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  • 1.
    Craftman, Åsa
    et al.
    Sophiahemmet Högskola.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    von Strauss, Eva
    Hillerås, Pernilla
    Sophiahemmet Högskola.
    Westerbotn, Margareta
    Sophiahemmet Högskola.
    Unlicensed personnel administering medications to older persons living at home: a challenge for social and care services2015In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, 201-210 p.Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 2.
    Craftman, Åsa
    et al.
    Sophiahemmet Högskola.
    Westerbotn, Margareta
    Sophiahemmet Högskola.
    von Strauss, Eva
    Hillerås, Pernilla
    Sophiahemmet Högskola.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Older people's experience of utilisation and administration of medicines in a health- and social care context2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, 760-768 p.Article in journal (Refereed)
    Abstract [en]

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

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

    DESIGN: A qualitative descriptive study.

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

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

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

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

  • 3.
    Engström, Gabriella
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Humming as a potential tool for facilitating feeding situations between persons with dementia, and their caregiver. A single case study2012In: Music and Medicine, ISSN 1943-8621, Vol. 4, no 4, 231-236 p.Article in journal (Refereed)
    Abstract [en]

    Persons with dementia (PWDs) have a major cognitive decline in the ability to meet universal self-care needs, including self-feeding and maintaining a sufficient intake of fluids and food. The aim was to describe whether caregivers’ humming during lunch situations affected eating and feeding problems in PWDs. An experimental single-case design was used, involving video observation. At baseline, PWDs were fed by their caregivers in the usual way and at intervention the PWDs were fed while a caregiver hummed. Analysis using the Edinburgh Feeding Evaluation (EdFED) showed that for Mrs Smith, the EdFED score decreased from a mean score of 14 at baseline to a mean score of 8.5 during the intervention. Mrs Green experienced a decrease in mean score from 12 at baseline to 8.5 during the intervention. This pilot study suggests that humming during lunch situations might enhance eating and feeding abilities for PWD and should be further studied

  • 4.
    Engström, Gabriella
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Williams, Christine
    Florida Atlantic University.
    Götell, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Evaluation of communication behavior in persons with dementia during caregivers’ singing2011In: Nursing Reports, ISSN 2039-439X, E-ISSN 2039-4403, Vol. 1, no 4, 15-20 p.Article in journal (Refereed)
    Abstract [en]

    The number of persons with dementia (PWD) is increasing rapidly worldwide. Cognitive impairments and communication difficulties are common among PWD. Therefore, gaining mutual togetherness in caring relation between PWD and their caregivers is important. This study was to investigate the effects of music therapeutic care (MTC) during morning care situations on improving verbal and nonverbal communication behaviors in people with dementia. An observation study with 10 PWD participating. Videotaped interactions (VIO) between PWD and their caregivers were conducted during eight weekly sessions, four recordings consisted of usual morning care and four recordings were of morning care with MTC intervention. The Verbal and Nonverbal Interaction Scale was used to analyze the recorded interactions at a later time. The unsociable verbal variable Cursing decreased significantly (P=.037) during MTC when compared with the baseline measurement. A significant (P=.000) reduction was observed for the unsociable nonverbal variable Does not respond to question. MTC significantly (P=.01) increased the mean score for the sociable nonverbal variable – Calm – relaxed. For sociable verbal communication, significant differences were observed for the variables Use coherent communication (P=.012), Use relevant communication (P=.009), Responds to questions (P=.000), Humming (P=.004), Singing (P=.000). MTC during morning care situations can be an effective non-pharmacological treatment, as well as nursing intervention in order to improve sociable communication behaviors, as well as reduce unsociable communication behaviors of PWDs

