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Larsson H, Beck I, Blomqvist K. Perspectives on existential loneliness. Narrations by older people in different care contexts. Int J Qual Stud Health Well-being 2023; 18:2184032. [PMID: 36871234 PMCID: PMC9987781 DOI: 10.1080/17482631.2023.2184032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
The aim was to explore existential loneliness in different long-term care contexts as narrated by older people. A qualitative secondary analysis was performed of 22 interviews with older people in residential care, home care, and specialized palliative care. The analysis started with naive reading of interviews from each care context. As these readings showed similarity with Eriksson's theory of the suffering human being, the three different concepts of suffering were used as an analytic grid. Our result indicates that suffering and existential loneliness are interrelated for frail older people. Some situations and circumstances that trigger existential loneliness are the same in the three care contexts while others differ. In residential and home care, unnecessary waiting, not feeling at home and not being encountered with respect and dignity can trigger existential loneliness while seeing and hearing others suffering can give rise to existential loneliness in residential care. In specialized palliative care, feelings of guilt and remorse are prominent in relation to existential loneliness. In conclusion, different healthcare contexts have various conditions for providing care that meet the existential needs of older people. Hopefully our results will be used as a basis for discussions in multi-professional teams and among managers.
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Affiliation(s)
- Helena Larsson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- The Research Platform for Collaboration for Health, Kristianstad University, Kristianstad, Sweden
| | - Ingela Beck
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- The Research Platform for Collaboration for Health, Kristianstad University, Kristianstad, Sweden
- The Institute for Palliative Care, Region Skane and Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Division of Oncology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Kerstin Blomqvist
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- The Research Platform for Collaboration for Health, Kristianstad University, Kristianstad, Sweden
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Weston EJ, Jefferies D, Stulz V, Glew P, McDermid F. A global exploration of palliative community care literature: An integrative review. J Clin Nurs 2023; 32:5855-5864. [PMID: 37060200 DOI: 10.1111/jocn.16707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/21/2023] [Accepted: 03/23/2023] [Indexed: 04/16/2023]
Abstract
AIM This review sought to discover how community nurses globally provide palliative care, with specific focus on how they manage the personal and professional stressors associated with caring for dying clients in the home. DESIGN An integrative review methodology was used to gain insight into how community palliative care is delivered worldwide. BACKGROUND The provision of home palliative care by community nurses gives clients the ability to spend their final days in familiar surroundings. Research has focussed on the provision of palliative care in the inpatient setting, with little known about the community setting. METHODS Data were collected through a literature search, then a critical analysis approach was used to evaluate the strengths of palliative care literature by analysing recurrent themes to stimulate further research on the topic. DATA SOURCES The following databases were used to conduct the literature search: CINAHL, Medline, Pubmed, Scopus, Ovid. RESULTS The results highlighted the importance of building a skilled palliative community nursing workforce and the need to offer specialised palliative care training to nurses, particularly around difficult conversations and service coordination. CONCLUSION The literature identified the challenges implicit within the community nursing role in delivering palliative care, but it did not identify the factors that enhance the nurses' ability to manage the stressors associated with this role. The input of nurses must be sought to understand the development of resilience. IMPLICATIONS FOR THE PROFESSION Community palliative care nursing requires time spent with clients and family members who are suffering, therefore predisposing nurses to stress. Effort must be made to provide palliative care nurses with support to enhance professional resilience.
