FÖRSLAG TILL FÖRBÄTTRINGSARBETE OCH KVALITETSUTVECKLING
Bilaga 4. Granskningsmall av kvalitativa artiklar (SBU, 2017)
1. Syfte
Utgår studien från en väldefinierad problemformulering/frågeställning?
2. Urval
Är urvalet relevant?
Är urvalsförfarandet tydligt beskrivet? Är kontexten tydligt beskriven? Finns relevant etiskt resonemang?
Är relationen forskare/urval tydligt beskriven?
Motsvarar urvalet studiens inklusions- och exklusionskriterier?
3. Datainsamling
Är datainsamlingen tydligt beskriven? Är datainsamlingen relevant?
Råder datamättnad?
Har forskaren hanterat sin egen förförståelse i relation till datainsamlingen?
4. Analys
Är analysen tydligt beskriven?
Är analysförfarandet relevant i relation till datainsamlingsmetoden? Råder analysmättnad?
Har forskaren hanterat sin egen förförståelse i relation till analysen? 5. Resultat
Är resultatet logiskt? Är resultatet begripligt? Är resultatet tydligt beskrivet?
Redovisas resultatet i förhållande till teoretiskt referensram? Genereras hypotes/teori/modell?
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Bilaga 5. Artikelmatriser
Title Author, country
and year Aim Method, sample and analysis Findings Quality
A painful experience of limited understanding: healthcare professionals’ experiences with palliative care of people with severe dementia in
Norwegian nursing homes
May Helen Midtbust Rigmor Einang Alnes Eva Gjengedal Else Lykkeslet To explore and increase knowledge of healthcare professionals’ experiences with palliative care to people with severe dementia in nursing homes
Qualitative study with in- depth interviews using a phenomenological approach The healthcare professionals struggle to understand how to help persons with severe dementia. Coming up short in situations related to pain relief and how to cope with behavioral symptoms, such as aggression and rejection of care. Medium Norway
7 licensed practical nurses and 13 registered nurses from 4 Norwegian nursing homes.
2018
Most interviews lasted approximately 60 min, they were recorded and transcribed verbatim. The text was broken down into parts or meaning units related to the phenomenon under study, then grouped into subcategories related to their content.
35
Title Author, country
and year Aim Method, sample and analysis Findings Quality
Caring for people with dementia in the
acute setting: a study of nurses views
Louise Nolan To explore nurses' experiences of caring for older people with dementia in an acute hospital setting.
In-depth, non-directive, conversational interviews.
The findings in this study surest that nurses are aware of the challenging nature of dementia care and work hard to meet this challenge within the limitations of the acute care environment. Skilled, knowledgeable nurses are critical for person-centred quality dementia care and specialized dementia education is consequently essential. Medium Ireland
7 nurses was interviewed over a period of 3 months. All were registered general nurses, female, and held varied levels of nursing education.
2007
Thematic content analysis. Multiple sources of data contributed to the expansion of the
researchers understanding, including: transcript data, the researcher's personal and professional
understanding, data from a reflective journal and conceptual frameworks located within the related literature.
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Title Author, country
and year Aim Method, sample and analysis Findings Quality
Exploring nursing staff views of responsive behaviours of people with dementia in long- stay facilities
Clifford C. Doody O.
To explore nursing staff views of
supporting people with dementia and
responsive behaviours in long- term care facilities
Qualitative study, semi- structured interview. Recognizing and understanding responsive behavior, resources and interventions to support people with dementia and responsive
behavior, the impact of education on nursing practice and the care environment.
High
Ireland
9 nurses from general nursing home facilities or in long- stay units in psychiatric hospitals in Ireland
2017
In- depth audio- recorded interviews lasting an average of 46 min. Each interview was transcribed, categorized and coded.
37
Title Author, country
and year Aim Method, sample and analysis Findings Quality
Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews
Risa Fukuda Yasuko Shimizu Natsuko Seto
This study aimed to explore the challenges nurses face in
providing care to patients with dementia in acute care hospitals in Japan.
A qualitative study using focus group interviews.
In this study, we identified a cycle that occurs in the care of patients with dementia in acute care hospitals. Nurses are required to deal with patients’ problematic behavior. They take measures such as hiding intra- venous infusion lines and placing sensor mats to prevent problematic behavior. However, these mea- sures may make the environment less familiar to patients with dementia, resulting in an increase in problematic behavior. Medium Japan
Six acute hospitals with surgical and medical wards in the western region of Japan.
Participants were nurses in surgical and internal medicine wards, excluding intensive care units. 2015
The qualitative synthesis method was used for data analysis. Three processes were used: code making, grouping, and chart making.
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Title Author, country
and year Aim Method, sample and analysis Findings Quality
Nurses' experiences of abusive/non-abusive caring for demented patients in acute care settings
Catharina Eriksson Britt-Inger Saveman
The aim of the study was to describe nurses' experiences of
difficulties related to caring for patients with dementia in acute care settings.
Interviews that lasted between 20 and 90 min.
The findings from this small study illuminate a problematic area within acute care, which needs to be further explored. The study demonstrates that the nurses experienced that they were unable to care for
dementia patients in an adequate way, with the nurses reporting situations of force, abuse and neglect. When nursing staff is unable to interpret the patient's verbal or nonverbal communication, this leads to a disturbance in the interaction
between carer and patient.
High
Sweden
The study was carried out in five acute care wards and one accident and emergency department. 12 nurses were interviewed. 2002
Qualitative thematic content analysis. Reading of the text, followed by a division into meaningful units and sorting out the structures that emerged as the analysis, interpretation progressed. The style of the interviews varied, from fragmented and superficial to more detailed and deep narratives. The text was read again and each narrative was worked through again and their meaning units were sorted under their respective themes. The themes were brought together,
formulated, written down and provided with
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Title Author, country
and year Aim Method, sample and analysis Findings Quality
Nursing care for people with frontal- lobe dementia – difficulties and possibilities Edberg A K. Edfors E. To describe nurses’ experience of difficulties and possibilities in caring for people with
dementia diseases with frontal-lobe
dysfunction
Qualitative study with open interviews The difficulties experienced by the nurses related mainly to the residents’ behavior. The results show that the nurses reflected on the meaning behind the residents’
behavior, which in turn guided their own actions and strategies.
High
Sweden
10 nurses working at a special housing unit for people with frontal-lobe dementia. Located in a municipality in southern Sweden.
2008
The interviews lasted 60– 90minutes, recorded on tape and then transcribed verbatim. The aim of the study was identified, condensed and coded according to what the text communicated.
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Title Author, country
and year Aim Method, sample and analysis Findings Quality
Nursing home caregivers’
explanations for and coping strategies with residents’ aggression: a qualitative study Zeller A. Dassen T Kok G. Needham I. Halfens JG R.
This study explored caregivers’
perspectives regarding the conditions and situations of resident aggression and practical strategies caregivers use to deal with aggression.
Qualitative study, semi- structured interviews
The reasons and triggers for aggressive behavior indicate that caregivers have knowledge of a broad range of possible reasons for residents’ aggression. Medium Switzerland 30 caregivers in total, 18 persons were registered nurses, 5 nursing assistants and 7 nursing students from 4 nursing homes 2011
Five focus group
interviews lasting between 60–90 minutes. The interview had guiding questions in written form and opening questions that were transcribed verbatim.
41
Title Author, country
and year Aim Method, sample and analysis Findings Quality
Ongoing challenges responding to behavioural and psychological symptoms of dementia Ostaszkiewicz J. Lakhan P. O’Connell B. Hawkins M. To describe nurses’ experiences of caring for people with BPSD in LTC, and strategies nurses used to deal with these symptoms.
Qualitative study, group interviews
The findings revealed five main interrelated themes: 1 working under difficult conditions, 2 BPSD: an everyday encounter, 3 making sense of BPSD, 4 attempting to manage BPSD, and 5 feeling undervalued Medium Australia
30 nurses from 3 long- term aged care units in Australia
2015 Each focus group
interview was conducted for 1 h, recorded and transcribed verbatim.
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Title Author, country
and year
Aim Method, sample and
analysis Findings Quality Staff perceptions of successful management of severe behavioral problems in dementia special care units Foley L K. Sudha S. Sloane D P. Gold D T. To examine the relationships and behavioral characteristics of residents, management techniques of the staff and family
participation in the management of persons with severe behavioral problems Qualitative study, structured interview Behavior prevalence and severity, management techniques, use of psychotropic medication and physical restraint, comorbidity, and family interaction. Medium USA
19 nursing staff, 4 social workers, 70 residents with primary diagnosis of Alzheimer’s disease conducted in 36 nursing homes 2003 Audiotaped interviews with open-ended questions were transcribed and factors associated with success and failure were identified independently
43
Title Author, country
and year
Aim Method, sample and
analysis
Findings Quality
Preparation to care for confused older patients in general hospitals: a study of UK health professionals Amanda Griffiths Alec Knight Rowan Harwood John R.F. Gladman
The objective was to explore doctors, nurses and allied health professionals’ perceptions of their preparation to care for confused older patients on general hospital wards.
A quota sampling strategy, 60 semi-structured interviews. Findings indicate that a revision of training across healthcare professions in the UK is required, and that increased specialist support should be
provided, so that the workforce is properly prepared to care for older patients with cognitive problems
Medium
England
11 medical, geriatric and orthopaedic wards in a British teaching hospital. Doctors, nurses and allied healthcare professional 2013
Data were analyzed using the Consensual Qualitative Research approach.
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Title Author, country
and year
Aim Method, sample and
analysis
Findings Quality
The use of non- pharmacological interventions for dementia behaviours in care homes: findings from four in- depth, ethnographic case studies Tamara Backhouse Anne Killett Bridget Penhale Richard Gray
To explore the use of NPIs in care homes to manage BPSD
In-depth, ethnographic case studies
NPIs, some of which are the focus of efficacy research, were used in care homes but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities. High Australia
Four care homes and interviews with 40 care- home staff and 384 hours of participant observations 2016
Data were typed up, anonymised and stored securely. The framework approach was used to analyse the extensive qualitative data set. Themes, processes and interpretations were discussed, refined and validated with all authors.
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Title Author, country
and year Aim Method, sample and analysis Findings Quality
Different attitudes when handling aggressive behaviour in dementia -
narratives from two caregiver groups
K. Skovdahl A.L. Kihlgren M. Kihlgren
The purpose was to study caregivers’ reflections about and attitudes to
behavioural and psychiatric symptoms of dementia (BPSD) and how they dealt with the symptoms.
Narrative interviews The findings indicated the importance of a balance for the residents as well as for the caregivers, if a positive
relationship was to develop.
Furthermore, caregivers stated that support was crucial, not only for the residents but also for
themselves, if they were expected to cope with
demanding
Medium
Sweden With 15 formal caregivers, who had been permanently employed for at least one year and who had
experience of aggressive behaviour, from three different units (five caregivers at each unit). 2003
A phenomenological- hermeneutic approach was used for the analysis of the interviews. The main themes that emerged were: a need for balance
between demands and competence; and a need for support