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James, I., Kihlgren, A., Norell Pejner, M. & Tavemark, S. (2024). First-line managers struggling to lead home care based on the individual’s needs and goals – conflict between ethical principles. Leadership in Health Services, 37(5), 84-98
Open this publication in new window or tab >>First-line managers struggling to lead home care based on the individual’s needs and goals – conflict between ethical principles
2024 (English)In: Leadership in Health Services, ISSN 1188-3669, Vol. 37, no 5, p. 84-98Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual’s needs and goals. Design/methodology/approach: In this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis. Findings: The results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization’s needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle. Originality/value: The FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual’s needs and goals. 

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2024
Keywords
Home care, Individual goal, Leadership, Participatory appreciative action reflection, Value-based leadership, Ethical principles, Organizational culture
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-98382 (URN)10.1108/lhs-05-2023-0035 (DOI)38262006 (PubMedID)2-s2.0-85182816423 (Scopus ID)
Funder
Örebro University, 2019-02575
Available from: 2024-02-07 Created: 2024-02-07 Last updated: 2024-03-06Bibliographically approved
James, I., Pejner, M. N. & Kihlgren, A. (2024). Nurse assistants' experiences and knowledge of how they create a meaningful daily life for older persons receiving municipal home healthcare. Scandinavian Journal of Caring Sciences, 38(1), 159-168
Open this publication in new window or tab >>Nurse assistants' experiences and knowledge of how they create a meaningful daily life for older persons receiving municipal home healthcare
2024 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 38, no 1, p. 159-168Article in journal (Refereed) Published
Abstract [en]

Aims and Objectives: To explore nurse assistants' experiences and knowledge of how they create a meaningful daily life for older people receiving municipal home healthcare.

Design: A participatory appreciative action reflection approach.

Methods: Interviews, participant observations and informal conversations with 23 nurse assistants in municipal home healthcare generated the data. A thematic analysis was used.

Results: Two main themes were developed. The first main theme, building a reciprocal relationship, was structured by three subthemes: To strengthen the older person's self-esteem, to co-create care and to create equality. The second main theme, creating meaning, was structured by two subthemes: To create closeness and to receive appreciation. The two main themes are each other's prerequisite. Nursing assistants' building reciprocal relationships gives meaning; through the meaning, reciprocal relationships are achieved, and by that, meaningful daily lives for both the older people and the nurse assistants.

Conclusion: Nurse assistants built a reciprocal relationship both for the older people and for the nurse assistant. This contributes to create a meaningful daily life for the older people. The older person was the main character, and it seems that the nurse assistants apply person-centred care, which can represent a shared common vision that can be used in the encounter.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
home healthcare, meaningful daily life, municipal home care, nurse assistants, older people, participatory appreciative action reflection, person-centred care
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-97294 (URN)10.1111/scs.13219 (DOI)001083364800001 ()37815122 (PubMedID)2-s2.0-85173777931 (Scopus ID)
Available from: 2023-11-03 Created: 2023-11-03 Last updated: 2024-02-23Bibliographically approved
Tavemark, S., Kihlgren, A., Norell Pejner, M. & James, I. (2023). Individual goal-setting in municipal homecare: A participatory appreciative action and reflection study. Journal of Public Health Research, 12(2), 1-11
Open this publication in new window or tab >>Individual goal-setting in municipal homecare: A participatory appreciative action and reflection study
2023 (English)In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 12, no 2, p. 1-11Article in journal (Refereed) Published
Abstract [en]

Background: There is a need for structural change in municipal homecare to shift power to older persons and to center the individuals in need. To make this change, the individual older persons should have enough self-determination to formulate their own individual homecare goals. Our aim was to explore how stakeholders reason about individual goal-setting in homecare.

Design and methods: We theoretically and methodologically used a participatory appreciative action and reflection (PAAR) design. The stakeholders, that is, the older persons, the older persons’ relatives, and the multi-professional team, were seen as co-researchers. Data were collected between 2019 and 2020 through in depth-interviews, focus group discussions, and reference groups. The data were analyzed using thematic analysis.

Results: We learned from the stakeholders that it was a struggle to sustain the individual’s goal to continue life as usual, that is, being an ordinary human being with an ordinary everyday life and maintaining individual roles. The individual wants to improve health, be active, and enjoying life. The individuals were struggling against the homecare organization, which tended to overshadow the individual’s goals. The individual’s goals fall under several legal jurisdictions and come to be overshadowed by the professionals’ dominant goal. The organization is rigid, with finances and resources creating the framework.

