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  • 1.
    Aléx, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Constructions of various femininities among the oldest old women2006In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 27, no 10, p. 853-872Article in journal (Refereed)
    Abstract [en]

    This study forms part of the Ume 85+ Study, and the aim was to explore various gendered constructions of femininities among the oldest old women. Femininities are seen as various ways of shaping oneself as a woman in relation to the impact of historical, social, and cultural circumstances. Thematic narratives were analyzed using qualitative content analysis. Through interpreting these narratives in the light of gender theories, we were able to discern four femininities: “being connected,” “being an actor,” “living in the shadow of others,” and “being alienated.” The oldest old women displayed complex outlooks on femininities, and no femininity was interpreted as being in the center related to the other femininities. Further research is needed in order to disclose the complexity of femininities related to factors such as social class, ethnicity, and financial situation among the oldest old, and to acquire a greater knowledge of various femininities.

  • 2.
    Aléx, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Allmänmedicin.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Balancing within various discourses: the art of being old and living as a Sami woman.2006In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 27, no 10, p. 873-892Article in journal (Refereed)
  • 3.
    Aléx, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Construction of masculinities among men aged 85 and older in the north of Sweden2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 4, p. 451-459Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to analyse the construction of masculinities among men aged 85 and older. BACKGROUND: All societies have a gender order, constructed from multiple ideas of what is seen as feminine and masculine. As the group of men aged 85 and older is increasing in size and their demand for care will increase, we must recognize the importance of studying these men and various discourses of masculinities. DESIGN: Qualitative explorative. METHODS: Qualitative content analysis was used to analyse thematic narratives. Masculinity theories provided the point of departure for the analysis. RESULTS: The analysis coalesced into three masculinities. 'Being in the male centre', developed from subthemes as: taking pride in one's work and economic situation; being in the centre in relation to others; regarding women as sexual objects; and belonging to a select group. 'Striving to maintain the male facade' developed from subthemes as: emphasizing 'important' connections; having feelings of loss; striving to maintain old norms and rejecting the fact of being old. 'Being related' was formulated from subthemes as: feeling at home with domestic duties; being concerned; accepting one's own aging; and reflecting on life. CONCLUSIONS: Our study indicates the importance of being aware of the existence of multiple masculinities, in contrast to the generally unproblematic and unsubtle particular healthcare approaches which consider men as simply belonging to one masculinity. Relevance to clinical practice. Diverse masculinities probably affect encounters between men and healthcare providers and others who work with an older population and therefore our results are of importance in a caring context.

  • 4.
    Angström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Children undergoing cancer treatment describe their experiences of comfort in interviews and drawings.2014In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 31, no 3, p. 135-46Article in journal (Refereed)
    Abstract [en]

    Children with cancer often undergo a long course of treatment, described as painful, and associated with feelings of discomfort and need of comfort. The aim of this descriptive interview study was to investigate how children, aged 3 to 9 years, undergoing cancer treatment describe their experience of comfort. The children were interviewed and asked to make drawings. Data were content analyzed and four themes were constructed-enduring discomfort, expressing discomfort, finding comfort, and comforting others. The findings show that the children endured discomfort during treatment, and were sometimes able to express it. They found comfort especially from their family and from hospital staff. The children also described that they comforted family members. The findings are in accordance with previous research about children's and adults' accounts of comfort. An incidental finding is that parents were surprised when they listened to the children's accounts of their experience of discomfort and comfort and achieved a better understanding of their children.

  • 5.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Being a palliative nurse for persons with severe congestive heart failure in advanced homecare.2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, p. 314-323Article in journal (Refereed)
    Abstract [en]

    Advanced homecare for persons with congestive heart failure is a ‘new’ challenge for palliative nurses. The aim of this study is to illuminate the meaning of being a palliative nurse for persons with severe congestive heart failure in advanced homecare. Narrative interviews with 11 nurses were conducted, tape-recorded, and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. One meaning of being a palliative nurse is being firmly rooted and guided by the values of palliative culture. Being adaptable to the patient's way of life carries great weight. On one hand nurses live out this value, facilitating for the patients to live their everydaylife as good as possible. Being a facilitator is revealed as difficult, challenging, but overall positive. On the other hand nurses get into a tight corner when values of palliative culture clash and do not correspond with the nurses interpretation of what is good for the person with congestive heart failure. Being in such a tight corner is revealed as frustrating and giving rise to feelings of inadequacy. Thus, it seems important to reflect critical on the values of palliative culture.

