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Emelyanova A, Blix BH, Larsson A, Olafsdottir SA, Rautio A. Age-inclusive Arctic outdoor spaces: a policy review in four Nordic countries. Int J Circumpolar Health 2024; 83:2339561. [PMID: 38615335 PMCID: PMC11017993 DOI: 10.1080/22423982.2024.2339561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024] Open
Abstract
In the last decade, policy strategies were adopted in response to population ageing in the Nordic countries. Governmental actions have to be evaluated in terms of their efficacy. The objective of this article is to identify and review the policies related to age-inclusive outdoor spaces in the Arctic regions of Nordic countries. Our analysis focuses on central government white papers that address the older adults in Finland, Norway, Sweden, and Iceland. A review of such policy documents provides insights into the predominant understandings of older adults and healthy ageing. Moreover, such analysis may identify "blind spots" in the national policies, especially regarding the sparsely researched northernmost and rural Arctic territories. Our results demonstrate how the older populations in the Nordic Arctic and their access to outdoor spaces are addressed in the policy documents. We found that with few exceptions, the older people of the rural Arctic is strikingly absent in the Nordic national governmental papers. Moreover, access to outdoor spaces is mentioned in general terms, and specific challenges of the rural Arctic context, such as the harsh climate, long winters and geographical distances are not addressed. The noticed omissions might be the result of "urban-rural", "south-north", "indoor-outdoor", and "generalisation" biases.
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Affiliation(s)
- Anastasia Emelyanova
- Thule Institute, University of Oulu, Oulu, Finland
- Arctic Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Bodil H. Blix
- Department of health and care sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Faculty of education, arts and sports, Western Norway University of Applied Science, Bergen, Norway
| | - Agneta Larsson
- Division of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Steinunn A. Olafsdottir
- Department of Physical Therapy, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Arja Rautio
- Arctic Health, Faculty of Medicine, University of Oulu, Oulu, Finland
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Voie KS, Wiles J, Mæhre KS, Kristiansen M, Helgesen AK, Blix BH. The timescapes of older adults living alone and receiving home care: An interview study. J Aging Stud 2024; 68:101212. [PMID: 38458730 DOI: 10.1016/j.jaging.2024.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
In this study, we drew on Barbara Adam's (1998) timescape perspective and applied a timescape lens to our analysis of how nine older adults who live alone, receive home care and are considered by home care professionals to be frail, experience living (in) time. Over a period of eight months, we conducted three interviews with each of the nine participants. We analysed the data using reflexive thematic analysis and drew on timescapes to further interpret our preliminary analysis. Our results show that situated everyday time, place across time, and large-scale time interact in the framing and shaping of older adults' everyday lives. Older adults' embodied experiences of being of advanced age, living alone and receiving home care influenced their timescapes. We propose that paying attention to older adults' timescapes can enable home care professionals and other supporters to consider older adults' health, well-being, vulnerabilities and strengths from a broader perspective than the 'here and now' and thereby enhance the provision of person-centred care.
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Affiliation(s)
- Kristin S Voie
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Kjersti Sunde Mæhre
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Margrethe Kristiansen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway; Faculty of Health, Welfare and Organisation, Østfold University College, Halden 1757, Norway.
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway; Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Bergen 5063, Norway.
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3
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Blix BH, Clandinin J, Steeves P, Caine V. Entangling Reciprocity With the Relational in Narrative Inquiry. Qual Inq 2024; 30:275-281. [PMID: 38464422 PMCID: PMC10923650 DOI: 10.1177/10778004231172227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
In this article, we develop, through drawing forward fragments of our experiences, a concept of reciprocity as always situated within the relational ontology of narrative inquiry. Reciprocity is most commonly understood within a transactional sense, an exchange of goods. We show important aspects of reciprocity in narrative inquiry, including the importance of intentionally creating and responding to spaces where reciprocity occurs and can be sustained over time and place, and the potential reciprocity holds to change who we, and those with whom we work, are. As we reconsider the ways in which reciprocity is not understood as a transaction in a relational methodology, new questions about the entanglement of reciprocity and recognition emerge. We understand that recognition does not necessarily have to be reciprocal, but recognition is necessary to compose a space where reciprocity can live in our ordinary interactions with others.
