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Glasdam S, Xu H, Gulestø RJA. A call for theory-inspired analysis in qualitative research: Ways to construct different truths in and about healthcare. Nurs Inq 2024:e12642. [PMID: 38638008 DOI: 10.1111/nin.12642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
Over the last 50 years, there has been significant development of qualitative research and related methods in healthcare. Theoretical frameworks support researchers in selecting appropriate research approaches, procedures and analytical tools. However, the implications of the choice of theory are sparsely elucidated. Based on a text excerpt from a public debate article, the study aimed to show how different theory-inspired analytical perspectives produced varied understandings of the same text. The study presented three subanalyses inspired by Bourdieu's sociological theory, Lazarus and Folkman's psychological theory and utilitarian ethics, respectively. The analyses showed that by using different theoretical analytical perspectives in inductive processes, an immediate interpretation of the text was not obvious. It became possible to spot the underlying meta-theoretical assumptions, as the interpretations were not taken for granted or indisputable. Our analyses suggest that different theoretical lenses lead to different interpretations of the same empirical material, recognising the existence of multiple truths or realities. Thus, utilising a theoretical perspective in inductive analyses can enhance transparency and rigour because the analytical optics are made explicit to the reader. This allows the reader to follow the analysis processes and comprehend from which theoretical starting point a truth arises.
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Affiliation(s)
- Stinne Glasdam
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hongxuan Xu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ragnhild J A Gulestø
- Department of Health Sciences, Institute of Nursing, VID Specialized University, Oslo, Norway
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Glasdam S, Xu H, Stjernswärd S. Socialisation of children to nurse and nursing images: A Goffman-inspired thematic analysis of children's picture books in a Swedish context. Nurs Inq 2024; 31:e12603. [PMID: 37767729 DOI: 10.1111/nin.12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Picture books are often part of children's socialisation processes, contributing to the children forming images of the world, including ideas about (categories of) people, such as nurses. The study aims to explore how nurses/nursing are portrayed in children's picture books in a Swedish context. Through a systematic search, 44 books were included for analysis using thematic analysis and a theoretical lens inspired by Goffman. The results were presented in three themes: 'The costume characterised and designated nurses', 'Nurses and nursing were defined through specific activities and accessories', and 'Nurses' role as caregivers and decency practitioners'. The results showed that nurses were depicted/described in varied contexts, performing their roles mainly front stage in 'hands-on work' in close contact with patients and relatives. Nurses were attributed different accessories and personality characteristics. Nurses/nursing were generally set within a healthcare context, oftentimes within an overarching medical logic. Historical depictions of nurses' uniforms still appeared as a signifier for nurses/nursing. The presentation of nurses/nursing might have potential implications on children's understanding of and for reputations of nurses/nursing in the long term as primary socialisation and related understandings of the (sub)world(s) are deeply rooted in humans.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Integrative Health Research, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hongxuan Xu
- Department of Health Sciences, Integrative Health Research, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sigrid Stjernswärd
- Department of Health Sciences, Health-promoting Complex Interventions, Faculty of Medicine, Lund University, Lund, Sweden
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Shahriari M, Nia DH, Kalij F, Hashemi MS. Challenges of home care: a qualitative study. BMC Nurs 2024; 23:215. [PMID: 38549100 PMCID: PMC10976792 DOI: 10.1186/s12912-024-01878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/17/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Despite countless benefits of home care, unfortunately, the variety and quality of services provided by homecare centers are uncertain. This study was conducted to explore of home care challenges. METHODS The present qualitative study used the content analysis approach. A total of 17 participants, including nurses, managers of home care centers, and patients, were enrolled through purposive sampling. Data were collected using semi-structured interviews and analyzed through Granheim's qualitative content analysis method. RESULTS In order to explain the challenges of home care, after analyzing the data, 700 primary codes, 15 initial categories, sub-subcategories and two main categories, including 'infrastructural challenges' and 'challenges related to the process of home care services provision' emerged. The main category, "infrastructural challenges", consisted of 4 sub-categories (the challenge of acculturalization of home care services, economic challenges of providing services, challenges related to human resources, and the challenge of policymaking and setting regulations and rules for home care). The second main category, "challenges related to the process of home care services provision", consisted of 2 subcategories: challenges of improving the quality of home care services and the challenge of facilities for service provision. CONCLUSION In order to promote and improve the quality of home care services, in addition to providing insurance coverage for the services, acculturalization and revising the bylaws, empowering the human resource, enhancing the monitoring of the performance of home care centers, and employing modern technology need to be taken into account.
