”Med mobilen i lomma” Pårørendes erfaringer når en av deres nære dør i sykehjem

I dag og i årene fremover har helsevesenet store omsorgsutfordringer knyttet til økningen av antall eldre i befolkningen. En stor andel eldre avslutter livet i sykehjem, og de fleste har pårørende hos seg i tiden rundt dødsfallet. Hensikten med studien var å øke forståelsen for hvordan det erfares å være pårørende ved livets slutt i sykehjem, og å få kunnskap om hvordan helsepersonell kan bistå familien i prosessen. Data ble samlet ved hjelp av semistrukturerte, individuelle intervju av seks pårørende som nylig erfarte å miste en av sine nære i sykehjem. De pårørende ble rekruttert fra to forskjellige sykehjem. Resultatet viser at pårørende opplever at døden i sykehjem kan være uforutsigbar og fremmed. Svingninger i sykdomsforløp og usikkerhet i forhold til tidsaspektet i forventet levetid, førte til at pårørende alltid måtte være tilgjenglig. Når møte med døden for mange er fremmed, beskriver pårørende behovet for trygghet i en ukjent situasjon

"Med mobilen i lomma" : pårørendes erfaringer når en av deres nære dør

I dag og i årene fremover har helsevesenet store omsorgsutfordringer knyttet til økningen av antall eldre i befolkningen. En stor andel eldre avslutter livet i sykehjem, og de fleste har pårørende hos seg i tiden rundt dødsfallet. Hensikten med studien var å øke forståelsen for hvordan det erfares å være pårørende ved livets slutt i sykehjem, og å få kunnskap om hvordan helsepersonell kan bistå familien i prosessen. Data ble samlet ved hjelp av semistrukturerte, individuelle intervju av seks pårørende som nylig erfarte å miste en av sine nære i sykehjem. De pårørende ble rekruttert fra to forskjellige sykehjem. Resultatet viser at pårørende opplever at døden i sykehjem kan være uforutsigbar og fremmed. Svingninger i sykdomsforløp og usikkerhet i forhold til tidsaspektet i forventet levetid, førte til at pårørende alltid måtte være tilgjengelig. Når møte med døden for mange er fremmed, beskriver pårørende behovet for trygghet i en ukjent situasjon.publishedVersio

Tverrprofesjonelt samarbeid i primærhelsetjenesten - En styrke for pasienten sin pleie og behandling

Sammendrag I dag og i årene fremover vil helsevesenet stå overfor store utfordringer, med en voksende andel eldre i befolkning hvor mange har komplekse helseutfordringer. Mange bor i eget hjem med sammensatte problemstillinger og et stort tjenestebehov. Hensikten med studien var å få kunnskap om i helsepersonells erfaringer med tverrprofesjonelt samarbeid i primærhelsetjeneste, og hvilken betydning dette har for å nå et helhetlig pasientforløp. Data ble samlet ved tre fokusgruppeintervjuer av i alt 13 helsepersonell i tre kommuner i Midt-Norge. Resultatet viser at tverrprofesjonelt samarbeid fordrer tid til samarbeid og avhenger av respekt og tillit mellom de forskjellige faggruppene.. Åpen og tydelig kommunikasjon er avgjørende for å kunne opprettholde et velfungerende tverrprofesjonelt samarbeid. Tverrprofesjonell samarbeidslæring, er en viktig kompetanse som må læres allerede gjennom helse- og sosialutdannelsene. Komplekse behov hos pasienten fordrer tjenester fra flere profesjoner, og tverrprofesjonelt samarbeid er viktig for å ivareta et helhetlig pasientforløp

Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals’ experiences

Abstract Background Dementia has become a major public health issue worldwide due to its rapidly increasing prevalence and an increasing number of dementia-related deaths in long-term care facilities. The aim of this study was to examine health professionals’ experiences of potential barriers and facilitators in providing palliative care for people with severe dementia in long-term care facilities. Methods This was a qualitative descriptive study. The data were collected from four focus groups and 20 individual in-depth interviews with healthcare professionals from four Norwegian nursing homes. The data were analysed by thematic text analysis, as described by Braun and Clarke. Results The major findings indicate that healthcare professionals experience a lack of continuity as the main barrier to facilitating palliative care. Time pressure and increased efficiency requirements especially affect the weakest and bedridden residents with dementia. The healthcare professionals feel conflicted between wanting to spend more time caring for each individual resident and feeling pressure to help everyone. Although resources are scarce, dying residents are always given priority by healthcare professionals, either by the hiring of extra personnel or the reorganization of tasks in a way that facilitates someone staying with the terminal resident. Advanced care planning was highlighted as a facilitator in providing palliative care, but the extensive use of temporary staff among nurses and doctors and the relocation between the sheltered and long-term wards threaten the continuity in planning and providing palliative care. Conclusions The findings indicate that healthcare professionals experienced several structural barriers that prevented the provision of palliative care to people with severe dementia in long-term care facilities. Increasing demands for economic rationality lead to a lack of continuity of care. Organizational changes, such as measures to increase the competence and the proportion of permanent employees and the prevention of burdensome end-of-life transitions, should be implemented to improve continuity and quality of care

Moral distress - a threat to dementia care? A qualitative study of nursing staff members’ experiences in long-term care facilities

Background Dementia is a public health priority worldwide due to its rapidly increasing prevalence and poses challenges with regard to providing proper care, including end-of-life care. This study is part of a research project about nursing staff members’ experiences with providing palliative care for people with severe dementia in long-term care facilities. In an earlier study, we found that structural barriers that complicated the provision of palliative care led to moral distress among nursing staff. In this study, we performed a secondary analysis of the same data set to gain a deeper understanding of nursing staff members experiences of moral distress while providing palliative care for residents with severe dementia in long-term care facilities. Methods A qualitative, descriptive design was used. Data were collected during in-depth interviews with 20 nursing staff members from four Norwegian long-term care facilities. Content previously identified as moral distress was reanalysed by thematic text analysis, as described by Braun and Clarke, to gain a deeper understanding of the phenomenon. Results The nursing staff members’ experiences of moral distress were generally of two types: those in which nursing staff members felt pressured to provide futile end-of-life treatment and those in which they felt that they had been prevented from providing necessary care and treatment. Conclusion The findings indicate that nursing staff members’ experiences of moral distress were related to institutional constraints such as time limitations and challenging prioritizations, but they were more often related to value conflicts. Nursing staff members experienced moral distress when they felt obligated to provide care and treatment to residents with severe dementia that conflicted with their own values and knowledge about good palliative care. Both education interventions focused on improving nursing staff members’ skills regarding communication, ethical judgement and coping strategies; in addition, supportive and responsive leadership may have significant value with regard to reducing moral distress. Our findings indicate a need for further research on interventions that can support nursing staff members dealing with ethical conflicts in providing palliative care to residents with dementia.publishedVersio

Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals' experiences

Background Dementia has become a major public health issue worldwide due to its rapidly increasing prevalence and an increasing number of dementia-related deaths in long-term care facilities. The aim of this study was to examine health professionals’ experiences of potential barriers and facilitators in providing palliative care for people with severe dementia in long-term care facilities. Methods This was a qualitative descriptive study. The data were collected from four focus groups and 20 individual in-depth interviews with healthcare professionals from four Norwegian nursing homes. The data were analysed by thematic text analysis, as described by Braun and Clarke. Results The major findings indicate that healthcare professionals experience a lack of continuity as the main barrier to facilitating palliative care. Time pressure and increased efficiency requirements especially affect the weakest and bedridden residents with dementia. The healthcare professionals feel conflicted between wanting to spend more time caring for each individual resident and feeling pressure to help everyone. Although resources are scarce, dying residents are always given priority by healthcare professionals, either by the hiring of extra personnel or the reorganization of tasks in a way that facilitates someone staying with the terminal resident. Advanced care planning was highlighted as a facilitator in providing palliative care, but the extensive use of temporary staff among nurses and doctors and the relocation between the sheltered and long-term wards threaten the continuity in planning and providing palliative care. Conclusions The findings indicate that healthcare professionals experienced several structural barriers that prevented the provision of palliative care to people with severe dementia in long-term care facilities. Increasing demands for economic rationality lead to a lack of continuity of care. Organizational changes, such as measures to increase the competence and the proportion of permanent employees and the prevention of burdensome end-of-life transitions, should be implemented to improve continuity and quality of care