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Biomedical subjects

A Norberg

Publications and source records attributed to A Norberg.

At least 91 records · Page 5Linked to original sources
PubMed1996

Maternal thinking in dementia care.

Carers of demented people living in a group dwelling were interviewed and observed individually and together. The aim of the study was to illuminate the thinking of pre-identified good dementia carers and to make explicit their means of understanding demented people. The tape-recorded and transcribed interviews were interpreted using a phenomenological hermeneutic method. The findings showed that these carers explicitly referred to the concept of mother, used when explaining their ability to understand demented people. They created a home-like atmosphere together with the inhabitants. The findings were interpreted metaphorically as maternal love, thinking and practice in creating an understanding relationship with the demented people they cared for. This metaphorical aptitude considered the fulfilment of life for these demented people and included partly unconscious tools that the carers used to compensate for the loss of abilities suffered by the demented people. The carers' attitudes towards the inhabitants of the ward and each other were based on respect as in a functioning family. Their ambition was interpreted as an attempt to create an atmosphere that functioned not only as an institution, but as an incubator for human lives, which had become dependent on others for their survival and the preservation of their human dignity throughout their physical existence.

Anxiety↗
PubMed1996

Eating despite severe difficulties: assessment of poststroke eating.

A programme for the assessment and nursing diagnoses of eating difficulties among stroke patients was tested. The patients' experiences regarding eating were expressed in interviews and dialogues. Eating was observed during both a test meal and regular meals. The assessments included the prerequisites for eating as well as oral, pharyngeal and oesophageal functions. General and specific nursing diagnoses as well as life consequences (handicap) were established, based on assessment of disabilities and impairments, and interviewing the patients and their families, respectively. The general nursing diagnoses were formulated on admission after the test meal and these were reformulated to form specific nursing diagnoses after assessments of the functions. The programme presented proved to be useful in clinical practice. It is emphasized that many assessments must be co-ordinated for each individual.

Adult↗
PubMed1996

Burnout, empathy and sense of coherence among Swedish district nurses before and after systematic clinical supervision.

The relationships between, on the one hand, burnout, empathy and sense of cohoerence (SOC) and, on the other, personality traits were investigated, together with the effects of systematic clinical supervision on these phenomena among Swedish district nurses. The results in the supervisory group (n = 21) were compared with those of a comparison group (n = 12) in a quasi-experimental design. Personality traits were assessed by means of the Karolinska Scales of Personality. The results indicated some correlations between personality traits and burnout, empathy, and SOC, as well as correlations between the latter three phenomena. There were no significant effects of clinical supervision on burnout, empathy, or SOC. More research is needed regarding the effects of clinical nursing supervision.

Burnout, Professional↗
PubMed1996

Patients' narratives concerning good and bad caring.

Narratives from patients (n = 80) and patients' relatives (n = 12) were collected to illuminate experiences of good and bad caring episodes and to obtain descriptions of good caring. Narratives describing good caring included such task aspects as swift and correct assessment and access to information. Aspects less frequently mentioned were, for example, being given time, receiving pain relief and good food. Relationship aspects mentioned; having an interest shown in the care, being taken seriously and being cared about. There are parallels regarding relationship aspects between the narratives concerning good and bad caring episodes; for example what was praised in the good caring narratives was criticized in those describing bad caring. Such parallels were being/not being trusted, being/not being believed and being/not being respected. The narrations concerning bad caring were more specific and more vivid than those about good caring. The authors' interpretation was that the bad episodes were unexpected and very painful and therefore remained imprinted in the patients' memories. The descriptions of good caring included relationship aspects in only 34 cases, task aspects in only five cases and a combination of both in 50 cases. The ultimate purpose of the study was to obtain a basis for the development of a policy for good caring founded on patients' experiences. It is desirable that further studies be undertaken within various clinical specialties which would also take into consideration medical, social and cultural perspectives.

Adolescent↗
PubMed1996

Caring for demented patients.

According to E.H. Erikson, the developmental task of old age consists of looking back and remembering one's life, accepting and taking responsibility for the past, imagining the future, and living toward death. Dealing with this final life crisis and achieving wholeness and meaning is a difficult task for the healthy person, and it is vastly more difficult for the elderly person with dementia. Those who care for elderly patients with dementia must remember for them, see their future as they would have seen it, and know and respect their philosophy of life. They must also know how to communicate with their patients in order to reach them, a task that is often arduous and frustrating. The patient's experience of wholeness and meaning must be promoted during all caregiving activities. Caregivers must be encouraged to experience their patients as unique and valuable persons.

Dementia↗
PubMed1996

Narratives by district nurses about elder abuse within families.

Twenty-one district nurses (DNs) narrated 44 cases of elder abuse within families. A phenomenological-hermeneutical analysis revealed that the experiences were complex and often included families providing care for an elderly person. The abuse seemed to be related to the inability of one party to meet the care demands required by the elderly, by him- or herself, or by the situation. It also seemed to be related to an inhibiting dependency between the parties, a negative execution of power over the weaker party, and a history of violence. When the experiences were considered within the perspective of Lögstrup's ethics, it appeared that the DNs tried to remain neutral by not consciously reflecting on the ethical demands in the abuse situations. The findings suggest that nurses need support to enable them to decide about provision of care at home and to judge "the core" in abuse situations. They might gain this support through reflection on a meta-level, taking various perspectives into account, and thus making it possible to achieve new dimensions for decision making.

Adult↗
PubMed1996

Dinner music for demented patients: analysis of video-recorded observations.

At a nursing home ward for demented patients, selections of dinner music were played during three periods of 2 weeks. At the end of the study was a control period. The reactions of five patients to three different types of music were registered by video observations. This study showed that the patients were affected by music, particularly soothing music. For example, it was found that when music was played one of the study's restless patients became unusually calm whereas another fed herself more than usual. The patients spent more time with dinner when music was played. Dinner music made the patients eat more calmly. Music as a nursing tool is an intervention that is simple to realize and worth trying. A tentative conclusion of this study is that music can beneficially affect restless and agitated demented patients.

Aged↗
PubMed1996

Disclosure of basic strengths and basic weaknesses in demented patients during morning care, before and after staff training: analysis of video-recordings by means of the Erikson theory of "eight stages of man".

In the field of care for aging persons, it is commonly understood that personality changes occur in dementia patients. It is reported to be a consistent part of the clinical syndrome and to occur early in the disease. The aim of this study was to investigate if strengths and weaknesses, described by E.H. and J.M. Erikson as basic quality in the person, could be interpreted in severely demented patients during a caring activity, and if a difference in these qualities could be seen after staff completed a training program in "integrity promoting care." The morning care of five patients was video-recorded and a phenomenological-hermeneutic analysis of the patient's and staff's interaction was conducted. The findings indicate that the complex qualities of someone's personality are more preserved than could be expected considering the cognitive handicap. It seems, however, that demented patients need a special, supportive environment for their full mental potential to be realized. It is reasonable to assume that, if the staff are given knowledge of how to create a positive climate for the demented patients and the opportunity to implement it, the patients will show a rich pattern of mental reactions in spite of their dementia.

Aged↗
PubMed1995

When the severely ill elderly patient refuses food. Ethical reasoning among nurses.

Forty registered nurses (RNs) regarded as "good and experienced" in either cancer or dementia care, were asked about their decision to feed or not feed a severely ill elderly woman (a hypothetical case). In order to compare ethical reasoning in the two groups of nurses and to illuminate what it means to RNs to face a situation where the patients can/cannot decide for themselves, a phenomenological hermeneutic approach was used for the analysis. Both groups saw themselves as the advocate for their patients but in different ways. The RNs who talked about a mentally alert patient emphasized that they encouraged their patient to speak up for herself, while the RNs who talked about a severely demented patient emphasized that they tried very hard to interpret their patient's vague and unclear communicative cues and to act as her advocate, especially in relation to physicians. Transcending experiences of dying relatives and patients as well as role models helped them to achieve their ambition of putting themselves in the patient's shoes in order to respect and understand her or his wish and/or what was best for them. The majority of RNs strongly rejected active euthanasia.

Adult↗
PubMed1995

Women's perceptions of childbirth and childbirth education before and after education and birth.

OBJECTIVE: to illuminate women's perceptions of childbirth and childbirth education before and after education and birth. DESIGN: qualitative, using tape-recorded interviews to collect data. Interpretation was performed from Antonovsky's concept sense of coherence. SETTING: childbirth education, a part of parent education in Sweden. PARTICIPANTS: eleven women expecting their first child, where the pregnancy was planned and normal MEASUREMENTS AND FINDINGS: the development of perceptions of childbirth and childbirth education was described. The women adopted the content of the education in different ways. Fear as well as unreflected knowledge seemed to block acquisition of new knowledge. Factors which contributed to a childbirth experience worse than expected were lack of or inconsistent information. Increased knowledge about childbirth and experiences of confirmation during childbirth contributed to a good or better experience than expected. KEY CONCLUSION: any model of childbirth education which does not take into consideration the individual woman's perceptions of childbirth and childbirth education seems to be inadequate. IMPLICATIONS FOR PRACTICE: the findings stress the importance of individual assessment of expectations of and experiences of childbirth education. Consistency in information given before and during childbirth supports a sense of comprehensibility, manageability and meaningfulness.

Adult↗
PubMed1995

Facial expressions of patients with dementia: a comparison of two methods of interpretation.

Two methods of interpreting the videotaped facial expressions of four patients with severe dementia of the Alzheimer type were compared. Interpretations of facial expressions performed by means of unstructured naturalistic judgments revealed episodes when the four patients exhibited anger, disgust, happiness, sadness, and surprise. When these episodes were assessed by use of a modified version of the Facial Action Coding System, there was, in total, 48% agreement between the two methods. The highest agreement, 98%, occurred for happiness shown by one patient. It was concluded that more emotions could be judged by means of the unstructured naturalistic method, which is based on an awareness of the total situation that facilitates imputing meaning into the patients' cues. It is a difficult task to find a balance between imputing too much meaning into the severely demented patients' sparse and unclear cues and ignoring the possibility that there is some meaning to be interpreted.

