Högskolan i Skövde

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 (those 65 years of age and older) have the lowest digital competence and are thus at an increased risk of exclusion from a digitalizing society. To bridge this digital divide, several Swedish municipalities have introduced a service called Digital Coach (DC), where older persons can request in-home support for their digital needs. Little is known about older persons’ experiences of this unique service.

Objective

To study older persons’ experiences of one-to-one in-home support, with their digital needs, through the DC service.

Methods

A qualitative study was conducted through interviews, and the data were analysed using qualitative content analysis following the approach of Graneheim and Lundman.

Results

The older persons (n = 14) expressed awareness of the importance of digital competence to keep up with the times to avoid exclusion and vulnerability. They requested support to become part of a digital society. The DC service was experienced as providing respectful support at home, which is considered a calm, safe environment. They expressed that the support made them feel valued and increased opportunities for independence and social participation.

Conclusions

Older persons found one-to-one in-home support to be the optimal form of support for their digital needs. The support gave them the best conditions to achieve digital competence, and without the support, would have felt stranded. Efforts to support older persons’ digital competence should be based on the older persons’ own digital needs and be provided in their home.

Aim

To describe patients' with chronic obstructive pulmonary disease (COPD) experiences of group-based self-management education with a digital website.

Design

A qualitative approach with a phenomenologicalmethod. Patients participating in an earlier study, with self-experience of COPD as a special competence, were involved as research partners at the design of this study.

Methods

Eleven individual and two group interviews with five participants in each group were conducted.

Results

Group-based self-management education with a digital website supports learning. Sharing experiences with others in similar situations creates security and reduces the feeling of being alone. Based on questions and discussion in the group, and through self-reflection, general information is transformed into useful knowledge and understanding of one's own situation. COPD information on the website provides an opportunity to gain knowledge continuously based on needs that contributes to learning. This research has demonstrated that adapting learning activities to individual learning styles increases sustainability of learning. Sharing experiences reduces feelings of loneliness. It is therefore important to create spaces for sharing experiences and in-depth reflection that support learning over time.

Background: Digitalization is seen as a necessity to manage the increasing burden on the health care system and is accordingly considered an important tool in the transformation to integrated care (Swedish Nära vård). However, when health care is digitalized older persons are at increased risk of being marginalized and dependent on others due to their generally lower digital competence. To address this, several Swedish municipalities offer individual support to older persons in their own home, a service called Digital Coach (DC). As this service is new, the aim is to describe older persons’ experiences of getting individual support with digital needs in the context of home. Method: Semi-structured interviews (n=14) were conducted with older persons who have had DC support in their home. The focus was on older persons’ experiences of the support. Data was analyzed with qualitative content analysis. Results, preliminary: The overall theme, to be a valued person in the digital society, represents a feeling of being taken seriously and worth investing resources in to gain access to society. Three categories emerged: (1) The need to keep up with the times which means to understand and navigate the new digital landscape with the opportunity for independence and participation, (2) Support and respect in the learning situation, is crucial for feeling comfortable to expose insufficient knowledge, and (3) Increased digital competence empowers autonomy and is manifested as the ability to handle the digital tools and services by your own creates a feeling of joy and satisfaction and increases the opportunity to participate in both social and community activities. Conclusion: The result shows that individual support with digital needs in the context of home increase digital competence in older persons and create feelings of being valued and included in the digital society, which can extend to integrated person-centered care.

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.

This qualitative study describes how reflection can be supported by using reflective tools in group education in type 2 diabetes. The changed conditions for living with a long-term illness may lead to increased anxiety and new demands that affect one’s current life situation. The didactic model, ‘The challenge–to take charge of one’s life with long-term illness’, has been developed into ‘Taking responsibility in life with type 2 diabetes–a model for group education in primary care’. Specialized diabetes nurses and dieticians received training, a manual and continuous guidance in applying the model. Reflection diaries, notes and interviews both from the patients and the caregivers were analyzed using a phenomenological hermeneutic method. The results show that using images as reflective tools engages thoughts and feelings in a way that appears to be important for one’s learning in life with a chronic illness. The images contribute to allowing a distance from one’s situation, actions, thoughts and feelings, which seems fruitful for investigating and discovering new ‘things’ about oneself. With the support of reflective tools and guiding questions, reflection is led to a deeper existential level where both caregivers and patients contribute by asking questions that support the reflection process.

PURPOSE: To address the consequences of living with supraventricular tachycardia and to improve the quality of treatment, there is a need to highlight patient experiences of treatment with catheter ablation. Therefore, the aim was to describe the phenomenon of catheter ablation, as it is experienced by patients being treated awake.

METHODS: A descriptive design was applied based on a reflective lifeworld research founded on phenomenological epistemology. Interviews were conducted between December 2021 and Mars 2022 with seven women and five men, three to twelve months after they underwent catheter ablation.

RESULTS: Patients undergoing catheter ablation while awake during treatment, which includes experiences of relying on others expertise, being actively passive, and striving to be cured. It entails experiences of having a foreign object moving in one's body and heart and can be endured through strategies of mainly shifted one's mental focus.

CONCLUSIONS: The effort of undergoing a catheter ablation procedure is worthwhile as the confirmation of a physical curable condition that opens a future with possibilities instead of the obstacle in daily life that tachycardia entails. For the patients, an informative and caring conversation was needed that would have provided the support they lacked before and during the ablation.

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. 

BACKGROUND: Outpatients seek to visit health care facilities for episodes of tachycardia-related signs and symptoms. The challenge for physicians is to balance a proper initial assessment and avoid overlooking a possible arrhythmia. This common clinical situation affects individuals and health care utilization, and effective management may substantially affect health care resources. This study aimed to explore health care utilization for outpatients with episodes of tachycardia visiting health care centres (HCCs) and/or emergency departments (EDs). METHOD: This retrospective study used data of adult outpatients (≥ 18 years) who were assessed by a physician as having a specific or nonspecific diagnosis of arrhythmia between 2017 and 2018, and data were retrieved from medical records and a regional registry database. Data was analysed with appropriate statistical analyses to identify disparities between sex, age and terms of search pattern for each health care facility. Analysis of variance was used to test disparities between the sexes, and one-factor ANOVA was used for the incidence of missed arrhythmias. RESULTS: A total of 2719 visits with 2373 outpatients were included in the study. The result showed a significant difference in the total number of visits (n = 2719) between female and male patients (68% vs. 32%, p < .001). In the 60-69- and 70-79-year age groups, females had significantly higher frequencies of visits than males (p = .018). A significant difference was also observed between sexes in terms of which health care facility they tended to visit (p < .001). Ninety-five percent of the outpatients visiting EDs were hospitalized. When estimating the incidence of missed arrhythmias (diagnoses) in relation to assessments, the results showed a 5% missed diagnosis involving potential atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia. Moreover, the referral rate was low, especially from HCCs to cardiologists. CONCLUSIONS: This study shows a significant difference in total visits in HCCs and/or EDs by patients of different sexes and indicates the need for improved care for outpatients with episodes of tachycardia. Sex- and age-related differences must be addressed with an aim of providing equal care. Finally, the low rate of referral from HCCs to cardiologists compared to the high proportion of hospitalizations from EDs, deserves further investigation. 

Reflective supervision in higher education means that students, continuously and systematically (according to a given model), together with teachers who supervise them, process experiences from work-based education and the university-based part of education. In two early studies of nursing students’ and teachers’ experiences of critical reflection as part of the reflective supervision, we have identified signs of existence of shared learning community. The purpose of the present study is to investigate teachers’ and students’ expressions of shared learning community, in light of the teaching form reflective supervision. The data consist of interviews from the two previous studies. The result of the analysis shows how students and supervising teachers express common experiences from the reflective supervision. The result shows a shared learning community as structured processing of vocational knowledge, challenging perspective meeting and exchange of perspectives, openness to each other's experiences and learning processes and interaction between the common and the individual. The study shows how the model reflective supervision contributes to a creative common environment for learning for both students and teachers in higher education.