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Glasdam S, Xu H, Stjernswärd S. Socialisation of children to nurse and nursing images: A Goffman-inspired thematic analysis of children's picture books in a Swedish context. Nurs Inq 2024; 31:e12603. [PMID: 37767729 DOI: 10.1111/nin.12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Picture books are often part of children's socialisation processes, contributing to the children forming images of the world, including ideas about (categories of) people, such as nurses. The study aims to explore how nurses/nursing are portrayed in children's picture books in a Swedish context. Through a systematic search, 44 books were included for analysis using thematic analysis and a theoretical lens inspired by Goffman. The results were presented in three themes: 'The costume characterised and designated nurses', 'Nurses and nursing were defined through specific activities and accessories', and 'Nurses' role as caregivers and decency practitioners'. The results showed that nurses were depicted/described in varied contexts, performing their roles mainly front stage in 'hands-on work' in close contact with patients and relatives. Nurses were attributed different accessories and personality characteristics. Nurses/nursing were generally set within a healthcare context, oftentimes within an overarching medical logic. Historical depictions of nurses' uniforms still appeared as a signifier for nurses/nursing. The presentation of nurses/nursing might have potential implications on children's understanding of and for reputations of nurses/nursing in the long term as primary socialisation and related understandings of the (sub)world(s) are deeply rooted in humans.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Integrative Health Research, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hongxuan Xu
- Department of Health Sciences, Integrative Health Research, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sigrid Stjernswärd
- Department of Health Sciences, Health-promoting Complex Interventions, Faculty of Medicine, Lund University, Lund, Sweden
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Hoffmann E, Andersen PT, Mogensen CB, Prinds C, Primdahl J. Relatives' negotiations with healthcare professionals during older people's admission in an emergency department: An ethnographic study. Nurs Open 2023; 10:6381-6389. [PMID: 37312450 PMCID: PMC10416047 DOI: 10.1002/nop2.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Relatives are recognised as important for older patients' care and treatment. Variations in relatives' opportunities to negotiate the quality and continuity of older people's care and treatment can potentially lead to inequality in older people's access to care and treatment. AIM This study aimed to examine relatives' opportunities and strategies for negotiation with health care professionals (HCPs) during the admission of older people to emergency departments in Denmark. MATERIALS AND METHODS We planned a qualitative ethnographical study employing a hermeneutic approach. Observations focused on social situations and interactions between relatives and HCPs. The analysis was guided by qualitative content analysis. RESULTS The analysis derived one main theme, attitude to action, containing three subthemes: frustration obtaining access, presenting the case and a powerful relationship. Being active appeared to be essential to achieving possibilities for negotiation with HCPs. DISCUSSION Inspired by Bourdieu, habitus, doxical values and institutional logics of relatives seem to affect their opportunities to negotiate with HCPs during older people's admission to an emergency department. CONCLUSION Active and proactive relatives seem to have better opportunities to negotiate with HCPs during older people's acute hospital admission than reactive, passive and hesitant relatives. The logic of public management and the medical profession seem to dominate and influence doxa in the EDs and put special demands on the relatives. This imbalance constitutes a risk of inequality in older people's access to health.
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Affiliation(s)
- Eva Hoffmann
- University College South DenmarkAabenraaDenmark
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- OPEN, Open Patient data ExplorativeRegion of Southern DenmarkOdenseDenmark
| | | | - Christian Backer Mogensen
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
| | - Christina Prinds
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
- Research Unit of Obstetrics and GynaecologyUniversity of Southern DenmarkOdenseDenmark
| | - Jette Primdahl
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
- Danish Hospital for Rheumatic DiseasesUniversity Hospital of Southern DenmarkSønderborgDenmark
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Fu C, Glasdam S, Stjernswärd S, Xu H. A Qualitative Systematic Review About Children's Everyday Lives when a Parent Is Seriously Ill with the Prospect of Imminent Death - Perspectives of Children and Parents. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228221149767. [PMID: 36628967 DOI: 10.1177/00302228221149767] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Parental dying is a life changing experience for children. This study explores children's strategies and (inter)actions in their everyday life when facing critically ill parents and imminent death, from the children's and parents' perspectives. A qualitative systematic review was carried out, registered in PROSPERO (CRD42022306862). A literature search and screening in six databases resulted in eighteen articles. Thematic analysis showed that children were capable of developing various strategies to cope in everyday life, even in vulnerable situations. From parents' and children's perspectives, inclusion, openness, and communication about parents' situations, taking children's age and needs into consideration, were important to face and cope with the situation. Children were life-capable, also in vulnerable and difficult situations. This calls for the necessity of developing children-led support, by acknowledging, and taking the children's experiences, and resources, as starting points to tailor adequate support for children of critically ill parents.
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Affiliation(s)
- Cong Fu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stinne Glasdam
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sigrid Stjernswärd
- Health-promoting Complex Interventions, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hongxuan Xu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Fu C, Glasdam S. The 'good death' in Mainland China - A Scoping Review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100069. [PMID: 38745620 PMCID: PMC11080441 DOI: 10.1016/j.ijnsa.2022.100069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 01/13/2023] Open
Abstract
Background Since the mid 80'ies, the western palliative care philosophy has influenced the development of palliative care in mainland China. However, it has caused several challenges. Objective To explore the understanding of the 'good death' among authorities, professionals, patients, and their relatives in end-of-life care settings in mainland China. Design Scoping review. The PRISMA-ScR checklist was used. The study is not registered. Settings End-of-life care settings, Mainland China. Participants Authorities, healthcare professionals, adult patients, and general population in mainland China. Method Literature searches were performed through Medline, CINAHL, PsycInfo, and Web of Sciences from 2001-2021, last search 21.4.2021. Inclusion criteria were: Empirical research studies investigating 'good death' or political documents about 'good death', perspectives from authorities, professionals, patients, and/or relatives, and studies following the Declaration of Helsinki. Exclusion criteria were: Literature reviews, languages other than English and Chinese, editorials, letters, comments, and children's death/dying.The analysis consisted of analysing the data including a descriptive numerical summary analysis and a qualitative thematic analysis. Results Nineteen articles and two political documents were included. The 19 studies were carried out from 2003-2020, with data collected from 1999 to 2019. The political documents were written in 2012 and 2017, respectively. The thematic analysis resulted in three themes: 'Medicalisation of death', 'Communication about death - a clash between two philosophies', and 'Dying and death were socially dependent'. The medicalisation of death meant the understanding of the 'good death' primarily focused on physical symptoms and treatments. The good death was understood as painless and symptom-free, where all symptoms could be measured and assessed. Dignity and shared decision-making were connected to the understanding of the 'good death'. However, the contents of the 'good death' varied across the different actors. The understanding of the 'good death' in mainland China was a negotiation between Chinese traditional philosophy and contemporary western medicine practice. There was a tension between openness and silence about death, which reflected the importance of death education. The understanding of the 'good death' consisted partly of a timely and practical preparation for the death and afterlife, partly of a matter of social and financial issues. Conclusions There seemed to be a clash between two different cultures in the understanding of a good death in Mainland China, where western philosophy seemed to rule the political medical actors while traditional Chinese philosophy seemed to rule parts of the population.
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Affiliation(s)
- Cong Fu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1 B, S- 222 41 Lund, Sweden
| | - Stinne Glasdam
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1 B, S- 222 41 Lund, Sweden
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Stjernswärd S, Glasdam S. The European Standard EN 17398:2020 on Patient Involvement in Health Care - a Fairclough-Inspired Critical Discourse Analysis. Policy Polit Nurs Pract 2022; 23:130-141. [PMID: 35306903 PMCID: PMC9014666 DOI: 10.1177/15271544221088250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concept of ‘patient involvement’ is highlighted in healthcare. However, hindrances
can prevent its implementation. This article explored how ‘patient involvement’ is
understood and on what ideas this understanding is based through a critical textual
analysis of the European document on patient involvement in health systems using a
Fairclough-inspired critical discourse analysis. The findings showed that the document
arose from a social discourse based on a mix of a neoliberal ideology, with a
marketisation of care focusing on a cost-effective and evidence-based logic of care,
and a humanistic ideology of patient involvement. It had the form of a
normative, consensus-based standard, supported by European organisations. The document
incorporated a visionary, well-intentioned abstract guide to promote patient involvement
across European care contexts, however without addressing hindrances nor differences
across the contexts in which it ought to be implemented. It raises questions about its
usability, inviting further research into empirical applications.
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Affiliation(s)
- Sigrid Stjernswärd
- Department of Health Sciences, 59568Lund University Faculty of Medicine, Lund, Sweden
| | - Stinne Glasdam
- Department of Health Sciences, 59568Lund University Faculty of Medicine, Lund, Sweden
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Klevan T, Sommer M, Borg M, Karlsson B, Sundet R, Kim HS. Part III: Recovery-Oriented Practices in Community Mental Health and Substance Abuse Services: A Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413180. [PMID: 34948790 PMCID: PMC8701262 DOI: 10.3390/ijerph182413180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 12/05/2022]
Abstract
In recent decades, recovery-oriented practice has become the major approach in mental health and substance abuse care, especially in community mental health and substance abuse services. Various models of recovery-oriented practice have come to form the basis of the integration of this approach in service settings. The study aims to elucidate the characteristics of recovery-oriented practice as experienced by participants in the practice. The method used was a qualitative meta-synthesis that integrated the findings from thirty-four empirical papers published by one research group. Four meta-themes were developed: (a) helping and supporting, (b) collaborating and relating, (c) identity integration in practice, and (d) generating hope through nurturing and helping. These themes emphasize the value of relationships and connectedness, contextuality, and resources that can be mobilized in practice. The results emphasize the need to incorporate the elements in the four major themes as “working capital” for practitioners to realize recovery-oriented practice. The concepts of personal, social, and economic capital as working capital are elaborated, drawing from the meta-themes as the basis for recovery-oriented practice in mental health and substance abuse services.
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Gulestø R, Lillekroken D, Bjørge H, Halvorsrud L. Interactions between healthcare personnel and family caregivers of people with dementia from minority ethnic backgrounds in home-based care-An explorative qualitative study. J Adv Nurs 2021; 78:1389-1401. [PMID: 34806211 DOI: 10.1111/jan.15101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/14/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
AIMS To explore how healthcare personnel in home-based care perceive interactions with family caregivers of people with dementia from minority ethnic backgrounds. BACKGROUND Research shows that the organization of home-based care rarely allows opportunities to provide support to family caregivers in practice. However, how these organizational structures influence the way in which healthcare personnel perceive their interactions with family caregivers of people with dementia from minority ethnic backgrounds remains an unexplored area. DESIGN An explorative qualitative study inspired by a critical realist approach using Pierre Bourdieu's theoretical concepts of field, habitus and capital. METHODS Data were collected through individual semi-structured interviews with six nurses and four auxiliary nurses employed in home-based care in Norway. The data were analysed using a thematic analysis approach. The participants were recruited in September and October 2020. FINDINGS 'Family caregivers perceived as facilitators of or barriers to collaborative care' was identified as an overarching theme, supported by two main themes: 'Preconditions for successful collaboration' and 'Challenges for collaborative relationships'. The findings revealed that the participants mainly focused their attention on the dementia patients from minority ethnic backgrounds, while they felt that the family caregivers influenced the way in which they provided healthcare. CONCLUSIONS The findings demonstrate that timesaving strategies have a major influence on healthcare personnel's perceptions of family caregivers from minority ethnic backgrounds. Attention towards the needs of the family caregivers was often replaced by evaluations of their usefulness in the provision of healthcare to the dementia patients. IMPACT This study raises concerns about home-based care as a rigid and inflexible system. It therefore provides opportunities to raise questions on status quo, stimulate debate and encourage fresh thinking with regards to the support and inclusion of family caregivers in the home-based care system for people with dementia from minority ethnic backgrounds.
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Affiliation(s)
- Ragnhild Gulestø
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Heidi Bjørge
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Glasdam S, Jacobsen CB, Boelsbjerg HB. Nurses' refusals of patient involvement in their own palliative care. Nurs Ethics 2020; 27:969733020929062. [PMID: 32627661 PMCID: PMC7564292 DOI: 10.1177/0969733020929062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice. AIM To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective. METHOD A case study based on an anthropological field study among patients with advanced cancer in Denmark. ETHICAL CONSIDERATIONS Followed the principles of the Helsinki Declaration. FINDINGS Two cases illustrated situations where nurses refused patient involvement in their own case. DISCUSSION Focus on two ethical issues, namely 'including patients' experiences in palliative nursing care' and 'relational distribution of power and knowledge', inspired primarily by Hannah Arendt's concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients' palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned 'thoughtlessness' of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients' invitations to involve them in their own case. CONCLUSION The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that 'thoughtlessness' appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses' ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare.
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Responsibilisation of caregivers in depression: the limitations of policy-based evidence. SOCIAL THEORY & HEALTH 2020. [DOI: 10.1057/s41285-020-00136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glasdam S, Ekstrand F, Rosberg M, van der Schaaf AM. A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:141-152. [PMID: 31385188 PMCID: PMC7039838 DOI: 10.1007/s11019-019-09918-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients' drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses' profession in the palliative field and help them implement palliative care philosophy in practice.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, Baravägen 3, 222 41 Lund, Sweden
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Oute J, Bjerge B. Ethnographic reflections on access to care services. JOURNAL OF ORGANIZATIONAL ETHNOGRAPHY 2019. [DOI: 10.1108/joe-12-2017-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is twofold: to explore how gatekeepers’ ways of regulating the researchers’ access to knowledge in/about care services reflect the systemic and interpersonal values that inform Danish welfare systems’ daily workings at the street level; and also explore how the authors’ methodological experiences mirror the value-informed regulatory strategies that professionals and users themselves experience in their daily encounters in the same local practices that the authors have studied.
Design/methodology/approach
The paper takes its empirical point of departure in a multisited ethnographic field study of the management of citizens with complex problems in Danish welfare systems.
Findings
By means of Michael Lipsky’s outline of access regulation, the authors will analyze the following regulatory strategies that are identified during the fieldwork: “Gatekeepers’ sympathy and creaming,” “Queuing and delay,” and ‘Withdrawal of consent and “no resources.” The paper suggests that trust, shared goals and sympathy seem to be key to the process of getting access.
Originality/value
Despite principles of neutrality, equal rights and access to services in welfare systems, the authors’ experiences thus tend to support other research within bureaucratic and care organizations, which has found that interpersonal relations, sympathy, dislikes, norms and values, etc., can heavily influence timely access to services, tailored information and support.
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Annerstedt CF, Glasdam S. Nurses' attitudes towards support for and communication about sexual health-A qualitative study from the perspectives of oncological nurses. J Clin Nurs 2019; 28:3556-3566. [PMID: 31165516 DOI: 10.1111/jocn.14949] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022]
Abstract
AIM AND OBJECTIVES To explore nurses' articulations of support and communication regarding sexual health with patients. BACKGROUND Sexual health is adversely effected by cancer and various oncological treatments. Patients' often have the experience that healthcare professionals do not talk about sexual health. METHOD Semi-structured interviews were conducted with seven nurses in Southern Sweden. Content analyses were made, inspired by Foucault's concepts of power, discipline and normalisation. SRQR checklist was used. RESULTS Patients' sexual health had low priority in the oncological clinic from the perspective of nurses. The medical logic directed nurses' articulations about sexual health towards a physical view, understood as sex, and sexual problems, which could be treated pharmacologically. Further, nurses articulated a sexual norm that sex belongs to young people and younger persons in permanent, monogamous and heterosexual relationships. This norm-governed nurses' inclusion and exclusion of patients in communication about sexual health. According to nurses, most patients did not mention sex, but some patients challenged the clinic's norms. Assessing sexual health problems, nurses often engaged other professions and thereby became gatekeepers for patients' options for getting help. CONCLUSIONS From the perspective of nurses, nurses' support and communication regarding sexual health with patients with cancer diagnosis were relatively absent and had a low priority in an oncological clinic. Overall, the nurses had the power to set the agenda about patients' sexual health in the oncological clinic. The clinical gaze became a disciplinary technique that tacitly defined by whom, in what way and how sexual health could be articulated in an oncological clinic. RELEVANCE TO CLINICAL PRACTICE By illuminating nurses' preconceptions, thoughts and actions in relation to cancer patients' sexual health, the results invite practitioners to reflect upon and discuss the challenges, opportunities and limitations in providing inclusive and supportive sexual health care to cancer patients.
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Affiliation(s)
| | - Stinne Glasdam
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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