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  • 1.
    Antonsson, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaktion i särskilt boende för personer med utvecklingsstörning och utmanande beteende2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: People with learning disabilities communicate in various ways depending on their abilities. Communication difficulties affect interactions between people with learning disabilities and their professional carers’ and this places a high demand on the carers to interpret and understand each individual’s wishes and needs. At the same time, there is a risk that the carers will be misunderstood. If carers fail to understand what the residents are trying to communicate, and vice versa, situations with challenging behaviour such as an unwillingness to interact or verbal and physical aggression may occur.

    Aim: The overall aim of this thesis was to explore the interactions between adults with learning disabilities and carers in special accommodations as well as to evaluate the effects of an intervention created for carers working with people with learning disabilities at special accommodations.

    Method: The setting for the study was at special accommodations in one county in northern Sweden. In study I, information regarding 556 adults with learning disabilities was collected. In both study II & III, 11 people with learning disabilities and 16 of their carers participated. In study IV, 7 carers and one person with learning disabilities participated. Data in study I consist of carers’ estimations of the residents disabilities and frequency of restraint use. Video-recorded observations and individual narrative interviews were used in study II and study III, and in study IV multiple methods of data collection were used in a mixed method design with both carers’ estimations using instruments and with semi-structured interviews. Methods for analyses in study II, III and IV were qualitative content analysis and in study I and IV statistical analyses were used.

    Results: Study I revealed that of the 556 residents studied, 99 (18%) had been subjected to physical restraint use over the previous week. Of these participants, almost all were subjected to more than one type of restraint. The most commonly used physical restraint was a belt in chair (74%). Use of physical restraint can be related to both physical disabilities and challenging behaviours in the interaction between people with learning disabilities and their carers’. In interviews for study II, the carers reflected on both successful and unsuccessful interactions after viewing video of situations where they have been participating. Examples of successful interactions included understanding cues, satisfying needs, and managing situations with challenging behaviours. The carers’ reflected on how successful interactions could influence their feeling of security, confidence, and satisfaction among the residents. The carers also reflected on the consequences of unsuccessful interactions, which included causing irritation, aggression and violence. In study III, interactions between 11 residents with learning disabilities and 16 of their caregivers were recorded on video. Verbal and non-verbal interaction skills used among the carers were identified. Four ‘caring situations’ were chosen as examples of skilled interactions. The results showed that skilled interactions between the carers and their clients were based on being confirming, sharing daily life experiences, giving time and space, and using congruent and distinct language. Study IV evaluated the effects of a web-based learning intervention, based on a theoretical model, and the results showed an increased ability among the carers to handle situations with challenging behaviour and a decreased frequency of challenging behaviour.

    Conclusion: Physical restraint is commonly used in special accommodations for people with learning disabilities. Use of physical restraint can be related to both physical disabilities and challenging behaviours in the interaction between people with learning disabilities and their carers. Carers find the use of physical restraint difficult and exhausting. A break in communication between people with learning disabilities and their carers could lead to impaired interaction that creates situations of challenging behaviour. When carers are able to interact successfully with people who have limited ability to communicate verbally, it seems to give satisfaction to both the residents and their carers in group homes. Carers often experience helplessness and uncertainty in situations with challenging behaviour and express a need for support. The carers considered the web-based training program to be useful. Further, a decrease of situations of challenging behaviour was observed after the web-based program was implemented. This indicates that the web-based training program may be useful in training for carers, both novices and more experienced carers in special accommodations for people with learning disabilities

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  • 2.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, U
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundström, Mats
    Umeå University, Faculty of Medicine, Department of Nursing.
    Effects and experiences of a web-based training program for professional carers working with people with learning disabilities and challenging behaviourManuscript (preprint) (Other academic)
  • 3.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing. University West, Department of Health Sciences, Trollhättan, Sweden.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing. University West, Department of Health Sciences, Trollhättan, Sweden.
    Lundström, Mats O.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Evaluation of a Web-Based Training Program for Professional Carers Working With People With Learning Disabilities and Challenging Behavior: A Pilot Study with SSED-Design2016In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 37, no 10, p. 734-743Article in journal (Refereed)
    Abstract [en]

