Home health nurses’ views on participating in pre-ambulance emergency treatment : A qualitative descriptive study

As part of the Health Care Interaction project that was rolled out in western Sweden, home health nurses were called on as first responders to provide emergency treatment to patients, while waiting for the ambulance to arrive. The aim of this study was to evaluate how the home health nurses were prepared for the project before they were enrolled and what competencies they needed to develop to feel confident about their new role. In this qualitative descriptive study, eleven home health nurses from six municipalities that implemented the project were interviewed, and the data were analysed by content analysis. The COREQ guidelines were followed in the reporting of this study. The findings show that some municipalities did not have a training or preparation course in place, and guided the nurses to refer to self-education material. The nurses emphasised the importance of continuously updating their knowledge and skills through regular training. Further, feedback and reflection were considered important as reinforcement of learning. Keywords: registered nurse, emergency treatment, clinical competence, interview, descriptivepublishedVersionPaid Open Acces

Corroborating indicates nurses’ ethical values in a geriatric ward

The aim of the study was to identify nurses’ ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic

A comprehensive picture of ethical values in caring encounters, based on experiences of those involved : Analysis of concepts developed from empirical studies

Older people should have a life with a sense of value and should feel confident. These ethical values, which are expressed in normative ethics, are expected to prevail in empirical ethics. Central components of nursing are the ethical issues of autonomy, beneficence, non-maleficence and the principles of justice. The general aim of this thesis is to identify and describe the ethical values that are apparent in the caring encounter and their influence on the people involved. This is done from the perspective of the older person in study (I), next of kin in study (II) and nurses in study (III). In study (IV) the aim was to synthesize the concepts from empirical studies (I- III) and analyze, compare and interrelate them with normative ethics. Studies (I, III) were empirical observational studies including follow-up interviews. Twenty-two older people participated voluntarily in study (I), and in study (III) 20 nurses participated voluntarily. In study (II) fourteen next of kin were interviewed. In studies (I- III) constant comparative analysis, the core foundation of grounded theory, was used. Five concepts were used in the analysis in study (IV); three from the grounded theory studies (I- III) and two from the theoretical framework on normative ethics i.e. the ICN code and SFS law. Five categories; being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category ‚Approaching‛ in study (I). ‘Approaching’ indicates the ethical values that guide nurses in their caring encounters with older people. These ethical values are noted by the older people and are greatly appreciated by them, and also lead to improved quality of care. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category ‚Being amenable‛, a concept identified in the next of kin’s description of the ethical values that they and the older patients perceive in the caring encounter. In study (III), three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category ‚Corroborating‛. Corroborating deals with support and interaction. Empirical ethics and normative ethics are intertwined, according to the findings of this study (IV). Normative ethics influence the nurse’s practical performance and could have a greater influence in supporting nurses as professionals. Criteria of good ethical care according to this thesis are: showing respect, invitation to participation, allowing self-determination, and providing safe and secure care. These criteria are elements of the concept of being professional. Professionalism of nurses is shown by: the approach nurses adapt to the performance of their duties, and their competence and knowledge, but also how they apply laws and professional code

Ethical values in caring encounters from elderly patients’ and next of kin´s perspective

The welfare of the elderly population is one of the most important goals of the public health services. At macro level the Swedish National Board of Health and Welfare state that the premier goal is for elderly people to have dignified and comfortable lives. They should have a life with a sense of value and feel confident. These ethical values which are expressed on macro level or as normative ethics are expected to prevail at micro level. In our study the micro level is the caring encounter between the elderly patient, next of kin and nurses. Ethical values and morals are important aspects that influence the quality of care, videlicet in empiric ethics. The aim of study (I) was to identify and describe the ethical values experienced by the older person in the daily interaction with nurses in a ward for older people during caring encounters. In study (II) the aim was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Study (I) which was an empirical observational study included follow-up interviews. Twenty-two older people participated voluntarily. In study (II) interviews with fourteen next of kin were conducted. In both studies Constant comparative analysis, the core foundation of grounded theory was used. Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category in study (I): Approaching. Approaching concerns the way people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, which involves verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older people. This ethical value is noted by the older person and has an individual value, as well as leading to improved quality of their care. The older person will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and next of kin. Nurses who focus on elderly patients’ well-being as a final principle will affect next of kin and their experience of this fundamental situation

Empirical Ethical Values Promoting Good Caring Encounters with Older Patients and Relatives in a Geriatric Setting

Objective: This study describes empirical ethical values promoting good caring encounters with older patients 65, relatives, and care staff in a geriatric clinic.  Methods: Hermeneutic method was used in a secondary analysis, a re-analysis, of data already collected in three previous studies describing empirical ethical values. Data in the previous studies was collected in a geriatric clinic at a county hospital in a medium-sized city in Sweden. In study I were older patients (n = 22) with registered nurses and enrolled nurses observed during caring encounters (n = 57). Study II was an interview study with older patients´ relatives (n = 14). Study III observed encounters with registered nurses (n = 20) who cared for older patients. Result: Empirical ethical values promoting good caring encounters comprising a welcoming environment, moral actions in physical and social movements, showing respect, participation, security, and a worthy start, middle, and end of caring encounters. Conclusion: Bearing these empirical ethical values in mind should help care staff to focus on patient safety and their own ethical values, with the aim to promote good caring encounters with older patients and relatives. Respect establishes the basis for reciprocity, when people in caring encounters trust one another, security ensues and the fundamentals for patient safety fall into place.

Staffs’ experiences of the management of older adults with urinary incontinence

Background. Urinary incontinence is a complex public health problem for older adults both in Sweden and internationally. It is estimated that 50-80% of older adults in residential care facility have problems with urinary incontinence. Several studies illuminate staffs’ attitudes that incontinence is as a natural consequence of aging, which means that assessment and treatment are overlooked. There is also a lack of knowledge and compliance in relation to whether care staff is followed guidelines or not. Therefore, the aim of the present study was to describe staffs’ experiences of the management of older adults with urinary incontinence in residential care facility.  Methods. The design was explorative with an inductive approach with 17 individual interviews. Data were analyzed using qualitative content analysis. Results. The analysis led to following three categories: Staffs’ management; The organization’s impact; and Creating wellbeing factors for older adults with urinary incontinence. The staff had different views of what an investigation is and what measures are needed to be done. To achieve a good individual patient care there is need of a greater knowledge about good nursing, communication and dialogue between the various working groups.  Conclusions. Staffs’ management, the organization’s impact, and creating wellbeing factors are central to older adults’ influence and to experience quality of life. Implementing an evidence-based practice requires a long-term process-focused approach in order to improve the structure of daily work and to encourage staffs’ learning and competence development.Inkontinensprojek

Empirical Ethical Values Promoting Good Caring Encounters with Older Patients and Relatives in a Geriatric Setting

Objective: This study describes empirical ethical values promoting good caring encounters with older patients 65, relatives, and care staff in a geriatric clinic.  Methods: Hermeneutic method was used in a secondary analysis, a re-analysis, of data already collected in three previous studies describing empirical ethical values. Data in the previous studies was collected in a geriatric clinic at a county hospital in a medium-sized city in Sweden. In study I were older patients (n = 22) with registered nurses and enrolled nurses observed during caring encounters (n = 57). Study II was an interview study with older patients´ relatives (n = 14). Study III observed encounters with registered nurses (n = 20) who cared for older patients. Result: Empirical ethical values promoting good caring encounters comprising a welcoming environment, moral actions in physical and social movements, showing respect, participation, security, and a worthy start, middle, and end of caring encounters. Conclusion: Bearing these empirical ethical values in mind should help care staff to focus on patient safety and their own ethical values, with the aim to promote good caring encounters with older patients and relatives. Respect establishes the basis for reciprocity, when people in caring encounters trust one another, security ensues and the fundamentals for patient safety fall into place.