Biomedical subjects

P O Sandman

Publications and source records attributed to P O Sandman.

At least 19 recordsLinked to original sources

PubMed2006

Caring or uncaring--meanings of being in an oncology environment.

AIM: This paper reports a study illuminating meanings of being in the physical environment of an oncology centre as narrated by patients, significant others and staff. BACKGROUND: The physical environment of hospitals can convey different messages. For example, landscape pictures, plants and comfortable chairs can convey positive messages, while sparsely decorated and run-down environments can convey negative values. Traditional healthcare environments may be experienced as unfamiliar, strange and alienating, fostering feelings of stress and vulnerability. The majority of research on care environments has employed experimental designs to test different environmental variables, for example sound, colour and architecture, in relation to patient outcomes such as recovery, pain and blood pressure. There is, however, little research-based understanding of the meanings of being in these environments. METHODS: A phenomenological hermeneutic approach was applied to analyse 17 interviews with patients, significant others and staff carried out during the spring of 2004 at an oncology centre in Sweden. FINDINGS: The physical environment was found to influence experiences of care in four ways: first, by being a symbol expressing messages of death and dying, danger, shame and stigma, less social value and worth; second by containing symbols expressing messages of caring and uncaring, life and death; third, by influencing interaction and the balance between being involved and finding privacy; and fourth, by containing objects that could facilitate a shift of focus away from the self: being able to escape the world of cancer, and finding light in the midst of darkness. The comprehensive understanding illuminates the physical environment as not merely a place for caring, but as an important part of caring that needs to be accounted for in nursing care. CONCLUSION: To promote well-being among patients, we need to ask ourselves if the environment imposes rather than eases suffering. Our findings also suggest the importance of not limiting our conceptions of nursing to nurse-patient relationships, but of using the therapeutic potential of the total environment in nursing care.

Adult↗

PubMed2006

The duality in using information and communication technology in elder care.

AIM: The aim of this paper is to report a study illuminating values and perceptions held by professional carers of older people about the use of information and communication technology applications. BACKGROUND: Various information and communication technology applications have successfully been developed to help solve a variety of problems in elder care. Beside different technical barriers and the assumed negative attitudes among older people, staff values and attitudes have been found to be an important cause of resistance to change and slowness in introduction of information and communication technology in health care of older people. METHODS: An interview study was conducted in 2004 with 10 healthcare personnel with 3-26 years experience of working in home care and nursing homes in Northern Sweden. Qualitative content analysis was used to identify recurring themes in the data. RESULTS: The interpretation of values and perceptions among carers revealed a duality where the carers perceived information and communication technology as a promoter of both inhumane and humane care, a duality that seemed to make them defensive and resistant to change. Within the overall duality, other dualities were embedded that described both perceptions about the care of older people and about being a carer. There was evidence of resistance among professional carers towards an introduction of information and communication technology applications in elder care. Carers considered that the same attributes of information and communication technology that could promote humane care could also lead to dehumanized care. CONCLUSION: There should be an ethical discussion when introducing information and communication technology applications in elder care. The best caring alternative for all those concerned should be considered. It should promote aspects of wellbeing and dignity for frail older people and fears of inhumane care among carers must be recognized and discussed.

Adaptation, Psychological↗

PubMed2004

Discharge planning: "fooling ourselves?"--patient participation in conferences.

BACKGROUND: The aim of discharge planning conferences (DPCs) is to co-ordinate resources and to enhance patient involvement in care in connection with relocation from hospital. DPCs can be characterized as institutional conversations, and are often executed as standard procedures, but the scientific basis for the activity is weak. AIMS AND OBJECTIVES: The aim of this study was to illuminate and describe the communication at DPCs. DESIGN: A purposeful and consecutive sample of eight DPCs was collected in which the future care of eight women, aged 70 years or more, was discussed. METHODS: Transcribed video recordings were analysed in two steps. "The initial analysis" aimed at describing the structure and content of the communication. This description constituted the basis for an interpretation, leading to "the focused analysis" aiming at finding evidence for the assumptions made in the interpretation. RESULTS: The result revealed that the participation of patients was very less the DPCs. The decisions had often already been made, and the women were expected to be pleased with the decision; institutional representatives (IRs) frequently justified their actions by referring to bureaucratic praxis. CONCLUSIONS: The women were both encouraged and excluded from participation by the IRs. This dichotomy occurred because the IRs, as professionals, struggled to simultaneously realize their caring mission and their obligation to enforce the values and rules of the institution, i.e. efficiency and rationality. Thus, IRs and patients were equally imprisoned within the institutional system. RELEVANCE TO CLINICAL RESEARCH: This result illustrates how conflicting paradigms are imbedded and reproduced by healthcare professionals in their communicative praxis. Awareness of this is a prerequisite for improvements in working procedures congruent with a caring paradigm that support patient participation.

Activities of Daily Living↗

PubMed2003

Video-phone communication with cognitively impaired elderly patients.

We investigated the potential role of remote interactions via video-phone in the care of the elderly. Family members and nursing staff were interviewed about their experiences of communicating with elderly people via video-phone. Seven family members and seven nursing staff participated in the studies. The interviews were analysed using qualitative content analysis. The results showed that it was possible for elderly people with cognitive impairment to engage in remote communication when certain conditions were met. There were also indications that the video-phone interaction sometimes increased the attention and focus of the elderly subjects.

Adult↗

PubMed2002

Promoting a good life among people with Alzheimer's disease.

AIM: To illuminate the meaning of offering care and a place to live to people with Alzheimer's disease in a special care unit. RATIONALE: There is a need to gain a deeper understanding about so called 'homelike' care settings, and about how to promote experiences of being at home in residents with Alzheimer's disease. The study is part of a long-term study in a special care unit. METHODS: The study comprises phenomenological hermeneutic interpretation of interviews with 10 care providers. RESULTS: The analyses revealed a number of caring aspects such as, for example, 'viewing dignity and striving to preserve a sense of self in the resident', 'encouraging a sense of belonging', 'offering relief' and 'promoting a sense of power and control in the resident', although integrated and reflected in each other. The caring aspects constituted the themes confirmation, familiarity, communion and agency considered as dimensions of the good life. CONCLUSION: To avoid simplification in which, for example, the furniture from a certain decade become the standard for good care, it seems important to focus upon the meaning of the good life. Care that promotes a good life of people with Alzheimer's disease seemed relationship centred.

Activities of Daily Living↗

PubMed2002

Nurse-doctor interaction in teleconsultations between a hospital and a geriatric nursing home.

The aim of the present study was to elucidate both the interaction between a doctor and five registered nurses and the problems or tasks dealt with in teleconsultations between a university clinic for geriatric medicine and a nursing home for the elderly in northern Sweden. The interaction and problems or tasks were studied through analyses of video-recorded teleconsultations and through open interviews with the participating staff. The results indicated that teleconsultations between a geriatrician and the nurses at a nursing home for the elderly can be a useful tool for providing medical services. Teleconsultations alter both the 'power-control' and 'practice spheres' for the doctor and the nurses, and must be based on mutual trust. The use of teleconsultations gives the nurse a larger role as the presenter of medical problems, and gives the doctor the role of remote consultant.

Aged↗

PubMed2001

How patients with dementia spend their time in a psycho-geriatric unit.

This paper presents the findings of a work sampling study conducted at an assessment unit for patients with dementia at a university hospital in Northern Sweden. The aim of the study was to describe the activity of the demented patients' day at a psycho-geriatric unit, and to investigate the correlation between the patients' characteristics and time provided by nursing staff, in order to increase our knowledge of institutionalized demented patients situation. The sample consisted of 24 patients with dementia. The activities of patients were monitored at 10-min interval between 7.00 a.m. and 9.10 p.m. In total, 2024 activities were recorded. The findings showed that being demented and placed in a psycho-geriatric unit is a life in solitude for most of the time. The variation in time patients spent in solitude could partly be explained by their communication abilities. For patients with dementia, communion is essential for their well-being. In order to develop their well-being, it seems important to enhance our knowledge about the reasons, that influence the nursing staffs' perceptions of patients with dementia, to decrease their time in solitude.

Aged↗

PubMed2001

Factors relating to the use of physical restraints in geriatric care settings.

Physical restraints are commonly used on older persons living in geriatric care settings. The aim of this study was to investigate the influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence. In this cross-sectional study of 33 nursing home wards and 12 group living units for old persons with dementia in two municipalities in northern Sweden, 540 residents (mean age 82) and 529 staff members were evaluated for resident and staff characteristics and organizational and environmental variables. The proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff's attitudes towards use of restraints were the strongest discriminators between restraint-free wards and wards that used restraints. A classification function analysis showed that these three variables could correctly classify the wards as restraint-free, low-use, and high-use wards in 63.6% of the cases, with the highest figures for restraint-free wards (91%). This study has shown that the use of physical restraints is strongly connected with residents' functional status and nursing staffs' attitudes toward their use.

Aged↗

PubMed2001

A retrospective study of functional ability among people with dementia when admitted to group-dwelling.

OBJECTIVE: To describe functional ability among people with dementia when admitted to group-dwelling (GD) during different time periods, and the probability of their remaining in these units for the rest of their lives. DESIGN: Retrospective study of functional ability and likelihood of staying in GD. SETTING: Thirteen GD units in the Sundsvall region, Sweden. SUBJECTS: One-hundred-and-forty-two demented people admitted to GD in the period 1986-1996. MAIN OUTCOME MEASURES: Ability to manage personal care and somatic and psychiatric status were measured with the use of a rating scale. RESULT: On comparing people over the years, a significant increase was found in the need of assistance to manage everyday life on admission to GD. The likelihood of living the rest of life in GD has increased over time. CONCLUSIONS: Increasing dependency and increasing probability of remaining in GD may influence the intention of GD as a unique way of caring for people with dementia. It is crucial to consider these changes in order to encourage the development of GD.

Activities of Daily Living↗

PubMed2000

Nurses' work in a hospice and in an oncological unit in Sweden.

This paper presents the results of a work-sampling study aimed at describing and comparing the activities of nurses at a free-standing in-patient hospice and a hospital oncological unit. Data suggests that although patient care at both sites is structured by organizational routines, the content and quantity of the nurses' physical and emotional labor differed markedly. Hospice nurses spend significantly more of their working time with patients and/or relatives (37%) than the oncological nurses (21%). When they are with patients the nurses in both settings are most often performing a physical activity such as helping patients with their daily activities in the hospice, and helping patients with needs in relation to investigations and treatment in the oncological unit.

Hospices↗

PubMed1999

Unwillingness to be violated: carers' experiences of caring for a person acting in a disturbing manner. An interview study.

Carers working in psychiatric care are sometimes exposed to insane, unpredictable and violent actions. In rare cases a patient appears to be resistant to all forms of pharmacological treatment. Fifteen carers (four registered nurses, 11 enrolled nurses) on a psychiatric ward in Sweden were interviewed about their experiences when caring for a person who acted in a disturbing manner. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. Four themes were formulated which describe the carers' uncertainty about the future, their inability to interpret the patient's disturbing behaviour and their own overall feeling of meaninglessness. The carers were of the opinion that the patient had the power and ruled the ward, which led to them feeling they were subjugated victims. The interviews also revealed the carers' recognition of forbidden feelings and actions and unknown negative sides. These results were interpreted and reflected on in the light of an ethical framework in order to achieve a deeper understanding of the text. This paper shows that an ethical perspective is important when searching for the meaning of caring for patients acting in a disturbing manner. The study raises the question: 'Is it possible to establish good when evil has dominion?'.

Attitude of Health Personnel↗

PubMed1998

The role of advocacy in critical care nursing: a caring response to another.

With the aim of clarifying critical care nursing, six critical care nurses, working in a Swedish intensive care unit (ICU) were each asked to narrate a care situation with which they had been satisfied or dissatisfied. The stories were tape-recorded and analysed using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. The themes uncovered in the analysis describe the nurse's role of advocacy as: to build a caring relationship, to carry out a commitment, to empower, to make room for and interconnect, to be a risk-taker, to be a moral agent and to create a trusting atmosphere conducive to recovery. The meaning of the role of advocacy lies in a moral and existential response to another human being, an expression of caring. Advocacy rests on the patient-nurse relationship and occurs as an outspoken demand of another human being whose autonomy is threatened. The results are discussed from the ethical perspectives of Lögstrup, Watson's concept of care, and existential advocacy as expressed by Gadow.

Attitude of Health Personnel↗

PubMed1998

How patients spend their time in a hospice and in an oncological unit.

This paper presents the findings from a work sampling study. At 10-minute intervals the activities of patients in a hospice, and in an oncological unit were monitored for a day or a night. In total, 5286 observations of patient activities were recorded. The findings showed that being a patient, especially in the oncological unit, was apparently a very lonely experience with limited social interaction and purposeful activity. Hospice patients, in contrast, were less alone, spending much of their time with their relatives. Although none of the patients at either site spent a major part of either day or night with nurses, hospice patients and nurses spent significantly more time together, and their encounters more often lasted longer. Nursing care at both sites was mainly related to 'doing' rather than 'being', i.e. when with patients, nurses most often had some task to accomplish. The study shows the importance of increasing our understanding of the use of time and the combination of doing and being that reflects good nursing care of the dying.

Activities of Daily Living↗

PubMed1998

From optimism to pessimism. A case study of a psychiatric patient.

This article focuses on the results of a single case study which illuminates an understanding of phases in nursing care for a patient in a psychiatric setting in Sweden. The focus of this study is a 50-year-old man who showed progressive deterioration from increased motor activity to oral, sexual, destructive and aggressive actions. Data collection using five methods occurred during a 21-month period. Results of the content analysis processes identified four distinct but non-discrete phases of the patient's complex condition. Medical and nursing care was categorized in three approaches: optimistic, strategic and resigned. The results raise the question of whether there is action that is without any meaning as an expression of the patient's wishes, thoughts and feelings. It seems clear that the patient in this study felt really angry and in despair. However, during moments of lucidity, he also indicated that he felt this was not an authentic expression of his 'real' self. His experience was that of a splintered world.

Aggression↗

PubMed1998

The view of caring among patients and personnel.

All patients in hospital care and primary health care in the country of Västerbotten, Sweden (n = 5158) were asked to express their level of satisfaction with the quality of care. The study was carried out on one specific day. All personnel on duty that day (n = 2824) were also included and asked to give their interpretations of their patients' experiences. A questionnaire containing positive and negative statements concerning both the relationship and the task aspects of care was used. The results showed that the youngest and oldest patients expressed the highest degree of satisfaction, while young and middle-aged patients expressed a more restrained view. The least satisfactory aspects concerned the opportunities to express criticism and the possibilities of receiving information about access to help outside the health care organization. The personnel's responses agreed with those of the patients, but fewer personnel thought that their patients were satisfied than was in fact the case.

Adolescent↗

PubMed1998

Physical restraints in geriatric care. Knowledge, attitudes and use.

The aim of the present study was to investigate the use of physical restraints in institutional elder care and staff knowledge about and attitudes toward the use of these restraints. Poor knowledge and negative attitudes toward the use of restraints were found among staff. Significant differences between various staff categories were found concerning knowledge about the use of restraints; nurse aids had the lowest and physicians the highest scores on the knowledge test. Nurse aids demonstrated the least negative attitudes (were most prone to use restraints) and physicians the most negative. Furthermore, there was a significant relation between attitudes and knowledge, i.e. staff with poor knowledge also demonstrated the least negative attitudes toward the use of restraints. Despite these negative attitudes among staff, we found a large proportion of restrained patients in the institutions investigated. Twenty-nine percent of the patients at the investigated clinics were physically restrained. The most common reason given was that restraints were used to prevent falls. No documentation of the observed use of restraints was found in any of the restrained patients' hospital records.

Adult↗

PubMed1997

Assessment of acute pain in preterm infants by evaluation of facial expression and frequency domain analysis of heart rate variability.

In ten preterm infants (postconceptional age 27-35 weeks) facial expression and heart rate variability (HRV) were investigated during three situations: (a) the infant at rest in its crib or incubator, (b) provocation of the withdrawal flexor reflex by application of von Frey's hairs, and (c) lancing and squeezing for blood sampling. Video recordings of facial expressions, mixed at random, were categorised as the baby being either undisturbed, disturbed or in pain and a detailed scoring for each situation was performed. Mean heart rate (HR) was calculated and power spectral analysis was assessed on data from segments of 45-s duration from the three procedures. Flexor withdrawal did not evoke visual signs of pain or influence HRV, but caused a slight increase in HR. The lancing and squeezing of the heel evoked a facial expression of pain in all infants. The HR increased and a reduction in both total HRV and power in the low frequency band of the HRV spectrum was seen during blood sampling. The differentiation between painful and non-painful procedures was more apparent when principal component analysis of HRV was applied.

Acute Disease↗

PubMed1997

Cost of illness due to dementia in Sweden.

The gross cost of illness due to dementia was estimated to be SEK30.7 billion in 1991 while the net cost was estimated to be SEK20 billion. The sensitivity analysis showed a variation between SEK20 billion and SEK36 billion in 1991.

Aged↗