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Affiliation(s)
- Mohsen Shahriari
- Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, School of Nursing and midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Donya Hafezi Nia
- Nursing Student, Department of Psychiatric Nursing, School of Nursing and Midwifery, Donya Hafezi Nia, Isfahan University of Medical Sciences, Isfahan, MS, Iran
| | - Fatemeh Kalij
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, 4 Fatemeh kalij, MS, Nursing Student, Isfahan, Iran
| | - Maryam Sadat Hashemi
- Nursing & Midwifery Care Research Center, Department of Nursing Critical Care, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
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Leclerc-Loiselle J, Gendron S, Daneault S. Nursing activities for health promotion in palliative home care: an integrative review. Palliat Care Soc Pract 2024; 18:26323524241235191. [PMID: 38487793 PMCID: PMC10938613 DOI: 10.1177/26323524241235191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.
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Affiliation(s)
- Jérôme Leclerc-Loiselle
- School of Nursing, Université de Sherbrooke, 150, Pl. Charles-Le Moyne, L1-7730, Longueuil, QC J4K 0A8, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - Sylvie Gendron
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Serge Daneault
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
- Research centre of Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
- Integrated University Health and Social Services Centre of Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
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Karidar H, Lundqvist P, Glasdam S. Inclusion and Participation in a Support Programme for Bereaved Adolescents - Relational Perspectives From an Ethnographic Field Study in a Swedish Context. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231185802. [PMID: 37353971 DOI: 10.1177/00302228231185802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
The death of a parent is a life-changing event, and different programmes are developed to support children. This study explored how parental bereaved adolescents were included and (inter)acted in a Swedish support programme. The conducted ethnographic field study included six adolescents, their parents, and eight volunteers. The empirical material was thematically analysed through a theoretical lens inspired by Bourdieu. Three themes emerged: 'Different strategies for adolescents' inclusion in the programme,' 'Medico-psychological understanding of grief and suffering,' and 'Reproduction of the logic of the school.' Adolescents were included in the programme through different strategies, where adults functioned as gatekeepers. The programme reproduced the school logic and was based on a medico-psychological grief/bereavement understanding. Volunteers had pedagogic authority and concomitant symbolic power, ruling adolescents to do what they must do in the meetings, silently socialising them into the medical logic. The adolescents only interacted and communicated with each other during breaks.
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Affiliation(s)
- Hakima Karidar
- Department of Health Sciences, Lund University, Lund, Sweden
- Palliative and Advanced Homecare (ASIH), Lund, Sweden
| | - Pia Lundqvist
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Stinne Glasdam
- Department of Health Sciences, Lund University, Lund, Sweden
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Bryk A, Roberts G, Hudson P, Harms L, Gerdtz M. The concept of holism applied in recent palliative care practice: A scoping review. Palliat Med 2023; 37:26-39. [PMID: 36333861 DOI: 10.1177/02692163221129999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Whilst there is a sense of holism existing within palliative care practice, what is not clear is the extent to which holism, as applied in recent palliative care practice, has been adequately researched. Currently, no reviews on this topic were identified through systematic and scoping review registries. AIM To identify and describe the available published evidence on the key features of holism and the core domains underpinning the application of holism in relation to recent palliative care practice. DESIGN Scoping review using the Johanna Briggs Institute design. DATA SOURCES MEDLINE, EMCARE, and CINAHL (Ovid), PsycINFO, SocINDEX, SCOPUS and Web of Science. (International, peer-reviewed, published papers in the English language from January 2010to December 2020). RESULTS Five studies met inclusion criteria. Two studies used qualitative methods, one used mixed-methods, and two were randomised controlled trials. The research investigated (1) frameworks for holistic care and (2) assessment tools applied in palliative care settings. CONCLUSIONS The results from the review led to identifying key features of palliative care that were presented as interconnected aspects of holistic care domains in both assessments and interventions. The literature revealed a focus on curative and biomedical approaches to disease management with holistic aspects acknowledged, but not in the forefront of core service delivery. Holism was generally conceptualised as an overarching theoretical framework to palliative care service provision and positioned as an adjunct to palliative models of care. These findings point to a gap in research that links the concept of holism to applied palliative care practices.
