Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room-An interview study with registered nurses.

AIM: To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life-threateningly ill patients' care needs from the perspective of a person-centred fundamental care framework. DESIGN: A descriptive, qualitative interview study. METHOD: Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. RESULTS: Three themes were identified: Task-oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person-centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. CONCLUSION: From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person-centred care. IMPACT: To date, little is known about registered nurses' work approach and prerequisites in meeting life-threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person-centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person-centred fundamental care and thereby avoid fundamental care being missed.

A comparison of spouse and non-spouse carers of people with dementia: a descriptive analysis of Swedish national survey data.

BACKGROUND: Being an informal carer of a person with dementia (PwD) can have a negative effect on the carer's health and quality of life, and spouse carers have been found to be especially vulnerable. Yet relatively little is known about the care provided and support received by spouse carers. This study compares spouse carers to other informal carers of PwDs regarding their care provision, the support received and the psychosocial impact of care. METHODS: The study was a cross-sectional questionnaire-based survey of a stratified random sample of the Swedish population aged 18 or over. The questionnaire explored how much care the respondent provided, the support received, and the psychosocial impact of providing care. Of 30,009 people sampled, 11,168 (37.7 %) responded, of whom 330 (2.95 %) were informal carers of a PwD. RESULTS: In comparison to non-spouse carers, spouse carers provided more care more frequently, did so with less support from family or the local authority, while more frequently experiencing negative impacts on their social life and psychological and physical health. Spouse carers also received more carer support and more frequently experienced a closeness in their relationship with the care-recipient. CONCLUSIONS: Spouse carers of PwD differed from non-spouse carers on virtually all aspects of their care situation. Policy and practice must be more sensitive to how the carer-care-recipient relationship shapes the experience of care, so that support is based on an understanding of the individual carer's actual needs and preferences rather than on preconceptions drawn from a generalised support model.

Experience of self-management of medications among older people with multimorbidity.

AIMS AND OBJECTIVES: To explore the experience of self-managing medication among older people with multimorbidity. BACKGROUND: Older people with multimorbidity are now more likely to live at home and to self-medicate. Reduced assistance from professional caregivers is associated with medical errors. DESIGN: Face-to-face interviews were conducted with older people with multimorbidity. METHODS: Participants aged ≥75 years with ≥2 medical diagnoses and living at home or in special accommodation were interviewed. Twenty-eight men and women (mean age 84 years) participated. Interviews lasted from 45 minutes-2 hours and were transcribed verbatim. A lifeworld-based phenomenological method was used for analysis. RESULTS: Uncertainty among the participants increased with their experience of side effects and concern that the medication might be harmful. These uncertainties were reinforced by a fear of malpractice when several physicians were involved. This meant living with ambivalence when taking the medication, which required a trade-off between symptom relief and reducing side effects. A lack of continuity with physicians and nurses led to uncertainty in maintaining an overview of the medications. By contrast, when the relationships were supportive and caring, the uncertainties diminished. Four concepts were used to describe the various meanings of this experience: adapting to a new lifestyle; ambivalence towards medicine; experience of side effects and concerns about medical errors; and relationships as sources of feeling secure. CONCLUSIONS: Medications can cause side effects, and unclear benefits increase the uncertainty for older people with multimorbidity. Health care professionals need to develop an understanding of each patient's experience of such uncertainty. RELEVANCE TO CLINICAL PRACTICE: Health care professionals can give support and show understanding for older people's existential uncertainty by creating good relationships and continuity in care, and offering appropriate information. Regular visits should be scheduled to manage any problems patients might have when self-medicating.

Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden.

(1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer-care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.

Toward a consensus on the nature of empathy: A review of reviews.

OBJECTIVE: The objective was to provide a synthesis of already synthesized literature on empathy in order to identify similarities and differences among conceptualizations. METHODS: A review of reviews was conducted to locate synthesized literature published between January 1980 and December 2019. Two authors screened and extracted data, and quality-appraised the sources. A total of 52 articles deemed relevant to this overview were synthesized using thematic analysis. RESULTS: The analysis resulted in four themes found in most empathy conceptualizations. In empathy, the empathizer (1) understands, (2) feels, and (3) shares another person's world (4) with self-other differentiation. CONCLUSIONS: Most writings about empathy begin by claiming that there is far from a consensus on how empathy should be defined. This article shows a developing consensus among neuroscientists, psychologists, medical scientists, nursing scientists, philosophers, and others that empathy involves understanding, feeling, sharing, and self-other differentiation. PRACTICE IMPLICATIONS: A clarification of the content of empathy may assist practitioners and researchers in avoiding confusion regarding the meaning of the concept, as well as in developing and measuring the relevant aspects of the concept.

Fundamentals of care in the emergency room - An ethnographic observational study.

BACKGROUND: There is a strong biomedical focus within emergency care. However, while failure to meet patients' fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients. AIM: This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms. METHODS: Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics. RESULTS: Observations showed that registered nurses (RN) identified patients' fundamental care needs and provided nursing care. However, the RNs' focus on the patient decreased over time. When the RN communicated with the patient, the patients' physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs' ability to meet patients' fundamental care needs. CONCLUSION: Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient-nurse relationship to meet the patient's physical, psychosocial, and relational needs.

Paradoxes of person-centred care: A discussion paper.

Aim: Previous research has mainly focused on the advantages of PCC and less on its disadvantages. Hence, there is a need to further explore the recent research regarding PCC from both sides. Therefore, the aim of this paper is to elucidate the advantages and disadvantages of PCC. Design: Discussion paper. Methods: We searched relevant literature published January 2000-March 2018 in PubMed, Medline, CHINAL, Scopus and Web of Science. Results: The results showed that PCC can contribute to improved health and well-being, improved mutual interaction in relationships, improved cost-effectiveness and improved work environment, while the disadvantages can involve increased personal and financial costs, exclusion of certain groups, increased personal and financial costs, exclusion of staff's personhood and unfairness due to empathy. An analysis of the existing literature on PCC showed paradoxes, which call for further investigation.

"Same same or different?" A review of reviews of person-centered and patient-centered care.

OBJECTIVE: To provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts. METHODS: A synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis. RESULTS: The analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life. CONCLUSIONS: While there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals. PRACTICE IMPLICATIONS: Clarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.

That mr. Alzheimer you never know what he's up to, but what about me? A discourse analysis of how Swedish spouse caregivers can make their subject positions understandable and meaningful.

The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs.