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  • 1.
    Andersson, Anna
    et al.
    Department of Health Sciences, University West, Trollhättan, Sweden.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health Sciences, University West, Trollhättan, Sweden.
    Nilsson, Maria Skyvell
    Department of Health Sciences, University West, Trollhättan, Sweden.
    Newly-graduated nurses’ work-integrated learning: a qualitative study from an educational and occupational perspective2022In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 59, article id 103290Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe newly graduated nurses’ (NGNs’) experience of work-integrated learning (WIL), from an educational and occupational perspective. Background: NGNs often find themselves unprepared to meet occupational demands on their competence on entering working life, and express difficulties integrating educational theory into a practical context. Qualitative and effective WIL becomes particularly important for NGNs to develop the competence required to handle the transition from education to working life. Design: This is a qualitative, descriptive study with an inductive approach. Methods: Seven focus-group discussions were performed and subjected to qualitative content analysis. Results: The results revealed that WIL for NGNs includes personal mastering of several professional roles: a self-directed and collaborative learning role, a relational nursing role, and a transition from a student role to a collegial role. Furthermore, WIL entails adapting to organisational requirements, including development of contextual workplace knowledge and understanding; striving for confidence in medical-technical performance; and developing an experience-based understanding of clinical situations. Conclusion: The results reveal that WIL is complex, encompassing adaptation to roles and personal capabilities that increase new graduates’ competence and preparation for work. In addition, WIL requires personal commitment to one's own learning as well as organisational and social support.

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

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

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

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

  • 5.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundström, Mats
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Skilled interaction among professional carers in special accommodations for adult people with learning disabilities2013In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 20, no 7, p. 576-583Article in journal (Refereed)
    Abstract [en]

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

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

  • 6.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Facing bad news: a case study focusing on families having a child with congenital heart diseaseManuscript (preprint) (Other academic)
  • 7.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 2, p. 187-192Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management.

    Methods: Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis.

    Results: The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions.

    Conclusion: It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients' self-management, and also may strengthen the DSNs in their professional performance.

    Practice implications: Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role.

  • 8.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personnel's Experiences of Phlebotomy Practices after Participating in an Educational Intervention Programme2014In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, p. 1-8, article id 538704Article in journal (Refereed)
    Abstract [en]

    Background. Blood specimen collection is a common procedure in health care, and the results from specimen analysis have essential influence on clinical decisions. Errors in phlebotomy may lead to repeated sampling and delay in diagnosis and may jeopardise patient safety. This study aimed to describe the experiences of, and reflections on, phlebotomy practices of phlebotomy personnel working in primary health care after participating in an educational intervention programme (EIP). Methods. Thirty phlebotomists from ten primary health care centres participated. Their experiences were investigated through face-to-face interviews. Findings were analysed using qualitative content analysis. Results. The participants perceived the EIP as having opened up opportunities to reflect on safety. The EIP had made them aware of risks in relation to identification procedures, distractions from the environment, lack of knowledge, and transfer of information. The EIP also resulted in improvements in clinical practice, such as a standardised way of working and increased accuracy. Some said that the training had reassured them to continue working as usual, while others continued as usual regardless of incorrect procedure. Conclusions. The findings show that EIP can stimulate reflections on phlebotomy practices in larger study groups. Increased knowledge of phlebotomy practices improves the opportunities to revise and maximise the quality and content of future EIPs. Educators and safety managers should reflect on and pay particular attention to the identification procedure, distractions from the environment, and transfer of information, when developing and implementing EIPs. The focus of phlebotomy training should not solely be on improving adherence to practice guidelines.

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  • 9.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personnel’s experiences of venous blood specimen collection practices after participating in an educational intervention programmeManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to describe primary healthcare personnel’s experiences of venous blood specimen collection practices after participating in an educational intervention programme.

    Background: Venous blood specimen collection is one of the most frequent procedures in healthcare, and the results from specimen analysis have essential influence on clinical decisions. Errors in specimen collection may lead to repeated sampling and delay in diagnosis, and may jeopardise patient safety.

    Design: This is a qualitative, descriptive study based on individual interviews subjected to qualitative content analysis.

    Methods: A convenient sample of 30 venous blood specimen collection personnel from ten primary healthcare centres participated in this study. Their experiences were investigated through face-to-face interviews and analysed using qualitative content analysis.

    Results: In this study we found that the participants experienced that the education opened up opportunities for reflections on safety. They became aware of risks in relation to identification procedures, environmental disturbances, lack of knowledge and transfer of information. They had also achieved improvements in clinical practice such as standardised ways of working and increased accuracy. However, some described that they felt strengthened in working as usual and worked as usual in a correct way or as usual in an incorrect way.

    Conclusions: Our findings indicate that a short educational programme opens up opportunities for reflections about safety. Education is needed to improve and maintain a good quality of venous blood specimen collection practices.

    Relevance to clinical practice: Developers of education should reflect on and pay attention to the identification procedure, environmental disturbances, and transferral of information, when developing educational intervention programmes, and not focus solely on improving adherence to guideline practices.

