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  • 1.
    Dahlberg, Karin
    et al.
    Växjo universitet, IVOSA.
    Summer Meranius, Martina
    Mälardalen University, Department of Caring and Public Health Sciences.
    The relevance of Merlarleau-Ponty`s philosophy for the understanding of health and health science methodology.2008In: 5th central and Eastern European Conference on Phenomenology.: "Corporeity and affectivity" in celebration of Merlau-Ponty`s 100th birthday., 2008Conference paper (Other academic)
  • 2.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Sweden.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Högskolan Dalarna.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Viktigt att anhörigvårdarna får stöd efter unika behov2019In: Dagens samhälle, ISSN 1652-6511, Vol. 19 septemberArticle in journal (Other (popular science, discussion, etc.))
  • 3.
    Hammar, L. M.
    et al.
    Dalarna Univ, Sch Educ Hlth & Soc, Falun, Sweden.
    Willimas, C. L.
    Florida Atlantic Univ, Christine E Lynn Coll Nursing, Boca Raton, FL 33431 USA..
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    McKee, K. J.
    Dalarna Univ, Sch Educ Hlth & Soc, Falun, Sweden..
    Extended Support to increase Quality of Life in Spouse Caregivers of Older Adults with Dementia. A pilot study2018In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 66, p. S76-S76Article in journal (Other academic)
  • 4.
    Håkansson Eklund, Jakob
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala universitet.
    Kumlin, Tomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kaminsky, Elenor
    Uppsala universitet, Sweden.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie J
    Högskolan Borås, Sweden.
    Condén, Emelie
    Region Västmanland, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    "Same same or different?" A review of reviews of person-centered and patient-centred care2019In: Royal college of Nursing, Sheffield, UK, 2019Conference paper (Refereed)
  • 5.
    Håkansson Eklund, Jakob
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala universitet.
    Kumlin, Tomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kaminsky, Elenor
    Uppsala universitet.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie J
    Condén, Emelie
    Region Västmanland, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    "Same same or different?" A review of reviews of person-centred and patinet-centred care2018In: International Conference on Communication in Healthcare, Porto, Portugal, 2018Conference paper (Refereed)
  • 6.
    Håkansson Eklund, Jakob
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kumlin, Tomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kaminsky, Elenor
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie Johansson
    Univ Boras, Fac Caring Sci Work Life & Social Welf, SE-50190 Boras, Sweden..
    Conden, Emelie
    Uppsala Univ, Vastmanland Hosp, Clin Res Ctr, Uppsala, Sweden..
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    "Same same or different?" A review of reviews of person-centered and patient-centered care2019In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, no 1, p. 3-11Article, review/survey (Refereed)
    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.

  • 7.
    Håkansson Eklund, Jakob
    et al.
    Stockholm University, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Toward a consensus on the nature of empathy: A review of reviews2021In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 104, no 2, p. 300-307Article in journal (Refereed)
    Abstract [en]

    Objective

    The objective was to provide a synthesis of already synthesized literature on empathy in order to identify similarities and differences among conceptualizations.

    Methods

    A review of reviews was conducted to locate synthesized literature published between January 1980 and December 2019. Two authors screened and extracted data, and quality-appraised the sources. A total of 52 articles deemed relevant to this overview were synthesized using thematic analysis.

    Results

    The analysis resulted in four themes found in most empathy conceptualizations. In empathy, the empathizer (1) understands, (2) feels, and (3) shares another person’s world (4) with self-other differentiation.

    Conclusions

    Most writings about empathy begin by claiming that there is far from a consensus on how empathy should be defined. This article shows a developing consensus among neuroscientists, psychologists, medical scientists, nursing scientists, philosophers, and others that empathy involves understanding, feeling, sharing, and self-other differentiation.

    Practice implications

    A clarification of the content of empathy may assist practitioners and researchers in avoiding confusion regarding the meaning of the concept, as well as in developing and measuring the relevant aspects of the concept.

  • 8.
    Johansson, Marcus F.
    et al.
    Dalarna University, Sweden.
    McKee, Kevin J.
    Dalarna University, Sweden.
    Dahlberg, Lena
    Dalarna University, Sweden; Karolinska Institutet, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Williams, Christine L.
    Christine E Lynn College of Nursing, Florida Atlantic University, United States.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. School of Health and Welfare, Dalarna University, Falun, 791 88, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 52, Sweden.
    Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 3, article id 1788Article in journal (Refereed)
    Abstract [en]

    (1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse car-ers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced. 

  • 9.
    Johansson, Marcus F.
    et al.
    Dalama University, Sweden.
    McKee, Kevin J.
    Dalama University, Sweden.
    Dahlberg, Lena
    Dalama University, Sweden; Karolinska Instutet, Aging Res Ctr, Sweden; Stockholm University, Sweden.
    Williams, Christine L.
    Florida Atlantic Univ, Christine E Lynn Coll Nursing, USA.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hanson, Elizabeth
    Linnaeus University, Swedish Family Care Competence Ctr, Box 762, Sweden.
    Magnusson, Lennart
    Linnaeus University, Swedish Family Care Competence Ctr, Sweden.
    Ekman, Björn
    Lund University, Sweden.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Dalama Univ, Sch Hlth & Welfare, SE-79188 Falun, Sweden.;Malardale.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Alfred Nobels Alle 23, SE-14152 Huddinge, Sweden..
    A comparison of spouse and non-spouse carers of people with dementia: a descriptive analysis of Swedish national survey data2021In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, no 1, article id 338Article in journal (Refereed)
    Abstract [en]

    Background: Being an informal carer of a person with dementia (PwD) can have a negative effect on the carer's health and quality of life, and spouse carers have been found to be especially vulnerable. Yet relatively little is known about the care provided and support received by spouse carers. This study compares spouse carers to other informal carers of PwDs regarding their care provision, the support received and the psychosocial impact of care.

    Methods: The study was a cross-sectional questionnaire-based survey of a stratified random sample of the Swedish population aged 18 or over. The questionnaire explored how much care the respondent provided, the support received, and the psychosocial impact of providing care. Of 30,009 people sampled, 11,168 (37.7%) responded, of whom 330 (2.95%) were informal carers of a PwD.ResultsIn comparison to non-spouse carers, spouse carers provided more care more frequently, did so with less support from family or the local authority, while more frequently experiencing negative impacts on their social life and psychological and physical health. Spouse carers also received more carer support and more frequently experienced a closeness in their relationship with the care-recipient.

    Conclusions: Spouse carers of PwD differed from non-spouse carers on virtually all aspects of their care situation. Policy and practice must be more sensitive to how the carer-care-recipient relationship shapes the experience of care, so that support is based on an understanding of the individual carer's actual needs and preferences rather than on preconceptions drawn from a generalised support model.

  • 10.
    Johansson Sundler, Annelie
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Berglund, Mia
    Högskolan i Skövde, Institutionen för vård och natur.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalens högskola.
    Thurang, Anna
    Rusner, Marie
    Nilsson, Christina
    Karlsson, Ann-Christin
    Pettersson, Bengt-Olof
    Bremer, Anders
    Varför vårdvetenskap?2008In: Vårdvetenskapliga vägskäl / [ed] Maria Berglund, Annelie Johansson Sundler, Åsa Roxberg, Växjö: Växjö universitet , 2008, p. 49-60Chapter in book (Other academic)
  • 11.
    Marmstål Hammar, Lena
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. School of Education, Health, and Society, Dalarna University, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie Johansson
    Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
    The care of and communication with older people from the perspective of student nurses. A mixed method study2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 52, p. 1-6Article in journal (Refereed)
    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.

  • 12.
    Marmstål Hammar, Lena
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Swall, Anna
    Karolinska Institute, Sweden; Sophiahemmet College University, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Ethical aspects of caregivers' experience with persons with dementia at mealtimes2016In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, no 6, p. 624-635Article in journal (Refereed)
    Abstract [en]

    Background:

    Persons with dementia are at risk of malnutrition and thus in need of assistance during mealtimes. Research suggest interventions for caregivers to learn how to facilitate mealtimes and eating, while other suggest a working environment enabling the encounter needed to provide high-quality care. However, the phenomenon of caring for this unique population needs to be elucidated from several perspectives before suggesting suitable implications that ensure their optimal health.

    OBJECTIVES: 

    To illustrate the meanings within caregivers' experiences of caring for persons with dementia during mealtime situations. We also measured weight and food intake among individuals with dementia to explain better the phenomenon of caring for them during mealtimes.

    METHODS: 

    Mixed method including focus group interviews with seven caregivers analyzed using phenomenological hermeneutics. In addition, for nine persons with dementia, weight and food intake were collected and descriptive statistics were calculated.

    ETHICAL CONSIDERATIONS: 

    Ethical review was obtained from an ethics committee, and all caregivers signed a consent form after being informed on the issue of research ethics. Relatives for persons with dementia were informed and signed the consent. In addition, throughout the study, the persons' expressions were observed aiming to respect their vulnerability, integrity, and dignity.

    FINDINGS: 

    One theme emerged from interviews (struggling between having the knowledge and not the opportunity), which was built upon three subthemes (being engaged and trying; feeling abandoned and insufficient; being concerned and feeling guilty). Seven of nine persons with dementia lost a minimum of 1.3 kg of weight and ate a maximum of 49.7% of the food served.

    CONCLUSION: 

    Caregivers struggle because they have knowledge about how to provide high-quality care but are unable to provide this care due to organizational structures. The weight loss and insufficient eating among the persons with dementia may support this conclusion. Sufficient time for adequate care should be provided.

  • 13.
    Marmstål Hammar, Lena
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Dalarna University, Sweden; Karolinska Insitutet, Sweden.
    Williams, Christine L.
    Florida Atlantic University, USA.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    McKee, Kevin
    Dalarna University, Sweden.
    Being ‘alone’ striving for belonging and adaption in a new reality: The experiences of spouse carers of persons with dementia2021In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 20, no 1, p. 273-290Article in journal (Refereed)
    Abstract [en]

    Background and aim

    Spouse carers of a person with dementia report feeling lonely and trapped in their role, lacking support and having no time to take care of their own health. In Sweden, the support available for family carers is not specialised to meet the needs of spouse carers of people with dementia. The aim of the study described in this paper was to explore spouse carers’ experiences of caring for a partner with dementia, their everyday life as a couple and their support needs.

    Methods

    Nine spouse carers of a partner with dementia living at home were recruited through a memory clinic and a dementia organisation. Semi-structured interviews were conducted with the participants, focusing on their experiences of providing care, their support needs in relation to their caring situation, their personal well-being and their marital relationship. The interviews were transcribed and underwent qualitative content analysis.

    Results

    The analysis resulted in one overall theme Being ‘alone’ striving for belonging and adaption in a new reality, synthesized from four sub-themes: (1) Being in an unknown country; (2) Longing for a place for me and us; (3) Being a carer first and a person second; and (4) Being alone in a relationship.

    Conclusions

    The training of care professionals regarding the unique needs of spouse carers of people with dementia needs improvement, with education, in particular, focusing on their need to be considered as a person separate from being a carer and on the significance of the couple’s relationship for their mutual well-being.

  • 14.
    Martina, Summer Meranius
    et al.
    University of Borås, Sweden.
    Josefsson, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Complexity in Daily Living of Older Adults with Multimorbidity: Health, Social and Informal Care Utilization and Costs2018In: HSOA Journal of Gerontology & Geriatric Medicine, E-ISSN 2381-8662, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to describe health, social and informal care utilization and costs for older adults with multimorbidity. The design was descriptive and retrospective.

    Methods: The setting was a medium-sized town in an urban area of Sweden and included 10 health centers. Data were collected during 2011 using individual, structured interviews with the informal carers of 20 older adults with multimorbidity. Retrospectively, for a period of 18 months, data were also collected from the older adults’ patient registers and records, as data regarding the costs of their health and social care, in- and out-patient care and municipal care including home services.