  • 6.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Ekman, Inger
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Living with severe chronic heart failure in palliative advanced home care.2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 4, p. 295-302Article in journal (Refereed)
    Abstract [en]

    Background - Living with severe chronic heart failure (CHF) in palliative care has been little studied.

    Aim - The aim of this study is to illuminate meaning of living with severe CHF in palliative advanced home care through patients' narratives.

    Methods-Narrative interviews were conducted with 4 patients, tape-recorded and transcribed verbatim. A phenomenological–hermeneutic method was used to interpret the text.

    Results - Meaning of living with severe CHF in palliative advanced home care emerged as ‘knocking on death's door’ although surviving. The course of the illness forces one to live a ‘roller coaster life,’ with an ongoing oscillation between ups and downs. Making it through the downs breeds a kind of confidence in one's ability to survive and the will to live is strong. Being offered a safety belt in the ‘roller coaster’ by the palliative advanced home care team evokes feelings of security.

    Conclusions - Meaning of living with severe CHF in palliative advanced home care is on one hand, being aware of one's imminent death, on the other hand, making it through the downs i.e. surviving life-threatening conditions, breed confidence in also surviving the current down. Being constructively dependent on palliative advanced home care facilitates everyday life at home.

  • 7.
    Choowattanapakorn, Tassana
    et al.
    Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Resilience among women and men aged 60 years and over in Sweden and in Thailand2010In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 12, no 3, p. 329-335Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to compare the level of resilience of people aged > or = 60 years in Sweden and Thailand. In a randomized sample of 422 people in Sweden and a convenience sample of 200 people in Thailand, the level of resilience was measured by using the Resilience Scale. A chi(2)-analysis was used for the differences between proportions. The relationships between the background variables and the resilience scores were analyzed by using stepwise multiple linear regression. The mean scores of resilience were 144 for the Swedish participants and 146 for the Thai participants. The two samples differed in their background characteristics. The Thai participants were more likely to be women, to be widowed, and to have more children, while among the Swedish participants, more women were married and more participants were aged > or = 80 years. Despite different background characteristics, the Swedish and the Thai participants' scores were almost the same on the Resilience Scale. More studies are necessary to address aspects of gender and ethnicity in relation to resilience.

  • 8.
    Dahlqvist, Vera
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
    Glasberg, Ann-Louise
    Umeå University, Faculty of Medicine, Nursing.
    Lindahl, Elisabeth
    Umeå University, Faculty of Medicine, Nursing.
    Lützén, Kim
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Nursing.
    Sørlie, Venke
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Development of the perceptions of conscience questionnaire.2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 2, p. 181-193Article in journal (Refereed)
    Abstract [en]

    Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses' assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers.

  • 9.
    Dahlqvist, Vera
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Omvårdnad.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Dealing with stress: Patterns of self-comfort among healthcare students.2008In: Nurse Education Today, ISSN 0260-6917, Vol. 28, no 4, p. 476-584Article in journal (Refereed)
  • 10.
    Dahlqvist, Vera
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Facing inadequacy and being good enough: psychiatric care providers' narratives about experiencing and coping with troubled conscience2009In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, no 3, p. 242-247Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to illuminate the meaning of encounters with a troubled conscience among psychiatric therapists. Psychiatric care involves ethical dilemmas which may affect conscience. Conscience relates to keeping or losing a sense of personal integrity when making judgments about one's actions. Ten psychiatric therapists were interviewed in June 2006. The interviews were tape-recorded, transcribed verbatim and interpreted using a phenomenological-hermeneutic method. Two themes 'Facing inadequacy' and 'Struggling to view oneself as being 'good enough'' are presented. In the therapists interviewed, awareness of their use of power, a sense of powerlessness and a sense of blame gave rise to feelings of betrayals and shameful inadequacy. By sharing their inadequacy with co-workers, they managed to endure the sense of their inadequacy which otherwise would have threatened to paralyse them. Finding consolation in sharing wearing feelings, becoming realistic and attesting their worthiness, they reached reconciliation and found confirmation of being good enough. The findings are interpreted in light of Lögstrup's ethics of trust, according to which conscience alerts us to silent but radical ethical demand and the risk of self-deception.