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Affiliation(s)
- Emily J Weston
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 22 Main Street, Blacktown, New South Wales, 2148, Australia
| | - Diana Jefferies
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia
| | - Virginia Stulz
- Centre for Nursing and Midwifery Research, Nepean Hospital, Level 1, South Wing, Court Building, Derby Street, Kingswood, New South Wales, Australia
| | - Paul Glew
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia
| | - Fiona McDermid
- School of Nursing and Midwifery, Building 7, Office 6, Campbelltown Campus, Campbelltown, New South Wales, Australia
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Phianhasin L, Belza B, Byun E. Are Patients Who Are Unconscious Able to Understand and Perceive Their Environment? An Existential Perspective of Providing Care. J Gerontol Nurs 2023; 49:3-5. [PMID: 37256760 DOI: 10.3928/00989134-20230512-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Lalipat Phianhasin
- Department of Medical Nursing Faculty of Nursing Mahidol University Bangkok, Thailand
- School of Nursing, University of Washington Seattle, Washington
| | - Basia Belza
- de Tornyay Center for Healthy Aging School of Nursing, University of Washington Seattle, Washington
| | - Eeeseung Byun
- Harborview Medical Center Endowed Professor in Critical Care School of Nursing, University of Washington Seattle, Washington
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Holmberg K, Bergkvist K, Adalsteinsdóttir S, Wengström Y, Lundh Hagelin C. Nursing as a balancing act in allogeneic hematopoietic cell transplantation -nurses' experiences through participation in workshops. Eur J Oncol Nurs 2023; 63:102300. [PMID: 36893569 DOI: 10.1016/j.ejon.2023.102300] [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: 06/30/2022] [Revised: 01/09/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE Registered nurses have a key role in supporting patients during the trajectory of allogeneic hematopoietic cell transplantation (allo-HCT). However, the circumstances for performing nursing are not previously outlined therefore the purpose of this study was to explore the conditions for nursing care in allo-HCT. METHOD An explorative design, inspired by Experienced based co-design was used to gather experiences, thoughts and visions of nursing care in allo-HCT by means of workshops. Thematic analysis was applied to analyse the data. RESULT An overarching theme that was defined from the data was nursing as a balancing act and illustrating conditions for performing nursing in a highly medical-technical environment. The theme included three sub-themes: Fragmented care vs holistic care outlining how the holistic approach to care disappeared when the care became fragmented; Proximity vs distance illuminating the balance between seeing the patient as an independent person despite illness and the need for support; Teamwork vs stand-alone demonstrating the difficulties inherent in adapting to both teamwork and independence in nursing. CONCLUSION This study shows that the conditions for RNs and nursing care in allo-HCT care is to balance tasks and approach towards the patient and themselves. RNs must weigh and balance what is most important in the moment and where something else often has to be put aside. It is difficult for RNs to find the time to plan each patient's care and to support the patient in the way they see as most optimal to prepare for discharge, self-care and rehabilitation.
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Affiliation(s)
- Katarina Holmberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; Department of Nursing, Sophiahemmet University, Stockholm, Sweden.
| | - Karin Bergkvist
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; Department of Nursing, Sophiahemmet University, Stockholm, Sweden
| | | | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; Karolinska Comprehensive Cancer Centre, Karolinska University Hospital, Stockholm, Sweden; Cancer Theme, Breast Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Carina Lundh Hagelin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
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Lindberg E, Fridh I. Postgraduate nursing students' experiences of simulation training and reflection in end-of-life communication with intensive care patients and their families. Nurs Health Sci 2021; 23:852-861. [PMID: 34436818 DOI: 10.1111/nhs.12873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/07/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022]
Abstract
Losing a loved one in the intensive care unit relates to a risk of developing stress and complicated grief. Education in intensive care nursing should cover end-of-life care, and the use of simulation in nursing education is a powerful instrument to develop confidence in end-of-life care. The aim of this study was to explore postgraduate nursing students' experiences with simulation training in end-of-life communication with intensive care patients and their families. Twenty-nine students answered a questionnaire and nine students participated in an interview. Analyses were conducted according to the principles of phenomenography. The result is presented in four categories including the following: the design of the scenario affects learning, uncertainty overshadows learning, intertwining theory and practice contributes to learning, and learning to encounter existential dimensions. The conclusion is that high-fidelity simulation training contributes toward preparing students to be attuned to what it can be like to be a family member in this situation. The scenarios contributed toward preparing the students to engage in end-of-life conversations during clinical placements.
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Affiliation(s)
- Elisabeth Lindberg
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Vester LB, Holm A, Dreyer P. Patients' and relatives' experiences of post-ICU everyday life: A qualitative study. Nurs Crit Care 2021; 27:392-400. [PMID: 34258842 DOI: 10.1111/nicc.12682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND As advancements in intensive care treatment have resulted in decreased mortality rates, more attention has been given to the experience of life after critical illness. Despite an increase in literature describing the physical, psychological, and cognitive health problems arising after critical illness, there is a shortage of research exploring the lifeworld of patients and relatives, including its internal and external interplay in everyday life. Addressing this is essential for gaining insights into the experience of everyday life and recovery after critical illness. AIMS AND OBJECTIVES To explore patients' and relatives' experiences of everyday life after critical illness. DESIGN Data were collected using semi-structured interviews with 7 relatives and 12 patients. Interviews were audiotaped and transcribed verbatim. METHODS Drawing on the phenomenological-hermeneutic tradition, data were analysed using Ricoeur's theory of interpretation, as described by Dreyer and Pedersen. FINDINGS The lifeworld of everyday life was disclosed in the theme "Finding oneself after critical illness," described as an overall comprehensive understanding. This theme was divided into the subthemes (a) redefining the self, (b) reintegrating with family, and (c) resuming everyday life, which followed the trajectory of the three phases: the known past, the uncertain present, and the unknown future. CONCLUSION Critical illness and physical, psychological, and cognitive health problems create new and emerging difficulties in patients' and relatives' experiences of everyday life after intensive care. These experiences affect their understanding of themselves, their families, and their ability to resume pre-intensive care unit everyday life. IMPLICATIONS FOR PRACTICE The study underlines the need to supplement the affirmed domains in post-intensive care syndrome with a social domain to enhance family-centred care within the intensive care unit and across sectoral borders. Additionally, it highlights the need to develop rehabilitation strategies aimed at patients' and relatives' multifactorial health problems.
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Affiliation(s)
| | - Anna Holm
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | - Pia Dreyer
- Institute of Public Health, Section of Nursing, Aarhus University, Aarhus C, Denmark.,Department of Intensiv Care, Aarhus University Hospital, Aarhus N, Denmark.,Bergen University, Bergen, Norway
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Olofsson J, Rämgård M, Sjögren-Forss K, Bramhagen AC. Older migrants' experience of existential loneliness. Nurs Ethics 2021; 28:1183-1193. [PMID: 33926317 PMCID: PMC8640269 DOI: 10.1177/0969733021994167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age. Aim: This study explored older migrants’ experience of existential loneliness. Research design: Qualitative study. Participants and research context: Data were collected through interviews (n = 15) with older (>65) migrants’ in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data. Ethical considerations: The study was conducted in accordance with the principles of research ethics. Findings: The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country. Discussion: Ethical reflection and knowledge about how older migrants’ life story can lead to experiencing existential loneliness, could be of use in care for older migrants’. Conclusion: This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country.
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Værland IE. Existential challenges due to severe pre-eclampsia when becoming parents. Midwifery 2021; 97:102967. [PMID: 33721573 DOI: 10.1016/j.midw.2021.102967] [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: 10/07/2020] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To deepen the understanding of parents' existential challenges and experiences when having a premature infant due to the mother's pre-eclampsia. DESIGN Two empirical studies based on reflective lifeworld research (RLR), were conducted to investigate parents' experiences of having a premature infant due to mother's pre-eclampsia. A further abstraction was possible. The two essences were synthesised into a general structure. Then, a philosophical examination of the existential issues was done using Karl Jaspers' concept of limit situation and health theory outlined by Dahlberg and Segesten. SETTING Maternity ward and neonatal intensive care unit. PARTICIPANTS Nine mothers and six fathers. FINDINGS The findings revealed the experiences of a vulnerable group of parents in the maternity ward and in the neonatal intensive care unit (NICU). The parents faced a paradoxical experience. They experienced mothers' severe illness and in some cases accompanied by the possibility of death, at the same time they experienced the joy of becoming parents. The premature birth and the mother's severe symptoms revealed the intertwinement of biological and existential features. Pre-eclampsia restricted the mothers from fulfilling the major project in their lives: to become real mothers. These experiences were elucidated by the concept of limit situations as suffering, struggle, death, and paradoxes of life as well as the health theory with its biological and existential dimensions. KEY CONCLUSION Some parents experienced closeness to death and the beginning of life as almost intertwined. These two fundamental facets of life are connected to existential features and challenges. The study also underlined the antinomies of life; suffering and facing severe illness that could cost both the mother's and infant's lives, and at the same time feeling the happiness of becoming parents. IMPLICATIONS FOR PRACTICE Health professionals should know how these experiences affect parents. They should be sensitive when approaching mothers and fathers in such situations. The families' vulnerability must be considered within the physical space of health services. If the parents needs to talk, time and staff should be available to meet their needs.
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Affiliation(s)
- Inger Emilie Værland
- Nursing and Health Care Research Group, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.
