants in Sweden: A phenomenographic study
    (Swedish)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-54270 (URN)
    Available from: 2017-01-03 Created: 2017-01-03 Last updated: 2017-10-18Bibliographically approved
    4. Knowledge, experiences and attitudes of dental and health care personnel in Sweden towards infant dental enucleation
    Open this publication in new window or tab >>Knowledge, experiences and attitudes of dental and health care personnel in Sweden towards infant dental enucleation
    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-54271 (URN)
    Available from: 2017-01-03 Created: 2017-01-03 Last updated: 2017-10-18Bibliographically approved
  • 5.
    Biswas, Animesh
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to  deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.

    List of papers
    1. Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh
    Open this publication in new window or tab >>Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh
    2014 (English)In: Health, ISSN 1949-5005, Vol. 6, no 16, p. 2218-2226Article in journal (Refereed) Published
    Abstract [en]

    Objectives: The aim of the study was to examine the process of community maternal, neonatal deaths and still births notification within the Bangladesh government health structure using the Maternal and Neonatal Death Review (MNDR) system. The study also explored the feasibility and acceptance of community death notification in the MNDR system.

    Methods: The study was under-taken in the Thakurgaon district of Bangladesh during 2010. During the study a mix of both qualitative and quantitative information was collected. A review of the documentation process of community death notification was undertaken and focus group discussions (FGDs) with community members, health care providers and managers in a sub-district were conducted, with in-depth interviews (IDIs) with district heath and family planning managers. Quantitative data were collected from community death notifications in the district during January to December 2010.

    Results: The death notification process was implemented by the government health care system within the Thakurgaon district. Field level health and family planning staff collected maternal and neonatal death information, recorded the death on the notification form and reported back to the Upazila (sub-district of the district) focal point at the Upazila health complex (primary health care centre). Community people were encouraged to share their death information to field level health staff. The health and family planning managers in the district periodically discussed the maternal and neonatal deaths and prepared remedial action plans in high death notified areas. In 2010, 59 maternal deaths, 739 neonatal deaths and 633 still births were reported in Thakurgaon district. District health and family planning departments performed community death notification as part of their routine daily work and integrated these procedures with other field level activities.

    Place, publisher, year, edition, pages
    China: Scientific Research Publishing, 2014
    Keywords
    Community death notification, maternal and neonatal death, bangladesh
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:oru:diva-41207 (URN)10.4236/health.2014.616257 (DOI)
    Note

    Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2017-10-17Bibliographically approved
    2. Maternal and neonatal death review (MNDR): A useful approach to identifying appropriate and effective maternal and neonatal health initiatives in Bangladesh
    Open this publication in new window or tab >>Maternal and neonatal death review (MNDR): A useful approach to identifying appropriate and effective maternal and neonatal health initiatives in Bangladesh
    Show others...
    2014 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh.

    Methods: Both quan- titative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangla- desh. Death notifications from households, subsequent data collections from a focus-group discus- sion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines.

    Results: A total of four maternal deaths, 21 neonatal deaths and 15 still births were reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness pro- grammes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community health- care providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, still birth = 8; in 2012 maternal death = 1, neonatal death = 8, still birth = 13).

    Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

    Keywords
    Maternal and neonatal health, death review, primary healthcare, Bangladesh
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:oru:diva-41213 (URN)
    Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2017-10-18Bibliographically approved
    3. Experiences of Community Verbal Autopsy in Maternal and Newborn Health of Bangladesh
    Open this publication in new window or tab >>Experiences of Community Verbal Autopsy in Maternal and Newborn Health of Bangladesh
    Show others...
    2015 (English)Manuscript (preprint) (Other academic)
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Public health
    Identifiers
    urn:nbn:se:oru:diva-46529 (URN)
    Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-10-18Bibliographically approved
    4. Social Autopsy: A Social Intervention to Generate Community Awareness of Maternal and Neonatal Deaths
    Open this publication in new window or tab >>Social Autopsy: A Social Intervention to Generate Community Awareness of Maternal and Neonatal Deaths
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Public health
    Identifiers
    urn:nbn:se:oru:diva-46531 (URN)
    Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-10-17Bibliographically approved
    5. Facility Death Review of Maternal and Neonatal Deaths in Bangladesh
    Open this publication in new window or tab >>Facility Death Review of Maternal and Neonatal Deaths in Bangladesh
    Show others...
    2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 11, article id e0141902Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.

    Methods This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.

    Results: FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.

    Discussion: FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.

    Place, publisher, year, edition, pages
    San Francisco, USA: Public Library of Science, 2015
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Public health
    Identifiers
    urn:nbn:se:oru:diva-46535 (URN)10.1371/journal.pone.0141902 (DOI)000364303800035 ()26540233 (PubMedID)2-s2.0-84951309788 (Scopus ID)
    Note

    Funding Agencies:

    UNICEF, Bangladesh through Canadian CIDA (Department of Foreign Affairs, Trade and Development)

    Department for International Development (DFID) & European Commission (EC)

    Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2018-07-02Bibliographically approved
    6. The economic cost of implementing maternal and neonatal death review in a district of Bangladesh
    Open this publication in new window or tab >>The economic cost of implementing maternal and neonatal death review in a district of Bangladesh
    (English)Manuscript (preprint) (Other academic)
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Public health
    Identifiers
    urn:nbn:se:oru:diva-46533 (URN)
    Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-10-17Bibliographically approved
  • 6.
    Carlsson, Eva
    Örebro University, School of Health and Medical Sciences.
    Communication about eating difficulties after stroke: from the perspectives of patients and professionals in health care2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Stroke is one of the major causes of eating difficulties (EDs). It is one of the leading causes of death and disability and one of the most important factors contributing to health-care costs. There is a clear association between EDs after stroke and undernutrition, where studies have shown that structured screening of eating function among stroke patients can predict nutritional problems as well as need for subsequent institutional care. Reliable and valid instruments that can identify EDs exist, but there is lack of knowledge on how persons experience living with EDs after stroke. Stroke unit care is evidence-based and grounded in multidisciplinary collaboration and continuity of care. The overall aim of this thesis is to explore and describe EDs after stroke as represented by health care professionals in patient records (PRs) and transferred information, and as described by persons living with EDs after stroke. An additional aim is to explore methodological aspects related to the inclusion of persons with EDs and communication impairment in research studies.

    Both quantitative and qualitative methods were used. Two studies used descriptive designs (I, II), one an explorative design (III) and one applied a methodological discussion (IV). In one of the studies PR data were used (I), in another study data were derived from three sources: PRs, screening of patients and interviews with nurses (II). Persons with EDs after stroke participated in Study III while literature, empirical data and researchers' experiences served as the data in study IV. Data were analysed by categorisation of phrases (I), content analysis (II) and descriptive statistics (I, II), by qualitative analysis (III) and by processing of literature and empirical findings in two research groups (IV).

    The main findings from the studies on representation of stroke care in PRs (I, II) showed that, despite that >50% of patients in Study I and all patients in Study II had EDs, there were few signs of multidisciplinary collaboration dealing with this problem. Unsystematic screening for swallowing difficulties was routine, whereas screening for nutritional risk and EDs was lacking (I, II). Multidisciplinary discharge summaries proved to have low quality and entailed little information on patients' eating ability (I). The two EDs most frequently documented were swallowing and lack of energy to complete a meal (I,II). EDs were described in vague terms (I, II). In Study II, all patients had swallowing difficulties and most patients had lack of energy to complete a meal. The electronic information transfer tool held information on eating ability for most patients (II), but the nursing staff in residential home care perceived deficiencies in that information, even identifying several EDs not reported at discharge (II).

    Experiences from persons living with EDs after stroke were presented in one main theme: Striving to live a normal life, including three sub-themes: Abandoned to learn on one's own (little support from health care professionals to learn to handle eating), Experiencing losses (loss of eating functions and loss of valued activities) and Feeling dependent in mealtime situations (III). One major finding from the methodological exploration (IV) is that creative approaches and suitable methods for inclusion of participants with EDs and communication impairment into qualitative studies can be found in the fields of aphasiology and learning disabilities. Another major finding from Study IV is that researchers need good communication skills as well as knowledge in neuropsychology.

    A general conclusion is that screening for EDs should be routine in stroke care and that a multidisciplinary terminology to express EDs must be developed to provide accurate information transfer. Health care professionals need to enhance their knowledge in nutrition and provide support to stroke patients with EDs with the goal that they can eat and perform meal-related activities in accordance with their habits before the stroke. To gain access to the experiences of persons with EDs and communication impairment researchers need to test participatory approaches when planning for inclusion of those persons.

    List of papers
    1. Multidisciplinary recording and continuity of care for stroke patients with eating difficulties
    Open this publication in new window or tab >>Multidisciplinary recording and continuity of care for stroke patients with eating difficulties
    2010 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 24, no 3, p. 298-310Article in journal (Refereed) Published
    Abstract [en]

    Eating difficulties after stroke are common and can, in addition to being a risk for serious medical complications, impair functional capability, social life and self-image. Stroke unit care entails systematic multidisciplinary teamwork and continuity of care. The purpose of this study was to describe (i) multidisciplinary stroke care as represented in patient records for patients with eating difficulties, and (ii) the written information that was transferred from hospital to elderly care. Data from 59 patient records were analysed with descriptive statistics and by categorization of phrases. Signs of multidisciplinary collaboration to manage eating problems were scarce in the records. While two notes from physiotherapists were found, nurses contributed with 78% of all notes (n = 358). Screening of swallowing and body weight was documented for most patients, whereas data on nutritional status and eating were largely lacking. The majority of notes represented patients' handling of food in the mouth, swallowing and lack of energy. Care plans were unstructured and few contained steps for managing eating. Discharge summaries held poor information on care related to eating difficulties. The language of all professionals was mostly unspecific. However, notes from speech-language therapists were comprehensive and entailed information on follow-up and patient participation

    Place, publisher, year, edition, pages
    New York, USA: Informa Healthcare, 2010
    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3039 (URN)10.3109/13561820903011976 (DOI)000276624100009 ()20178426 (PubMedID)2-s2.0-77951112541 (Scopus ID)
    Note

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2712

    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2018-04-19Bibliographically approved
    2. Informational continuity at discharge in patients with eating difficulties after stroke
    Open this publication in new window or tab >>Informational continuity at discharge in patients with eating difficulties after stroke
    (English)Manuscript (preprint) (Other academic)
    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3040 (URN)
    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2018-01-13Bibliographically approved
    3. Stroke and eating difficulties: long-term experiences
    Open this publication in new window or tab >>Stroke and eating difficulties: long-term experiences
    2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 7, p. 825-834Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Previous studies have shown that eating difficulties after stroke are common and often associated with communication problems. These difficulties, however, have mainly been studied from a professional perspective. Although numerous aspects of dysfunction have been identified, little knowledge exists about the experiences of living with eating difficulties. AIM: To explore how people affected by stroke experience living with eating difficulties, during a prolonged period. DESIGN: Explorative, qualitative case study. METHODS: Repeated interviews and participant observations with three persons 1.5-2 years after their last stroke. Data were analysed using qualitative analysis. RESULTS: Eating difficulties after stroke were experienced as Striving to live a normal life, with the subthemes Abandoned to learn on one's own, Experiences of losses and Feeling dependent. The process of getting back to a life that resembled life before the stroke was experienced as long-lasting and hard work. The informants felt that they were abandoned to manage eating training on their own. The informants experienced a loss of functional eating ability and the ability to perform activities related to food and meals. Feelings of dependence were experienced in mealtime situations. CONCLUSION: Living with eating difficulties after stroke is a complex phenomenon. The informants felt abandoned because of lack of support from the nursing staff. They were left on their own to deal with the difficult process of adjusting to a new way of eating and losses regarding mealtime activities. The combination of repeated interviews and participant observations seemed to be an approach that should be tested in larger studies. RELEVANCE TO CLINICAL PRACTICE: This case study indicates a need for nurses to develop and use evidence-based guidelines for eating training during the continuum of care. Nurses need to assess patient's habits and desires related to eating, and to adjust environment according to patient preferences.

    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3041 (URN)10.1111/j.1365-2702.2004.01023.x (DOI)
    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2017-12-14Bibliographically approved
    4. Methodological Issues in Interviews Involving people with Communication Impairments After acquired Brain Damage
    Open this publication in new window or tab >>Methodological Issues in Interviews Involving people with Communication Impairments After acquired Brain Damage
    Show others...
    2007 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 17, no 10, p. 1361-1371Article in journal (Refereed) Published
    Abstract [en]

    Qualitative research has made a significant contribution to the body of knowledge related to how people experience living with various chronic diseases and disabilities, however, the voices of certain vulnerable populations, particularly those with impairments that affect their ability to communicate, are commonly absent. In recent years, a few researchers have attempted to explore the most effective ways to ensure that the voices of people with communication impairments from acquired brain damages can be captured in qualitative research interviews, yet several methodological issues related to including this population in qualitative research remained unexamined. In this article, the authors draw on insights derived from their research on the experiences of adult survivors of stroke and traumatic brain injury to describe methodological issues related to sampling, informed consent, and fatigue in participant and researcher while also making some recommendations for conducting qualitative interviews with these populations.

    Place, publisher, year, edition, pages
    Newbury Park, Calif.: Sage Publications, 2007
    Keywords
    communication impairnment, qualitative research, interviewing, informed consent, fatigue
    National Category
    Nursing Social Sciences Interdisciplinary
    Research subject
    vårdvetenskap
    Identifiers
    urn:nbn:se:oru:diva-4329 (URN)10.1177/1049732307306926 (DOI)
    Note
    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2712 Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2018-01-13Bibliographically approved
  • 7.
    Carlsson, Eva
    Örebro University, Department of Health Sciences.
    Understanding Persons with Eating Difficulties and Communication Impairment after Stroke: Patients Experiences and Methodological Issues in Qualitative Interviews2006Licentiate thesis, monograph (Other academic)
    Abstract [en]

    Difficulties with eating are common after stroke and are often associated with communication problems. Although numerous aspects of dysfunction have been identified, little is known about the experiences of living with eating difficulties after stroke. A few researchers have attempted to explore how best to ensure that the voices of people with communication impairment can be captured in qualitative research interviews, but several methodological issues related to including this population in qualitative research have remained unexamined. The purpose of the thesis was to illuminate the phenomenon of eating difficulties after stroke and to discuss methodological issues involved in interviewing persons with communication impairment. Study I had a qualitative, descriptive design involving repeated interviews and participant observations with three persons 1½ years post-stroke. Eating difficulties after stroke were experienced as Striving to live a normal life with the sub-themes Abandoned to learn on one’s own, Experiences of losses, and Feeling dependent. The findings showed that “eating difficulties after stroke” is a complex phenomenon, and that, based on the experiences of stroke survivors, there is a need for health care professionals to develop and use methods for eating training and other forms of support during the continuum of care. The combination of repeated interviews and participant observations seemed to be an approach that should be tested in larger studies. Study II was a methodological exploration based on the experiences gained in Study I and in a qualitative study involving persons with traumatic brain injury. Methodological issues related to sampling, obtaining informed consent, and fatigue in participant and researcher were discussed, and strategies for conducting qualitative interviews with these populations were suggested.

  • 8.
    Dahlkvist, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The Garden/Patio in Residential Care Facilities for Older People: Characteristics and the Users Perspectives2015Licentiate thesis, comprehensive summary (Other academic)
    List of papers
    1. 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 spaces
    Open this publication in new window or tab >>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 spaces
    2014 (English)In: Journal of Housing for the Elderly, ISSN 0276-3893, E-ISSN 1540-353X, Vol. 28, no 1, p. 85-106Article in journal (Refereed) Published
    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.

    Keywords
    design elements, garden/patio, residential living homes for older people
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-36267 (URN)10.1080/02763893.2013.858094 (DOI)2-s2.0-84897731588 (Scopus ID)
    Note

    Export Date: 1 September 2014

    Available from: 2014-09-01 Created: 2014-09-01 Last updated: 2018-09-12Bibliographically approved
    2. Relationships between garden greenery and the health of older people in residential care facilities: A multi-level cross-sectional study
    Open this publication in new window or tab >>Relationships between garden greenery and the health of older people in residential care facilities: A multi-level cross-sectional study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Identifiers
    urn:nbn:se:oru:diva-44768 (URN)
    Available from: 2015-06-01 Created: 2015-06-01 Last updated: 2017-10-17Bibliographically approved
  • 9.
    Dwyer, Lise-Lotte
    Örebro University, School of Health and Medical Sciences.
    Dignity in the end of life care: what does it mean to older people and staff in nursing homes?2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The discussion of a palliative care and a dignified death has almost exclusively been applied to people dying of cancer. As people are getting older and are living longer, nursing homes have become an important place for end-of-life care and death. Dignity is a concept often used in health care documents but their meaning is rarely clarified.

    The main aim of this thesis was to gain a deeper understanding of what dignity meant to older people in end of life care as well as to nursing home staff. The thesis comprises four studies. The first and second study involved older people living in nursing home settings studied from a hermeneutic perspective. In the first study twelve older people in two nursing homes were interviewed two to four times over a period of 18–24 months during 2002–2003. Altogether, 39 interviews were analyzed by a hermeneutic method. Dignity was closely linked to self-image and identity. The themes of unrecognizable body, dependence and fragility constituted threats to dignity. The third theme, inner strength and sense of coherence, seemed to assist the older people in maintaining dignity of identity. In the second study the aim was to acquire a deeper understanding of how three older women from study I, created meaning in everyday life at the nursing home. A secondary analysis was carried out and showed meaning in everyday life was created by an inner dialogue, communication and relationships with others. The third study was to explore nursing home staff members’ experience of what dignity in end-of –life care means to older people and to themselves.

    Totally 21 interviews with staff were carried out and analyzed through a qualitative content analysis. The meaning of older people’s dignity was conceptualized as feeling trust, which implied being shown respect. Staff members’ dignity was conceptualized as maintaining self-respect. Dignity was threatened in situations where staff experienced themselves and the older people as being ignored and thereby marginalized. The fourth study was carried out through focus groups discussions with 20 staff members about seven older peoples dying death and care. The analyses showed that conversations and discussions about death were rare. Death was surrounded by silence. It was disclosed that the older dying person’s thoughts and attitudes of death were not explicitly known. A dignified death meant alleviation of bodily suffering and pain and meaningfulness. The staff’s ethical reasoning mainly concerned their experience of a gap between their personal ideals of what a dignified end of life should include and what they were able to provide in reality, which could result in conscious stress. Staff members need training and support. End of life care demands competence and teamwork.

    A challenge for future care of older people would be to develop a nursing home environment in which human dignity is promoted.

    List of papers
    1. Views on dignity of elderly nursing home residents
    Open this publication in new window or tab >>Views on dignity of elderly nursing home residents
    2006 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 130-146Article in journal (Refereed) Published
    Abstract [en]

    Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence.

    Keywords
    dignity, dignity and end-of-life care, nursing and dignity, palliative care and dying, self-image
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-15602 (URN)10.1191/0969733006ne851oa (DOI)000235684100005 ()
    Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2017-12-11Bibliographically approved
    2. Three nursing home residents speak about meaning at the end of life
    Open this publication in new window or tab >>Three nursing home residents speak about meaning at the end of life
    2008 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 1, p. 97-109Article in journal (Refereed) Published
    Abstract [en]

    This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18-24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize.

    Keywords
    dying, end of life, meaning, older people, palliative care
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-15603 (URN)10.1177/0969733007083938 (DOI)000254219700011 ()
    Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2017-12-11Bibliographically approved
    3. Dignity as experienced by nursing home staff
    Open this publication in new window or tab >>Dignity as experienced by nursing home staff
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-15604 (URN)
    Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2017-10-17Bibliographically approved
    4. Nursing home staff's reasoning about death and dying
    Open this publication in new window or tab >>Nursing home staff's reasoning about death and dying
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-15605 (URN)
    Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2017-10-17Bibliographically approved
  • 10.
    Ek, Kristina
    Örebro University, School of Health and Medical Sciences.
    Att leva med mycket svår kronisk obstruktiv lungsjukdom: ett liv i slowmotion2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to describe how people with very severe obstructive pulmonary disease (COPD) experienced their every day lives and created meaning, with focus on end-of-life. A second aim was to describe how death and dying can be viewed from the perspective of relatives to people with COPD. In study I, eight patients were interviewed about how COPD affected their everyday lives. A phenomenological method was used. In study II, four people with COPD who lived alone were interviewed over time, to illuminate how the illness influenced their everyday life and their existential thoughts about life and death. In study III, four couples of whom one partner in each couple had COPD were interviewed several times to illuminate the affect the illness had on the spousal relationship, their self-expressed needs, and their existential thoughts, from the perspective of two people living together. A phenomenological-hermeneutic method was used for the analyses in studies IIand III. Study IV aimed at studying patients’ last six months of life with focuson dying and death, and in this study content analysis was used.The studies (I-IV) revealed that suffering from very severe COPD can be a daily struggle to survive as well as to maintain the self-image. The studies also explicate experiences of a shrinking life space, and questions of meaning were being challenged (I). Study II showed that living alone provided feelings of independency. However the bodily losses reminded the patients’ about death and raised fears about death of being painful, as they did not want to face death alone. For the couples in study III living with COPD meant living in a changed pace with uncertainty, changed intimate relationship and finding new ways of living together. Study IV outlined the trajectory of illness to be irregular and characterized by periods of sudden deterioration, making it difficult to plan for the future. Death was experienced as an unexpected experience and was described by all as peaceful. The results in this thesis have outlined important insight into the existential challenges of living with COPD as experienced by the ill persons themselves and their next of relatives.

    List of papers
    1. Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study
    Open this publication in new window or tab >>Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study
    2008 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 62, no 4, p. 470-478Article in journal (Refereed) Published
    Abstract [en]

    Title. Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study Aim. This paper is a report of a study to describe the essential structure of the lived experience of living with severe chronic obstructive pulmonary disease (COPD) during the palliative phase of the disease. Background. Chronic obstructive pulmonary disease is one of the most common diseases throughout the world. Shortness of breath, fatigue and cough are the most troublesome symptoms, and living with COPD often imposes limitations on daily living. The disease has a great impact on quality of life and affects the extent to which people can be active in daily life. Methods. We conducted qualitative interviews of eight people with COPD and collected data over a 2-month period in 2003. Our patients were recruited from two pulmonary disease clinics in West Sweden. We used a phenomenological methodology to analyse the interviews. Findings. Daily life for people with COPD is affected in several different ways. The patients described how their physical limitations forced them to refrain from meaningful activities in everyday life and led to social isolation. Everyday emotions vacillated between viewing life as meaningful and meaningless. A sense of involvement and the belief that life was meaningful gave the individual the energy and the desire to continue living and to envision a future. Conclusion. Nursing care should include support and facilitation, so that patients can live rather than exist to the end of their lives. It is important to learn from patients and tailor activities to their social, existential and physical priorities, where appropriate family-centred support may be most effective. © 2008 Blackwell Publishing Ltd.

    Keywords
    Chronic illness, Chronic obstructive pulmonary disease, End of life, Interviews, Nursing, Palliative care, Phenomenology
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-14359 (URN)10.1111/j.1365-2648.2008.04611.x (DOI)000255714600007 ()
    Available from: 2011-01-28 Created: 2011-01-28 Last updated: 2017-12-11Bibliographically approved
    2. Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease
    Open this publication in new window or tab >>Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease
    2011 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 7, p. 1480-1490Article in journal (Refereed) Published
    Abstract [en]

    Aim: This paper is a report of a study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone.

    Background: Chronic obstructive pulmonary disease affects an increasing number of people. Breathlessness, fatigue and dejection are common symptoms during the last years of life.

    Method: Repeated qualitative interviews with four participants were conducted over an 8-month period in 2008. The data comprised 17 interviews, 15 telephone conversations and various field notes. A phenomenological hermeneutical method was used to interpret the text.

    Findings: The analysis resulted in two main themes and five sub-themes. The first main theme, Being subordinated to the sick body, implies that the body, assistive devices and entrusting oneself to the hands of others can both extend and restrict the living space. The second main theme, Protecting significant values of identity, encompasses both the struggle to maintain self-image and the awareness of one's own death.

    Conclusion: Living alone with advanced chronic obstructive pulmonary disease is a challenging and complex phenomenon. The everyday life was characterized by a struggle to keep autonomy during a time of increasing dependency and need for help. A person-centred nursing care, built upon peoples' own experiences, may be one way to promote identity and dignity in patients even when they are close to death.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2011
    Keywords
    chronic obstructive pulmonary disease, living alone, nursing, oxygen therapy, phenomenological-hermeneutic
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-15355 (URN)10.1111/j.1365-2648.2010.05604.x (DOI)000292779400007 ()21375574 (PubMedID)2-s2.0-79958755798 (Scopus ID)
    Available from: 2011-04-21 Created: 2011-04-21 Last updated: 2017-12-11Bibliographically approved
    3. Shifting life rhythms: couples' stories about living together when one partner has advanced chronic obstructive pulmonary disease
    Open this publication in new window or tab >>Shifting life rhythms: couples' stories about living together when one partner has advanced chronic obstructive pulmonary disease
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-15356 (URN)
    Available from: 2011-04-21 Created: 2011-04-21 Last updated: 2019-04-05Bibliographically approved
    4. Living in uncertainty: illness and dying trajectory in advanced COPD
    Open this publication in new window or tab >>Living in uncertainty: illness and dying trajectory in advanced COPD
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-15357 (URN)
    Available from: 2011-04-21 Created: 2011-04-21 Last updated: 2019-04-05Bibliographically approved
  • 11.
    Eldh, Ann Catrine
    Örebro University, Department of Health Sciences.
    Patient participation: what it is and what it is not2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In general, patient participation is regarded as being informed and partaking in decision making regarding one’s care and treatment. This interpretation is common in legislation throughout the Western world and corresponding documents guiding health care professionals, as well as in scientific studies. Even though this understanding of the word participation can be traced to a growing emphasis on individuals’ autonomy in society and to certain dictionary defi nitions, there are other ways of understanding participation from a semantic point of view, and no trace of patients’ descriptions of what it is to participate can be found in these definitions.

    Hence, the aim of this dissertation was to understand patients’ experience of the phenomenon of patient participation. An additional aim was to understand patients’ experience of non-participation and to describe the conditions for patient participation and non-participation, in order to understand the prerequisites for patient participation.

    The dissertation comprises four papers. The philosophical ideas of Ricoeur provided a basis for the studies: how communication can present ways to understand and explain experiences of phenomena through phenomenological hermeneutics. The first and second studies involved a group of patients living with chronic heart failure. For the fi rst study, 10 patients were interviewed, with a narrative approach, about their experience of participation and non-participation, as defi ned by the participants. For the second study, 11 visits by three patients at a nurse-led outpatient clinic were observed, and consecutive interviews were performed with the patients and the nurses, investigating what they experience as patient participation and non-participation. A triangulation of data was performed to analyse the occurrence of the phenomena in the observed visits. For paper 3 and 4, a questionnaire was developed and distributed among a diverse group of people who had recent experience of being patients. The questionnaire comprised respondent’s description of what patient participation is, using items based on findings in Study 1, along with open-ended questions for additional aspects and general issues regarding situations in which the respondent had experienced patient participation and/or non-participation.

    The findings show additional aspects to patient participation: patient participation is being provided with information and knowledge in order for one to comprehend one’s body, disease, and treatment and to be able to take self-care actions based on the context and one’s values. Participation was also found to include providing the information and knowledge one has about the experience of illness and symptoms and of one’s situation. Participation occurs when being listened to and being recognised as an individual and a partner in the health care team. Non-participation, on the other hand, occurs when one is regarded as a symptom, a problem to be solved. To avoid non-participation, the information provided needs to be based on the individual’s need and with recognition of the patient’s knowledge and context.

    In conclusion, patient participation needs to be reconsidered in health care regulations and in clinical settings: patients’ defi nitions of participation, found to be close to the dictionaries’ description of sharing, should be recognised and opportunities provided for sharing knowledge and experience in two-way-communication.

    List of papers
    1. The phenomena of participation and non-participation in health care: experiences of patients attending a nurse-led clinic for chronic heart failure
    Open this publication in new window or tab >>The phenomena of participation and non-participation in health care: experiences of patients attending a nurse-led clinic for chronic heart failure
    2004 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 3, no 3, p. 239-246Article in journal (Refereed) Published
    Abstract [en]

    Background: Patient participation is stressed in the health care acts of many western countries yet a common definition of the concept is lacking. The understanding of experiences of patients with chronic heart failure (CHF) who attend nurse-led specialist clinics, a form of care suggested as beneficiary to this group, may promote a better understanding of participation. Aim: To investigate the meanings of participation and non-participation as experienced by patients living with CHF. Methods: Narrative interviews analysed in the phenomenological hermeneutic tradition inspired by Ricoeur where the interpretation is made in the hermeneutic circle, explaining and understanding the experienced phenomena. Findings: Participation was experienced as to “be confident”, “comprehend” and “seek and maintain a sense of control”. Non-participation was experienced as to “not understand”, “not be in control”, “lack a relationship” and “not be accountable”. The findings indicate that the experiences of participation and non-participation can change over time and phases of the disease and treatment. Conclusion: The study suggests an extended view on the concept of participation. Patients' experiences of participation in health care can vary and should therefore be an issue for dialogue between nurses and patients with CHF in nurse-led specialist clinics.

    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3169 (URN)10.1016/j.ejcnurse.2004.05.001 (DOI)
    Available from: 2006-11-14 Created: 2006-11-14 Last updated: 2018-01-13Bibliographically approved
    2. The meaning of patient participation for patients and nurses at a nurse-led clinic for chronic heart failure
    Open this publication in new window or tab >>The meaning of patient participation for patients and nurses at a nurse-led clinic for chronic heart failure
    2006 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 1, p. 45-53Article in journal (Refereed) Published
    Abstract [en]

    BackgroundThe legislation of many Western countries emphasizes active patient participation. Patients with chronic heart failure (CHF), however, have experienced participation differently from the general interpretation of legal definitions. Education improves uptake of self-management strategies yet knowledge is lacking about support of patients' own resources in CHF.

    AimTo explore the phenomena of patient participation and non-participation as shown in patient visits to a nurse-led clinic for CHF and as experienced by the patients and nurses.

    MethodsData triangulation of field notes from participatory observations and texts from narrative interviews with the patients and assigned nurse specialists. Data were analyzed according to the phenomenological hermeneutic tradition.

    FindingsPatients' experience of participation and non-participation was interpreted as “Being responsible and accepting responsibility” and “Lacking an equal relationship while being controlled”, respectively. Nurses experienced patient participation as “Getting information and security to act” and patient non-participation as “Not accepting”.

    ConclusionConflicting values of patients and nurses, which were interpreted with respect to participation and non-participation, presumably might influence patient information and education negatively. The issue of participation should be raised as a means of attaining concordance and to facilitate patient participation with education specifically tailored to the individual patient's needs.

    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3170 (URN)10.1016/j.ejcnurse.2005.06.002 (DOI)
    Available from: 2006-11-14 Created: 2006-11-14 Last updated: 2018-01-13Bibliographically approved
    3. Additional understanding of participation in health care: findings from a patient survey
    Open this publication in new window or tab >>Additional understanding of participation in health care: findings from a patient survey
    (English)Manuscript (Other academic)
    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3171 (URN)
    Available from: 2006-11-14 Created: 2006-11-14 Last updated: 2018-01-13Bibliographically approved
    4. Conditions for patient participation and non-participation in health care
    Open this publication in new window or tab >>Conditions for patient participation and non-participation in health care
    2006 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 5, p. 503-514Article in journal (Refereed) Published
    Abstract [en]

    This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.

    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3172 (URN)10.1191/0969733006nej898oa (DOI)
    Available from: 2006-11-14 Created: 2006-11-14 Last updated: 2018-01-13Bibliographically approved
  • 12.
    Eriksson, Jeanette Källstrand
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Being on the trail of ageing: functional visual ability and risk of falling in an increasingly ageing population2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The elderly population is estimated to increase worldwide. One of the major health determinants identified in this population are injuries where one of the most prevalent causes are falls. The overall aim of this thesis was to describe and explore visual impairment and falls of inpatients and independently living elderly in the community and how daily life activities were influenced by visual ability and risk of falling. Methods in the studies were a quantitative retrospective descriptive design for study I followed by two quantitative retrospective and explorative studies where in study II perceived vision related quality of life and in study III performance-based visual ability were investigated. Study IV was a qualitative explorative study using classic grounded theory. In study I all falls of inpatients at a medical clinic 65 years and older (n=68) were registered during one year. In study II and III a random sample (n=212) of independently living elderly between 70 and 85 years of age participated in both studies. In study IV seven women and six men between 73 and 85 years of age from the two previous studies and six visual instructors (n=19) participated. The data in study I was collected during 2004, study II and III between February 2009 to March 2010 and study IV December 2009 to January 2013. The results in study I showed that most falls in five hospital wards occurred at night and those most affected had an established visual impairment. Almost half the population in study II and III fell at least once. Perceived vision when performing daily life activities showed a positive association between visual impairment and falls in men but not in women (II). No associations were found between performance-based measured visual ability and falls (III). Visually impaired elderly did not consider risk of falling as a problem (􀀪􀀷). Their main concern is to remain themselves as who they used to be which is managed by self- preservation while maintaining their residual selves and resisting self decay. Maintaining residual self is done by living in the past mostly driven by inertia while resisting self decay is a proactive and purposeful driven strategy. It is a complex issue to do fall risk assessments and planning fall preventive action where the individual’s entire life situation has to be taken into consideration.