    Results: The primary result was that older adults with multimorbidity utilize health and social care from different principals, through different contacts. The results also provide insight into the complexity of these older adults’ daily living. Their 18-month health and social care costs varied between 12,084 and 137,187 Euros. For 12 older adults who utilized informal care, their calculated costs varied between 2,092 and 70,590 Euros.

    Conclusion: The conclusion is that the increasing number of older adults with multimorbidity and their health and social care utilization and costs should be taken into account in healthcare policy and the organization of health and social care.

  • 15.
    Narkbubpha, Rapeepan
    et al.
    Phachomklao College of Nursing.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare.
    Experiences of Teenagers withUnplanned Pregnanciesin Phetchaburi Province, Thailand2012In: Philippine journal of nursing, ISSN 0048-3818, Vol. 82, p. 57-63Article in journal (Refereed)
    Abstract [en]

    The purpose of this study is for readers to

    understand the various experiences teenage

    parents endure within the Phetchaburi Province of

    Thailand. Using a qualitative research design, ten (10)

    pregnant teenagers between the ages of 15-19 years old

    were interviewed. A semi-structured, in-depth interview

    was used as the primary means of data collection. In

    addition, data were analyzed using the process of

    manifest content analysis. The four main themes that

    emerged were: (1) circumstances leading to pregnancy

    was due to the failure of contraception and lack of

    knowledge regarding proper sexual education, (2)

    recognition of pregnancy was late because the teenagers

    have neither experienced pregnancy nor did they have

    knowledge of self-monitoring during pregnancy, (3) the

    reactions towards the pregnancies were typically

    negative reactions from girls, boyfriends, and parents (4)

    life changes after the pregnancy were due to the strong

    concerns about dropping out of school and being

    ostracized by the community. The findings implied an

    improvement for healthcare services. For instance,

    teenagers should participate in sexual education classes

    that offer precautionary lessons towards pregnancy.

    Moreover, educational programs (specifically meeting the

    T

    Send correspondence to: Rapeepan Narkbubpha, RN, M.N.S., Phachomklao College of Nursing, Phetchaburi Province 203 Moo 2 Thongchai District,

    Amphoe Muang, Phetchaburi Province, Thailand 76000 Tel+66-8990-86672, Fax+66-3240-0573, E-mail address: rapeepan2549@gmail.com or

    Martina Summer Meranius, RN, PhD. A Senior Lecturer, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna - Västerås,

    Sweden, E-mail address: martina.summer.meranius@mdh.se

    Martina Summer Meranius

    , PhD, RN

    physical and emotional needs of pregnant teenagers)

    should be established so that pregnant teenagers can

    continue their pregnancy without quitting school.

  • 16.
    Pavedahl, Veronica
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Muntlin, Åsa
    Uppsala University, Sweden; Uppsala University Hospital, Uppsala, Sweden.
    Fundamentals of care in the emergency room – An ethnographic observational study2021In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 58, article id 101050Article in journal (Refereed)
    Abstract [en]

    Background: There is a strong biomedical focus within emergency care. However, while failure to meet patients’ fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients. Aim: This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms. Methods: Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics. Results: Observations showed that registered nurses (RN) identified patients’ fundamental care needs and provided nursing care. However, the RNs’ focus on the patient decreased over time. When the RN communicated with the patient, the patients’ physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs’ ability to meet patients’ fundamental care needs. Conclusion: Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient–nurse relationship to meet the patient's physical, psychosocial, and relational needs. 

  • 17.
    Pavedahl, Veronica
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Muntlin, Åsa
    Uppsala Univ Hosp, Dept Emergency Care & Internal Med, Uppsala, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Med Management Ctr, LIME, Stockholm, Sweden.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.
    Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room: An interview study with registered nurses2022In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 78, no 7, p. 2165-2174Article in journal (Refereed)
    Abstract [en]

    Aim To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life-threateningly ill patients' care needs from the perspective of a person-centred fundamental care framework. Design A descriptive, qualitative interview study. Method Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. Results Three themes were identified: Task-oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person-centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. Conclusion From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person-centred care. Impact To date, little is known about registered nurses' work approach and prerequisites in meeting life-threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person-centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person-centred fundamental care and thereby avoid fundamental care being missed.

