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  • 1.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Benzein, Eva
    Lindberg, Jenny
    Persson, Carina
    Processes toward the end of life and dialysis withdrawal: Physicians' and nurses' perspectives2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, article id 969733019848050Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory.

    AIM: The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease.

    RESEARCH DESIGN AND PARTICIPANTS: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data.

    ETHICAL CONSIDERATIONS: Ethical approval was obtained (Dnr 2014/304-31).

    FINDINGS AND DISCUSSION: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress.

    CONCLUSION: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.

  • 2.
    Gransjön Craftman, Åsa
    et al.
    Sophiahemmet University.
    Swall, Anna
    Båkman, Kajsa
    Grundberg, Åke
    Sophiahemmet University.
    Hagelin, Carina Lundh
    Caring for older people with dementia reliving past trauma2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, article id 969733019864152Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The occurrence of behavioural changes and problems, and degree of paranoid thoughts, are significantly higher among people who have experienced extreme trauma such as during the Holocaust. People with dementia and traumatic past experiences may have flashbacks reminding them of these experiences, which is of relevance in caring situations. In nursing homes for people with dementia, nursing assistants are often the group of staff who provide help with personal needs. They have firsthand experience of care and managing the devastating outcomes of inadequate understanding of a person's past experiences.

    AIM: The aim was to describe nursing assistants' experiences of caring for older people with dementia who have experienced Holocaust trauma.

    RESEARCH DESIGN: A qualitative descriptive and inductive approach was used, including qualitative interviews and content analysis.

    PARTICIPANTS AND RESEARCH CONTEXT: Nine nursing assistants from a Jewish nursing home were interviewed.

    ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethical Review Board, Stockholm.

    FINDINGS: The theme 'Adapting and following the survivors' expression of their situation' was built on two categories: Knowing the life story enables adjustments in the care and Need for flexibility in managing emotional expressions.

    DISCUSSION AND CONCLUSION: The world still witnesses genocidal violence and such traumatic experiences will therefore be reflected in different ways when caring for survivors with dementia in the future. Person-centred care and an awareness of the meaning of being a survivor of severe trauma make it possible to avoid negative triggers, and confirm emotions and comfort people during negative flashbacks in caring situations and environments. Nursing assistants' patience and empathy were supported by a wider understanding of the behaviour of people with dementia who have survived trauma.

  • 3.
    Lejman, Eva
    et al.
    Sophiahemmet University.
    Westerbotn, Margareta
    Sophiahemmet University.
    Pöder, Ulrika
    Wadensten, Barbro
    The ethics of coercive treatment of people with dementia2013In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 3, p. 248-262Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to describe how registered nurses in nursing homes ensure legal security, good and safe nursing care and uphold the dignity of nursing home residents with severe dementia without violating residents' integrity. Semi-structured interviews were conducted with 10 charge nurses in a county in central Sweden. The transcribed interviews were examined using manifest and latent content analyses. The manifest analysis identified actual local routines involving coercive treatment and registered nurses' descriptions of complications and alternative measures. The latent analysis resulted in three themes describing nursing strategies: one with coercive treatment, one with coercive treatment under specific circumstances and one to prevent coercive treatment. Interpretations of legal terms regarding coercive treatment and inadequate gerontological nursing training and understaffing seem to preserve the use of coercive treatment.

  • 4. Marmstål Hammar, Lena
    et al.
    Swall, Anna
    Sophiahemmet University.
    Summer Meranius, Martina
    Ethical aspects of caregivers' experience with persons with dementia at mealtimes2016In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, no 6, p. 624-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Persons with dementia are at risk of malnutrition and thus in need of assistance during mealtimes. Research suggest interventions for caregivers to learn how to facilitate mealtimes and eating, while other suggest a working environment enabling the encounter needed to provide high-quality care. However, the phenomenon of caring for this unique population needs to be elucidated from several perspectives before suggesting suitable implications that ensure their optimal health.

    OBJECTIVES: To illustrate the meanings within caregivers' experiences of caring for persons with dementia during mealtime situations. We also measured weight and food intake among individuals with dementia to explain better the phenomenon of caring for them during mealtimes.

    METHODS: Mixed method including focus group interviews with seven caregivers analyzed using phenomenological hermeneutics. In addition, for nine persons with dementia, weight and food intake were collected and descriptive statistics were calculated.

    ETHICAL CONSIDERATIONS: Ethical review was obtained from an ethics committee, and all caregivers signed a consent form after being informed on the issue of research ethics. Relatives for persons with dementia were informed and signed the consent. In addition, throughout the study, the persons' expressions were observed aiming to respect their vulnerability, integrity, and dignity.

    FINDINGS: One theme emerged from interviews (struggling between having the knowledge and not the opportunity), which was built upon three subthemes (being engaged and trying; feeling abandoned and insufficient; being concerned and feeling guilty). Seven of nine persons with dementia lost a minimum of 1.3 kg of weight and ate a maximum of 49.7% of the food served.

    CONCLUSION: Caregivers struggle because they have knowledge about how to provide high-quality care but are unable to provide this care due to organizational structures. The weight loss and insufficient eating among the persons with dementia may support this conclusion. Sufficient time for adequate care should be provided.

  • 5.
    Mattiasson, Anne-Cathrine
    et al.
    Sophiahemmet University College.
    Andersson, L
    Nursing home staff attitudes to ethical conflicts with respect to patient autonomy and paternalism1995In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 2, no 2, p. 115-30Article in journal (Refereed)
    Abstract [en]

    Six case studies on nursing home staff attitudes to patient autonomy have been analysed. The case studies are based on six polarities within autonomy, as developed by Collopy. In total, 189 professional caregivers, comprising the staff of 13 nursing homes in the county of Stockholm, Sweden, responded to questions based on the case studies. Results show that the attitudes within each professional category had a high level of internal correspondence. Nurses consistently supported patient preferences to the highest degree, followed by assistant nurses and auxiliary staff. Nurses' aides ranked lowest in supporting patient preferences. In only one of the cases were background variables of significance.

  • 6.
    Mattiasson, Anne-Cathrine
    et al.
    Sophiahemmet University College.
    Hemberg, M
    Intimacy--meeting needs and respecting privacy in the care of elderly people: what is a good moral attitude on the part of the nurse/carer?1998In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 5, no 6, p. 527-34Article in journal (Refereed)
    Abstract [en]

    This article explores notions of intimacy in the caring context. The aspects discussed are: privacy and intimacy; intimacy as emotional and/or physical closeness; intimacy as touch; sexual intimacy and normal ageing; sexual intimacy and patients suffering from dementia; and intimacy as trust. Examples are given and problems are identified, with reflection on the attitude and behaviour of the carer. It is suggested that when trying to make moral decisions in concrete situations it is imperative that the carer is aware of the values upon which his or her own thinking is based. It is argued that the guiding principle should be the moral assumption that the carer's responsibility can never be interpreted as a right to disregard the wishes of the patient. Hence, the key word in daily care is 'respect'.

  • 7.
    Randers, Ingrid
    et al.
    Sophiahemmet University College.
    Mattiasson, Anne-Cathrine
    Sophiahemmet University College.
    The experiences of elderly people in geriatric care with special reference to integrity2000In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 7, no 6, p. 503-19Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers' integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people's integrity relating to their corporal self were the least violated. On the other hand, their psychological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people's social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions.

  • 8.
    Randers, Ingrid
    et al.
    Sophiahemmet University College.
    Olson, Tina H
    Mattiasson, Anne-Cathrine
    Sophiahemmet University College.
    Confirming older adult patients' views of who they are and would like to be2002In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 9, no 4, p. 416-31Article in journal (Refereed)
    Abstract [en]

    This article reveals a 91-year-old cognitively intact man's lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient's basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played the role of an 'old cognitively impaired man', which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver's ability to respect and confirm each and every patient for who he or she is and would like to be.

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