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Hadeei S. Development and Validation of a New Measurement Scale for Existential Loneliness. Assessment 2024; 31:1100-1113. [PMID: 37876135 DOI: 10.1177/10731911231204831] [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] [Indexed: 10/26/2023]
Abstract
This article deals with the development and initial validation of the Existential Loneliness Scale (ELS). An initial pool of 40 items, generated based on literature review, qualitative studies, and previously developed scales, was evaluated by the experts' judgment, so 30 items were retained and then administered to an Iranian sample of 433 youth and adult participants aged 20 to 85 years. Participants also completed other measures relevant for construct validity: Existential Loneliness Questionnaire (ELQ), De Jong Gierveld Loneliness Scale (DJGLS-6), Existential Anxiety Questionnaire (EAQ), Meaning in Life Questionnaire (MLQ), Beck Depression Inventory (BDI-13), and Satisfaction with Life Scale (SWLS). Exploratory factor analysis and parallel analysis showed strong evidence of unidimensionality. This result was also supported by confirmatory factor analysis test. Finally, 19 items were kept, which were free from DIF by gender and by marital status. The scale had high internal consistency (α = .95 and ω = .95) and adequate test-retest reliability with a 1-month interval (r = .74). Examination of the ELS' correlation with criterion measures indicated that the scale has good concurrent, discriminant, and convergent validity. Findings revealed the ELS as a reliable, valid, and suitable instrument to measure existential loneliness in the Iranian adult population.
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Carr S. A gradual separation from the world: commentary on a qualitative exploration of existential loneliness in old age. Br J Community Nurs 2023; 28:586-590. [PMID: 38032719 DOI: 10.12968/bjcn.2023.28.12.586] [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] [Indexed: 12/01/2023]
Abstract
AIMS AND METHODS Loneliness is a prevalent and significant issue. It has been identified as a particularly important physical and mental health risk for older people. This article critically explores and discusses a recent study that sought to qualitatively explore the lived experiences of existential loneliness in a large sample of older people living in retirement community contexts. FINDINGS The data pointed to complex, multilayered challenges, often brought about by ageing, that give rise to unique experiences of existential loneliness for many older people. CONCLUSIONS For clinical practitioners, understanding how older people experience existential loneliness is essential if we are to develop support mechanisms that compassionately and empathically respond to them.
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Affiliation(s)
- Sam Carr
- Department of Education and Centre for Death and Society, University of Bath, UK
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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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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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Jonasson LL, Bångsbo A, Billhult A, Wolmesjö M. Older adults' experiences of participation in daily activities in Swedish assisted living. BMC Geriatr 2023; 23:762. [PMID: 37990295 PMCID: PMC10662507 DOI: 10.1186/s12877-023-04484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND According to Swedish law, older adults in Sweden should be able to live a good, safe, and independent life with social and healthcare provided, based on their individual needs. In assisted living in Swedish eldercare the environment affects the older adults' ability to participate in decision-making and strengthens their ability to feel meaningfulness. The ability of staff working in social and healthcare to invite older adults to participate varies. It is important to examine how older adults perceive their situation, as caregivers in eldercare tend to focus on routine work and experience difficulties in meeting the individual needs of older adults. The aim of this study was to explore how older adults in assisted living experienced participation in daily activities. METHODS A qualitative interview study was conducted in two municipalities in the western part of Sweden. An exploratory and inductive design was used. Individual interviews were conducted with 11 older adults living in two different assisted living facilities. The data were analysed using thematic analysis. RESULTS The interviews resulted in three themes: Being involved, Sense of well-being, and Influenced by the context. The older adults' experiences of participation were interpreted as feelings of being involved in daily life activities, and how they felt involved in their own care and nursing. Participation created prerequisites for well-being. Sense of well-being could be related to feelings of security and social community. The organisation and work environment of the healthcare staff had a great impact on their ability to increase the participation of the older adults. The older adults were aware of the everyday work situation of the providers of social and healthcare and were Influenced by the context. DISCUSSION/CONCLUSION Important conditions for a good quality of life and participation for the older adults are to be treated with respect, receive information, and be able to choose. The older adults expressed several good ideas for improvements and a willingness to be involved in the development of the organisation at different levels. It is essential to invite older adults in assisted living to participate in the design of care and nursing.
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Affiliation(s)
- Lise-Lotte Jonasson
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Angela Bångsbo
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Annika Billhult
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Wolmesjö
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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McKenna-Plumley PE, Turner RN, Yang K, Groarke JM. "It's a feeling of complete disconnection": experiences of existential loneliness from youth to older adulthood. BMC Psychol 2023; 11:408. [PMID: 37990348 PMCID: PMC10664587 DOI: 10.1186/s40359-023-01452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Existential loneliness is a feeling which stems from a sense of fundamental separation from others and the world. Although commonly mentioned in the loneliness literature, there is relatively little empirical work on this construct, and existing work tends to focus on older and seriously ill individuals. The present study aimed to understand how people experience existential loneliness without specific constraints on precipitating factors like illness or age. METHODS A qualitative online survey collected data from 225 adults aged 16 to 72 years old. Participants were asked to write about their experiences of existential loneliness and how these experiences compared to non-existential loneliness. Data were analysed using reflexive thematic analysis. RESULTS Of 225 participants, 51% knew the meaning of "existential loneliness" upon accessing the survey and in total, 83% had experienced existential loneliness. 93% of these participants had also experienced loneliness that was not existential in nature. 175 participants provided qualitative data regarding their experiences of existential loneliness, from which four themes were identified: Existential loneliness is (1) A deeper form of loneliness, and (2) A feeling of deep disconnection, in which (3) Cognitive evaluations and negative emotions are central elements, and (4) Stress and mental health issues are perceived as relevant factors. CONCLUSIONS Existential loneliness is a deeply rooted and impactful form of loneliness which involves feelings of profound separateness. This aspect of loneliness is deserving of further attention. Future research directions are suggested.
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Affiliation(s)
- Phoebe E McKenna-Plumley
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK.
- Centre for Identity and Intergroup Relations, School of Psychology, Queen's University Belfast, Belfast, UK.
| | - Rhiannon N Turner
- Centre for Identity and Intergroup Relations, School of Psychology, Queen's University Belfast, Belfast, UK
| | - Keming Yang
- Department of Sociology, Durham University, Durham, UK
| | - Jenny M Groarke
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
- School of Psychology, University of Galway, Galway, Ireland
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Tarbi EC, Broden EG, Rosa WE, Hayden A, Morgan BE. Existential Care in Daily Nursing Practice. Am J Nurs 2023; 123:42-48. [PMID: 37732668 PMCID: PMC10805359 DOI: 10.1097/01.naj.0000979092.39243.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
ABSTRACT Relationship-centered palliative nursing during serious illness requires existential care. Yet, multilevel systemic barriers hinder nurses' ability to provide this care. The authors suggest ways to navigate these barriers, highlighting existential care priorities that nurses can attend to in their daily practice. These include 1) maintaining a strengths-based orientation, 2) taking a life course perspective, 3) grounding care firmly in relationships, and 4) responding moment to moment. They propose that by emphasizing existential care in palliative nursing, we can create a more compassionate and human-centered health system.
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Affiliation(s)
- Elise C Tarbi
- Elise C. Tarbi is an assistant professor in the Department of Nursing at the University of Vermont in Burlington. Elizabeth G. Broden is a fellow in the Yale National Clinician Scholars Program in New Haven, CT, and has received funding from a National Institutes of Health training grant (5T32HS017589) to the Yale School of Public Health. William E. Rosa is assistant attending behavioral scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City. Adam Hayden is an independent scholar and unaffiliated patient advocate. Brianna E. Morgan is a postdoctoral fellow in the Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Langone Health in New York City. Contact author: Elise C. Tarbi, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Reblin M, Iacob E, Tay DL, Li H, Hebdon MCT, Beck A, Donaldson G, Cloyes KG, Ellington L. Family Caregiver Reports of Their Own and Patient Symptoms in Cancer Home Hospice Approaching End-of-Life. Am J Hosp Palliat Care 2023; 40:508-516. [PMID: 35689339 PMCID: PMC9734284 DOI: 10.1177/10499091221108119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context: Family caregivers assume the primary responsibility of assessing and managing hospice cancer patient symptoms while simultaneously managing their own wellbeing and symptoms. Objectives: Describe caregivers' assessment of hospice cancer patient and their own symptoms during the last 60 days of patient life, and assess the relationship between patient and caregiver symptoms over time. Methods: Caregiver symptom report of self and cancer home hospice patient symptom data were collected via telephone in the final 60 days of patient life. Descriptive data on symptom severity and prevalence were summarized. Exploratory Factor Analysis was used to group individual symptoms. Factors representing patient symptoms, caregiver symptoms, and caregiver outlook were analyzed using mixed-effects analysis to determine relationships between factors and change in relationship between factors over time. Results: Data from 61 patient-caregiver dyads are presented. At least 1 day of moderate-to-severe symptoms were reported in the majority of dyads. Significant auto-regressive associations were found, namely previous factor scores for an individual positively predicted the next factor scores for that individual. Previous caregiver report of patient symptoms was also positively associated with the next report of caregiver symptoms; previous caregiver report of their own symptoms were negatively associated with their next report of patient symptoms. Patient and caregiver symptoms and caregiver outlook worsened over time and the relationship between patient and caregiver symptoms strengthened closer to death. Conclusion: Our findings may guide hospice care team responses to caregiver and patient symptoms to promote individual level and unit level functioning.
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Affiliation(s)
- Maija Reblin
- School of Medicine, University of Vermont, Burlington, VT, USA
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Djin L. Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Hui Li
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Anna Beck
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Gary Donaldson
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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De Vleminck A, Craenen L, Stevens J, Lemaigre V, Pype P, Deliens L, Pardon K. Emotional cues and concerns of patients with a life limiting, chronic illness during advance care planning conversations in general practice. PATIENT EDUCATION AND COUNSELING 2023; 107:107563. [PMID: 36428170 DOI: 10.1016/j.pec.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore a) to what extent patients with serious illness express emotional cues and concerns during advance care planning (ACP) conversations with their general practitioner (GP), b) the content of cues/concerns and c) GPs' responses to cues/concerns. METHODS Cues/concerns and GPs' responses in 20 conversations were coded using the Verona Codes (VR-CoDES and Verona Codes-P). A qualitative thematic analysis was used to identify overarching themes within the content of the cues/concerns. RESULTS A total of 216 cues/concerns were identified (range: 1-28; mean: 13) in 85% of conversations; with 85% of these being cues/implicit expressions of emotions. In 72% of responses, the GP provided space for the patient to elaborate on cues/concerns. The most common theme cues/concerns were expressed about was "the consequences of illness on quality of life and burdening others". CONCLUSION Emotions were mainly communicated implicitly as cues and the content varied greatly. The amount of cues/concerns expressed show that ACP can evoke many emotions. PRACTICE IMPLICATIONS GPs should be attentive to implicit expressions of emotions as these provide opportunities to engage patients in tailored ACP conversations. As patients expressed many cues/concerns, GPs are recommended to have recurrent conversations with patients and actively ask about diverse ACP topics.
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Affiliation(s)
- Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium.
| | - Lara Craenen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium
| | - Julie Stevens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium; Department of Public Health and Primary Care, Ghent University, Belgium
| | - Valentine Lemaigre
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium
| | - Peter Pype
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium; Department of Public Health and Primary Care, Ghent University, Belgium
| | - Koen Pardon
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium
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Hanna JR, McConnell T, Harrison C, Patynowska KA, Finucane AM, Hudson B, Paradine S, McCullagh A, Reid J. 'There's something about admitting that you are lonely' - prevalence, impact and solutions to loneliness in terminal illness: An explanatory sequential multi-methods study. Palliat Med 2022; 36:1483-1492. [PMID: 36081273 PMCID: PMC9749015 DOI: 10.1177/02692163221122269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Loneliness is a prevalent societal issue and can impact on a person's physical and mental health. It is unclear how loneliness impacts on end of life experiences or how such feelings can be alleviated. AIM To explore the perceived prevalence, impact and possible solutions to loneliness among people who are terminally ill and their carers in Northern Ireland through the lens of health and social care professionals. DESIGN An explanatory multi-method study. SETTING/PARTICIPANTS An online survey (n = 68, response rate 30%) followed by three online focus groups with palliative and end of life care health and social care professionals (n = 14). Data were analysed using descriptive statistics and thematic analysis. RESULTS Loneliness was perceived by professionals as highly prevalent for people with a terminal illness (92.6%) and their carers (86.8%). Loneliness was considered a taboo subject and impacts on symptoms including pain and breathlessness and overall wellbeing at end of life. Social support was viewed as central towards alleviating feelings of loneliness and promoting connectedness at end of life. Four themes were identified: (1) the stigma of loneliness, (2) COVID-19: The loneliness pandemic (3) impact of loneliness across physical and mental health domains and (4) the power of social networks. CONCLUSION There is a need for greater investment for social support initiatives to tackle experiences of loneliness at end of life. These services must be co-produced with people impacted by terminal illness to ensure they meet the needs of this population.
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Sjöberg M, Rasmussen BH, Edberg AK, Beck I. Existential aspects documented in older people’s patient records in the context of specialized palliative care: a retrospective review. BMC Health Serv Res 2022; 22:1356. [PMID: 36384554 PMCID: PMC9667671 DOI: 10.1186/s12913-022-08753-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Documentation of older people’s end-of-life care should cover the care given and provide an overview of their entire situation. Older people approaching the end of life often have complex symptoms, live with bodily losses, and face an unknown future in which existential aspects come to the forefront. Knowledge of the existential aspects recorded in palliative care documentation is sparse and merits improvement. This knowledge is relevant to the development of more holistic documentation and is necessary in order to promote reflection on and discussion of documentation of the sensitive existential considerations arising in palliative care. The aim of this study was to describe the documentation of existential aspects in the patient records of older people receiving specialized palliative care. Methods Data were obtained from a retrospective review of the free-text notes in 84 records of randomly selected patients aged ≥75 years enrolled in specialized palliative care units who died in 2017. The notes were analysed using an inductive qualitative content analysis. Results The notes documented existential aspects in terms of connotations of well-being and ill-being. Documented existential aspects were related to the patients’ autonomy concerning loss of freedom and self-determination, social connectedness concerning loneliness and communion, emotional state concerning anxiety and inner peace, and state of being concerning despair and hope. The notes on existential aspects were, however, not recorded in a structured way and no care plans related to existential aspects were found. Conclusions Existential aspects concerning both ill-being and well-being were sparsely and unsystematically documented in older people’s patient records, but when notes were extracted from these records and analysed, patterns became evident. Existential aspects form an important basis for delivering person-centred palliative care. There is a need to develop structured documentation concerning existential aspects; otherwise, patients’ thoughts and concerns may remain unknown to healthcare professionals.
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Voultsos P, Tsompanian A, Deligianni M, Tsamadou E, Tsaroucha AK. A qualitative study of nursing practitioners' experiences with COVID-19 patients dying alone in Greece. Front Public Health 2022; 10:981780. [PMID: 36339201 PMCID: PMC9634155 DOI: 10.3389/fpubh.2022.981780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
Background In Greece, there is still limited research on death in isolation due to COVID-19. This deserves attention because of the recent financial crisis, which profoundly impacted public health, and the high relevance of the Hippocratic tradition to the moral values of clinical practice. Methods A prospective qualitative study using in-depth interviews with 15 frontline nursing practitioners working in a COVID-19 ward or intensive care unit (ICU) was conducted from July 2021 to December 2021. Results The inability of family members to say a final goodbye before, during, or after death by performing proper mourning rituals is extremely inhuman and profoundly impacts the mental health status of patients, family members, and nursing practitioners. Patients and their family members strongly desire to see each other. Epidemiology, liability, and proper nursing performance emerged as reasons for the enforced strict visitation restrictions. Participants emphasized that visitations should be allowed on an individual basis and highlighted the need for the effective use of remote communication technology, which, however, does not substitute for in-person contact. Importantly, physicians allowed "clandestine" visits on an individual basis. Nursing practitioners had a strong empathic attitude toward both patients and their families, and a strong willingness to provide holistic care and pay respect to dead bodies. However, they also experienced moral distress. Witnessing heartbreaking scenes with patients and/or their families causes nursing practitioners to experience intense psychological distress, which affects their family life rather than nursing performance. Ultimately, there was a shift from a patient-centered care model to a population-centered care model. Furthermore, we identified a range of policy- and culture-related factors that exaggerate the negative consequences of dying alone of COVID-19. Conclusion These results reinforce the existing literature on several fronts. However, we identified some nuances related to political decisions and, most importantly, convictions that are deeply rooted in Greek culture. These findings are of great importance in planning tailored interventions to mitigate the problem of interest and have implications for other similar national contexts.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Tsompanian
- Postgraduate Program on Bioethics, Laboratory of Bioethics and Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Deligianni
- Laboratory of Forensic Medicine & Toxicology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eftychia Tsamadou
- Laboratory of Forensic Medicine & Toxicology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra K. Tsaroucha
- Postgraduate Program on Bioethics, Laboratory of Bioethics and Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Wajid M, Rajkumar E, Romate J. Exploring the End-of-Life Experiences of Advanced Cancer Patients from India. Health Psychol Res 2022. [DOI: 10.52965/001c.36272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Paying attention to the socio-cultural characteristics of advanced cancer patients as they pass through the final stages of life can help healthcare professionals and mental health professionals assess the end-of-life experiences of terminally ill patients better. A comprehensive study of this population in the Indian context is helpful to devise individualized end-of-life care that aligns with their preferences and focuses on their comfort. Method The dataset comprised information-rich cases of 10 advanced cancer patients from Bangalore, India, selected using the purposive sampling method. The semi-structured interviews with the participants were audio-recorded, transcribed, and translated. Identification of patterns and commonalities in the dataset helped generate codes. The codes were used to narrow down to overarching themes. Results The standout themes were outlook on life, unfulfilled goals, end-of-life expectations, and death anxieties and attitudes to impending death. Significance of Results The study highlights the psychosocial and cultural needs of the patients in end-of-life care. How advanced cancer patients long for psychological care from mental health professionals and empathy from their loved ones. This study argues for renewed attention on the socio-cultural characteristics of terminally ill patients to enhance individualized care through culturally-competent interventions.
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Yun RC, Fardghassemi S, Joffe H. Thinking too much: How young people experience rumination in the context of loneliness. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2022. [DOI: 10.1002/casp.2635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rumi Chloe Yun
- Division of Psychology and Language Sciences University College London London UK
| | - Sam Fardghassemi
- Division of Psychology and Language Sciences University College London London UK
| | - Hélène Joffe
- Division of Psychology and Language Sciences University College London London UK
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Akter S, Sarker M, Hossain P, Ahmad N, Zaman S. Solidarity and suffering: enrolled terminal patients’ and their caregiver’s experiences of the community-based palliative care programme in an urban slum of Bangladesh. Palliat Care Soc Pract 2022; 16:26323524221095104. [PMID: 35548025 PMCID: PMC9081719 DOI: 10.1177/26323524221095104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Palliative care has been recognised as a global health challenge. Although accessibility has increased, there is little recognition of the importance of palliative care in low- and middle-income countries. In Bangladesh, institutional palliative care is not accessible due to a lack of awareness, financial constraints, and fewer facilities. Hence, there needs to be a better understanding of providing and improving existing community-based palliative care. For this, it is essential to understand the experiences of patients and their caregivers who require palliative care. With this aim, this study explores the experiences of palliative patients and their primary caregivers enrolled in a palliative care project, ‘Momotamoy Korail’ run by Bangabandhu Sheikh Mujib Medical University in an urban slum, Dhaka. Methods: This research is a part of a larger qualitative study that relied on a focused ethnographic approach. For this study, we used 19 in-depth interviews following a semi-structured guideline with the palliative care patients and their primary caregivers enrolled in the community-based palliative care project. Results: Mostly women (wives and daughters-in-law) are the primary caregivers in a family. Therefore, male patients are more likely to receive family care than female patients. Both male and female patients expressed the desire for a death free of suffering. All patients felt lonely and socially abandoned with a perception of being a burden to their families. Despite the diversity in physical, social, psychological, and financial suffering, patients and caregivers were optimistic towards a healthy life free of illness. All respondents were satisfied with the care they received from the palliative care assistants, which provide them hope and dignity for life. Conclusion: Experiences of the respondents can improve the quality of the existing community-based palliative care services and add great value to the discipline of palliative care in public health. The findings provided an understanding of what would be required to extend community-based palliative care to other healthcare settings. More awareness through community mobilisation about the need for and benefit of palliative care is needed to make it sustainable.
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Affiliation(s)
- Sayema Akter
- Research Fellow, BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka 1213, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Heidelberg University, Heidelberg, Germany
| | - Puspita Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Health Research Methods, McMaster University, Hamilton, ON, Canada
| | | | - Shahaduz Zaman
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK
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15
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Chan WCH, Woo RKW, Kwok DKS, Yu CTK, Chiu LMH. Impact of COVID-19 on Mental Health of Palliative Care Professionals and Services: A Mixed-Methods Survey Study. Am J Hosp Palliat Care 2021; 39:1227-1235. [PMID: 34904449 PMCID: PMC9458472 DOI: 10.1177/10499091211057043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction This study aimed to examine the mental health of palliative care professionals in Hong Kong during the COVID-19 pandemic, the relationship of mental health with socio-demographic factors, and the impact of the pandemic on palliative care services. Methods A total of 142 palliative care professionals in Hong Kong participated in an online survey. The questionnaire includes measurements on depression, anxiety, perceived stress, post-traumatic stress, professional quality of life, items that measure the effect of COVID-19 on palliative care services, and one open-ended question for describing how the services were affected. Descriptive and multivariate regression analyses were conducted. Quantitative and qualitative data about the impact of COVID-19 on palliative care services were analyzed and triangulated using a mixed-methods approach. Results Up to 82%, 43%, and 42% of the participants felt moderately to highly stressed, anxious, and depressed, respectively, during the pandemic. Younger participants tended to have poorer mental health and professional quality of life. Around 82% felt stressed when communicating with patients and family members under the no-visiting policy during the pandemic. More than three-quarters of participants showed lack of confidence in the anti-epidemic policy of the government. Qualitative findings identified 3 themes affecting the provision of palliative care: 1. the tightening of restrictions on visitors; 2. the limited provision of services; and 3. staff deployment. Conclusions Appropriate responses are required to give extra support to palliative care professionals during the pandemic and facilitate their coping with the impact of COVID-19 on the provision of palliative care.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, 26451The Chinese University of Hong Kong, Hong Kong
| | - Raymond Kam Wing Woo
- Palliative Care Unit, Department of Medicine & Geriatrics, 518774Caritas Medical Centre, Hong Kong
| | - Denis Ka-Shaw Kwok
- Department of Social Work, 26451The Chinese University of Hong Kong, Hong Kong
| | - Clare Tsz Kiu Yu
- Division of Psychiatry, 4919The University of College London, London, UK
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16
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Wallin V, Mattsson E, Omerov P, Klarare A. Caring for patients with eating deficiencies in palliative care-Registered nurses' experiences: A qualitative study. J Clin Nurs 2021; 31:3165-3177. [PMID: 34850477 DOI: 10.1111/jocn.16149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES The aim was to explore RNs' experiences of caring for patients with eating deficiencies in palliative care. BACKGROUND Food and mealtimes are fundamental aspects for wellbeing and social interactions. The worldwide trajectory of ageing populations may result in increased need for palliative care. Everyday life with chronic life limiting illness and eating deficiencies is challenging for patients and families. RNs are key care providers at end-of-life. DESIGN A qualitative study with an inductive approach was used. METHODS Nineteen experienced RNs in palliative care were interviewed through telephone; interviews were audio recorded and transcribed verbatim. Inductive qualitative content analysis was performed, and the COREQ checklist was used to guide proceedings. RESULTS The overarching theme, Supporting persons with eating deficiencies in-between palliative care and end-of-life care, is represented by three sub-themes: Easy to stick with doing, Just being, without doing, is hard and Letting go. Near end-of-life, eating symbolized social belonging and quality of life for RNs, whereas for patients and families, eating symbolized life. RNs tried practical solutions, however, not always according to patients' and families' preferences. CONCLUSIONS RNs were well prepared to tackle physical inconveniences and provide support, however, less prepared to encounter existential, psychological and social issues in relation to eating deficiencies. Although RNs stated that human beings stop eating when they are about to die, letting nature run its' course and facilitating patients' transition to end-of-life care was challenging. RELEVANCE TO CLINICAL PRACTICE Food and mealtimes represent fundamental aspects of human life and denote central parts in RNs clinical practice in palliative care. The findings can inspire development of a comprehensive palliative care approach to support patients and families. Structured reflection in relation to clinical practice may support and encourage RNs, caring for patients with eating deficiencies, in mastering both doing and being.
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Affiliation(s)
- Viktoria Wallin
- Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Pernilla Omerov
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anna Klarare
- Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
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Fee A, Hanna J, Hasson F. Pre-loss grief experiences of adults when someone important to them is at end-of-life: A qualitative systematic review. DEATH STUDIES 2021; 47:1-15. [PMID: 34751635 DOI: 10.1080/07481187.2021.1998935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pre-loss grief can be experienced by relatives before impending death; however, limited understanding exists about the impact of pre-loss grief on bereavement. This systematic review aimed to synthesize qualitative research evidence reporting adults' experiences of pre-loss grief within cancer care. Thirteen studies were selected, and three key themes identified. Findings indicate that relatives transitioned through lived experiences during end-stage cancer, and that meanings attached to these experiences influenced how they experienced pre-loss grief. Limited formal support was identified to navigate these experiences; however, context was seen as important, and skilled healthcare practitioners and physical environment were key to facilitating preparedness.
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Affiliation(s)
- Anne Fee
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
| | - Jeff Hanna
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
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18
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A Conceptual Review of Loneliness in Adults: Qualitative Evidence Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111522. [PMID: 34770035 PMCID: PMC8582800 DOI: 10.3390/ijerph182111522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022]
Abstract
The paper reports an evidence synthesis of how loneliness is conceptualised in qualitative studies in adults. Using PRISMA guidelines, our review evaluated exposure to or experiences of loneliness by adults (aged 16+) in any setting as outcomes, processes, or both. Our initial review included any qualitative or mixed-methods study, published or unpublished, in English, from 1945 to 2018, if it employed an identified theory or concept for understanding loneliness. The review was updated to include publications up to November 2020. We used a PEEST (Participants, Exposure, Evaluation, Study Design, Theory) inclusion criteria. Data extraction and quality assessment (CASP) were completed and cross-checked by a second reviewer. The Evidence of Reviews of Qualitative Research (CERQual) was used to evaluate confidence in the findings. We undertook a thematic synthesis using inductive methods for peer-reviewed papers. The evidence identified three types of distinct but overlapping conceptualisations of loneliness: social, emotional, and existential. We have high confidence in the evidence conceptualising social loneliness and moderate confidence in the evidence on emotional and existential loneliness. Our findings provide a more nuanced understanding of these diverse conceptualisations to inform more effective decision-making and intervention development to address the negative wellbeing impacts of loneliness.
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A gradual separation from the world: a qualitative exploration of existential loneliness in old age. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
This study sought to explore qualitatively experiences of existential loneliness (EL) in 80 older people living in retirement communities across the United Kingdom and Australia. Qualitative semi-structured interviews permitted in-depth exploration of issues such as biographical narrative, close relationships, loss, feelings of loneliness and retirement living. It was our intention to conduct a large-scale, deep-listening exercise that would provide further clues about EL in older people and the circumstances that give rise to such feelings. Data provided rich insight into older people's inner lives. Core themes identified loss of close attachments, lack of physical touch and intimacy, deterioration of health and body, and lack of an emotional language through which to express EL as central to older people's experiences. Furthermore, there was a suggestion that the move to retirement living was for many people inextricably connected to their experience of EL. Our data further support and extend the notion that EL can be thought of as a gradual sense of separation from the world and that ageing intensifies a myriad of social, emotional and physical circumstances that prompt its emergence. This sense of existential isolation need not be thought of as exclusive to those experiencing extreme frailty or who face death imminently – our data pointed to a clear and gradual emergence of EL throughout later life.
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Abstract
OBJECTIVE Providing care to a loved one with cancer places demands on caregivers that result in changes to their daily routines and disruptions to their social relationships that then contribute to loneliness. Though caregivers' psychosocial challenges have been well studied, loneliness - a determinant of health - has not been well studied in this population. This narrative review sought to describe the current evidence on loneliness among caregivers of cancer patients. We aimed to (1) define loneliness, (2) describe its prevalence, (3) describe the association between loneliness and health outcomes, (4) describe risks and consequences of loneliness among cancer caregivers, (5) identify ways to assess loneliness, and (6) recommend strategies to mitigate loneliness in this unique population. METHOD We used evidence from articles listed in PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, book chapters, and reports. Articles were reviewed for the following inclusion criteria: (1) published in English, (2) caregivers of cancer patients, (3) loneliness as a study variable, and (4) peer-reviewed with no restriction on the timeframe of publication. Caregivers were defined as relatives, friends, or partners who provide most of the care and support for someone with cancer. RESULTS Eighteen studies met inclusion criteria and were included in the analysis. Caregivers' experiences of loneliness can contribute to negative effects on one's social, emotional, and physical well-being. Social support interventions may not be sufficient to address this problem. Existing recommendations to mitigate loneliness include cognitive and psychological reframing, one-on-one and group therapy, befriending, resilience training, and technology-based interventions. SIGNIFICANCE OF RESULTS Limited attention to loneliness in cancer caregivers poses a twofold problem that impacts patient and caregiver outcomes. Interventions are critically needed to address loneliness as a determinant of health in caregivers, given their pivotal role in providing care and impacting health outcomes for people with cancer.
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21
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Österlind J, Henoch I. The 6S-model for person-centred palliative care: A theoretical framework. Nurs Philos 2021; 22:e12334. [PMID: 33089912 PMCID: PMC8243997 DOI: 10.1111/nup.12334] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022]
Abstract
Palliative care is provided at a certain timepoint, both in a person's life and in a societal context. What is considered to be a good death can therefore vary over time depending on prevailing social values and norms, and the person's own view and interpretation of life. This means that there are many interpretations of what a good death can actually mean for an individual. On a more general level, research in palliative care shows that individuals have basic common needs, for example physical, mental, social and spiritual well-being. Therefore, in today's pluralistic Western society, it becomes important that palliative care is person centred to enable individuals to receive, as far as can be achieved, care that promotes as good a life as possible based on the person's own needs and preferences, and in accordance with evidence and current laws. For many years a research group, consisting nurse researchers together with nurses working in palliative care, has developed a model for person-centred palliative care, the 6S-model. The model's central concept is Self-image, where the starting point is the patient as a person and their own experience of the situation. The other concepts: Self-determination, Symptom relief, Social relationships, Synthesis and Strategies are all related to the patient's self-image, and often to each other. The model's development, value base and starting assumptions are reported here, as are examples of how the model is applied in palliative care in Sweden. The model has been, and still is, constantly evolving in a collaboration between researchers and clinically active nurses, and in recent years also with patients and close relatives.
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Affiliation(s)
- Jane Österlind
- Department of Health Care SciencesPalliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
| | - Ingela Henoch
- The Sahlgrenska AcademyInstitute of Health and Care SciencesUniversity of GothenburgGothenburgSweden
- Angered Local HospitalGothenburgSweden
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22
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Experiences of loneliness among older people living alone. A qualitative study in Quebec (Canada). AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
In this article, we analyse experiences of loneliness among older people living alone. Current knowledge suggests that loneliness is a significant social issue that can compromise health and wellbeing, and that seniors living alone are at a higher risk of loneliness. Based on a qualitative methodological approach and semi-structured interviews conducted with 43 people aged 65 or over living alone in Montreal (Quebec, Canada), this study sought to understand how they perceive, reflect on and react to loneliness. The results show that these seniors perceive loneliness as a dynamic, and rarely static, experience, which has a very different significance, depending on whether it is chosen or circumstantially imposed. The experience of loneliness recounted by the seniors we met is characterised by its heterogeneity, and involves, to varying degrees, their relationship to themselves (solitude), to others (family (and friends) loneliness and loneliness in love) and/or to the world (existential loneliness and aloneness). Lastly, our analyses highlight how social factors, such as age, gender, marital status, social network and socio-economic conditions, shape the experience of loneliness among seniors. These factors also influence the strategies that seniors develop to prevent or alleviate loneliness, strategies that yield very mixed results.
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Broady TR. Carers’ Experiences of End‐of‐Life Care: A Scoping Review and Application of Personal Construct Psychology. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12278] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Strang P, Bergström J, Martinsson L, Lundström S. Dying From COVID-19: Loneliness, End-of-Life Discussions, and Support for Patients and Their Families in Nursing Homes and Hospitals. A National Register Study. J Pain Symptom Manage 2020; 60:e2-e13. [PMID: 32721500 PMCID: PMC7382350 DOI: 10.1016/j.jpainsymman.2020.07.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/27/2022]
Abstract
CONTEXT Preparation for an impending death through end-of-life (EOL) discussions and human presence when a person is dying is important for both patients and families. OBJECTIVES The aim was to study whether EOL discussions were offered and to what degree patients were alone at time of death when dying from coronavirus disease 2019 (COVID-19), comparing deaths in nursing homes and hospitals. METHODS The national Swedish Register of Palliative Care was used. All expected deaths from COVID-19 in nursing homes and hospitals were compared with, and contrasted to, deaths in a reference population (deaths in 2019). RESULTS A total of 1346 expected COVID-19 deaths in nursing homes (n = 908) and hospitals (n = 438) were analyzed. Those who died were of a more advanced age in nursing homes (mean 86.4 years) and of a lower age in hospitals (mean 80.7 years) (P < 0.0001). Fewer EOL discussions with patients were held compared with deaths in 2019 (74% vs. 79%, P < 0.001), and dying with someone present was much more uncommon (59% vs. 83%, P < 0.0001). In comparisons between nursing homes and hospital deaths, more patients dying in nursing homes were women (56% vs. 37%, P < 0.0001), and significantly fewer had a retained ability to express their will during the last week of life (54% vs. 89%, P < 0.0001). Relatives were present at time of death in only 13% and 24% of the cases in nursing homes and hospitals, respectively (P < 0.001). The corresponding figures for staff were 52% and 38% (P < 0.0001). CONCLUSION Dying from COVID-19 negatively affects the possibility of holding an EOL discussion and the chances of dying with someone present. This has considerable social and existential consequences for both patients and families.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden.
| | - Jonas Bergström
- Palliative Care Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Lisa Martinsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Staffan Lundström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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25
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Chung BPM, Olofsson J, Wong FKY, Rämgård M. Overcoming existential loneliness: a cross-cultural study. BMC Geriatr 2020; 20:347. [PMID: 32928151 PMCID: PMC7491097 DOI: 10.1186/s12877-020-01753-y] [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] [Received: 10/09/2019] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moving into a long-term care facility (LTCF) can reduce the ability for older adults to engage in meaningful roles and activities and the size of their social network. These changes and losses can lead them to experience existential loneliness (EL)-the intolerable emptiness and lack of meaningful existence resulted from the losses they have experienced. While EL has often been understood as a universal human experience, it has primarily been studied in people from Western cultures; little is known about how EL may be experienced by and manifested in people from Eastern cultures. Hence, this qualitative study aimed to describe the experience and coping of EL in Hong Kong Chinese and Swedish older adults living in LTCFs. METHODS A qualitative study using Thorne's (2004) interpretive description was conducted. Thirteen Chinese and 9 Swedes living in LTCFs in Hong Kong, China and Malmo, Sweden, respectively were interviewed about their experience of EL in two series of semi-structured interviews. Data were analyzed using thematic analysis. RESULTS The core theme of "overcoming EL" described the participants' experience of EL, which came about through the combined process of "Feeling EL" and "Self-Regulating". Both Chinese and Swedish participants had similar experience with EL. Realizing that they did not want to living with EL anymore, they coped by reframing their experience and identifying new meaning in their life. CONCLUSIONS The study findings suggested that early and clear counselling support that help older adults to define new meaning in life may help them cope. In addition, more opportunities should be available at the LTCFs to promote quality relationships, enable older adults to reflect on their lives with pride, and support their ability to do the things they enjoy.
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Affiliation(s)
- B P M Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China
| | - J Olofsson
- Faculty of Health and Society, Institute of Care Science, Malmo University, 25, Hus F, Malmo, Malmo, Sweden
| | - F K Y Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China.
| | - M Rämgård
- Faculty of Health and Society, Institute of Care Science, Malmo University, 25, Hus F, Malmo, Malmo, Sweden
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Steindal SA, Nes AAG, Godskesen TE, Dihle A, Lind S, Winger A, Klarare A. Patients' Experiences of Telehealth in Palliative Home Care: Scoping Review. J Med Internet Res 2020; 22:e16218. [PMID: 32369037 PMCID: PMC7238080 DOI: 10.2196/16218] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/18/2020] [Accepted: 02/10/2020] [Indexed: 01/20/2023] Open
Abstract
Background Telehealth is increasingly being used in home care and could be one measure to support the needs of home-based patients receiving palliative care. However, no previous scoping review has mapped existing studies on the use of telehealth for patients in palliative home care. Objective The aim of this study was to map and assess published studies on the use of telehealth for patients in palliative home care. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic and comprehensive search of Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health was performed for studies published between January 2000 and October 2018. Two authors independently assessed eligibility and extracted data. Results The review included 22 papers from 19 studies. Four thematic groupings were identified among the included papers: easy and effortless use of telehealth regardless of the current health condition, visual features that enhance communication and care via telehealth, symptom management and self-management promotion by telehealth, and perceptions of improved palliative care at home. Conclusions The use of telehealth in palliative home care seems to be feasible, improving access to health care professionals at home and enhancing feelings of security and safety. The visual features of telehealth seem to allow a genuine relationship with health care professionals. However, there are contradicting results on whether the use of telehealth improves burdensome symptoms and quality of life. Future research should investigate the experiences of using telehealth among patients with life-limiting illness other than cancer and patients aged 85 years or older. More research is needed to increase the body of knowledge regarding the effectiveness of telehealth on symptoms and quality of life.
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Affiliation(s)
| | | | - Tove E Godskesen
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | | | - Susanne Lind
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Anna Klarare
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Clinical Psychology in Healthcare, Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Larsson H, Rämgård M, Kumlien C, Blomqvist K. Spouses' existential loneliness when caring for a frail partner late in life - a hermeneutical approach. Int J Qual Stud Health Well-being 2020; 15:1734166. [PMID: 32116141 PMCID: PMC7067191 DOI: 10.1080/17482631.2020.1734166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs. Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner. Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other. Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses’ existential needs visible and to provide support based on their needs.
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Affiliation(s)
- Helena Larsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Margareta Rämgård
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Christine Kumlien
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Kerstin Blomqvist
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
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Gilmour F, Riccobono R, Haraldsdottir E. The value of poetry therapy for people in palliative and end of life care. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1684866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Fiona Gilmour
- University of St. Andrews, St Andrews, Scotland
- Queen Margaret University, Musselburgh, Scotland
| | - Rossella Riccobono
- School of Modern LanguagesUniversity of St. Andrews, St Andrews, Scotland
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Hemberg J, Bergdahl E. Dealing with ethical and existential issues at end of life through co-creation. Nurs Ethics 2019; 27:1012-1031. [PMID: 31522601 DOI: 10.1177/0969733019874496] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND In research on co-creation in nursing, a caring manner can be used to create opportunities for the patient to reach vital goals and thereby increase the patient's quality of life in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. Nurses must be extra sensitive to patients' and their relatives' needs with regard to ethical and existential issues and situations in home care encounters, especially at the end of life. AIM The aim of this study was to explore nurses' experiences of dealing with ethical and existential issues through co-creation at the end of life in palliative home care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT The material consisted of texts from interviews with 12 nurses in a home care context. A hermeneutical approach was used, and the method was inspired by a thematic analysis. ETHICAL CONSIDERATIONS Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Ethical permission to conduct the study was given from organizations that participated in this study. FINDINGS A main theme and four subthemes emerged. The main theme was "Deep co-creative relationships are needed to manage ethical and existential issues at the end of life." A model was created to display the findings and relations between ethical issues and situations and the need for a deep trustful caring relationship to solve problems in palliative home care. DISCUSSION Together, the themes can be considered as a tool for learning and dealing with ethical and existential issues at the end of life in home care. The themes can also be seen as a part of nurses' ethical competence within this context. CONCLUSION The quality of life at the end of life can be improved through co-creation, despite difficult ethical and existential issues. Future research should focus on co-creation from the patients' perspective.
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Tarbi EC, Meghani SH. A concept analysis of the existential experience of adults with advanced cancer. Nurs Outlook 2019; 67:540-557. [PMID: 31040052 PMCID: PMC6764914 DOI: 10.1016/j.outlook.2019.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/04/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attention to the existential dimension of an individual's experience during serious illness is important. However, existential concerns continue to be poorly defined in literature, leading to neglect in the clinical realm. PURPOSE This concept analysis seeks to clarify the concept of the existential experience within the context of adults with advanced cancer. METHODS Rodgers' evolutionary method of concept analysis was used. DISCUSSION Existential experience in adults with advanced cancer is a dynamic state, preceded by confronting mortality, defined by diverse reactions to shared existential challenges related to the parameters of existence (body, time, others, and death), resulting in a dialectical movement between existential suffering and existential health, with capacity for personal growth. Personal factors and the ability to cope appear to influence this experience. CONCLUSION These findings can drive future research and enhance clinician ability to attend to the existential domain, thereby improving patient experience at end-of-life.
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Affiliation(s)
- Elise C Tarbi
- University of Pennsylvania School of Nursing, Philadelphia, PA.
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Aoki T, Urushibara‐Miyachi Y. A qualitative study of socially isolated patients' perceptions of primary care. J Gen Fam Med 2019; 20:185-189. [PMID: 31516804 PMCID: PMC6732495 DOI: 10.1002/jgf2.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/21/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the previous quantitative study revealed that social isolation was negatively associated with patient experience of primary care, the underlying reasons for this phenomenon remain unclear. In the present study, we aimed to explore the reasons underlying the influence of social isolation on patient experience in the primary care setting. METHODS This study was a qualitative study and part of a mixed methods research. Semistructured telephone interviews were performed. We recruited participants among eligible participants in the previous quantitative survey who were classified as being socially isolated. Data were transcribed verbatim and analyzed thematically by two independent researchers until saturation was reached. RESULTS Eight socially isolated patients in the research were interviewed. In the thematic analysis, three major themes emerged as reasons underlying the influence of social isolation on patient experience of primary care: restriction of information about local primary care physicians, finding a usual primary care physician haphazardly, and superficial relationship with a usual primary care physician. CONCLUSIONS This study identified three major themes, which are beneficial to expand our understanding of socially isolated patients' perceptions of primary care. These findings can be used to improve patient experience of primary care in socially isolated patients.
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Affiliation(s)
- Takuya Aoki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto UniversityKyotoJapan
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Edberg AK, Bolmsjö I. Exploring Existential Loneliness Among Frail Older People as a Basis for an Intervention: Protocol for the Development Phase of the LONE Study. JMIR Res Protoc 2019; 8:e13607. [PMID: 31414663 PMCID: PMC6712957 DOI: 10.2196/13607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. OBJECTIVE This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. METHODS The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. RESULTS The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. CONCLUSIONS The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/13607.
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Affiliation(s)
- Anna-Karin Edberg
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Ingrid Bolmsjö
- Faculty of Health & Society, Malmö University, Malmö, Sweden
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Henoch I, Österlind J. Development of the 6S Dialogue Tool to facilitate person‐centred palliative care. J Adv Nurs 2019; 75:3138-3146. [DOI: 10.1111/jan.14115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Angered Local Hospital Gothenburg Sweden
| | - Jane Österlind
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal University College Stockholm Sweden
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Högberg C, Alvariza A, Beck I. Patients’ experiences of using the Integrated Palliative care Outcome Scale for a person‐centered care: A qualitative study in the specialized palliative home‐care context. Nurs Inq 2019; 26:e12297. [DOI: 10.1111/nin.12297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Cecilia Högberg
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Palliative Home Care Capio ASIH Dalen Stockholm Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Palliative Home Care Capio ASIH Dalen Stockholm Sweden
| | - Ingela Beck
- Institute for Palliative Care Lund University and Region Skåne Lund Sweden
- Oncology, Department of Clinical Sciences Lund, Faculty of Medicine Lund University Lund Sweden
- Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences Kristianstad University Kristianstad Sweden
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Sundström M, Blomqvist K, Edberg AK, Rämgård M. The context of care matters: Older people's existential loneliness from the perspective of healthcare professionals-A multiple case study. Int J Older People Nurs 2019; 14:e12234. [PMID: 31025806 DOI: 10.1111/opn.12234] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/20/2019] [Accepted: 03/07/2019] [Indexed: 01/11/2023]
Abstract
AIM To explore existential loneliness among older people in different healthcare contexts from the perspective of healthcare professionals. BACKGROUND Professionals meet and care for older people in most care contexts and need to be prepared to address physical, psychological, social and existential needs. Addressing existential loneliness can be both challenging and meaningful for professionals and is often not prioritised in times of austerity. DESIGN A multiple case study design was used. METHODS Focus group interviews were conducted with healthcare professionals (n = 52) in home, residential, hospital and palliative care settings. The analysis was performed in two steps: firstly, a within-case analysis of each context was conducted, followed by a cross-case analysis. FINDINGS Differences and similarities were observed among the care contexts, including for the origin of existential loneliness. In home care and residential care, the focus was on life, the present and the past, compared to hospital and palliative care, in which existential loneliness mainly related to the forthcoming death. The older person's home, as the place where home care or palliative care was received, helped preserve the older person's identity. In hospital and palliative care, as in institutional care, the place offered security, while in residential care, the place could make older people feel like strangers. Creating relationships was considered an important part of the professionals' role in all four care contexts, although this had different meanings, purposes and conditions. CONCLUSIONS The context of care matters and influences how professionals view existential loneliness among older people and the opportunities they have to address existential loneliness. IMPLICATIONS FOR PRACTICE Support for professionals must be tailored to their needs, their education levels and the context of care. Professionals need training and appropriate qualifications to address existential loneliness related to existential aspects of ageing and care.
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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
| | - Kerstin Blomqvist
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Anna-Karin Edberg
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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37
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Mah K. Existential loneliness and the importance of addressing sexual health in people with advanced cancer in palliative care. Psychooncology 2019; 28:1354-1356. [DOI: 10.1002/pon.5092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/18/2019] [Accepted: 04/08/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer CentreUniversity Health Network Toronto Ontario
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38
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Iranmanesh S, Ghazanfari Z, Sävenstedt S, Häggström T. Professional Development: Iranian and Swedish Nurses’ experiences of Caring for Dying People. J Palliat Care 2018. [DOI: 10.1177/082585971102700304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our world is rapidly becoming a global community. This creates a need for us to further understand the universal phenomena of death and professional care for dying persons. A transcultural study was undertaken using a phenomenological approach to illuminate the meaning of nurses’ experiences of professional development in the contexts of Iran and Sweden. Eight registered nurses working in oncology units in Tehran, Iran, and eight working in the context of a hospital and private homes in northern Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics inspired by Paul Ricoeur. A naive reading guided a structural analysis, which yielded four main themes: coping with existential, organizational, and cultural contexts; sharing knowledge, experiences, and responsibilities; using embodied knowledge; and developing personal competence. The interpreted comprehensive understanding revealed that the meaning of professional development is that it actualizes other-oriented values and self- oriented values. Caring professionally for dying people was a learning process that could help nurses to develop their personal and professional lives when they were supported by teamwork, reflective practice, and counselling.
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Affiliation(s)
- Sedigheh Iranmanesh
- S Iranmanesh (corresponding author) Razi Faculty of Nursing and Midwifery, Kerman Medical University, Haft Bagh Boulevard, Kerman, Iran
| | - Zahra Ghazanfari
- Razi Faculty of Nursing and Midwifery, Kerman Medical University, Kerman, Iran
| | - Stefan Sävenstedt
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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39
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Affiliation(s)
- Peter Strang
- Karolinska Institutet and Stockholms Sjukhem Foundation, Stockholm, Sweden
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40
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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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Aebischer Perone S, Nikolic R, Lazic R, Dropic E, Vogel T, Lab B, Lachat S, Hudelson P, Matis C, Pautex S, Chappuis F. Addressing the needs of terminally-ill patients in Bosnia-Herzegovina: patients' perceptions and expectations. BMC Palliat Care 2018; 17:123. [PMID: 30454032 PMCID: PMC6245800 DOI: 10.1186/s12904-018-0377-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many terminally ill patients in Bosnia-Herzegovina (BiH) fail to receive needed medical attention and social support. In 2016 a primary healthcare centreer (PHCC) in Doboj (BiH) requested the methodological and technical support of a local partner (Fondacija fami) and the Geneva University Hospitals to address the needs of terminally ill patients living at home. In order to design acceptable, affordable and sustainable solutions, we involved patients and their families in exploring needs, barriers and available resources. METHODS We conducted interviews with 62 purposely selected patients using a semi-structured interview guide designed to elicit patients' experiences, needs and expectations. Both qualitative and quantitative analyses were conducted, using an inductive thematic approach. RESULTS While patients were aware that their illnesses were incurable, they were poorly informed about medical and social support resources available to them. Family members appeared to be patients' main source of support, and often suffered from exhaustion and financial strain. Patients expressed feelings of helplessness and lack of control over their health. They wanted more support from health professionals for pain and other symptom management, as well as for anxiety and depression. Patients who were bedridden or with reduced mobility expressed strong feelings of loneliness, social exclusion, and stigma from community members and - occasionally - from health workers. CONCLUSIONS Our findings suggest a wide gap between patients' end-of-life care needs and existing services. In order to address the medical, psychological and social needs of terminally ill patients, a multi-pronged approach is called for, including not only better symptom management through training of health professionals and improved access to medication and equipment, but also a coordinated inter-professional, inter-institutional and multi-stakeholder effort aimed at offering comprehensive medical, psycho-social, educational and spiritual support.
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Affiliation(s)
- S Aebischer Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205, Geneva, Switzerland.
| | - R Nikolic
- Primary Health Care Center, Dom zdravja Doboj, Nemanjina 18, 74000, Doboj, Bosnia and Herzegovina
| | - R Lazic
- Primary Health Care Center, Dom zdravja Doboj, Nemanjina 18, 74000, Doboj, Bosnia and Herzegovina
| | - E Dropic
- Fondacija fami, Kralja Aleksandra 52, 74000, Doboj, Bosnia and Herzegovina
| | - T Vogel
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - B Lab
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - S Lachat
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - P Hudelson
- Transcultural consultation and interpretation, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - C Matis
- Geriatrics and community palliative care unit, Geneva University Hospitals, Avenue Cardinal-Mermillod 36, 1227, Carouge, Switzerland
| | - S Pautex
- Geriatrics and community palliative care unit, Geneva University Hospitals, Avenue Cardinal-Mermillod 36, 1227, Carouge, Switzerland
| | - F Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205, Geneva, Switzerland
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Sjöberg M, Edberg AK, Rasmussen BH, Beck I. Being acknowledged by others and bracketing negative thoughts and feelings: Frail older people's narrations of how existential loneliness is eased. Int J Older People Nurs 2018; 14:e12213. [DOI: 10.1111/opn.12213] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 08/13/2018] [Accepted: 09/24/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Marina Sjöberg
- Department of Care Science, Faculty of Health and Society; Malmö University; Malmö Sweden
- The Research Platform for Collaboration for Health, Faculty of Health Science; Kristianstad University; Kristianstad Sweden
| | - Anna-Karin Edberg
- The Research Platform for Collaboration for Health, Faculty of Health Science; Kristianstad University; Kristianstad Sweden
| | - Birgit H. Rasmussen
- The Institute for Palliative Care; Lund University and Region Skane; Lund Sweden
- Department for Health Sciences, Faculty of Medicine; Lund University; Lund Sweden
| | - Ingela Beck
- The Research Platform for Collaboration for Health, Faculty of Health Science; Kristianstad University; Kristianstad Sweden
- The Institute for Palliative Care; Lund University and Region Skane; Lund Sweden
- Division of Oncology, Department of Clinical Sciences Lund, Faculty of Medicine; Lund University; Lund Sweden
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Sjöberg M, Beck I, Rasmussen BH, Edberg AK. Being disconnected from life: meanings of existential loneliness as narrated by frail older people. Aging Ment Health 2018; 22:1357-1364. [PMID: 28714734 DOI: 10.1080/13607863.2017.1348481] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study illuminated the meanings of existential loneliness (EL) as narrated by frail older people. METHOD Data were collected through individual narrative interviews with 23 people 76-101 years old receiving long-term care and services. A phenomenological hermeneutical analysis was performed, including a naïve reading and two structural analyses as a basis for a comprehensive understanding of EL. RESULT Four themes were identified related to meanings of EL: (1) being trapped in a frail and deteriorating body; (2) being met with indifference; (3) having nobody to share life with; and (4) lacking purpose and meaning. These intertwined themes were synthesized into a comprehensive understanding of EL as 'being disconnected from life'. CONCLUSION Illness and physical limitation affects access to the world. When being met with indifference and being unable to share one's thoughts and experiences of life with others, a sense of worthlessness is reinforced, triggering an experience of meaninglessness and EL, i.e. disconnection from life. It is urgent to develop support strategies that can be used by health care professionals to address older people in vulnerable situations, thereby facilitating connectedness.
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Affiliation(s)
- Marina Sjöberg
- a Department of Care Science, Faculty of Health and Society , Malmö University , Malmö , Sweden.,b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden
| | - Ingela Beck
- b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden.,c The Institute For Palliative Care , Region Skåne and Lund University , Lund , Sweden.,d Department of Clinical Sciences Lund, Division of Oncology, Faculty of Medicine , Lund University , Lund , Sweden
| | - Birgit H Rasmussen
- c The Institute For Palliative Care , Region Skåne and Lund University , Lund , Sweden.,e Department for Health Sciences, Faculty of Medicine, Unit of Older People's Health and Person Centred Care , Lund University , Lund , Sweden
| | - Anna-Karin Edberg
- b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden
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An E, Lo C, Hales S, Zimmermann C, Rodin G. Demoralization and death anxiety in advanced cancer. Psychooncology 2018; 27:2566-2572. [PMID: 30053317 DOI: 10.1002/pon.4843] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The circumstances of advanced cancer can cause considerable psychological distress, including death anxiety and demoralization. Although these states of existential distress have a negative impact on the quality of life of patients with advanced cancer, they are rarely evaluated as outcomes or targets of interventions in this population. In an effort to improve understanding of existential distress, a structural model of relationships among death anxiety, demoralization, symptom burden, and social relatedness was tested in patients with advanced cancer. METHODS A total of 307 patients with advanced cancer completed baseline measures including the Death and Dying Distress Scale, the Demoralization Scale, the modified Experiences in Close Relationships Scale, the Life Completion subscale of the Quality of Life Evaluation-Cancer scale, the Memorial Symptom Assessment Scale, and Karnofsky Performance Status. A structural equation model of protective and risk factors for demoralization and death anxiety was tested. RESULTS The final model had good fit (SRMR = 0.061; RMSEA = 0.077; CFI = 0.927; NNFI = 0.902) in which death anxiety was positively associated with demoralization (β = 0.71), and demoralization was positively associated with symptom burden (β = 0.31) and negatively associated with social relatedness (β = -0.74). CONCLUSIONS The findings of this study suggest that demoralization and death anxiety are closely linked in patients with advanced cancer. The contribution of both symptom burden and low social relatedness to demoralization suggests that an integrated intervention addressing both physical and psychosocial disease factors may be most effective at alleviating such states of existential distress.
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Affiliation(s)
- Ekaterina An
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Christopher Lo
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Department of Psychology, University of Guelph-Humber, Toronto, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Paulsen B, Johnsen R, Hadders H. Nurses' experience with relatives of patients receiving end-of-life care in nursing homes and at home: A questionnaire-based cross-sectional study. Nurs Open 2018; 5:431-441. [PMID: 30062037 PMCID: PMC6056440 DOI: 10.1002/nop2.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/21/2018] [Indexed: 11/09/2022] Open
Abstract
AIM The aim of this study was to explore any differences between nurses working in nursing home and home-based care in their experiences regarding relatives' ability to accept the imminence of death and relatives' ability to reach agreement when deciding on behalf of patients unable to consent. DESIGN An electronic questionnaire-based cross-sectional study. METHOD An electronically distributed survey to 884 nurses in long-term care in Norway in May 2014. A total of 399 nurses responded (45%), of which 197 worked in nursing homes and 202 in home-based care. RESULTS Nurses in home-based care, more often than their colleagues in nursing homes, experienced that relatives had difficulties in accepting that patients were dying. Nurses who often felt insecure about whether life extension was in consistency with patients' wishes and nurses who talked most about life-prolonging medical treatment in communication with relatives more often experienced that relatives being reluctant to accept a poor prognosis and disagreements between relatives in their role as proxy decision makers for the patient.
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Affiliation(s)
- Bård Paulsen
- Health service researchSINTEF Technology and SocietyTrondheimNorway
| | - Roar Johnsen
- Department of Public Health and NursingNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Hans Hadders
- Department of Public Health and NursingNorwegian University of Science and Technology (NTNU)TrondheimNorway
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46
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Larsson H, Edberg AK, Bolmsjö I, Rämgård M. Contrasts in older persons' experiences and significant others' perceptions of existential loneliness. Nurs Ethics 2018; 26:1623-1637. [PMID: 29772961 DOI: 10.1177/0969733018774828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the views of frail older persons and their significant others concerning existential loneliness are in concordance. OBJECTIVE To contrast frail older (>75) persons' experiences with their significant others' perceptions of existential loneliness. METHODS A case study design was chosen for this study. Individual interviews with frail older persons (n = 15) and interviews with their significant others (n = 19), as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. ETHICAL CONSIDERATIONS This study was conducted in accordance with the principles of research ethics. FINDINGS The findings showed three themes: (1) Meaningless waiting in contrast to lack of activities, (2) Longing for a deeper connectedness in contrast to not participating in a social environment and (3) Restricted freedom in contrast to given up on life. DISCUSSION Knowledge about the tensions between older persons' and their significant others' views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. CONCLUSION It is of importance that health care professionals listen to both the frail older person and their significant other(s) and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person.
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Affiliation(s)
- Helena Larsson
- Malmö University, Sweden; Kristianstad University, Sweden
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The Importance of Parental Connectedness and Relationships With Healthcare Professionals in End-of-Life Care in the PICU. Pediatr Crit Care Med 2018; 19:e157-e163. [PMID: 29329163 DOI: 10.1097/pcc.0000000000001440] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Support from healthcare professionals in a PICU is highly valuable for parents of dying children. The way they care for the patients and their families affects the parents' initial mourning process. This study explores what interaction with hospital staff is meaningful to parents in existential distress when their child is dying in the PICU. DESIGN Qualitative interview study. SETTING Level 3 PICU in the Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, and the Netherlands. SUBJECTS Thirty-six parents of 20 children who had died in this unit 5 years previously. INTERVENTIONS Parents participated in audio-recorded interviews in their own homes. The interviews were transcribed and analyzed using qualitative methods. MEASUREMENTS AND MAIN RESULTS Parents' narratives of their child's end-of-life stage in the PICU bespeak experiences of estrangement, emotional distancing, and loneliness. Significant moments shared with hospital staff that remained valuable even after 5 years primarily involved personal connectedness, reflected in frequent informational updates, personal commitment of professionals, and interpersonal contact with doctors and nurses. CONCLUSIONS Parents whose children died in the PICU value personal connectedness to doctors and nurses when coping with existential distress. Medical and nursing training programs should raise awareness of parents' need for contact in all interactions but especially in times of crisis and apprehension.
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Khoshnood Z, Iranmanesh S, Rayyani M, Dehghan M. Getting Out or Remaining in the Cage of Inauthentic Self: The Meaning of Existential Challenges in Patients' with Cancer. Indian J Palliat Care 2018; 24:131-138. [PMID: 29736113 PMCID: PMC5915877 DOI: 10.4103/ijpc.ijpc_179_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context: Cancer as a life-threatening disease develops a range of existential challenges in persons. These challenges cause the patients to encounter some existential questions and tensions. This study method focuses on a person's experience about them. Aims: The aim of this study is to illuminate the meaning of existential challenges in patients with cancer in Iran. Subjects and Methods: A hermeneutic phenomenological approach, influenced by the philosophy of Ricoeur, was used to analyze the experiences of 10 Iranian patients with cancer. Data analysis was based on three stages of simple and fast understanding, structural analysis, and comprehensive understanding. Results: The present study showed that existential challenges in patients with cancer can be considered as getting out or remaining in the cage of inauthentic self. This theme consists of two subthemes “Being exposed to the light of awareness that revealed the cage of inauthentic self” and “The tension between getting out of the cage or remaining.” First, being exposed to the light of awareness revealed the cage of inauthentic self which subjectively refers to the emergence of existential questions, the past, the fear of future, and the collapse of physical body identity. Second, the tension between getting out of the cage or still staying which is characterized by anger, denial, sense of loneliness, and depression. Conclusions: According to the results of this qualitative study, it is possible to form discussion groups with peers or have self-reflective practice teaching groups to reflect patients' questions and existential challenges. In this way, participants can express themselves, share their experiences, challenges, learn, and find the answers.
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Affiliation(s)
- Zohreh Khoshnood
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Sedigheh Iranmanesh
- 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
| | - Mahlegha Dehghan
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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Bernard M, Hayek AS, Spring G, Borasio GD, Diawara F. Interventions psychologiques centrées sur la spiritualité : revue de la question. PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0641-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wong A, Chau AKC, Fang Y, Woo J. Illuminating the Psychological Experience of Elderly Loneliness from a Societal Perspective: A Qualitative Study of Alienation between Older People and Society. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070824. [PMID: 28754027 PMCID: PMC5551262 DOI: 10.3390/ijerph14070824] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022]
Abstract
Loneliness is a common experience among older people that is associated with health risks and negative well-being. As a psychological phenomenon, it has typically been defined in Western research literature as the discrepancy between desired and actual interpersonal relations. In our qualitative study in Hong Kong, we offer insight into ageing and loneliness in an urban environment of the non-Western world and propose to reconceptualise loneliness by exploring older people's experience of alienation at the societal level as an important but often neglected dimension of their loneliness. Thirty-seven community-dwelling, Chinese adults aged 65 and above were interviewed in focus groups and their accounts analysed and interpreted using a phenomenological approach. Findings revealed that focus group participants perceived insufficient care for older people, a growing distance between themselves and society, and their disintegrating identity in society to be primary sources of societal alienation. In response, older people adopted a more passive lifestyle, attributed marginalisation and inequality to old age, and developed negative feelings including unease towards ageing, vulnerability and helplessness, and anger. The emergence of these key components and underlying themes of societal alienation illuminated neglected facets of the psychological phenomenon of loneliness and highlighted new implications for policy, practice, and research from a societal perspective to address older people's loneliness in urban settings.
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Affiliation(s)
- Anna Wong
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Anson K C Chau
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Yang Fang
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Jean Woo
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China.
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
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