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  • 1.
    Ehrlich, Kethy
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute; Department of Geriatric Medicine, Danderyd Hospital.
    Boström, Anne-Marie
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute; Department of Geriatric Medicine, Danderyd Hospital.
    Mazaheri, Monir
    School of Health, Care and Social Welfare, Division of Caring Sciences, Mälardalen University.
    Heikkilä, Kristiina
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute.
    Emami, Azita
    Aging Research Center (ARC), Karolinska Institute; Biobehavioral Nursing & Health Systems, School of Nursing, University of Washington, Seattle, WA, USA.
    Family caregivers’ assessments of caring for a relative with dementia: A comparison of urban and rural areas2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 1, p. 27-37Article in journal (Refereed)
    Abstract [en]

    AIM: This study aimed to describe and compare urban and rural family caregivers' reactions to caring for a relative with dementia and to examine the associations between caregiving and socio-demographic factors.

    BACKGROUND: Most studies on family caregivers' experiences caring for older people with dementia have been conducted in urban areas, and little is known about the experiences of family caregivers living in rural areas.

    DESIGN: A cross-sectional study design was used.

    METHODS: A total of 102 caregivers (response rate 85%) from urban (n=57) and rural (n=46) areas completed the Caregiver Reaction Assessment (CRA) Scale and demographic information. Data were analysed using descriptive and inferential statistics and linear regression models.

    RESULTS: Overall, family caregivers reported high satisfaction even if they also reported high impact on finances and daily living. Rural caregivers experienced a higher negative impact on finances but reported more support from family members than urban caregivers. Age, gender and relationship were significantly associated with four of the five CRA subscales. Educational level and geographical setting were not associated with any of the CRA subscales.

    CONCLUSIONS: The results of the study raise questions about the financial situation of older female caregivers and on the expectations of built-in family structures in urban and rural areas. Further studies focusing on the meaning and constitution of a family would help us to understand how these factors influence family caregiving both in rural and urban areas.

    IMPLICATIONS FOR PRACTICE: To provide person-centred care and to avoid stereotyped caregiving, a better picture of traditions in family caregiving can improve a more differentiated and appropriate professional caregiving pliable with the cultural context in which it is carried out.

  • 2.
    Eriksson, Henrik
    et al.
    Department of Caring and Public Health Sciences, Mälardalen University, Eskilstuna.
    Sandberg, Jonas
    Mälardalens högskola, Institutionen för vård- och folkhälsovetenskap.
    Transitions in men´s caring identities: from home-based care to nursing home placement.2008In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 3, no 2, p. 131-137Article in journal (Refereed)
  • 3.
    Gransjön Craftman, Åsa
    et al.
    Sophiahemmet University; Aging Research Center (ARC) Karolinska Institutet and Stockholm University.
    Hammar, Lena M
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet; School of Health Care and Social Welfare, Mälardalen University; .
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine. Aging Research Center (ARC) Karolinska Institutet and Stockholm University.
    Hillerås, Pernilla
    Sophiahemmet University; Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Westerbotn, Margareta
    Sophiahemmet University; Division of Caring Science, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet.
    Unlicensed personnel administering medications to older persons living at home: a challenge for social and care services2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, p. 201-210Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge.

    AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care.

    METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis.

    RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality.

    CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients.

    IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

  • 4.
    Hellström, Ingrid
    et al.
    Linköping University.
    Eriksson, Henrik
    The Swedish Red Cross University College.
    Sandberg, Jonas
    Ersta Sköndal University College.
    Chores and sense of self: gendered understandings of voices of older married women with dementia2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 2, p. 127-135Article in journal (Refereed)
    Abstract [en]

    Background. Marital relationships in dementia are forged between the person withdementia and the care partner, and such relationships have an impact on the way inwhich dementia is understood and experienced. The everyday work that underpinsthe relationship is usually divided between spouses and based on traditional divisions of household chores.

    Aims and objectives. The aim was to describe how older women with dementia express the importance of their homes and their chores in everyday life.

    Methods. Seven women with dementia, who were cohabiting with their husbands, were interviewed on up to five occasions at home during a five-to-six-year period on the following themes: the home, their dementia illness, everyday life, their relationships with their husbands and dignity and autonomy.

    Results. The qualitative analysis showed three different patterns in the women’s narratives: keeping the core of the self through the home, keeping the self through polarising division of labour and keeping the self through (re-) negotiations of responsibilities. The feeling of one’s home and home-related chores is an essential way to express who you are.

    Conclusion. The women stated that household chores are the centre of their lives despite their dementia disease and that the home, even though it shrinks, still makes the women see themselves as an important person, namely the ‘competent wife’.

    Implications for practice. Nurses need to be aware that ‘doing gender’ may be a means of preserving personhood as well as of sustaining couplehood in dementia.

  • 5.
    Kraft, Mia
    et al.
    The Swedish Red Cross University College.
    Blomberg, Karin
    Medical and Health Sciences, Örebro University.
    Hedman, Ann-Marie
    The Swedish Red Cross University College.
    The health care professionals' perspectives of collaboration in rehabilitation: an interview study2014In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 9, no 3, p. 209-216Article in journal (Refereed)
    Abstract [en]

    Background

    In previous literature, it has been recognised that the extent to which different healthcare professionals collaborate may affect both the quality and safety of care, and patient outcomes. Collaboration appears to be an essential part of professional practice, yet there is a lack of knowledge and understanding of collaboration in the context of short-term care units. Therefore, this study was undertaken to better understand how professionals in this context view collaboration.

    Aim

    To describe collaboration in rehabilitation from the perspective of healthcare professionals.

    Methods

    Qualitative interviews were conducted with ten healthcare professionals, including: occupational therapists, physiotherapists and nurses, who worked in three different short-term care settings. The interviews were transcribed, and qualitative content analysis was used.

    Findings

    Four categories, all of which included both positive and negative descriptions of collaboration, were identified: (i) Crossing professional and organisational boundaries (ii) Awareness of own professional identity (iii) Information and knowledge transfer and (iv) Balancing between patient, system and process.

    Conclusions

    The findings indicate the importance of leadership and organisational structures for stimulating communication, and promoting collaboration between team members. In addition, working as a professional in short-term care requires individual skills in collaboration efforts, including awareness of one's own professional identity.

    Relevance to clinical practice

    Opportunities for supervision could be one way to increase individuals' awareness of their own role in the team.

  • 6.
    Rydeman, IngBritt
    et al.
    Department of Neurobiology, Care Science and Society, Karolinska Institutet, Center for family and community medicine, Stockholm.
    Törnkvist, Lena
    Karolinska Institutet, Department of Neurobiology, Care Science and Society, Center for Family and Community Medicine.
    Getting prepared for life at home in the discharge process - from the perspective of the older persons and their relatives2010In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 5, no 4, p. 254-264Article in journal (Refereed)
    Abstract [en]

    Aim: To examine how older persons in need of home-nursing care and their relatives experience the discharge process and develop a model that explains the experience. Background: The discharge process has well-known deficiencies and is therefore a challenging issue requiring improvement in many countries. Research focusing on patient-centred factors has attracted very little critical attention. Design: Grounded theory was used to analyze semi-structured interviews with 26 older persons and their relatives. Findings: The analysis resulted in a theoretical model that depicts factors determining whether the older persons and their relatives feel prepared or unprepared for life at home at the time of discharge. Conclusions: The older persons and/or their relatives felt prepared at the time of discharge if their needs were satisfied in the three significant areas of preparation. Not only were the professionals’ skills of the utmost importance in preparing the older persons/relatives, but also the latter’s own approach if the professionals were unskilled. Relevance for clinical practice. A knowledge of the preparation areas and skills can be of use for improving the quality of the discharge process from the older persons’ and their relatives’ perspective, i.e. through policies, checklists and teaching programmes.

  • 7.
    Rydholm Hedman, Ann-Marie
    et al.
    Red Cross University College of Nursing.
    Heikkilä, Kristina
    Grafström, Margareta
    Strömberg, Lars
    Red Cross University College of Nursing.
    Hip fractures and cognitive state: patient outcomes and proxies’ perceptions of the rehabilitation period2008In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 3, no 3, p. 178-186Article in journal (Refereed)
    Abstract [en]

    Background.  Numerous studies are available on hip fracture and rehabilitation outcomes, some mention dementia but very few from a family/proxy perspective.

    Aim.  To investigate whether cognitive state influences the hip fracture patients’ rehabilitation outcomes as well as the proxies’ perceptions of the 6-month rehabilitation period.

    Design.  A survey with structured and unstructured questions. Statistics and content analysis.

    Methods.  The questionnaire was sent to 40 proxies of hip fracture patients with and without cognitive impairment, 32 replied. Statistics and content analysis were used to analyse the data.

    Results.  In the cognitively impaired group, physical function decreased (P = 0.0241) as well as locomotion (P = 0.0005) compared to pre-fracture. This group mainly participated in rehabilitation sessions in institutions (P = 0.0001) and their main support came from nursing staff. The cognitively impaired group assessed the rehabilitation period as being of a much lower quality than the cognitively intact group (P = 0.0048). In the impaired group, hindrances to rehabilitation were low level of staffing, and lack of access to rehabilitation resources such as physiotherapists.

    Conclusions and relevance for clinical practice.  Hip fracture patients are a dichotomous group and cognition is decisive for physical and social outcomes as well as type of rehabilitation support.

  • 8.
    Sandberg, Jonas
    et al.
    Department of Caring Sciences Ersta Sköndal University College, Stockholm.
    Eriksson, Henrik
    Department of Caring and Public Health Sciences, Malardalen University, Eskilstuna.
    From alert commander to passive spectator: older male carers’ experience of receiving formal support2009In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, no 1, p. 33-40Article in journal (Refereed)
    Abstract [en]

    Aim. The aim was to describe older male carers' experience of receiving formal support. Background. To older male carers, creating new roles seems to be important. Their need for support in their caregiving is poorly understood. Design. A qualitative approach with a critical perspective on men and masculinities was used. Participants. Focus groups comprising a total of 11 men were used. Methods. Qualitative content analysis was adopted. Results. Three categories of response were found: 'using ad hoc solutions for maintaining a protective environment', 'coping but being left behind' and 'recapturing the caregiving role'. Discussion. Not only the quantity of support services offered to older male carers but also their quality dimension, based on a genuine understanding of the men's support needs, must be addressed. Conclusions. Professional caregivers attempt to relieve the men of their care obligations entirely. A reciprocal arrangement involving the men as partners, instead, may help them to regard their caring experience as valuable, which is important to their self-image. Relevance to clinical practice. These men's socially based networks need to be recognized by professional caregivers as important, to reframe the men's identity and notion of masculinity

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