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Strandberg, Gunilla
Publications (10 of 55) Show all publications
Ericson-Lidman, E. & Strandberg, G. (2019). Care providers’ troubled conscience related to an implementation of a time management system in residential care for older people: a participatory action research study. Scandinavian Journal of Caring Sciences
Open this publication in new window or tab >>Care providers’ troubled conscience related to an implementation of a time management system in residential care for older people: a participatory action research study
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Care providers in residential care for older people often refer to time shortage, a problem that may generate troubled conscience.

Aim: The aim of the study was to describe a PAR process to assist care providers in municipal residential care for older people to constructively deal with their troubled conscience related to an implemented time management system.

Method: This intervention study was carried out with 14 care providers and their manager in residential care for older people with the support of participatory action research (PAR). The recorded PAR sessions were transcribed and compiled with inspiration from content analysis.

Ethical considerations: The participants were given oral and written information and gave their written informed consent.

Findings: The PAR process was found to empower the participants to form their own structure of the practical professional planning, adapted to the residents needs and to their daily work. In this process, participants used their troubled conscience as a driving force and as an asset.

Conclusion: Instead of launching change without any deeper information, it is important to carefully prepare, involve and inform those who are going to execute the change. Meeting places should be arranged wherein care providers have the opportunity to share and reflect on challenging situations that can generate troubled conscience, especially when comprehensive changes in their work are going to be implemented.

Keywords
action research, qualitative approaches, care for older people.
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-164681 (URN)10.1111/scs.12779 (DOI)
Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2019-11-04
Ericson-Lidman, E. & Strandberg, G. (2018). Using a developed participatory action research process in practice to help care providers deal with troubled conscience in residential care of older people. Action Research, 16(2), 190-206
Open this publication in new window or tab >>Using a developed participatory action research process in practice to help care providers deal with troubled conscience in residential care of older people
2018 (English)In: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 16, no 2, p. 190-206Article in journal (Refereed) Published
Abstract [en]

Stress of conscience seriously influence the quality of care and the wellbeing of the care providers in care for older people. It is therefore of great importance to take measures to address, and relieve but preferably prevent stress related to troubled conscience. In our participatory action research studies, we have used troubled conscience as a driving force to relieve care providers’ burden and to increase quality of care. The aim with this paper is to present our experiences of using a further developed participatory action research process in practice to deal with care providers’ troubled conscience in residential care for older people. The contribution to participatory action research practice in our studies is a support to the participatory action research process through using a modified model of problem processing, an approach which we found fruitful. In the paper, we describe our experiences and discuss them in relation to relevant literature and theory. Our experiences are that in participatory action research it is crucial to build a trusting relationship and striving to create a fruitful dialogue between the researchers and the participants. In our studies, we found that participatory action research is an easy approach to adapt as a problem-solving process in clinical practice and in nursing research.

Place, publisher, year, edition, pages
London: Sage Publications, 2018
Keywords
Troubled conscience, participatory action research, care for older people
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-129337 (URN)10.1177/1476750316678916 (DOI)000435909700005 ()2-s2.0-85048890995 (Scopus ID)
Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2018-09-21Bibliographically approved
Åhlin, J., Strandberg, G., Norberg, A., Ternestedt, B.-M. & Ericson-Lidman, E. (2017). Care providers’ narrated experiences of working in private non-profit residential care for older people during downsizing and reorganisation, focusing on troubled conscience. Nordic journal of nursing research, 37(4), 177-185
Open this publication in new window or tab >>Care providers’ narrated experiences of working in private non-profit residential care for older people during downsizing and reorganisation, focusing on troubled conscience
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2017 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 4, p. 177-185Article in journal (Refereed) Published
Abstract [en]

Knowledge about care providers’ experiences of working in residential care of older people during times of downsizing and reorganisation is scarce, and it is not known whether/how their conscience is influenced by such changes. The aim was to describe care providers’ experiences of working in private residential care for older people during downsizing and reorganisation, focusing on troubled conscience. This study adopted a qualitative descriptive design based on interviews with seven care providers. A qualitative content analysis was used. The overall understanding was revealed as perceiving oneself as pinioned in between current circumstances to provide care and what one’s conscience conveyed. Care providers perceived: deteriorating working conditions as exhausting, downsizing and reorganisation as triggering one’s conscience when collaborating, troubled conscience when downsizing and reorganisation decrease the quality of care, and good management as crucial during downsizing and reorganisation. The results highlight that adequate communication strategies, well-functioning leadership and opportunities to know together and share what one’s conscience tells are aspects that need consideration.

