Carrying on life at home or moving to a nursing home: frail older people’s experiences of at-homeness

Aims and objectives The aim was to explore frail older people’s lived experiences of managing life at home on the verge of moving to a nursing home. Background As people age, their reserve capacity decreases, increasingthe risk of morbidity and frailty.. The experience of frailty extends beyond declining health and physical well-being and encompasses various dimensions, including familiarity with both the place and the people around. Design A phenomenological study. Methods We interviewed ten frail people aged 72–90 years in-depth in their homes. We used phenomenological hermeneutical analysis inspired by van Manen and followed the COREQ checklist. Results We identified three main themes: (1) being home with cherished people and possessions, (2) giving the nursing home a go and (3) attuning to the natural rhythms. Conclusions Our study gives insight into the lived experiences with frailty related to at-homeness. The experience of being lost in transition represents a uniquely significant experience for frail older people, foregrounding existential issues and carrying the potential of at-homeness.publishedVersio

In the borderland of the body: How home-dwelling older people experience frailty

Rationale The increasing number of frail home-dwelling older people has sharpened the focus on discovering and implementing suitable treatment and care in clinical practice, aiming to prevent loss of physical functioning and preserve their autonomy and well-being. People's embodied experiences may yield rich descriptions to help to understand frailty. Thoroughly understanding older people's individual perceptions is especially relevant because the numbers of home-dwelling older people are increasing, and people tend to develop more health problems and become frailer as they age. Their perspectives are important to develop knowledge and high-quality care. Aim To explore the lived experiences of frail home-dwelling older people. Methods We conducted a phenomenological study to obtain in-depth descriptions of the phenomenon. We interviewed 10 home-dwelling older adults (seven women and three men, 72–90 years old) in depth about their lived experience of frailty. We analysed the data using a hermeneutic phenomenological approach described by van Manen. Findings The lived experience of frailty is described in one essential theme: frailty as being in the borderland of the body, including three interrelated subthemes: (1) the body shuts down; (2) living on the edge; and (3) not giving up. Conclusions Our study gives insight into lived experiences with frailty among home-dwelling older people related to their own body. Older people's experience of meaningful activities strengthened their feeling of being themselves, despite their frail and deteriorating body. Healthcare providers must consider the strategies of frail older people to consider both their vulnerabilities and self-perceived strengths. The resources and deficits of frail older people present in the state of being frail need to be recognised.publishedVersio

Besøk på sykehjem. En kvantitativ studie av sykehjemsbeboeres besøkshyppighet

Social contact is essential for the well-being of the nursing home residents.Visiting frequency in nursing homes is rarely investigated. The purpose of this study was to map the number of visits for nursing home residents. Nursing students collected data during their nursing home practice. 355 residents were included in this cross-sectional study. We explored the association between visit frequency and age, gender, type of department, activities of daily living (ADL) and length of stay. Data was analyzed using statistical analysis. The average number of visits was 8,8 per month. However, there were differences in visit frequency among the 15 institutions. Residents in the long-term department received fewer visits compared to the dementia and short-term department. Significant correlations between ADL function, gender, length of stay, age and frequency of visits were not found. More research to identify causes for the differences in visit frequency between different institutions is needed.Keywords: nursing homes; visiting; visit frequency; sykehjem; besøk; besøkshyppighe

Tacit practice in care homes

Background: Care home practice has been described as complex, even though it might comprise common everyday activities. Research has indicated that nursing staff consider assisting care home residents to be demanding work, much of which remains tacit or is taken for granted. The tacit knowledge that lies behind nurses’ work is an important issue to explore and describe. Aims: To describe tacit care practices and understand the complexity of nursing practice in care homes. Methods: An ethnographic study was used to gain an in-depth understanding of nursing practice in care homes in a Nordic context. Findings: Nursing staff appeared to be committed to daily work routines but also reported having to deal with a number of unexpected events each day, some of which were particularly challenging. Dealing with some residents’ behaviours could evoke difficult emotions among staff, such as irritation and aversion – emotions that could be difficult to admit to. Despite this, staff seemed to believe they had to manage their responses and offer good care to all residents. Synthesising these findings led to the theme of ‘tacit care home practice’. Examples of such tacit practice are described in this article. Discussion: Staff develop a common habitus of caring, including dealing with unexpected events and behaviours that are sometimes regarded as unpleasant. This habitus is often taken for granted and therefore needs to be explicated and discussed. Conclusions and implications for practice: The statement ‘we just do it’ suitably describes nursing staff’s habitus of caring, which includes dealing with unexpected events and unpleasant behaviours Describing these tacit aspects of care can extend our understanding of some previously unarticulated aspects of care home practice These findings suggest a need for greater awareness, better communication and reflection in relation to these tacit elements of practice. This could contribute to improved nursing practice in care home

”Vi berre gjer det”. Beskrivingar av skjult pleiepraksis i sjukeheim

Nursing home practice is often described as complex, even though it might be regarded as consisting of common, everyday activities. Research indicates that nursing staff consider assisting nursing home patients to be difficult and demanding work. At the same time, new regulations are issued for improving quality in nursing homes. Further, nursing staff acts according to a practical sense, and when asked to describe the rules under which they act, they are unable to do so. Research is required to understand the patterns of care that are unspoken and taken for granted. The aim of this project was to uncover, explore and describe some characteristics of the implicit aspects of care practice in nursing homes. An ethnographic design was selected for this study in order to allow an in-depth understanding of nursing practice in nursing homes. Data were collected in two nursing homes and were comprised of observations of the staff providing care in two nursing homes, document analyses and interviews. The findings show that the nursing staff always seemed to know what to do, and that they knew the residents well. Findings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their established nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines in their daily work. In addition, the staff had to deal daily with several unexpected events, and always seemed to know what to do. Further unexpected events are described and explored. A seemingly ordinary but unexpected event develops in to a chaotic situation. This was unusual, but with further investigation and in the light of theory, the study illustrates the complexity of nursing home practice. The findings also showed that close contact with some residents’ behaviours could evoke difficult emotions in the staff, such as irritation and aversion. However, it was difficult for the staff to admit to these feelings. In spite of this, nursing staff seemed to believe that they simply had to manage their responses and offer good care to all residents. The nursing staff had developed a habitus of caring, and their own statement “we just do it” is a suitable description of how these implicit parts are just being done. Theoretical frameworks contributed to making sense of the data and gaining a new understanding of these unarticulated issues in nursing home practice. Bourdieu’s concept of habitus was useful when trying to understand how the staff seemed automatically to know what to do. Habitus regulates actions without being a product of rules; it makes a group of people act as though “collectively orchestrated without the action of a conductor”. Further, Douglas’ concept of “dirt as a matter out of place” was used in trying to gain an understanding of the nursing staff’s reactions to pollution. According to Douglas, dirt is systematically classified and involves the rejection of inappropriate elements. The aim of this project was to uncover, explore and describe some characteristics of the implicit aspects of care practice in nursing homes. The nursing staff’s own statement, “we just do it”, is a suitable description of how these implicit parts, existing of both knowledge and experience, are just being done. The nursing staff performs the care automatically, and at the same time they deal with dirt and unpleasant tasks, because they are committed to the residents. In the thesis, this is called habitus of caring. The nursing staff has developed a habitus of caring which consists of; knowing the residents, commitment to routines, unexpected events, dirt, as well as unpleasant behaviours that evoke difficult emotions. By exploring and describing the practice, in light of the concept of habitus from Bourdieu and “dirt as a matter out of place” from Douglas, the analyses have contributed to extend our understanding of some unarticulated aspects of nursing home practice

Praksisveiledere var sensorer på test i grunn­leggende sykepleie

Denne studien kartla hvilke erfaringer sykepleiere i praksis fikk da de var med som sensor på en praktisk test av studentene på skolen. Studien kartla også hvilken betydning disse erfaringene hadde på innholdet i og kvaliteten på veiledningen av studenter i praksis

Fastlegers erfaringer med frisklivssentral som tiltak for livsstilsendring – en kvalitativ studie

Fysisk inaktivitet er en veldokumentert risikofaktor for en rekke kroniske sykdommer. Likevel er to av tre voksne og eldre i Norge fysisk inaktive. Fastleger og kommunal helsetjeneste skal fremme helse og forebygge sykdom blant risikogrupper og veilede om fysisk aktivitet for pasienter med behov for det. Om lag 60 % av norske kommuner har etablert frisklivssentraler som en del av helsetilbudet for å gi strukturert hjelp til fysisk aktivitet for risikogrupper. Denne kvalitative studien har undersøkt ti fastlegers erfaringer med frisklivssentral som tiltak for livsstilsendring. Analysen var inspirert av systematisk tekstkondensering. Funnene viser at flere informanter hadde positive erfaringer med henvisning til frisklivssentral. Disse informantene beskrev frisklivssentralen som et tilbud med god kompetanse og et supplement til veiledning de ikke hadde tid til. Andre informanter var skeptiske til tilbudet grunnet manglende dokumentert helseeffekt og at frisklivssentralen kun passet for mennesker som kunne trene på dagtid. Det var delte meninger om tilbudet passet best for umotiverte eller motiverte pasienter. Studien bidrar med ny kunnskap om fastlegers erfaringer med frisklivssentral. Funnene kan bidra til bevisstgjøring rundt egen praksis både hos leger og frisklivssentraler samt inspirere til utvikling av samarbeidet