Mid Sweden University

Purpose The aim of this study was to elucidate meanings of participation in care for older people after hip fracture surgery and nurses working in an orthopaedic ward. Methods A qualitative phenomenological hermeneutical design was used. We conducted personal interviews with a narrative approach with 11 older people recovering from hip fracture surgery and 12 nurses working in an orthopaedic ward. Results The results show that for older people, participation meant being a co-creator in their own care, founded on being met with sensitivity and support, being told what is going to happen, taking responsibility and asking questions and being able to influence care. For nurses, patient participation meant meeting the patients' needs and requests by being open and allowing them to influence care while at the same time recognizing that the patients' possibility to influence care was limited. Conclusion The study shows that for older people and nurses, the phenomenon of participation has similar meanings but also differences. When older people participate in their care, they become a co-creator in care and confirmed as a person. This highlights the importance of a nurse-patient relationship built on trust, connectedness and communication based on a shared understanding.

Background: When death ends a life, the impact of caring for person who suffered a period of illness or diseasecontinues for significant others who are left to grieve. They should be offered support to avoid complicated grief.This can be provided in different ways and individually or in groups. This study aims to describe significant others’experiences of participation in bereavement groups.Methods: Ten bereavement groups that each met five times offered support for the significant others of deceasedloved ones who had been cared for by a palliative-care team. After the five meetings, the grieving members (n =46)completed written comments about the role of the groups; they also commented one year after participating (n =39).Comments were analyzed with qualitative content analysis with a directed approach using the theory of a good deathaccording to the 6S’s: self-image, self-determination, social relationships, symptom control, synthesis and summation,and surrender.Results: Bereavement groups were found to be a source for alleviating grief for some significant others, but not allexperienced relief. Moreover, grief was found to persist during participation. Another finding involved the impact ofthe role of the palliative home-care team on bereavement support. To evaluate the experience of participating in abereavement group, the use the 6S’s as a model was a strength of the analysis. Bereavement groups could enhancethe self and offer relief from grief. Participation was described as social relationships that offered a sense of coherenceand understanding in grief. The effects of participation were more meaningful close to the loss and could lose efficacyover time. Bereavement support provided before a loved one’s death was seen as valuable.Conclusion: Overall, the bereavement groups eased the grief of significant others close to the death of their lovedone. However, moving forward, several of the significant others were not sure that their participation eased their grief.To identify persons who may remain in a state of complicated grief, a routine of planned contacts with the bereavedshould begin before death and be followed up later than six months after the death of a loved one.

BACKGROUND: A hip fracture is an unexpected, subjective, traumatic experience that affects the person in both physical and emotional ways.

PURPOSE: The purpose of this study was to describe rural older people's experiences of recovering after hip fracture surgery.

METHODS: Thirteen individual interviews were conducted with older people. The interview texts were analyzed with qualitative content analysis.

RESULTS: Patients described finding themselves in a new and vulnerable situation, dependent on others for simple everyday chores. They struggled to regain independence while staying positive, convinced that they would recover. Fear of another fall, as well as lack of information, made recovery at home difficult.

CONCLUSION: Older people who experience hip fractures need support during the recovery process. Because recovery begins at the hospital, this study highlight patients' need to participate in recovery planning, as well as the need to have information about what it means to be affected by a hip fracture and how to prevent it from happening again. This study emphasizes that nurses' awareness of patients' need to participate in planning the recovery process is crucial for enabling patients' return to a daily life that is similar to their prefracture life.

Introduction: The in-hospital rehabilitation of patients who have undergone surgery for hip fracture requires a team-based effort, in which nurses play an all-embracing role throughout the patients’ hospital stays. Although discharge planning has been widely studied, little is known about discharge planning from hospitals to homes in rural settings. Aim: To describe nurses’ views on discharge planning for older patients after hip fracture surgery who live in their own homes in rural areas. Methods: A qualitative method was used. Four focus group interviews were conducted with 18 nurses who work at an orthopaedic clinic. The interview texts were analysed with qualitative content analysis. Findings: Nurses expressed that patients needed support from healthcare personnel as well as relatives in order to prepare for life at home. They also expressed that patients were not supported in all aspects of discharge planning because they faced difficulties in having their voices heard. Nurses described that many of those aspects were beyond their own control, which had left them with little to non-ability to influence discharge planning. Findings additionally indicate that discharge planning seems not affected by occurring in rural settings. Conclusions: Although discharge planning is intended to meet the unique wishes and needs of each patient given the realities of existing resources, nurses’ responsibilities in discharge planning are unclear. This study shows an organisation in which healthcare personnel continue to make decisions for patients. Significance for nurses to perform a discharge planning that support patients’ participation seems to be a communication based on shared understanding.

Bakgrund

Kontrakturer är vanligt förekommande bland den äldre befolkningen samt hos personer som lider av olika sjukdomar. Det finns många förödande konsekvenser i dagligt liv för en person med kontraktur. Fastän behandlingar görs för att förhindra uppkomsten av kontrakturer samt behandla redan uppkomna kontrakturer så finns ännu ingen konsensus när det gäller vilken behandlingsmetod som är mest effektiv

Syftet med denna litteraturöversikt var att undersöka det vetenskapliga stödet för behandlingsmetoder som används för att förebygga eller behandla kontrakturer.

Metod

Litteratursökningar gjordes genom att använda databaserna Cinahl, Amed, Medline och PEDro. De artiklar som inkluderades rankades genom att använda PEDro kvalitetspoäng. Artiklarna sorterades utifrån vilken behandlingsmetod som undersöktes och resultaten från originalstudien extraherades och koncentrerades.

Resultat

Tjugosex artiklar uppfyllde inklusionskriterierna och togs med i litteraturöversikten. I resultatet framkom sju behandlingsmetoder. Flertalet av behandlingsmetoderna visade inte på tillräckligt vetenskapligt stöd varken för att förkasta eller rekommendera metoden. När det gäller stretching, för personer som inte viljemässigt kan utnyttja det vunna rörelseomfånget, fanns det dock anledning att tvivla på värdet av behandlingen. De metoder som indikerade positiva resultat är de som använder aktiva rörelser samt försiktig positionering, men fler väldesignade studier behövs.

Samverkansarenan ”Sociala vård- omsorgsgruppen” för politiker- och tjänstemän i Jämtlands län och Region Jämtland Härjedalen har utifrån regeringsuppdraget ”Sammanhållen vård och omsorg om de mest sjuka äldre 2012” beslutat om enstrategi- och handlingsplan ”Bättre liv för sjuka äldre” med fokus på de äldres behov. I handlingsplanen fanns ett uppdrag att ta fram ett förslag till geriatriskt stöd i länet. Efter kartläggning om behovet beslutades att driva ett länsövergripande projekt finansierat av Region Jämtland Härjedalen och länets kommuner. Projektet pågår 2014-09-01 till och med 2016-08-31. Syftet med projektet är att utgöra ett kompetenscentrum inom geriatrik i syfte att leda till trygghet för den äldre personen. Projektet inriktas på tre områden; kompetenscentrum, konsultativ funktion och samverkan. Kompetenser som ingår i geriatriska stödet är sjuksköterska med utbildning i vård av äldre 100 %, geriatriker 50 %, farmaceut och dietist på vardera 20 % tjänst. Region Jämtland Härjedalens båda FoU-miljöer bidrar på uppdrag av Ledningskraft (styrgrupp för frågor gemensamma för länets kommuner och hälso- och sjukvården inom äldreområdet) med varsin del i utvärderingen av projektet. FoU Jämt som är kommunernas forsknings- och utvecklingsenhet för socialtjänst och kommunal hälso- och sjukvård ansvarar för kvalitativ uppföljning tillsammans med Mittuniversitetets avdelning för omvårdnad. Uppföljningen är gjord av Ingegerd Skoglind-Öhman vid FoU Jämt och Kerstin Björkman-Randström vid Mittuniversitetet. Uppföljningen har gjorts genom fokusgruppsintervjuer och enskilda intervjuer med professioner inom kommuner och privata utförare, samt regionens primärvård respektive specialiserade vård. Totalt intervjuades 25 personer. Intervjuerna visar att kännedomen om projektet geriatriskt stöd är begränsad bland de intervjuade, och att ett fåtal av dem själva aktivt har konsulterat stödet. De intervjupersoner som har deltagit i föreläsningar via projektet, eller som har tagit del av informationsmaterial om geriatrik via projektets hemsida uttrycker uppskattning över detta. Sammanfattningsvis konstateras att intentionen med projektet som verksamhetsstöd i helhet har beskrivits positivt av de intervjuade.

Background

There is a move towards the provision of rehabilitation for older people in their homes. It is essential to ensure that rehabilitation services promote independence of older people.

Aim

The aim of the study was to explore multidisciplinary teams' experiences of home rehabilitation for older people.

Methods

Five focus groups were conducted with multidisciplinary teams based in a municipality in Sweden, covering seven different professions. In total, 28 participants volunteered to participate in these interviews. Interviews were transcribed verbatim and analysed according to content analysis.

Results

Two main categories, as well as four subcategories, emerged. The first main category, having a rehabilitative approach in everyday life, consisted of the subcategories: ‘giving ‘hands-off’ support’ and ‘being in a home environment’. The second main category, working across professional boundaries, consisted of the subcategories: ‘coordinating resources’ and ‘learning from each other’.

Conclusion

Common goals, communication skills and role understanding contributed to facilitating the teams' performances of rehabilitation. A potential benefit of home rehabilitation, because the older person is in a familiar environment, is to work a rehabilitative approach into each individual's activity in their everyday life in order to meet their specific needs. At an organisational level, there is a need for developing services to further support older people's psychosocial needs during rehabilitation.

Implications for practice

Team performance towards an individual's rehabilitation should come from an emerged whole and not only from the performance of a specific professional approach depending on the traditional role of each profession. A rehabilitative approach is based on ‘hands-off’ support in order to incorporate an individual's everyday activities as a part of their rehabilitation.

Objective: To explore the experiences of older people and their supporting family members in relation to home rehabilitation, with a focus on activity and participation. Methods: Qualitative interviews were carried out with 6 older people and 6 family members at 1 and 6 months after the older person’s discharge to their home. Qualitative content analysis of the data was carried out. The International Classification of Functioning, Disability and Health provides a guiding framework for rehabilitation. Results: Informants’ experiences of home rehabilitation contributed to the formation of 6 categories: (i) living with a frail body; (ii) striving for well-being in daily life; (iii) being close at hand; (iv) feeling dependent in daily life; (v) struggling to carry on; and (vi) striving to be at home. Conclusion: Older people’s goals were to return to daily routines and to perform meaningful activities without feeling dependent on other people. Family members’ participation was crucial. Psychosocial support and autonomy were essential for facilitating activity and participation. Healthcare professionals should consider each individual’s unique experiences along with the significance of being at home.

Avhandlingens övergripande syfte var att studera multidisciplinära teams, äldre personers och familjemedlemmars erfarenheter av hemrehabilitering. Avhandlingen baseras på fyra studier (I-IV). Alla studierna har en kvalitativa beskrivande design. Datamaterialet utgjordes av fokusgruppsintervjuer med personal arbetande i team i kommunal hälso- och sjukvård (I), intervjuer med äldre personer, över 65 år, som vårdats på sjukhuset och därefter fortsatt rehabilitering i hemmet (II,III,IV), samt familjemedlemmar involverade i de äldres rehabilitering (II).

Studie I visade på betydelsen av att möta äldres individuella behov och att arbeta utifrån ett rehabiliterande förhållningssätt i avsikt att ge en hjälp som inte innebär att ta över handlingar från den äldre. Väsentligt var att i teamet reflektera över hur man agerar utifrån den egna professionen för att kunna utveckla ett rehabiliterande förhållningssätt i det dagliga arbetet. I resultatet framkom att teamen uppfattade hemrehabilitering som positiv för de äldre, men mindre lämpligt om de äldre var svårt sjuka och de kände sig otrygga i sitt hem. Respekt för de äldres integritet i deras hem och att göra de närstående delaktiga i rehabiliteringen betonades. Resultatet visade på att för att kunna utveckla samarbetet i teamet finns behov av att diskutera varje professions ansvarsområde och klargöra gränser mellan varandras ansvarområden. Behovet av att tillföra psykosocial kompetens i teamet framhölls för att möta de äldres behov. I studie II framkom att de äldre upplevde rehabiliteringen vara en balansgång i att känna av vad kroppen orkar med för dagen och vad som är realistiskt att uppnå för att känna välbefinnande. Tryggheten i att ha någon i familjen nära sig i hemmet var oumbärligt för att våga utföra träning och vardagliga aktiviteter. Resultatet visar på de äldres upplevelse av otillfredsställelse med att vara beroende av andra. Familjemedlemmar var engagerade i de äldres rehabilitering genom att finnas till hands, hjälpa till och vara stödjande, vilket var en självklar handling men också utmanande i att kunna hjälpa på rätt sätt. Bristande information om hjälpmedels funktion och användning skapade frustration. Resultatet visar att både de äldre och deras familjemedlemmar ser hemmiljön bidra till att underlätta rehabilitering. Det som försvårar är när gränsen för det egna hemmet inskränkts i och med att och personal ofta gick "in och ut" i det egna hemmet.

Studie III visar på ett flertal faktorer i de äldres vardag och i det omgivande samhället som inverkat underlättande eller hindrande på aktiviteter och delaktighet vid hemrehabilitering. Resultatet beskrivs utifrån Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF) i 19 kategorier i domänen omgivningsfaktorer. Som underlättande faktorer framträder bl.a. tillgång till hjälpmedel, en fysisk miljö tillgänglig för aktiviteter samt att få stöd från närstående, vänner och personal i hälso- och sjukvård och omsorg. I resultatet framkom betydelsen av ett empatiskt förhållningssätt när personal möter den äldre personen i dennes hem. Resultatet indikerar att hemrehabilitering inte till fullo tillgodoser äldres behov av rehabilitering. I studie IV framkommer personliga faktorer som inre styrka, motivation, engagemang och tålamod för att nå positiva resultat i en rehabilitering som sträcker sig över flera år. Rehabilitering beskrivs i fysiska och psykiska faser som övergick i att hantera en fysisk funktionsnedsättning med svårigheter att gå i dagligt liv. Resultatet visar på betydelsen av adekvat information, vikten av socialt stöd och tillgänglighet till hälso- och sjukvårdspersonal under rehabiliteringsprocessen.

Avhandlingen bidrar till en ökad kunskap om hur multidisciplinära team, äldre personer och familjemedlemmar upplever rehabilitering i hemmiljö. Nyttan med avhandlingen kan medföra att hemrehabilitering som vårdform kan bli föremål för diskussioner om hur det utformas och organiseras för att på bästa sätt stödja de äldre och närstående med utgångspunkt från de äldres och närståendes erfarenheter och upplevelser. Detta kan ses gagna deltagarna på individnivå men även för utveckling inom yrkesprofessionen. Avhandlingen har även visat på möjligheten att implementera ICF i rehabiliterande omvårdnad.

The aim of the thesis was to study home rehabilitation as experienced by multidisciplinary teams, older people and their family members. The thesis is based on four studies (I-IV), all of which used a qualitative descriptive design. The data consisted of focus group interviews with rehabilitation practitioners working in teams in local health care services (I), interviews with seniors, i.e. over 65 years, who, because of illness or injury had been hospitalized and where their rehabilitation continued in their own home environment (II,III,IV) and interviews with family members involved in home rehabilitation (II).

