Sofia Kjellström

What actions promote a positive ethical climate? A critical incident study of nurses’ perceptions

Few qualitative studies explore the phenomenon of positive ethical climate and what actions are perceived as promoting it. Therefore, the aim of this study was to explore and describe actions that acute care ward nurses perceive as promoting a positive ethical climate. The critical incident technique was used. Interviews were conducted with 20 nurses at wards where the ethical climate was considered positive, according to a previous study. Meeting the needs of patients and next of kin in a considerate way, as well as receiving and giving support and information within the work group, promoted a positive ethical climate. Likewise, working as a team with a standard for behaviour within the work group promoted a positive ethical climate. Future research should investigate other conditions that might also promote a positive ethical climate.

Literature review: Status and trends of research ethics in Swedish nurses’ dissertations

Research ethics is increasingly formally regulated, but little is known about how ethical considerations are reported in dissertations. The aim of this literature study was to describe the status and trends of ethical considerations in Swedish doctoral dissertations written by registered nurses. A total of 77 dissertations from 1987, 1997, and 2007 met the inclusion criteria and were analyzed by descriptive statistics. Ethical considerations were mostly overlooked in 1987, but almost ubiquitous by 2007. All dissertations in 2007, except one, had a section on ethical considerations; however, these were short, lacking in references, and short on content. The most common topic was informed consent and approval from research ethics review boards, followed by confidentiality and ethical aspects of methodological issues. Our results imply that the quantity and quality of ethical considerations must be improved in order to assure ethical soundness for participants, patients, researchers, and society.

Older persons have ambivalent feelings about the use of monitoring technologies

BACKGROUND: As they age, older persons prefer to continue to live in their own homes. Sensors in the environment and/or bodily worn systems that monitor people might contribute to an increased sens ...

Creating relationships with persons with moderate to severe dementia

The study describes how relationships are created with persons with moderate to severe dementia. The material comprises 24 video sequences of Relational Time (RT) sessions, 24 interviews with persons with dementia and eight interviews with professional caregivers. The study method was Constructivist Grounded Theory. The categories of ‘Assigning time’, ‘Establishing security and trust’ and ‘Communicating equality’ were strategies for arriving at the core category, ‘Opening up’, which was the process that led to creating relationships. Both parties had to contribute to create a relationship; the professional caregiver controlled the process, but the person with dementia permitted the caregivers overtures and opened up, thus making the relationship possible. Interpersonal relationships are significant to enhancing the well-being of persons with dementia. Small measures like RT that do not require major resources can open paths to creating relationships.

Older Persons' Reasoning about Responsibility for Health: Variations and Predictions:

With many Western societies structured for adults to live longer and take responsibility for their health, it is valuable to investigate how older persons reason about this demand. Using mixed methods, this pilot studied how older persons reason about responsibility for health and their responsibility as a patient. Interviews with a small Swedish sample of 65–84 year olds were analyzed for qualitative characteristics and quantitative complexity in reasoning. Using adult development theory, we predicted at least three different stages of performance in reasoning. Results indicated four different stages: two where there is no actual reasoning about health and responsibility, and two where reasoning does occur, each qualitatively different. Results suggest a long-standing blind spot in health studies, that older people do not comprehend responsibility issues in the same way. There are significant implications for closing this gap between demand to take responsibility and capabilities to do so.

Values at stake: autonomy, responsibility, and trustworthiness in relation to genetic testing and personalized nutrition advice

Personalized nutrition has the potential to enhance individual health control. It could be seen as a means to strengthen people’s autonomy as they learn more about their personal health risks, and receive dietary advice accordingly. We examine in what sense personalized nutrition strengthens or weakens individual autonomy. The impact of personalized nutrition on autonomy is analyzed in relation to responsibility and trustworthiness. On a societal level, individualization of health promotion may be accompanied by the attribution of extended individual responsibility for one’s health. This constitutes a dilemma of individualization, caused by a conflict between the right to individual freedom and societal interests. The extent to which personalized nutrition strengthens autonomy is consequently influenced by how responsibility for health is allocated to individuals. Ethically adequate allocation of responsibility should focus on prospective responsibility and be differentiated with regard to individual differences concerning the capacity of adults to take responsibility. The impact of personalized nutrition on autonomy also depends on its methodological design. Owing to the complexity of information received, personalized nutrition through genetic testing (PNTGT) is open to misinterpretation and may not facilitate informed choices and autonomy. As new technologies, personalized nutrition and PNTGT are subject to issues of trust. To strengthen autonomy, trust should be approached in terms of trustworthiness. Trustworthiness implies that an organization that develops or introduces personalized nutrition can show that it is competent to deal with both the technical and moral dimensions at stake and that its decisions are motivated by the interests and expectations of the truster.

Experiences of Swedish Military Medical Personnel in Combat Zones: Adapting to Competing Loyalties

OBJECTIVES The aim of this qualitative study is to explore the Swedish military personnels experience of what it means to perform a caring role in a combat zone. This study assesses the challenges faced by military medical personnel in the context of a combat zone. METHODS The design was descriptive with a qualitative inductive approach. Twenty military medical personnel (physicians, nurses, and combat lifesavers) were interviewed individually. They had been involved in international military operations between 2009 and 2012. This study was analyzed using qualitative content analysis. RESULTS The analysis produced four categories: being in a primarily noncaring organization, caring in emotionally charged relationships, lacking an open dialog about expectations of killing and having to prioritize scarce resources. CONCLUSIONS This study shows that medical personnel easily adapt to a military setting. They care but also perform other tasks when they are in a combat zone. The medical personnel want to give care to host nation but use drugs they can spare.

Assessing complexity in learning outcomes - a comparison between the SOLO taxonomy and the model of hierarchical complexity

An important aspect of higher education is to educate students who can manage complex relationships and solve complex problems. Teachers need to be able to evaluate course content with regard to complexity, as well as evaluate students’ ability to assimilate complex content and express it in the form of a learning outcome. One model for evaluating complexity is the Structure of Observed Learning Outcomes (SOLO) taxonomy. The aim of this analysis is to address the limitations of the SOLO taxonomy in detecting the more subtle differences of the learning outcomes and to clarify the concept of learning modes. This is done by analysing the SOLO taxonomy by means of the model of hierarchical complexity (MHC). The two models are compared by examining their respective theoretical background, the definitions and descriptions of the stages of each model, as well as through evaluating examples illustrating the SOLO levels using MHC. The two models can be viewed as compatible, with MHC also being able to put the SOLO taxonomy in an adult development context, thereby emphasising the importance of developing the students’ access to complex thinking.

Applying adult development theories to improvement science

Purpose The purpose of this paper is to address how adult development (AD) theories can contribute to quality improvement (QI). Design/methodology/approach A theoretical analysis and discussion on how personal development empirical findings can relate to QI and Demings four improvement knowledge domains. Findings AD research shows that professionals have qualitatively diverse ways of meaning-making and ways to approach possibilities in improvement efforts. Therefore, professionals with more complex meaning-making capacities are needed to create successful transformational changes and learning, with the recognition that system knowledge is a developmental capacity. Practical implications In QI and improvement science there is an assumption that professionals have the skills and competence needed for improvement efforts, but AD theories show that this is not always the case, which suggests a need for facilitating improvement initiatives, so that everyone can contribute based on their capacity. Originality/value This study illustrates that some competences in QI efforts are a developmental challenge to professionals, and should be considered in practice and research.

Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study

Abstract Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units. Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators. Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work. Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society. Key Points Staff at well-functioning primary care units (PCUs) experienced healthy work environments The included PCUs shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a healthy work environment, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.