  • 10.
    Dahlgren, Lars
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Emmelin, Maria
    Lund University.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing. University West.
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Winkvist, Anna
    Department of Clinical Nutrition, Sahlgrenska Academy.
    Qualitative methodology for international public health2019 (ed. 3)Book (Other academic)
  • 11.
    Ekwall, Eva
    et al.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ternestedt, Britt-Marie
    Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden.
    Sorbe, Bengt
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patients' perceptions of communication with the health care team during chemotherapy for the first recurrence of ovarian cancer2011In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 15, no 1, p. 53-58Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to explore what women with recurrent ovarian cancer perceived as important in their communication with the health care team.

    METHOD: Interviews were conducted with 12 women at the end of chemotherapy treatment at a department of gynecological oncology in central Sweden. The interviews were subjected to qualitative content analysis.

    RESULTS: The findings stress the importance for the health care team to offer each woman the opportunity for support in becoming familiar with the disease. This theme of becoming familiar with the disease is underpinned by four sub-themes: being acknowledged as a unique person, getting help to make sense of information regarding the disease and its treatment, having the opportunity to be involved and to share responsibility, and feeling confident that medical expertise was adequate. Becoming familiar with the disease was expressed as a process of understanding and assimilating the whole new situation. To achieve familiarity, the women needed help from the health care team to make sense of the information they received. They stressed the importance of being able to influence encounters with health professionals, in accordance with their own perspectives. Being acknowledged as a unique person was a prerequisite to achieve familiarity. Also important to the women was having the opportunity to share responsibility for their care and lives with someone from the health care team.

    CONCLUSION: Helping women with recurrence of ovarian cancer attain a sense of familiarity with the disease should be an important priority for health care providers.

  • 12.
    Graneheim, Ulla H.
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health Sciences, University West, Trollhättan, Sweden.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Methodological challenges in qualitative content analysis: A discussion paper2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 56, p. 29-34Article in journal (Refereed)
    Abstract [en]

    This discussion paper is aimed to map content analysis in the qualitative paradigm and explore common methodological challenges. We discuss phenomenological descriptions of manifest content and hermeneutical interpretations of latent content. We demonstrate inductive, deductive, and abductive approaches to qualitative content analysis, and elaborate on the level of abstraction and degree of interpretation used in constructing categories, descriptive themes, and themes of meaning. With increased abstraction and interpretation comes an increased challenge to demonstrate the credibility and authenticity of the analysis. A key issue is to show the logic in how categories and themes are abstracted, interpreted, and connected to the aim and to each other. Qualitative content analysis is an autonomous method and can be used at varying levels of abstraction and interpretation.

  • 13.
    Graneheim, Ulla Hällgren
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    A lesson to learn: patients´critiques of diabetes nursing2011In: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 11, no 1, p. 0-0Article in journal (Refereed)
    Abstract [en]

    Background:  Most nurses sincerely wish the best for their patients and express frustration when they do not follow their advice. Reflecting on a critique of diabetes nursing from a patient perspective is essential to bridge gaps between health professionals and patients with diabetes and their understandings of possibly divergent treatment goals. Aim:  The aim of this study was to describe what patients with type 2 diabetes view as most important for diabetes specialty nurses to learn about receiving care for diabetes. Method:  An interview study was conducted among 44 patients diagnosed with type 2 diabetes over two years in Sweden. Narrative interviews were analysed using qualitative content analysis. Findings: ‘Not making a mountain out of a molehill’, ‘the more routine, the less life’, and ‘to err is human’ were identified as themes in the participants’ views about what nurses could learn, reflecting a criticism of some traditional aspects of diabetes nursing; i.e., a one-sided disease perspective, high adherence expectations, and a paternalistic attitude. Conclusion: Diabetes specialty nurses are focused on preventing complications by striving to regulate diabetes. A challenge for these nurses is to show they are partners; i.e., on the same side as the patients. Otherwise, nurses and patients will both lose. Possibly core caring values of nursing such as consoling, relieving, healing, and relating have not been given enough priority or have been replaced with more goal-oriented values such as treating, curing, and being effective.

  • 14.
    Graneheim, Ulla Hällgren
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hovering between heaven and hell: an observational study focusing on a woman with schizophrenia, dementia and 'disturbing behaviour', and on her care providersManuscript (preprint) (Other academic)
  • 15.
    Graneheim, Ulla Hällgren
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    The meaning of living with dementia and disturbing behaviour as narrated by three persons admitted to a residential home.2006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 11, p. 1397-403Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of our study was to illuminate the meaning of living with dementia and disturbing behaviour, as narrated by three persons admitted to a residential home. BACKGROUND: Living with dementia and so-called disturbing behaviour in an institution involves interaction with care providers and fellow residents and poses a challenge to all who are involved. METHODS: We asked the head nurses at a residential home to select persons with dementia and disturbing behaviour who were willing to be interviewed and able to communicate verbally. We performed 10 informal conversational interviews with three persons. The interviews were transcribed into text and interpreted using a phenomenological hermeneutic method inspired by Ricoeur's philosophy. RESULTS: The findings indicate that the meaning of living with dementia and disturbing behaviour, as narrated by three persons admitted to a residential home, is about being surrounded by disorder, being trapped by restriction and being set aside, as well as about being included. The findings are interpreted as a collapse of relations to self and others intertwined with occasional episodes of togetherness. This is reflected on in relation to the literature on homelessness and at-homeness and loss and maintenance of personal and social selves. RELEVANCE TO CLINICAL PRACTICE: The view others have of the person with dementia and of disturbing behaviour determines the nursing care given. Taking the residents' personal history and actual context into account, disturbing behaviour may be seen as a way persons with dementia express their story and maintain their self.

  • 16.
    Graneheim, Ulla Hällgren
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences of loneliness among the very old: the Umeå 85+ project.2010In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 14, no 4, p. 433-438Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aims to elucidate experiences of loneliness among the very old, who live alone. METHOD: Twenty-three women and seven men, aged 85-103 years, were interviewed about their experiences of loneliness. The text was subjected to qualitative content analysis. RESULT: The descriptions of loneliness were twofold: on the one hand, living with losses and feeling abandoned represented the limitations imposed by loneliness; and on the other, living in confidence and feeling free represented the opportunities of loneliness. The findings indicate that experiences of loneliness among the very old are complex, and concern their relations in the past, the present, and the future. CONCLUSION: Experiences of loneliness among the very old can be devastating or enriching, depending upon life circumstances and outlook on life and death. We interpreted these two aspects of loneliness as feelings of homelessness and at-homeness.

  • 17.
    Hallgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hovering between Heaven and Hell: An Observational Study Focusing on the Interactions between One Woman with Schizophrenia, Dementia, and Challenging Behaviour and her Care Providers2015In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 36, no 7, p. 543-550Article in journal (Refereed)
    Abstract [en]

    This case study aims to illuminate the interactions between one woman (Alice) with schizophrenia, dementia, and challenging behaviour and her professional caregivers. We performed participant observations of these interactions and conducted informal interviews at the residential home where the woman lived. The transcripts were subjected to qualitative content analysis. The results showed that the interactions between Alice and her caregivers were experienced as hovering between heaven and hell. Alice struggled to bring order into her chaotic life world by splitting herself and others, and her caregivers struggled to protect Alice's and their own dignity by limiting her challenging behaviours. They also strived to understand their own and Alice's behaviour. Current practice in caring for people with challenging behaviour usually focuses on symptom reduction through medication and behavioural modification. Instead, we suggest moving toward an understanding of the experiences behind the challenging behaviours and designing person-centred care based on each patients' reality.

  • 18.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Beteendeförändringar vid demenssjukdom: ett personcentrerat perspektiv2009In: Personcentrerad omvårdnad i teori och praktik / [ed] David Edvardsson, Lund: Studentlitteratur , 2009Chapter in book (Other academic)
  • 19.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Störande beteende i interaktionen mellan personer med demens och deras vårdare2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Det övergripande syftet med avhandlingen var att belysa innebörden i interaktionen mellan personer med demens och så kallat störande beteende och deras vårdare. I delstudierna I och II deltog en kvinna med frontallobsdemens och störande beteende (Ruth) respektive en kvinna med schizofreni, demens och störande beteende (Alice) och deras vårdare. Fjorton respektive 30 deltagande observationer samt sex respektive sju reflekterande samtal med vårdare genomfördes. Texterna tolkades med hjälp av kvalitativ innehållsanalys. I delstudie III gjordes narrativa intervjuer med sex vårdare och i delstudie IV genomfördes 10 informella samtal med tre personer med demens och störande beteende. Dessa texter tolkades med hjälp av fenomenologisk hermeneutisk metod.

    Innebörden i interaktionen mellan personerna med demens och störande beteende och deras vårdare handlar om att befinna sig i kaos och pendla mellan motsatser: att känna sig hemlös och hemma och att ”vara herre ”och ”vara slav”. Vårdarna upplever konflikter mellan att göra gott för individen och/eller kollektivet samt mellan de demensdrabbades beroende och önskan om självbestämmande.

    Såväl personerna med demens och störande beteende som deras vårdare pendlar mellan att känna sig hemlösa och hemma. Ruth lever i en fragmenterad värld där hon slåss för att skydda sitt revir. Hon kämpar också för att bli bekräftad samtidigt som hon bekräftar andra. Vårdarna bekräftar henne genom att möta henne i hennes värld. Alice lever i en tudelad värld där hon pendlar mellan ”himmel och helvete”. Hon misstror vårdarnas avsikter och slåss för sitt liv men hon visar också sin uppskattning och bekräftar vårdarnas ansträngningar. Även vårdarna upplever en tudelad värld. Innebörden i att leva med demens och störande beteende på institution handlar om att vara omgiven av oordning, fångad av begränsningar, satt åt sidan men också räknad med. Vårdarna befinner sig också i kaos och förstår inte vad det störande beteendet betyder. De upplever att de är fråntagna initiativet och känner sig utmattade och hjälplösa. Då och då upplever de att de har kontroll och känner sig dugliga och accepterade.

    Vårdarna pendlar mellan att ”vara herre” och ”vara slav”. Dialektiken mellan herre och slav handlar om kampen för ömsesidig bekräftelse. När vårdaren möter den demensdrabbade i sin egen (vårdarens) värld reduceras personen med demens till ett objekt. Därmed objektifierar vårdaren också sig själv. När vårdaren möter personen med demens i hans eller hennes värld, betraktar vårdaren den demensdrabbade som en betydelsefull person vars existens är viktig att bekräfta. Därmed känner sig också vårdaren betydelsefull.

    I hemmastaddheten bekräftas både personen med demens och vårdaren och kampen mellan herre och slav övergår i en Jag- Du relation. Störande beteenden är beteenden som inte bekräftar den andre. När vårdarna inte blir bekräftade upplever de personerna med demens vara störande och när personerna med demens inte blir bekräftade upplever de vårdarna vara störande. Bekräftelse uppstår i interaktioner som präglas av hemmastaddhet medan störande beteende visar sig i interaktioner som kännetecknas av hemlöshet.

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  • 20.
    Hällgren Graneheim, Ulla H
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Slotte, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Markström Säfsten, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Contradictions between ideals and reality: registered nurses' experiences of dialogues with in-patients in psychiatric care2014In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 35, no 5, p. 395-402Article in journal (Refereed)
    Abstract [en]

    This study explored ten registered nurses’ experiences of di- alogues with inpatients in psychiatric care. Data were collected through four focus group discussions, and two individual inter- views. The nurses described contradictions between their nursing ideals about dialogues and the reality faced in psychiatric inpatient care, resulting in an unsatisfactory work situation and feelings of insufficiency. We conclude that in order to improve quality of care and increase well-being for both patients and health care workers, nursing interventions, such as dialogues and meaningful activities, need to be offered to patients. A management that is visible and present on-site should encourage and facilitate health care work- ers’ participation in clinical supervision.

  • 21.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Female caregivers' perceptions of reasons for violent behaviour among nursing home residents2012In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 19, no 2, p. 154-161Article in journal (Refereed)
    Abstract [en]

    Accessible summary

    • Threats and violence against professional caregivers present a growing health and safety problem in elderly care.
    • Caregivers attribute violent behaviour in the elderly to patient characteristics, caregiver approach and disorder in the environment.
    • Caregivers involved in a violent situation should strive to see the person behind the behaviour and the frustration that may have prompted it, to understand what the behaviour is meant to communicate, and to tailor interventions to the individual.

    Abstract

    Threats and violence against professional caregivers present a growing health and safety problem in elderly care. We aimed to explore female caregivers' perceptions of reasons for violent behaviour among nursing home residents. Forty-one caregivers at three nursing homes were interviewed and their responses were subjected to qualitative content analysis, which revealed three content areas of perceived reasons for patient violence: patient characteristics, caregiver approach and environmental aspects. The caregivers' perceptions were formulated in three core statements: ‘they (the residents) are not who they used to be’, ‘we (the caregivers) have acted inappropriately’ and ‘we (residents and caregivers) are all surrounded by disorder’. Our findings indicate that the reasons for violence are complex and multifactorial, so interventions should be individually tailored. Caregivers involved in a violent situation need to see the person behind the behaviour, try to interpret what the behaviour is meant to communicate and adjust the intervention according to individual need.

  • 22.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Persson Ljung, Inga-Maj
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Balancing between contradictions: the meaning of interaction with people suffering from dementia and "behavioral disturbances"2005In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 60, no 2, p. 145-157Article in journal (Refereed)
    Abstract [en]

    Interacting with people who suffer from dementia poses a challenge for care providers, and the presence of behavioral disturbances adds a further complication. Our article is based on the assumption that behavioral disturbances are meaningful expressions of experiences. Six narrative interviews were conducted with care providers with the aim of illuminating the meaning of interaction with people suffering from dementia and behavioral disturbances. The interviews were tape-recorded, transcribed into text, and interpreted using a phenomenological hermeneutic methodology. The findings indicate that interacting with people with dementia and behavioral disturbances, as narrated by care providers, means balancing between contradictions concerning meeting the person in my versus her/his world, feeling powerless versus capable, and feeling rejected versus accepted. Interaction involves being at various positions along these continua at different points in time. Furthermore, it means facing ethical dilemmas concerning doing good for the individual or the collective. This is interpreted as a dialectic process and is reflected on in light of Hegel's reasoning about the struggle between the master and the slave.

  • 23.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and 'behavioural disturbances', and on her care providers2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 36, no 2, p. 256-265Article in journal (Refereed)
    Abstract [en]

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

  • 24.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Johansson, Anneli
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family caregivers' experiences of relinquishing the care of a person with dementia to a nursing home: insights from a meta-ethnographic study2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 215-224Article in journal (Refereed)
    Abstract [en]

    Many people with dementia are cared for in their homes by family caregivers. As the dementia progresses, admission of the family member to a nursing home becomes inevitable. The aim of this meta-ethnographic study was to describe caregivers' experiences of relinquishing the care of a family member with dementia to a nursing home. A systematic literature search of PubMed, Cinahl and PsychInfo, between the years 1992 and 2012, was performed, and 10 qualitative articles, based on 180 family caregivers' experiences, were included. The family caregivers' described their experiences as a process that went from being responsible for the decision, through living with the decision, adjusting to a new caring role and having changed relationships. They felt unprepared and lonely with these changes. They experienced loss, guilt and shame, but also feelings of relief. Their roles in the nursing home environment were to make sure that the individual needs of the person with dementia were respected and to monitor the quality of care. They wished to maintain their relationship with the person with dementia and to establish meaningful relationships with caring staff. The process of relinquishing care is similar to a crisis process, which starts with a turning point, followed by a coping face and finally the outcome of the process. The adaption to the new situation can be facilitated if the family caregivers are recognised as partners in the care of the person with dementia. The family caregivers' unique knowledge of their relatives' previous life story should be acknowledged in both care planning and daily care. Welcoming family caregivers to regular meetings with staff can contribute to increase the feeling of partnership. Offering staff clinical supervision could be one way of preparing them to deal with the emotional strain reported by family caregivers.

  • 25.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Högskolan Väst, Trollhättan.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvalitativ innehållsanalys2023In: Vetenskaplig teori och metod: från idé till examination inom vård- och hälsovetenskap / [ed] Maria Henricson, Lund: Studentlitteratur AB, 2023, 3, p. 295-312Chapter in book (Other academic)
  • 26.
    Hällgren Graneheim, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. University West, Department of Health Sciences, Trollhattan, Sweden.
    Åstrom, Sture
    Umeå University, Faculty of Medicine, Department of Nursing. University West, Department of Health Sciences, Trollhattan, Sweden.
    Until Death Do Us Part: Adult Relatives' Experiences of Everyday Life Close to Persons with Mental Ill-Health2016In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 37, no 8, p. 602-608Article in journal (Refereed)
    Abstract [en]

    This study illuminates adult relatives' experiences of everyday life close to a person with mental ill-health. The study was based on nine diaries and four narrative interviews with relatives of people with mental ill-health. Data were subjected to qualitative content analysis. The participants experienced everyday life as a constant fight, for better and for worse, with psychiatric care. They were fighting for the mentally ill person's right to care; sometimes they felt resigned, but yet they had a confidence in the care. Their mission in life was to sacrifice themselves, meaning that they felt indispensable and became lonely and socially isolated. They considered their mission to last until death set them apart because they were keeping a family secret, and had great worries about the future. We conclude that relatives experience a two-folded stigma in living close to a person with mental ill-health and in becoming lonely and socially isolated.

  • 27.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Graneheim, Ulla Hällgren
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Female caregivers' experiences of exposure to violence in nursing homes2009In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, no 1, p. 46-53Article in journal (Refereed)
    Abstract [en]

    Although earlier studies have examined caregivers' experiences of exposure to violence, few have investigated female caregivers working in nursing homes with a specific focus on experiences throughout the entire scenario of a violent situation. This study illuminates female caregivers' experiences of being exposed to violence in nursing homes. Twenty caregivers working in three nursing homes located in northern Sweden were asked to narrate about a situation in which they had been exposed to violence. Their narratives were analysed by using qualitative content analysis. We found that the caregivers had preconceived ideas about violent behaviour, that they experienced a loss of control over the situation, and that they then strove to regain control. Experiences such as these may influence caregivers' interactions with residents who display violent behaviour. As a result of violent interactions, caregivers may distance themselves from the residents, an attitude that may decrease the quality of care. There is a risk that violence in nursing homes is accepted and normalized as a part of the job and hence persists.

  • 28.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Richter, Jörg
    Eisemann, Martin
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Exposure to violence in relation to personality traits, coping abilities, and burnout among caregivers in nursing homes: a case-control study.2008In: Scandinavian journal of caring sciences, ISSN 1471-6712, Vol. 22, no 4, p. 551-559Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although violence toward caregivers occurs often and caregivers' ability to interact and deal with difficult situations is relevant in preventing such violence, few studies have been conducted that focus on caregivers' characteristics.

    AIM: This study explores the relationship between perceived exposure to violence and demographical factors, parental rearing, personality traits including coping abilities, defence styles, and burnout among caregivers working in nursing homes.

    METHOD: A total of 196 caregivers working in nursing homes were included. They were asked to complete questionnaires concerning demographical factors and exposure to violence. One group of female caregivers reporting no exposure to violence (n = 20) was matched with one group of exposed to violence (n = 20). Both groups were asked to complete questionnaires concerning parental rearing, personality traits, coping abilities, and burnout.

    RESULT: Around 68.4% of the caregivers had been exposed to violence during the previous year and 22.4% several times a week. Caregivers 50 years of age or younger and employed in geriatric care for more than 3 years were more frequently exposed to violence. Inter-group differences were found regarding 'maternal rejection' and 'burnout'. No statistical differences could be found concerning defence styles, coping ability, temperament, or character aspects.

    CONCLUSION: Violence toward caregivers occurs frequently and appears to be influenced by several factors. 'Maternal rejection' and 'burnout' among caregivers exposed to violence might influence the communication between caregivers and residents, rendering more violence. However, personality traits among caregivers do not seem to be associated with exposure to violence.

  • 29.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Physically violent behaviour in dementia care: characteristics of residents and management of violent situations2011In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 15, no 5, p. 573-579Article in journal (Refereed)
    Abstract [en]

    Objective: Physically violent behaviour (PVB) is common among residents with dementia and often complicates nursing care. This study aims to explore types of caring situations, resident characteristics related to PVB and professional caregivers' management of PVB.

    Methods: The study included 40 group homes for 309 residents with dementia. Data was gathered by means of structured interviews, the Multi-Dimensional Dementia Assessment Scale and the Geriatric Rating Scale.

    Results: Ninety-eight of the residents (31.7%) were assessed as showing PVB during the preceding week. Three factors were independently associated with PVB: male gender, antipsychotic treatment and decline in orientation. Violent residents were more likely to have impaired speech, difficulties understanding verbal communication and prescribed analgesics and antipsychotics than were non-violent residents. PVB occurred mainly in intimate helping situations and was managed by symptom-oriented approaches, such as distraction, medication and isolation. The working team also held frequent discussions about the residents with PVB.

    Conclusion: This study shows that PVB is frequently displayed among residents in group homes for persons with dementia and the caregivers mainly manage PVB in a symptom-oriented way. To enhance the quality of care for patients with dementia, there is a need for interventions that aim to understand and manage the residents' physical violent behaviour.

  • 30.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Being flexible and tuning in: professional caregivers' reflections on management of violent behaviour in nursing homes2013In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 8, no 4, p. 290-298Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: This qualitative, descriptive study aimed to illuminate professional caregivers' reflections on managing residents' violent behaviour in nursing homes.

    Background: Violence towards caregivers in the care of older people is a challenge attracting increasing attention in nursing research. However, studies that focus on the approaches caregivers in nursing homes resort to and how they manage everyday care situations involving threats and violent situations are relatively few.

    Methods: The study was based on 41 interviews in which the caregivers reflected on their own courses of action in violent situations. The interviews were subjected to qualitative content analysis.

    Results: This study showed that caregivers were flexible and in tune with the resident by averting and defusing threatening and violent situations. The caregivers tried to give care in line with the residents' condition, control their own spontaneous reactions and interpret the residents' reactions as communicative signs indicating how they should interact with the resident in the situation. As a last resort, when previous approaches had been unsuccessful, the caregivers took a firm stand, confronted the resident and the violent behaviour more directly, but with respect and with the residents' best interests in mind.

    Conclusions: These findings illuminate how caregivers successfully can manage threatening and violent behavior in nursing homes by being flexible and tuning in with the resident but also by taking a firm stand with the residents' best interests in mind. To be flexible and in tune with residents, it is important to know the residents' personal histories. This may mean involving stakeholders, such as family members and friends, in the care of residents with violent behaviour.

    Implications for practice: We believe that it is important to involve stakeholders in the care of threatening and violent residents in nursing homes as it is important to get information on the residents' personal history. However, there are risks when interpreting residents' behaviour in light of their personal histories as relatives experiences may be subjective and the information may give the caregivers preconceived ideas about the resident.

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  • 31.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    In the eye of the beholder: How female caregivers in nursing homes perceive violence2007In: 5th European congress on violence in clinical psychiatry., 2007Conference paper (Refereed)
  • 32.
    Isaksson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Violence in nursing homes: perceptions of female caregivers.2008In: Journal of clinical nursing, ISSN 1365-2702, Vol. 17, no 12, p. 1660-6Article in journal (Refereed)
    Abstract [en]

    AIM: This study illuminates how female caregivers in nursing home perceive violence.

    BACKGROUND: Previous studies have focused on prevalence and types of violence and injuries in various settings and among various professionals. There are, however, few studies that examine how caregivers perceive violence.

    METHODS: Forty-one female caregivers at nursing homes were asked to reflect on a vignette containing a situation where a female caregiver is exposed to violence from a male resident. The reflections were analysed by qualitative content analysis.

    FINDINGS: The main finding indicates that perceiving an action as violent is in the eye of the beholder. Caregivers perceive violence to be challenging, intentional, excusable, ordinary and contextual relative to their own experience and attitudes.

    CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: As the perception of violence is subjective, there is a risk that violent incidents will be under-reported as well as over-reported. To avoid this, it is important to construct a well-defined operationalised definition of violence for research purposes. Our findings also indicate the need for individually structured and adjusted support for caregivers. To explore the complexity of violence, further research should focus on how caregivers and residents experience violence in a nursing home.

  • 33.
    Jansson, Leila
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing. bDepartment of Health Sciences, University West, Trollhättan, Sweden.
    Nurses' experiences of assessing suicide risk in specialised mental health outpatient care in rural areas2018In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 39, no 7, p. 554-560Article in journal (Refereed)
    Abstract [en]

    This study describes nurses' experiences of assessing suicide risk in specialised mental health outpatient care in rural areas in Sweden. We used a qualitative, descriptive design based on twelve interviews that were subjected to qualitative content analysis. The results showed that the nurses felt anguish due to a lack of control. They expressed uncertainty and loneliness, and they struggled with ethical issues and organisational challenges. Having the sole responsibility to assess suicide risk can increase a person's emotional vulnerability and moral stress. Consequently, in order to prevent ill health among these nurses, there is a need for a tolerant work climate and an organisation that provides support to its employees.Assessing suicide risk is a demanding task within mental health outpatient care. Further, nurses operating in rural areas have to initiate and conduct assessments on their own, and they are, together with the physician in charge, also held individually responsible for their assessments. Consequently, it is important to describe nurses' experiences of how they deal with questions concerning suicide risk. Their experiences can foster awareness of the responsibility and the ethical standpoints related to assessing suicide risk, can help outline the need for further education and supervision, and can improve support from co-workers and management.

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  • 34.
    Johansson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Olsson Ruzin, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Remaining connected despite separation: former family caregivers’ experiences of aspects that facilitate and hinder the process of relinquishing the care of a person with dementia to a nursing home2014In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 18, no 8, p. 1029-1036Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This qualitative study aimed to illuminate former family caregivers’ experiences of aspects that facilitate and hinder the process of relinquishing the care of a person with dementia to a nursing home. METHOD: Ten narrative interviews with former family caregivers were performed and subjected to qualitative content analysis. RESULTS: An overall theme showed that family caregivers were remaining connected to the person with dementia despite separation. They experienced being ‘caught by surprise’ when the placement occurred. Negative expectations of dementia care made the separation more difficult. Lacking adequate information increased feelings of insecurity. Despite these hurdles, family caregivers found meaning in the new situation as they felt that they could remain connected to their loved one. Being recognized as partners in care of the person with dementia after placement was a facilitating aspect. Family caregivers regarded a well-functioning interaction with staff and a supportive social network as reassuring since they facilitated staying in touch. CONCLUSION: Knowledge of the relinquishing process and adequate information about dementia and its progression may help family caregivers better prepare for and adapt to the situation. Family caregivers need to be recognized as partners in care and a welcoming nursing home environment is of utmost importance.

  • 35.
    Jutterström, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ideal versus real conditions for type 2 diabetes care: diabetes specialty nurses’ perspectives2012In: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 11, no 2Article in journal (Refereed)
    Abstract [en]

    Background: Since diabetes specialty nurses are the professionals who spend the most time with patients living with diabetes, they probably have the greatest influence on the quality of diabetes care. Therefore, their personal perceptions about what constitutes “good care” in type 2 diabetes care are important to explore.

    Aim: The aim of this study was to describe conditions for “good care” in type 2-diabetes as perceived by diabetes specialty nurses.

    Method: Twenty-one experienced diabetes specialty nurses participated in three focus group interviews. Data were analyzed using qualitative content analysis.

    Findings: The findings are presented in four themes describing diabetes specialty nurses’ perspectives on ideal versus real conditions for type 2 diabetes care: 1) Diabetes counseling built on empowerment versus governance; 2) Diabetes management built on comprehensive versus biomedical views; 3) Diabetes organization built on nurse-led versus physician-led care; and 4) Diabetes policies built on quality versus equality.

    Conclusion: The ideal diabetes care is perceived as complex to achieve. Conflicting paradigms, power relations, and departmentalization of work are influencing the potential to deliver ideal diabetes care and to increase satisfaction among diabetes specialty nurses and patients. The diabetes specialty nurses described themselves as the “hub” of diabetes care, and they perceived conflicts between ideal versus real conditions in type 2 diabetes care. Patient centredness is not a real condition in diabetes care.

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  • 36.
    Lindgren, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aminoff, Carina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Features of every day life in psychiatric inpatient care for self-harming: an observational study of six women2015In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 36, no 2, p. 82-88Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe the features of everyday life in psychiatric inpatient care as experienced by women who self-harm. Participant observations and informal interviews were conducted with six women and were subjected to qualitative content analysis. The major feature of everyday life in psychiatric inpatient care was ‘being surrounded by disorder’, which consisted of ‘living in a confusing environment, being subject to routines and rules that offer safety but lack consistency’ and ‘waiting both in loneliness and in togetherness’. The nursing staff spent minimal time with the patients and the women turned to each other for support, care and companionship.

  • 37.
    Lindgren, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Aström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Graneheim, Ulla Hällgren
    Umeå University, Faculty of Medicine, Department of Nursing.
    Held to ransom: parents of self-harming adults describe their lived experience of professional care and caregivers2010In: International journal of qualitative studies on health and well-being, ISSN 1748-2631, Vol. 5, no 3Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to discover and describe lived experiences of professional care and caregivers among parents of adults who self-harm. Narrative interviews were conducted with six parents of daughters with self-harming behaviours and analysed using a phenomenological hermeneutic approach. The meanings of the parents' narratives of their lived experiences of professional care and caregivers were interpreted as their being involved in 'limit situations' comparable to hostage dramas. Several meaningful themes contributed to this interpretation: being trapped in a situation with no escape; being in the prisoner's dock; groping in the dark; and finding glimmers of hope. Parents of daughters who were in care because of self-harming often felt obliged to pay an emotional ransom, which included feelings of being accused, being 'broken', being confused, and feeling lost. Moments of peace occurred as welcome breaks offering a short time of rest for the parents. Situations that were understood by the parents and solved in a peaceful way were experienced as a respite and inspired parents with hope for their daughters' recovery.

  • 38.
    Lindgren, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eklund, Margita
    Umeå University, Faculty of Medicine, Department of Nursing.
    Melin, Ylva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Graneheim, Ulla Hällgren
    Umeå University, Faculty of Medicine, Department of Nursing.
    From Resistance to Existence-Experiences of Medication-Assisted Treatment as Disclosed by People with Opioid Dependence2015In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 36, no 12, p. 963-970Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe the lived experiences of participating in a medication-assisted treatment as disclosed by individuals with opioid dependence. Eleven narrative interviews were conducted and subjected to qualitative content analysis. The experiences of participating in the programme were described as a process from resistance to existence. The participants seized the chance to claim a life lived with dignity, struggled with hidden challenges, and eventually were freed from their pasts and were grateful for an existence with dignity. The recovery process was a long-term commitment and participants asked for a more individual and flexible process based on personal needs and values.

  • 39.
    Lindgren, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meanings of caring for people who self-harm as disclosed in narratives of dialectical behaviour therapy professionals2015In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 22, no 6, p. 371-378Article in journal (Refereed)
    Abstract [en]

    Accessible summary This paper adds a phenomenological hermeneutic perspective on meanings of caring for adult people who self-harm as disclosed in narratives of dialectical behaviour therapy (DBT)-trained professionals. This paper shows that providing DBT care for people who self-harm means embarking an unpredictable journey, sometimes lonely, but also often together with the person who self-harm and with the DBT team. This paper emphasizes professionals' benefits of the tools and structure offered by DBT; however, the text points to the importance of the genuine meeting, including confirmation, as a prerequisite to recovery. This paper suggests that further research might focus on the meanings of genuine meetings and their organizational prerequisites. AbstractIn this paper, we aim to explore meanings of caring for adult people who self-harm as described in the narratives of professionals trained in dialectical behaviour therapy (DBT). We conducted narrative interviews with nine professionals working in a DBT team and used a phenomenological hermeneutical method to analyse their narratives. Our comprehensive understanding cast the caring relationship as an unpredictable journey, in which the professionals were guides or companions who aimed to walk side-by-side with the person who self-harms, prove to be trustworthy, and keep on track. They sometimes saw the journey as lonely and sometimes as a joint endeavour. Our analysis was informed by Martin Buber's writings on the genuine meeting' and confirmation. The professionals emphasized the importance of the tools and structure offered by DBT; however, the text points to the importance of the genuine meeting, including confirmation, as a prerequisite to recovery. Mental health nurses need opportunities for continuous training and counselling.

  • 40.
    Lindgren, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health Sciences, University West, Trollhättan, Sweden.
    Abstraction and interpretation during the qualitative content analysis process2020In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 108, article id 103632Article in journal (Refereed)
    Abstract [en]

    Qualitative content analysis and other ‘standardised’ methods are sometimes considered to be technical tools used for basic, superficial, and simple sorting of text, and their results lack depth, scientific rigour, and evidence. To strengthen the trustworthiness of qualitative content analyses, we focus on abstraction and interpretation during the analytic process. To our knowledge, descriptions of these concepts are sparse; this paper therefore aims to elaborate on and exemplify the distinction and relation between abstraction and interpretation during the different phases of the process of qualitative content analysis. We address the relations between abstraction and interpretation when selecting, condensing, and coding meaning units and creating categories and themes on various levels. The examples used are based on our experiences of teaching and supervising students at various levels. We also highlight the phases of de-contextualisation and re-contextualisation in describing the analytic process. We argue that qualitative content analysis can be both descriptive and interpretative. When the data allow interpretations of the latent content, qualitative content analysis reveals both depth and meaning in participants’ utterances.

  • 41.
    Lindgren, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Molin, Jenny
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Balancing between a Person-Centred and a Common Staff Approach: Nursing Staff's Experiences of Good Nursing Practice for Patients Who Self-Harm2021In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 42, no 6, p. 564-572Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe nursing staff's experiences of good nursing practice in psychiatric in-patient care for patients with self-harming behavior. The participants were nine nurses and eight nursing assistants working in two in-patient wards in general psychiatry. Four focus group discussions were held and subjected to qualitative content analysis. The findings showed that good nursing practice balanced a person-centred approach with a common staff approach, allowing people who self-harm and staff to share responsibility for structuring everyday life, keeping to the plan, communicating decisions, and finding individual opportunities for relief. Reflective discussions among the staff concerning prejudice, emotional stress, lack of resources, and shortcomings in care planning could also prevent a stigmatizing culture and organizational deficiencies, which would be beneficial for both the people who self-harm and the staff.