    List of papers
    1. Visual impairment and falls: a register study
    Open this publication in new window or tab >>Visual impairment and falls: a register study
    2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 3, p. 366-372Article in journal (Refereed) Published
    Abstract [en]

    The aim of this register study was to investigate falls and fall injuries of inpatients 65 years and over to determine whether a causal factor of visual impairment was documented. All Organisation for Economic Cooperation and Development (OECD) countries have an increasing older population with falls and fall injuries becoming a major problem. A visual impairment can be an independent risk factor for falls but can also occur in combination with other intrinsic and extrinsic risk factors. A retrospective non-randomised register study. In 2004, all documented falls of inpatients aged 65 years and over were examined. Medical records and eye clinic records were scrutinised to identify whether any visual impairment have been documented. The majority of falls occurred between the hours of 24:00-06:00 and the inpatients most often affected were those with a visual impairment. The falls occurred in connection with movement when the inpatient was unaccompanied. Documentation in records at the medical clinic was defective and subjectively perceived visual impairment was not documented at all. Both subjective and objective visual impairment occurred in all eye clinic records. Visual impairment along with the ageing process are features affecting falls and the hospital environment needs to be adapted by improving the use of strong, contrasting colours and providing good lighting for older inpatients with visual impairment during the night time period. Hospital safety for older people with visual impairment is a concern if falls are to be reduced. Healthcare professionals need to undertake individual risk assessments to establish the degree of visual impairment of the older person so that appropriate interventions can be implemented to reduce the incidence of falls and fall injuries.

    Keywords
    documentation, falls, nursing intervention, older, opthalmology, quality of life
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-35857 (URN)10.1111/j.1365-2702.2008.02516.x (DOI)000262476100006 ()
    Available from: 2014-08-05 Created: 2014-08-05 Last updated: 2017-12-05Bibliographically approved
    2. Perceived vision-related quality of life and risk of falling among community living elderly people
    Open this publication in new window or tab >>Perceived vision-related quality of life and risk of falling among community living elderly people
    2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 433-439Article in journal (Refereed) Published
    Abstract [en]

    Perceived vision-related quality of life and risk of falling among community living elderly people Falls and fall injuries among the elderly population are common, since ageing is a risk factor of falling. Today, this is a major problem because the ageing population is increasing. There are predictive factors of falling and visual impairment is one of them. Usually, only visual acuity is considered when measuring visual impairment, and nothing regarding a person's functional visual ability is taken into account. Therefore, the aim of this study was to assess the perceived vision-related quality of life among the community living elderly using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and to investigate whether there was any association among vision-related quality of life and falls. There were 212 randomly selected elderly people participating in the study. Our study indicated that the participants had an impaired perceived vision-related health status. General health was the only NEI VFQ-25 variable significantly associated with falls in both men and women. However, among men, near and distance activities, vision-specific social functioning, role difficulties and dependency, color and peripheral vision were related to falls.

    Keywords
    falls, elderly, community living, vision-related quality of life
    National Category
    Nursing
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-29762 (URN)10.1111/j.1471-6712.2012.01053.x (DOI)000318815700028 ()
    Available from: 2013-06-27 Created: 2013-06-25 Last updated: 2017-12-06Bibliographically approved
    3. History of falling and visual ability among independently living elderly in Sweden
    Open this publication in new window or tab >>History of falling and visual ability among independently living elderly in Sweden
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Purpose To assess performance-based visual ability among independently living elderly subjects and to investigate whether there was any association between visual ability and falls.

    Methods Two hundred and ninety eight randomly selected subjects 70–85 years of age were invited for an examination including mono- and binocular visual acuity (VA) and contrast sensitivity (CS), stereoscopic vision, monocular visual fields (VF), which were integrated to estimate the binocular visual fields. Type of lenses used in their habitual correction was noted.

    Results Out of the 212 subjects who came for examination 43 % reported at least one fall. Most subjects had normal visual tests; 90% had normal binocular VA, 85% had normal binocular CS, and almost 80% had positive stereopsis. Twenty-nine subjects had visual field defects in the lower quadrants of the binocular visual field, 14 of these reported at least one fall. No significant associations were seen between falls and the various visual parameters; odds ratios were 0.80 for worse binocular VA, 0.77 for worse binocular CS, 1.55 for not normal stereoscopic vision, but wide confidence limits made it difficult to draw firm conclusions about any association. Bifocal or progressive spectacles were worn by 71% with no significant difference between fallers and non-faller (p=0.42).

    Conclusion Even though more than 40% of the sample had experienced one or more falls, no associations were seen with functional visual tests. Our results suggest that there may be more powerful predictors of falling than decreased visual ability.

    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-35859 (URN)
    Available from: 2014-08-05 Created: 2014-08-05 Last updated: 2017-10-17Bibliographically approved
    4. A grounded theory of seniors’ self-preservation: maintaining residual self and resisting decay
    Open this publication in new window or tab >>A grounded theory of seniors’ self-preservation: maintaining residual self and resisting decay
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    One of the major health issues in elderly are injuries and the second most prevalent causes of injury-related hospitalizations are falls. The purpose of this grounded theory study was to generate an explanatory theory of seniors living independently in the community and how they possibly resolve issues influenced by visual impairment and risk of falling. Thirteen elderly people living independently in the community (seven women and six men, aged between 73 and 85 years) and six visual instructors participated as data informants in this interview and observational study where we applied classic grounded theory. The elderly individuals were maintaining their residual self and resisting self-decay as part of an overarching pattern of behaviour that we call self-preservation. The main concern of participants was to remain themselves as who they used to be. This study is not a typology of people but of their behaviour and one person could use both these strategies to preserve self. He or she would both maintain their residual selves by living with the past, keeping their home intact, maintaining past activities and appearances by facading and avoiding burdening their family; as well as resisting self-decay by exercising, using walking aids or hearing aids or maintaining support networks with neighbours, friends or other groups of seniors as well as being physically active. Whilst maintaining one’s residual self is mostly driven by inertia resisting self-decay is often a proactive and purposely driven strategy.

    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-35860 (URN)
    Available from: 2014-08-05 Created: 2014-08-05 Last updated: 2017-10-17Bibliographically approved
  • 13.
    Ewertsson, Mona
    Örebro University, School of Health Sciences.
    Lärande av praktiska färdigheter inom sjuksköterskeprofessionen: studier av lärande i olika arenor2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A central part of the nursing profession is the performance of practical skills. In order to provide adequate care, maintain patient-safety, and feel comfortable in the profession, registered nurses (RNs) need to be equipped with requisite skills. Overall aim: To explore and describe how learning and development of practical skills occurs during the preparatory phases and within the nursing profession. Method: Qualitative (I, III, IV) and quantitative methods (II) were used. Data were collected through individual interviews (I, IV), questionnaires (II) and participant observations, including informal talks (III, IV). Results: Both students and new RNs expressed a need to learn and develop practical skills (I, II, III, IV). Less than half of the new RNs had access to a clinical skill laboratory (CSL), where they could learn and practice practical skills (II). The students described that learning at a CSL had been meaning for their clinical practice. They also expressed a great need for continuing learning in real patient situations (I, III, IV). During clinical practice, preceptors and students took different approaches which affected student’s learning processesö (I, III, IV). There was a tension between learning at a CSL and learning in clinical practice sites because students perceived differences in the performance of skills. Students described that they understood that performance of skills could be done in different ways without injuring patients. However, the data also showed deviations in performances that could jeopardize patientsafety. In these situations, student’s behavior differed (I, IV). One third of new RNs deviated from evidence based guidelines when they performed practical skills which they were unfamiliar with (II). Both students and new RNs reported that reflection in connection with the performance of practical skills was not common (I, II III, IV). Conclusions: Cooperation between university CSLs and clinical settings must be intensified in order to enhance the understanding of learning processes regarding practical skills. A consensus regarding academic approaches should be reached. Universities need to support preceptors in educational issues where the importance of reflection is clarified and exemplified. Increasing patient-safety requires that new RNs receive opportunities for training in artificial environments, and that a culture that reinforces the use of guidelines and a reflective stance is cultivated.