    The interaction between people with intellectual disabilities and professional carers is often influenced by communicative difficulties contributing challenging behaviours. The aims of this study were to evaluate to a web-based training program aimed at improving carers' abilities to interact with people with learning disabilities who exhibit challenging behaviours and to explore carers' experiences of participating in such a program. A single-subject experimental design and mixed methods were used to integrate qualitative and quantitative data. Triangulation of questionnaires, interviews with carers, and assessments of one woman's behaviour was performed. The participants were professional carers aged 20 to 55 years. The web-based training program increased carers' abilities to handle challenging behaviours and decreased challenging behaviours in daily care. The program improved the opportunities to offer training to carers who work in community-based accommodations with limited time to receive training.

  • 4.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundström, Mats
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Caregivers' reflections on their interactions with adult people with learning disabilities2008In: Journal of Microscopy, ISSN 0022-2720, E-ISSN 1365-2818, Vol. 15, no 6, p. 484-91Article in journal (Refereed)
    Abstract [en]

    People with learning disabilities and their professional carers often have difficulty interacting. The aim of this study was to illuminate carers' reflections on their interactions with adult people with learning disabilities. In a previous study, interactions between 16 carers and 11 residents with learning disabilities were recorded on video. In this study, stimulated recall interviews about the interactions were carried out with all the carers. The text was analysed using qualitative content analysis. The findings indicate that the carers reflected on both successful and unsuccessful interaction. Examples of successful interaction included understanding cues, satisfying needs, and managing challenging behaviours, and the carers reflected on the influences that successful interaction had on security, confidence, and satisfaction among the residents. Examples of unsuccessful interaction included failing to understand cues, failing to satisfy needs and failing to manage challenging behaviours, and the carers reflected on the consequences of such interaction, which included irritation, aggression and violence among the residents. Our findings have implications for interventions aimed at strengthening the competence of carers and developing strategies for managing challenging behaviour, in order to ensure high-quality care and a good working climate. © 2008 The Authors.

  • 5.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    School Nurses' Attitudes toward Family Involvement in School Healthcare2020In: Health Behavior and Policy Review, ISSN 2326-4403, Vol. 7, no 1, p. 51-58Article in journal (Refereed)
    Abstract [en]

    Objective: We evaluated school nurses' attitudes towards family involvement in school healthcare when children exhibit signs of mental health problems.

    Methods: In a cross-sectional study, the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument was used to measure school nurses' (N = 133) attitudes towards family involvement. Data were analyzed with the Mann-Whitney U-test.

    Results: School nurses (95%) encountered students with mental health problems every day or every week. Overall, school nurses were positive towards family involvement in school healthcare. Primary school nurses were more positive compared to secondary school nurses, seeing the family as a resource and a conversation partner. School nurses who felt that they had insufficient tools to work with children with mental health problems saw the family as a burden compared to school nurses who reported they have sufficient tools.

    Conclusion: School nurses' attitudes toward involving families as a resource are promising. However, when nurses perceive themselves as lacking sufficient tools to respond to children's mental health problems, they are more likely to experience the family as a burden than a resource. Cooperation between school nurses and families may be crucial. Therefore, we suggest a Family Health Conversations model to improve nurse-family collaboration

  • 6.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundström, Mats
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Skilled interaction among professional carers in special accommodations for adult people with learning disabilities2013In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 20, no 7, p. 576-583Article in journal (Refereed)
    Abstract [en]

    ACCESSIBLE SUMMARY: • Communicative difficulties affect interactions between people with learning disabilities and their carers. • Interactions between carers and residents in special accommodations for people with learning disabilities were recorded on video and skilled interactions were illuminated. • Results of the study show that skilled interaction between the carers and the people with learning disabilities is based upon being confirming, sharing daily life experience, giving time and space, and using congruent and distinct language.

    ABSTRACT: Communicative difficulties affect interactions between people with learning disabilities and their carers. Despite such difficulties, however, some carers seem to interact successfully with people who have limited ability to communicate verbally and exhibit challenging behaviour. This study aims to illuminate skilled interaction among carers working in special accommodations for people with learning disabilities. Interactions between 16 caregivers and 11 residents with learning disabilities were recorded on video. Verbal and non-verbal interaction skills among the carers were identified. Four caring situations with people with learning disabilities were chosen to illuminate skilled interaction. The transcribed text was subjected to qualitative content analysis and core stories were created. The results show that skilled interaction between the carers and the people with learning disabilities is based upon being confirming, sharing daily life experience, giving time and space, and using congruent and distinct language. In this paper we present examples that offer concrete suggestions of how to promote successful interaction and create meaning in the shared day-to-day life in special accommodations for people with learning disabilities.

  • 7.
    Lundström, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Antonsson, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Use of physical restraints with people with intellectual disabilities living in Sweden's group homes2011In: Journal of Policy and Practice in Intellectual Disabilities, ISSN 1741-1122, E-ISSN 1741-1130, Vol. 8, no 1, p. 36-41Article in journal (Refereed)
    Abstract [en]

    People with intellectual disabilities (ID) often exhibit physical and communicative difficulties as well as challenging behaviors. Physical restraints are one method used to manage challenging behaviors and promote physical safety for people with ID, their fellow residents, and professional carers. However, there is a lack of data regarding the practice of employing physical restraints in Swedish group homes for people with ID. The aim was to investigate the prevalence of physical restraint use in group homes for people with ID, and to identify the characteristics of individuals subjected to these restraints. The study had a cross-sectional design and included 556 people with ID, aged 16–90 years, living in 118 group homes. Physical restraint use and residents' characteristics were surveyed with a questionnaire. Of the 556 residents studied, 99 (17.8%) had been subjected to physical restraint over the previous week. Of these, 99.2% were subjected to more than one type of restraint. The most commonly used type of physical restraint was a belt (73.7%). Using logistic regression analysis, the independent risk factors strongly associated with being physically restrained were inability to walk independently, impaired speech, screaming and shouting continuously, epileptic seizures, and spasticity. Despite the absence of legal authority for physical restraint use in group homes for people with ID, physical restraints are frequently used in Sweden. Both physical impairments and behavioral symptoms are significantly associated with physical restraint use.

  • 8.
    Pusa, Susanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dorell, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Erlingsson, Christen
    Antonsson, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurses' perceptions about a web-based learning intervention concerning supportive family conversations in home health care2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 7–8, p. 1314-1326Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the perceptions that municipal primary healthcare nurses and municipal registered nurses had about a web-based learning intervention concerning supportive family health conversations in municipal home health care.

    BACKGROUND: Even though family health conversations are well grounded in theory with several reported benefits for patients and families, most working nurses have little or no training in practising family systems nursing including family health conversations. Continued learning is necessary for nurses, where web-based learning may be one answer of updating the professional skills and knowledge of nurses regarding supporting families.

    DESIGN: The study used a descriptive design and followed the "Consolidated criteria for reporting qualitative research" (COREQ) checklist.

    METHODS: Twenty-one nurses participated in an educational intervention that consisted of web-based learning and two face-to-face seminars about family systems nursing including family health conversations. The nurses were interviewed after completion, and the audio-recorded interviews were transcribed verbatim and analysed using qualitative content analysis.

    RESULTS: The findings consist of nurses' perceptions regarding the disposition of instruction, the prerequisites for learning and a changed approach when working with families. The findings are further reflected on through Illeris' theory concerning learning triangle.

    CONCLUSIONS: The findings are encouraging for educating nurses in family health conversations at their workplace, with the purpose of supporting patients and families. However, it is important to be aware of the different dimensions of learning, in addition to the appraisal of social aspects and organisational circumstances when educating nurses as they influence the utilisation of the knowledge.

    RELEVANCE TO CLINICAL PRACTICE: This web-based learning intervention seems to be suitable for educating nurses in family health conversations and could be an appropriate step towards implementing these conversations in home health care with the purpose of supporting families.

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