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  • 1. Andersson, Nina
    et al.
    Klang, Birgitta
    Petersson, Gunilla
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Differences in clinical reasoning among nurses working in highly specialised paediatric care2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 5-6, p. 870-879Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. The aim of the study was to examine differences in clinical reasoning among novice, experienced and specialist paediatric nurses. Background. Highly specialised paediatric care requires specific knowledge and ongoing skill performance of the nurses employed. There is a lack of research in how paediatric nurses manage the daily care problems they encounter and how they acquire the skills required to give patients the best possible care. More knowledge is needed about how paediatric nurses with different experience and education reason and communicate about paediatric patient situations. Design. The study was based on six recorded group discussions of a fictitious, but realistic paediatric case. Three categories of nurses: novices (n = 7), experienced (n = 7) and specialists (n = 7) from a paediatric hospital participated. A qualitative content analysis approach was chosen to examine differences in clinical reasoning. Results. Several themes were uncovered: child's social situation, child abuse and the child's illness, qualitative differences emerged in how the nurses discussed the case. Three approaches were identified: a task-oriented approach (novices and experienced), an action-oriented approach (novices and experienced) and hypothesis-oriented approach (specialists) while discussing the case. Conclusion. When comparing nurses in three competence groups, it was established that the groups with extensive experience and specialist education reasoned differently than the other groups. Between the novice and experienced groups, no obvious differences were found. Thus, the importance of experience alone for the development of competence is still an open question. Experience combined with further education appears important for developing professional competence in paediatric care. Relevance to clinical practice. Nurses' reasoning in clinical paediatric care is related to experience and training.

  • 2. Athlin, A. Muntlin
    et al.
    Farrokhnia, N.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Introduction of multi-professional teamwork: a promising approach towards a more patient-centred care in the emergency department2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 274-275Article in journal (Other academic)
  • 3.
    Banerjee, Albert
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    James, Robert
    McGregor, Margaret
    Lexchin, Joel
    Nursing Home Physicians Discuss Caring for Elderly Residents: An Exploratory Study2018In: Canadian Journal on Aging, ISSN 0714-9808, E-ISSN 1710-1107, Vol. 37, no 2, p. 133-144Article in journal (Refereed)
    Abstract [en]

    Despite the increasing complexity of nursing home care, the role of physicians caring for residents is largely unexplored. This international, exploratory study sought to learn about physicians' roles, responsibilities, and tasks as well as investigate the unique qualities of medical practice in nursing homes. We conducted interviews with 18 physicians, who reported making important contributions to the quality of resident care, including clarifying the goals of care, working to reduce unnecessary medication and hospitalization, as well as contributing to staff education. Nursing home practice involved physicians in networks of relations that were instrumental to the quality of medical care and physicians' job satisfaction. The importance of these relationships disrupts the oft-drawn boundary between the medical and the social, suggesting that good medical practice depends on good social practice. Reflecting the exploratory nature of the study, we recommend research to better understand and support the relational dimensions of nursing home medicine.

  • 4. Beck, Ingela
    et al.
    Törnquist, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Broström, Linus
    Edberg, Anna-Karin
    Having to focus on doing rather than being: nurse assistants' experience of palliative care in municipal residential care settings2012In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 4, p. 455-464Article in journal (Refereed)
    Abstract [en]

    Background

    Palliative care should be provided, irrespective of setting to all patients facing a life-threatening illness and to their families. The situation and needs of older people differ from those of younger people since they often have several co-existing diseases and health complaints. This implies an extensive need for care and for longer periods of palliative care. The main providers of palliative care for older people are nurse assistants, who are also those with the shortest education.

    Aim

    The aim of this study was to illuminate nurse assistants’ experience of palliative care for older people in residential care.

    Design

    The study had an explorative, descriptive design.

    Settings

    Thirteen residential care units in three different districts in a large city in southern Sweden.

    Participants

    Twenty-five nurse assistants selected to represent variations in age, gender workplace and work experience.

    Methods

    Data were collected from six focus-group interviews and subjected to content analysis to gain an understanding of the phenomenon.

    Results

    The nurse assistants described palliative care as a contrast to the everyday care they performed in that they had a legitimate possibility to provide the care needed and a clear assignment in relation to relatives. Palliative care also meant having to face death and dying while feeling simultaneous that it was unnatural to talk about death and having to deal with their own emotions. They emphasised that they were in need of support and experienced leadership as invisible and opaque, but gained strength from being recognized.

    Conclusion

    In order to support nurse assistants in providing high quality end-of-life care, more focus is needed on the trajectory of older peoples’ dying, on the importance of involving relatives throughout the period of care provision, and on support when encountering death and dying. There is also a need for engaged care leaders, both registered nurses and managers, to recognize the work of nurse assistants and to support care provision for older people within the framework of palliative care philosophy.

  • 5.
    Brodin, Jane
    Stockholm University, Faculty of Social Sciences, Department of Child and Youth Studies.
    Parents of children at an early developmental level2005In: Communication in a Shared World (S. Kalman, Ed.), Budapest: Hungarian Bliss Foundation , 2005, p. 30-33Chapter in book (Other academic)
    Abstract [en]

    The paper is based on a presentation on  the 5th Eastern and Central European regional Augmentative and Alternative Communication (AAC) conference held in Budapest in December 2005.

  • 6.
    Brodin, Jane
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Child and Youth Studies.
    Renblad, Karin
    Högskolan i Borås.
    How many positive results on inclusion do we need to make a change?2009In: Assistive Technology From Adapted Equipment to Inclusive Environments / [ed] P.L. Emiliani, L. Burzagli, A. Como, F. Gabbanini and A-L. Salminen, The Netherlands: IOS Press , 2009, Vol. 25, p. 708-712Chapter in book (Other academic)
    Abstract [en]

    The expectations of Information and Communication Technologies (ICT) as a tool for participation and equal opportunities for all have been highly valued within the European community. For children and young persons with disabilities the expecations have been of special importance as they have found their opportunities for inclusion on the agenda. Inclusion is not only a physical placement. Inclusion means to be part of, to share, to communicate and to be someone to count with. The aim of the article is to stress research on inclusion of children and highlight how ICT has been and still is used in the schools to enhance participation and equal opportunities for all. Our intention is to stress challenging research results and we ask 'how many positive results on inclusion do we need to make changes?' and 'where are all the progressive decision-makers who will implement the research results?'.

  • 7.
    Brodin, Jane
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Child and Youth Studies.
    Renblad, Karín
    Högskolan i Borås.
    How many positive results on inclusion do we need to make a change?2009In: Presentation at the AAATE (Advancement in assistive technology in Europe) conference in Florens, Italy, August 2009. Abstract published in conference program., Florens, Italy, 2009Conference paper (Refereed)
    Abstract [en]

    The expectation of ICT as a tool for participation and equal opportunities for all have been highly valued within the EU. This paper focuses on inclusion of children and young persons and the key concept is Nothing about us without us....

  • 8. Bülow, Per
    et al.
    Andersson, Gunnel
    Denhov, Anne
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Research and Development Unit, Psychiatry South Stockholm, Sweden.
    Topor, Alain
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Research and Development Unit, Psychiatry South Stockholm, Sweden; University of Agder, Norway.
    Experience of Psychotropic Medication - An Interview Study of Persons with Psychosis2016In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 37, no 11, p. 820-828Article in journal (Refereed)
    Abstract [en]

    Psychotropic drugs, particularly antipsychotic types, are a cornerstone of the treatment of people with psychosis. Despite numerous studies showing that drug treatment with psychotropic drugs initially alleviates psychiatric symptoms, the proportion of people with mental health problems and symptoms that do not follow doctors' prescriptions, thus exhibiting so-called non-adherence, is considerable. Non-adherence is predominantly seen as a clinical feature and as a patient characteristic that is especially due to patients' poor understanding that they are ill. There is also a widespread notion that non-adherence is of great disadvantage to the patient. This article is based on interviews with 19 persons diagnosed with psychosis. It challenges the notion of patients being either adherent or non-adherent to the doctor's orders. The findings show that persons with psychosis are active agents when it comes to adjusting medication. The interviewees created their own strategies to gain power over treatment with psychotropic drugs. The most common strategies were to adjust the doses or take breaks of varying lengths from the medication. These deviations from prescriptions were important to conceal, not only from their own psychiatrists, but from all psychiatric staff.