Aged↗
PubMed1995

Nurses' skills in managing ethically difficult care situations: interpretation of nurses' narratives.

A total of 18 good nurses experienced in the care of cancer patients were asked to describe care situations where it had been difficult to know what was 'the right and good' thing to do for the patient. The purpose of the study was to throw light on how they disclosed themselves in managing ethically difficult care situations; to elucidate the nurse as a part of the concrete care situation. A phenomenological hermeneutic interpretation disclosed the use of paradigm cases, placing in opposition to each other negative and positive outcomes, limiting and liberating maxims, and reserved and open approaches, on the part of nurses with limited versus extensive skills in managing ethically difficult care situations. These patterns were interpreted as revealing psychological defences. The study stresses the importance of recurrent education in nursing and nursing ethics, and of individual support.

Adult↗
PubMed1995

Stories about living in a hospital ward as narrated by schizophrenic patients.

Ten schizophrenic patients were interviewed about their own experiences of life in a hospital ward, of their care provider and of the care received. The interview texts were analysed using a phenomenological hermeneutic method. Fatigue, thinking about problems/inner activities, relations and longings for the pre-illness days were themes that occurred in the stories. Seven of the ten interviewees stated that they suffered from fatigue. They were preoccupied with an inner dialogue, trying to solve problems on their own. The patients were alone in their stories. The problems that the patients expressed with regard to relationships arose because they both longed for and feared contact with others, and they felt that they were not 'themselves' when they were with others. For developing care, the importance of learning more about the patients' experiences, especially regarding fatigue, is emphasized.

Adaptation, Psychological↗
PubMed1995

Schizophrenic patients' image of their carers and the carers' image of their patients: an interview study.

In order to gain a deeper understanding of how long-term adult schizophrenic patients perceive themselves, their carers and the care they receive in relation to how the carers perceive their patients, themselves and the care they provide, a narrative interview study, analysed using a method inspired by Ricoeur's philosophy, was performed. The main findings of this study were that both patients and carers who saw the patients as a subject stressed the confirming relation between the parties as an essential element of the care. The carers who saw the patient as an object did not share this opinion. They had a more restricted point of view, seeing their goal only as providing a variety of care activities and keeping the schizophrenic patients at the hospital. This study also points out that confirmation is provided in the meeting between patient and carers.

Adult↗
PubMed1995

District nurses' stories of difficult care episodes narrated during systematic clinical supervision sessions.

In systematic clinical supervision sessions 23 Swedish district nurses narrated 147 difficult care situations. The aim of the study was to illuminate their lived experiences of those situations. The following themes emerged in the analysis of the stories: coming too close to the patient; keeping and restoring patient's hope; conflicting opinions; feeling powerless; meeting unrealistic demands; patients' trust in alternative medicine; feeling disgust, shame and guilt; relations to patients' families; and communication gaps. The findings strongly emphasize that district nurses experienced problems in the home care of seriously ill patients. They must not only serve as containers for patients' emotional strain, but they also have to support relatives in their anxiety. However, findings also showed that there was often a balance between negative and positive dimensions in these meetings with dying patients and their families. It seems important to form support groups to help district nurses deal with demanding care situations and to relieve them of feelings and thoughts aroused in the provision of care. Support in the form of clinical supervision may impact the quality of care in a positive way.

Adaptation, Psychological↗
PubMed1995

Metaphorical pain language among fibromyalgia patients.

Fourteen women with fibromyalgia described their pain experiences using words indicating a model of pain that presented pain as an aggressive physical deformation and a torture-like experience. Metaphorical expressions were used which was seen as a means for enabling the patients to disclose tacit knowledge. The pain experience was narrated as being steady and without any distinct bodily location. Only causes explaining the present aggravation of the pain and treatment leading to a temporary relief were related.

Adult↗
PubMed1995

The stories of physicians, registered nurses and enrolled nurses about ethically difficult care episodes in surgical care.

Twenty physicians, 19 registered nurses (RN), and 20 enrolled nurses (EN) working in surgical care in Sweden narrated their experiences of being in ethically difficult care situations. All three professional groups disclosed a strong wish to help patients. The narrations of the physicians and the ENs indicated that they were very much involved in their patients, while most of the RNs' stories were narrated from a distanced onlooker's perspective and disclosed a lot of moral outrage, mainly directed towards physicians. The physicians were the only group that emphasized the importance of acting in accordance with science and proven experience. Like RNs they emphasized the importance and difficulty of telling the truth to the patients and their families and being open to one's own and others' harsh experiences. RNs and ENs emphasized the patient's right to a death with dignity and the difficulties connected with being with dying patients, and they also described feelings of powerlessness and neglect of patients related to a heavy work load. ENs narrated difficulties related to providing patients with individualized but fair care.

Adult↗