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  • 1.
    Björklund, Margereth
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    A health promotion perspective of living with head and neck cancer2012In: Head and neck cancer / [ed] Mark Agulnik, INTECH , 2012, p. 393-428Chapter in book (Other academic)
  • 2.
    Björklund, Margereth
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Health promotion and everyday living with head and neck cancer: a qualitative study2011Book (Other academic)
    Abstract [en]

    In society there is a growing awareness that a vital factor for patients with chronic diseases is how well they are able to function in their everyday lives. The aim was to reach a deeper understanding of living with head and neck cancer (HNC). Interviews were performed and critical incident technique, thematic and latent content, and interpretative descriptive analysis were used. Everyday living was expressed as living in captivity, in the sense that patients’ sometimes life-threatening symptoms were constant reminders of the disease. Patients struggled to find power and control from inner strength and other health resources, e.g. social networks, nature, hobbies, activity, and health professionals. Some patients were more vulnerable and felt lost and abandoned by health services, especially before and after treatment. A mutual working relationship during dialoguing and sensed co-operation and equality in encounters with competent health professionals could promote health and well-being. The findings highlight psychosocial rehabilitation in a patient-centred organisation when health professionals support patients’ inner strength and health resources.

  • 3.
    Björklund, Margereth
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Living with head and neck cancer: a health promotion perspective - a qualitative study2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aim: In society there is a growing awareness that a vital factor for patientswith chronic diseases, such as head and neck cancer (HNC), is how well they are able to function in their every day lives – a common, but often overlooked, public health issue. The overall aim of this thesis is to reach a deeper understanding of living with HNC and to identify the experiences that patients felt promoted their health and well-being. It also explores the patients' experiences of contact and care from health professionals and whether these encounters could increase their feelings of health and well-being; salutogenic approach.

    Methods: This thesis engages a qualitative data design. On three occasions, 35 purposivelyselected patients were interviewed (31 from Sweden and one from Denmark, Finland, Island, and Norway). The first study was conducted in the Nordic counties (I), and the remainingstudies were conducted in Sweden (II, III, IV). Interviews were performed on a single basis(I, II, III) and then repeated (IV). The individual, semi-structured qualitative interviews usedopen-ended questions (n=53). Three different forms of analyses were used: critical incident technique (I), thematic content analysis (II), latent content analysis (III), and interpretativedescriptive analysis (paper IV).

    Findings: Living with head and neck cancer was expressed as living in captivity, in the sensethat patients' sometimes life-threatening symptoms were constant reminders of the disease. The patients experienced a threat against identity and existence. Patients struggled to find power and control over everyday life, and if successful this appeared to offer them better health and well-being along with spiritual growth. The general understanding was that these patients had strong beliefs in the future despite living on a virtual rollercoaster. The patients went through a process of interplay of internal and external enabling that helped them acquire strength and feelings of better health and well-being. Consequently, they found power and control from inner strength and other health resources, e.g. social networks, nature, hobbies, activity, and health professionals. However, the findings also revealed the opposite; that some patients were more vulnerable and felt powerless and faced everyday life with emotional and existential loneliness. They were dependent on next of kin and health professionals. Having good interpersonal relationships and emotional support 24 hours a day from next of kin were crucial, as were health promoting contacts and care from health professionals. This health promoting contact and care built on working relationships with competent health professionals that were available, engaged, respectful, validating, and, above all experienced in the treatment phase. But many patients experienced not health promoting contact and care – and a sense of not being respected, or even believed. Added were the patients' experiences of inadequate coordination between phases of their lengthy illness trajectory. They felt lost and abandoned by health services, especially before and after treatment.

    Conclusions: Inner strength, good relationships with next of kin, nature, hobbies, andactivities could create strength and a sense of better health and well-being. Patients experienced a mutual working relationship during dialoguing and sensed co-operation and equality in encounters with competent health professionals. This could lead to enhanced power and control i.e. empowerment in a patient's everyday life. The findings highlight psychosocial rehabilitation in a patient-centred organisation when health professionals supportpatients' inner strength and health resources , and also offer long-term support to next of kin.Finally, this research suggests that if health professionals could gain a deeper understanding of the psychosocial, existential, social, and economic questions on patients' minds, they could better sense how patients feel and would be better equipped not only to offer greater support, but to raise their voices to improve health policy and health care for these patients. 

