Research circles with home care recipients and care staff - a method to increase understanding of what quality in home care impliesA research circle is a method in participatory research, which aims to strengthen the bottom-up perspective and thereby establish a more democratic process for common knowledge formation. The methodology means that more voices and perspectives are made visible, as well as identifying concrete proposals for change. A shared knowledge formation requires that all participants experiences, and knowledge contributions are taken into account and the researchers role as circle leader is to contribute by connecting to current research and other sources of knowledge in the area of study. The purpose of the present study is to explore and if so, how to the research circle method is useful as an initial stage of a research and development process.The article describes research circle about quality in home care, i.e interventions that take place in the individual’s home outside of assisted living facilities. Quality is a complex concept and often a subjective experience. To find answers to the question of what the meaning of quality in home care services is, research circles are conducted with home care recipients and caregivers separately.As the research circles are ongoing, the results are still preliminary. To highlight the method, two themes about what quality in home care means, have been chosen to describe the joint knowledge formation, which is based on an interaction between theory and practice. Our ambition is that the results produced by the research circle as a method should also be used as a basis for organizational learning within home care and thus contribute to increased qualit

The design of assisted living facilities is an issue that has engaged architects and contractors since they began building the first residential homes. Previous research has shown that participation in everyday activities promotes wellbeing in older people. Many assisted living facilities have locked units that limit the individuals ability to move freely. Our interest is directed towards older peoples opportunities to be physically active in assisted living facilities and how the physical environment affects these opportunities. The aim of this study was to increase the understanding of the importance of the physical environment to enable physical activities in assisted living facilities. The empirical material consists of observations and semi-structured interviews with thirteen residents and seventeen staff in four assisted living facilities in Sweden. The results show how the physical environment influences the opportunities for physical activity. Certain factors in the physical environment can be both promoting and limiting. An unsuitable environment limits the ability of older people to be physically active.

Aim: Physical activity has been described as important for the well-being of all individuals, including the very old. The aim of this study was to investigate how physical activity is performed at assisted living facilities, the situations in which older people were and wanted to be physically active and the role of the physiotherapist at each facility.

Methods: To achieve this aim, an ethnographic study including observations and interviews was conducted at four assisted living facilities.

Results: The results show that physical activity neither was an issue in focus at any of the assisted living facilities, nor were recommendations on physical activity followed. Individuals that were able to exercise themselves could do so, whereas those in need of assistance had but limited possibilities to be physically active. There was a need for physical activity that the staff do not necessarily and sufficiently identify.

Conclusion: The study illustrated that there were major variations in how older people engaged in physical activity and how physical activities were part of everyday life. Physiotherapists played no clear role at the facilities, especially with regard to preventive exercise. Older individuals were not involved in determining which activities should be made available to the residents.

Fysisk aktivitet beskrivs vara positiv både för den fysiska och den psykiska hälsan för personer i alla åldrar. Det finns rekommendationer för hur mycket fysisk aktivitet människor bör ägna sig åt varje dag. Idag finns även rekommendationer för fysisk aktivitet framtagna för personer som bor i särskilt boende.

Syftet med avhandlingen är att belysa olika aspekter av fysisk aktivitet i särskilt boende utifrån dem som bor där, dem som arbetar i verksamheten samt utifrån förutsättningarna i den fysiska miljön. Tidigare forskning visar vikten av att vara fysiskt aktiv, samt att det finns risk för passivitet när människor flyttar till särskilt boende. Det är därför angeläget att undersöka villkoren för fysisk aktivitet i den speciella miljö som det särskilda boendet utgör.

En etnografisk metod har använts där observationer, intervjuer och informationsbroschyrer utgjort det empiriska materialet.

