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  • 1. Agneta, Breitholtz
    et al.
    Snellman, Ingrid
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Ingegerd, Fagerberg
    Ersta Skondal Univ Coll, Stockholm, Sweden..
    Older persons self determination within municipal home care services2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, p. 142-142Article in journal (Other academic)
  • 2.
    Arving, Cecilia
    et al.
    Uppsala University.
    Holmström, Inger
    Uppsala University.
    Creating a new profession in cancer nursing?: Experiences of working as a psychosocial nurse in cancer care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2939-2947Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe the nature of being a psychosocial nurse in cancer care.

    BACKGROUND: Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored.

    DESIGN: A qualitative inductive interview approach was used.

    METHODS: A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed.

    RESULTS: The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were.

    CONCLUSIONS: This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care. RELEVANCE TO CLINICAL PRACTICES: The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls.

  • 3.
    Blomberg, Karin
    et al.
    Örebro universitet, Sweden.
    Bisholt, Birgitta
    Karlstads universitet, Sweden.
    Kullén Engström, Agneta
    Högskolan Borås, Sweden.
    Ohlsson, Ulla
    Örebro universitet, Sweden.
    Sundler Johansson, Annelie
    Högskolan Skövde, Sweden.
    Gustafsson, Margareta
    Örebro universitet, Sweden.
    Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education.2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 15-16, p. 2264-2271Article in journal (Refereed)
    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.

  • 4. Boroujeni, Ali Zargham
    et al.
    Mohammadi, Rakhshandeh
    Oskouie, Sayede Fatemeh Haghdoost
    Sandberg, Jonas
    Mälardalen University, School of Health, Care and Social Welfare.
    Iranian nurses' preparation for loss: finding a balance in end-of-life care2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 16, p. 2329-2336Article in journal (Refereed)
    Abstract [en]

    Aim. To explore the nurse-patient interaction in terminally ill situations in acute care, focusing on the nurses' preparation for loss. Background. Caring for dying patients can be a distressing and sometimes even threatening experience for nurses. Despite the vast body of literature on nurse/patient interaction and the quality of end-of-life care, few studies focus specifically on nurses' experience. Design. A grounded theory approach was used to explore nurses' interaction with dying patients and their families and examine how nurses deal with situations in which the patient's death is inevitable. Method. Eighteen nurses were interviewed up to three times each at three teaching hospitals in Isfahan, Iran, during autumn 2006. A shortlist of possible participants was obtained by means of theoretical sampling and those who had experienced the death of patients and were able to express their feelings verbally were selected. Results. The results clarified a core consideration: striking a balance between restorative and palliative care, information and hope, expectations and abilities and intimacy and distance. Conclusion. Attaining a balance in caring for dying patients is a major challenge to nurses: it concerns not only their interactions with patients and their families, but also their perceptions of themselves and their actions in end-of-life care. Relevance to clinical practice. In end-of-life care, it is important for nurses to be able to change the focus of their care when the patient's condition is diagnosed as irreversible. They also need to be well equipped to maintain a balance, thereby preparing themselves for the patient's forthcoming death.

  • 5.
    Frank, Catharina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Asp, Margareta
    Mälardalen University, School of Health, Care and Social Welfare.
    Dahlberg, Karin
    Växjö University.
    Patient participation in emergency care. A phenomenographic analysis of caregivers´conceptions2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 18, p. 2555-2562Article in journal (Refereed)
  • 6.
    Gustafsson, Christine
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Stockholm, Sweden.
    Asp, Margareta
    Mälardalen University, School of Health, Care and Social Welfare.
    Fagerberg, Ingegerd
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Stockholm, Sweden.
    Reflection in night nursing: a phenomenographic study of municipal night duty registered nurses' conceptions of reflection2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 10, p. 1460-1469Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of the study was to describe nurses' conception of reflection in their working situation. Background. To be a municipal night duty registered nurse in Sweden means to shoulder nursing care responsibility for numerous units with older people in need of care. Two night nurses share nursing care responsibility for up to 1300 people. In nursing research, reflection is an often-mentioned phenomenon discussed with advantages and benefits within the 'traditional fields' of nursing (hospital context). A question to ask is, how do night nurses having an untraditional amount of nursing care responsibility conceptualise and experience reflection in their working situation? Design. A phenomenographic methodology was used. Methods. Data were collected by interviewing all nurses (n = 7) in a medium-sized municipality bordering a metropolitan area of Sweden. Results. The nurses' conceptions of reflection are categorised as 'Field of applications' (an instrument for interpreting, a strategy for handling the working situation and an approach to learning) and 'Field of prerequisites' (presence facilitates reflection; flexibility implies reflection; courage in thought and activity increases reflection). Conclusion. The findings reveal that reflection in the nurses' working situation is more than an instrument for learning, understanding and encouragement for change and improvement. Reflection is conceptualised as an instrument for interpreting nursing care situations, which requires courage and is facilitated by presence and flexibility. Reflection is also conceptualised as an approach to handling, managing and coping with a sometimes impossible working situation that includes nursing responsibility for hundreds of older people and can sometimes entail difficulties and stress. Relevance to clinical practice. The findings showed that reflection has a broader use than had earlier been described. Deliberate use of reflection could mean improved nursing practice. This guides nursing managers to pay attention to the phenomenon as an instrument for nursing care improvement.

  • 7.
    Hedman, Ann-Mari
    et al.
    Red Cross University College of Nursing.
    Fonad, Edit
    Karolinska Institutet.
    Sandmark, Helene
    Mälardalen University, School of Health, Care and Social Welfare.
    Older people living at home: Associations between falls and health complaints in men and women2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 19-20, p. 2945-2952Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To investigate the associations between self-reported falls and health complaints, among persons aged 75 years and older living at home, and to investigate gender differences in the associations. Background: There are several studies concerned with risk factors for falling, and others related to health complaints, but not many with associations between falls and health complaints. There are some inconsistent data of incidence and gender-related differences in falling. Design: Case-control community-based study. Methods: In total, 1243 persons living in two municipal districts in Sweden answered a questionnaire. Odds ratios (OR) and regression models with 95% confidence interval (CI) were used to determine the associations between self-reported falls and different health complaints. Results: The adjusted (multivariate) linear regression showed that urinary incontinence, self-rated health and tiredness were significantly associated with falls for both men and women living at home. The gender-related differences in falling were associated with the variables such as self-rated health for men and tiredness and pain in the hands, elbows, legs or knees for women. Conclusion: An association is evident between falls and urinary incontinence, poor self-rated health and tiredness for older persons living at home. Gender differences in falls show an association with poor self-rated health, tiredness and pain in the hands, elbows, legs or knees. Relevance to clinical practice: As older people are expected to live in their own homes as long as possible, more knowledge is required about what determines the risk of falling. Nurses in community care are recommended to use assessment tools that include urinary incontinence in order to detect the risk of falling.

  • 8.
    Holmström, Inger
    et al.
    Uppsala universitet, Sweden.
    Höglund, Anna T
    Uppsala universitet, Sweden.
    Response to commentary by Sarah Winch on Holmström I & Höglund AT: The faceless encounter: ethical dilemmas in telephone nursing2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 23, p. 3251-3252Article in journal (Other academic)
  • 9.
    Holmström, Inger
    et al.
    Uppsala Science Park, Uppsala, Sweden.
    Höglund, Anna T.
    Uppsala Science Park, Uppsala, Sweden.
    The faceless encounter: ethical dilemmas in telephone nursing2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1865-1871Article in journal (Refereed)
    Abstract [en]

    Aim. This paper aims to present the findings of a study designed to describe ethical dilemmas, in the form of conflicting values, norms and interests, which telenurses experience in their work.

    Background. Telephone nursing is an expanding part of health care. Telephone nurses in Sweden assess care needs, provide advice, support and information, and recommend and coordinate healthcare resources. Lately, ethical demands on healthcare professionals in general have increased. The reasons include new biomedical competence, an ageing population and constrained resources which have made priority setting a primary concern for doctors and nurses. When ethical problems arise, colleagues need open dialogue. Despite this, nurses lack such a dialogue.

    Method. A purposeful sample of 12 female telenurses in Sweden was interviewed twice during 2004 and 2005. The transcribed interviews were analysed thematically.

    Results. Five themes were found: talking through a third party; discussing personal and sensitive problems over the phone; insufficient resources and the organization of health care; balancing callers' information needs with professional responsibility; and differences in judging the caller's credibility.