Keywords
care providers, conscience, content analysis, downsizing, reorganisation, residential care of older people
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-129450 (URN)10.1177/2057158516678160 (DOI)
Available from: 2016-12-29 Created: 2016-12-29 Last updated: 2018-11-16Bibliographically approved
Viglund, K., Jonsén, E., Lundman, B., Nygren, B. & Strandberg, G. (2017). Sources and expressions of inner strength among old people who have experienced a crisis in life associated with a disease. Nordic journal of nursing research, 37(1), 20-26
Open this publication in new window or tab >>Sources and expressions of inner strength among old people who have experienced a crisis in life associated with a disease
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2017 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 1, p. 20-26Article in journal (Refereed) Published
Abstract [en]

Inner strength is reported as an important resource associated with aging, health, and disease management. The aim was toexplore inner strength in people (n ¼ 12) aged 65 years and older, who had experienced a crisis in life associated with a disease. The participants had self-rated their inner strength as high. We found that sources of inner strength were mutual love and support, and the fact that tough times have been managed before. Expressions of inner strength comprised focusing on possibilities instead of brooding, facing and take an active part in care and treatment, and being able to confront reality and pick yourself up again. Inner strength is a complex phenomenon. Increased knowledge of inner strength can serve as an aid inefforts to identify the need to promote inner strength.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
disease management, experiences, inner strength, old people, qualitative content analysis
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-124961 (URN)10.1177/2057158516659839 (DOI)
Available from: 2016-08-31 Created: 2016-08-31 Last updated: 2018-06-07Bibliographically approved
Åhlin, J., Ericson-Lidman, E., Norberg, A. & Strandberg, G. (2015). A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people. Scandinavian Journal of Caring Sciences, 29(2), 277-287
Open this publication in new window or tab >>A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 277-287Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this cross-sectional, descriptive study was to compare assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel (HCP) working in two different organisations for care of older people.

METHODS: This cross-sectional, descriptive comparative study was performed among Registered Nurses and nurse assistants working in two different organisations (n(1)  = 98, n(2)  = 488) for residential care of older people. The organisations were chosen to be as different as possible, and data were collected using four different questionnaires. Hierarchical cluster analysis with multiscale bootstrap resampling was used to compare the associations between all items in the questionnaires. Descriptive statistics, 95% confidence intervals, chi-squared tests, Cohen's d, Cramer's V and the φ coefficient were all used to judge differences between the organisations.

RESULTS: The associations between stress of conscience, perceiving one's conscience as a burden, and burnout were similar in both organisations. Perceiving one's conscience as far too strict and having a troubled conscience from being unable to live up to one's standards were associated with stress of conscience and burnout in one organisation. Women had higher levels of stress of conscience and reported lower social support from co-workers compared with men.

CONCLUSIONS: This study shows that associations between perceptions of conscience, stress of conscience and burnout are common experiences that are similar among HCP despite great differences in the characteristics of organisations. It can be burdensome for HCP to be unable to realise their ambitions to provide good care, and sex/gender can be an important factor to consider in the development of measures against the negative effects of stress of conscience. More studies are needed about how HCP's ambition to provide good care and sex/gender are related to perceptions of conscience, stress of conscience and burnout.

Keywords
burnout, perceptions of conscience, residential care of older people, social support, stress of conscience
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-98475 (URN)10.1111/scs.12161 (DOI)000354260700009 ()25154457 (PubMedID)
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2018-06-07Bibliographically approved
Ericson-Lidman, E. & Strandberg, G. (2015). Learning to deal constructively with troubled conscience related to care providers' perceptions of deficient teamwork in residential care of older people: a participatory action research study. Scandinavian Journal of Caring Sciences, 29(2), 215-224
Open this publication in new window or tab >>Learning to deal constructively with troubled conscience related to care providers' perceptions of deficient teamwork in residential care of older people: a participatory action research study
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 215-224Article in journal (Refereed) Published
Abstract [en]

Conscience can be perceived as an asset that helps care providers to provide good care, but it can also be a burden that generates stress of conscience (stress related to a troubled conscience). Participatory action research (PAR) has been shown to be successful in supporting care providers in residential care of older people to learn to deal with their troubled conscience in challenging and demanding care situations. The aim of the study was to describe an intervention process to assist care providers in residential care of older people to constructively deal with their troubled conscience related to perceptions of deficient teamwork. The study design was grounded in PAR. Nine enrolled nurses (ENs), two nursing aids (NAs), one Registered Nurse (RN) and their manager participated in 12 PAR sessions. All sessions were tape-recorded, and a domain analysis of the transcriptions was performed. Findings show that a PAR-based intervention can support care providers to understand, handle and take measures against deficient teamwork. Using troubled conscience as a driving force can increase the opportunities to improve quality of care in residential care for older people. During the PAR process, participants raised their awareness of the need to view the team in a wider sense and that the manager and the Registered Nurse should also be members of the team to improve team outcome. To improve clinical practice, we suggest that teams in residential care of older people should be enabled to share and reflect on challenging situations that generate troubled conscience. However, as shown in this study, care providers might need support in order to facilitate and promote sharing and reflecting on what their conscience tells them.

Keywords
Participatory action research, residential care for older people, troubled conscience
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-90646 (URN)10.1111/scs.12152 (DOI)000354260700003 ()24867477 (PubMedID)
Available from: 2014-06-26 Created: 2014-06-26 Last updated: 2018-06-07Bibliographically approved
Ericson-Lidman, E. & Strandberg, G. (2015). Learning to Deal Constructively With Troubled Conscience Related to Care Providers' Perceptions of Not Providing Sufficient Activities for Residents. Clinical Nursing Research, 24(2), 221-227
Open this publication in new window or tab >>Learning to Deal Constructively With Troubled Conscience Related to Care Providers' Perceptions of Not Providing Sufficient Activities for Residents
2015 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 2, p. 221-227Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to illuminate an intervention process to assist care providers in municipal care of older people to constructively deal with their troubled conscience generated from their perceived shortcomings about not providing sufficient activities for residents. The study design was grounded in participatory action research. Twelve care providers and their manager participated in intervention sessions. Content analysis was used to analyze the transcriptions. By sharing their experiences with each other, care providers became aware of, and confirmed in one another, what types of activities were meaningful for residents and actions were taken to provide such activities. The importance of being attentive and relying on residents' responses, that is, providing person-centered activities, was found to be satisfying to residents and eased the care providers' troubled conscience. An enlightened conscience can be an important asset, which may prevent ill-health and improve quality of care.

Keywords
conscience, troubled conscience, activities, municipal care of older people, participatory action research
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-84823 (URN)10.1177/1054773813500139 (DOI)000351053300007 ()24021209 (PubMedID)
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2018-06-08Bibliographically approved
Ericson-Lidman, E., Renström, A.-S., Åhlin, J. & Strandberg, G. (2015). Relatives' perceptions of residents' life in a municipal care facility for older people with a focus on quality of life and care environment. International Journal of Older People Nursing, 10(3), 160-169
Open this publication in new window or tab >>Relatives' perceptions of residents' life in a municipal care facility for older people with a focus on quality of life and care environment
2015 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, p. 160-169Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Relatives' perceptions of their older loved one's living conditions at residential care facilities are poorly described in interviews. Older persons often find it difficult to make their voices heard and an alternative is to ask a relative who knows the person well to express their views.

AIM: This study aimed to describe relatives' perceptions of residents' life in a municipal care facility for older people with a focus on quality of life and care environment.

DESIGN: A qualitative study design was used. Data were collected through nine interviews with six relatives of older people living in a residential care facility.

METHODS: The interviews were recorded, transcribed and analysed using content analysis.

RESULTS: The analysis resulted in three main themes and eight subthemes. The main themes were: Residents' life/quality of life is perceived to be in the hands of the care providers, Residents' disabilities and lack of stimulation are perceived to threaten their quality of life, and The secure climate in the residence is perceived to be coloured by Death's waiting room.

CONCLUSIONS: The study emphasizes the importance of cocreating a constructive dependency and to take on the challenge of creating a feeling of at-homeness for each resident. It is important to be aware that what relatives perceive as monotony and passivity may be a problem for some residents, but not for all.

IMPLICATIONS FOR PRACTICE: This study highlights the need to create a powerful partnership between relatives, care providers and residents to enhance the quality of life for residents. Every single meeting is important and makes a difference for the resident. Care providers might need to support relatives to understand that the last phase of life might be about focusing inwardly and reflecting on one's whole life as a way to end it.

Keywords
care environment, municipal residential care, older people, quality of life, relatives
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-99494 (URN)10.1111/opn.12063 (DOI)000359834100002 ()25470425 (PubMedID)
Available from: 2015-02-12 Created: 2015-02-09 Last updated: 2018-06-07Bibliographically approved
Ericson-Lidman, E. & Strandberg, G. (2015). Troubled conscience related to deficiencies in providing individualised meal schedule in residential care for older people: a participatory action research study. Scandinavian Journal of Caring Sciences, 29(4), 688-696
Open this publication in new window or tab >>Troubled conscience related to deficiencies in providing individualised meal schedule in residential care for older people: a participatory action research study
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 688-696Article in journal (Refereed) Published
Abstract [en]

Food and mealtimes should be adapted to the older person's individual needs and desires, a fact that is often ignored in favour of a functional mealtime organisation. This study was grounded in participatory action research (PAR), and the aim of the study was to illuminate a PAR process to assist care providers in constructively dealing with their troubled conscience generated from perceived shortcomings in providing an individualised meal schedule in residential care for older people. Care providers and their manager participated in twelve PAR sessions. The participants' troubled conscience was eased by reflecting on and sharing their thoughts about their perception of a lack of individualised meal schedule and a lack of opportunities for meaningful interventions. The researchers in PAR became the bridge between the care providers and the management that was needed to improve individualised mealtime schedule. This study pinpoints how difficult it can be to make small changes in a rigid organisation that is run by a management that does not have the hands-on knowledge about the daily care provided by the organisation. This study points to the need of creating communication arenas wherein all personnel involved in care for older people, at all organisational levels, together meet to create a good care for older people. However, the care providers have been provided with tools, uncomplicated to use, to continue to let their voices being heard.

Keywords
mealtime schedule, participatory action research, residential care for older people, troubled conscience
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-99493 (URN)10.1111/scs.12197 (DOI)000368345900009 ()25622910 (PubMedID)
Available from: 2015-02-12 Created: 2015-02-09 Last updated: 2018-06-07Bibliographically approved
Åhlin, J., Ericson-Lidman, E., Norberg, A. & Strandberg, G. (2014). Care providers' experiences of guidelines in daily work at a municipal residential care facility for older people. Scandinavian Journal of Caring Sciences, 28(2), 355-363
Open this publication in new window or tab >>Care providers' experiences of guidelines in daily work at a municipal residential care facility for older people
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 355-363Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Guidelines are used as a way of promoting high-quality health care. Most research concerning guidelines has focused on physician behaviour and to improve one specific aspect of care. Care providers working within municipal residential care of older people have described that working with multiple guidelines sometimes exposed them to contradictory demands and trouble their conscience.

AIM: To describe care providers' narrated experiences of guidelines in daily work at a municipal residential care facility for older people.

DESIGN: A qualitative descriptive design was adopted.

METHODS: Interviews with eight care providers were carried out between February and March 2012 and analysed by qualitative content analysis.

RESULTS: Care providers described experiences that guidelines are coming from above and are controlling and not sufficiently anchored at their workplace. Furthermore, they described guidelines as stealing time from residents, colliding with each other, lacking practical use and complicating care, and challenging care providers' judgment. The overall understanding is that care providers describe experiences of struggling to do their best, prioritising between arcane guidelines while keeping the residents' needs in the foreground.

CONCLUSION: In order to prevent fragmented use, guidelines have to be coordinated and adapted to the reality of daily practice before implementation. It seems essential to provide opportunities for discussions between care providers, registered nurses and management about how to make guidelines work within their daily practice. Sufficient support, knowledge and involvement are likely key issues that can help care providers to constructively work according to guidelines and thus, by extension, improve the quality of care.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keywords
Guidelines, municipal residential care, older people, care providers, content analysis
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-81055 (URN)10.1111/scs.12065 (DOI)000334503400017 ()23865824 (PubMedID)
Available from: 2013-10-01 Created: 2013-10-01 Last updated: 2018-06-08Bibliographically approved
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