  • 11.
    Eggers, Thomas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ekman, Sirkka-Liisa
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nursing Staff's Understanding Expressions of People With Advanced Dementia Disease2013In: Research and Theory for Nursing Practice, ISSN 1541-6577, E-ISSN 1945-7286, Vol. 27, no 1, p. 19-34Article in journal (Refereed)
    Abstract [en]

    People with advanced dementia disease (ADD) are known to have communication difficulties and thus it presents a challenge in understanding the expressions of these people. Because successful communication presupposes cooperation at least between 2 individuals, both individual's actions must be acknowledged. The aim of this study is to describe nursing staff's ways of understanding the expressions of people with ADD when communicating with them. Interviews from 8 nursing staff were analyzed using qualitative content analysis. Two themes were constructed: "Being in communication" and "Doing communication." Being in communication means that nursing staff perceive people with ADD as being capable of communication. Doing communication means that nursing staff attempt different individualized strategies to understand what people with ADD communicate. Good care of people with ADD presupposes nursing staff that are willing and able to relate to other people and to maintain good care for people with ADD continuous education and supervision are needed.

  • 12.
    Eggers, Thomas
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Ekman, Sirkka-Liisa
    Counteracting fragmentation in the care of people with moderate and severe dementia.2005In: Clinical Nursing Research, ISSN 1054-7738, Vol. 14, no 4, p. 343-69Article in journal (Refereed)
  • 13. Ekman, Inger
    et al.
    Swedberg, Karl
    Taft, Charles
    Lindseth, Anders
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brink, Eva
    Carlsson, Jane
    Dahlin-Ivanoff, Synneve
    Johansson, Inga-Lill
    Kjellgren, Karin
    Lidén, Eva
    Öhlén, Joakim
    Olsson, Lars-Eric
    Rosén, Henrik
    Rydmark, Martin
    Sunnerhagen, Katharina Stibrant
    Person-centered care -ready for prime time.2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 4, p. 248-251Article in journal (Refereed)
    Abstract [en]

    Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.

  • 14.
    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.

  • 15.
    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.

  • 16.
    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.

  • 17. Fagerberg, Ingegerd
    et al.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    "Learning by doing": or how to reach an understanding of the research method phenomenological hermeneutics2009In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 29, no 7, p. 735-739Article in journal (Refereed)
    Abstract [en]

    One problem addressed in teaching graduate students qualitative research methods is practising the cognitive and conative skills that students need to generate both rich data and meaningful analysis. The aim of the study was to illuminate development in a group of pre-doctoral and doctoral students as they learnt the phenomenological hermeneutics research method. In a course comprising 18 doctoral students we used the "guided path" pedagogical approach and decided to use a subject of which everyone has lived experience, "troubled conscience", for the phenomenological hermeneutic analysis conducted with the students. As the students progressed in their learning experience of the research method, they analysed their data according to the steps in the method, and we as teachers conducted separate analyses of the same data. The results point in the same direction as previous studies in the field. This is discussed in terms of strength of the pedagogical approach and the students' learning, since despite the fact that their data are limited and not very detailed they were able to come up with results that were in line with previous research.

  • 18.
    Fischer, Regina Santamäki
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Feeling whole: the meaning of being consoled narrated by very old people2010In: The journal of pastoral care & counseling : JPCC, ISSN 1542-3050, Vol. 64, no 1, p. 3.1-12Article in journal (Refereed)
    Abstract [en]

    Interviews with 13 people, over 85 years, with high scored Self-transcendence, were analyzed using a phenomenological hermeneutic method. The meaning of being consoled was interpreted to Feeling whole, an immediate experience of: being carried and embraced by God (Feeling connected to God), supported by the loving care and affection from others (Feeling connected to fellow beings and the world), being relaxed, peaceful and full of joy and experiencing hope (Being connected to self).

  • 19.
    Fischer, Regina Santamäki
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Embracing opposites: meanings of growing old as narrated by people aged 852008In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 67, no 3, p. 259-271Article in journal (Refereed)
    Abstract [en]

    Many old people suffer from prolonged and multiple bodily ailments, new diseases, and increased risk for disadvantages and losses in life. Aging also means becoming mature and wise. This study illuminates the meaning of the lived experience with respect to changes in late life. Using a phenomenological hermeneutic method, this study analyzes transcribed interviews of 15 85-year-old people. Four themes were formulated: embracing weakness and strength, embracing slowness and swiftness of time, embracing reconciliation and regret, and embracing connectedness and loneliness. From these analyses, growing old was described as—maintaining one's identity in spite of the changes that come with aging and, embracing opposites—being changed and feeling being the same.

  • 20. 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.

  • 21. Fjelltun, Aud-Mari Sohini
    et al.
    Henriksen, Nils
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gilje, Fredricka
    Normann, Hans Ketil
    Carers' experiences with overnight respitecare: a qualitative study2009In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 29, no 3, p. 23-27Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to explore experiences with overnight respite care (ORC) of Norwegian carers who provided care to frail elderly awaiting nursing home placement.

    Background In many Western countries respite care has become part of health care service provision, and various types of respite care are available. The intent with respite care can be twofold; caring for the care receiver and supporting the carer.

    Methods This was a descriptive qualitative study. Interviews were conducted with 15 carers, transcribed and analysed by qualitative content analysis.

    Findings The carers described various experiences with ORC. If ORC supported the family unit, it was welcomed by carers and experienced as supportive. If ORC did not support the family unit, many carers rejected ORC, and it was experienced as non-supportive. Two categories were constructed: 'experiencing ORC as supportive for the family as a unit' and 'not experiencing ORC as supportive for the family as a unit'.

    Conclusion To support more carers, nurses have to listen to carers’ experiences about ORC. Nurses need to take responsibility for the family as a unit and provide more flexible ORC services based on both carers’ and elderly’s needs.

  • 22. 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.

  • 23. Gilje, Fredricka
    et al.
    Talseth, Anne-Grethe
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Psychiatric nurses' response to suicidal psychiatric inpatients: struggling with self and sufferer.2005In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, Vol. 12, no 5, p. 519-26Article in journal (Refereed)
  • 24.
    Glasberg, Ann-Louise
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Dahlqvist, Vera
    Umeå University, Faculty of Medicine, Nursing.
    Lindahl, Elisabeth
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Nursing.
    Sørlie, Venke
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Development and initial validation of the Stress of Conscience Questionnaire2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 6, p. 633-648Article in journal (Refereed)
    Abstract [en]

    Stress in health care is affected by moral factors. When people are prevented from doing 'good' they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach's alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: 'internal demands' and 'external demands and restrictions'. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.

  • 25.
    Glasberg, Ann-Louise
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Burnout and 'stress of conscience' among healthcare personnel.2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 4, p. 392-403Article in journal (Refereed)
  • 26.
    Glasberg, Ann-Louise
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Omvårdnad.
    Sources of burnout among healthcare employees as perceived by managers.2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 60, no 1, p. 10-19Article in journal (Refereed)
  • 27.
    Gustafsson, Gabriella
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Burnout and perceptions of conscience among health care personnel: a pilot study.2010In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, no 1, p. 23-38Article in journal (Refereed)
    Abstract [en]

    Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one's conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group.

  • 28.
    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.

  • 29.
    Gustafsson, Gabriella
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Persson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personality traits among burnt out and non-burnt out health-care personnel at the same workplaces: a pilot study.2009In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 18, no 5, p. 336-348Article in journal (Refereed)
    Abstract [en]

    Stress-related illnesses, such as burnout, have increased over the last decade, but not everyone at the same workplace develops burnout, suggesting that individual factors may contribute to this phenomenon. The aim of this study was to describe patterns of personality traits among two groups of health-care personnel from the same workplaces, one group on sick leave due to medically-assessed burnout, and one group with no indication of burnout, respectively. Fourteen psychiatric- (n = 7) and elderly (n = 7)-care units, located in one specific area in a municipality in northern Sweden, participated in this questionnaire-based study. The participants (n = 40), on sick leave due to medically-assessed burnout (n = 20), and those with no indication of burnout (n = 20), respectively, completed Cattell's 16 Personality Factors Questionnaire between February and December 2004. Conventional statistical methods and partial least square regression were used to analyze data. The results showed that the burnout group had lower scores regarding emotional stability and higher scores regarding anxiety than the non-burnout group, but the results also showed a wide variation of personality traits within groups. The most important indicators for belonging to the burnout group were 'openness to changes' and 'anxiety', and for belonging to the non-burnout group, 'emotional stability', 'liveliness', 'privateness' (i.e. forthright or discreet), and 'tension'. The result indicates complex interactions between personality traits and the context in which the individual lives. It seems to be important to increase our awareness of when personality traits may constitute opportunities versus risks in dealing with one's existing circumstances.

