Change search
Refine search result
12 1 - 50 of 53
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Brännström, Margareta
    et al.
    Department of Nursing, Umeå University, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Grönlund, Catarina Fischer
    Department of Nursing, Umeå University, Sweden.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Söderberg, Anna
    Department of Nursing, Umeå University, Sweden.
    Meeting in a 'free-zone': Clinical ethical support in integrated heart-failure and palliative care2019In: Article in journal (Refereed)
    Abstract [en]

    Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams.Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare.Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis.Results: The CES was found to offer possibilities for meeting in an ethical ‘free-zone’ where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints.Conclusion: Participating in CES was experienced as meeting in an ethical ‘free-zone’ and seemed to be a means of facilitating integration of palliative and heart-failure care.

  • 2.
    Darehed, David
    et al.
    Department of Medicine, Ga ̈ llivare Hospital, Sweden.
    Norrving, Bo
    Department of Clinical Sciences, Lund University, Sweden.
    Stegmayr, Birgitta
    Department of Public Health and Clinical Medicine, Umea ̊ University.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Blom, Mathias C.
    Department of Clinical Sciences, Department of Medicine, Lund University.
    Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: A Swedish multicenter register study2017In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881Article in journal (Refereed)
    Abstract [en]

    Introduction

    It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome.

    Patients and methods

    This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011–2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission.

    Results

    A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio = 0.985, 95% confidence interval = 0.978–0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval = 2.6–5.5) for direct admission to a stroke unit versus the reference hospital.

    Discussion and conclusion

    We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.

  • 3.
    Ejneborn-Looi, Git-Marie
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Gabrielsson, Sebastian
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Solving the Staff's Problem or Meeting the Patients’ Needs: Staff Members’ Reasoning about Choice of Action in Challenging Situations in Psychiatric Inpatient Care2014In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 35, no 6, p. 470-479Article in journal (Refereed)
    Abstract [en]

    Coercion in challenging situations is often seen as a necessary component of psychiatric care. This study aims to describe staff members’ reasoning about their choice of action in challenging situations in inpatient psychiatric care. Focus group interviews with 26 staff members were analyzed using qualitative content analysis. The results provide an overview of the integrated structure of participants’ reasoning and suggest that staff members’ reasoning about choice of action can be described as a matter of either solving the staff's problems or meeting the patients’ needs. These results can be of use in further research, educational interventions, and staff development activities.

  • 4.
    Fischer Grönlund, Catarina E. C.
    et al.
    Umeå University.
    Söderberg, Anna I.S.
    Umeå University.
    Zingmark, Karin
    County Council of BD.
    Sandlund, S. Mikael
    Umeå University.
    Dahlqvist, Vera
    Ersta Sköndal University College.
    Ethically difficult situations in hemodialysis care: Nurses’ narratives2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 6, p. 711-722Article in journal (Refereed)
    Abstract [en]

    Background: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose. Research question: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience. Research design: This study has a phenomenological hermeneutic approach. Participants: Narrative interviews were carried out with 10 registered nurses working in dialysis care. Ethical considerations: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University. Results: One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’. Discussion: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience. Conclusion: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.

  • 5.
    Forslund, Ann-Sofie
    et al.
    Department of Medicine, Sunderby hospital.
    Lundblad, Dan
    Department of Medicine, Sunderby Hospital.
    Jansson, Jan-Håkan
    Skelleftea Hospital, Department of Medicine .
    Zingmark, Karin
    Department of Medicine, Sunderby Hospital.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about lifestyle2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no Suppl. 1, p. S13-Article in journal (Refereed)
    Abstract [en]

    Aims: To describe risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about lifestyle.Design: An explanatory mixed methods design was used.Methods: All people registered in the northern Sweden Monica myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n=71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis.Results: The quantitative results showed that about 60% of the people had no history of ischemic heart disease or hypertension before the out-of-hospital cardiac arrest whereas 25% and 17% had been diagnosed with myocardial infarction and diabetes mellitus, respectively. Eighty percent of the people had total cholesterol levels greater than 5.0 mmol/l and/or were taking lipid lowering medications. Almost half were smokers and overweight. The qualitative results are presented in three categories ‘descriptions of lifestyle after surviving’, ‘modifying the lifestyle to the new life situation’ and ‘a changed view on life’. The participants described that their lifestyle focused on the importance of being needed and meaning something to others, feeling well and doing things of their choice. They tried to find a reason why the cardiac arrest happened and make appropriate lifestyle changes although they made their own assessmnet of risk behaviours. The participants expressed being grateful for a second chance at life and tried to have a positive outlook on life.Conclusions: For most people in this study out-of-hospital cardiac arrest was the first symptom of coronary heart disease. In the interviews the participants expressed that they were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some of the patricipants chose to ignore this knowledge to some extent and preferred to live a ‘good life’. A life where risk factor treatment played a minor part. The results of this study indicates that health care workers and patients should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours and lifestyle changes linked to these things.

  • 6.
    Forslund, Ann-Sofie
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Lundblad, Dan
    Department of Medicine, Sunderby Hospital.
    Jansson, Jan-Håkan
    Department of Public Health and Clinical Medicine, Umeå university.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about what lifestyle means to them: a mixed methods study2013In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 13, no August, article id 62Article in journal (Refereed)
    Abstract [en]

    Background The known risk factors for coronary heart disease among people prior suffering an out-of-hospital cardiac arrest with validated myocardial infarction aetiology and their thoughts about what lifestyle means to them after surviving have rarely been described. Therefore the aim of the study was to describe risk factors and lifestyle among survivors. Methods An explanatory mixed methods design was used. All people registered in the Northern Sweden MONICA myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n = 71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis. Results About 60 % of the people had no history of ischemic heart disease before the out-of-hospital cardiac arrest, but 20 % had three cardiovascular risk factors (i.e., hypertension, diabetes mellitus, total cholesterol of more or equal 5 mmol/l or taking lipid lowering medication, and current smoker). Three categories (i.e., significance of lifestyle, modifying the lifestyle to the new life situation and a changed view on life) and seven sub-categories emerged from the qualitative analysis. Conclusions For many people out-of-hospital cardiac arrest was the first symptom of coronary heart disease. Interview participants were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some chose to ignore this knowledge to some extent and preferred to live a "good life", where risk factor treatment played a minor part. The importance of the support of family members in terms of feeling happy and having fun was highlighted by the interview participants and expressed as being the meaning of lifestyle. Perhaps the person with illness together with health care workers should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours linked to these things.

