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The context of care matters: Older people's existential loneliness from the perspective of healthcare professionals-A multiple case study.
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.ORCID iD: 0000-0002-1284-3086
Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.
Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0003-1235-620X
2019 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 14, no 3, article id e12234Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019. Vol. 14, no 3, article id e12234
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mau:diva-4271DOI: 10.1111/opn.12234ISI: 000483649600005PubMedID: 31025806Scopus ID: 2-s2.0-85064926567Local ID: 30064OAI: oai:DiVA.org:mau-4271DiVA, id: diva2:1401101
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-06-17Bibliographically approved
In thesis
1. Existentiell ensamhet hos sköra äldre personer: Vårdpersonals och volontärers erfarenheter och behov av stöd
Open this publication in new window or tab >>Existentiell ensamhet hos sköra äldre personer: Vårdpersonals och volontärers erfarenheter och behov av stöd
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Malmö universitet, 2020. p. 116
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 2020:2
Keywords
Existentiell ensamhet, Sköra äldre personer, Vårdpersonal, Volontärer, Frivilligorganisationer, Enhetschefer, Vårdkontext, Stöd, Intervjuer, Case study, Innehållsanalys, Enkätstudie
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-7340 (URN)10.24834/isbn.978-91-7877-065-6 (DOI)31119 (Local ID)978-91-7877-065-6 (ISBN)978-91-7877-066-3 (ISBN)978-91-87973-47-5 (ISBN)31119 (Archive number)31119 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2022-04-26Bibliographically approved

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Sundström, MalinRämgård, Margareta

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