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Harder, M., Söderbäck, M. & Ranheim, A. (2018). Health care professionals’ perspective on children’s participation in health care situations: encounters in mutuality and alienation. International Journal of Qualitative Studies on Health and Well-being, 13(1), Article ID 1555421.
Open this publication in new window or tab >>Health care professionals’ perspective on children’s participation in health care situations: encounters in mutuality and alienation
2018 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, article id 1555421Article in journal (Refereed) Published
Abstract [en]

Purpose: Encounters between health care professionals, parents and children in health care services for children are complex as these encounters involve the various perspective and understanding of each person involved. The aim of the study is to describe health care professionals’ understanding of significant encounters with children and parents to uncover the meaning of participation. Method: A qualitative descriptive design was applied. The health care professionals’ narratives (n = 35) of their significant encounters with children were interpreted from the perspective of participation. A phenomenological-hermeneutical approach was used in the analysis. Results: The findings show children’s participation as a dynamic movement in mutuality and alienation which can vary within a situation or between different situations involving the same persons. The movement can occur in mutuality and or in alienation depending on what or towards whom the persons direct themselves. Understanding participation as a movement in health care situations is useful in supporting children’s opportunities to participate from their own perspective and deal with health care examinations. Conclusion: The outcome of a situation can never be predicted. Still, professionals can be aware of their actions in encounters with children.

Place, publisher, year, edition, pages
Taylor and Francis Ltd., 2018
Keywords
Children, encounters, health care professional, health care situations, participation, phenomenological-hermeneutical approach, alienation, article, child, clinical article, female, health care personnel, human, male, narrative
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-42259 (URN)10.1080/17482631.2018.1555421 (DOI)000453916900001 ()30704374 (PubMedID)2-s2.0-85058927751 (Scopus ID)
Available from: 2019-01-03 Created: 2019-01-03 Last updated: 2019-06-18Bibliographically approved
Golsaeter, M., Johansson, L.-O. & Harder, M. (2017). General practitioners' accounts of how to facilitate consultations with toddlers - an interview study. Scandinavian Journal of Primary Health Care, 35(1), 3-9
Open this publication in new window or tab >>General practitioners' accounts of how to facilitate consultations with toddlers - an interview study
2017 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 1, p. 3-9Article in journal (Refereed) Published
Abstract [en]

Objective: To describe general practitioners' (GPs') accounts of how to facilitate consultations with children aged 1-2 years. Design: A qualitative study based on focus group interviews. Setting and subjects: Five focus group interviews were conducted with a total of 25 GPs at Swedish primary health care (PHC) centres. The GPs regularly invited toddlers to consultations. Result: The GPs' accounts of how to facilitate consultations with toddlers revealed descriptions of making efforts to instil confidence in the situation to enable the consultation. Toddlers in need of health care always visit the GP with adults such as their parents, guardians or other relatives. Therefore, the GP directs efforts towards the adults and the child more or less simultaneously, as they both need to rely on the GP. The GPs describe how they instil confidence in the adults by establishing a mutual understanding that the consultation is necessary to secure the child's health. Regarding the child, the GP instils confidence by establishing a relationship in order to approach the child and accomplish bodily examinations. Conclusion: The result shows that GPs' encounters with children in consultations are two-sided. The GP needs to conduct bodily examinations to secure the child's health and development, but to do so he/she needs to establish purposeful relationships with the adults and the child by instilling confidence. This indicates that establishing relationships in the consultation is significant, and a way to achieve a child-centred consultation.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Children, consultation, focus group, general practitioner, qualitative study, general practice, Sweden
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-35127 (URN)10.1080/02813432.2017.1287518 (DOI)000396039600002 ()28277052 (PubMedID)2-s2.0-85014519793 (Scopus ID)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2017-11-29Bibliographically approved
Harder, M., Enskar, K. & Golsater, M. (2017). Nurses' use of pliable and directed strategies when encountering children in child and school healthcare. Journal of Child Health Care, 21(1), 55-64
Open this publication in new window or tab >>Nurses' use of pliable and directed strategies when encountering children in child and school healthcare
2017 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 21, no 1, p. 55-64Article in journal (Refereed) Published
Abstract [en]

Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3-16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.

National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-35174 (URN)10.1177/1367493516679014 (DOI)000397413600007 ()29156977 (PubMedID)2-s2.0-85034619053 (Scopus ID)
Available from: 2017-04-13 Created: 2017-04-13 Last updated: 2018-10-16Bibliographically approved
Harder, M., Christensson, K. & Söderbäck, M. (2015). Undergoing an immunization is effortlessly, manageable or difficult according to five-year-old children. Scandinavian Journal of Caring Sciences, 29(2), 268-276
Open this publication in new window or tab >>Undergoing an immunization is effortlessly, manageable or difficult according to five-year-old children
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 268-276Article in journal (Refereed) Published
Abstract [en]

