Högskolan i Skövde

Aim: The aim was to analyse people's accounts of subarachnoid haemorrhage (SAH) and to describe how they initiate and create meaning for the onset and events surrounding the SAH.

Background: Being struck by a SAH is a dramatic event, often followed by unconsciousness. There is therefore a special need for a patient to try to create some kind of meaning for the event during recovery and afterwards.

Method: Nine interviews were carried out in home settings and discourse analysis was used to interpret the data.

Findings: People stricken by SAH seem to be able to judge from memory for when they were becoming ill. Critical events related to SAH were existential threats and existential insights; and time as 'waiting' and time as 'structuring meaning'. The reconstruction of the illness event may be interpreted as an identity-creating process.

Conclusion: The reconstruction of the illness is a tool that can be used by nurses and other health professionals to understand a patient's self-positioning and identity-construction.

En intervjustudie om vårdrelationen ur sjuksköterskors perspektiv

This article presents a hermeneutic phenomenological analysis of interview material in which 12 seniors living in Special Housing Accommodation (SHA) facilities reflect on the experience of living in such facilities. Of particular interest in the analysis is living in a SHA as a phenomenon. The finding shows that the phenomenon of lived experience in a SHA seems to be a state of ambiguity regarding one’s existence, which is made up of several constituents (elements of meaning).The analysis contributes to the understanding of how the phenomenon of SHA living is coming into existence as a need, due to an individual’s failing health; however, the SHA is not considered to be a true home. Accordingly, this has consequences to the subject position for the seniors in that they have to navigate between existing and not existing. The seniors learn to cope with living in the SHA by lowering their expectations of life and existence while the SHA provides the prerequisites for their existence. An implication for promoting care is to support the seniors to enable a full existence of life within SHA living.

This article aims to show how a discourse and communication based approach in the context of the care of the elderly provides a basis for reflecting on pain. Based on six hours of data from talk encounters between care professionals and elderly clients, an activity analysis of institutional settings and categorization of interactional discourse was undertaken. The focus  was:  (a)  how  elderly  people  initiated  painful accounts, and (b) how the professionals oriented to such  accounts.  It  is  found  that  pain-talks  are  governed by the institutional practice of different phases: framing; mapping troubles and symptoms; clients’ self  presentations;  counseling,  and  concluding.  This phase structure exemplifies knowledge of communicative  activities  and  is  part  of  practical  knowledge which  the  party,  or  at  least  the  professional,  is  expected to become acquainted with. A thematic interactional map of critical moments related to pain as (a) social death and hope, and (b) presentation of self as  past  and  self  as  present  emerges.  The  caring  aspect is to support hope and to change the focus from social death to life and recovering. In foregrounding health, it is important for the elderly people to affirm their identity of themselves as being good and honest persons.

This article describes need assessment dialogues, the circumstances surrounding care, and the provision of residential care and in-home support for the elderly in Sweden, as seen from a communicative perspective. The purpose was to systematically describe and analyse the accounts of welfare officers concerning elderly care. The research questions were: How is the internal care context perceived and constituted through discourse? How do welfare officers manage the daily demands, expectations, tasks, and dilemmas in the encounter with the individual citizen? What significance do the welfare officers give their work and their professional tasks?Eleven interviews with welfare officers from elderly and handicapped care organisation of three municipalities were held, and a discursive analysis was made from the collected data. Four characteristic discursive phenomena in the welfare officers' accounts were observed: (I) the rights of the elderly, (II) living at home, (III) good relations, and (IV) the complaisance. The study shows that the dialogues with elderly contain communicative dilemmas and mixed loyalties. The welfare officers navigate between different perspectives and double approaches. She/he uses the navigating as a strategy and proficiency in their work. However, these proficiencies remain largely unnoticed and unreflected as techniques, strategies, or tools for attaining favourable care.

The aim of the study was to describe and analyse institutional practice in need assessment dialogues. The questions were: How are the dialogues structured? How is the professional dialogue content combined with: the institutional, traditional and personal perspectives? How are communicative problems solved?