    Conclusion. The present study has identified five different themes in which Swedish telenurses experience ethical dilemmas in their work. This shows how ethical dilemmas in various forms are present in telenursing. Questions of autonomy, integrity and prioritizing are particularly highlighted by the participating nurses. Telenurses in Sweden also experience new ethical demands due to a multicultural society. Although several of the identified dilemmas also occur in other areas of nursing we argue that these situations are particularly challenging in telenursing.

    Relevance to clinical practice. The work organization should provide opportunities for ethical competence-building, where ethical dilemmas in telenursing are highlighted and discussed. Such a strategy might lead to decreased moral uncertainty and distress among telenurses, with positive consequences for callers.

  • 10.
    Holmström, Inger K.
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nokkoudenmaki, Mai-Britt
    Tunafors Primary Healthcare Ctr, Eskilstuna, Sweden..
    Zukancic, Selma
    Care and treatment, Torshälla, Sweden.
    Sundler, Annelie J.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    It is important that they care: older persons' experiences of telephone advice nursing2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 11-12, p. 1644-1653Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesThe aim of the study was to explore older persons' experiences of telephone advice nursing at primary healthcare centres. BackgroundTelephone 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. DesignThis study has a descriptive design with a qualitative inductive approach. MethodsData were collected via interviews with a purposive sample of 10 older persons in 2014. The data were analysed using qualitative content analysis. ResultsThe 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. ConclusionsThis 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 practiceThe 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.

  • 11.
    Höglund, Anna T
    et al.
    Uppsala universitet.
    Holmström, Inger
    Uppsala universitet.
    "It's easier to talk to a woman" - aspects of gender in Swedish telenursing2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 22, p. 2979-2986Article in journal (Refereed)
    Abstract [en]

    Aim. To describe and explore gender aspects in telenursing as experienced by Swedish telenurses.

    Background. Telenurses at call centres in Sweden offer triage recommendations and self-care advice to the general public over the telephone, on a wide range of health problems. The demands on telenurses are multifaceted and competence is needed in many fields such as nursing, pharmacology, psychology and communication. Previous studies have shown that telenurses encounter many ethical dilemmas and that some of these are to do with gender related issues. Most telenurses, as well as most callers, are women. It is, therefore, reasonable to believe that gender plays an important role in the work of telenurses.

    Design. Descriptive and explorative qualitative design.

    Methods. A purposive sample of 12 female telenurses in Sweden participated in in-depth interviews twice during 2004–2005. The transcribed interviews were analysed inductively with a stepwise thematic method.

    Results. Five themes emerged from the interviews, namely: female subordination in the family, disrespect in dialogue with female nurses, distrust in fathers' competence, reluctant male callers and woman-to-woman connection.

    Conclusions. Gender construction and cultural gender norms seem to be at work in the encounter between Swedish telenurses and callers. Questions of power relations, the picture of the mother/woman as the primary carer for small children and distrusting men in their parental role were particularly highlighted.

    Relevance to clinical practice. Telenurses should be aware of the risk of stereotyping their dialogues with callers in a way that seems to fit better with female callers' ways of communicating. Clinical supervision based on reflective practice and peer reviews of calls might diminish this risk. Telenurses also need more training in handling overt or covert power messages based on male superiority.

  • 12.
    Kristensen, Dorte V.
    et al.
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Sundler, Annelie J.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, Boras, Sweden..
    Eide, Hilde
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Hafskjold, Linda
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Ruud, Iren
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4613-4621Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo describe the characteristics of communication practice in home care visits between older people (over 65years old) and nurse assistants and to discuss the findings from a person-centered perspective. BackgroundThe 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. DesignA descriptive design with a qualitative inductive approach was used. MethodFifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis. ResultsFour 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. ConclusionsThe 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 practiceBeing 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.

  • 13.
    Laennerstroem, Linda
    et al.
    Uppsala Univ, Sweden..
    von Celsing, Anna-Sophia
    Uppsala Univ, Sweden..
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wallman, Thorne
    Uppsala Univ, Sweden..
    Registered nurses' work with sick leave questions by telephone in primary health care2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 5-6, p. 641-647Article in journal (Refereed)
    Abstract [en]

