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The meaning of good and bad care in the community care: older people's lived experiences
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
2009 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, no 3, p. 156-65Article in journal (Refereed) Published
Abstract [en]

In spite of a considerable body of research in the past decades on what does or does not constitute good care for older people, there are still few studies addressing this question in which older people narrate their experiences of being dependent on community care. This study was therefore carried out aiming to explore older people's lived experiences of what good and bad care meant to them, when it was offered by community care services. Nineteen older persons in three Swedish communities participated in the study, which used a phenomenological-hermeneutic approach. Data were collected through unstructured interviews and Colaizzi's framework was utilized in the analysis of the data. The key theme arising from the analysis was that of being encountered as a human being by caregivers who, through the provision of safe and secure care, provide opportunities for living life as usual. When any of these circumstances are lacking, bad care will be the consequence. As the general intention in society is to ensure good quality of care to older people as well as others, the findings in our study should have important implications for providers of community care for older people.

Place, publisher, year, edition, pages
2009. Vol. 4, no 3, p. 156-65
National Category
Nursing
Identifiers
URN: urn:nbn:se:du-15761DOI: 10.1111/j.1748-3743.2008.00156.xPubMedID: 20925772OAI: oai:DiVA.org:du-15761DiVA, id: diva2:747404
Available from: 2014-09-16 Created: 2014-09-16 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Experiences of health and care, when being old and dependent on community care
Open this publication in new window or tab >>Experiences of health and care, when being old and dependent on community care
2007 (English)Licentiate thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Fakulteten för samhälls- och livsvetenskaper, 2007
Series
Karlstad University Studies, ISSN 1403-8099 ; 2007:50
Keyword
older people, community care, dependency, health, adjustment, compensation, factors of quality of care, phenomenology
National Category
Nursing
Research subject
Hälsa och välfärd
Identifiers
urn:nbn:se:du-15766 (URN)978-91-7063-155-9 (ISBN)
Presentation
2008-02-08, Fryxellsalen, 1B 306, Karlstads Universitet, 09:00
Opponent
Supervisors
Available from: 2014-09-16 Created: 2014-09-16 Last updated: 2014-09-16Bibliographically approved
2. Health and quality of care from older peoples' and formal caregivers' perspective
Open this publication in new window or tab >>Health and quality of care from older peoples' and formal caregivers' perspective
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective.

Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II).

The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV).

Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II).

Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV).

Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2011. p. 78
Series
Karlstad University Studies, ISSN 1403-8099 ; 2011:63
Keyword
Older people, community care, dependency, health, adaptation, compensation, phenomenology, quality of care, organizational climate, stress of conscience, competence, health, sense of coherence, formal caregivers
National Category
Nursing
Research subject
Hälsa och välfärd
Identifiers
urn:nbn:se:du-15765 (URN)978-91-7063-402-4 (ISBN)
Public defence
2012-01-20, 1B306 Fryxellsalen, Karlstads universitet, Karlstad, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2014-09-16 Created: 2014-09-16 Last updated: 2014-09-16Bibliographically approved

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