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  • 1.
    Dorell, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Östlund, Ulrika
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurses' perspective of conducting family conversation2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 30867Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Nurses are in a prime position to manage to support families that have a family member living in a residential home for older people. Nurses' attitudes about meeting patients' family members vary. Studies describe that some nurses consider family members as a burden. But some nurses consider family members a resource and think it is important to establish good relationships with them.

    AIM: The aim of this study was to describe how registered nurses (RNs) experienced to participate in and conduct the intervention Family Health Conversations (FamHCs) with families in residential homes for older people.

    METHODS: The intervention FamHC was accomplished at three residential homes for older people. FamHC is a family systems nursing (FSN) intervention developed to support families facing the ill health of someone in the family. One RN from each residential home conducted the conversations. The RNs wrote diary notes directly after each conversation. The RNs were also interviewed 1 month after they had each conducted four FamHCs. The diary notes and the interviews were analysed separately by qualitative content analysis, and the findings were then summarized in one theme and further discussed together.

    FINDINGS: The main findings were that the RNs experience the conversations as a valuable professional tool involving the whole family. The RNs grasped that silence can be a valuable tool and had learned to attentively listen to what the families were saying without interrupting, allowing them and the families to reflect upon what the family members said.

    CONCLUSION: The findings show that the FamHC can be helpful for RNs in their work, helping them to perceive and understand the needs and desires of the families.

  • 2.
    Enarsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hellzen, Ove
    “Being good or evil”: applying a common staff approach when caring for patients with psychiatric disease2008In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 3, no 4, p. 219-229Article in journal (Refereed)
    Abstract [en]

    This study was performed to gain a deeper understanding of how psychiatric staff, when caring for patients with psychiatric disease, experience situations that include a common staff approach directed toward an individual client. Nine nurses were interviewed. The interviews were analyzed with a phenomenological-hermeneutic method in order to illuminate the lived experience of applying a common staff approach. The results revealed several meanings: shedding light on carers' mutual relationships; being deserted by nurse colleagues; being aware of one's own basis of evaluation, and that of others; being judged by the patient as good or evil; and becoming sensitive to the patient's suffering. The comprehensive understanding was that the nurse has a difficult choice—to focus on relations with one's colleagues or to focus on the situation of the patient, who seems to suffer when a common staff approach is used.

  • 3.
    Enarsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hellzén, Ove
    "They can do whatever they want": meanings of receiving psychiatric care based on a common staff approach2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 1, p. 5296-Article in journal (Refereed)
    Abstract [en]

    This study deepens our understanding of how patients, when cared for in a psychiatric ward, experience situations that involve being handled according to a common staff approach. Interviews with nine former psychiatric in-patients were analyzed using a phenomenological-hermeneutic method to illuminate the lived experience of receiving care based on a common staff approach. The results revealed several meanings: discovering that you are as subjected to a common staff approach, becoming aware that no one cares, becoming aware that your freedom is restricted, being afflicted, becoming aware that a common staff approach is not applied by all staff, and feeling safe because someone else is responsible. The comprehensive understanding was that the patient's understanding of being cared for according to a common staff approach was to be seen and treated in accordance with others' beliefs and valuations, not in line with the patients' own self-image, while experiencing feelings of affliction.

  • 4.
    Forsberg, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Survivors' experiences from a train crash2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 4, p. 8401-Article in journal (Refereed)
    Abstract [en]

    Rarely described are people's lived experiences from severe injury events such as train crashes. The number of train crashes named disasters with ≥10 killed and/or ≥100 nonfatally injured grows globally and the trend shows that more people survive these disasters today than did so in the past. This results in an increased number of survivors needing care. The aim of the study was to explore survivors' experiences from a train crash. Narrative interviews were performed with 14 passengers 4 years after a train crash event. Qualitative content analysis was used to analyse the interviews. Experiences were captured in three main themes: (1) Living in the mode of existential threat describes how the survivors first lost control, then were thrown into a state of unimaginable chaos as they faced death. (2) Dealing with the unthinkable described how survivors restored control, the central role of others, and the importance of reconstructing the event to move forward in their processing. (3) Having cheated death shows how some became shackled by their history, whereas others overcame the haunting of unforgettable memories. Furthermore, the result shows how all experienced a second chance in life. Experiencing a train crash meant that the passengers experienced severe vulnerability and a threat to life and interdependence turned out to play a crucial role. Focusing on helping other passengers on site was one way to regain the loss of control and kept the chaos at bay. Family, friends, and fellow passengers turned out to be extremely important during the recovery process why such closeness should be promoted and facilitated.

  • 5. Grim, Katarina
    et al.
    Rosenberg, David
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Svedberg, Petra
    Schön, Ulla-Karin
    Shared decision-making in mental health care: a user perspective on decisional needs in community-based services2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 30563Article in journal (Refereed)
    Abstract [en]

    Background: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice.

    Objective: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden.

    Methods: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.’s model of SDM.

    Results: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process.

    Conclusions and Implications for Practice: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system. 

  • 6. Hajradinovic, Yvonne
    et al.
    Tishelman, Carol
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Goliath, Ida
    Family members' experiences of the end-of-life care environments in acute care settings: A photo-elicitation study2018In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, article id 1511767Article in journal (Refereed)
    Abstract [en]

    Purpose: This article explores experiences of the acute-care environment as a setting for end-of-life (EoL) care from the perspective of family members of a dying person.

    Method: We used participant-produced photographs in conjunction with follow-up interviews with nine family members to persons at the EoL, cared for in two acute-care settings.

    Results: The interpretive description analysis process resulted in three constructed themes-Aesthetic and unaesthetic impressions, Space for privacy and social relationships, and Need for guidance in crucial times. Aspects of importance in the physical setting related to aesthetics, particularly in regard to sensory experience, and to a need for enough privacy to facilitate the maintenance of social relationships. Interactions between the world of family members and that of professionals were described as intrinsically related to guidance about both the material and immaterial environment at crucial times.

    Conclusion: The care environment, already recognized to have an impact in relation to patients, is concluded to also affect the participating family members in this study in a variety of ways.

  • 7.
    Isaksson, Joakim
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindqvist, Rafael
    Göteborgs universitet, Institutionen för Socialt arbete .
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Struggling for recognition and inclusion: parents' and pupils' experiences of special support measures in school2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 1Article in journal (Refereed)
    Abstract [en]

    During the last decade an increasing use of differentiated support measures for pupils with special educational needs, indicative of a discrepancy between educational policies and practices, has been witnessed in Sweden.  Another trend has been the increased use of medical diagnoses in school. The aim of this study was to explore the main concern of support given to pupils with special educational needs and how pupils and parents experience and handle this. Interviews were conducted with 8 pupils in grades 7-9 – and their parents – at two compulsory schools in a city in northern Sweden. A grounded theory approach was used for analysing the interview data. A conceptual model was generated illuminating the main concern of special support measures for pupils and parents. The core category of the model, struggling for recognition and inclusion, was related to two categories which further described how this process was experienced and handled by the participants. These categories were labelled negotiating expertise knowledge within a fragmented support structure and coping with stigma, ambivalence and special support measures. The developed conceptual model provides a deeper understanding of an ongoing process of struggle for recognition and inclusion in school as described by the pupils and parents.

  • 8. Kneck, Åsa
    et al.
    Fagerberg, Ingegerd
    Eriksson, Lars E.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Living with diabetes: development of learning patterns over a 3-year period2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, p. 24375-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Learning involves acquiring new knowledge and skills, and changing our ways of thinking, acting, and feeling. Learning in relation to living with diabetes is a lifelong process where there is limited knowledge of how it is experienced and established over time. It was considered important to explore how learning was developed over time for persons living with diabetes. AIM: The aim of the study was to identify patterns in learning when living with diabetes, from recently being diagnosed, and over a 3-year period. MATERIALS AND METHODS: A longitudinal qualitative descriptive design was used. Thirteen participants, with both type I and type II diabetes, were interviewed at three different occasions during a 3-year period. Qualitative content analysis was used in different steps in order to distinguish patterns. FINDINGS: Five main patterns of learning were identified. Two of the patterns (I and II) were characterized by gradually becoming comfortable living with diabetes, whereas for one pattern (IV) living with diabetes became gradually more difficult. For pattern V living with diabetes was making only a limited impact on life, whereas for Pattern III there was a constant management of obstacles related to illness. The different patterns in the present study showed common and different ways of learning and using different learning strategies at different timespans. CONCLUSION: The present study showed that duration of illness is not of importance for how far a person has come in his own learning process. A person-centered care is needed to meet the different and changing needs of persons living with diabetes in relation to learning to live with a lifelong illness.

  • 9.
    Lindgren, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Öster, Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    'They don't understand…you cut yourself in order to live.': Interpretative repertoires jointly constructing interactions between adult women who self-harm and professional caregivers2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 3, p. 7254-Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to illuminate interpretative repertoires that jointly construct the interaction between adult women who self-harm and professional caregivers in psychiatric inpatient care. Participant observations and informal interviews were conducted among six women who self-harm and their professional caregivers in two psychiatric inpatient wards, and analysed using the concept of interpretative repertoires from the discipline of discursive psychology. The analysis revealed four interpretative repertoires that jointly constructed the interaction. The professional caregivers used a "fostering repertoire" and a "supportive repertoire" and the women who self-harmed used a "victim repertoire" and an "expert repertoire." The women and the caregivers were positioned and positioned themselves and people around them within and among these interpretative repertoires to make sense of their experiences of the interaction. It was necessary to consider each woman's own life chances and knowledge about herself and her needs. The participants made it clear that it was essential for them to be met with respect as individuals. Professional caregivers need to work in partnership with individuals who self-harm-experts by profession collaborating with experts by experience. Caregivers need to look beyond behavioural symptoms and recognise each individual's possibilities for agency.

  • 10. Logdberg, Ulrika
    et al.
    Nilsson, Bo
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Kostenius, Catrine
    "Thinking about the future, what's gonna happen?": How young people in Sweden who neither work nor study perceive life experiences in relation to health and well-being2018In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, article id 1422662Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to explore how young people in Sweden who neither work nor study perceive life experiences in relation to health and well-being.

