Search

This study explores policy makers’, health-care professionals’ and senior volunteers’ perceptions of senior volunteers. Two Norwegian government white papers regarding older adult care and welfare services, which were published over a period of 19 years, were selected for close examination. Furthermore, focus group interviews with a purposeful sample of five senior volunteers and 15 health-care professionals were conducted. The study explores the discursive formations of senior volunteers in the government white papers and how they are negotiated in the senior volunteers’ and the health-care professionals’ narratives. Two dominant discourses were presented in the white papers: a prevention discourse (in which volunteering was presented primarily as a means to prevent volunteers’ loneliness and need for care services) and a sustainability discourse (in which the volunteers were presented as instrumental in future sustainable care services). Both discourses echo a common overarching discourse about a capacity crisis due to the ageing population. The senior volunteers were positioned as partners and active agents in both their own narratives and the health-care professionals’ narratives. Their position as independent and as spokespersons for the less empowered were evident only in the senior volunteers’ own narratives. Only the health-care professionals referenced the prevention discourse and capacity issues. The senior volunteers presented themselves as competent, efficient political actors, and they resisted both the prevention and sustainability discourses. In the senior volunteers’ narratives, social and political participation were interrelated. The study demonstrates that new discursive landscapes must be created to capture the diversity among senior volunteers and their efforts. While senior volunteers must be meaningfully involved in decision making, planning and design, their positions as independent and active agents must also be ensured. Authentic partnerships between senior volunteers and public care services involve a balance between involvement and independence. [ABSTRACT FROM AUTHOR]

Background: Norwegian government white papers have stated that the Sami population is reluctant to seek help from healthcare services and has traditions of self-help and the use of local networks. Objective: In this article we explore healthcare professionals' discursive constructions of Sami persons with dementia and their families' reluctance to seek and accept help from healthcare services. Design: The article is based on an analysis of focus group interviews with healthcare professionals (n = 18) in four municipalities in Northern Norway with multiethnic populations. A narrative context analysis, which involved an examination of sequences of discourse, was employed. Results: Reluctance to seek and accept help among Sami service users and assumptions about self-support were recurring themes in the focus groups. The reluctance was attributed to macro contexts, such as socio-historical processes and cultural norms, and to micro contexts, such as individual and interpersonal factors including the healthcare professionals' cultural backgrounds and language competence. The healthcare professionals' positioning as insiders or outsiders (Sami or non-Sami) affected their attributions. Conclusions: Local healthcare professionals are at the front line for providing and assessing service users' needs for healthcare services. Consequently, their perceptions of service users' needs are pivotal for achieving equity in healthcare. The established opinion that Sami "take care of their own" and are reluctant to seek and accept help may lead to omissions or neglect. Healthcare professionals' awareness about how present encounters in healthcare settings are framed and shaped by the service users' previous and prevailing experiences of marginalisation and subordination is crucial to avoid omissions or neglect resulting from assumptions about cultural preferences. Discursively shaped boundaries and differences between groups may create the impression that the distance between the groups is too wide to traverse, which in turn may lead to further marginalisation of service users in healthcare encounters. [ABSTRACT FROM AUTHOR]

Objective: This study explores stroke survivors’ and relatives’ negotiation of relational and activity change in their interrelated long-term meaning-making processes of everyday life and what it means for the experience of progress and well-being.Material and methods: Repeated retrospective in-depth interviews were conducted with both the stroke survivor and relatives. A Critical Psychological Perspective gives the frame of reference to study more closely what is going on in and across particular contexts in family members’ ongoing social practices.Results: An asymmetric problematic relationship can develop among the participants in the context of family life. However, the analysis identifies six beneficial relational and activity changes, which contribute to a reciprocal, balanced repositioning, and help the family move in a more positive direction. The repositioning processes facilitate a new transformation of family we-ness, which is important for the participants’ experience of process and well-being. The comprehensive family work that has to be done is about managing the imbalance of everyday life, upholding separate activities outside the family sphere and dealing with the fact that peripheral others become more peripheral.Conclusion: The study addresses some arguments for taking a family-centred perspective in occupational therapy practice, as well as in a stroke rehabilitation service in general. [ABSTRACT FROM PUBLISHER]

The point of departure for this article is narrative gerontology's conceptualization of life as storied and the assumption that identity development and meaning making do not cease at any age, but rather continue throughout life. We suggest that if identity construction is considered to be a lifelong project, narrative gerontology would benefit from applying analytical perspectives focused on the situated activity of narration. In this article, we apply a three-level positioning analysis to segments of interviews with two elderly Sami women concerning missed opportunities or roads not taken and, more specifically, to narrations about missed opportunities for education. We argue that such narrations should not necessarily be considered expressions of regret or processes of reconciliation but rather as pivotal in here-and-now identity constructions. Narrations about missed opportunities demonstrate that what narrators choose to insert into their life stories is chosen for a purpose and for an audience in a specific interpersonal and discursive context. We suggest that narrative gerontology would benefit from a broader focus on the diversity of sites of engagement in which older adults perform identity constructions. This shift implies moving beyond traditional studies of older adults' life stories and biographical narratives as related in the context of qualitative research interviews (of which the present study of Sami older adults' life stories is indeed an example). [ABSTRACT FROM AUTHOR]

This study explores stroke survivors' experience of being part of an institutional rehabilitation context and what it means for the immediate experience of discharge home. The aim is to develop a deeper understanding of how the dynamic phenomenon body, participation in everyday life and sense of self interrelates and changes through stroke survivors' movement in and between the two contexts and what this phenomenon means for stroke survivors' process of change and well-being in the early rehabilitation trajectory. Repeated, retrospective, in-depth interviews were conducted with nine persons living with moderate impairment after stroke and their closest relatives. Phenomenological and critical psychological concepts are used for analysing the data. Stroke survivors' experience indicates that their time as in-patients is important for their safety in the early juncture. Being part of an institutional rehabilitation context mobilizes stroke survivors' to optimize focus, energy and hope of physical recovery. At the same time it appears to postpone feelings of uncertainty and grief as well as reflection on their situation. However, immediately after homecoming a critical passage in the stroke survivors' rehabilitation trajectory appears because the perception of body, participation in everyday life and the sense of self undergo profound changes. This study stresses the importance of broadening the scope of professional initiative and paying attention to the post-rehabilitation context of everyday life during the in-patient stay. [ABSTRACT FROM PUBLISHER]

Abstract: The Sami are an indigenous people living in Norway, Sweden, Finland, and Russia. Historically, national states have made strong efforts to assimilate the Sami people into the majority populations, and the Sami have experienced stigmatization and discrimination. However, after World War II, there has been a revitalization process among the Sami that was pioneered by the Sami Movement and gradually adopted in broader spheres of Norwegian society. The lifespans of the current cohort of elderly Sami unfold throughout a historical period in which contrasting public narratives about the Sami have dominated. The purpose of this study was to explore the relationship between elderly Sami's individual life stories and contrasting public narratives about the Sami. Nineteen elderly Sami individuals in Norway were interviewed. This article is a dialogical narrative analysis of the life stories of four elderly Sami. The article illuminates how individual life stories are framed and shaped by public narratives and how identifying is an ongoing process also in late life. A dialogical relationship between individual life stories and public narratives implies that individual stories have the capacity to shape and revise dominant public narratives. To do so, the number of stories that are allowed to act must be increased. A commitment in dialogic narrative research on minority elderly is to make available individual stories from the margins of the public narratives to reduce narrative silences and to prevent the reproduction of established “truths”. [Copyright &y& Elsevier]

This study examined four policy documents published by the Norwegian government from 1995 to 2009 describing issues regarding the provision of public services to elderly Sami in Norway. Adopting a Foucauldian discourse analytic approach, we explored how the statements regarding elderly Sami and care services in these documents are situated within contemporary ethno-political and healthcare discourses. The documents exhibited two major and interrelated trends: the predominant portrayal of the Sami and the ethos of cultural congruent care. The analysis demonstrated a high degree of discursive continuity throughout the four documents, with the image of the elderly Sami constructed in the earliest document reproduced to a large extent in the newer documents. We suggest that a critical cultural perspective offers an alternative to the understanding of culture and the concept of cultural congruent care found in the documents. From a critical cultural perspective, culture is seen as relational, changing over time, and dependent on social context, history, gender, and other factors. In this view, cultural competence does not involve learning a fixed, coherent body of knowledge comprising “the Sami culture”. A critical cultural perspective challenges those who provide care to the elderly Sami to become aware of social, political, and historical processes while simultaneously acknowledging that the impacts of these processes on the lives of the individuals they encounter can never be fully known. Furthermore, this perspective prompts healthcare providers to reflect on how their assumptions about the people they encounter are shaped by their own social, cultural, economic, and professional backgrounds. We suggest that the authorities initiate a new policy document based on current insights into the everyday experiences of the current cohort of elderly Sami as well as contemporary social, ethno-political, and healthcare discourses. [ABSTRACT FROM PUBLISHER]

The aim of this study was to explore how caregivers experience collaboration in rural municipalities in northern Norway. We conducted fieldwork with a dementia team in addition to seventeen qualitative in-depth interviews with formal and family caregivers. The caregivers had ethnic Sami and ethnic Norwegian affiliation. The theme ‘negotiating ethnic and ethno-political positions’ was identified through thematic analysis and developed using positioning theory. Ethnicity involves dynamic and situated personal affiliations, and participants negotiate each other's ethnic positions in practice. Negotiations of ethnic positions hamper collaboration between formal and family caregivers, and ethno-political positions reinforce stereotyped ethnic positions. This study contributes to the understanding of and the debate over positions on ethno-cultural collaboration in health care. In practice, participants negotiate the health policy concept of ‘cultural facilitation’, which must be broadened to ensure equal healthcare services. [ABSTRACT FROM PUBLISHER]

Purpose: Research has mainly focused on the first year of recovery trajectory after stroke, but there is limited knowledge about how stroke survivors manage their long-term everyday lives. This study seeks to fill this gap by exploring the long-term (1-13 years) negotiations of stroke survivors when they experience progress, wellbeing and faith in the future. Method: Repeated in-depth interviews were conducted with nine people living with moderate impairment after stroke and their closest relatives. Concepts from phenomenology and critical psychology constituted the frame of reference of the study. Results: The long-term stroke recovery trajectory can be understood as a process of struggling to overcome tensions between three phenomena under ongoing change: the lived body, participation in everyday life and sense of self. During the recovery process, stroke survivors experience progress, well-being and faith in the future when moving towards renewed relationships, characterised by (1) a modified habitual body, (2) repositioned participation in specific everyday life contexts and (3) a transformed sense of self. Conclusions: This study stresses the importance of developing new forms of professional support during the long-term recovery trajectory, to stimulate and increase interaction and coherence in the relationship between the stroke survivor's bodily perception, participation in everyday life and sense of self. [ABSTRACT FROM AUTHOR]

Researching the outcomes of assistive technology devices (ATDs) for older clients is important to facilitate clinical decision-making. However, to understand the outcomes associated with ATDs, one must investigate the users' experiences and acknowledge the user as an active participant in diverse social contexts. Purpose: To enhance understanding of the users' perspective regarding ATDs, this study aimed to investigate the meaning of the ATD for older individuals still living in their home environment. Methods: To provide descriptions of ATD experiences, older individuals who received a new ATD to compensate for their challenges in moving around, assist in self-care or both were recruited for the study. Participants were interviewed twice, with a few months between interviews, about their experience in using their new ATD. The interview transcripts were analyzed in a hermeneutical-phenomenological research approach. Results: The analysis revealed three recurring themes associated with the description of ATD experiences: 'enabling performance and choice', 'transformation from requiring assistance to assisting others', and 'preparing for the future'. Conclusion: The results show that ATDs are used to enhance competence, mastery, control, self-worth, hope, and preparedness. The ATD service delivery should be client-centered and the client should be acknowledged as an active participant in producing change. [ABSTRACT FROM AUTHOR]

Objective: Providing assistive technology devices to older individuals living in their ordinary homes is an important intervention to increase and sustain independence and to enable ageing at home. However, little is known about older individuals' experiences and needs in the assistive technology device (ATD) service delivery process. The purpose of this study was to investigate older individuals' experiences during the service delivery process of ATDs. Methods: Nine older individuals were interviewed three times each throughout the ATD service delivery process. The interviews were analysed within a hermeneutical phenomenological perspective. Results: The results show that the service delivery process could be interpreted as an enigmatic journey and described using four themes: 'hope and optimistic expectations', 'managing after delivery or needing additional help', 'having available help versus being abandoned', and 'taking charge or putting up'. Conclusions: The results emphasize the need for occupational therapists to maintain an individualized approach towards older clients throughout the service delivery process. The experiences of older individuals were diverse and related to expectations that were not necessarily articulated to the occupational therapist. The situation when the ATD is delivered to the client was highlighted by the clients as an important event with the potential to facilitate a successful service delivery process. [ABSTRACT FROM AUTHOR]

An unmet need for assistive technology devices (ATD) occurs when a person would benefit from ATD, as assessed by health-care professionals or by the person In question. Unmet ATD needs In the elderly population have been documented, but little is known about the experience of living with such unmet needs. Purpose: To investigate the unmet need experiences of home-dwelling elderly people In Norway who have applied for ATD. Method: Nine elderly people who lived at home and had applied for ATD were interviewed. The interview transcripts were analysed withIn a hermeneutical phenomenological perspective. Results: The unmet ATD need experiences involved enduring a difficult situation by adjusting their expectations and activities, being introduced to ATD as a possible solution to the difficulties and negotiating this potential solution In light of the perceived situation. Conclusion: Observers assessments of unmet ATD needs are not readily experienced as such by the elderly. Adjusting expectations and activities enabled the participants to maintaIn meaningful activities but also made the difficulties less likely to be articulated as unmet needs. When encountering elderly people, health-care professionals must be sensitive to the unarticulated needs and potential difficulties of the elderly In performing everyday activities. [ABSTRACT FROM AUTHOR]

Introduction: The large number of people affected by dementia diseases poses major challenges for public health, healthcare services and healthcare service providers. The Western health policy of ageing in place rests on a triad collaboration among patients, healthcare service providers and family caregivers. Such collaborations presuppose involvement in and influence on a vague juridical landscape. Several researchers have stated the need for knowledge about decision-making processes regarding admission to nursing homes for persons with dementia. The research question of this study is as follows: How do family caregivers experience involvement in and influence on the nursing home decision-making process for persons with dementia? Theory/Methods: The data consist of twelve in-depth interviews with family caregivers to persons with dementia. By the use of positioning theory, we demonstrate how family caregivers strive to balance their assumed duty to take care of the person with their needs to take care of themselves. Results: The family caregivers involvement (or non-involvement) in the complex decision-making process is demonstrated through seven positions: 1) the self-condemning determiner, 2) the dominant, 3) the proponent, 4) the saluting, 5) the pending, 6) the prisoner, and 7) the stooge. Discussions: We discuss why expedient positions are more available for some individuals and the consequences that family caregivers' various positions have on the healthcare policy aim of collaboration, and moreover, of equal healthcare services. Conclusions: Health care policies regarding ageing in place rest on a third party: the family caregivers. This study contributes family caregivers' experiences of involvement in and influence on the nursing home decision-making process for persons with dementia. Knowledge of how family caregivers present themselves and others within positions is useful in understanding how decisions regarding admission to nursing homes are made, and further, in evaluating individuals' access to healthcare. This knowledge is important for Health care providers in order for them to provide tailored support and thus facilitate the involvement of family caregivers in nursing home decisionmaking processes for persons with dementia. Lessons learned: To pinpoint the legislated user involvement for persons with dementia and reduce the family caregivers' decisional burden, politicians and healthcare services must understand, acknowledge and emphasize family caregivers' own needs. If the Health care providers are aware of potential positions in interactions with family caregivers of persons with dementia, they may enable more expedient positions for themselves and family caregivers. More expedient positions may result in fewer conflicts and reduced decisional burden when demanding decisions as admission to nursing homes must be made. Limitations:The study design is an exploratory, qualitative design based on an interactional perspective, where 'reality' is context bound and thus the results reflect one of several possible interpretations. Suggestions for future research: Our model of family caregivers' positions can be useful for further development of decisional aid to reduce conflicts and negative effects of care for family caregivers in home-based care. [ABSTRACT FROM AUTHOR]

Community health-care services for older, home-dwelling persons with dementia tend to be underutilised. Family care-givers provide substantial care, and they often arrange for and co-ordinate health-care services on behalf of persons with dementia. The aim of this study was to examine family care-givers' knowledge of unused services and their self-reported reasons for non-use of such services. We gathered cross-sectional survey data from 430 family care-givers of older persons with dementia in Northern Norway. Multinomial logistic regression analysis was used to identify predictors of family care-givers' knowledge of unused services. An open-ended question regarding reasons for non-use of services was analysed by thematic text analysis. Characteristics of family care-givers (e.g. education level) and factors related to the care-giving circumstances (e.g. negative impact of care-giving) predicted family care-givers' knowledge of unused services. Reasons for non-use of services were multifaceted and complex, and were related to attributes of the person with dementia and/or the family care-giver (e.g. reluctance to use services) and/or the health-care services (e.g. low quality). Although services were unused, several family care-givers indicated substantial needs for the services. Strategies aimed at addressing the non-use of services should emphasise individuals' and families' needs and the adaptation of information about available services and their benefits for both care recipients and family care-givers. A relationship-centred care approach is thus recommended in dementia care. [ABSTRACT FROM AUTHOR]

People with Sami and Norwegian background are frequent users of traditional folk medicine (TM). Traditional healing, such as religious prayers of healing (reading) and the laying on of hands, are examples of commonly used modalities. The global aim of this study is to examine whether health personnel's knowledge, attitudes and experiences of traditional healing affect their clinical practice. Semi-structured individual interviews (n=32) and focus group interviews (n=2) were conducted among health personnel in two communities in Northern Norway. The text data was transcribed verbatim and analysed based on the criteria for content analysis. Six themes were identified. The participants had acquired their knowledge of traditional healing through their childhood, adolescence and experience as health personnel in the communities. They all expressed that they were positive to the patients' use of traditional healing. They justified their attitudes, stating that "there are more things in heaven and earth" and they had faith in the placebo effects of traditional healing. The health personnel respected their patients' faith and many facilitated the use of traditional healing. In some cases, they also applied traditional healing tools if the patients asked them to do so. The health personnel were positive and open-minded towards traditional healing. They considered reading as a tool that could help the patients to handle illness in a good way. Health personnel were willing to perform traditional healing and include traditional tools in their professional toolkit, even though these tools were not documented as evidence-based treatment. In this way they could offer their patients integrated health services which were tailored to the patients' treatment philosophy. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 108-116 Maintain a level of activity and exercise is advice often given to patients with chronic musculoskeletal pain, but many patients find physical activity painful and consequently hesitate to move. Disability seems to be associated with fear of pain and there is a need to enhance our understanding of patients' beliefs and attitudes about how fear of pain affects physical activity and why some people are active despite their pain. The aim of this research was to understand thoughts and experiences about pain related to activity in patients with musculoskeletal disorders; the situations that promoted pain and if and how fear was expressed. Five women and five men, recruited from a larger survey on fear, pain and physical activity were interviewed. The interviews were analysed by qualitative methods for themes about participants' pain and beliefs about pain. By interpreting signals from the body, patients calculated and planned their daily life to stay active despite pain and participate in their social lives. Pain was a signal with diverse meanings which, with the influence of time, seemed to change from a sign of danger to a reminder to moderate their level of activity. By experimenting with different activities, patients learned how to gradually remain or become physically active. Patients strived to stay active despite pain. The interpretation of pain changed over time, from a threatening signal to a signal with diverse meanings. The findings provide insights that may improve the educational rehabilitation of patients with musculoskeletal pain. [ABSTRACT FROM AUTHOR]