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Hemmet som arena för äldres rehabilitering
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Avhandlingens övergripande syfte var att studera multidisciplinära teams, äldre personers och familjemedlemmars erfarenheter av hemrehabilitering. Avhandlingen baseras på fyra studier (I-IV). Alla studierna har en kvalitativa beskrivande design. Datamaterialet utgjordes av fokusgruppsintervjuer med personal arbetande i team i kommunal hälso- och sjukvård (I), intervjuer med äldre personer, över 65 år, som vårdats på sjukhuset och därefter fortsatt rehabilitering i hemmet (II,III,IV), samt familjemedlemmar involverade i de äldres rehabilitering (II).

Studie I visade på betydelsen av att möta äldres individuella behov och att arbeta utifrån ett rehabiliterande förhållningssätt i avsikt att ge en hjälp som inte innebär att ta över handlingar från den äldre. Väsentligt var att i teamet reflektera över hur man agerar utifrån den egna professionen för att kunna utveckla ett rehabiliterande förhållningssätt i det dagliga arbetet. I resultatet framkom att teamen uppfattade hemrehabilitering som positiv för de äldre, men mindre lämpligt om de äldre var svårt sjuka och de kände sig otrygga i sitt hem. Respekt för de äldres integritet i deras hem och att göra de närstående delaktiga i rehabiliteringen betonades. Resultatet visade på att för att kunna utveckla samarbetet i teamet finns behov av att diskutera varje professions ansvarsområde och klargöra gränser mellan varandras ansvarområden. Behovet av att tillföra psykosocial kompetens i teamet framhölls för att möta de äldres behov. I studie II framkom att de äldre upplevde rehabiliteringen vara en balansgång i att känna av vad kroppen orkar med för dagen och vad som är realistiskt att uppnå för att känna välbefinnande. Tryggheten i att ha någon i familjen nära sig i hemmet var oumbärligt för att våga utföra träning och vardagliga aktiviteter. Resultatet visar på de äldres upplevelse av otillfredsställelse med att vara beroende av andra. Familjemedlemmar var engagerade i de äldres rehabilitering genom att finnas till hands, hjälpa till och vara stödjande, vilket var en självklar handling men också utmanande i att kunna hjälpa på rätt sätt. Bristande information om hjälpmedels funktion och användning skapade frustration. Resultatet visar att både de äldre och deras familjemedlemmar ser hemmiljön bidra till att underlätta rehabilitering. Det som försvårar är när gränsen för det egna hemmet inskränkts i och med att och personal ofta gick "in och ut" i det egna hemmet.

Studie III visar på ett flertal faktorer i de äldres vardag och i det omgivande samhället som inverkat underlättande eller hindrande på aktiviteter och delaktighet vid hemrehabilitering. Resultatet beskrivs utifrån Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF) i 19 kategorier i domänen omgivningsfaktorer. Som underlättande faktorer framträder bl.a. tillgång till hjälpmedel, en fysisk miljö tillgänglig för aktiviteter samt att få stöd från närstående, vänner och personal i hälso- och sjukvård och omsorg. I resultatet framkom betydelsen av ett empatiskt förhållningssätt när personal möter den äldre personen i dennes hem. Resultatet indikerar att hemrehabilitering inte till fullo tillgodoser äldres behov av rehabilitering. I studie IV framkommer personliga faktorer som inre styrka, motivation, engagemang och tålamod för att nå positiva resultat i en rehabilitering som sträcker sig över flera år. Rehabilitering beskrivs i fysiska och psykiska faser som övergick i att hantera en fysisk funktionsnedsättning med svårigheter att gå i dagligt liv. Resultatet visar på betydelsen av adekvat information, vikten av socialt stöd och tillgänglighet till hälso- och sjukvårdspersonal under rehabiliteringsprocessen.

Avhandlingen bidrar till en ökad kunskap om hur multidisciplinära team, äldre personer och familjemedlemmar upplever rehabilitering i hemmiljö. Nyttan med avhandlingen kan medföra att hemrehabilitering som vårdform kan bli föremål för diskussioner om hur det utformas och organiseras för att på bästa sätt stödja de äldre och närstående med utgångspunkt från de äldres och närståendes erfarenheter och upplevelser. Detta kan ses gagna deltagarna på individnivå men även för utveckling inom yrkesprofessionen. Avhandlingen har även visat på möjligheten att implementera ICF i rehabiliterande omvårdnad.

Abstract [en]

The aim of the thesis was to study home rehabilitation as experienced by multidisciplinary teams, older people and their family members. The thesis is based on four studies (I-IV), all of which used a qualitative descriptive design. The data consisted of focus group interviews with rehabilitation practitioners working in teams in local health care services (I), interviews with seniors, i.e. over 65 years, who, because of illness or injury had been hospitalized and where their rehabilitation continued in their own home environment (II,III,IV) and interviews with family members involved in home rehabilitation (II).

Study I showed the importance of meeting the individual needs of the elderly person while applying a rehabilitative approach to provide help, without compromising the individual´s independence. It was imperative that the team reflected on how to perform professionally in order to develop a rehabilitative approach in their daily work. The results show that the team regarded home rehabilitation as having a positive effect on the seniors. However, it was less suitable if the individuals in question were seriously ill and therefore felt less safe at home. Respect for the integrity of the individual in their own homes as well as the involvement of their family members in the rehabilitation process, were emphasized. The results showed that in order to develop cooperation within the team of team members it was necessary to clarify the duties and responsibilities of the different groups of healthcare professionals involved. It was emphasized, that there was a need to enhance the psychosocial competence of the team regarding senior care. Study II revealed that the elderly individuals themselves experienced their rehabilitation as a balance between sensing what their body could actually cope with and what was realistically acceptable to achieve a feeling of well-being. The feeling of security that a member of the family was at hand, proved vital for the individuals to dare to attempt the rehabilitation exercises and other everyday activities. Results show that the individuals are uncomfortable with having to be dependent on others. Family members were involved in the rehabilitation process by being on-hand, providing support and generally helping out, all of which can be considered as quite ordinary, yet it was challenging to know when to help in the right way. Unfamiliarity with technical aids and appliances was cause for frustration. Results showed that the elderly individuals and their families alike consider the home environment to be a contributing factor in facilitating the rehabilitation process. However, what made this difficult was when the boundaries for the home were breached by healthcare staff coming and going in and out of one´s own home. Study III shows several aspects of senior care, in everyday life and society in general, that have facilitating or hindering impacts on participation in exercise rehabilitation in the home environment. The results are described according to International Classification of Functioning, Disability and Health (ICF) in 19 categories in the domain of environmental factors. Facilitating factors include access to aids and equipment, a physical environment which enables exercise and support from family members, friends and healthcare practitioners. The results showed the importance of an empathetic approach when healthcare practitioners meet older people in their own home environment. The results indicate that home rehabilitation does not fully meet the rehabilitation needs of the elderly. Study IV describes personal factors such as inner strength, motivation, commitment and willingness to achieve positive results in rehabilitation extending over several years. Rehabilitation is described in physical and psychological phases that evolved into dealing with physical impairment effecting everyday activities. The results showed the importance of adequate information, the importance of social support and accessibility to healthcare professionals during the rehabilitation process. The thesis contributes to an increased understanding of how multidisciplinary teams, the elderly individuals themselves and their families experience rehabilitation in the home environment. The findings in this thesis can contribute to discussions about how home rehabilitation as a form of senior care can be organized in ways to best support elderly individuals in need of rehabilitation and their family members according to their own experiences. This can benefit individual participants and also promote the development of the healthcare profession. This thesis has also demonstrated the possibility to implement the ICF as a tool for describing healthcare needs in rehabilitation nursing.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet , 2013. , 49 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 145
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-19209ISBN: 978-91-87103-68-1 (print)OAI: oai:DiVA.org:miun-19209DiVA: diva2:628188
Supervisors
Available from: 2013-06-13 Created: 2013-06-13 Last updated: 2013-06-13Bibliographically approved
List of papers
1. Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people
Open this publication in new window or tab >>Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people
2014 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 9, no 1, 25-33 p.Article in journal (Refereed) Published
Abstract [en]

Background

There is a move towards the provision of rehabilitation for older people in their homes. It is essential to ensure that rehabilitation services promote independence of older people.

Aim

The aim of the study was to explore multidisciplinary teams' experiences of home rehabilitation for older people.

Methods

Five focus groups were conducted with multidisciplinary teams based in a municipality in Sweden, covering seven different professions. In total, 28 participants volunteered to participate in these interviews. Interviews were transcribed verbatim and analysed according to content analysis.

Results

Two main categories, as well as four subcategories, emerged. The first main category, having a rehabilitative approach in everyday life, consisted of the subcategories: ‘giving ‘hands-off’ support’ and ‘being in a home environment’. The second main category, working across professional boundaries, consisted of the subcategories: ‘coordinating resources’ and ‘learning from each other’.

Conclusion

Common goals, communication skills and role understanding contributed to facilitating the teams' performances of rehabilitation. A potential benefit of home rehabilitation, because the older person is in a familiar environment, is to work a rehabilitative approach into each individual's activity in their everyday life in order to meet their specific needs. At an organisational level, there is a need for developing services to further support older people's psychosocial needs during rehabilitation.

Implications for practice

Team performance towards an individual's rehabilitation should come from an emerged whole and not only from the performance of a specific professional approach depending on the traditional role of each profession. A rehabilitative approach is based on ‘hands-off’ support in order to incorporate an individual's everyday activities as a part of their rehabilitation.

Keyword
Focus group, Home rehabilitation, Multidisciplinary team, Municipality, Older people
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17698 (URN)10.1111/opn.12013 (DOI)2-s2.0-84894484062 (Scopus ID)
Available from: 2012-12-12 Created: 2012-12-12 Last updated: 2017-12-07Bibliographically approved
2. Activity and participation in home rehabilitation: Older people's and family members perspectives
Open this publication in new window or tab >>Activity and participation in home rehabilitation: Older people's and family members perspectives
2013 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 2, 211-216 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the experiences of older people and their supporting family members in relation to home rehabilitation, with a focus on activity and participation. Methods: Qualitative interviews were carried out with 6 older people and 6 family members at 1 and 6 months after the older person’s discharge to their home. Qualitative content analysis of the data was carried out. The International Classification of Functioning, Disability and Health provides a guiding framework for rehabilitation. Results: Informants’ experiences of home rehabilitation contributed to the formation of 6 categories: (i) living with a frail body; (ii) striving for well-being in daily life; (iii) being close at hand; (iv) feeling dependent in daily life; (v) struggling to carry on; and (vi) striving to be at home. Conclusion: Older people’s goals were to return to daily routines and to perform meaningful activities without feeling dependent on other people. Family members’ participation was crucial. Psychosocial support and autonomy were essential for facilitating activity and participation. Healthcare professionals should consider each individual’s unique experiences along with the significance of being at home.

Keyword
rehabilitation, older people, family member, interviews, qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17697 (URN)10.2340/16501977-1085 (DOI)000315179700017 ()2-s2.0-84875984561 (Scopus ID)
Available from: 2012-12-12 Created: 2012-12-12 Last updated: 2017-12-07Bibliographically approved
3. Impact of environmental factors in home rehabilitation − a qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers
Open this publication in new window or tab >>Impact of environmental factors in home rehabilitation − a qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers
2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 9, 779-787 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation. Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.

Keyword
Activity, environment, home rehabilitation, ICF, multidisciplinary team, participation
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-16139 (URN)10.3109/09638288.2011.619621 (DOI)000301587200011 ()22004413 (PubMedID)2-s2.0-84858412563 (Scopus ID)
Available from: 2012-04-26 Created: 2012-04-26 Last updated: 2017-12-07Bibliographically approved
4. "I have to be patient" - A longitudinal case study of an older man's rehabilitation experience after a hip replacement surgery
Open this publication in new window or tab >>"I have to be patient" - A longitudinal case study of an older man's rehabilitation experience after a hip replacement surgery
2013 (English)In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 8, 160-169 p.Article in journal (Refereed) Published
Abstract [en]

Background: Aging can bring about an increased risk of disability. Following illness or injures, rehabilitation is essentialif the individual affected is to attain and maintain independence. Performing rehabilitation with a person-centeredapproach is vital for positive outcomes. Health providers are increasingly interested in developing rehabilitation servicesin outpatient settings for older people in their own homes. Aim: The aim of this study was to describe an older man’s rehabilitation experience after a hip replacement surgery.Design: A longitudinal qualitative descriptive single case study.Methods: Interviews were conducted on four occasions with the participant in his own home. The interviews wereconducted one month, seven months, one year, and five years after the patient was discharged from the hospital. The datawere analyzed using qualitative content analysis.Results: Three categories emerged: (i) having feelings of despair, (ii) being in charge, and (iii) having rehabilitative support. The results demonstrate the participant’s decreased ability to walk after a complicated hip surgery, and his physical and psychological struggle for well-being in everyday life. A strong motivation to return to as normal a life aspossible facilitated the rehabilitation. Also, a supportive family and accessible health care professionals were essential tothe positive outcome of the home rehabilitation.Conclusion: Rehabilitation can extend over a long period to maintain and improve mobility. Also, living with a disability causes feelings of despair. The home can be a source of energy but also a place of challenges during rehabilitation. To support older people in achieving their rehabilitation goals and engaging in meaningful activities, professionals should focus on personal factors, psychosocial support and on influential factors in the home environment and in society in general.

Keyword
Older people, rehabilitation, case study, home
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-18795 (URN)10.5430/jnep.v3n8p160 (DOI)
Available from: 2013-04-24 Created: 2013-04-23 Last updated: 2017-12-06Bibliographically approved

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