期刊论文详细信息
BMC Geriatrics
Fluctuation between Powerlessness and Sense of Meaning - A Qualitative Study of Health Care Professionals’ Experiences of Providing Health Care to Older Adults with Long-Term Musculoskeletal Pain
Catharina Gillsjö3  Kristina Nässén2  Mia Berglund1 
[1] School of Health and Education, Health and Learning Research Centre: Aging and Long-Term Health Problems, University of Skövde, Skövde, Sweden;Academy of Care, Working Life and Social Welfare, University of Borås, Borås, Sweden;College of Nursing, University of Rhode Island, Kingston, USA
关键词: Home;    Long-term musculoskeletal pain;    Older adults;    Experiences;    Health care providers;   
Others  :  1223051
DOI  :  10.1186/s12877-015-0088-y
 received in 2015-02-26, accepted in 2015-07-16,  发布年份 2015
PDF
【 摘 要 】

Background

There is an increasing number of older adults living with long-term musculoskeletal pain and related disabilities. These problems are frequently unrecognized, underreported, and inadequately treated. Since many older adults desire to remain at home for as long as possible, it is important that individualized and holistically tailored care is provided in these settings. However, there is a complexity in providing care in this context. The aim of this study was to describe health care professionals’ experiences of providing health care to older adults living with long-term musculoskeletal pain at home.

Methods

The phenomenon, “To provide health care to older adults living with long-term musculoskeletal pain at home”, was studied using reflective lifeworld research (RLR) which is based on phenomenological epistemology. Ten health care providers (nurse, physiotherapists, and occupational therapists) were interviewed and data was analysed.

Results

The health care professional’s emotions fluctuated between powerlessness and meaningfulness. Needs, opportunities, understanding and respect had to be balanced in the striving to do good in the provision of health care in differing situations. Caring for older adults with long-term pain required courage to remain in the encounter despite feelings of insecurity and uncertainty about the direction of the dialogue. The essence of caring for older adults with long-term pain consisted of the following constituents: Sense of powerlessness; striving to provide good health care; and understanding and respect.

Conclusions

The findings indicated that the health care professionals strived to do good and to provide health care that was holistic and sensitive to the older adults’ needs. A significant sense of powerlessness in the situation was experienced by the health care professionals. These findings address and support the need to develop methods that can be used to guide health care providers who support older adults in the context of their homes.

【 授权许可】

   
2015 Berglund et al.

【 预 览 】
附件列表
Files Size Format View
20150830022155751.pdf 469KB PDF download
【 参考文献 】
  • [1]Cavanaugh JC, Blanchard-Fields F: Adult development and aging. 6th edition. Australia, Wadsworth/Cengage Learning; 2011.
  • [2]Ahacic K, Kåreholt I: Prevalence of musculoskeletal pain in the general Swedish population from 1968 to 2002: Age, period, and cohort patterns. Pain 2010, 151(1):206-14.
  • [3]Fors S, Lennartsson C, Lundberg O: Health inequalities among older adults in Sweden 1991–2002. Eur J Pub Health 2008, 18(2):138-43.
  • [4]Bergman S, Herrström P, Högström K, Petersson IF, Svensson B, Jacobsson LT: Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study. J Rheumatol 2001, 28(6):1369-77.
  • [5]Woo J, Leung J, Lau E: Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health 2009, 123(8):549-56.
  • [6]Buchman AS, Shah RC, Leurgans SE, Boyle PA, Wilson RS, Bennett DA: Musculoskeletal pain and incident disability in community-dwelling older adults. Arthritis Care Res 2010, 62(9):1287-93.
  • [7]Shah RC, Buchman AS, Boyle PA, Leurgans SE, Wilson RS, Andersson GB, Bennett DA: Musculoskeletal pain is associated with incident mobility disability in community-dwelling elders. J Gerontol A Biol Sci Med Sci 2011, 66A(1):82-8.
  • [8]Weathers E, Creedon R: The impact of osteoarthritis on psychological wellbeing. Br J Nurs 2011, 20(4):243-6.
  • [9]Woolf AD, Pfleger B: Burden of major musculoskeletal conditions. Bull World Health Organ 2003, 81(9):646-56.
  • [10]Fried L, Ferrucci L, Darer J, Williamson J, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004, 59(3):255-63.
  • [11]Blomqvist K, Edberg A-K: Living with persistent pain: Experiences of older people receiving home care. J Adv Nurs 2002, 40(3):297-306.
  • [12]Fänge A, Ivanoff SD: The home is the hub of health in very old age: Findings from the ENABLE-AGE project. Arch Gerontol Geriatr 2009, 48(3):340-5.
  • [13]Rioux L: The well-being of aging people living in their own homes. J Environ Psychol 2005, 25(2):231-43.
  • [14]Teeland L: Home, sick: Implications of health care delivery in the home. Scand Hous Plan Res 1998, 15(4):271-82.
  • [15]Gillsjö C, Schwartz-Barcott D, von Post I: Home: The place the older adult can not imagine living without. BMC Geriatr 2011, 11(1):10.
  • [16]Williams AM: Shaping the practice of home care: Critical case studies of the significance of the meaning of home. Int J Palliat Nurs 2004, 10(7):333-42.
  • [17]Williams AM: Changing geographies of care: Employing the concept of therapeutic landscapes as a framework in examining home space. Soc Sci Med 2002, 55(1):141-54.
  • [18]Gillsjö C: Older adults’ conceptions of home and experiences of living with long-term muscusloskeletal pain at home. University of Rhode Island, USA; 2012.
  • [19]Gillsjö C, Schwartz-Barcott D, Bergh I: Learning to endure long-term musculoskeletal pain in daily life at home: a qualitative interview study of the older adult’s experience. J Gerontol Geriat Res 2013, 2(136):10.
  • [20]Törnkvist L, Gardulf A, Strender L-E: Patients’ satisfaction with the care given by district nurses at home and at primary health care centres. Scan J Caring Sci 2000, 14(2):67-74.
  • [21]Podichetty VK, Mazanec DJ, Biscup RS: Chronic non-malignant musculoskeletal pain in older adults: Clinical issues and opioid intervention. Postgrad Med J 2003, 79(937):627-33.
  • [22]Tai-Seale M, Bolin J, Bao X, Street R: Management of chronic pain among older patients: Inside primary care in the US. Eur J Pain 2011, 15(19):1087.
  • [23]Weiner DK, Herr K, Rudy TE: Persistent pain in older adults: An interdisciplinary guide for treatment. Springer, New York; 2002.
  • [24]Brown ST, Kirkpatrick MK, Swanson MS, McKenzie IL: Pain experience of the elderly. Pain Manag Nurs 2011, 12(4):190-6.
  • [25]Cairncross L, Magee H, Askham J: A hidden problem: Pain in older people. Picker Institute Europe, Oxford; 2007.
  • [26]Clarke A, Martin D, Jones D, Schofield P, Anthony G, McNamee P, Gray D, Smith BH: “I Try and Smile, I Try and Be Cheery, I Try Not to Be Pushy. I Try to Say ‘I’m Here for Help’ but I Leave Feeling… Worried”: A Qualitative Study of Perceptions of Interactions with Health Professionals by Community-Based Older Adults with Chronic Pain. PLoS ONE 2014, 9(9):e105450.
  • [27]Sloman R, Ahern M, Wright A, Brown L: Nurses’ knowledge of pain in the elderly. J Pain Symptom Manag 2001, 21(4):317-22.
  • [28]Yong HH: Can attitudes of stoicism and cautiousness explain observed age-related variation in levels of self-rated pain, mood disturbance and functional interference in chronic pain patients? Eur J Pain 2006, 10(5):399-407.
  • [29]Helme RD, Horne DJ, De L, Gibson SJ, Yong H-H: Development of a pain attitudes questionnaire to assess stoicism and cautiousness for possible age differences. J Gerontol B Psychol Sci Soc Sci 2001, 56(5):279-84.
  • [30]Eccleston C, Crombez G: Pain demands attention: A cognitive–affective model of the interruptive function of pain. Psychol Bull 1999, 125(3):356-66.
  • [31]Gallagher S, Bennett KM, Halford JCG: A comparison of acute and long-term health-care personnel’s attitudes towards older adults. Int J Nurs Pract 2006, 12(5):273-9.
  • [32]Kydd A, Wild D, Nelson S: Attitudes towards caring for older people: findings and recommendations for practice. Nurs Older People 2013, 25(4):21-8.
  • [33]Kydd A, Touhy T, Newman D, Fagerberg I, Engstrom G: Attitudes towards caring for older people in Scotland, Sweden and the United States. Nurs Older People 2014, 26(2):33-40.
  • [34]Kane MN: Factors affecting social work students’ willingness to work with elders with alzheimer’s disease. J Soc Work Educ 1999, 35(1):71-85.
  • [35]Lyons B, Dunson-Strane T, Sherman F: The joys of caring for older adults: training practitioners to empower older adults. J Community Health 2014, 39(3):464-70.
  • [36]Heidegger M: Being and time. Harper Collins, New York; 2008.
  • [37]Husserl E. Fenomenologins idé. [The idea of phenomenology]. Göteborg: Daidalos; 1907/1989.
  • [38]Merleau-Ponty M: Phenomenology of Perception, vol. Book. 2nd edition. Routledge, London; 2002.
  • [39]Dahlberg K, Todres L, Galvin K: Lifeworld-led healthcare is more than patient-led care: an existential view of well-being. Med Health Care Philos 2009, 12(3):265-71.
  • [40]Todres L, Galvin KT, Dahlberg K: “Caring for insiderness”: Phenomenologically informed insights that can guide practice. Int J Qual Stud Health Well-being 2014, 9:21421.
  • [41]Radwin LE: ‘Knowing the patient’: a review of research on an emerging concept. J Adv Nurs 1996, 23(6):1142-6.
  • [42]Liaschenko J: Knowing the patient? In Nursing Praxis: Knowledge and action. Edited by Hayes SE, Hayes VE. Sage, Thousand Oaks; 1997.
  • [43]Tanner CA, Benner P, Chesla C, Gordon DR: The phenomenology of knowing the patient. Image J Nurs Sch 1993, 25(4):273-80.
  • [44]Kim HS: The nature of theoretical thinking in nursing. 3rd edition. Springer Pub. Co., New York; 2010.
  • [45]Liaschenko J: Ethics in the work of acting for patients. Adv Nurs Sci 1995, 18(2):1-12.
  • [46]Liaschenko J, Fisher A: Theorizing the knowledge that nurses use in the conduct of their work. Res Theory Nurs Pract 1999, 13(1):29-41.
  • [47]Dewar A: Assessment and management of chronic pain in the older person living in the community. Aust J Adv Nurs 2006, 24(1):33-8.
  • [48]Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, Carlsson J, Dahlin-Ivanoff S, Johansson I-L, Kjellgren K, et al.: Person-centered care — ready for prime time. Eur J Cardiovasc Nurs 2011, 10(4):248-51.
  • [49]Liaschenko J: The moral geography of home care. Adv Nurs Sci 1994, 17(2):16-26.
  • [50]Liaschenko J: Nursing work, housekeeping issues, and the moral geography of home care. In Aging: Caring for our elders. 11th edition. Edited by Weisstub DN, Thomasma DC, Gauthier S, Tomossy GF. Kluwer Academic Publishers, Dordrecht; 2001:123-37.
  • [51]Kim HS: An integrative framework for conceptualizing clients: A proposal for a nursing perspective in the new century. Nurs Sci Q 2000, 13(1):37-40.
  • [52]Andrews GJ: Towards a more place-sensitive nursing research: an invitation to medical and health geography. Nurs Inq 2002, 9(4):221-38.
  • [53]Corbin JM, Strauss AL: Unending work and care: Managing chronic illness at home. Jossey-Bass, San Francisco; 1988.
  • [54]Corbin JM, Strauss AL: Making arrangements: The key to home care. In The home care experience: Ethnography and policy. Edited by Gubrium JF, Sankar A. Sage Publications, Inc, Newbury Park, California; 1990:59-73.
  • [55]Berglund M: Att ta rodret i sitt liv: Lärande utmaningar vid långvarig sjukdom [Taking charge of one’s life: Challenges for learning in long-term illness], No 47/2011. Dissertation, Växjö; 2011.
  • [56]Dahlberg K, Dahlberg H, Nyström M: Reflective lifeworld research. 2nd edition. Lund, Studentlitteratur; 2008.
