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  • 1. Abdullahi, A.
    et al.
    Kalid, Mohamed
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Kipchumba, E.
    Sulaiman, M.
    Supporting Micro-enterprise in Humanitarian Programming: Impact Evaluation of Business Grants versus Unconditional Cash Transfer2023Inngår i: Journal of African Economies, ISSN 0963-8024, E-ISSN 1464-3723, Vol. 32, nr 4, s. 415-437Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Humanitarian programming in fragile economies often use unconditional cash transfers (UCTs) to offset food insecurity. However, there is an increasing focus on using cash transfers to boost household incomes beyond the short-term through micro-enterprise start-up and growth. This paper conducts a randomised control trial to measure the impact of three different sizes of business grants against UCT in Somalia. We find that giving the same amount of money as a lump sum business grant results in higher likelihood of business ownership and income compared with UCT in the short run (3-4 months after the transfers). However, the impacts are larger and persist 3 years later only for those who received larger amount of grants. The results indicate our 'medium'-sized grant being more cost-effective. © 2022 The Author(s).

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  • 2.
    Ahmed, Hamdi
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    Babayeva, Irade
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    Att belysa stressfaktorer som påverkar kommunikationen mellan sjuksköterskor och patienter inom sluten vård: En litteraturöversikt2022Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: En av de viktigaste egenskaperna i sjuksköterskeprofession är att etablera en dialog med patienterna för att lära sig mer om patientens nuvarande situation. Stress som är relaterad till arbetet orsakar en dålig fysisk och psykisk hälsa och påverkar sjuksköterskornas arbetsmiljö. En bra sjuksköterska försöker alltid förbättra relationerna mellan patienter och sjuksköterskor så att det är lättare att komma till grundproblemet. En god kommunikation bidrar till att patienter känner sig involverad och får möjligheten att förmedla sin upplevelse. Syfte: Att belysa stressfaktorer som påverkar kommunikationen mellan sjuksköterskor och patienter inom slutenvård. Metod: En strukturerad litteraturöversikt med inslag av den metodologi som används vid systematiska litteraturöversikter. Resultatet innehöll 15 vetenskapliga artiklar och hämtades från Psycinfo, Pubmed och Cinahl. Resultat: Underbemanning ökar sjuksköterskans arbetsbelastning som i sin tur minimerar förmågan att se efter patientens behov. Tidspress bidrar till att sjuksköterskorna inte hinner slutföra sina arbetsuppgifter vilket i sin tur leder till arbetsbelastning för kollegorna. Kulturella skillnader och språkbarriärerna är några stressfaktorer som även kan försvåra kommunikationen mellan patienter och sjuksköterskor. Slutsats: Brist på erfarna sjuksköterskor höjer sjuksköterskans arbetsrelaterade stress vilket i sin tur reducerar förmågan att se patientens behov. Dokumentation och underbemanningen skapar en stressig arbetsmiljö och detta leder till en ökad arbetsbelastning. Tidsbrist minimerar kommunikationen mellan sjuksköterskor och patienter vilket leder till bristande omvårdnad. Kulturella skillnader leder till att sjuksköterskorna inte kommunicerar med patienter lika mycket på grund av rädslan att förolämpa patienternas kultur.

  • 3.
    Andersson, Mathias
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Idrotts- och hälsovetenskap. Region Dalarna (Smärtrehablilitering Säter och Smärtmottagning Falun).
    Kvinnor med fibromyalgi föredrar tungt belastande träning2022Inngår i: Best Practice NordicArtikkel i tidsskrift (Annet vitenskapelig)
    Fulltekst (pdf)
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  • 4.
    Andersson, Mathias
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Idrotts- och hälsovetenskap. Smärtmottagningen Falun, Region Dalarna, Falun; Smärtehabilitering Säter, Region Dalarna, Säter.
    Åberg, Anna Cristina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Uppsala University.
    von Koch, Lena
    Karolinska Institutet.
    Palstam, Annie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Women with fibromyalgia prefer resistance exercise with heavy loads: A randomized crossover pilot study2021Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, artikkel-id 6276Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 5.
    Ayoub, Maria
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Udo, Camilla
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Randell, Eva
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Promoting social engagement for young adults living in social isolation in Sweden: Social workers and health care professionals’ perceptions of success factors2023Inngår i: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, nr 1, s. 63-75Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 6.
    Ayoub, Maria
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Udo, Camilla
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Årestedt, Kristofer
    Department of Health and Caring Sciences, Faculty of Health and Life Science, Linnaeus University, 352 52 Växjö, Sweden.
    Kreicbergs, Ulrika
    Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden;Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institute, 171 77 Solna, Sweden;Louis Dundas Center, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK.
    Lövgren, Malin
    Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden;Advanced Pediatric Home Care, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, 171 64 Solna, Sweden.
    The Family Talk Intervention in Pediatric Oncology: Potential Effects Reported by Parents2024Inngår i: Children, E-ISSN 2227-9067, Vol. 11, nr 1, s. 95-95Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 7.
    Egal, Jama Ali
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Women search for normality in birth: Solutions empowering resilience and reproductive agency while reducing adverse outcomes for Somaliland women2023Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    This thesis aimed to explore the causes of severe pregnancy outcomes and maternal deaths in Somaliland (studies I and II) and how these causes are influenced by the context of the wider health system (studies III and IV). 

    Methodology: Both quantitative and qualitative methodologies were used. A prospective cross-sectional design was used to collect data for studies I and II. Study II focused on maternal deaths using a mixed method design. Studies III and IV used individual interviews to explore the needs of women when choosing a place of birth and the role of traditional birth attendants (TBAs) in maternity services in Somaliland. 

    Analysis: Data were analysed using descriptive statistics and percentages. An inductive content analysis was used for study III, and a qualitative thematic analysis was used for study IV.

    Results: Study I showed that the maternal near-miss (MNM) ratio was 56 MNMs per 1,000 live births according to the Sub-Saharan Africa (SSA) criteria and 13 MNMs per 1,000 live births according to the WHO criteria. The mortality index was highest among women with medical complications. Study II highlighted that 89% of these women self-referred to the hospital and that only 25% were admitted to the intensive care unit. Poor risk awareness and inadequate interprofessional collaboration contributed to missed opportunities. Study III showed that the lack of reproductive agency involved in facility-based births makes home births a first choice, regardless of potential risks and medical needs. Study IV demonstrated that TBAs need to be better connected with health facilities and skilled birth attendants (SBAs) to reduce maternal and neonatal mortality and morbidities in Somaliland.

    Conclusion: Women search for normality in birth, and the midwifery profession could provide this normality by facilitating resilience and reproductive agency while reducing adverse outcomes of pregnancy, birth and the postpartum period. There is a need to improve the quality of maternal health services by implementing evidence-based obstetric interventions and continuous in-service training. The referral system needs to be strengthened by utilising TBAs as a community resource to support community maternal and child health centres.

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  • 8.
    Egal, Jama Ali
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Essa, Amina
    University of Hargeisa, Somaliland.
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa. Karolinska Institutet, Stockholm.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland2023Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, artikkel-id 100862Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital.

    METHOD: A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo.

    RESULTS: From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital.

    CONCLUSION: The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.

    Fulltekst (pdf)
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  • 9.
    Egal, Jama Ali
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland.
    Kiruja, Jonah
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland.
    Litorp, Helena
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Incidence and causes of severe maternal outcomes in Somaliland using the sub-Saharan Africa maternal near-miss criteria: A prospective cross-sectional study in a national referral hospital.2022Inngår i: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 159, nr 3, s. 856-864Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland.

    METHODS: A prospective cross-sectional study was conducted from April 15, 2019, to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data was collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions and ratios.

    RESULTS: The MNM ratio were 56 (SSA criteria) and 13 (WHO criteria) per 1,000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric haemorrhage (13%), pregnancy-related infection (10%) and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum haemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after three hours.

    CONCLUSION: There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for health care providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.

    Fulltekst (pdf)
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  • 10.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Klockar, Erika
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Department of Health Sciences, Lund University, Lund.
    von Koch, Lena
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Theme Neuro Karolinska University Hospital, Stockholm.
    Ytterberg, Charlotte
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Finch, Tracy
    Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna, Uppsala University, Falun; Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Jones, Fiona
    Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, London, United Kingdom.
    Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study2022Inngår i: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 11, nr 5, artikkel-id e37672Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients' confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided.

    OBJECTIVE: The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context.

    METHODS: We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design.

    RESULTS: Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022.

    CONCLUSIONS: This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management.

