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  • 1.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ängquist, Karl-Axel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Barnekow-Bergkvist, Margareta
    Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel.2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 3, p. 251-258Article in journal (Refereed)
  • 2.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
    Fürst, Carl-Johan
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    End-of-life care in residential care homes: a retrospective study of the perspectives of family members using the VOICES questionnaire2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 72-84Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Europe, residential care homes (RCHs) are replacing hospitals as the place where death occurs, and they play an important role in end-of-life (EOL) care.

    OBJECTIVE: The aim was to describe the quality of care during the last 3 months and last 3 days of life of those who died in RCHs as reported by family members. We also investigated whether there were differences in the EOL care of younger patients (<85 years) vs. the oldest old patients (≥85 years) as reported by family members.

    DESIGN: A retrospective survey design.

    METHODS: Deaths (n = 189) at 19 RCHs in one municipality in Sweden were included. Family members were sent the VOICES questionnaire 1 month after their elderly relative had died. Descriptive statistics were used.

    RESULTS: In the last 3 days before death, most family members reported there was enough help with nursing (93%) and personal care (78.5%). Among the family members, 86% were told that the resident was likely to die shortly. Most (94.1%) of residents were reported to have died at their preferred place. No significant difference was found between age groups. Family members also reported that about half of the elderly had pain (46.5%) and 86.4% received treatment; 55.9% had breathlessness and 39.7% received treatment. Breathlessness was significantly (p = 0.01) more common in the younger group, and they were treated more often (p = 0.006) than the oldest old.

    CONCLUSION: This study revealed an overall positive picture of personal and nursing care and communication. These findings indicate that the quality of EOL care at RCHs is high. Inadequate management was found for symptom relief the last days of life. This suggests that this subject merits further attention by care professionals. To achieve better quality of EOL care at RCHs, we emphasise the importance of systematically working to improve symptom relief.

  • 3. Bergland, Adel
    et al.
    Kirkevold, Marit
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Psychometric properties of the Norwegian Person-centred Climate Questionnaire from a nursing home context2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 4, p. 820-828Article in journal (Refereed)
    Abstract [en]

    Background: The physical and psychosocial environments in nursing homes influence the residents everyday life as well as their well-being and thriving. The staffs perceptions of and relationships with the residents are crucially important to quality care. Quality care is described often as person-centred. Few measurement tools exist that focus on person-centred care in nursing homes.

    Objective: The aim of this study was to evaluate the psychometric properties of the Norwegian version of the Person-centred Climate QuestionnaireStaff version (PCQ-S).

    Design: This study had a cross-sectional survey design.

    Participants and Settings: Two hundred and nine healthcare and support staff in five nursing homes in the eastern part of Norway.

    Methods: The Swedish PCQ-S was translated into Norwegian with forward and backward translation. The relevance of the items included in the questionnaire was assessed by an expert panel of 10 nursing home care staff, because the questionnaire has not been used in this context previously. A psychometric evaluation using statistical estimates of validity and reliability was performed. The discriminatory capacity of the questionnaire was also tested.

    Results: The content validity index was satisfactory (0.78). The PCQ-S showed high internal consistency reliability in that Cronbachs a was satisfactory for the total scale (0.92) and the three subscales (0.81, 0.89 and 0.87). The testretest reliability was also satisfactory as evident from a Spearmans correlation coefficient of 0.76 (p < 0.01) between the total PCQ scores at test and retest. The Norwegian version retained the original factor structure of the Swedish version.

    Conclusion: As the psychometric evaluation showed satisfactory validity and reliability scores, this study supports the Norwegian version of the PCQ-S when applied to a sample of nursing home staff.

  • 4.
    Bernspång, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fugl-Meyer, Axel R.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Viitanen, Matti
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Perceptual function in the elderly and after stroke1988In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 2, no 2, p. 75-79Article in journal (Refereed)
    Abstract [en]

    Perceptual function was assessed in 60 clinically healthy subjects aged about 60 (n=34) and 80 (n=26), and in stroke survivors who were assessed either early (n=109) or four to six years (n=75) after the stroke. Using two indices, one characterising low-order perception and the other higher-order perception, the clinically healthy subjects invariably had no impairment in the low-order index. Slight impairments occurred in 35% of 60-year-old and 77% of 80-year-old healthy subjects. Considerably more pronounced disturbances occurred in the stroke victims, among whom about 60% had impairment or higher-order perceptual function and about 10% had low-order perceptual deficits. Thus as higher-order perception is age dependent, it appears that in rehabilitation of stroke allowance should be made for predictable signs of advancing age.

  • 5.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lehuluante, Abraraw
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 675-682Article in journal (Refereed)
    Abstract [en]

    Little research has been done to try to understand how patient-centred care is understood and practised by healthcare professionals specialising in patients with diabetes. Experiences from patient-centred practices need to be highlighted as a way of motivating diabetes specialist nurses to take a patient-centred approach. The aim of this study was to describe diabetes specialist nurses' experiences of practising patient-centred care in the context of a type 2 diabetes intervention. The study design was descriptive and used qualitative methods. Focus group interviews complemented by individual semi-structured interviews were analysed by qualitative content analysis. The main theme of the diabetes specialist nurses' experiences of practising patient-centred care was an altered professional role. The main theme was based on two themes: ambivalence towards practising patient-centred care and enriched relationships with the patients. The ambivalence towards practising patient-centred care was based on the three subthemes: a position of withdrawn expertise, inconvenience of changing routines and insights that patient-centred care is difficult but possible. Their experiences of enriched relationships with patients were based on the two subthemes: courage to discuss the severity of diabetes and increased engagement in patients' daily lives. The diabetes specialist nurses' experiences with practising patient-centred care included doubts about their ability to practise in such a way and about the feasibility of such care. At the same time, their enriched relationships with patients were seen as an opportunity to engage in patients' lives. Training and support for practising patient-centred care may improve diabetes specialist nurses skills in patient-centred care and self-management support in type 2 diabetes.

  • 6.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Ekman, Inger
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Being a close relative of a person with severe, chronic heart failure in palliative advanced home care - a comfort but also a strain.2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 3, p. 338-344Article in journal (Refereed)
    Abstract [en]

    Within previous research on family care of terminally ill people, studies have only rarely been carried out concerning heart failure care. This study aims to illuminate meanings of being a close relative of a person with severe, chronic heart failure (CHF) in palliative advanced home care (PAHC). Narrative interviews were conducted with three close relatives, tape-recorded, transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. Meanings of being a close relative is to follow the life-threatening ups and downs, the person with CHF is going through. This means being on primary call, always on standby to mediate security and pleasure. In the deepest downs it is also to call for the back-up call i.e. the PAHC team, trusting their ability to show up on time to alleviate in the worst downs i.e. ease suffering. This study reveals that to be the close relative that the ill person is dependent on 24 hours a day is both a comfort and a strain.

  • 7.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jaarsma, Tiny
    Faculty of Health Sciences, Linköping University.
    Struggling with issues about cardiopulmonary resuscitation (CPR) for end-stage heart failure patients2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 379-385Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Integrating heart failure and palliative care teams combines unique expertise from both cardiology and palliative care. However, professionals from the two arenas of life-saving cardiology and palliative care may well have different experiences with and approaches to patient care. Little is known how to optimally discuss cardiopulmonary resuscitation with patients and their relatives and what challenges are for healthcare providers.

    OBJECTIVE: The aim of this study was to describe the experiences and thoughts of members of an integrated heart failure and palliative care team concerning talking about CPR with end-stage heart failure patients.

    METHOD: We used a descriptive qualitative design, conducting group interviews during 2011 with professionals from different disciplines working with heart failure patients over a 1-year period. A qualitative content analysis was performed to examine the interview data.

    RESULTS: Professional caregivers in integrated heart failure and palliative homecare are struggling with the issue of CPR of end-stage heart failure patients. They wrestle with the question of whether CPR should be performed at all in these terminally ill patients. They also feel challenged by the actual conversation about CPR with the patients and their relatives. Despite talking them about CPR with patients and relatives is difficult, the study participants described that doing so is important, as it could be the start of a broader end-of-life conversation.

    CONCLUSION: Talking with patient and relatives about CPR in end-stage heart failure, as suggested in the current heart failure guidelines, is a challenge in daily clinical practice. It is important to discuss the difficulties within the team and to decide whether, whom, how and when to talk about CPR with individual patients and their relatives.

  • 8. Bäckström, Britt
    et al.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    The experience of being a middle-aged close relative of a person who has suffered a stroke: six months after discharge from a rehabilitation clinic2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, p. 116-124Article in journal (Refereed)
    Abstract [en]

    The experience of being a middle-aged close relative of a person who has suffered a stroke - six months after discharge from a rehabilitation clinicBeing a close relative brings with it a large number of consequences, with the life situation changing over time. The aim of this study was to illuminate the experiences of being a middle-aged close relative of a person who has suffered a stroke 6 months after being discharged from a medical rehabilitation clinic. Narrative interviews were conducted with nine middle-aged close relatives and analysed using a content analysis with a latent approach. The analysis revealed that being close to someone who had suffered a stroke 6 months after discharge meant; a struggling for control and a renewal of family life in the shadow of suffering and hope. The middle-aged close relatives began to perceive the changed reality. They were struggling to take on something new, become reconciled and find a balance in their family life. Their ability to work, relief from caring concerns and having support and togetherness with others seemed to be essential for the close relatives in their efforts to manage their life situation and maintain their well-being. Having reached the 'halfway point' in their lives and still with half of their life in front of them created worries. They felt dejected about their changed relationships and roles, experience a sense of loss of shared child responsibilities, a negative impact on their marital relationships and sexual satisfaction. They felt trapped in a caring role and they worried about how to endure in the future. The middle-aged close relatives' experiences were of being alone and neglected, in an arduous and complex life situation filled with loss and grief. The findings highlights that health professionals need to see and listen to the close relatives' experiences of transition in order to provide appropriate support adjusted to their varying needs during a time of renewal.

  • 9.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Berglin, Björn
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "It should be an ordinary thing": a qualitative study about young people´s experiences of taking the HIV-test and getting the test result2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 4, p. 678-683Article in journal (Refereed)
    Abstract [en]

    Aim:  Increased HIV-testing has public health benefits, but for youth there is a multitude of barriers against the test. The aim of this study is to explore how young women and men in Sweden experience HIV-testing within primary healthcare.

    Method:  Six focus-group interviews were tape recorded, transcribed verbatim and analysed according to qualitative content analysis.

    Results:  Three themes emerged, describing how the informants were met before, during and after testing; ‘Obstacles accessing the clinic’– describes their perceptions on how to overcome different barriers and enter into primary health care. ‘Quick and easy testing’– describes perceptions of the testing procedure and ‘Conflicting and unclear information about test results’– describes inconsistencies concerning communication of the test result and a concern about ‘what would happen’ in the event of an HIV-positive finding. Most of these youth preferred the HIV-test ‘quick and easy’ and preferred a telephone referral of the test result. A minority of them worried about HIV, and they thought that the staff seemed to be unprepared for an HIV-positive test result.

    Conclusion:  According to these youth, a quick and easy testing procedure together with a short pretest discussion may be sufficient and may also help normalising the testing practice. In a Swedish context, it may be common to see heterosexual youth as a risk-free population, and this perception may act as a barrier for HIV-testing and increase missed opportunities for early diagnose of HIV within primary care.

  • 10.
    Dahlheim Englund, Ann-Charlotte
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Hartman, Jan
    Segesten, Kerstin
    Assisting teens with asthma to take command.2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 2, p. 193-201Article in journal (Refereed)
    Abstract [en]

    To meet and work with teenagers may be a challenge for caregivers as adolescence is a period when youths try to establish autonomy. Although asthma is an increasing problem worldwide, few studies have addressed professional caregivers' motives and actions. Therefore, the aim of this study was to describe professional caregivers' strategies in their work with teenagers with asthma. Grounded theory, inspired by Glaser, was used to uncover the phenomenon. The informants were seven professional caregivers who worked at an eight-day asthma camp for teenagers in Sweden. Participant observations and interviews were used, and the first author collected the data and participated in the activities. Findings show that professional caregivers' core concern is to assist teenagers with asthma to take command. This core concern gives rise to five strategies: showing respect, being at hand, promoting own responsibility, promoting to exceed boundaries and promoting reflections. In professional caregivers' attempt to assist teenagers to take command some differences are seen in the way they support boys and girls. One conclusion drawn from our study is that the provisional theory of 'Assisting teenagers with asthma to take command' is not only suitable for professional caregivers working at asthma camps; it may, in some degree, also be used as a source of inspiration for professional caregivers in other settings.

  • 11.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Research and Development in Disaster Medicine, Umeå University.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Impact on life after a major bus crash - a qualitative study of survivors' experiences2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 1, p. 155-163Article in journal (Refereed)
    Abstract [en]

    Background Crashes occur regularly throughout the world and can result in multiple fatalities and many injuries. Research into how survivors experience a crash is very limited. AimTo describe and analyse the nonphysical consequences of a multifatality bus crash in Sweden and the subsequent effect on the surviving passengers' lives. MethodThe participants were all (n=56) of the survivors of a major bus crash. The passengers were interviewed approximately one month after the bus crash. The interviews were analysed using a qualitative content analysis. ResultsPrior to the arrival of rescue personnel at the crash site, helpfulness emerged among the passengers. Further, the crash generated an impact on the surviving passengers' lives from a short-term perspective. The passengers displayed a diverse need for crisis support; informal support from family and friends was essential for the early healing process. Sleep difficulties and a change in travel routines were the most common consequences. Lastly, passengers sought closure in order to move on with their lives. ConclusionThe passengers' reactions to and behaviour following a crash offer an insight into the, relatively unexplored, interaction between people experiencing a major road traffic crash. It is necessary to have a flexible crisis support system, and the vital role of family support ought to be upgraded.