    Aims and objectives To describe registered nurses' work with sick leave questions by telephone. BackgroundIn Sweden, when a sick person needs to request a sickness certification, it is common to contact the primary healthcare centre. The main access to primary health care is by telephone, with a registered nurse answering the care seeker's questions, triaging and helping care seekers to the right level of care. Registered nurses' work with sick leave questions has not been studied, except for two qualitative interview studies. DesignA descriptive cross-sectional study. MethodsA questionnaire with 120 questions was distributed to 185 registered nurses in one county in central Sweden. Descriptive statistics were used for analysis. ResultsResponse rate was 62% (n=114). Registered nurses (n=105) in this study talked weekly to persons on, or at risk, for sick leave. A large part (n=78) felt they had a role in the care of persons on sick leave, consisting of booking appointments as well as acting as a pilot, advisor, caretaker and coordinator. For 74 of 114 registered nurses, it was problematic to handle the phone calls weekly. Measures were often' booking appointments with physicians (n=67) and seldom' providing information on social insurance rules (never' n=51). The registered nurses expressed a great need for more education. ConclusionRegistered nurses in this study reported having a role in the care of persons on sick leave when handling sick leave questions by telephone. The telephone calls were problematic to handle, and the registered nurses expressed a great need for education and training in social insurance medicine. Relevance to clinical practiceThere is a need to educate and train registered nurses in social insurance medicine to provide high-quality nursing for patients on or at risk for sick leave.

  • 14.
    Lööf, Helena
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Sophiahemmet University, Stockholm,Sweden.
    Johansson, Unn-Britt
    Sophiahemmet University, Stockholm,Sweden.
    “A body in transformation”: - An Empirical phenomenological study about fear-avoidance beliefs towards physical activity among persons experiencing moderate to severe rheumatic pain2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Aims. To gain a better understanding of fear-avoidance beliefs towards physical activity and body awareness in people experiencing moderate to severe rheumatic pain.  Background. Rheumatoid arthritis and psoriatic arthritis are long-term conditions with pain as the prominent symptom. Health-promoting physical activity is recommended, and can have an analgesic effect. High self-rated pain has previously been reported to be associated with increased fear-avoidance behaviour in relation to physical activity. Body awareness, which includes attentional focus and awareness of internal body sensations, could be valuable in the nursing care of long-term diseases.   Design. Empirical phenomenological.  Methods. An empirical phenomenological psychological method was applied. Interviews were undertaken in 2016 with 11 informants (eight females and three males, age range 44–71 years) who were diagnosed with rheumatoid arthritis (n = 7) or psoriatic arthritis (n = 4), with a disease duration ranging from 3–35 years. The mean visual analogue scale score in the study sample was 60 mm.   Results. Three typologies were identified: “My relatively fragile physical status”, “I am an active creator” and “Part of something bigger than myself.” Conclusions. The current findings indicated that pain anticipation and fear-avoidance beliefs towards physical activity sometimes affected the behaviour of individuals with long-term rheumatic pain syndromes. People experiencing moderate to high rheumatic pain tended to focus on their fragile physical and emotional state. By adopting a more favourable attitude towards the self, the body could be restored to a state of calm and balance.  Relevance to clinical practice. The current findings are relevant for healthcare professionals engaged in health-promotion clinical practice.

  • 15.
    Marmstål Hammar, Lena
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Emami, Azita
    Seattle Univ, Coll Nursing.
    Götell, Eva
    Mälardalen University, School of Health, Care and Social Welfare.
    Engström, Gabriella
    Mälardalen University, School of Health, Care and Social Welfare.
    The impact of caregivers' singing on expressions of emotion and resistance during morning care situations in persons with dementia: an intervention in dementia care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 7-8, p. 969-978Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim was to describe expressions of emotions and resistiveness to care among persons with dementia (PWD), during morning care situations without and with music therapeutic caregiving (MTC). BACKGROUND: Effective caregiving is dependent on the interpersonal relationship between nurse and patient. PWD suffer from major cognitive impairment, making interaction with others problematic. Such patients often react with problematic behaviours such as resistance and anger towards the care activity and the caregiver. Earlier research suggests that MTC - when caregivers sing for or together with PWD during caregiving - can reduce resistance and evoke positive emotions in PWD. DESIGN: This was an intervention study whereby MTC was implemented during morning care situations while PWD were being cared for. METHOD: The study included ten, 66-92-year-old men and women with severe dementia living in a nursing home in Sweden. Video observations of eight weekly sessions, consisting of four recordings of usual morning care and four recordings of morning care with MTC, provided data. The resistiveness to care scale and the observed emotion rating scale were used for analysis. RESULTS: Pull away was the most common resistant behaviour under both conditions. The PWDs' expressions of resistant behaviour, such as pull away, grab object and adduction, were significantly reduced under the intervention situation. Positively expressed emotions, specifically pleasure and general alertness, significantly increased under the MTC intervention compared with the 'usual' morning care sessions. CONCLUSIONS: MTC can be an effective nursing intervention to provide PWD a more pleasant experience of morning care situations as it decreases resistant behaviour and increases positive emotions. RELEVANCE TO CLINICAL PRACTICE: MTC offers a potential non-pharmacologic treatment that can be used in caring for PWD.

