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Existentiell ensamhet hos sköra äldre personer: Vårdpersonals och volontärers erfarenheter och behov av stöd
Malmö universitet, Fakulteten för hälsa och samhälle (HS), Institutionen för vårdvetenskap (VV).ORCID-id: 0000-0002-1284-3086
2020 (svensk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The overall aim of the thesis was to explore healthcare professionals’ and volunteers’experiences of encountering older persons’ existential loneliness, the significance ofthe care context, and first-line managers’ view of support. Three of the studies werequalitative with a descriptive design (studies I–III) and the fourth was quantitativewith a cross-sectional design (Study IV). The data collection for studies I and II wasbased on focus group interviews with healthcare professionals (i.e., nurse assistant,registered nurse, physician, occupational therapist, physiotherapist, social counsellor,and social worker) in home care, residential care, hospital care, palliative care,primary care, and pre-hospital care. The data collection for Study III was based onfocus group interviews and individual interviews with volunteers from variousorganisations. Study IV was based on a questionnaire sent to first-line managers inmunicipal care, examining their views of support for staff and volunteers encounteringexistential issues among older persons.

The findings of Study I indicated that, during the everyday care of older people,healthcare professionals experienced existential loneliness in various ways andsituations related to ageing, illness, and end of life. The professionals’ stories aboutencountering older persons’ existential loneliness revealed that they often felt insecureabout how to talk about existential issues. They also felt inadequate and frustratedwhen encountering barriers such as the older person’s bodily limitations, demands andneeds (perceived as insatiable), personal privacy, or fear and difficulty in encounteringexistential issues. Study II was a multiple case study of the care contexts of homecare, residential care, hospital care, and palliative care. The findings indicated that thecare context matters regarding professionals’ views and interpretations of the originof existential loneliness. In home care and residential care, these views andinterpretations concerned life, the present, and the past. In hospital and palliative care,existential loneliness mainly concerned the older person’s forthcoming death.Professionals considered creating relationships an important part of their role in allcare contexts, although the meanings, purposes, and conditions of these relationshipsdiffered (Study II). Study III showed that being a volunteer meant being a fellowhuman being, alleviating others’ and one’s own loneliness. Becoming a volunteer was a way of finding meaning, and volunteering made the volunteers feel rewarded andsimultaneously emotionally challenged. Encountering loneliness, includingexistential loneliness, required sensitivity to others’ needs for both closeness anddistance. The findings of Study IV, based on a questionnaire, indicated that 88% ofthe first-line managers found that older persons sometimes or often expressedexistential loneliness. They also reported that staff insecurity was the major obstacleto talking about existential issues with the older persons. Support was provided in theform of structured reflection, but provision of systematic supervision was reported byonly 6% of first-line managers. The managers reported that most support was providedby themselves or by registered nurses. Almost half of the managers (44%) reportedthat, at their units, volunteers were engaged in activities such as everydayconversations and/or music/entertainment. In addition, they also reported a desire forvolunteers to be more involved in both everyday and existential conversations. Inconclusion, one of the most important findings of this thesis was the insecurity of theprofessionals, manifested in a fear of discussing existential issues. This was revealedin the interviews with the professionals and confirmed by the first-line managers.According to both professionals and volunteers, the relationship with the older personwas important when encountering existential issues. The thesis demonstrates theimportance of helping professionals focus on existential issues about life and death and of the potential of volunteers as an important complement in the care of olderpeople.

sted, utgiver, år, opplag, sider
Malmö universitet, 2020. , s. 116
Serie
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 2020:2
Emneord [sv]
Existentiell ensamhet, Sköra äldre personer, Vårdpersonal, Volontärer, Frivilligorganisationer, Enhetschefer, Vårdkontext, Stöd, Intervjuer, Case study, Innehållsanalys, Enkätstudie
HSV kategori
Identifikatorer
URN: urn:nbn:se:mau:diva-7340DOI: 10.24834/isbn.978-91-7877-065-6Lokal ID: 31119ISBN: 978-91-7877-065-6 (digital)ISBN: 978-91-7877-066-3 (tryckt)ISBN: 978-91-87973-47-5 (tryckt)OAI: oai:DiVA.org:mau-7340DiVA, id: diva2:1404255
Tilgjengelig fra: 2020-02-28 Laget: 2020-02-28 Sist oppdatert: 2022-04-26bibliografisk kontrollert
Delarbeid
1. Encountering existential loneliness among older people: perspective of health professionals
Åpne denne publikasjonen i ny fane eller vindu >>Encountering existential loneliness among older people: perspective of health professionals
2018 (engelsk)Inngår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, artikkel-id 1474673Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

ABSTRACT Purpose: Existential loneliness is part of being human that is little understood in health care, but, to provide good care to their older patients, professionals need to be able to meet their existential concerns. The aim of this study was to explore health care professionals’ experiences of their encounters with older people they perceive to experience existential loneliness. Method: We conducted 11 focus groups with 61 health professionals working in home care, nursing home care, palliative care, primary care, hospital care, or pre-hospital care. Our deductive–inductive analytical approach used a theoretical framework based on the work of Emmy van Deurzen in the deductive phase and an interpretative approach in the inductive phase. Results: The results show that professionals perceived existential loneliness to appear in various forms associated with barriers in their encounters, such as the older people’s bodily limitations, demands and needs perceived as insatiable, personal shield of privacy, or fear and difficulty in encountering existential issues. Conclusion: Encountering existential loneliness affected the professionals and their feelings in various ways, but they generally found the experience both challenging and meaningful.

sted, utgiver, år, opplag, sider
Taylor & Francis, 2018
Emneord
Existential loneliness, older peole, lifeworld, health care professionals, focus groups
HSV kategori
Identifikatorer
urn:nbn:se:mau:diva-14643 (URN)10.1080/17482631.2018.1474673 (DOI)000434312200001 ()29869590 (PubMedID)2-s2.0-85048219978 (Scopus ID)26011 (Lokal ID)26011 (Arkivnummer)26011 (OAI)
Tilgjengelig fra: 2020-03-30 Laget: 2020-03-30 Sist oppdatert: 2024-06-17bibliografisk kontrollert
2. The context of care matters: Older people's existential loneliness from the perspective of healthcare professionals-A multiple case study.
Åpne denne publikasjonen i ny fane eller vindu >>The context of care matters: Older people's existential loneliness from the perspective of healthcare professionals-A multiple case study.
2019 (engelsk)Inngår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 14, nr 3, artikkel-id e12234Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

AIM: To explore existential loneliness among older people in different healthcare contexts from the perspective of healthcare professionals. BACKGROUND: Professionals meet and care for older people in most care contexts and need to be prepared to address physical, psychological, social and existential needs. Addressing existential loneliness can be both challenging and meaningful for professionals and is often not prioritised in times of austerity. DESIGN: A multiple case study design was used. METHODS: Focus group interviews were conducted with healthcare professionals (n = 52) in home, residential, hospital and palliative care settings. The analysis was performed in two steps: firstly, a within-case analysis of each context was conducted, followed by a cross-case analysis. FINDINGS: Differences and similarities were observed among the care contexts, including for the origin of existential loneliness. In home care and residential care, the focus was on life, the present and the past, compared to hospital and palliative care, in which existential loneliness mainly related to the forthcoming death. The older person's home, as the place where home care or palliative care was received, helped preserve the older person's identity. In hospital and palliative care, as in institutional care, the place offered security, while in residential care, the place could make older people feel like strangers. Creating relationships was considered an important part of the professionals' role in all four care contexts, although this had different meanings, purposes and conditions. CONCLUSIONS: The context of care matters and influences how professionals view existential loneliness among older people and the opportunities they have to address existential loneliness. IMPLICATIONS FOR PRACTICE: Support for professionals must be tailored to their needs, their education levels and the context of care. Professionals need training and appropriate qualifications to address existential loneliness related to existential aspects of ageing and care.

sted, utgiver, år, opplag, sider
John Wiley & Sons, 2019
HSV kategori
Identifikatorer
urn:nbn:se:mau:diva-4271 (URN)10.1111/opn.12234 (DOI)000483649600005 ()31025806 (PubMedID)2-s2.0-85064926567 (Scopus ID)30064 (Lokal ID)30064 (Arkivnummer)30064 (OAI)
Tilgjengelig fra: 2020-02-28 Laget: 2020-02-28 Sist oppdatert: 2024-06-17bibliografisk kontrollert
3. Being a volunteer encountering older people's loneliness and existential loneliness: alleviating loneliness for others and oneself
Åpne denne publikasjonen i ny fane eller vindu >>Being a volunteer encountering older people's loneliness and existential loneliness: alleviating loneliness for others and oneself
2021 (engelsk)Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 35, nr 2, s. 538-547Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background The increasing proportion of older people worldwide is challenging society and the healthcare sector to develop new solutions, such as involving volunteers, especially to combat loneliness among older people. Loneliness is a broad concept comprising, for example existential loneliness - a deep feeling of aloneness in the world. We know little about volunteers' experience of encountering older people's loneliness in general and existential loneliness in particular. Such knowledge is important in order to develop high-quality volunteering. Aim This study aimed to describe volunteers' experience of becoming and being a volunteer, and encountering older people's loneliness in general and existential loneliness in particular. Methods This descriptive qualitative study is based on eight focus group interviews and twelve individual interviews with volunteers from different organisations, analysed using conventional content analysis. Findings Being a volunteer meant being a fellow human being, alleviating loneliness for others and oneself. Becoming a volunteer was a way of finding meaning, and volunteering made the volunteers feel rewarded and simultaneously emotionally challenged. Being a volunteer also meant acting on one's values, challenging boundaries when necessary. Encountering loneliness, including existential loneliness, required sensitivity to others' needs for both closeness and distance. Conclusion Being a volunteer benefitted not only the older persons the volunteers met, but also the volunteers' own sense of meaning, by alleviating their own loneliness. Sharing existential thoughts and having meaningful conversations about life and death are challenging, but can contribute to the personal growth of the volunteers themselves. It is important to remember that not all volunteers are confident in having existential conversations, so it is important to pay attention to each volunteer's prerequisites and needs. In addition, there is a need for support to volunteers' engagement such as clarifying their role and clarifying the responsibility and expectations from health and social care.

sted, utgiver, år, opplag, sider
John Wiley & Sons, 2021
Emneord
encounters, existential loneliness, focus groups, individual interviews, loneliness, older people, qualitative study, volunteers
HSV kategori
Identifikatorer
urn:nbn:se:mau:diva-17476 (URN)10.1111/scs.12869 (DOI)000531722900001 ()32400051 (PubMedID)2-s2.0-85084484142 (Scopus ID)
Tilgjengelig fra: 2020-06-12 Laget: 2020-06-12 Sist oppdatert: 2024-06-17bibliografisk kontrollert
4. Encountering older persons’ existential issues: First-line managers’ views on staff’s and volunteers’ possibilities, obstacles and need for support
Åpne denne publikasjonen i ny fane eller vindu >>Encountering older persons’ existential issues: First-line managers’ views on staff’s and volunteers’ possibilities, obstacles and need for support
2020 (engelsk)Manuskript (preprint) (Annet vitenskapelig)
HSV kategori
Identifikatorer
urn:nbn:se:mau:diva-17202 (URN)
Tilgjengelig fra: 2020-05-08 Laget: 2020-05-08 Sist oppdatert: 2023-01-09bibliografisk kontrollert

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