  • 12.
    Edvardsson, J David
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Nursing.
    Rasmussen, Birgit Holriz
    Umeå University, Faculty of Medicine, Nursing.
    Sensing an atmosphere of ease: a tentative theory of supportive care settings.2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 4, p. 344-353Article in journal (Refereed)
    Abstract [en]

    Nightingale saw the art of nursing as providing an environment in which patients were offered the best conditions for nature to act upon them. However, we still have limited research-based understandings of care settings experienced as supportive by patients, significant others and staff. The aim of this study was to construct a theoretical understanding of processes contributing to supportive care settings. The authors used grounded theory design and the constant comparative method to analyse theoretically sampled interview and observational data from three different contexts of care. The tentative theory conceptualizes supportive care settings as sensing an atmosphere of ease, and five categories were recognized: experiencing welcoming; recognizing oneself in the environment; creating and maintaining social relations; experiencing a willingness to serve; and experiencing safety. Having one's expectations of the environment exceeded was a mediating factor in sensing an atmosphere of ease. Sensing an atmosphere of ease facilitated experiences of being able to locate oneself in familiar and safe surroundings; being able to follow one's own rhythm; being seen, acknowledged and cared about; and having possibilities of benefiting from beauty and contacts with others.

  • 13.
    Efraimsson, Eva
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Nursing.
    Rasmussen, Birgit H
    Umeå University, Faculty of Medicine, Nursing.
    "They were talking about me"--elderly women's experiences of taking part in a discharge planning conference.2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 1, p. 68-78Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Discharge planning procedures needs improving to make transition to care settings in the community smooth, safe and secure. Research about discharge planning that involves a patient perspective is limited. The intention of this study was to focus on the patients' (elderly women) experiences of taking part in discharge planning conferences (DPCs) to deepen our understanding of the meaning of facing "the world of the institution" from a life-world perspective. AIM: This study aims at describing elderly women's experience of taking part in a DPC as they are about to be discharged from hospital. METHODOLOGICAL DESIGN: To illuminate the phenomenon from a life-world perspective, an interview study was chosen. Eight follow-up interviews with seven elderly women were carried out. The interviews were analysed using a qualitative content analysis methodology. FINDINGS: The interpretation of data was that the women's future was as in suspense as they got ill or were hit by accidents. The analysis revealed four themes that reflected the women's experiences of taking part in the DPCs: Being affiliated; Being in focus, Standing outside; and finally Being unprepared. STUDY LIMITATIONS AND CONCLUSION: The limitations of the study are related to: selection of participants; participation in the interview was connected to a video recording study; gap in time between participation in the DPC and the interview. The findings are still seen as trustworthy as the experiences expressed by the participating women in data are to be seen as a contribution to an emerging understanding of the meaning of the phenomenon from a life world perspective. The findings make clear that the institutional world easily and without much resistance from the patients transgresses the border of their life worlds. This awakes a need to reconsider how a caring perspective can be established in practice.

  • 14. Eklund, Mona
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Predictors of valued everyday occupations, empowerment and satisfaction in day centres: implications for services for persons with psychiatric disabilities2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 582-590Article in journal (Refereed)
    Abstract [en]

    This study addresses predictors of occupational value, empowerment and satisfaction with the rehabilitation received in day centres for people with psychiatric disabilities. These outcomes represent varying aspects of relevance for the day centre context and together create a manifold outcome picture. This was a longitudinal study with approval from the regional research vetting board. Self-report instruments were used, and the investigated predictors motivation for going to the day centre, occupational engagement, socio-demographic factors and self-reported diagnosis. Attendees (N = 108) at 8 day centres participated and filled in self-report questionnaires regarding the predictor and outcome variables. A baseline measurement and a 14-month follow-up composed the data. Occupational engagement at baseline could predict all three outcomes at the follow-up. Motivation for the day centre activities and not preferring work before attending the day centre were positive for satisfaction with the day centre. A low participation rate, although comparable with previous studies on the target group, was a limitation of this study. To conclude, both occupational engagement and motivation are factors that can be stimulated by the staff in day centres. Actions for how to accomplish that, and thereby also more positive outcomes of the day centre services, are proposed, such as a system of freedom of choice among day centres, and between day centres and supported employment.

  • 15.
    Enberg, Birgit
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Work satisfaction, career preferences and unpaid household work among recently graduated health-care professionals: a gender perspective2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 2, p. 169-177Article in journal (Refereed)
  • 16.
    Enberg, Birgit
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Work experiences among nurses and physicians in the beginning of their professional careers - analyses using the effort-reward imbalance model2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, ISSN 0283-9318, Vol. 27, no 1, p. 36-43Article in journal (Refereed)
    Abstract [en]

    Work experiences among nurses and physicians in the beginning of their professional careers analyses using the effortreward imbalance model The aim of the study was to scrutinise how nurses and physicians, employed by the county councils in Sweden, assess their work environment in terms of effort and reward at the start of their career. The aim was also to estimate associations between work satisfaction and the potential outcomes from the effortreward imbalance (ERI) questionnaire. The study group, 198 nurses and 242 physicians who graduated in 1999, is a subsample drawn from a national cross-sectional survey. Data were collected in the third year after graduation among the nurses and in the fourth year after graduation among registered physicians. The effortreward imbalance questionnaire, together with a question on work satisfaction, was used to evaluate psychosocial factors at work. The results reveal that nurses scored higher on effort, lower on reward and experienced higher effortreward imbalance, compared with physicians. Women scored higher on work-related overcommitment (WOC) compared with men. Among the physicians, logistic regression analysis revealed a statistically significant association between WOC and ERI, sex, effort and reward. Logistic regression analysis also revealed a statistically significant association between WOC and ERI and between WOC and effort among the nurses. Dissatisfaction with work was significantly higher among those who scored worst on all three ERI subscales (effort, reward and WOC) and also among those with the highest ERI ratios compared with the other respondents. In conclusion, to prevent future work-related health problems and work dissatisfaction among nurses and physicians in the beginning of their professional careers, signs of poor psychosocial working conditions have to been taken seriously. In future work-related stress research among healthcare personnel, gender-specific aspects of working conditions must be further highlighted to develop more gender-sensitive analyses.

  • 17.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Skellefteå.
    Larsson, Lise-Lotte Franklin
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Palliative Research Center, Ersta Sköndal University College, Stockholm.
    Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 337-346Article in journal (Refereed)
    Abstract [en]

    Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health.

  • 18.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Sköndal University College, Stockholm, Sweden.
    Persson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Healthcare personnel's experiences of situations in municipal elderly care that generate troubled conscience2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 215-223Article in journal (Refereed)
    Abstract [en]

    Healthcare personnel may perceive troubled conscience when feeling inadequate and powerless. It is important to further explore healthcare personnel's descriptions of situations in daily work, which generate troubled conscience to increase the awareness of such situations. This study aimed to describe health care personnel's experiences of situations in municipal elderly care that generate troubled conscience. In this qualitative study, interviews were conducted with Registered and Enrolled nurses and nursing assistants (n = 20) working in municipal elderly care. The interviews were tape-recorded, transcribed verbatim and analysed with content analysis. Situations that generated troubled conscience was (i) Being caught between different demands, comprising being forced to prioritize between different residents' needs, being torn between residents'-/relatives'-/and co-workers' needs and expectations' and between work and private life, (ii) Being torn away from residents to other 'must do's', comprising stealing time from residents' to do housekeeping chore' and to 'obey' rules and recommendations, (iii) Feeling unable to relieve suffering, comprising falling short when striving to help, lacking knowledge, advice and support and time to ease residents' suffering and finally, (iv) Being part of providing care that is or feels wrong, comprising providing poor care and/or witnessing co-workers providing poor care, and being forced to give care that feels wrong. These findings identify important factors that generate stress of conscience (stress caused by troubled conscience), including difficulties with balancing priorities and following rules and recommendations that seem contrary to best care, and the need for interdisciplinary teamwork. Findings point to that sharing what conscience tells in the work team opens up possibilities for healthcare personnel to constructively deal with troubled conscience. Intervention studies are needed to explore whether such measures contribute to relieve the burden of troubled conscience and increase possibilities to provide high quality care.

