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Bylund-Grenklo, T., Werkander Harstäde, C., Sandgren, A., Benzein, E. & Östlund, U. (2019). Dignity in life and care: the perspectives of Swedish patients in a palliative care context.. International Journal of Palliative Nursing, 25(4), 193-201
Open this publication in new window or tab >>Dignity in life and care: the perspectives of Swedish patients in a palliative care context.
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2019 (English)In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 25, no 4, p. 193-201Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: How patients preserve their sense of dignity in life is an important area of palliative care that remains to be explored.

AIMS: To describe patients' perspectives of what constitutes a dignified life within a palliative care context.

METHODS: Twelve palliative care patients were interviewed about their views on living with dignity. Data were analysed using qualitative content analysis.

RESULTS: What constitutes a dignified life during end-of-life care was captured by the theme 'I may be ill but I am still a human being' and presented under the categories 'preserving my everyday life and personhood', 'having my human value maintained by others through 'coherence' and 'being supported by society at large'.

CONCLUSION: Patients' sense of dignity can be preserved by their own attitudes and behaviours, by others and through public support. Health professionals need to adopt a dignity-conserving approach, for which awareness of their own attitudes and behaviours is crucial.

Place, publisher, year, edition, pages
Mark Allen Group, 2019
Keywords
Care of the dying, Dignity, Health professionals, Palliative care
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-82230 (URN)10.12968/ijpn.2019.25.4.193 (DOI)000464949000006 ()31013197 (PubMedID)
Funder
The Kamprad Family Foundation, 20152002
Available from: 2019-04-26 Created: 2019-04-26 Last updated: 2019-05-03Bibliographically approved
Lindmark, U., Bülow, P. H., Mårtensson, J. & Rönning, H. (2019). The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review. Nursing Open, 1-12
Open this publication in new window or tab >>The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review
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2019 (English)In: Nursing Open, E-ISSN 2054-1058, p. 1-12Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: To continuing the quest of the concept of transition in nursing research and toexplore how the concept of transition is used in occupational therapy, oral health andsocial work as well as in interdisciplinary studies in health and welfare, between2003–2013.Design: An integrative literature review.Methods: PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Indexand AMED databases from 2003–2013 were used. Identification of 350 articles includingthe concept of transition in relation to disciplines included. Assessment of articlesare in accordance to Meleis’ typologies of transition by experts in each discipline.Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS).Results: Meleis’ four typologies were found in all studied disciplines, except developmentin oral health. The health‐illness type was the most commonly explored,whereas in social work and in occupation therapy, situational transitions dominated.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
literature review, nursing theory, occupational therapy, oral health, social welfare, social work, theory–practice gap, transition
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-81382 (URN)10.1002/nop2.249 (DOI)
Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-05-17
Wallerstedt, B., Benzein, E., Schildmeijer, K. & Sandgren, A. (2019). What is palliative care?: Perceptions of healthcare professionals. Scandinavian Journal of Caring Sciences, 33(1), 77-84
Open this publication in new window or tab >>What is palliative care?: Perceptions of healthcare professionals
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 77-84Article in journal (Refereed) Published
Abstract [en]