  • 16.
    Mazaheri, Monir
    et al.
    Karolinska Institutet, Stockholm, Sweden; Tehran University of Medical Sciences, Tehran, Iran.
    Eriksson, L.E.
    Karolinska Institutet, Stockholm, Sweden.
    Heikkilä, K.
    Karolinska Institutet, Stockholm, Sweden.
    Nasrabadi, A.N.
    Tehran University of Medical Sciences, Tehran, Iran.
    Ekman, S.L.
    Karolinska Institutet, Stockholm, Sweden.
    Sunvisson, H.
    Örebro University, Örebro, Sweden.
    Experiences of living with dementia in Iran: qualitative content analysis of semi-structured interviews2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 21-22, p. 3032-3041Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe people's experiences of living with dementia in Iran. Background: A knowledge gap exists regarding the experiences of living with dementia in nonWestern contexts. This gap may be especially apparent within the Iranian context, where dementia research is relatively new. Deeper understanding about context-related experiences of dementia is a prerequisite for nurses' ability to provide adequate and meaningful care. Design: Qualitative, cross-sectional design. Methods: Qualitative content analysis of semi-structured interviews with people living with dementia inurban Iran (six women and nine men; 60-87 years old). Results: The participants experienced their condition as a state of forgetfulness that was accompanied by losses and dependency on others. They wanted to feel good about themselves and feel important, but they continually struggled with matters such as a loss of accountability, feelings of futility and the frustration of others. Economic dependency and a lack of economic resources were sources of feelings of futility. Conclusion: Experiences of living with dementia in Iran included a substantial struggle to stay connected to the social world and to deal with dramatic life changes, aspects of living with dementia that seem to be universal. However, the feelings of financial burden and the experience of being nagged for their shortfalls by family members have seldom been described in other studies and seem to represent a cultural aspect of their experience. Relevance to clinical practice: The results of the study call for further nursing efforts insupporting people living with dementia in their struggle with their altered lives and in retaining their connections to everyday life. Furthermore, their family members might benefit from specific nursing interventions including information about dementia and advice on how to help the family members with dementia to interact with others while exercising their individual strengths.

  • 17.
    Palesjö, Carina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nordgren, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ., Sweden.
    Asp, Margareta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Being in a critical illness-recovery process: a phenomenological hermenetical study2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 23-24, p. 3494-3502Article in journal (Refereed)
    Abstract [en]

    Aims and objective. The aim of this study was to describe and interpret the essential meaning of the lived experiences of being in a critical illness-recovery process after a life-threatening condition. 

    Background. The critical illness-recovery process after a life-threatening condition takes several years and does not only include patients' experiences during intensive care. Previous research has mainly focused on what critically ill patients recall. However, from a phenomenological point of view, experiences are more than memories alone. To plan and perform relevant health care and social support for patients who have survived a life-threatening condition, a more profound understanding about their lived experiences is needed. 

    Design and method. In this qualitative study, a phenomenological hermeneutical approach was used. Interviews were conducted with seven patients, two to four years after they had received care in an intensive care unit in Sweden. 

    Results. The comprehensive understanding of the results shows that the critical illness-recovery process after a life-threatening condition means an existential struggle to reconcile with an unfamiliar body and with ordinary life. This can be understood as an 'unhomelikeness' implying a struggle to create meaning and coherence from scary and fragmented memories. The previous life projects, such as work and social life become unfamiliar when the patient's fragile and weak body is disobedient and brings on altered sensations. 

    Conclusions. Patients who survive a life-threatening condition have an immense need for care and support during the entire critical illness-recoveryprocess, and also after the initial acute phase. They need a coherent understanding of what happened, and support to be able to perform their changed life projects. 

    Relevance to clinical practice. Supporting and caring for patients' recovery from a life-threatening condition involves recognising the patients' struggle and responding to their existential concerns.