Background: To prevent diseases among children they regularly undergo immunizations. Previous research show different approaches available to facilitate immunization-procedures for children to protect them from harm. To complement this research and provide care suited for children, research recognizing their perceptions of undergoing such a procedure is needed. Aim: The aim of this study was to describe 5-year-old children's perceptions of undergoing an immunization. Method: A phenomenographic approach and analysis was used to describe the children's (n = 21) various perceptions. The data-collection was accomplished directly after the immunization to grasp the children's immediate perceptions. Drawings and reflective talks were used as they are considered as suitable methods when involving young children in research. The right to conduct research with children was approved by the appropriate research ethics committee and also by each child and the parents. Results: The findings show that children's perceptions of an immunization-procedure may vary from effortlessly, to manageable or difficult. Regardless of how the child perceive the immunization-procedure each perception embrace the children's descriptions of actors and articles in the situation, their feelings in the situation and also their actions to deal with the immunization. Nevertheless, these descriptions vary according to how the children perceive the immunization as effortlessly, manageable or difficult. Conclusion: Children's and adults' perceptions of medical procedures may differ and children need guidance, time and space to deal with them. Recognizing children's perceptions of undergoing an immunization contributes to the promotion of their right to be involved in their own health care and towards the development of child-centred care. 

Keywords
Child health care, Children, Drawing, Immunization, Perceptions, Phenomenography, Reflection
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-27979 (URN)10.1111/scs.12160 (DOI)000354260700008 ()24974763 (PubMedID)2-s2.0-84928925315 (Scopus ID)
Available from: 2015-05-15 Created: 2015-05-15 Last updated: 2019-06-18Bibliographically approved
Ranheim, A., Söderbäck, M. & Harder, M. (2014). Facilitating young children's participation in health care situations. In: : . Paper presented at International Conference in Health, Social Welfare and Coproduction at Mälardalen University in Eskilstuna 9 - 10 th September, 2014.
Open this publication in new window or tab >>Facilitating young children's participation in health care situations
2014 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Facilitating young children’s participation in health care situations Background An initiative was given to perform a collaborative research project with health practices in Sörmland on facilitating young children’s participation in health care situations. Departing from workshop with healthcare professionals conveyed that it is an ambiguous challenge to be in care situations with children since each situation depends on its participants; the child, the parents and the professionals. These findings were used in reflective forums to integrate theory and practice to broaden the professionals’ awareness of the child’s perspective in care situations. The project is inspired by a clinical application research (CAR) design, where scientifically trained researchers work with health care professionals, building a team to exchange experiences related to data collection, interpretations and the applicability of the results.

The use of research involves a process of learning as well as engaging beliefs and actions, and these questions are foundational for the practice of clinical care. Such approach aims at facilitating the use of research in clinical practice, to reduce the eventual gap between theory and its practical application.

 

The overall aim of the project is to facilitate young children’s participation in their health care situations Method and Material The CAR design involves understanding, interpretation and application. This means reflecting on care situations and being confronted with assumptions from theoretical perspectives as well as training an openness and awareness in caring encounters. The team work is in a continued progress and will last during 2014. The data analysis will then proceed.

Result :Some preliminary result will be presented about the process and outcome of the clinical application research Clinical implications: This study may contribute to the stock of knowledge regarding the implementation of an interactive communicative device with the purpose to facilitate young children’s participation in their health care situations.

National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-27145 (URN)
Conference
International Conference in Health, Social Welfare and Coproduction at Mälardalen University in Eskilstuna 9 - 10 th September, 2014
Available from: 2014-12-19 Created: 2014-12-19 Last updated: 2017-09-27Bibliographically approved
Harder, M. (2014). Kommunikation med barn vid hälsobesök. In: Maja Söderbäck (Ed.), Kommunikation med barn och unga i vården: . Stockholm: Liber
Open this publication in new window or tab >>Kommunikation med barn vid hälsobesök
2014 (Swedish)In: Kommunikation med barn och unga i vården / [ed] Maja Söderbäck, Stockholm: Liber, 2014Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2014
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-24619 (URN)9789147114061 (ISBN)
Available from: 2014-03-11 Created: 2014-03-11 Last updated: 2014-10-03Bibliographically approved
Golsäter, M., Enskär, K. & Harder, M. (2014). Nurses´encounters with children in child and school health care: negotiated guidance within a given frame. Scandinavian Journal of Caring Sciences, 28(3), 591-599
Open this publication in new window or tab >>Nurses´encounters with children in child and school health care: negotiated guidance within a given frame
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 591-599Article in journal (Refereed) Published
Abstract [en]

Background:Throughout childhood, children take part in health visits according to a health-monitoring programme. The visits are aimed to promote the children’s development and health and to strengthen them to take own responsibility for their health. Nurses’ actions when encountering children at these visits are not explored to any great extent. Exploring nurses’ actions can facilitate their reflections on their actions towards children and thereby promote children’s involvement in such visits. Aim: The aim of this study was to explore nurses’ actions when encountering children at health visits. Method: A qualitative explorative design, based on 30 video recordings of health visits in child and school health care, was used in this study. These visits were ordinary real-life health visits. The data were subjected to qualitative content analysis. The right to conduct video recordings during health visits was approved by appropriate research ethics committees. Results: The findings show that nurses, in order to carry out the health visits, encounter children through negotiated guidance. This guidance is understood as the process through which the nurses reach agreement with the children, and is comprised of directed and pliable strategies. At one moment, the nurse can use a directed strategy to inform the child and at the next moment a pliable strategy to provide the child space within the given frame, the health-monitoring programme. By using these strategies intertwined, the nurse can provide the child space within the given frame and, at the same time, fulfil his/ her responsibility to promote children’s health and development. Conclusion: The results highlight nurses’ challenging and complex assignment of guiding children to promote their engagement in the health visits, thereby enabling the nurses to promote the children’s health and development according to the national health-monitoring programme.

Keywords
nurses, child health care, children, health visits, school health care, video recordings, qualitative content analysis
National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-22863 (URN)10.1111/scs.12087 (DOI)000340288100019 ()2-s2.0-84904970711 (Scopus ID)
Available from: 2013-11-18 Created: 2013-11-18 Last updated: 2017-12-06Bibliographically approved
Harder, M., Christensson, K. & Söderbäck, M. (2013). Four year old children's negotiation strategies to influence and deal with a Primary Health Care situation. Children & society, 27(1), 35-47
Open this publication in new window or tab >>Four year old children's negotiation strategies to influence and deal with a Primary Health Care situation
2013 (English)In: Children & society, ISSN 0951-0605, E-ISSN 1099-0860, Vol. 27, no 1, p. 35-47Article in journal (Refereed) Published
Abstract [en]

In Sweden, children’s health and development are promoted through Primary Child Health Care (PCHC) visits. The children participate in these visits from their own perspective through bodily and verbal expressions. This study explores four-year-old children’s expressions when they as actors take part in a PCHC situation. The conceptualisation of the children’s expressions reveals various actions that exhibit their affirmative and delaying negotiation strategies to influence and deal with these situations. For PCHC nurses, these findings may encourage to view children as negotiating participants and inspire to sensitivity when inviting children and guiding them through health visits

Keywords
children, expressions, hermeneutic, analysis, Primary Child Health care, videoobservation
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-7912 (URN)10.1111/j.1099-0860.2011.00365.x (DOI)000312145100004 ()2-s2.0-84870702851 (Scopus ID)
Projects
Barns delakighet i vårdsituationer
Available from: 2010-02-09 Created: 2010-02-09 Last updated: 2017-12-12Bibliographically approved
Coyne, I. & Harder, M. (2011). Children's participation in decision-making: Balancing protection with shared decision-making using a situational perspective. Journal of Child Health Care, 15(4), 312-319
Open this publication in new window or tab >>Children's participation in decision-making: Balancing protection with shared decision-making using a situational perspective
2011 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, no 4, p. 312-319Article in journal (Refereed) Published
Abstract [en]

Children's participation in decision-making in the health care setting is complex because parents and health professionals tend to take a protective stance towards children to act in their best interest. Children prefer to be protected in some situations and to share decision-making in others. Adults in the health care setting need to consider children as individuals, rather than as a homogenous group, and take into account that a child's competence and preferences will depend on the circumstances in every situation. This article argues for a situational perspective of children's participation to act in the child's best interest and to balance protection with shared decision-making, according to children's rights and desires.

Keywords
children's participation, decision-making, children's rights, parents, support
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-15504 (URN)10.1177/1367493511406570 (DOI)000299562500007 ()2-s2.0-84860613427 (Scopus ID)
Available from: 2012-10-24 Created: 2012-10-10 Last updated: 2019-01-24Bibliographically approved
Harder, M., Christensson, K., Coyne, I. & Söderbäck, M. (2011). Five-year-old Children's Tuning-in and Negotiation Staregies in an Immunization Situation. Qualitative Health Research, 21(6), 818-829
Open this publication in new window or tab >>Five-year-old Children's Tuning-in and Negotiation Staregies in an Immunization Situation
2011 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 21, no 6, p. 818-829Article in journal (Refereed) Published
Abstract [en]

In this article, we have explored 5-year-old children's expressions when they as actors took part in an immunization situation in the Primary Child Health Care (PCHC) service in Sweden. Although children's health and development are the main concern in the PCHC service, their perspectives in such a setting have not been explored fully. To capture children's perspectives we used a hermeneutic design and video observations. The findings revealed children as competent and active participants, contributing to the construction of the PCHC situation in mutuality with the nurse and the parent. The conceptualization of children's expressions and actions revealed how they influenced and dealt with a PCHC situation by using strategies of tuning-in, affirmative negotiation, and delaying negotiation. Understanding children's actions will assist nurses to act with sensitivity when they encounter and support children.

Place, publisher, year, edition, pages
SAGE, 2011
Keywords
children; health care; hermeneutics; immunization; observation
National Category
Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:mdh:diva-10671 (URN)10.1177/1049732311400629 (DOI)000290214400008 ()21343432 (PubMedID)2-s2.0-79955597620 (Scopus ID)
Projects
Barns delaktighet i vårdsitationer
Available from: 2010-11-01 Created: 2010-11-01 Last updated: 2017-12-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1740-8072

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