  • 9.
    Edman, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    What's in a name?: Alcohol and drug treatment and the politics of confusion2009In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, Vol. 26, no 4, p. 339-353Article in journal (Refereed)
    Abstract [en]

    Aims

    The aim of this article is to investigate the use of a rather vague medical conceptual framework within the compulsory treatment of alcohol and drug users in Sweden during the 20th century. Focus lies on exploring how a phenomenon come to be described as pathological, what the causes are for certain actions all of a sudden being interpreted in medical terms, and what consequences that might lead to.

    Design

    Supported by theoretical speculations on medicalization processes and conceptual history, two empirical cases (the compulsory care of alcohol abusers in the 1950’s and the legislative process leading to psychiatric compulsory care of drug users in the late 1960’s) are investigated. The first case draws mainly upon official reports and archive material from alcohol treatment institutions, whilst the second case is built from reading official reports and parliamentary material. The research task for the two empirical cases has not quite been the same: whereas the first case is illustrated by the discrepancies between the labelling of treatment activities and the treatment actually carried out, the second case rather draws upon the enlargement of the field of signification of the disease concept to cover most aspects of drug use.

    Results

    A medicalization process on different levels is traced both in the post-war compulsory treatment of alcohol abusers as well as being a part of the launching of compulsory psychiatric care of drug abusers from the late 1960’s onwards.

    Conclusion

    The investigated cases shows how the medicalization processes gained from a conceptual vagueness, a widening of the conceptual dimensions of both the treatment and disease concepts. In this, the medicalization of alcohol abuse in the 1950’s and drug abuse in the 1960’s made way for a paternalistic justification of compulsory care measures that might otherwise have become politically troublesome.

  • 10.
    Elwin, Marie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ek, Lena
    Schroder, Agneta
    Kjellin, Lars
    Autobiographical Accounts of Sensing in Asperger Syndrome and High-Functioning Autism2012In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 26, no 5, p. 420-429Article in journal (Refereed)
    Abstract [en]

    Sensory experiences in Asperger syndrome (AS) or high-functioning autism (HFA) were explored by qualitative content analysis of autobiographical texts by persons with AS/HFA. Predetermined categories of hyper- and hyposensitivity were applied to texts. Hypersensitivity consists of strong reactions and heightened apprehension in reaction to external stimuli, sometimes together with overfocused or unselective attention. It was common in vision, hearing, and touch. In contrast, hyposensitivity was frequent in reaction to internal and body stimuli such as interoception, proprioception, and pain. It consists of less registration, discrimination, and recognition of stimuli as well as cravings for specific stimuli. Awareness of the strong impact of sensitivity is essential for creating good environments and encounters in the context of psychiatric and other health care.

  • 11.
    Emami, Azita
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Seattle University, USA.
    Safipour, Jalal
    Constructing a questionnaire for assessment of awareness and acceptance of diversity in healthcare institutions2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, article id 145Article in journal (Refereed)
    Abstract [en]

    Background: To develop a healthcare environment that is congruent with diversity among care providers and care recipients and to eliminate ethnic discrimination, it's important to map out and assess caregivers' awareness and acceptance of diversity. Because of a lack of standardized questionnaires in the Swedish context, this study designed and standardized a questionnaire: the Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions (AAAD, for short).

    Method: The questionnaire was developed in four phases: a comprehensive literature review, face and content validity, construct validity by factor analysis, and a reliability test by internal consistency and stability assessments.

    Results: Results of different validity and reliability analyses suggest high face, content, and construct validity as well as good reliability in internal consistency (Cronbach's alpha: 0.68 to 0.8) and stability (test-retest: Spearman rank correlation coefficient: 0.60 to 0.76). The result of the factor analysis identified six dimensions in the questionnaire: 1) Attitude toward discrimination, 2) Interaction between staff, 3) Stereotypic attitude toward working with a person with a Swedish background, 4) Attitude toward working with a patient with a different background, 5) Attitude toward communication with persons with different backgrounds, 6) Attitude toward interaction between patients and staff.

    Conclusion: This study introduces a newly developed questionnaire with good reliability and validity values that can assess healthcare workers' awareness and acceptance of diversity in the healthcare environment and healthcare delivery.

  • 12.
    Forinder, Ulla
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Nordic School of Public Health NHV, Sweden.
    Lindahl Norberg, Annika
    Posttraumatic growth and support among parents whose children have survived stem cell transplantation2014In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 18, no 4, p. 326-335Article in journal (Refereed)
    Abstract [en]

    In the current study, we investigated the occurrence of posttraumatic growth (PTG) among parents whose children had had stem cell transplantation (SCT) and survived. Although SCT is well established, it remains stressful and dangerous, and SCT is only performed if there is no other choice of treatment to be considered. A questionnaire batteries including the Post-Traumatic Stress Disorder (PTSD) Check ListCivilian version and the Post-Traumatic Growth Inventory were sent out to a cross-sectional national sample of parents of children who had had SCT six months or more before the study. The response rate was 66% (n = 281). The data were analyzed in relation to parents' appraisal of the event, gender, and perceived social support. The results confirm that SCT in childhood is an event of extreme adversity for the parents. Indications of PTSD were found among an important minority of the parents. Nevertheless, a large proportion of the parents had experienced growth as a consequence of the child's illness. Appreciation of life and personal strength were the domains with the highest scores. Moreover, a higher level of PTG was correlated with a higher level of posttraumatic stress and with an experience of the trauma as more severe. In summary, the study indicates that PTG is a relevant concept for this group of parents.

  • 13. Granhagen Jungner, Johanna
    et al.
    Tiselius, Elisabet
    Stockholm University, Faculty of Humanities, Department of Swedish Language and Multilingualism, Institute for Interpreting and Translation Studies.
    Lützén, Kim
    Blomgren, Klas
    Pergert, Pernilla
    Creating a Meeting Point of Understanding: Interpreters' Experiences in Swedish Childhood Cancer Care2016In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 33, no 2, p. 137-145Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Children and families with a foreign background and limited Swedish proficiency have to communicate through interpreters in childhood cancer care centers in Sweden. Interpreter-mediated events deal with many difficulties that potentially hinder the transfer of information. The purpose of our study was to explore interpreters' experiences of interpreting between health care staff and limited Swedish proficiency patients/families in childhood cancer care.

    DESIGN: Using purposive samples, we interviewed 11 interpreters individually. The interviews were analyzed using qualitative content analysis.

    FINDINGS: Analyses of the data resulted in the main theme of creating a meeting point of understanding, constructed from 3 subthemes: balancing between cultures, bridging the gaps of knowledge, and balancing between compassion and professionalism.

    DISCUSSION: Our result shows that in order to create a sustainable meeting point of understanding, it is necessary to explain both the context and cultural differences. These results suggest that the responsibility for information transfer lies with both the health care profession and the interpreters. Tools have to be developed for both parties to contribute to creating the meeting point of understanding.

  • 14.
    Gransjön Craftman, Åsa
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Sophiahemmet University, Sweden.
    Hammar, Lena M.
    von Strauss, Eva
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). The Swedish Red Cross University College, Sweden.
    Hillerås, Pernilla
    Westerbotn, Margareta
    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.

