Enjoying Work or Burdened by it? How Personal Assistants Experience and Handle Stress at Work.

A personal assistant has to promote equality in living conditions for persons with severe disabilities. The aim of this study was to explore how personal assistants experience their work and what strategies they employ to alleviate work-related stress. Thirty personal assistants were interviewed and latent content analysis was performed. The findings regarding the experiences of work-related stress could be brought together under the theme of "difficulties of being in a subordinate position," and those regarding management strategies could be brought together under the theme of "coming to terms with the work situation." There is a need to empower personal assistants through training programs including tailored education, working communities, and coaching

Актуальные условия развития инновационной деятельности промышленных предприятий Республики Беларусь

Background: Motivational interviewing is a collaborative conversational style intended to strengthen motivation to change. It has been shown to be effective in addressing many different lifestyle problems as well as in chronic disease management, and many disease prevention guidelines promote use of motivational interviewing. The aim of the present study was twofold: to assess to what extent the primary care nurses in the study perform motivational interviewing according to the Motivational Interviewing Treatment Integrity Code and to investigate how the participating primary care nurses rated their own performance in motivational interviewing. Method: The study was based on twelve primary care nurses' audio-recorded motivational interviewing sessions with patients (total 32 sessions). After each session, the nurses completed a questionnaire regarding their experience of their own performance in motivational interviewing. The audio-recorded sessions were analyzed using Motivational Interviewing Integrity Code 3.1.1. Results: None of the nurses achieved beginning proficiency in all parts of any motivational interviewing sessions and two nurses did not achieve beginning proficiency in any parts or sessions. Making more complex than simple reflections was the specific verbal behavior/summary score that most nurses achieved. Beginning proficiency/competency in "percent open questions" was the summary score that fewest achieved. Conclusion: Primary care nurses did not achieve beginning proficiency/competency in all aspects of motivational interviewing in their recorded sessions with patients, where lifestyle change was discussed. This indicates a need for improvement and thus additional training, feedback and supervision in clinical practice with motivational interviewing.Funding: University of Gavle in Sweden, STROKE-Riksforbundet (The Swedish Stroke Association) in Sweden, Erik, Karin och Gosta Selanders Foundation in Sweden </p

Gerotranscendence from a Nursing Perspective – from Theory to Implementation

The overall aim of the present thesis was to gain further knowledge about the nursing theoretical basis of care of older people, to translate the theory of gerotranscendence into practical guidelines, and to implement the theory and guidelines in practical settings. Study I comprised a literature search and a review with qualitative analysis of nursing theories. The conclusion drawn was that nursing theories do not provide guidance on how to care for older people or on how to support them in the developmental process of ageing. Thus, there is a need to develop a nursing care model that, more than contemporary theories, takes human ageing into consideration. Study II was a qualitative interview study involving staff working in care of older people. The interviews were qualitatively analysed. The conclusion was that staff members need an interpretative framework that allows them to understand the signs they sometimes observe in older people. Such a framework would enable staff to develop a broader approach to their care for older people. Parts of this framework can be found in the theory of gerotranscendence. In Study III, guidelines for practical care of older people were derived from the theory of gerotranscendence. Focus group interviews were used and other sources supporting the guidelines were given. A qualitative analysis of the interviews was carried out, and the theory of gerotranscendence was used as the theoretical framework. The guidelines could be used to promote a development toward gerotranscendence and could also be of value for people who have already attained a state of gerotranscendence. The guidelines focus on the individual, activities and the organisation. In Study IV, the theory of gerotranscendence and practical guidelines were introduced in a nursing home. Data were collected via qualitative interviews with staff and residents, and observations were made. Qualitative analysis and triangulation were performed. As theoretical frameworks, both the theory of gerotranscendence and innovation theory were used. The result showed that the most used guidelines were those focusing on the individual; these concern what each staff member could do in his/her relation to the resident and care. The findings showed further that those staff members who interpreted signs in line with the theory of gerotranscendence also used the guidelines. The staff who were early to adopt and promote the guidelines were those individuals who described a feeling of harmony with essential parts of the gerotranscendence theory. The most important finding of this thesis was that it was possible to translate a theory such that it could generate practical guidelines that could be used by the staff. There are probably many theories that could be translated in order to be implemented in practical care, e.g. to build a bridge between theory and practice, thereby helping staff. Innovation theory could be of general interest in all contexts in which work towards change is being conducted.Det övergripande syftet med denna avhandling var att få kunskap om den omvårdnads teoretiska basen för vård av äldre, och att översätta teorin om gerotransendens till praktiska guidelines, och att införa teorin om gerotranscendens och guidelines i praktiken Studie I, var en litteratursökning med en kvalitativ analys av omvårdnadsteorier. Den visade att dessa teorier inte ger någon vägledning om hur omvårdnad av äldre ska ske eller hur man kan stödja äldre i deras utvecklingsprocess. Därför finns det ett behov att utveckla en omvårdnadsmodell som mer än nuvarande teorier beaktar människans åldrande. Studie II, var en kvalitativ intervjustudie med personal i äldrevård. Intervjuerna analyserades kvalitativt. Studien påvisade att personal behöver mer kunskaper om åldrandeprocessen så att de kan förstå tecken och beteenden de ibland observerar hos de äldre. Detta skulle göra det möjligt för personal att utveckla ett vidare perspektiv för hur de kan stödja äldre personer. I studie III, utarbetades guidelines från teorin om gerotranscendens. Fokus grupps intervjuer användes. Intervjuerna analyserades kvalitativt och teorin om gerotranscendens användes som teoretisk grund. Dessutom ges i studien hänvisning till andra källor som stödjer guidelines. Guidelines kan användas för att stödja en utveckling mot gerotranscendens och kan också vara av värde för personer som redan uppnått gerotranscendens. Guidelines innehåller åtgärder som vårdare kan göra enskild, ger förslag till aktiviteter och organisatoriska åtgärder. I studie IV, introducerades teorin om gerotranscendens och de utarbetade guidelines på ett äldreboende. Kvalitativa intervjuer gjordes med personal och boende och observationer genomfördes. Detta analyserades kvalitativt och triangulering användes, både teorin om gerotranscendens och innovations teori användes som teoretisk grund. Resultatet visade att de mest använda guidelines var de som enskilda vårdare kunde utföra självständigt. Vidare att den personal som förklarade tecken de såg hos äldre i linje med teorin om gerotranscendens, använde också guidelines. Den personal som tidigt tog till sig och stödde användandet av guidelines var de som själva beskrev att de kände igen sig själva i delar av teorin, Det viktigaste resultatet in denna avhandling är att det var möjligt att översätta en teori till praktiskt användbara guidelines. Förmodligen finns det fler teorier som skulle kunna översättas och implementeras i praktisk verksamhet, vilket skulle vara att bygga en bro mellan teori och praktik, och hjälpa personal att kunna omsätta teorier praktiskt. Innovationsteori kan vara av generellt intresse i alla sammanhang när förändringsarbete bedrivs

Family members' experiences of personal assistance given to a relative with disabilities.

Personal assistance is a type of home care common to many countries even though entitlement and legislative framework may vary from country to country. At present, there exists no knowledge about the family members' experiences of such assistance; therefore, the aim of this study was to investigate family members' experiences of personal assistance given to a relative of working age with a functional disability. Twenty-five family members who had a relative with a severe neurological disease in Sweden were interviewed about the significance of personal assistance, and the qualitative interviews were subjected to qualitative latent content analysis. The overall findings verify the close connection between the family members' experiences and their perception of the quality of the caring relationship between the personal assistant and the person with disability. The main finding was an appreciation of the personal assistance on the part of the family members. However, in situations where the encounter between the assistant and the relative with disability was perceived negatively, the family members experienced great anxiety. The shortcomings were the inability to maintain a private life with assistance and the limitation of choice because of the shortage of personal assistants. Beyond these general findings, this study found that personal assistance was experienced by the family members in terms of dignity and empowering care. This theme was generated from seven subthemes: Insight into private life, Security through the close relation, Social life through freedom of movement, Influence over the organisation of assistance, Self-determination and understanding, Friendship and mutual respect and Adaption to the dependency on assistance. The findings indicate that responsible officials, work leaders and assistants need constantly to improve the implementation of the law. In such efforts, the experiences of family members described in this study are a source of knowledge

The ethics of coercive treatment of people with dementia

The aim of the present study was to describe how registered nurses in nursing homes ensure legal security, good and safe nursing care and uphold the dignity of nursing home residents with severe dementia without violating residents’ integrity. Semi-structured interviews were conducted with 10 charge nurses in a county in central Sweden. The transcribed interviews were examined using manifest and latent content analyses. The manifest analysis identified actual local routines involving coercive treatment and registered nurses’ descriptions of complications and alternative measures. The latent analysis resulted in three themes describing nursing strategies: one with coercive treatment, one with coercive treatment under specific circumstances and one to prevent coercive treatment. Interpretations of legal terms regarding coercive treatment and inadequate gerontological nursing training and understaffing seem to preserve the use of coercive treatment