  • 30. Hedman, Ragnhild
    et al.
    Hansebo, Görel
    Ternestedt, Britt-Marie
    Hellström, Ingrid
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Sköndal University College, Stockholm.
    Expressed Sense of Self by People With Alzheimer’s Disease in a Support Group Interpreted in Terms of Agency and Communion2016In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 35, no 4, p. 421-443Article in journal (Refereed)
    Abstract [en]

    The self is constructed in cooperation with other people and social context influences how people perceive and express it. People with Alzheimer's disease (AD) often receive insufficient support in constructing their preferred selves, but little is known about how they express themselves together with other people with AD. In accordance with Harré's social constructionist theory of self, this study aimed to describe how five people with mild and moderate AD express their Self 2 (i.e., their personal attributes and life histories) in a support group with a facilitator experienced in communicating with people with AD. The participants' expressions of their Self 2 were analyzed with qualitative abductive content analysis and interpreted in terms of agency and communion and a lack of agency and communion. The findings highlight the importance of supporting a sense of agency and communion when assisting people with AD in constructing their self.

  • 31. Hedman, Ragnhild
    et al.
    Hansebo, Görel
    Ternestedt, Britt-Marie
    Hellström, Ingrid
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    How people with Alzheimer's disease express their sense of self: analysis using Rom Harre's theory of selfhood2013In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 12, no 6, p. 713-733Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to use Harré's social constructionist theory of selfhood to describe how people with mild and moderate Alzheimer's disease (AD) express their sense of self. The findings show that Self 1, the embodied sense of being a person, was expressed fluently by participants through the use of first-person indexicals. Self 2, the experienced personal attributes and life narrative, had undergone changes. Those changes were not entirely for the worse; participants had also developed new skills in managing life with AD. In a lifetime perspective, those changes were minor and participants perceived themselves to be basically the same people that they were before having AD. When constructing Self 3, the social personae, participants usually described being supported by others, but sometimes described being exposed to malignant positioning. They also feared that they might become more exposed to negative attitudes as their AD progressed. However, participants were understanding towards the offensive behaviours of others.

  • 32. Hedman, Ragnhild
    et al.
    Hellstrom, Ingrid
    Ternestedt, Britt-Marie
    Hansebo, Gorel
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Social positioning by people with Alzheimer's disease in a support group2014In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 28, p. 11-21Article in journal (Refereed)
    Abstract [en]

    People with Alzheimer's disease (AD) are often negatively positioned by others, resulting in difficulties upholding a positive sense of self. This might cause them to withdraw socially and apparently 'lose their minds'. Conversely, the sense of self can be strengthened with the support from others. This study aimed to describe, in accordance with positioning theory, how people with moderate AD positioned themselves and each other in a support group for people with AD. We describe five first-order positions; the project manager, the storyteller, the moral agent, the person burdened with AD, and the coping person. In the interactions that followed among the support group participants, those positions were mainly affirmed. This enabled participants to construct strong and agentic personae, and to have the severity of their illness acknowledged. Despite their language impairment participants managed to position and reposition themselves and others by assistance of the trained facilitator.

  • 33. Hellzen, Ove
    et al.
    Asplund, Kenneth
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Omvårdnad.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    The meaning of caring as described by nurses caring for a person who acts provokingly: an interview study.2004In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 18, no 1, p. 3-11Article in journal (Refereed)
  • 34.
    Henriksen, Nils
    et al.
    UiT The Arctic University of Norway.
    Sohini Fjelltun, Aud-Mari
    University Hospital of North Norway.
    Normann, Hans Ketil
    UiT The Arctic University of Norway.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Sköndal University College.
    Nursing home placement in Norway: characteristics of older people assigned to placement2015In: Nordisk sygeplejeforskning, ISSN 1892-2678, E-ISSN 1892-2686, Vol. 5, no 2, p. 133-150Article in journal (Refereed)
    Abstract [en]

    To determine the characteristics of older people assigned to nursing home placement and to illuminate the factors emphasised in the assignments, thirty-two home health care leaders in a Norwegian municipality completed a questionnaire regarding their assessment of the levels of functioning of the assigned individuals. These assessments were compared with assessments of individuals who had been placed on a waiting list to receive an assignment and of residents who had already been admitted to a nursing home. The individuals who had received assignments had higher rates of cognitive impairment, memory disturbances, disorientation and psychiatric symptoms compared with the individuals awaiting placement. The individuals with assignments had better motor function and a greater ability to accomplish daily activities without assistance than those in the other two groups. The physical workloads were the lowest for the carers of older people assigned to placement. Individuals without cognitive impairment and with low/worse motor function had to wait longer for nursing home placement than individuals with cognitive impairment. Older people with low/worse motor function required more assistance with their daily activities from informal carers. The implications for nursing are to recognise the physical workloads of carers and the necessity of offering them respite and support.

  • 35.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and 'behavioural disturbances', and on her care providers2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 36, no 2, p. 256-265Article in journal (Refereed)
    Abstract [en]

    AIM: The study aims to illuminate how one woman with severe dementia and so-called behavioural disturbances acts in relation to her care providers and how the care providers act in relation to her. METHODS: Fourteen participant observations, including one woman with dementia and six care providers, were performed. A reflective dialogue focusing on the interaction between the woman and her care providers followed each observation. The tape-recorded observational notes and reflective dialogues were fixed as a text, which was subjected to a thematic content analysis. FINDINGS: The main findings are that the interaction between a woman with severe dementia and "behavioural disturbances" and her care providers relates to privacy, identity, autonomy and security. The phenomena are intertwined and also in conflict with each other. Interaction is a complex dialectic process in which those who are engaged meet problems that can be solved and are involved in dilemmas that cannot be solved, only related to.

  • 36.
    Håkanson, Cecilia
    et al.
    Stockholm, Sweden.
    Cronfalk, Berit Seiger
    Stockholm, Sweden; Stord Haugesund University College, Norway.
    Henriksen, Eva
    Stockholm, Sweden.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Palliative Research Centre, Ersta University College and Ersta Hospital, Stockholm, Sweden.
    Ternestedt, Britt-Marie
    Stockholm, Sweden.
    Sandberg, Jonas
    Stockholm, Sweden; Jönköping, Sweden.
    First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care2014In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 8, p. 71-78Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.

  • 37.
    Hörnsten, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Psychosocial maturity among people with diabetes mellitus2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 6, p. 777-784Article in journal (Refereed)
    Abstract [en]

    There is a relationship between coping with chronic illness and a person's psychosocial development.

    The aim of this study was to describe dimensions of psychosocial development based on results of a previous factor analysis of the Modified Erikson Psychosocial Stage Inventory among people with type 2 diabetes.

    Interviews were carried out with 10 people with diabetes. The transcribed interviews were analysed by qualitative content analysis into main categories, categories and themes.

    The categories were trust, lack of trust, positive identity, identity confusion, integrity and lack of integrity. Themes that permeated the categories in a positive way were 'activity' and 'involvement', while themes that permeated the categories in a negative way were 'passivity' and 'alienation'. Our interpretation is that the category 'trust' is the basis for 'identity', and together 'trust' and 'identity' are the basis for maturity and 'integrity'.

    A conclusion is that positive psychosocial maturity has to do with attaining trust, identity and integrity through activity and involvement. Qualities important for maturation through trust, identity and integrity are understanding, capacity, purposefulness and fortitude. Our interpretation of maturity is considered as being an important and interesting focus in nursing, while the above related qualities are closely connected to coping with diabetes.

  • 38.
    Johan, Åhlin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Astrid, Norberg
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Sköndal Högskola, Ersta Sköndal University College .
    Ternestedt, Britt-Marie
    Ersta Sköndal Högskola, Ersta Sköndal University College .
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Care providers’ narrated experiences of working in private residential care for older people during downsizing and reorganisation with focus on troubled conscienceArticle in journal (Refereed)
  • 39.
    Jonsén, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sense of meaning in life among the oldest old people living in a rural area in northern Sweden2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, p. 221-229Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Having meaning in life is important for all people, and according to Erikson's developmental theory, this is especially true for older adults. However, there are few studies about meaning in life focusing on the oldest old.

    AIM: The aim of our study was to illuminate the sense of meaning in life in the oldest old living in northern Sweden.

    DESIGN: The study has a qualitative explorative and interpretative design.

    METHOD: We interviewed three men and seven women between 85 and 95 years old and analysed the interviews using qualitative content analysis.

    FINDINGS: Our findings revealed the following four themes: 'Creating space for living', 'Living in connection with others and nature', 'Seeing oneself as a link between generations' and 'Having trust in God'.

    CONCLUSIONS: The sense of meaning in life in the oldest old was linked to regarding oneself as having a mission to carry out and to finding beauty, joy and happiness in life. The sense of meaning involved transferring to coming generations what earlier generations had left and having a deeply rooted faith in being taken care of from birth to the afterlife.

    IMPLICATIONS FOR PRACTICE: When caring for the oldest old, it is important to take their experiences of sense of meaning in life into consideration and to focus on ways to maintain important sources of meaning in life.

  • 40.
    Juthberg, Christina
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Omvårdnad.
    Perceptions of conscience in relation to stress of conscience.2007In: Nursing Ethics, ISSN 0969-7330, Vol. 14, no 3, p. 329-343Article in journal (Refereed)
  • 41.
    Juthberg, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Perceptions of conscience, stress of conscience and burnout among registered nurses and nurse assistants in municipal residential care of older people2010In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 66, no 8, p. 1708-18Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study of patterns of perceptions of conscience, stress of conscience and burnout in relation to occupational belonging among Registered Nurses and nursing assistants in municipal residential care of older people.Background. Stress and burnout among healthcare personnel and experiences of ethical difficulties are associated with troubled conscience. In elder care the experience of a troubled conscience seems to be connected to occupational role, but little is known about how Registered Nurses and nursing assistants perceive their conscience, stress of conscience and burnout.Method. Results of previous analyses of data collected in 2003, where 50 Registered Nurses and 96 nursing assistants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire and Maslach Burnout Inventory, led to a request for further analysis. In this study Partial Least Square Regression was used to detect statistical predictive patterns.Result. Perceptions of conscience and stress of conscience explained 41·9% of the variance in occupational belonging. A statistical predictive pattern for Registered Nurses was stress of conscience in relation to falling short of expectations and demands and to perception of conscience as demanding sensitivity. A statistical predictive pattern for nursing assistants was perceptions that conscience is an authority and an asset in their work. Burnout did not contribute to the explained variance in occupational belonging.Conclusion. Both occupational groups viewed conscience as an asset and not a burden. Registered Nurses seemed to exhibit sensitivity to expectations and demands and nursing assistants used their conscience as a source of guidance in their work. Structured group supervision with personnel from different occupations is needed so that staff can gain better understanding about their own occupational situation as well as the situation of other occupational groups.

  • 42.
    Juthberg, Christina
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Eriksson, Sture
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Omvårdnad.
    Stress of conscience and perceptions of conscience in relation to burnout among care-providers in older people.2008In: Journal of Clinical Nursing, ISSN 1365-2702, Vol. 17, no 14, p. 1897-1906Article in journal (Refereed)
  • 43.
    Langø Kristiansen, Per Jørgen
    et al.
    The Arctic University of Norway, Norway.
    Normann, Hans K
    The Arctic University of Norway, Norway.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Sköndal University College.
    Fjelltun, Aud-Mari
    Tromsø, Norway.
    Skaalvik, Mari W
    The Arctic University of Norway, Norway.
    How do people in the early stage of Alzheimer's disease see their future?2017In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 16, no 2, p. 145-157Article in journal (Refereed)
    Abstract [en]

    Older people fear Alzheimer's disease. Central to the fear of the disease is the dread of the loss of identity or self. The aim of this study is to investigate the thoughts people in an early stage of Alzheimer's disease have about their future selves, and the consequences these thoughts have for their temporary lives. The concepts of future and self are understood in terms of the concepts 'possible selves' and 'selfhood'. The participants in the study are two men in their early 60 s. The data consist of four individual interviews and 11 facilitated family conversations including two of their next of kin. The data were collected over a two-year period. The data were interpreted using a hermeneutic analysis inspired by Gadamer. The main findings were the efforts made by the participants to live in the present and their worries about a future as 'living dead'.

  • 44.
    Lindahl, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Gilje, Fredricka
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Striving for purity: shared understandings in retired Swedish care providers' narratives on nursing care around 1950.2004In: Journal of Holistic Nursing, ISSN 0898-0101, Vol. 22, no 4, p. 333-350Article in journal (Refereed)
  • 45.
    Lindahl, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gilje, Fredricka
    University of Alaska Anchorage, USA.
    Norberg, Astrid
    Ersta Sköndals University College, Sweden.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurses' ethical reflections on caring for people with malodorous exuding ulcers2010In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, no 6, p. 777-790Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to illuminate nurses' reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews were analysed using qualitative content analysis. Our interpretations of participants' reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to 'do good' and 'be good'. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to 'do good' for patients and 'be good' nurses.

  • 46.
    Lindahl, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Omvårdnad.
    The meaning of caring for people with malodorous exuding ulcers.2008In: Journal of Advanced Nursing, ISSN 1365-2648, Vol. 62, no 2, p. 163-71Article in journal (Refereed)
  • 47.
    Lindahl, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Omvårdnad.
    The meaning of living with malodorous exuding ulcers.2007In: Journal of Nursing and Healthcare of Chronic Illnes in association with Journal of Clinical Nursing, ISSN 0962-1067, Vol. 16, no 3A, p. 68-75Article in journal (Refereed)
  • 48. Lindseth, Anders
    et al.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    A phenomenological hermeneutical method for researching lived experience.2004In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 18, no 2, p. 145-53Article in journal (Refereed)
  • 49.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fischer, Regina Santamäki
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inner strength in relation to functional status, disease, living arrangements, and social relationships among people aged 85 years and older2012In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 33, no 3, p. 167-176Article in journal (Refereed)
    Abstract [en]

    Inner strength is described as an important resource that promotes well-being. We used data from a sample of 185 people in the Umeå 85+ cohort study to relate inner strength and its attributes to objective health variables. The Resilience, Sense of Coherence, Purpose in Life, and Self-Transcendence scales were used to assess aspects of inner strength, and strong correlations between the scales were found. Prevalence of heart failure, chronic obstructive pulmonary disorder, osteoporosis, or diagnosed depression was associated with low inner strength. Significant relationships were also found between high inner strength and various measures of social relationships. Participants with a higher degree of inner strength had better physical health and more satisfying social relationships. The promotion of inner strength should be a major aim of geriatric nursing.

  • 50.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inner strength-A theoretical analysis of salutogenic concepts.2010In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, International journal of nursing studies, ISSN 1873-491X, Vol. 47, no 2, p. 251-260Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Theoretical and empirical overlaps between the concepts of resilience, sense of coherence, hardiness, purpose in life, and self-transcendence have earlier been described as some kind of inner strength, but no studies have been found that focus on what attributes these concepts have in common. OBJECTIVES: The objective of this study was to perform a theoretical analysis of the concepts of resilience, sense of coherence, hardiness, purpose in life, and self-transcendence, in order to identify their core dimensions in an attempt to get an overarching understanding of inner strength. PRINT METHOD: An analysis inspired by the procedure of meta-theory construction was performed. The main questions underlying the development of the concepts, the major paradigms and the most prominent assumptions, the critical attributes and the characteristics of the various concepts were identified. RESULTS: The analysis resulted in the identification of four core dimensions of inner strength and the understanding that inner strength relies on the interaction of these dimensions: connectedness, firmness, flexibility, and creativity. These dimensions were validated through comparison with the original descriptions of the concepts. CONCLUSION: An overarching understanding of inner strength is that it means both to stand steady, to be firm, with both feet on the ground and to be connected to; family, friends, society, nature and spiritual dimensions and to be able to transcend. Having inner strength is to be creative and stretchable, which is to believe in own possibilities to act and to make choices and influence life's trajectory in a perceived meaningful direction. Inner strength is to shoulder responsibility for oneself and others, to endure and deal with difficulties and adversities. This knowledge about inner strength will raise the awareness of the concept and, in turn, hopefully increase our potential to support people's inner strength.

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