  • [57]Giorgi AP: A phenomenological analysis of descriptions of concepts of learning obtained from a phenomenographic perspective. Institutionen för pedagogik, Göteborgs universitet, Göteborg; 1986.
  • [58]Dahlberg H, Dahlberg K: To not make definite what is indefinite. A phenomenological analysis of perception and its epistemological consequences. J Humanist Psychol 2003, 31(4):34-50.
  • [59]SOU 2004:68. Sammanhållen hemvård [SOU 2004:68. Shared home care]. Betänkande av Äldrevårdsutredningen. Stockholm:Socialdepartementet. Available at. http://www.regeringen.se/rattsdokument/statens-offentliga-utredningar/2004/06/sou-200468/. webcite
  • [60]SCS. Social Service Act (1980:620) [SFS: Socialtjänstlagen (1980:620)]. Available at. http://www.riksdagen.se/webbnav/index.aspx?nid=3911&bet=1980:620. webcite
  • [61]SCS. Health Act (1982:763) [SFS: Hälso- och sjukvårdslag (1982:763)]. Available at. http://www.notisum.se/rnp/sls/lag/19820763.htm. webcite
  • [62]Dahlberg K: The essence of essences—the search for meaning structures in phenomenological analysis of lifeworld phenomena. Int J Qual Stud Health Well-being 2006, 1(1):11-9.
  • [63]World Medical Association 2008. Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. Available at. http://www.wma.net/en/30publications/10policies/b3/17c.pdf. webcite
  • [64]Bindels J, Cox K, Widdershoven G, van Schayck OCP, Abma TA: Care for community-dwelling frail older people: a practice nurse perspective. J Clin Nurs 2014, 23(15–16):2313-22.
  • [65]Zanocchi M, Maero B, Nicola E, Martinelli E, Luppino A, Gonella M, Gariglio F, Fissore L, Bardelli B, Obialero R, et al.: Chronic pain in a sample of nursing home residents: Prevalence, characteristics, influence on quality of life (QoL). Arch Gerontol Geriatr 2008, 47(1):121-8.
  • [66]Helme RD, Gibson SJ: The epidemiology of pain in elderly people. Clin Geriatr Med 2001, 17(3):417-31.
  • [67]D’Arcy Y: Pain in the older adult. Nurse Pract 2008, 33(3):18-24.
  • [68]Seomun G-A, Chang SO, Lee PS, Lee SJ, Shin HJ: Concept analysis of coping with arthritic pain by South Korean older adults: Development of a hybrid model. Nurs Health Sci 2006, 8(1):10-9.
  • [69]Harkins SW: What is unique about the older adult’s pain experience? In Persistent pain in older adults: an interdisciplinary guide for treatment. Edited by Weiner DK, Herr K, Rudy TE. Springer Publisher Company, Inc, New York; 2002:4-17.
  • [70]Melding PS: Foreword. In Pain in older persons. 35th edition. Edited by Gibson SJ, Weiner DK. IASP Press, Seattle; 2005:xi-xiv.
  • [71]Gillsjö C, Schwartz-Barcott D, Bergh I, Dahlgren LO. Older adults’ ways of dealing with daily life while living with long-term musculoskeletal pain at home. J Appl Gerontol. 2012;31(5):685-705.
  • [72]Berglund M, Sjögren R, Ekebergh M: Reflect and learn together – when two supervisors interact in the learning support process of nurse education. J Nurs Manag 2012, 20(2):152-8.
  • [73]Binding LL, Morck AC, Moules NJ: Learning to see the other: A vehicle of reflection. Nurse Educ Today 2010, 30(6):591-4.
  • [74]Bégat I, Severinsson E: Reflection on how clinical nursing supervision enhances nurses’ experiences of well-being related to their psychosocial work environment. J Nurs Manag 2006, 14(8):610-6.
  • [75]Petersson B-O: Handledning för vårdare - ett lärande möte utifrån patientens livsvärld. Linnéunviersitetet, Växjö; 2010.
  • [76]Lemieux-Charles L, McGuire WL: What do we know about health care team effectiveness? A review of the literature. Med Care Res Rev 2006, 63(3):263-300.
  • [77]Brooks P: Issues with chronic musculoskeletal pain. Rheumatology (Oxford) 2005, 44(7):831-3.
  • [78]Brooks P: The burden of musculoskeletal disease—a global perspective. Clin Rheumatol 2006, 25(6):778-81.
  • [79]Woolf AD, Åkesson K: Understanding the burden of musculoskeletal conditions. The burden is huge and not reflected in national health priorities. Br Med J 2001, 322(7294):1079-80.
  • [80]Barber JB, Gibson SJ: Treatment of chronic non-malignant pain in the elderly: Safety considerations. Drug Saf 2009, 32(6):457-74.
  • [81]Stake RE: Qualitative case studies. In Handbook of qualitative research. 3rd edition. Edited by Denzin NK, Lincoln YS. Sage, Thousand Oaks; 2005:443-66.
  • [82]Gillsjö C, Berglund M: Reflective STRENGTH-Giving Dialogue Developed to Support Older Adults in Learning to Live with Long- Term Pain: A Method and a Study Design. J Gerontol Geriat Res 2014, 3(5):1000187.
  文献评价指标  
  下载次数:5次 浏览次数:19次