'Overjoyed that I can go outside': Using walking interviews to learn about the lived experience and meaning of neighbourhood for people living with dementia

This study explores the relationships between people living with dementia and their neighbourhood as they venture out from home on a regular and often routine basis. Here, we report findings from the Swedish field site of an international 5-year project: Neighbourhoods: our people, our places. The aims of this study were to investigate the lived experience of the neighbourhood for people with dementia and through this to better understand the meaning that neighbourhood held for the participants. In this study, we focus on the walking interviews which were conducted with 14 community-dwelling people with dementia (11 men and 3 women) and were analysed using an interpretative phenomenological method. Four themes were revealed from these interviews: life narratives embedded within neighbourhood; the support of selfhood and wellbeing through movement; the neighbourhood as an immediate social context; and restorative connections to nature. These themes were distilled into the ‘essence’ of what neighbourhood meant for the people we interviewed: A walkable area of subjective significance and social opportunity in which to move freely and feel rejuvenated. We have found that the neighbourhood for community-dwelling people with dementia holds a sense of attachment and offers the potential for freedom of movement. Our research indicates that a dementia diagnosis doesn’t necessarily reduce this freedom of movement. The implications for practice and policy are considered: future research should explore and pay closer attention to the diverse living conditions of people living with dementia, and not least the particular challenges faced by people living alone with dementia

Experiences and contributions of people living with dementia to the social life of everyday places

This chapter focusses on work programme 4 of the Neighbourhoods study entitled ‘Neighbourhoods: Our People, Our Places’ (N:OPOP). We used a creative mix of qualitative methods, including network mapping, mobile interviews, and home tours with people living with dementia and their care partners in England, Scotland, and Sweden. We focused explicitly on the subjective meaning of neighbourhoods for people living with dementia with a view to understand how people could be better supported to live in community settings. Neighbourhoods matter to people with dementia because of the type of support they can offer, and this chapter presents insights into how and why this might be the case. Neighbourhoods can enable people living with dementia to develop and sustain connections, maintain a sense of belonging, and contribute to the diversity and inclusivity of local places. Neighbourhoods are not simply fixed locations within which activities happen but are an amalgamation of connections to people and other places over time, understood and experienced in the context of other locations and times. Drawing on our published work (Ward et al., 2021 a, b, c) , this chapter considers how people living with dementia are not passive observers of neighbourhood life but, instead, engage in the social rhythms of neighbourhoods and, with support, actively shape them as neighbourhoods of choice, though with such choices are often restrained by contexts and circumstances. The chapter is presented as follows. First, we provide a brief overview of some of allied research that has explored the importance of neighbourhoods spaces as sites for social interaction for people living with dementia.. Next, it outlines the ways in which we gathered and analysed our data. It then presents three interconnected ‘snapshots’ of our findings exploring: i) neighbourhoods as assemblages of connections; ii) neighbourhoods as real and symbolic sites of support; and iii) understanding neighbourhoods and change in the context of living with dementia. The chapter then outlines how our findings might influence thinking about: neighbourhoods as relational places; how neighbourhoods might contribute to social health; and how people living with dementia can, with support, engage in neighbourhoods of choice. Collectively, these themes point to the relevance of understanding the ‘lived neighbourhood’ for people living with dementia

Taking time: the temporal politics of dementia, care and support in the neighbourhood

Dementia is a global health challenge and currently the focus of a coordinated international response articulated through the notion of ‘dementia-friendly communities and initiatives’ (DFCIs). Yet, while increasing research attention has been paid to the social and spatial dimensions to life with dementia in a neighbourhood setting, the temporalities of dementia have been largely overlooked. This article sets out different aspects of the lived experience of time for people with dementia and unpaid carers, before exploring the temporal politics of formal dementia care and support. The authors show that time is a site for material struggle and a marker of unequal relations of power. People with dementia and unpaid carers are disempowered through access to formal care, and this is illustrated in their loss of (temporal) autonomy and limited options for changing the conditions of the care received. The authors advocate for a time-space configured understanding of the relationship with neighbourhood and foreground a tempo-material understanding of dementia. Set against the backdrop of austerity policy in the UK, the findings reveal that ongoing budgetary restrictions have diminished the capacity for social care to mediate in questions of social justice and inequality, at times even compounding inequity

Neighbourhood nursing : connection, place and meaning in the everyday experience of dementia