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Affiliation(s)
- Andrea Bryk
- Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Greg Roberts
- Jesuit Social Services, Support After Suicide, Melbourne, VIC, Australia
| | - Peter Hudson
- Centre for Palliative Care, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Louise Harms
- Department of Social Work, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Marie Gerdtz
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Melbourne, VIC, Australia
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Fu C, Glasdam S. The 'good death' in Mainland China - A Scoping Review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100069. [PMID: 38745620 PMCID: PMC11080441 DOI: 10.1016/j.ijnsa.2022.100069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 01/13/2023] Open
Abstract
Background Since the mid 80'ies, the western palliative care philosophy has influenced the development of palliative care in mainland China. However, it has caused several challenges. Objective To explore the understanding of the 'good death' among authorities, professionals, patients, and their relatives in end-of-life care settings in mainland China. Design Scoping review. The PRISMA-ScR checklist was used. The study is not registered. Settings End-of-life care settings, Mainland China. Participants Authorities, healthcare professionals, adult patients, and general population in mainland China. Method Literature searches were performed through Medline, CINAHL, PsycInfo, and Web of Sciences from 2001-2021, last search 21.4.2021. Inclusion criteria were: Empirical research studies investigating 'good death' or political documents about 'good death', perspectives from authorities, professionals, patients, and/or relatives, and studies following the Declaration of Helsinki. Exclusion criteria were: Literature reviews, languages other than English and Chinese, editorials, letters, comments, and children's death/dying.The analysis consisted of analysing the data including a descriptive numerical summary analysis and a qualitative thematic analysis. Results Nineteen articles and two political documents were included. The 19 studies were carried out from 2003-2020, with data collected from 1999 to 2019. The political documents were written in 2012 and 2017, respectively. The thematic analysis resulted in three themes: 'Medicalisation of death', 'Communication about death - a clash between two philosophies', and 'Dying and death were socially dependent'. The medicalisation of death meant the understanding of the 'good death' primarily focused on physical symptoms and treatments. The good death was understood as painless and symptom-free, where all symptoms could be measured and assessed. Dignity and shared decision-making were connected to the understanding of the 'good death'. However, the contents of the 'good death' varied across the different actors. The understanding of the 'good death' in mainland China was a negotiation between Chinese traditional philosophy and contemporary western medicine practice. There was a tension between openness and silence about death, which reflected the importance of death education. The understanding of the 'good death' consisted partly of a timely and practical preparation for the death and afterlife, partly of a matter of social and financial issues. Conclusions There seemed to be a clash between two different cultures in the understanding of a good death in Mainland China, where western philosophy seemed to rule the political medical actors while traditional Chinese philosophy seemed to rule parts of the population.
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Affiliation(s)
- Cong Fu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1 B, S- 222 41 Lund, Sweden
| | - Stinne Glasdam
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1 B, S- 222 41 Lund, Sweden
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Stjernswärd S, Glasdam S. The European Standard EN 17398:2020 on Patient Involvement in Health Care - a Fairclough-Inspired Critical Discourse Analysis. Policy Polit Nurs Pract 2022; 23:130-141. [PMID: 35306903 PMCID: PMC9014666 DOI: 10.1177/15271544221088250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concept of ‘patient involvement’ is highlighted in healthcare. However, hindrances
can prevent its implementation. This article explored how ‘patient involvement’ is
understood and on what ideas this understanding is based through a critical textual
analysis of the European document on patient involvement in health systems using a
Fairclough-inspired critical discourse analysis. The findings showed that the document
arose from a social discourse based on a mix of a neoliberal ideology, with a
marketisation of care focusing on a cost-effective and evidence-based logic of care,
and a humanistic ideology of patient involvement. It had the form of a
normative, consensus-based standard, supported by European organisations. The document
incorporated a visionary, well-intentioned abstract guide to promote patient involvement
across European care contexts, however without addressing hindrances nor differences
across the contexts in which it ought to be implemented. It raises questions about its
usability, inviting further research into empirical applications.
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Affiliation(s)
- Sigrid Stjernswärd
- Department of Health Sciences, 59568Lund University Faculty of Medicine, Lund, Sweden
| | - Stinne Glasdam
- Department of Health Sciences, 59568Lund University Faculty of Medicine, Lund, Sweden
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Agren A, Nedlund AC, Cedersund E, Krevers B. Dying as an issue of public concern: cultural scripts on palliative care in Sweden. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:507-516. [PMID: 33959886 PMCID: PMC8557170 DOI: 10.1007/s11019-021-10022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/01/2021] [Indexed: 06/12/2023]
Abstract
In Sweden, palliative care has, over the past decades, been object to policies and guidelines with focus on how to achieve "good palliative care". The aim of this study has been to analyse how experts make sense of the development and the current state of palliative care. Departing from this aim, focus has been on identifying how personal experiences of 'the self' are intertwined with culturally available meta-level concepts and how experts contribute to construct new scripts on palliative care. Twelve qualitative interviews were conducted. Four scripts were identified after analysing the empirical material: 1. script of paths towards working within palliative care; 2. script of desirable and deterrent reference points; 3. script of tensions between improvement and bureaucracy; and 4. script of low status and uncertain definitions. The findings of this study illustrate how experts in complex ways intertwine experiences of 'the self' with meta-levels concepts in order to make sense of the field of palliative care. The participants did not endorse one "right way" of "good" deaths. Instead, palliative care was considered to be located in a complex state where the historical development, consisting of both desirable ideals, death denials and lack of guidelines, and more recent developments of strives towards universal concepts, "improvement" and increased bureaucracy altogether played a significant role for how palliative care has developed and is organised and conducted today.
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Affiliation(s)
- Axel Agren
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
- Department of Culture and Society (IKOS), Linköping University, Campus Norrköping, Sweden
| | - Ann-Charlotte Nedlund
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Elisabet Cedersund
- Department of Culture and Society (IKOS), Linköping University, Campus Norrköping, Sweden
| | - Barbro Krevers
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
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Gulestø R, Lillekroken D, Bjørge H, Halvorsrud L. Interactions between healthcare personnel and family caregivers of people with dementia from minority ethnic backgrounds in home-based care-An explorative qualitative study. J Adv Nurs 2021; 78:1389-1401. [PMID: 34806211 DOI: 10.1111/jan.15101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/14/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
AIMS To explore how healthcare personnel in home-based care perceive interactions with family caregivers of people with dementia from minority ethnic backgrounds. BACKGROUND Research shows that the organization of home-based care rarely allows opportunities to provide support to family caregivers in practice. However, how these organizational structures influence the way in which healthcare personnel perceive their interactions with family caregivers of people with dementia from minority ethnic backgrounds remains an unexplored area. DESIGN An explorative qualitative study inspired by a critical realist approach using Pierre Bourdieu's theoretical concepts of field, habitus and capital. METHODS Data were collected through individual semi-structured interviews with six nurses and four auxiliary nurses employed in home-based care in Norway. The data were analysed using a thematic analysis approach. The participants were recruited in September and October 2020. FINDINGS 'Family caregivers perceived as facilitators of or barriers to collaborative care' was identified as an overarching theme, supported by two main themes: 'Preconditions for successful collaboration' and 'Challenges for collaborative relationships'. The findings revealed that the participants mainly focused their attention on the dementia patients from minority ethnic backgrounds, while they felt that the family caregivers influenced the way in which they provided healthcare. CONCLUSIONS The findings demonstrate that timesaving strategies have a major influence on healthcare personnel's perceptions of family caregivers from minority ethnic backgrounds. Attention towards the needs of the family caregivers was often replaced by evaluations of their usefulness in the provision of healthcare to the dementia patients. IMPACT This study raises concerns about home-based care as a rigid and inflexible system. It therefore provides opportunities to raise questions on status quo, stimulate debate and encourage fresh thinking with regards to the support and inclusion of family caregivers in the home-based care system for people with dementia from minority ethnic backgrounds.
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Affiliation(s)
- Ragnhild Gulestø
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Heidi Bjørge
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Abstract
What, precisely, are we seeking to achieve in offering 'life-saving' treatment to patients with cancer? Research funding agencies and pharmaceutical industry media releases, and government cancer screening programs all promise that their cancer programs save lives. But everybody dies. The nature of life and death from cancer is explored philosophically in this essay, with particular reference to the quality of life, and its meaning, during the period of prolongation of survival by 'life-saving' cancer care.
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Affiliation(s)
- J Harvey Turner
- Department of Nuclear Medicine, The University of Western Australia, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia
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McMillan K, Wright DK, McPherson CJ, Ma K, Bitzas V. Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses' Relational Practice During the Coronavirus Pandemic. Glob Qual Nurs Res 2021; 8:23333936211051702. [PMID: 34761076 PMCID: PMC8573617 DOI: 10.1177/23333936211051702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses' moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.
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Affiliation(s)
- Kim McMillan
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - David K Wright
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Kristina Ma
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Vasiliki Bitzas
- Clinical Administrative Coordinator, Geriatrics and Palliative Care, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada
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Glasdam S, Loodin H, Wrigstad J. Articulations of antimicrobial resistance in trade union financed journals for nurses in Scandinavia - A Foucauldian perspective. Nurs Inq 2021; 28:e12396. [PMID: 33484079 PMCID: PMC8365678 DOI: 10.1111/nin.12396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022]
Abstract
Antimicrobial resistance (AMR) in bacterial infections is a growing threat to humanity and a challenge to healthcare systems worldwide. Healthcare professionals have an important role in preventing AMR and the spreading of infections. This article focuses on trade union financed journals for nurses in Scandinavia studying how the journals articulate AMR to its readership. A systematic literature search over an eleven-year period was conducted, using web-based national trade union financed journals, searching for 'bacteria' and 'resistance'. A thematic analysis, inspired by Foucault's concepts of power and governmentality, was made of 131 texts to understand, which kind of practices, strategies and policies the journals frame regarding AMR. The time period studied resulted in the recognition of four separate themes: the horror scenario, the 'dangerous' other, healthcare professionals as a source of resistance development and AMR as a field of research and producer of research qualifications. The study concludes that the journals tend: to present AMR in apocalyptic terms with more research and pharmaceutical industries needed for avoidance; to point out problems in other countries, populations, and sometimes nurses' working conditions, but primarily with other professionals' behaviour; and lastly, to present the nurse as a good fairy and disciplinator of doctors.
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Affiliation(s)
- Stinne Glasdam
- Department of Health SciencesIntegrative Health ResearchFaculty of MedicineLund UniversityLundSweden
| | - Henrik Loodin
- Department of Service Management and Service StudiesLund UniversityHelsingborgSweden
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14
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Fjørtoft AK, Oksholm T, Delmar C, Førland O, Alvsvåg H. Home-care nurses' distinctive work: A discourse analysis of what takes precedence in changing healthcare services. Nurs Inq 2020; 28:e12375. [PMID: 32725871 DOI: 10.1111/nin.12375] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 11/30/2022]
Abstract
Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients' homes. This greatly impacts nurses' work in home care, making their work increasingly diverse and demanding. In this study, we explore home-care nursing through a critical discourse analysis of focus group interviews with home-care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home-care nurses' work. Changes have made nurses' work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses' work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses' work to help shape the further development of home-care nursing.
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Affiliation(s)
- Ann-Kristin Fjørtoft
- Center of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway.,Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Trine Oksholm
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Charlotte Delmar
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Institute of Public Health, Department of Nursing Science, Health Faculty, Aarhus, Denmark
| | - Oddvar Førland
- Centre for Care Research Western Norway, Western Norway University of Applied Sciences, Bergen, Norway
| | - Herdis Alvsvåg
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
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15
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Glasdam S, Jacobsen CB, Boelsbjerg HB. Nurses' refusals of patient involvement in their own palliative care. Nurs Ethics 2020; 27:969733020929062. [PMID: 32627661 PMCID: PMC7564292 DOI: 10.1177/0969733020929062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice. AIM To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective. METHOD A case study based on an anthropological field study among patients with advanced cancer in Denmark. ETHICAL CONSIDERATIONS Followed the principles of the Helsinki Declaration. FINDINGS Two cases illustrated situations where nurses refused patient involvement in their own case. DISCUSSION Focus on two ethical issues, namely 'including patients' experiences in palliative nursing care' and 'relational distribution of power and knowledge', inspired primarily by Hannah Arendt's concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients' palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned 'thoughtlessness' of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients' invitations to involve them in their own case. CONCLUSION The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that 'thoughtlessness' appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses' ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare.
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16
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Dixe MDA, Santo IDDO, Lopes S, Catarino H, Duarte S, Querido A, Laranjeira C. Knowledge and Myths about Palliative Care among the General Public and Health Care Professionals in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134630. [PMID: 32605086 PMCID: PMC7369792 DOI: 10.3390/ijerph17134630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022]
Abstract
Background: International research has shown that healthcare professionals (HCPs) and nonhealthcare professionals (NHCPs) are unaware of the goals and purposes of palliative care. This study evaluates the knowledge of palliative care among a sample of Portuguese adults and correlates their level of knowledge with age, gender, profession, and experience of family member’s palliative care. Method: A cross-sectional online survey was carried out on a sample of 152 HCPs and 440 NHCPs who completed an anonymous questionnaire of sociodemographic, family, and professional data, and an instrument of 26 dichotomous (true or false) questions focusing on palliative care goals and purposes. Results: The 592 participants had a mean age of 31.3 ± 11.1 years, and most were female. Statistically significant differences between statements considered as correct by HCPs and NHCPs were found in 24 statements; HCPs had the highest percentage of correct answers. The terms most frequently associated with palliative care mentioned by NHCPs were chronic and progressive disease (n = 76), while HCPs mostly mentioned quality-of-life promotion (n = 29). Women, the elderly, and HCPs had a higher level of knowledge regarding palliative care (p < 0.001). Conclusions: Results clearly show gaps in knowledge of palliative care, especially among NHCPs. An integrated approach is needed to inform and clarify the philosophy and goals of palliative care in different settings in order to improve knowledge.
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Affiliation(s)
- Maria dos Anjos Dixe
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
- Correspondence:
| | - Irene Dixe de Oliveira Santo
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
- Weiss Memorial Hospital, 4646 North Marine Drive, Chicago, IL 60640, USA
| | - Saudade Lopes
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
| | - Helena Catarino
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
| | - Susana Duarte
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal;
| | - Ana Querido
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
- Center for Research in Health and Information Systems (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Carlos Laranjeira
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
- Research in Education and Community Intervention (RECI I&D), Piaget Institute of Viseu, 3515-776 Viseu, Portugal
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17
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Boelsbjerg HB, Glasdam S. Dying Fit or Not-Physical Activity as Antidote to Death? OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:771-791. [PMID: 32237959 DOI: 10.1177/0030222820913716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physical activity has increasingly gained attention within palliative care. This article aims to explore how the idea of physical activity influences patients with advanced cancer and health-care professionals' interactions. The empirical material was gathered as part of an anthropological field study about palliative care needs among 16 patients with advanced cancer, consisting of observations and interviews with patients, relatives, and professionals. Two of the patient cases were analyzed, inspired by Goffman's theory, showing how patients and health-care professionals interact in relation to physical activity. The findings show that patients played roles either embracing physical activity or distancing it by postponement. Professionals played expert roles of duty and attachment, stressing the importance of physical activity. Thus, they accepted a minimum of physical activity when patients were close to death. Professionals regarded patients' absence of physical activity as a lack of desire to live; patients regard it as a way to live.
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Affiliation(s)
- Hanne Bess Boelsbjerg
- Interacting Minds Centre, the Medical Faculty, Aarhus University.,Institute for Clinical Medicine, Centre for Planned Surgery, Regional Hospital Silkeborg
| | - Stinne Glasdam
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University
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18
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Glasdam S, Bjerström C, Engberg de Carvalho C. Coping strategies among patients with malignant lymphoma- a qualitative study from the perspectives of Swedish patients. Eur J Oncol Nurs 2019; 44:101693. [PMID: 31783326 DOI: 10.1016/j.ejon.2019.101693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/13/2019] [Accepted: 11/16/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE There is a dearth of research on coping strategies of patients with malignant lymphoma. The aim of this article is to explore how these patients cope with cancer in everyday life. METHOD Semi-structured interviews were conducted with nine patients in Sweden. A thematic analysis was made, inspired by Antonovsky's theory of sense of coherence. The SRQR checklist was used. RESULTS Patient's coping strategies are shown within three themes: 'Life experiences supported coping strategies during treatment', 'Between completed treatment and (possible) cure', and 'Illness brought closeness and distance in social relationships'. Three different coping strategies were identified during treatment: trying to control the situation, seeing opportunities in difficulties, and doing other activities to limit thoughts about disease and treatment. Four different coping strategies were identified after treatment ended, namely projecting responsibility and anger onto the healthcare system, maintaining the outer facade as a strong person who had control over the situation, talking about disease, side effects and emotions and putting the focus on the future, and managing life by anticipating death. Family =and friends were a part of patients' coping strategies, but to different extents and in different ways. Diagnosis and treatment for malignant lymphoma brought closeness and distance in social relationships. CONCLUSION Patients with malignant lymphoma cope with cancer in different ways in everyday life influenced by their life experiences and life conditions. Further research should focus on cancer patients' coping strategies in a relational perspective, as coping and coping opportunities are embedded in social context and social relationships.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1 B, S-222 41, Lund, Sweden.
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