  • 15. Gransjön Craftman, Åsa
    et al.
    von Strauss, Eva
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rudberg, Susanne L.
    Westerbotn, Margareta
    District nurses' perceptions of the concept of delegating administration of medication to home care aides working in the municipality: A discrepancy between legal regulations and practice2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 3-4, p. 569-578Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe district nurses perceptions of the concept of delegating medication management to unlicensed personnel working in municipal social care. Background. The delegation of medical tasks involves responsibility and is regulated by law to avoid damage and injuries and to protect the patient. The delegation of the administration of medication is a multifaceted task. The delegating district nurse is responsible for the outcome and should also follow up the delegated task. Design. A descriptive qualitative study, involving semi-structured interviews and content analysis. Methods. Twenty district nurses were interviewed. The interviews were audio taped. The data were collected from April 2009August 2010 and analysed using content analysis. Results. The findings revealed that the statutes of delegation appear to be incompatible with practice, however, mostly due to lack of time. Communication between district nurses and home care aides, as well as tutoring, was regarded as important. The district nurses found it imperative to be available to the home care aides and made an effort to create a trusting atmosphere. Conclusions. District nurses cannot manage their workload without delegating the administration of medication in the present organisational model of health care and social care. The statutes regarding delegating medicine tasks are also cumbersome and difficult to incorporate for district nurses who are responsible for the delegation. Relevance to clinical practice. The findings elucidate the current situation as regards district nurses and the need to delegate the administration of medication. Health care and social care for home-dwelling older patients, as well as statutes, needs to be evaluated and updated to meet and be prepared for the increasing demands of care.

  • 16.
    Gransjön Craftman, Åsa
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Sophiahemmet University, Sweden.
    Westerbotn, Margareta
    von Strauss, Eva
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). The Swedish Red Cross University College, Sweden.
    Hillerås, Pernilla
    Marmstål Hammar, Lena
    Older people's experience of utilisation and administration of medicines in a health- and social care context2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 760-768Article in journal (Refereed)
    Abstract [en]

    Background: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care.

    Aim: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care.

    Design: A qualitative descriptive study.

    Methods: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used.

    Findings: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process.

    Conclusions: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine.

    Relevance to Clinical Practice: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health-and social care delivery is efficient and improve outcome for the recipient of care.

  • 17.
    Gunnarsson, Evy
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    "Man får inte stanna upp": om äldre kvinnors och mäns vardagsliv och kropppens förändring2009In: Genus i omsorgens vardag / [ed] Evy Gunnarsson, Marta Szebehely, Stockholm: Gothia Förlag AB, 2009, p. 101-117Chapter in book (Other academic)
  • 18. Harrington, Charlene
    et al.
    Choiniere, Jacqueline
    Goldmann, Monika
    Jacobsen, Frode Fadnes
    Lloyd, Liz
    McGregor, Margaret
    Stamatopoulos, Vivian
    Szebehely, Marta
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Nursing Home Staffing Standards and Staffing Levels in Six Countries2012In: Journal of Nursing Scholarship, ISSN 1527-6546, E-ISSN 1547-5069, Vol. 44, no 1, p. 88-98Article in journal (Refereed)
    Abstract [en]

    Purpose: This study was designed to collect and compare nurse staffing standards and staffing levels in six counties: the United States, Canada, England, Germany, Norway, and Sweden. Design: The study used descriptive information on staffing regulations and policies as well as actual staffing levels for registered nurses, licensed nurses, and nursing assistants across states, provinces, regions, and countries. Methods: Data were collected from Internet searches of staffing regulations and policies along with statistical data on actual staffing from reports and documents. Staffing data were converted to hours per resident day to facilitate comparisons across countries. Findings: We found wide variations in both nurse staffing standards and actual staffing levels within and across countries, although comparisons were difficult to make due to differences in measuring staffing, the vagueness of standards, and limited availability of actual staffing data. Both the standards and levels in most countries ( except Norway and Sweden) were lower than the recommended levels by experts. Conclusions: Our findings demonstrate the need for further attention to nurse staffing standards and levels in order to assure the quality of nursing home care.

  • 19. Harrington, Charlene
    et al.
    Jacobsen, Frode F.
    Panos, Justin
    Pollock, Allyson
    Sutaria, Shailen
    Szebehely, Marta
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Marketization in Long-Term Care: A Cross-Country Comparison of Large For-Profit Nursing Home Chains2017In: Health Services Insights, ISSN 1178-6329, Vol. 10, p. 1-23Article in journal (Refereed)
    Abstract [en]

    This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability.

  • 20. Hörberg, Anna
    et al.
    Kalén, Susanne
    Jirwe, Maria
    Scheja, Max
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Lindström, Veronica
    Treat me nice! -a cross-sectional study examining support during the first year in the emergency medical services2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, article id 92Article in journal (Refereed)
    Abstract [en]

    Background Working in the emergency medical service (EMS) can be extremely varying and sometimes physically and psychologically demanding. Being new in this context can be a great challenge. This study aim to describe what ambulance nurses consider to be important support during the first year in the EMS.

    Methods Three hundred and eighty-nine eligible participants that had graduated from the prehospital emergency care program were identified via university registrations office in Sweden. The eligible participants received a study specific questionnaire via mail consisting of 70 statements about support during the first year. The perceived importance of each statement were graded on a 7-point Likert scale. The gradings were analysed using descriptive statistics and frequencies, mean and SD were calculated.

    Results Two hundred and thirty questionnaires were returned fully completed, giving a response rate of 59%. Fourteen statements regarding desirable support were rated with mean values >6.00 and SD<1.00 and considered as being the most important during the first year in the EMS. The important supports regarded; colleagues and work environment, management and organisation, experience-based knowledge, introduction period, practical support, and theoretical support. Most statements regarded culture and climate and the way the newcomers wanted to be treated.

    Conclusion It was concluded that an important way to support newcomers in the EMS is to treat them nice'. This can be achieved by creating an open climate and a welcoming culture where the new professionals feel trusted and treated with respect, created ways to work structurally, have applicable medical guidelines, and for newcomers to receive feedback on their actions.

  • 21. Hörberg, Anna
    et al.
    Lindström, Veronica
    Scheja, Max
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Conte, Helen
    Kalen, Susanne
    Challenging encounters as experienced by registered nurses new to the emergency medical service: explored by using the theory of communities of practice2019In: Advances in Health Sciences Education, ISSN 1382-4996, E-ISSN 1573-1677, Vol. 24, no 2, p. 233-249Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore challenging encounters experienced by registered nurses (RN) during their first year in the emergency medical service by using the social learning theory of communities of practice. During the first year in a new professional practice, a new RN experiences a transition during which the new professional identity is being formed. This is a challenging and demanding period of time. According to the learning theory of communities of practice by Lave and Wenger, individuals' learning and development in a new professional practice occurs through participation in social activity and is influenced by context. This study is based on the qualitative data from semi-structured interviews. Thirty-two RNs working in the Swedish emergency medical service were interviewed via telephone during the spring of 2017. A qualitative content analysis with deductive reasoning of the interviews was used. The analysis process generated the main category; New RNs participation is challenged by unpredictability and uncertainty in practice. The main category was based on three generic categories; Loneliness in an unpredictable context, Uncertainty about the team, and Uncertainty in action. The challenges new RNs encounter during the first year relate to all three dimensions of a community of practice; mutual engagement, joint enterprise and shared repertoire. The encountered challenges also relate to the EMS context. Taking into account all these aspects when designing support models for RN's professional development may be advantageous for creating positive development for RNs new to the EMS and/or similar practices.

  • 22. Janah, Asmaa
    et al.
    Gauthier, Lynn R.
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Bousquet, Philippe Jean
    Le Bihan, Christine
    Tuppin, Philippe
    Peretti-Watel, Patrick
    Bendiane, Marc-Karim
    Access to palliative care for cancer patients between diagnosis and death: a national cohort study2019In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 11, p. 443-455Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Introducing palliative care earlier in the disease trajectory has been found to provide better management of physical and psychological suffering. In France, the proportion of cancer patients who receive palliative care is unclear. This study aimed primarily to measure the prevalence of access to inpatient palliative care and associated patient-level factors, and to identify the time between access to palliative care and death.

    Patients and methods: A nationwide retrospective cohort study using data from the French national health system database (SNDS). All those diagnosed with cancer in 2013 who died between 2013 and 2015 were included. Access to inpatient palliative care was the main outcome.

    Results: Of the 313,059 patients diagnosed with cancer in 2013 in France, 72,315 (23%) died between 2013 and 2015. Overall, 57% had access to inpatient palliative care. The following groups were the most likely to have access to palliative care: women (adjusted odds ratio, aOR: 1.15; 95% CI: 1.11-1.20), people aged 18-49 (aOR: 1.38; 95% CI: 1.26-1.51), individuals with metastatic cancer (aOR: 2.04; 95% CI: 1.96-2.13), and patients with cancer of the nervous system (aOR: 1.80; 95% CI: 1.62-2.01). The median time between palliative care and death was 29 (interquartile range: 13-67) days.

    Conclusion: More than half of cancer patients who died within 2 years after diagnosis had access to inpatient palliative care. Access to palliative care occurs late in the disease trajectory, often during the final month of life. Further research and guidelines are warranted to optimize access to early, standardized palliative care.

  • 23. Johansson-Pajala, Rose-Marie
    et al.
    Jorsäter Blomgren, Kerstin
    Bastholm-Rahmner, Pia
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Martin, Lene
    Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: a qualitative study of medication management2016In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    Objective: To explore registered nurses' experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. Design: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. Setting: Five focus groups in five different long-term care settings in two regions in Sweden. Subject: A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. Results: The findings reveal that RNs in municipal long-term care settings can be regarded as vigilant intermediaries in the patients' drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. Conclusion: The RNs play a central but also complex role as vigilant intermediaries in the medication monitoring process, including the issue of responsibility. Improving RNs' possibility to monitor their patients' drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs' pharmacovigilant activities.

  • 24.
    Johnell, Kristina
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Comparison of prescription drug use between community dwelling and institutionalized elderly in Sweden2012In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 29, no 9, p. 751-758Article in journal (Refereed)
    Abstract [en]

    Background Most previous studies about drug use in the elderly population have either investigated drug use in institutions or in the community-dwelling setting. Hence, very few studies have compared drug use in institutionalized and community-dwelling elderly, maybe because of a lack of sufficiently large databases. Objective The aim of the study was to investigate differences in drug use patterns between community-dwelling and institutionalized elderly, after adjustment for age, gender and number of other drugs (used as a proxy for overall co-morbidity). Methods We analysed data from individuals aged >= 65 years who filled at least one drug prescription between July and September 2008 and were consequently registered in the Swedish Prescribed Drug Register (n = 1,347,564; 1,260,843 community-dwelling and 86,721 institutionalized elderly). A list of current prescriptions was constructed for every individual on the arbitrarily chosen date 30 September 2008. Outcome measures were the 20 most common drug classes and the 20 most common individual drugs. Logistic regression analysis was used to investigate whether institutionalization was associated with use of these drugs, after adjustment for age, gender and number of other drugs. Results Institutionalized elderly were more likely than community-dwelling elderly to use antidepressants, laxatives, minor analgesics, opioids and hypnotics/sedatives, after adjustment for age, gender and number of other drugs. On the contrary, institutionalization was negatively associated with use of lipid modifying agents, angiotensin II antagonists, selective calcium channel blockers, beta-blocking agents and ACE inhibitors, after adjustment for age, gender and number of other drugs. Conclusions Our results indicate that institutionalized elderly are more likely than community-dwelling elderly to use psychotropics, analgesics and laxatives, but less likely to receive recommended cardiovascular drug therapy, which may indicate a need for implementation of evidencebased guidelines for drug treatment in this vulnerable group of elderly patients. Further research is needed to elucidate to what extent the differences in drug use between community-dwelling and institutionalized elderly are explained by different underlying disease patterns and by different prescribing traditions in the different settings.

  • 25. Joling, Karlijn J.
    et al.
    van Eenoo, Liza
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Universita`Cattolica Sacro Cuore, Italy.
    Smaardijk, Veerle R.
    Declercq, Anja
    Onder, Graziano
    van Hout, Hein P. J.
    van der Roest, Henriette G.
    Quality indicators for community care for older people: A systematic review2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 1, article id e0190298Article, review/survey (Refereed)
    Abstract [en]

    Background

    Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality.

    Methods

    Relevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality.

    Results

    Searches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain 'Additional evidence, formulation and usage' (51%), followed by 'Scientific evidence' (39%) and 'Stakeholder involvement' (28%).

    Conclusion

    A substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes.

  • 26. Jongstra, Susan
    et al.
    Beishuizen, Cathrien
    Andrieu, Sandrine
    Barbera, Mariagnese
    van Dorp, Matthijs
    van de Groep, Bram
    Guillemont, Juliette
    Mangialasche, Francesca
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    van Middelaar, Tessa
    Moll van Charante, Eric
    Soininen, Hilkka
    Kivipelto, Miia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Richard, Edo
    Development and Validation of an Interactive Internet Platform for Older People: The Healthy Ageing Through Internet Counselling in the Elderly Study2017In: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 23, no 2, p. 96-104Article in journal (Refereed)
    Abstract [en]

    Background: A myriad of Web-based applications on self-management have been developed, but few focus on older people. In the face of global aging, older people form an important target population for cardiovascular prevention. This article describes the full development of an interactive Internet platform for older people, which was designed for the Healthy Ageing Through Internet Counselling in the Elderly (HATICE) study. We provide recommendations to design senior-friendly Web-based applications for a new approach to multicomponent cardiovascular prevention. Methods: The development of the platform followed five phases: (1) conceptual framework; (2) platform concept and functional design; (3) platform building (software and content); (4) testing and pilot study; and (5) final product. Results: We performed a meta-analysis, reviewed guidelines for cardiovascular diseases, and consulted end users, experts, and software devel-opers to create the platform concept and content. The software was built in iterative cycles. In the pilot study, 41 people aged >= 65 years used the platform for 8 weeks. Participants used the interactive features of the platform and appreciated the coach support. During all phases adjustments were made to incorporate all improvements from the previous phases. The final platform is a personal, secured, and interactive platform supported by a coach. Discussion: When carefully designed, an interactive Internet platform is acceptable and feasible for use by older people with basic computer skills. To improve acceptability by older people, we recommend involving the end users in the process of development, to personalize the platform and to combine the application with human support. The interactive HATICE platform will be tested for efficacy in a multinational randomized controlled trial (ISRCTN48151589).

  • 27. Jonsson, Catherine Aaro
    et al.
    Catroppa, Cathy
    Godfrey, Celia
    Smedler, Ann-Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Anderson, Vicki
    Individual profiles of predictors and their relations to 10 years outcome after childhood traumatic brain injury2013In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 27, no 7-8, p. 831-838Article in journal (Refereed)
    Abstract [en]

    Background: Outcome after childhood traumatic brain injury (CTBI) is heterogeneous, with several predictors influencing long-term outcome. Method: This exploratory study used person-oriented cluster analysis to investigate individual profiles of medical, psychological and social predictors and their relation to longitudinal development in a sample of 127 participants with mild, moderate and severe CTBI. Outcome of cognitive, adaptive and academic function was measured at 30 months and 10 years post-injury. Results: A nine-cluster solution, explaining 67% of the variance in the sample, resulted in two clusters with individuals with mostly mild injuries, five with mostly moderate injured individuals and two clusters with severely injured individuals. Best outcome at 10 years post-injury had a cluster with individuals with moderate injuries, young age at injury, average socioeconomic status (SES) and high pre-injury adaptive function. Worst outcome had a small cluster with severely injured individuals, young age at injury, average SES and average pre-injury adaptive function. Conclusions: The findings suggest that pre-injury adaptive function is an influential predictor of outcome following moderate CTBI. Age at injury in the severe group appears to have increased influence over time, with younger age at injury associated with reduced outcome at 10 years after severe CTBI.

