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Gustafsson LK, Bondesson A, Pettersson T, Söderman M. Dilemmas in rehabilitation and patient strategies in an intensive home intervention: a follow-up study. Int J Qual Stud Health Well-being 2023; 18:2253001. [PMID: 37665969 PMCID: PMC10478589 DOI: 10.1080/17482631.2023.2253001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The original project, where older persons received reablement performed by an interprofessional team showed success factors for IHR. However, since there is a lack of knowledge about why some persons do not recover despite receiving IHR, this study follows up patients' experiences of IHR. AIM To describe older persons' perceived dilemmas in the reablement process within the framework of IHR. METHOD 11 CIT interviews with participants who have previously received IHR, were analysed, interpreted and categorized according to CIT. The study was approved by the Swedish Ethical Review Authority. RESULTS The results showed disease-related dilemmas, fatigue or pain so that participants could not cope with the prescribed exercises. New diseases appeared, as well as medication side effects made exercising difficult, and painkillers became a prerequisite for coping with IHR. Low self-motivation and mistrust towards the staff emerged like lack of trust due to otherness such as sex, cultural background, or language also became critical. CONCLUSIONS Interventions that consider individual- and contextual dilemmas are very important. By recognizing critical situations, this study can work as a basis of evidence to further develop interventions for older people living in their own homes and to ensure them to stay there.
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Affiliation(s)
- Lena-Karin Gustafsson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Anna Bondesson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Tina Pettersson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Mirkka Söderman
- Senior lecturer, Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
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Söderman M, Bondesson A, Pettersson T, Gustafsson LK. "Intensive-Home-Rehabilitation" Intervention for Older Persons: A Follow-Up Study of Team Members' Perceptions. J Multidiscip Healthc 2023; 16:2207-2216. [PMID: 37551340 PMCID: PMC10404402 DOI: 10.2147/jmdh.s409879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/02/2023] [Indexed: 08/09/2023] Open
Abstract
Background Reablement as a concept includes a health-promoting perspective with the goal of strengthening health and the ability to perform and participate in daily activities, a broader perspective than in general home care and rehabilitation. Reablement interventions have shown to be both more effective and to a greater extent improve the function and health-related quality of life of older persons when compared to traditional home-based care. Success factors for intensive-home-rehabilitation (IHR), an intervention based on the reablement concept, have been described earlier; however, there is a lack of knowledge about why some persons do not recover despite receiving IHR. Aim The aim was to shed light on the older persons' conditions during IHR from the perspective of the rehabilitation team members and to describe obstacles to recovery. Methods Qualitative analysis of health and care records of persons (65+) who received IHR (n=19) performed by an interprofessional team. Results The analysis revealed various problematic situations, dilemmas, that occurred in the older persons' lives during IHR, as well as their consequences and the strategies employed by the older persons as a result. IHR aspects perceived as successful by the older persons also emerged, as well as differences in experiences of the physical and mental aspects of the IHR. Analysis also revealed reasons why the IHR might be experienced as broadly successful. Conclusion The older persons seemed to be satisfied with IHR and achieved their goals; however, some seemed to need more time to reach their goals. Background factors such as having additional diagnoses and living alone might affect the rehabilitation process. Implication for Practice The study provides knowledge regarding the importance of IHR for the recovery process for the increasing numbers of older persons, which might also be useful in other patient groups requiring otherwise long-term rehabilitation and recovery such as after covid-19 infection.
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Affiliation(s)
- Mirkka Söderman
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Anna Bondesson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Tina Pettersson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Lena-Karin Gustafsson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
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Fernández-Salazar S, Ramos-Morcillo AJ, Leal-Costa C, García-González J, Hernández-Méndez S, Ruzafa-Martínez M. [Evidence-Based Practice competency and associated factors among Primary Care nurses in Spain]. Aten Primaria 2021; 53:102050. [PMID: 33892230 PMCID: PMC8090992 DOI: 10.1016/j.aprim.2021.102050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors. DESIGN Cross-sectional, national survey design, carried out between January and March 2020. SETTING PC in Spain. PARTICIPANTS Seven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience. MAIN MEASUREMENTS (1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out. RESULTS The mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization. CONCLUSIONS These findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results.
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Affiliation(s)
- Serafín Fernández-Salazar
- Estrategia de Cuidados de Andalucía, Servicio Andaluz de Salud, AGS Nordeste de Jaén, Úbeda, Jaén, España
| | | | - César Leal-Costa
- Departamento de Enfermería, Facultad de Enfermería, Campus de Espinardo, Universidad de Murcia, Murcia, España
| | - Jessica García-González
- Departamento de Enfermería, Facultad de Ciencias Sociosanitarias, Campus de Lorca, Universidad de Murcia, Lorca, Murcia, España
| | | | - María Ruzafa-Martínez
- Departamento de Enfermería, Facultad de Enfermería, Campus de Espinardo, Universidad de Murcia, Murcia, España
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Moe A, Enmarker I. Research utilization in municipality nursing practice in rural districts in Norway: a cross-sectional quantitative questionnaire study. BMC Nurs 2020; 19:86. [PMID: 32943983 PMCID: PMC7488847 DOI: 10.1186/s12912-020-00475-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/25/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Scientific knowledge and theory constitute part of the nurse's competence and evidence-based nursing practice. To obtain and maintain these skills, nurses require access to research utilization. The aim of the present study was therefore to describe and compare nurses in nursing homes and home-based nursing care and their use of research knowledge in their practice in elderly care in Norwegian rural districts. METHODS The Research Utilization Questionnaire (RUQ) was employed in cross-sectional quantitative design. One hundred nurses were recruited from ten rural municipalities that participated in the study. Inclusion criteria for participating were registered nurses and employees working in the municipal elderly care service for 6 months or more. RESULTS Most participants were younger than 55 years old, worked in permanent jobs, and were educated more than 5 years ago. The result showed that nurses in nursing homes were significantly more positive compared to nurses in home-based nursing care when analyzing all three domains in the RUQ together, as well as for attitudes towards research when testing each domain separated. Overall, each item in the domains revealed opinions that were more positive for nurses in nursing homes. The regression analysis showed that attitudes towards research, as well as availability and support of research utilization predicted the use of research in daily practice. CONCLUSIONS Positive attitudes, availability, and support for research utilization can contribute to greater use of research in nursing practice and improve the quality of service. Younger nurses' knowledge about using research should be shared with senior colleagues, who possess much experience in practice. In collaboration, they can develop evidence-based practice by the implementation of research seen in the context of nurses' experiences, user involvement, and person-centred practice. The i-PARIHS (Promoting Action on Research Implementation in Health Services) framework can be a useful tool in this implementation process.