How do first-line managers in elderly care experience their work situation from a structural and psychological empowerment perspective? : An interview study

BACKGROUND: The work situation for first-line managers in elderly care is complex and challenging. Little is known about these managers' work situation from a structural and psychological empowerment perspective. AIM: To describe first-line managers' experiences of their work situation in elderly care from a structural and psychological empowerment perspective. METHOD: Interviews from 14 female first-line managers were analysed using qualitative content analysis. RESULTS: The theme described the managers' work situation as "It's not easy, but it's worth it." In the four subthemes, the managers described their work in terms of "Enjoying a meaningful job," "A complex and demanding responsibility that allows great authority within set boundaries," "Supported by other persons, organisational preconditions and confidence in their own abilities" and "Lacking organisational preconditions, but developing strategies for dealing with the situations." CONCLUSION: The managers described having various amounts of access to structural empowerment and experienced a feeling of meaning, competence, self-determination and impact, that is, psychological empowerment in their work. IMPLICATIONS FOR NURSING MANAGEMENT: It is vital that first-line managers have access to organisational support. Therefore, upper management and first-line managers need to engage in continuous dialogue to customize the support given to each first-line manager

Experiences of Informational Needs and Received Information Following a Prenatal Diagnosis of Congenital Heart Defect

OBJECTIVE: To explore the need for information and what information was actually received following a prenatal diagnosis of a congenital heart defect, in a country where termination of pregnancy beyond 22 weeks of gestation is not clinically performed. METHODS: Twenty-six Swedish-speaking pregnant women (n = 14) and partners (n = 12) were consecutively recruited for semi-structured telephone interviews following the prenatal diagnosis of congenital heart defect. Data was analyzed using content analysis. RESULTS: Although high satisfaction with the specialist information was described, the information was considered overwhelming and complex. Objective, honest and detailed information about multiple subjects were needed, delivered repeatedly and supplemented by written information/illustrations. Eighteen respondents had used the Internet to search for information and found issues involving searching difficulties, low quality, and that it was too complex, insufficient or unspecific. Those who terminated the pregnancy criticized that there was a lack of information about termination of pregnancy, both from health professionals and online sources, resulting in unanswered questions and unpreparedness. CONCLUSION: Individuals faced with a prenatal diagnosis of a congenital heart defect need individualized and repeated information. These needs are not all adequately met, as individuals are satisfied with the specialist consultation but left with unanswered questions regarding pregnancy termination

Primary care nurses' performance in motivational interviewing : a quantitative descriptive study

Background: Motivational interviewing is a collaborative conversational style intended to strengthen motivation to change. It has been shown to be effective in addressing many different lifestyle problems as well as in chronic disease management, and many disease prevention guidelines promote use of motivational interviewing. The aim of the present study was twofold: to assess to what extent the primary care nurses in the study perform motivational interviewing according to the Motivational Interviewing Treatment Integrity Code and to investigate how the participating primary care nurses rated their own performance in motivational interviewing. Method: The study was based on twelve primary care nurses' audio-recorded motivational interviewing sessions with patients (total 32 sessions). After each session, the nurses completed a questionnaire regarding their experience of their own performance in motivational interviewing. The audio-recorded sessions were analyzed using Motivational Interviewing Integrity Code 3.1.1. Results: None of the nurses achieved beginning proficiency in all parts of any motivational interviewing sessions and two nurses did not achieve beginning proficiency in any parts or sessions. Making more complex than simple reflections was the specific verbal behavior/summary score that most nurses achieved. Beginning proficiency/competency in "percent open questions" was the summary score that fewest achieved. Conclusion: Primary care nurses did not achieve beginning proficiency/competency in all aspects of motivational interviewing in their recorded sessions with patients, where lifestyle change was discussed. This indicates a need for improvement and thus additional training, feedback and supervision in clinical practice with motivational interviewing.Funding: University of Gavle in Sweden, STROKE-Riksforbundet (The Swedish Stroke Association) in Sweden, Erik, Karin och Gosta Selanders Foundation in Sweden </p

General practitioners' experiences as nursing home medical consultants

OBJECTIVE: To describe general practitioners' experiences of being the principal physician responsible for a nursing home. METHOD: Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. RESULT: Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. CONCLUSION: The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems