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  • 1.
    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.

  • 2.
    Ericson-Lidman, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åhlin, Johan
    Umeå University, Faculty of Medicine, Department of Nursing.
    Assessments of stress of conscience, perceptions of conscience, burnout, and social support before and after implementation of a participatory action-research-based intervention2017In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 26, no 2, p. 205-223Article in journal (Refereed)
    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.

  • 3.
    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)
  • 4.
    Åhlin, Johan
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stress of conscience and burnout among healthcare personnel working in residential care of older people2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background This thesis was part of the research programme ‘Stress of Conscience and Burnout among Healthcare Personnel in Elderly Care’ at Umeå University. Relationships have been found between stress of conscience, perception of conscience, burnout, and social support. No longitudinal studies investigating these relationships have been performed previously, thus it was not known how these relationships develop over time. Neither was it known how stress of conscience and other phenomena of importance might vary between organisations because no comparative studies have been performed. It seems important to organize the care of older people in such a way that healthcare personnel can stay healthy at their workplace, especially because the aging population is expected to grow. Studies have shown that stress of conscience is associated with the well being of healthcare personnel and the quality of care they provide. In order to develop measures against stress of conscience, it seems important to gain a deeper understanding of the aspects in daily work that can generate troubled conscience among healthcare personnel.

     

    Aim The overall aim of this thesis was to describe, compare, and investigate longitudinal relationships between stress of conscience, perceptions of conscience, burnout, social support and person-centred care among healthcare personnel working in two different organisations for residential care of older people. Furthermore, the aim was to deepen the understanding of some aspects of importance that generate troubled conscience at each of the two organisations. Based on the emerging knowledge from the research programme and the results from studies І and ІІ, important aspects that can generate troubled conscience among healthcare personnel were shown to be working with guidelines and working during times of downsizing and reorganisation.

    Methods Studies Ι and ΙΙ took quantitative approaches with a longitudinal design (Ι) and a cross-sectional design (ΙΙ), while studies ΙΙΙ and IV were based on a qualitative approach. In study Ι, the participants were healthcare personnel working in an organisation for residential care of older people with a public mode of operation located in a small town in northern Sweden (baseline n = 488, follow-up n = 277). In study ΙΙ, the participants were healthcare personnel working in two different organisations chosen to be as different from each other as possible regarding their characteristics. In this study, an organisation with a private mode of operation and located in a large city in the south of Sweden (n = 98) was compared to the baseline data from the publically run organisation from the small town in study Ι (n = 488). In studies ΙΙΙ (n = 8) and IV (n = 7), the participants were care providers working at the same public organisation (ΙΙΙ) and private organisation (IV) as in studies Ι and ΙΙ. Quantitative data were analysed using partial least square regression with jack-knife approximate t-tests, hierarchical cluster analysis with multiscale bootstrap resampling, descriptive statistics, hypotheses tests, effect size measures, and confidence intervals. Qualitative data were analysed using qualitative content analysis.

    Results The main results showed that the healthcare personnel reported higher levels of stress of conscience than have been reported in other studies. Perceiving one’s conscience as a burden, having high levels of emotional exhaustion and depersonalisation, and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. Associations between stress of conscience and perceiving one’s conscience as a burden and burnout were similar among healthcare personnel despite the differences in the characteristics of the organisations they worked in. Women reported higher levels of stress of conscience and less social support from their co-workers compared to men. This thesis also provides new insights about how working according to guidelines and during times of downsizing and reorganisation can be burdensome issues for care providers and can generate troubled conscience. An overall understanding of care providers experiences of guidelines in daily work was revealed as struggling to do their best; prioritising between arcane guidelines while keeping the residents’ needs in the foreground.  They described experiences that guidelines were coming from above, were controlling and not sufficiently anchored at their workplace. They also described guidelines as stealing time from residents, colliding with each other, lacking practical use and complicating care, and challenging their judgment. An overall understanding of care providers’ experiences of working  during times of downsizing and reorganisation was revealed as perceiving oneself as pinioned in between current circumstances to provide care and what one’s conscience conveyed. They perceived loss of good management, changed working conditions as exhausting and activating their conscience. They also expressed how they perceived troubled conscience when working conditions decreased the quality of care.

    Conclusion The results is reflected on in relation to a nursing care model as it seems important to understand the results from a society- and organizational perspective as well as from an individual perspective. The results of the thesis show that it is important to provide healthcare personnel with opportunities to follow and express what their conscience tells them at their workplace in order to buffer the effects of stress of conscience. Support, knowledge, involvement, time, and additional resources are key issues that can help care providers to work more constructively with guidelines in their daily practice. The results show that in times of downsizing and reorganisation it is important to exercise leadership that promotes care providers’ feelings of involvement, security, and togetherness in order to relieve some of the healthcare personnel’s burdensome experiences. An overall understanding of the results is that it seems important to organize the residential care of older people in such a way that registered nurses and leaders are able to be present in healthcare personnel’s daily practice. Healthcare personnel need attendant and supportive leaders who can help them to solve various forms of work-related problems and to help them make priorities in the daily care of residents. This seems important regardless of whether the priorities are between guidelines and residents’ needs or a consequence of an increasingly stressful work environment during times of downsizing and reorganisation. Further studies are needed in order to investigate the importance of gender in relation to stress of conscience and if different kinds of support are needed for women than for men in order to buffer the effects of stress of conscience. Finally, more longitudinal multilevel studies are needed in order to investigate how organisations’ characteristics and organisational changes affect healthcare personnel’s levels of stress of conscience.

  • 5.
    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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Revalidation of the perceptions of conscience questionnaire (PCQ) and the stress of conscience questionnaire (SCQ)2012In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, no 2, p. 220-232Article in journal (Refereed)
    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.

  • 9.
    Åhlin, Johan
    et al.
    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. Department of Health Care Sciences, Ersta Sköndal University College, Sweden.
    Ternestedt, Britt-Marie
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Care providers’ narrated experiences of working in private non-profit residential care for older people during downsizing and reorganisation, focusing on troubled conscience2017In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 4, p. 177-185Article in journal (Refereed)
    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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