  • 28. Kempe, Annica
    et al.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Noor-Aldin Alwazer, Fatoom
    Christensson, Kyllike
    Johansson, Annika
    Yemeni women's perceptions of own authority during childbirth: what does it have to do with achieving the Millennium Development Goals?2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 10, p. 1182-1189Article in journal (Refereed)
    Abstract [en]

    Background: women's underutilisation of professional care during childbirth in many low-income countries is a serious concern in terms of achievement of maternal Millennium Development Goal 5.

    Objective: to explore women's perceived own authority within the modern and traditional spheres of childbirth in a high maternal mortality setting on the Arab peninsula. Yemen is a signatory to the Millennium Development Goals and one of 10 countries chosen for the United Nations Millennium Project. In Yemen, home birth has remained the norm for several decades in spite of high maternal mortality and morbidity rates.

    Design: a multistage (stratified-purposive-random) sampling process was used. Two hundred and twenty women with childbirth experience in urban/rural Yemen were selected at random for interview. Answers to the question 'Did you feel that you were the authority during childbirth?' were analysed using qualitative content analysis.

    Setting: the governorates of Aden, Lahej, Hadramout, Taiz and Hodeidah.

    Findings: three main themes emerged from the analysis: (i) 'Being at the centre', including two categories 'being able to follow through on own wants' and its opposite 'to be under the authority of others'; (ii) 'A sense of belonging' with the categories 'belonging and support among women in the community' and 'the denial of support, the experience of separation' and (iii) 'Husband's role in childbirth' including one category 'opportunity to show authority over the husband'. Authority was experienced primarily among women within the traditional childbirth sector although a general complaint among women delivered by trained medical staff was the loss of own authority.

    Key conclusions and implications for practice: these findings show that women's authority during childbirth is decreasing in the context of Safe Motherhood and the expansion of modern delivery care. This is likely to be an important reason why women underutilise professional care. Acquisition of knowledge from the traditional childbirth sector regarding how women exercise authority to facilitate childbirth would constitute an asset to skilled delivery and Safe Motherhood. The findings from Yemen are likely to be relevant for other low-income countries with similar persistent high home delivery rates, low status of women, and high maternal mortality and morbidity rates.

  • 29. Ljungberg, Amanda
    et al.
    Denhov, Anne
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Psychiatry South Stockholm, Sweden.
    Topor, Alain
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Psychiatry South Stockholm, Sweden; University of Agder, Norway.
    A Balancing Act-How Mental Health Professionals Experience Being Personal in Their Relationships with Service Users2017In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 38, no 7, p. 578-583Article in journal (Refereed)
    Abstract [en]

    Background: Although being personal in relationships with service users is commonly described as an important aspect of the way that professionals help people with severe mental problems, this has also been described to bring with it a need to keep a distance and set boundaries. Aims: This study aims to explore how professionals working in psychiatric care view being personal in their relationships with users. Method: Qualitative interviews with 21 professionals working in three outpatient psychiatric units, analyzed through thematic analysis. Results: Being personal in their relationships with users was described as something that participants regarded to be helpful, but that also entails risks. Participants described how they balanced being personal by keeping a distance and maintaining boundaries in their relationships based on their experience-based knowledge to counter these risks. While these boundaries seemed to play an important part in the way that they act and behave, they were not seen as fixed, but rather as flexible and dynamic. Boundaries could sometimes be transgressed to the benefit of users. Conclusions: Being personal was viewed as something that may be helpful to users, but that also entails risks. Although boundaries may be a useful concept for use in balancing these risks, they should be understood as something complex and flexible.

  • 30. Lofvenmark, Caroline
    et al.
    Saboonchi, Fredrik
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Edner, Magnus
    Billing, Ewa
    Mattiasson, Anne-Cathrine
    Evaluation of an educational programme for family members of patients living with heart failure: a randomised controlled trial2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 1-2, p. 115-126Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. Background. When a person is diagnosed with heart failure, the daily life of the family members is also affected. Design. Randomised controlled trial. Methods. A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. Results. There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0.001, R2 = 0.35) and depression (p = 0.021, R2 = 0.37). Younger family members were found to have a higher quality of life (p < 0.01). Conclusion. Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. Relevance to clinical practice. Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.

  • 31. Lunden, Anne
    et al.
    Teräs, Marianne
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Kvist, Tarja
    Haggman-Laitila, Arja
    A systematic review of factors influencing knowledge management and the nurse leaders' role2017In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 6, p. 407-420Article, review/survey (Refereed)
    Abstract [en]

    Aim

    To describe factors facilitating or inhibiting the development of registered nurses' competency and nurse leader's role in knowledge management.

    Background

    Nurses' competency directly influences patient safety and the quality and effectiveness of patient care. Challenges of nurse leaders in knowledge management include acquiring, assessing and utilising current knowledge and assessing and enhancing competency.

    Evaluation

    A systematic search was conducted in PubMed, CINAHL, SCOPUS and ERIC databases in April 2015. The search identified 18 relevant research articles published between 2009 and 2015. The quality of the studies was appraised in accordance with study designs.

    Key issue

    Knowledge management is facilitated by an organisation culture that supports learning, sharing of information and learning together. Leader commitment and competency were factors related to leadership facilitating knowledge management.

    Conclusion

    Nurse leaders need evidence-based interventions to support shared learning and to create infrastructures that facilitate competence development. Future research is especially needed to evaluate connections between knowledge management and patient outcomes.

    Implications for nursing management and leadership

    The results of this review can be utilised in enhancing factors to facilitate knowledge management in clinical practice and identifying nurse leaders' role in strengthening nurses' competency.

  • 32. Lunden, Anne
    et al.
    Teräs, Marianne
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Kvist, Tarja
    Häggman-Laitila, Arja
    Nurse leaders' perceptions and experiences of leading evidence: A qualitative enquiry2019In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 8, p. 1859-1868Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe nurse leaders' perceptions and experiences of leading evidence-based practices (EBP).

    Background: Leaders can promote EBP in nursing with their own personal example and by striving to renew structures, processes and working cultures. However, previous studies have shown that nurse leaders have tended to be passive with regard to EBP.

    Methods: An interview study using general qualitative methods. In total, 33 individual interviews and seven focus groups of leaders were conducted in 2015 and 2017. Data were analysed thematically.

    Results: The respondents were unfamiliar with EBP as activities that lead to effective patient care. EBP were described as indistinguishable from other practices, lost and random. Overall, they lacked competence with EBP. The activities of nurse leaders do indicate a tentative commitment to EBP, but their main goals seem to be maintaining the status quo.

    Conclusion: Unfamiliarity with EBP reflects adversely on the operations of an entire organisation. The nurse leaders have an opportunity to enhance their understanding with EBP, which will lead to the renewal and improvement of the operating culture and the quality of strategic leadership.

    Implications for nursing management: Leaders should take clear responsibility for EBP on the strategic, operational and educational level.