    List of papers
    1. Walking the bridge: Nursing students' learning in clinical skill laboratories
    Open this publication in new window or tab >>Walking the bridge: Nursing students' learning in clinical skill laboratories
    2015 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 15, no 4, p. 277-283Article in journal (Refereed) Published
    Abstract [en]

    Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified walking the bridge in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking.

    Keywords
    Clinical skills laboratory, Learning, Nursing education, Nursing students, Practical skills, Simulation
    National Category
    Nursing
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-45675 (URN)10.1016/j.nepr.2015.03.006 (DOI)000358807100005 ()25892366 (PubMedID)
    Available from: 2015-08-28 Created: 2015-08-28 Last updated: 2018-07-01Bibliographically approved
    2. Use of technical skills and medical devices among new registered nurses: A questionnaire study
    Open this publication in new window or tab >>Use of technical skills and medical devices among new registered nurses: A questionnaire study
    Show others...
    2015 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, no 12, p. 1169-1174Article in journal (Refereed) Published
    Abstract [en]

    Background: One comprehensive part of nursing practice is performing technical skills and handling of medical equipment. This might be challenging for new registered nurses (RNs) to do in patient-safe way.

    Objectives: The aim of this study was to describe and compare the extent to which new RNs perform various technical skills and handle medical devices in different settings, and to investigate their possibility for continued learning in this respect. A further aim was to describe their perceptions of incident reporting related to technical skills and medical devices.

    Design: A cross-sectional study with descriptive and comparative design.

    Participants: RNs who recently graduated from a nursing programme at three Swedish universities and had worked as a RN for up to 1year were included in the study (n=113, response rate 57%).

    Method: Data were collected by means of a postal questionnaire.

    Results: Half of the RNs reported that they performed several of the listed tasks every day or every week, regardless of workplace. These tasks were most frequently performed in surgical departments. The majority of the participants (76%) stated a need of continued practical training. However, less than half of them (48%) had access to a training environment. Several participants (43%) had been involved in incidents related to technical skills or medical devices, which were not always reported. Nearly a third of the participants (31%) did not use the existing guidelines when performing technical skills, and reflection on performance was uncommon.

    Conclusions: This study highlights the importance of shared responsibilities between nurse educators and health care employers to provide learning opportunities for new RNs in technical skills, to maintain patient safety. To increase the safety culture where nursing students and new RNs understand the importance of using evidence-based guidelines and taking a reflective approach in the performance of technical tasks is needed.

    Place, publisher, year, edition, pages
    Churchill Livingstone, 2015
    Keywords
    Clinical competence, Clinical laboratory, Equipment and supplies, Incident reports, Medical devices, New registered nurses, Nursing skills, Patient safety
    National Category
    Nursing
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-47060 (URN)10.1016/j.nedt.2015.05.006 (DOI)000365372700007 ()26059922 (PubMedID)2-s2.0-84946492078 (Scopus ID)
    Available from: 2015-12-11 Created: 2015-12-11 Last updated: 2018-07-02Bibliographically approved
    3. Nursing students’ socialisation into practical skills
    Open this publication in new window or tab >>Nursing students’ socialisation into practical skills
    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-56895 (URN)
    Available from: 2017-03-29 Created: 2017-03-29 Last updated: 2017-10-18Bibliographically approved
    4. Tensions in learning professional identities: nursing students narratives and participation in practical skills during their clinical practice
    Open this publication in new window or tab >>Tensions in learning professional identities: nursing students narratives and participation in practical skills during their clinical practice
    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-56896 (URN)
    Available from: 2017-03-29 Created: 2017-03-29 Last updated: 2017-10-18Bibliographically approved
  • 14.
    Ewertzon, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Familjemedlem till person med psykossjukdom: bemötande och utanförskap i psykiatrisk vård2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis focused on the situation of family members of persons with psychotic illness, particular on their experience of the approach of the healthcare professionals and of their feelings of alienation regarding the professional care of their family member. A further aim was to explore how siblings who have participated in a support group for siblings experienced their situation.

    A questionnaire was developed that enabled the aims of this thesis to be investigated (I). Seventy family members from various parts of Sweden participated, and data were collected via the questionnaire developed in study I (II-III). Thirteen siblings who previously had participated in a support group participated in follow-up focus groups interviews (IV).

    The questionnaire developed was shown to be reliable and valid in these studies (I). In many cases, the participants had experienced an approach from professionals that indicated that they did not experience openness, confirmation and cooperation, and that they felt powerless and socially isolated in relation to the care. There was also found to be a certain degree of association between how the participants experienced the approach and whether they felt alienation (II). The majority of the participants considered openness, confirmation, and cooperation to be important aspects of professional’s approach. The result also identified a low level of agreement between the participants’ experience and what they considered to be significant in the professional’s approach (III). The findings revealed the complexity of being a sibling of an individual with psychotic illness. Participating in a support group for siblings can be of importance in gaining knowledge and minimizing feelings of being alone (IV).

    Although the psychiatric care services in Sweden have been aware of the importance of cooperating with family members, the results indicated that there is a need for further research in this area. 

    List of papers
    1. Developing the concept of family involvement and the alienation questionnaire in the context of psychiatric care
    Open this publication in new window or tab >>Developing the concept of family involvement and the alienation questionnaire in the context of psychiatric care
    2008 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 17, no 6, p. 439-449Article in journal (Refereed) Published
    Abstract [en]

    Research shows that family members of persons with a mental illness often experience a lack of involvement in the psychiatric care of their relative. An interpretation of the findings of these studies raises the question whether the family members’ experience of not being involved can be conceptualised in terms of alienation towards mental health services from their encounter with psychiatric care. 

    In order to explore this possibility, the Family Involvement and Alienation Questionnaire (FIAQ) was constructed, guided by relevant theoretical frameworks and empirical research. The content validity of the questionnaire was evaluated by two groups of experienced researchers who had sound knowledge of the theoretical frameworks used. Validity based on the response process was evaluated by parents of persons with mental illness. The reliability of the questionnaire was evaluated by a test-retest design, in a group of 15 family members. The data were analysed by a non-parametric statistical method.

