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Biomedical subjects

I R Hallberg

Publications and source records attributed to I R Hallberg.

70 records · Page 4Linked to original sources
PubMed1993

Identifying and defining abuse of elderly people, as seen by witnesses.

The aim of this study was to analyse how Swedish district nurses defined and identified abuse of elderly people in practice. Twenty-one district nurses were interviewed by means of open-ended questions and their responses were analysed qualitatively. The main findings related to a central theme 'overriding the boundaries of a person's integrity/autonomy' and four categories; the act of abuse, the relationship between the abused person and the perpetrator, the experience of the abused person and the intention of the perpetrator. The reasoning of the district nurses focused on these issues. The district nurses included various aspects in the process of identifying abuse of elderly people and the findings demonstrate the complexity of the practitioner's situation. This seems logical since such abuse is complex and involves many aspects, which makes the diagnostic process difficult. The findings may be useful for nurses when they assess and intervene in abuse of elderly people. Thus, the significance of this study is mainly practical.

Adult↗
PubMed1993

Strain among nurses and their emotional reactions during 1 year of systematic clinical supervision combined with the implementation of individualized care in dementia nursing.

This study aimed at exploring nurses' views of the characteristics of severely demented patients, the difficulties these characteristics produced and the emotional reactions they evoked during the provision of care. Also, it aimed at exploring any changes in these aspects during a year of regular systematic clinical supervision combined with the implementation of individualized care at an experimental ward (EW) (n = 19) and at a control ward (CW) (n = 19). Data were collected by means of the Strain in Nursing Care scale, assessing the presence of certain characteristics in the patients, and how difficult each characteristic can be to handle. The Emotional Reactions in Nursing Care scale was also used, assessing 18 pairs of emotions. The analysis showed that agitation, not being responsive and unruly behaviour were the most common features while emptiness and agony turned out to be the most difficult problems to handle in the provision of care. Feelings of defeat and dissociation were reported to be almost as common as feelings of control and association. The EW nurses saw the patients as significantly more responsive, and victims of nihilation to a lesser degree and also patients' willfulness and emptiness was significantly easier to handle during the year of intervention. There were no significant changes on the CW. The mean values improved significantly in several aspects on the EW in comparison to the CW; patients seen as victims of nihilation, easier to handle agony, obediency, willfulness, evaluation and improved feelings of devotion and beneficence in the nurses. Thus the intervention seemed to improve the nurse-patient relationship and to decrease the experience of strain in the nurses.

Adaptation, Psychological↗
PubMed1993

Nurse turnover with special reference to factors relating to nursing itself.

Nurse turnover may decrease the quality of nursing care due to the loss of knowledge. It also results in high costs for the employer. Hence, the factors contributing to nurse turnover, if correctly understood, are important in order to know how to reduce it. This study aimed at exploring what contributing factors nurses who had decided to leave referred to concerning their decision to resign. A questionnaire was posted to all nurses who had left within one county council and 142 nurses responded. The most important factors behind the decision to leave turned out to be the following: difficult to implement changes, lack of influence and recognition, to much weekend and evening duty as well as the psychological burden inherent in nursing. The importance of the first three factors became significantly more important when those who remained in the geographical area were compared with those who moved or started to study. The findings support the idea that job satisfaction indirectly influences nurses turnover. However, it also points to the fact that what increases job satisfaction in nursing may need further research. Psychological burden for instance has not been taken into consideration before. In order to increase job satisfaction, thereby reducing nurse turnover, influence and recognition, lessening of the psychological burden and individually planned work schedules seem to be the most important factors.

Decision Making↗
PubMed1993

Patterns of abuse of the elderly in their own homes as reported by district nurses.

This study aimed at describing patterns of abuse of elderly persons living in their homes as experienced by district nurses in a county of Sweden. 12% of the district nurses (n = 153) reported 30 cases. Those abused were 78.7 years old (mean) and half of them had disturbed memory and mental state and were mostly isolated. The abuser was a relative of the abused person and 64.2 years old (mean). Psychological abuse was the most frequently reported kind of abuse. Along with the abuse the abusers' behaviour was commonly experienced as unpleasant and aggressive and/or combined with family conflicts. The results indicated that abuse is very much a family affair. To guide district nurses in a family-oriented approach is justified by the results. It also seems important further to investigate the pattern of how the different types of abuse occur.

Aged↗
PubMed1993

Experienced and skilled nurses' narratives of situations where caring action made a difference to the patient.