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Lundvall M, Hörberg U, Palmér L, Carlsson G, Lindberg E. Young men's experiences of living with existential concerns: "living close to a bottomless darkness". Int J Qual Stud Health Well-being 2020; 15:1810947. [PMID: 32854600 PMCID: PMC7482899 DOI: 10.1080/17482631.2020.1810947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction Young men may struggle in life with challenges of various concerns about their identity and who they want to be in life. Many health issues arise from social norms and wider societal determinations and for today’s young men, following such norms poses a risk of losing oneself. An essential part of health are connected to the existential dimensions in life and concerns who you are, and how well you know and understand yourself. However; little is known about what it means for young men to live a life with existential concerns. Purpose and method The purpose of this phenomenological study, based on reflective lifeworld research (RLR), is to describe young men’s experiences of living with existential concerns for which they have sought support. Eight lifeworld interviews were conducted. Results The results essentially show that young men living with existential concerns describe their situations as living close to a bottomless darkness. This is further described according to four constituents: enduring everyday life, striving for a solution, hearing an inner self-critical voice, and wearing a hard shell. Conclusion We conclude that strengthening young men’s health processes requires healthcare professionals to create an atmosphere where young men feel safe talking about existential concerns without feeling exposed and vulnerable.
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Affiliation(s)
- Maria Lundvall
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås , Borås, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Linnaeus University , Växjö, Sweden
| | - Lina Palmér
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås , Borås, Sweden
| | - Gunilla Carlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås , Borås, Sweden
| | - Elisabeth Lindberg
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås , Borås, Sweden
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Gullick J, West S. Heideggerian hermeneutic phenomenology as method: modelling analysis through a meta-synthesis of articles on Being-towards-death. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:87-105. [PMID: 31264089 DOI: 10.1007/s11019-019-09911-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While the richness of Heideggerian philosophy is attractive as a healthcare research framework, its density means authors rarely utilise its fullest possibilities as an hermeneutic analytic structure. This article aims to clarify Heideggerian hermeneutic analysis by taking one discrete element of Heideggerian philosophy (Being-towards-death), and using it's clearly defined structure to conduct a meta-synthesis of Heideggerian phenomenological studies on the experience of living with a potentially life-limiting illness. The findings richly illustrate Heidegger's philosophy that there is either an inauthentic positioning towards death, or an authentic positioning towards death with a proposition that (1) death is certain; (2) death is indefinite; (3) death is non-relational; and (4) death is not-to-be-outstripped. None of the 29 included studies on the experience of a confrontation with death fully utilised this framework, despite claiming a grounding in Heideggerian thought. This demonstrates the value in modelling how Heideggerian existential structures can be used proactively as analytical 'hooks' for data in research claiming a basis in this philosophy and/or method. By modelling the potential application of an important Heideggerian philosophical construct to published qualitative data, this meta-synthesis has revealed new domains and more nuanced understandings of the temporal structure of Being-towards-death. Such an approach helps to more fully unveil the existential concerns of people at the core of interpretative phenomenological enquiry and may provide a blueprint to map either primary or synthesised data to other key ontological existentials.
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Affiliation(s)
- Janice Gullick
- A4:32, MO2, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- International Institute of Qualitative Methods, University of Alberta, Edmonton, AB, Canada.
| | - Sandra West
- A5:11, MO2, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Razban F, Mehdipour-Rabori R, Rayyani M, Mangolian Shahrbabaki P. Meeting death and embracing existential loneliness: A cancer patient's experience of being the sole author of his life. DEATH STUDIES 2020; 46:208-223. [PMID: 32048554 DOI: 10.1080/07481187.2020.1725932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Facing the truth of death in silence instead of fearing and denying it enables people to regain their freedom. This qualitative case study aimed to illuminate the meaning of a single person's experience of confronting death and living with cancer. The transcripts of unstructured interviews were analyzed using the hermeneutic phenomenological method. Data analysis led to extraction of four themes including "Confronting death, meeting nonbeing and longing for being", "Embracing existential loneliness, responsibility and freedom", "Taking over the mind, living mindfully, a meaningful life", and "Flourishing authentic self-love, moving in the path of caring and healing the self".
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Affiliation(s)
- Farideh Razban
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Roghayeh Mehdipour-Rabori
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Rayyani
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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Sundström M, Edberg AK, Rämgård M, Blomqvist K. Encountering existential loneliness among older people: perspectives of health care professionals. Int J Qual Stud Health Well-being 2018; 13:1474673. [PMID: 29869590 PMCID: PMC5990949 DOI: 10.1080/17482631.2018.1474673] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Existential loneliness is part of being human that is little understood in health care, but, to provide good care to their older patients, professionals need to be able to meet their existential concerns. The aim of this study was to explore health care professionals' experiences of their encounters with older people they perceive to experience existential loneliness. METHOD We conducted 11 focus groups with 61 health professionals working in home care, nursing home care, palliative care, primary care, hospital care, or pre-hospital care. Our deductive-inductive analytical approach used a theoretical framework based on the work of Emmy van Deurzen in the deductive phase and an interpretative approach in the inductive phase. RESULTS The results show that professionals perceived existential loneliness to appear in various forms associated with barriers in their encounters, such as the older people's bodily limitations, demands and needs perceived as insatiable, personal shield of privacy, or fear and difficulty in encountering existential issues. CONCLUSION Encountering existential loneliness affected the professionals and their feelings in various ways, but they generally found the experience both challenging and meaningful.
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Affiliation(s)
- Malin Sundström
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, SWEDEN
- Faculty of Health and Society, Malmö University, Malmö, SWEDEN
| | - Anna-Karin Edberg
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, SWEDEN
| | | | - Kerstin Blomqvist
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, SWEDEN
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13
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Cummings R. Recognition Theory in Nurse/Patient Relationships: The contribution of Gillian Rose. Nurs Philos 2018; 19:e12220. [PMID: 30259637 DOI: 10.1111/nup.12220] [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: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022]
Abstract
Recognition theory attempts to conceptualize interpersonal relationships and their normative political implications. British social philosopher Gillian Rose developed her own version of recognition rooted in the work of Georg Hegel. This article applies Rose's theory of recognition to care, arguing that its emphasis on lack of identity, the dynamic process of recognition and the existential risks involved accurately describes the relationship between nurse and patient. Rose's version is compared to both contemporary notions of the interpersonal in healthcare literature, other forms of recognition theory and Emmanuel Levinas's vision of intersubjective relationships, a traditional philosophical basis for nursing care. In each case, I will argue that Rosean recognition is a fuller, more complex and ultimately more satisfying view of the relationships involved.
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Affiliation(s)
- Rachel Cummings
- Department of Sociology, Goldsmiths, University of London, London, UK
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Bolmsjö I, Tengland PA, Rämgård M. Existential loneliness: An attempt at an analysis of the concept and the phenomenon. Nurs Ethics 2018; 26:1310-1325. [DOI: 10.1177/0969733017748480] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: According to ethical guidelines, healthcare professionals should be able to provide care that allows for the patients’ values, customs and beliefs, and the existential issues that are communicated through them. One widely discussed issue is existential loneliness. However, much of the debate dealing with existential loneliness concludes that both the phenomenon and the concept are quite vague. Aim: To clarify what constitutes existential loneliness, and to describe its lived experiences. A further aim was to provide a definition of existential loneliness that can function as a tool for identifying the phenomenon and for differentiating it from other kinds of loneliness. Method: A literature review including theoretical and empirical studies. Different search strategies were used to gather the articles included in the study. The analysis of the empirical studies had an interpretative approach. The articles were also analysed with the aim of providing a definition of existential loneliness. This was done by means of criteria such as language, uniqueness, theory and usefulness. This study is not empirical and does therefore not require an ethics review. Results: The analysis resulted in two main characteristics. The first one was perceiving oneself as inherently separated (disconnected) from others and from the universe. The second one brings out emotional aspects of EL, such as isolation, alienation, emptiness and a feeling of being abandoned. The empirical findings were divided into two categories: experiences of EL and circumstances in which EL arises. A definition of EL is also suggested, based on the two main characteristics identified. Conclusion: In order to meet patients’ needs, it is an ethical duty for healthcare staff to be able to recognise experiences of EL, that is, to communicate with the patients about these experiences in an appropriate manner. This in turn demands knowledge about existential issues and skills to deal with them.
