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  • 1.
    Andersson, Elin
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bohlin, Linda
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Fekete, Zoltán
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke.2018Ingår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.

    METHODS: The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.

    RESULTS: In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows: a) More frequently documented symptoms from the face, legs/arms, and speech; b) More frequently assessments of neurology, face, arms/legs, speech, and eyes; c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation; d) Less frequently documented symptoms of headache, vertigo, and nausea; and e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled. In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.

    CONCLUSION: Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations. Andersson E , Bohlin L , Herlitz J , Sundler AJ , Fekete Z , Andersson Hagiwara M . Prehospital identification of patients with a final hospital diagnosis of stroke.

  • 2.
    Arkkukangas, M
    et al.
    Mälardalens högskola.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Söderlund, A
    Mälardalens Högskola.
    Eriksson, S
    Umeå University.
    Johansson, A-C
    Mälardalens högskola.
    Older persons’ experiences of home-based exercise with behaviour change support2017Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, nr 12, s. 905-913Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and well-being in older persons.

    Purpose: This descriptive study used a qualitative inductive approach to describe older persons’ experiences of a fall-preventive, home-based exercise program with support for behavioral change. Methods: Semi-structured interviews were conducted with 12 elderly persons aged 75 years or older, and a qualitative content analysis was performed.

    Results: Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise.

    Conclusion: With support from physiotherapists (PTs), home-based exercise can be adapted to individual circumstances in a meaningful way. Including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning, and give hope for an extended active life in old age. 

  • 3.
    Berglund, Mia
    et al.
    University of Skövde.
    Westin, Lars
    University of Skövde.
    Svanström, Rune
    University of Skövde.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Suffering caused by care--patients' experiences from hospital settings.2012Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 7, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Suffering and well-being are significant aspects of human existence; in particular, suffering and well-being are important aspects of patients' experiences following diseases. Increased knowledge about existential dimensions of illness and healthcare experiences may be needed in order to improve care and reduce unnecessary suffering. Therefore, the aim of this paper is to illuminate the phenomenon of suffering experienced in relation to healthcare needs among patients in hospital settings in Sweden. In this study, we used a reflective lifeworld approach. The data were analysed with a focus on meanings. The results describe the essential meaning of the phenomenon of suffering in relation to healthcare needs. The patients were suffering during care-giving when they felt distrusted or mistreated and when their perspective on illness and health was overlooked. Suffering was found to arise due to healthcare actions that neglected a holistic and patient-centred approach to care. Unfortunately, healthcare experiences that cause patients to suffer seem to be something one needs to endure without being critical. The phenomenon can be described as having four constituents: to be mistreated; to struggle for one's healthcare needs and autonomy; to feel powerless; and to feel fragmented and objectified. The study concludes that there are problems associated with patients experiencing suffering at the hands of healthcare providers, even if this suffering may not have been caused deliberately to the patient. Consequently, conscious improvements are needed to lessen the suffering caused by care-giving, as are strategies that promote more patient-centred care and patient participation.

  • 4.
    Bisholt, Birgitta
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ohlsson, Ulla
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kullén Engström, Agneta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gustafsson, Margareta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nursing students' assessment of the learning environment in different clinical settings2014Ingår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 14, nr 3, s. 304-310Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Nursing students perform their clinical practice in different types of clinical settings. The clinical learning environment is important for students to be able to achieve desired learning outcomes. Knowledge is lacking about the learning environment in different clinical settings. Aim The aim was to compare the learning environment in different clinical settings from the perspective of the nursing students. Design A cross-sectional study with comparative design was conducted. Method Data was collected from 185 nursing students at three universities by means of a questionnaire involving the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. An open-ended question was added in order to ascertain reasons for dissatisfaction with the clinical placement. Results The nursing students' satisfaction with the placement did not differ between clinical settings. However, those with clinical placement in hospital departments agreed more strongly that sufficient meaningful learning situations occurred and that learning situations were multi-dimensional. Some students reported that the character of the clinical setting made it difficult to achieve the learning objectives. Conclusion In the planning of the clinical placement, attention must be paid to whether the setting offers the student a meaningful learning situation where the appropriate learning outcome may be achieved.

  • 5.
    Björk, Maria
    et al.
    Jönköping University.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hallstöm, Inger
    Lund university.
    Hammarlund, Kina
    Högskolan i Skövde.
    Like being covered in a wet and dark blanket - Parents' lived experiences of losing a child to cancer2016Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 25, s. 40-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of this study was to illuminate parents' lived experiences of losing a child to cancer. Method: Interviews and a narrative about parents' experiences of losing a child to cancer were gathered from six parents of children whom had participated in a longitudinal study across the child's illness trajectory. The analysis of the data was inspired by van Manen's hermeneutic phenomenological approach. Results: One essential theme emerged: Like being covered in a wet and dark blanket, as well as six related themes: Feeling conflicting emotions, Preparing for the moment of death, Continuing parenting after death, Recollecting and sharing memories, Working through the sorrow and New perspectives in life. Conclusion: There is a need for good palliative care. If not, there is a risk that the parent will perseverate and blame themselves for not being a good parent during the suffering child's last time in life. Meetings with the parents six months and two years after the child's death might facilitate healing through the grief process.

  • 6. Blom, Helen
    et al.
    Gustavsson, Christina
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Participation and support in intensive care as experienced by close relatives of patients: a phenomenological study.2013Ingår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, nr 1, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to explore participation and support as experienced by close relatives of patients at an intensive care unit (ICU).

    METHOD: This study used the phenomenological approach as developed by Dahlberg et al. (2008) as a method for reflective lifeworld research. Seven close relatives of critically ill patients cared for at an ICU were interviewed. The data were analysed with a focus on meanings.

    RESULTS: Being allowed to participate in the care of critically ill patients at an ICU is important for close relatives to the patients. Their experiences can be described as having four constituents: participation in the care of and being close to the patient; confidence in the care the patient receives; support needed for involvement in caregiving; and vulnerability.

    CONCLUSION: Participation with and support from health-care professionals are important for the relatives' well-being and their ability to contribute to the patients' care. Health-care professionals, especially critical care nurses, need to create an atmosphere that invites relatives to participate in the care provided at an ICU.

  • 7. Blomberg, Karin
    et al.
    Bisholt, Birgitta
    Kullén Engström, Agneta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Olsson, Ulla
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gustafsson, Margareta
    Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education2014Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, nr 15-16, s. 2264-2271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. BACKGROUND: Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. DESIGN: A cross-sectional study with evaluative design. METHODS: Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. RESULTS: Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. CONCLUSIONS: The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. RELEVANCE TO CLINICAL PRACTICE: It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support.

  • 8. Blomberg, Karin
    et al.
    Isaksson, Ann-Khristin
    Allvin, Renée
    Bisholt, Birgitta
    Ewertsson, Mona
    Kullén Engström, Agneta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ohlsson, Ulla
    Sundler Johansson, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gustafsson, Margareta
    Work stress among newly graduated nurses in relation to workplace and clinical group supervision2016Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, nr 1, s. 80-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to investigate occupational stress among newly graduated nurses in relation to the workplace and clinicla group supervision. Being a newly graduated nurse is particulary stressful. Whar remains unclear is wehter teh workplace and clinical group supervision affect the stress. A cross-sectional comperative study was performed. Data were collected by means of a numerical scale measuring occupational stress, questions about workplace and clinicla group supervision. One hundred and thirteen nusres were included in the study. Conclusions: Newly graduated nurses experience great strss and need support. Nusrse participating in clinical group supervision reported significantly less stress.

  • 9.
    Gustafsson, Margareta
    et al.
    Örebro Universitet.
    Kullén Engström, Agneta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ohlsson, Ulla
    Örebro Universitet.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bisholt, Birgitta
    Karlstad universitet.
    Nurse teacher models in clinical education from the perspective of student nurses - A mixed method study2015Ingår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, nr 12, s. 1289-1294Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The aim was to describe and compare the clinical teacher's role in different models of clinical practice from the perspective of student nurses.

    DESIGN AND SETTINGS: The study took place in collaboration with two Swedish universities that applied different educational models in clinical practice. A mixed method approach was used. The quantitative part had a comparative design and the qualitative part had a descriptive design.

    PARTICIPANTS: The study group consisted of 114 student nurses (response rate 87%). Fifty-three of them had met clinical teachers employed at the university and not participating in the daily clinical work (University Nurse Teachers, UNTs), whilst 61 had met clinical teachers dividing their time between teaching and nursing (Clinical Nurse Teachers, CNTs). Eight students participated in the qualitative part of the study.

    METHODS: A questionnaire including the CLES+T scale was used to ascertain the students' perception of the clinical teacher's role, complemented by interviews directed towards an enrichment of this perception.

    RESULTS: Students meeting CNTs agreed more strongly than those meeting UNTs that the teacher had the ability to help them integrate theory and practice. Whilst spontaneous meetings between students and CNTs occurred, students mostly met UNTs in seminars. Students meeting UNTs felt alone but did appreciate having someone outside the clinical environment to provide support if they did not get along with their preceptor.

    CONCLUSIONS: In the case of UNTs, it is important that they keep their knowledge of clinical issues updated and visit the clinical placement not only for seminars but also to give students emotional support. In the case of CNTs, it is important that they are members of the faculty at the university, take part in the planning of the clinical courses and are able to explain the learning goals to the students.

  • 10.
    Gustafsson, Tanja
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lindberg, Elisabeth
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    ACTION: A Person-centred Communication Intervention Targeting Nurse Assistants in Home Care for Older Persons2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: The aging population and the number of older persons living at home are increasing. Some have extensive needs for care, which leads to increased demands on professionals in home care settings. Professionals’ need to have sufficient competency to promote health and wellbeing among older persons. For sustainable care, there is a need for efficient educational efforts in the home care context. Person-centred communication may increase the quality of care and improve older persons independence.

    Aim: To develop, test and evaluate a web based educational intervention on person-centred communication targeting nurse assistants (NA) in home care setting.

    Method: A stepwise web based education, consisting of eight modules, was developed and tested. The education was evaluated using both quantitative and qualitative data.

    Results: In all, 23 NAs participated in the education. The majority of the NAs (n=21) participated in five or more modules. Overall, the education was experienced as feasible and accessible. Challenges emerged during the time of the intervention, such as time constrains, technical problems, and participants´ engagement.

    Conclusion: The web-based education was found to be a feasible way to offer education to home care staff, although successful implementation requires adaptations to the current context. Engagement from managers, especially considering the NAs motivation to complete the education is important for accomplishment by participants.

    Implications: This study can contribute to the knowledge regarding how to develop, test and evaluate an educational intervention, and considerations found to be important during the implementation process for success.

  • 11.
    Gustafsson, Tanja
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lindberg, Elisabeth
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    The Development and Process Evaluation of the ACTION Study. A Person-centred Communication Intervention Targeting Nursing Staff in Home Care for Older Persons2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Person-centred communication is important to assure the quality of home care services and to promote older persons independence and influence over their lives. Previous research indicates challenges regarding communication between professionals and home care recipients, and how to deliver efficient educational efforts in the home care context. Hitherto, research on design and implementation of this type of intervention is scarce.

    Aims and objectives: To describe the development and process evaluation of an education intervention in person-centred communication for nursing staff (NS) in home care.

    Method: The web-based education consisted of eight modules, including short video based lectures and movies, one group supervision, and reflective assignments. The content was based on previous research of health care communication and person-centred care. Data was collected from multiple sources (web analytics, interviews, evaluation forms, and field notes), before, during and after the implementation, and analysed by a combination of quantitative and qualitative approaches.

    Results: In all, 23 NS participated in the education. Initial analysis indicate that a majority of the participants completed six or more modules. Overall, the content was experienced as relevant and interesting. The flexibility and accessibility of the web-based format was appreciated, as well as the mix of lectures, short movies, reflective assignments and group supervision. Challenges included developing content relevant to work teams with diverse competence levels and individual differences (e.g. age, language, motivation). Furthermore, time constrains and structure of work emerged as barriers for implementing the education, in some cases adding stress and fragmentation to NS´ work.

    Conclusions: This type of intervention seems to be a feasible approach for flexible educations in person-centred communication for NS. Engagement and commitment from managers and team leaders may be key factors in succeeding, with impact on participants´ motivation to fulfil the education.

  • 12. Hafskjold, Linda
    et al.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmström, Inger K
    Sundling, Vibeke
    van Dulmen, Sandra
    Eide, Hilde
    A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol.2015Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, nr 4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice.

    METHODS AND ANALYSIS: This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments.

    ETHICS AND DISSEMINATION: Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.

  • 13.
    Hammar, Lena Marmstål
    et al.
    Karolinska Institutet.
    Holmström, Inger K
    Mälardalens University.
    Skoglund, Karin
    Mälardalens University.
    Meranius, Martina Summer
    Mälardalens University.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    The care of and communication with older people from the perspective of student nurses. A mixed method study.2017Ingår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 52, s. 1-6, artikel-id S0260-6917(17)30025-4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people.

    OBJECTIVE: The aim of this study was to investigate student nurses' views on the care of and communication with older people.

    DESIGN: A descriptive study with a mixed-method approach was conducted.

    METHODS: Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015.

    RESULTS: The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites.

    CONCLUSIONS: Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed.

  • 14. Hammarlund, Kina
    et al.
    Andersson, Emilie
    Tenenbaum, Hanna
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    We are also interested in how fathers feel: a qualitative exploration of child health center nurses' recognition of postnatal depression in fathers2015Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: To become a parent is an emotionally life-changing experience. Paternal depression during the postnatal period has been associated with emotional and behavioral problems in children. The condition has predominantly been related to mothers, and the recognition of paternal postnatal depression (PND) has been paid less attention to. PND in fathers may be difficult to detect. However, nurses in pediatric services meet a lot of fathers and are in a position to detect a father who is suffering from PND. Therefore, the aim of this study was (a) to explore Child Health Center nurses' experiences of observing depression in fathers during the postnatal period; and (b) to explore hindrances of observing these fathers.

    METHODS: A qualitative descriptive study was conducted. Ten nurses were interviewed in 2014. A thematic data analysis was performed and data were analyzed for meaning.

    RESULTS: Paternal PND was experienced as being vague and difficult to detect. Experiences of fathers with such problems were limited, and it was hard to grasp the health status of the fathers, something which was further complicated when routines were lacking or when gender attitudes influenced the daily work of the nurses.

    CONCLUSION: This study contributes to an increased awareness of hindrances to the recognition of PND in fathers. The importance to detect all signals of paternal health status in fathers suffering from PND needs to be acknowledged. Overall, more attention needs to be paid to PND in fathers where a part of the solution for this is that they are screened just like the mothers.

  • 15. Henoch, Ingela
    et al.
    Browall, Maria
    Melin-Johansson, Christina
    Danielson, Ella
    Udo, Camilla
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Björk, Maria
    Ek, Kristina
    Hammarlund, Kina
    Bergh, Ingrid
    Strang, Susann
    The Swedish version of the Frommelt Attitude Toward Care of the Dying scale: aspects of validity and factors influencing nurses' and nursing students' attitudes.2014Ingår i: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 37, nr 1, s. 1-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Nurses' attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language.

    OBJECTIVES: The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients.

    METHODS: A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used.

    RESULTS: The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach α's. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients.

    CONCLUSIONS: Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses' attitudes toward caring for dying patients.

    IMPLICATION FOR PRACTICE: Care culture might influence nurses' attitudes toward caring for dying patients; the benefits of education need to be explored.

  • 16. Holmström, Inger K
    et al.
    Nokkoudenmäki, Mai-Britt
    Zukancic, Selma
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    It is important that they care - older persons' experiences of telephone advice nursing.2016Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, nr 11-12, s. 1644-1653Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of the study was to explore older persons' experiences of telephone advice nursing at primary healthcare centres.

    BACKGROUND: Telephone advice nursing is expanding worldwide, and the older population is increasing. Little is known about older persons' experiences of telephone advice nursing provided by primary healthcare.

    DESIGN: This study has a descriptive design with a qualitative inductive approach.

    METHODS: Data were collected via interviews with a purposive sample of 10 older persons in 2014. The data were analysed using qualitative content analysis.

    RESULTS: The older persons' experiences were described in two themes: the patient-friendly aspects of telephone advice nursing and the patient-unfriendly aspects of telephone advice nursing. The themes can be understood as two sides of the same coin; the differences point to both the advantages and disadvantages of the service and are further illuminated through seven subthemes.

    CONCLUSIONS: This study contributes to increased awareness of the advantages and disadvantages of the telephone advice nursing system as experienced by older persons. To be the focus of attention during calls was highlighted as important; and clear communication was deemed crucial. When the communication between the nurse and the older persons was perceived as good and the perspective of the caller was the focus, an experience of safety and satisfaction was described. Older persons had great confidence in the telephone nurses' competence and perceived their ability to access the service as mostly good, even if it was sometimes difficult to use the service.

    RELEVANCE TO CLINICAL PRACTICE: The communicative competence of telephone nurses is essential when providing telephone advice nursing to older persons. In addition, a person-centred approach is important to provide optimal care in telephone advice nursing.

  • 17.
    Holmström, Inger
    et al.
    Mälardalens Högskola.
    Krantz, A
    Ängens vårdcentral, Örebro.
    Karagacil, L
    Hemsjukvården, Vård och omsorg Västerås stad.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Frequent callers in primary healthcare – a nursing perspective2017Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 3, nr 3, s. 622-632Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    Håkansson Eklund, Jakob
    et al.
    Mälardalen University.
    Holmström, Inger K
    Mälardalen University.
    Kumlin, Tomas
    Mälardalen University.
    Kaminsky, Elenor
    Uppsala University.
    Skoglund, Karin
    Mälardalen University.
    Höglander, Jessica
    Mälardalen University.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Condén, Emilie
    Uppsala University.
    Summer Merenius, Martina
    Mälardalen University.
    Same same or different? A review of reviews of person-centred and patient-centred care.2018Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    To provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts.

    Methods

    A synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis.

    Results

    The analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life.

    Conclusions

    While there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals.

    Practice implications

    Clarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.

  • 19. Höglander, J
    et al.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Spreeuwenberg, P
    Holmström, I K
    Eide, H
    van Dulmen, S
    Håkansson Eklund, J
    Female gender explains emotional communication in home care2018Konferensbidrag (Refereegranskat)
  • 20.
    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
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Registered Nurses' and nurse assistants' responses to older persons' expressions of emotional needs in home care.2017Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, nr 12, s. 2923-2932Artikel i tidskrift (Refereegranskat)
    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.

  • 21.
    Kristensen, Dorte V
    et al.
    University College of Southeast Norway.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Eide, Hilde
    University College of Southeast Norway.
    Hafskjold, Linda
    University College of Southeast Norway.
    Ruud, Iren
    University College of Southeast Norway.
    Holmström, Inger K
    Mälardalen University.
    Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits.2017Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, nr 23-24, s. 4613-4621Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the characteristics of communication practice in home care visits between older people (over 65 years old) and nurse assistants and to discuss the findings from a person-centered perspective.

    BACKGROUND: The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial.

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

    METHOD: Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis.

    RESULTS: Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being.

    CONCLUSIONS: The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students.

    RELEVANCE TO CLINICAL PRACTICE: Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication.

  • 22. Larsson, Margaretha
    et al.
    Björk, Maria
    Ekebergh, Margaretha
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Striving to make positive difference: School nurses’ experiences of promoting the health and well-being of adolecents girls’2014Ingår i: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364, Vol. 30, nr 5, s. 358-365Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In Sweden, school nurses are part of the School Health Service with the main objective of health promotion to support students’ health and attainment of educational goals. The aim in this phenomenological study was to illuminate the experiences of school nurses in promoting the health and well-being of adolescent girls. Seventeen school nurses were interviewed, both in groups and individually, to facilitate personal disclosure and expressions from their lived experiences. To achieve their goal of improving the health of adolescent girls, school nurses require flexibility in their approach and in endeavoring to make a positive difference they experience many challenges. This study concluded that school nurses can tactfully provide adolescent girls with knowledge and health guidance adjusted to individual needs and empowering the individual girl to participate in her own health process.

  • 23. Larsson, Margaretha
    et al.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ekebergh, Margaretha
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The influence of living conditions on adolescent girls' health2012Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 7, nr 1, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Adolescence is described by the Swedish National Board of Health and Welfare as the healthiest period in life. However, adolescent girls differ in that they self-report that their health decreases with age. The aim of this hermeneutical study was to describe the meaning of living conditions in relation to adolescent girls’ health. Guided by principles of reflective lifeworld research, 15 interviews with adolescent girls were analysed. The result section consists of four narratives with their existential interpretations illustrating different ways of approaching living conditions and their meaning for health and well-being. The narratives are: Approaching everyday life in a balanced way—feeling harmonious; approaching everyday life with ambiguity—feeling confused; approaching everyday life as an intellectual project—striving for control; approaching everyday life as a struggle—feeling forlorn. In addition, a comprehensive understanding was developed by using the lifeworld dimensions: lived body, lived room, lived time, and lived relations. These dimensions may deepen the understanding of important parts of those living conditions which are meaningful for the girls’ health and well-being. By using the dimensions, complex living conditions have been explored and the meaning of different parts clarified. The girls’ thoughts and feelings are often ambiguous and sometimes contradictory, depending on the situation. The health of adolescent girls needs to be understood against the background of their experiences of living conditions. One way to support their health and well-being seems to be to supply them with forums where they can talk about their living conditions.

  • 24. Larsson, Margaretha
    et al.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ekebergh, M
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Beyond Self-Rated Health: The Adolescent Girl's Lived Experience of Health in Sweden2013Ingår i: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364, Vol. 29, nr 1, s. 71-79Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this phenomenological study was to describe the phenomenon of health as experienced by adolescent girls in Sweden. Fifteen adolescent girls were interviewed with a focus on what made them feel well in their everyday life. This study reveals that the adolescent girl's health is a complex phenomenon interwoven with their lives. Health arises in meaningful contexts, in an adolescent girl's relations to others as well as in her ability to manage her life. Health is shaped in their everyday life and can be understood as a mood of "being" well that involves actions and practices. The results show that it is important to meet these girls from an open approach in order to support and strengthen their health and well-being. The health of adolescent girls can be supported, and it is a challenge for professionals, particularly school nurses, who meet these girls in everyday life to improve their health.

  • 25. Larsson, Margaretha
    et al.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ekebergh, Margaretha
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Björk, Maria
    Altering the Parenting Role: Parents’ Experience of Supporting the Health and Well-Being of Their Adolescent Girls. 2015Ingår i: Child and Youth Care Forum, ISSN 1053-1890, E-ISSN 1573-3319, Vol. 44, nr 3, s. 419-432Artikel i tidskrift (Refereegranskat)
  • 26.
    Olander, Agnes
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson, Henrik
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bremer, Anders
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
    Ljungström, Lars
    Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome2019Ingår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, artikel-id 19:43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients withseps is are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays.

    Methods: This was a retrospective observational study. The patients’ electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed.

    Results: In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serumglucose level and altered mental status during prehospital care were found to be associated with an adverse outcome.

    Conclusions: The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.

  • 27.
    Peilot, Birgitta
    et al.
    Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital.
    Andréll, Paulin
    Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital.
    Gottfries, Johan
    Department of Chemistry and Molecular Biology, Gothenburg University.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Mannheimer, Clas
    Department of Molecular and Clinical Medicine/Pain Centre, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital.
    Vulnerability and Resilience in Patients with Chronic Pain in Occupational Healthcare: A Pilot Study with a Patient-Centered Approach.2018Ingår i: Pain Research and Treatment, ISSN 2090-1542, E-ISSN 2090-1550, Vol. 2018, artikel-id 9451313Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim of this pilot study was to describe vulnerability and resilience and possible subgroups in patients with chronic work related musculoskeletal pain in occupational healthcare. A second aim was to evaluate a patient-centered approach.

    Methods: This study was based on consecutive patients with chronic pain, seen by the same physician and sick-listed full or part time three months or longer. They were included during a period of three months. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8 months. A patient-centered approach was applied where the patient's whole situation was taken into account.

    Results: A dominance of an insecure dismissing attachment pattern and a subnormal sense of coherence (SOC) was reported both at baseline and at follow-up. The patients (n=38) reported significant improvement of pain severity (p=0.01), pain interference (p=0.001), life control (p=0.01), affective distress (p=0.02), and dysfunction (p=0.001) on the multidimensional pain inventory (MPI) and fewer patients were sick-listed full time at follow-up (13 patients versus 21). By means of multivariate data analyses this change in MPI was confirmed and was also correlated with a significant increase in health related quality of life (HRQoL). Moreover subgroups with different outcome at follow-up were identified according to attachment pattern and subgroups on MPI.

    Conclusion: A patient-centered approach may be of value for patients with chronic pain in occupational healthcare, improving pain and dysfunction. Patients with chronic pain are a heterogeneous group where outcome of treatment might be influenced by individual resilience and/or vulnerability.

  • 28. Peilot, Birgitta
    et al.
    Andréll, Paulin
    Samuelsson, Anita
    Mannheimer, Clas
    Frodi, Ann
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Time to gain trust and change--experiences of attachment and mindfulness-based cognitive therapy among patients with chronic pain and psychiatric co-morbidity.2014Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The treatment of patients with chronic pain disorders is complex. In the rehabilitation of these patients, coping with chronic pain is seen as important. The aim of this study was to explore the meaning of attachment and mindfulness-based cognitive therapy (CT) among patients with chronic pain and psychiatric co-morbidity. A phenomenological approach within a lifeworld perspective was used. In total, 10 patients were interviewed after completion of 7- to 13-month therapy. The findings reveal that the therapy and the process of interaction with the therapist were meaningful for the patients' well-being and for a better management of pain. During the therapy, the patients were able to initiate a movement of change. Thus, CT with focus on attachment and mindfulness seems to be of value for these patients. The therapy used in this study was adjusted to the patients' special needs, and a trained psychotherapist with a special knowledge of patients with chronic pain might be required.

  • 29.
    Råberus, Anna
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmström, I K
    Galvin, Kathleen
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    The nature of patient complaints: a resource for healthcareimprovements2018Ingår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677Artikel i tidskrift (Refereegranskat)
  • 30. Skoglund, K
    et al.
    Holmström, I K
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hammar Marmstål, L
    Previous work experience and age do not affect final semester nursing student self-efficacy in communication skills2018Ingår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 68, s. 182-187Artikel i tidskrift (Refereegranskat)
  • 31. Skoglund, K
    et al.
    Holmström, I
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hammar Marmstål, L
    Communication skills nursing education2018Konferensbidrag (Refereegranskat)
  • 32.
    Sundler, Annelie Johansson
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gustafsson, Tanja
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lindberg, Elisabeth
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Maurin Söderholm, Hanna
    Högskolan i Borås, Akademin för bibliotek, information, pedagogik och IT.
    Holmström, I K
    ACTION - A person-centred communication intervention in home care of older persons2018Konferensbidrag (Refereegranskat)
  • 33.
    Sundler, Annelie Johansson
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hjertberg, F
    Keri, H
    Holmström, I K
    Attributes of person-centred communication. A Qualitative Exploration of communication with older persons during home healthcare visits2018Konferensbidrag (Refereegranskat)
  • 34.
    Sundler, Annelie Johansson
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Johansson, E
    Anaesthesia care unit, Västmanlands Sjukhus, Västerås, Sweden.
    Johansson, L
    Anaesthesia and intensive care unit, Hallands Sjukhus, Varberg, Sweden.
    Hedén, Lena E
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Incidents reported by nurse anesthetists in the operating room2018Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The quality of health care and patient safety in the operating room is a major concern for nurse anaesthetists. However, few studies have focused on the experiences of nurse anaesthetists’ and their contributions to safety in this setting. Therefore, this study aims to explore the content and frequency of incidents reported by nurse anaesthetists in the operating room and the risks involved in these incidents. A retrospective study with a descriptive design was conduct. Data were gathered concerning 220 incidents reported by nurse anaesthetists from 2012 to 2015 in operating rooms at a middle-sized hospital in Sweden. These were analysed with a method for qualitative and quantitative content analysis. The findings are presented in five categories: communication and teamwork; routines and guidelines; patient care; nurses’ work environment; devices, materials and technologies. In 184 (73%) of the incidents, there was either a risk of harm or there was an actual harm to patients or nurses. Of all incidents only 23 (10%) had harmed patients or nurses. Few of these incidents involved patient harm (= 6), while a greater number involved harm to nurses (= 17). The findings reveal lack of communication and interprofessional teamwork as the two most common areas for the reported incidents, followed by problems related to lack of compliance with guidelines and routines. The findings suggest that strategies are needed to improve these areas. Patient safety reporting systems may be important to identify risk in preventing patients and health care professionals from being harmed. In addition, the findings indicate that the nurses sought to prevent harm to patients rather than to themselves. Consequently, increased attention to the work environments of nurses, and most likely other professionals, in the operating room may be needed to prevent health care professionals from being harmed.

  • 35.
    Sundler, Annelie Johansson
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lindberg, Elisabeth
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nilsson, Christina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Palmér, Lina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Qualitative thematic analysis – based on phenomenology2018Konferensbidrag (Refereegranskat)
  • 36.
    Sundler, Annelie Johansson
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Råberus, Anna
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmström, Inger K
    Mälardalens Högskolan, Uppsala Universitet.
    Mänskliga rättigheter ochrätten till hälsa. En analys av anmälningar till patientnämnderna i VästraGötaland2017Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Denna rapport visar att patienters rättigheter är otydliga när det gäller rätten till hälso- och sjukvård. Otydligheten kan leda till att hälso- och sjukvården framstår som rättsosäker. Det finns möjligheter att förbättra kvalitet, trygghet och patientsäkerhet, där anmälningar från patienter och närstående kan utgöra ett värdefullt underlag. En av rapportens slutsatser är att det finns ett behov av en mer patient- och personcentrerad hälso- och sjukvård.

    I denna rapport beskrivs resultaten från ett forskningsprojekt där anmälningar till patientnämnderna i Västra Götaland analyserats med fokus på mänskliga rättigheter. Ett strategiskt urval av 170 anmälningar som patienter eller närstående lämnat till patientnämnderna under år 2015 har här analyserats.

    Resultaten beskrivs i fyra delar. I den första delen presenteras beskrivande statistik för anmälningarna. Den andra delen beskriver innehållet i anmälningarna, vilket handlar om att inte ha tillgång till hälso- och sjukvård, brister i kontinuitet och uppföljning, felaktigheter eller vårdskador till följd av hälso- och sjukvård, brister i kommunikation och samverkan, bemötande, attityder och förhållningssätt i möten med hälso- och sjukvårdspersonal, samt hälso- och sjukvård som går emot patientens vilja. Därefter följer den del där anmälningarna analyserats utifrån ett patient- och mäniskorättsperspektiv. Här beskrivs fem teman som berör rätten till hälsa och patienters rättigheter vid ohälsa och sjukdom, rätten till hälso- och sjukvård och patienters rättigheter vid akuta tillstånd, rätten till god och säker hälso- och sjukvård och patienters säkerhet, rätten till värdighet och ett bra bemötande, samt hälso- och sjukvårdspersonalens rättigheter. I den fjärde och sista delen av resultaten har anmälningarna granskats utifrån ett normkritiskt och intersektionellt perspektiv. Här framträder vissa grupper av patienter som mer sårbara än andra, och den utsatthet och maktaspekter som framträder i analysen beskrivs.

    I anmälningarna till patientnämnderna framkommer situationer där patienters rättigheter brister i möten med hälso- och sjukvården, där det kan vara svårt för patienter att utkräva sin rätt. Anmälningarna synliggör patienters upplevelser av att kvalitet, trygghet och patientsäkerhet brister, och patientnämndernas verksamhet spelar en viktig roll i att synliggöra dessa brister för att kunna bidra till förbättringar inom hälso- och sjukvården. För att säkerställa de mänskliga rättigheterna och rätten till hälsa behöver hälso- och sjukvården anpassas utifrån invånares behov.

    Anmälningarna visar att det ibland finns brister i hälso- och sjukvårdens förmåga att utgå från en helhetssyn på patienten. Enskilda personer är sårbara i kontakt med hälso- och sjukvården, och patienters utsatthet och olika maktförhållanden mellan patienter och hälso-  och sjukvårdspersonal behöver hanteras ansvarsfullt för att inte skapa ojämlikheter eller leda till upplevelser av diskriminering. Ett professionellt bemötande kräver också kommunikativ kompetens och empati hos hälso- och sjukvårdspersonal. En slutsats av detta är att det finns behov av en mer patientcentrerad hälso- och sjukvård, som tydligare beaktar enskilda personers förutsättningar och behov, liksom organisatoriska förbättringar som främjar patientens vårdkedja och samverkan mellan vårdverksamheter.

  • 37.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Svåra samtal2016Ingår i: Äldre i centrum, ISSN 1401-5110, Vol. 3, s. 30-31Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 38.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bisholt, Birgitta
    Ohlsson, Ulla
    Björk, Maria
    Kullén Engström, Agneta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gustafsson, Margareta
    Student nurses' experiences of the clinical learning environment in relation to the organization of supervision: A questionnaire survey2014Ingår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 34, nr 4, s. 661-666Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim The aim was to investigate student nurses' experiences of the clinical learning environment in relation to how the supervision was organized. Background The clinical environment plays an essential part in student nurses' learning. Even though different models for supervision have been previously set forth, it has been stressed that there is a need both of further empirical studies on the role of preceptorship in undergraduate nursing education and of studies comparing different models. Method A cross-sectional study with comparative design was carried out with a mixed method approach. Data were collected from student nurses in the final term of the nursing programme at three universities in Sweden by means of a questionnaire. Results In general the students had positive experiences of the clinical learning environment with respect to pedagogical atmosphere, leadership style of the ward manager, premises of nursing, supervisory relationship, and role of the nurse preceptor and nurse teacher. However, there were significant differences in their ratings of the supervisory relationship (p < 0.001) and the pedagogical atmosphere (p 0.025) depending on how the supervision was organized. Students who had the same preceptor all the time were more satisfied with the supervisory relationship than were those who had different preceptors each day. Students' comments on the supervision confirmed the significance of the preceptor and the supervisory relationship. Conclusion The organization of the supervision was of significance with regard to the pedagogical atmosphere and the students' relation to preceptors. Students with the same preceptor throughout were more positive concerning the supervisory relationship and the pedagogical atmosphere.

  • 39.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Dahlberg, Karin
    Ekebergh, Margaretha
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Living with experiences following a myocardial infarction.2003Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 2, nr 3, s. 229-236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Coronary heart disease is a major cause of sudden death and morbidity in the developed world, as well as a cause of great suffering. Research within this area has primarily focused symptoms, risk factors and treatment. The aim of this paper was to explore women's experiences following a myocardial infarction (MI). Eight women were interviewed; the interviews were audiotaped and transcribed into text and analysed using a phenomenological approach. To explore the meaning that is experienced in the lived world of the patient a method of reflective lifeworld research, based upon phenomenological epistemology has been used. The results indicate that the body is vital for the women in their lifeworlds. After a MI the patient's natural and unreflective relationship with the body and the lived world is interrupted. Uncertainty about life and death as well as the body is experienced as a suffering in the women's lifeworlds. In relation to this, the women's existence is characterised by an uncertainty and a loss of context. It is through reconciliation with their bodies and their illnesses that the women can achieve a sense of well-being and harmony in life. In that process the women can re-establish a natural relationship with their bodies and lifeworlds.

  • 40.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Dahlberg, Karin
    Ekenstam, Claes
    The meaning of close relationships and sexuality: women's well-being following a myocardial infarction.2009Ingår i: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, nr 3, s. 375-387Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Relationships and sexuality following heart attack (MI) have been studied; nevertheless, little is known about the meaning of social support and relationships to health and well-being after an MI. To our knowledge, no qualitative studies have further investigated the phenomenon. In this study we explore the meaning of close relationships and sexuality to women's health and well-being following MI. Ten women were interviewed using a reflective lifeworld approach and phenomenological epistemology. The meaning of women's close relationships following an MI appears to be closely intertwined with their long-term health process; both health processes and the relationships are affected. Suffering after an MI can be compared to taking a fall in that close relationships can become a safety net. Close relationships and sexuality are integrated into their lived bodies, and in that way have profound influence in their lifeworld experiences. Not all close relationships are intimate; however, all close and meaningful relationships can provide power and strength to the women's health processes. At the same time, these relationships also appear to drain energy and cause suffering.

  • 41.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Eide, Hilde
    van Dulmen, Sandra
    Holmström, Inger K
    Communicative challenges in the home care of older persons - a qualitative exploration.2016Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 10, s. 2435-2444Artikel i tidskrift (Refereegranskat)
    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.

  • 42.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ekebergh, Margaretha
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    The Meaning of Well-being and Participation in the Process of Health and Care: Women’s experiences following a myocardial infarction.2006Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 1, nr 2, s. 100-108Artikel i tidskrift (Refereegranskat)
  • 43.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Hallström, Inger
    Hammarlund, Kina
    Björk, Maria
    University of Skövde.
    Living an everyday life through a child's cancer trajectory: families' lived experiences 7 years after diagnosis.2013Ingår i: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 30, nr 6, s. 293-300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to illuminate the lived experiences of families where a child had survived 7 years from a diagnosis of childhood cancer. This article describes one part of an inductive and longitudinal research project that included 17 families. Four families whose child was diagnosed with cancer 7 years previously were interviewed using a hermeneutical phenomenological approach. The families lived experience was described in one essential theme, "Living an everyday life through the child's cancer trajectory," further illuminated in 3 related themes: "Leaving the disease behind yet feeling its presence," "Being the same yet always different," and "Feeling stronger yet vulnerable." The results suggest that family members feel vulnerable even if a long period of time has passed since completion of treatment. To varied degrees they still may need support. When moving forward in life, the family members are helped if they can reconcile their memories and experiences derived from the childhood cancer trajectory.

  • 44.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Höglander, Jessica
    Mälardalens Högskola.
    Eklund, Jakob Håkansson
    Mälardalens Högskola.
    Eide, Hilde
    University College of Southeast Norway.
    Holmström, Inger K
    Mälardalens Högskola.
    Older persons' expressions of emotional cues and concerns during home care visits. Application of the Verona coding definitions of emotional sequences (VR-CoDES) in home care.2017Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, nr 2, s. 276-282Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: This study aims to a) explore to what extent older persons express emotional cues and concerns during home care visits; b) describe what cues and concerns these older persons expressed, and c) explore who initiated these cues and concerns.

    METHODS: A descriptive and cross-sectional study was conducted. Data consisted of 188 audio recorded home care visits with older persons and registered nurses or nurse assistants, coded with the Verona coding definitions on emotional sequences (VR-CoDES).

    RESULTS: Emotional expressions of cues and concerns occurred in 95 (51%) of the 188 recorded home care visits. Most frequent were implicit expressions of cues (n=292) rather than explicit concerns (n=24). Utterances with hints to hidden concerns (63,9%, n=202) were most prevalent, followed by vague or unspecific expressions of emotional worries (15,8%, n=50). Most of these were elicited by the nursing staff (63%, n=200).

    CONCLUSION: Emotional needs expressed by the older persons receiving home care were mainly communicated implicitly. To be attentive to such vaguely expressed emotions may demand nursing staff to be sensitive and open.

    PRACTICE IMPLICATIONS: The VR-CoDES can be applied on audio recorded home care visits to analyse verbal and emotional communication, and may allow comparative research.

  • 45.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Pettersson, Annika
    Berglund, Mia
    Undergraduate nursing students' experiences when examining nursing skills in clinical simulation laboratories with high-fidelity patient simulators: A phenomenological research study.2015Ingår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 35, nr 12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Simulation has become a widely used and established pedagogy for teaching clinical nursing skills. Nevertheless, the evidence in favour of this pedagogical approach is weak, and more knowledge is needed in support of its use. The aim of this study was (a) to explore the experiences of undergraduate nursing students when examining knowledge, skills and competences in clinical simulation laboratories with high-fidelity patient simulators and (b) to analyse these students' learning experiences during the examination. A phenomenological approach was used, and qualitative interviews were conducted among 23 second-year undergraduate nursing students-17 women and 6 men. The findings revealed that, irrespective of whether they passed or failed the examination, it was experienced as a valuable assessment of the students' knowledge and skills. Even if the students felt that the examination was challenging, they described it as a learning opportunity. In the examination, the students were able to integrate theory with practice, and earlier established knowledge was scrutinised when reflecting on the scenarios. The examination added aspects to the students' learning that prepared them for the real world of nursing in a safe environment without risking patient safety. The study findings suggest that examinations in clinical simulation laboratories can be a useful teaching strategy in nursing education. The use of high-fidelity patient simulators made the examination authentic. The reflections and feedback on the scenario were described as significant for the students' learning. Undergraduate nursing students can improve their knowledge, understanding, competence and skills when such examinations are performed in the manner used in this study.

  • 46.
    Sundler J, Annelie
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Svanström, Rune
    Hjärtats osäkerhet: en begrereppsanalys2013Ingår i: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 33, nr 1, s. 42-47Artikel i tidskrift (Refereegranskat)
  • 47. Sundling, V
    et al.
    Hafskjold, L
    Holmström, I K
    Höglander, J
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Eide, H
    Supportive Communication in Home Health Care: A Cross-national Comparative Study2018Konferensbidrag (Refereegranskat)
  • 48.
    Sundling, Vibeke
    et al.
    University College of Southeast Norway.
    Sundler, Annelie Johansson
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Holmström, Inger K
    Uppsala University.
    Kristensen, Dorte Vesterager
    University College of Southeast Norway.
    Eide, Hilde
    University College of Southeast Norway.
    Mindfulness predicts student nurses' communication self-efficacy: A cross-national comparative study.2017Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, nr 8, s. 1558-1563, artikel-id S0738-3991(17)30146-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The aim of this study was to compare student nurses' communication self-efficacy, empathy, and mindfulness across two countries, and to analyse the relationship between these qualities.

    METHODS: The study had a cross-sectional design. Data was collected from final year student nurses in Norway and Sweden. Communication self-efficacy, empathy, and mindfulness were reported by questionnaires; Clear-cut communication with patients, Jefferson Scale of Empathy, and Langer 14 items mindfulness scale.

    RESULTS: The study included 156 student nurses, 94 (60%) were Swedish. The mean communication self-efficacy score was 119 (95% CI 116-122), empathy score 115 (95% CI 113-117) and mindfulness score 79 (95% CI 78-81). A Mann-Whitney test showed that Swedish students scored significantly higher on communication self-efficacy, empathy, and mindfulness than Norwegian students did. When adjusted for age, gender, and country in a multiple linear regression, mindfulness was the only independent predictor of communication self-efficacy.

    CONCLUSION: The Swedish student nurses in this study scored higher on communication self-efficacy, empathy, and mindfulness than Norwegian students did. Student nurses scoring high on mindfulness rated their communication self-efficacy higher.

    PRACTICE IMPLICATIONS: A mindful learning approach may improve communication self-efficacy and possibly the effect of communication skills training.

  • 49. Svanström, Rune
    et al.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gradually losing one's foothold--a fragmented existence when living alone with dementia.2015Ingår i: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 14, nr 2, s. 145-163Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The number of persons with dementia who lives at home for a longer period of time after diagnosis is increasing. Even if the literature in the dementia field is growing, there is a need for more knowledge about everyday life of persons with a dementia disease; particularly the lived perspective of persons who live alone. The aim of this study was to elucidate the phenomenon of living alone with dementia and having a manifest care need. This phenomenological study was carried out from a reflective lifeworld approach. The data material in the study consisted of field notes from 32 visits and transcriptions from 11 tape-recorded conversations with six participants. The results reveal that the person with dementia who lives alone ends up in a vague existence where they cannot survive alone. The person's level of activity comes to a halt and body movement becomes slower. Daily life becomes more difficult to manage and the person's earlier natural way of relating to the world and the people around them is gradually lost. This is followed by a loneliness and forgetfulness that cloud the meaning of life. This study highlights the importance of the patient's perspective needed to better understand the inner life of a person who suffers from dementia. This understanding is important in the organization of help and care as well as for caregivers to better understand these individuals and their needs.

  • 50. Svanström, Rune
    et al.
    Sundler J, Annelie
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Berglund, Mia
    Westin, Lars
    Suffering caused by care-elderly patients' experiences in community care.2013Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 8, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Growing old involves many changes in life and implies an increased risks of illness and different forms of disabilities. Life may change in a radical way when a person gets a disease like dementia or moves to a nursing home due to disabilities or needs. In both cases, it often leads to an increased dependency on care where the patient becomes exposed and vulnerable and thereby at a higher risk for experiencing different forms of suffering.

    AIM: The aim of this study was to elucidate and gain a deeper understanding of elderly patients' experiences of suffering in relation to community care in nursing homes and home care services.

    MATERIALS AND METHODS: A lifeworld hermeneutical approach was used. Phenomenological interviews and conversations with an open approach were conducted and analysed with a focus on meanings.

    FINDINGS: The findings were presented in four main themes; an absence of the other in care, an absence of dialogues, a sense of alienation and a sense of insecurity. The findings in this study revealed that persons who were cared for in nursing homes and home care services sometimes were exposed to an unnecessary suffering. The suffering sometimes was caused by various caring actions, that is, unnecessary suffering. The suffering caused by care that aroused was due to caregiver's inability to be present, to show their face, and truly meet the patient.

    CONCLUSION: Suffering from care increased the elderly patients' feelings of insecurity, loneliness, and alienation; this seemed to be the foundation for patients' experiences of being outside a human community. There was a lack of knowledge and understanding about the patient's lifeworld.

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