Forty-five skilled and experienced nurses working at long-term, medical and surgical care clinics narrated 88 caring situations. The aim of the study was to interpret these narratives concerning the nurses' caring actions and the type of situations where they experienced that their caring made a difference to the patient. There were eight types of caring actions that were then condensed into three interaction and intervention approaches; 1) deliberate distanced interaction and intervention with the patient; 2) deliberate providing of prerequisites for interaction and intervention with the patient; and 3) deliberate deep interaction with the patient when intervening. These approaches were used when the nurses dealt with the following three types of caring situations: caring focusing on the nurse-patient relationship, on medical intervention, and on practical problem solving. The first two approaches occurred in situations focusing on acute medical intervention and on practical problem solving. All approaches occurred in situations focusing on the nurse-patient relationship. The finding that experienced and skilled nurses described situations where the depth of their contact with the patient varied can be expressed in the phrase "how I act depends on the situation." The skill to find the right level of involvement seems important.

Adult↗
PubMed1993

Experienced nurses' narratives of their being in ethically difficult care situations. The problem to act in accordance with one's ethical reasoning and feelings.

In previous interviews, experienced nurses have reported that their decisions in ethical matters depended "on the situation at hand." We interviewed 18 good, experienced cancer nurses to determine how they handled ethical decisions. They were asked to give an account of difficult situations that required ethical decisions to be made. The 60 narrated situations were interpreted step-by-step departing from the following two questions: What do nurses experience when being in ethically difficult care situations? What does the expression "it depends on the situation at hand how I act" mean? In complex situations, the nurses reported that the ethical situations that arose were regarded either as overwhelming or at the other end of the spectrum, as possible to grasp, and they expressed either loneliness or togetherness, respectively. When reporting overwhelming situations, the nurses mostly referred to themselves by using the word "one," i.e., "one would" and used "they" when referring to their coactors. When narrating situations possible to grasp, they used the terms "I" and "we." The most important situational factor that was revealed in these narratives was whether or not the nurses had a support group in which to share their thoughts. Without the support group, they reported difficulties acting in accordance with their ethical reasoning and feelings.

Adult↗
PubMed1992

Diagnostic reasoning in the care of a vocally disruptive severely demented patient. A case report.

In order to investigate the effect of nursing investigations based on diagnostic reasoning and research findings on vocally disruptive behaviour in a severely demented patient a single subject study was set up. The nursing diagnoses described problems that seemed connected with sensory deprivation and care that had not been adapted to the patient's abilities. The vocally disruptive behaviour decreased when the nursing treatment plan was followed. When the caregivers stopped following the care plan the disruptive behaviour increased. Another intervention was made and once again the disruptive behaviour decreased. In conclusion the study showed that nursing diagnoses and orders were not enough. The caregivers must also understand the importance of following the care plan and cope with the emotional reactions evoked by the care. Effective leadership, regular supervision of and support to the caregivers seem necessary.

Aged↗
PubMed1992

Caregivers' experience of providing care for demented persons living at home.

Caregivers providing home-care for demented persons answered a questionnaire concerning what was satisfactory or problematic when providing home-care. They were also asked what needs/wishes they had for themselves and for the demented persons. The findings reflected the impact of a functioning interpersonal relationship between the caregiver and the demented person and his family. The difficulties in handling problematic behaviour, and the necessity to be able to stimulate and provide activities for the demented were also emphasized. Moreover, the caregivers stressed their role as supporters of the patients' families, their need for more and better cooperation with the staff of the psychogeriatric clinic, and their need for training and supervision in how to manage their relationship with the demented person. Hence, it seems urgent to try to practise and evaluate systematic clinical guidance to provide knowledge and systematic supervision about how to manage demented persons in their own social context so that they can stay in their homes.

Adolescent↗
PubMed1990

Staff interaction with vocally disruptive demented patients compared with demented controls.

This study addressed the effect of social isolation on vocally disruptive demented patients (V); the results center on the amount of time patients spent in interactions, and the differences in type and time of staff-patient interaction (IA), compared to controls (C). Semi-structured observations were collected (1100 hours) for 37 vocally disruptive patients and 37 controls, all residents of psychogeriatric wards. Quantitative analysis revealed a low frequency of interactions, elicited mainly for procedural matters and short duration of most interaction episodes. Multiple regression analysis showed a significant difference in the type of interaction: there was more correction of undesired behaviour for vocally disruptive patients than for controls. The results show that social isolation is part of the institutionalized demented patients' life. The dominance of short interaction episodes could contribute to overstimulation. The only significant difference found was the frequency of corrective interactions in the group of vocally disruptive patients. We conclude that this is not the cause of their behaviour, but it may reinforce it. Other factors that might cause and maintain this behaviour require investigation.

Aged↗
PubMed1990

A comparison between the care of vocally disruptive patients and that of other residents at psychogeriatric wards.

This study aimed at examining the relationship between the occurrence of vocally disruptive behaviour and the care of demented patients. The results presented here focus on the contents of the patient's daily life provided by the staff. In all the psychogeriatric wards within one county council, having patients identified as vocally disruptive, 37 patients exhibiting this behaviour and 37 controls were studied. Semistructured continuous observations for 15 hours per patient (7.00 a.m.-10.00 p.m.) were made. Data from a previous report revealed that the vocally disruptive patients were more physically dependent on the staff as compared to controls. However, the physical care provided did not differ significantly. The patients spent 21% of the observed time in caring activities, mainly physical care, 18% of the time they were sleeping or dozing, and 71% of the observed time they were left to themselves and reduced to inactivity and solitude. Regression analysis disclosed that only the amount of activating care in a group was significantly related to the vocally disruptive behaviour. Hence the data support the idea that understimulation is present in the demented patient's life but it can hardly be the cause of the behaviour. However, the environment might contribute to the occurrence and maintenance of vocally disruptive behaviour.

Activities of Daily Living↗
PubMed1990

Staffs' interpretation of the experience behind vocally disruptive behavior in severely demented patients and their feelings about it. An explorative study.

This study illuminates the experience behind the vocally disruptive behavior in demented patients and their caregivers' reactions to it. Because of the communicative disturbances of the patients, caregivers were asked to act as their vicarious informants. Projective identification, transference, and countertransference were supposed to take place between the patients and their caregivers. Thus, a psychological framework was used. Seventeen experienced caregivers were interviewed after listening to tape-recordings of two patients exhibiting vocally disruptive behavior. Analysis revealed that caregivers regarded anxiety as the most common experience behind the behavior. Seven categories of explanations were obtained: anxiety over abandonment, dissolution, loss of autonomy, threats to integrity, an expression of bodily needs, reactions to disturbing environment, and automatic behavior. Caregivers wished to understand and help but felt powerless and insufficient. The results stress the importance of finding ways of interpreting severely demented patients exhibiting vocally disruptive behavior. The importance of supervision to support the caregiver in the extremely burdensome situation is also elucidated.

Anxiety↗
PubMedDate not supplied

Skilled nurses' experiences of caring.

The content and the meaning of nurses' caring in practice remain poorly illuminated. To contribute to a better understanding, the meaning of caring, abilities needed for caring, experiences that make caring worthwhile, and the source of the strength needed to continue caring were focused on in interviews with experienced nurses in surgical (n = 15), medical (n = 15), and long-term (n = 15) care. The analysis showed both similarities and differences between the three groups of nurses. One similarity lay in the ability of the nurses within their caring role to understand the situation, to establish contact with the patient, and to act in the patient's best interest especially regarding the relief of pain and anxiety. On the other hand, one of the differences was that the nurses engaged in long-term care emphasized support of the patients' psychosocial needs more than nurses engaged in surgical and medical care, who emphasized support of the patients' weakened vital functions. The analysis also disclosed that almost all of the nurses had been troubled by problems of patient care when they were new to their jobs, but experience and maturity had given them strength. Care in itself gave the nurses satisfaction and pleasure and made it worthwhile. Positive cooperation with coworkers and patients' families were the main sources of their strength to continue caring.

Adult↗
PubMedDate not supplied

Nurses' lived experience of being a preceptor.

Registered nurses' lived experience of preceptorship was studied in this phenomenological study. To illuminate the meaning of registered nurses' experience of being a preceptor for student nurses, individual tape-recorded interviews were conducted with 17 registered nurses. They narrated their experience of being a personal preceptor for student nurses during practical training on a hospital unit, and the interviews transcribed verbatim were analyzed phenomenological-hermeneutically. The analysis revealed two main themes (1) including the student in their daily work and (2) increasing awareness of the process of learning, as well as six other themes, which contributed to a new comprehension of the meaning of being a preceptor. All the themes were related to the ongoing preceptor-preceptee relationship. The preceptors' thinking on past experiences and their ideas of nursing care in the future were present simultaneously. Nurses acting as preceptors were perceived as conscious individuals, demanding a balance of their daily work responsibility with increased awareness of the professional demands of nursing care. Preceptors gained increased awareness of and a desire to fulfill the student nurses' varied learning needs and increased awareness of their own learning process.

Adult↗
PubMedDate not supplied

The parallel process in clinical supervision with a schizophrenic client.

The authors analyze a male nurse's account of how he experienced his interaction with a female schizophrenic client during sessions of systematic clinical supervision. Notes taken during 15 sessions were analyzed by means of open coding. The analysis revealed the importance of being aware of the parallel process that occurs among the client, the primary nurse, and the unit staff.

Adult↗
PubMedDate not supplied

Impact of delirium on professionals.

There is a paucity of empirical research on the impact of delirium on professionals' reactions, interpretations or attitudes to people in a delirious state. This is striking because it stands to reason that it is demanding to take care of a person who is disoriented, perhaps agitated and who may hallucinate and/or act in a manner that calls for interventions involving the use of force or actions that oppose the will of the patient. Apart from some recent intervention studies, there is also little empirical research focusing on the care of delirious patients. Because of the lack of research, deductions will be made from research findings in other areas as well as research findings focusing on the views of patients about what it was like to have been confused, which they narrated afterwards.

Attitude of Health Personnel↗