Background: Recent policy is marked by a shift towards enabling people with dementia to remain at home and in their neighbourhoods, yet little is known about the wider perspective of neighbourhood as an everyday place of connection, practice and meaning in the lives of people with experience of dementia.   Aims: The aim of this thesis is twofold. The first aim is to explore the neighbourhood as an everyday place for people with experiences of dementia. The second aim is to explore neighbourhood as a place for practice.   Methods and Designs: Five studies are included in the thesis with both quantitative and qualitative designs. Study I had a cross-sectional exploratory and descriptive design. A total cohort of 17, 405 people with a dementia diagnosis were identified and matched with data about home care services and housing, and were then associated with socio-demographic factors in three county councils: Östergötland, Stockholm and Västerbotten. Study II had a phenomenological design; 14 community-dwelling people diagnosed with dementia in the County of Östergötland participated using walking interviews. Study III had an inductive and exploratory qualitative design including 14 community-dwelling people living alone with dementia in England, Scotland and Sweden involving multiple data collection methods. Study IV had an inductive and explorative qualitative design that included 22 people with the lived, personal and professional experiences of dementia and used semi-structured individual and group interviews. Study V had an inductive and explorative qualitative design where the perspectives of 18 participants (registered and specialist nurses) were included using shadowing as the main method for data collection.   Findings: In study I, 72% of the cohort was living in ordinary housing and 28% in special housing of the total of 17, 405 people with a dementia diagnosis. Overall, 52% of 17, 405 people with dementia in three county councils (Östergötland, Stockholm and Västerbotten) were living alone. Study II revealed that walking in the neighbourhood was an integral part of their day-to-day activities that helped them to manage life with dementia. Connection to nature by being outdoors was a restorative practice for people living with dementia. Neighbourhood was often described as a social context, although some participants living alone revealed that their social contacts were mainly staff working in municipal home care. In study III, participants across all three field sites channelled their efforts to stay connected to the neighbourhood into creating new ways of maintaining social networks and relationships. By participating in several activities (provided in the United Kingdom by the third-sector and charitable groups, and in Sweden, by the municipalities), bonds of friendship were created. However, the impact of stigma surrounding dementia was highlighted by the participants, which caused experiences of involuntary solitude or loneliness. Despite the impact of stigma, participants took control over their lives by searching for new daily social connections in the neighbourhood and were by no means passive in the face of the challenges in everyday life. In study IV, the participants discussed how dementia was stigmatized in the community. People  living with dementia were often not being respected as active citizens with their own resources in the community. Being socially active in a group or in public spaces were strategies to maintain a social role in the community. Participants with different experiences of dementia wanted the day care centres and teams to be more centrally involved in person-centred care and health-promoting improvements. Finally, in study V, participants struggled with the commonly held view of their role and their workplace within the health care system, interpreting it as being invisible, as if placed in a black box. The tasks and responsibilities of the participants were shifting to assistant nurses, neighbours and family members according to the socio-economic level of the municipality. Nonetheless, the participants were clearly part of the neighbourhood. The findings of this thesis have been integrated into a combined thematic analysis based on the five studies to reach an overall representation of people’s experiences of neighbourhood as an everyday place and a place for practice in the context of dementia. Five main themes (and three sub-themes) emerged from the analysis: (1) walkable attachment to the lived neighbourhood; (2) daily activities promote health and well-being; (3) opportunities for social connections; (4) just treat us as active citizens; (5) neighbourhood: a place for practice. The analysis suggested the neighbourhood was not only described as a walkable, social and citizenship arena in the context of dementia; it was also a place where practice was ongoing around the clock (studies II, III, IV and V) because most of the people with dementia are living in ordinary housing (study I).   