  • 5.
    Engström, Gabriella
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Williams, Christine
    , Florida Atlantic University.
    Götell, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    The Impact of Singing in Caring for a Person With Dementia: Single Case Analysis of Video Recorded Sessions2011In: Music and Medicine, ISSN 1943-863X, Vol. 3, no 2, 95-101 p.Article in journal (Refereed)
  • 6.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Can humming caregivers´ facilitate feeding during mealtime situations with persons with dementia? A qualitative study2013In: Non-pharmacological Therapies in Dementia, ISSN 1949-484X, Vol. 3, no 1, 11-22 p.Article in journal (Refereed)
    Abstract [en]

    Background. ‘Music Therapeutic Caregiving’, defined as when caregivers’ sing for or together with persons with dementia care situations, has been shown to facilitate the caring situation, and enhance positive and decrease negative expressions in persons with dementia. No studies about singing during mealtimes have been conducted, and this project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. Aim. To describe professional caregivers’ experiences of humming during meal time while feeding persons with dementia. Method. An intervention with caregivers humming was implemented during lunch time. Focus group interviews were conducted to fetch the caregivers experiences. Qualitative content analysis was used to analyse the interviews. Results. The caregivers described that humming disseminated relaxation and joy, and awakened memories about the songs hummed which encouraged the persons with the dementia to join in the songs. They also described that humming seemed to make the persons with dementia associate with mealtime and could make them eat more. However it also revealed suspiciousness and agitation from the persons with dementia. Conclusion. Humming during mealtime revealed mainly positive as well as some negative influences. More and larger studies are needed to be able to draw general conclusions.

  • 7.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Caregivers' Singing Facilitates Mutual Encounter: Implementation and Evaluation of Music Therapeutic Caregiving in Complex Dementia care Situations2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Persons with severe dementia suffer from major cognitive impairment, and are in need of considerable caring services. They commonly react with problematic behaviors, such as resistance and aggression in close care (e.g., morning care situations). Non-pharmacological treatments such as care interventions should be used to enhance mutuality in the encounter and minimize problematic behaviors. Music Therapeutic Caregiving (MTC) is one such intervention and involves the caregiver singing for or together with the persons with dementia during caregiving. MTC is proposed to decrease expressions of aggressive behaviors and thereby enhance communication between persons with dementia and their caregivers. In addition, it has been suggested that MTC can enhance the posture and sensory awareness of persons with dementia, as well as alter the characteristics of the emotions and moods of both the caregivers and the persons with dementia.

     

    This thesis was designed with the aim of demonstrating how interventions using MTC impacted the participants in this study, which included patients with severe dementia and their caregivers. Five studies were included in this thesis, each of which focused on specific aspects of morning care situations with or without the use of MTC. The first study (I) aimed to describe the experiences of professional caregivers while caring for persons with dementia. The second study (II) aimed to present professional caregivers´ impressions of the persons with dementia. The third study (III) aimed to describe how persons with dementia and their caregivers express verbal and non-verbal communication and make eye contact during the care activity ‘getting dressed’. The fourth study (IV) focused on a single case and was designed to describe the expressions of emotion and of resistiveness to care of two nursing home residents with severe dementia, during morning care situations without and with music therapeutic caregiving. The final study (V) aimed to describe expressions of emotions and resistiveness to care among two groups of persons with dementia.

     

    Study I revealed that during usual morning care situations (without the use of MTC), the caregivers often had problems reaching the persons with dementia and described a struggle when it was necessary to physically restrain some patients due to aggression and resistance. They found consolation when the persons with dementia showed them affection. In study II, the persons with dementia were described as not mentally present during usual morning care situations, and their resistance and aggression lead to difficulties in communicating and cooperating. Study III revealed that the caregivers communicated mainly with verbal instructions and body movements, and that they seldom invited the persons with dementia to participate in the communication. The responses of persons with dementia were at times active and compliant, and other times confused, disruptive, resistant and aggressive.

     

    During MTC, the caregivers described a feeling of well-being, as positive emotions seemed dominant for both the caregivers (study I) and the persons with dementia (study II). The caregivers sense of well-being led to a joyful and positive encounter with the persons with dementia (study I). In study II, caregivers found the persons with dementia better able to express themselves appropriately. Expressions of positive emotions were dominant amongst patients and they were mainly described as relaxed, self-confident, and pliable. Study III also showed that the persons with dementia commonly responded to caregivers’ communication in a composed manner, by being active, compliant and relaxed. Study III further revealed that the caregivers seemed more interested in communicating with the persons with dementia and solicited mutual engagement. In study IV, both residents increased positive expressed emotions, while the negative expressed emotions and resistance decreased. Study V also revealed that the positive emotions, such as pleasure and general alertness significantly increased during MTC, while resistant behaviors, such as pulling away, grabbing objects and adduction, were significantly reduced.

     

    From this thesis, it can be concluded that the use of MTC during morning care situations with persons with dementia can increase their positive expressed emotions, decrease their negative expressed emotions and resistance to care, and lead to a more positive interaction with their caregivers. It can also be concluded that MTC can enhance communication between persons with dementia and their caregivers during caring and thus increase the mutuality in the encounter, thereby facilitating an interpersonal relation during morning care situations. More research concerning MTC is needed and should be conducted using different data collection and analysis methods, as well as different care situations.

  • 8.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Involving people with dementia in Swedish research2011In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 51, 254-254 p.Article in journal (Other academic)
  • 9.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    The impact of caregivers’ singing on expressions of resistance and communication during morning care situations in persons with dementia2014In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 54, 41-42 p.Article in journal (Refereed)
    Abstract [en]

    The impact of caregivers’ singing on expressions of emotion and communication during morning care situations in persons with dementia

    The number of persons with dementia (PWD) is increasing rapidly worldwide. Emotions and communication difficulties are common and non-pharmacological interventions should be considered.  The inclusion criteria were diagnosed with severe dementia, living at nursing homes and a Mini–Mental State Examination (MMSE) score > 12. Music Therapeutic Caregiving (MTC), when a caregiver sings for or together with the PWD was conducted during morning care. Baseline and intervention sessions were videotaped during eight weeks. The PWDs’ expressions of resistant behavior were significantly reduced under the intervention situation[Gabriella2] . A significant (P=.000) reduction was observed for the unsociable nonverbal variable Does not respond to question. MTC significantly (P=.01) increased the mean score for the sociable nonverbal variable – Calm –Relaxed. For sociable verbal communication, significant differences were observed for the variables Use coherent communication (P=.012), Use relevant communication (P=.009), Responds to questions (P=.000), Humming (P=.004) and Singing (P=.000).

  • 10.
    Marmstål Hammar, Lena
    et al.
    Mälardalens högskola.
    Emami, Azita
    College of Nursing, University of Seattle, USA.
    Engström, Gabriella
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Götell, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Communicating through caregiver singing during morning care situations in dementia care2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 1, 160-168 p.Article in journal (Refereed)
    Abstract [en]

    It is well known that persons with dementia (PWD) have problems expressing and interpreting communication, making interaction with others difficult. Interaction between PWD and their caregivers is crucial, and several strategies have been investigated to facilitate communication during caregiving. Music therapeutic caregiving (MTC) - when caregivers sing for or together with PWD during caregiving activities - has been shown to enhance communication for PWD, evoking more vitality and positive emotions. The aim of this study was to describe how PWD and their caregivers express verbal and nonverbal communication and make eye contact during the care activity 'getting dressed', during morning care situations without and with MTC. Findings revealed that during the situations without MTC, the caregivers led the dressing procedure with verbal instructions and body movements and seldom invited the PWD to communicate or participate in getting dressed. Patterns in responses to caregivers' instructions included both active and compliant responses and reactions that were resistant and aggressive, confused, and disruptive. In contrast to the 'ordinary' morning care situation, during MTC, the caregivers seemed interested in communicating with the PWD and solicited their mutual engagement. Although verbal communication consisted of singing about things other than getting dressed, e.g. dancing, love, sailing, God, the PWD mostly responded to caregivers in a composed manner, by being active, compliant, and relaxed, though some were also resistant or incongruent. The authors conclude that MTC could be a way for PWD and their caregivers to successfully interact and co-operate during caring situations, as it seems to evoke enhanced communication for both partners in this context