    Methods: A task-based interview technique was used and data was analysed with qualitative content analysis. Interviews were conducted with 16 participants aged 16-20 who were unemployed and not eligible for upper secondary school, or who had dropped out of school.

    Results: Three themes emerged from the analysis illustrating how the young people perceive their life experiences in relation to health and well-being: Struggling with hardships in the absence of caring connections, Feeling good when closely connected to others, and Being forced to question what has been taken for granted. Each theme consists of 2-3 subthemes.

    Conclusion: Based on the young people's narrated experiences health can be understood as: something that is created in relation to others and in relation to the social and cultural context; as something dynamic and changeable; as the ability to adapt and respond to challenges; and finally as something existing on a collective as well as an individual level. Implications for school, social services and health promotion initiatives are discussed, with an emphasis on working with young people.

  • 11.
    Molin, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Quality of interactions influences everyday life in psychiatric inpatient care: patients' perspectives2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, no 1, article id 29897Article in journal (Refereed)
    Abstract [en]

    Everyday life consists of daily activities that are taken for granted. It forms the foundation for human efforts and contains elements of both comfort and boredom. Because everyday life escapes no one, life in a psychiatric ward will become ordinary while staying there. This study aims to explore everyday life in psychiatric inpatient care based on patients' experiences. We individually interviewed 16 participants with experiences of psychiatric inpatient care and analysed the data in accordance with the methods of grounded theory. Data collection and analysis continued in parallel in accordance with the method. Our results showed that everyday life is linked to the core category quality of interactions influences everyday life, and three constructed categories — staff makes the difference, looking for shelter in a stigmatizing environment, and facing a confusing care content — were related to the core category. Our results highlight the importance of ordinary relationships between staff and patients in psychiatric inpatient care. These results can be used to develop nursing interventions to improve psychiatric inpatient care and might also be used as a basis for reflective dialogues among staff.

  • 12.
    Mårell, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindgren, Monica
    Ternulf Nyhlin, Kerstin
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Berglund, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    "Struggle to obtain redress": women's experiences of living with symptoms attributed to dental restorative materials and/or electromagnetic fields2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, no 1, article id 32820Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the experiences of illness and the encounters with health care professionals among women who attributed their symptoms and illness to either dental restorative materials and/or electromagnetic fields, despite the fact that research on health effects from dental fillings or electricity has failed to substantiate the reported symptoms. Thirteen women (aged 37-63 years) were invited to the study and a qualitative approach was chosen as the study design, and data were collected using semi-structured interviews. The analysis was conducted with a constant comparative method, according to Grounded Theory. The analysis of the results can be described with the core category, "Struggle to obtain redress," the two categories, "Stricken with illness" and "A blot in the protocol," and five subcategories. The core category represents the women's fight for approval and arose in the conflict between their experience of developing a severe illness and the doctors' or dentists' rejection of the symptoms as a disease, which made the women feel like malingerers. The informants experienced better support and confirmation from alternative medicine practitioners. However, sick-leave certificates from alternative medicine practitioners were not approved and this led to a continuous cycle of visits in the health care system. To avoid conflicting encounters, it is important for caregivers to listen to the patient's explanatory models and experience of illness, even if a medical answer cannot be given.

  • 13. Possmark, Sofie
    et al.
    Berglind, Daniel
    Sellberg, Fanny
    Ghaderi, Ata
    Persson, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    To be or not to be active – a matter of attitudes and social support?: Women’s perceptions of physical activity five years after Roux-en-Y Gastric Bypass surgery2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1612704Article in journal (Refereed)
    Abstract [en]

    Purpose: Despite positive health advantages of post-surgery physical activity (PA) for bariatric surgery patients, the majority is not sufficiently physically active. The aim was to explore women’s perceptions and experiences concerning PA five years after Roux-en-Y Gastric Bypass (RYGB) surgery.

    Methods: Eleven women were interviewed five years post-surgery. Grounded Theory approach was applied.

    Results: The core-category “Attitudes and surrounding environment influence activity levels” includes three attitudes towards PA: “Positive attitudes”, “Shifting attitudes” and “Negative attitudes”. Participants with a positive attitude were regularly physically active, felt supported and proud of their achievements. Contrary, participants with a negative attitude didn’t prioritize PA, didn’t feel supported and saw no need or benefit of PA. Some participants revealed an on-off behaviour, hovering between the attitudes of vigorous PA and sedentary lifestyle, without sustainable balance. The majority mostly viewed PA as a mean to lose weight.

    Conclusion: The level of perceived post-surgery PA was related to the participants’ attitudes towards PA and whether or not they had a supportive environment. These findings might explain why bariatric surgery patients often fail to be sufficiently active post-surgery, and highlight the need for prolonged support and motivational interventions to promote sustainable PA post-bariatric surgery.

  • 14. Schön, Ulla-Karin
    et al.
    Grim, Katarina
    Wallin, Lars
    Rosenberg, David
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Svedberg, Petra
    Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study2018In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, article id 1421352Article in journal (Refereed)
    Abstract [en]

    Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden.

    Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact.

    Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations.

    Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

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