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  • 1.
    Björkman Randström, Kerstin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Hemmet som arena för äldres rehabilitering2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    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.

  • 2.
    Björkman Randström, Kerstin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Svedlund, Marianne
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    "I have to be patient" - A longitudinal case study of an older man's rehabilitation experience after a hip replacement surgery2013In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 8, p. 160-169Article in journal (Refereed)
    Abstract [en]

    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.

  • 3.
    Björkman Randström, Kerstin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Svedlund, Marianne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Impact of environmental factors in home rehabilitation − a qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 9, p. 779-787Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation. Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.

  • 4.
    Björkman Randström, Kerstin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Svedlund, Marianne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Paulson, Margareta
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Activity and participation in home rehabilitation - older people's and family members' perspectives: Meeting abstract2010In: Journal of Clinical Nursing. Suppl 1, Wiley-Blackwell, 2010, Vol. 19, p. 85-85Conference paper (Refereed)
  • 5.
    Björkman Randström, Kerstin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Svedlund, Marianne
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Paulson, Margareta
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Activity and participation in home rehabilitation: Older people's and family members perspectives2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 2, p. 211-216Article in journal (Refereed)
    Abstract [en]

    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.

  • 6.
    Björkman Randström, Kerstin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Wengler, Yvonne
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Svedlund, Marianne
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people2014In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 9, no 1, p. 25-33Article in journal (Refereed)
    Abstract [en]

    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.

  • 7.
    Clifford Lind, Maria
    et al.
    FoU JÄMT; Östersund.
    Björkman Randström, Kerstin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Ledvård vid kontrakturer2016Report (Other academic)
    Abstract [sv]

    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.

  • 8. Nygren, Björn
    et al.
    Björkman Randström, Kerstin
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Lejonklou, Anna-Kerstin
    Lundman, Berit
    Reliability and validity of a Swedish language version of the Resilience Scale2004In: Journal of Nursing Measurement, ISSN 1061-3749, E-ISSN 1945-7049, Vol. 12, no 3, p. 169-178Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to test the reliability and validity of the Swedish language version of the Resilience Scale (RS). Participants were 142 adults between 19–85 years of age. Internal consistency reliability, stability over time, and construct validity were evaluated using Cronbach's alpha, principal components analysis with varimax rotation and correlations with scores on the Sense of Coherence Scale (SOC) and the Rosenberg Self-Esteem Scale (RSE). The mean score on the RS was 142 (SD = 15). The possible scores on the RS range from 25 to 175, and scores higher than 146 are considered high. The test-retest correlation was .78. Correlations with the SOC and the RSE were .41 (p < 0.01) and .37 (p < 0.01), respectively. Personal Assurance and Acceptance of Self and Life emerged as components from the principal components analysis. These findings provide evidence for the reliability and validity of the Swedish language version of the RS.

  • 9.
    Segevall, Cecilia
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Björkman Randström, Kerstin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Söderberg, Siv
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    A spider in a broken web: nurses' views on discharge planning for older patients after hip fracture surgery who live in their own homes in rural areas2018In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 8, no 7Article in journal (Refereed)
    Abstract [en]

    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.

  • 10.
    Segevall, Cecilia
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Söderberg, Siv
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Björkman Randström, Kerstin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    The Journey Toward Taking the Day for Granted Again: The Experiences of Rural Older People's Recovery From Hip Fracture Surgery2019In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 38, no 6, p. 359-366Article in journal (Refereed)
    Abstract [en]

    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.

  • 11.
    Segevall, Cecilia
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Söderberg, Siv
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Björkman Randström, Kerstin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    The journey towards taking the day for granted again - older peoples’ experiences of recovering from a hip fracture in rural areasManuscript (preprint) (Other academic)
  • 12.
    Skoglind-Öhman, Ingegerd
    et al.
    FoU JÄMT; Östersund.
    Björkman Randström, Kerstin
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Uppföljning av projektet Geriatriskt stöd i Regionen Jämtland Härjedalen och kommunerna i Jämtlands län: Olika professioners erfarenheter av samverkan inom projektets ram (2014-2016)2016Report (Other academic)
    Abstract [sv]

    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.

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