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Affiliation(s)
| | | | | | - Vera Caine
- Univerisity of Victoria, British Columbia, Canada
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Dinesen TA, Blix BH, Gramstad A. Professional strategies in upper secondary school dropout management among youth in the Sami areas of Norway: a focus group study. Int J Circumpolar Health 2023; 82:2198112. [PMID: 37014958 PMCID: PMC10075505 DOI: 10.1080/22423982.2023.2198112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
The upper secondary school dropout rate is a challenge in many western countries, and measures have been taken to prevent dropout. The dropout rate in Norway is stable but is the highest among the northernmost counties. The aim of this study is to explore the strategies employed by upper secondary school teachers and their collaborators to prevent dropout from upper secondary school among Sami youth in northern Norway. This study is based on three focus group interviews with teachers, advisers, nurses, and counsellors in the Sami areas of northern Norway. The thematic analysis identified two main strategies, namely tracking the student and giving the student time. A transparent environments, cultural competence, and interdisciplinary collaboration were identified as prerequisites for successfully implementing the two strategies to prevent dropout from upper secondary school.
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Affiliation(s)
- Tone Aashild Dinesen
- Department of Social Education, Faculty of Health Sciences, UiT, The Arctic University of Norway, Harstad, Norway
| | - Bodil H Blix
- Department of health and care sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway
- Department of education, arts and sports, Western Norway University of Applied Sciences
| | - Astrid Gramstad
- Department of health and care sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway
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Blix BH, Ågotnes G. Aging Successfully in the Changing Norwegian Welfare State: A Policy Analysis Framed by Critical Gerontology. Gerontologist 2023; 63:1228-1237. [PMID: 36478067 PMCID: PMC10448990 DOI: 10.1093/geront/gnac177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In the 21st century, the future of the Norwegian welfare state is broadly debated. In Norway, as in other countries, concerns regarding the sustainability and affordability of the welfare state in light of the projected population development have been voiced in public and academic discourse, and not least in governmental statements and documents. Because we consider texts, such as government white papers, as both products and producers of discursively based understandings of the social world, a close examination of policy documents can provide insight into the predominant understanding of a distinct phenomenon in a specific society at a particular point in time. RESEARCH DESIGN AND METHODS The article is based on a critical discourse analysis of 3 recent Norwegian government policy documents addressing the older adult population. RESULTS We demonstrate that prominent ideas from the widely contested successful aging paradigm are embedded and forwarded in current Norwegian policies, where ideas about successful and healthy aging produced and reproduced in the documents frame and shape expectations toward older adults. DISCUSSION AND IMPLICATIONS We argue that the ideas and ideals of successful aging and neoliberalism in parallel pave the way for changes in the historically generous and comprehensive Norwegian social democratic welfare state. For decision makers, the rhetoric of successful aging that emphasizes activity, productivity, self-reliance, and freedom of choice is undoubtedly more convenient to communicate to the public than explicit arguments for the necessity of downscaling public services.
