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  • 1.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Björck, Martin
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Wanhainen, Anders
    Patients' experiences of being informed about having an abdominal aortic aneurysm: a follow-up case study five years after screening2009In: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 27, no 3, p. 70-74Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe patients' experiences 5 years after being informed about having an abdominal aortic aneurysm (AAA), at screening, in a subgroup of patients who suffered a decrease in quality of life (QoL) 12 months after screening. Of 6 patients with a decreased QoL 12 months after AAA screening, one had died, one declined to participate and one suffered cognitive problems and was therefore excluded. The remaining 3 patients (all men, aged 79-80 years) were interviewed in their homes. The interviews were analysed using thematic content analysis. The result shows that the patients have feelings of security about offered professional care, despite awareness of having an AAA. These feelings include having a relationship of trust with the surgeon; having trust in screening, follow-up checks and the possible treatment for their AAAs; and having awareness of the severity of the disease. Furthermore, the patients experience having an AAA to be symbolically 'like a drop in the ocean.' This means having no physical problems related to AAA, and having more difficulties with other diseases or problems in life overshadows the awareness about the AAA. An observed reduction in QoL among subjects with screening-detected AAA was mainly explained by other diseases or problems that overshadow the AAA. However, the low number of participants indicates a need for extended studies on this topic.

  • 2.
    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.

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

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

  • 4.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Ekman, Inger
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Narratives of a man with severe chronic heart failure and his wife in palliative advanced home care over a 4.5-year period.2007In: Contemporary Nurse, ISSN 1037-6178, Vol. 27, no 1, p. 10-22Article in journal (Refereed)
  • 5.
    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.

  • 6.
    Burström, Marianne
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Manliga patienter med hjärtsvikt och deras erfarenheter av att vara trygga och otrygga2007In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 3, no 27, p. 24-28Article in journal (Refereed)
    Abstract [en]

    To be safe is a basic human need. Although feelings of being unsafe has been identified as a common problem among persons who live with heart failure there are few qualitative studies focusing on the problem. The aim of this study was to describe what it means to be safe or unsafe for men with heart failure. Seven men with heart failure, functional class NYHA II-III, were interviewed in focus groups. The interviews were analysed with content analysis. Threat of sudden death was described as both a source of safety and unsafety, and living with a fear of drowning in their own body fluid was seen as a source of unsafety for the men. In meetings with caregivers and relatives it was of importance to be received as a unique and valuable person. The confidence to the heart specialist was almost supernatural and the specialist nurse was spoken about as valuable for the feeling of being safe. In conclusion, to be seen with respect by physicians and nurses who have good ability to listen to the men's experience of living with heart failure can probably increase the men's feelings of safety. Further, it is important that physicians and nurses have good knowledge about heart failure.

  • 7.
    Burström, Marianne
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Life experiences of security and insecurity among women with chronic heart failure2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 4, p. 816-825Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study illuminating womens experiences of living with chronic heart failure with a focus on feelings of security and insecurity.

    Background. To be secure is a basic human need. Although feelings of being insecure has been found to be a common problem among people who live with chronic heart failure few qualitative studies, particularly among women, have been carried out in the field.

    Method. Eight women took part in focus group interviews during 2006. The data were analysed using qualitative content analysis. Findings. The womens feelings of security include acceptance of the past, everyday life and the future, trusting the self and the body despite the disease, not having to deal with dependency alone, and faith in care and treatment. The womens feelings of insecurity include feeling guilty for being sick and incapacitated, fear of living with a frail and failing body, anxiety about growing dependence on others, loneliness and death and lack of faith in care and treatment.

    Conclusion. The outlook on the past, the present and the view about the future, can be fundamental for the quality of life, and the sense of security and insecurity among women living with chronic heart failure. To support a sense of security it seems essential that nursing staff attempt to understand the womens outlook on life and their personal interpretations of living with chronic heart failure. This can be crucial for enhancing feelings of security in daily life for these women.

  • 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.
    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.

  • 10.
    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.

  • 11.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Renström, Anna-Stina
    Hospital of Skellefteå City.
    Åhlin, Johan
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Relatives' perceptions of residents' life in a municipal care facility for older people with a focus on quality of life and care environment2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, p. 160-169Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

  • 12.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Being closely connected to health care providers experiencing burnout: putting one's life on hold to help.2010In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 16, no 1, p. 101-123Article in journal (Refereed)
    Abstract [en]

    Being closely connected to a person experiencing illness may be a trying experience.This study aimed to illuminate meanings of being closely connected to health care providers experiencing burnout. Ten interviews were conducted with five people closely connected (i.e., family members or supportive friends) to health care providers recovering from burnout. The interviews were tape-recorded and transcribed verbatim, and the resulting text was interpreted using a phenomenological-hermeneutic method. One consequence of being closely connected to health care providers experiencing burnout is putting one's life on hold to help. In facing an almost unmanageable burden, those closely connected revealed their own suffering, emphasizing their need for support. Health care professionals need to be aware that those who are closely connected to a person experiencing burnout may lack knowledge about burnout and its related challenges. It is to be hoped such knowledge would allow significant others to better support the person experiencing burnout and promote their own health.

  • 13.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Burnout - co-workers' perceptions of signs preceding workmates' burnout2007In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 60, no 2, p. 199-208Article in journal (Refereed)
  • 14.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Care providers learning to deal with troubled conscience through participatory action research2013In: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 11, no 4, p. 386-402Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify a process to assist care providers in dealing constructively with their troubled conscience generated by a difficult situation in elderly care relating to spitting behaviour. Our idea was, with help from participatory action research (PAR), that sharing and reflecting with others upon the voice of conscience, may support care providers to find ways to deal constructively with troubled conscience. Care providers in municipal elderly care participated in intervention sessions over one year, and with support from PAR, they were able to learn to ease the burden of a troubled conscience. They dealt with their troubled conscience constructively by sharing their thoughts and feelings, and gaining more knowledge about behavioural symptoms. They were trying to take relevant measures when caring for the resident, and perceiving the behaviour as unintentional. In this study PAR contributes with increased understanding of the necessity to listen to one's conscience and of the possibility of using conscience as a driving force, to develop clinical practice. This contribution of PAR may in the long run increase quality of care and work-related health.

  • 15.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Care providers’ troubled conscience related to an implementation of a time management system in residential care for older people: a participatory action research study2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 16.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dealing with troubled conscience in municipal care of older people2013In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 3, p. 300-311Article in journal (Refereed)
    Abstract [en]

    Troubled conscience may jeopardize the health of health-care personnel and, hence, the quality of care provided. Learning more about how personnel deal with their troubled conscience therefore seems important. The aim of this study was to describe personnel's experiences of how they deal with troubled conscience generated in their daily work in municipal care of older people. Interviews were conducted with 20 care providers and analysed with a thematic content analysis. The findings show that in order to deal with troubled conscience, personnel dialogued with themselves and with others. They took measures in a direction they perceived to be correct, and they expressed a need for distancing and re-energizing. It is of importance to share situations that generate troubled conscience in order to find ways to deal with them. Reconsidering one's ways of dealing with troubled conscience may give care providers an opportunity to reach consensus within themselves.

  • 17.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Learning to deal constructively with troubled conscience related to care providers' perceptions of deficient teamwork in residential care of older people: a participatory action research study2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 215-224Article in journal (Refereed)
    Abstract [en]

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

  • 18.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Learning to Deal Constructively With Troubled Conscience Related to Care Providers' Perceptions of Not Providing Sufficient Activities for Residents2015In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 2, p. 221-227Article in journal (Refereed)
    Abstract [en]

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

  • 19.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Meanings of being a supervisor for care providers suffering from burnout: from initial signs to recuperation2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 3, p. 366-375Article in journal (Refereed)
    Abstract [en]

    To illuminate meanings of being a supervisor for care providers suffering from burnout: from initial signs to recuperation.

    Background

    Supervisors in health care, i.e. supervisors with first-line responsibilities for a work unit, are exposed to heavy demands, especially in times of downsizing and restructuring of the healthcare system. When care providers show signs of developing burnout, these demands are even greater. Methods Interviews with 12 supervisors in health care were interpreted using a phenomenological-hermeneutic method.

    Results

    Being a supervisor when someone in the work team shows signs of burnout means struggling to help them to continue working. In this predicament and being responsible for the unit, the supervisors are torn between focusing on relations and on production. When the care provider reports sick, they are left with feelings of hopelessness and self-blame.

    Conclusions and implications for nursing management Supervisors face almost unmanageable strain, caught between conflicting demands. It seems important that supervisors are offered opportunities to share their feelings about this predicament as well as gaining increased knowledge about burnout. This is important if the supervisors are to give proper support, but it will also help to turn supervisory failure into development and to protect the health of the supervisors.

  • 20.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Troubled conscience related to deficiencies in providing individualised meal schedule in residential care for older people: a participatory action research study2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 688-696Article in journal (Refereed)
    Abstract [en]

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

  • 21.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Using a developed participatory action research process in practice to help care providers deal with troubled conscience in residential care of older people2018In: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 16, no 2, p. 190-206Article in journal (Refereed)
    Abstract [en]

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

  • 22.
    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.

  • 23.
    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.

  • 24.
    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.

  • 25.
    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.

  • 26.
    Gustafsson, Gabriella
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Meanings of staying healthy in a context where others developed burnout: phenomenological-hermeneutic interpretation of healthcare personnel's narratives2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 2Article in journal (Refereed)
    Abstract [en]

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

  • 27.
    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)
  • 28.
    Jonsén, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fagerström, Lisbeth
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vähäkangas, Magdalena
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Psychometric properties of the Swedish version of the purpose in life scale (PIL)2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, p. 41-48Article in journal (Refereed)
    Abstract [en]

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

  • 29.
    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.

  • 30.
    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.

  • 31.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hägglund, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fatigue in elderly with chronic heart failure: an under-recognized symptom2009In: Aging Health, ISSN 1745-509X, E-ISSN 1745-5103, Vol. 5, no 5, p. 619-624Article in journal (Refereed)
    Abstract [en]

    In this secondary analysis of interviews with people with chronic heart failure, we examine living with fatigue in terms of obstacles and opportunities on personal, systemic and societal levels. On a personal level, people report that their bodies force them to rest, and to give in to and make space in their lives for fatigue. The need for rest is strong, but resting and inactivity are also regarded as dangerous. The healthcare system provides assistance through home care and technical equipment. However, society imposes obstacles, such as a lack of services in the immediate surroundings that prevent living well. In conclusion, people with chronic heart failure can manage their lives on a personal level by means of selection, optimization and compensation, and the healthcare system can provide further support; however, on a societal level there is lack of resources for those suffering from fatigue due to chronic heart failure.

  • 32.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Forsberg, Karl Anton
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Kent
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Sense of coherence (SOC) related to health and mortality among the very old: The Umeå 85+ study2010In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 51, p. 329-332Article in journal (Refereed)
    Abstract [en]

    We describe associations between sense of coherence (SOC) and sense of well-being, diseases, physical function and the predictive value of SOC on depression and mortality. The study included 190 participants, aged 85-103 years. Linear correlation analysis was used for relationships between SOC scores and continuous variables. The effects of SOC score on 1- and 4-year mortality, as well as on depression at the 5-year follow-up, were investigated using Cox regression models. The mean SOC score was 71.8+/-10.2 (+/-S.D.). SOC score was positively related to well-being (p

  • 33.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Eisemann, Martin
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Nursing.
    Psychometric properties of the Swedish version of the Resilience Scale2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 2, p. 229-237Article in journal (Refereed)
    Abstract [en]

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

  • 34.
    Lundman, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Viglund, Kerstin
    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.
    Fischer, Regina Santamäki
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Development and psychometric properties of the Inner Strength Scale.2011In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, no 10, p. 1266-1274Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Four dimensions of inner strength were previously identified in a meta-theoretical analysis: firmness, creativity, connectedness, and flexibility.

    OBJECTIVE: The aim of this study was to develop an Inner Strength Scale (ISS) based on those four dimensions and to evaluate its psychometric properties.

    METHOD: An initial version of ISS was distributed for validation purpose with the Rosenberg Self-Esteem Scale, the resilience scale, and the sense of Coherence Scale. A convenience sample of 391 adults, aged 19-90 years participated. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were used in the process of exploring, evaluating, and reducing the 63-item ISS to the 20-item ISS. Cronbach's alpha and test-retest were used to measure reliability.

    RESULTS: CFA showed satisfactory goodness-of-fit for the 20-item ISS. The analysis supported a fourfactor solution explaining 51% of the variance. Cronbach's alpha on the 20-item ISS was 0.86, and the test-retest showed stability over time (r=0.79).

    CONCLUSION: The ISS was found to be a valid and reliable instrument for capturing a multifaceted understanding of inner strength. Further tests of psychometric properties of the ISS will be performed in forthcoming studies.

  • 35.
    Lövheim, Hugo
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Graneheim, Ulla H.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Changes in sense of coherence in old age: a 5-year follow-up of the Umeå 85+ study2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 13-19Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to describe the changes in sense of coherence (SOC) over time and relate these changes to negative life events among very old people. Design: Prospective and longitudinal study. Subjects:  190 old women and men participated, of whom 56 could be included in the 5-year follow-up. Methods: The mean SOC score from the first and second data collection were compared using a paired sample t-test. The relationship between the index of negative life events and the changes on SOC score between the two data collections was investigate using linear regression. Main outcome measures: Antonovsky's SOC scale and an index of negative life events including severe physical and mental diseases, various losses as losses of spouses, cognitive and functional ability. Result:  For the whole group of subjects (n = 56), the SOC scores was higher (70.1 vs. 73.7, p = 0.029) at the second point measure. The most common negative life events at follow-up were loss of independence in activities in daily living and decrease in cognitive function. A significant correlation between the index of negative life events and changes in SOC over 5 years was found (p = 0.025). The more negative life events, the more decrease in SOC. Conclusion: We concluded that there is a risk of decreased SOC and thereby quality of life when negative life events accumulate among very old people. Nursing interventions might play an important role for maintaining and perhaps strengthening SOC among old people exposed to negative life events.

  • 36.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Beroende av vård: innebörden av fenomenet som det visar sig genom patienters, deras anhörigas och vårdares berättelser2002Doctoral thesis, comprehensive summary (Other academic)
  • 37.
    Strandberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Självständighet och gemenskap under åldrandet2012In: Det goda åldrandet / [ed] Astrid Norberg, Berit Lundman, Regina Santamäki Fischer, Studentlitteratur AB, 2012, 1, p. 239-256Chapter in book (Other academic)
  • 38.
    Strandberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meaning of dependency on care as narrated by nurses2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 1, p. 84-91Article in journal (Refereed)
    Abstract [en]

    This article is part of an ongoing study aimed at illuminating the meaning of dependency on care. The aim of this particular study is to illuminate the meaning of the phenomenon 'dependency on care' as narrated by nurses. Interviews with 20 nurses were conducted, tape-recorded and transcribed verbatim. A phenomenological-hermeneutic approach was used to interpret the data. The meaning of dependency on care is revealed as laborious for both patients and nurses. The nurses' text discloses that for patients, dependency on care is a miserable loss of self-determination and self-worth. Nurses appear to be moved by dependents' difficult life and want to do whatever they can for the dependent. Dependency on care is a burdensome responsibility for nurses. For nurses dependency on care is revealed as evoking feelings of guilt and insufficiency and of being constantly concerned and worried. It is to struggle to be patient and understanding, having the arduous task of putting oneself into the dependent patients' shoes in order to cope with the demanding task of balancing between helping and not helping too much. The interpretation discloses, however, that nurses distinguish between easy and trying dependency on care. The understanding indicates that when they meet 'good' patients, nurses reappraise the situation, transform it into something new and meaningful, that is dependency on care is disclosed as 'easy to take'. When coming across'difficult' patients dependency on care is disclosed as trying. It seems that within the unique nurse-patient relationship patients may participate in such a way as to facilitate or inhibit nurses in finding meaning in the immediate caregiving situation. Nurses' evaluations of what constitutes a 'good' or a 'difficult' patient, respectively, seem to play an important role in distinguishing between dependency on care that is easy and that which is trying. The result is viewed through an existential paradigm and there is also reflection about what nurses perceive as valuable qualities in patients which might influence the quality of care.

  • 39.
    Strandberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    An exemplar of a positive perspective of being dependent on care2000In: Scholarly inquiry for nursing practice, ISSN 0889-7182, Vol. 14, no 4, p. 327-346; discussion 347-353Article in journal (Refereed)
    Abstract [en]

    This article is part of an ongoing study which aims at disclosing the meaning of being dependent on care. From a larger data set derived from 10 patients, interviews with one severely ill patient, her daughter and two of her professional nurses were selected to illuminate a "positive" meaning of being dependent on care. The interviews were tape-recorded and transcribed verbatim and followed by interpretation of transcripts using a phenomenological-hermeneutic approach inspired by Paul Ricoeur's philosophy. The interpretation discloses the meaning of being dependent on care as balancing between being free and negotiating when receiving care. Whether or not dependency on care is negotiated about seems to be about how the power that lies in the existing differences in ability is used. When ability, that is, power, is used to compensate inability, the patient appears free to be dependent on care. Dependency on care is accepted for what it is, when it is. When dependency on care is negotiated about, the differences in ability, that is, power, risk setting limits for what dependency on care is to be. There is a risk that dependency on care will be limited within the frame of what is regarded as polite, appealing and pleasing.

  • 40.
    Strandberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Being overwhelmed by the feeling of having a home and family: One aspect of the meaning of being dependent on care. A study of one patient and two of his nurses.2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 35, no 5, p. 717-727Article in journal (Refereed)
    Abstract [en]

    RATIONALE: This article is part of an ongoing study which aims at disclosing the meaning of being dependent on care. From a larger body of data, interviews with one patient and two of his nurses were selected to study. AIM: The aim was to deepen understanding of the meaning of being dependent on care when this appears desirable for the patient. METHODS: A phenomenological-hermeneutic approach was used to interpret the material. Interviews were recorded and transcribed verbatim. FINDINGS/DISCUSSION: The interpretation discloses the meaning of being dependent on care as an overwhelming, unfamiliar feeling of having a home and family. The patient is beguiled into believing he is the ruler in an established relationship and his dependency on care gives him an opportunity to be surrounded by loving, altruistic, helpful people. Being dependent on care is overwhelming and irresistible, i.e. coveted, but simultaneously it is like walking on thin ice, i.e. treacherous. The irresistible desire concerns being unconditionally cared about. The danger is that this 'family membership' will not last. It is brought to the patient because of his dependency on care and it is based on his terms. There is reflection about the patient being unprepared for dealing with his own world of loneliness.

  • 41.
    Strandberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meaning of dependency on care as narrated by 10 patients2003In: Research and Theory for Nursing Practice, ISSN 1541-6577, E-ISSN 1945-7286, Vol. 17, no 1, p. 65-84Article in journal (Refereed)
    Abstract [en]

    This article is part of an ongoing study that aims to illuminate the meaning of dependency on care. The aim of this particular study is to disclose the meaning of dependency on care as narrated by patients. We conducted interviews with patients (six men and four women) who had been in medical or surgical wards for at least 14 days. Seven of the patients were also interviewed one week after discharge. The participants ranged in age from 41 to 84 years old. The interviews were tape-recorded and transcribed verbatim. A phenomenological-hermeneutic approach was used to interpret the resulting text. The results show that to be dependent on care is to face the inevitability of not being able to manage by oneself--it is being attached to the nurses and bound to the care they offer. Being dependent on care involves a struggle to get care without treading on the nurses' toes. The nurses are one's lifelines and getting care is essential, no matter what. It is better to receive any form of care, good or bad, than to receive nothing. Being dependent on care is to be exposed and subjected to a nurse's ability and benevolence. One comprehensive understanding of the meaning of dependency on care is simply that "one does not saw off the branch one is sitting on." Furthermore, dependency on care involves a struggle to move forward in a life that hurts. Patients lose much of their freedom of choice in daily life and grieve their loss of ability and value. Patients may be able, however, to see things they would have never noticed earlier in life. Dependency on care is understood as one kind of "limit situation." Patients who are dependent on care may reevaluate their potential in life and gain another perspective on life.

  • 42.
    Strandberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Struggling to be/show oneself valuable and worthy to get care: One aspect of the meaning of being dependent on care--a study of one patient, his wife and two of his professional nurses2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 1, p. 43-51Article in journal (Refereed)
    Abstract [en]

    Dependency on care has commonly been described negatively and as a problem that needs to be addressed. From a larger data material, interviews with an old, hospitalized man with a chronic disease, his wife and two of his professional nurses was selected to study. The aim was to illuminate the meaning of being dependent on care, when it appears "negative". A phenomenological-hermeneutic approach was used to interpret the material. The interpretation shows that dependency on care is reluctantly shown although it is expected to be expressed and/or respected as it is shown. This makes dependency on care camouflaged and the space to be dependent is limited. The meaning of being dependent on care is understood as a two-dimensional struggle for existence. One dimension of the struggle is about to be/show oneself worthy to get care, as dependency on care holds a fear to be abandoned. The other dimension of the struggle is about to be/show oneself valuable as a human being, as identity is built upon being able to manage oneself and be strong. The interpretation if reflected on can open up possibilities to improve the quality of life for patients who are dependent on care.

  • 43.
    Viglund, Kerstin
    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.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden.
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing Education, University of Applied Sciences, Mariehamn, Åland, Finland.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Psychometric properties of the Swedish version of the selection, optimization, compensation questionnaire2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 460-467Article in journal (Refereed)
    Abstract [en]

    Background: The model of selection, optimization and compensation has been proposed as a model of adaptive management strategies throughout the lifespan.

    Aim: The aim of this study was to test the psychometric properties of a translated Swedish version of the 12-item selection, optimization, and compensation (SOC) questionnaire.

    Method: The 12-item SOC questionnaire is composed of four subscales: elective selection (ES), loss-based selection, optimization and compensation. A convenience sample of 122 Swedish-speaking people, aged 19-85, participated in a study of the validity and reliability of the SOC questionnaire. Cronbach's alpha coefficient, corrected item-total correlation and Cronbach's alpha if item deleted were used for reliability testing. Two other scales, the ways of coping questionnaire and Rosenberg's self-esteem scale, were used to test convergent validity, and the geriatric depression scale was used to test discriminant validity. Stability over time was evaluated using a test-retest model with a 2-week interval.

    Results: The 12-item SOC questionnaire showed a Cronbach's alpha value of 0.50, and the subscales ranged from α=0.16 to α=0.64. Two items in the ES subscale had negative values on the corrected item-total correlation and showed substantial improvement (>0.05) in Cronbach's alpha when item deleted. When these two items that influenced internal consistency were deleted, Cronbach's alpha rose to 0.68.

    Conclusion: The Swedish version of the 12-item SOC questionnaire showed deficiencies in a test of internal consistency because of two items in the ES subscale, and these two items were deleted. A consequence of the reduction is a weakening of the ES subscale and thereby to some extent the SOC questionnaire in total. Further testing is advisable. However, the 10-item SOC questionnaire was acceptable in a test of validity and reliability.

  • 44.
    Viglund, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inner strength among old people who have experienced a crisis in lifeManuscript (preprint) (Other academic)
    Abstract [en]

    Inner strength is a resource associated with health and disease management. Our objective was to elucidate inner strength in the narratives of people 65 years and older who had experienced a crisis in life associated with a disease. They had self-rated their inner strength as high, and qualitative content analysis was used in the interpretation of the narratives (n = 12). In the narratives, we found that inner strength comprised feelings of being connected and finding life worth living. Having faith in oneself and one’s possibilities and facing and taking an active part in the situation were also expressed. Finally, coming back and finding ways to go forward in life were found to be essential aspects of inner strength.

  • 45.
    Viglund, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inner strength in relation to age, gender and culture among old people: a cross-sectional population study in two Nordic countries.2013In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 17, no 8, p. 1016-1022Article in journal (Refereed)
    Abstract [en]

    Objectives: The theoretical framework for the study was the Model of Inner Strength, and the Inner Strength Scale (ISS)developed based on the Model was used. The aim was to examine inner strength in relation to age, gender and culture among old people in Sweden and Finland.

    Method: This study forms part of the GErontological Regional DAtabase (GERDA)-Botnia project that investigates healthy ageing with focus on the dignity, social participation and health of old people. The participants (N = 6119) were 65-, 70-, 75- and 80-year old and living in two counties in Sweden or Finland. The ISS consists of 20 items relating to four interrelated dimensions of inner strength, according to the Model of Inner Strength. The range of possible ISS scores is 20-120, a higher score denoting higher inner strength.

    Result: The result showed that the 65-year-old participants had the highest mean ISS score, with a decrease in score for every subsequent age. The lowest score was achieved by the 80-year-old participants. Women had slightly but significantly higher mean ISS scores than men. Only small differences were found between the counties.

    Conclusion: The study population came from Sweden and Finland; still, despite the different backgrounds, patterns in the distribution of inner strength were largely similar. The present study provides basic and essential information about inner strength in a population of old people.

  • 46.
    Viglund, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inner strength as a mediator of the relationship between disease and self-rated health among old people2014In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 1, p. 144-152Article in journal (Refereed)
    Abstract [en]

    AIM: To explore inner strength as a mediator of the relationship between disease and self-rated health among older people.

    BACKGROUND: Qualitative research has indicated that inner strength is an essential resource for an individual affected by disease. A hypothesis of inner strength as a mediator of the relationship between disease and self-rated health was proposed. The theoretical framework of inner strength was based on the Model of Inner Strength.

    DESIGN: A cross-sectional design was used.

    METHOD: The sample included 6119 participants from Finland and Sweden, in the ages of 65, 70, 75 and 80 years. The GERDA-Botnia questionnaire, which included the Inner Strength Scale and items related to diseases and self-rated health, was sent out between October and December 2010. Structural equation modelling was used to test a hypothesized model.

    RESULTS: The result indicated that having a disease was associated with poorer self-rated health and a lower degree of inner strength and a higher degree of inner strength was associated with better self-rated health. The result supported the hypothesis by indicating that inner strength partially mediated the relationship between disease and self-rated health.

    CONCLUSION: This large cross-sectional study with participants from 65 to 80 years of age from Finland and Sweden showed that inner strength can be a resource for older people affected by disease. Increasing inner strength in older people affected by disease may be one intervention to support experiences of health despite disease.

  • 47.
    Viglund, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsén, Ellisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sources and expressions of inner strength among old people who have experienced a crisis in life associated with a disease2017In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

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

  • 48.
    Åhlin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ericson-Lidman, Eva
    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.
    Longitudinal relationships between stress of conscience and concepts of importance2013In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 8, p. 927-942Article in journal (Refereed)
    Abstract [en]

    The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one's conscience as a burden, having feelings of emotional exhaustion and depersonalization and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one's conscience in one's work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience.

  • 49.
    Åhlin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Skondal Univ Coll, Stockholm, Sweden.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 277-287Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 50.
    Åhlin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Care providers' experiences of guidelines in daily work at a municipal residential care facility for older people2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 355-363Article in journal (Refereed)
    Abstract [en]

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

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

    DESIGN: A qualitative descriptive design was adopted.

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

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

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

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