Ökningen av befolkningen 65 år och äldre har lett till ökat intresse för den äldre människans hälsa och sociala engagemang i samhället. Som en följd av detta har Gävle kommun sökt och antagits som medlem i WHO:s nätverk för äldrevänliga städer och samhällen 2019 med ambitionen att förbättra för de äldre kommuninvånarna utifrån WHO:s åtta utvecklingsområden, samhällsstöd med transporter och mobilitet, boende och bostäder, social delaktighet, god hälso- och sjukvård, utomhusmiljöer, parker och byggnader, respekt och social tillhörighet och möjliga utvecklingsområden. Syftet med denna forskningsstudie var att beskriva äldre personers erfarenheter av sin livssituation i Gävle kommun utifrån WHO:s åtta utvecklingsområden. Tretton äldre personer mellan 66 och 85 år deltog fördelat i tre fokusgruppsintervjuer. I Resultatet framkom sju teman som belyste deltagarnas erfarenheter; möjligheten att komma ut i samhället, hur boendet fungerade i vardagen, känslan av social tillhörighet och delaktighet, möjligheten att få stöd och service av hälso- och sjukvården, upplevelserna av att känna sig respekterade, möjligheten till att delta i olika aktiviteter samt hur de som kommuninvånare har möjlighet till medborgardeltagande. Slutsatsen av studien visar att de äldre kommuninvånarna är en grupp att räkna med när det handlar om framtidens äldrevänliga kommuner. Äldre personer vill vara delaktiga i och kunna påverka utvecklingen av de beslut som fattas i kommunen när det gäller frågor som rör äldre personer. Mot den bakgrunden ges förslag på åtgärder som kan förbättra Gävle kommuns intention till en äldrevänlig kommun där de äldre kommuninvånarna får möjlighet att vara delaktiga i kommunens fortsatta arbete.

BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care.

OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation.

RESEARCH DESIGN: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed.

FINDINGS: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people.

DISCUSSION AND CONCLUSION: Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents in nursing homes.

Bakgrund

Den svenska äldreomsorgen blir allt mer ansträngande att arbeta inom. Stora organisa-toriska förändringar har lett till att arbetet upplevs som oroligt och stressfullt. Den administrativa rollen har ökat och första-linjens chefers möjligheter att delta i det dagliga arbetet har minskat. För att klara av de allt högre krav som ställs är det viktigt att cheferna känner att de har goda strukturella förutsättningar (empowerment), handlingsutrymme och känner att de har kontroll över sitt arbete.

Syfte

Att beskriva manliga första-linjens chefers upplevelser av sin arbetssituation i äldreomsorgen.

Metod

Semi-strukturerade intervjuer gjordes med fjorton manliga första-linjens chefer i äldreomsorgen i Sverige från hösten 2010 till våren 2011. Intervjuguiden var inspirerad av teorier om empowerment. Tolv chefer arbetade inom kommunal äldreomsorg och två chefer inom privat äldreomsorg. Deltagarna valdes utifrån ett ändamålsenligt urval med förhoppningen om att ge en variation i sina skildringar. De hade arbetat som chefer mellan 0.5-35 år. Intervjuerna varade mellan 1-2.5 timmar och materialet analyserades med kvalitativ innehållsanalys. Två teman och fem subteman skapades.

Resultat

Det första temat handlade om när organisatoriska krav var i balans med chefernas upplevda chefsansvar och strukturella förutsättningar. Där beskrevs upplevelserna av att vara ensam men inte utelämnad, att ha frihet inom givna ramar samt en känsla av tillfredsställelse och stimulans i arbetet. Det andra temat handlade om när organisatoriska krav var i obalans med chefernas upplevda chefsansvar och strukturella förutsättningar. Detta tema beskrev chefernas känsla av frustration och en känsla av uppgivenhet. Sammantaget upplevde de manliga första-linjens cheferna att arbetssituationen var både utmanande, komplex och föränderlig. Cheferna behövde bättre tillgång till strukturella förutsättningar, speciellt i form av resurser, stöd och information. Utmaningarna sågs dock som en ständig drivkraft för cheferna. De beskrev att deras arbete var ”mödan värt” även om de ibland upplevde arbetssituationen som negativ. Slutsatsen i studien var att cheferna upplevde sitt arbete som en positiv utmaning även om de beskrev brister i sitt stöd.

The purpose of the present study was to describe young Finnish unemployed men's experiences of having participated in a specific active labor market program, intended to fight unemployment and offered at a resource center. Fifteen young unemployed Finnish men in the age range 18 to 27 years were interviewed face-to-face. Purposive sampling was used to increase the variation among informants. The interview texts were analyzed using both manifest and latent qualitative content analysis. The present results reported that the young men felt that they, thanks to the program at the resource center, had acquired daily routines and could ultimately believe in the future. The young men described how they now had a structure, economic support, and that they could return to their daily life. The informants also described how they could see new possibilities and believe in oneself. There is a lack of empirical studies assessing the possible impact of active labor market programs on the unemployed based on participants' own experiences. Further research is needed to describe and elucidate in more detail the effects of targeted support measures and the needs of unemployed men of different ages and living in different contexts.

3 key points

• In this way of flipped classroom students valued first seeking the knowledge before the expert came to present and discuss the subject.

• Our analysis revealed that students learn when they overcome difficulties, when they seek facts themselves and discuss in seminars and when their own knowledge is challenged.

• In planning their courses, teachers must give students opportunities to be active learners instead of passive listeners and knowledge consumers.

When students come to university for advanced studies, there must be challenges. The academic environment should provide opportunities for students to develop important metacompetencies such as problem-solving abilities for tackling unfamiliar problems, training in oral and written communication, and self-regulated planning of their work and studies (Lizzio 2002). The question is if we, the teachers who plan the courses, use the short time allotted to teaching and learning in the best way possible?

To become a specialized primary care nurse in Sweden, students have one year of primary care (with a Master´s paper) and two months of specialized pharmacology. One aim of the pharmacology course is for students to learn about nursing care for patients with common skin diseases, examine them and prescribe simple medications. For years, the traditional teaching approach in this course has been to invite a medical doctor to give a lecture and then to have seminar discussions and an exam. Inspired by the pedagogical discussion of “flipped classroom” (Gerstein 2011) we asked ourselves whether it would be more instructive for students to begin by searching for relevant information on skin disorders instead of by being passive listeners during a lecture?

Aim/focus of the innovation

To give students the opportunity to be more active in their own learning, we reversed the traditional order of learning methods.

Implementation of the innovation                                                                                               

The students first had to find information on how to examine skin disorders and nursing care for patients with common skin diseases, and then write a text that would be discussed in a seminar prior to meeting the lecturer. In this new arrangement, we hoped students would become more active, practice evaluating knowledge and prepare themselves before the lecture.

Methods used to assess the innovation

To understand more about how students learn in this reversed teaching order, we asked all students in the course to voluntarily write a paper about their learning experiences. All 23 students decided to participate in the study. Their mean age was 38 years and mean time working as a nurse, prior to the Master’s Programme in Primary Care, 7 years. In 2015, two researchers jointly conducted a content analysis of all written data, using Graneheim and Lundman’s (2004) approach.

Key findings

Our analysis revealed four categories concerning how students experienced learning in this reversed order. They described they learn when they seek facts themselves, when they overcome difficulties, when their own knowledge is challenged and when they are able to prepare and think before they meet an expert. The analysis and our findings will be presented in detail, including codes and quotations, at the conference. We will also offer a theoretical discussion of Kolb´s Learning Circle, applying the concepts Concrete Experience, Active Experimentation, Reflective Observation and Abstract Conceptualization to our findings (Kolb 1984).

References

Gerstein, J. (2011). The Flipped Classroom Model: A Full Picture. Retrieved January 15, 2015, from http://usergeneratededucation.wordpress.com/2016/01/21/the-flipped-classroom-model-a-full-picture.

Graneheim, U.H. & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, vol. 24, 105-112.

Kolb, D.A. (1984). Experiential learning: experiences as the source of learning and development. New Jersey: Englewood Cliffs

Lizzio, A., Wilson, K. & Simons, R. (2002). University students’ perceptions of the learning environment and academic outcomes: implications for theory and practice. Studies in Higher Education, vol. 27, no. 1, 27-52.

Aim

To describe what verbal behaviors/kinds of talk occur during recorded motivational interviewing sessions between nurses in primary care and their patients. The aim was also to examine what kinds of nurse talk predict patient change talk, neutral talk and/or sustain talk.

Background

Motivational interviewing is a collaborative conversational style. It has been shown to be effective, in addressing health behaviors such as diet, exercise, weight loss and chronic disease management. In Sweden, it is one of the approaches to disease prevention conversations with patients recommended in the National Guidelines for Disease Prevention. Research on the mechanisms underlying motivational interviewing is growing, but research on motivational interviewing and disease prevention has also been called for.

Design

A descriptive and predictive design was used.

Methods

Data were collected during 2011-2014. Fifty audio-recorded motivational interviewing sessions between 23 primary care nurses and 50 patients were analyzed using Motivational Interviewing Sequential Code for Observing Process Exchanges. The frequency of specific kinds of talk and sequential analysis (to predict patient talk from nurse talk) were computed using the software Generalized Sequential Querier 5.

Findings

The primary care nurses and patients used neutral talk most frequently. Open and negative questions, complex and positive reflections were significantly more likely to be followed by change talk and motivational interviewing-inconsistent talk, positive questions and negative reflections by sustain talk.

Conclusions

To increase patients’ change talk, primary care nurses need to use more open questions, complex reflections as well as questions and reflections directed toward change.

There is a lack of knowledge about how older people living with chronic illness describe the meaning of autonomy and participation, indicating a risk for reduced autonomy and participation in their everyday life. The purpose of this study was to describe the meaning of autonomy and participation among older people living with chronic illness in accordance with their lived experience. The design was descriptive with a phenomenological approach guided by Giorgi's descriptive phenomenological psychological method. Purposive sampling was used, and 16 older people living with chronic illness who lived in an ordinary home participated in individual interviews. The findings showed that the meaning of autonomy and participation among the older people emerged when it was challenged and evoked emotional considerations of the lived experience of having a chronic illness. It involved living a life apart, yet still being someone who is able, trustworthy and given responsibility – still being seen and acknowledged. The meaning of autonomy and participation was derived through life memories and used by the older people in everyday life for adjustment or adaption to the present life and the future. Our conclusion is that autonomy and participation were considered in relation to older people's life memories in the past, in their present situation and also their future wishes. Ability or disability is of less importance than the meaning of everyday life among older people. We suggest using fewer labels for limitations in everyday life when caring for older people and more use of the phrase ‘ability to act’ in different ways, based on older people's descriptions of the meaning of autonomy and participation.

Aim

To describe male first-line managers' experiences of their work situation in elderly care.

Background

First-line managers' work is challenging. However, less attention has been paid to male managers' work situation in health care. Knowledge is needed to empower male managers.

Method

Fourteen male first-line managers were interviewed. The interview text was subjected to qualitative content analysis.

Result

Work situations were described as complex and challenging; challenges were the driving force. They talked about ‘Being on one's own but not feeling left alone’, ‘Having freedom within set boundaries’, ‘Feeling a sense of satisfaction and stimulation’, ‘Feeling a sense of frustration’ and ‘Having a feeling of dejection and resignation’.

Conclusion

Although the male managers report deficiencies in the support structure, they largely experience their work as a positive challenge.

Implications for nursing management

To meet increasing challenges, male first-line managers need better access to supportive structural conditions. Better access to resources is needed in particular, allowing managers to be more visible for staff and to work with development and quality issues instead of administrative tasks. Regarding organisational changes and the scrutiny of management and the media, they lack and thus need support and information from superiors.