  • 18.
    Roxberg, Åsa
    et al.
    Växjö Universitet.
    Eriksson, Katie
    Åbo Academy, Finland: Central Hospital, Helsinki, Finland .
    Rehnsfeldt, Arne
    Linköping University, Sweden.
    Fridlund, Bengt
    Växjö University.
    The meaning of consolation as experienced by nurses in a home-care setting2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 8, p. 1079-1087Article in journal (Refereed)
  • 19.
    Salzmann-Erikson, M.
    et al.
    University of Gävle, Gävle, Sweden.
    Rydlo, Cecilia
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wiklund Gustin, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. UiT-Norges Arktiske Univesitet, Norway.
    Getting to know the person behind the illness - the significance of interacting with patients hospitalised in forensic psychiatric settings2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 9-10, p. 1426-1434Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. Background: Relationships between staff and patients in forensic psychiatric settings should be grounded in trust and confidence, and the patients need opportunities for emotional reconciliation. However, relationships can be challenging for nurses, who sometimes distance themselves from patients' expressions of suffering. The role of forensic mental health nurses is nebulous, as are the prescriptives and the implementation of nursing practices. Design: Qualitative descriptive design. Methods: In-depth interviews with five nurses who all work in forensic psychiatric settings. Results: We present a descriptive analysis of what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. The results are presented in two main categories: (1) getting to know the person behind the illness and (2) making a difference. Conclusion: Care in forensic psychiatry needs to shift towards a more long-term view of the role of nursing, focusing less on the traditional and stereotypical identity of the productive nurse and more on the care given when nurses slow down and take the time to see the patients as individuals. Establishing trusting relationships with patients in forensic psychiatric settings is viewed as a less oppressive way to control patients and guide them in directions that are preferable for the nurses and for the society. Relevance to clinical practice: Nurses may use simple strategies in their daily practice such as sitting on the sofa with patients to establish trust. We stress that nurses should abandon policing roles and custodial activities in favour of guiding principles that promote individual recovery, treatment and health-promoting care.

  • 20.
    Stålberg, Anna
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandberg, Anette
    Mälardalen University, School of Education, Culture and Communication, Educational Sciences and Mathematics.
    Larsson, Thomas B
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Imelda, Coyne
    Trinity College, Dublin, Ireland.
    Söderbäck, Maja
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Curious, Thoughtful and Affirmative – Young Children’s Meanings of Participation in Healthcare Situations when using an Interactive Communication Tool2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 1-2, p. 235-246Article in journal (Refereed)
  • 21.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Engstrom, Gabriella
    Florida Atlantic Univ, USA.
    Experience of self-management of medications among older people with multimorbidity2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 19-20, p. 2757-2764Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To explore the experience of self-managing medication among older people with multimorbidity. Background. Older people with multimorbidity are now more likely to live at home and to self-medicate. Reduced assistance from professional caregivers is associated with medical errors. Design. Face-to-face interviews were conducted with older people with multimorbidity. Methods. Participants aged >= 75 years with >= 2 medical diagnoses and living at home or in special accommodation were interviewed. Twenty-eight men and women (mean age 84 years) participated. Interviews lasted from 45 minutes-2 hours and were transcribed verbatim. A lifeworld-based phenomenological method was used for analysis. Results. Uncertainty among the participants increased with their experience of side effects and concern that the medication might be harmful. These uncertainties were reinforced by a fear of malpractice when several physicians were involved. This meant living with ambivalence when taking the medication, which required a trade-off between symptom relief and reducing side effects. A lack of continuity with physicians and nurses led to uncertainty in maintaining an overview of the medications. By contrast, when the relationships were supportive and caring, the uncertainties diminished. Four concepts were used to describe the various meanings of this experience: adapting to a new lifestyle; ambivalence towards medicine; experience of side effects and concerns about medical errors; and relationships as sources of feeling secure. Conclusions. Medications can cause side effects, and unclear benefits increase the uncertainty for older people with multimorbidity. Health care professionals need to develop an understanding of each patient's experience of such uncertainty. Relevance to clinical practice. Health care professionals can give support and show understanding for older people's existential uncertainty by creating good relationships and continuity in care, and offering appropriate information. Regular visits should be scheduled to manage any problems patients might have when self-medicating.

  • 22.
    Widarsson, M.
    et al.
    Uppsala University, Uppsala, Sweden.
    Engström, G.
    Florida Atlantic University, United States.
    Tydén, T.
    Uppsala University, Uppsala, Sweden.
    Lundberg, P.
    Uppsala University, Uppsala, Sweden.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    'Paddling upstream': Fathers' involvement during pregnancy as described by expectant fathers and mothers2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, p. 1059-1068Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe the perspectives of expectant mothers and fathers on fathers' involvement during pregnancy. Background: Becoming a father is a major life event and paternal involvement during pregnancy has a positive influence on the family. However, research into both expectant mothers' and fathers' perspectives on fathers' involvement during pregnancy is relatively scarce. Design: A descriptive qualitative study was used. Methods: Thirty expectant parents (20 women and 10 men) were interviewed either as part of one of four focus groups or in an individual interview. Qualitative content analysis was performed on the interview transcripts. Results: A theme of 'Paddling upstream' emerged as an expression of the latent content of the interviews concerning perspectives on fathers' involvement. Five sub-themes described the manifest content: trying to participate, trying to be understanding, trying to learn, trying to be a calming influence and trying to find a balanced life. Expectant parents suggested several ways to improve fathers' involvement and to meet parents' need for shared involvement. Conclusion: Expectant mothers and fathers wanted the father to be more involved in the pregnancy. Although fathers attempted different strategies, they did not always perceive what was expected of them and encountered many barriers as they tried to navigate through this unique experience. The best support for the father was the mother. Expectant parents wanted their healthcare to include the father more thoroughly and to focus on the whole family. Relevance to clinical practice: Prenatal care professionals can overcome barriers that prevent paternal involvement. Although fathers are not able to engage in the pregnancy on the same level as the mother, we suggest that their specific needs also be recognised through an increased awareness of gender norms in healthcare.

  • 23.
    Wiklund, Lena
    Mälardalen University, School of Health, Care and Social Welfare.
    Existential aspects of living with addiction - Part I: meeting challenges2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 18, p. 2426-2434Article in journal (Refereed)
    Abstract [en]

    AIM: This paper aims to explore the existential aspects of living with addiction.

    BACKGROUND: This study arises from data from a previous research project carried out by the author and takes as its point of departure the patient's perspective. Addiction is described as being related to traumatic experience and to loss of control, shame, guilt and low self-esteem, but also to spirituality. This causes profound suffering and drugs are used as a means of handling this suffering.

    DESIGN: Hermeneutic inquiry was used to explore peoples experiences of living with addiction.

    METHOD: The first study was based on interviews with people with rich, personal experience of addiction. This study constitutes a secondary analysis of the same data and was conducted using a hermeneutic approach.

    RESULTS: On an existential level the experiences of living with addiction can be understood as a striving to meet and resolve challenges associated with spirituality caused by a person's suffering and, paradoxically, also by his/her efforts to relieve that suffering through the use of drugs. These challenges are presented as themes focusing on the conflict that must be met; meaning - meaninglessness, connectedness - loneliness, life - death, freedom - adjustment, responsibility - guilt, control - chaos.

    CONCLUSION: Living with addiction appears as being in the midst of a struggle with existential challenges. Furthermore, the use of drugs is paradoxical as it momentarily relieves suffering but at the same time increases it.

    RELEVANCE TO CLINICAL PRACTICE: Addressing the challenges will facilitate nurses interaction with addicted persons. When facing challenges, including the motivational aspects, instead of focusing on problems, health can be promoted and suffering relieved.

  • 24.
    Wiklund, Lena
    Mälardalen University, School of Health, Care and Social Welfare.
    Existential aspects of living with addiction - Part II: caring needs.: A hermeneutic expansion of qualitative findings2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 18, p. 2435-2443Article in journal (Refereed)
    Abstract [en]

    AIM: This paper aims to describe caring needs associated with existential aspects of living with addiction.

    BACKGROUND: Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing.

    DESIGN: Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction.

    METHOD: This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background.

    RESULTS: The themes presented are: meaning - meaninglessness, connectedness - loneliness, life - death, freedom - adjustment, responsibility - guilt, control - chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability.

    CONCLUSIONS: When caring for patients suffering from addiction nurses should address patients' spirituality. The caring communion is vital, as it is the foundation for meeting the patients' needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others.

    RELEVANCE TO CLINICAL PRACTICE: Understanding and being able to identify patients' caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient's recovery.

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