  • 4.
    Björklund, Margereth
    et al.
    Centre for Health Promotion Research, Halmstad University.
    Fridlund, Bengt
    Centre for Health Promotion Research, Halmstad University.
    Cancer patients' experiences of nurses' behaviour and health promotion activities: a critical incident analysis1999In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 8, no 4, p. 204-212Article in journal (Refereed)
    Abstract [en]

    Patients with head and neck cancer report several disease- and health-related problems before, during and a long time after completed treatment. Nurses have an important role in educating/supporting these patients about/through the disease and treatment so that they can attain well-being. This study describes the cancer patients' experiences of nurses' behaviour in terms of critical incidents after nurses had given them care to promote health. The study had a qualitative, descriptive design and the method used was the critical incident technique. Twenty-one informants from the Nordic countries diagnosed with head and neck cancer were strategically selected. It was explained to the informants what a critical incident implies before the interviews took place; this was defined as a major event of great importance, an incident, which the informants still remember, due to its great importance for the outcome of their health and well-being. The nurses' behaviour was examined, and critical incidents were involved in 208 cases-150 positive and 58 negative ones-the number of incidents varying between three and 20 per informant. The nurses' health promotion activities or lack of such activities based on the patients' disease, treatment and symptoms, consisted of informing and instructing the patients as well as enabling their participation. Personal consideration and the nurses' cognisance, knowledge, competence, solicitude, demeanour and statements of understanding were found to be important. Continuous health promotion nursing interventions were of considerable value for the majority of this group of cancer patients. Oncology nurses could reconfirm and update the care of head and neck cancer patients by including health promotion activities in individual care plans. By more frequent use of health promotion models, such as the empowerment model, the nurses could identify and focus on those individuals who needed to alter their life-style as well as tailor their approach towards these patient by setting goals for well-being and a healthy life-style.

  • 5.
    Björklund, Margereth
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    CICE, Linnaeus University, Växjö, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Experiences of psychological flow as described by people diagnosed with and treated for head and neck cancer2019In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 43, article id 101671Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe flow as experienced by people diagnosed with and treated for head and neck cancer.

    METHOD: A descriptive design based on a deductive qualitative content analysis was used to explain Csikszentmihalyi's flow theory from the perspective of people living with head and neck cancer. Interviews were conducted with seven participants diagnosed with and treated for different forms and stages of head and neck cancer.

    RESULTS: Experiences of flow were associated with people's interests, skill levels and actions involving and creating both happiness and the feeling of something worth living for. Optimal flow was a state of consciousness in which mind and body work together, and the people were completely absorbed in an activity related to nature, hobbies or family. Microflow occurred as part of everyday life, relieving stress and anxiety and helping them to focus on their daily routines. This included humming, listening to the radio or watching TV.

    CONCLUSIONS: The people's inner strength and desire to feel better made flow possible, and they used unknown skills that enhanced self-satisfaction. Managing self-care activities increased feelings of control, participation and enjoyment. This calls for person-centred care with a salutogenic approach based on the people's own interests, skill levels and actions; what makes the person feel happy.

    The full text will be freely available from 2020-10-09 00:00
  • 6.
    Björklund, Margereth
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Berg, Agneta
    Kristianstad University College, Kristianstad, Sweden.
    Health promoting contacts as encountered by individuals with head and neck cancer2009In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 1, no 3, p. 261-268Article in journal (Refereed)
    Abstract [en]

    Aim.  To describe the characteristics of health promoting contacts with health professionals as encountered by individuals with head and neck cancer.

    Background.  Head and neck cancer has a profound and chronic impact on the individual’s everyday life, e.g. physical problems that hinder speaking, breathing, eating and drinking. Furthermore, fear and uncertainty can lead to long-term psychological and psychosocial problems. The National Institute of Public Health in Sweden advocates that all care contacts should improve the quality of the individual’s health.

    Design.  A qualitative descriptive and explorative design was used. Eight participants were interviewed in the year 2005 and a qualitative thematic content analysis of the data was performed.

    Findings.  Health promoting contacts were defined as contacts where health care professionals contribute positively to the well-being of individual patients. Characteristics include being available, engaged, respectful and validating. Three themes were identified: being believed in one’s illness story; having a working relationship with health professionals and receiving individualised, tailored care.

    Conclusions.  Health promoting contacts were experienced mainly during the treatment phase, when patients had daily contact with specific, qualified health professionals. Although the interview questions focused on health promoting contacts, nearly half of the contacts were experienced as not health promoting. Feelings of abandonment were particularly manifested before and after treatment. The starting point for achieving health promoting contact lies in understanding the patient’s lifeworld in relation to health, illness and suffering and focusing on the individual’s personal strengths and health resources.

    Relevance to clinical practice.  The findings highlighted the importance of ensuring that patient interests and concerns are core considerations in health care. The participants viewed continuing individualised, tailored care and access to ear, nose and throat healthcare professionals as highly important.

  • 7.
    Björklund, Margereth
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Berg, Agneta
    Kristianstad University College, Kristianstad, Sweden.
    Health promotion and empowerment from the perspective of individuals living with head and neck cancer2008In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 12, no 1, p. 26-34Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to shed light on health promotion from the perspective of individuals living with head and neck cancer. Eight informants were interviewed and latent content analysis was used. Individuals living with head and neck cancer experienced many problems that had a negative impact on their health. One overarching main theme was demonstrated; the ability to regain control and empower oneself. Three themes emerged: (1) Being enabled by dialogue with one's inner self, including three sub-themes: transformed and improved self-esteem, recognising and embracing existentiality, and increased self-determination. (2) Being enabled by means of contact with a social network, including two sub-themes: emotional support and practical support. (3) Being enabled by means of contact with and a passion for the environment, including two sub-themes: nature, hobbies and activities. Empowerment, the goal of health promotion, was understood as an ongoing process, and the ability to promote health varied and was dependent on internal and external enabling of acting and doing. The interpretation of this ongoing process demonstrates interplay assisted by a dialogue with one's inner self, contact with a social network and a passion for the environment. Altogether, these findings may inspire nurses and other health care professionals to support the individual's empowerment process and pose non-pathology-oriented questions such as "what improves your health?" or "what makes you feel good?"

  • 8.
    Björklund, Margereth
    et al.
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Sarvimäki, Anneli
    The Nordic School of Public Health, Gothenburg.
    Berg, Agneta
    Högskolan Kristianstad, Avdelningen för Hälsovetenskap.
    Living with head and neck cancer: a profile of captivity2010In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 2, no 1, p. 22-31Article in journal (Refereed)
    Abstract [en]

    Aim. To illuminate what it means to live with head and neck cancer.

    Background. Patients could experience head and neck cancer as more emotionally traumatic than other cancers because of visible disfigurement and its life-threatening impact on vital functions. This long-term illness often leads to lifestyle changes such as to physical function, work and everyday tasks, interpersonal relationships and social functioning.

    Design. This study used a qualitative and explorative longitudinal and prospective design with semi-structured interviews and open-ended questions. Twenty-one interviews were conducted with six participants with newly diagnosed or newly recurrent head and neck cancer. The analysis was descriptive and interpretive.

    Findings. The participants were living 'in captivity' in the sense that their symptoms were constant reminders of the disease. Our findings also revealed existential loneliness and spiritual growth, as interpreted within six themes: altered sense of affiliation; hostage of health care; locked up in a broken body, but with a free spirit; confined in a rogue body, forced dependency on others, and caught up in a permanent illness trajectory.

    Conclusions. Living with head and neck cancer involves emotional and existential vulnerability. The participants and their next of kin experienced insufficient support from health services and inadequate coordination between phases of their lengthy illness trajectory. These findings call for changes in oncological rehabilitation and management. Patient care must take a holistic view of everyone involved, centring on the individual and the promotion of health. A care coordinator could navigate between the individual patient needs and appropriate health services, hopefully with results that lessen the individual's emotional and existential confinement.

  • 9.
    Dimenäs, Jörgen
    et al.
    Institutionen för pedagogik, Högskolan i Borås.
    Björklund, Margereth
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Häggkvist, Kristin
    Högskolan i Borås.
    Larsson, Ingamay
    Högskolan i Borås.
    Malm, Annika
    Högskolan i Borås.
    Rundgren, Monica
    Högskolan i Borås.
    Welin Mod, Agneta
    Högskolan i Borås.
    Retorikens beprövande erfarenhet ur yrkesverksamma lärar- och sjuksköterskehandledares perspektiv2012In: Utbildning och Lärande / Education and Learning, ISSN 2001-4554, Vol. 6, no 1, p. 98-116Article in journal (Refereed)
    Abstract [en]

    This study aims to investigate the concept of proven experience, which is being increasingly used and emphasised in documents relating to the education of student teachers and nurses as well as in the training of these two professions. The study is aimed at academic vocational training (AVT) and is based upon interviews with the tutors of student teachers and nurses during their periods of AVT. The purpose of this study is to understand what constitutes the essence of proven experience, arising from the verbal statements given by AVT tutors in the field. The conclusion of this study is that the concept of proven experience should be considered at three levels: experience, tested experience and proven experience. Furthermore, those who use it without further consideration should understand the complexity of the concept. From a critical perspective it seems that government agencies use a concept that we assume is more characterised by ideological rhetoric than by conceptual preciseness.

  • 10.
    Wahlström, Solveig
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Björklund, Margereth
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Munck, Berit
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    The professional role of skilled birth attendants’ in Nepal – A phenomenographic study2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, p. 60-66Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to describe the Nepali Skilled Birth Attendants’ (SBAs) perceptions of their professional role.

    Methods: Fifteen Nepalese SBAs were interviewed using a semi-structured interview guide. A phenomenographic approach was chosen to describe their qualitatively different and unreflective conceptions of the professional role. Data was analysed in a seven-step process and three description categories and six conceptions emerged.

    Results: The SBAs described the role as provider, the role as counsellor and the role as educator. As provider, the SBA maintained midwifery nursing and prevented maternal deaths. As counsellor, the SBA advocated and empowered women and facilitated family planning. As educator, the SBA promoted health of families and health in the society. She also tutored students and colleagues about skills and human rights.

    Conclusion: The SBAs’ vulnerability emerged especially in rural areas while preventing complications and newborn and maternal death in rural areas where she often worked alone with lack of proper equipment and access to other medical professionals. The SBAs perceived that their professional roles required knowledge and experiences, were safety was closely linked to health education. Ethical dilemma could arose when they had to relate to the families' cultural decisions. Education was a key factor connected to close life-saving procedures and to retain good quality and safety in newborn and maternal healthcare. The SBAs switched between their three roles, always striving to be aware of compliance with the Sustainable Development Goals policy. 

    The full text will be freely available from 2020-05-21 00:00
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