  • 18.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare.
    "Era delar är min helhet": En studie om att vara äldre och multisjuk2010Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Abstract

    Summer Meranius, Martina (2010). “Era delar är min helhet”. En studie om att vara äldre och multisjuk. (You see parts but I am whole. A study of older persons’ experience of multimorbidity).

     

    The overall aim of this thesis is to describe what it means to be old and live with multimorbidity. An additional aim is to examine and describe the contextual meaning of the phenomenon in ordinary housing and nursing homes, and a third aim is to deepen our understanding of the situation for old people who also are ill. The thesis uses a caring science perspective and a reflective lifeworld approach founded on phenomenological philosophy. This approach searches for and describes the meaning of a phenomenon, its variations and its essential meaning structure. Interviews were used for data collection and data were analyzed for meaning, searching for the essence of the phenomenon. The findings are presented in two empirical studies and one philosophical excursion. The empirical studies have been further thematized with the essential meanings from the empirical studies. The philosophical excursion is the result of a more profound understanding of the thematized meanings.

    The essential meaning of being old and living with multimorbidity in ordinary housing is described as a struggle to maintain identity in a life situation that changes. Multimorbidity and aging pose existential barriers at the same time as the possibility of living an independent life and being oneself is hindered. Ordinary housing is experienced as a place where the old can be themselves, and a place that is associated with independence. On the other hand, multimorbidity threatens the possibility of continuing to live in their private homes, as does the failure of others to meet the old as individuals.

    The essential meaning of being old and living with multimorbidity in nursing homes is described as striving for independence which brings with it a zest for life and a feeling of security. The older’s degree of independence can change due to the fragile health situation, and is characterized by the experience of not being a burden for the busy caregivers and relatives. Independence can change to insecurity, vulnerability and helplessness.

    The themes of essential meaning that have been extracted from the empirical studies suggest that the experiences of frailty and loneliness differ more between those living in ordinary housing and in nursing homes than the experiences of trust and independence differ.

    The philosophical excursion illuminates how older people with multimorbidity experience their lives as an ability to manage their daily lives and not merely an absence of disease symptoms. A person is “just” sick, independently of the objective quantity of diseases s/he may suffer from. Health and wellbeing occur from the ability to live in existential coherence, which is encouraged when the older people are allowed to retain their habits, the ability to be oneself, individual’s life story and by social relationships, as well as by continuity among the caregivers.

     

    Key words: ageing, comorbidity, gerontological nursing, nursing homes, older people,ordinary housing, phenomenology

  • 19.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Health and social care management of older people with multimorbidity. A holistic approach2015Conference paper (Refereed)
  • 20.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    How does the healthcare system affect medication self-management among older adults with multimorbidity?2015Conference paper (Refereed)
  • 21.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare.
    Kvalitativ uppföljning av multisjuka äldre2011Report (Other (popular science, discussion, etc.))
    Abstract [sv]

    Kvalitativa uppföljningar av multisjuka äldre är ett nationellt projekt under ledningen av Sveriges Kommuner och Landsting. Projektet syftar till att identifiera systembrister/hinder, hitta systemlösningar som ger den multisjuka äldre bättre vård- och omsorgskvalité. Syftet är även att öka den samhällsekonomiska nyttan av de resurser som finns samlade i vård- och omsorgssystemet kring den multisjuka äldre, samt utvärdera och vidareutveckla metoden för kontinuerlig användning. I projektet har 20 äldre, 11 män och 9 kvinnor med medianålder på 79 år, följts upp med intervjuer, registerdata, journaldata och läkemedelsdata inom slutenvården, öppna specialistvården, primärvården och kommunala omsorgen. Även 13 anhöriga har intervjuats om vården och omsorgen som har berört de äldre.

    Resultatet visar bland annat följande medianvärden under 18 månader för Västmanland: slutenvårdskonsumtion 19,5 dygn; antal akutmottagningsbesök 4. Antal besök hos läkare inom öppna specialistvården 6,5 hos primärvårdsläkare 5 och hos distriktssköterskan 6. Fyra äldre hade även fått hembesök av primärvårdsläkare och åtta av distriktssköterskan. Hälften av de äldre hade hemtjänst och sex i kommunalregi. Den totala redovisade tiden för hemtjänst hade ett medianvärde på 206 timmar medan motsvarande siffra för den totala tiden som redovisades hos kunden var 125 timmar. Troligen berodde detta på att de äldre sade ifrån sig insatsen eller inte utnyttjade den om de till exempel låg på sjukhus. Tretton anhöriga intervjuades varav fyra förvärvsarbetade och nio var pensionerade vid intervjutillfället. Tre av de fyra arbetande anhöriga hade tagit ledigt från sitt arbete för att hjälpa sin anhörig – en, tre och 12 timmar per månad.

    Av läkemedelsgranskningen framgår att äldre använde i snitt 10 läkemedel och de vanligaste läkemedelsrelaterade problemen var otillräcklig effekt, underbehandling, biverkningar samt för hög dos. Vidare framgår av journalläsningen att epikriser ofta kom sent till familjeläkarmottagningar och att de inte alltid var kompletta. Detta ställde till konkreta problem för flera av personerna i undersökningen. Positivt var att endast 20 % av de multisjuka i undersökningsgruppen stod på lugnande medel och/eller sömnmedel (att jämföra med t.ex. 50 % för motsvarande undersökningsgrupp i relativt närliggande Dalarna) och att ingen stod på långverkande bensodiazepin.

    Kostnader för de 20 individerna varierade under 18 månaders period mellan 122 927 kr till 1 034 827kr. Granskningen av fallbeskrivningarna visar att för lite fokus låg på att förstå och agera på äldres grundläggande behov. Däremot låg för mycket fokus på olika insatser, reaktioner på diagnos och uppstådda skador, för lite på symptom och situation. De 12 fallbeskrivningar som redovisas, visar mer i detalj, vilka problem och behov äldre har och hur dessa följs upp i vården och omsorgen.

  • 22.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    KVALITETSREGISTER INOM ÄLDREOMSORG - 10 framgångsfaktorer för lärande och kvalitetsutveckling2015Report (Other (popular science, discussion, etc.))
    Abstract [sv]

    Sammanfattning

    Projektet Kvalitetsregister för lärande och kvalitetsutveckling genom- fördes i samverkan mellan Västerås stad, Eskilstuna kommun och akademin för Hälsa, vård och välfärd Mälardalens högskola inom ramen för Mälardalens Kompetenscentrum för Hälsa och Välfärd.

    Projektets syfte har varit att ta fram och undersöka en modell för kontinuerligt lärande och verksamhets- och kvalitetsutveckling inom kommunal vård och omsorg. Projektet omfattar kvalitetsregister Senior alert och BPSD-registret. Genom litteraturstudier, intervjuer med framgångsrika verksamheter som har använt dessa register, workshop med en expertgrupp med kunskaper om registren samt pilotförsök har en lärmodell utvecklats och prövats. Lärmodellen består av 10 framgångsfaktorer.

    •   Ledarskap

    •   Teamarbete

    •   Ansvar

    •   Personcentrerad vård/omsorg

    •   Värdegrund

    •   Stödjande strukturer

    •   Reflekterande kommunikation

    •   Målbild

    •   Kunskap om nuläget

    •   Resultat och uppföljning

      Lärdomar av projektet är att organisationer behöver arbeta strategiskt och ta vara på sina egna framgångsrika verksamheter genom att skapa förutsättningar för lärande. Organisationer behöver skapa och behålla sina egna ”stödjande strukturer” för att stödja kvalitets- utveckling inom verksamheterna och på alla nivåer inom organisationen. Genom införandet av kvalitetsregister har kunskaps- behovet om preventivt arbetssätt och förbättringskunskap blivit tydligt. Verksamheter behöver ta vara på den kunskap som erbjuds via olika aktörer som arbetar med kvalitetsutveckling inom äldre- omsorgen, men utbildningsansvaret kan inte i längden, ligga på de enskilda verksamheterna. Aktörer för utbildning, vård och omsorg behöver diskutera hur kunskaper hos undersköterskorna kan in- hämtas. Utbildningsaktörer behöver ta sitt ansvar och organisationer behöver ge stöd till sina verksamheter för att arbeta preventivt utifrån kvalitetsregister.

      Projektets resultat visar tydligt vilka omfattande ansträngningar chefer lägger på att driva arbetet med kvalitetsregister. Det är därför viktigt att organisationer skapar lämpliga styrmedel för att belöna och uppmuntra ett långsiktigt hållbart arbete med att bedriva hög- kvalitativ och patientsäker vård och omsorg inom den kommunala vården och omsorgen. 

  • 23.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare.
    Vad kan hälsa vara för multisjuka äldre?2011In: Ä - En tidning för Riksföreningen för Sjuksköterkan inom Äldrevård, ISSN 2001-1164, Vol. 1, no 1, p. 6-10Article in journal (Other (popular science, discussion, etc.))
  • 24.
    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.

  • 25.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Fagerberg, Ingegerd
    Mälardalen University, School of Health, Care and Social Welfare.
    Dahlberg, Karin
    How can the experience of being old and suffer from comorbidity challenge our understanding of careIn: How can the experience of being old and suffer from comorbidity challenge our understanding of careConference paper (Other academic)
    Download full text (pdf)
    FULLTEXT01
  • 26.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Uppsala, Sweden.
    Håkansson, Jakob
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Breitholtz, Agneta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Moniri, Farah
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Skogevall, Sofia
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare.
    Rasoal, Dara
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Paradoxes of person‐centred care: A discussion paper2020In: Nursing Open, E-ISSN 2054-1058, Vol. 7, no 5, p. 1321-1329Article, review/survey (Refereed)
    Abstract [en]

    AIM: Previous research has mainly focused on the advantages of PCC and less on its disadvantages. Hence, there is a need to further explore the recent research regard-ing PCC from both sides. Therefore, the aim of this paper is to elucidate the advan-tages and disadvantages of PCC.

    DESIGN: Discussion paper.

    METHODS: We searched relevant literature published January 2000–March 2018 in PubMed, Medline, CHINAL, Scopus and Web of Science.

    RESULTS: The results showed that PCC can contribute to improved health and well-being, improved mutual interaction in relationships, improved cost-effectiveness and im-proved work environment, while the disadvantages can involve increased personal and financial costs, exclusion of certain groups, increased personal and financial costs, exclu-sion of staff's personhood and unfairness due to empathy. An analysis of the existing literature on PCC showed paradoxes, which call for further investigation.

  • 27.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Josefsson, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden.
    Health and social care management for older adults with multimorbidity: a multiperspective approach.2017In: Scandinavian Journal of caring Sciences, ISSN 0283-9318, Vol. 31, no 1, p. 96-103Article in journal (Refereed)
    Abstract [en]

    Multimorbidity, a condition common among older adults, may be regarded as a failure of a complex system. The aim of this study was to describe the core components in health and social care management for older adults with multimorbidity. A cross-sectional design included two methods: individual interviews and group discussions. A total of 105 participants included older adults with multimorbidity and their relatives, care staff and healthcare policymakers. Data were analysed using content analysis. The results show that seven core components comprise a multiperspective view of health and social care management for older adults with multimorbidity: political steering, leadership, cooperation, competence, support for relatives, availability and continuity. Steps should be taken to ensure that every older adult with multimorbidity has a treatment plan according to a multiperspective view to prevent fragmentation of their health care. This study provides relevant evidence developing a multiperspective model of health and social care management for older adults with multimorbidity.

  • 28.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Josefsson, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Health and social care management of older people with multimorbidity: A holistic approach2015In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, no Suppl 2, p. 670-670Article in journal (Refereed)
  • 29.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Josefsson, Karin
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. (Äldreforskning).
    Management Practices Promoting Sustained Implementation of the Quality Register Senior Alert for Older Adults in Municipal Care in Sweden2018In: The Open Nursing Journal, ISSN 1874-4346, Vol. 12, p. 215-224Article in journal (Refereed)
    Abstract [en]

    Background:

    Senior Alert is a national quality register aimed at supporting a standardized, structured, and systematic preventive care process foradults aged 65 and over in the areas malnutrition, pressure ulcers, falls, problems with oral health and bladder dysfunction. Therefore, the quality register is particularly suitable for older adults with multimorbidity.

    Aim:

    The aim was to describe management practices that contributed to the sustained implementation of the quality register Senior Alert in municipal elderly care in Sweden.

    Methods:

    The design of this pilot study was descriptive and inductive. The sample of n = 12 included managers (n = 7) and care staff (n = 5) at seven municipal care homes for older adults in Sweden. The study was performed between April 2014 and June 2014 using two methods: Individual interviews and nonparticipant unstructured observations. Data were analyzed using qualitative content analysis.

    Results:

    The analysis led to the following generic categories: leading teamwork, leading a preventive care process and leading a supportive organizational structure, and to one main category: management promoting learning and quality improvement.

    Conclusion:

    To be sustainable, Senior Alert implementations in municipal elderly care need management. Management, by leading teamwork, a preventive care process and a supportive organizational structure, is essential for achieving learning and quality improvement.

  • 30.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    How does the healthcare system affect medication self-management among older adults with multimorbidity?2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 1, p. 91-98Article in journal (Refereed)
    Abstract [en]

    Individuals with multimorbidity commonly have several concurrent prescriptions and experience healthcare obstacles related to managing different diagnoses and medications. This study aimed to provide a deeper understanding of how older adults with multimorbidity experience medication self-management and how this is affected by the healthcare system. The National Board of Research Ethics approved the study, and 20 older adults with multimorbidity participated in in-depth interviews that were analysed using a hermeneutic approach. Three levels of interpretation emerged. At the first level, lack of participation in healthcare communication hinders adherence and safety, and feeling abandoned to self-care leads to health risk-taking. At the second level, the healthcare organisation is seen as an obstacle to medication self-management. The overall interpretation was a system of repairing ‘parts’ but not enabling the experience of health. This study shows that the healthcare system is able to treat and relieve an individual's symptoms, but seems unable to help them achieve and promote good health, or to provide the support they need to function in everyday life.

  • 31.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    HOW DOES THE HEALTH-CARE SYSTEM AFFECT MEDICATION SELF-MANAGEMENT AMONG OLDER ADULTS WITH MULTIMORBIDITY?2015In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, p. 254-254Article in journal (Refereed)
  • 32.
    Åberg [Engström], Annica
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Högskolan Dalarna.
    That mr. Alzheimer… you never know what he’s up to, but what about me? A discourse analysis of how Swedish spouse caregivers can make their subject positions understandable and meaningful2018In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, p. 1748-2631, article id ZQHW 1554025Article in journal (Refereed)
    Abstract [en]

    The spouses of people suffering from dementia are commonly first-in-line caregivers. This canhave a considerable effect on their own lives, health and marriages. Several studies havefocused on spouses’experiences, but very few have focused in any depth on their descrip-tions of themselves as subjects. Therefore, the aim of this study is to describe how spousecaregivers can express themselves when living with and caring for their partners withdementia. The study has a qualitative approach with a discourse analysis design and usesanalytical tools such as rhetoric, subject positions and categorization. The results reveal threesubject positions: as an actor, as a parent and as a survivor. The results show that as spousesstruggle with external and internal clashes as subjects, they therefore need to develop copingstrategies. They also experience pronounced loneliness and a risk to their own health. There isthus a need to support these spouses as individuals in their differing and changing needs.

    Download full text (pdf)
    That mr. Alzheimer ... you never know what he ’s up to, but what about me? A discourse analysis of how Swedish spouse caregivers can make their subject positions understandable and meaningful
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