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Biomedical subjects

A Norberg

Publications and source records attributed to A Norberg.

At least 127 records · Page 7Linked to original sources
PubMed1994

Ethical aspects of dental care for demented patients. Methodological considerations.

Management of demented patients who forcefully refuse dental treatment may cause ethical dilemmas and arouse feelings of frustration and anxiety in the dentist. The aim of this study is to develop and evaluate an appropriate method for analysing ethical problems in dentistry for demented patients. A taperecorded transcribed semistructured interview was performed with four experienced and competent hospital dentists. A phenomenological-hermeneutic method was used in the analysis of the narratives and the structured parts of the interviews compared with the interpretation of the narratives to focus on each interview as a whole. The dentists' professional task in dentistry for severely demented patients are both treating and caring. They have to make the treatment decision and also perform the treatment task. This may contribute to the results of this study that hospital dentists' concept in conflict situations are very vague. The results and tendencies of this study disclose a need for further knowledge about the handling of ethical conflicts in dental management of severely demented patients. With some modifications the narrative method and the analysis model used in this study are suitable in further studies.

Aged↗
PubMed1994

[Morning care of patients with Alzheimer's dementia: a theoretical model based on direct observation].

Five hospitalized patients in different stages of Alzheimer-type dementia were monitored by unstructured, direct observations during morning care. Orem's model of nursing as a compensation for the patient's lack of self-care capabilities was used as a frame of reference for an analysis of the behaviours of patients and nurses during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients was able to manage morning care independently, but there was a wide variation in their highest level of performance.

Alzheimer Disease↗
PubMed1994

[Verbal communication and behavior during meals of 5 hospitalized patients with Alzheimer's disease].

Five institutionalized patients with Alzheimer-type dementia were observed (video-recorded) during meals. The aim was to assess their meal behaviour and social interaction. The results showed that when the patients ate without the participation of staff, the two least demented patients became 'caregivers' in the group and helped the three most demented patients to eat. When two mental health nurses joined the group, the patients dropped their roles as helpers. The conversation in the group could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all comprehensible utterances concerned food and eating and almost all conversation concerned the present.

Alzheimer Disease↗
PubMed1994

[The interaction between the parkinsonian patient and his caregiver during feeding: a theoretical model].

A theoretical model for the assessment of the interaction between the patient with Parkinson's disease and his caregiver during assisted feeding is suggested. It is based on literature about impairments in Parkinson's disease and about interaction. The main concepts of the model are clarity of cues, sensitivity, interpretation, responsiveness and synchrony. It is suggested that the patient should be allowed to focus on the socioemotional content versus the task content of communication during different phases of interaction during the meal.

Feeding Behavior↗
PubMed1994

[Care of demented patients with severe communication problems].

Two time-studies and an interview study were carried out at a geriatric clinic. The aim was to elucidate how much time caregivers use for direct patient care in their contact with severely demented patients compared with non-demented patients as well as how they experience the care of demented patients in a task assignment care system. The analysis showed that more time was used to help non-demented patients than demented patients with the same ADL-performance. Five types of patient reactions to communicative attempts made by the caregivers were described: the patient seems to enjoy contact, he avoids contact, contact leads to aggression, he reacts only sporadically to contact and he does not show any reactions to it. The caregivers described negative reactions to demented patients with communication problems. Communication problems seem to be a threat to caregivers' commitment.

Activities of Daily Living↗
PubMed1994

[Effects of the training in integrity-promoting care on the interactions in a long-term ward].

A training programme in integrity-promoting care was given the staff of a long-term ward and practised during a three months intervention period. The effects were analysed in different parameters and compared with a control ward. This report describes analysis of video-recorded interactions (12 hs) during social activities between demented patients and caregivers and changes induced by the programme. The video-recorded episodes, containing mainly music and coffee sessions were interpreted from a model on interaction with demented patients suggested by Athlin and Norberg. The results indicate that the training programme and the guidance during the intervention resulted in increased understanding of demented patients' situation among the staff. They became more sensitive, adapted their cues and made the environment easier to interpret for the patients. This in turn led to the fact that the patients appeared more sensitive and clear in their cues. A positive circle developed.

Empathy↗
PubMed1994

Systematic clinical supervision and its effects for nurses handling demanding care situations. Interviews with Swedish district nurses and hospital nurses in cancer care.

This study reports the findings of how district nurses (n = 23) and hospital nurses (n = 9) in cancer care experienced social support in immediate connection with demanding care situations, as well as the effect of systematic clinical supervision. The study is based on their own accounts. The data were collected by means of semi-structured interviews. The findings indicate that there is a great need to unburden oneself of job-related thoughts and feelings, and to receive support after having been in emotionally demanding care situations. The nurses were of the opinion that the supervision had provided relief, confirmation, and professional development. These findings can be understood in the light of Antonovsky's theory, "sense of coherence," which comprises the components: comprehensibility, manageability, and meaningfulness. More research is needed to discover further ways to support the personnel.

Adult↗
PubMed1993

Nurse-patient interaction after training in integrity promoting care at a long-term ward: analysis of video-recorded morning care sessions.

Morning care is a complex and problematic task for the demented patient, who has problems in understanding and coping with the situation. A training programme of integrity promoting care was given to the staff of a long-term ward and improvements of care were implemented during a 3 month intervention period. To evaluate possible effects, different parameters were used and compared with the data of a control ward. This report describes how caregivers behaved towards demented patients during morning care, before and after the training, and how patients' behaviour changed. The results are based on behaviour samples from 10 patients and 10 caregivers during 99 video-recorded morning care sessions, "double blindly" analysed. The number of coding schemes was 483, each consisting of 93 questions. The most prominent differences observed after the intervention were the increased number of opportunities to take part in decisions and activities given to the patients by the caregivers, more co-operation from patients, and finally an increase in verbal contact initiated both by patients and caregivers. It seems reasonable to suggest that when the environment was made more adequate and the demented patients could cope with it, they could use latent abilities that were not manifest in a less adequate environment.

Activities of Daily Living↗
PubMed1993

An international perspective of active euthanasia: attitudes of nurses in seven countries.

This exploratory study examines the ethical justification that cancer care and dementia care nurses gave for active voluntary euthanasia. A convenient sample of 319 nurses working in seven countries was interviewed using a structured interview guide. The great majority of the nurses could not ethically justify active voluntary euthanasia. Even if the law changed, only 96 of the total sample viewed active voluntary euthanasia as ethical. For those nurses who could ethically justify active voluntary euthanasia, the majority did so because of the patients' suffering.

Adult↗
PubMed1993

The significance of a sense of coherence for subjective health in persons with insulin-dependent diabetes.

The strength of an insulin-dependent, diabetic (IDDM) person's sense of coherence (SOC), conceptualized according to Antonovsky's salutogenetic model, was related to patterns of problem-solving and to emotional coping strategies. These personal SOC scores were also related to reported positive experiences, problems in daily life, problems in relation to the environment, worries about long-term complications, tedium and well-being which had been measured 5 years earlier. In the entire IDDM group the mean score for the SOC was 143. There was a significant correlation between the SOC scores and coping patterns (Z--2.053, P < 0.04). The subgroup labelled 'experts' had the highest SOC scores. There were also significant correlations between the SOC scores and problems in relation to the environment (r--0.08, P 0.03), tedium (r--0.69 P 0.01) and well-being (r--0.64, P 0.02). There were no correlations between the SOC scores and metabolic control, reported experiences that the disease had positively influenced the diabetic person's life, problems in daily life, or worries about long-term complications. It was concluded that a sense of coherence seems an important factor which contributes to successful emotional coping with the demands of the disease. As subjective health is an important nursing goal the salutogenic model appears to have potential utility in the care for the person with IDDM.

Activities of Daily Living↗
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

Relationships between demented elderly people and their families: a follow-up study of caregivers who had previously reported abuse when caring for their spouses and parents.

The aim of the study was to elucidate how relationships develop over time in abusive families. Family members of demented elderly people who previously reported abuse in the care of the elderly relatives are interviewed in a follow-up study. In this current study the families did not mention any abusive behaviour. They narrated their feelings toward their care recipient in the following main categories: mothering, grieving, feeling guilty, distancing and objectifying. When the family members expressed mothering thoughts, there were no expressions of guilt, objectifying or distancing, and the prior relationship was narrated as good. The families who talked about the demented person at a distance or by objectifying did not express feelings of mothering or grief for the relative.

Aged↗
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

Intensive care: situations of ethical difficulty.

Twenty enrolled nurses (ENs), 20 registered nurses (RNs) and 20 physicians working in intensive care in northern Sweden narrated 255 stories about their experience of being in ethically difficult care situations. The ENs' stories mainly concerned problems relating to relationship ethics, the stories narrated by the physicians mainly concerned problems relating to action ethics, while the RNs' stories gave equal attention to both kinds of problems. The most common theme of both the RNs' and the physicians' stories was that of too much treatment. An obvious similarity between the ENs, RNs and physicians was that they saw themselves as equally lacking in influence in ethically difficult care situations. The only apparent difference between the three groups, however, was that the ENs brought up relationship problems more often than the others. Thus, the differences between the RNs and the physicians were fewer than usually reported in the literature. This might be related to the specialization of intensive care.

Adult↗
PubMed1993

Cases of elder abuse, intervention and hopes for the future, as reported by home service personnel.

This study aimed at describing cases of elder abuse reported by witnesses, intervention offered and opinions of further intervention strategies. Home service personnel from various parts of Sweden reported 97 cases. The abused person was a women in 75% of the cases. Many of the abused persons were physically and psychologically handicapped. In most of the cases the perpetrator was a spouse or a child and in one third of the cases they had a caregiving responsibility. Psychological abuse together with financial exploitation was most frequently reported. The perpetrators' possibilities to profit financially from the abused and the family conflicts were commonly reported to be contributory causes. In 75% of the cases intervention was offered. The Swedish welfare system has no specific intervention strategies in case of abuse of the elderly and therefore more possibilities to intervene and more research concerning intervention are needed.

Aged↗
PubMed1993

Caregivers' reactions to the physical appearance of a person in the final stage of dementia as measured by semantic differentials.

The semantic differential (SeD) technique was applied to 158 caregivers from a nursing home in the northern part of Sweden. The questionnaire contained fifty-eight bipolar scales of adjective pairs and the interviewees indicated their reactions to a described picture of a severely demented person: A factor analysis revealed three dimensions; an ethical one, an esthetical one, and one about the person's own feelings. The fifty-eight scales were mostly rated toward the negative poles. The severely demented person was rated as painful, apathetic, suffering, weak, afraid, sad, cold, dark, rough, and ugly. Four years later a comparable group of caregivers (n = 93) answered a revised questionnaire containing the 26 SeD scales with factor loadings > .50 for the picture of the severely demented person. The result was nearly identical and alternative interpretations are discussed.

Adult↗
PubMed1993

Relationship between bilingual demented immigrants and bilingual/monolingual caregivers.

This study illuminates the relationship between bilingual demented patients and bilingual/monolingual caregivers during morning care sessions regarding the promotion of integrity in demented persons. Seven demented Finnish immigrants were videotaped during morning care together with bilingual and monolingual Swedish-speaking caregivers. A phenomenological-hermeneutic analysis of the videotapes was performed based on Ricoeur's philosophy. The structural analysis was made by means of the Erikson theory of "eight stages of man." Comparisons were made regarding demented immigrants' relationships with Swedish-Finnish speaking and Swedish speaking caregivers respectively. Three different patterns of relationship were seen: positive, negative, and mixed relationship. The study showed that bilingual caregivers' relationships with bilingual patients was positive or mainly positive (mixed), while the monolingual Swedish speaking caregivers had severe problems communicating with the same patients and therefore had more difficulties creating a positive relationship with them. It seems important that bilingual caregivers engage in the care of demented bilingual patients in order to help them use their latent competence and show themselves more clearly in the communication with their caregivers.

Acculturation↗