    Fulltekst (pdf)
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  • 11.
    Eneslätt, Malin
    et al.
    Marie Cederschiöld högskola.
    Ayoub, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Udo, Camilla
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Kreicbergs, Ulrika
    Marie Cederschiöld högskola.
    Lövgren, Malin
    Marie Cederschiöld högskola.
    Mål och innehåll i samtal med familjer  inom stödprogrammet Family Talk Intervention i barnonkologi2023Konferansepaper (Fagfellevurdert)
  • 12.
    Falk Johansson, Marcus
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    For better and for worse, till death do us part: Support needs of persons caring for a co-habitant spouse or partner with dementia2024Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Caring for a partner with dementia is typically stressful and challenging. Such carers can become overwhelmed by their responsibilities, neglecting their personal needs as well as their need for support as a carer. Receipt of support is low among spouse carers, while the support received may not be appropriate for their needs. More research is required to develop effective support for this important group of carers. 

    Overall aim: To explore the life- and caring situation of spouses caring for a partner with dementia and to increase the understanding of their needs and experiences of support.  

    Methods: This thesis consists of four papers (I-IV): I, Analysis of data on informal carers of persons with dementia (n=330) from a cross-sectional survey of a stratified random probability sample of adults in Sweden (N=30 009); II and III, a cross-sectional survey of a convenience sample of people aged 65 years or older caring for a partner with dementia (N=175). Hierarchal regression models explored positive and negative aspects of caring (II), and principal component analysis examined carers’ perceptions of support (III); IV, a thematic analysis of semi-structured telephone interviews with 24 spouse carers, exploring their caring experiences. 

    Results: Compared to other carers, spouses of persons with dementia received less support from family or local authorities, while experiencing more negative impact from caring (I). Negative impact from, and positive value of, caring among spouses, were associated with different aspects of their situation (II). Support was perceived as important, yet spouses may not perceive support to themselves as more important than support to their partner (III). Spouse carers experienced a loss of self and felt confined in their situation, finding it hard to distinguish between their needs and those of their partner (IV). 

    Conclusion: Compared to other carers, spouses are more exposed to the negative aspects of caring, while being less supported. Support to spouse carers should focus on strengthening the positive aspects of caring to mitigate the negative aspects. As a spouse’s needs are conditioned by their partner’s, support should focus on spouses’ personal needs and their partners’ care needs.

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  • 13.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Summer Meranius, Martina
    Mälardalens Högskola.
    Williams, Christine L.
    Marmstål Hammar, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Mälardalen University.
    Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons With Dementia in Sweden2021Inngår i: Family Caregiving and Persons with Dementia, 2021, Vol. 5, s. 154-Konferansepaper (Fagfellevurdert)
    Abstract [en]

    As welfare providers struggle to meet the care needs of persons with dementia (PwDs), most of their needs are being met by a family carers, most often a spouse. The situation for spouse carers is unique, e.g., with grief, loneliness and loss of intimacy combining with stress and poor health. Research is needed to develop adequate support for spouse carers based on evidence of what influences negative and positive outcomes of care. The present study investigated psychosocial correlates of spouse carers’ (i) negative impact and (ii) positive value of caring. Data from a cross-sectional survey of 165 spouse carers community-resident in Sweden was analysed in two hierarchical regression models to predict negative impact and positive value of caring. Results found that negative impact and positive value were explained by different variables, significant predictors for negative impact included carer stress, health, and emotional loneliness, and change in intimacy with the care-recipient, while positive value was predicted by mutuality, change in closeness to the care-recipient and quality of support. Negative impact and positive value shared variance of only 17.2%. Thus, negative impact and positive value represent different aspects of the carer situation. Consequently, support needs to target several aspects in carers’ life, aiming to; facilitate for spouses to manage PwD’s impairment, increase emotional support while also strengthening the relationship between carer and PwD to reduce negative impact while increasing positive value.

    Fulltekst (pdf)
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  • 14.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet & Stockholm University.
    Summer Meranius, Martina
    Mälardalens Högskola .
    Williams, Christine L.
    Marmstål Hammar, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Mälardalens universitet; Karolinska institutet.
    Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden2022Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 3, artikkel-id 1788Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    (1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.

    Fulltekst (pdf)
    fulltext
  • 15.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. The Swedish National Graduate School for Competitive Science on Ageing and Health.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Williams, Christine L.
    Florida Atlantic University Christine E Lynn College of Nursing.
    Martina, Summer Meranius
    Mälardalens Högskola.
    Marmstål Hammar, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Spouse’s supported and unsupported care of persons with dementia: Home care and the informal caregiver’s perspective2021Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction. Caring for a person with dementia (PWD) can negatively affect the quality of life of informal carers, and research suggests spouse carers, often being older, are particularly vulnerable and requiring of support. Yet the formal support offered is rarely tailored to meet the needs of spouse carers of PWDs. The aim of the present study was to compare spouse carers to other carers of PWDs on a range of factors, as a foundation for a better understanding of their support needs. 

    Material and methods. Cross-sectional survey. In late 2018 a random stratified sample was taken of the Swedish population aged 18 and older. Of 30,009 people contacted, 11,168 completed and returned a questionnaire or completed a web-based version, a response rate of 37.3%. The questionnaire contained questions on whether the respondent was an informal carer for another person, the extent of care provided, contact with and support received from formal services, and impacts of care.

    Results. Of the respondents, 378 (3.38%) were carers of PWDs, of whom 107 (28.3%) were spouse carers. Spouse carers compared to other carers of PWD provide care more intenselyand are more informed on their right to support from local authorities. While more often being offered formal support in their carer role, they are less supported in providing care and report a higher negative impact (for all p<.05). 

    Conclusions. Formal support is offered to spouse carers in their carer role, but might not be tailored to their specific needs of support.

  • 16.
    Falk Johansson, Marcus
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Karolinska Institutet; Stockholm University.
    Williams, Christine L.
    Summer Meranius, Martina
    Hanson, Elizabeth
    Magnusson, Lennart
    Ekman, Björn
    Marmstål Hammar, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Mälardalen University, Västerås; Karolinska Institutet, Huddinge.
    A comparison of spouse and non-spouse carers of people with dementia: a descriptive analysis of Swedish national survey data2021Inngår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 21, artikkel-id 338Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Being an informal carer of a person with dementia (PwD) can have a negative effect on the carer’s health and quality of life, and spouse carers have been found to be especially vulnerable. Yet relatively little is known about the care provided and support received by spouse carers. This study compares spouse carers to other informal carers of PwDs regarding their care provision, the support received and the psychosocial impact of care.

    Fulltekst (pdf)
    fulltext
  • 17.
    Fridberg, Helena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. University of Gothenburg.
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Karolinska Institute, Stockholm.
    Operationalisation of person-centred care in a real-world setting: a case study with six embedded units2022Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikkel-id 1160Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Although person-centred care (PCC) is growing globally in popularity it is often vague and lacks conceptual clarity and definition. The ambiguity stretches from PCC's underlying philosophical principles and definitions of the concept to how it is operationalised and practised on the ground by health care professionals. We explore how the PCC model by the Gothenburg University Centre for Person-centred Care (GPCC) was operationalised in a real-world setting by using a set of recommendations by Fixsen and others that define and structure the core components of innovations in four distinct but interrelated components: philosophical principles and values, contextual factors, structural elements and core practices. Thus, this study aimed to increase knowledge about core practices in PCC in six health care units in real-world circumstances.

    METHODS: A case study with six embedded health care units was conducted from 2016 to 2019. We collected data from three sources: interviews (n = 12) with change agents, activity logs and written documents. Data were triangulated, and core practices were identified and deductively coded to the PCC model's structural elements: initiating, working and safeguarding the partnership with patients.

    RESULTS: We identified operationalisations of PCC in line with the three structural elements in the GPCC model at all included health care units. A range of both similarities and dissimilarities between units were identified, including the level of detail in describing PCC practices, when these practices were conducted and by whom at the workplace. The recommendations for describing the core components of PCC also helped us identify how some operationalisations of PCC seemed more driven by contextual factors, including a new regulation for planning and documenting care across health care specialities.

    CONCLUSIONS: Our findings show how PCC is operationalised in different health care units in a real-world setting based on change agents' understanding of the concept and their unique context. Increased knowledge of PCC and its philosophical principles and values, contextual factors, structural elements and core practices, is necessary to build a common understanding of the PCC-concept. Such knowledge is essential when PCC is operationalised as part of implementation efforts in health care.

    Fulltekst (pdf)
    fulltext
  • 18.
    Fridberg, Helena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg.
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm.
    Tracking, naming, specifying, and comparing implementation strategies for person-centred care in a real-world setting: a case study with seven embedded units2022Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikkel-id 1409Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The implementation of person-centred care (PCC) is advocated worldwide. Stakeholders in charge of implementing PCC as a broad-scale change across the health care sector face two intertwined and complex challenges. First, making sense of PCC as an intervention with complex innovation characteristics and second, staging implementation of PCC by choosing appropriate implementation strategies. We aimed to explore one of these challenges by tracking, naming, specifying, and comparing which strategies and how strategies were enacted to support the implementation of more PCC in a real-world setting represented by one health care region in Sweden.

    METHODS: A case study with seven embedded units at two organisational levels within a health care region was conducted from 2016 to 2019. Data were collected from three sources: activity logs, interviews, and written documents. Strategies were identified from all sources and triangulated deductively by name, definition, and cluster in line with the taxonomy Expert Recommendations for Implementing Change (ERIC) and specified according to recommendations by Proctor and colleagues as actor, action, action target, temporality, dose, outcome, and justification.

    RESULTS: Four hundred thirteen activities were reported in logs, representing 43 discrete strategies identified in ERIC (n = 38), elsewhere (n = 1), or as emerging strategies (n = 4). The highest reported frequencies of discrete strategies were identified as belonging to two clusters: Train and educate stakeholders (40%) and Develop stakeholder interrelationships (38%). We identified a limited number of strategies belonging to the cluster Use evaluative and iterative strategies (4.6%) and an even smaller number of strategies targeting information to patients about the change initiative (0.8%). Most of the total dose of 11,076 person-hours in the 7 units was spent on strategies targeting health care professionals who provide PCC (81.5%) while the dose of strategies targeting support functions was 18.5%.

    CONCLUSIONS: Our findings show both challenges and merits when strategies for implementation of PCC are conducted in a real-world setting. The results can be used to support and guide both scientists and practitioners in future implementation initiatives.

    Fulltekst (pdf)
    fulltext
  • 19.
    Gelin, Maria
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Center for Clinical Research Dalarna, Uppsala University, Falun.
    Gesar, Berit
    Center for Clinical Research Dalarna, Uppsala University, Falun; Uppsala University, Uppsala.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Center for Clinical Research Dalarna, Uppsala University, Falun.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna, Uppsala University, Falun; Uppsala University, Uppsala.
    Introducing a triage and Nurse on Call model in primary health care - a focus group study of health care staff's experiences2023Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikkel-id 1299Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: With the increased demand for health care services and with simultaneous staff shortages, new work models are needed in primary health care. In November 2015, a Swedish primary health care centre introduced a work model consisting of a structured patient sorting system with triage and Nurse on Call. The aim of this study was to describe the staff's experiences of introducing the triage and Nurse on Call model at the primary health care centre.

    METHODS: Five focus group discussions with staff (n = 39) were conducted 4 years after the introduction of the work model. Groups were divided by profession: medical secretaries, nursing assistants, physicians, primary health care nurses, and registered nurses. The transcribed text from the discussions was analysed using qualitative inductive content analysis.

    RESULTS: The analysis generated one overarching theme: The introduction of triage and Nurse on Call addresses changed preconditions in primary health care, but the work culture, organization, and acquisition of new knowledge are lagging behind. The overarching theme had five categories: (1) Changed preconditions in primary health care motivate new work models; (2) The triage and Nurse on Call model improves teamwork and may increase the quality of care; (3) Unclear purpose and vague leadership make introducing the work model difficult; (4) Difficulties to adopt the work model as it challenges professional autonomy; and (5) The triage and Nurse on Call model requires more knowledge and competence from nurses in primary health care.

    CONCLUSIONS: This study contributes with knowledge about implications of a new work model in primary health care from the perspective of health care staff. The work model using triage and Nurse on Call in primary health care was perceived by participants to increase availability and optimize the use of resources. However, before introduction of new work models, it is important to identify barriers to and facilitators for successful improvements in the local health care context. Additional education for the health care staff is important if the transition is to be successful. Complementary skills and teamwork, supported by a facilitator seems important to ensure a well-prepared workforce.

    Fulltekst (pdf)
    fulltext
  • 20.
    Gyllensten, Hanna
    et al.
    University of Gothenburg, Gothenburg; .
    Tistad, Malin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Karolinska Institute, Stockholm.
    Fridberg, Helena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. University of Gothenburg, Gothenburg.
    Analysis on personnel costs and working time for implementing a more person-centred care approach: a case study with embedded units in a Swedish region2023Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 10, artikkel-id e073829Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Our aim was to describe the time and costs used during the implementation of a more person-centred care (PCC) approach as part of ordinary practice.

    DESIGN: A case study with embedded units.

    SETTING: Region Dalarna, Sweden.

    PARTICIPANTS: The Department for Development (DD) staff who provided a central support function in the implementation and six healthcare units: nephrology, two geriatric care and rehabilitation units, two psychiatry units and primary care.

    INTERVENTIONS: More PCC.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Working days and related salary costs reported by categories indicating costs for implementation strategies, service delivery, and research/development costs.

    RESULTS: The healthcare units logged on average 5.5 working days per staff member. In the healthcare units, 6%-57% of the time reported was used for implementation strategies, 40%-90% for service delivery and 2%-12% for research/development. Of the time reported by the DD, 88% was assigned to implementation strategies. Costs associated with reported time indicated 23% of costs for this implementation occurred in the DD. Using the budgeted cost, this proportion increased to 48%. The budget for the DD corresponded to SEK 2.30 per citizen per year and 0.009% of the total healthcare budget of the region.

    CONCLUSIONS: The study found that a large part of resources used for this implementation of more PCC occurred in the DD, although at least half of the costs occurred in the healthcare units. Moreover, the cost of providing a central support function corresponds to a tiny proportion of the total health budget.

    Fulltekst (pdf)
    fulltext
  • 21.
    Jones, Amanda
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Jess, Kari
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Schön, Ulla-Karin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Stockholm University, Stockholm.
    How do users with comorbidity perceive participation in social services?: A qualitative interview study2021Inngår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, nr 1, artikkel-id 1901468Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 22.
    Jones, Amanda
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Knutsson, O.
    Schön, Ulla-Karin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Stockholm University.
    Coordinated individual care planning and shared decision making: staff perspectives within the comorbidity field of practice: Personals perspektiv på samordnad individuell planering och delat beslutsfattande inom samsjuklighetsområdet2022Inngår i: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 25, nr 2, s. 355-367Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Integrated treatment is recommended for users with a comorbidity of mental illness and substance misuse. However, due to a divided support system, coordinated individual care planning (CIP) and user participation are emphasised to provide users with the necessary support. One way of increasing user participation is through shared decision making. However, the challenges are evident why coordination and user participation are not used in practice as intended. To contribute with knowledge to bridge the gap between the intended CIP process and practice, this study examined the problems and solutions perceived by staff. Future workshops were conducted with 17 staff members from social services and health care. Problems and solutions were identified within three main areas: organisation and staff knowledge, coordination among staff, and staff attitudes and user participation. The problems are in agreement with previous research, but this study contributes with knowledge regarding solutions. Overall, the solutions expressed relate to improving collaboration between providers and users and having more resources to conduct this work. However, the study also assents to the question if CIP is the best way to coordinate support or if integrated treatment should be the future. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

  • 23.
    Kalid, Mohamed
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Flacking, Renée
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Sulaiman, Munshi
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Effects of Nutrition Counselling and Unconditional Cash Transfer on Child Growth and Family Food Security in Internally Displaced Person Camps in Somalia: A Quasi-Experimental Study2022Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 20, artikkel-id 13441Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effects of nutrition counselling (NC) and unconditional cash transfer (UCT) in improving growth in children under five and household food security are poorly understood in humanitarian settings. Therefore, this study aimed to evaluate the effects of NC and NC combined with unconditional cash transfer (NC + UCT) on children’s growth and food security in Somalia. The study was performed with a quasi-experimental design in two districts in the Banadir region of Somalia. Caregivers (n = 255) with mildly to moderately malnourished children aged 6 to 59 months old (n = 184) were randomized to the NC, NC + UCT and control groups. The interventions consisted of weekly NC for three months alone or in combination with UCT. The outcome variables were wasting, underweight, stunting, and food security. Difference-indifferences analysis was used to estimate the effect of the interventions. Our study did not find any significant impacts of NC or NC + UCT on child wasting, underweight, stunting, food security or household expenses. In conclusion, NC, alone or in combination with UCT, did not impact children’s growth or household food security. Thus, a culturally tailored NC programme over a longer period, supplemented with cash transfer, could be beneficial to consider when designing interventions to reduce malnutrition and food insecurity.

    Fulltekst (pdf)
    fulltext
  • 24.
    Kiruja, Jonah
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Quality of maternal healthcare: Exploring severe maternal outcomes and the influence of delays and decision-making on caesarean sections in a low-resource setting2023Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Somaliland has one of the highest maternal mortality rates worldwide, yet there is limited evidence for severe maternal outcomes and challenges with the provision and utilisation of emergency obstetric care (EmOC). This thesis studied quality of maternal healthcare by exploring severe maternal outcomes and the influences of delays and decision-making on caesarean sections in Somaliland.

    In Paper I, incidences of severe maternal outcomes and unmet need for emergency obstetric care interventions were investigated at the national hospital using a cross sectional study. The maternal mortality ratio was 462 per 100,000 live births and the maternal near miss ratio 56.5 per 1000 live births, according to sub-Saharan Africa criteria. Most laparotomies (60%) were performed after more than 3 hours. Medical complications (63%) had the highest mortality index.

    In Paper II, an explorative qualitative study using focus group discussions was conducted with healthcare providers. A collective decision-making process at the family rather than individual level by the woman; poverty and lack of awareness; and healthcare system factors such as miscommunication, infrastructure and inadequate collaboration were experienced as factors contributing to delays with the utilisation of EmOC.

    In Paper III, a cohort study examined whether there was an association between delayed caesarean section (CS) and adverse maternal and newborn outcomes and the type of barrier leading to delayed CS. A delay in CS of more than 3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, (95% CI [1.13–2.21]). Moreover, family decision-making for consent was the most important barrier leading to delays of more than 3 hours (48%). 

    In Paper IV, a mixed methods study was conducted to investigate barriers to and facilitators of timely family consent for CS. Women with hypertensive disorders (aOR 8.491, 95% [1.076–66.991]) and obstetric hemorrhage (aOR 3.209, 95% CI [1.159–8.887]) were likely to have late family consent for CS. Poor communication and understanding, differences in understanding between family members on the need for CS and absence of the person giving consent were barriers to timely family consent for CS to be performed. Husband’s autonomous decision-making for CS, adequate disclosure of all relevant information about CS and previous CS aided timely family consent for CS performance.

    There is need to improve the overall quality of maternal healthcare to reduce severe maternal outcomes. A proactive-orientated model is suggested with strategies targeting the community and healthcare system including training of healthcare providers on intracultural communication competence, obtaining consent and using associated protocols and guidelines, interprofessional collaboration and the use of alternative birth methods other than CS. Antenatal care should be used to prepare families for potential obstetric emergencies and obtain written informed consent. Moreover, women should be allowed to give consent in maternal health emergencies.

    Fulltekst (pdf)
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  • 25.
    Kiruja, Jonah
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Essén, Birgitta
    Uppsala University, Uppsala, Sweden.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Healthcare providers' experiences of comprehensive emergency obstetric care in Somaliland: An explorative study with focus on cesarean deliveries2022Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 34, artikkel-id 100768Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This study aimed to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care (EmOC) with a focus on cesarean deliveries in a referral hospital and maternal and child health centers in Somaliland.

    METHODS: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight HCPs were divided into groups of 6-8 for discussions lasting 1 to 2 h. All HCPs included in the study had experiences with the provision of EmOC. Data were analyzed using thematic analysis.

    RESULTS: Collective family decision making was identified by HCPs as a barrier to the provision of EmOC. This tradition of decision making at a group level was perceived as time-consuming and delayed HCPs from obtaining informed consent for EmOC. Low socioeconomic status and poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal EmOC at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure.

    CONCLUSIONS: HCPs encountered difficulties with the provision of EmOC. A broad array of strategies targeting the community and healthcare system is needed, including training of HCPs on intracultural communication competence, interprofessional collaboration and use of alternative birth methods other than CS. Antenatal care can be used to prepare families for potential obstetric emergencies and as an opportunity to obtain written informed consent.

    Fulltekst (pdf)
    fulltext
  • 26.
    Kiruja, Jonah
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. University of Hargeisa, Hargeisa, Somaliland.
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Egal, Jama Ali
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. University of Hargeisa, Hargeisa, Somaliland.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa. Karolinska Institutet, Stockholm.
    Litorp, Helena
    Uppsala University, Uppsala; Karolinska Institutet, Stockholm.
    Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context: a cohort study in a national referral hospital2023Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, nr 1, artikkel-id 2207862Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members.

    OBJECTIVE: To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor's decision were also explored.

    METHODS: Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1-3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression.

    RESULTS: Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13-2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32-0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001).

    CONCLUSIONS: In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed.

    Fulltekst (pdf)
    fulltext
  • 27.
    Klockar, Erika
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna - Uppsala University, Falun; Uppsala University.
    Finch, Tracy
    Northumbria University, Newcastle upon Tyne, UK..
    Jones, Fiona
    Kingston University and St George's, University of London, London, UK..
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Self-management from the perspective of people with stroke – An interview study2023Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 112, artikkel-id 107740Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Self-management support can improve quality of life, mood, self-efficacy, and physical function following a stroke. Knowledge of how people with stroke understand and experience self-management in different contexts is crucial to developing effective self-management support. This study explored how people with stroke understand and practice self-management during the post-acute phase. Method: A descriptive study using qualitative content analysis to explore data from semistructured interviews Results: Eighteen participants were interviewed. Most participants interpreted self-management as ‘taking care of their business’ and ‘being independent”. However, they encountered difficulties performing daily activities, for which they felt unprepared. Although interest in implementing self-management support increases, participants did not report receiving specific advice from healthcare professionals. Conclusion: People continue to feel unprepared to manage everyday activities after hospital discharge and must largely work things out for themselves. There is an overlooked opportunity to start the process of self-management support earlier in the stroke pathway, with healthcare professionals and people with stroke combining their skills, ideas and expertise. This would enable confidence to self-management to flourish rather than decrease during the transition from hospital to home. Practical implications: Individual tailored self-management support could help people with stroke more successfully manage their daily lives post-stroke. © 2023 The Authors

    Fulltekst (pdf)
    fulltext
  • 28.
    Klockar, Erika
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Lund.
    McCarthy, Linnea
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Koch, Lena von
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna, Falun; Uppsala University, Uppsala.
    Jones, Fiona
    Faculty of Health and Social Care Sciences, Kingston University & St George's, University of London, London, UK, GB.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The Swedish Stroke Self-Efficacy Questionnaire: translation and cross-cultural adaptation2024Inngår i: Journal of Patient-Reported Outcomes, E-ISSN 2509-8020, Vol. 8, artikkel-id 55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To translate and cross-culturally adapt the Stroke Self-Efficacy Questionnaire (SSEQ) from English to Swedish and to evaluate psychometric properties of the questionnaire.

    METHODS: A cross-sectional study design, where the translation followed a process including initial translation, synthesis, backward translation, expert committee, and pretest. Content validity was assessed using Content validity index (CVI). Psychometric assessments included floor-ceiling effects and internal consistency.

    RESULTS: Language and cultural congruence were achieved, and content validity index scores were high (0.923-1). The psychometric evaluations provided acceptable outcomes concerning internal consistency, with Cronbach's alpha scores for the total scale (0.902), the activities subscale (0.861) and the self-management subscale (0.818) respectively. Ceiling effects were evident, but no floor effects.

    CONCLUSION: This study found the Swedish version of the SSEQ promising as a tool for assessment of self-efficacy in a Swedish stroke care setting, although further psychometric assessments are recommended in future studies.

    Fulltekst (pdf)
    fulltext
  • 29.
    Koistinen, Susanne
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Umeå University.
    Ståhlnacke, Katri
    Olai, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Uppsala University.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Carlsson, Eva
    Older people's experiences of oral health and assisted daily oral care in short-term facilities.2021Inngår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 21, nr 1, artikkel-id 388Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Older people's oral health has improved, and many retain their natural teeth throughout their life. However, their daily oral care can be more difficult because of compromised general health and the reduced capacity for self-care that often comes with old age. More knowledge is needed about how older people view their oral health and oral care. The aim of this study was to describe how older people in short-term care experience their oral health and daily oral care.

    METHOD: A descriptive, qualitative study was performed through interviews with 14 older people (74-95 years) recruited from short-term care units in two Swedish regions. Data were analysed using inductive content analysis.