     

    The results of the validity and reliability evaluations show that of the 46 original items 28 items in the questionnaire would be useful in exploring the concept of family involvement and alienation in the context of psychiatric care. Further, minor modification may make the FIAQ useful in exploring these concepts in other settings.

    Place, publisher, year, edition, pages
    London: Wiley- Blackwell, 2008
    Keywords
    Family involvement, Psychiatric care, Questionnarie, Reliability, Validity
    National Category
    Nursing
    Research subject
    Caring Sciences w. Medical Focus
    Identifiers
    urn:nbn:se:oru:diva-6202 (URN)10.1111/j.1447-0349.2008.00570.x (DOI)
    Available from: 2009-04-04 Created: 2009-04-04 Last updated: 2017-12-13Bibliographically approved
    2. Family members' involvement in psychiatric care: experiences of the healthcare professionals' approach and feeling of alienation
    Open this publication in new window or tab >>Family members' involvement in psychiatric care: experiences of the healthcare professionals' approach and feeling of alienation
    2010 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 17, no 5, p. 422-432Article in journal (Refereed) Published
    Abstract [en]

    The involvement of family members in psychiatric care is important for the recovery of persons with psychotic disorders and subsequently reduces the burden on the family. Earlier qualitative studies suggest that the participation of family members can be limited by how they experience the professionals’ approach, which suggests a connection to the concept of alienation. Thus, the aim of this study was in a national sample investigate family members’ experiences of the psychiatric health-care professionals’ approach. Data were collected by the Family Involvement and Alienation Questionnaire (FIAQ). The median level and quartiles were used to describe the distributions and data were analysed with non-parametric statistical methods. Seventy family members of persons receiving psychiatric care participated in the study.  

    The results indicate that a majority of the participants respond that they have experiencing a negative approach from the professionals, indicating lack of confirmation and cooperation. The results also indicate that a majority of the participants felt powerlessness and social isolation in the care being provided, indicating feelings of alienation. A significant but weak association was found between the family members´ experiences of the professionals´ approach and their feelings of alienation.

    Place, publisher, year, edition, pages
    Oxford: Blackwell Publishing, 2010
    Keywords
    Family participation, professional-family relations, psychiatric care
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-11685 (URN)10.1111/j.1365-2850.2009.01539.x (DOI)000277869300005 ()
    Available from: 2010-08-31 Created: 2010-08-31 Last updated: 2018-04-19Bibliographically approved
    3. Family member's expectation of the psychiatric healthcare professionals' approach towards them
    Open this publication in new window or tab >>Family member's expectation of the psychiatric healthcare professionals' approach towards them
    2011 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 18, no 2, p. 146-157Article in journal (Refereed) Published
    Abstract [en]

    The importance of involving family members in the care of individuals with schizophrenia or other psychotic illnesses has received increasing attention within psychiatric health-care services. However, several studies suggest that family members often experience a lack of involvement. Furthermore, research indicates that family members’ experience of the professional’s approach has bearing on whether they feel involved or not. Thus, the aims of this study were to investigate the level of importance that the family members of individuals with schizophrenia or other psychotic illnesses ascribe to the professionals’ approach, the level of agreement between their experiences and what they consider as important, and aspects they consider to be important with regards to contact with professionals. Seventy family members from various parts of Sweden participated. Data were collected by the Family Involvement and Alienation Questionnaire and open-ended questions. The median level and quartiles were used to describe the distribution, and percentage agreement was analysed. Open-ended questions were analysed by qualitative content analysis. The results reveal that the majority of the participants consider Openness, Confirmation, and Cooperation as important aspects of a professional’s approach. Continuity emerged as an additional aspect. The results show a low level of agreement between the participants’ experience and what they consider as important.

    Place, publisher, year, edition, pages
    Oxford: Blackwell Publishing, 2011
    Keywords
    family expectation, family involvement, professional-family relations, professionals´approach, psychiatric healtcare services
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-14645 (URN)10.1111/j.1365-2850.2010.01647.x (DOI)000287096200010 ()21299727 (PubMedID)2-s2.0-79551628836 (Scopus ID)
    Available from: 2011-02-16 Created: 2011-02-16 Last updated: 2018-05-02Bibliographically approved
    4. A lonely life journey bordered with struggle: being a sibling of an individual with psychosis
    Open this publication in new window or tab >>A lonely life journey bordered with struggle: being a sibling of an individual with psychosis
    2012 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 33, no 3, p. 157-164Article in journal (Refereed) Published
    Abstract [en]

    Research suggests that siblings of individuals with severe mental illness are affected by the situation of their affected sibling and that the health care services seem to partly fail in meeting their needs for support. The aim of this study was therefore to explore how siblings of individuals with a psychotic illness, and who have participated in a support group, experience their situation. Thirteen informants participated in focus group interviews, which were analysed by inductive content analysis. The findings were interpreted in an overall single theme: A lonely life journey bordered with struggle. This theme consists of three categories: facing existential thoughts, facing ambiguity in approach and engagement, and facing disparate attitudes and expectations.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Informa Healthcare, 2012
    Keywords
    Qualitative content analysis, Focus group interview, Mutal support group, Psychotic illnesses, Siblings
    National Category
    Medical and Health Sciences Nursing
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-21647 (URN)10.3109/01612840.2011.633735 (DOI)22364427 (PubMedID)2-s2.0-84857585605 (Scopus ID)
    Available from: 2012-02-14 Created: 2012-02-14 Last updated: 2018-05-08Bibliographically approved
  • 15.
    Faag, Carina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    A comprehensive nurse-led intervention for patients with peripheral vestibular disorders: the feasibility and benefits2015Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Dizziness and balance problems are common symptoms at all ages, the symptoms are more common in women than in men and increases with age. Several studies clearly demonstrate that peripheral vestibular disorders symptoms may lead to the patients reporting functional consequences of a physical, mental and social character. The overall aim of this thesis was to investigate the efficacy and feasibility of an intervention for patients with peripheral vestibular disorders that contains patient education in groups in combination with individual support. The study is a randomized controlled trial (RCT). Thirty-six patients participated in the study: the intervention group (n = 18), who received the intervention and standard care, and patients in a control group (n = 18), who received standard care. The intervention includes a patient education program and individualized nursing support during a six-month period. Outcomes were collected by self-assessment questionnaires about dizziness-related symptoms, well-being, sense of coherence, and self-care measured at baseline before randomization and at six and nine months later. All patients were also instructed to complete a diary where they recorded symptoms that arose during an episode of dizziness. The main results show that the patients who received the intervention rated statistically significant fewer vertigo-related symptoms and a higher sense of coherence than the control group at the ninemonth follow-up. The intervention was feasible and seems to support the patients to manage symptoms. The effects were small and must be considered in relation to the efforts of the intervention. Confirmative studies are warranted.