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Affiliation(s)
- Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gudmund Ågotnes
- Department of Welfare and Participation, and Centre for Care Research, West, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Voie KS, Blix BH, Helgesen AK, Larsen TA, Maehre KS. Professional home care providers' conceptualisations of frailty in the context of home care: A focus group study. Int J Older People Nurs 2023; 18:e12511. [PMID: 36357358 PMCID: PMC10078232 DOI: 10.1111/opn.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND In Norway, as in many other countries, more people receive health and care services in their homes than before. Home care professionals provide care and support to people with a range of health and care needs. Older home care service users are sometimes referred to as 'frail', but the terms 'frail' and 'frailty' have different meanings in different contexts, and little is known about the meaning ascribed to the terms in the context of home care services. Home care services are crucial for many older persons who have health challenges, and how home care professionals conceptualise frailty might shape clinical encounters. OBJECTIVES The purpose of this study is to explore how home care professionals conceptualised frailty in the context of home care. METHODS We conducted four focus group discussions with 14 home care professionals who worked in municipal home care in northern Norway and analysed the data using thematic analysis. RESULTS Our analysis resulted in five themes: '"Frail" - a term which is too imprecise to be useful', 'Frailty as a consequence of ageing', 'Frailty as lack of engagement and possibilities for engagement', 'Frailty as a contextual phenomenon' and 'Frailty as potentially affected by care'. The home care professionals conceptualised frailty as an individual trait but also as resulting from the interplay between individual and environmental factors. Moreover, their conceptualisations of frailty represented a continuum between frailty as related to prevention and management ('cure') and frailty as related to ageing as natural decline ('care'). CONCLUSION The home care professionals conceptualised frailty diversely, as moving along a continuum between cure and care. Diverse conceptualisations of frailty might be necessary if nurses are to meet the changing and varying care needs of older persons who live in their own homes and need health and care services.
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Affiliation(s)
- Kristin S Voie
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | - Toril Agnete Larsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kjersti Sunde Maehre
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Blix BH, Glasdam S, Jacobsen FF. Introduksjon til spesialnummer om etnisk og kulturelt mangfold i helse- og omsorgstjenestene i kommunene. TFO 2022. [DOI: 10.18261/tfo.8.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bjerkmo L, Helgesen AK, Blix BH. Experiences of Being Significant Others to Older Adults with Frailty Living Alone in Rural Arctic Norway: A Qualitative Study. Healthc Policy 2022; 15:1283-1292. [PMID: 35800151 PMCID: PMC9255900 DOI: 10.2147/rmhp.s367079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Our aim in this study was to explore how significant others experience being “significant” to older adults living alone with frailty in rural Arctic areas in northern Norway. The proportion of older adults in the population is larger and growing faster in rural- than in urban areas. Due to out-migration of the younger generations, many significant others live far from the older adults. Methods Our results are based on a thematic analysis of semistructured interviews with ten persons identified as significant others by older adults in rural Arctic Norway. Results The analysis resulted in two main themes and five subthemes: 1. Restoring and maintaining balance in the older adult’s life with the following three subthemes: 1.1. balancing between the older adult’s capacity and the physical environment; 1.2. emotional support; and 1.3. balancing between the older adult’s need for help and the services offered; and 2. Maintaining balance in one’s own life with the following two subthemes: 2.1. family and working life; and 2.2. tensions between family members. The rural Arctic context in which the older adult lived was relevant to varying degrees in all themes. Conclusion Our results showed that experiences of being the significant other involve a continuous balancing act affected by the older adult’s life situation, the significant other’s own life and the rural Arctic context in which the older adult lives. Our study adds to previous conceptualizations of frailty as both a bodily and a relational phenomenon framed by materialities, the understanding of frailty as also a situated phenomenon.
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Affiliation(s)
- Lena Bjerkmo
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
- Correspondence: Lena Bjerkmo, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway, Tel +4777644739, Email
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
- Faculty of Health, Welfare, and Organisation, Østfold University College, Halden, N-1757, Norway
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
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Brinchmann BS, Lyngmo S, Herholdt-Lomholdt SM, Blix BH. Multiple perspectives and dialogue in understanding experiences of living with eating disorders: Two narratives-four unpackings. J Eat Disord 2022; 10:24. [PMID: 35168660 PMCID: PMC8848953 DOI: 10.1186/s40337-022-00554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This is a response to Conti et al.'s article, "Listening in the dark: why we need stories of people living with severe and enduring anorexia nervosa" (published in JED, 2016), and its call for relational metaphors and a relational approach to supplement the traditional medical/psychological diagnostic language used to describe the life experiences and complex emotions of people affected by an eating disorder. METHODS Four authors with different backgrounds unpack two narratives, 'The Prima Donna with the Green Dress' and 'Breaking down the Wall', both narrated during fieldwork in multifamily therapy. The narratives are unpacked from the perspective of a therapist within multifamily therapy, a researcher who conducted the fieldwork, a researcher based in phenomenology and a researcher based in narrative inquiry. The authors enter into dialogue with the narratives, and with each other. RESULTS The four authors focus on different elements within the narratives and understand them differently. One, focuses on strength and pride, and art expression as a different form of language for people living with an eating disorder. Another, on the experience of isolation, boundaries, and balancing openness and closedness. A third, sees the narratives as expressing a wish to see and be seen, and the fourth focuses on the absence of, and longing for, a shared space to explore. CONCLUSION The aim is not to reach a correct or shared interpretation of the narratives but to explore how different perspectives may contribute to different insights, not only about one family in particular but about, more generally, the experiences of people living with an eating disorder. Our work shows the significance of engaging with multiple perspectives and dialogue as supplements to the traditional medical/psychiatric diagnostic language in both clinical practice and research.
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Affiliation(s)
- Berit Støre Brinchmann
- The Faculty of Nursing and Health Sciences, Nord University, 8026, Bodø, Norway. .,Regional Centre for Eating Disorders, Nordland Hospital, 8076, Bodø, Norway.
| | - Siri Lyngmo
- Regional Centre for Eating Disorders, Nordland Hospital, 8076, Bodø, Norway
| | | | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
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Blix BH, Stalsberg H, Moholt JM. Demografisk utvikling og potensialet for uformell omsorg i Norge. TFO 2022. [DOI: 10.18261/issn.2387-5984-2021-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Blix BH, Munkejord MC. Indigenous Sami Family Caregivers' Experiences With Accessing and Collaborating With Municipal Health and Care Services. Glob Qual Nurs Res 2022; 9:23333936221123333. [PMID: 36120534 PMCID: PMC9479542 DOI: 10.1177/23333936221123333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Previous research has indicated that Indigenous Sami families in Norway
use public home-based care services less often than their non-Sami
peers. Based on qualitative interviews with Sami family caregivers, we
explore what they experience as barriers to accessing public care
services for older adults living with dementia, and how they
experience collaborating with care services providers. Through a
reflexive thematic approach, we identified that rather than a cultural
norm of “taking care of one’s own,” the underuse of public care
services among Sami families were related to several intertwined
circumstances. The Sami family caregivers reported barriers to
accessing public care, such as lack of familiarity with the services
and cultural and language concerns and the legacy of history, and
drivers for continuing family care, such as blurred distribution of
responsibility, lack of continuity of care, and culturally unsafe
caring environments and marginalizing practices.
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Affiliation(s)
- Bodil H Blix
- UiT The Arctic University of Norway, Tromsø, Norway
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Nilsen MK, Blix BH, Sletvold H, Olsen RM. Older Adults Living in Sheltered Housing's Experiences of Involvement in Pro Re Nata Decisions. A Narrative Positioning Analysis. Glob Qual Nurs Res 2021; 8:23333936211056930. [PMID: 34841007 PMCID: PMC8611287 DOI: 10.1177/23333936211056930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022] Open
Abstract
Decisions regarding pro re nata medications might be challenging due to the complex
nature of the practice. The aim of this study was to expand our understanding of the
experiences of older people living in sheltered housings with regard to shared
decision-making concerning pro re nata medications. In this study, we conducted in-depth
interviews with residents living in Norwegian sheltered housings. The analysis was
inductive, based on a narrative positioning analysis. Twelve residents were interviewed,
and three narratives representing participants’ variation are presented. People take
different positions in shared decision-making of pro re nata medication, and they position
themselves variously at different levels and situations. Prevailing master narratives
affect the residents’ positions in shared decision-making. Contrasts in older adults’
experiences indicate that shared decision-making is not straightforward and is highly
reliant on the context. Seemingly, they wish to be involved and not involved at the same
time, a contradiction that healthcare providers need to consider.
