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Danielson, Ella
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Wennerberg, M. M. T., Lundgren, S. M., Eriksson, M. & Danielson, E. (2018). Me and You in Caregivinghood – Dyadic resistance resources and deficits out of the informal caregiver's perspective. Aging & Mental Health, 1-8
Open this publication in new window or tab >>Me and You in Caregivinghood – Dyadic resistance resources and deficits out of the informal caregiver's perspective
2018 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, p. 1-8Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: To present Specific and Generalized Resistance Resources (SRRs/GRRs) and Deficits (SRDs/GRDs) described by 32 informal caregivers as originating from themselves and their older adult carerecipients as dyads. Method: Salutogenic interviewing was used to assemble data from caregivers. A theory-driven, memo-guided and comparative analysis using within- and across- case analysis was applied to unravel resources and deficits influencing the outcomes when they managed tension associated with caregiving. Findings: Living in fellowship in a well-functioning dyad unites the essence of having access to dyadic SRRs/GRRs. Such access enables dyads to use their specific dyadic tension management to resolve challenges through cooperation, derives ‘positive’ life-experiences and preserves dyad functioning. Struggling alone in a malfunctioning dyad indicates the presence of dyadic SRDs/GRDs counteracting such a development. If these SRDs/GRDs accumulate, the dyad become less able to resolve challenges, ‘negative’ life-experiences accumulates, the carerecipient's capability to cooperate decreases, caregiver's workload increases, the dyad becomes increasingly malfunctioning and moves towards the point where caregiving ends due to lack of usable SRRs/GRRs. Conclusions: Findings reveals the complex duality of caregiving and the necessity to assess all available SRRs/GRRs and SRDs/GRDs for caregiving dyads, including out of the carerecipient's perspective. Appropriate ‘salutogenic’ support reduces SRDs/GRDs, makes available SRRs/GRRs usable or provides alternative SRRs/GRRs, thereby dyadic tension management and dyadic functionality is preserved during this phase of life labelled Caregivinghood. The study adds new knowledge to the salutogenic framework regarding central, theoretical concepts and suggests how data for health promoting initiatives conducted the ‘salutogenic way’ may be acquired. 

Keywords
Dyadic tension management, health promotion, salutogenesis, specific and generalized resistance resources and deficits, theory-driven qualitative design
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-34110 (URN)10.1080/13607863.2018.1471582 (DOI)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-07-04Bibliographically approved
Wennerberg, M. M. .., Eriksson, M., Lundgren, S. M. & Danielson, E. (2018). Unravelling Swedish informal caregivers' Generalised Resistance Deficits. Scandinavian Journal of Caring Sciences, 32(1), 186-196
Open this publication in new window or tab >>Unravelling Swedish informal caregivers' Generalised Resistance Deficits
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 186-196Article in journal (Refereed) Published
Abstract [en]

In salutogenic theory, individual/contextual, immaterial/material characteristics enabling movements towards health are labelled Specific and Generalised Resistance Resources, SRRs/GRRs, and characteristics counteracting such movements Specific and Generalised Resistance Deficits, SRDs/GRDs. The aim of this paper was to present SRDs and GRDs described by caregivers as stemming from themselves and their care recipient. Guided by salutogenic theory, an explorative design was used to collect data through interviews with 32 Swedish informal caregivers. During the theory-driven analysis, SRDs were unravelled using within-case approaches. To be able to unite them as GRDs across cases, a serviceable GRD definition was developed from the existing theoretical GRR definition. In findings, SRDs are visualised in citations and GRDs described in detail. Caregivers' experiences of SRDs/GRDs are presented as themes: 'Experiencing personal deficiencies', when stemming from themselves; and 'Struggling with an uncooperative co-worker', when stemming from their care recipients. Findings indicate that if these themes dominate a caregiver's view of life, she/he seems to have reached the 'breaking point' when caregiving ends due to lack of usable SRRs/GRRs. To prolong the time until this occurs, support, making otherwise unusable SRRs/GRRs usable, is needed. When designing this type of 'salutogenic' support, it seems essential to involve the target group (e.g. caregivers, care recipients), to ascertain what their SRRs/GRRs and SRDs/GRDs may consist of. Such knowledge regarding SRRs/SRDs could be used to design individualised support, and regarding GRRs/GRDs to design generalised support at group level. This study suggests how such new knowledge regarding resistance resources and deficits could be acquired.

Keywords
Caregivinghood, GRD definition, Health promotion, Home care, Informal caregiver, Life-experiences, Salutogenesis, Specific and Generalised Resistance Deficits, Support, Theory-driven qualitative design
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-30961 (URN)10.1111/scs.12446 (DOI)000426524200018 ()28425120 (PubMedID)2-s2.0-85018659380 (Scopus ID)
Note

Version of record online: 20 April 2017

Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2018-04-03Bibliographically approved
Høgsnes, L., Danielson, E., Norbergh, K.-G. & Melin-Johansson, C. (2016). Healthcare professionals' documentation in nursing homes when caring for patients with dementia in end of life - a retrospective records review. Journal of Clinical Nursing, 25(11-12), 1663-1673
Open this publication in new window or tab >>Healthcare professionals' documentation in nursing homes when caring for patients with dementia in end of life - a retrospective records review
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 11-12, p. 1663-1673Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To investigate how end-of-life care was described by healthcare professionals in records of deceased persons affected by dementia who had lived in Swedish nursing homes. Background: In the final stage of dementia disease, the persons are often cared for at nursing homes and they often die there. The research concurs that a palliative approach to end-of-life care is essential but there are still some limitations regarding research about what constitutes the end-of-life care provided to persons affected by dementia in Sweden. Design: Descriptive qualitative method with a retrospective approach. Method: Nursing records (n = 50) and medical records (n = 50) were retrospectively reviewed in two nursing homes. The analysis was conducted using deductive and inductive content analysis. Three phases of The Liverpool Care Pathway; Initial assessment, Continuous assessment and Follow-up, were used deductively to first sort the text in the records, then the text in each phase was further analysed with inductive content analysis. Four categories and 11 subcategories described the content in the records. Results: The end-of-life care was described in the healthcare records based on such categories as decision-making, participation and communication, assessment and prevention of symptom and following up after the residents had died. Conclusion: Paticularly, physical symptoms were documented and, to a lesser degree, psychological or existential/spiritual needs. Relevance to clinical practice: Healthcare professionals must have a holistic view of the person affected by dementia during the end-of-life care and, according to this study, more focus must be placed on their psychosocial and existential needs in the documentation of end-of-life care.

Keywords
Dementia, Documentation, End of life, Palliative care, Patient records
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-27839 (URN)10.1111/jocn.13184 (DOI)000375866200018 ()27139172 (PubMedID)2-s2.0-84964777712 (Scopus ID)
Note

Article

Available from: 2016-06-09 Created: 2016-06-09 Last updated: 2017-11-30Bibliographically approved
Høgsnes, L., Norbergh, K.-G., Danielson, E. & Melin Johansson, C. (2016). The Shift in Existential Life situation of Adult Children to Parents with Dementia Relocated to Nursing Homes. Open Nursing Journal, 10, 122-130
Open this publication in new window or tab >>The Shift in Existential Life situation of Adult Children to Parents with Dementia Relocated to Nursing Homes
2016 (English)In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 10, p. 122-130Article in journal (Refereed) Published
Abstract [en]

Background:

Previous research describes spouses and adult children of people with dementia as a homogeneous group using one term: family caregivers. Recent research shows that the needs and experiences of spouses and adult children differ, therefore they cannot be studied as a homogeneous group.

Aims:

The aim of the study was to describe the shift in existential life situations of adult children of a parent with dementia relocated to nursing homes.

Design:

This is a qualitative study with an interpretive approach.

Methods:

Face-to-face interviews were held with 11 adult children aged 48-65 years. The interviews lasted 30–60 minutes and data were analysed using interpretive content analysis.

Findings:

The adult children described how they experienced their life situation before and after their parents’ relocation. Before relocation they described feelings of powerlessness, loneliness in their responsibilities, loss and guilt. After relocation they had feelings of freedom, ongoing responsibility, living with loss and having a new relationship with death.

Conclusion:

The most important finding in our study was that adult children developed a different relationship with death than before the parent became affected by dementia. It is essential that healthcare staff understand and address the adult children’s existential life situations and the suffering they are experiencing. Healthcare staff need to be conscious about adult children’s needs for support to address their existential life situations before and after their parents relocate to nursing homes.

Keywords
Adult Children, Dementia, Existential, Nursing Homes, Qualitative Methods
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-29366 (URN)10.2174/1874434601610010122 (DOI)2-s2.0-85032090284 (Scopus ID)
Available from: 2016-11-30 Created: 2016-11-30 Last updated: 2017-12-06Bibliographically approved
Wennerberg, M. M., Eriksson, M., Danielson, E. & Lundgren, S. M. (2016). Unravelling Swedish informal caregivers' Generalised Resistance Resources. Scandinavian Journal of Caring Sciences, 30(3), 602-613
Open this publication in new window or tab >>Unravelling Swedish informal caregivers' Generalised Resistance Resources
2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 3, p. 602-613Article in journal (Refereed) Published
Abstract [en]

Background

Interlinked aspects, as demographic changes, accentuation on home-based community care, increase the amount of informal caregivers to older adults. To preserve and enhance their health are subsequently essential and a reoccurring topic on political agendas. How this may be achieved is vividly debated and mainly focused on elimination of risks and stresses associated with caregiving. Within health promotion, the salutogenic approach focusing on resources to health is recognised and this approach was used to acquire necessary knowledge to enhance caregivers' health ‘the salutogenic way’.

Aim

To present Generalised and Specific Resistance Resources (GRRs/SRRs) described by caregivers as stemming from themselves and their carerecipients.

Methodology

To unravel caregivers' GRRs/SRRs, a theory-driven, explorative design guided by definitions of GRRs/SRRs was utilised. Data were collected through salutogenically guided interviews with 32 Swedish caregivers in one municipality. Inductively, data were analysed using content analysis to identify each caregiver's SRRs and thereafter deduction to identify the population's GRRs.

Findings

The synthesis of findings, caregivinghood, encompasses several domains of GRRs seemingly involved in caregivers' movements towards health. In the caregiver domain, ‘Being someone significant in my own eyes’ unites the essence of having access to GRRs stemming from oneself and ‘Being “blessed” with a co-operative co-worker’ that of having access to GRRs stemming from the carerecipient. This may be the core in an orientation to life which creates positive life experiences, since it enables caregivers to find a ‘fit’ between the possible and desired when resolving challenges.

Conclusion and implications

Health-promoting initiatives should be conducted as partnerships between formal and informal sources due to the versatility of GRRs. It also seems essential to empower both parties so that they may make sense of their situation and use their available GRRs/SRRs in this ‘joint venture’ of managing. Thereby, their motivation to continue the journey through Caregivinghood may be enhanced.

Keywords
caregivinghood, Generalised Resistance Resources, health promotion, homecare, informal caregiver, nursing, positive life experiences, salutogenesis, theory-driven qualitative design
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-28865 (URN)10.1111/scs.12292 (DOI)000383803300019 ()26530836 (PubMedID)2-s2.0-84983503448 (Scopus ID)
Available from: 2016-09-22 Created: 2016-09-22 Last updated: 2017-11-21Bibliographically approved
Strang, S., Henoch, I., Danielson, E., Browall, M. & Melin-Johansson, C. (2014). Communication about existential issues with patients close to death-nurses' reflections on content, process and meaning. Psycho-Oncology, 23(5), 562-568
Open this publication in new window or tab >>Communication about existential issues with patients close to death-nurses' reflections on content, process and meaning
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2014 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 23, no 5, p. 562-568Article in journal (Refereed) Published
Abstract [en]

ObjectiveEncountering dying patients with implicit existential questions requires the nurses to have positive and comfortable attitude to talking about existential issues. This paper describes the nurses' reflections on existential issues in their communication with patients close to death. MethodsNurses (n=98) were recruited from a hospital, hospices and homecare teams. Each nurse participated in five group reflection sessions that were recorded, transcribed and analysed using qualitative content analysis. ResultsThree domains and nine themes emerged. The content domain of the existential conversation covered living, dying and relationships. The process domain dealt with using conversation techniques to open up conversations, being present and confirming. The third domain was about the meaning of existential conversation for nurses. The group reflections revealed a distinct awareness of the value of sensitivity and supportive conversations. ConclusionThis study supports the assertion that experience of talking about existential issues and supporting environment make nurses comfortable when counselling patients close to death. It was obvious from this study that having the courage to be present and confirming, having time and not trying to solve' every existential problem were the most important factors in conversations with the patients close to death. Copyright (c) 2013 John Wiley & Sons, Ltd.

Keywords
communication, counselling, nurse, existential, end-of-life care, hospice
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-22016 (URN)10.1002/pon.3456 (DOI)000333767200010 ()2-s2.0-84897980529 (Scopus ID)
Available from: 2014-06-02 Created: 2014-05-28 Last updated: 2017-12-05Bibliographically approved
Rafii, F., Fatemi, N. S., Danielson, E., Melin-Johansson, C. & Modanloo, M. (2014). Compliance to treatment in patients with chronic illness: A concept exploration. Iranian Journal of Nursing and Midwifery, 19(2), 159-67
Open this publication in new window or tab >>Compliance to treatment in patients with chronic illness: A concept exploration
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2014 (English)In: Iranian Journal of Nursing and Midwifery, ISSN 1735-9066, Vol. 19, no 2, p. 159-67Article in journal (Refereed) Published
Abstract [en]

Background: Patients' compliance to treatment is an important indicator for evaluating the successful management in chronic illnesses. Despite the fact an applicable definition of compliance is required to suitable intervention and research, this concept is not clear and there is no consensus concerning its meaning, definition, and measurement. The aim of this study was to explore the concept of compliance and to formulate a working definition. Materials and Methods: Theoretical phase of Schwartz-Barcott and Kim's Hybrid Model of concept analysis was used to analyze the concept of compliance. Data were collected by using literature reviews. Medline, CINAHL, Ovid, Elsevier, Pro Quest and Blackwell databases were searched from 1975 to 2010 using the keywords "Compliance," "Non-compliance," "Adherence," and "Concordance." Articles published in English were selected if they included adult patients with chronic illnesses and reported attributes of compliance; 23 such relevant articles were chosen. Results: The attributes of compliance included patient obedience, ability to implement medical advice, flexibility, responsibility, collaboration, participation, and persistence in implementing the advices. Antecedents are organized into two interacting categories: Internal factors refer to the patient, disease, and treatment characteristics and external factors refer to the healthcare professionals, healthcare system, and socioeconomic factors. Compliance may lead to desirable and undesirable consequences. A working definition of compliance was formulated by comparing and contrasting the existing definitions with regard to its attributes which are useful in clinical practice and research. Conclusions: This finding will be useful in clinical practice and research. But this working definition has to be tested in a clinical context and a broad view of its applicability has to be obtained.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-22921 (URN)
Available from: 2014-09-11 Created: 2014-09-11 Last updated: 2016-09-29Bibliographically approved
Browall, M., Henoch, I., Melin-Johansson, C., Strang, S. & Danielson, E. (2014). Existential encounters: nurses' descriptions of critical incidents in cancer care at end of life. European Journal of Oncology Nursing, 18(S1), S35-S35
Open this publication in new window or tab >>Existential encounters: nurses' descriptions of critical incidents in cancer care at end of life
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2014 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no S1, p. S35-S35Article in journal, Meeting abstract (Other academic) Published
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-23434 (URN)000343363500091 ()
Available from: 2014-11-21 Created: 2014-11-17 Last updated: 2017-12-05Bibliographically approved
Browall, M., Henoch, I., Melin-Johansson, C., Strang, S. & Danielson, E. (2014). Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care. European Journal of Oncology Nursing, 18(6), 636-644
Open this publication in new window or tab >>Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care
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2014 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 6, p. 636-644Article in journal (Refereed) Published
Abstract [en]

Nurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress. Aim: The aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer. Methods and sample: Nurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured. Results: Eighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live. Conclusions: This study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs.

Keywords
Cancer, Critical incidents, End of life care, Existential encounters, Nurses' experiences
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-22925 (URN)10.1016/j.ejon.2014.06.001 (DOI)000346222800015 ()2-s2.0-84912048803 (Scopus ID)
Available from: 2014-09-11 Created: 2014-09-11 Last updated: 2017-12-05Bibliographically approved
Udo, C., Melin-Johansson, C., Henoch, I., Axelsson, B. & Danielson, E. (2014). Surgical nurses’ attitudes towards caring for patients dying of cancer: a pilot study of an educational intervention on existential issues. European Journal of Cancer Care, 23(4), 426-440
Open this publication in new window or tab >>Surgical nurses’ attitudes towards caring for patients dying of cancer: a pilot study of an educational intervention on existential issues
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2014 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 23, no 4, p. 426-440Article in journal (Refereed) Published
Abstract [en]

This is a randomised controlled pilot study using a mixed methods design. The overall aim was to test an educational intervention on existential issues and to describe surgical nurses' perceived attitudes towards caring for patients dying of cancer. Specific aims were to examine whether the educational intervention consisting of lectures and reflective discussions, affects nurses' perceived confidence in communication and to explore nurses' experiences and reflections on existential issues after participating in the intervention. Forty-two nurses from three surgical wards at one hospital were randomly assigned to an intervention or control group. Nurses in both groups completed a questionnaire at equivalent time intervals: at baseline before the educational intervention, directly after the intervention, and 3 and 6 months later. Eleven face-to-face interviews were conducted with nurses directly after the intervention and 6 months later. Significant short-term and long-term changes were reported. Main results concerned the significant long-term effects regarding nurses' increased confidence and decreased powerlessness in communication, and their increased feelings of value when caring for a dying patient. In addition, nurses described enhanced awareness and increased reflection. Results indicate that an understanding of the patient's situation, derived from enhanced awareness and increased reflection, precedes changes in attitudes towards communication.

Keywords
Existential, Intervention, Mixed methods, Pilot study, Randomised controlled study, Surgical nurses
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17411 (URN)10.1111/ecc.12142 (DOI)000337744500002 ()2-s2.0-84902550403 (Scopus ID)
Note

Published online 29 Jan 2014.

Available from: 2012-11-21 Created: 2012-11-21 Last updated: 2017-12-07Bibliographically approved
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