Mid Sweden University

This study aimed to describe how older adults with complex health problems manage their everyday lives in their own homes and how they interact with given home care. In this multiple-case study, a total of 14 individual interviews were conducted with five older adults over the course of one year. Deductive and inductive content analyses were performed. Three descriptive categories were each identified in the deductive (‘home care as interpersonal continuity’, ‘home care as information continuity’ and ‘home care as management continuity’) and inductive analyses (‘Lack of social contact with carers’, ‘Desire to be heard throughout the care process’ and ‘Carers are short on time’). Quality home care services are difficult to realize if interpersonal interaction is subordinated to effective task-solving.

Aim

To explore and describe older persons' unique experiences of care encounters with home care nurses in a real-life context.

Background

The increasing number of older persons in society contributes to increases in age-related impairments compromising their quality of life. Future care consists of “hospitals at home” where care encounters occur in a person's private domain, partly becoming a clinical workplace. Scant research has focused on how older persons experience care encounters with home care nurses and needs to be highlighted.

Design

Multiple-case study.

Methods

The cases relied on replication logic and five purposive sampled older persons were interviewed. Data were analysed using qualitative content analysis and differences within and between cases were explored and findings across the cases were replicated.

Findings

The cross-analysis emerged in three categories: “Nursing routine rules the care encounters”, “Lack of knowledge and information” and “Dependency on support from others”.

Conclusions

Our research has found that older persons face challenges while receiving home care, including limited engagement in their care and the need for enhanced support. Implementing person-centred care in homes poses ethical challenges that require careful consideration. Home care nurses should prioritise understanding each patient individually, recognising them beyond their patient role, which necessitates more thorough and time-sensitive care encounters.

Reporting Method

Findings were reported using COREQ guidelines.

Patient or Public Contribution

Patients were interviewed and contributed with data for this study.

Implications for the Profession and Patient Care

This study emphasises the need to prioritise individualised care in home settings and listen to the voices of older individuals to enhance quality.

Denne kunnskapsoppsummeringen identifiserer, beskriver og sammenfatter forsknings- og utviklingsarbeid som omhandler selvmordsrisiko og tiltak i kommunale helse- og omsorgstjenester for å forebygge selvmord hos eldre. Oppsummeringen gir også et overblikk over juridiske, faglige og politiske dokumenter som regulerer og gir føringer for selvmordsforebyggende arbeid i kommunale helse- og omsorgstjenester. Kunnskapsoppsummeringen har fulgt de metodiske trinnene beskrevet for scoping reviews av Arksey og O’Malley (2005). Oppsummeringen inkluderer 28 publikasjoner, hvorav 21 er vitenskapelige artikler og 7 er andre typer faglige publikasjoner som beskriver forsknings- og utviklingsarbeid. De fleste (19) publikasjonene beskriver arbeid gjennomført med deltakere eller datainnsamling i Norge, mens seks av publikasjonene viser arbeid utført i Sverige og én i Danmark. I tillegg er det inkludert en internasjonal oversiktsartikkel og en europeisk populasjonsstudie, begge funnet relevante for skandinavisk kontekst. De vitenskapelige artiklene er publisert i tidsrommet 2018–2023. De identifiserte studiene viser den økte sårbarheten for selvmord blant eldre og vektlegger viktigheten av å ta tak i unike utfordringer, inkludert fysisk og psykisk uhelse og sosioøkonomiske forhold. Publikasjonene understreker at helsepersonell rapporterer mangel på kunnskap om selvmordsforebygging, noe som viser et stort behov for opplæring og bevisstgjørende tiltak. Den oppsummerte kunnskapen peker også på behovet for å forbedre kommunikasjonen og dialogen mellom helsepersonell og eldre, for å kunne identifisere faresignaler og tilby tilstrekkelig eksistensiell støtte. For å møte disse utfordringene foreslås ulike tiltak, blant annet opplæringsprogrammer for helsepersonell, implementering av forebyggingsstrategier og bevisstgjøring om eksisterende hjelperessurser som Helsedirektoratets veiledningsmateriell. Samtidig understrekes viktigheten av å involvere og støtte pårørende og skape et mer inkluderende og støttende lokalmiljø for eldre, noe som motvirker ensomhet. Resultatene viser at det er nødvendig å styrke det selvmordsforebyggende arbeidet blant eldre og iverksette tiltak som tar hensyn til deres spesifikke behov og utfordringer. Det trengs strategier som sikrer samarbeid mellom ulike aktører, inkludert helsepersonell, pårørende og samfunnet ellers, for å skape et tryggere og mer støttende miljø for eldre mennesker.

ABSTRACT Aim To explore and gain a deeper understanding of older persons' experiences of care encounters when their home becomes a workplace. Background Worldwide healthcare services are increasingly being provided in older persons' homes by registered nurses. This presents new challenges as the home environment of older persons now doubles as a workplace for healthcare professionals. However, there is limited research available on how older persons experience care encounters when their homes serve as workplaces and how this influences their overall well-being and quality of life. Design A qualitative hermeneutic study. Methods In-depth face-to-face interviews were conducted in Sweden from October 2023 to January 2024 with 10 purposefully selected older persons (aged 65+). Each participant received regular visits from a home care nurse in their home to address specific care needs, such as wound care, medication administration, blood sampling and general supervision. The interviews were audiotaped, transcribed verbatim and analysed using a hermeneutic interpretation. Findings The hermeneutic analysis emerged with one main theme: ?Experiencing care encounters at home as a lottery?, with two underlying themes: ?Adapting to loss of control in the private sphere? and ?Striving for independence while navigating daily living?. Conclusions Older persons try to control their lives despite the challenges associated with ageing and receiving care at home. They strive to maintain their independence and autonomy, which reflects their desire for self-determination. Supporting these efforts in an interdependent relationship can enhance their well-being and quality of life. Reporting Method Findings were reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. Patient or Public Contribution Data were collected by patient interviews. Implications for the Profession and Patient Care This study emphasises the importance of supporting older persons in maintaining control over their lives while being cared for in their homes. In the care encounters with home care nurses, their well-being and quality of life can be improved by respecting their autonomy, involving them in decision-making and offering tailored support.

Aim

The aim of this review was to synthesise qualitative research into how nurses perceive and experience encountering patients in forensic inpatient care.

Review method

This review followed the steps of meta-ethnography developed by Noblit and Hare.

Data sources

Twelve studies, published from 2011 to 2021, were identified through a search of relevant databases in December 2021.

Findings

The synthesis revealed three third-order and 10 second-order constructs during the translation of concepts in the studies. These are: Adopting the patient’s perspective (liberation, comprehension and resistance), Action (security, trust, flexibility and predictability) and Activation (afraid or safe, involved or indifferent and boundaries). Further, a line of argument was developed which indicates that in forensic psychiatry inpatient care, nurses experience having to deal with internal and external resistance that affects their freedom of choice in the creation of a caring relationship.

Conclusion

The encounter is experienced as a continuous process in which the foundation is laid for the encounter (approach), the encounter unfolds and develops (action) and the nurse experiences the encounter (activation). The process is intertwined with and takes place in a context where care is influenced by the duality of the task (task), the culture of care (context), the patient’s expression (patient) and the nurse’s own impression of the patient’s expression (oneself).

Implications

Professional communities should support initiatives that can strengthen nurses’ self-awareness and provide opportunities for reflection on practice, which will both benefit the resilience of the nursing staff and the quality of care for patients in this setting.

The concept of dementia‐friendly communities focuses on the lived experience of people who have dementia and is most relevant to addressing their needs and the needs of those people who live with and provide support for them. The goal of communities becoming dementia‐friendly is for dementia to be normalized and recognized as a disabling condition. People with dementia find being connected to self, to others, and to the environment by meaningful activities as important. According to the concept underlying dementia-friendly communities, people with dementia or cognitive decline can continue to live in the community if their residential community has sufficiently strong social capital. The aim of this study is to explore staff and leaders’ experiences in implementing interventions to enhance a more inclusive dementia-friendly community. A municipality in northern Sweden with a population of approx. 100 000 inhabitants decided to create a dementia friendly municipality. As part of the initiative, a Centre for support was established. The Centre offered support for both individuals and groups, did home visits, and provided information about Dementia. Interviews were conducted with staff who had undergone training in a structured form of multidimensional support, the PER-model®, and worked at the Centre for support. The staff consisted of registered nurses, occupational therapists, and specialized nurses who had worked there for more than five years, and all had training in dementia. All interviews were audio-recorded and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis. Results suggest that implementing the PER-model® of support for persons in the early stages of dementia and their next of kin added a much-needed form of support and perceived possibilities to enhance daily life in the early stages of dementia. The staff appreciated that the structure of PER-model® was evidenced based. They also realized that they never even considered that the person with dementia also needed support in the early stages but that they now had tools for that as well. Creating a dementia friendly municipality offering different kinds of support for all stages of dementia is a challenge. However, evidence-based tools and a broad spectrum of different types of support, whether individual or group, are needed to tailor to everyone’s needs. A conviction that all citizens are equal and should all be involved in the community is a strong motivator.

Many ill people want to be cared for at home, and home care nurses face an infinite number of encounters when providing that service. Despite the rising prominence of home care organizations worldwide, little research has been conducted on the encounters between home care nurses and patients and how encounters influence the nursing care provided. The aim of the present study was to describe home care nurses’ experiences of encounters with patients in their homes. In total, 11 home care nurses were selected through purposive sampling. The data consisted of individual interviews, which were analyzed through qualitative content analysis, and reported using COREQ reporting guidelines. The results were based on two categories describing the importance of adapting to each patient's needs and collaborating with the person being cared for. Implementing the findings could enable nurses to care for the patients without reducing them to recipients of objectified care.

The aim of this study was to describe the phenomenon of “fleeing the encounter when facing resistance” as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one’s emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers’ self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient’s lifeworld but also their own.

Background: Nurses working in home care often encounter patients with multiple diagnoses in an unpredictable environment, which can cause ethical and emotional challenges and affect their daily work. However, research about encounters in home care is sparse.

Aim: To illuminate the meaning of nurses’ lived experiences of encountering patients in home care.

Method: The study has a qualitative design and adopts a phenomenological hermeneutic approach. This approach was chosen to shed light on the meaning of the nurses’ everyday experiences by interpreting texts transcribed from lived narrations. After obtaining ethical approval participants (n=11) were recruited through purposive sampling.

Findings: The findings are presented under three main themes:

1) “Being receptive to the other”, which illustrates the meaning of being open-minded and taking the time to acknowledge the patient.

2) “Handling the unpredictable”, which illustrates the meaning of encountering the unknown in the patient’s home.

3) “Managing frustration”, which illustrates the meaning of managing your emotions to highlight the needs of the patients. The variety of encounters made different impressions on the nurses which affected the provided care.

Discussion: During unpredictable encounters, it was sometimes hard to determine and assess the best care for the patients. The findings highlight that misinterpreting the patients’ needs worried the nurses and caused their consciences to be troubled. Nurses must manage their own and their patients’ vulnerability in order to be receptive to what the patients conveyed. When doing so, nurses will discover a genuine interest in the other and counteract the risk of overlooking the patients. The unilateral ethical demand requires the nurses to take care of the patients’ lives selflessly. We are all in each other’s power because our vulnerability and loneliness will facilitate a natural trust. A trust that we hope will be answered and fulfilled by measures that touch and show care and affection.

Conclusions: Although encountering patients in home care means relating to the other unconditionally, it is sometimes hard to perceive the wishes and needs of the patient and to respond to the ethical demand. However, this was facilitated by shifting the focus from problem-solving an deficiency to get to know the person. Additionally, management of vulnerability will also increase the ability of the nurse to encounter the patient in home care more perceptively.