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Affiliation(s)
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Hege Sletvold
- Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Rose Mari Olsen
- Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway.,Centre for Care Research Mid-Norway, Nord University, Namsos, Norway
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Caine V, Steeves P, Berendonk C, Blix BH, Jean Clandinin D. Narrative care: Unpacking pandemic paradoxes. Nurs Inq 2021; 29:e12462. [PMID: 34541743 DOI: 10.1111/nin.12462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Abstract
During the coronavirus disease 2019 pandemic, public health has issued three interrelated dominant narratives through social media and news outlets: First, to care for others, we must keep physically distant; second, we live in the same world and experience the same pandemic; and third, we will return to normal at some point. These narratives create complexities as they collide with the authors' everyday lives as nurses, educators, and women. This collision creates three paradoxes for us: (a) learning to care by creating physical distance, (b) a sense of togetherness erases inequities, and (c) returning to normal is possible. To inquire into these three paradoxes, we draw on our experiences with Ingrid, an older adult who requires in-home physical care, and Matthew, a man with multiple disabilities including severe oral dyspraxia and developmental delays. We outline how narrative care is a counterstory to the dominant narratives and enables us to find ways to live our lives within the paradoxes. Narrative care allows us, through attention to embodiment, liminality, and imagination, to create forward looking stories. Understanding narrative care within these paradoxes allows us to offer more complex understandings of the ways narrative care can be embodied in our, and others', lives.
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Affiliation(s)
- Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela Steeves
- Centre for Research for Teacher Education and Development, Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | | | - Bodil H Blix
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - D Jean Clandinin
- Centre for Research for Teacher Education and Development, Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
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Bjerkmo L, Helgesen AK, Larsen TA, Blix BH. "Falling off the wagon": older adults' experiences of living with frailty in rural arctic communities. Int J Circumpolar Health 2021; 80:1957569. [PMID: 34382501 PMCID: PMC8366667 DOI: 10.1080/22423982.2021.1957569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Most populations around the world are ageing. The proportion of older adults in the population is larger and is growing more rapidly in rural communities than in urban areas. Longevity increases the risk of frailty. Our aim was to explore how single-living frail older adults experience living with frailty in everyday life in rural Arctic areas. Over eight months, we conducted a series of three interviews with eight older adults identified as frail by home care services in two rural municipalities in northern Norway. We conducted a thematic analysis. We generated three themes. Frailty as a dynamic phenomenon indicated that the participants’ experiences of frailty varied over time. Frailty as part of old age referred to the findings that many participants tried to adapt to the changing circumstances, while others found it more challenging to accept the experienced limitations. Frailty in a rural Arctic context concerned the findings that the rural Arctic environment affected the participants’ experiences of frailty due to its long, snowy winters; long distances between communities and municipal centres; and out-migration. Our results demonstrate that frailty is a consequence of the interplay between ageing persons and their physical and social environments.
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Affiliation(s)
- Lena Bjerkmo
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway.,Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Toril Agnete Larsen
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway
| | - Bodil H Blix
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway
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Blix BH, Berendonk C, Clandinin DJ, Caine V. The necessity and possibilities of playfulness in narrative care with older adults. Nurs Inq 2020; 28:e12373. [PMID: 32662183 DOI: 10.1111/nin.12373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 11/27/2022]
Abstract
For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long-term care, we show the possibilities of playfulness in the co-composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times.