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Affiliation(s)
- Aud Moe
- Faculty of Health Science, Nord University, Postbox 1490, N-8049 Bodø, Norway
- Centre of Care Research, Levanger, Mid Norway Norway
| | - Ingela Enmarker
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Home Healthcare Nurses' Attitudes, Confidence, and Engagement in Evidence-Based Practice. Home Healthc Now 2019; 37:79-87. [PMID: 30829785 DOI: 10.1097/nhh.0000000000000723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evidence-based practice (EBP) is becoming standard in today's healthcare arena and home care organizations are not exempt from integrating evidence into practice to improve patient outcomes. There is a scarcity of research literature that examines the behaviors and attitudes of home healthcare nurses (HHNs) regarding EBP. In this study, a descriptive survey design was used to investigate HHNs' a) information-seeking behaviors when providing nursing care, b) administrative support for EBP (as perceived by HHNs), c) attitudes toward EBP, and d) EBP engagement and confidence in providing EBP nursing care. Self-reported data were collected by internet and paper survey. The survey consisted of a 65-item questionnaire that included the Nurses' Attitudes Toward Evidence-Based Practice Scale, which has previously established validity and reliability. A convenience sample of 95 HHNs participated in the study. Results suggest HHNs' EBP attitudes are positive. A positive and significant relationship was found between attitudes and hours worked (r = 0.21, p = 0.047) and educational level (r = 0.45, p = 0.0001); 95% confidence level. Confidence levels in providing EBP care were moderate, and HHNs did not perceive EBP as an agency priority. HHNs need to be supported and encouraged in the facilitation of EBP, a task made easier when they are knowledgeable about EBP, have confidence in their EBP skills, and have the support of their organizations.
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Gustafsson LK, Östlund G, Zander V, Elfström ML, Anbäcken EM. 'Best fit' caring skills of an interprofessional team in short-term goal-directed reablement: older adults' perceptions. Scand J Caring Sci 2019; 33:498-506. [PMID: 30653689 DOI: 10.1111/scs.12650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 12/11/2018] [Indexed: 11/27/2022]
Abstract
This paper reports a study conducted to illuminate older adults' perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults' reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver-patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care.
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Affiliation(s)
- Lena-Karin Gustafsson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden
| | - Gunnel Östlund
- Division of Social work, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden
| | - Viktoria Zander
- Division of Psychology, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden
| | - Magnus L Elfström
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden
| | - Els-Marie Anbäcken
- Division of Social work, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden
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Röing M, Holmström IK, Larsson J. A Metasynthesis of Phenomenographic Articles on Understandings of Work Among Healthcare Professionals. QUALITATIVE HEALTH RESEARCH 2018; 28:273-291. [PMID: 28715988 DOI: 10.1177/1049732317719433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Phenomenography is a qualitative research method based on the assumption that almost any phenomenon will be understood by a group of people in a limited number of ways. Our aim in this article was to identify the different ways work can be understood by healthcare professionals. In a world where the delivery of healthcare is continually changing, a metasynthesis of phenomenographic articles on healthcare professionals' understandings can provide knowledge about the focus and meaning of work for these individuals today. Our metaethnographic synthesis of 14 selected phenomenographic articles identified five different ways of understanding work, ranging from a limited to an all the more comprehensive view on patients and their needs. This range of understandings reveals problem areas and challenges facing healthcare professionals today. The possibility exists as well that limited understandings of work may be negative consequences of current demands for efficiency and all the more limited healthcare resources.
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Affiliation(s)
| | - Inger K Holmström
- 1 University of Uppsala, Uppsala, Sweden
- 2 Mälardalen University, Västerås, Sweden
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Mallion J, Brooke J. Community- and hospital-based nurses' implementation of evidence-based practice: are there any differences? Br J Community Nurs 2016; 21:148-54. [PMID: 26940618 DOI: 10.12968/bjcn.2016.21.3.148] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this paper is to discuss the effect of nurses' beliefs, knowledge, and skills on the implementation of evidence-based practice (EBP) in hospital and community settings. EBP refers to the implementation of the most up-to-date robust research into clinical practice. Barriers have been well documented and traditionally include the negative beliefs of nurses as well as a lack of time, knowledge, and skills. However, with degree entry nursing and a focus on community health care provision, what has changed? A comprehensive search of contemporary literature (2010-2015) was completed. The findings of this review show that the traditionally acknowledged barriers of a lack of time, knowledge, and skills remained; however, nurses' beliefs toward EBP were more positive, but positive beliefs did not affect the intentions to implement EBP or the knowledge and skills of EBP. Nurses in hospital and community settings reported similar barriers and facilitators.
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Affiliation(s)
| | - Joanne Brooke
- Associate Professor in Dementia Care, University of West London, London, England
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