Publikationer

 

Mina publikationer i diva

  • How can the experience of being old and suffer from comorbidity challenge our understanding of care
  • Varför vårdvetenskap?
  • The relevance of Merlarleau-Ponty`s philosophy for the understanding of health and health science methodology.
  • "Era delar är min helhet" : En studie om att vara äldre och multisjuk

    Abstract

    Summer Meranius, Martina (2010). “Era delar är min helhet”. En studie om att vara äldre och multisjuk. (You see parts but I am whole. A study of older persons’ experience of multimorbidity).

     

    The overall aim of this thesis is to describe what it means to be old and live with multimorbidity. An additional aim is to examine and describe the contextual meaning of the phenomenon in ordinary housing and nursing homes, and a third aim is to deepen our understanding of the situation for old people who also are ill. The thesis uses a caring science perspective and a reflective lifeworld approach founded on phenomenological philosophy. This approach searches for and describes the meaning of a phenomenon, its variations and its essential meaning structure. Interviews were used for data collection and data were analyzed for meaning, searching for the essence of the phenomenon. The findings are presented in two empirical studies and one philosophical excursion. The empirical studies have been further thematized with the essential meanings from the empirical studies. The philosophical excursion is the result of a more profound understanding of the thematized meanings.

    The essential meaning of being old and living with multimorbidity in ordinary housing is described as a struggle to maintain identity in a life situation that changes. Multimorbidity and aging pose existential barriers at the same time as the possibility of living an independent life and being oneself is hindered. Ordinary housing is experienced as a place where the old can be themselves, and a place that is associated with independence. On the other hand, multimorbidity threatens the possibility of continuing to live in their private homes, as does the failure of others to meet the old as individuals.

    The essential meaning of being old and living with multimorbidity in nursing homes is described as striving for independence which brings with it a zest for life and a feeling of security. The older’s degree of independence can change due to the fragile health situation, and is characterized by the experience of not being a burden for the busy caregivers and relatives. Independence can change to insecurity, vulnerability and helplessness.

    The themes of essential meaning that have been extracted from the empirical studies suggest that the experiences of frailty and loneliness differ more between those living in ordinary housing and in nursing homes than the experiences of trust and independence differ.

    The philosophical excursion illuminates how older people with multimorbidity experience their lives as an ability to manage their daily lives and not merely an absence of disease symptoms. A person is “just” sick, independently of the objective quantity of diseases s/he may suffer from. Health and wellbeing occur from the ability to live in existential coherence, which is encouraged when the older people are allowed to retain their habits, the ability to be oneself, individual’s life story and by social relationships, as well as by continuity among the caregivers.

     

    Key words: ageing, comorbidity, gerontological nursing, nursing homes, older people,ordinary housing, phenomenology

  • Vad kan hälsa vara för multisjuka äldre?
  • Kvalitativ uppföljning av multisjuka äldre

    Kvalitativa uppföljningar av multisjuka äldre är ett nationellt projekt under ledningen av Sveriges Kommuner och Landsting. Projektet syftar till att identifiera systembrister/hinder, hitta systemlösningar som ger den multisjuka äldre bättre vård- och omsorgskvalité. Syftet är även att öka den samhällsekonomiska nyttan av de resurser som finns samlade i vård- och omsorgssystemet kring den multisjuka äldre, samt utvärdera och vidareutveckla metoden för kontinuerlig användning. I projektet har 20 äldre, 11 män och 9 kvinnor med medianålder på 79 år, följts upp med intervjuer, registerdata, journaldata och läkemedelsdata inom slutenvården, öppna specialistvården, primärvården och kommunala omsorgen. Även 13 anhöriga har intervjuats om vården och omsorgen som har berört de äldre.

    Resultatet visar bland annat följande medianvärden under 18 månader för Västmanland: slutenvårdskonsumtion 19,5 dygn; antal akutmottagningsbesök 4. Antal besök hos läkare inom öppna specialistvården 6,5 hos primärvårdsläkare 5 och hos distriktssköterskan 6. Fyra äldre hade även fått hembesök av primärvårdsläkare och åtta av distriktssköterskan. Hälften av de äldre hade hemtjänst och sex i kommunalregi. Den totala redovisade tiden för hemtjänst hade ett medianvärde på 206 timmar medan motsvarande siffra för den totala tiden som redovisades hos kunden var 125 timmar. Troligen berodde detta på att de äldre sade ifrån sig insatsen eller inte utnyttjade den om de till exempel låg på sjukhus. Tretton anhöriga intervjuades varav fyra förvärvsarbetade och nio var pensionerade vid intervjutillfället. Tre av de fyra arbetande anhöriga hade tagit ledigt från sitt arbete för att hjälpa sin anhörig – en, tre och 12 timmar per månad.

    Av läkemedelsgranskningen framgår att äldre använde i snitt 10 läkemedel och de vanligaste läkemedelsrelaterade problemen var otillräcklig effekt, underbehandling, biverkningar samt för hög dos. Vidare framgår av journalläsningen att epikriser ofta kom sent till familjeläkarmottagningar och att de inte alltid var kompletta. Detta ställde till konkreta problem för flera av personerna i undersökningen. Positivt var att endast 20 % av de multisjuka i undersökningsgruppen stod på lugnande medel och/eller sömnmedel (att jämföra med t.ex. 50 % för motsvarande undersökningsgrupp i relativt närliggande Dalarna) och att ingen stod på långverkande bensodiazepin.

    Kostnader för de 20 individerna varierade under 18 månaders period mellan 122 927 kr till 1 034 827kr. Granskningen av fallbeskrivningarna visar att för lite fokus låg på att förstå och agera på äldres grundläggande behov. Däremot låg för mycket fokus på olika insatser, reaktioner på diagnos och uppstådda skador, för lite på symptom och situation. De 12 fallbeskrivningar som redovisas, visar mer i detalj, vilka problem och behov äldre har och hur dessa följs upp i vården och omsorgen.

  • Experiences of Teenagers withUnplanned Pregnanciesin Phetchaburi Province, Thailand

    The purpose of this study is for readers to

    understand the various experiences teenage

    parents endure within the Phetchaburi Province of

    Thailand. Using a qualitative research design, ten (10)

    pregnant teenagers between the ages of 15-19 years old

    were interviewed. A semi-structured, in-depth interview

    was used as the primary means of data collection. In

    addition, data were analyzed using the process of

    manifest content analysis. The four main themes that

    emerged were: (1) circumstances leading to pregnancy

    was due to the failure of contraception and lack of

    knowledge regarding proper sexual education, (2)

    recognition of pregnancy was late because the teenagers

    have neither experienced pregnancy nor did they have

    knowledge of self-monitoring during pregnancy, (3) the

    reactions towards the pregnancies were typically

    negative reactions from girls, boyfriends, and parents (4)

    life changes after the pregnancy were due to the strong

    concerns about dropping out of school and being

    ostracized by the community. The findings implied an

    improvement for healthcare services. For instance,

    teenagers should participate in sexual education classes

    that offer precautionary lessons towards pregnancy.

    Moreover, educational programs (specifically meeting the

    T

    Send correspondence to: Rapeepan Narkbubpha, RN, M.N.S., Phachomklao College of Nursing, Phetchaburi Province 203 Moo 2 Thongchai District,

    Amphoe Muang, Phetchaburi Province, Thailand 76000 Tel+66-8990-86672, Fax+66-3240-0573, E-mail address: rapeepan2549@gmail.com or

    Martina Summer Meranius, RN, PhD. A Senior Lecturer, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna - Västerås,

    Sweden, E-mail address: martina.summer.meranius@mdh.se

    Martina Summer Meranius

    , PhD, RN

    physical and emotional needs of pregnant teenagers)

    should be established so that pregnant teenagers can

    continue their pregnancy without quitting school.

  • KVALITETSREGISTER INOM ÄLDREOMSORG - 10 framgångsfaktorer för lärande och kvalitetsutveckling

    Sammanfattning

    Projektet Kvalitetsregister för lärande och kvalitetsutveckling genom- fördes i samverkan mellan Västerås stad, Eskilstuna kommun och akademin för Hälsa, vård och välfärd Mälardalens högskola inom ramen för Mälardalens Kompetenscentrum för Hälsa och Välfärd.

    Projektets syfte har varit att ta fram och undersöka en modell för kontinuerligt lärande och verksamhets- och kvalitetsutveckling inom kommunal vård och omsorg. Projektet omfattar kvalitetsregister Senior alert och BPSD-registret. Genom litteraturstudier, intervjuer med framgångsrika verksamheter som har använt dessa register, workshop med en expertgrupp med kunskaper om registren samt pilotförsök har en lärmodell utvecklats och prövats. Lärmodellen består av 10 framgångsfaktorer.

    •   Ledarskap

    •   Teamarbete

    •   Ansvar

    •   Personcentrerad vård/omsorg

    •   Värdegrund

    •   Stödjande strukturer

    •   Reflekterande kommunikation

    •   Målbild

    •   Kunskap om nuläget

    •   Resultat och uppföljning

      Lärdomar av projektet är att organisationer behöver arbeta strategiskt och ta vara på sina egna framgångsrika verksamheter genom att skapa förutsättningar för lärande. Organisationer behöver skapa och behålla sina egna ”stödjande strukturer” för att stödja kvalitets- utveckling inom verksamheterna och på alla nivåer inom organisationen. Genom införandet av kvalitetsregister har kunskaps- behovet om preventivt arbetssätt och förbättringskunskap blivit tydligt. Verksamheter behöver ta vara på den kunskap som erbjuds via olika aktörer som arbetar med kvalitetsutveckling inom äldre- omsorgen, men utbildningsansvaret kan inte i längden, ligga på de enskilda verksamheterna. Aktörer för utbildning, vård och omsorg behöver diskutera hur kunskaper hos undersköterskorna kan in- hämtas. Utbildningsaktörer behöver ta sitt ansvar och organisationer behöver ge stöd till sina verksamheter för att arbeta preventivt utifrån kvalitetsregister.

      Projektets resultat visar tydligt vilka omfattande ansträngningar chefer lägger på att driva arbetet med kvalitetsregister. Det är därför viktigt att organisationer skapar lämpliga styrmedel för att belöna och uppmuntra ett långsiktigt hållbart arbete med att bedriva hög- kvalitativ och patientsäker vård och omsorg inom den kommunala vården och omsorgen. 

  • Health and social care management of older people with multimorbidity. A holistic approach
  • Health and social care management of older people with multimorbidity : A holistic approach
  • How does the healthcare system affect medication self-management among older adults with multimorbidity?
  • Experience of self-management of medications among older people with multimorbidity

    Aims and objectives. To explore the experience of self-managing medication among older people with multimorbidity. Background. Older people with multimorbidity are now more likely to live at home and to self-medicate. Reduced assistance from professional caregivers is associated with medical errors. Design. Face-to-face interviews were conducted with older people with multimorbidity. Methods. Participants aged >= 75 years with >= 2 medical diagnoses and living at home or in special accommodation were interviewed. Twenty-eight men and women (mean age 84 years) participated. Interviews lasted from 45 minutes-2 hours and were transcribed verbatim. A lifeworld-based phenomenological method was used for analysis. Results. Uncertainty among the participants increased with their experience of side effects and concern that the medication might be harmful. These uncertainties were reinforced by a fear of malpractice when several physicians were involved. This meant living with ambivalence when taking the medication, which required a trade-off between symptom relief and reducing side effects. A lack of continuity with physicians and nurses led to uncertainty in maintaining an overview of the medications. By contrast, when the relationships were supportive and caring, the uncertainties diminished. Four concepts were used to describe the various meanings of this experience: adapting to a new lifestyle; ambivalence towards medicine; experience of side effects and concerns about medical errors; and relationships as sources of feeling secure. Conclusions. Medications can cause side effects, and unclear benefits increase the uncertainty for older people with multimorbidity. Health care professionals need to develop an understanding of each patient's experience of such uncertainty. Relevance to clinical practice. Health care professionals can give support and show understanding for older people's existential uncertainty by creating good relationships and continuity in care, and offering appropriate information. Regular visits should be scheduled to manage any problems patients might have when self-medicating.

  • HOW DOES THE HEALTH-CARE SYSTEM AFFECT MEDICATION SELF-MANAGEMENT AMONG OLDER ADULTS WITH MULTIMORBIDITY?
  • Ethical aspects of caregivers' experience with persons with dementia at mealtimes

    Background:

    Persons with dementia are at risk of malnutrition and thus in need of assistance during mealtimes. Research suggest interventions for caregivers to learn how to facilitate mealtimes and eating, while other suggest a working environment enabling the encounter needed to provide high-quality care. However, the phenomenon of caring for this unique population needs to be elucidated from several perspectives before suggesting suitable implications that ensure their optimal health.

    OBJECTIVES: 

    To illustrate the meanings within caregivers' experiences of caring for persons with dementia during mealtime situations. We also measured weight and food intake among individuals with dementia to explain better the phenomenon of caring for them during mealtimes.

    METHODS: 

    Mixed method including focus group interviews with seven caregivers analyzed using phenomenological hermeneutics. In addition, for nine persons with dementia, weight and food intake were collected and descriptive statistics were calculated.

    ETHICAL CONSIDERATIONS: 

    Ethical review was obtained from an ethics committee, and all caregivers signed a consent form after being informed on the issue of research ethics. Relatives for persons with dementia were informed and signed the consent. In addition, throughout the study, the persons' expressions were observed aiming to respect their vulnerability, integrity, and dignity.

    FINDINGS: 

    One theme emerged from interviews (struggling between having the knowledge and not the opportunity), which was built upon three subthemes (being engaged and trying; feeling abandoned and insufficient; being concerned and feeling guilty). Seven of nine persons with dementia lost a minimum of 1.3 kg of weight and ate a maximum of 49.7% of the food served.

    CONCLUSION: 

    Caregivers struggle because they have knowledge about how to provide high-quality care but are unable to provide this care due to organizational structures. The weight loss and insufficient eating among the persons with dementia may support this conclusion. Sufficient time for adequate care should be provided.

  • How does the healthcare system affect medication self-management among older adults with multimorbidity?

    Individuals with multimorbidity commonly have several concurrent prescriptions and experience healthcare obstacles related to managing different diagnoses and medications. This study aimed to provide a deeper understanding of how older adults with multimorbidity experience medication self-management and how this is affected by the healthcare system. The National Board of Research Ethics approved the study, and 20 older adults with multimorbidity participated in in-depth interviews that were analysed using a hermeneutic approach. Three levels of interpretation emerged. At the first level, lack of participation in healthcare communication hinders adherence and safety, and feeling abandoned to self-care leads to health risk-taking. At the second level, the healthcare organisation is seen as an obstacle to medication self-management. The overall interpretation was a system of repairing ‘parts’ but not enabling the experience of health. This study shows that the healthcare system is able to treat and relieve an individual's symptoms, but seems unable to help them achieve and promote good health, or to provide the support they need to function in everyday life.

  • Health and social care management for older adults with multimorbidity: a multiperspective approach.

    Multimorbidity, a condition common among older adults, may be regarded as a failure of a complex system. The aim of this study was to describe the core components in health and social care management for older adults with multimorbidity. A cross-sectional design included two methods: individual interviews and group discussions. A total of 105 participants included older adults with multimorbidity and their relatives, care staff and healthcare policymakers. Data were analysed using content analysis. The results show that seven core components comprise a multiperspective view of health and social care management for older adults with multimorbidity: political steering, leadership, cooperation, competence, support for relatives, availability and continuity. Steps should be taken to ensure that every older adult with multimorbidity has a treatment plan according to a multiperspective view to prevent fragmentation of their health care. This study provides relevant evidence developing a multiperspective model of health and social care management for older adults with multimorbidity.

  • The care of and communication with older people from the perspective of student nurses. A mixed method study

    Background Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people. Objective The aim of this study was to investigate student nurses' views on the care of and communication with older people. Design A descriptive study with a mixed-method approach was conducted. Methods Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015. Results The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites. Conclusions Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed.

  • Complexity in Daily Living of Older Adults with Multimorbidity : Health, Social and Informal Care Utilization and Costs

    Aim: The aim of the study was to describe health, social and informal care utilization and costs for older adults with multimorbidity. The design was descriptive and retrospective.

    Methods: The setting was a medium-sized town in an urban area of Sweden and included 10 health centers. Data were collected during 2011 using individual, structured interviews with the informal carers of 20 older adults with multimorbidity. Retrospectively, for a period of 18 months, data were also collected from the older adults’ patient registers and records, as data regarding the costs of their health and social care, in- and out-patient care and municipal care including home services.

    Results: The primary result was that older adults with multimorbidity utilize health and social care from different principals, through different contacts. The results also provide insight into the complexity of these older adults’ daily living. Their 18-month health and social care costs varied between 12,084 and 137,187 Euros. For 12 older adults who utilized informal care, their calculated costs varied between 2,092 and 70,590 Euros.

    Conclusion: The conclusion is that the increasing number of older adults with multimorbidity and their health and social care utilization and costs should be taken into account in healthcare policy and the organization of health and social care.

  • Extended Support to increase Quality of Life in Spouse Caregivers of Older Adults with Dementia. A pilot study
  • Management Practices Promoting Sustained Implementation of the Quality Register Senior Alert for Older Adults in Municipal Care in Sweden

    Background:

    Senior Alert is a national quality register aimed at supporting a standardized, structured, and systematic preventive care process foradults aged 65 and over in the areas malnutrition, pressure ulcers, falls, problems with oral health and bladder dysfunction. Therefore, the quality register is particularly suitable for older adults with multimorbidity.

    Aim:

    The aim was to describe management practices that contributed to the sustained implementation of the quality register Senior Alert in municipal elderly care in Sweden.

    Methods:

    The design of this pilot study was descriptive and inductive. The sample of n = 12 included managers (n = 7) and care staff (n = 5) at seven municipal care homes for older adults in Sweden. The study was performed between April 2014 and June 2014 using two methods: Individual interviews and nonparticipant unstructured observations. Data were analyzed using qualitative content analysis.

    Results:

    The analysis led to the following generic categories: leading teamwork, leading a preventive care process and leading a supportive organizational structure, and to one main category: management promoting learning and quality improvement.

    Conclusion:

    To be sustainable, Senior Alert implementations in municipal elderly care need management. Management, by leading teamwork, a preventive care process and a supportive organizational structure, is essential for achieving learning and quality improvement.

  • That mr. Alzheimer… you never know what he’s up to, but what about me? A discourse analysis of how Swedish spouse caregivers can make their subject positions understandable and meaningful

    The spouses of people suffering from dementia are commonly first-in-line caregivers. This canhave a considerable effect on their own lives, health and marriages. Several studies havefocused on spouses’experiences, but very few have focused in any depth on their descrip-tions of themselves as subjects. Therefore, the aim of this study is to describe how spousecaregivers can express themselves when living with and caring for their partners withdementia. The study has a qualitative approach with a discourse analysis design and usesanalytical tools such as rhetoric, subject positions and categorization. The results reveal threesubject positions: as an actor, as a parent and as a survivor. The results show that as spousesstruggle with external and internal clashes as subjects, they therefore need to develop copingstrategies. They also experience pronounced loneliness and a risk to their own health. There isthus a need to support these spouses as individuals in their differing and changing needs.

  • "Same same or different?" A review of reviews of person-centered and patient-centered care

    Objective: To provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts. Methods: A synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis. Results: The analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life. Conclusions: While there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals. Practice implications: Clarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.