  • 11.
    Marmstål Hammar, Lena
    et al.
    Mälardalens högskola.
    Emami, Azita
    University of Seattle.
    Engström, Gabriella
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Götell, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Finding the key to communion – Caregivers’ experience of ‘music therapeutic caregiving’ in dementia care: A qualitative analysis2011In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 10, no 1, 98-111 p.Article in journal (Refereed)
    Abstract [en]

    ‘Music therapeutic caregiving’ (MTC), when caregivers sing for or together with persons with dementia (PWDs) during caring situations, has been suggested as a way to reduce PWDs’ behavioral and psychological symptoms of dementia (BPSD). An intervention was designed to elucidate what influences MTC might have on PWDs and their caregivers. The aim was to describe professional caregiverś experiences of caring for PWDs during morning care situations without and with MTC. Group interviews were conducted, and a qualitative content analysis was performed. Two themes were revealed. The first (without MTC), Struggling for care in communion, encompassed four sub-themes: Hampered communication; Physical and mental struggle with aggression; Struggling with ethical demands; and The reward — consolation and love. The second theme (with MTC), Consolidating care in communion, encompassed two sub-themes: awakening cooperation, and feeling of well-being. The authors conclude that MTC could be used to help caregivers provide improved care.

  • 12.
    Marmstål Hammar, Lena
    et al.
    Mälardalens högskola.
    Emami, Azita
    College of Nursing, University of Seattle, USA.
    Engström, Gabriella
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Götell, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Reactions of Persons with Dementia to Caregivers Singing in Morning Care Situations2010In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, no 4, 35-41 p.Article in journal (Refereed)
    Abstract [en]

    Music therapeutic caregiving', when caregivers sing for or together with persons with severe dementia during care situations, has been suggested as a way to reduce problematic behaviors in dementia care. The present study implemented this technique as an intervention in dementia care. Six caregivers participated in group interviews about their experiences of morning care situations without and with'Music therapeutic caregiving'. Through a qualitative content analysis two themes emerged.'Being in a different reality' was based on'usual' morning care situations. The caregivers' experienced the persons with dementia as absent-minded; communication and cooperation were difficult. The second theme,'Being present', was based on morning care situations with the intervention. The caregivers described communication as enhanced; the persons with dementia expressed themselves more appropriately, making cooperation possible. The results indicate that'Music therapeutic caregiving' might lead to a more positive experience of the person with dementia and seems to increase receptivity to caregiving.

     

  • 13.
    Marmstål Hammar, Lena
    et al.
    Mälardalens högskola.
    Emami, Azita
    Seattle Univ, Coll Nursing.
    Götell, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Engström, Gabriella
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    The impact of caregivers' singing on expressions of emotion and resistance during morning care situations in persons with dementia: an intervention in dementia care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 7-8, 969-978 p.Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim was to describe expressions of emotions and resistiveness to care among persons with dementia (PWD), during morning care situations without and with music therapeutic caregiving (MTC). BACKGROUND: Effective caregiving is dependent on the interpersonal relationship between nurse and patient. PWD suffer from major cognitive impairment, making interaction with others problematic. Such patients often react with problematic behaviours such as resistance and anger towards the care activity and the caregiver. Earlier research suggests that MTC - when caregivers sing for or together with PWD during caregiving - can reduce resistance and evoke positive emotions in PWD. DESIGN: This was an intervention study whereby MTC was implemented during morning care situations while PWD were being cared for. METHOD: The study included ten, 66-92-year-old men and women with severe dementia living in a nursing home in Sweden. Video observations of eight weekly sessions, consisting of four recordings of usual morning care and four recordings of morning care with MTC, provided data. The resistiveness to care scale and the observed emotion rating scale were used for analysis. RESULTS: Pull away was the most common resistant behaviour under both conditions. The PWDs' expressions of resistant behaviour, such as pull away, grab object and adduction, were significantly reduced under the intervention situation. Positively expressed emotions, specifically pleasure and general alertness, significantly increased under the MTC intervention compared with the 'usual' morning care sessions. CONCLUSIONS: MTC can be an effective nursing intervention to provide PWD a more pleasant experience of morning care situations as it decreases resistant behaviour and increases positive emotions. RELEVANCE TO CLINICAL PRACTICE: MTC offers a potential non-pharmacologic treatment that can be used in caring for PWD.

