Effects of the Intervention “Reflective STRENGTH-Giving Dialogues” for Older Adults Living with Long-Term Pain: A Pilot Study

Background. Long-term musculoskeletal pain is a major, often undertreated, disabling health problem among an increasing number of older adults. Reflective STRENGTH-giving dialogues (STRENGTH) may be a tool to support older adults living with long-term pain. The main aim of this pilot study was to investigate the immediate and longitudinal effect of the intervention STRENGTH on levels of pain, wellbeing, occurrence of depression symptoms, and sense of coherence (SOC) among community-dwelling older adults suffering from musculoskeletal pain compared to a control group. Methods. The study was semiexperimental with an intervention group and a control group. The effect of a single STRENGTH intervention was reported on the Numeric Rating Scale (NRS) regarding pain and wellbeing. To evaluate the longitudinal effect of STRENGTH, using the Brief Pain Inventory-Short Form (BPI-SF), the Geriatric Depression Scale-20 (GDS-20), SOC-13 at baseline (T1), and six months after the intervention/no intervention (T2), a total of 30 older adults, aged 72 to 97 years (Mdn 86 years), were included consecutively and fulfilled the intervention series (n = 18) or untreated controls (n = 12). Results. The intervention with STRENGTH decreases pain (NRS 6 Mdn versus NRS 4 Mdn, p \u3c 0.001) and increases wellbeing (NRS 7 Mdn versus NRS 8 Mdn, p \u3c 0.001). After a six-month study period with STRENGTH, no longitudinal effect difference was found compared to baseline. Compared to the control group, there was an increasing trend between decreased pain level and increased SOC level for STRENGTH intervention. Conclusions. This pilot study supports STRENGTH’s effect as a pain-alleviating model that provides a decrease in pain levels and an increase of wellbeing in older adults with long-term pain. STRENGTH dialogues could be a useful intervention to provide individually holistic care in older adults living with long-term pain

Older Adults Experiences of Reflective STRENGTH-Giving Dialogues: An Interview Study

Background: A major health problem that frequently accompanies old age is long-term pain, but pain must be acknowledged by older adults and health care providers. Interventions are needed to alleviate pain and suffering while holistically providing health care that promotes wellbeing. The intervention project, Reflective STRENGTHGiving Dialogues© (STRENGTH) was implemented to increase health and wellbeing among community dwelling older adults living with long-term musculoskeletal pain at home. Aim: The aim of this study was to describe the older adults\u27 experiences of the intervention Reflective STRENGTH-Giving Dialogue. Method: A life world hermeneutic approach was used in collection and analysis of data. Twenty community dwelling older adults participated were interviewed in their homes after the intervention. Findings: The findings consisted of five themes and showed that the older adults experienced the Reflective STRENGTH-Giving Dialogues as a continuous and trusting relationship that alleviates the pain and breaks the loneliness. They expressed it as a new way to talk about life with pain. The dialogues supported reflection and memory and resulted in a transition in orientation in life. Conclusion: The Reflective STRENGTH-Giving Dialogues helped the older adults to increase their intellectual, emotional, and physical engagement in daily living. The dialogues facilitated a transition in orientation from past to present, to the future, and from obstacles to opportunities. The dialogues were oriented towards enjoyments, meaning, courage and strength in life as a whole which promoted the older adults’ sense of well-being and vitality. The dialogues also facilitated carrying out small and large life projects. The Reflective STRENGTH-Giving Dialogues created a deepened caring relationship that contributed to an increased sense of security, strength and courage, all of which enhanced the potential for better health and wellbeing

“It is like living in a diminishing world”: older persons’ experiences of living with long-term health problems – prior to the STRENGTH intervention

Introduction: Ageing is often associated with multiple long-term health problems influencing older persons’ well-being in daily living. It is not unusual that the point of interest in research is often on the management of the actual health problem instead of being holistic and person-centred. Purpose: To describe the phenomenon of living with long-term health problems that influence daily living, from the older persons’ perspective. Methods: Qualitative individual interviews were conducted with 34 older persons living with long-term health problems. The data were analysed using a Reflected Lifeworld Research (RLR) approach, grounded in phenomenology. Results: Life with long-term health problems entails living in a diminishing world. It entails living in uncertainty, not being able to trust one’s own ability. The freedom to make decisions of your own is deprived by relatives and health-care providers. Living with long-term health problems entails being dependent on support in daily life and a strive to maintain meaningfulness in daily living. Conclusions: The results address a need for extended individual and holistic guidance and support in living with long-term health problems to increase the older person’s sense of well-being and meaning in life

Manoeuvring between anxiety and control: Patients' experience of learning to live with diabetes: A lifeworld phenomenological study

Abstract Research shows that people with diabetes want their lives to proceed as normally as possible, but some patients experience difficulty in reaching their desired goals with treatment. The learning process is a complex phenomenon interwoven into every facet of life. Patients and healthcare providers often have different perspectives in care which gives different expectations on what the patients need to learn and cope with. The aim of this study, therefore, is to describe the experience of learning to live with diabetes. Interviews were conducted with 12 patients afflicted with type 1 or type 2 diabetes. The interviews were then analysed with reference to the reflective lifeworld research approach. The analysis shows that when the afflicted realize that their bodies undergo changes and that blood sugar levels are not always balanced as earlier in life, they can adjust to their new conditions early. The afflicted must take responsibility for balancing their blood sugar levels and incorporating the illness into their lives. Achieving such goals necessitates knowledge. The search for knowledge and sensitivity to changes are constant requirements for people with diabetes. Learning is driven by the tension caused by the need for and dependence on safe blood sugar control, the fear of losing such control, and the fear of future complications. The most important responsibilities for these patients are aspiring to understand their bodies as lived bodies, ensuring safety and security, and acquiring the knowledge essential to making conscious choices

Older persons’ experiences of Reflective STRENGTH‐Giving Dialogues – ‘It\u27s a push to move forward’

Rationale: Experiences of the innovative method Reflective STRENGTH‐Giving Dialogue (STRENGTH), which is grounded in a lifeworld perspective and developed to improve quality of care, is described in this study. Innovative thinking in developing health and social care, which may include digital solutions, is required to ensure a meaningful and dignified life in old age. Aim: The aim of this study was to describe experiences of the intervention Reflective STRENGTH‐Giving Dialogue from the perspective of older persons living with long‐term health problems. Method: Individual qualitative interviews were conducted with 27 older persons who participated in the intervention. The older persons wrote notes from each dialogue in booklets, and the booklets became part of the study data, analysed with a Reflective Lifeworld Research approach. Results: STRENGTH is experienced as an opportunity to reflect upon life and identify small and large life projects. Dialogues that lead to change in thoughts and actions influence the older persons\u27 well‐being, sense of balance, joy and meaning in life. There is an experience of STRENGTH as a starting point and a push to move forward in an effort to experience joy and meaning in life when living with long‐term health problems. Conclusions: STRENGTH has the potential to contribute to quality improvement in person‐centred care and enhance meaning in life for older persons living with long‐term health problems. However, the use of a digital tool in this particular context poses challenges that must be considered

Ungdomars framtidstro och föräldrarnas arbetssituation

Arbetslöshet och/eller långtidssjukskrivning hos föräldrar är en vanlig situation för många tonåringar. Påverkar det deras framtidstro? En deskriptiv studie av ca 6 500 tonåringar i Uppsala Län genomfördes i syfte att se huruvida deras framtidstro samvarierade med föräldrarnas arbetssituation. Kontrollfrågor gällande depression, dialog med föräldrar, välmående samt nöjdhet med livet analyserades likaså. Sambandet mellan föräldrars arbetssituation och tonåringens framtidssyn var inte signifikant. Resultatet för föräldrars arbetssituation i förhållande till depression var dock signifikant. Sambanden mellan framtidstro och dialog med föräldrar, välmående respektive nöjdhet med livet var starkt signifikanta. Resultaten är i linje med tidigare forskning. Det betonas att ytterligare forskning behövs gällande tonåringars uppväxt i familjer där arbetslöshet och långtidssjukrivning finns

Taking charge of one's life : Challenges for learning in long-term illness

A starting point for this thesis is that patients’ learning has not received sufficient attention and thus has not featured in the study programmes in the field of caring. Focus has instead been placed on patients being given information and advice about their illness and treatment, advice that they are then expected to comply with. Too little attention has been paid to the individual who lives with his/her illness and who should be considered to have significant experiences. The overall aim has been to analyze and describe the phenomenon of learning to live with long-term illness as well as to develop a didactic model that can help carers to support patients’ learning processes. The theoretical perspective in the thesis is lifeworld theory, which permeates ontological, epistemological and methodological standpoints and also the view on learning. The design and carrying out of the research is based on a reflective lifeworld approach. The empirical study consists of interviews with people who live with different types of long-term illnesses. The learning that follows life with a long-term illness is generated in such a way as to respond to the will to live the well-known everyday life. A greater understanding of the empirical results has been achieved by a lifeworld philosophical elucidation, with a particular focus on learning turning points and the importance of reflection. Based on the empirical results, the lifeworld philosophical elucidation and the caring science lifeworld didactics a didactic model has been formulated. This model is entitled: The challenge – to take charge of one’s life with long-term illness. The model contains four theses: 1) Confronting one’s life situation and challenging to make a change, 2) Positioning oneself at a distance when creating a new whole, 3) Developing self-consciousness and taking responsibility, 4) Making learning visible with the aim of providing development and balance in life. The results in the thesis show that a genuine learning is something that differs from the learning of information and that the learning must be supported at an existential level based on the sufferer’s situation and for a long period of time

Att ta rodret i sitt liv : Lärande utmaningar vid långvarig sjukdom

A starting point for this thesis is that patients’ learning has not received sufficient attention and thus has not featured in the study programmes in the field of caring. Focus has instead been placed on patients being given information and advice about their illness and treatment, advice that they are then expected to comply with. Too little attention has been paid to the individual who lives with his/her illness and who should be considered to have significant experiences. The overall aim has been to analyze and describe the phenomenon of learning to live with long-term illness as well as to develop a didactic model that can help carers to support patients’ learning processes. The theoretical perspective in the thesis is lifeworld theory, which permeates ontological, epistemological and methodological standpoints and also the view on learning. The design and carrying out of the research is based on a reflective lifeworld approach. The empirical study consists of interviews with people who live with different types of long-term illnesses. The learning that follows life with a long-term illness is generated in such a way as to respond to the will to live the well-known everyday life. A greater understanding of the empirical results has been achieved by a lifeworld philosophical elucidation, with a particular focus on learning turning points and the importance of reflection. Based on the empirical results, the lifeworld philosophical elucidation and the caring science lifeworld didactics a didactic model has been formulated. This model is entitled: The challenge – to take charge of one’s life with long-term illness. The model contains four theses: 1) Confronting one’s life situation and challenging to make a change, 2) Positioning oneself at a distance when creating a new whole, 3) Developing self-consciousness and taking responsibility, 4) Making learning visible with the aim of providing development and balance in life. The results in the thesis show that a genuine learning is something that differs from the learning of information and that the learning must be supported at an existential level based on the sufferer’s situation and for a long period of time

Reflekterande handledning – en plattform för studenters och lärares gemensamma lärande

Reflective supervision in higher education means that students, continuously and systematically (according to a given model), together with teachers who supervise them, process experiences from work-based education and the university-based part of education. In two early studies of nursing students’ and teachers’ experiences of critical reflection as part of the reflective supervision, we have identified signs of existence of shared learning community. The purpose of the present study is to investigate teachers’ and students’ expressions of shared learning community, in light of the teaching form reflective supervision. The data consist of interviews from the two previous studies. The result of the analysis shows how students and supervising teachers express common experiences from the reflective supervision. The result shows a shared learning community as structured processing of vocational knowledge, challenging perspective meeting and exchange of perspectives, openness to each other's experiences and learning processes and interaction between the common and the individual. The study shows how the model reflective supervision contributes to a creative common environment for learning for both students and teachers in higher education