Background Despite increased attention and knowledge in palliative care, there is still confusion concerning how to interpret the concept of palliative care and implement it in practice. This can result in difficulties for healthcare professionals in identifying patients whom would benefit from palliative care, which, in turn, could lead to a delay in meeting patients' needs. Aim To explore healthcare professionals' perceptions of palliative care. Method Data were collected through twelve interprofessional focus group interviews in community care and hospital wards in south Sweden (n = 74). All interviews were analysed with latent content analysis. Results Three domains were revealed: first, a blurred conceptual understanding as participants described palliative care using synonyms, diagnoses, phases, natural care and holism; second, a challenge to communicate transitions concerned the importance of how and when the transition to palliative care was communicated and documented; finally, a need for interprofessional collaboration was described as well as the consequences for severely ill persons, relatives and healthcare professionals when it was not established. Conclusion The perceptions about how to interpret palliative care differed as well as when palliative care should be offered and decided, which might have practical consequences. How long a person has left to live is of great significance for decision-making, caregiving and preparation in palliative care. The challenge is to use interprofessional communication to promote understanding and collaborate across varied care levels. Integrating palliative care across diverse care levels could be one way to reduce the ambiguity of palliative care.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
palliative care, perceptions, healthcare professionals, focus group interviews, conceptual definition, communication, collaboration
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-81850 (URN)10.1111/scs.12603 (DOI)000462154100007 ()30101989 (PubMedID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Parola, V., Coelho, A., Sandgren, A., Fernandes, O. & Apostolo, J. (2018). Caring in Palliative Care: A Phenomenological Study of Nurses' Lived Experiences. Journal of Hospice and Palliative Nursing, 20(2), 180-186
Open this publication in new window or tab >>Caring in Palliative Care: A Phenomenological Study of Nurses' Lived Experiences
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2018 (English)In: Journal of Hospice and Palliative Nursing, ISSN 1522-2179, E-ISSN 1539-0705, Vol. 20, no 2, p. 180-186Article in journal (Refereed) Published
Abstract [en]

Providing palliative care involves serious challenges for nurses, such as end-of-life decisions, contact with people's suffering and dying, and increased risk of burnout. However, studies have revealed that the burnout level of health professionals working in palliative care is lower than that of health professionals working in other settings. This study aimed to describe the lived experiences of nurses caring in a palliative care unit. A phenomenological descriptive study was undertaken. Nine nurses were recruited from a palliative care unit in Portugal. Data were collected using individual interviews and analyzed following the method of Giorgi. Five themes reflect the essence of the lived experience: (1) experience centered on the relationship with the other (ie, the patient and the family), (2) experience centered on the relationship with one's own self, (3) exhausting experience, (4) rewarding experience, and (5) the team as a pillar. These findings can be valuable for understanding the challenges and strategies experienced by nurses caring in palliative care and for designing interventions that focus on reducing the risk of burnout among nursesnot only those working in palliative care but also those working in other contexts who experience regular contact with suffering and death.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
end-of-life care, palliative care, phenomenology, professional burnout, qualitative research
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-72293 (URN)10.1097/NJH.0000000000000428 (DOI)000427794800011 ()
Available from: 2018-04-06 Created: 2018-04-06 Last updated: 2018-04-06Bibliographically approved
Alftberg, Å., Ahlström, G., Nilsen, P., Behm, L., Sandgren, A., Benzein, E., . . . Rasmussen, B. H. (2018). Conversations about Death and Dying with Older People: An Ethnographic Study in Nursing Homes. Healthcare, 6(2), Article ID 63.
Open this publication in new window or tab >>Conversations about Death and Dying with Older People: An Ethnographic Study in Nursing Homes
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2018 (English)In: Healthcare, E-ISSN 2227-9032, Vol. 6, no 2, article id 63Article in journal (Refereed) Published
Abstract [en]

Nursing homes are often places where older persons come to die. Despite this, death and dying are seldom articulated or talked about. The aim of this study was to explore assistant nurses' experiences of conversations about death and dying with nursing home residents. This study is part of an implementation project through a knowledge-based educational intervention based on palliative care principles. An ethnographic study design was applied in seven nursing homes, where eight assistant nurses were interviewed and followed in their daily assignments through participant observations. The assistant nurses stated that they had the knowledge and tools to conduct such conversations, even though they lacked the time and felt that emotional strain could be a hinder for conversations about death and dying. The assistant nurses used the strategies of distracting, comforting, and disregarding either when they perceived that residents' reflections on death and dying were part of their illness and disease or when there was a lack of alignment between the residents' contemplations and the concept of dying well. They indicated that ambivalence and ambiguity toward conversations about death and dying should be taken into consideration in future implementations of knowledge-based palliative care that take place in nursing homes after this project is finalized.

Place, publisher, year, edition, pages
MDPI, 2018
Keywords
auxiliary nurse, existential communication, frailty, ethnographic approach, life-limiting disease, older, aged, palliative care, residential care, end-of-life
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-79499 (URN)10.3390/healthcare6020063 (DOI)000436494800036 ()29899220 (PubMedID)
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-01-15Bibliographically approved
Persson, H. A., Sandgren, A., Furst, C.-J., Ahlström, G. & Behm, L. (2018). Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team's perspective. BMC Geriatrics, 18, Article ID 134.
Open this publication in new window or tab >>Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team's perspective
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2018 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, article id 134Article in journal (Refereed) Published
Abstract [en]

Background: Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team's perspective. Methods: The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. Results: The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category "Going into a bubble" illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category "The body begins to shut down" illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. Conclusions: This study conveys new knowledge concerning the multidisciplinary team's collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Dying, Multidisciplinary team, Nursing home, Older persons, Palliative care, Signs
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-76878 (URN)10.1186/s12877-018-0825-0 (DOI)000435391600003 ()29898674 (PubMedID)
Available from: 2018-07-17 Created: 2018-07-17 Last updated: 2018-07-17Bibliographically approved
Blomqvist, M., Sandgren, A., Carlsson, I.-M. & Jormfeldt, H. (2018). Enabling healthy living: Experiences of people with severe mental illness in psychiatric outpatient services. International Journal of Mental Health Nursing, 27(1), 236-246
Open this publication in new window or tab >>Enabling healthy living: Experiences of people with severe mental illness in psychiatric outpatient services
2018 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 1, p. 236-246Article in journal (Refereed) Published
Abstract [en]

It is well known that people with severe mental illness have a reduced life expectancy and a greater risk of being affected by preventable physical illnesses such as metabolic syndrome, cardiovascular disease and type 2 diabetes. There are still, however, only a few published studies focusing on what enables healthy living for this group. This study thus aimed to describe what enables healthy living among people with severe mental illness in psychiatric outpatient services. The data were collected in qualitative interviews (n=16) and content analysis was used to analyze the data. The interviews resulted in an overall theme Being regarded as a whole human being by self and others, which showed the multidimensional nature of health and the issues that enable healthy living among people with severe mental illness. Three categories emerged: (i) everyday structure (ii), motivating life events and (iii) support from significant others. The results indicate that a person with severe mental illness needs to be encountered as a whole person if healthy living is to be enabled. Attaining healthy living requires collaboration between the providers of care, help and support. Health care organizations need to work together to develop and provide interventions to enable healthy living and to reduce poor physical health among people with severe mental illness.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
healthy living, mental health nursing, patient's experiences, qualitative content analysis, severe mental illness
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-70245 (URN)10.1111/inm.12313 (DOI)000419717100023 ()28160392 (PubMedID)
Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2018-01-30Bibliographically approved
Blomqvist, M., Ivarsson, A., Carlsson, I.-M., Sandgren, A. & Jormfeldt, H. (2018). Health risks among people with severe mental illness in psychiatric outpatient settings. Issues in Mental Health Nursing, 39(7), 585-591
Open this publication in new window or tab >>Health risks among people with severe mental illness in psychiatric outpatient settings
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2018 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 39, no 7, p. 585-591Article in journal (Refereed) Published
Abstract [en]

Life expectancy is greatly reduced in patients with schizophrenia, and cardiovascular diseases are a leading cause of mortality. The aim of this cross-sectional study was to investigate the prevalence of overweight, obesity, and cardiovascular disease (CVD) risk and to investigate the relationships between self-rated health, sense of coherence, CVD risk, and body mass index (BMI) among people with severe mental illness (SMI) in psychiatric outpatient settings. Nearly 50% of the participants were exposed to moderate/high risk of CVD and over 50% were obese. The results showed no statistically relationships between the subjective and objective measures (Bayes factor <1) of health. The integration of physical health into clinical psychiatric nursing practice is vital.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
National Category
Nursing Psychiatry
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-73232 (URN)10.1080/01612840.2017.1422200 (DOI)000445651800007 ()29446657 (PubMedID)
Available from: 2018-04-22 Created: 2018-04-22 Last updated: 2018-10-22Bibliographically approved
Vogel, G., Forinder, U., Sandgren, A., Svensen, C. & Joelsson-Alm, E. (2018). Health-related quality of life after general surgical intensive care. Acta Anaesthesiologica Scandinavica, 62(8), 1112-1119
Open this publication in new window or tab >>Health-related quality of life after general surgical intensive care
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 8, p. 1112-1119Article in journal (Refereed) Published
Abstract [en]

BackgroundImpaired mental and physical health are common complications after intensive care that could influence the patient's health-related quality of life (HRQoL). Earlier research has mainly focused on HRQoL in mixed surgical and medical ICU populations. This study aimed to describe and analyze factors associated with HROoL after discharge from a general surgical ICU. MethodsA prospective cohort study was conducted in a general surgical ICU in Sweden between 2005 and 2012. Adult patients (18years) with an ICU length of stay 96hours were included. HRQoL was measured at 3, 6, and 12months after discharge from the ICU using a questionnaire (SF-36). A linear mixed model was used to analyze changes over time and Wilcoxon Signed Rank Tests were used to compare the 12-months results to an age and gender matched reference population in Sweden. Linear regression analyses were performed to explore the impact on HRQoL from background variables. ResultsOf 447 patients eligible for the study, 276 patients (62%) answered SF-36 at least once at 3, 6 or 12months after ICU care and were included in the study. HRQoL improved over time but was still significantly lower at 12months compared to the reference population. Female gender, age <75years, living single, and ICU-stay of more than 14days were associated with lower HRQoL. ConclusionGeneral surgical ICU patients reports low HRQoL 1year after ICU stay. The impaired HRQoL could be a long-lasting problem with major consequences for the individual, family, and society.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
critical care, health related quality of life, intensive care unit, SF-36
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-77370 (URN)10.1111/aas.13139 (DOI)000440897800012 ()29687441 (PubMedID)
Available from: 2018-08-28 Created: 2018-08-28 Last updated: 2018-08-28Bibliographically approved
Hjelmfors, L., Sandgren, A., Strömberg, A., Mårtensson, J., Jaarsma, T. & Friedrichsen, M. (2018). “I was told that I would not die from heart failure”: patient perceptions of prognosis communication. Applied Nursing Research, 41, 41-45
Open this publication in new window or tab >>“I was told that I would not die from heart failure”: patient perceptions of prognosis communication
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2018 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 41, p. 41-45Article in journal (Refereed) Published
Abstract [en]

Aim and objectives

To describe patients’ experiences of communication about their heart failure prognosis and explore how these experiences affected their preferences for future communication about the prognosis.

Background

Professionals need to discuss about the heart failure prognosis with patients in order to improve their understanding of their illness and address palliative care needs.

Methods

An inductive and exploratory design was used. A total of 24 patients (75% men, 52–87 years of age) in New York Heart Association class I-III from primary outpatient care participated in focus group-, or individual semi-structured interviews. Thematic analysis was used to identify and interpret patterns in the data.

Findings

Two overarching themes, “The message sent” and “Hoping for the best or preparing for the worst”, each with three sub-themes, were discovered during the thematic analysis. Many patients described that professionals had not provided them with any prognosis information at all. Other patients described professional information about prognosis that was given in an either very optimistic or very negative way. However, patients also described situations where professionals had given information in a way that they thought was perfect for them to handle, and in accordance with their preferences.

Conclusion

This study shows that patients have different experiences and preferences for communication about prognosis and uses different approaches in order to cope living with a chronic illness such as heart failure.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-73214 (URN)10.1016/j.apnr.2018.03.007 (DOI)000435427100008 ()29853212 (PubMedID)
Available from: 2018-04-22 Created: 2018-04-22 Last updated: 2018-07-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3155-575x

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