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  • Public defence: 2018-05-04 10:00 Juvika
    Solum Myren, Gunn Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Dagaktivitetstilbud for personer med demens som bor hjemme: ”Dagen i dag den kan bli vår beste dag”2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of the thesis was to examine how persons with dementia in who live at home experience day care services and what the services mean to them, their relatives and care staff. For persons with dementia, everyday life often lacks social and sensory stimuli, and research has shown that their relatives experience a burden of care that strains their quality of life. In response, more knowledge is necessary about how municipal services in should be designed to ensure that persons with dementia can stay at home for as long as possible. From 2020, municipalities in Norway, will have a statutory duty to offer day care services to persons with dementia. The thesis is based on four qualitative studies. In study I, fieldwork comprised observations and informal conversations with persons with dementia (participants) who receive care from two day care services and staff. Study II involved semi-structured interviews and study III, narrative interviews with relatives, whereas study IV involved semi-structured interviews with care staff. In study I, results revealed that location and buildings affected the inclusion of participants in activities. Where as homey, familiar environments contributed to greater activity among participants, institutional environments contributed to greater passivity, at least from the perspective of participants and staff. In turn, the meaningfulness of participants’ everyday lives depended on staff adaptiveness in exercising person-centred care. In study II, relatives of persons with dementia reported that the pre- and post-diagnosis periods were challenging for them and that the day care services, especially the daily routines that they established, were thus exceptionally meaningful. The relatives reported not only that could they afford to rest on days when the persons with dementia received day care services but that the participants experienced those days to be meaningful as well. At the same time, they reported struggling with deciding for how long it would be reasonable for the persons with dementia to live at home. In study III, results revealed that living with persons with dementia affected the everyday lives of spouses and cohabitants, who had to assume new roles and adapt to living lives full of commitment, singularity, anxiety and oneliness. Spouses and cohabitants not only sought to optimally manage their domestic arrangements but also conceal from others how they felt or thought about their situations. To those ends, day care services therefore helped them to persevere in caring for and living with their loved ones, as well as afforded them time to pursue their personal interests. Being visited by day care staff prevented them from having to ask for help because staff members were there to offer it instead.…Last, during study IV, staff reported striving to implement person-centred care by ensuring the dignity of participants and their relatives and facilitating meaningful activities according to individual needs. However, staff also reported facing various barriers in realising person-centred care, including staff shortages, different levels of functioning among participants and limitations in the design of spaces and their location. When developing day care services, it is important to consider both the physical design and location of buildings in which care will be offered. Person-centred care can guide the organization of adequate, tailored day care services able to afford persons with dementia meaningful everyday lives.

  • Public defence: 2018-05-18 10:30 M108, Sundsvall
    Rönngren, Ylva
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Supporting healthy lifestyle habits in persons with mental disorders: The development of a nurse-led lifestyle intervention2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Persons with mental disorders have an increased risk of developing health problems. One reason for this is poor lifestyle habit support. The aim of this thesis was to develop and evaluate a nurse-led lifestyle intervention for persons with mental disorders. Two versions of the intervention were conducted in the municipality (versions I, II) and one in a primary healthcare setting (version III). The educational elements of the intervention were led by nurses and practically executed by nursing staff (study II and III). In study IV education was both led and executed in practice by nurses. Data were collected through focus groups, individual interviews, and measurements. Study I, a qualitative development study, showed that, when motivating for lifestyle changes, it was important to structure daily life and provide emotional support. Loneliness, lack of knowledge and support, and general resources were identified as barriers to lifestyle changes. Version I contained health education for nursing staff and individual lifestyle habit support to persons with mental disorders, which included physical exercises and cognitive support. Study II was a qualitative acceptability study of the intervention (version I) and its assessment tools. The intervention with its relational, educational, and supportive dimensions and the assessment tools was promising. In Study III (version II), a quantitative pilot study, persons with mental disorders received health education together with the nursing staff. The intervention provided improvements to various degrees in health-related variables of quality of life, cognitive performance, walking capacity, and waist circumference. Study IV (version III), a qualitative study, included health education and individual lifestyle habit support for young adults with mental illness. The young adults experienced challenges including psychiatric symptoms, loneliness, and a lack of social understanding. The thesis results showed that the core components of the intervention with interpersonal relationships, where nursing staff played an important role, and further components such as health education and health discussions, in addition to cognitive support, worked well together to support lifestyle habit changes. Those components already exist and may therefore be easy to implement into daily nursing practice in different housing conditions and with individuals of different ages and needs for mental health care support. Group education was a way not only to develop new health strategies but also to establish social relationships. The intervention may also be modified to work with other groups of persons who need more explicit lifestyle habit support. However, to better determine the efficacy and sustainability of the intervention, larger studies over a longer time should be conducted.