    RESULTS: The findings are described in one main category, three categories and nine sub-categories. The main category was Adapting to a changed oral condition while striving to retain independence. The first category, Wanting to manage daily oral care independently, contained three subcategories: Having always brushed my teeth without help, Being satisfied with my mouth and teeth, and Having to accept help if necessary. The second category, Acceptance of changes in oral condition, had three subcategories: Difficulty in chewing and swallowing, Difficulty with tooth brushing, and Not considering a dentist visit to be worth the cost. The third category, Barriers to receiving assistance from staff, had three subcategories: Staff lacking the time to help, Not wanting to be a burden, and Lack of confidence in staff's knowledge.

    CONCLUSIONS: The participants were generally satisfied with their oral health despite an expressed need for dental treatment. Daily oral care was something they wanted to manage themselves, and they had a strong desire to stay independent for as long as possible. Closer collaboration between dental and health care staff is necessary in order to implement clinical practice guidelines for oral health care and increase nursing staff's attention towards older peoples' oral health.

    Fulltekst (pdf)
    fulltext
  • 30.
    Maregn, Rahel Tesfa
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Bourret, Kirsty
    Karolinska Institutet, Stockholm; McMaster University, Hamilton, Ontario, Canada.
    Egal, Jama Ali
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. University of Hargeisa, Hargeisa, Somalia.
    Esse, Amina
    University of Hargeisa, Hargeisa, Somalia.
    Mattison, Cristina
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa. Karolinska Institutet, Stockholm.
    Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system2023Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 3, artikkel-id e067315Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To explore midwives' perspectives in providing sexual reproductive healthcare services in the Somaliland health system.

    METHODS: An exploratory qualitative design using focus group discussions (n=6) was used. The study was conducted in the capital of Somaliland, Hargeisa, at six maternal and child healthcare centres that provide sexual and reproductive healthcare (SRH) services. Qualified midwives (n=44) who had been working in the maternal and child health centres for a minimum of 1 year were recruited to participate, and only one did not participate due to illness.

    RESULTS: The results showed that Somaliland midwives face multiple challenges from a lack of formal arrangements, primarily written guidelines and policies, that explicitly define their role as healthcare professionals, which impact the quality of care they provide. They also reported feeling unsafe when practising according to their professional scope of practice due to challenging cultural norms, customary traditions and Somaliland's legal system. Finally, the midwives called for support, including training, institutional protection and psychological support, to enhance their ability and fulfil their role in SRH services in Somaliland.

    CONCLUSION: Midwives are essential to the provision of equitable SRH services to women and girls, yet are not fully supported by policies, laws or institutions, often living in fear of the consequences of their behaviours. Our research highlights the importance of understanding the context of Somaliland midwifery in order to better support the development of the midwifery workforce, stronger governance structures and midwifery leadership. Appropriately addressing these challenges faced by midwives can better sustain the profession and help to improve the quality of care provided to women and girls and ultimately enhance their reproductive health outcomes.

    Fulltekst (pdf)
    fulltext
  • 31.
    Marmstål Hammar, Lena
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Mälardalens Högskola.
    Falk Johansson, Marcus
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Summer Meranius, Martina
    Mälardalens Högskola.
    Exhausted and trapped in isolation. Caring for a spouse with dementia during the Covid-19 pandemic2021Inngår i: Family Caregiving (HS Poster), 2021, s. 800-801Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Even before the Covid-19 pandemic, spouse carers of persons with dementia (PwDs) found their care responsibilities overwhelming and had little time to focus on their own lives. To minimize the risk of being infected with Covid-19, older persons are recommended to self-isolate in their homes, while formal support such as respite care and day care centers are withdrawn. This study involved semi-structured interviews with 24 spouse carers of community-living PwDs, with the aim of describing their situation during the pandemic. The interviews were analyzed with qualitative content analysis. Results revealed that they commonly declined help because of the perceived risk of their spouse being infected with Covid-19 and thus also possibly causing their death. They described feelings of being trapped in their situation, as they experienced having no choice than take all responsibility for the care of their partner themselves, with cost of being unable to take necessary breaks. This was described as making an already strained situation almost unbearable, which led to conflicts with their partner. However, the spouses also described positive aspects due to strategic changes in health and social care provision to prevent the spread of the virus, such as greater staff continuity in home care services, and patient transportation service. These made the PwD less stressed and influenced their everyday life positively. It could be concluded that the extent burden during the Covid-19 pandemic calls for extensive development of tailored support to better tackle the rapid changes that can occur in a society.

    Fulltekst (pdf)
    fulltext
  • 32.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Perceptions and experiences of safety at home: a survey among older adults in Sweden2022Inngår i: 26th Nordic Congress of Gerontology. Abstracts: Change and continuity, 2022, s. 277-277Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction

    Home safety is important to prevent injuries and accidents in older adults living at home. Feeling safe at home is also essential for frail older adults’ well-being. "Ageing in place" is a term focusing on enabling older adults to stay in their ordinary homes, rather than in special housing. But when older adults continue living at home, more injuries and accidents can occur. The aim of this study was to explore older adults’ experiences, preventive measures, and feelings of safety in their home in relation to a range of potential home-based health and safety hazards.

    Methods and Materials

    The study had a cross-sectional design and was based on a national telephone survey among 400 adults over 70 years of age, living at home in ordinary housing in Sweden. Descriptive and comparative statistics were used to analyse the data.

    Results

    The participants rated the importance of feeling safe at home as high, and seldom felt unsafe. Higher age, greater frequency of feeling unsafe at home or in the neighbourhood, access to support, better health, importance of safety and living alone were associated with level of worry or for having taken preventive measures against some but not all hazards in the home.

    Conclusions

    Taking preventive measures is not always is not always associated with experiences or level of worry. Age, feelings of safety, access to support, health and living alone or not, are all factors that can influence level of worry or for taking preventive measures or not against specific hazards in the home.

  • 33.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Preventing accidents and injuries: older adults' experiences, worries, and preventive measures regarding home hazards2022Inngår i: 36th Annual Conference of the European Health Psychology Society. Abstracts: Charting new territories in health psychology, 2022, s. 707-707Konferansepaper (Fagfellevurdert)
  • 34.
    Mauritzson, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    McKee, Kevin J
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Borg, Johan
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Older Adults' Experiences, Worries and Preventive Measures Regarding Home Hazards: A Survey on Home Safety in Sweden2023Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, nr 2, artikkel-id 1458Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Home safety is important for preventing injuries and accidents among older adults living at home. Feeling safe at home is also essential for older adults' well-being. Thus, this study aimed to explore older adults' perceptions of safety in their homes by examining their experiences, worries and preventive measures in relation to a range of potential home-based health and safety hazards. The study was a national cross-sectional telephone survey of 400 randomly selected adults over 70 years of age living at home in ordinary housing in Sweden. Participants were asked for their experience of, worry about, and preventive measures taken regarding fifteen home hazards. Data were also collected on background variables including age, health, and cohabitation status. Falls and stab/cut injuries were the most experienced hazards and worry was highest for burglary and falls, while preventive measures were most common for fire and burglary. While older adults' experience and worry regarding home hazards were associated with preventive measures, these associations were not strong and other factors were associated with preventive behaviour. Further identification of the main determinants of older adults' preventive behaviour can contribute to policy for effectively reducing home accidents.

    Fulltekst (pdf)
    fulltext
  • 35.
    Melander, Sara
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet.
    Dahl, Oili
    Falk, Ann-Charlotte
    Lindström, Veronica
    Andersson, Erik
    Gustavsson, Petter
    Rudman, Ann
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet.
    Critical incidents and post-traumatic stress symptoms among experienced registered nurses during the COVID-19 pandemic: A cross-sectional study2024Inngår i: International Journal of Nursing Studies Advances, E-ISSN 2666-142X, Vol. 6, artikkel-id 100194Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Registered nurses working on the frontline during the COVID-19 pandemic encountered significant challenges, including exposure to critical incidents. Critical incidents refer to sudden unexpected clinical events that surpass an individual's ability to cope, leading to considerable psychological distress, which could potentially result in the development of post-traumatic stress disorder symptoms. Research has shown a high prevalence of post-traumatic stress disorder symptoms among healthcare workers, particularly those in close contact with COVID-19 patients.

    Objective: To assess the levels of post-traumatic stress symptoms among registered nurses in relation to exposure to working conditions during the COVID-19 pandemic, such as how much their work was affected by the pandemic, re-deployment, working hours hindering sufficient recovery between shifts and critical incidents.

    Design: Cross sectional study.

    Setting(s): The registered nurses working in multiple health care services covering all 21 geographic regions in Sweden.

