Swedish Home Research Articles

EHealth Services in the Near and Distant Future in Swedish Home Care Nursing.

Sweden and other developed countries are putting deliberate efforts into eHealth and digitalization of home care nursing. eHealth services have big potential in this area because they can provide mobile access to healthcare information. This study explores the eHealth services that home care nursing providers in Sweden currently use, plan to use, and have discarded. It also investigates their eHealth visions for the future. We sent a survey to the 264 Swedish municipalities responsible for home care nursing and received 144 responses (55%). The results show a large diversity of eHealth services in use. A few can be considered core services since they are broadly implemented or will be in the near future. Trials are also being carried out with more specialized services. The respondents envision more automation and remote monitoring services, while technical and usability issues are the main obstacles to implementation today. Much knowledge can be gained from proper evaluation of the ongoing work. More research is needed regarding (1) what eHealth can offer home care nursing, (2) the effects of using eHealth in home care nursing, and (3) if and how home care nursing organizations need to adapt to best make use of eHealth.

Aesthetic judgments and meaning-making during cooking in Home and Consumer Studies

In Swedish home and consumer studies (HCS), cooking forms a part of the core content, and students often experience the results in a sensuous way – by eating the food. Sensuous, or aesthetic, experiences may affect students’ meaning-making and thus what is learned within the subject. There is a lack of research concerning the aesthetic aspects of cooking in a learning context; therefore, this study aims to explore HCS students’ meaning-making by focusing on aesthetic judgments during formalized cooking practices. The research question is, in what ways do students use aesthetic judgments in meaning-making processes during cooking? The data comes from video-documented classroom observations where the students cook together. Using a pragmatic approach and practical epistemology analysis (PEA), three ways in which the students use aesthetic judgments are illustrated: as arguments in negotiations, as reference points when reactualizing experiences, and as nonverbal actions evaluating sensory qualities. Empirical examples exemplify how aesthetic judgments play a role in establishing power relations, entail social/normative values, and influence the “tacit knowing” of cooking. The study found that aesthetic experiences are integral and important in students’ meaning-making during cooking practices. Moreover, by adding a new classroom context to the methodology used, its applicability for investigating aesthetic experiences and meaning-making is confirmed and widened.

Evaluation of person-centeredness in nursing homes after a palliative care intervention: pre- and post-test experimental design

BackgroundThe needs of care based on palliative principles are stressed for all people with progressive and/or life-limiting conditions, regardless of age and the place in which care is provided. Person-centred palliative care strives to make the whole person visible and prioritizes the satisfaction of spiritual, existential, social, and psychological needs to the same extent as physical needs. However, person-centred palliative care for older persons in nursing homes seems to be sparse, possibly because staff in nursing homes do not have sufficient knowledge, skills, and training in managing symptoms and other aspects of palliative care.MethodsThis study aimed to evaluate whether an educational intervention had any effect on the staff’s perception of providing person-centred palliative care for older persons in nursing homes. Methods: A knowledge-based palliative care intervention consisting of five 2-h seminars during a 6-month period was implemented at 20 nursing homes in Sweden. In total, 365 staff members were participated, 167 in the intervention group and 198 in the control group. Data were collected using two questionnaires, the Person-centred Care Assessment Tool (P-CAT) and the Person-Centred Climate Questionnaire (PCQ-S), answered before (baseline) and 3 months after (follow-up) the educational intervention was completed. Descriptive, comparative, and univariate logistical regression analyses were performed.ResultsBoth the intervention group and the control group revealed high median scores in all subscales at baseline, except for the subscale amount of organizational and environmental support in the P-CAT. The staff’s high rating level of person-centred care before the intervention provides limited space for further improvements at follow-up.ConclusionThis study shows that staff perceived that managers’ and the organization’s amount of support to them in their everyday work was the only area for improvement in order to maintain person-centred care. The experiences among staff are crucial knowledge in understanding how palliative care can be made person-centred in spite of often limited resources in nursing homes. The dose and intensity of education activities of the intervention model need to be tested in future research to develop the most effective implementation model.Trial registrationNCT02708498. Date of registration 26 February 2016.

Perceptions of self-determination and quality of life among Swedish home care recipients - a\xa0cross-sectional study

BackgroundIt is acknowledged that preservation of self-determination is very important in order for older adults to experience good quality of life, but to what degree and in what areas people receiving help from home care service experience self-determination is unknown. Few studies have examined the perception of self-determination in relation to quality of life among older adults living at home with help from home care services. Thus, the aim of this study was to explore perceptions of self-determination among older adults living at home with the support of home care services, and to test whether older adults who perceive a higher degree of self-determination also feel they have a better quality of life.MethodsThis cross-sectional study was conducted in one municipality in northern Sweden. A total of 134 older adults (≥ 65 years) were included. Data were collected by means of a survey including questionnaires about background characteristics, self-determination, and health-related quality of life. Descriptive statistics regarding background characteristics for groups with high and low self-determination respectively were presented and the differences between the groups were analyzed using the Chi-square test and the Mann-Whitney U test.ResultsOur main finding shows that the majority of older adults with support from home care services experience self-determination in the dimensions use of time, and self-care. However, a wide variation was found in self-reported self-determination in all dimensions. Results also show that the group with higher self-reported self-determination also reported a greater degree of experienced quality of life in comparison with the group with lower self-reported self-determination.ConclusionsIn line with earlier research, our results found a positive relation between self-determination and quality of life. The results are relevant for the care of older adults and indicate a need of further research. The results presented in this paper could serve as a guide when planning for improved self-determination among older adults in home care service.Trial registrationNCT02846246.

Next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: a phenomenographic study.

BackgroundBeing involved in the care of a loved one is a desire of many next of kin. However, according to several studies of the perceptions of nursing home staff, the involvement of next of kin is not an obvious part of care. To be able to involve next of kin in care at nursing homes, the perceptions of what participation means are an important piece of knowledge. The aim of this study was therefore to describe variations in next of kin's perceptions of the meaning of participation in the care of older persons living in nursing homes.MethodsEighteen next of kin of older persons living in ten nursing homes in Sweden were recruited for interviews. The study design was based on a phenomenographic approach, focusing on the qualitatively different ways in which a person perceives, experiences or conceptualises a phenomenon or certain aspect of reality.ResultsFive categories emerged from analysis of the interviews, representing the next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: be present; communicate; monitor; do practical tasks; and to represent. The next of kin expressed meanings that belonged to more than one category, and the categories were interdependent.ConclusionsOur results indicate that there are several meanings of next of kin's perceptions of participation at nursing homes. Nursing home staff's knowledge of these perceptions is important to enable next of kin to participate according to their own preferences.

Relationships between structural and psychological empowerment, mediated by person-centred processes and thriving for nursing home staff

Person-centred care has been shown to have positive outcomes for patients and for staff. However, the complexity of the link between structural conditions, work in a person-centred manner and outcomes for staff is insufficiently described. We tested the relationship between structural empowerment and psychological empowerment, as mediated by nursing home staff members’ self-ratings of working in a person-centred manner, the person-centred climate and thriving. Questionnaires were distributed to staff working in 12 nursing homes in Sweden. A serial mediation model was tested. The results showed that higher access to structural empowerment was related to higher psychological empowerment mediated by staff working in a more person-centred manner, improved person-centred climate, and improved staff ratings of thriving. These results point to the importance of strengthening the preconditions for staff to work in a person-centred manner and nursing home managers play an important role in this.

End-of-life care in a nursing home: Assistant nurses' perspectives.

Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. To describe assistant nurses' perspectives of providing care to older persons at the end of life in a nursing home. Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Seven assistant nurses from a nursing home in Sweden were randomly selected. The research was approved by the local ethics committee. Three main categories emerged; "Death a natural part of life"; "The older person's well-being"; and "Care in the moment of death"; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons' dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development.

Care and creativity: the care worker in Sweden

Loneliness and a loss of hope affect many older people who are living independently. Rosemary Hurtley visited a care home in Sweden that adopted a different care model: staff and residents work together on art projects

Striking a Balance: A Qualitative Study of Next of Kin Participation in the Care of Older Persons in Nursing Homes in Sweden.

Most of the care in nursing homes is palliative in nature, as it is the oldest and the frailest people who live in nursing homes. The aim of this study was to explore next of kin’s experiences of participating in the care of older persons at nursing homes. A qualitative design was used, based on semi-structured interviews with 40 next of kin, and analyzed using qualitative content analysis. An overarching theme emerged, a balancing act consisting of three categories: (1) visiting the nursing home; (2) building and maintaining relationships; and (3) gathering and conveying information. The next of kin have to balance their own responsibility for the older person’s wellbeing by taking part in their care and their need to leave the responsibility to the staff due to critical health conditions. The next of kin wanted to participate in care meetings and conversations, not only in practical issues. The findings indicate the need to improve the next of kin’s participation in the care as an equal partner. Increased knowledge about palliative care and decision-making of limiting life-prolonging treatment may lead to a higher quality of care.

Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services.

IntroductionAn increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs. The staff’s well-being is crucial because it can affect the quality of their work, although literature on job strain among home care staff is limited.AimTo describe perceived job strain among home care staff and to examine correlations between job strain, personal factors, and organizational factors.MethodsThe study applied a cross-sectional survey design. Participants were dementia care specialists who work in home care (n=34) and other home care staff who are not specialized in dementia care (n=35). The Strain in Dementia Care Scale (SDCS) and Creative Climate Questionnaire instruments and demographic variables were used. Descriptive and inferential statistics (including regression modeling) were applied. The regional ethical review board approved the study.ResultsHome care staff perceived job strain – particularly because they could not provide what they perceived to be necessary care. Dementia care specialists ranked job strain higher (m=5.71) than other staff members (m=4.71; p=0.04). Job strain (for total score and for all five SDCS factors) correlated with being a dementia care specialist. Correlations also occurred between job strain for SDCS factor 2 (difficulties understanding and interpreting) and not having Swedish as first language and SDCS factor 5 (lack of recognition) and stagnated organizational climate.ConclusionThe study indicates that home care staff and particularly dementia care specialists perceived high job strain. Future studies are needed to confirm or reject findings from this study.

Moving back to “mamma”? Divorce, intergenerational coresidence, and latent family solidarity in Sweden

AbstractOne of the most obvious consequences of divorce is the moving out of one or both ex‐partners from the formerly common household. Here we focus on a particular postdivorce residential move, the return to the parental home in Sweden, where intergenerational coresidence is uncommon. We ask whether family dissolution increases the likelihood of intergenerational coresidence among separated/divorced individuals who have at least 1 child below age 18. Furthermore, we ask whether the strength of the effect depends on socio‐economic and geographical factors. Our analysis of 670,777 individuals from Swedish population register data shows that even if living with parents is, in absolute terms, not a common intergenerational support strategy, its likelihood increases considerably after a family dissolution. This event increases the probability of living with one's parents especially among men, those with low incomes, and those who live close to their parent(s). We discuss the implications of our findings for the literature on patterns of intergenerational support across Europe.

Psychotropic and anti-dementia treatment in elderly persons with clinical signs of dementia with Lewy bodies: a cross-sectional study in 40 nursing homes in Sweden

BackgroundElderly persons with a dementia diagnosis often suffer from different neuropsychiatric symptoms (NPS) such as delusions, hallucinations, depression, anxiety, irritability and agitation. Currently, the medical treatment for NPS consists mostly of psychotropic medication such as hypnotics/sedatives, anxiolytics and antipsychotics. In elderly persons with dementia, usage of antipsychotics is less appropriate because of the risk of side effects such as parkinsonism, rapid cognitive decline, cerebrovascular events and finally mortality. Furthermore, elderly persons with dementia with Lewy bodies (DLB) are often hypersensitive to antipsychotics with numerous serious adverse events such as somnolence, sedation, extra-pyramidal symptoms, delirium and increased mortality. The aim of this study was to investigate the usage of psychotropics with a focus on antipsychotics and anti-dementia medication (according to the Anatomical Therapeutic Chemical Classification System) in elderly persons with clinical signs of DLB living in dementia nursing homes (NHs) in Sweden.MethodsBetween 2012 and 2013, we applied a specially designed questionnaire that covered the clinical DLB features according to the consensus criteria of DLB. We also collected computerized medical lists from the Swedish National Medication Dispensing System from the same period. All dementia NHs (n = 40) in Malmö, the third largest city in Sweden, were covered. Of 650 eligible residents, 610 (94%) were included with 576 medical lists. The mean age was 86 years and 76% were women.ResultsTreatment with antipsychotics was seen in 22% of residents, hypnotics/sedatives in 41%, antidepressants in 50% and anxiolytics in 58%. We also found an increasing usage of antipsychotics from 25% to 43% in residents with the increasing number of DLB features. Anti-dementia medications were found in 45% of the elderly with a dementia diagnosis. However, residents with two or more DLB features had less anti-dementia medication (37%) than the rest of the dementia-diagnosed NH residents (62–69%).ConclusionsResidents with 2–4 DLB clinical features in Swedish NHs receive an unfavourable medical treatment with high antipsychotic usage and insufficient anti-dementia medication. These findings show the importance of identifying elderly persons with DLB features more effectively and improving the collaboration with nursing care to provide better medical prescription.

Pupils’ Participation in and Response to Sustainable Food Education in Swedish Home and Consumer Studies: A Case-Study

ABSTRACTThe aim of this study is to explore conditioning factors influencing learning opportunities in food-related education taught from a perspective of sustainable development. Over the course of the eighth-grade school year, data were derived from field studies of two classes taught in Home and Consumer Studies with an exploratory case-study design. Data were analyzed using thematic and ideal-type analysis, resulting in four ideal-type portrayals: the Convinced, the Easygoing, the Unable, and the Skeptical, which characterize how pupils participate in and respond to sustainable food education in different ways. The characteristics of each of the four ideal types imply contextual frames that condition unequal learning opportunities in sustainable food education. By identifying, scrutinizing, and accommodating to existing conflicts and related structures, educational policy makers and practicing teachers can increase opportunities for pupils to develop informed reasoning, regardless of their ideal type characteristics.

Towards evidence-based palliative care in nursing homes in Sweden: a qualitative study informed by the organizational readiness to change theory

BackgroundSweden has a policy of supporting older people to live a normal life at home for as long as possible. Therefore, it is often the oldest, most frail people who move into nursing homes. Nursing home staff are expected to meet the existential needs of the residents, yet conversations about death and dying tend to cause emotional strain. This study explores organizational readiness to implement palliative care based on evidence-based guidelines in nursing homes in Sweden. The aim was to identify barriers and facilitators to implementing evidence-based palliative care in nursing homes.MethodsInterviews were carried out with 20 managers from 20 nursing homes in two municipalities who had participated along with staff members in seminars aimed at conveying knowledge and skills of relevance for providing evidence-based palliative care. Two managers responsible for all elderly care in each municipality were also interviewed. The questions were informed by the theory of Organizational Readiness for Change (ORC). ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care.ResultsAnalysis of the data yielded ten factors (i.e., sub-categories) acting as facilitators and/or barriers. Four factors constituted barriers: the staff’s beliefs in their capabilities to face dying residents, their attitudes to changes at work as well as the resources and time required. Five factors functioned as either facilitators or barriers because there was considerable variation with regard to the staff’s competence and confidence, motivation, and attitudes to work in general, as well as the managers’ plans and decisional latitude concerning efforts to develop evidence-based palliative care. Leadership was a facilitator to implementing evidence-based palliative care.ConclusionsThere is a limited organizational readiness to develop evidence-based palliative care as a result of variation in the nursing home staff’s change efficacy and change commitment as well as restrictions in many contextual conditions. There are considerable individual- and organizational-level challenges to achieving evidence-based palliative care in this setting. The educational intervention represents one of many steps towards developing a culture conducive to evidence-based nursing home palliative care.

Prevalence of pain and pharmacological pain treatment among old people in nursing homes in 2007 and 2013

PurposeMany elderly people living in nursing homes experience pain and take analgesic medication. The aim of this study was to analyze the prevalence of pain and pharmacological pain treatment among people living in nursing homes in Sweden, in two large, comparable, samples from 2007 to 2013.MethodsCross-sectional surveys were performed in 2007 and 2013, including all residents in nursing homes in the county of Västerbotten, Sweden. A total of 4933 residents (2814 and 2119 respectively) with a mean age of 84.6 and 85.0 years participated. Of these, 71.1 and 72.4% respectively were cognitively impaired. The survey was completed by the staff members who knew the residents best.ResultsThe prescription of opioids became significantly more common while the use of tramadol decreased significantly. The staff reported that 63.4% in 2007 and 62.3% in 2013 had experienced pain. Of those in pain, 20.2% in 2007 and 16.8% in 2013 received no treatment and 73.4 and 75.0% respectively of those with pain, but no pharmacological treatment, were incorrectly described by the staff as being treated for pain.ConclusionsThere has been a change in the pharmacological analgesic treatment between 2007 and 2013 with less prescribing of tramadol and a greater proportion taking opioids. Nevertheless, undertreatment of pain still occurs and in many cases, staff members believed that the residents were prescribed analgesic treatment when this was not the case.

A Visual Analysis on How the Physical Environment Conditions Relatives’ Involvement in Nursing Homes

This study seeks to describe how the composition of the physical care environment conditions relatives’ involvement in nursing home institutions. It is well known that the physical care environment in institutions has a significant impact on the well-being of residents and the work satisfaction of nursing staff. Less explored is how physical care environmental factors are related to the involvement of relatives in nursing homes. A visual analysis of 52 photographs from three nursing homes in Sweden shows how the physical environment acts to condition the involvement of relatives through the use of design, information displays, and cultural symbols. Although various aspects of the physical environment promoted participation of relatives, that engagement was based on certain limited concepts of involvement. This suggests that other conceptual frameworks of involvement in nursing homes are possible, and that these might encourage other aspects of involvement from the relatives of nursing home residents.

Dysphoric symptoms in relation to other behavioral and psychological symptoms of dementia, among elderly in nursing homes

BackgroundBehavioral and psychological symptoms of dementia (BPSD) are common and varied in the elderly. The aim of the current study was to explore associations between BPSD and dysphoric symptoms at different levels of cognitive impairment.MethodsAssessments of 4397 elderly individuals living in nursing homes in Sweden were performed. Data on cognitive function and BPSD were collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The relationships between dysphoria and eight BPSD factors were plotted against cognitive function to investigate how dysphoria affects BPSD throughout the dementia disease.ResultsOverall, dysphoric symptoms were most prevalent in persons with moderate cognitive impairment. However, moderate to severe dysphoric symptoms showed no clear variation with cognitive impairment. Furthermore, aggressive behavior, verbally disruptive/attention-seeking behavior, hallucinatory symptoms and wandering behavior were more common with concurrent dysphoria regardless of cognitive function. In contrast, passiveness was more common with concurrent dysphoria in mild cognitive impairment but not in moderate to severe cognitive impairment.ConclusionsBPSD, including aggressive behavior and hallucinations, were more common with concurrent dysphoric symptoms, providing insight into behavioral and psychological symptoms among individuals with cognitive impairment. Apathy was more commonly associated with concurrent dysphoria at early stages of cognitive decline but not at later stages, indicating that apathy and dysphoria represent separate syndromes among elderly patients with moderate to severe cognitive impairment.

A psychometric evaluation of the Swedish version of the Research Utilization Questionnaire using a Rasch measurement model.

Evidence-based practice and research utilisation has become a commonly used concept in health care. The Research Utilization Questionnaire (RUQ) has been recognised to be a widely used instrument measuring the perception of research utilisation among nursing staff in clinical practice. Few studies have however analysed the psychometric properties of the RUQ. The aim of this study was to examine the psychometric properties of the Swedish version of the three subscales in RUQ using a Rasch measurement model. This study has a cross-sectional design using a sample of 163 staff (response rate 81%) working in one nursing home in Sweden. Data were collected using the Swedish version of RUQ in 2012. The three subscales Attitudes towards research, Availability of and support for research use and Use of research findings in clinical practice were investigated. Data were analysed using a Rasch measurement model. The results indicate presence of multidimensionality in all subscales. Moreover, internal scale validity and person response validity also provide some less satisfactory results, especially for the subscale Use of research findings. Overall, there seems to be a problem with the negatively worded statements. The findings suggest that clarification and refining of items, including additional psychometric evaluation of the RUQ, are needed before using the instrument in clinical practice and research studies among staff in nursing homes.

Self-esteem in children in joint physical custody and other living arrangements

ObjectivesParental support has been shown to be important for children's self-esteem, which in turn is related to later important life outcomes. Today, an increasing number of children in the Western world spend time in both the parents' respective households after a separation. Children who live with both parents report more parental support than children who live only with one parent after a divorce. We took the opportunity of the commonness of children sharing their time between their parents' homes in Sweden to investigate children's self-esteem in relation to family type. Study design and methodsWith nationally representative survey data (ULF) collected from both parents and children, we analyze differences in children's self-esteem among 4823 10–18 year olds in nuclear families, joint physical custody and those living mostly or only with one parent after a separation using ordinary least squares regression, adjusting for demographic and socioeconomic characteristics. ResultsWe found no significant difference in self-esteem between children who lived equally much with both parents, mostly with one parent and those in nuclear families, whereas children in single care showed lower self-esteem compared with children in the other living arrangements. The difference was not explained by socioeconomic factors. ConclusionThe self-esteem of children who share their time between their parent's respective homes after a separation does not deviate from that in their peers in nuclear families. Instead, those in single care reported lower self-esteem than those in the other living arrangements. These differences were not explained by socioeconomic factors. Longitudinal studies are needed to establish pre- and post-separation family characteristics that influence self-esteem and well-being in young people.

Sexual Health Among Young People Forcibly Placed at Group Homes in Sweden (6:21)

Sexual Health Among Young People Forcibly Placed at Group Homes in Sweden (6:21)