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Affiliation(s)
- Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, Centre for Care Research North, UiT The Arctic University of Norway, Tromso, Norway
| | | | - D Jean Clandinin
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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17
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Larsen LS, Moholt JM, Hamran T, Henriksen N, Blix BH. Erfaringer med deltakelse på kommunale pårørendeskoler. TFO 2020. [DOI: 10.18261/issn.2387-5984-2020-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Jill-Marit Moholt
- Senter for omsorgsforskning, nord. Institutt for helse- og omsorgsfag, UiT Norges arktiske universitet
| | - Torunn Hamran
- Institutt for helse- og omsorgsfag, UiT Norges arktiske universitet
| | - Nils Henriksen
- Institutt for helse- og omsorgsfag, UiT Norges arktiske universitet
| | - Bodil H. Blix
- Institutt for helse- og omsorgsfag, UiT Norges arktiske universitet
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18
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Abstract
This qualitative study explores Sami and non-Sami clinicians' assumptions about Sami culture and their experiences in providing mental health services to Sami patients. The aim is to better understand and improve the ways in which culture is incorporated into mental health services in practice. Semi-structured interviews were conducted with 20 clinicians in mental health outpatient clinics in the northern Sami area in Troms and Finnmark County in Norway. The findings show that clinicians' conceptualizations of culture influence how they take cultural considerations about their Sami patients into account. To better integrate culture into clinical practice, the cultures of both patient and clinician, as well as of mental health care itself, need to be assessed. Finally, the findings indicate a lack of professional team discussions about the role of Sami culture in clinical practice.
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19
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Henriksen N, Moholt JM, Blix BH. Perceptions of Family Caregivers of Home-Dwelling Persons with Dementia regarding Access to Information and Involvement in Decisions. J Aging Soc Policy 2020; 32:260-275. [DOI: 10.1080/08959420.2019.1707058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nils Henriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jill-Marit Moholt
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bodil H. Blix
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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20
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Berendonk C, Blix BH, Hoben M, Clandinin DJ, Roach PM, Compton RM, Cave MT, Caine V. A Narrative Care approach for persons living with dementia in institutional care settings. Int J Older People Nurs 2019; 15:e12278. [PMID: 31577388 DOI: 10.1111/opn.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/26/2019] [Accepted: 08/29/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES We will provide insights in the theoretical background and key concepts of a Narrative Care approach, such as narrative cultures, narrative curiosity, narrative co-composition and narrative reflective practice. BACKGROUND Care understood as narrative practice underscores the importance of experiences and how these shape identities. Important to the quality of care in institutional care settings is the ability of care providers to cope with complexities and uncertainties in older adults' stories, which can be realised by attending to ways that foster and co-compose evolving and forward-looking narratives. Recognising these ongoing co-compositions means that persons living in institutional care settings and care providers live, tell, retell and relive their experiences. A change in the current institutional culture is necessary to implement care as narrative practice. To support such a change, approaches are needed that foster a focus on experiences and relationships and make relational ethics central to care. METHODS The proposed Narrative Care approach is the result of an iterative development process involving a literature review, interviews with, and observations of, care providers, dialogues with an advisory committee, and consultation with experts. MAIN CONTRIBUTIONS The proposed Narrative Care approach aims to help care providers (a) to recognise the importance of curiosity in a person's verbal and embodied narratives-especially for those living with dementia; (b) to take note of individual experiences in all of their complexity and uncertainty; (c) to respect these narratives; (d) to open up spaces to co-compose new narratives; and (e) to allow care providers to engage in narrative reflective practices that shape who they are and are becoming. CONCLUSION The introduced approach responds to the need of implementing strategies to think and work narratively in institutional care settings. IMPLICATIONS FOR PRACTICE Narrative Care has the potential to reshape task-oriented, technical notions of care. Concepts such as embodied narratives, relational ethics, narrative co-composition and narrative reflective practice must be integrated in the education of all care providers.
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Affiliation(s)
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - D Jean Clandinin
- Faculty of Education, University of Alberta, Edmonton, AB, Canada.,Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Pamela M Roach
- Brain and Mental Health Research Clinics, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Roslyn M Compton
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marie T Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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21
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Abstract
Here, we explore the experiences and practices of care in the context of assisted living facilities (ALFs) in rural areas from the perspectives of family members, health care professionals, and senior citizen interest group representatives. Specifically, we focus on the potential for ALFs to safeguard and unify the health care policy ambitions of equity, quality, and aging in place. Focus group interviews with health care professionals and interest group representatives and individual interviews with family members were conducted in largely rural Norwegian municipalities. Providing high-quality health care services in people’s homes remains challenging, particularly in rural areas. ALFs have been introduced as a compromise, a home away from home. In rural areas, ALFs are typically localized in community centers. ALFs are neither homes nor nursing homes, and residents possess varying and changing care needs. Several parties experience challenges with respect to safety, evolving care needs, and responsibilities. Moreover, the service allocation and user payment systems may undermine equity. This study indicates that health care authorities should evaluate whether prioritizing assisted living is still suitable for the aging population in rural areas and beyond.
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Abstract
In the past decades, narrative practices have been developed, and care has been conceptualized as being narrative in nature. More recently, narrative care has been developing both as a practice and a field of study. It is necessary to make the theoretical foundations of narrative care visible to avoid the risk of narrowly defining narrative care as a matter of storytelling and listening. In this article, we develop an understanding of narrative care grounded in early feminist pragmatist philosophy, with a focus on social and political activism and experience. Pragmatism holds the possibilities to open spaces for realities that are constantly in flux and for emergent situations that must be considered across time, diverse places and social contexts. With the aid of Vera’s stories about her relationship with Tammy, we demonstrate the importance of recognizing that realities are multiple, complex and uncertain. Furthermore, we discuss how the stronghold of formula stories and issues of power, positioning and inequities, restrict people’s possibilities to be, become and co-author their stories. We also argue that the playfulness, imagination and world travelling of narrative care are in line with early feminist pragmatism, which draws on a wide and diverse range of experiences. Jane Addams linked democracy to dialogue, joint experiences and social equality. This calls for the development of ethical frameworks grounded in care that are more specifically focused on relational ethics and a commitment to dialogical and relational democracy and the prioritization of community.
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Moholt JM, Friborg O, Blix BH, Henriksen N. Factors affecting the use of home-based services and out-of-home respite care services: A survey of family caregivers for older persons with dementia in Northern Norway. Dementia (London) 2018; 19:1712-1731. [PMID: 30322275 PMCID: PMC7309361 DOI: 10.1177/1471301218804981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Family caregivers contribute substantially to the care for older home-dwelling people with dementia, although community healthcare services tend to be underutilized. In this study, we aimed to explore the use and predictors of use of home-based and out-of-home respite care services available to older home-dwelling persons with dementia, as reported by the family caregivers. Method A cross-sectional survey was administered to family caregivers (n = 430) in Northern Norway during April to November 2016. The use of healthcare services was categorized into two types according to principal component analysis: home-based services and out-of-home respite care services (R2 = 44.1%). Predictors of service use were examined with bivariate correlation, multiple linear regression, and Poisson regression analyses. Results The use of home-based services among persons with dementia was significantly higher for persons with advanced age, persons living in urban areas, persons living in an assisted living facility, persons living alone, and persons able to manage being alone for a short period of time. Among the family caregiver variables, higher age, status as a daughter, son, or other family member, higher educational level, and full-time employment also predicted greater use of home-based services. Same ethnicity was associated with use of fewer home-based services. The use of out-of-home respite care services was significantly higher among male persons with dementia and among those living in urban areas. In addition, fewer out-of-home respite care services were used by male caregivers or daughters of the care recipient, while the use was higher when the caregivers experienced more caregiving demands or had provided care for longer periods of time. Conclusions These results indicate areas that policymakers and healthcare providers should consider to identify families who underutilize healthcare services and to achieve a more equal and efficient allocation of services in accordance with families' needs.
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Affiliation(s)
- Jill-Marit Moholt
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Bodil H Blix
- Centre for Care Research North, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Nils Henriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
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