Conclusion: The thesis presents a new foundation and knowledge to understand neighbourhood as a place for everyday life and practice by applying a new lens for understanding. The neighbourhood can be understood as a place linked by connections that people actively searched out, and where the meaning of place emerges via movement of the body through the world. It is also a site where practices support everyday life for people with dementia, especially for those living alone with dementia. This points to the need to re-think nursing practice, where “neighbourhood nursing” as a formal model with a lifeworld perspective has to be established in dialogue with citizens.Bakgrund: Den senaste samhällsutvecklingen och de politiska ambitionerna har utgått alltmer från att göra det möjligt för personer med demenssjukdom att bo kvar allt längre i sina hem och grannskap. Trots denna utveckling finns det lite kunskap utifrån det bredare perspektivet om grannskapet som en vardaglig plats för relationer, omvårdnad samt vilken mening det har för personer som har erfarenhet av demens. Syfte: Syftet med avhandlingen var för det första att undersöka grannskapet som en plats i vardagen för personer som har erfarenheter av demens, och för det andra, att undersöka grannskapet som en plats för omvårdnad. Design och metod: Avhandlingen inkluderar fem delstudier med både kvalitativ och kvantitativ design. Studie I hade en explorativ och beskrivande tvärsnittsdesign. Totalt ingick det 17 405 personer med en demensdiagnos som identifierades och samkördes med information av hemtjänstinsatser och boende. Denna informationen förenades sedan med de socio-demografiska faktorerna i de tre regionerna Östergötland, Stockholm och Västerbotten. Studie II hade en femenologisk design som inkluderade 14 personer som bodde i ett eget boende med en demensdiagnos i Östergötlands län och som deltog i ´promenad intervjuer´. Studie III hade en induktiv och beskrivande kvalitativ design vilket inkluderade 14 personer som bodde ensamma i ett eget boende med en demensdiagnos i England, Skottland och Sverige. De 14 personer som bodde i ett eget boende med en demensdiagnos i Studie III deltog i flera datainsamlingsmetoder. Studie IV hade en induktiv och beskrivande kvalitativ design som inkluderade 22 personer med levda, personliga och professionella erfarenheter av demens som deltog i semistrukturerade individuella och gruppintervjuer. Slutligen, Studie V hade också en induktiv och beskrivande kvalitativ design där 18 deltagare (legitimerade sjuksköterskor och specialistsjuksköterskor) inkluderades skuggning som är den huvudsakliga metoden för datainsamlingen. Resultat: I Studie I fann vi att 72 % av den totala befolkningen av 17 405 personer med en demensdiagnos bodde i ordinärt boende och 28 % i särskilt boende. Sammantaget bodde 52 % av de 17 405 personerna med demens i singelhushåll i de tre regionerna Östergötland, Stockholm och Västerbotten. Studie II påvisade att promenader i grannskapet var en betydelsefull del av deras dagliga aktiviteter som hjälpte personer med en demensdiagnos att hantera ett liv med demens. Att vara utomhus i naturen medförde att personer med demens knöt an till naturen och genom det återhämtade sig. Grannskapet beskrivs ofta som ett socialt sammanhang, även om vissa deltagare som bodde ensamma berättade att deras sociala kontakter främst var med personalen som arbetade i den kommunala hemsjukvården (och hemtjänsten). I studie III beskrev personer med demens i England, Skottland och Sverige hur de ansträngde sig för att hålla kvar kontakten med grannskapet men också hur de skapade nya sätt att upprätthålla och hitta nya sociala nätverk och kontakter. Dessa vänskapsband skapades genom att delta i olika aktiviteter (som tillhandahålls i England av tredje sektorn och välgörenhetsgrupper, och i Sverige, av kommunerna). Även effekterna av stigmatiseringen kring att leva med demens betonades av deltagarna, de beskrev detta som en orsak till ofrivillig ensamhet. Trots påverkan av stigmatiseringen tog personerna med demens, kontroll över sina liv, genom att finna nya dagliga sociala kontakter i grannskapet. Personer med demens är intressearde av att anta nya utmaningarna i vardagen. I studie IV diskuterade personerna med olika erfarenheter av demens hur demenssjukdomen som ett stigmatiserat tillstånd i samhället påverkade dem. De ansåg att deltagarna som lever med en demensdiagnos ofta inte respekterades som aktiva medborgare med sina egna resurser i samhället. Personerna med olika erfarenhet av demens framhöll också att vara socialt aktiv i en grupp eller i offentliga rum var strategier för att upprätthålla en social roll i samhället. Förutom betydelsen av det sociala livet påpekade personerna med olika erfarenheter av demens att de skulle önska att dagverksamheterna och demensteamen skulle utgå mer utifrån person-centrerad vård och hälsofrämjande förhållningssätt. Slutligen, i studie V observerades det hur legitimerade sjuksköterskor och specialistsjuksköterskor kämpade med den vanligt förekommande synen på deras profession och arbetsplatsen inom hälso-och sjukvården som gav sig uttryck som osynlig. Deras uppgifter och ansvar hade även förändrats och allt mer hade överlåtits till undersköterskor, grannar och familjemedlemmar och kommunernas socioekonomiska status hade betydelse. Legitimerade sjuksköterskor och specialistsjuksköterskorna var en självklar del av grannskapet. Resultaten av denna avhandling har integrerats i en sammansatt tematisk analys baserad på de fem studierna för att nå en övergripande representation av människors upplevelser av grannskapet som en plats för det dagliga livet och omvårdnad med utgångspunkt utifrån erfarenheter av demens. Analysen resulterade i fem huvudteman (och tre underteman): (1) anknytning till det existerade grannskapet via promenader (2) dagliga aktiviteter främjar hälsa och välbefinnande; (3) möjligheter för sociala kontakter; (4) behandla oss som aktiva medborgare; (5) grannskapet som en plats för omvårdnad. Grannskapet beskrivs inte bara som en framkomlig, social medborgarskapsarena i relation till demens, utan var även en plats där sjuksköterskepraxis pågick dygnet runt (studierna II, III, IV och V) eftersom de flesta personer som lever med demens bor i ordinärt boende (studie I). Konklusion: Avhandlingen presenterar ett nytt underlag och ny kunskap för att förstå grannskapet som en plats för dagligt liv och omvårdnad genom att använda ett nytt perspektiv för att få förståelse. Grannskapet kan förstås som en plats förenad genom förbindelser som människor aktivt söker efter och där betydelsen av grannskapet inträder genom kroppens rörelse ut mot världen. Det är också en plats där omvårdnad sker som i sin tur stödjer vardagslivet för personer med demens, särskilt för dem som lever ensamma med demens. Detta visar på behovet av att tänka om i praktiken vad det gäller omvårdnaden, där ”omvårdnad i grannskapet” som en modell med ett livsvärldsperspektiv behövs i dialog med medborgarna.Pozadina: Nedavni trend demencije ogleda se u ovome da osobe koje žive sa demencijom ostanu u kući ili u susjedstvu, ali još uvijek nije poznato mnogo u široj perspektivi koju nude ta susjedstva kao svakodnevno mjesto povezivanja, medicinske njege, te samog značaja u životu onih koji žive sa demencijom. Ciljevi: Cilj je istražiti susjedstvo kao svakodnevno mjesto boravka za ljude koji žive od demencije, te kao drugo istražiti susjedstva kao mjesta gdje bi se pružala medicinska njega. Metode i dizajni: Ukupno pet studija uključeno je u rad sa kvantitativnim i kvalitativnim dizajnom. Studija I imala je istraživački i opisni dizajn. Populacija od 17. 405 ljudi sa dijagnozom demencije bila je identifikovana, te usklađena sa podacima o kućnoj njezi i mjestu prebivališta, a zatim povezana sa tri općine: Östergötland, Štokholm i Vasterboten. Studija II imala je fenomenološki dizajn gdje je 14 osoba koje žive sa demencijom u porodičnoj kuci učestovalo u Östergötlandu u intervju pri šetnji. Studija III imala je induktivni i istraživački kvalitativni dizajn koji je uključivao 14 ljudi iz porodičnog domaćinstva koji žive sami sa demencijom u Engleskoj, Škotskoj i Švedskoj, uključujući više metoda prikupljanja podataka. Studija IV imala je induktivni i istraživački kvalitativni dizajn koji je obuhvatio 22 osobe koje žive, ili imaju lično i profesionalno iskustvo sa demencijom, gdje su se koristili pojedinačni i grupni intervju. Studija V imala je induktivni i istraživački kvalitativni dizajn gdje je uljućeno ukupno 18 medicinskih sestara, a kao glavna metoda za prikupljanje podataka korištena je metoda praćenja i posmatranja. Završni rezultati: U studiji I, 72% od 17. 