  • 33. Lundgren, Dan
    et al.
    Ernsth Bravell, Marie
    Börjesson, Ulrika
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden; Karolinska Institutet, Sweden.
    The Impact of Leadership and Psychosocial Work Environment on Recipient Satisfaction in Nursing Homes and Home Care2019In: Gerontology and geriatric medicine, E-ISSN 2333-7214, Vol. 5, p. 1-9Article in journal (Refereed)
    Abstract [en]

    This study examines the association between nursing assistants' assessment of leadership, their psychosocial work environment, and satisfaction among older people receiving care in nursing homes and home care. Cross-sectional surveys were conducted with nursing assistants (n = 1,132) and people receiving care (n = 1,535) in 45 nursing homes and 21 home care units. Direct leadership was associated with the psychosocial work environment in nursing homes and home care. Furthermore, better leadership was related to higher satisfaction among nursing assistants and older people in nursing homes. Thus, indirect leadership had no effect on recipients' satisfaction in either nursing homes or home care. The path analysis showed an indirect effect between leadership factors and recipient satisfaction. The findings suggest that the psychosocial work environment of nursing assistants and recipient satisfaction in nursing homes can be increased by improving leadership.

  • 34.
    Lärka Paulin, Sanja
    et al.
    Stockholm University, The Stockholm Institute of Education.
    Bernehäll Claesson, Inger
    Stockholm University, The Stockholm Institute of Education.
    Brodin, Jane
    Stockholm University, The Stockholm Institute of Education.
    Familjer med barn med muskelsjukdomar: Inflytande och medverkan i beslutsprocessen2000Report (Other academic)
    Abstract [sv]

    Många familjer med barn med funktionsnedsättningar har stora svårigheter i sitt vardagsliv och speciellt gäller detta familjernas möjligheter att få stöd. Samhället har enligt lag skyldighet att tillhandahålla olika former av stöd, men det tycks inte alltid somom det stöd som erbjuds svarar mot familjens behov.

  • 35. Lööf, Helena
    et al.
    Johansson, Unn-Britt
    Henriksson, Elisabet Welin
    Lindblad, Staffan
    Saboonchi, Fredrik
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Development and psychometric testing of the Swedish version of the Body Awareness Questionnaire2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 7, p. 1643-1651Article in journal (Refereed)
    Abstract [en]

    Aim This paper is a report of the development and psychometric testing of the Swedish version of the Body Awareness Questionnaire to measure bodily focus of attention. Background The Body Awareness Questionnaire has been identified as an instrument with excellent psychometric properties within the concept of body awareness. It has been used in both research and clinical settings in different contexts. However, a validated Swedish version is not available. Method A cross-sectional design was applied for adaptation of the Body Awareness Questionnaire and psychometric validation. Data were collected between autumn 2009 and spring 2011 from 120 patients diagnosed with rheumatoid arthritis, and from 120 students. The concurrent think aloud' method was used in a pre-test to determine the usability of the questionnaire. Cronbach's alpha was used to test the internal consistency, and confirmatory factor analysis was performed to test the construct validity. Results According to the confirmatory factor analysis, neither the one-factor model nor the four-factor model tested in this study fulfilled the pre-specified criteria in accordance with the Comparative Fit Index, Standardized Root Mean Squared Residual and the Root Mean Square Error of Approximation. The value of Cronbach's alpha for the Swedish version of the Body Awareness Questionnaire was satisfactory. Conclusion Our results indicate that the two models tested in this study do not provide a good fit to the observed data. Further refinement and testing of the Swedish version of the Body Awareness Questionnaire is therefore required. The concept of body awareness may be useful in the management of chronic disease and can be addressed in nursing.

  • 36.
    Morin, Lucas
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Observatoire national de la fin de vie, France.
    Aubry, Regis
    Home-based palliative care support teams in France: A nationwide survey2015In: Médecine palliative, ISSN 1636-6522, Vol. 14, no 3, p. 152-161Article in journal (Refereed)
    Abstract [en]

    Context

    Home-based palliative care support teams have been widely developed in France over the course of the last 2 decades. This national survey aimed to describe the characteristics of home-based palliative care support teams, and to investigate their activities (e.g. clinical support, coordination, teaching).

    Methods

    This study is based on a nationwide survey conducted among all existing home-based palliative care support teams in France between September, 15 and December, 15, 2012.

    Results

    Among 98 home-based palliative care support teams in France, 78 participated in our survey (response rate = 80%). Coordination staff consisted of 8 professionals on average (4.9 full time equivalents). However, our results show a considerable heterogeneity in the composition of the staff: some home-based palliative care support teams do not include any psychologists(n = 17), social workers (n = 28) or even physicians (n = 10). In 2011, 17,326 patients were followed by a home-based palliative care support team, i.e. 225 patients on average (SD = 133). Cancer remains the most frequent underlying condition. Hospital discharge and symptom management are the two most frequent reasons for referral. Finally, home-based palliative care support teams are involved in various teaching activities, not only toward community-based professionals but also toward nursing home and hospital-based professionals.

    Conclusion

    Our study highlights considerable variation in the functioning, the staff and the activities of home-based palliative care support teams in France.

  • 37.
    Morin, Lucas
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Aubry, Régis
    Palliative care in hospital-at-home services in France / Soins palliatifs en hospitalisation à domicile: A nationwide study using administrative data / état des lieux à partir des données hospitalières2017In: Médecine palliative, ISSN 1636-6522, Vol. 16, no 1, p. 7-20Article in journal (Refereed)
    Abstract [en]

    Background

    Hospital-at-home services have a key role in providing palliative care to people with complex needs at home. This study aimed to examine and describe the development of palliative care in hospital-at-home services between 2008 and 2014 in France.

    Methods

    Aggregated data were extracted from the national hospital registry (PMSI) to describe the delivery of palliative care by hospital-at-home services and to measure variation over time and across geographical areas.

    Results

    Hospital-at-home services increased the provision of palliative care between 2008 and 2014 (+61 % increase in the number of home-based hospitalizations, accounting for 28,000 patients in 2014). Palliative care now accounts for 23.6 % of the total number of days of hospitalization. During the same period, the mean age of patients and their level of activity of daily living impairment increased. Cancer remains the most frequent diagnosis: the 30 most common tumor localizations are found in nearly 60 % of the total case-mix. In 2014, almost 18,000 individuals died while being hospitalized at home (including 13,700 during a palliative care stay), the proportion of deaths in overall number of discharges rising from 7.2 % in 2008 to 10.2 % in 2014. However, we found considerable variation in the development of palliative care in hospital-at-home services across counties (from 0.5 to 87.5 palliative care home-based hospitalization per 1000 deaths).

    Conclusion

    The provision of palliative care by hospital-at-home services remains insufficient compared with the needs for home-based palliative care in the general population. It is therefore necessary to significantly increase the number of beneficiaries, while ensuring high-quality palliative care.

  • 38.
    Morin, Lucas
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Observatoire national de la fin de vie, France.
    Aubry, Régis
    The development of palliative care services in France (1987-2013)2015In: Medecine palliative, ISSN 1636-6522, Vol. 14, no 3, p. 134-141Article in journal (Refereed)
    Abstract [en]

    Aim

    Our study aimed to monitor the development of palliative care services in France between 1987 and 2013 and to examine the geographical distribution of these services overtime.

    Methods

    We conducted a meta-analysis of published data and grey literature'' to obtain reliable estimates for the years 1987, 1993, 1997, 2001, 2003, 2005, 2007, 2008, 2010, 2012 and 2013.

    Results

    Between 1987 and 2013, the number of palliative care units increased from six to 130, resulting in an increase from 150 to 1412 palliative care unit beds. In addition, 431 hospital palliative care support teams were installed in hospital facilities. The number of palliative care beds has increased from 232 to 4663 between 2001 and 2004. Finally, home-based palliative care support teams have been widely developed since 1997, although we noticed a decrease in their number between 2010 and 2013. However, despite this significant development of palliative care services in France, regional discrepancies have increased over time.