    Participants: A total of 1,923 registered nurses, who are part of a Swedish national cohort and have been followed since their nursing education, were invited to participate in a survey in late September 2021 (15 to 19 years post graduation).

    Methods: The data were analyzed using descriptive statistics, unpaired t-tests, and one-way analysis of variance. Cohen's d was employed to quantify differences in mean levels between subgroups.

    Results: The response rate were 56.5 %. Over 50 % of experienced registered nurses reported significant disruptions to their work environments. In total, 85 % of registered nurses were exposed to at least one critical incident in their work during the pandemic, with 60 % facing organisational changes and nearly 50 % experiencing emotionally distressing situations. The exposure to work situations involving critical incidents consistently demonstrated strong associations with higher levels of post-traumatic stress disorder symptoms compared to those not exposed, with effect sizes ranging from moderate to high.

    Conclusions: This study underscores the profound impact that working conditions, such as redeployment and exposure to critical incidents, have on the mental health of registered nurses. We offer valuable insights into registered nurses’ pandemic-related challenges, highlighting the need for support and interventions to prevent and manage critical incidents, ultimately promoting their well-being. We also highlight the significance of thorough workforce readiness planning for future pandemics and other challenging health care scenarios, such as staff shortage. © 2024 The Author(s)

    Fulltekst (pdf)
    fulltext
  • 36.
    Nordin, Susanna
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Sturge, Jodi
    Ayoub, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    Jones, Allyson
    McKee, Kevin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Dahlberg, Lena
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Aging Research Center, Karolinska Institutet & Stockholm University.
    Meijering, Louise
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The Role of Information and Communication Technology (ICT) for Older Adults’ Decision-Making Related to Health, and Health and Social Care Services in Daily Life—A Scoping Review2022Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 1, artikkel-id 151Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Information and communication technology (ICT) can potentially support older adults in making decisions and increase their involvement in decision-making processes. Although the range of technical products has expanded in various areas of society, knowledge is lacking on the influence that ICT has on older adults’ decision-making in everyday situations. Based on the literature, we aimed to provide an overview of the role of ICT in home-dwelling older adults’ decision-making in relation to health, and health and social care services. A scoping review of articles published between 2010 and 2020 was undertaken by searching five electronic databases. Finally, 12 articles using qualitative, quantitative, and mixed-method designs were included. The articles were published in journals representing biology and medicine, nursing, informatics, and computer science. A majority of the articles were published in the last five years, and most articles came from European countries. The results are presented in three categories: (i) form and function of ICT for decision-making, (ii) perceived value and effect of ICT for decision-making, and (iii) factors influencing ICT use for decision-making. According to our findings, ICT for decision-making in relation to health, and health and social care services was more implicitly described than explicitly described, and we conclude that more research on this topic is needed. Future research should engage older adults and health professionals in developing technology based on their needs. Further, factors that influence older adults’ use of ICT should be evaluated to ensure that it is successfully integrated into their daily lives. 

    Fulltekst (pdf)
    fulltext
  • 37.
    Nyberg, Stina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    Personers upplevelser av att leva med kronisk obstruktiv lungsjukdom (KOL): En litteraturöversikt2023Independent thesis Basic level (degree of Bachelor), 5 poäng / 7,5 hpOppgave
    Abstract [sv]

    Bakgrund: Kronisk obstruktiv lungsjukdom (KOL) är en kronisk inflammation i lungorna som förstör lungvävnaden, minskar lungkapaciteten och går inte att bota. År 2030 beräknas sjukdomen utgöra den tredje största dödsorsaken samt patientgruppen i världen. KOL medför ett stort lidande och försämrad livskvalité för den drabbade. Syfte: Syftet med denna litteraturöversikt var att beskriva personers upplevelser av att leva med kronisk obstruktiv lungsjukdom (KOL). Metod: Examensarbetet genomfördes som en strukturerad litteraturöversikt. 13 artiklar från databaserna CINAHL och PsycINFO analyserades och sammanställdes med Fribergs analysmetod. De inkluderade artiklarna var av kvalitativ design. Resultat: Tre kategorier och nio underkategorier identifierades. Sammantaget upplevde personer med KOL att de begränsades både fysiskt och psykiskt och sjukdomen medförde många negativa känslor. Något som underlättade deras vardag var användning av hjälpmedel. Slutsats: Litteraturöversikten tyder på att personer som lever med KOL ibland upplever en anklagande attityd från sjukvården och att de har bristande kunskap om sjukdomen. Trots de betungande aspekterna av att hantera KOL framkom det även att personer med KOL utvecklade känslor av acceptans för sjukdomen och hur de kunde hantera situationer i det dagliga livet.

  • 38.
    Palstam, Annie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Andersson, Mathias
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Idrotts- och hälsovetenskap. Smärtrehabilitering Säter/Smärtmottagning Falun, Region Dalarna.
    Lange, Elvira
    Grenholm, Anton
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    A Call to Include a Perspective of Sustainable Development in Physical Therapy Research2021Inngår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 101, nr 3, artikkel-id pzaa228Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 39.
    Palstam, Annie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Sahlgrenska akademin, Göteborgs universitet/Sahlgrenska universitetssjukhuset.
    Grenholm, Anton
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Andersson, Mathias
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Idrotts- och hälsovetenskap. Smärtrehabilitering Säter/Smärtmottagning Falun, Region Dalarna.
    Lange, Elvira
    Sektionen för fysioterapi, avdelningen för hälsa och rehabilitering, Institutionen för neurovetenskap och fysiologi, Sahlgrenska akademin, Göteborgs universitet.
    Fysioterapi och hållbar utveckling: Hänger det ihop – och varför behöver vi engagera oss?2021Inngår i: Fysioterapi, ISSN 1653-5804, nr 4, s. 38-44Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Klimatförändringarna utgör det största hotet mot folkhälsan under detta århundrade, något som förväntasbåde öka och förändra den framtida belastningen på hälso- och sjukvården. Samtidigt bidrar hälso- ochsjukvården genom sin egen verksamhet till en betydande del av samhällets miljöbelastning. Ytterligare enkoppling mellan miljö och hälsa är att många förändringar som syftar till att minska miljöbelastningen samtidigtmedför vinster för folkhälsan. Sammantaget medför dessa samband att hälso- och sjukvården har en mycketcentral roll i omställningen mot hållbar utveckling. I detta sammanhang har fysioterapin unika och specifikamöjligheter att bidra, något som bör medvetandegöras, utvärderas och kommuniceras. Denna artikel tar uppbegreppet hållbar utveckling i relation till fysioterapi och föreslår samtidigt en riktning för fortsatt reflektion därfysioterapin har möjligheten att stärkas som en ledande aktör i omställningen mot framtidens hälso- ochsjukvård.

    Fulltekst (pdf)
    fulltext
  • 40.
    Palstam, Annie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Sahlgrenska Academy, University of Gothenburg.
    Sehdev, Simran
    Barna, Stefi
    Andersson, Mathias
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Idrotts- och hälsovetenskap.
    Liebenberg, Nina
    Sustainability in physiotherapy and rehabilitation2022Inngår i: Orthopaedics and Trauma, ISSN 1877-1327, Vol. 36, nr 5, s. 279-283Artikkel i tidsskrift (Fagfellevurdert)
  • 41.
    Persson, Christine
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Uppsala University, Uppsala.
    Ericson, Jenny
    Uppsala University, Uppsala.
    Salari, Raziye
    Uppsala University, Uppsala.
    Eriksson, Mats H.
    Örebro University, Örebro.
    Flacking, Renée
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    NICU parents' mental health: A comparative study with parents of term and healthy infants2023Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, nr 5, s. 954-966Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To compare mental health in parents of preterm/ill infants and parents of term and healthy infants before birth and 1 month after hospital discharge.

    METHODS: A comparative cohort design was used. In total 439 parents from six neonatal intensive care units (NICUs) and 484 parents from four maternity units (MUs) in Sweden answered a survey 1 month after discharge.

    RESULTS: Parents in neonatal units experienced significantly more psychologically traumatic births and rated their health and the health of their infants less favourably the first week after delivery than parents in MUs. In the neonatal units, both parents had better possibilities to stay together with the infant during hospital stay. There was no difference between the NICU and MU groups in postpartum depressive symptoms 1 month after discharge. Experiencing a traumatic birth was not related to an increased risk of perinatal depressive symptoms (Edinburgh Postnatal Depression Scale ≥13) for mothers in NICUs. In contrast, the risk of depression increased for mothers in MUs.

    CONCLUSION: Family togetherness, parent-infant closeness and emotional support at NICUs may contribute to the positive outcome. Further studies are needed to assess the long-term effects of how family togetherness and closeness influence families long-term.

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  • 42.
    Quarles van Ufford, Sara
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Polisanmälan och tvärprofessionell samverkan i Barnahus: Om socialtjänstens perspektiv på polisanmälan och tvärprofessionell samverkan när barn misstänks vara utsatta för våld och sexuella övergrepp2023Rapport (Annet vitenskapelig)
    Abstract [sv]

    I denna rapport presenteras resultaten av en studie som genomförts på uppdrag av Barnahus i Dalarna. Barnahus i Dalarna startades 2007 med målsättningen att erbjuda barn som misstänks vara utsatta för våldsbrott i nära relationer och sexualbrott ett behovsanpassat omhändertagande. Verksamheten utgörs av tvärprofessionell samverkan mellan Åklagarkammaren i Falun, Polismyndigheten Dalarna, socialtjänsten i Dalarnas samtliga kommuner, Barn- och ungdomsmedicin i Dalarna och Barn- och ungdomspsykiatrin i Dalarna. Under 2021 uppmärksammades en minskning av ärenden som aktualiseras för samråd i Barnahus och det uppfattades viktigt att öka kunskapen om socialtjänsternas perspektiv på polisanmälan och tvärprofessionell samverkan. Det uppdrogs därför till Sara Quarles van Ufford, Högskolan Dalarna, att genomföra en intervjustudie med representanter för de socialtjänster som ingår i barnahussamverkan. 

    Syftet var att undersöka socialtjänsternas perspektiv på polisanmälan av misstänkta vålds- och sexualbrott mot barn och identifiera upplevda hinder, möjligheter och förbättringsområden för tvärprofessionell samverkan, samt belysa socialtjänsternas utgångspunkter vid utredning av våld mot barn. Studien baserades på semistrukturerade intervjuer med första linjens arbetsledare inom socialtjänsten som analyserades kvalitativt med hjälp av tematisk analysmetod. 

    Resultaten visade att socialtjänsterna delvis har olika utgångspunkter och strategier för att utreda våld mot barn vilket påverkar inställningen till att polisanmäla brottsmisstankar – och som leder till att våld mot barn handläggs på olika sätt. Det framkom att bedömningar av om en polisanmälan ska göras kraftigt skiljer sig åt, liksom den upplevda nyttan och konsekvenserna av en polisanmälan. Medan vissa betonar vikten av att barnet synliggörs som brottsoffer menar andra att en polisanmälan försvårar samarbete och stöd till familjen. Generellt uppfattas socialtjänstens utredningsprocess försvåras när brottsutredningen drar ut på tiden med negativa konsekvenser för barn och familjer – och vetskapen om att förundersökningar tenderar att dra ut på tiden kan upplevas som ett hinder för att göra en polisanmälan. Samtidigt menar flera informanter att en utebliven polisanmälan kan innebära risker för att våld och intressekonflikter mellan barn och föräldrar förminskas och inte utreds på djupet. Vidare framkom att tvärprofessionell samverkan ofta uppfattas upphöra efter det initiala samrådet och att barnpsykiatrisk kompentens inte upplevs tillgänglig vid behovsbedömningar som aktualiseras i ett senare skede av processen. Det uppfattas också vara svårt för barn som aktualiseras i Barnahus att få hjälp via Barn- och ungdomspsykiatrin. Generellt uppfattas det finnas flera vinster med att göra en polisanmälan – men också flera förbättringsområden för tvärprofessionell samverkan som kan sammanfattas i fem övergripande områden: 

    • Tydliggöra, stärka och jämställa barnahusaktörernas roller 
    • Ökad snabbhet i brottsutredningen och synkronisering med socialtjänstens utredning
    • Förbättrade möjligheter för fortsatt tvärprofessionell samverkan i Barnahus med fokus på stöd och behandling
    • I större utsträckning beakta geografiska aspekter i barnahussamverkan
    • Ökat fokus på ”barnets bästa” i barnahussamverkan 
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  • 43.
    Quarles van Ufford, Sara
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap.
    The Protection Paradox: A Study of Children’s Rights to Participation and Protection against Violence in Swedish Child Welfare Practice2023Inngår i: The International Journal of Children's Rights, ISSN 0927-5568, E-ISSN 1571-8182, Vol. 31, nr 3, s. 756-776Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Child participation is considered crucial for the authorities’ ability to protect children from violence – yet children’s actual participation is limited, and participation and protection rights under the UN Convention on the Rights of the Child are often understood as opposites. This article aims to explore children’s rights to participation and protection against violence in Swedish social services’ handling of violence against children. Child welfare reports, investigations and child social records, were analysed using quantitative content analysis and thematic analysis. Insufficient conditions for child participation and poor access to protection and support were indicated. Upon closer analysis of cases that did not lead to protection or support, different aspects of an overarching theme, The Protection Paradox, were identified, which meant protection against participation or unprotected autonomy.

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  • 44.
    Quarles van Ufford, Sara
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Heimer, Maria
    Uppsala University, Uppsala .
    Schön, Ulla-Karin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Stockholm University, Stockholm.
    Linell, Hanna
    Stockholm University, Stockholm.
    Discretion and Strategies for Investigating Child Abuse: Social Workers’ Conceptions of Child Abuse Investigations and Police Reporting2023Inngår i: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263XArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Understanding the capacity of child welfare (CW) organisations to deal with child abuse is complex, and dependent on the specific CW context. Sweden occupies a unique position in trying to balance high demands for CW and protection with a strong family support focus, which carries a risk of overlooking children who need protection. Drawing on an understanding of social service organisations as street-level bureaucracies, this article explores discretion in child abuse cases by examining conditions affecting discretion and strategies for investigating child abuse, including police reporting. Thematic analysis of interviews with Swedish supervising social workers showed that staff’s conceptions of the CW system influenced the exercise of discretion, leading to different strategies for dealing with child abuse. This resulted in different practices and potentially unequal access to child protection and support, highlighting the wide margin of discretion. This article concludes that the interplay between knowledge and governance is central to equal child protection. This article contributes to the discussion of discretion in CW organisations by underlining the importance of being particularly vigilant about discretion when both children and parents are considered clients, as the child risks being lost as a subject with individual needs and rights.

  • 45.
    Quarles van Ufford, Sara
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Heimer, Maria
    Uppsala University, Uppsala.
    Schön, Ulla-Karin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete.
    Linell, Hanna
    Stockholm University, Stockholm.
    The Swedish social services' police reporting and children's access to protection and support in child abuse cases: A quantitative content analysis.2022Inngår i: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 133, artikkel-id 105828Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The UN Convention on the Rights of the Child prohibits all forms of violence against children. Sweden was early in introducing a ban on disciplinary violence; however, difficulties have been noted in identifying children in need of protection and providing help for children exposed to violence.

    OBJECTIVES: The purpose of this study was to explore the social services' police reporting and children's access to protection and support in cases of physical and sexual child abuse.

    METHODS: The sample consisted of 291 child welfare reports from three Swedish municipalities. Data were collected from child welfare reports, investigations, and child social records and analyzed using quantitative content analysis.

    RESULTS: A majority of the cases, including cases with a high indication for police reporting, were not reported to the police by the social services. Although the child in 60.1 % of cases provided information about violence, 70.7 % of all child welfare investigations were completed without support measures, and only 8.2 % led to protection or support linked to violence. Children's participation was limited, suggesting inadequate conditions for children's access to protection and support.

    CONCLUSIONS: Children's right to protection against violence requires the recognition of children as active participants with access to safe participation. Failure to report suspected crimes against children risks minimizing acts of violence or making violence invisible. Difficulties in handling conflicts of interest between children and parents risk neither protection nor support being provided for the child.

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  • 46.
    Roos, Charlotte
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Factors Associated with Older Peoples´ Perceptions of Dignity and Well-being at Residential Care Facilities.2021Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Dignity and well-being should be promoted in care of older people living at residential care facilities (RCFs). In addition, care should be person-centred. Dignity and well-being can be interpreted as person-centred outcomes. Older people living at RCFs experience a lack of dignity and well-being. To promote this, it is important to understand the associated factors to target. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to attitudes of staff, the care environment and individual issues (age, gender, self-rated health and dementia) among older people living at RCFs. A national cross-sectional study was conducted retrospectively. All older people 65 years and older (n=71,696) living at RCFs in 2018 were invited to respond to the survey. The survey included the areas: self-rated health, indoor-outdoor-mealtime environment, performance of care, treatment from staff, safety, social activities, availability of staff and care in its entirety. Age, gender and diagnosed dementia were collected from two national databases. Data was analysed using ordinal logistic regression models. The result indicated that respondents who had experienced disrespectful treatment, who did not thrive in the indoor-outdoor-mealtime environment, who rated their health as poor and respondents with dementia had higher odds of being dissatisfied with dignity and well-being. There is a need to improve the prerequisites of staff regarding respectful attitudes and to improve the care environment. The Person-centred Practice framework, targeting the prerequisites of staff and the care environment, can be used as a theoretical framework for designing future improvements. 

  • 47.
    Roos, Charlotte
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Factors associated with older peoples´ perceptions of dignity and well-being in residential care facilities.2021Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Dignity and well-being should be promoted in care of older people living in residential care facilities (RCFs). In addition, care in RCFs should also promote person-centred care. According to the person-centred practice (PCP) framework dignity and well-being are being described as the result of person-centred care. Thus, previous research indicate that older people living in RCFs (residents) experience a lack of dignity and well-being and improvements are needed. To know what to target to improve care it is important to understand what factors are associated with residents´experiences of dignity and well-being in RCFs. The aim of this study was to examine the associations between perceived dignity and well-being and factors related to attitudes of staff, the care environment and individual issues (age, gender, self-rated health and dementia) among residents. Our hypothesis was that residents’ perceptions of satisfaction with dignity and well-being are associated with the attitudes of staff, the indoor-outdoor-mealtime environment and individual factors. We suggest that perceptions of a) respectful attitudes of staff, b) supportive indoor-outdoor-mealtime environment and c) good health are associated with higher satisfaction regarding dignity and well-being. Methods: A national cross-sectional study was conducted. All residents 65 years and older (n=71 696) living in RCFs in Sweden in 2018 were included in the study. The response rate was 49%. Data was collected using a national survey by the Swedish National Board of Health and Welfare. The survey questions included the areas: self-rated health, indoor-outdoor-mealtime environment, performance of care and attitudes of staff. Age, gender and diagnosed dementia were collected from two national databases. Data was analysed using descriptive statistics and ordinal logistic regression models. Results: Respondents who had experienced disrespectful attitudes of staff, who did not thrive in the indoor-outdoor-mealtime environment, who rated their health as poor and respondents diagnosed with dementia had higher odds of being dissatisfied with aspects of dignity and well-being. Discussion and conclusion: To improve care regarding dignity and well-being there is a need a) to target the prerequisites of staff regarding respectful attitudes and b) to target the care environment. The Person-centred practice framework, targeting the prerequisites of staff (knowledge, skills and attitudes) and the care environment (physical environment), could be used as a theoretical framework for designing future improvements. Practical research implications: As the result indicate what factors to target to promote dignity and well-being, it can be used by managers and registered nurses when improving care and designing future interventions to promote dignity and well-being in RCFs. 

  • 48.
    Roos, Charlotte
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Older people’s perceptions of what is needed to experience dignity and well-being at residential care facilities.2021Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Dignity and well-being are central values in the legislation on care of older people living in residential care facilities (RCFs) in Sweden. In addition, care of older people living in RCFs should be person-centred. Dignity and well-being can according to the person-centred practice framework be interpreted as person-centred outcomes. Despite this older people living in RCFs have described that they not fully experience dignity and well-being and improvements are needed. To improve care it is essential to know what to target. The aim of this study was therefore to describe residents’ perceptions and experiences of what is needed to live with dignity and a sense of well-being. A descriptive design with a qualitative approach was used. Open-ended interviews were carried out with 20 older people living at RCFs. Inductive content analysis was used to analyse data and one overarching theme and three categories emerged. The categories revealed the importance of, and that staff and the care environment supported, to manage daily life by oneself, to be shown respect and to belong to a social context. The overarching theme revealed the importance of having a feeling to still matter. For older people to experience the person-centred outcomes dignity and well-being managers at RCFs need to develop and support the staff prerequisites related to knowledge, skills and attitudes and to improve the care environment. According to the person-centred practice framework, the staff prerequisites and the care environment must be taken into account to achieve the person-centred outcomes dignity and well-being. 

     

    This study relates to global sustainability regarding development goal number three – Good health and well-being – implying to promote well-being for all in all ages. This study has a focus on older people and their experiences of what is needed to promote their well-being at RCFs. The results revealed, among other things, that it was important to manage daily life by oneself and this was related to health issues. This implies that this study also deals with health. The results from the study can be used to design improvements to promote older peoples´ health and well-being at RCFs, and in that way sustainability goal number three might be reached.

  • 49.
    Roos, Charlotte
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Older People’s Perceptions of what is Needed to Experience Dignity and Well-being at Residential Care Facilities2021Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Dignity and well-being are central values in care of older people living in residential care facilities. In addition, care of older people living in residential care facilities should be person-centred. Dignity and well-being can according to the person-centred practice framework be interpreted as person-centred outcomes. Despite this older people living in residential care facilities have described that they not fully experience dignity and well-being and improvements are needed. To improve care it is important to know what to target. The aim of this qualitative study was therefore to describe residents’ perceptions and experiences of what is needed to live with dignity and a sense of well-being. Interviews were carried out with older people living at residential care facilities (n=20). Inductive content analysis was used to analyse data and one overarching theme and three categories emerged. The result revealed the importance of, and that staff and the care environment supported, to manage daily life by oneself, to be shown respect and to belong to a social context. For older people to experience the person-centred outcomes dignity and well-being managers at residential care facilities need to develop and support the staff prerequisites related to knowledge, skills and attitudes and to improve the care environment. According to the person-centred practice framework, the staff prerequisites and the care environment must be taken into account to achieve the person-centred outcomes dignity and well-being.

     

     

  • 50.
    Roos, Charlotte
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Promoting dignity and well-being in residential care facilities: Older persons’ perceptions and experiences of important aspects and associated factors2022Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Objective: The overall aim of this thesis was to increase knowledge regarding the perceptions and experiences of aspects and factors associated with perceived dignity and well-being among older persons living in residential care facilities. Study I describes residents’ perceptions and experiences regarding important aspects of experiencing dignity and well-being. Study II examines the associations between perceptions of dignity and well-being and the attitudes of staff, the indoor-outdoor-mealtime environments and individual factors for residents. Study III examines the same associations as Study II over a three-year period. Study IV examines residents’ perceptions of empowerment, person-centred climate and life satisfaction before and after a caregiver intervention concerning the Swedish national fundamental values of dignity and well-being. 

    Methods: The studies were performed in residential care facilities in Sweden. The participants were residents living in these facilities. Study I is a qualitative study that used semi-structured interviews to collect data. Data were analysed using qualitative content analysis. Study II, a cross-sectional study, and Study III, a longitudinal study, are based on national questionnaire data from the Swedish National Board of Health and Welfare. Data from 2016, 2017 and 2018 were used and analysed using descriptive statistics and ordinal logistic regression models. Study IV is a cluster-randomized controlled trial with a pre-and post-test design. Data were collected using the Patient Empowerment Scale, the Person-centred Climate Questionnaire – patient version, the Life Satisfaction Questionnaire and the EQ-5D questionnaire. Data were analysed using descriptive statistics, the Chi-square test, the Wilcoxon signed-rank test, the Mann-Whitney U test and generalized estimating equation models.

    Findings: To experience dignity and well-being it was important for residents to feel that they still matter. To feel this, it was vital to be able to manage daily life, to have influence and to belong to a social context (I). Residents who had experienced disrespectful attitudes of staff, who did not thrive in the indoor-outdoor-mealtime environments, who rated their health and mobility as poor, and who were diagnosed with dementia had higher odds of being dissatisfied with aspects of dignity and well-being (II). These associations were persistent over a three-year period (III). After an intervention concerning the Swedish national fundamental values of dignity and well-being, the residents in the intervention group reported higher scores for perceived empowerment, person-centred climate and life satisfaction (IV).

    Conclusion: To promote dignity and well-being, the attitudes of staff, the indoor-outdoor-mealtime environments and the individual factors of poor health, poor mobility and a dementia diagnosis need to be targeted. The Person-centred practice framework, targeting the prerequisites of staff and the care environment, could be used as a theoretical framework for designing improvement strategies that aim to promote dignity and well-being. First-line managers and registered nurses in residential care facilities have different knowledge and skills. They therefore need to work together as a team when developing improvement strategies that aim to promote the dignity and well-being of residents. In addition, residents should be included on the team given their knowledge regarding what is important for promoting dignity and well-being.

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