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  • 1. Anderberg, Patrice
    et al.
    Lepp, Margret
    University of Borås, School of Health Science.
    Berglund, AL
    Segesten, Kerstin
    University of Borås, School of Health Science.
    Preserving dignity in caring for older adults: a concept analysis2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 59, no 6, p. 635-643Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a concept analysis of the meaning of preserving dignity. BACKGROUND: Preserving dignity, especially when caring for older adults, is essential when giving nursing care. There is a lack of clarity about what kinds of caring activities lead to preserved dignity. METHOD: Data were collected using several databases (CINAHL, Age Info, Libris, Medline, Pub Med, Psyc INFO and Blackwell Synergy) covering the years 1990-2005. The keywords used were 'dignity', 'human dignity', 'preserving dignity', 'elderly', 'aged', combined with 'patients/persons', 'caring relation' and 'nursing'. The analysis covered 53 articles, dissertations, reports and textbooks. FINDINGS: Dignity may be defined as a concept that relates to basic humanity. Dignity consists of inherent and external dimensions, which are common for all humans and at the same time are unique for each person, relating to social and cultural aspects. The attributes of preserving dignity are individualized care, control restored, respect, advocacy and sensitive listening. Antecedents are professional knowledge, responsibility, reflection and non-hierarchical organization. The consequences are strengthening life spirit, an inner sense of freedom, self-respect and successful coping. CONCLUSION: Preserving an older adult's dignity is complex. By using the attributes in, for example, nursing documentation, the action and value of preserving dignity could be made visible as a professional nursing activity.

  • 2.
    Bondestam, E
    et al.
    Sahlgrenska.
    Hovgren, K
    Sahlgrenska.
    Gaston Johansson, F
    Sahlgrenska.
    Jern, S
    Sahlgrenska.
    Herlitz, Johan
    [external] Sahlgrenska.
    Holmberg, S
    Sahlgrenska.
    Pain assessment by patient and nurse in the early phase of acute myocardial infarction1987In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 12, no 6, p. 677-682Article in journal (Refereed)
    Abstract [en]

    In 47 patients admitted to the coronary care unit (CCU) at Sahlgren's Hospital in Göteborg, Sweden, due to acute myocardial infarction (MI) the intensity of pain independently assessed by the patient and by the nurse on duty was evaluated during the first 24 hours in CCU. Pain was assessed according to a modified numerical rating scale graded from 0-10, where 0 meant no pain and 10 meant the most severe pain. A positive correlation between the patients’ and nurses’ assessments was found (r = 0-76; P < 0-001). However, the nurses under-estimated the patients’ pain in 23% of the situations and over-estimated it in 20%. Over-estimation was particularly found when heart rate and blood pressure increased. Many patients scoring their pain to fairly high degrees were not given pain-relieving treatment. Treatment with morphine did not cause substantial pain relief in a substantial number of patients. A significantly positive correlation was found between the patients’ and nurses’ assessments of pain, although underestimation as well as over-estimation occurred. A few patients with severe pain were not treated and when treatment was given it was often ineffective.

  • 3. Brink, E
    et al.
    Brändström, Y
    Cliffordsson, C
    Herlitz, Johan
    [external].
    Karlson, BW
    Illness consequences after myocardial infarction: problems with physical functioning and return to work.2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 64, no 6, p. 587-594Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study to explore health problems, physical and mental functioning, and physical activity in working-age patients after myocardial infarction, in order to assess the possible effects of these factors on return to work. BACKGROUND: A diagnosis of myocardial infarction may discourage patients from continuing an active working life. Enabling myocardial infarction patients to return to work has benefits for both individuals and society. METHODS: A convenience sample was recruited of 88 patients, <or=65 years of age, who had suffered a myocardial infarction. Assessments of employment, health-related quality of life and physical activity (footsteps per day) were conducted in 2005-2006, 4-6 months after myocardial infarction. To explore data and compare groups, t-tests were applied. Logistic regression analyses were performed to identify variables that best predicted return to work. RESULTS: Differences were identified between individuals who were employed after myocardial infarction and those who were not. Those not in work scored lower on variables related to the physical dimension of health-related quality of life and on physical activity. Logistic regression revealed that a multivariate model including age, physical dimension of health-related quality of life and footsteps per day predicted return to work in 68% of all cases (R2=0.344). CONCLUSION: Low physical health and low physical activity after myocardial infarction negatively affect returning to work. These findings stress the importance of clinical assessment of myocardial infarction patients' daily physical activity and physical functioning.

  • 4.
    Dellve, Lotta
    et al.
    [external].
    Hadzibajramovic, E
    Ahlborg JR, G
    Work attendance among health care workers: prevalence, incentives and consequences for health and performance2011In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, ISSN 0309-2402, Vol. 67, no 9, p. 1918-1929Article in journal (Refereed)
    Abstract [en]

    Aim.  This paper is a report of a cohort study of healthcare workers’ work attendance, and its long-term consequences’ on health, burnout, work ability and performance. Background.  Concepts and measures of work attendance have varied in the scientific literature. Attending work in spite of being sick can have serious consequences on health. There is little knowledge on which individual and work-related conditions that increase work attendance and the long-term impact on health and performance. Method.  Prospective analyses of three measures of work attendance i.e. sickness attendance, uninterrupted long-term attendance and balanced attendance (≤7 days of sick leave per year and no sickness attendance) were done using questionnaire data from a 2-year cohort study (2004–2006) of randomly selected healthcare workers (n = 2624). Incentives (e.g. effort-reward balance, social support, meaningfulness) and requirements (e.g. time-pressure, dutifulness, high responsibility) to attend work as well as general health, burnout, sick leave, work ability and performance were assessed. Results.  There was a positive relation between balanced work attendance and incentives, whereas high sickness attendance was associated with requirements. Follow up after 2 years showed that balanced attendance was associated with sustained health and performance while sickness attendance was associated with poor health, burnout, sick-leave and decreased performance. Conclusion.  It is important to distinguish between measures of work attendance as they differ in relation to incentives, and health- and performance-related consequences. Sickness attendance seems to be an important risk indicator. A balanced work attendance should be promoted for sustained health and performance in healthcare organisations.

  • 5.
    Dellve, Lotta
    et al.
    Gothenburg University.
    Samuelsson, L
    Tallborn, A
    Fasth, A
    Hallberg, L R-M
    Stress and well-being among parents of children with rare diseases: a prospective intervention study2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, ISSN 0309-2402, Vol. 53, no 4, p. 392-402Article in journal (Refereed)
    Abstract [en]

    Aim.  This paper reports a study to assess stress, well-being and supportive resources experienced by mothers and fathers of children with rare disabilities, and how these variables were affected by an intensive family competence intervention. Background.  Despite diagnosis-specific studies, little overall knowledge exists about life-consequences for families of children with rare disorders. Method.  We used a prospective design with baseline data and two follow-ups (at 6 and 12 months) after an intervention. The intervention aimed at empowering parents in managing their child's disability. Parents from all parts of Sweden visiting a national centre for families of children with rare disabilities were consecutively selected (n = 136 mothers, 108 fathers). Instruments of parental stress, social support, self-rated health, optimism and life satisfaction and perceived physical or psychological strain were used. Stratified analyses were carried out for mothers and fathers, and related to parental demands: single mothers, full-time employment, participation in a parent association, child's age and type of disability. Results.  We found high parental stress, physical and emotional strain among mothers, especially among single mothers. Fathers showed high stress related to incompetence, which decreased after the intervention. Decreased strain was found among full-time working mothers and fathers after the intervention. Parents’ perceived knowledge and active coping and mothers’ perceived social support were increased at follow-up. Factors related to parents’ overall life satisfaction (57–70% explained variance) changed after the intervention, from being more related to internal demands (perceived strain, incompetence and social isolation) to other conditions, such as problems related to spouse, paid work and social network. Conclusion.  Parents, especially fathers and full-time working parents, may benefit from an intensive family competence programme.

  • 6. From Attebring, M
    et al.
    Hartford, M
    Hjalmarson, A
    Caidahl, K
    Karlsson, T
    Herlitz, Johan
    [external].
    Smoking habits and predictors of continued smoking in patients with acute coronary syndromes.2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 46, no 6, p. 614-623Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Most patients with acute coronary syndrome quit smoking when hospitalized, although several have been found to relapse and resume smoking within 3 months. AIM: This paper reports a study to identify factors that can predict who will resume smoking after hospitalization for an acute coronary syndrome. METHODS: Patients (n = 1320) below the age of 75 years, admitted to a Swedish university hospital coronary care unit with acute coronary syndromes, between September 1995 and September 1999, were consecutively included. Data were collected from hospital medical records and included information on previous clinical history, former illnesses and smoking. During their hospitalization, an experienced nurse interviewed the patients by using a structured questionnaire to obtain additional information. Patients were followed up 3 months after the discharge. Those who continued to smoke (non-quitters) were compared with those who had stopped (quitters) with regard to age, sex, medical history, clinical course, and intention to quit. To identify factors independently related to continued smoking, a logistical regression in a formal forward stepwise mode was used. RESULTS: Of the patients admitted, 33% were current smokers. Three months after discharge, 51% of these patients were still smoking. There were no significant differences in age, gender or marital status between non-quitters and quitters. In a multivariate analysis, independent predictors of continued smoking were: non-participation in the heart rehabilitation programme (P = 0.0008); use of sedatives/antidepressants at time of admission (P = 0.001); history of cerebral vascular disease (P = 0.002), history of previous cardiac event (P = 0.01); history of smoking-related pulmonary disease (P = 0.03) and cigarette consumption at index (P = 0.03). CONCLUSIONS: Smoking patients who do not participate in a heart rehabilitation programme may need extra help with smoking cessation. The findings may provide means of identifying patients in need of special intervention.

  • 7.
    Holmström, Inger
    et al.
    Mälardalens Högskola.
    Krantz, A
    Ängens vårdcentral, Örebro.
    Karagacil, L
    Hemsjukvården, Vård och omsorg Västerås stad.
    Sundler J, Annelie
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Frequent callers in primary healthcare – a nursing perspective2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 3, no 3, p. 622-632Article in journal (Refereed)
    Abstract [en]

    AIM:

    To: (a) describe how telephone nurses define a frequent caller; and (b) describe their experiences with calls from frequent callers to primary healthcare centres.

    BACKGROUND:

    Telephone nursing has been noted to be a cost-effective method to enhance access to and use of health care. Some patients use these services extensively and are called 'frequent callers'. Little is known about this group of callers, the reasons behind these calls and telephone nurses' experiences and strategies to manage the calls.

    DESIGN:

    Descriptive design with a qualitative inductive approach.

    METHODS:

    Interviews were conducted with ten telephone nurses in Sweden in 2015. Qualitative content analysis was conducted.

    RESULTS:

    A main theme was established, called 'Balancing between the experienced and assessed needs', which described the telephone nurses' experiences with calls made by frequent callers to primary healthcare centres and was further described in five categories with 15 subcategories. The categories described telephone nurses' definitions of frequent callers, telephone nurses' views of the underlying reasons for the calls, challenges related to frequent callers, experiences with an increased work load and strategies used to manage and help frequent callers.

    CONCLUSION:

    Frequent callers were commonly encountered by telephone nurses' in this study. Their calls were experienced as complex and demanding to manage. The findings point to needs for guidelines and routines to improve the care of frequent callers. In addition, support and training in communication skills to encounter this group of callers in an optimal and safe way may be required.

  • 8.
    Höglander, Jessica
    et al.
    Mälardalen University.
    Eklund, Jakob Håkansson
    Mälardalen University.
    Eide, Hilde
    University College of Southeast Norway.
    Holmström, Inger K
    Uppsala University.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Registered Nurses' and nurse assistants' responses to older persons' expressions of emotional needs in home care.2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 12, p. 2923-2932Article in journal (Refereed)
    Abstract [en]

    AIM: This study aims to explore nurse assistants' and Registered Nurses' responses to older persons' expressions of emotional needs during home care visits.

    BACKGROUND: Communication is a central aspect of care. Older persons might express different emotions and needs during home care visits and such expressions can be challenging to respond to. Little is known about communication in home care or nursing staff responses to older persons' expressed emotional needs.

    DESIGN: Descriptive, cross-sectional design on nursing staff responses to older persons' negative emotions in home care.

    METHODS: Collected data consisted of audio recordings of home care visits between older persons and nursing staff. Data were collected between August 2014-November 2015. The nursing staff responses to older persons' negative emotions in the communication were analysed with the Verona Coding Definitions of Emotional Sequences (VR-CoDES).

    RESULTS: The nursing staff most often give non-explicit responses, providing space for further disclosure of older persons' expressed negative emotions. Such responses were more frequent if the nursing staff had elicited the older persons' expressions of a negative emotion than if such expressions were elicited by the older persons themselves. Most frequent types of responses were backchannel, active invitation or information advice.

    CONCLUSION: The nursing staff responses were mainly non-explicit responses providing space for older persons to tell more about their experiences. Such responses can be discussed in terms of person-centred communication and is important for the comfort of emotional concerns.

  • 9. Knutsson, Susanne
    et al.
    Samuelsson, I. P.
    Hellström, A.-L.
    Bergbom, I.
    Children’s experiences of visiting a seriously ill/injured relative on an adult intensive care unit2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 61, no 2, p. 154-162Article in journal (Refereed)
    Abstract [en]

    Title. Children’s experiences of visiting a seriously ill/injured relative on an adult intensive care unit Aim. This paper is a report of a study of children’s experiences of visiting a seriously ill/injured relative in an intensive care unit. Background. Little attention has been paid to children’s experiences and needs when visiting a relative being cared for at a high technological adult intensive care unit. Instead, the focus has been on adult’s experiences and needs. Method. In 2004, 28 children (14 girls, 14 boys) aged 4–17 years who had visited an adult relative were interviewed 3 months after the visit. A hermeneutic approach was used when interpreting and analysing the text. Findings. Four themes were generated from the data: It meant waiting, It was strange, It was white and It was good. Waiting was experienced as difficult, increasing the feeling of uncertainty, exclusion and separation, which in turn led to tension and concern. ‘It was strange’ was perceived as unfamiliar but also with interest and curiosity. The experience of the intensive care unit was that it was white. Everything in the patient’s room was experienced as white and gloomy. It lacked joy. ‘It was good’ was stated about the outcome of the visit because through this they were given the opportunity to meet and see the relative by themselves. This evoked feelings of relief and joy. The visit did not seem to frighten the child; instead it generated feelings of release and relief. Conclusion. Children’s experiences of visiting an adult intensive care unit seem to support theories that emphasize the involvement and participation of children in family matters.

  • 10.
    Kullén Engström, Agneta
    et al.
    [external].
    Rosengren, K
    Hallberg, L
    Balancing involvement: employees' experiences of merging hospitals in Sweden2002In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 38, no 1, p. 11-18Article in journal (Refereed)
    Abstract [en]

    Background. The health care of today stands in front of demands on financial and structural changes. New technology and global economy are forces driving on the change process. Aims. The aim of this study is to describe and broaden the understanding of the employees' experience of being involved in a merger between two health care districts in Sweden. Methods. This study was carried out from a qualitative approach according to the grounded theory tradition. From a theme guide with specific questions, 31 interviews were carried out with employees working in the health care. Findings. Five categories emerged from the body of interviews: balancing involvement, trust respect, challenge and commitment. Balancing involvement was defined as an overall core category related to the other categories. The categories trust, respect, challenge and commitment were related to subcategories and affected the core category balancing involvement. Conclusions. The overall findings point to the importance of balancing the employees' involvement in order to reach goal fulfilment change in a merger process.

  • 11.
    Lindahl, Berit
    et al.
    University of Borås, School of Health Science.
    Sandman, PO
    Rasmussen, B
    On becoming dependent on home mechanical ventilation2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 49, no 1, p. 33-42Article in journal (Refereed)
    Abstract [en]

    Aim.  The aim of this paper is to illuminate meanings of becoming dependent on home mechanical ventilator treatment. Background.  People suffering from chronic alveolar hypoventilation and requiring home mechanical ventilation represent a small but increasing group in society, and are some of the most vulnerable individuals with chronic disabilities. Method.  Thirteen people about to begin ventilator treatment at home were interviewed. Data were tape-recorded and analysed according to a phenomenological-hermeneutic method. Findings.  Findings revealed two contrasting meanings of being in the process of becoming dependent on a ventilator, interpreted as getting breath or holding breath. This interpretation is presented in two composite stories. Conclusions.  The findings imply possibilities and deficiencies in meeting patients’ existential needs, such as helping them to breathe spiritually by supporting them as they get their breath after such a life-changing event as becoming dependent on a ventilator.

  • 12.
    Magnusson, Lennart
    et al.
    University of Borås, School of Health Science.
    Hanson, Elizabeth
    University of Borås, School of Health Science.
    Supporting frail older people and their family carers at home using information and communication technology: cost analysis2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, no 6, p. 645-657Article in journal (Refereed)
    Abstract [en]

    Aim. This paper describes a cost analysis of a home-based support service for frail older people and their family carers in two municipalities in West Sweden and using information and communication technology. Background. A key challenge facing nurse managers across Europe is an increasingly aged population, combined with reduced numbers of young adults of working age. New solutions are needed to provide quality, cost-effective community care services to frail older people and their family carers. Methods. A case study methodology involving five families was used, and included a detailed cost description of the technology-based service compared with usual services. Cost data were collected in June 2002. This work formed part of a larger project exploring the impact of a technology-based service known as, Assisting Carers using Telematics Interventions to meet Older Persons’ Needs (ACTION). In addition to cost data, information was gathered on the quality of life of frail older people and their family carers, and the job satisfaction and work methods of nurses and other practitioners based in the community. The cost analysis comprised a description of the family and their caring situation, the perceived benefits of the telematic based support service and an assessment of its impact on the use of other care services. These analyses were carried out with the help of needs assessors who were known to the families, and nurses working in the ACTION call centre. All results were validated by the five participating families. Results. Cost savings were achieved in all cases, and the benefits to older people and their carers were also considerable. As a result of the cost analysis and overall evaluation data, ACTION has been implemented as a mainstream service in the municipalities involved. Conclusion. Researchers, nurses, other practitioners and community care managers can work together with frail older people and their family carers to develop quality, cost-effective support services that reduce demands on staff whilst providing benefits to users.

  • 13.
    Nilsson, Stefan R
    et al.
    [external].
    Hallqvist, Carina
    Sidenvall, Birgitta
    Enskär, Karin
    Children’s experiences of procedural pain management in conjunction with trauma wound dressings2011In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 7, p. 1449-1457Article in journal (Refereed)
    Abstract [en]

    Aim.  This paper is a report of the experiences of children (5–10 years) of procedural pain when they underwent a trauma wound care session. Background.  Procedural pain in conjunction with trauma wound care often induces anxiety and distress in children. Children need to alleviate pain and avoid the development of fear in conjunction with examinations and treatments. The nurse could help children to reach this goal by using the comfort theory, which describes holistic nursing in four contexts: physical, psychospiritual, environmental and sociocultural. Few studies have focused on children’s experiences of comforting activities in conjunction with trauma wound dressings. Methods.  This study was conducted between May 2008 and January 2010. Thirty-nine participants aged 5–10 were consecutively included in this study. The wound care session was standardized for all the participants, and semi-structured qualitative interviews with open-ended questions were conducted with all the children in conjunction with the procedure. All the interviews were transcribed verbatim and analysed with qualitative content analysis. Findings.  Four themes were identified: clinical competence, distraction, participation and security. The children were helped to reach comforting activities to enhance pain management. Conclusion.  Children require more than just analgesics in wound care. They also need to experience security and participation in this context. When children feel clinical competence in wound care, they trust the nurse to carry out the wound dressing and instead can focus on the distraction that increases their positive outcomes.

  • 14.
    Sundler J, Annelie
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eide, Hilde
    van Dulmen, Sandra
    Holmström, Inger K
    Communicative challenges in the home care of older persons - a qualitative exploration.2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 10, p. 2435-2444Article in journal (Refereed)
    Abstract [en]

    AIM: To explore communicative challenges in encounters between nurse assistants and older persons during home care visits.

    BACKGROUND: The older population is increasing worldwide. Currently, there is a shift in care for older people from institutional care to home care. Providing home care in a person's home involves several challenges, including the complexity of communication.

    DESIGN: A descriptive observational design with a qualitative approach was used.

    METHODS: The data consisted of audio recordings of real-life encounters during home care visits between nurse assistants and older persons, collected in 2014. A hermeneutic phenomenological analysis was conducted.

    RESULTS: Communicative challenges were identified: (a) in situations where the older persons had a different view than the nurse assistants on the care task and its content; and (b) when unexpected actions or turns occurred in the communication. Challenges included older person's existential issues, fragility and worries and concerns, which often appeared to be only vaguely expressed and difficult to verbally detect and tackle. This engendered a risk of misinterpretation or ignorance of these challenges.

    CONCLUSION: The findings point to the importance of communication as the key to facilitate person-centred home care. Communication training should focus more on addressing needs and existential issues in older persons. Person-centred home care for older persons needs to be addressed at both an individual and an organizational level.

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