Being in want of control: Experiences of being on the road to, and making, a suicide attempt

Attempted suicide is a risk factor for future suicidal behaviour, but understanding suicidality from the perspective of people who have experienced attempted suicide is limited. The aim of the study was to explore the lived experience of being suicidal and having made a suicide attempt, in order to identify possible implications for health care professionals. Semi-structured individual interviews were held with 10 persons shortly after they attempted suicide and were analysed through qualitative content analysis. The participants’ experience of being suicidal and of having attempted suicide could be described as “Being on the road towards suicidal action”, which culminated in an experience of either chaos or turned off emotions, “Making sense of the suicide attempt”, and “Opening the door to possible life lines”. An overall theme, “Being in want of control”, captured their all-embracing lack of sense of control and was seen in relation to different aspects of oneself, overall life-situation, the immediate suicide attempt situation and in the outlook on the future. Being in want of control may be a relevant and general feature of being suicidal. People who have attempted suicide need more adequate help to break vicious circles before they reach a point of no return and enter an acute suicidal state of mind. Patients’ experience-based knowledge is highly important to listen to and use clinically as well as theoretically when constructing suicide prevention programs

Existential Issues in Palliative Care

The main purpose of this dissertation is to describe how terminally ill patients experienced their situation, and what their views about the future were. Further, the experiences and attitudes of relatives of such patients, and of health care professionals, were also central. Focus was on existential issues, such as autonomy, meaning, guilt, relations, dignity, and communication. In the first paper, a case based on actual facts was described and analysed. The study showed that in every situation where a decision has to be made, there is often more than one alternative interpretation of the situation and how to act. The studies in the other papers comprised 18 patients in palliative care (diagnosed with advanced cancer and ALS) and 8 close relatives of ALS patients. Moreover, 7 caregivers, formal and informal, were interviewed in a focus group. Data were collected from in-depth interviews with patients and relatives and from focus group interviews with caregivers. The results showed that patients experienced a number of problems concerning existential issues and consider these questions important. The patients diagnosed with cancer wished to be able to discuss existential issues with someone. The ALS patients experienced problems particularly in connection with physical inability. Close relatives of ALS patients need more information about the disease and the process of the disease and have to be supported and viewed as individuals with their own preferences. One practical question is: Who's responsibility is it to try to meet existential needs in palliative care? The results of the focus group study indicate that, depending on the circumstances, several different solutions can be sufficiently satisfactory, and possible ways of handling the problems are suggested

Obesity in Somali migration women due to post migration dietary changes and decreasing self-esteem : a qualitative interview study on diet, knowledge ab out risk of heart disease, inactivity, body image and self-esteem

The last-decade incidence of myocardial infarction (MI) has diminished dramatically in most age groups but not in middle-aged women in Sweden. There has been a large influx of immigrants and it has been shown that immigrant wom en have a higher BMI and are less physically active than Swedish women. Thereby they have a higher risk for heart disease. The aim of the study was to examine post-migration diet ary changes, and knowledge about risks for heart diseases among Somali women. Furthermore, to examine the women’s perceptions of body image, self-esteem, and their knowledge about the positive effect of physical activity. The qualitative research method was used and eight Soma li women aged 40 years or more, who have lived in Sweden longer than ten years, were in terviewed with the help of a semi- structured questionnaire. The study revealed that S omali migrated women in Sweden had changed their diet and experienced weight increase. They reported low self-esteem and little motivation for physical activity. They understood t hat they had a higher risk for heart disease as compared to Swedish women and they had, in gener al, a preference for big body size. The women of this study are, in combination with other risk factors, at a high risk of myocardial infarction. They all revealed a general knowledge a bout the relationship between obesity and inactivity and enhanced risks for heart disease. Th ey had a preference for a larger female body image. They expressed low self-esteem, loneliness, and alienation from society. It is important to address the health issue among migrant Somali wo men in Sweden, but since this study had few informants, larger studies and more science is needed to further investigate the problem

Exploring Existential Loneliness Among Frail Older People as a Basis for an Intervention : Protocol for the Development Phase of the LONE Study

BACKGROUND: International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. OBJECTIVE: This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. METHODS: The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. RESULTS: The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. CONCLUSIONS: The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/13607

Attitudes to and Experiences of Physical Activity among Migrant Women from Former Yugoslavia : a qualitative interview study about physical activity and its beneficial effect on heart health, in Malmo, Sweden.

Background: Many risk factors for heart disease can be reduced by lifestyle modifications such as physical activity, but the attitude to and the knowledge about the beneficial effect of physical activity vary among the population. Migrant women are reported to have a higher BMI and to be less physically active than the Swedish-born women. In order to motivate them to participate in physical activity it is necessary to understand that they are not a homogenous group, and thus their knowledge about, needs for, and attitude to physical activity have to be examined. Aim: The aim of the study was to explore structural and individual factors working either as barriers against or as motivation for a change towards higher levels of physical activity and a healthy lifestyle. Furthermore, the aim was to investigate if the migration had changed the women's level of physical activity and what would be required to increase it. Method: Seven women from Bosnia living in Malmo, Sweden, were interviewed by means of a semi-structured interview guide. The data was analyzed using Burnard's content analysis method. Results: The findings were presented in two categories, namely, "barriers against physical activity" and "motivational factors for physical activity". With regard to the category "barriers against physical activity", the move to Sweden had led to losses and shifts in lifestyles for the women. The greatest lifestyle changes were reported among women who had moved from rural areas in Bosnia to urban areas in Sweden. They found it troublesome to reach the same activity level in Sweden and expressed a greater need to do so. Earlier negative experiences or no experiences at all, of performing physical activity, as well as the winter climate, were seen as obstacles to being active. All the women prioritized family, work, school, and club activities above physical activity. With respect to the category "motivational factors for physical activity", it was found that physical activity could help improve their mental balance, and the women also considered the possibility of losing weight. Conclusion: The study showed that although these migrant women had difficulties finding appropriate and realistic physical activities, and prioritized family activities, they desired to be more physically active, even if the climate was seen as a hindrance. They also reported that physical activity could be a means to achieve better mental health as well as weight loss. Politicians ought to allocate funding, and public health worker to focus more on and enable this high risk group of immigrant women to become more physical active. They should also be informed about their increased risk of myocardial infarction. This, to stimulate increased physical activity among them and in ought to be in co-working with their own immigrant organization

Attitudes to and Experiences of Physical Activity among Migrant Women from Former Yugoslavia : a qualitative interview study about physical activity and its beneficial effect on heart health, in Malmo, Sweden.

Background: Many risk factors for heart disease can be reduced by lifestyle modifications such as physical activity, but the attitude to and the knowledge about the beneficial effect of physical activity vary among the population. Migrant women are reported to have a higher BMI and to be less physically active than the Swedish-born women. In order to motivate them to participate in physical activity it is necessary to understand that they are not a homogenous group, and thus their knowledge about, needs for, and attitude to physical activity have to be examined. Aim: The aim of the study was to explore structural and individual factors working either as barriers against or as motivation for a change towards higher levels of physical activity and a healthy lifestyle. Furthermore, the aim was to investigate if the migration had changed the women's level of physical activity and what would be required to increase it. Method: Seven women from Bosnia living in Malmo, Sweden, were interviewed by means of a semi-structured interview guide. The data was analyzed using Burnard's content analysis method. Results: The findings were presented in two categories, namely, "barriers against physical activity" and "motivational factors for physical activity". With regard to the category "barriers against physical activity", the move to Sweden had led to losses and shifts in lifestyles for the women. The greatest lifestyle changes were reported among women who had moved from rural areas in Bosnia to urban areas in Sweden. They found it troublesome to reach the same activity level in Sweden and expressed a greater need to do so. Earlier negative experiences or no experiences at all, of performing physical activity, as well as the winter climate, were seen as obstacles to being active. All the women prioritized family, work, school, and club activities above physical activity. With respect to the category "motivational factors for physical activity", it was found that physical activity could help improve their mental balance, and the women also considered the possibility of losing weight. Conclusion: The study showed that although these migrant women had difficulties finding appropriate and realistic physical activities, and prioritized family activities, they desired to be more physically active, even if the climate was seen as a hindrance. They also reported that physical activity could be a means to achieve better mental health as well as weight loss. Politicians ought to allocate funding, and public health worker to focus more on and enable this high risk group of immigrant women to become more physical active. They should also be informed about their increased risk of myocardial infarction. This, to stimulate increased physical activity among them and in ought to be in co-working with their own immigrant organization

From cure to palliation: Staff communication, documentation, and transfer of patient

In the transition from curative treatment to palliative care of a general end-of-life patient population, the internal communication of the acute care staff seems to be less than optimal. The communication had reference to the dialogue within the staff both before and after the decision to concentrate on palliative care, and possible transfer of the patient. This survey of Swedish nurses and physicians showed that most of 780 respondents wanted more internal communication, and a more individualized procedure of decision-making. All staff should be informed about the decision made but full agreement was not seen as realistic. The largest difference of opinion between nurses and physicians concerned the involvement of nurses in the decision-making about the transition. A uniform documentation of the decision to transfer care focus was the ideal. Approximately every fourth patient in acute care is transferred to receive palliative care. Only approximately half of the respondents had any training in palliative care and the majority wanted more training. There seems to be a need for more palliative care training, perhaps somewhat different for each speciality. Furthermore, a common language to enable nurses and physicians to communicate more easily may improve the transition process

Ethical considerations of refusing nutrition after stroke

The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we deal with the different kinds of refusal of nutritional treatment? We argue that patients' autonomy should be respected as far as possible, while also considering that those who have suffered a stroke might re-evaluate their life as a result of a beneficial prognosis. However, if patients persist with their refusal, health care professionals should force nutritional treatment only when it is clear that the patients will re-evaluate their future life