  • 14.
    Marmstål Hammar, Lena
    et al.
    Mälardalens högskola.
    Götell, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Engström, Gabriella
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Singing while caring for persons with dementia2011In: Arts and Health, ISSN 1753-3015, E-ISSN 1753-3023, Vol. 3, no 1, 39-50 p.Article in journal (Refereed)
    Abstract [en]

    Persons with dementia (PWDs) can suffer from major cognitive impairment, but are known to retain an ability to express both negative and positive emotions. Negative expressed emotions and resistance make caregiving problematic. Music Therapeutic Caregiving (MTC) – when caregivers sing for or together with PWDs during care – has been shown to decrease PWDs' negative expressed emotions and resistance, and increase positive expressed emotions. This single case study included two cases, two women with severe dementia, and measures expressed emotions and expressions of resistiveness to care during “usual” morning care situations and morning care situations with MTC. Video observations were conducted resulting in four recordings of usual morning care and four recordings of morning care with MTC. For analysis, the Observed Emotion Rating Scale and Resistiveness to Care Scale were used. Results revealed that in both cases, expressions of resistant behavior and negative emotions decreased, while expressions of positive emotions increased during morning care situations with MTC. The authors conclude that MTC may be an effective method for caregivers to use to facilitate care situations with PWDs, and also a way for PWDs to experience care situations as less unpleasant, and more joyful.

  • 15.
    Marmstål Hammar, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Mälardalens University; Karolinska Institute.
    Holmström, Inger K
    Skoglund, Karin
    Meranius, Martina Summer
    Sundler, Annelie J
    The care of and communication with older people from the perspective of student nurses. A mixed method study2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 52, 1-6 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people.

    OBJECTIVE: The aim of this study was to investigate student nurses' views on the care of and communication with older people.

    DESIGN: A descriptive study with a mixed-method approach was conducted.

    METHODS: Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015.

    RESULTS: The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites.

    CONCLUSIONS: Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed.

  • 16.
    Marmstål Hammar, Lena
    et al.
    Mälardalens högskola.
    Swall, Anna
    Sophiahemmet Högskola.
    Summer Meranius, Martina
    Ethical aspects of caregivers' experience with persons with dementia at mealtimes2016In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, no 6, 624-635 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Persons with dementia are at risk of malnutrition and thus in need of assistance during mealtimes. Research suggest interventions for caregivers to learn how to facilitate mealtimes and eating, while other suggest a working environment enabling the encounter needed to provide high-quality care. However, the phenomenon of caring for this unique population needs to be elucidated from several perspectives before suggesting suitable implications that ensure their optimal health.

    OBJECTIVES: To illustrate the meanings within caregivers' experiences of caring for persons with dementia during mealtime situations. We also measured weight and food intake among individuals with dementia to explain better the phenomenon of caring for them during mealtimes.

    METHODS: Mixed method including focus group interviews with seven caregivers analyzed using phenomenological hermeneutics. In addition, for nine persons with dementia, weight and food intake were collected and descriptive statistics were calculated.

    ETHICAL CONSIDERATIONS: Ethical review was obtained from an ethics committee, and all caregivers signed a consent form after being informed on the issue of research ethics. Relatives for persons with dementia were informed and signed the consent. In addition, throughout the study, the persons' expressions were observed aiming to respect their vulnerability, integrity, and dignity.

    FINDINGS: One theme emerged from interviews (struggling between having the knowledge and not the opportunity), which was built upon three subthemes (being engaged and trying; feeling abandoned and insufficient; being concerned and feeling guilty). Seven of nine persons with dementia lost a minimum of 1.3 kg of weight and ate a maximum of 49.7% of the food served.

    CONCLUSION: Caregivers struggle because they have knowledge about how to provide high-quality care but are unable to provide this care due to organizational structures. The weight loss and insufficient eating among the persons with dementia may support this conclusion. Sufficient time for adequate care should be provided.

  • 17.
    Marmstål Hammar, Lena
    et al.
    Mälardalens högskola.
    Williamn, Christine
    Florida Atlantic University.
    Swall, Anna
    Sophiahemmet Högskola.
    Engström, Gabriella
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Humming as a mean of communicating during meal time situations: A Single Case study involving a women with severe dementia and her caregiver2012In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 2, no 3, 93-102 p.Article in journal (Refereed)
    Abstract [en]

    Objective:

    ‘Music Therapeutic Caregiving’, when caregivers sing for or together with persons with dementia during morning care situations, has been shown to increase verbal and nonverbal communication between persons with dementia and their caregivers, as well as enhance positive and decrease negative emotions in persons with dementia. No studies about singing during mealtimes have been conducted, and this pilot project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. The aim of this pilot project was threefold: to describe expressed emotions in a woman with severe dementia, and describe communication between her and her caregivers without and with the caregiver humming. The aim was also to measure food and liquid intake without and with humming.

    Method: The study was constructed as a Single Case ABA design in which the ordinary mealtime constituted a baseline which comprised a woman with severe dementia being fed by her caregivers in the usual way. The intervention included the same woman being fed by the same caregiver who hummed while feeding her. Data comprised video observations that were collected once per week over 5 consecutive weeks. The Verbal and Nonverbal Interaction Scale and Observed Emotion Rating Scale were used to analyze the recorded interactions.

    Results:

    A slightly positive influence of communication was shown for the woman with dementia, as well as for the caregiver. Further, the women with dementia showed a slight increase in expressions of positive emotions, and she ate more during the intervention.

    Conclusion:

    Based on this pilot study no general conclusions can be drawn. It can be concluded, however, that humming while feeding persons with dementia might slightly enhance communication, and positive expressed emotions in persons with dementia. To confirm this, more studies on group levels are needed. Because previous studies have found that caregiver singing during caring situations influences persons with dementia positively it might be desirable to test the same during mealtime.

  • 18.
    Marmstål Hammar, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Williams, Christine
    Florida Atlantic University.
    Development of the Verbal and Nonverbal Interaction Scale for Persons with Dementia2016Conference paper (Other academic)
  • 19.
    Marmstål Hammar, Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Williams, Christine
    Florida Atlantic University.
    The moderating and covarying effects of social support and pain intensity on depressive symptomology among racially and ethnically diverse older adults2016Conference paper (Other academic)
  • 20. Park, Juyoung
    et al.
    Newman, David
    Engström, Gabriella
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Swall, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    The moderating and covarying effects of social support and pain intensity on depressive symptomology among racially and ethnically diverse older adults2017In: Pain Management, ISSN 1758-1869, Vol. 7, no 1, 19-32 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To examine the interplay of social support, pain intensity and ethnicity as moderators and covariates of relationship on depressive symptomatology.

    METHODS: Racially and ethnically diverse elders responded to measures of depressive symptomatology and social support.

    RESULTS: Hispanics reported significantly higher prevalence of moderate pain intensity and depressive symptomology, and lower prevalence of high social support compared with other ethnic groups. Although social support showed reduced depressive symptomatology among those with high pain intensity, it did not play a significant role in decreasing depressive symptomatology among those with low/moderate pain intensity.

    CONCLUSION: Social support in decreasing depressive symptomatology is more effective in older adults with high pain intensity than those with moderate or low levels of pain intensity.

  • 21. Ramsten, Camilla
    et al.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    Martin, Lene
    Göransson, Kerstin
    ICT and intellectual disability: A survey of the organizational support on municipality level in Sweden2015Conference paper (Other academic)
  • 22.
    Ramsten, Camilla
    et al.
    Mälardalen university.
    Marmstål Hammar, Lena
    Mälardalen university.
    Martin, Lene
    Mälardalen university.
    Göransson, Kerstin
    Karlstad university.
    ICT and intellectual disabillity: A survey of organizational support at the municipal level in Sweden2017In: JARID: Journal of applied research in intellectual disabilities, ISSN 1360-2322, E-ISSN 1468-3148, Vol. 30, no 4, 705-713 p.Article in journal (Refereed)
    Abstract [en]

    Background

    Young adults today have grown up in a society where information and communication technology (ICT) support empowerment and social participation. Young adults with mild-to-moderate intellectual disability are at risk for marginalization by the digital divide. The aim was to map and describe how municipal organizations in Sweden organize support in terms of policy and strategies to enable the use of ICT in social care for adults with a mild-to-moderate intellectual disability.

    Methods

    A quantitative, cross-sectional survey including all municipalities in Sweden (= 290) was conducted (response rate: 51%, = 147). Descriptive statistics were used.

    Results

    Findings indicate a lack of organizational support for staff as well as for young adults with mild-to-moderate intellectual disability.

    Conclusion

    Municipalities request more knowledge about strategies for making ICT available. Despite the lack of comprehensive strategies for ICT, some Swedish municipalities have taken the initiative in this are

  • 23.
    Summer Meranius, Martina
    et al.
    Mälardalens högskola.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    How Does the Health-care System Affect Medication Self-management among Older Adults with Multimorbidity?2015Conference paper (Other academic)
  • 24.
    Summer Meranius, Martina
    et al.
    Mälardalens högskola, Hälsa och välfärd.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    How does the healthcare system affect medication self-management among older adults with multimorbidity?2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 1, 91-98 p.Article in journal (Refereed)
    Abstract [en]

    Individuals with multimorbidity commonly have several concurrent prescriptions and experience healthcare obstacles related to managing different diagnoses and medications. This study aimed to provide a deeper understanding of how older adults with multimorbidity experience medication self-management and how this is affected by the healthcare system. The National Board of Research Ethics approved the study, and 20 older adults with multimorbidity participated in in-depth interviews that were analysed using a hermeneutic approach. Three levels of interpretation emerged. At the first level, lack of participation in healthcare communication hinders adherence and safety, and feeling abandoned to self-care leads to health risk-taking. At the second level, the healthcare organisation is seen as an obstacle to medication self-management. The overall interpretation was a system of repairing ‘parts’ but not enabling the experience of health. This study shows that the healthcare system is able to treat and relieve an individual's symptoms, but seems unable to help them achieve and promote good health, or to provide the support they need to function in everyday life.

  • 25.
    Widarsson, M.
    et al.
    Uppsala University, Uppsala, Sweden.
    Engström, G.
    Florida Atlantic University, United States.
    Tydén, T.
    Uppsala University, Uppsala, Sweden.
    Lundberg, P.
    Uppsala University, Uppsala, Sweden.
    Marmstål Hammar, Lena
    Mälardalens högskola.
    'Paddling upstream': Fathers' involvement during pregnancy as described by expectant fathers and mothers2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, 1059-1068 p.Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe the perspectives of expectant mothers and fathers on fathers' involvement during pregnancy. Background: Becoming a father is a major life event and paternal involvement during pregnancy has a positive influence on the family. However, research into both expectant mothers' and fathers' perspectives on fathers' involvement during pregnancy is relatively scarce. Design: A descriptive qualitative study was used. Methods: Thirty expectant parents (20 women and 10 men) were interviewed either as part of one of four focus groups or in an individual interview. Qualitative content analysis was performed on the interview transcripts. Results: A theme of 'Paddling upstream' emerged as an expression of the latent content of the interviews concerning perspectives on fathers' involvement. Five sub-themes described the manifest content: trying to participate, trying to be understanding, trying to learn, trying to be a calming influence and trying to find a balanced life. Expectant parents suggested several ways to improve fathers' involvement and to meet parents' need for shared involvement. Conclusion: Expectant mothers and fathers wanted the father to be more involved in the pregnancy. Although fathers attempted different strategies, they did not always perceive what was expected of them and encountered many barriers as they tried to navigate through this unique experience. The best support for the father was the mother. Expectant parents wanted their healthcare to include the father more thoroughly and to focus on the whole family. Relevance to clinical practice: Prenatal care professionals can overcome barriers that prevent paternal involvement. Although fathers are not able to engage in the pregnancy on the same level as the mother, we suggest that their specific needs also be recognised through an increased awareness of gender norms in healthcare.

  • 26. Williams, C. L.
    et al.
    Newman, D.
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Preliminary psychometric properties of the verbal and nonverbal interaction scale: An observational measure for communication in persons with dementia2017In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 38, no 5, 381-390 p.Article in journal (Refereed)
    Abstract [en]

    Little attention has been given to sociable/unsociable communication in persons with dementia despite the importance of these behaviors in maintaining engagement in marital relationships. An observational measure of verbal and nonverbal communication in persons with dementia (Verbal and Nonverbal Interaction Scale-CR) who were engaged in conversations with spouses was tested for reliability and validity. Married persons with dementia were video-recorded at home conversing with spouses over 10 weeks (N = 118 recordings). Reliability [inter-coder (.92), test-retest (r =.61-.77), internal consistency (α =.65 -.79)] were adequate. Following an intervention, the Verbal and Nonverbal Interaction Scale-CR predicted improved communication over 10 weeks. The ratio of sociable to unsociable communication improved by 4.46 points per session [β = 4.46, t(10) = 1.96, p =.039]. VNVIS-CR is recommended to describe sociable and unsociable communication in persons with dementia as they engage in conversations with spouses.

  • 27. Williams, Christine L
    et al.
    Newman, David
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Preliminary study of a communication intervention for family caregivers and spouses with dementia2017In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study was to designed to examine the feasibility and preliminary outcomes of CARE: Caring About Relationships and Emotions, a 10-week, home-based, intervention to support married couples affected by dementia.

    METHODS: Fifteen older couples participated in a single group repeated measures feasibility study. Weekly, video-recorded conversations over 10 weeks were used to rate communication using the Verbal/Nonverbal Interaction Scale for caregivers and care receivers.

    RESULTS: Accounting for mental status of care recipients, the ratio of social to unsocial communication showed a significant improvement across sessions-an average of 4.46 points per session [β = 4.46, t(10) = 1.96, p = .039]. Spouse caregiver (CG) communication showed a significant decrease in the number of disabling communications with approximately .65 decreased comments per session [β = 0.654, t(11) = -2.61, p = .024].

    CONCLUSIONS: At home dyadic, relationship-focused psychoeducational intervention to improve communication in spouses affected by dementia has the potential to improve communication outcomes. Creative ways of working with couples are needed to help them sustain their relationships and maintain their health.

  • 28.
    Williams, Christine
    et al.
    Florida Atlantic University.
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Development of the Verbal and Nonverbal Interaction Scale for Persons with Dementia2016Conference paper (Other academic)
  • 29. Williams, Cristine
    et al.
    Newman, David
    Marmstål Hammar, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Communication Outcomes of a Program to Sustain Relationships in Couples Aff­ected by Dementia2017Conference paper (Refereed)
1 - 29 of 29
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