Study I showed the importance of meeting the individual needs of the elderly person while applying a rehabilitative approach to provide help, without compromising the individual´s independence. It was imperative that the team reflected on how to perform professionally in order to develop a rehabilitative approach in their daily work. The results show that the team regarded home rehabilitation as having a positive effect on the seniors. However, it was less suitable if the individuals in question were seriously ill and therefore felt less safe at home. Respect for the integrity of the individual in their own homes as well as the involvement of their family members in the rehabilitation process, were emphasized. The results showed that in order to develop cooperation within the team of team members it was necessary to clarify the duties and responsibilities of the different groups of healthcare professionals involved. It was emphasized, that there was a need to enhance the psychosocial competence of the team regarding senior care. Study II revealed that the elderly individuals themselves experienced their rehabilitation as a balance between sensing what their body could actually cope with and what was realistically acceptable to achieve a feeling of well-being. The feeling of security that a member of the family was at hand, proved vital for the individuals to dare to attempt the rehabilitation exercises and other everyday activities. Results show that the individuals are uncomfortable with having to be dependent on others. Family members were involved in the rehabilitation process by being on-hand, providing support and generally helping out, all of which can be considered as quite ordinary, yet it was challenging to know when to help in the right way. Unfamiliarity with technical aids and appliances was cause for frustration. Results showed that the elderly individuals and their families alike consider the home environment to be a contributing factor in facilitating the rehabilitation process. However, what made this difficult was when the boundaries for the home were breached by healthcare staff coming and going in and out of one´s own home. Study III shows several aspects of senior care, in everyday life and society in general, that have facilitating or hindering impacts on participation in exercise rehabilitation in the home environment. The results are described according to International Classification of Functioning, Disability and Health (ICF) in 19 categories in the domain of environmental factors. Facilitating factors include access to aids and equipment, a physical environment which enables exercise and support from family members, friends and healthcare practitioners. The results showed the importance of an empathetic approach when healthcare practitioners meet older people in their own home environment. The results indicate that home rehabilitation does not fully meet the rehabilitation needs of the elderly. Study IV describes personal factors such as inner strength, motivation, commitment and willingness to achieve positive results in rehabilitation extending over several years. Rehabilitation is described in physical and psychological phases that evolved into dealing with physical impairment effecting everyday activities. The results showed the importance of adequate information, the importance of social support and accessibility to healthcare professionals during the rehabilitation process. The thesis contributes to an increased understanding of how multidisciplinary teams, the elderly individuals themselves and their families experience rehabilitation in the home environment. The findings in this thesis can contribute to discussions about how home rehabilitation as a form of senior care can be organized in ways to best support elderly individuals in need of rehabilitation and their family members according to their own experiences. This can benefit individual participants and also promote the development of the healthcare profession. This thesis has also demonstrated the possibility to implement the ICF as a tool for describing healthcare needs in rehabilitation nursing.

Background: Aging can bring about an increased risk of disability. Following illness or injures, rehabilitation is essentialif the individual affected is to attain and maintain independence. Performing rehabilitation with a person-centeredapproach is vital for positive outcomes. Health providers are increasingly interested in developing rehabilitation servicesin outpatient settings for older people in their own homes. Aim: The aim of this study was to describe an older man’s rehabilitation experience after a hip replacement surgery.Design: A longitudinal qualitative descriptive single case study.Methods: Interviews were conducted on four occasions with the participant in his own home. The interviews wereconducted one month, seven months, one year, and five years after the patient was discharged from the hospital. The datawere analyzed using qualitative content analysis.Results: Three categories emerged: (i) having feelings of despair, (ii) being in charge, and (iii) having rehabilitative support. The results demonstrate the participant’s decreased ability to walk after a complicated hip surgery, and his physical and psychological struggle for well-being in everyday life. A strong motivation to return to as normal a life aspossible facilitated the rehabilitation. Also, a supportive family and accessible health care professionals were essential tothe positive outcome of the home rehabilitation.Conclusion: Rehabilitation can extend over a long period to maintain and improve mobility. Also, living with a disability causes feelings of despair. The home can be a source of energy but also a place of challenges during rehabilitation. To support older people in achieving their rehabilitation goals and engaging in meaningful activities, professionals should focus on personal factors, psychosocial support and on influential factors in the home environment and in society in general.