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Aim. This paper is a report of a study of self-care agency and perceived health in a group ofpersons using advanced medical technology at home. Background. An increasing number of persons are using medical technology for self-care. Few studies describe daily life in this context at an overriding level, irrespective of the specific sort of technology. A connection between self-care, perceived health and sense of coherence has previous been implied. Methods. A descriptive, comparative, cross-sectional quantitative design was used. Data were collected from a questionnaire in the winter 2009/2010. The questionnaire addressed perceiveed health and daily life with medical technology, and applied Swedish versions of the Appraisal of Self-care Agency scale and the 13-item version of Antonovsky’s sense of coherence scale. Results. The questionnaire was answered by 180 adults performing self-care at home involving long-term oxygen, a ventilator, peritoneal or blood dialysis. Health-related and technology-related variables in daily life were rated as satisfactory to a high extent. Perceived health was rated significantly lower among participants using long-term oxygen. Sufficient sense of coherence and knowledge of how to use technology, close contacts with other persons, and not feeling helpless contributed positively as factors for self-care agency. Positive factors for perceived health were being satisfied with life, having an active life, and not feeling helpless, while age was a negative factor. Conclusion. Daily life is manageable for persons using these types of technology. Long-term oxygen treatment and advanced age can be seen as risk factors for perceiving ill health., Funding Agencies|Department of Nursing, Health and Culture, University West||Division of Nursing Science, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linkoping University||University of Agder||University West, Sweden||University of Agder, Norway

Scand J Caring Sci; 2010 Health-illness transition among persons using advanced medical technology at home. This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive atti, This is the pre-reviewed version of the following article:Angelika Fex, Gullvi Flensner, Anna-Christina Ek and Olle Söderhamn, Health-illness transition among persons using advanced medical technology at home, 2011, Scandinavian Journal of Caring Sciences, (25), 2, 253-261.which has been published in final form at: http://dx.doi.org/10.1111/j.1471-6712.2010.00820.xCopyright: Blackwell Publishing Ltdhttp://eu.wiley.com/WileyCDA/Brand/id-35.html

Scand J Caring Sci; 2010 Health-illness transition among persons using advanced medical technology at home. This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive atti, This is the pre-reviewed version of the following article:Angelika Fex, Gullvi Flensner, Anna-Christina Ek and Olle Söderhamn, Health-illness transition among persons using advanced medical technology at home, 2011, Scandinavian Journal of Caring Sciences, (25), 2, 253-261.which has been published in final form at: http://dx.doi.org/10.1111/j.1471-6712.2010.00820.xCopyright: Blackwell Publishing Ltdhttp://eu.wiley.com/WileyCDA/Brand/id-35.html

Scand J Caring Sci; 2010 Health-illness transition among persons using advanced medical technology at home. This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive atti, This is the pre-reviewed version of the following article:Angelika Fex, Gullvi Flensner, Anna-Christina Ek and Olle Söderhamn, Health-illness transition among persons using advanced medical technology at home, 2011, Scandinavian Journal of Caring Sciences, (25), 2, 253-261.which has been published in final form at: http://dx.doi.org/10.1111/j.1471-6712.2010.00820.xCopyright: Blackwell Publishing Ltdhttp://eu.wiley.com/WileyCDA/Brand/id-35.html

An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from health-care professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs were receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context.

Scand J Caring Sci; 2010 Health-illness transition among persons using advanced medical technology at home. This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive atti, This is the pre-reviewed version of the following article:Angelika Fex, Gullvi Flensner, Anna-Christina Ek and Olle Söderhamn, Health-illness transition among persons using advanced medical technology at home, 2011, Scandinavian Journal of Caring Sciences, (25), 2, 253-261.which has been published in final form at: http://dx.doi.org/10.1111/j.1471-6712.2010.00820.xCopyright: Blackwell Publishing Ltdhttp://eu.wiley.com/WileyCDA/Brand/id-35.html

Scand J Caring Sci; 2010 Health-illness transition among persons using advanced medical technology at home. This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive atti, This is the pre-reviewed version of the following article:Angelika Fex, Gullvi Flensner, Anna-Christina Ek and Olle Söderhamn, Health-illness transition among persons using advanced medical technology at home, 2011, Scandinavian Journal of Caring Sciences, (25), 2, 253-261.which has been published in final form at: http://dx.doi.org/10.1111/j.1471-6712.2010.00820.xCopyright: Blackwell Publishing Ltdhttp://eu.wiley.com/WileyCDA/Brand/id-35.html

Aim. This study aimed to describe lived experiences of self-care among persons using advanced medical technology at home. Background. An increased number of people are performing self-care while using different sorts of advanced medical technology at home. Knowledge of different patient groups' lived experiences of this situation may be useful for nurses and other caregivers in educating and supporting these patients. Design. A qualitative design was used. Methods. Suitable patients in western Sweden were informed by their nurses and invited to participate. Ten people, who performed self-care at home, either while using long-term oxygen therapy from a ventilator or oxygen cylinder, or while performing peritoneal or haemodialysis, were interviewed. The interviews were analysed using a descriptive phenomenological methodology. Results. Prerequisites for self-care when using advanced medical technology at home were: support from professional caregivers and significant others; cognitive capacity; and a positive attitude to life. This type of self-care contains steps for living healthy, for planning and for adjusting technology. It involves a process of learning and feelings both of being tied up and of feeling free. Additionally, it has influences on the home environment. Conclusion. Self-care in this context can be described on a generic level. Self-care is more than mastering the technology; it also means dealing with daily life activities for healthy living, planning for the use of the equipment and activities, having knowledge about bodily signs of good and ill-health, and adjusting treatment according to the circumstances. Relevance to clinical practice. Self-care in this context involves a learning process with education and continuing access to support from professional caregivers. With knowledge and support, patients are able to assume substantial responsibility for self-care. Needs for design improvements of medical technology for use at home are raised.

Fatigue is not only a complex phenomenon accompanying different illness conditions but is also a common complaint among individuals in the general population. Among individuals diagnosed with the chronic neurological disease multiple sclerosis (MS), one-third describe fatigue as the very first symptom, however it is invisible to others. When adopting an action-theoretic approach to health, fatigue may be considered to influence the individual’s goals of life and subjectively perceived health. The aim of this study was to describe perceived fatigue in relation to perceived health among working-aged individuals diagnosed with MS (n = 155), and in a comparative group of individuals randomly selected from the general population living in the same geographical area (n = 190). A self-report questionnaire including the Fatigue Impact Scale, a checklist of six symptoms, questions covering perceived health and levels of and perceptions of fatigue was used for the data collection. The responses on perceived health were dichotomized into two categories: ‘good health’ and ‘ill health’. Of the individuals with MS, 50% graded their perceived health as ill compared with 18% in the reference group (p < 0.001), and 68% graded fatigue as one of their worst symptoms compared with 21% in the reference group. In both groups, higher presence of symptoms and impact of fatigue in daily activities correlated negatively to perceived health. Compared with the individuals in the reference group, the individuals with MS reported higher impact of fatigue in physical areas in both the category of ‘good health’ (p < 0.001) and ‘ill health’ (p < 0.01). The perceived impact of fatigue was mirrored in increased problems in social and family activities. In conclusion, individuals with MS perceive fatigue as one of their worst symptoms three times as often as individuals in the general population. However, individuals with MS probably also adapt themselves or shift in their response to fatigue

Fatigue is a complex phenomenon that, for those not affected, is hard to understand. To achieve better assessments, caregivers need reliable and valid tools. The aim of this study was to investigate the reliability and validity of the Swedish version of the Fatigue Impact Scale (FIS) among working-aged individuals diagnosed with multiple sclerosis (MS), as well as in a comparative group randomly selected from the general population in the same geographical area. Both individuals with MS (n=161) and individuals recruited from the general population (n=194) participated in the study. A questionnaire was used for the data collection. The data were analysed using non-parametric statistical methods. Reliability of FIS was addressed by item-to-item and item-to-total correlations. Concurrent validity was tested for by analysing correlations between the FIS and general questions, and construct validity by investigation of differences in the FIS scores between known groups. The FIS was found to be homogenous, with item-to-total correlation coefficients of 0.42 ≤ rs≤0.86 (p<0.001), reflecting the instrument's reliability. The correlations between the FIS and the general questions confirm its concurrent validity, 0.27 ≤ rs≤0.84 (p<0.001). The differences in FIS scores between known groups demonstrate its construct validity. Furthermore, the FIS showed the ability to discriminate between groups of individuals with differences in perceived impact of fatigue.

Fatigue is a major problem among individuals diagnosed with multiple sclerosis (MS), but its meaning in daily living is unclear. The aim was to describe MS-related fatigue as lived by a group of individuals diagnosed with MS. Interviews with nine individuals were analysed from a phenomenological perspective. Main findings: MS-related fatigue is living with a time-consuming and all absorbing phenomenon, involving the body and the whole human being. Fatigue is commonly non-constructively perceived and expressed in terms of energy loss, emotional afflictions, dependency and restrictions of life in general, however, it is also constructively perceived and involves a desire to accept life and strive for a better situation. Conclusion: MS-related fatigue is a comprehensive phenomenon and its relationship with self-care requires further investigation.

Undernutrition among elderly patients is a significant problem in nursing care. The aims of this study were to develop and test an instrument for identifying actual and potential undernutrition among elderly patients in clinical nursing care. A Likert-type scale consisting of 15 items was constructed. A consecutive sample of 56 elderly patients (>65 years) in a geriatric rehabilitation ward in western Sweden were interviewed with the instrument. The data were mainly analysed with non-parametric statistical methods. The results showed that the instrument was a fairly reliable scale with a Cronbach's alpha coefficient of 0.72. Evidence of validity concerning face validity, criterion-related validity—including concurrent and predictive validity—and construct validity was shown in the study group. Further testing is required if the instrument is to be used in clinical nursing care and research.

The aim of this thesis was to explore the nature of elderly people's potential for selfcare from a nursing perspective. The research was performed within an empirical frame of reference as well as within a phenomenological frame at a descriptive and hermeneutical level. In order to implement a relation-searching study, one instrument was translated and a new instrument constructed. Both tools were tested for reliability and validity. A relation-searching study and a phenomenological study were then performed. The participating elderly were 65+ years of age and Jiving in a health district in western Sweden. The study groups consisted of 1) a convenience sample comprising inpatients (n=52) and their caregivers (n=53) in three nursing homes and one geriatric rehabilitation department, 2) a consecutive sample of in-patients (n=57) in a geriatric rehabilitation department, 3) an age stratified random sample, from which 125 persons agreed to participate in the study, and 4) for the phenomenological study, nine persons from the original age stratified random sample participated together with two conveniently chosen persons lrom a pilot study. The in-patients were interviewed, and the home dwelling persons completed a mailed questionnaire and wrote self-reports, respectively. Bivariate and multivariate statistical methods were used in the quantitative studies. The Empirical Phenomenalogical Psychological (EPP) method and a phenomenological-hermeneutical method were used in the analyses of the self-reported narratives. The results showed that the constructed instrument, the Self-care Ability Scale for the Elderly (SASE), is a reliable and valid tool for the appraisal of elderly people's perceived ability for self-care. The Swedish version of the Appraisal of Self-care Agency (ASA) scale is a reliable and valid tool for the appraisal of elderly people's perceived activation of self-care ability. The proposed theoretical relationship between self-care ability and self-care act, Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.