  • 19.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Meanings of being a female co-worker to a person developing burnout.2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 2, p. 155-162Article in journal (Refereed)
    Abstract [en]

    Burnout is dramatically increasing in many industrialised countries. Burnout is mainly studied from the perspective of the burnout person although it has been confirmed to affect co-workers as well. This study aimed to illuminate meanings of being a female co-worker to a person developing burnout. Fifteen interviews with nursing and medical staff were performed, tape-recorded and transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. One meaning of being a female co-worker is struggling, on the one hand to understand and help the person developing burnout and on the other hand to manage their work and survive oneself. This means to be torn between helping the workmate and managing their work. Co-workers are filled with contradictory feelings, from deep concern to aversion and when the workmate finally goes on sick leave, co-workers' feelings of shortcomings and failure emerge, along with troubled conscience. This study reveals a picture of the difficulties of being a female co-worker to a person developing burnout that it is crucial to be aware of.

  • 20.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    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 study2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 215-224Article in journal (Refereed)
    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.

  • 21.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Troubled conscience related to deficiencies in providing individualised meal schedule in residential care for older people: a participatory action research study2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 688-696Article in journal (Refereed)
    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.

  • 22.
    Erlingsson, Christen
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Carlson, Sharon
    Saveman, Britt-Inger
    Perceptions of elder abuse: voices of professionals and volunteers in Sweden: an exploratory study2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 2, p. 151-159Article in journal (Refereed)
  • 23. Fjelltun, Aud-Mari
    et al.
    Henriksen, Nils
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gilje, Fredicka
    Normann, Hans Ketil
    Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents: a comparative study.2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 4, p. 736-747Article in journal (Refereed)
    Abstract [en]

    The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses' physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly's functional levels may illuminate the extent of the carers' workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi-Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly's need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.

  • 24. Fjelltun, Aud-Mari Sohini
    et al.
    Henriksen, Nils
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gilje, Fredricka
    Normann, Hans Ketil
    Nurses' and carers' appraisals of workload in care of frail elderly awaiting nursing home placement.2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 1, p. 57-66Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study is to describe carers' and nurses' appraisals of workload in care of frail elderly awaiting nursing home (NH) placement. BACKGROUND: Carers' workload of care for frail elderly awaiting NH placement has been studied separately from that of nurses' workload. The literature neither addressed a comparison of carers' and nurses' appraisals of psychological and physical workloads nor the most strenuous factors common to the workloads of both nurses and carers in care of the same elderly person. The terms 'carers' and 'nurses' in this paper refer to informal caregivers and to both enrolled nurses and Registered Nurses respectively, when no particular one is stated. METHOD: The sample comprised 11 nurses and 11 carers paired based on care provided to the same elderly person awaiting NH placement in Norway. Data collected by a workload-scale was analyzed by descriptive statistics. Data collected by individual interviews were analyzed by qualitative content analysis. Carers' and nurses' appraisals of workload were compared and contrasted and most strenuous factors described. FINDINGS: The findings show that both carers and nurses rated workload levels maximum. Carers' highest ratings concerned psychological workload, while nurses' highest ratings concerned physical workload. The workload ratings concerning elderly with advanced dementia disease were most similarly aligned. Qualitative content analysis showed three categories that describe the most strenuous factors common to the workloads of both carers and nurses. These were feeling responsible, burdened and ambivalent. CONCLUSION: This study reports carers' and nurses' appraisals of workload in care of frail elderly awaiting NH placement. The results show many similarities and some differences. These results may help guide policy development to address resource allocations to elderly care. Further research is needed to address workloads of care for elderly awaiting NH placement.

  • 25.
    Forsberg, Karl-Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy Nils
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meanings of participating in a lifestyle programme for persons with psychiatric disabilities.2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 357-364Article in journal (Refereed)
    Abstract [en]

    Lifestyle changes that affect physical and psychological health are described in research literature; however, the meaning of participating in a lifestyle intervention programme together with the staff has not been described. This study illuminates meanings of participating in a lifestyle programme as experienced by persons with psychiatric disabilities. The first author interviewed five women and six men with schizophrenia and depressive syndrome, aged 26-53, participating in a lifestyle programme. The transcribed interviews were analysed using a phenomenological hermeneutic approach inspired by the philosophy of Ricoeur. Meanings of participating in a lifestyle programme include my health can be improved as both the physical effects and the obstacles are considered and the daily life is partially given a changed content in new experiences and by participating in something to take pride in. The meanings of participating together with the staff mean an increased sense of closeness and equality with the staff expressed in changes in relationships and the difference between the two groups being revealed and also in becoming aware of the life situation, an insight into the loss of a healthy life but also hope for the future is expressed. The conclusions that could be drawn from this study are that a lifestyle intervention affects health and other important life areas such as the content of daily life and the relationship with the carers, which appears to affect the sense of hope and the ability to see new possibilities. Carers should find situations and activities where the residents and carers participate under equal conditions giving the residents the opportunity to leave the sick roll, experience equality and develop good relationships.

  • 26.
    Forsgärde, Marianne
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Westman, Berith
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Professional carers’ struggle to be confirmed.: Narratives within the care of the elderly and disabled.2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 1, p. 12-18Article in journal (Refereed)
    Abstract [en]

    Twenty-seven members of staff working in special types of housing in Sweden narrated 95 narratives about their experience of being in problematic situations during the working day. The narratives were interpreted using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. The narratives mainly concerned interactions with colleagues and very few narratives concerned interactions with residents and relatives. On the relationship level of communication there is evidence that many interactions among the staff, residents and relatives were of a receptive and disconfirming nature. The results indicate that the staff feel lonely, and struggled to maintain self-esteem and to be confirmed.

  • 27. Forslund, Ann-Sofie
    et al.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lundblad, Dan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Söderberg, Siv
    A second chance at life: people's lived experiences of surviving out-of-hospital cardiac arrest2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 4, p. 878-886Article in journal (Refereed)
    Abstract [en]

    Background: There is more to illuminate about people's experiences of surviving out-of-hospital cardiac arrest (OHCA) and how such an event affects people's lives over time. Aims: This study aimed to elucidate meanings of people's lived experiences and changes in everyday life during their first year after surviving OHCA. Methods: A qualitative, longitudinal design was used. Eleven people surviving OHCA from northern Sweden agreed to participate and were interviewed 6 and 12 months after the event. A phenomenological hermeneutic interpretation was used to analyse the transcribed texts. Findings: The structural analysis resulted in two themes: (i) striving to regain one's usual self and (ii) a second chance at life, and subthemes (ia) testing the body, (ib) pursuing the ordinary life, (ic) gratitude for help to survival, (iia) regaining a sense of security with one's body, (iib) getting to know a new self, and (iic) seeking meaning and establishing a future. Conclusion: To conclude, we suggest that people experienced meanings of surviving OHCA over time as striving to regain their usual self and getting a second chance at life. The event affected them in many ways and resulted in a lot of emotions and many things to think about. Participants experienced back-and-forth emotions, when comparing their present lives to both their lives before cardiac arrest and those lives they planned for the future. During their first year, participants' daily lives were still influenced by being dead' and returning to life. As time passed, they wanted to resume their ordinary lives and hoped for continued lives filled with meaning and joyous activities.

  • 28.
    Glasberg, Ann-Louise
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Eriksson, Sture
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Factors associated with 'stress of conscience' in healthcare.2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 2, p. 249-258Article in journal (Refereed)
    Abstract [en]

    AIM: The main purpose of this study was to examine factors related to 'stress of conscience' i.e. stress related to a troubled conscience in healthcare. METHODS: A series of questionnaires was completed by 423 healthcare employees in northern Sweden as part of this cross-sectional study. The series of questionnaires comprised the 'Stress of Conscience Questionnaire', 'Perception of Conscience Questionnaire', 'Revised Moral Sensitivity Questionnaire', Social Interactions Scale, Resilience Scale and a Personal/Work Demographic form. RESULTS: Nonautomatic stepwise regression analysis with forward inclusion resulted in a model that explained approximately 39.6% of the total variation in stress of conscience. Individual items associated with stress of conscience were; perceiving that conscience warns us against hurting others while at the same time not being able to follow one's conscience at work and having to deaden one's conscience to keep working in healthcare. In addition moral sensitivity items belonging to the factor 'sense of moral burden' were; one's ability to sense patient's needs means that one is doing more than one has strength for, having difficulty to deal with feelings aroused when a patient is suffering and one's ability to sense patient's needs means feeling inadequate all added significantly to the model. In addition, deficient social support from superiors, low levels of resilience and working in internal medicine wards were all associated with stress of conscience. CONCLUSION: Healthcare employees seem to experience stress of conscience in their everyday practise. Particular contributing factors are not being able to follow one's conscience at work, and the 'negative' dimension of moral sensitivity - moral burden - which is an inability to deal with moral problems. Thus, in order for conscience and moral sensitivity to become an asset instead of a burden, healthcare employees need to be able to express their moral concerns.

  • 29. Grue, Else Vengnes
    et al.
    Ranhoff, Anette Hylen
    Noro, Anja
    Finne-Soveri, Harriet
    Jensdóttir, Anna Birna
    Ljunggren, Gunnar
    Bucht, Gösta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Björnson, Leif Jan
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Schroll, Marianne
    Jónsson, Palmi V
    Vision and hearing impairments and their associations with falling and loss of instrumental activities in daily living in acute hospitalized older persons in five Nordic hospitals2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 4, p. 635-643Article in journal (Refereed)
    Abstract [en]

    Background: Many older people believe sensory problems are inevitably, a part of growing old, and avoid assessment and help. Such problems are often also overlooked by health professionals. The aim of this study was to find the prevalence of hearing and vision impairment and their associations with loss of instrumental activities in daily living (IADL) and risk of falling in patients aged 75 years or older, admitted to a medical ward in an acute hospital in each of the five Nordic countries. Method: The Minimum Data Set for Acute Care was used for data collection in 770 patients. Premorbid data, admission data and history of falls over 3 months were obtained on admission by interview and observation. Hearing impairment was present if the patient required a quiet setting to be able to hear normal speech. Vision impairment was defined as unable to read regular print in a newspaper. Results: Bivariate and logistic regression analyses were performed. Forty-eight per cent of the patients had a hearing impairment, 32.3% had vision impairment and 20.1% had both. Hearing impairment was associated with falling but not in the logistic regression model. Hearing and vision impairment were associated with loss of IADL but only combined impairment was independently. Conclusion: Hearing and vision impairments were frequent among older patients in the medical wards. Falling was associated with hearing loss and IADL loss with hearing, vision and combined impairments. Sensory loss was also associated with fear of falling. It is recommended routinely to screen sensory functions in older patients in a medical setting. Intervention studies are needed to determine whether improvements in hearing and vision can prevent falls and further loss of function in this patient population.

  • 30.
    Gustafsson, Gabriella
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Meanings of becoming and being burnout: phenomenological-hermeneutic interpretation of female healthcare personnel's narratives2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 4, p. 520-528Article in journal (Refereed)
    Abstract [en]

    The incidence of burnout has increased in many industrialized countries. Burnout is mainly studied among people still at work and with quantitative methods. The present study aimed to illuminate the meanings of becoming and being burnout as narrated by healthcare personnel on sick leave because of symptoms of burnout. Interviews with 20 female healthcare personnel were performed, tape-recorded and transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. The result shows that the meanings of becoming and being burnout are to be torn between what one wants to be and what one manages. It is as one's ideals have become more like demands and no matter the circumstances, one must be and show oneself as being capable and independent. It is also to be dissatisfied with oneself for not living up to one's ideals as well as disappointed with other people for not giving the confirmation one strives for. Feelings of being a victim of circumstances emerge. Thus, becoming and being burnout is leading a futile struggle to live up to one's ideal, failing to unite one's ideal picture with one's reality and experiencing an overwhelming feebleness. This is interpreted in the light of Buber's philosophy as well as relevant empirical studies about burnout. One conclusion is that it seems important to reflect on as well as discuss between one another about our everyday reality; what are reasonable vs. unreasonable demands. Hopefully, such reflections will increase our tolerance of ourselves and others and our insightfulness of what is possible to achieve in work as well as in private life. This study is ethically approved.

  • 31.
    Gustafsson, Gabriella
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Meanings of staying healthy in a context where others developed burnout: phenomenological-hermeneutic interpretation of healthcare personnel's narratives2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 2Article in journal (Refereed)
    Abstract [en]

    Burnout has become a major problem in many industrialized countries, but not everyone at the same work place develops burnout. The present paper aimed to illuminate meanings of staying healthy in a context where others developed burnout as narrated by healthcare personnel. Interviews were conducted with 20 healthcare personnel and were interpreted using a phenomenological-hermeneutic method. The result shows that the meanings of staying healthy are to be rooted in an outlook on life perceiving its many-sidedness and the strengths and weaknesses of oneself and others with forbearance. One is striving to shoulder responsibility for oneself and for others and is also receptive towards the circumstances of life, striving to judge the possibilities of being and acting in order to attempt to influence things in what is believed to be the right direction. Being able to let go of injustice and look after oneself with a clear conscience is also revealed as meanings of staying healthy. In conclusion, forbearance with life's many-sidedness seems to pervade one's experiences, judgements and actions in life when dealing with one's reality, and thus, it is interpreted as essential for staying healthy in a context where others developed burnout. This study is ethically approved.

  • 32.
    Gyllencreutz, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Johanna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rolfsman, Ewa
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Outdoor pedestrian fall-related injuries among Swedish senior citizens: injuries and preventive strategies2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 225-233Article in journal (Refereed)
    Abstract [en]

    Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs.

