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Hjelm, M., Holmgren, A.-C., Willman, A., Bohman, D. & Holst, G. (2015). Family members of older persons with multi-morbidity and their experiences of case managers in Sweden: an interpretive phenomenological approach. International Journal of Integrated Care, 15(Jan-Mar)
Open this publication in new window or tab >>Family members of older persons with multi-morbidity and their experiences of case managers in Sweden: an interpretive phenomenological approach
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2015 (English)In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 15, no Jan-MarArticle in journal (Refereed) Published
Abstract [en]

Background: Family members of older persons (75+) with multi-morbidity are likely to benefit from utilising case management services performed by case managers. However, research has not yet explored their experiences of case managers. Objectives: The aim of the study was to deepen the understanding of the importance of case managers to family members of older persons (75+) with multi-morbidity. Design: The study design was based on an interpretive phenomenological approach. Method: Data were collected through individual interviews with 16 family members in Sweden. The interviews were analysed by means of an interpretive phenomenological approach. Results: The findings revealed one overarching theme: “Helps to fulfil my unmet needs”, based on three sub-themes: (1) “Helps me feel secure – Experiencing a trusting relationship”, (2) “Confirms and strengthens me – Challenging my sense of being alone” and (3) “Being my personal guide – Increasing my competence”. Conclusion and discussion: The findings indicate that case managers were able to fulfil unmet needs of family members. The latter recognised the importance of case managers providing them with professional services tailored to their individual needs. The findings can contribute to the improvement of case management models not only for older persons but also for their family members.

Place, publisher, year, edition, pages
Igitur publishing, 2015
Keywords
case management, integrated care, family members, interpretive phenomenology, multi-morbidity, older persons
National Category
Nursing
Identifiers
urn:nbn:se:bth-6326 (URN)000352658200010 ()oai:bth.se:forskinfo937D754C744053A5C1257E22004A23E7 (Local ID)oai:bth.se:forskinfo937D754C744053A5C1257E22004A23E7 (Archive number)oai:bth.se:forskinfo937D754C744053A5C1257E22004A23E7 (OAI)
External cooperation:
Note

Open Access Journal

Available from: 2015-05-26 Created: 2015-04-09 Last updated: 2017-12-04Bibliographically approved
Hjelm, M., Holst, G., Willman, A., Bohman, D. & Kristensson, J. (2015). The work of case managers as experienced by older persons (75+) with multi-morbidity – a focused ethnography. BMC Geriatrics, 15, Article ID 168.
Open this publication in new window or tab >>The work of case managers as experienced by older persons (75+) with multi-morbidity – a focused ethnography
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2015 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, article id 168Article in journal (Refereed) Published
Abstract [en]

Background

Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons’ (75+) with multi-morbidity experiences of case managers.

Methods

The study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012–2013.

Results

The data revealed four themes illustrating the older persons’ experiences of case managers:

1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present.

Conclusions

This study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.

Keywords
Aged, Case management, Comorbidity, Continuity of patient care, Delivery of health care, Ethnography, Intervention, Multi-morbidity, Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:bth-11231 (URN)10.1186/s12877-015-0172-3 (DOI)000366545100001 ()
Available from: 2015-12-18 Created: 2015-12-18 Last updated: 2017-12-01Bibliographically approved
Gustafsson, M., Holst, G., Kristensson, J., Willman, A. & Bohman, D. (2013). Case managers’ experiences of their everyday practice. In: European Geriatric Medicine: . Paper presented at 9th Congress of the EUGMS. Venice: Elsevier Masson SAS, 4(Supplement 1)
Open this publication in new window or tab >>Case managers’ experiences of their everyday practice
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2013 (English)In: European Geriatric Medicine, Venice: Elsevier Masson SAS , 2013, Vol. 4, no Supplement 1Conference paper, Oral presentation only (Refereed)
Abstract [en]

Introduction.– Today, there is an interest in how Case Management (CM) should be designed to best suit the complex needs of the older people with multi-morbidity. Current research on CM has mainly focused on health care costs and consumption, but the results have been inconsistent and ranging from positive outcomes to no effect. To improve CM, there is need to investigate what mechanisms are important for a successful intervention. To advance this knowledge, there is a necessity for studies investigating the experiences of those practicing CM i.e. Case Managers. There might be unknown factors or interpersonal factors that can contribute to a CM intervention's success or failure. Therefore, the aim of this study was to explore the Case Managers’ experiences of their everyday practice. Methods.– The study design was qualitative and descriptive utilizing an ethnographic approach, consisting of participant observations, a focus group interview and individual interviews with nine Case Managers conducted during 2012/2013. The interviews were recorded and transcribed verbatim and then subjected to content analysis. Results.– Three main themes described Case Managers’ experience of their everyday practice: navigating the older person, working to improve the health care system and being the older persons advocate. Conclusions.– Findings from this study sheds light on the complexity of CM for older people with multi-morbidity, from the experiences of Case Managers. These findings could help in the development of CM models designed for older people with complex health needs.

Place, publisher, year, edition, pages
Venice: Elsevier Masson SAS, 2013
National Category
Nursing
Identifiers
urn:nbn:se:bth-6836 (URN)10.1016/j.eurger.2013.07.156 (DOI)000325236300001 ()oai:bth.se:forskinfo4AC472E444FC12CCC1257C32004A03B5 (Local ID)oai:bth.se:forskinfo4AC472E444FC12CCC1257C32004A03B5 (Archive number)oai:bth.se:forskinfo4AC472E444FC12CCC1257C32004A03B5 (OAI)
Conference
9th Congress of the EUGMS
Note

(European Union Geriatric Medicine Society)

Available from: 2013-12-02 Created: 2013-11-29 Last updated: 2017-05-26Bibliographically approved
Gustafsson, M., Kristensson, J., Holst, G., Willman, A. & Bohman, D. (2013). Case managers for older persons with multi-morbidity and their everyday work -- a focused ethnography. BMC Health Services Research, 13(496)
Open this publication in new window or tab >>Case managers for older persons with multi-morbidity and their everyday work -- a focused ethnography
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2013 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 496Article in journal (Refereed) Published
Abstract [en]

Background Modern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences. Methods The study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis. Results An overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy. Conclusions Findings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs.

Place, publisher, year, edition, pages
Biomed Central, 2013
Keywords
Case manager, Case management, Continuity of care, Ethnography, Focused ethnography, Intervention, Multi-morbidity, Older persons, Thematic analysis
National Category
Nursing
Identifiers
urn:nbn:se:bth-6677 (URN)10.1186/1472-6963-13-496 (DOI)000330068400001 ()oai:bth.se:forskinfo4EF83943962328F6C1257C32004D756A (Local ID)oai:bth.se:forskinfo4EF83943962328F6C1257C32004D756A (Archive number)oai:bth.se:forskinfo4EF83943962328F6C1257C32004D756A (OAI)
Note

Open access journal

Available from: 2014-07-17 Created: 2013-11-29 Last updated: 2017-12-04Bibliographically approved
Taube, E., Kristensson, J., Midlöv, P., Holst, G. & Jakobsson, U. (2013). Loneliness Among Older People: Results from the Swedish National Study on Aging and Care – Blekinge. Open Geriatric Medicine Journal, 6(1), 1-10
Open this publication in new window or tab >>Loneliness Among Older People: Results from the Swedish National Study on Aging and Care – Blekinge
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2013 (English)In: Open Geriatric Medicine Journal, ISSN 1874-8279, Vol. 6, no 1, p. 1-10Article in journal (Refereed) Published
Abstract [en]

Abstract: Objectives: To investigate the prevalence and predictors of loneliness in older people (aged 78+) over a sixyear period. Method: The sample (n=828) was drawn from the Swedish National Study on Aging and Care and the respondents were followed up at three and six years. Data were collected by means of structural interviews with supplementary questionnaires. Results: Half of the respondents reported that they felt lonely sometimes or more often. Women, widows/-ers living alone were more prone to report loneliness. Both independent associated factors and predictors were identified showing that loneliness is associated with and predicted by both physical and psychosocial outcomes. Discussion: Loneliness is common among older people and seems to be a steady state affected mainly by psychological and psychosocial factors such as personality, satisfaction with life, risk of depression, lack of friends and loss of spouse. Psychosocial interventions targeting emotional loneliness and social isolation are suggested.

Place, publisher, year, edition, pages
Bentham Open, 2013
Keywords
Aged, health, loneliness, psychosocial factors
National Category
Nursing
Identifiers
urn:nbn:se:bth-7032 (URN)10.2174/1874827901306010001 (DOI)oai:bth.se:forskinfoAB31C7E89AA5B410C1257AF5003F8935 (Local ID)oai:bth.se:forskinfoAB31C7E89AA5B410C1257AF5003F8935 (Archive number)oai:bth.se:forskinfoAB31C7E89AA5B410C1257AF5003F8935 (OAI)
External cooperation:
Available from: 2013-01-17 Created: 2013-01-16 Last updated: 2017-12-04Bibliographically approved
Lindström, V., Andersson, K., Lintrup, M., Holst, G. & Berglund, J. (2012). Prevalence of sleep problems and pain among the elderly in Sweden. The Journal of Nutrition, Health & Aging, 16(2), 180-83
Open this publication in new window or tab >>Prevalence of sleep problems and pain among the elderly in Sweden
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2012 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 16, no 2, p. 180-83Article in journal (Refereed) Published
Abstract [en]

Background/Objectives: Sleep problems and pain are common among the elderly and have been shown to affect quality of life. The objectives were to determine the prevalence of sleep problems and pain among the elderly and to compare the two factors in relation to age and gender. Design: A cross-sectional study based on baseline material collected by the Swedish National Study on Aging and Care in Blekinge (SNACBlekinge). Setting: The data were gathered from questionnaires distributed between the years 2001 and 2003 in the municipality of Karlskrona, Sweden. Participants: The participants comprised 1402 Swedish men and women aged 60-96. Results: Of all the participants 70 percent met the criteria for sleep problems and 62 percent indicated some experience of pain during the preceding 4 weeks. Both sleep problems and pain were more frequent among women than men and sleep problems tended to be more common with increasing age. Among the participants who experienced pain during the preciding 4 weeks 77 percent suffered from sleep problems. Conclusions: Sleep problems and pain are common among older people. Furthermore it is common to suffer from sleep problems when pain has been experienced during the preciding 4 weeks.

Place, publisher, year, edition, pages
Springer, 2012
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:bth-7180 (URN)10.1007/s12603-011-0356-2 (DOI)000301189000012 ()oai:bth.se:forskinfoF761C9A6E50455F0C125797B0036AD01 (Local ID)oai:bth.se:forskinfoF761C9A6E50455F0C125797B0036AD01 (Archive number)oai:bth.se:forskinfoF761C9A6E50455F0C125797B0036AD01 (OAI)
External cooperation:
Available from: 2012-11-27 Created: 2012-01-04 Last updated: 2017-12-04Bibliographically approved
Holst, G., Rennemark, M. & Hallberg, I. (2012). Self and next of kin’s assessment of personality and sense of coherence in elderly people: Implications for dementia care. Dementia, 11(1), 19-30
Open this publication in new window or tab >>Self and next of kin’s assessment of personality and sense of coherence in elderly people: Implications for dementia care
2012 (English)In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 11, no 1, p. 19-30Article in journal (Refereed) Published
Abstract [en]

Nurses sometimes fail to understand the behaviour of individuals with severe dementia. Information from a next of kin may help to bridge this communicative gap. One factor that influences a person’s reaction to a disease is their personality and ability to cope with stress. The aim of this study was to evaluate the inter-rater agreement between healthy elderly people’s self-assessment and the assessment made by a next of kin concerning personality and sense of coherence. The participants (n¼154) answered questions from the Eysenck Personality Inventory (EPI) and the Antonovsky Sense of Coherence (SOC) scale. The study shows high or moderate agreement in ratings when analysed by means of an intra-class correlation coefficient (range between r¼.57 and r¼.72) and the results indicate that in general a close relative is able to report on the personality of a next of kin. The inter-rater agreement was high on SOC and extraversion and somewhat lower on neuroticism. For neuroticism, length of time in the relationship increased the odds for a good inter-rater agreement. Thus, seemingly a next of kin is a reliable informant for the elderly in general and is probably also able to add information useful in the nursing care of people with dementia.

Place, publisher, year, edition, pages
Sage, 2012
Keywords
Dementia, Family caregiving
National Category
Nursing
Identifiers
urn:nbn:se:bth-7452 (URN)10.1177/1471301211421238 (DOI)oai:bth.se:forskinfo8B76F18C3C299560C12579120021B088 (Local ID)oai:bth.se:forskinfo8B76F18C3C299560C12579120021B088 (Archive number)oai:bth.se:forskinfo8B76F18C3C299560C12579120021B088 (OAI)
External cooperation:
Available from: 2012-09-18 Created: 2011-09-21 Last updated: 2017-12-04Bibliographically approved
Holst, G. & Edberg, A.-K. (2011). Wellbeing among people with dementia and their next of kin over a period of 3 years. Scandinavian Journal of Caring Sciences, 25(3), 549-557
Open this publication in new window or tab >>Wellbeing among people with dementia and their next of kin over a period of 3 years
2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, p. 549-557Article in journal (Refereed) Published
Abstract [en]

Little is known about the dyadic experience over time of people with dementia and their next of kin. The aim of this study was to investigate the state of mind of people with dementia, their next of kin’s experience of burden and satisfaction, and factors associated with these experiences over a 3-year period. The sample consisted of 32 people with dementia living at home with family caregivers in the south of Sweden. Data were collected during the period 2004–2007 and consisted of patients self reports (GDS), dementia nurse assessment (MMSE, Berger and ADL) and next-of-kin assessment (patient’s state of mind and care provision). Data also consisted of nextof- kin’s self reports concerning health, burden and satisfaction. The result showed that patients’ state of mind was mainly positive at baseline but a deterioration was seen over time in the patient’s mood and cognitive functioning together with an increase in ADLdependency and suspected depression. Dependency in personal ADL entailed a higher risk of being in a negative state of mind. For next of kin the experience of burden increased while satisfaction decreased over the 3 years. The inter-relationship between the patients’ mood and the caregiver’s satisfaction and burden seems to get stronger over time. At baseline caregiver burden was mainly related to the next of kins’ general health and to patient behaviours that were difficult to handle. During the progression of the disease caregiver satisfaction becomes increasingly related to patient state of mind and dependency. There is, however, a need for more research focusing on the specific inter-relational aspects as previous studies have mainly focused on either the situation for the person with dementia or on the caregiver.

Place, publisher, year, edition, pages
Wiley, 2011
Keywords
dementia, community care, family perspective
National Category
Nursing
Identifiers
urn:nbn:se:bth-7585 (URN)10.1111/j.1471-6712.2010.00863.x (DOI)000293756500018 ()oai:bth.se:forskinfo6B358A4A64EE9E31C125781800382132 (Local ID)oai:bth.se:forskinfo6B358A4A64EE9E31C125781800382132 (Archive number)oai:bth.se:forskinfo6B358A4A64EE9E31C125781800382132 (OAI)
Available from: 2012-09-18 Created: 2011-01-14 Last updated: 2017-12-04Bibliographically approved
Holst, G. & Rennemark, M. (2010). Can communicative problems between caregivers and patients with severe dementia be bridged by help from a close family member?. Paper presented at 20th Nordic Congress of Gerontology. Paper presented at 20th Nordic Congress of Gerontology. Reykjavik
Open this publication in new window or tab >>Can communicative problems between caregivers and patients with severe dementia be bridged by help from a close family member?
2010 (English)Conference paper, Oral presentation only (Refereed) Published
Abstract [en]

Several studies have shown connections between personality and various kinds of behavioural and psychological symptoms in dementia. It has for example been found that personality traits such as introversion, rigidity, and a tendency to suppress emotions, as remembered retrospectively by a close family member, correlated positively with disturbed communicative behaviors in people with severe dementia. This finding indicates that personality characteristics should be considered in nursing care because they may help a caregiver to understand communicative attempts from a person not able to speak for themselves, i.e. express their feelings. Information from a next of kin about a sick person’s personality may help to bridge communicative gaps in care situations. However, the reliability of such information is not known. The aim of the present study was to evaluate the inter-rater agreement between healthy elderly people`s self-assessment and the assessment made by a next of kin concerning personality and Sense of Coherence (SOC). The participants (n=154) answered questions from the Eysenck personality scale and the Antonovsky SOC scale. The study shows high or moderate agreement in ratings when analysed by means of an intra-class correlation coefficient (range between r =.57 and r = .72) indicating that in general a close relative is able to report on the personality of a next of kin. The inter-rater agreement was high on SOC and Extraversion and somewhat lower on Neuroticism. For Neuroticism, length of time of relationship increased the odds for a good inter-rater agreement. Thus seemingly a next of kin is a reliable informant for the elderly in general and is probably also able to add information useful in the nursing care of people with a severe dementia disease.

Place, publisher, year, edition, pages
Reykjavik: , 2010
National Category
Psychology Nursing Medical and Health Sciences
Identifiers
urn:nbn:se:bth-7834 (URN)oai:bth.se:forskinfo4DF3418F4108F775C125770000386D02 (Local ID)oai:bth.se:forskinfo4DF3418F4108F775C125770000386D02 (Archive number)oai:bth.se:forskinfo4DF3418F4108F775C125770000386D02 (OAI)
Conference
20th Nordic Congress of Gerontology
Available from: 2012-09-18 Created: 2010-04-09 Last updated: 2015-06-30Bibliographically approved
Holst, G., Willman, A., Fagerström, C., Borg, C., Hellström, Y. & Borglin, G. (2010). Quality of care: Prevention of pressure ulcers – Nursing students facilitating evidence-based practice. Vård i Norden, 30(1), 40-42
Open this publication in new window or tab >>Quality of care: Prevention of pressure ulcers – Nursing students facilitating evidence-based practice
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2010 (English)In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 30, no 1, p. 40-42Article in journal (Refereed) Published
Abstract [en]

This development project was aimed at engaging nursing students in a project targeting the prevention and reduction of pressure ulcers on an education based hospital ward. An intervention was implemented based on systematic assessment, skin observation, together with training and educational sessions, i.e. on how to make risk assessments and how to prevent and treat a pressure ulcer, were carried out. The project demonstrated the importance of offering nursing students an environment for clinical practice which supports them in participating and developing patient care starting from Evidence-Based Practice. During the project no patients developed pressure ulcers while on the ward. The opportunity to act as facilitators of evidence-based methods was found to enhance student ability to draw conclusions and make connections between quality of care and end result.

Place, publisher, year, edition, pages
Sykepleiernes Samarbeid i Norden (SSN), 2010
Keywords
Nursing education, Evidence-Based Practice, Pressure Ulcer, Quality Improvement
National Category
Nursing
Identifiers
urn:nbn:se:bth-7868 (URN)oai:bth.se:forskinfo2F40DAECC964E3FDC12576D90044CE28 (Local ID)oai:bth.se:forskinfo2F40DAECC964E3FDC12576D90044CE28 (Archive number)oai:bth.se:forskinfo2F40DAECC964E3FDC12576D90044CE28 (OAI)
Available from: 2012-09-18 Created: 2010-03-01 Last updated: 2017-12-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4342-0780

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