Conclusion: We learned that older persons receiving homecare must have the same rights as other citizens in society, which is in line with public health goals.

Place, publisher, year, edition, pages
Sage Publications, 2023
National Category
Health Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-95487 (URN)10.1177/22799036231181198 (DOI)001004419500001 ()37361239 (PubMedID)2-s2.0-85163039972 (Scopus ID)
Funder
Örebro University
Available from: 2023-06-19 Created: 2023-06-19 Last updated: 2023-07-07Bibliographically approved
Kihlgren, A., James, I. & Pejner, M. N. (2023). We have to turn a transatlantic liner-Leaders' perspectives on creating a meaningful life for older persons receiving municipal care. Nursing Open, 10(10), 6836-6844
Open this publication in new window or tab >>We have to turn a transatlantic liner-Leaders' perspectives on creating a meaningful life for older persons receiving municipal care
2023 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 10, no 10, p. 6836-6844Article in journal (Refereed) Published
Abstract [en]

Aims: To describe leaders' perspectives on what is important to create a meaningful daily life for older persons receiving municipal elderly care.Design: This study combined the Participatory Appreciative Action Reflection approach and qualitative methods.Methods: Focus Group Discussions were performed with eighty leaders that was analysed with qualitative content analysis.Results: One overall theme emerged "We have to turn a transatlantic liner". The leaders proposed a need to change from an institutional care to a more person-centered care approach on all levels of the healthcare system. This meant that everyone in the organization needed to think outside the box and find new ways to provide care to older persons. They needed to hire the right persons with the right values and knowledge. The leaders would need to provide for and support staff empowerment. There was also a need to see the older person and their relatives as co-participants.No Patient or Public Contribution.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
action research, elderly care, implementation, leaders perspective, meaningful daily life
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-96228 (URN)10.1002/nop2.1932 (DOI)001023638300001 ()37408144 (PubMedID)2-s2.0-85164510885 (Scopus ID)
Funder
Örebro University
Available from: 2023-08-07 Created: 2023-08-07 Last updated: 2023-12-11Bibliographically approved
James, I. (2022). Att lära och leva en värdegrund. In: Elisabeth Bergdahl; Fia Andersson (Ed.), Deltagarbaserad aktionsforskning: tillsammans för kunskap, lärande och förändring (pp. 135-159). Lund: Studentlitteratur AB
Open this publication in new window or tab >>Att lära och leva en värdegrund
2022 (Swedish)In: Deltagarbaserad aktionsforskning: tillsammans för kunskap, lärande och förändring / [ed] Elisabeth Bergdahl; Fia Andersson, Lund: Studentlitteratur AB, 2022, p. 135-159Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur AB, 2022
Keywords
Deltagarbaserad forskning, Värdegrund
National Category
Health Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-93980 (URN)9789144154039 (ISBN)
Available from: 2023-03-22 Created: 2023-03-22 Last updated: 2023-06-20Bibliographically approved
Kihlgren, A., Norell Pejner, M. & James, I. (2021). Core values and local guarantees of dignity in the care of older persons: Application, obstacles and further actions. Scandinavian Journal of Caring Sciences, 35(2), 616-625
Open this publication in new window or tab >>Core values and local guarantees of dignity in the care of older persons: Application, obstacles and further actions
2021 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 35, no 2, p. 616-625Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIM: Due to reported shortcomings in elderly care in Sweden, the government has introduced national guidelines to establish core values and guarantees of dignity. With a bottom-up perspective, core values and local guarantees of dignity were developed using an participatory and appreciative action and reflection (PAAR) approach and implemented in municipal elderly care. The aim of this study was to evaluate the core values and local guarantees of dignity applied by the municipal healthcare staff caring for older persons. METHOD AND RESULTS: A cross-sectional descriptive design study using a questionnaire was conducted one year after the implementation of core values and local guarantees of dignity in municipal elderly care. In total, 608 caregivers answered the questionnaire. The results show that the caregivers strived to apply the core values and local guarantees of dignity, but experienced obstacles from the organisation. Proposals were given to facilitate further application of the core values.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
Caregivers’ view, core values, elderly care, implementation, local guarantees of dignity
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-83982 (URN)10.1111/scs.12878 (DOI)000539630400001 ()32529659 (PubMedID)2-s2.0-85086345165 (Scopus ID)
Available from: 2021-05-11 Created: 2021-05-11 Last updated: 2024-07-23Bibliographically approved
James, I. (2020). Att bygga kunskap vid vård i livets slut. In: B Andershed ; BM Ternstedt ; C Håkansson (Ed.), Palliativ vård: Begrepp & perspektiv i teori och praktik (pp. 525-538). Studentlitteratur AB
Open this publication in new window or tab >>Att bygga kunskap vid vård i livets slut
2020 (English)In: Palliativ vård: Begrepp & perspektiv i teori och praktik / [ed] B Andershed ; BM Ternstedt ; C Håkansson, Studentlitteratur AB, 2020, p. 525-538Chapter in book (Other academic)
Place, publisher, year, edition, pages
Studentlitteratur AB, 2020
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-86952 (URN)9789144131078 (ISBN)
Available from: 2021-11-08 Created: 2021-11-08 Last updated: 2021-11-08Bibliographically approved
James, I., Norell Pejner, M. & Kihlgren, A. (2019). Creating conditions for a sense of security during evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study. BMC Geriatrics, 19(1), 1-12, Article ID 351.
Open this publication in new window or tab >>Creating conditions for a sense of security during evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study
2019 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 19, no 1, p. 1-12, article id 351Article in journal (Refereed) Published
Abstract [en]

Background: Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge.

Methods: This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data.

Results: Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person’s identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other’s conditions. The person’s self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed.

Conclusion: Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people’s self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing. 

Place, publisher, year, edition, pages
London, UK: BioMed Central (BMC), 2019
Keywords
Evenings and nights, Home health care, Older persons, Ordinary housing, Participatory appreciative action and reflection, Sense of security
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-83940 (URN)10.1186/s12877-019-1372-z (DOI)000511870400001 ()31842776 (PubMedID)2-s2.0-85076684734 (Scopus ID)
Available from: 2019-12-23 Created: 2021-05-10 Last updated: 2024-07-04Bibliographically approved
Lidström-Holmqvist, K. & James, I. (2019). Patient participation in municipal elderly care from the perspective of nurses and occupational therapists. Nursing Open, 6(3), 1171-1179
Open this publication in new window or tab >>Patient participation in municipal elderly care from the perspective of nurses and occupational therapists
2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 1171-1179Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to describe how nurses and occupational therapists in municipal care of older people define and implement patient participation in their daily work. Design: This study had a cross-sectional design. Data were collected using an online questionnaire. Methods: The questionnaire had both closed and open-ended questions. One-hundred and fourteen nurses and occupational therapists responded. Data were analysed with descriptive statistics and thematic analysis. Results: Two main themes were identified as follows: "The professionals’ perspective at the centre - Patient participation to enhance compliance" and "The patients’ perspective at the centre - Patient participation as an ongoing process." The themes covered a continuum. On one extreme, patient participation was equated with making the patient comply with what the professionals wanted to do. On the other extreme, all power was transferred to the patient. The first theme was restricted to the decision-making process. The second theme covered the entire care or, rehabilitation, process.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Health services for older people, nurses, occupational therapists, patient participation
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-83983 (URN)10.1002/nop2.302 (DOI)000476917700057 ()31367443 (PubMedID)2-s2.0-85069769004 (Scopus ID)
Available from: 2021-05-11 Created: 2021-05-11 Last updated: 2021-11-29Bibliographically approved
Svantesson, M., Silén, M. & James, I. (2018). It's not all about moral reasoning: Understanding the content of Moral Case Deliberation. Nursing Ethics, 25(2), 212-229
Open this publication in new window or tab >>It's not all about moral reasoning: Understanding the content of Moral Case Deliberation
2018 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 25, no 2, p. 212-229Article in journal (Refereed) Published
Abstract [en]

Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain.

Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces.

Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority.

Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation.

Findings: Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%).

Conclusion: The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Clinical ethics, ethics consultation, ethics rounds, healthcare professionals, Moral Case Deliberation, psychosocial aspects, qualitative research
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-83951 (URN)10.1177/0969733017700235 (DOI)000429899900008 ()28421865 (PubMedID)2-s2.0-85044337153 (Scopus ID)
Funder
AFA Insurance
Available from: 2017-06-26 Created: 2021-05-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4362-2902

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