Kjell Kallenberg

Dimensional analysis of sense of coherence using structural equation modelling

The sense of coherence (SOC) concept has been criticized on conceptual and psychometric grounds. The aim of this study was to develop the concept using structural equation modelling. The short 13‐item version of the SOC questionnaire was used and data were collected from two different samples. Each sample consisted of about 2000 individuals, selected to be representative of the Swedish population. A model with a general factor and two subordinate specific factors yielded a satisfactory solution in both samples. The two factors were labelled Social Comprehension and Commitment and Unpleasant Emotions and Inner Tension respectively. It was concluded that the 13‐item SOC scale could to a certain degree be regarded as a measure of negative affectivity and that the suggested model makes the SOC concept more theoretically coherent. Copyright

Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds

Objective: To evaluate one ethics rounds model by describing nurses’ and doctors’ experiences of the rounds. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses’ expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous. Conclusion: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented.

Moral stress in international humanitarian aid and rescue operations : a grounded theory study

Humanitarian aid professionals frequently encounter situations in which one is conscious of the morally appropriate action but cannot take it because of institutional obstacles. Dilemmas like this are likely to result in a specific kind of stress reaction at the individual level, labeled as moral stress. In our study, 16 individuals working with international humanitarian aid and rescue operations participated in semistructured interviews, analyzed in accordance with a grounded theory approach. A theoretical model of ethical decision making from a moral stress perspective was developed. The practical implications of the study are discussed.

Interprofessional ethics rounds concerning dialysis patients: staff’s ethical reflections before and after rounds

Objective: To evaluate whether ethics rounds stimulated ethical reflection. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd’s framework but were also statistical in nature. Findings: Seventy-six per cent of the respondents reported a moderate to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p<0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds. Conclusion: The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice.

View of life in persons with dementia

Objective: To study the view of life in dementia. The view of life of an individual is defined as a conception of reality, a central system of values and a basic emotional attitude. Method: Interviews with persons (N = 21) with mild to moderate dementia of the Alzheimer’s type. The interview data were interpreted with a phenomenological hermeneutical method. Results: Despite their cognitive deterioration it was possible to understand the view of life of the participants in the frame of their life story. Their view of life seemed to guide them towards selecting mainly emotionally powerful and value-oriented memories. No exceptional characteristics that could be traced to their dementia disease were found in the participants’ views of life. Conclusions: The view of life of the participants with mild to moderate dementia was vital for their life story and was not erased by dementia. Implications: In order to respect people with dementia as persons, caregivers should strive for gaining some knowledge of their view of life.

Leadership and Moral Stress: Individual Reaction Patterns among First Responders in Acute Situations that Involve Moral Stressors

The aim was to gain a deeper understanding of individual reaction patterns among professional first responders (emergency treatment, military officers, and police officers) during and after acute situations that involve moral stressors in combination with cumulative stress. Swedish and Norwegian informants within these professional groups were interviewed (n=37). Data were analyzed according to a grounded theory approach. A model was developed according to which long-term effects following such stress exposure depends on the character of the continued everyday living. In particular, the frequency and intensity of perceived daily hassles and uplifts is important. Cognitivebehavioral aspects are discussed to prevent and/or reduce negative long-term reactions.

View of life and health

The quest for causes behind health and sickness proposes deeper causes like per- sonality and general view of life. Two such concepts have been shown to associate with health indicators in a systematic way, sense of coherence and view of life. Sense of coherence (SOC) is defined as the sum of three factors, comprehensibility, manage- ability, and meaningfulness. View of life (VOL) consists of three components, general theories of man and the world, a central value system, and a basic attitude. Two em- pirical studies are summarized where the concepts are related to bereavement and health, respectively. It is concluded that there are many similarities between the two concepts. They both emphasize integration and coherence and connote basic struc- tures in belief systems. They can be related to personality structure and the coping process. The concepts differ in scope and depth. SOC can be considered as part of the connotation of VOL. SOC is quantitatively measurable while VOL presumes qualitative methods of assessment. In studies of health, where factors pertaining to world view or sense of coherence are not in focus, but studied rather as possible confoun- ders, methodological simplicity points to use of the SOC concept. In studies of health where the deeper causal structures are in focus, VOL should also be used, since it per- mits greater depth of analysis. Ideally, both concepts should be applied for a full un- derstanding between mans inner processes and health.

Contextual factors affecting moral stress: a study of military and police officers

PurposeThe purpose of this paper is to identify and gain a deeper understanding of environmental, organizational, and group conditions, and leadership-related issues in particular, in severely stre ...

The disposal of the aborted fetus--new guidelines: ethical considerations in the debate in Sweden.

During the 70s and 80s ethical debate concerning the fetus became intensive. The great advances made in medical technology and research and improvements in prenatal diagnosis as well as in embryological research have led us to believe that the fetus is an individual with recognised claims to protection. In Sweden the aborted fetus has previously been considered merely as a risk-disposal problem, equivalent to dangerous and infected material and there have been no specific guidelines for the treatment of the fetus after abortion. In July 1990 treatment of aborted fetuses was changed with the general guidelines from the National Board of Health and Welfare. The present paper sets out the main contents of the guidelines and discusses the gradually changing views concerning the status of the human fetus in Sweden, as well as the public debate which has been a contributing factor to these changes.