  • 33.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    Areas for quality improvements in heart failure care: quality of care from the family members' perspective2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care.

    OBJECTIVE: To describe family members' perceptions of quality of HF care in an outpatient setting.

    METHODS: A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV.

    RESULTS: Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members.

    CONCLUSION: Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.

  • 34.
    Hellström Ängerud, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ekman, Inger
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Centre for Person-Centred Care, University of Gothenburg (GPCC), Gothenburg, Sweden.
    Areas for quality improvements in heart failure care: quality of care from the patient's perspective2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 4, p. 830-838Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Heart failure is a serious condition with high mortality and a high symptom burden. Most patients with heart failure will be taken care of in primary care but the knowledge of how the quality of care is perceived by patients with heart failure is limited.

    OBJECTIVE: The aim was to explore how patients with heart failure report quality of care, in an outpatient setting.

    METHODS: Seventy-one patients with a confirmed diagnosis of heart failure and who were cared for in an outpatient setting were included in this cross-sectional study. Quality of care was assessed with a short form of the Quality from the Patient's Perspective questionnaire. The items measured four dimensions, and each item consists of both perceived reality of the received care and its subjective importance.

    RESULTS: Inadequate quality was identified in three out of four dimensions and in items without dimension affiliation. In total, inadequate quality was identified in 19 out of 25 items. Patients reported the highest level of perceived reality in 'my family member was treated well' and the lowest perceived reality in 'effective treatment for loss of appetite'. Effective treatment for shortness of breath was of the highest subjective importance for the patients.

    CONCLUSION: Important areas for improvement in the quality of care for patients with heart failure in an outpatient setting were identified, such as symptom alleviation, information, participation and access to care.

  • 35. Holst, Mette
    et al.
    Yifter-Lindgren, Elinor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatric Center, Umeå.
    Surowiak, Mirek
    Nielsen, Kari
    Mowe, Morten
    Carlsson, Maine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Geriatric Center, Umeå.
    Jacobsen, Bent
    Cederholm, Tommy
    Fenger-Groen, Morten
    Rasmussen, Henrik
    Nutritional screening and risk factors in elderly hospitalized patients: association to clinical outcome?2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, p. 953-961Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to test the intervalidity of three different nutrition screening tools towards a broad population of elderly hospitalized patients. The association with risk factors and mortality was investigated. This is a prospective cohort study in three medical, surgical and geriatric settings, in Denmark and Sweden. Patients >65 years were consecutively included. Patients were screened by mini-nutritional assessment (MNA), malnutrition universal screening tool (MUST) and nutritional risk screening (NRS-2002). Anthropometrics, cognitive test (SPMSQ), as well as a questionnaire investigation regarding eating problems and life situation, were performed. Mortality within 12 months was investigated. In total, 233 patients mean (SD) age 81(7.64) years were included. A large variation in prevalence of nutritional risk was determined between the screening tools, MNA was 68% vs. MUST, 47% and NRS 54%, p < 0.0001. An overall agreement of 67% was seen (κ 0.52-0.55). Risk factors were associated with nutritional risk, including depressive mood. Only handgrip strength, fungus in mouth, serum albumin, CRP and cognitive function were associated with mortality. Fungus had the strongest association (OR 3.7; CI 1.19-11.30). The overall mortality rate was 27% during 12 months. However, none of the three screening tools predicted 12-month mortality. The findings show great variation in the prevalence of nutritional risk of under nutrition both between the tools and the settings. The level of agreement between the tools was moderate, and none of the three tools were capable of predicting 12-month mortality. A functional and psychological evaluation including oral health seems recommendable in elderly patients at nutritional risk.

  • 36.
    Hägglund, Lena
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Omvårdnad.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Omvårdnad.
    Depression among elderly people with and without heart failure, managed in a primary healthcare setting.2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 3, p. 376-382Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND RESEARCH OBJECTIVES: Depression is common among patients with heart failure (HF) and among elderly in general. Problems in diagnosing and care planning can arise as symptoms of HF, dyspnoea and especially fatigue, are nonspecific and also overlap with symptoms of depression. The objective of this study was to describe the prevalence and compare degrees of depression among patients with confirmed HF, patients with symptoms similar to HF (no heart failure, NHF) and a reference group in one primary healthcare centre (PHC), after adjusting for background characteristics and fatigue. SUBJECTS AND METHODS: A descriptive case-reference study was conducted in one PHC in a middle-sized city. Participants were 49 patients with confirmed HF, 59 patients with symptoms similar to HF (NHF) and 40 people in a reference group. After informed consent data were collected by structured interviews using the Geriatric Depression Scale and the Multidimensional Fatigue Inventory-20. Odds ratios for the outcomes HF vs. NHF, HF vs. reference group, and NHF vs. reference group were calculated. RESULTS: The HF and NHF groups had similar degrees of depression which were significantly higher than for the reference group. This difference between the groups did not remain significant when adjusting for physical fatigue. More patients in the NHF than in the HF group were living alone and there were more women in the NHF than in the reference group. CONCLUSIONS: Prevalence of depression and degrees of fatigue were higher among elderly from a PHC who experienced HF symptoms, independent of objectively measured heart function, compared with elderly without such symptoms. When comparing degrees of depression between the three groups and adjusting for fatigue, the physical dimension of fatigue was of greater importance in explaining group differences.

  • 37.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Johansson, Anneli
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family caregivers' experiences of relinquishing the care of a person with dementia to a nursing home: insights from a meta-ethnographic study2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 215-224Article in journal (Refereed)
    Abstract [en]

    Many people with dementia are cared for in their homes by family caregivers. As the dementia progresses, admission of the family member to a nursing home becomes inevitable. The aim of this meta-ethnographic study was to describe caregivers' experiences of relinquishing the care of a family member with dementia to a nursing home. A systematic literature search of PubMed, Cinahl and PsychInfo, between the years 1992 and 2012, was performed, and 10 qualitative articles, based on 180 family caregivers' experiences, were included. The family caregivers' described their experiences as a process that went from being responsible for the decision, through living with the decision, adjusting to a new caring role and having changed relationships. They felt unprepared and lonely with these changes. They experienced loss, guilt and shame, but also feelings of relief. Their roles in the nursing home environment were to make sure that the individual needs of the person with dementia were respected and to monitor the quality of care. They wished to maintain their relationship with the person with dementia and to establish meaningful relationships with caring staff. The process of relinquishing care is similar to a crisis process, which starts with a turning point, followed by a coping face and finally the outcome of the process. The adaption to the new situation can be facilitated if the family caregivers are recognised as partners in the care of the person with dementia. The family caregivers' unique knowledge of their relatives' previous life story should be acknowledged in both care planning and daily care. Welcoming family caregivers to regular meetings with staff can contribute to increase the feeling of partnership. Offering staff clinical supervision could be one way of preparing them to deal with the emotional strain reported by family caregivers.

  • 38.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindahl, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Persson, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, Kristina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Strategies in health-promoting dialogues: primary healthcare nurses' perspectives: a qualitative study2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 235-244Article in journal (Refereed)
    Abstract [en]

    Aim and objectives The aim of this study was to describe dialogic strategies about health and lifestyle used by primary healthcare nurses (PHNs) in the Vasterbotten Intervention Programme (VIP) in Sweden.

    Background The VIP offers all citizens aged 40, 50 and 60 in Vasterbotten County an individual health check-up followed by a health-promoting dialogue with a specialist PHN. Inconsistencies in previous reports of the effects of lifestyle counselling and health promotion suggest that it is important to study dialogues about health and lifestyle to understand health-promoting strategies and to highlight aspects important to improving their effects.

    Method In 2010, we conducted in-depth interviews with ten experienced PHNs working with the VIP at eight healthcare centres in Vasterbotten County, Sweden. Qualitative content analysis was used to illuminate the nurses' strategies in health-promoting dialogues. The Regional Ethics Board (Dno 06-126M) approved the study.

    Results The PHNs used various strategies in dialogues about health and lifestyle that fell under the five themes 'Guiding patients vs. pressuring them; Adjusting to patients vs. directing the conversation; Inspiring confidence vs. instilling fear; Motivating and supporting patients vs. demanding responsibility; and lastly, Introducing emotionally charged subjects or avoiding them'.

    Conclusions The results of this study may add knowledge about the difficulties and opportunities in health counselling. In the discussion, we suggest professional reflection as a means to increase knowledge and awareness about the self and context in the process of health counselling.

  • 39.
    Isaksson, Rose-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Zingmark, Karin
    Prehospital experiences of older men with a first myocardial infarction: a qualitative analysis within the Northern Sweden MONICA Study2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 4, p. 787-797Article in journal (Refereed)
    Abstract [en]

    Aim:  To explore older men's prehospital experiences of their first myocardial infarction (MI). Background:  The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in MI. The majority of people experiencing MI are men. But few studies have been conducted solely on men's experiences before seeking medical care for MI. The objective of this study was to explore older men's experiences of symptoms and their reasoning during the prehospital phase of their first MI. Method:  Data collection was carried out through individual interviews with 20 men representing the age range 65-80 (mean 71) years. The participants were interviewed 3 days after admission for a confirmed first MI. The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews. Findings:  The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill-being to a cluster of alarming symptoms. The participants dealt with conceptions about MI symptoms. They were unsure about the cause of their symptoms, which did not correspond to their expectations about an MI, and whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction. Conclusions:  Understanding older men's prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life.

  • 40.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Abramsson, MaiGreth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenvall, Jessica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hornsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Diabetes empowerment and needs for self-management support among people with type 2 diabetes in a rural inland community in northern Sweden2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 3, p. 521-527Article in journal (Refereed)
    Abstract [en]

    Background: Self-management among people with T2D includes being responsible for attaining a blood sugar level within the normal range, eating healthy food, exercising and following prescriptions for medication, something that may need support. In rural areas, access to health care may be limited, and support from family members becomes important.

    Aim: The aim of this study was to describe perceptions and associations of diabetes empowerment, self-management ability and needs of self-management support among people with T2D in a northern rural community of Sweden.

    Method: People with T2D (n = 159) living a rural municipality in northern Sweden answered the SWE-DES-23 questionnaire and additional questions concerning self-management and needs for self-management support.

    Results: A higher diabetes empowerment was associated with longer diabetes duration and support from healthcare professionals and relatives. Women rated a need for self-management support significantly higher than men did. Nonretired persons rated a significantly higher need for self-management support and a lower perception of support from healthcare professionals compared to retired persons. Cohabitant persons had a significantly higher perception of support from relatives and also estimated a higher need for relatives’ involvement in clinical visits compared to persons living alone. Both the newly diagnosed and also those people with a diabetes duration of 10–15 years rated a higher need for group support. Higher self-awareness and readiness to change were apparent among people with short and long diabetes duration. Furthermore, self-management ability, support from healthcare professionals and from relatives and lastly diabetes duration was associated with diabetes empowerment.

    Conclusion: Not only people newly diagnosed with T2D should be offered patient-centred group support, strengthening patient empowerment. For future, family-focused care and education and training in person-centred care among diabetes specialist nurses is recommended.

  • 41.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jutterström, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Validity and reliability testing of the Swedish version of Melbourne Decision Making Questionnaire2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 405-412Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Melbourne Decision-Making Questionnaire (MDMQ) is an attempt to capture and measure coping strategies that people use. The instrument had not previously been translated into Swedish. The aim of this study was to evaluate validity and reliability of the Swedish version of the MDMQ.

    METHOD: A Swedish translation was performed and back-translated. A group of five pilot readers evaluated content validity. The translated questionnaire was tested among 735 patients, healthcare workers, healthcare students and teachers. A parallel analysis (PA), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed.

    RESULT: An initial EFA with a four-factor solution showed a low concordance with the original 22-item four-factor model with a very low Cronbach's alpha in one of the dimensions. However, a second EFA with a three-factor solution showed a good model fit for the Swedish translation of the Melbourne Decision-Making Questionnaire (MDMQ-S) with a satisfactory Cronbach's alpha. A CFA showed a goodness of fit after deleting six items.

    CONCLUSION: After testing the MDMQ-S, we found support for validity and reliability of the instrument. We found the 16-item version of MDMQ-S to be satisfactory concerning the subscales vigilance, procrastination and buck-passing. However, we found no support that the hypervigilance dimension could be measured by the MDMQ-S.

  • 42.
    Jerdén, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hillervik, Charlotte
    Hansson, Ann-Christin
    Flacking, Renée
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Experiences of Swedish community health nurses working with health promotion and a patient-held record2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 4, p. 448-454Article in journal (Refereed)
  • 43.
    Jonsén, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fagerström, Lisbeth
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vähäkangas, Magdalena
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Psychometric properties of the Swedish version of the purpose in life scale (PIL)2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, p. 41-48Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to test the theoretical assumptions beyond the Purpose in Life (PIL) scale, and to elucidate the underlying structure of the Swedish version of the PIL. The PIL, originally created by Crumbaugh and Maholick, is a 20-item scale of the Lickert type with possible scores ranges from 20 to 140, the higher score, the stronger PIL. The analysis was based on 449 participants, 62% of whom were women, from five different samples, ranging from 19 to 103 years old. An exploratory factor analysis restricted to three factors was performed. The factors were labelled meaning in existence, freedom to create meaning in daily life, and will to find meaning in future challenges. These factors reflected the three dimensions described by Frankl. Cronbach's alpha coefficient for the total scale was 0.83 and varied between 0.54 and 0.83 in the three factors. We concluded that the Swedish version of the PIL scale seems to have construct validity and reliability. Our results give support to the fact that the PIL scale captures and confirms the theoretical assumptions of Frankl's existential theory. We consider the PIL scale to be both feasible and appropriate for use in nursing research.

  • 44.
    Keisu, Britt-Inger
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Öhman, Ann
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Enberg, Birgit
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Employee effort – reward balance and first-level manager transformational leadership within elderly care2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    Background: Negative aspects, staff dissatisfaction and problems related to internal organisational factors of working in elderly care are well-known and documented. Much less is known about positive aspects of working in elderly care, and therefore, this study focuses on such positive factors in Swedish elderly care. We combined two theoretical models, the effort–reward imbalance model and the Transformational Leadership Style model. The aim was to estimate the potential associations between employee-perceived transformational leadership style of their managers, and employees' ratings of effort and reward within elderly care work.

    Methods: The article is based on questionnaires distributed at on-site visits to registered nurses, occupational therapists, physiotherapists (high-level education) and assistant nurses (low-level education) in nine Swedish elderly care facilities. In order to grasp the positive factors of work in elderly care, we focused on balance at work, rather than imbalance.

    Results: We found a significant association between employees' effort–reward balance at work and a transformational leadership style among managers. An association was also found between employees' level of education and their assessments of the first-level managers.

    Conclusions: We conclude that the first-level manager is an important actor for achieving a good workplace within elderly care, since she/he influences employees' psychosocial working environment. We also conclude that there are differences and inequalities, in terms of well-being, effort and reward at the work place, between those with academic training and those without, in that the former group to a higher degree evaluated their first-level manager to perform a transformational leadership style, which in turn is beneficial for their psychosocial work environment. Consequently, this (re)-produce inequalities in terms of well-being, effort and reward among the employees at the work place.

  • 45. Krupic, Ferid
    et al.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Fatahi, Nabi
    The impact of knowledge and religion on organ donation as seen by immigrants in Sweden2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 4, p. 687-694Article in journal (Refereed)
    Abstract [en]

    Background: Transplantation of organs is one of the most successful medical advances of the past 60 years and transplantation is the treatment of choice for severe organ failure worldwide. Despite this situation, and the general acknowledgement of organ donation as a global priority, demand for organs outstrips supply in virtually every country in the world. Aim: The aim of the study was to elucidate factors that influence immigrant's decisions regarding organ donation. Methods: Data were collected through three group interviews using open-ended questions and qualitative content analysis. 32 participants, 16 men and 16 women from Bosnia and Herzegovina, Somalia, Lebanon and Kosovo participated in focus group interviews (FGI). Results: Analysis of the collected data resulted in two main categories: Information about organ donation' and Religious aspects of organ donation and a number of subcategories'. Some of the influencing factors concerning organ donation were mainly related to limited information from society as well as limited information from healthcare professionals. Religious aspects, fear and prejudices about organ donation were other factors that mentioned by participants as hamper regarding organ donation. Conclusion: In order to improve immigrants' attitude towards organ donation, information about this issue and identification of the hampering factors, particularly culturally related factors such as the religious aspect, is essential. In this context, different intervention studies are needed to increase monitories groups' attitude towards organ donations.

  • 46.
    Lehti, Arja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Walking down 'Via Dolorosa' from primary health care to the specialty pain clinic: patient and professional perceptions of inequity in rehabilitation of chronic pain2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 45-53Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic.

    SETTING AND METHODS: This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method.

    RESULTS: The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care.

    CONCLUSION: From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation.

  • 47.
    Lilliehorn, Sara
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Kero, Anneli
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Meaning of work and the returning process after breast cancer: a longitudinal study of 56 women2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 267-274Article in journal (Refereed)
    Abstract [en]

    Background: An increasing number of women survive breast cancer and a majority return to work. However, findings based on mean values may conceal individual processes that need to be better understood to discuss meaningful rehabilitation.

    Aim: The purpose of this paper is to describe the sick-leave pattern of a group of Swedish women with primary breast cancer but foremost to explore their ideas about what motivates and discourages their return to work.

    Method: Fifty-six women were repeatedly interviewed over a period of 18 to 24 months. Interview sections that clearly illustrated the women’s experiences and ideas about work were categorized using the comparative similarities-differences technique.

    Findings: The average length of sick leave was 410 days (range 0-942). Six months after the first day of sick leave, 29% worked at least their previous service grade. At 12 months, 55%, and at 18 months 57% did so. Those treated with chemotherapy had in average more than twice as large sick leave as those who did not. Three categories emerged. ‘Motives for not returning to work’ consists of four sub-categories: ‘I’m still too fragile to return to work’; ‘My workplace is a discouraging place’; ‘I took an opportunity to pause’ and ‘I’ve lost the taste for work’. ‘Motives for returning’ consists of two sub-categories: ‘Work generates and structures my everyday life’ and ‘I miss my workplace’. Finally, ‘Transition in work approach’ reflects a changed approach to work.

    Conclusion: The meaning of work varies over time, but first and foremost work was regarded as an important part of the healing process as it restores the disruption of everyday life. Guidelines cannot be reduced to a linear relationship with biomedical variables but the individual context of everyday life must be considered.

  • 48. Lindahl, Jeanette
    et al.
    Elmqvist, Carina
    Thulesius, Hans
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia .
    Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire - family version2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 859-864Article in journal (Refereed)
    Abstract [en]

    Background: In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed.

    Setting: Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden.

    Method: The Person-centred Climate Questionnaire – Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality – three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P.

    Aim: The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context.

    Results: The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item–total correlations were >0.3 and <0.7.

    Conclusion: In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.

  • 49.
    Lindström, Meta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Wulff, Marianne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Lalos, Ann
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, p. 542-548Article in journal (Refereed)
    Abstract [en]

    Background:  While there exists an extensive amount of research regarding the medical aspects of abortion, there is a great lack of studies investigating staff's views and experiences of working in abortion services.

    Aims:  To elucidate gynaecologists' and midwives'/nurses' experiences, perceptions and interactions working in abortion services, their experiences of medical abortions and abortions performed at the woman's home. An additional aim was to illustrate gynaecologists', midwives' and nurses' visions of their future professional roles within the abortion services.

    Method:  Three focus group discussions within each profession were carried out in 1-hour sessions with a total of 25 gynaecologists and 15 midwives/nurses from three different hospitals.

    Results:  The content analysis reflected that gynaecologists and midwives/nurses had no doubts about participating in abortions despite the fact that they had experienced complex and difficult situations, such as repeat and late-term abortions. They experienced their work as paradoxical and frustrating but also as challenging and rewarding. However, they were rarely offered ongoing guidance and continuously professional development education. For gynaecologists, as well as midwives/nurses, their experiences and perceptions were strongly linked to the concurrent development of abortion methods. The interaction between the professions was found to be based on great trust in each other's skills.

    Conclusions:  In order to promote women's health, gynaecologists' and midwives'/nurses' need for a forum for reflection and ongoing guidance should be acted on. With a higher number of abortions done medically and a higher proportion of home abortions, midwives/nurses will get increased, responsibilities in the abortion services in the future.

  • 50.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Eisemann, Martin
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Nursing.
    Psychometric properties of the Swedish version of the Resilience Scale2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 2, p. 229-237Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate resilience in relation to age and gender, and to elucidate the underlying structure of the Swedish version of the Resilience Scale (RS). The RS, originally created by Wagnild and Young is a 25 items scale of Lickert type with possible scores ranges from 25 to 175, the higher the score, the stronger resilience. A standardized procedure was used for translation. The analysis was based on 1719 participants, 1248 women and 471 men, from eight different samples, aged from 19 to 103 years. We found that the participants estimated their resilience as relatively high. There was a significant relationship between age and resilience, for every year RS score increased with 0.134 units. There was no relation between gender and resilience. From a factor analyses five factors emerged, equanimity, meaningfulness, perseverance, existential aloneness and self-reliance reflecting the five dimensions described by Wagnild and Young.

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