Resultatet visar att äldre personer och personal i särskilt boende inte definierar begreppet fysisk aktivitet på samma sätt utan att det finns olika uppfattningar om vad begreppet innebär. De kulturer och normer som påverkar hur personalen tänker kring fysisk aktivitet har betydelse. Det finns därvid även en acceptans för att äldres individuella önskemål inte alltid kan tillgodoses. Fysioterapeuten förefaller inte ha en tydlig roll på det särskilda boendet, speciellt inte när det gäller preventiva insatser. De rekommendationer för fysisk aktivitet som finns används sällan och uppnås inte heller. Den fysiska miljön har dock betydelse för om fysisk aktivitet främjas eller förhindras. Det finns ett antal faktorer som kan uppfattas främjande eller begränsande för individens möjlighet att vara fysiskt aktiv. De fysiska faktorerna går i vissa fall att påverka från att utgöra en begränsande faktor till att förändras och bli en främjande faktor. Det finns en skillnad när det gäller omfattningen av fysisk aktivitet på det boende som har lokaler som är avsedda för just detta ändamål, i jämförelse med enheter där sådana lokaler saknas.

Physical activity is described as being positive for both physical and mental health and for people of all ages. A daily level and amount of physical activity has been recommended for older people. There are also specific recommendations for people living in assisted living facilities.

The purpose of this dissertation is to illustrate different aspects of physical activity in assisted living facilities in relation to the people living, and the people working, in assisted living facilities. Previous research shows the importance of being physically active and the risk of passivity when people move to assisted living facilities. It is therefore important to examine the conditions of physical activity in the particular environment that the assisted living facilities consist of.

An ethnographic method has been used for which observations, interviews and information brochures constitute the empirical material.

The results show that older people and staff do not always define the concept of physical activity in the same way, and what is meant by the term is perceived differently. The cultures and norms for how staff think about physical activity is of great importance. There is an acceptance that the older person’s individual wishes cannot be met. Physiotherapists appear to have no clear role in the assisted living facilities, in particular in regard to preventive physical activity. The national recommendations for physical activity are rarely used and are not achieved. The physical environment is important and can promote or prevent physical activity. There are a number of factors that can be perceived as promoting or limiting the individual’s ability to be physically active. In some cases, the physical factors can influence a limiting factor to change and to become a promoting factor. There is a difference between the extent of physical activity in assisted living facilities which have dedicated premises for this purpose, compared to facilities where such premises are lacking.

Fysisk aktivitet för äldre beskrivs i litteraturen som något positivt och viktigt och har kommit i fokus under senare år. I svensk äldreomsorg dominerar ett aktivitetsteoretiskt synsätt och det finns även internationella rekommendationer om fysisk aktivitet för äldre. Få studier har dock undersökt hur behovet av fysisk aktivitet tillfredsställs i det särskilda boendet.

Syftet med denna studie var att undersöka hur äldreomsorgens personal tänker och agerar när det gäller fysisk aktivitet för äldre. Det empiriska materialet består av observationer och intervjuer på fyra särskilda boenden i två olika svenska kommuner.

Resultaten visar betydelsen av rådande kulturer och normer för hur personalen tänker och agerar kring fysisk aktivitet. Det finns en motsättning mellan hur personalen diskuterar äldres önskemål om stöd för fysisk aktivitet och hur hänsyn tas till fysisk aktivitet i det dagliga arbetet. Denna motsättning visar sig genom att personalen beskriver vikten av fysisk aktivitet för de äldre personerna samtidigt som denna prioriteras bort till förmån för andra arbetsuppgifter. Det förefaller ha skapats en acceptans för att äldres individuella önskemål inte kan tillgodoses om personalen har andra uppgifter att utföra.

Physical activity is described in the literature as positive and important, and has come into focus in recent years. An activity-based theoretical approach dominates in Swedish eldercare, and there are also international recommendations on physical activity for older people. Nevertheless, few studies have explored how the need for physical activity is satisfied at assisted living facilities.

The aim of this study was to investigate how professionals working in eldercare think about and act to promote physical activities for elderly people. The empirical data consists of observations and interviews conducted at four assisted living facilities in two different Swedish municipalities.

The results show how cultures and norms are important for how professionals think and act regarding physical activity. There is a contradiction between how professionals discuss elderly people’s need for support for physical activity and how they act in their day-to-day work. There seems to be an acceptance that elderly people’s individual needs cannot be met if professionals have other tasks to perform.

Perceptions of physical activity among older people and staff in residential homes

Introduction

In this paper, I will describe how people define the concept of physical activity and how they understand this phenomenon. This is a part of my PhD-studies, focusing on opportunities to be physically active and factors that may affect the possibilities in residential homes.

Physical activity is often described as positive and important for all people. Physical activity when moving to a residential home can be problematic when people often are in high age and have major disabilities and diseases, which may affect the physical ability (SOU 2008:113).

There are several researchers who have defined the concept of physical activity. A common definition of physical activity is Caspersen et al (1985) definition; “Physical activity is any bodily movement produced by skeletal muscles that result in energy expenditure”. The effects of physical activity have been described in many studies. Swedish Council on Technology Assessment has done a compilation of studies on various methods to promote physical activity (SBU 2007). It describe that a physical active lifestyle reduces the risk of developing various diseases. Physical activity has a secondary preventive effect when the disease has already occurred may be affected. This is said to also apply to older persons. Public Health Institute has published with advice based on current research findings on how physical activity can be used to prevent and treat various diseases (FYSS 2008). It explains that physical activity and exercise can help prevent and reduce the number of age-related physical and psychological changes in the body. Welmer et al. (2012)  have made interviews with people in the age of 80-91.The old people describes that they did not see physical activity as a self-defined activity but as a consequence of other activities (social aspects) that are perceived as more important than the actual physical activity. Some people described that morning exercise or a walk gave more energy and gave a better mood while others described the care of things in their own home, such as make the bed, washing dishes and being able to take care of things in the garden, as important. There was also some that described these activities as boring but necessary, and nothing they did because they really wanted. Some people in the study wanted to do things for themselves, while others wanted to be with others.

Studies point out that when the elderly person's own opinions, desires and needs must be reflected in efforts to promote occupational performance so increasing their motivation to participate Activities that take place at senior housing is often done in groups. The supply to meet an individual's needs for physical activity is very limited. Staff perception of lack of time is a likely reason why collective activities priority over individual. It could also be because the staff do not have knowledge that some people have the need for individual activities (Greenfield et al 1985).

As the body ages altered bones, joints and muscles, which means loss of power, slower movements and gradually worse coordination. These factors often involve an impaired ability to perform certain daily activities which can lead to physical inactivity (Dehlin et al 2000). Tinetti et al (1993) and Rydwik (2008) describes the body's abilities can be positively affected by physical exercise into old age. They also describe how mental health is positively affected by physical activity. Most people who live in residential homes is in the so-called fourth age which is the last phase of life (Laslett 1994, 1996). They often have multiple diseases, have severe disabilities and are in need of care and attention. Andersson (2009) describes the fourth age as the time when you are older and dependent on aid to survive. The boundary between the third and fourth age varies according to the needs of health care that the elderly have and do not follow as much chronological age.

Staff's role in creating opportunities for physical activity

The staff have an important role in need of assistance and help for those who is living in residential homes. If the older persons has major physical problems they need someone who motivates and encourages. It creates an opportunity to be involved in their activities and planning of their daily lives. Staff can also be an obstacle. Is the staff afraid for the patient to fall they often help with everyday activities. By helping it save time too which often is

rendered as a major flaw in the elderly care.

Surveys have been made of how stuff reason about activities (Lundström 2003). The staff felt that the older mainly participated in activities who involved personal care. It was easier to motivate the elderly to be active when the person was just moved. When the person had lived for a while it became more difficult to justify. , prompting staff to musing over what role they had in passivating the elderly. The range of activities in addition to personal care was very limited. The staff lacked knowledge about the interests of older people.

Surveys have been made of how the staff is reasoning about activities (Lundström 2003). The staff felt that the older mainly participated in activities involving personal care. It was easier to motivate the elderly to be active when the person was just moved. When the elder had lived for a while he became more difficult to justify. This meant that staff wondered what role they had in the passivation The staff lacked knowledge about the interests of older people. The staff have an important role in finding out what each individual user has needs and desires. A survey has shown that staff are often the main interlocutor (Karlsson 2006).

There is conflicting research describes where staff describe that the older people are able to decide for themselves how they want their day, when you want to go to bed when you want to shower and how they want to be active. While describing the staff that it was not going to let the older people decide by themselves because there are procedures that must be followed. These procedures often have with the organization to do such as staffing and scheduling (Harnett 2010).

Regardless of who supports the elderly to perform various activities will affect the helper's behavior Sr. ability of activity positively or negatively (Tamm 1999).

Aim

The overall aim of my thesis is to study how people in the fourth age, living in residential homes, are willing and have opportunities for physical activity and how the opportunities to be active is affected by the physical environment and the staff behavior.

The aim of this part of the study is to describe variations in perceptions of the concept of physical activity.

Method

A phenomenographic research approach was used to analyze semistructurated interviews with older people and the staff at four residential homes in two different municipalities in Sweden.

Phenomenography is a qualitative research method developed at the Department of Education at the University of Gothenburg. Special features of the method is that it aims to describe different perceptions of a phenomenon. The purpose is not to find out whether some phenomenon is true or false, how many thinks so and so, it is to know how people perceive the phenomenon. The goal is to try to observe a hypothetical range of understanding of a phenomenon. One way to do this is to analyze interviews and compiling various kinds of statements in the categories of description. Relationships between categories of description can then be examined in phenomenography sample space. The process focused on identifying perceptions and examine how perceptions relate to each other. The phenomenografs mean that an idea is something we take for granted. Thus a perception that we do not need to have reflected upon, but as we build our arguments. (Svensson 1984; Marton & Booth 2000).

Population

Totally 30 interviews has been carried out in residential homes. The residential homes have been chose strategically from the perspectives. The residential homes has been statistically choose from the perspectives of large municipality, small municipality, inner city, suburban area and rural. 14 of these interviews have been carried out with older people and the rest of the interviews has been carried out with the stuff in the categories' care staff, head, occupational therapist and physiotherapist. All of the interviewed staff was women.

Among the interviewed elderly were 9 persons women and 5 persons men. Their age had a spread of between 70-95 years, with mean age 87 years. All the people had been living in residential care for more than 6 months.

Physical activity is described as positive and important for all people. Maintaining a physical activity when moving to residential homes can be problematic when people often have high age, significant impairments and diseases, which affects the physical ability.

The residential home should have a home-like atmosphere and provide opportunities for physical activity both indoors and outdoors. The apartments are often small so that it can be difficult to be physically active in them. So most of the physical activity must be done in public areas.

The aim is to investigate how people are interested in, and able to, physical activities even though they often have significant disabilities, and how older people in residential homes are experiencing opportunities for physical activity and how the opportunities are affected by the property's physical environment.

The result will be based on participant observations, to be done in four residential homes in two municipalities in Sweden. The observations will be carried out during 2013 and is part of a thesis project. The method is chosen to be able to understand people's lives from an "inside perspective", for a time spent in the elderly homes and to some extent also participating in the activities that occur.

The result will be an account of the observations with a focus on physical activity in their environment and is expected to show factors in the areas of physical environments, the individual's own will, personnel matter and is expected to show how people living in residential homes to be physically active, how they can be physically active based on the physical environment they live in and the staff's ability to support the physical play.

Objectives: The rehabilitation needs of most people living in residential care are to a large extent met through rehabilitative work in everyday life. The analysis presented is based on rehabilitative activities in Norrköping Municipality in relation to activity theory and the theory of gerotranscendence.

Most people who live in residential care are in the so-called fourth age. They have multiple illnesses, major disabilities and need care. Activities in nursing homes need to be varied according to the residents' abilities and interests. Participation in everyday life is crucial for older people's health and wellbeing.

Theory and Method: Two major theories explain in social gerontology how individual's adapt to the aging process; activity theory and the theory of gerotranscendence.

In Sweden an activity theoretical approach is taken to elderly care. The theory purport that older people who are active and have contacts with others are happier than those who are not active.

The theory of gerotranscendence is based on the idea that values and ideas about life change and we get a more spiritual and cross-border perspective as we age. Social activities are less important. The elderly may have an increased need for self-imposed loneliness.

Results: An analysis was made of physical and social activities. This showed that the activities usually occurred in groups and for the most part were based on activity theory. Very few activities can be traced to the theory of gerotranscendence.

The user can choose whether to participate in activities or not. On the other hand is it not made clear that users are involved in planning the activities to be implemented. When an event occurs an interesting side effect is that staff are released and can be with those who do not want to participate in organized activities

Conclusion: Staff must meet the patient's need for activity by offering activities that are based on the two theories.