Mapping, assessing and deciding on social welfare or other aid measures for elderly people is one part of the concretisation of the elderly care policy in the encounter with the individual citizen. This concretisation is not just a simple transfer of political goals but, rather, contains implications for elderly care institutions as a whole, for elderly oriented social work and for processing. Examples of such implications are demands on knowledge growth in elderly oriented social work and demands on professional practice. The institutional actors, the case officers, serve an important purpose for the elderly in the encounter with elderly care. The need assessment dialogue between case officers and elderly persons is thus seen as a communicative activity or practice through which they (re)produce elderly care. It is this that the study attempts to give shape to.

The project has its theoretical underpinning in social constructionism and in dialogism, which explain people’s everyday actions and interaction and how people make their knowledge and assumptions comprehensible. The social constructionist theory also explains how social institutions are created and maintained in people’s interaction in institutional talk.

Data have been collected in the form of video recordings of 16 need assessment meetings and consist of about 12 hours of recorded need assessment dialogues. Content analyses of interactive courses of events in need assessment dialogues have been performed.

The results show that phases constitute the structure of the dialogues and make them comprehensible. The phases serve different functions in the need assessment dialogues. The phase structure can be seen as a sub activity, which has specific aims and solves different tasks that are central to the case officer’s work. The phase structure consists of: opening, framing, mapping of needs, information and counselling, the turning-point in the dialogue and conclusion. A prominent feature of the study is the relationship between institutional order and professional practice. This relationship is the basis of different dilemmas in the encounter with the client. The key task facing the case officer is to bridge these dilemmas by means of different strategies. The case officer’s professional task in need assessments is not only to assess care requirements but also to make the institutional prerequisites of the aid measures comprehensible to the client and to transform care requirements into institutional abstractions. The knowledge contribution consists of an understanding of the complexity of the dialogue and how meaning and perspectives in the dialogue are produced interactively in different ways. An important knowledge contribution is the importance of communication in elderly oriented social work. This is a key factor in establishing a working relationship between the client and the case officer. It is also a key factor in the case officer’s professional practice.

Background It is increasingly recognized that analysis of 'ordinary' language use and social interaction can contribute to our understanding of how individuals express and experience pain, as well as reveal ways in which human suffering is managed. However, there are few studies with a communicative approach to pain which focus on elderly clients. The purpose of this study is to describe language use with regard to accounts of pain experience in a Swedish context of elderly care.Method Based on six hours of recorded, transcribed and translated data from care encounters, an activity analysis of institutional settings as well as categorization of interactional discourse was made. There was a twofold focus: how elderly people initiate painful accounts, and how the professionals orient to such accounts. Attention is drawn to how both parties oriented primarily to the task of information exchange, and how they accomplished credibility by attending to aspects of role-relations and face-work and by shifting between institutional, professional and life-world frames in subtle, but different, ways. Findings It was found that the pain-talk encounters were a communicative activity (type), governed by the phases of: Framing, Mapping troubles and symptoms, Viz. clients, Self presentations, Counseling, and Concluding. A thematic interactional map of critical moment related to pain as social death and hope, and presentation of self as past and self as present, was achieved. Interpretation It is suggested that the caring aspect of professional skills is to support hope and to change focus from social death to life and recovering. It is also suggests that experience of pain in old age can be characterized as not only pathological but also as social and relational. This knowledge contributes to better understanding of pain and pain-related phenomena in old age, which might be useful in nursing.

Vad utmärker äldres framställningar om smärta? Kan det vara så att det sociala lidandet som smärtan orsakar kan vara värre än själva den fysiska smärtan? Hur gör människor när de ger och tar om mening om smärta i en samtalsinteraktion? I artikeln tecknas äldre människors språkliga arbete då de inom vård och omsorgssammanhang beskriver smärta och lidande.

The purpose of this article is to analyse the phenomenon of supportive care for older persons' well-being. The phenomenon is seen from the eldercarers' meaning-making through their lifeworld perspective at a residential care home. Based on primary empirical interview material with twelve professionals in the context of Swedish eldercare, a phenomenological analysis was undertaken. The result shows that the phenomenon of supportive care for older persons' well-being creates certain ambiguities in the professionals' meaning-making. In practice, it balances between the older persons' (from hereon called residents) needs and the conditions of the eldercare organization. The ambiguities (the what) is made up by three constituents: (i) freedom of choice for the older persons vs. institutional constraints, (ii) the residents' need for activation vs. wanting not to be activated, and (iii) the residents' need for routine vs. the eldercarers' not being able to know what the residents need. The conclusions drawn are that this ambiguity has consequences for the eldercarers' choice of handling supportive care for older persons' well-being (the how). They have to navigate between the support for authenticity, dwelling and mobility, and their own presence and time. In performing supportive care for older persons' well-being, the eldercarers have to consider aspects concerning the resident's lifeworld, the social setting of the eldercare ward, and the institutional demands of the organization. The practical implications for supporting well-being in the care of older residents are manifested in the importance of 'the little things', and the eldercarer's ability to give receptive attention, which requires presence.

This article presents a phenomenological analysis of interview material, in which 12 care professionals in elderly care reflect on the elderly's well-being within the frame of special housing accommodation. The perspective of the care professionals is of special interest. The findings show that the well-being is characterized as the elderly's feelings of being existentially touched. The well-being is an existential experience of being acknowledged as a human being and is an approach that classifies the elderly's needs as those of having, loving, and being. The meaning of the phenomenon is elucidated by the constituents: (1) to feel the freedom of choice, (2) to feel pleasure, and (3) to feel closeness to someone or something. The findings contribute new understanding of well-being in the elderly care by its existential dimension of the well-being as "just being'' and of doing things in order to experience meaningfulness. Accordingly, the well-being of the elderly as it is seen from the perspective of the care professionals involves both carers' subjectivity and intersubjectivity between the care professional and the elderly. An implication for promoting elderly's well-being is to develop awareness of these existential dimensions.

Äldre personer med utvecklingsstörning (ÄMU) är en ökande befolkningsgrupp till följd av förbättrad hälsovård och livsvillkor. Därmed får de ett ökat omvårdnads och boendebehov som äldrebefolkningen i övrigt. Kommunerna står därför inför en ny situation. Frågan är om ÄMU ska bo kvar i sin invanda miljö eller flytta till särskilt boende inom äldreomsorgen, eller finns det andra alternativ som tillgodoser ÄMU:s specifika behov. Syftet var att analysera och beskriva hur åtta socialchefer framställer boendeinsatser, omvårdnad och omsorg för ÄMU. En kommunikativ ansats har använts och diskursanalys (DA) i analysarbetet. Data samlades genom intervjuer. Socialchefernas framställningar om ÄMU och deras behov av särskilt boendestöd resovisas som: (i) diskursiv enighet, (ii) diskursiv oenighet och (iii) diskursiv dominans. Utmärkande drag i dessa är: 1) omsorgen om funktionshindrade och äldreomsorgen representerar olika omsorgskulturer som bör fogas samman, 2) cheferna tycks föredra omsorger om funktionshindrade som modell för äldreomsorgen, 3) kunskaper saknas i organisationen om ÄMU:s specifika behov, 4) diskursen om ÄMU och boendestöd är ett diskursivt problemområde i tiden, 5) är ännu på planeringsstadiet som en kommunikativ praktik, snarare än en materiell sådan. Dessa diskursiva drag utgör studiens kunskapsbidrag och kan användas för utvecklingen av boendestöd och omsorg/omvårdnad för ÄMU.

The aim of the study was to describe student’s accounts of school nursing and nursing activities. A purposive sample of nine informants was used, spanning students from two different schools aged between 17 and 19 years. Four  categories with sub categories emerged. (i) The students express emotions of being fond of the school nurse, but expect more caring attitudes from her (ii) The school nurse is seen as a good resource; however, the students’ confidence is partial. (iii) Reasons for consulting are mostly physical problems, despite psychological caring needs and (iv) SNHC activities are seen as useful, although too basic. These data expose a caring dilemma between the student’s needs and the professional/institutional achievements.