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  • 1.
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Struggling between a sense of belonging and a sense of alienation: Residents' experiences of living in a residential care facility for older people in Sweden2019Ingår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Living in residential care facilities for older people is described in both positive and negative terms. To maintain care quality of a vulnerable group in a constantly changing care context, it is important to continually describe their experiences. This qualitative study aims to describe residents’ experiences of living in a residential care facility for older people in Sweden. Six residents were interviewed and the interviews were analyzed using qualitative content analysis. The analysis resulted in nine sub-categories, two categories and one overall theme. Living in a residential care facility for older people is revealed as ‘Struggling between a sense of belonging and a sense of alienation’. It is of great importance for care providers to explore and try to understand what individuals perceive as factors for feelings of belonging, thereby preventing alienation.

  • 2.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Skellefteå.
    Larsson, Lise-Lotte Franklin
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Palliative Research Center, Ersta Sköndal University College, Stockholm.
    Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD2014Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, nr 2, s. 337-346Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 3.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Ersta Sköndal University College, Stockholm, Sweden.
    Persson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Healthcare personnel's experiences of situations in municipal elderly care that generate troubled conscience2013Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, nr 2, s. 215-223Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Meanings of being a female co-worker to a person developing burnout.2007Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, nr 2, s. 155-162Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Renström, Anna-Stina
    Hospital of Skellefteå City.
    Åhlin, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Relatives' perceptions of residents' life in a municipal care facility for older people with a focus on quality of life and care environment2015Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, nr 3, s. 160-169Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet.
    Strandberg, G.
    Umeå universitet.
    Dealing with troubled conscience by using participatory action research in residential care of older people in Sweden2014Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Objective: 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. 

    Method: The study design was grounded in participatory action research (PAR). Twelve care providers and their manager participated in 12 PAR-sessions, guided with inspiration from the three basic phases, look, think and act.

    Result: Participants wanted to learn more about a difficult care situation that generated troubled conscience; perceptions of not providing sufficient activities for residents. Together with researchers they brainstormed about and described the problem in a deeper way. Participants formulated actions taken to gain increased understanding about meaningful activities, that is, they inventoried their knowledge and their learning needs (phases 'look' and 'think'). When learning needs were fulfilled, they decided what was possible and meaningful to act on and how to do so (phase 'act'). Actions taken were continuously evaluated and revised with new actions implemented. By sharing their experiences, participants confirmed in one another and became aware of what types of activities were meaningful for residents and actions were taken to provide such activities. The importance of being attentive and rely on residents’ responses, to provide person-centered activities, was satisfying for residents and eased participants' troubled conscience.

    Conclusion: PAR contributed, through reflection and learning, with increased understanding of the necessity to listen to one’s conscience and to use conscience as a driving force to improve quality of care.

  • 7.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Being closely connected to health care providers experiencing burnout: putting one's life on hold to help.2010Ingår i: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 16, nr 1, s. 101-123Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Burnout - co-workers' perceptions of signs preceding workmates' burnout2007Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 60, nr 2, s. 199-208Artikel i tidskrift (Refereegranskat)
  • 9.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Care providers learning to deal with troubled conscience through participatory action research2013Ingår i: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 11, nr 4, s. 386-402Artikel i tidskrift (Refereegranskat)
    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.

  • 10.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Care providers’ troubled conscience related to an implementation of a time management system in residential care for older people: a participatory action research study2019Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Dealing with troubled conscience in municipal care of older people2013Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, nr 3, s. 300-311Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    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 study2015Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, nr 2, s. 215-224Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Learning to Deal Constructively With Troubled Conscience Related to Care Providers' Perceptions of Not Providing Sufficient Activities for Residents2015Ingår i: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, nr 2, s. 221-227Artikel i tidskrift (Refereegranskat)
    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.

  • 14.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Meanings of being a supervisor for care providers suffering from burnout: from initial signs to recuperation2009Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, nr 3, s. 366-375Artikel i tidskrift (Refereegranskat)
    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.

  • 15.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Troubled conscience related to deficiencies in providing individualised meal schedule in residential care for older people: a participatory action research study2015Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, nr 4, s. 688-696Artikel i tidskrift (Refereegranskat)
    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.

  • 16.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Using a developed participatory action research process in practice to help care providers deal with troubled conscience in residential care of older people2018Ingår i: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 16, nr 2, s. 190-206Artikel i tidskrift (Refereegranskat)
    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.

  • 17.
    Ericson-Lidman, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åhlin, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Assessments of stress of conscience, perceptions of conscience, burnout, and social support before and after implementation of a participatory action-research-based intervention2017Ingår i: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 26, nr 2, s. 205-223Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Interventions aiming to constructively address stress of conscience are rare. The aim of the study was to compare assessments of stress of conscience, perceptions of conscience, burnout, and social support among health care personnel (HCP) working in municipal residential care of older adults, before and after participation in a participatory action research (PAR) intervention aiming to learn to constructively deal with troubled conscience. Questionnaire data were collected at baseline and at follow-up (1-year interval; n = 29). Descriptive statistics and nonparametric statistical tests were used to make comparisons between baseline and follow-up. HCP gave significantly higher scores to the question, "Are your work achievements appreciated by your immediate superior?" at follow-up compared with baseline. No significant differences in levels of stress of conscience and burnout at follow-up were found. The results suggested that a PAR intervention aiming to learn HCP to deal with their troubled conscience in difficult situations could be partially successful.

  • 18.
    Johan, Åhlin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Astrid, Norberg
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Ersta Sköndal Högskola, Ersta Sköndal University College .
    Ternestedt, Britt-Marie
    Ersta Sköndal Högskola, Ersta Sköndal University College .
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Care providers’ narrated experiences of working in private residential care for older people during downsizing and reorganisation with focus on troubled conscienceArtikel i tidskrift (Refereegranskat)
  • 19.
    Juthberg, Christina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Experiences of a PAR Intervention in Care for Older People2016Ingår i: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 25, nr 6, s. 646-664Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Participatory action research (PAR) is an approach for dealing with problematic areas in practice. Follow-up studies in which participants describe their participation in PAR in detail are rare. This follow-up study aimed to describe care providers' (CPs) experiences of having participated in a PAR intervention designed to assist them to constructively deal with troubled conscience. Twenty-nine CPs who participated in a PAR intervention were interviewed 2 to 4 months post-intervention. Content analysis was used to analyze the data. The analysis revealed three main categories: the importance of having a communal and collaborative meeting place, perceived changes in daily life, and "It has been good, but it has not solved all of our problems." Using PAR to deal with troubled conscience might be an important organizational investment for the future that can help prevent ill health among CPs and maintain or improve the quality of care.

  • 20. Mazaheri, Monir
    et al.
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Joakim, Öhlén
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden.2018Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, nr 1, s. 380-388Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: A feature of the healthcare system in Sweden, particularly in the care of older people, is its cultural diversity in terms of having considerable numbers of both caregivers and care recipients with an immigrant background. Considering the influence of culture in ethical decision-making processes, the idea of conscience and the adverse effects of a troubled conscience, it is important to study the concepts of conscience and troubled conscience in culturally diverse populations. There is no published study regarding troubled conscience among immigrant populations that includes enrolled nurses.

    AIM: To illuminate the meanings of troubled conscience and how to deal with it among enrolled nurses with Iranian backgrounds working in Swedish residential care for Persian-speaking people with dementia who have emigrated from Iran.

    METHOD: The study was conducted with a phenomenological hermeneutic design. Ten enrolled nurses with an Iranian background, with at least one year's experience of taking care of older people with dementia, were interviewed. The study was reviewed by the Regional Ethical Review Board for ethical vetting of research involving humans. Appropriate measures were taken to ensure confidentiality and voluntary participation.

    RESULTS: The meanings of having a troubled conscience for the participants comprise not being a good person, including being an uncaring person, not acting according to one's values and living in a state of unease. Dealing with a troubled conscience involves trying to compensate for the harm one has caused and trying to prevent similar situations by being a responsible caregiver.

    CONCLUSIONS: The enrolled nurses understood themselves as caring people and not only caregivers. They knew that they should hear their conscience and respond to it by trying to be a caring person and acting according to their values. The findings should be interpreted in the given specific context.

  • 21. Mazaheri, Monir
    et al.
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Zargham-Boroujeni, Ali
    Öhlén, Joakim
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Ersta Sköndal University College, Sweden.
    Clear conscience grounded in relations: expressions of Persian-speaking nurses in Sweden2017Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, nr 3, s. 349-361Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts.

    RESEARCH OBJECTIVE: The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia.

    RESEARCH DESIGN: A phenomenological hermeneutical method guided the study.

    PARTICIPANTS AND RESEARCH CONTEXT: A total of 10 enrolled nurses with Iranian background, aged 33-46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden.

    ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential.

    FINDINGS: Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day.

    CONCLUSION: Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.

  • 22.
    Åhlin, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Eriksson, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Longitudinal relationships between stress of conscience and concepts of importance2013Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, nr 8, s. 927-942Artikel i tidskrift (Refereegranskat)
    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.

  • 23.
    Åhlin, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Ersta Skondal Univ Coll, Stockholm, Sweden.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    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 people2015Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, nr 2, s. 277-287Artikel i tidskrift (Refereegranskat)
    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.

  • 24.
    Åhlin, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Care providers' experiences of guidelines in daily work at a municipal residential care facility for older people2014Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, nr 2, s. 355-363Artikel i tidskrift (Refereegranskat)
    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.

  • 25.
    Åhlin, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Revalidation of the perceptions of conscience questionnaire (PCQ) and the stress of conscience questionnaire (SCQ)2012Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, nr 2, s. 220-232Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the 'Stress of Conscience Study'. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ.

  • 26.
    Åhlin, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Health Care Sciences, Ersta Sköndal University College, Sweden.
    Ternestedt, Britt-Marie
    Ericson-Lidman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Care providers’ narrated experiences of working in private non-profit residential care for older people during downsizing and reorganisation, focusing on troubled conscience2017Ingår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, nr 4, s. 177-185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Knowledge about care providers’ experiences of working in residential care of older people during times of downsizing and reorganisation is scarce, and it is not known whether/how their conscience is influenced by such changes. The aim was to describe care providers’ experiences of working in private residential care for older people during downsizing and reorganisation, focusing on troubled conscience. This study adopted a qualitative descriptive design based on interviews with seven care providers. A qualitative content analysis was used. The overall understanding was revealed as perceiving oneself as pinioned in between current circumstances to provide care and what one’s conscience conveyed. Care providers perceived: deteriorating working conditions as exhausting, downsizing and reorganisation as triggering one’s conscience when collaborating, troubled conscience when downsizing and reorganisation decrease the quality of care, and good management as crucial during downsizing and reorganisation. The results highlight that adequate communication strategies, well-functioning leadership and opportunities to know together and share what one’s conscience tells are aspects that need consideration.

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