    Conclusion

    Considering the extent and the nature of current palliative care needs at the population level, France's national end-of-life care strategy should shift from a palliative care service'' vision to an integrated palliative care'' perspective.

  • 39.
    Morin, Lucas
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Observatoire national de la fin de vie, France.
    Aubry, Régis
    Where do older people die? A nationwide study in France (1990-2010)2015In: Medecine palliative, ISSN 1636-6522, Vol. 14, no 3, p. 179-190Article in journal (Refereed)
    Abstract [en]

    Objectives

    We aimed to measure the variation in the place of death of older people in France between 1990 and 2010.

    Methods

    Retrospective, population-based study of death-certificate data. All decedents aged 75 or older who died in 1990, 2000 and 2010 were included (n = 1,001,848). Projections from 2010 to 2050 were developed using previous estimates reported by France's national institute for statistics and economic studies (Insee).

    Results

    Between 1990 and 2010, the proportion of home deaths decreased from 28.5 to 24.5%, while the proportion of deaths occurring in nursing home facilities increased (13.2 to 15.8%). In-hospital death rates remained stable over the study period (55.5 to 55.9%). After adjusting for individual-level variables, older people who died in 2010 had a reduced likelihood of dying at home (Odds Ratio [OR] = 0.81; 95% CI = 0.80-0.82) and increased odds of dying in hospitals (OR = 1.05; 95% CI = 1.04-1.06) or in nursing homes (OR = 1.15; 95% CI = 1.13-1.17), compared with 1990 decedents. If these trends continue, the number of deaths occurring in nursing home facilities is projected to be multiplied by 3.7 in 2050.

    Conclusions

    Our study demonstrates that the likelihood of dying at home decreased over the last 20 years, while the proportion of older people dying in nursing homes and in hospitals significantly increased. Beyond the ethical and social concerns that these changes might raise, from a demographic and macroeconomic perspective, this process of medicalization and institutionalization of death seems unsustainable for the healthcare system.

  • 40. Norberg, Joakim
    et al.
    Axelsson, Helén
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Barkman, Nilla
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hamrin, Monica
    Carlsson, Jan
    What psychodynamic supervisors say about supervision: Freedom within limits2016In: Clinical Supervisor, ISSN 0732-5223, E-ISSN 1545-231X, Vol. 35, no 2, p. 268-286Article in journal (Refereed)
    Abstract [en]

    Supervision is considered an important part of training in psychodynamic psychotherapy. In this study, we investigated psychodynamic supervisors' experiences of the supervisory relationship. We interviewed 15 experienced psychodynamic supervisors and analyzed the data following the constant comparison method. Findings indicated that supervisors facilitated the development of supervisees' own styles, but also provided them with negative feedback when they did not conform to proper psychodynamic theory. This often resulted in emotional reactions in supervisees that supervisors could only understand by using clinical conceptualizations. Findings suggested supervisors used different approaches depending on whether or not they felt they could trust supervisees' judgment.

  • 41. Osman, Fatumo
    et al.
    Flacking, Renée
    Klingberg Allvin, Marie
    Schön, Ulla-Karin
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Qualitative study showed that a culturally tailored parenting programme improved the confidence and skills of Somali immigrants2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 8, p. 1482-1490Article in journal (Refereed)
    Abstract [en]

    Aim: Parenting programmes tailored to immigrant parents have been reported to improve the mental health of the children and parents, as well as parents' sense of competence in parenting. However, research on parents' experiences of programmes tailored to their needs is scarce. This qualitative study aimed to describe Somali parents' experiences of how a culturally sensitive programme affected their parenting.

    Methods: The study was conducted in a middle-sized city in Sweden in 2015. Data were collected through semi-structured interviews with 50 participants two months after they took part in a parenting support programme. Inductive and deductive qualitative content analyses were used.

    Results: A light has been shed was a metaphor that emerged from the analysis and that captured the knowledge the parents gained from the parenting system in Sweden. Parents gained confidence in their parenting role and became emotionally aware of their child's social and emotional needs and how to respond to them. Holding the sessions in the participant's native language was important for the parents' participation and acceptance of the programme.

    Conclusion: Parenting programmes should be tailored to the specific needs of the participants and cultural sensitivity should be factored into programmes to attract immigrant parents.

  • 42.
    Rindstedt, Camilla
    Stockholm University, Faculty of Social Sciences, Department of Child and Youth Studies.
    Pain and nurses' emotion work in a paediatric clinic: Treatment procedures and nurse-child alignments2013In: Communication & Medicine. An Interdisciplinary Journal of Healthcare, Ethics and Society, ISSN 1612-1783, E-ISSN 1613-3625, Vol. 10, no 1, p. 51-61Article in journal (Refereed)
    Abstract [en]

    In the treatment of cancer in children, treatment procedures have been reported to be one of the most feared elements, as more painful than the illness as such. This study draws on a video ethnography of routine needle procedure events, as part of fieldwork at a paediatric oncology clinic documenting everyday treatment negotiations between nurses and young children. On the basis of detailed transcriptions of verbal and nonverbal staff–child interaction, the analyses focus on ways in which pain and anxiety can be seen as phenomena that are partly contingent on nurses’ emotion work. The school-age children did not display fear. In the preschool group, though, pain and fear seemed to be phenomena that were greatly reduced through nurses’ emotion work. This study focuses on three preschoolers facing potentially painful treatment, showing how the nurses engaged in massive emotion work with the children, through online commentaries, interactive formats (delegation of tasks, consent sequences, collaborative‘we’-formats), as well as solidarity-oriented moves (such as praise and endearment terms). Even a young toddler would handle the distress of needle procedures, when interacting with an inventive nurse who mobilized child participation through skilful emotion work.

  • 43. Roheger, Mandy
    et al.
    Zupanic, Eva
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Religa, Dorota
    Kalbe, Elke
    Eriksdotter, Maria
    Garcia-Ptacek, Sara
    Mortality and nursing home placement of dementia patients in rural and urban areas: a cohort study from the Swedish Dementia Registry2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 4, p. 1308-1313Article in journal (Refereed)
    Abstract [en]

    Background: Life in rural and urban areas differs in regard to social support and health care. Our aim was to examine the association between nursing home placement and survival of patients with dementia living in urban vs. rural areas.

    Methods: We performed a longitudinal cohort study of patients with dementia at time of diagnosis (n = 58 154) and at first follow-up (n = 21 522) including patients registered from 2007 through 2014 in the Swedish Dementia Registry (SveDem). Descriptive statistics are shown. Odds ratios with 95% CI are presented for nursing home placement and hazard ratios for survival analysis.

    Results: In age- and sex-adjusted analyses, patients living in urban areas were more likely to be in nursing homes at the time of dementia diagnosis than patients in rural areas (1.49, 95% CI: 1.29-1.73). However, there were no differences in rural vs urban areas in either survival after dementia diagnosis (urban: 0.99, 0.95-1.04, intermediate: 1.00, 0.96-1.04), or nursing home placement at first follow-up (urban: 1.00, 0.88-1.13; intermediate: 0.95, 0.85-1.06).

    Conclusion: Persons with dementia living in rural areas are less likely to live in a nursing home than their urban counterparts at the time of dementia diagnosis, but these differences disappear by the time of first follow-up. Differences in access to nursing homes between urban and rural settings could explain these findings. Results should be considered in the future healthcare decisions to ensure equality of health care across rural and urban areas.