405 ljudi koji su imali demenciju živjeli su porodičnim kućama a 28% u starački domovima. Ukupno 52% od 17. 405 ljudi koji žive sa demencijom u tri općine su Östergötland, Štokholm i Vasterboten žive sami. Studija II otkrila je kako svakodnevna šetanja je sastavni dio njihovih aktivnosti koje su im pomogle u životu sa demencijom. Može se reći da je boravak na otvorenom, te povezivanje sa prirodom je vrlo praktično za ljude koji žive sa demencijom. Susjedstvo je često opisano kao socijalni kontekst, iako su neki učesnici u istraživanju koji žive sami otkrili kako je njihov jedini društveni kontakt bio sa uposlenicima kućne njege. U studiji III učesnici ispitivanja u Engleskoj, Škotskoj i Švedskoj su sve svoje napore da ostanu povezani sa susjedstvom kako bi stvorili nove načine koji bi pomogli stvaranje novih veza i odnosa. Učestvovanjem u nekoliko aktivnosti (koje su u Velikoj Britaniji omogućile dobrotvorne i slobodne organizacije, a u Švedskoj općine) stvorene su veze i prijateljstva. Međutim, utjecaj predrasuda povezanih s demencijom, što su i naglašavali sudionici, vodilo je kao iskustvu samoće i usamljenosti. Uprkos utjecaju predrasuda, učesnici su preuzeli kontrolunad svojim životima, te su tražili nove svakodnevne društvene veze u susjedstvu, ne pokazujući tako pasivnost prema svakodnevnim izazovima s kojima se susreću. U studiji IV učesnici su razgovarali o predrasudama o demenciji u zajednici. Ljudi koji žive sa demencijom često nisu uvaženi kao aktivni članovi koji mogu doprinijeti zajednici. Kako bi održali svoje uloge u zajednici vrlo je bitno da ostanu društveno aktivni. Učesnici sa različitim iskustvom demencije izrazili su želju da se centri za svakodnevnu njegu i timovi više baziraju kao unapređenju njege i zdravlja, kao i da se akcenat stavi na osobu za demencijom. Na kraju, u studiji V medicinske sestre su se borile sa općeprihvaćenim stavom o njima i njihovoj ulozi, te njihovom radnom mjestu u sistemu zdravstvene zaštite, opisujući to kao nevidljivo. Zadaci i odgovornosti medicinskih sestara prebacivali su se na pomoćne sestre, komšije i članove porodica prema društveno-ekonomskom nivou opštine. Unatoč tome, medicinske sestre su očito bile dio susjedstva. Iskustva, odnosno pronalasci u ovoj tezi integrisani su u kombinovanu analizu prema pet tematski obrađenih studija, kako bi se dostigao sveobuhvatan prikaz iskustava u susjedstvu kao svakodnevnom mjestu, te mjestu zdravstvene podrške u kontekstu demencije. Iz ove analize pojavilo se pet glavnih tema (kao i tri podteme): (1) povezanost sa susjedstvom; (2) svakodnevne aktivnosti promovišu zdravlje i dobrobit; (3) mogućnosti za socijalne veze; (4) tretiranje kao aktivne građane; (5) susjedstvo je mjesto za medicinske prakse neprekidno traju. Analize pokazuju kako se susjedstvo ne opisuje samo kao prohodno, socijalno i građansko polje u kontekstu demencije, već kao i mjesto gdje medicinske prakse neprekidno traju (studije II, III, IV i V), jer većina ljudi s demencijom žive u običnom domaćinstvu (studija I). Zaključak: Teza predstavlja nove temelje i znanja, kako bi se lakše razumio pojam susjedstva kao svakodnevnog mjesta za život, kao i njege kroz nove objektive razumijevanja. Susjedstvo bi se moglo shvatiti kao mjesto spojeno vezama koje ljudi aktivno potražuju gdje se značenje mjesta spaja sa kretanjem tijela kroz svijet. To je također mjesto gdje je svakodnevno obezbjeđena njega za ljude koji žive sa demencijom, posebno za one koji žive sami. Ovo ukazuje na potrebu da se preispita medicinska praksa, gdje se ‘’njega u susjedstvima’’ kao formalni model sa životnom perspektivom treba uspostaviti u dijalogu sa građanima.Ytterligare forskningsfinansiärer: Swedish Riksbankens Jubileumsfond, Economic and Social Research Council (ESRC), National Institute for HealthResearch (NIHR), Norrköping Municipality Research and Development Fund (Norrköpings fond för forskning och utveckling), County Council of Östergötland, Linköping University from its strategic research fund for Health Care and Welfare.</p

”It´s like walking in a bubble”, nursing students´ perspectives on age suit simulation in a home environment – group interviews from reflection seminars

Abstract Background Older persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults. Methods A qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis. Results The analysis generated three main themes; “It’s like walking in a bubble”, “An eye opener” and “Concerns about ageing and the current structure of geriatric care”. The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability. Conclusions Age suit simulation was described as an embodied and eye-opening experience, raising nursing students´ awareness of older persons´ functional limitations and the consequences for dignity and independence. Coping with cognitive loss was especially difficult. Students were motivated to apply their new knowledge to clinical practice. Age suit simulation can complement geriatric education, preparing students for the complex care needs of older persons

'Overjoyed that I can go outside' : Using walking interviews to learn about the lived experience and meaning of neighbourhood for people living with dementia.

This study explores the relationships between people living with dementia and their neighbourhood as they venture out from home on a regular and often routine basis. Here, we report findings from the Swedish field site of an international 5-year project: Neighbourhoods: our people, our places. The aims of this study were to investigate the lived experience of the neighbourhood for people with dementia and through this to better understand the meaning that neighbourhood held for the participants. In this study, we focus on the walking interviews which were conducted with 14 community-dwelling people with dementia (11 men and 3 women) and were analysed using an interpretative phenomenological method. Four themes were revealed from these interviews: life narratives embedded within neighbourhood; the support of selfhood and wellbeing through movement; the neighbourhood as an immediate social context; and restorative connections to nature. These themes were distilled into the 'essence' of what neighbourhood meant for the people we interviewed: A walkable area of subjective significance and social opportunity in which to move freely and feel rejuvenated. We have found that the neighbourhood for community-dwelling people with dementia holds a sense of attachment and offers the potential for freedom of movement. Our research indicates that a dementia diagnosis doesn't necessarily reduce this freedom of movement. The implications for practice and policy are considered: future research should explore and pay closer attention to the diverse living conditions of people living with dementia, and not least the particular challenges faced by people living alone with dementia

Health promotion initiative : A dementia-friendly local community in Sweden

Dementia is a great public health concern worldwide. Despite this, little is known from a health-promoting perspective about dementia in general as a public health issue, in dialog with people living with dementia, applicable at individual, group, and societal levels with regard to policies and practice. This study therefore aims to explore the experiences related to living with dementia in the local community by advancing a health-promoting perspective. Semi-structured individual and group interviews were conducted with participants (n = 22) with lived, professional, and personal experiences of dementia living in a medium-sized municipality in Sweden. Transcripts were analyzed by thematic analysis. Four themes emerged: health promotion through knowledge and public awareness, health promotion through opportunities to be active, health promotion through meaningful meeting places, and health promotion through improvements in the welfare system. We found that more knowledge and public awareness about dementia are needed to advance a health-promoting perspective and increase the prominence of dementia as a public health issue. Further research and policy need to focus more on how professionals in dementia care practice could be involved in promoting health and well-being for people with dementia.Funding agency: Norrköping Municipality Research and Development Fund(Norrköpings fond för forskning och utveckling) (NK KS 2016/0407)</p

Controlling the Uncontrollable : Patient Safety and Medication Management From the Perspective of Registered Nurses in Municipal Home Health Care

Most adverse events in health care are related to medication management and they are almost always preventable. Increased knowledge of patient safety related to medication management in home health care is an urgent issue to provide safe care for all patients regardless of where the health care takes place. This study explored patient safety within medication management in municipal home health care. Vignettes were used as stimulus during qualitative interviews with registered nurses. Three main themes with related subthemes were identified as challenges to patient safety within medication management in home health care: (1) challenges to information transfer, (2) challenges related to delegation, and (3) challenges of advanced medical treatments in the home. The issue of transfer of information permeated our findings. Coordinating medications, delegating tasks, along with more advanced care require clear communication between care providers to be compatible with patient safety within medication management in home health care.Funding Agencies|County Council of Ostergotland; Linkoping University; strategic research fund for Health Care and Welfare [2016186-14]; AFA Insurance [1702266]</p

‘I can see what's going on without being nosey…’: What matters to people living with dementia about home as revealed through visual home tours

Objectives: This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities. Methods: Forty-six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis. Results: Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia. Discussion: The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home

Discussing racism in healthcare : A qualitative study of reflections by graduate nursing students

Aim: The aim is to illustrate and analyse reflections from graduate nursing studentsover their experience of discussing racism in healthcare in an educational intervention.Design: A qualitative, descriptive design was adopted.Methods: Data were collected through written reflections and analysed through con-tent analysis. In total, 81 students participated in the intervention; 39 paediatric and42 public health care nursing students. Of those, 27 participants gave consent to havetheir written reflections included in the study.Results: Three main categories were developed in the content analysis of studentreflections: (a) the implicit embeddedness of racism in healthcare organization; (b) theeffect of racism on interactions with patients; and (c) a growing awareness of one'sown understanding of racism. This study indicates that student nurses discussed rac-ism as relevant to understanding good clinical practice for the benefit of patients andwork-based wellbeing of staff. This recognition of the organizational nature of racismwarrants nursing leaders and managers to include racism as a social determinant ofhealth in the undergraduate and graduate curricula to educate the next generation ofnursing about racism