Eva Jakobsson

The turning point: Identifying end-of-life care in everyday health-care practice

Abstract There is a broad consensus among international policy statements that care provided at end-of-life should be different from care provided during other periods of life which assumes a turning point which reflects the onset of the dying process and the associated care reorientation. Few studies derived from empirical data have described this turning point from a clinical perspective. With the purpose to increase the clinical understanding about the nature of such turning points this study explores this phenomenon as determined from health-care records of a representative sample of adults who accessed the public health care system, and who died in the County of Västra Götaland, Sweden, during 2001 (n = 229). Record entries reflecting a turning point, that is recognition of the patients as being at the end-of-life and a message about a switch from curative, life-extending or rehabilitative care to an emphasis on palliation, were found in slightly less than 70% of the records while slightly more than 30% lacked such descriptions. The record entries were analyzed with content analysis. As a whole, the descriptions were largely relying on a biomedical discourse and typically put in terms of signs of declining processes, undefined serious condition, prognostications of fatal outcome or justifications of given up active treatments. The procedures which followed the recognition of a turning point revealed that nurses and physicians typically emphasize procedures directed to the patients’ families, on re-orientation of treatments and on approaches to further care. The picture of the patients’ last time of life as reflected from these record entries is that end-of-life is described in biomedical and factual-oriented terms. The end-of-life care was broadly described in vague terms with lack of concrete care plans. Holistic and good end-of-life care as revealed in this study is indistinguishable, highly embedded in a medical model of care and, hence, an abstract and unknown territory without specific content.

Transcultural Encounters in a Medical Ward in Sweden: Experiences of Health Care Practitioners

The aim of this study was to explore the approach adopted by health care practitioners when handling transcultural encounters. The study was performed by means of action research, a reflective process led by practitioners and researchers working together to improve practice and solve problems. Data were collected through participant observations at a coronary unit in Sweden and group discussions with the health care professionals and were analyzed and interpreted using a hermeneutic approach. The narratives in the interview text illustrated a switch between three levels of understanding human behavior: the individual level (personality), the collective or group level (what is termed culture), and the universal level (human nature), focusing on differences in the first two and similarities in the third. This study highlights the importance of practitioners comprehending the complex relationship between individuality and cultural context and understanding cultural identity as being fluid and coexisting with other differences, such as class, education, gender, and age.

Older Peoples’ Descriptions of Becoming and Being Respite Care Recipients

The number of older people in the western world is increasing. Advancing age creates the need for care, including respite care. The aim of this study is to describe the experience of older people of becoming and being respite care recipients. Admission to respite care is a response to a range of practicalities in the home, such as the need to maintain privacy, dissatisfaction with home care, and deterioration in health. However, the participants in this study had little or no involvement in the decision regarding respite care placement. Activities, training, and medical treatment were found to be important to respite care recipients’ satisfaction with their care.