  • 7.
    Forslund, Ann-Sofie
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Jansson, Jan-Håkan
    Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University.
    Lundblad, Dan
    Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Meanings of people's lived experiences of surviving an out-of-hospital cardiac arrest, 1 month after the event2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 5, p. 464-471Article in journal (Refereed)
    Abstract [en]

    Background: The out-of-hospital cardiac arrest (OHCA) survival rate has been poor and stable for a long time, but more recent studies describe its increase. However, there are few studies in which people narrate their experiences from surviving. Objective: The aim of this study was to elucidate meanings of people's lived experiences of surviving an OHCA with validated myocardial infarction (MI) etiology, 1 month after the event. Methods: A purposive sample of 2 women and 9 men was interviewed between February 2011 and May 2012. A phenomenological hermeneutical method was used for analysis, which involved 3 steps: naive reading and understanding, structural analysis, and comprehensive understanding. Results: There were 2 themes, (1) returning to life and (2) revaluing life, and five subthemes, (1a) waking up and missing the whole picture, (1b) realizing it was not time to die, (2a) wondering why and seeking explanations, (2b) feeling ambiguous in relations, and (2c) wondering whether life will be the same. All were constructed from the analysis. Conclusions: Surviving an OHCA with validated MI etiology meant waking up and realizing that one had experienced a cardiac arrest and had been resuscitated. These survivors had memory loss and a need to know what had happened during the time they were dead/unconscious. They searched for a reason why they experienced an MI and cardiac arrest and had gone from being "heart-healthy" to having a lifelong illness. They all had the experience of passing from life to death and back to life again. For the participants, these differences led to a revaluation of what is important in life.

  • 8.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ejneborn-Looi, Git-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Knowledge of the patient as decision-making power: staff members’ perceptions of interprofessional collaboration in challenging situations in psychiatric inpatient care2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 784-792Article in journal (Refereed)
    Abstract [en]

    Challenging situations in psychiatric inpatient settings call for interprofessional collaboration, but the roles and responsibilities held by members of different professions is unclear. The aim of this study was to describe staff members' perceptions of interprofessional collaboration in the context of challenging situations in psychiatric inpatient care. Prior to the study taking place, ethical approval was granted. Focus group interviews were conducted with 26 physicians, ward managers, psychiatric nurses, and nursing assistants. These interviews were then transcribed and analysed using qualitative content analysis. Results described participants' perceptions of shared responsibilities, profession-specific responsibilities and professional approaches. In this, recognising knowledge of the patient as decision-making power was understood to be a recurring theme. This is a delimited qualitative study that reflects the specific working conditions of the participants at the time the study was conducted. The findings suggest that nursing assistants are the most influential professionals due to their closeness to and first-hand knowledge of patients. The results also point to the possibility of other professionals gaining influence by getting closer to patients and utilising their professional knowledge, thus contributing to a more person-centred care.

  • 9.
    Gabrielsson, Sebastian
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Person-centred care: Clarifying the concept in the context of inpatient psychiatry2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 3, p. 555-562Article in journal (Refereed)
    Abstract [en]

    This paper reports an analysis of the concept of person-centred care in the context of inpatient psychiatry. It has been suggested that person-centred care in inpatient psychiatry might differ from person-centred care in other contexts, indicating a need to clarify the concept in this specific context. Scholarly papers from health-related disciplines were identified following a systematic search of the electronic databases CINAHL, PUBMED and PsycINFO, covering records indexed up until March 2014. An evolutionary approach to concept analysis was applied, integrating principles for data extraction and analysis in integrative reviews. The concept of person-centred care was defined as cultural, relational and recovery-oriented. It aspires to improve care and calls for a transformation of inpatient psychiatry. The concept is closely related to the concepts of recovery and interpersonal nursing. The result is described in terms of attributes, antecedents, consequences and related concepts. It is concluded that the further development of the concept needs to consider the contexts of the concept at both conceptual and praxis levels. Further research should explore the nature of and relationships between context, culture, care practice and outcomes in inpatient psychiatry from a perspective of person-centred care. The results of this analysis can provide a framework for such research

  • 10.
    Gard, Gunvor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Eriksson, Margareta K.
    Department of Public Health, Norrbotten County Council, Luleå.
    Michaelson, Peter
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. peter.michaelson@ltu.se .
    Nordin, Catharina
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Calner, Tommy
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Multimodal pain rehabilitation (MMR) with additional tailored web-based pain rehabilitation: an RCT study2014Conference paper (Other academic)
  • 11.
    Grönlund, Catarina Fischer
    et al.
    Umeå University, Department of Nursing.
    Dahlqvist, Vera
    Umeå University, Department of Nursing.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sandlund, Mikael
    Department of Clinical Science/Psychiatry, Umeå University.
    Söderberg, Anna
    Department of Clinical Science/Psychiatry, Umeå University.
    Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions2016In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498, Vol. 28, no 4, p. 321-338Article in journal (Refereed)
    Abstract [en]

    Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) inspired by Habermas' theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved

  • 12.
    Grönlund, Catarina Fischer
    et al.
    Department of Nursing , Umeå University , Umeå.
    Söderberg, Anna
    Department of Nursing , Umeå University , Umeå.
    Dahlqvist, Vera
    Department of Nursing , Ersta Sköndal University College , Stockholm .
    Sandlund, Mikael
    Department of Clinical Science/Psychiatry , Umeå University , Umeå.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Communicative and organizational aspects of clinical ethics support2018In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567Article in journal (Refereed)
    Abstract [en]

    Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.

  • 13.
    Hamre, Kerstin Elisabeth
    et al.
    Kultur och Hälsa, Norrbottens läns landsting, Division Kultur och Utbildning.
    Zingmark, Karin
    FoU-chef, Norrbottens läns landsting.
    Bättre vård och roligare jobb med kreativ omsorg2012In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 89, no 2, p. 178-188Article in journal (Refereed)
  • 14.
    Isaksson, Rose Marie
    et al.
    Northern Sweden MONICA Myocardial Registry.
    Brulin, Christine
    Umeå University, Department of Nursing.
    Eliasson, Mats
    Department of Medicine, Sunderby Hospital.
    Näslund, Ulf
    Umeå University, Department of Public Health and Clinical Medicine.
    Zingmark, Karin
    Northern Sweden MONICA Myocardial Registry, Department of Research, Norrbotten County Council.
    Older women's prehospital experiences of their first myocardial infarction2013In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 28, no 4, p. 360-369Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Few qualitative studies have been conducted on older women's experiences of myocardial infarction (MI) and, in particular, the time before they seek medical care. OBJECTIVE: The aim of this study was to explore older women's prehospital experiences of their first MI. METHODS: Qualitative content analysis was performed on data from individual interviews with 20 women, aged 65 to 80 years (mean, 73.0 years). The participants were interviewed 3 days after admission to a hospital for a confirmed first MI. RESULTS: The women perceived their symptoms as a strange and unfamiliar development from indistinct physical sensations to persistent and overwhelming chest pain. Throughout the prehospital phase, they used different strategies such as downplaying and neglecting the symptoms. The symptoms were seen as intrusions in their daily lives, against which the participants defended themselves to remain in control and to maintain social responsibilities. As their symptoms evolved into constant chest pain, the women began to realize the seriousness of their symptoms. When the pain became unbearable, the women took the decision to seek medical care. CONCLUSION: Understanding the complex experiences of older women in the prehospital phase is essential to reducing their patient decision times. The findings of this study should be incorporated into the education of professionals involved in the care of cardiac patients, including those who answer informational and emergency telephone lines. Copyright © 2013 Wolters Kluwer Health

  • 15.
    Isaksson, Rose Marie
    et al.
    Southern Lapland Research Department, Vilhelmina.
    Brulin, Christine
    Umeå University, Department of Nursing.
    Eliasson, Mats
    Department of Medicine, Sunderby Hospital.
    Näslund, Ulf
    Umeå University, Department of Public Health and Clinical Medicine.
    Zingmark, Karin
    Southern Lapland Research Department, Vilhelmina, County Council of Norrbotten, Department of Research and Development.
    Prehospital experiences of older men with a first myocardial infarction: A qualitative analysis within the Northern Sweden MONICA Study2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 4, p. 787-797Article in journal (Refereed)
    Abstract [en]

    Aim: To explore older men's prehospital experiences of their first myocardial infarction (MI). Background: The delay between the onset of symptoms to the initiation of medical care is a major determinant of prognosis in MI. The majority of people experiencing MI are men. But few studies have been conducted solely on men's experiences before seeking medical care for MI. The objective of this study was to explore older men's experiences of symptoms and their reasoning during the prehospital phase of their first MI. Method: Data collection was carried out through individual interviews with 20 men representing the age range 65-80 (mean 71)years. The participants were interviewed 3days after admission for a confirmed first MI. The interviews were designed to prompt the men to describe their symptoms and their reasoning up to the decision to seek care. A qualitative content analysis was used to analyse the interviews. Findings: The prehospital phase in older men was found to be a complex and extended journey. The symptoms were perceived from diffuse ill-being to a cluster of alarming symptoms. The participants dealt with conceptions about MI symptoms. They were unsure about the cause of their symptoms, which did not correspond to their expectations about an MI, and whether they should seek medical care. They had difficulty making the final decision to seek care and strived to maintain a normal life. They initially tried to understand, reduce or treat the symptoms by themselves. The decision to seek medical care preceded a movement from uncertainty to conviction. Conclusions: Understanding older men's prehospital experiences of MI is essential to reduce their patient decision times. This requires knowledge about the complexity and dynamic evolvement of symptoms, beliefs and strategies to maintain an ordinary life. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

  • 16.
    Isaksson, Rose Marie
    et al.
    The Northern Sweden MONICA Myocardial Registry, Department of Research, Norrbotten County Council, Luleå.
    Jansson, Jan Håkan
    Department of Medicine and Geriatrics, Skellefteå Hospital.
    Lundblad, Dan
    Department of Medicine, Sunderby Hospital.
    Näslund, Ulf
    Department of Cardiology, Heart Centre, University Hospital, Umeå.
    Zingmark, Karin
    Department of Research, Norrbotten County Council.
    Eliasson, Mats
    Department of Medicine, Sunderby Hospital.
    Better long-term survival in young and middle-aged women than in men after a first myocardial infarction between 1985 and 2006: An analysis of 8630 patients in the Northern Sweden MONICA Study2011In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: There is conflicting and only scant evidence on the effect of gender on long-term survival after a myocardial infarction (MI). Our aim was to analyse sex-specific survival of patients for up to 23 years after a first MI in northern Sweden and to describe time trends.Methods: The Northern Sweden MONICA Myocardial Infarction Registry was linked to The Swedish National Cause of Death Registry for a total of 8630 patients, 25 to 64 years of age, 6762 men and 1868 women, with a first MI during 1985-2006. Also deaths before admission to hospital were included. Follow-up ended on August 30, 2008.Results: Median follow-up was 7.1 years, maximum 23 years and the study included 70 072 patient-years. During the follow-up 45.3% of the men and 43.7% of the women had died. Median survival for men was 187 months (95% confidence interval (CI) 179-194) and for women 200 months (95% CI 186-214). The hazard ratio (HR) for all cause mortality after adjustment for age group was 1.092 (1.010-1.18, P = 0.025) for females compared to males, i.e. 9 percent higher survival in women. After excluding subjects who died before reaching hospital HR declined to 1.017 (95%CI 0.93-1.11, P = 0.7). For any duration of follow-up a higher proportion of women were alive, irrespective of age group. The 5-year survivals were 75.3% and 77.5%, in younger (<57 years) men and women and were 65.5% and 66.3% in older (57-64 years) men and women, respectively. For each of four successive cohorts survival improved. Survival time was longer for women than for men in all age groups.Conclusions: Age-adjusted survival was higher among women than men after a first MI and has improved markedly and equally in both men and women over a 23-year period. This difference was due to lower risk for women to die before reaching hospital

  • 17.
    Johansson, Karin C
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Umeå University, Department of Nursing.
    Norberg, Astrid
    Umeå University, Department of Nursing.
    Narratives of care providers concerning picking behavior among institutionalized dementia sufferers1999In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 20, no 1, p. 29-32Article in journal (Refereed)
    Abstract [en]

    To illuminate the meaning of picking behavior in institutionalized people with dementia, the narratives of 15 care providers were interpreted using a method inspired by Ricoeur's phenomenologic hermeneutics. The care providers saw the behavior as a form of meaningful communication. The behavior was described as occurring in combination with wandering and in connection with restlessness and stress related to fatigue, difficulty communicating, and lack of occupation. The behavior also was seen as an attempt to engage in meaningful activities. Some care providers reported that the picking behavior caused them strain, whereas others reported a more positive reaction because the behavior made the ward more alive. Most care providers perceived the meaning of the picking behavior relative to the dementia sufferer's previous life and said they reacted by diverting, allowing, or understanding the picking.

  • 18.
    Karlsson, Eva
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Axelsson, Karin
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Fahlander, Kjell
    County Council of Norrbotten.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    "Carpe Diem": Supporting conversations between individuals with dementia and their family members2014In: Journal of Gerontological Nursing, ISSN 0098-9134, E-ISSN 1938-243X, Vol. 40, no 2, p. 38-46Article in journal (Refereed)
    Abstract [en]

    Remembrance of recent events is a major problem for individuals with dementia. Consequently, this article explores the process of acceptance and integration of a digital photograph diary (DPD) as a tool for remembrance of and conversations about daily life events. A design for multiple case studies was used. Seven couples, in which one individual in the couple had Alzheimer's disease, tested the DPD for 6 months. Data were collected in three sequences with interviews, observations, and screening instruments. In the analysis, all data were integrated to find common patterns of content. Some couples became regular users, while others used the DPD more sporadically. Factors contributing to regular use were how the DPD matched expectations, actual use, support, experienced usefulness, and reactions from family and friends. For those couples who became regular users, the DPD facilitated their conversation about recent daily activities

  • 19.
    Karlsson, Eva
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Axelsson, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    The challenge in meeting needs of persons with dementia with assistive technology2011In: e-health and nursing: How Can E-Health Promote Patient Safety? : ACENDIO 2011, 8th European Conference of ACENDIO / [ed] Fintan Sheerin, Dublin: Association for Common European Nursing Diagnoses, Interventions and Outcomes , 2011, p. 325-334Conference paper (Refereed)
  • 20.
    Karlsson, Eva
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Axelsson, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    The challenge of coming to terms with the use of a new digital assistive device: a case Study of two persons with mild dementia2011In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 5, p. 102-110Article in journal (Refereed)
    Abstract [en]

    There is an increased interest in supporting persons with dementia with technical services in daily life. The aim of this case study was to explore the complex issues involved in the process from a user driven development to the acceptance and usage of a new digital assistive device for persons with mild dementia. Even though it was developed in a user driven process and personalized to meet their individual needs they rarely used it. To deepening the understanding of this disparity between actual usage and perceived usefulness, the participants were studied whilst performing daily life activities through participant observations and interviews. Their partners were interviewed two years after the first observations to clarify the change in needs over time. The results show that the participant needs encompassed occupation, safety, social interaction, and memory support together with the receipt of general support. The overriding requirement for both participants was a need to maintain their self-image. When the digital assistive device did not correspond with the participants’ expectations or view of themselves, their interest in using it faded, since the digital assistive device failed to support their self-image. The acceptance of a digital assistive device by a person with dementia is a process that begins with identifying and personalizing the functions of the device according to individual needs, and then supporting the usage and the gradual integration of the device into daily life. During this process, the person’s selfimage must be taken into consideration and supported

  • 21.
    Karlsson, Eva
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Axelsson, Karin
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Stories about life narrated by people with Alzheimer's disease2014In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 12, p. 2791-2799Article in journal (Refereed)
    Abstract [en]

    AimTo explore how people with Alzheimer's disease present their life story.BackgroundLife story work is a key concept in a person-centred care. An important aspect in understanding the subjective experience and supporting the identity of people with dementia is to listen to their life stories.DesignA narrative design with interviews was used.MethodNine participants with Alzheimer's disease were encouraged to tell about their lives from childhood, adult life, to present life and about their thoughts on the future. The interviews were conducted between September 2010–March 2011 in the participants' homes, with their spouses present and were analysed with a method for analysis of narratives.FindingsContentment, Connectedness, Self-reliance and Personal growth were identified as core dimensions in the participants' life stories and shown like threads throughout life, from childhood, adult life to present life. All participants expressed an overall contentment with life, and connectedness was related to their relation with significant persons and to be included in the local community. Self-reliance was expressed as a strong confidence in the own ability and an overall curiosity throughout life as a sustained quest for personal growth.ConclusionsIt is important for healthcare professionals, who work with people with dementia, to understand that people with Alzheimer's disease can maintain an overall trusting and hopeful approach to life. It is also important to use life story work to enhance feelings of being connected to the world and thereby support their identity and sense of self.

  • 22.
    Karlsson, Eva
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Axelsson, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Sävenstedt, Stefan
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Aspects of Self and Identity in Narrations About Recent Events: Communication With Individuals With Alzheimer's Disease Enabled by a Digital Photograph Diary2017In: Journal of Gerontological Nursing, ISSN 0098-9134, E-ISSN 1938-243X, Vol. 43, no 6, p. 25-31Article in journal (Refereed)
    Abstract [en]

    The ability to narrate autobiographical memories is important for maintaining the identity of individuals with Alzheimer's disease (AD). The current study explored how the sense of self is manifested in narrations about recent events, enabled via a digital photograph diary. Use of a digital photograph diary was tested with seven individuals with AD and their household members. Narrative analysis was used to analyze audiorecordings of the pairs' communication about recent events shown in the photographs. The results show how individuals with AD understand events illustrated in recent photographs in relation to their sense of self and associated skills and abilities that are facets of their selfhood. This type of digital photograph diary has the potential to support individuals with AD to maintain their sense of self and participation in everyday life, and strengthen their relationships with household members; it could be an important tool in person-centered care.

  • 23.
    Karlsson, Margareta
    et al.
    Luleå University of Technology, Department of Business Administration, Technology and Social Sciences, Business Administration and Industrial Engineering.
    Garvare, Rickard
    Luleå University of Technology, Department of Business Administration, Technology and Social Sciences, Business Administration and Industrial Engineering.
    Zingmark, Karin
    Norrbotten County Council, Luleå.
    Nordström, Birgitta
    Norrbotten County Council, Luleå.
    Customer orientation in a Swedish county council2016In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 8, no 1, p. 2-16Article in journal (Refereed)
    Abstract [en]

    PurposeThe use of the customer concept and ways of interacting with customers in support functions are relatively new areas of interest for public organizations. The aim of this study is to describe the development towards a stronger customer orientation in a support function in a Swedish county council from a management team perspective.Design/methodology/approachA revision of plans and annual reports and individual interviews with the members of a management team was done. The interviews were examined using qualitative content analysis.FindingsThe results are presented in one overarching theme: the double-edged customer concept, and three themes: meeting the customer’s needs, being the customer’s specialist, and developing in collaboration with the customer. The development of a customer orientation is illustrated as a spiral involving the concepts of understanding, wanting, and acting.Originality/valueThe paper contributes to new understanding of how customer orientation develops in the context of public organizations’ support functions.

  • 24.
    Norberg, Astrid
    et al.
    University of Umeå, Department of Advanced Nursing, Umeå universitet, Institutionen för Omvårdnad.
    Nilsson, Lena
    Zingmark, Karin
    Umeå universitet, Institutionen för Omvårdnad.
    Att vara dement: människa instängd i trasig hjärna1994Book (Other (popular science, discussion, etc.))
  • 25.
    Nordmark, Sofi
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Inger
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Experiences and Views of the Discharge Planning Process Among Swedish District Nurses and Home Care Organizers: A Qualitative Study2015In: Home Health Care Management & Practice, ISSN 1084-8223, E-ISSN 1552-6739, Vol. 27, no 3, p. 108-118Article in journal (Refereed)
    Abstract [en]

    Discharge planning is an important care process, but deficits in planning are common. The aim of this study was to explore district nurses’ (DNs) and home care organizers’ (HCOs) experiences and views of the workflow during the discharge planning process (DPP). Demands, workload, time, collaboration, and engagement, together with knowledge and professional confidence, are factors that influence workflow and outcome of the DPP for DNs and HCOs. Strengths and obstacles at the organization, group, and individual levels affect the workflow during the discharge planning. Knowledge of these strengths and obstacles should help care providers in their practice as well as help management and politicians become more aware of prerequisites needed to achieve a safe and efficient workflow for securing the patient’s discharge.

  • 26.
    Nordmark, Sofi
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Inger
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Process evaluation of discharge planning implementation in healthcare using normalization process theory2016In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 16, no 1, article id 48Article in journal (Refereed)
    Abstract [en]

    BackgroundDischarge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. Information exchange and collaboration between care providers are essential, but deficits are common. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. However, there are still high rates of reported medical errors and adverse events related to failures in the discharge planning. Using theoretical frameworks such as Normalization Process Theory (NPT) can support evaluations of complex interventions and processes in healthcare. The aim of this study was to explore the embedding and integration of the DPP from the perspective of registered nurses, district nurses and homecare organizers.MethodsThe study design was explorative, using the NPT as a framework to explore the embedding and integration of the DPP. Data consisted of written documentation from; workshops with staff, registered adverse events and system failures, web based survey and individual interviews with staff.ResultsUsing the NPT as a framework to explore the embedding and integration of discharge planning after 10 years in use showed that the staff had reached a consensus of opinion of what the process was (coherence) and how they evaluated the process (reflexive monitoring). However, they had not reached a consensus of opinion of who performed the process (cognitive participation) and how it was performed (collective action). This could be interpreted as the process had not become normalized in daily practice.ConclusionThe result shows necessity to observe the implementation of old practices to better understand the needs of new ones before developing and implementing new practices or supportive tools within healthcare to reach the aim of development and to accomplish sustainable implementation. The NPT offers a generalizable framework for analysis, which can explain and shape the implementation process of old practices, before further development of new practices or supportive tools.

  • 27.
    Nordström, Birgitta
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Näslund, Annika
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Ekenberg, Lilly
    County Council of Norrbotten, Department of Research and Development.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    The ambiguity of standing in standing devices: a qualitative interview study concerning children and parents experiences of the use of standing devices2014In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 30, no 7, p. 483-489Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe children’s and parents’ experiences of the significance of standing in a standing device. Methods: Individual interviews were performed with six children/teenagers (aged 7–19 years) and 14 parents. The interviews were transcribed and analyzed using a qualitative content analysis. Findings: The analysis resulted in the major theme, the duality of uprightness and the related themes: (1) the instrumental dimension of standing; (2) the social dimension of standing; and (3) the ambivalent dimension of standing. Each of the themes comprised several subthemes. Conclusions: There is an inherent duality related to the use of a standing device. Standing in a standing device was seen as a treatment of body structures and functions, as well as a possible source of pain. Standing was considered to influence freedom in activities and participation both positively and negatively. The parents experienced that standing influenced other peoples’ views of their child, while the children experienced standing as a way to extend the body and as something that gave them benefits in some activities. Physiotherapists working with children should take into account both the social and physical dimensions of using a standing device and consider both the child’s and the parents’ views.

  • 28.
    Persson, Marit
    et al.
    Lulea, Department of Rehabilitation, Primary Health Care.
    Zingmark, Karin
    Department of Health and Medical Care, County Council of Norrbotten.
    Living with a person with Alzheimer's disease: Experiences related to everyday occupations2006In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 13, no 4, p. 221-228Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to illuminate experiences of daily occupations among spouses living with a person with Alzheimer's disease (AD). The study contains phenomenological-hermeneutic interpretation of interviews with eight spouses. The analysis revealed the participants as being in the process of a changing occupational situation. They come to live an occupational life intertwined with their partners' needs. An ongoing process of occupational adjustment is taking place as a response to the changing situation. The spouses were occupied with consequences of their partner's disease. They were striving for occupational meaning and at the same time living with threats to meaningful occupations. It can be concluded that living with a partner with AD is a complex dealing with occupational meaning. This complexity should be considered in interventions.

  • 29.
    Sirkka, Marianne
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Arbetsterapeuters erfarenheter av förbättringsarbete: en resa mot hållbar evidensbaserad praktik2017Conference paper (Refereed)
    Abstract [sv]

    Bakgrund: Arbetsterapeuter har skyldighet att bedriva en evidensbaserad verksamhet baserad på bästa tillgängligavetenskapliga kunskap, professionens expertkunnande, patienternas erfarenheter och tillgängliga resurser. Forskningvisar dock att implementering av evidensbaserade åtgärder kan vara besvärliga att omsätta i praktiken och påbörjadeförbättringsarbeten kan vara svåra att få hållbara över tid. Det har även visat sig att praxismodeller där de används gerförutsättningar för ett evidensbaserat arbetssätt men användandet har studerats i begränsad omfattning.Syfte: var att utforska arbetsterapeuters erfarenheter av att delta i ett långsiktigt förbättringsarbete baserad påOccupational Therapy Intervention Process Model (OTIPM).Metod: Data utgjordes av semistrukturerade intervjuer med 19 arbetsterapeuter i tre fokusgrupper år 2006 ochuppföljande tre fokusgruppsintervjuer år 2011. Materialet analyserades med kvalitativ innehållsanalys.Resultat/preliminärt resultat: Det långsiktiga förbättringsarbetet beskrevs som en resa mot en hållbar ochevidensbaserad praktik. Resultatet visar på en förändringsresa med tre sammanflätade perspektiv; 1) omvandla tankaroch handlingar genom återkommande kollegial reflektion, 2) hantera den upplevda dubbelheten av förändring, 3)utveckla en ömsesidigt professionell kultur.Slutsats: Studien visar hur ett reflekterande kollegialt förhållningssätt och användning av en arbetsterapeutisk praxismodell kan leda till implementering av evidensbaserad kunskap som stödjer kontinuerliga hållbara förbättringar ipraktiken.

  • 30.
    Sirkka, Marianne
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Occupational therapists' experiences of improvement work: a journey towards sustainable evidence-based practice2014In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 21, no 2, p. 90-97Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this qualitative descriptive study was to describe occupational therapists' experiences of participating in long-term improvement work based on the Occupational Therapy Intervention Process Model. Method. Data were collected by focus groups interviewed on two occasions (2006 and 2011). Nineteen occupational therapists participated on each occasion. The data obtained were analysed using a qualitative content analysis. Findings. The long-term improvement work was experienced as a journey towards sustainable and evidence-based occupational therapy practice. The journey, guided by the Occupational Therapy Intervention Process Model, led to increased client-centred and occupation-focused practice. The long journey of change involved three intertwined themes. The first theme describes how the occupational therapists transformed their thoughts and actions on an individual and group level. The second theme describes how they dealt with conflicting feelings and faced the duality of change. The third theme describes a shared professional culture, including confidence, clarity, and inter-professional community. Conclusion: The study shows how the collective use of an occupational therapy model of practice can lead to an integration of evidence-based knowledge that has long-lasting achievements in practice.

