Driving forces for home-based reablement: a qualitative study of older adults’ experiences

Hva er drivkreftene i hverdagsrehabilitering slik de eldre opplever det.As a result of the ageing population worldwide, there has been a growing international interest in a new intervention termed ‘reablement’. Reablement is an early and time-limited home-based intervention with emphasis on intensive, goal-oriented and interdisciplinary rehabilitation for older adults in need of rehabilitation or at risk of functional decline. The aim of this qualitative study was to describe how older adults experienced participation in reablement. Eight older adults participated in semi-structured interviews. A qualitative content analysis was used as the analysis strategy. Four main themes emerged from the participants’ experiences of participating in reablement: ‘My willpower is needed’, ‘Being with my stuff and my people’, ‘The home-trainers are essential’, and ‘Training is physical exercises, not everyday activities’. The first three themes in particular reflected the participants’ driving forces in the reablement process. Driving forces are intrinsic motivation in interaction with extrinsic motivation. Intrinsic motivation was based on the person’s willpower and responsibility, and extrinsic motivation was expressed to be strengthened by being in one’s home environment with ‘own’ people, as well as by the co-operation with the reablement team. The reablement team encouraged and supported the older adults to regain confidence in performing everyday activities as well as participating in the society. Our findings have practical significance for politicians, healthcare providers and healthcare professionals by contributing to an understanding of how intrinsic and extrinsic motivation influence reablement. Some persons need apparently more extrinsic motivational support also after the timelimited reablement period is completed. The municipal health and care services need to consider individualised follow-up programmes after the intensive reablement period in order to maintain the achieved skills to perform everyday activities and participate in society

Hvilken betydning har forebyggende hjemmebesøk? - En kvalitativ studie av eldre menneskers erfaringer

Bakgrunn: Det finnes en omfattende forskningslitteratur knyttet til helseeffekter av forebyggende hjemmebesøk til eldre, men det etterlyses mer kvalitativ forskning for å forstå hvilken betydning tilbudet har for de eldres hverdag. Hensikt: Hensikten med studien var å utforske eldre menneskers erfaringer med forebyggende hjemmebesøk, spesielt rettet mot betydningen selve besøket hadde for dem. Metode: I studien anvendes kvalitativ metode med en fenomenologisk-hermeneutisk tilnærming. Det ble gjort 15 semistrukturerte intervju. Tolv informanter var gifte, tre var enker. Analysen av materialet var eksplorerende og deskriptiv, og det ble foretatt systematisk tekstkondensering. Resultat: Funnene i studien viste at forebyggende hjemmebesøk har vært en positiv erfaring for de deltakende eldre, selv om noen av dem i utgangspunktet ikke så behovet for besøket. Analysen resulterte i fire hovedtema: 1. Vage forventninger, 2. Å oppleve seg sett, 3. Nyttige råd og påminnelser, 4. Å oppleve økt trygghet etter å ha fått en kontaktperson i kommunen. Konklusjon: Studien viser at hensikten med forebyggende hjemmebesøk ikke ble oppfattet av de eldre eller var for utydelig i sitt budskap. Likevel ble besøkene erfart som anerkjennende og nyttige

Mature Care and Nursing in Psychiatry: Notions Regarding Reciprocity in Asymmetric Professional Relationships

The idea behind this article is to discuss the importance and to develop the concept of reciprocity in asymmetric professional relationships. As an empirical starting point for an examination of the possible forms of reciprocity between patients and nurses in psychiatry, we chose two qualitative in-depth interviews with two different patients. The manners in which these two patients relate to medical personnel—one is dependent, the other is independent—show that this presents challenges to nurses. The theoretical context is provided by the notion of mature care as it has been developed by feminist-oriented ethics of care, in contrast to the notion of altruistic care. In relation to the concept of mature care, we discuss how nursing can be perceived in demanding relationships with patients in psychiatry. Reciprocity implies that, in principle, the interests of the nurses also matter in a nurse-patient relationship. We show that reciprocity—in practice—is complicated and challenging in a number of different ways. Mature care—with its systematic inclusion of relationships and reciprocity—provides an alternative understanding of what takes place between patients and nurses compared with an altruistic notion of care. As such, mature care can be regarded as an useful paradigm for nurse-patient relationships in psychiatry

The relatives’ voice: how do relatives experience participation in reablement? A qualitative study

Kari Margrete Hjelle,1,2 Herdis Alvsvåg,3 Oddvar Førland,2,3 1Department of Occupational Therapy, Physiotherapy, and Radiography, Faculty of Health and Social Sciences, 2Centre for Care Research Western Norway, Bergen University College, 3Faculty of Health Sciences, VID Specialized University, Bergen, Norway Background: Reablement is an early and time-limited home-based model of rehabilitation intervention with an emphasis on intensive, goal-oriented, and multidisciplinary assistance for persons experiencing functional decline. When rehabilitation in general takes place in the person’s own home, in contrast to an institution, relatives may have larger responsibilities in helping and supporting the family member. Although there is evidence, showing that family caregivers, such as spouses and children, experience burdens and demanding situations related to their caregiving role, there are currently few publications exploring relatives’ experiences of participating in reablement. The aim of our study was to explore and describe how relatives in a community setting in Norway experienced participation in the reablement process. Methods: Six relatives participated in semi-structured interviews. Qualitative systematic text condensation was used as the analysis strategy. Results: Five themes emerged that summarized the relatives’ experiences with reablement: 1) a wish to give and receive information, wish to be involved; 2) wish to be a resource in reablement process; 3) conflicting expectations; 4) have more free time to themselves; and 5) a lack of follow-up programs. Conclusion: Our findings highlight the involvement and collaborative process between health professionals, older adults, and relatives and have practical significance for health care services. To advance collaborative practices, the municipal health and social care services should consider establishing a system or a routine to foster this collaboration in reablement. Follow-up programs should be included. Keywords: family caregivers, involvement, system of collaboration, follow-up programs, conflicting expectation

The reablement team’s voice: a qualitative study of how an integrated multidisciplinary team experiences participation in reablement

Kari Margrete Hjelle,1,2 Olbjørg Skutle,2,3 Oddvar Førland,2,4 Herdis Alvsvåg4 1Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway; 2Centre for Care Research Western Norway, Bergen University College, Bergen, Norway; 3Department of Health and Social Educators, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway; 4VID Specialized University, Bergen, Norway Background: Reablement is an early and time-limited home-based rehabilitation intervention that emphasizes intensive, goal-oriented, and multidisciplinary assistance for people experiencing functional decline. Few empirical studies to date have examined the experiences of the integrated multidisciplinary teams involved in reablement. Accordingly, the aim of this study was to explore and describe how an integrated multidisciplinary team in Norway experienced participation in reablement.Methods: An integrated multidisciplinary team consisting of health care professionals with a bachelor’s degree (including a physiotherapist, a social educator, occupational therapists, and nurses) and home-based care personnel without a bachelor’s degree (auxiliary nurses and nursing assistants) participated in focus group discussions. Qualitative content analysis was used to analyze the resulting data.Results: Three main themes emerged from the participants’ experiences with participating in reablement, including “the older adult’s goals are crucial”, “a different way of thinking and acting – a shift in work culture”, and “a better framework for cooperation and application of professional expertise and judgment”. The integrated multidisciplinary team and the older adults collaborated and worked in the same direction to achieve the person’s valued goals. The team supported the older adults in performing activities themselves rather than completing tasks for them. To facilitate cooperation and application of professional expertise and judgment, common meeting times and meeting places for communication and supervision were necessary.Conclusion: Structural factors that promote integrated multidisciplinary professional decisions include providing common meeting times and meeting places as well as sufficient time to apply professional knowledge when supervising and supporting older persons in everyday activities. These findings have implications for practice and suggest future directions for improving health care services. The shift in work culture from static to dynamic service is time consuming and requires politicians, community leaders, and health care systems to allocate the necessary time to support this approach to thinking and working. Keywords: multidisciplinarity, rehabilitation, goal-setting, framework conditions, work culture, reablemen

Forebyggende hjemmebesøk til eldre. Idehåndbok med anbefalinger. Utviklingssentrene for sykehjem og hjemmetjenester på Vestlandet og Senter for omsorgsforskning, vest.

Uvod: Zubni karijes je najčešće patološko stanje tvrdih zubnih tkiva. Prema incidenciji u svjetskoj populaciji pripada skupini najčešćih patoloških stanja suvremenog čovjeka općenito. Kontrola pojavnosti karijesa nije jednostavna, jer je karijes posljedica složene interakcije bioloških, socijalnih i kulturalnih čimbenika, te prehrambenih i higijenskih navika pojedinca. Osnovni postupci u dijagnostici karijesa su vizualno-taktilni klinički pregled i radiološka dijagnostika. Svrha rada je prikazati prevalenciju karijesa kod studenata Stomatološkog fakulteta u Zagrebu određivanjem KEP i KEPp (DMFS) indeksa, te utvrditi postoji li razlika u nalazu prevalencije karijesa između vizualno-taktilne i radiološke dijagnostike karijesa. Također, svrha rada je bila ispitati navike u održavanju oralne higijene. Ispitanici i metode: U istraživanju je sudjelovalo 59 studenata Stomatološkog fakulteta u Zagrebu; 9 sa četvrte i 50 sa pete godine studija dentalne medicine. Klinički pregledi zubi obavljeni su na stomatološkom stolcu uporabom stomatološkog svjetla, zubnog ogledala i sonde. Radiološka dijagnostika karijesa učinjena je analizom intraoralnih zagriznih rendgenskih slika premolara i molara pohranjenih u računalo. Rezultati: Prosječna vrijednost KEPp indeksa svih ispitanika iznosi 7,06 (s.d.=5,43); ženski ispitanici 7,24 (s.d.=5,43), muški ispitanici 6,1 (s.d.=5,34). Radiološkom analizom otkriveno je 197 (3,02±3,31) aproksimalnih karijesa od kojih je samo 15 uočeno kliničkim pregledom. 54,2% ispitanika dva puta dnevno pere zube, 16,9% tri puta, a 6,8% više od tri puta. 84,2% ispitanika koristi zubni konac kao dodatno sredstvo za održavanje oralne higijene. Zaključak: Visoki KEPp indeks nakon kliničkoga pregleda i radiološke analize upućuje na potrebu edukacije i preventivnih mjera od najranije životne dobi. Veliki broj karijesa otkrivenih bitewing radiološkom analizom govori u prilog nedostatnosti kliničkog pregleda u dijagnostici karijesa.Introduction: Dental caries is the most common pathological condition of hard tooth tissue. According to the incidence in the world population, it belongs to the group of most common pathological conditions of modern man in general. Controlling caries is not easy, because caries is the result of a complex interaction between biological, social and cultural factors, and nutritional and hygienic habits of an individual. Basic procedures in caries diagnosis are visual-tactical clinical examination and radiological diagnosis. The purpose of this paper is to show the caries prevalence among students at the School of Dental Medicine in Zagreb by determining DMFS and DMFT index and to determine whether there is any difference in the findings of the caries prevalence obtained by visual-tactile examination and x-ray imaging (bitewing). Also, the purpose of the work was to examine habits in maintaining oral hygiene. Respondents and Methods: The study included 59 students of both sexes, and 9 of them were 4th and 50 of them 5th year of school of dental medicine. Clinical examinations were performed at the dental chair using dental light using dental light, dental mirror and probe.. After the clinical examination, two bitewing radiological images were recorded in the premolar and molar region. Radiological diagnosis of caries was performed by analyzing intraoral bitewing x-ray images of premolars and molars stored in the computer. Results: The average DMFS index is 7.06 (s.d. = 5.43); female respondents 7.24 (s.d. = 5.43), male respondents 6.1 (s.d. = 5.34). Radiological analysis revealed 197 (3.02 ± 3.31) approximate caries, of which only 15 were observed by clinical examination. 54.2% of the respondents brushed teeth twice a daily, 16.9% three times, and 6.8% more than three times. 84.2% of respondents use dental floss as an additional oral hygiene agent. Conclusion: The high DMFS index after clinical examination and radiological analysis indicates the need for education and preventive measures from earliest ages. A large number of caries discovered by bitewing radiological analysis suggests that just a clinical view is insufficient to show caries prevalence