Catharina Gillsjö

Experiences of the new role of advanced practice nurses in Swedish primary health care—A qualitative study

Experiences of the new role of advanced practice nurses in Swedish primary health care-A qualitative study The aim of this study was to investigate and describe the experiences of the first advanced practice nurses (APNs), a new profession for Swedish health care, and of their supervising general practitioners (GPs), regarding the new role and scope of practice of APNs in primary health care. Individual interviews were conducted with the four first APNs and one focus group interview was conducted with five supervising physicians. The material was transcribed verbatim and analysed using latent content analysis. The respondents expressed confidence and trust in the new role of APNs. Some opposition to this new role from the GPs and other colleagues was observed, but was nonetheless overcome. The experiences of the APN role indicate that the new role is clearly demarcated from the role of physicians. The APNs were considered an extra resource for both the GPs and other nurses, which contributed to an increased availability of care for patients. The APN role requires an explicit definition and demarcation in relation to responsibility and roles among colleagues. Further development of the APN role presupposes the right to prescribe medication and order treatments, as well as an evaluation of patient, organizational and inter-professional perspectives on the matter.

A concept analysis of home and its meaning in the lives of three older adults

AIM To identify and define the concept of home and its meaning in the lives of three older women. BACKGROUND For many older adults home is the centre of daily life and increasingly important as a place where health care is delivered. Yet, as a concept, home remains theoretically and empirically underdeveloped. METHODS The Hybrid Model of Concept Development was used to interface theoretical analysis and empirical observation with a focus on definition. A comprehensive, interdisciplinary literature review, semi-structured interviews with three older women and case and cross-case analysis were completed. RESULTS Interviewees spoke of childhood, community, residential, church and heavenly homes. Feelings of comfort and security were associated with residential homes, peace and quiet with church homes, safety and pleasure with heavenly homes. The experience of home as being taken for granted, unselfconscious and unrecognized, became obvious when one woman tried to consciously establish a sense of being at home in her new residence. CONCLUSION No single comprehensive and measurable definition was found. However, three major components were identified (place, relationship and experience) and used to define home as a place to which one is attached, feels comfortable and secure and has the experience of dwelling. RELEVANCE TO CLINICAL PRACTICE Every day assumptions about the meaning of home and home as just another place where health care is provided are called into question. Increased awareness and dialogue is needed among health-care providers working with older adults in their homes. Future research needs to explore the impact of home care on the older adults meaning of home and its potential impact on recovery.

Older Adults’ Ways of Dealing With Daily Life While Living With Long-Term Musculoskeletal Pain at Home

Long-term musculoskeletal pain is a global health problem among older adults. Yet little is known about how these older adults actually deal with daily life. This study’s aim is to describe the ways these older adults dealt with daily life at home. Phenomenography is used to collect and analyze data from semistructured interviews with 19 older adults and to identify the range in which they dealt with daily life. Findings consist of an outcome space that encompassed four categories: ignore, struggle, adjust, and resign. The different ways older adults dealt with daily life when living with long-term pain at home strengthen the importance of individualized plans of care in the home and a holistic perspective. Findings contribute to enhanced understanding of a common health problem among older adults that can be used to promote quality of care and improve the quality of life of older adults.

Reflective STRENGTH-Giving Dialogue Developed to Support Older Adults in Learning to Live with Long-Term Pain: A Method and a Study Design

Background: Long-term musculoskeletal pain is a major health problem that significantly impacts quality of life among older adults. Many lack professional guidance and must learn on their own to live with pain. This calls for a holistic method that addresses older adults’ needs in their situations. The developed method has its foundation in the didactic model: “The challenge – to take control of one’s life with long-term illness. Aim: The aim was to describe the method, Reflective STRENGTH-Giving Dialogue, and present a study design where the method is learned and used by health care providers to support older adults in learning to live their lives with long-term pain at home in a way that promotes health, well-being, meaning and strength in life. Methods: The pilot study design consists of an educational program including continuous supervision to health care providers during the accomplishment of dialogues with community dwelling older adults. The key dimensions in Reflective STRENGTH-Giving Dialogue are: Situation: Confront and ascertain the facticity in the current situation; Transition from “one to I” and Take charge in the situation; Reflect upon possibilities and choices; Engagement in fulfilling small and large life projects that gives joy and meaning in life; Get inner strength and courage; Tactful and challenging approach and Holistic perspective. Data will be collected through interviews and questionnaires. Qualitative and quantitative methods (NRS, BPI-SF, GDS, KASAM, MSQ) will be used for analysis. A control-group will be enrolled. Discussion and Relevance of Study: STRENGTH can be used to secure and enhance the quality of personcentered care. The method for dialogues can be a way to holistically and individually guide and support older adults in finding ways to live a meaningful life despite pain and to fulfill their desire to remain at home as long as possible .

Avancerad specialistsjuksköterska — frän idé till verklighet:

The role of the Nurse Practitioner has successfully been developed internationally within different areas of health care. To satisfy the needs of health care of the population in Sweden, an optimal utilization of the available resources is demanded and treatment of health care problems at an appropriate level of care is required to be able to give health care with good availability, high quality and safety. A collaboration started between the Primary Health Care in the county of Skaraborg and the University of Skövde to develop the role of the district nurses in primary health care toward a more specialized function with the competence to independently make decisions and solve health care problems. The plans of this new role in the health care system gained approval at the National Board of Health and Welfare and other public authorities. St Martins College, Great Britain and University of Rhode Island, USA have also been partners of collaboration. The result of the work became a curriculum of a new education in Sweden — Advanced Nursing Practice in Primary Health Care.

Fluctuation between Powerlessness and Sense of Meaning - A Qualitative Study of Health Care Professionals' Experiences of Providing Health Care to Older Adults with Long-Term Musculoskeletal Pain

BackgroundThere is an increasing number of older adults living with long-term musculoskeletal pain and related disabilities. These problems are frequently unrecognized, underreported, and inadequately treated. Since many older adults desire to remain at home for as long as possible, it is important that individualized and holistically tailored care is provided in these settings. However, there is a complexity in providing care in this context. The aim of this study was to describe health care professionals’ experiences of providing health care to older adults living with long-term musculoskeletal pain at home.MethodsThe phenomenon, “To provide health care to older adults living with long-term musculoskeletal pain at home”, was studied using reflective lifeworld research (RLR) which is based on phenomenological epistemology. Ten health care providers (nurse, physiotherapists, and occupational therapists) were interviewed and data was analysed.ResultsThe health care professional’s emotions fluctuated between powerlessness and meaningfulness. Needs, opportunities, understanding and respect had to be balanced in the striving to do good in the provision of health care in differing situations. Caring for older adults with long-term pain required courage to remain in the encounter despite feelings of insecurity and uncertainty about the direction of the dialogue. The essence of caring for older adults with long-term pain consisted of the following constituents: Sense of powerlessness; striving to provide good health care; and understanding and respect.ConclusionsThe findings indicated that the health care professionals strived to do good and to provide health care that was holistic and sensitive to the older adults’ needs. A significant sense of powerlessness in the situation was experienced by the health care professionals. These findings address and support the need to develop methods that can be used to guide health care providers who support older adults in the context of their homes.

Learning to Endure Long-Term Musculoskeletal Pain in Daily Life at Home: A Qualitative Interview Study of the Older Adult's Experience

Background: Worldwide, there is an increasing number of older adults, the majority of whom remain living at home. Not infrequently they live with long-term pain, especially musculoskeletal pain, which is associated with increased disability (physical, psychological, social) and a negative impact on quality of life. A deeper understanding of how older adults experience living with this type of pain is needed in order to improve well-being and quality of life. The study focused on the actual experience by living with this global, prevailing and disabling type of pain. The aim was to describe commonalities in how older adults endure long-term musculoskeletal pain in their daily life at home. Methods: This inductive, descriptive study included qualitative semi-structured face-to-face interviews with 19 participants (66 to 88 years) in their homes. Qualitative content analysis by Graneheim and Lundman was used to identify themes crossing participants’ experiences of enduring long-term pain in their daily life. Interviews were audiorecorded and transcribed verbatim. Results: All participants felt forced into “learning to live with pain” (main theme), in order to endure their pain. In time, they learned that: taking the pain as it comes, one day at a time; balancing the pain with activity, thoughts and emotions; self-talking; trying to be less of a burden to family and others; and capturing, enjoying and valuing moments of pleasure (sub-themes) helped them endure the pain. Conclusions: This experience was dominated by learning. The approaches generated to learn to endure pain in daily living by these participants should be discussed with older adults in similar situations for further additions, refinements and validation. Nurses can help to ease the older adult’s suffering by tailoring individualized and holistic care focused on guiding the older adult in learning to live with pain and preserving and promoting health and well-being with a maximum of care and a minimum of intrusion.

Keys to person-centred care to persons living with dementia – Experiences from an educational program in Sweden:

Growing old entails an increased risk of disabilities and illnesses such as dementia. The orientation in Sweden on national level is that individuals remain in their own homes if desired and receive person-centred home care. The aim of this study was to describe the experience of an educational program and its influence on daily provision of care to persons with dementia. A life-world approach was used. Data were collected through group interviews with care providers in the context of home. The findings are presented in five themes: Increased knowledge about dementia and treatment, Relationship-building in order to provide good care, Open and flexible approach conveys calm, Continuity and flexibility are cornerstones in the care and Perceived improvements. This person-centred educational intervention resulted in a care that was based on each individual’s personality, preferences and priorities in life. Education given with continuity over time is key to improving provision of care to person with dementia.

REFLECTIVE STRENGTH-GIVING DIALOGUE: A METHOD DEVELOPED TO SUPPORT OLDER ADULTS IN LEARNING TO LIVE WITH LONG-TERM MUSCULOSKELETAL PAIN AT HOME

Abstract Purpose; This paper aims to discuss whether the level of social isolation and loneliness as assessed by care managers corresponds to the level of social isolation and loneliness as perceived by the older persons whose care needs are being assessed. Design/methodology/approach This mixed methods study followed up the assessment of 40 older people by 20 care managers with a focus on the accuracy of the care manager’s assessment on the level of social isolation experienced by the service user. In order for this to be achieved structured interviews were conducted with both the older person and the care manager assessing their needs, with a specific focus on the assessment of loneliness and social isolation. Following these initial interviews two focus groups were then undertaken with the care manager to discuss the findings and unpack the assessment process. Findings The key issues were that the true level of social isolation and loneliness was under assessed by the care manager completing the assessment. That the care manager’s assessment was predominantly focused on the physical well-being of the older person and heavily influenced by the assessment paperwork. Originality/value This provides lessons for professionals about the lack of effectiveness of their assessment of social isolation and loneliness in older people, and the potential impact this has on the older person’s quality of life.

Older Adults' Experiences of Reflective STRENGTH-Giving Dialogues : An Interview Study

Background: A major health problem that frequently accompanies old age is long-term pain, but pain must be acknowledged by older adults and health care providers. Interventions are needed to allevi ...