  • 44.
    Saboonchi, Fredrik
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Red Cross University College, Sweden; Karolinska Institutet, Sweden.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Grossi, Giorgio
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Validation of Karolinska Exhaustion Scale: psychometric properties of a measure of exhaustion syndrome2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, p. 1010-1017Article in journal (Refereed)
    Abstract [en]

    Background The syndrome of exhaustion is currently a medical diagnosis in Sweden. The description of the syndrome largely corresponds to the suggested core component of burnout, that is exhaustion. Karolinska Exhaustion Scale (KES) has been constructed to provide specific assessment of exhaustion in clinical and research settings.

    Aim The purpose of the present study was to examine the psychometric properties of this scale in its original and revised versions by examining the factorial structure and measures of convergent and discriminant validity.

    Methods Data gathered from two independent samples (n1 = 358 & n2 = 403) consisting of patients diagnosed with 'reaction to severe stress, and adjustment disorder' were subjected to confirmatory factor analysis. The study's instruments were Karolinska Exhaustion Scale and Shirom Melam Burnout Measure. Correlation analyses were employed to follow up the established factorial structure of the scale. The study was ethically approved by Karolinska Institute regional ethic committee.

    Results The findings demonstrated adequate fit of the data to the measurement model provided by the revised version of KES Limitations: The main limitation of the present study is the lack of a gold standard of exhaustion for direct comparison with KES. (KES-26) and partially supported convergent validity and discriminant validity of the scale.

    Conclusion The demonstrated psychometric properties of KES-26 indicate sound construct validity for this scale encouraging use of this scale in assessment of exhaustion. The factorial structure of KES-26 may also be used to provide information concerning possible different clinical profiles.

  • 45. Sandlund, Christina
    et al.
    Kane, Kimberly
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Ekstedt, Mirjam
    Westman, Jeanette
    Patients' experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study2018In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, article id 111Article in journal (Refereed)
    Abstract [en]

    Background: The majority of patients who seek help for insomnia do so in primary health care. Nurse-led group treatment in primary care based on cognitive behavioral therapy for insomnia (CBT-I) can lead to improvements in both day-and nighttime symptoms. This study aimed to explore patients' experiences of nurse-led group treatment for insomnia in primary health care.

    Methods: Seventeen patients who had participated in the group treatment program were interviewed in five focus groups. Interview transcriptions were analyzed with qualitative content analysis.

    Results: Four themes emerged that described patients' experiences of the group treatment program. Involvement and trust open the door for change: Motivation to engage in treatment arose from patients' own desire for change, from being together with others who shared or understood their struggles, and from feeling emotionally affirmed and trustful. Competence arising from deeper understanding: Patients obtained knowledge and made it their own, which enabled them to develop functional sleep habits and let go of sleep performance and worry. The ability to impact their insomnia increased patients' trust in their own efficacy and helped them persist in behavioral change. Struggling with vulnerability and failure: Treatment was tough, and patients could feel challenged by external circumstances. Moreover, they could distrust their own efficacy. Tailoring treatment to individual needs: Patients experienced different life circumstances and adapted the techniques to their needs and abilities by focusing on what felt right for them.

    Conclusions: Patients went through a process of motivation, change, and challenges. They experienced certain aspects of treatment as essential to changing behavior and achieving improvements. Examples included being in a group with others who shared similar experiences, gaining knowledge about sleep, keeping a sleep diary, and practicing the sleep restriction technique. The study provides insights into patients' struggles during treatment, both those related to external circumstances and those related to feelings of vulnerability and failure. It also highlights the importance of adapting treatment to patients' differing needs, underscoring the value of person-centered care.

  • 46.
    Schön, Pär
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Lagergren, Mårten
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: results from a population-based study2016In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 24, no 5, p. 631-638Article in journal (Refereed)
    Abstract [en]

    There is limited knowledge about older people's length of stay (time until death) in institutional care and how it has changed over time. The aim of this study was to analyse changes in the length of stay for older people in institutional care between 2006 and 2012. All persons 65+ living in Kungsholmen (an urban area of Stockholm), who moved to an institution between 2006 and 2012, were included (N=1103). The data source was the care system part of a longitudinal database, the Swedish National Study on Aging and Care. The average length of stay was analysed using Laplace regression for the 10th to the 50th percentile for the years 2006-2012. The regressions showed that in 2006, it took an average of 764days before 50% of those who had moved into institutional care had died. The corresponding figure for 2012 was 595days, which amounts to a 22.1% decrease over the period studied (P=0.078). For the lower percentiles, the decrease was even more rapid, for example for the 30th percentile, the length of stay reduced from 335days in 2006 to 119days in 2012, a decrease of 64.3% (P<0.001). The most rapid increase was found in the proportion that moved to an institution and died within a short time period. In 2006, the first 10% had on average died after 85days, in 2012 after only 8days; a decrease in the length of stay of 90.5% (P=0.002). In general, there was a significant decrease in the length of stay in institutional care between 2006 and 2012. The most dramatic change over the period studied was an increase in the proportion of people who moved into an institution and died shortly afterwards.

  • 47. Sjölander, Annica
    et al.
    Jakobsson Ung, Eva
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Nilsson, Åsa
    Ung, Kjell-Arne
    Hospital Design with Nature Films Reduces Stress-Related Variables in Patients Undergoing Colonoscopy2019In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, no 4, p. 186-196Article in journal (Refereed)
    Abstract [en]

    Purpose: To examine whether patients' experiences could be improved during colonoscopy by designing the examination room to include a digital screen showing calm nature films. Background: Colonoscopy is the gold standard for examination of the large intestine and the rectum. Around 50% of individuals invited for colorectal cancer screening choose to refrain from the screening due to fear and anxiety. It is therefore important to improve patients' comfort during the procedure. Method: One of the four endoscopy rooms was rebuilt to include a large digital screen showing calm nature films. Patients were randomized to intervention (i.e., the room showing films) or control. During the colonoscopy, pulse and oxygen saturation were measured and the patients graded the intensity of pain and anxiety. Blood samples were taken regularly during the examination and were analyzed for glucose, cortisol, and prolactin. Results: The presence of calm nature films during colonoscopy decreased the release of cortisol, increased prolactin levels, and enhanced oxygen saturation. These effects were more apparent in patients who were unfamiliar with the procedure and the environment, patients who underwent the examination without analgesics or sedation, and patients whose examination procedure was relatively difficult and took a long time. Conclusions: The intervention described in this study is easy to implement and might help improve the patient experience during colonoscopy. However, this study was performed in a single health institution, and more studies are needed to further explore the role of film interventions in endoscopic and other medical procedures.

  • 48.
    Skogens, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    von Greiff, Ninive
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Topor, Alain
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Initiating and maintaining a recovery process - experiences of persons with dual diagnosis2018In: Advances in Dual Diagnosis, ISSN 1757-0972, E-ISSN 2042-8324, Vol. 11, no 3, p. 101-113Article in journal (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process.

    Design/methodology/approach - In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories.

    Findings - There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support.

    Research limitations/implications - The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having double trouble.

    Practical implications - The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs.

    Social implications - Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this.

    Originality/value - By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors.

  • 49.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kekki, Tuula
    Kuussaari, Kristiina
    Partanen, Airi
    Päihde- ja mielenterveyspalveluiden integraatio - kirjava käytäntö Suomen kunnissa2012In: Yhteiskuntapolitiikka, ISSN 1455-6901, Vol. 77, no 2, p. 167-175Article in journal (Other academic)
  • 50.
    Storm, Palle
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Intersektionalitet: ett användbart begrepp för sjuksköterskor inom vård och omsorg2019In: Ä : en tidning för Riksföreningen sjuksköterskan inom äldrevård : geriatriker, dietister inom geriatrik samt alla professioner runt den äldre patienten, ISSN 2001-1164, no 1, p. 22-23Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Vad betyder egentligen begreppet intersektionalitet, vad kan begreppet bidra med till sjuksköterskor som arbetar inom vården och omsorgen om äldre?

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