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Nilsen P, Wallerstedt B, Behm L, Ahlström G. Towards evidence-based palliative care in nursing homes in Sweden: a qualitative study informed by the organizational readiness to change theory. Implement Sci 2018; 13:1. [PMID: 29301543 PMCID: PMC5753464 DOI: 10.1186/s13012-017-0699-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/13/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Sweden has a policy of supporting older people to live a normal life at home for as long as possible. Therefore, it is often the oldest, most frail people who move into nursing homes. Nursing home staff are expected to meet the existential needs of the residents, yet conversations about death and dying tend to cause emotional strain. This study explores organizational readiness to implement palliative care based on evidence-based guidelines in nursing homes in Sweden. The aim was to identify barriers and facilitators to implementing evidence-based palliative care in nursing homes. METHODS Interviews were carried out with 20 managers from 20 nursing homes in two municipalities who had participated along with staff members in seminars aimed at conveying knowledge and skills of relevance for providing evidence-based palliative care. Two managers responsible for all elderly care in each municipality were also interviewed. The questions were informed by the theory of Organizational Readiness for Change (ORC). ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care. RESULTS Analysis of the data yielded ten factors (i.e., sub-categories) acting as facilitators and/or barriers. Four factors constituted barriers: the staff's beliefs in their capabilities to face dying residents, their attitudes to changes at work as well as the resources and time required. Five factors functioned as either facilitators or barriers because there was considerable variation with regard to the staff's competence and confidence, motivation, and attitudes to work in general, as well as the managers' plans and decisional latitude concerning efforts to develop evidence-based palliative care. Leadership was a facilitator to implementing evidence-based palliative care. CONCLUSIONS There is a limited organizational readiness to develop evidence-based palliative care as a result of variation in the nursing home staff's change efficacy and change commitment as well as restrictions in many contextual conditions. There are considerable individual- and organizational-level challenges to achieving evidence-based palliative care in this setting. The educational intervention represents one of many steps towards developing a culture conducive to evidence-based nursing home palliative care.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden.
| | - Birgitta Wallerstedt
- Department of Health and Care Sciences, Linnaeus University, SE-392 81, Kalmar, Sweden
| | - Lina Behm
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, SE-221 00, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, SE-221 00, Lund, Sweden
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Vaerland IE, Vevatne K, Brinchmann BS. Mothers' experiences of having a premature infant due to pre-eclampsia. Scand J Caring Sci 2017; 32:527-534. [DOI: 10.1111/scs.12476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 04/05/2017] [Indexed: 12/17/2022]
Affiliation(s)
| | - Kari Vevatne
- Department of Health; University of Stavanger; Stavanger Norway
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17
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Larsen JL, Hall EO, Jacobsen S, Birkelund R. Being in a standstill-of-life: women's experience of being diagnosed with systemic lupus erythematosus: a hermeneutic-phenomenological study. Scand J Caring Sci 2017; 32:654-662. [DOI: 10.1111/scs.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/03/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Janni Lisander Larsen
- Section of Nursing; Department of Public Health; Aarhus University; Aarhus Denmark
- Copenhagen Lupus and Vasculitis Clinic; Rheumatology and Spine Diseases Centre; Rigshospitalet; Copenhagen Denmark
| | - Elisabeth O.C. Hall
- Section of Nursing; Department of Public Health; Aarhus University; Aarhus Denmark
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic; Rheumatology and Spine Diseases Centre; Rigshospitalet; Copenhagen Denmark
| | - Regner Birkelund
- Institute of Regional Health Research; University of Southern Denmark & Lillebaelt Hospital; Vejle Denmark
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18
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Tornøe KA, Danbolt LJ, Kvigne K, Sørlie V. The challenge of consolation: nurses' experiences with spiritual and existential care for the dying-a phenomenological hermeneutical study. BMC Nurs 2015; 14:62. [PMID: 26609281 PMCID: PMC4658768 DOI: 10.1186/s12912-015-0114-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A majority of people in Western Europe and the USA die in hospitals. Spiritual and existential care is seen to be an integral component of holistic, compassionate and comprehensive palliative care. Yet, several studies show that many nurses are anxious and uncertain about engaging in spiritual and existential care for the dying. The aim of this study is to describe nurses' experiences with spiritual and existential care for dying patients in a general hospital. METHODS Individual narrative interviews were conducted with nurses in a medical and oncological ward. Data were analyzed using a phenomenological hermeneutical method. RESULTS The nurses felt that it was challenging to uncover dying patients' spiritual and existential suffering, because it usually emerged as elusive entanglements of physical, emotional, relational, spiritual and existential pain. The nurses' spiritual and existential care interventions were aimed at facilitating a peaceful and harmonious death. The nurses strove to help patients accept dying, settle practical affairs and achieve reconciliation with their past, their loved ones and with God. The nurses experienced that they had been able to convey consolation when they had managed to help patients to find peace and reconciliation in the final stages of dying. This was experienced as rewarding and fulfilling. The nurses experienced that it was emotionally challenging to be unable to relieve dying patients' spiritual and existential anguish, because it activated feelings of professional helplessness and shortcomings. CONCLUSIONS Although spiritual and existential suffering at the end of life cannot be totally alleviated, nurses may ease some of the existential and spiritual loneliness of dying by standing with their patients in their suffering. Further research (qualitative as well as quantitative) is needed to uncover how nurses provide spiritual and existential care for dying patients in everyday practice. Such research is an important and valuable knowledge supplement to theoretical studies in this field.
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Affiliation(s)
- Kirsten Anne Tornøe
- Lovisenberg Diaconal University College, Lovisenberg gt. 15B 0456, Oslo, Norway ; MF, Norwegian School of Theology, Gydas vei 4, Majorstuen 0302, P.O. Box 5144, Oslo, Norway ; Religionspsykologisk Senter (Center for the Psychology of Religion) Innlandet Hospital, P.O. Box 68 2312, Ottestad, Norway
| | - Lars Johan Danbolt
- MF, Norwegian School of Theology, Gydas vei 4, Majorstuen 0302, P.O. Box 5144, Oslo, Norway ; Religionspsykologisk Senter (Center for the Psychology of Religion) Innlandet Hospital, P.O. Box 68 2312, Ottestad, Norway
| | - Kari Kvigne
- Department of nursing, Faculty of Public Health, Hedmark University College, P.O. Box 400 2418, Elverum, Norway ; Department of nursing Nesna University College, Nesna, 8700 Norway
| | - Venke Sørlie
- Lovisenberg Diaconal University College, Lovisenberg gt. 15B 0456, Oslo, Norway
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Tornøe K, Danbolt LJ, Kvigne K, Sørlie V. A mobile hospice nurse teaching team's experience: training care workers in spiritual and existential care for the dying - a qualitative study. BMC Palliat Care 2015; 14:43. [PMID: 26385472 PMCID: PMC4574396 DOI: 10.1186/s12904-015-0042-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/28/2015] [Indexed: 12/28/2022] Open
Abstract
Background Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients’ spiritual and existential suffering is therefore important. The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team’s experience with teaching and training care workers in spiritual and existential care for the dying in nursing homes and home care settings. Methods The team of expert hospice nurses participated in a focus group interview. Data were analyzed using a phenomenological hermeneutical method. Results The mobile teaching team taught care workers to identify spiritual and existential suffering, initiate existential and spiritual conversations and convey consolation through active presencing and silence. The team members transferred their personal spiritual and existential care knowledge through situated “bedside teaching” and reflective dialogues. “The mobile teaching team perceived that the care workers benefitted from the situated teaching because they observed that care workers became more courageous in addressing dying patients’ spiritual and existential suffering. Discussion Educational research supports these results. Studies show that efficient workplace teaching schemes allowexpert practitioners to teach staff to integrate several different knowledge forms and skills, applying a holisticknowledge approach. One of the features of workplace learning is that expert nurses are able to guide novices through the complexities of practice. Situated learning is therefore central for becoming proficient. Conclusions Situated bedside teaching provided by expert mobile hospice nurses may be an efficient way to develop care workers’ courage and competency to provide spiritual and existential end-of-life-care. Further research is recommended on the use of mobile expert nurse teaching teams to improve nursing competency in the primary health care sector.
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Affiliation(s)
- Kirsten Tornøe
- Lovisenberg Diaconal University College, Lovisenberg gt.15B, 0456, Oslo, Norway. .,MF, Norwegian School of Theology, Gydas vei 4, Majorstuen, P.O. Box 5144, 0302, Oslo, Norway. .,Religionspsykologisk Senter (Center for the Psychology of Religion), Innlandet Hospital, P.O. Box 68, 2312, Ottestad, Norway.
| | - Lars Johan Danbolt
- MF, Norwegian School of Theology, Gydas vei 4, Majorstuen, P.O. Box 5144, 0302, Oslo, Norway. .,Religionspsykologisk Senter (Center for the Psychology of Religion), Innlandet Hospital, P.O. Box 68, 2312, Ottestad, Norway.
| | - Kari Kvigne
- Department of Nursing, Faculty of Public Health, Hedmark University College, P.O. Box 400, 2418, Elverum, Norway. .,Department of Nursing, Nesna University College, Nesna, Norway.
| | - Venke Sørlie
- Lovisenberg Diaconal University College, Lovisenberg gt.15B, 0456, Oslo, Norway.
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