Högskolan i Skövde

Background: Involuntary and existential loneliness is a widespread societal problem with serious impact on healthy aging and wellbeing. Over half of those older persons living in special housing express sense of loneliness. DigiSTRENGTH; Reflective STRENGTH-giving dialogues with the digital platform Digitala Samtal, address this problem and will be evaluated in this project. Aim: To describe how loneliness in older persons living in special housing is experienced and influenced by DigiSTRENGTH. Methods: A qualitative and quantitative design. Participants are care providers and residents in special housing. Results: Pre-analysis of interviews analyzed with a phenomenological approach shows that the participants find the dialogues to be of value for sense of health and wellbeing. The dialogues are conducted in a new way compared to ordinary conversations; have a direction, a goal and a meaning. Conclusions and Implications: The pre-analysis address the need of extended individual and holistic guidance and support to diminish involuntary and existential loneliness in older persons lives. Dissemination of innovative strategies in local health care, as DigiSTRENGTH, could contribute to advance quality of care and improve meaning in life for older persons in special housing.

Nursing students are important future health care providers to the growing number of older persons in society. However, two barriers are their common ageist attitudes and lack of interest in geriatrics. This is a concern in light of the global demand for nurses and a challenge that need to be addressed in nurse education. Age suit simulation has been shown to affect the attitudes of students toward older persons, but the important context of home is often missing from studies. Accordingly, the present study employed a quantitative approach with the goal of investigating the effects of aging simulation with an age suit in a home context as a part of experiential learning among second-year nursing students. The age simulation allowed the students to experience both specific and common health problems from the patient’s point of view in a controlled environment and a relevant context: the home. Data were collected using a questionnaire in a quasi-experimental pretest – posttest design with a control group. Results showed that the intervention had a positive effect on various aspects of the nursing students’ perspectives on caring for older persons. Work experience was associated with more positive attitudes. The control group was more negative toward geriatrics as a career choice than the intervention group. In conclusion, age suit simulation can be an innovative part of nurse education because it raises awareness and understanding of the health challenges of older persons, which are important in combating ageism among future nurses.

There is a national call for digital health innovations in the provision of health and social care, especially for older adults in the context of home. The Reflective STRENGTH-Giving Dialogue (STRENGTH) method is used to provide individual and holistic care using recurrent dialogues. The SelfSTRENGTH application (app) was developed to support reflection and stimulate activity that enables achievement of meaningful life projects. The objective of the study was to describe how the use of the SelfSTRENGTH app is perceived by older adults living with long-term health problems. A qualitative, descriptive and inductive design. Data, analyzed using a phenomenographic approach, consisted of individual qualitative interviews with older adults (age range = 74-96) conducted before (n = 34) and after (n = 27) participation in the STRENGTH intervention. The results consist of five categories of description: Resistance to use apps and digital tools; Health problems hinder its usefulness; Need of assistance is a prerequisite to be able to use the app; the app supports memory and reflection; and Using the app disperses thoughts and creates motivation. The outcome space thus contains descriptions of both barriers and possibilities regarding how the use of the SelfSTRENGTH app is perceived. The potential of using technology such as applications in health care is immense. However, long-term health problems in older adults, along with care providers' attitudes and opportunities to support, must be taken into consideration when implementing apps in health and social care.

Background

Older persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults.

Methods

A qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis.

Results

The analysis generated three main themes; “It’s like walking in a bubble”, “An eye opener” and “Concerns about ageing and the current structure of geriatric care”. The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability.

Conclusions

Age suit simulation was described as an embodied and eye-opening experience, raising nursing students´ awareness of older persons´ functional limitations and the consequences for dignity and independence. Coping with cognitive loss was especially difficult. Students were motivated to apply their new knowledge to clinical practice. Age suit simulation can complement geriatric education, preparing students for the complex care needs of older persons.

Socially Assistive Robots (SAR) has been suggested as an important technology in the shift of care from institution to home environments, and has been shown to nr effective in addressing loneliness and social isolation among older adults (Lee et al. 2023., Lorenz et al., 2016, Shishehgar et al., 2018). In a newly started research project RO-LIV, we employ a user experience design approach, involving older adults as co-designers and engaged actors, in order to identify needs, solutions, and obstacles for integrating socially assistive robots into older adults' homes. The research is organized into three work packages: Needs Analysis, Current Situation Analysis, and Conditions and Obstacles for Integration into the Home Environments. The expected results include a road map for the integration of socially assistive robots into older adults' homes, informed by a nuanced understanding of user needs and preferences. Overall, we emphasize the importance of adopting a user-centered approach in human-robot interaction research, particularly when designing solutions for older adults. By involving older adults in the design process and addressing their diverse needs, researchers can develop robotic systems that are address real user needs, are socially acceptable, and has an increased potential for adoption and impact on quality of life.

When the COVID-19 pandemic began to spread around the world, Swedish municipalities were unprepared. Different guidelines on how to act in relation to the disease varied and protective equipment was lacking. This study aims to describe the experiences of health and social care providers of working at municipality level during the COVID-19 pandemic. A total of 12 assistant nurses, 13 registered nurses, and three physicians were interviewed, individually or in groups, between fall 2020 and spring 2021. The interviews were semi-structured and were analyzed using thematic analysis, utilizing a design following the COREQ-checklist. Three main themes were identified as follows: ‘Initial chaotic situation and uncertainty regarding how to deal with the pandemic’; ‘Continuous changes in organization and work routines’, and ‘Management of the pandemic has become the new normal’. Though health and social care workers eventually managed to embed dealing with COVID-19 as a routine feature of their daily work, municipalities must prepare for future crises. 

Caring for a growing population of older adults with complex health problems in their homes is part of every-day work for many health care professionals in the world. This qualitative interview study explores the way health care professionals perceive possibilities and constraints when caring for older adults living with long-term pain in community home care in Sweden. The study aims to understand the relationship between health care professionals' subjective experiences and social structures such as the organization of care and shared norms and values in regard to their perceived space of action. Findings provide insight into how institutional structures such as organization and time, conflate with cultural notions, norms, and ideals, and how these enable and constrain health care professionals in their daily work but also create dilemmas. Findings suggest centering the meaning of structuring aspects in social organizations as a tool for reflection on priorities, improvement, and development in care settings. 

An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizations. The aim of the study was to describe nurses’ experiences in working and providing health care in the Mobile Integrated Care Model in the home with home health care physicians. Semi-structured interviews were conducted with 18 nurses and analyzed through qualitative content analysis. The method was compliant with the COREQ checklist. A mutually trusting collaboration with physicians, which formed person-centered care, created work satisfaction for the nurses. Working within the Mobile Integrated Care Model was negatively impacted by being employed by different organizations, lack of time to provide health care, and physicians’ person-centered work abilities.

Background

Implementation of digital technology has been suggested as a potential solution to future healthcare challenges. Healthcare personnel’s attitudes are important in the acceptance and implementation of digital technologies.

Aim

The aims of this study were to (1) translate and validate two different questionnaires to Norwegian and Swedish respectively, and then (2) use these to examine nursing students’ attitudes towards digital technology in healthcare, as well as their attitudes towards older adults’ abilities to use digital technology.

Design

Cross-sectional.

Methods

A web-based questionnaire was distributed in first year nursing students in a Norwegian and a Swedish university college, respectively. The questionnaire consisted of the short form of the ‘Information Technology Attitude Scales for Health (ITASH)’ and the ‘Attitudes Towards Older Adults Using Digital technology (ATOAUT-11)’ questionnaire. The questionnaires were translated and validated in both countries. Frequencies, Student’s t-test, and one-way ANOVA were used to analyze the data.

Results

In total 236 students responded to the questionnaire in the period September 2022 to April 2023. Students mainly reported positive attitudes towards digital technology use in general. They most agreed with the items ‘Using digital technology devices makes my communication with other health professionals faster’, ‘The sort of information I can get from the digital technology devices helps me give better care to patient’, and ‘Digital technology skills are becoming more and more necessary for healthcare professionals’. However, they reported more negative attitudes towards older adults using digital technology. They most agreed with the items ‘One needs a lot of patience to explain to an older adult how to use digital technologies’, ‘It’s hard to explain to older adults how to use digital technology’, ‘Using digital technology is harder for most older adults’, and ‘Most older adults fear using digital technology because they fear of being scammed or cheated’.

Conclusion

The ITASH and the ATOAUT-11 is appropriate for use in a Norwegian and Swedish setting. Even if nursing students are positive to digital technology in healthcare in general, they are sceptical to older adults using digital technology. This may impact on their attitudes to using digital technology in the healthcare of older adults. These aspects need emphasis when revising nursing education curricula focusing on developing technological competencies in nursing, and gaining knowledge regarding older adults’ use of digital technology.

Background

The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients’ and next of kin’s experiences of integrated care is however lacking, motivating exploration.

Method

A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later.

Results

The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making.

Conclusion

Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.