  • 31.
    Sirkka, Marianne
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    A process for developing sustainable evidence-based occupational therapy practice2014In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 21, no 6, p. 429-437Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this qualitative descriptive study was to describe how long-term improvement work based on the Occupational Therapy Intervention Process Model (OTIPM) evolved in an occupational therapy unit. Method: Data included written documents related to the improvement work (435 pages in total) from 2001 to 2013 that were analysed using pattern matching. Results: The findings from the analysis of the documents formed three main patterns describing reorientation towards the OTIPM, establishment of the implementation of the OTIPM, and ensuring the sustainability of the implementation. Each pattern contained a number of phases of the improvement work emanating from different reasons and resulting in different long-term achievements. The transformation between the phases was smooth, and several of the phases became starting points for improvement work that continued throughout the years. Conclusion: The findings showed how an occupational therapy model of practice, such as the OTIPM, can guide an improvement process and keep it going over a long period of time, thereby supporting sustainable improvements in practice.

  • 32.
    Sirkka, Marianne
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    En process för utveckling av hållbar evidensbaserad arbetsterapi2017Conference paper (Refereed)
    Abstract [sv]

    Bakgrund: För att uppnå hög kvalitet inom arbetsterapi måste ny kunskap hela tiden övervägas, reflekteras ochintegreras i det dagliga arbetet. Implementering av ny kunskap kräver ett långsiktigt förbättringsarbete med struktur, stödoch tid för att lyckas. Professionsanpassade modeller och ramverk avser att stödja arbetsterapeutisk intervention ochutveckla professionell kompetens. När modellerna används ger det förutsättningar för hållbart förbättringsarbete ochevidensbaserat arbetssätt men har i mycket begränsad utsträckning studerats ur detta perspektiv.Syfte: att utforska och beskriva hur ett långsiktigt förbättringsarbete vid en arbetsterapienhet baserat på OccupationalTherapy Intervention Process Model (OTIPM) utvecklades.Metod: Studien var en kvalitativ beskrivande studie av skriftliga dokument från långsiktigt förbättringsarbete. Dokumentenbestod av a) enhetsplaner, b) dokumentering från förbättringsarbetet, c) resultat av genomförda patientenkäter, d)resultat av genomförda journalgranskningar, e) ett generellt arbetsterapiprogram och sju specifika arbetsterapiprogram(både aktuella och reviderade versioner), f) aktuell journalföringsmanual, g) 20 patientinformationer, h) 90 rutindokument.Data analyserdes med mönsterjämförelser (pattern matching).Resultat/preliminärt resultat: Analysen av dokumenten bildade tre huvudmönster: a) omorientering mot OTIPM, b)implementeringen av OTIPM, c) säkerställande av hållbarheten av implementeringen. Varje mönster innehöll ett antalfaser som beskrev skälen till varför varje fas påbörjades, vad som påbörjades i varje fas och vad förbättringsarbetetresulterade i, flera av faserna blev startpunkter för nya förbättringar som fortsatte kontinuerligt genom åren.Slutsats: Resultatet visar hur en arbetsterapeutisk praxismodell som till exempel OTIPM, kan vägleda enförbättringsprocess och hålla den pågående under en länge tid och därigenom stödja hållbara kontinuerliga förbättringar ien arbetsterapi verksamhet

  • 33.
    Sjögren, Karin
    et al.
    Umeå University, Department of Nursing.
    Lindkvist, Marie
    Department of Statistics, Umeå University.
    Sandman, Per Olof
    Division of Nursing, Health Sciences Center, Lund University.
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Edvardsson, David
    Umeå University, Department of Nursing.
    Person-centredness and its association with resident well-being in dementia care units2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 10, p. 2196-2206Article in journal (Refereed)
    Abstract [en]

    Aim: To report a study of the relationship between person-centred care and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours among residents with dementia in residential care facilities. Background: Standardized measurements of person-centred care have not previously been used to investigate the relationship between person-centred care and well-being for residents with dementia in residential aged care units. Design: This study had a cross-sectional design. Method: Staff and resident surveys were used in a sample of 1261 residents with dementia and 1169 staff from 151 residential care units throughout Sweden. Valid and reliable scales were used to measure person-centredness and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours in residents. All data were collected in May 2010. Findings: Person-centred care was correlated with residents' ability to perform activities of daily living. Furthermore, residents in units with higher levels of person-centred care were rated as having higher quality of life and better ability to perform activities of daily living compared with residents in units with lower levels of person-centred care. Conclusions: There seems to be a relationship between person-centredness, residents' ability to perform activities of daily living, and residents' quality of life. Further studies are needed to explain the variation of person-centredness between units and the extent and ways this might impact on the quality of life and well-being of frail older residents with cognitive impairments in clinical practice. © 2013 Blackwell Publishing Ltd.

  • 34.
    Sjögren, Karin
    et al.
    Umeå University, Department of Nursing.
    Lindkvist, Marie
    Department of Statistics, Umeå University.
    Sandman, Per Olof
    Department of Neurobiology, Care Sciences and Society (NVS).
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Edvardsson, David
    Umeå University, Department of Nursing.
    Psychometric evaluation of the swedish version of the person-centered care assessment tool (P-CAT)2012In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 24, no 3, p. 406-415Article in journal (Refereed)
    Abstract [en]

    Background: Person-centered care is a multidimensional concept describing good care, especially within aged care and care for people with dementia. Research studies evaluating person-centered care interventions seldom use direct measurement of levels of person-centeredness. Existing scales that measure person-centeredness need further testing. This study evaluated the psychometric properties of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT). Methods: A cross-sectional sample of 1465 staff from 195 residential care units for older people in Sweden participated in the study. Validity, reliability, and discrimination ability of the scale were evaluated. Results: Confirmatory factor analysis, parallel analysis and exploratory factor analysis supported the construct validity of a two-factor solution. Reliability and homogeneity were satisfactory for the whole P-CAT as demonstrated by a Cronbach's α of 0.75. Test-retest reliability showed temporal stability of the scale, and the discrimination ability of the scale was satisfactory. Conclusion: The Swedish version of the P-CAT was found to be valid, reliable, and applicable for further use. Two subscales are recommended for the Swedish version. © 2011 International Psychogeriatric Association.

  • 35.
    Sjögren, Karin
    et al.
    Department of Nursing, Umeå University.
    Lindkvist, Marie
    Department of Statistics, Umeå School of Business and Economics, Umeå University.
    Sandman, Per-Olof
    Department of Nursing, Umeå University.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Edvardsson, David
    Department of Nursing, Umeå University.
    Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, no 1, article id 44Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDFew studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics.METHODSA cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi2 test, Eta Squared and Phi coefficient were used to analyse data.RESULTSHighly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care.CONCLUSIONSIt is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  • 36.
    Sjögren, Karin
    et al.
    Umeå University, Department of Nursing.
    Lindkvist, Marie
    Umeå universitet, Department of Statistics, Umeå School of Business and Economics, Umeå University.
    Sandman, Per-Olof
    Umeå University, Department of Nursing, Umeå universitet, Geriatriska institutionen, Umeå universitet, Institutionen för Omvårdnadsforskning.
    Zingmark, Karin
    Research Department, County Council of Norrbotten.
    Edvardsson, David
    Umeå University, Department of Nursing, Umeå university, School of Nursing and Midwifery, University of Dundee.
    To what extent is the work environment of staff related to person-centred care?: A cross-sectional study of residential aged care2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 9-10, p. 1310-1319Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To explore the relationship between staff characteristics, perceived work environment and person-centred care in residential aged care units. Background: Person-centred care is often described as the model of choice in residential aged care and in the care of persons with dementia. Few empirical studies have reported on the relationship between how staff experience different aspects of their work and person-centred care. Design: The study had a cross-sectional quantitative design. Methods: Staff in 151 residential aged care units in Sweden (n = 1169) completed surveys which included questions about staff characteristics, valid and reliable measures of person-centred care, satisfaction with work and care, job strain, stress of conscience and psychosocial unit climate. Statistical analyses of correlations, group differences and multiple linear regression analysis estimated with generalised estimating equation were conducted. Results: Higher levels of staff satisfaction, lower levels of job strain, lower levels of stress of conscience, higher levels of a supportive psychosocial unit climate and a higher proportion of staff with continuing education in dementia care were associated with higher levels of person-centred care. Job strain and a supportive psychosocial climate, explained most of the variation in person-centred care. Conclusions: This study shows that the work environment as perceived by staff is associated with the extent to which staff perceive the care as being person-centred in residential aged care. These empirical findings support the theoretical postulation that the work environment is an important aspect of person-centred care. Relevance to clinical practice: Promoting a positive and supportive psychosocial climate and a work environment where staff experience balance between demands and control in their work, to enable person-centred care practice, seems to be important implications for managers and leaders in residential aged care

  • 37.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    NLL.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Creating a balance between breathing and viability: Experiences of well-being when living with chronic obstructive pulmonary disease2015In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 16, no 1, p. 42-52Article in journal (Refereed)
    Abstract [en]

    Aim To describe experiences of well-being among people with moderate to very severe chronic obstructive pulmonary disease (COPD). BACKGROUND: Living with COPD is related to a complex life situation, and quality of life (QOL) is shown to decrease because of respiratory symptoms and fatigue. However, studies describing well-being in COPD as a subjective description of QOL are rare. METHODS: Ten participants with moderate to very severe COPD from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD study were interviewed about their experiences of well-being. A latent qualitative content analysis was used to analyse the data. Findings To achieve well-being despite breathlessness, the participants had to adapt to their limitations and live towards the future. They created a balance between breathing and viability by adjusting to a lifelong limitation, handling variations in illness, relying on self-capacity and accessibility to a trustful care. The participants adjusted to lifelong limitations through acceptance and replacement of former activities. They handled variations in illness by taking advantage of the good days and using emotional adaptation strategies. The participants relied on their own self-capacity, feeling that smoking cessation, physical activity and breathing fresh air increased their well-being. They requested accessibility to a trustful care and highlighted the need for continuous care relationships and access to medications. These findings can enhance health-care professionals' understanding of the possibilities for increased well-being for people living with COPD.

  • 38.
    Sundkvist, Ylva
    et al.
    Piteå River Valley Hospital, Department of Medicine and Rehabilitation.
    Zingmark, Karin
    Department of Health and Medical Care, County Council of Norrbotten.
    Leading from intermediary positions: First-line administrators' experiences of their occupational role and situation2003In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 10, no 1, p. 40-46Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to illuminate how first-line administrators in healthcare organizations perceive their occupational role and situation. Interviews were conducted with eight first-line administrators in healthcare environments (five women and three men). Five were registered nurses, one was an occupational therapist, one a physiotherapist and one had a degree in logopaedics. A semi-structured formula with broad open-ended questions was used for the personal interviews. A qualitative interpretive method was used in the analysis. The analysis resulted in three categories describing the perceived role and situation of being a first-line administrator, namely, "developing strategies to manage the leadership role", "being part of an organizational culture characterized by traditional values", and "treading a fine line and striving to manage the balancing act". The results from this study indicate that there is a need to support this group of leaders with training adjusted to the role and situation of leading from intermediary positions in organizations.

  • 39. Sävenstedt, Stefan
    et al.
    Brulin, Christine
    Umeå University, Department of Nursing.
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Sandman, Per-Olof
    Umeå University, Department of Nursing.
    Communicating with the very old in telecommunications: a study of nurses teleconsultations with frail elderly in a context of nursing homes2004In: 5th Nordic congress on telemedicine, TeleMedum , 2004Conference paper (Other academic)
  • 40. Sävenstedt, Stefan
    et al.
    Sandman, Per-Olof
    Umeå University, Department of Nursing.
    Zingmark, Karin
    Umeå University, Department of Nursing.
    The duality in using information and communication technology in elder care2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 56, no 1, p. 17-25Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this paper is to report a study illuminating values and perceptions held by professional carers of older people about the use of information and communication technology applications. BACKGROUND: Various information and communication technology applications have successfully been developed to help solve a variety of problems in elder care. Beside different technical barriers and the assumed negative attitudes among older people, staff values and attitudes have been found to be an important cause of resistance to change and slowness in introduction of information and communication technology in health care of older people. METHODS: An interview study was conducted in 2004 with 10 healthcare personnel with 3-26 years experience of working in home care and nursing homes in Northern Sweden. Qualitative content analysis was used to identify recurring themes in the data. RESULTS: The interpretation of values and perceptions among carers revealed a duality where the carers perceived information and communication technology as a promoter of both inhumane and humane care, a duality that seemed to make them defensive and resistant to change. Within the overall duality, other dualities were embedded that described both perceptions about the care of older people and about being a carer. There was evidence of resistance among professional carers towards an introduction of information and communication technology applications in elder care. Carers considered that the same attributes of information and communication technology that could promote humane care could also lead to dehumanized care. CONCLUSION: There should be an ethical discussion when introducing information and communication technology applications in elder care. The best caring alternative for all those concerned should be considered. It should promote aspects of wellbeing and dignity for frail older people and fears of inhumane care among carers must be recognized and discussed

  • 41. Sävenstedt, Stefan
    et al.
    Zingmark, Karin
    Fou-enheten i Piteå älvdal.
    Skall vi koppla upp oss eller be sköterskan komma: etiska reflektioner på användning av bildtelefoni i vården av äldre2002Report (Other academic)
  • 42. Sävenstedt, Stefan
    et al.
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Hydén, Lars-Christer
    Linköping University, Department of Communication Studies.
    Brulin, Christine
    Umeå University, Department of Nursing.
    Establishing joint attention in remote talks with the elderly about health: a study of nurses' conversation with elderly persons in teleconsultations2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 4, p. 317-24Article in journal (Refereed)
    Abstract [en]

    This study is a contribution to the sparsely studied field of nurses' teleconsultations with frail elderly people. The aim was to describe how talk and interaction are accomplished and by what means problems are handled that emerge from the fact that the communication is conducted via videoconferencing techniques. Recordings were made of 22 sessions of teleconsultation between nurses and elderly nursing home residents aided by enrolled nurses. The data were analysed with a qualitative method inspired by conversation and discourse analysis. The findings indicate that in order to create a joint attention the participants often had to verbally confirm and reconfirm that contact had been established. The triad of participants played a special part in maintaining the joint attention through compensating for the contextual aspect of the medium's limitations and the demented elderly person's communication problems. 'Talks about the communication' and passages of social talk took place when the nurse or the staff member wanted to re-establish and maintain joint attention. The joint attention seemed connected to a special sort of eye contact and gaze and to the type of camera projection that was used. One conclusion was that to create joint attention in nurses' teleconsultations with frail elderly people, the limitations in transferring communication cues and the limitations of what the camera can reveal of the general context could, to some extent, be made up for by verbal communication within the triad of participants. Another conclusion was that these limitations in the context of interaction in some situations also seemed to be an advantage for the demented elderly and contributed to increased attention

  • 43. Sävenstedt, Stefan
    et al.
    Zingmark, Karin
    Umeå University, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Department of Nursing.
    Being present in a distant room: aspects of teleconsultations with older people in a nursing home2004In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 14, no 8, p. 1046-57Article in journal (Refereed)
    Abstract [en]

    In a telecare project in Northern Sweden, videophones have been used to facilitate teleconsultations between nurses and elders at a nursing home. The authors designed this study to elucidate qualities in the communication in the professional encounter between nurses and elders assisted by nursing staff in the teleconsultations. They interviewed 2 registered nurses and 5 nursing staff members with long experience of using videophones in the telecare project, out of 20 staff members, and analyzed them using a phenomenological-hermeneutic method. In a comprehensive interpretation, teleconsultations could be understood as glimpses of the experience of being in the other's room with a feeling of providing nursing presence. This was attained when aspects such as familiarity, safety, transparency, and interest were promoted

  • 44. Sävenstedt, Stefan
    et al.
    Zingmark, Karin
    Umeå University, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Department of Nursing.
    Video-phone communication with cognitively impaired elderly patients2003In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 9, no Suppl. 2, p. 52-4Article in journal (Refereed)
    Abstract [en]

    We investigated the potential role of remote interactions via video-phone in the care of the elderly. Family members and nursing staff were interviewed about their experiences of communicating with elderly people via video-phone. Seven family members and seven nursing staff participated in the studies. The interviews were analysed using qualitative content analysis. The results showed that it was possible for elderly people with cognitive impairment to engage in remote communication when certain conditions were met. There were also indications that the video-phone interaction sometimes increased the attention and focus of the elderly subjects.

  • 45.
    Sävenstedt, Stefan
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zingmark, Karin
    Norrbottens Läns Landsting, FoU-enheten.
    Sävenstedt, Gerd
    Piteå kommun.
    E-hälsa i vård och omsorg av äldre: teknik, etik och praktik2007Book (Other academic)
  • 46.
    Wisten, Aase
    et al.
    Department of Internal Medicine, Sunderby Hospital, Lulea.
    Zingmark, Karin
    Department of Health and Welfare, County Council of Norrbotten.
    Supportive needs of parents confronted with sudden cardiac death-A qualitative study2007In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 74, no 1, p. 68-74Article in journal (Refereed)
    Abstract [en]

    The death of a close family member is one of life's greatest tragedies. When death is sudden and unexpected, there is an increased risk of posttraumatic reactions and complicated mourning. Care of the bereaved is still often overlooked in medical training and clinical practise. The aim of this study was to elucidate the perceived support and the needs of bereaved parents confronted with sudden cardiac death (SCD) in a young son or daughter. Data were derived from a qualitative contents analysis of tape-recorded, in-depth interviews with bereaved parents confronted with SCD 5-12 years post-loss. The 20 deceased individuals were part of the Swedish forensic SCD cohort of 15-35 year olds from 1992 to 1999. One third of the parents had had no contact with the emergency department (ED), one third had been disappointed after meeting care-givers at the ED who did not act with sensitivity and consistency, while one third were more or less satisfied with the handling at the ED. A majority of the parents experienced a lack of follow-up care; they had been left mainly to themselves to find information and support. Four factors were identified as being particularly important for the parents: evidence, reconstruction, explanation and sensitivity. There is a need of better routines to help the suddenly bereaved. A model of the major needs and a plan for the support needed are proposed. © 2007.

  • 47.
    Zingmark, Karin
    Umeå University, Department of Nursing.
    Experiences related to home in people with Alzheimer's disease2000Doctoral thesis, comprehensive summary (Other academic)
  • 48.
    Zingmark, Karin
    University of Umeå, Department of Advanced Nursing.
    Promoting an experience of at-homeness in people with Alzheimer's disease1994Licentiate thesis, comprehensive summary (Other academic)
  • 49.
    Zingmark, Karin
    Fou-enheten i Piteå älvdal.
    Ökat stöd i hemmet till äldre med demenssjukdom och deras anhöriga2002Report (Other academic)
  • 50.
    Zingmark, Karin
    et al.
    University of Umeå, Department of Advanced Nursing.
    Norberg, A.
    University of Umeå, Department of Advanced Nursing.
    Sandman, P. O.
    University of Umeå, Department of Advanced Nursing.
    The experience of being at home throughout the life span. Investigation of persons aged from 2 to 1021995In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 41, no 1, p. 47-62Article in journal (Refereed)
    Abstract [en]

    One hundred and fifty persons aged two to 102 narrated their experiences related to the phenomenon 'being at home.' Several common interdependent and interrelated aspects of the experience of being at home were identified throughout the life span. These aspects are believed to entail cognitive, emotional, and conative dimensions of the experience: safety, rootedness, harmony, joy, privacy, togetherness, recognition, order, control, possession, nourishment, initiative, power, freedom. The sense of being related was found to be a common condition of the experience of being at home, i.e., related to significant others, significant things, significant places, significant activities, oneself, and transcendence. In the process of maintaining the experience of being at home throughout life the phenomena 'being given a home,' 'creating a home,' 'sharing a home,' and 'offering a home' were integral parts. A progression in the experience of being at home throughout the life span was identified.

12 1 - 50 of 53
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf