Swedish Home Research Articles

Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results

BackgroundFall-related injuries affect the lives of elderly to a substantial degree. This quasi-experimental study investigates the fall-injury reducing effect of impact absorbing flooring among female nursing home residents.MethodsThe intervention site...

Experiences and Views of the Discharge Planning Process Among Swedish District Nurses and Home Care Organizers

Discharge planning is an important care process, but deficits in planning are common. The aim of this study was to explore district nurses’ (DNs) and home care organizers’ (HCOs) experiences and views of the workflow during the discharge planning process (DPP). Demands, workload, time, collaboration, and engagement, together with knowledge and professional confidence, are factors that influence workflow and outcome of the DPP for DNs and HCOs. Strengths and obstacles at the organization, group, and individual levels affect the workflow during the discharge planning. Knowledge of these strengths and obstacles should help care providers in their practice as well as help management and politicians become more aware of prerequisites needed to achieve a safe and efficient workflow for securing the patient’s discharge.

Injuries sustained during snow removal from roofs resulting in hospital care

Clearing snow from roofs causes serious injuries annually. The aim of this study was to describe injury mechanisms, injury panorama, and injury incidence in connection to this activity. A specific aim was to study the association between snow depth and injury incidence. A total of 95 people were injured during four study periods. The risk of injury is strongly associated with snow depth, and the incidence varied up to 10-fold between the studied winter seasons. The majority of injuries (91; 96%) occurred during leisure time and only four people were injured in the occupational setting. The most common injury mechanism was falling off roofs or ladders of residential homes. Nearly 60% sustained moderate or serious injuries (Maximum Abbreviated Injury Scale [MAIS] 2–3), and fractures accounted for almost half of all injuries. Because roofs of single-family homes in Sweden usually do not require snow removal for heavy snow loads, these injuries may have been both unnecessary and avoidable. Further education is required to advise the public on the risks associated with snow removal from roofs.

First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care.

The aim of this study was to investigate first-line nursing home managers’ views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care.Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes.The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.

The nutritional situation in Swedish nursing homes – A longitudinal study

Poor nutritional status is widespread among the elderly and is associated with increased morbidity and mortality. The aim of this study was to longitudinally describe the nutritional status in elderly people living in nursing homes. Nutritional status was recorded longitudinally in elderly people living in 11 different nursing homes in Sweden. Participants were examined at baseline by specially trained nurses who also assisted with questionnaires and collected data for current medical treatment from patient records. Nutritional status was evaluated at baseline and after 24 months with the mini nutritional assessment (MNA). The study included 318 subjects. The mean age of the participants was 85.0 years (range 65–101). At baseline, 41.6% were well nourished, 40.3% at risk of malnutrition, and 17.7% malnourished according to the MNA. Survival was significantly lower in the malnourished group. After 24 months, almost half of the population had died. The group of participants who survived at 24 months represents a population of better nutritional state, where 10.6% were malnourished at baseline increasing to 24.6% after 24 months. After 24 months, 38.7% of the participants showed a decline in nutritional state. The group with deteriorating MNA scores had higher weight, BMI values, and a higher hospitalization rate. The prevalence of malnutrition in nursing home residents increased over time and it is important to evaluate nutritional state regularly. Nutritional interventions should be considered in better nourished groups, as well as in malnourished individuals, to prevent a decline in nutritional state.

Low health related quality of life (QoL) in older adults is associated with chronic pain in women and with disturbed sleep in men

In this issue of the Scandinavian Journal of Pain Lena Sandin ranker and co-workers [1] describe part of a survey of health nd quality of life in older adult citizens living at home or in a nursng home in Sweden – the Swedish National Study on Ageing and are (SNAC-Blekinge). Their sample comprised 1402 persons aged 0–96 years, of whom 769 (55%) reported pain. Thus, they conrm that there is a high prevalence of chronic pain in the Nordic ountries and that pain is more frequent in females than in males 2–5]. This difference is present from puberty and it increases with ge, markedly so in the older adults (Fig. 1).

Making Each Other's Daily Life: Nurse Assistants' Experiences and Knowledge on Developing a Meaningful Daily Life in Nursing Homes.

Background:In a larger action research project, guidelines were generated for how a meaningful daily life could be developed for older persons. In this study, we focused on the nurse assistants’ (NAs) perspectives, as their knowledge is essential for a well-functioning team and quality of care. The aim was to learn from NAs’ experiences and knowledge about how to develop a meaningful daily life for older persons in nursing homes and the meaning NAs ascribe to their work.Methods:The project is based on Participatory and Appreciative Action and Reflection. Data were generated through interviews, participating observations and informal conversations with 27 NAs working in nursing homes in Sweden, and a thematic analysis was used.Result:NAs developed a meaningful daily life by sensing and finding the “right” way of being (Theme 1). They sense and read the older person in order to judge how the person was feeling (Theme 2). They adapt to the older person (Theme 3) and share their daily life (Theme 4). NAs use emotional involvement to develop a meaningful daily life for the older person and meaning in their own work (Theme 5), ultimately making each other’s daily lives meaningful.Conclusion:It was obvious that NAs based the development of a meaningful daily life on different forms of knowledge: the oreticaland practical knowledge, and practical wisdom, all of which are intertwined. These results could be used within the team to constitute a meaningful daily life for older persons in nursing homes.

Staff experiences of participation in everyday life of older people with intellectual disability who live in group homes

<span>This article aims to explore ways in which members of staff in group homes for people with intellectual disability experience participation, and what participation means for older people with intellectual disability. Qualitative interviews were performed with 15 members of staff at group homes in Sweden. The findings of this study are illustrated by considering two interacting themes and six subthemes. These involve staff experiences of the meaning of participation and factors which facilitate or inhibit it. The meaning of participation was expressed as doing and feeling. Staff described that participation for older people with intellectual disability was influenced by the individual characteristics of the residents, such as the relationship between age and disability. They also expressed the view that participation was influenced by organizational and physical contextual factors such as economics, time and space as well as the social environment. The latter included staff knowledge and skills, family and peers.</span>

The Role of Food Selection in Swedish Home Economics: The Educational Visions and Cultural Meaning

This article explores foods talked about and chosen in the education of Swedish Home Economics as a relationship between structural processes and agency. Three data sets from observations and focus group interviews with teachers and students were analyzed for food classifications. These were related to a culinary triangle of contradictions, showing factors of identity, convenience and responsibility. Results show that foods talked about and chosen by teachers and students were reflections of dominant cultural values. Results also indicate that teachers had more agency than students, but that the choices they made were framed by educational visions and cultural values.

Taking a shower

This article focuses on an activity routinely carried out in elderly care: taking a shower. The care setting is two nursing homes in Sweden hosting elderly people with dementia. The data consist of transcriptions of three caregivers’ interaction with their residents prior to, and during the performance of the shower task. While the shower routinely is rejected by the care recipient in these settings, the article demonstrates alternative ways of performing the task that are less imposing for the elderly person and that may maintain the care recipient’s dignity and sense of autonomy. The way opposition occurs during the course of the activity depends on how the care worker frames the performance of the task. When physical action is embedded and aligned with the care recipient’s concerns, the washing of the body progresses more smoothly. The article highlights the importance of allowing the care recipient to feel that her priorities form the basis for how the activity should proceed. The implications of this study for the care system are discussed in terms of providing opportunities for caregivers and elderly persons to build relationships of mutual trust and support.

See the error of your ways: Belligerent expertise and the curative power of ‘tough love’

This article examines a particular form of popular expertise, one that uses aggressive, face-threatening confrontations as a means of achieving its goals. The specific case under scrutiny is the Swedish home renovation programme The Angry Carpenter (Sw: Arga snickaren), here considered as an instance of what has been labelled belligerent broadcasting. The analysis demonstrates that belligerent outbursts and emotional displays serve essential, but varying functions in the construction of the host’s expertise. Belligerence is both a method to achieve epistemic status and for the enactment of expertise. Paradoxically, through his belligerence the host promotes a common-sense theory of good communication. A key lesson to be learned from programmes like this is the curative power of ‘tough love’. When nothing else works, belligerence is justified as a method for diagnosing problems, dealing with personal difficulties and restoring healthy households.

Autonomy and Control in Everyday Life in Care of Older People in Nursing Homes

Self-control and autonomy are not guaranteed when people age and are in need of help from others, especially in institution-based housing. This occurs despite the fact that it is a generally accepted belief that care should be delivered with the greatest possible degree of independence and autonomy. This article discusses older people's experiences with and the opportunities for autonomy in institution-based housing. Through focus group interviews and observations, the daily lives of residents at two nursing homes in Sweden were studied through a comparative approach using the theoretical framework of organizational culture. Three themes emerged showing how autonomy was not a reality for the residents. The first theme revealed an ambivalent mission, indicating ambiguity as to whether the nursing home was a place to live in or a place in which to be cared for. The second theme was symbolic power, which encompassed the staff's power embedded in the organization. The third theme was the ageist approach to care, which was noted in the way staff considered the residents to be old people who were unable and unwilling to strive for autonomy. The three themes were embedded in the organizational culture and were created and recreated in the interaction between residents and staff. A key question for further research is how to change the culture to strengthen the residents’ autonomy.

A Think Piece : Consumer Education for a Sustainable Society, Swedish Home and Consumer Studies as an Example

A Think Piece : Consumer Education for a Sustainable Society, Swedish Home and Consumer Studies as an Example

The importance of leadership style and psychosocial work environment to staff-assessed quality of care: implications for home help services

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross-sectional survey design was used and a total of 469 questionnaires were distributed (March-April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.

Prevalence and treatment of heart failure in Swedish nursing homes

BackgroundSince the burden of care for elderly patients with heart failure (HF) can be decreased by therapeutic measures, it is important that such patients are identified correctly. This study explores the prevalence of HF in nursing homes in Sweden, with special consideration of the risk of failure to diagnose HF in the study population. A second aim is to explore medication and the adherence to guidelines for the treatment of HF.Methods429 patients from 11 nursing homes were included during 2008–2011. Information about diagnoses and medications from patient records, blood samples, questionnaire responses and blood pressure measurements were collected. The baseline characteristics of the patients, their medications and one-year mortality were identified and then compared regarding HF diagnosis and B-type natriuretic peptide (BNP) levels. A BNP level of >100 ng/L was used to identify potential cases of HF.ResultsThe point prevalence of HF diagnosis in the medical records in the study population was 15.4%. With the recommended cut-off value for BNP, up to 196 subjects in the study population (45.7%) qualified for further screening of potential HF.The subjects in the HF and non-HF groups were similar with the exception of mean age, BNP levels and Mini Mental State Examination results which were higher in the HF group, and the eGFR and blood pressure, which were lower when HF. The subjects with higher BNP values were older and had lower eGFR, Hb, diastolic blood pressure and BMI. The subjects with HF diagnoses were in many cases not treated according to the guidelines. Loop diuretics were often used without concomitant ACE inhibitors or angiotensin receptor blockers. The subjects without HF diagnoses in the medical records at inclusion but with BNP values >100 ng/L had less appropriate HF medication. The one-year mortality was 52.9% in the population with HF.ConclusionsOur study suggests that the estimated prevalence of HF in nursing homes in Sweden would increase if BNP measurements were used to select patients for further examinations. The pharmacological treatment of HF varied substantially, as did adherence to guidelines.

The Swedish municipal food distribution service to the elderly living at home as experienced by the recipient's relatives.

The municipal Food distribution service (FD) to the elderly living at home is a part of the public social and care service in Sweden, The objective of this service is to ensure proper food intake for persons who are unable to do their own shopping, and prepare their own meals. The foremost reasons for the need of the FD service are in situations where there are illness related physical or psychological limitations. This means that the Swedish welfare system takes on the responsibility for its citizens when they have a legal social related need of care. Further, according to the Swedish social legislation, children or other relatives have no legal obligations to take care of their parents or elderly disabled relatives. This also means that the children or relatives of elderly people requiring social support have no legal right to be involved in the evaluation procedure of need assessment or the outcome of any social and care services granted by the Swedish social welfare system.The aim of the present study was to gain insight into how the relatives of elderly people living at home in Sweden experience the municipal service of ready-made meals distributed daily.The data was collected using in-depth interviews with relatives of elderly persons who use the municipal food distribution (FD) service (n=8). The transcribed interview material was analysed using the grounded theory method.The findings of this study revealed that the relatives of the municipal FD service recipients advocate for a food preparation service in the home of the recipient rather than the distribution of ready-made meals from a central kitchen. The results also revealed that the participating relatives felt frustrated by the legal limitations that make it impossible for them to influence the municipal FD service. The findings in this study also indicate that relatives should be considered as a resource in this matter and could actively participate, and have a positive influence on the quality of the municipal FD service for the elderly. The results of the study could have implications for nursing, public administration and gerontology.

International Expansion through Flexible Replication: Rethinking the Propositions

The international expansion of businesses today invites the analysis of organizational mechanisms that allow these businesses to thrive in spite of the known challenges of doing business in a foreign culture or market. Specifically, the extent to which firms replicate their existing business models relative to the perceived need for local adaptation is topical. This article is a commentary on the brilliant work of Anna Jonsson and Nicolai Foss, who outline a model of flexible replication, drawing from a longitudinal study of IKEA, the famous Swedish home furnishing company. Their study concludes with four propositions for further investigation. For the purpose of developing robust managerial applications, they recommend comparative case studies based on the four propositions. We provide a basis for questioning one of the key propositions, and offer an alternative proposition in an attempt to build a stronger foundation for further inquiry into the mechanisms of flexible replication.

Practical conditions for Home and Consumer Studies in Swedish compulsory education: a survey study

AbstractThe aim of the study was to map the field of internal and external conditions that Swedish Home and Consumer Studies teachers and pupils have contend with. A questionnaire was constructed and delivered online in November 2010. It contained 27 question covering teacher qualification, quality of premises and equipment, lesson time and collaboration, and the use of national syllabi. A total of 385 persons across the country answered the questionnaire; about 21% of those teaching Home and Consumer Studies in Swedish compulsory school during the school year 2009–2010. These respondents taught in a total of 392 compulsory schools, which equalled about 22% of the schools teaching grades 7–9 in Sweden. Almost a quarter (23%) of the teachers lacked formal training for Home and Consumer Studies. Respondents without an appropriate degree qualification included those trained as nursery school teachers, dietitians and civil engineers. As regards classrooms, while 88% of respondents reported access to fully equipped kitchens with stoves, sinks and work surfaces, 5% used regular classrooms and the remainder were obliged to come up with alternative solutions, such as using portable kitchens in regular classrooms or conducting their lessons in the school restaurant. This study raises many questions about the quality of Home and Consumer Studies provision in a number of schools. The local deficiencies in the nationally decided frame factors for Home and Consumer Studies found by the present study gives us reason to doubt that all pupils achieve the overall learning goals of ‘knowing in practice’ and making informed choices utilizing environmental, economic and health perspectives. This might affect the health and economy of the individuals in the long run, with implications for the national economy and public health. On the basis of these findings, we therefore recommend that current conditions for Home and Consumer Studies and how the subject should operate in schools become a focus for national debate.

Cost-benefit analyses of sprinklers in nursing homes for elderly

The risk of dying in fires in nursing homes is six times the risk of dying in fires at home in Sweden. One way to reduce this risk is to install fire sprinklers. This study measures the benefits using value of full lives, life years and quality adjusted life years (QALYs) for deaths and injuries. The results show that sprinklers are cost-effective in newly built nursing homes no matter what value of life is used. However, if sprinklers are installed in already existing buildings, they are cost-effective only if the value of a statistical life is used.

How the professionals can identify needs for improve- ment and improve Food Distribution service for the home-living elderly people in Sweden - an action research project

Background: Making changes to municipal social care and service has been found to be challenging to realise and highly multifaceted. The aim of this study was to describe how the professionals can identify needs for improvement and improve Food Distribution (FD) service for the home-living elderly people in Sweden. Methods: This study is part of a larger project with an action research approach focusing on to municipal FD to older people living in their own home in Sweden. The professionals involved in FD invited the first author to assist them in this process. The study participants were comprised of the following groups: “The Identification focus group” that identified need for improvement of FD (n= 5); “The Action focus group” that planned and choose suitable ‘action’ for improvement (n=5); “The First Evaluation group” (n=4) that evaluated the content of planned improvement and finally “The Second Evaluation group” (n=29) that evaluated the changes following improvement. The data was gathered and analysed by Story Dialogue Method. Results: The need to update and increase the FD recipient’s knowledge in nutrition by sending them informative letters was found to be an important area to focus on. The information letters (n=1700) were distributed to the all FD recipients in six municipalities in southern Sweden during April 2011. The results were evaluated during May 2011. The overall general estimation was that the content of the letters indicated that this was a suitable method for gaining information to make a nutrition competence update. Following this, “The Action focus group” decided: firstly, to continue preparing and distributing information letters to all FD recipients to be sent out twice a year, and secondly: to make the information letters accessible on the websites of the six municipalities and county councils involved. Conclusions: This study showed that systematic work inspired by an action research approach with motivated and involved participants can be beneficial and a starting point for the process of change in municipal service and care practice. The major conclusion of the study was that systematic reflection over everyday practice can be the vehicle for the future change of practice. The research process and the findings have implications for nursing, care of the elderly and gerontology.