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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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Larsen BH, Lundeby T, Gerwing J, Gulbrandsen P, Førde R. "Eh - What type of cells are these - flourishing in the liver?" Cancer patients' disclosure of existential concerns in routine hospital consultations. PATIENT EDUCATION AND COUNSELING 2022; 105:2019-2026. [PMID: 34839995 DOI: 10.1016/j.pec.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Advanced cancer poses a threat to all aspects of being, potentially causing existential suffering. We explore what kind of existential concerns patients with advanced cancer disclose during a routine hospital consultation, and how they communicate such concerns. METHODS We analyzed thirteen video-recorded hospital consultations involving adult patients with advanced cancer. The study has a qualitative and exploratory design, using procedures from microanalysis of face-to-face-dialogue. RESULTS Nearly all patients disclosed how the illness experience included losses and threats of loss that are strongly associated with existential suffering, displaying uncertainty about future and insecurity about self and coping. Patients usually disclosed existential concerns uninvited, but they did so indirectly and subtly, typically hiding concerns in biomedical terms or conveying them with hesitation and very little emotion. CONCLUSIONS Patients may have existential concerns they want to address, but they may be uncertain whether these are issues they can discuss with the physician. PRACTICE IMPLICATIONS Health professionals should be attentive to underlying existential messages embedded in the patient's questions and concerns. Acknowledging these existential concerns provides an opportunity to briefly explore the patient's needs and may direct how the physician tailors information and support to promote coping, autonomy, and existential health.
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Affiliation(s)
- Berit Hofset Larsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Centre for Medical Ethics, University of Oslo, Oslo, Norway.
| | - Tonje Lundeby
- Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Jennifer Gerwing
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway.
| | - Pål Gulbrandsen
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway; Division of Health Services Research and psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Reidun Førde
- Centre for Medical Ethics, University of Oslo, Oslo, Norway.
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Tarbi EC, Gramling R, Bradway C, Meghani SH. "If it's the time, it's the time": Existential communication in naturally-occurring palliative care conversations with individuals with advanced cancer, their families, and clinicians. PATIENT EDUCATION AND COUNSELING 2021; 104:2963-2968. [PMID: 33992483 PMCID: PMC8578593 DOI: 10.1016/j.pec.2021.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/25/2021] [Accepted: 04/22/2021] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To explore how patients with advanced cancer, their families, and palliative care clinicians communicate about existential experience during palliative care conversations. METHODS We analyzed data from the Palliative Care Communication Research Initiative (PCCRI) - a multisite cohort study conducted between 2014 and 2016 involving hospitalized adults with advanced cancer who were referred for inpatient palliative care consultations at two academic medical centers. We used a qualitative descriptive approach paired with inductive content analysis to analyze a random subsample of 30 patients from the PCCRI study (contributing to 38 palliative care conversations). RESULTS We found existential communication to be woven throughout palliative care conversations, with key themes related to: 1) time as a pressing boundary; 2) maintaining a coherent self; and 3) connecting with others. CONCLUSION Communication about existential experience is omnipresent and varied in palliative care conversations between individuals with advanced cancer, their families, and clinicians. PRACTICE IMPLICATIONS Clinicians can recognize that discussion of time, routines of daily life, and relationships in the clinical context may hold profound existential relevance in palliative care conversations. Understanding how patients and families talk about existential experience in conversation can create opportunities for clinicians to better meet these needs.
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Affiliation(s)
- Elise C Tarbi
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, USA; NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, USA.
| | - Robert Gramling
- Department of Family Medicine, University of Vermont College of Medicine, Burlington, USA
| | - Christine Bradway
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Salimah H Meghani
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, USA
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Hajdarevic S, Fallbjörk U, Fransson P, Åström S. Need of support perceived by patients primarily curatively treated for breast, colorectal, or prostate cancer and close to discharge from hospital-A qualitative study. J Clin Nurs 2021; 31:1216-1227. [PMID: 34288184 DOI: 10.1111/jocn.15977] [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: 02/25/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
AIM To describe perceived needs of support among patients close to discharge from the hospital and at the end of primary curative radiotherapy for breast, colorectal or prostate cancer. BACKGROUND Few studies have specifically explored patients' early support needs when ending primary curative treatment. DESIGN Qualitative interview study design. METHODS A purposive sample of 27 participants with breast, colorectal or prostate cancer aged 33-88 years. The interviews were analysed by qualitative content analysis. Reporting followed the COREQ guidelines. RESULTS Personal support to reach a sense of control and Social support for personal growth were two main themes, highlighting that people required adapted support from health care since needs of support could change over time. This support from health care was also relying on that trust-based relationships were developed. Through mutuality with others and engagement in meaningful activities people became enabled and felt further supported. Personal support from health care seems specifically important for the patients' feelings of control and could be a facilitator for patients to identify further support for personal growth in how to manage, on the one hand, illness and insecurity, and on the other, their well-being and everyday life with cancer. CONCLUSION To empower patients who are ending primary treatment and being close to discharge from hospital, healthcare professionals should recognise patients' shifting needs and adapt the support. Adapted support is significant for patients' sense of safety. Biomedical information is not sufficient to fully support patients. RELEVANCE TO CLINICAL PRACTICE Offering easy access to supportive care when primary treatment is finished could diminish people's stress, insecurity and avoidable use of healthcare services. Even after discharge, nurses preferably should adapt and offer support tailored to patients' needs. Such support may improve patients' sense of control and safety, trust in health care, feelings of community and encourage personal growth.
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Affiliation(s)
| | | | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Sture Åström
- Department of Nursing, Umeå University, Umeå, Sweden
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Green G, Reicher S, Herman M, Raspaolo A, Spero T, Blau A. Attitudes toward euthanasia-dual view: Nursing students and nurses. DEATH STUDIES 2020; 46:124-131. [PMID: 31983300 DOI: 10.1080/07481187.2020.1716887] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Caregivers such as nurses and nursing students have different religiosity backgrounds and have important roles as to terminally ill patients and euthanasia; however, they have different levels of knowledge and experience. Accordingly, the study identify differences between caregivers' religiosity level and euthanasia attitudes, examine differences between caregivers regarding attitude to euthanasia and identify differences between nurses by incidence of terminal patient caring and their relationship to euthanasia. Caregivers (210) volunteered fulfill survey. Main result suggests differences mostly between secular and traditional groups as to euthanasia. Accordingly, our suggestion is that the caregivers should improve communication via simulation of discussing euthanasia.
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Affiliation(s)
- Gizell Green
- Nursing Department, Ariel University, Ariel, Israel
| | - Sima Reicher
- Nursing Department, Ariel University, Ariel, Israel
| | | | | | - Tali Spero
- Nursing Department, Ariel University, Ariel, Israel
| | - Ayala Blau
- Nursing Department, Ariel University, Ariel, Israel
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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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Petursdottir AB, Svavarsdottir EK. The effectivness of a strengths‐oriented therapeutic conversation intervention on perceived support, well‐being and burden among family caregivers in palliative home‐care. J Adv Nurs 2019; 75:3018-3031. [DOI: 10.1111/jan.14089] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/11/2019] [Accepted: 03/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Asta B. Petursdottir
- Palliative Home‐Care Unit Landspitali – The National University Hospital of Iceland Kopavogur Iceland
- School of Health Sciences University of Iceland Reykjavík Iceland
| | - Erla Kolbrun Svavarsdottir
- School of Health Sciences University of Iceland Reykjavík Iceland
- Landspitali –The National University Hospital of Iceland Reykjavík Iceland
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Bruun Lorentsen V, Nåden D, Sæteren B. The meaning of dignity when the patients' bodies are falling apart. Nurs Open 2019; 6:1163-1170. [PMID: 31367442 PMCID: PMC6650645 DOI: 10.1002/nop2.301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/09/2019] [Accepted: 05/02/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND People with advanced cancer disease experience great bodily changes due to disease or treatment. They tend to feel ashamed when their bodies are subjected to such changes and they feel their dignity is threatened. AIM To explore the patients' experiences of the bodily changes in relation to dignity. DESIGN The study has a hermeneutic qualitative design. METHOD Individual in-depth interviews and participant observations were conducted with 13 patients with advanced cancer disease at a hospice inpatient unit in Norway. Gadamer's ontological hermeneutics inspired the interpretation. RESULTS AND CONCLUSION The patients' unpredictable, sick bodies forced the patients, or gave them the opportunity, to relate to their bodies in an honest way. The patients, living in interaction between suffering and health, strove to find dignity. The patients had a will to live and they experienced a love in their unruly bodies that both helped alleviate their suffering and give them an experience of enhanced dignity. It is important that nurses have insight into the consequences of bodily changes for the patients' experiences of dignity in health and suffering to provide good, dignified care.
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Affiliation(s)
- Vibeke Bruun Lorentsen
- Department of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Dagfinn Nåden
- Department of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
| | - Berit Sæteren
- Department of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
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Lee GL, Ramaswamy A. Physical, psychological, social, and spiritual aspects of end-of-life trajectory among patients with advanced cancer: A phenomenological inquiry. DEATH STUDIES 2018; 44:292-302. [PMID: 30569828 DOI: 10.1080/07481187.2018.1541944] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/03/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
The study examined and described the perspectives of people living with advanced cancer and the changes over time in their needs and experiences. This paper reports the accounts of 11 terminally-ill people who gave a total of 25 in-depth interviews. Participants were recruited when they began receiving home hospice care service, and they were followed up over time, as their disease progressed. Framework method was used to organize the data and identify themes. The findings highlighted that end-of-life care needs to be holistic, encompassing physical, psychological, social, and spiritual needs, as well as dynamic along the course of disease progression.
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Affiliation(s)
- Geok Ling Lee
- Department of Social Work, National University of Singapore, Singapore, Singapore
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Ozanne A, Henoch I, Strang S. Is blogging a new form of communication in palliative health care? A qualitative research study. Int J Palliat Nurs 2018; 24:238-245. [PMID: 29792771 DOI: 10.12968/ijpn.2018.24.5.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To illuminate experiences of living with life-threatening diseases as described in blogs and the experience of blogging about these matters. METHODS A secondary analysis of 21 blogs was performed. RESULTS It was difficult for bloggers to accept what they perceived to be the unacceptable aspects of having an life-threatening disease. They searched for hope and acceptance, and tried to manage their life. They felt strengthened by supportive encounters with health professionals, relatives, friends, and from their blogging. However, they also felt that they were set aside in relation to both health professionals and relatives. CONCLUSION These patients appreciated being able to express their feelings and received support from their readers. Even if patient blogs can be used in health care, research and education, there is a lack of research studies that have examined the benefits of using blogging for any of these purposes.
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Affiliation(s)
- Anneli Ozanne
- Associate Professor, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingela Henoch
- Associate Professor, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susann Strang
- Associate Professor, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ghodraty Jabloo V, Alibhai SMH, Fitch M, Tourangeau AE, Ayala AP, Puts MTE. Antecedents and Outcomes of Uncertainty in Older Adults With Cancer: A Scoping Review of the Literature. Oncol Nurs Forum 2018. [PMID: 28632247 DOI: 10.1188/17.onf.e152-e167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Uncertainty is a major source of distress for cancer survivors. Because cancer is primarily a disease of older adults, a comprehensive understanding of the antecedents and outcomes of uncertainty in older adults with cancer is essential.
. LITERATURE SEARCH MEDLINE®, PsycINFO®, Scopus, and CINAHL® were searched from inception to December 2015. Medical Subject Headings (MeSH) terms and free text words were used for the search concepts, including neoplasms, uncertainty, and aging.
. DATA EVALUATION Extracted data included research aims; research design or analysis approach; sample size; mean age; type, stage, and duration of cancer; type and duration of treatment; uncertainty scale; and major results.
. SYNTHESIS Of 2,584 articles initially identified, 44 studies (30 qualitative, 12 quantitative, and 2 mixed-methods) were included. Evidence tables were developed to organize quantitative and qualitative data. Descriptive numeric and thematic analyses were used to analyze quantitative results and qualitative findings, respectively. Outcomes were reported under four main categories. CONCLUSIONS Uncertainty is an enduring and common experience in cancer survivorship. Uncertainty is affected by a number of demographic and clinical factors and affects quality of life (QOL) and psychological well-being.
. IMPLICATIONS FOR PRACTICE Uncertainty should be considered a contributing factor to psychological well-being and QOL in older adults with cancer. Nurses are in a unique position to assess negative effects of uncertainty and manage these consequences by providing patients with information and emotional support.
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van Roij J, Fransen H, van de Poll-Franse L, Zijlstra M, Raijmakers N. Measuring health-related quality of life in patients with advanced cancer: a systematic review of self-administered measurement instruments. Qual Life Res 2018; 27:1937-1955. [PMID: 29427216 DOI: 10.1007/s11136-018-1809-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are becoming increasingly important in clinical practice. The implementation of PROMS in routine practice is challenging because information regarding psychometric quality of measurement instruments is fragmented and standardization is lacking. The aim of this study is to evaluate the quality of self-administered HRQoL measurement instruments for use in patients with advanced cancer in clinical practice. METHODS A systematic literature search was performed in PubMed, Embase, PsycINFO, and CINAHL to identify studies concerning self-administered HRQoL measurement instruments in patients with advanced cancer between January 1990 and September 2016. Quality of the measurement instruments was assessed by predefined criteria derived from the COSMIN checklist. RESULTS Sixty-nine articles relating to 39 measurement instruments met the inclusion criteria. Information regarding important measurement properties was often incomplete. None of the instruments performed sufficient on all measurement properties. Considering available information, the EORTC QLQ-C15-PAL appeared to have adequate psychometric properties, together with the EORTC QLQ-BM22. CONCLUSIONS Many of the existing HRQoL measurement instruments have not yet been evaluated in an adequate manner. Validation of self-administered HRQoL measurement instruments is an ongoing development and should be prioritized. This review contributes to improved clarity regarding the availability and quality of HRQoL measurement instruments for patients with advanced cancer and supports health care professionals in an adequate selection of suitable PROMs in clinical practice.
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Affiliation(s)
- Janneke van Roij
- The Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands.
| | - Heidi Fransen
- The Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Lonneke van de Poll-Franse
- The Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Myrte Zijlstra
- The Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands.,Department of Medical Oncology, Radboud MC, Nijmegen, The Netherlands
| | - Natasja Raijmakers
- The Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands
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Kvåle K, Synnes O. Living with life-prolonging chemotherapy-control and meaning-making in the tension between life and death. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28892215 DOI: 10.1111/ecc.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 11/29/2022]
Abstract
Chemotherapy, radiotherapy, hormone therapy and immune therapy have made many cancers chronic, potential curable diseases rather than inevitably fatal, but the treatments are often both mentally and physically stressful even if the side effects varies. The right use of palliative chemotherapy is a complex issue and there are many aspects to take into consideration. The aim of the study was to gain insight into the illness narratives of cancer patients, from the day they suspected that something was wrong up to the present day where they are living with incurable cancer, undergoing life-prolonging chemotherapy. Thirteen narrators were included. They were all cancer patients on chemotherapy with the intention of prolonging life (informed by their oncologist) in an outpatient's clinic in Norway. Narrative analyse of their illness stories was applied. The main findings showed that the narrators considered their lives worth living in spite of the treatment. They seemed to take control and build a new life on "what was left after the storm," and described how they found meaning living in the tension between life and death.
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Affiliation(s)
- K Kvåle
- VID Specialized University, Bergen, Fyllingsdalen, Norway
| | - O Synnes
- Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway
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Godskesen T, Kihlbom U. "I Have a Lot of Pills in My Bag, You Know": Institutional Norms in the Provision of Hope in Phase I Clinical Cancer Trials. J Oncol Pract 2017; 13:679-682. [PMID: 28837376 DOI: 10.1200/jop.2017.021832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tove Godskesen
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Ulrik Kihlbom
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
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Rohde G, Kersten C, Vistad I, Mesel T. Spiritual Well-being in Patients With Metastatic Colorectal Cancer Receiving Noncurative Chemotherapy: A Qualitative Study. Cancer Nurs 2017; 40:209-216. [PMID: 27101099 PMCID: PMC5402710 DOI: 10.1097/ncc.0000000000000385] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2016] [Indexed: 12/04/2022]
Abstract
BACKGROUND Spiritual well-being (SWB) is an important quality-of-life dimension for cancer patients in the palliative phase. Therefore, it is important for healthcare professionals to recognize the concept of SWB from the patient's point of view. A deeper understanding of how patients experience and reflect upon these issues might influence patient care. OBJECTIVES The aim of this study was to explore SWB in colorectal cancer patients receiving chemotherapy in the palliative phase. METHODS We used a qualitative method of in-depth interviews and a hermeneutic editing approach for the analyses and interpretations. RESULTS Twenty colorectal cancer patients in the palliative phase, aged 34 to 75 years, were included: 12 patients were receiving first-line chemotherapy, and 8 patients were receiving second-line chemotherapy. Through empirical analyses, we identified subthemes according to the SWB dimensions defined by the European Organisation for Research and Treatment of Cancer quality-of-life group. Under the SWB dimension, (i) relationships with self and others, we identified the subthemes: (a) strategies for inner harmony and (b) sharing feelings with significant others. Under the dimension, (ii) existential issues, we identified the subtheme (c) coping with end-of-life thoughts. Under the dimension, (iii) specifically religious and/or spiritual beliefs and practices, we identified the subtheme (d) seeking faith as inner support. CONCLUSION Knowledge about cancer patients' use of different strategies to increase their SWB may help healthcare professionals to guide patients through this vulnerable phase. IMPLICATION FOR PRACTICE Healthcare professionals need sufficient courage and willingness to share their patients' thoughts, beliefs, and grief to be able to guide patients toward improving their SWB.
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Affiliation(s)
- Gudrun Rohde
- Author Affiliations: Faculty of Health and Sport Sciences, University of Agder (Dr Rohde); Department of Clinical Research (Dr Rohde), Center for Cancer Treatment (Dr Kersten), and Department of Obstetrics and Gynecology (Dr Vistad), Sorlandet Hospital HF; and Department of Religion, Philosophy, and History, University of Agder (Dr Mesel), Kristiansand, Norway
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Terkamo-Moisio A, Kvist T, Kangasniemi M, Laitila T, Ryynänen OP, Pietilä AM. Nurses’ attitudes towards euthanasia in conflict with professional ethical guidelines. Nurs Ethics 2016; 24:70-86. [DOI: 10.1177/0969733016643861] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Despite the significant role of nurses in end-of-life care, their attitudes towards euthanasia are under-represented both in the current literature and the controversial debate that is ongoing in several countries. Research questions: What are the attitudes towards euthanasia among Finnish nurses? Which characteristics are associated with those attitudes? Research design: Cross-sectional web-based survey. Participants and research context: A total of 1003 nurses recruited via the members’ bulletin of the Finnish Nurses Association and social media. Ethical considerations: Ethical approval was obtained from the Committee on Research Ethics of the university to which the authors were affiliated. Findings: The majority (74.3%) of the participants would accept euthanasia as part of Finnish healthcare, and 61.8% considered that Finland would benefit from a law permitting euthanasia. Most of the nurses (89.9%) thought that a person must have the right to decide on his or her own death; 77.4% of them considered it likely that they would themselves make a request for euthanasia in certain situations. Discussion: The value of self-determination and the ability to choose the moment and manner of one’s death are emphasized in the nurses’ attitudes towards euthanasia. Conclusion: A continuous dialogue about euthanasia and nurses’ shared values is crucial due to the conflict between nurses’ attitudes and current ethical guidelines on nursing.
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Affiliation(s)
| | | | | | | | | | - Anna-Maija Pietilä
- University of Eastern Finland, Finland; Social and Health Care Services, Finland
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17
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Maley CM, Pagana NK, Velenger CA, Humbert TK. Dealing With Major Life Events and Transitions: A Systematic Literature Review on and Occupational Analysis of Spirituality. Am J Occup Ther 2016; 70:7004260010p1-6. [PMID: 27294990 DOI: 10.5014/ajot.2016.015537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic literature review analyzed the construct of spirituality as perceived by people who have experienced or are experiencing a major life event or transition. The researchers investigated studies that used narrative analysis or a phenomenological methodology related to the topic. Thematic analysis resulted in three major themes: (1) avenues to and through spirituality, (2) the experience of spirituality, and (3) the meaning of spirituality. The results provide insights into the intersection of spirituality, meaning, and occupational engagement as understood by people experiencing a major life event or transition and suggest further research that addresses spirituality in occupational therapy and interdisciplinary intervention.
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Affiliation(s)
- Christine M Maley
- Christine M. Maley, MS, OTR/L, is Occupational Therapist, South Bay Early Intervention, Lowell, MA
| | - Nicole K Pagana
- Nicole K. Pagana, MS, OTR/L, is Occupational Therapist, Susquehanna Health, Williamsport, PA
| | - Christa A Velenger
- Christa A. Velenger, MS, OTR/L, is Occupational Therapist, Robert Wood Johnson University Hospital Hamilton, Hamilton, NJ
| | - Tamera Keiter Humbert
- Tamera Keiter Humbert, DEd, OTR/L, is Associate Professor, Occupational Therapy, Elizabethtown College, Elizabethtown, PA;
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Torskenæs KB, Kalfoss MH, Sæteren B. Meaning given to spirituality, religiousness and personal beliefs: explored by a sample of a Norwegian population. J Clin Nurs 2015; 24:3355-64. [PMID: 26335018 DOI: 10.1111/jocn.12962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this article is to explore the meanings given to the words 'spirituality', 'religiousness' and 'personal beliefs' by a Norwegian sample of healthy and sick individuals. BACKGROUND Studies show that a high proportion of nurses do not identify the spiritual needs of their patients, even if the nurses are educated to give care for the whole person, including the spiritual dimension. DESIGN This study used an exploratory qualitative design. METHODS Qualitative data generated from six focus groups were collected in southeast Norway. The focus groups were comprised of three groups of health professionals (n = 18) and three groups of patients from different institutions (n = 15). RESULTS The group discussions revealed that the meanings of spirituality, religiousness and personal beliefs were interwoven, and the participants had difficulty in finding a common terminology when expressing their meanings. Many of the participants described the spiritual dimension with feelings of awe and respect. They were dependent on spirituality in order to experience balance in life and cope with life crises. CONCLUSION The themes and categories identified by the focus group discussion highlights that spirituality ought to be understood as a multilayered dimension. An appreciation of the spiritual dimension and it's implication in nursing may help to increase health and decrease suffering. RELEVANCE TO CLINICAL PRACTICE Health professionals need to be cognizant of their own sense of spirituality to investigate the spiritual needs among their patients. This study's focus group discussions helped both patients and health professionals to improve their knowledge regarding the meanings given to the spiritual dimension.
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Ellingsen S, Roxberg Å, Kristoffersen K, Rosland JH, Alvsvåg H. The pendulum time of life: the experience of time, when living with severe incurable disease--a phenomenological and philosophical study. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:203-215. [PMID: 25205069 DOI: 10.1007/s11019-014-9590-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to gain a deeper understanding of the experience of time when living with severe incurable disease. A phenomenological and philosophical approach of description and deciphering were used. In our modern health care system there is an on-going focus on utilizing and recording the use of time, but less focus on the patient's experience of time, which highlights the need to explore the patients' experiences, particularly when life is vulnerable and time is limited. The empirical data consisted of 26 open-ended interviews with 23 participants receiving palliative care at home, in hospital or in a nursing home in Norway. The theoretical frameworks used are mainly based upon K. Martinsens philosophy of care, K. E. Løgstrup phenomenological philosophy, in addition to C. Saunders' hospice philosophy, L. Feigenberg's thanatology and U. Qvarnström's research exploring patient's reactions to impending death. Experience of time is described as being a movement that moves the individual towards death in the field of opposites, and deciphered to be a universal, but a typical and unique experience emerging through three integrated levels: Sense of time; where time is described as a movement that is proceeding at varying speeds. Relate to time; where the awareness of limited life changes the understanding of time to be more existential. Being in time; where limited time seems to clarify the basic living conditions and phenomena of life. The existence of life when the prospect of death is present is characterized by emotional swings that move within polarizing dimensions which is reflected in the experience of time illustrated as the moves of the pendulum in a grandfather clock. The diversity of the experience of time is oscillating between going fast or slow, being busy or calm, being unpredictable but predictable, safe or unsafe and between being good or bad, depending on the embodied situation of the individual.
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Affiliation(s)
- Sidsel Ellingsen
- Department of Nursing and Health Care, Haraldsplass Deaconess University College, Bergen, Norway,
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Best M, Aldridge L, Butow P, Olver I, Webster F. Conceptual analysis of suffering in cancer: a systematic review. Psychooncology 2015; 24:977-86. [PMID: 25754062 DOI: 10.1002/pon.3795] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient suffering is a neglected area of care, partly because of poor definitions. The aim of this study was to distill what is currently known about suffering in the health literature in order to generate a conceptual basis for further research. METHODS A systematic review focusing on suffering across all cancers was undertaken. The search included peer-reviewed English articles published between 1992 and 2012 in MEDLINE, Embase, PsycINFO and the Cochrane Library databases focusing on conceptualisation of suffering in adult cancer patients. Seminal theoretical articles conceptualising suffering more generally were also eligible. To ensure identification of a sufficiently broad range of conceptualisations of suffering in cancer, the search strategy was drafted iteratively. Study findings were subjected to conceptual analysis using the evolutionary method. RESULTS One hundred twenty-eight studies were identified, which discussed definitions or conceptualisations of suffering. In terms of its attributes, suffering is defined as 'an all-encompassing, dynamic, individual phenomenon characterized by the experience of alienation, helplessness, hopelessness and meaninglessness in the sufferer which is difficult for them to articulate. It is multi-dimensional and usually incorporates an undesirable, negative quality.' Surrogate terms, antecedents and consequences of suffering are described. CONCLUSIONS The systematic review revealed that suffering includes holistic suffering, which is multidimensional, oscillating, individual and difficult for individuals to express. Opportunities should be provided for patients to express their suffering. The potential for suffering to be transcended needs to be recognized and facilitated by healthcare staff.
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Affiliation(s)
- Megan Best
- Psycho-Oncology Co-operative Research Group, University of Sydney, Level 6 North, Lifehouse C39Z, New South Wales, 2006, Australia
| | - Lynley Aldridge
- Psycho-Oncology Co-operative Research Group, University of Sydney, Level 6 North, Lifehouse C39Z, New South Wales, 2006, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, University of Sydney, Level 6 North, Lifehouse C39Z, New South Wales, 2006, Australia
| | - Ian Olver
- Cancer Council Australia, GPO Box 4708, Sydney, New South Wales, 2001, Australia
| | - Fleur Webster
- Cancer Australia, Locked Bag 3, Strawberry Hills, New South Wales, 2012, Australia
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Development and Preliminary Testing of a Meaning-Centered Program for Young Adults With Advanced-Stage Cancer. J Hosp Palliat Nurs 2015. [DOI: 10.1097/njh.0000000000000146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aoun SM, Nekolaichuk C. Improving the evidence base in palliative care to inform practice and policy: thinking outside the box. J Pain Symptom Manage 2014; 48:1222-35. [PMID: 24727305 DOI: 10.1016/j.jpainsymman.2014.01.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/23/2014] [Accepted: 02/07/2014] [Indexed: 02/01/2023]
Abstract
The adoption of evidence-based hierarchies and research methods from other disciplines may not completely translate to complex palliative care settings. The heterogeneity of the palliative care population, complexity of clinical presentations, and fluctuating health states present significant research challenges. The aim of this narrative review was to explore the debate about the use of current evidence-based approaches for conducting research, such as randomized controlled trials and other study designs, in palliative care, and more specifically to (1) describe key myths about palliative care research; (2) highlight substantive challenges of conducting palliative care research, using case illustrations; and (3) propose specific strategies to address some of these challenges. Myths about research in palliative care revolve around evidence hierarchies, sample heterogeneity, random assignment, participant burden, and measurement issues. Challenges arise because of the complex physical, psychological, existential, and spiritual problems faced by patients, families, and service providers. These challenges can be organized according to six general domains: patient, system/organization, context/setting, study design, research team, and ethics. A number of approaches for dealing with challenges in conducting research fall into five separate domains: study design, sampling, conceptual, statistical, and measures and outcomes. Although randomized controlled trials have their place whenever possible, alternative designs may offer more feasible research protocols that can be successfully implemented in palliative care. Therefore, this article highlights "outside the box" approaches that would benefit both clinicians and researchers in the palliative care field. Ultimately, the selection of research designs is dependent on a clearly articulated research question, which drives the research process.
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Affiliation(s)
- Samar M Aoun
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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How older people with incurable cancer experience daily living: A qualitative study from Norway. Palliat Support Care 2014; 13:1037-48. [DOI: 10.1017/s1478951514001011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:An increasing number of older people are living with incurable cancer as a chronic disease, requiring palliative care from specialized healthcare for shorter or longer periods of time. The aim of our study was to describe how they experience daily living while receiving palliative care in specialized healthcare contexts.Method:We conducted a qualitative research study with a phenomenological approach called “systematic text condensation.” A total of 21 participants, 12 men and 9 women, aged 70–88, took part in semistructured interviews. They were recruited from two somatic hospitals in southeastern Norway.Results:The participants experienced a strong link to life in terms of four subthemes: to acknowledge the need for close relationships; to maintain activities of normal daily life; to provide space for existential meaning-making and to name and handle decline and loss. In addition, they reported that specialized healthcare contexts strengthened the link to life by prioritizing and providing person-centered palliative care.Significance of results:Older people with incurable cancer are still strongly connected to life in their daily living. The knowledge that the potential for resilience remains despite aging and serious decline in health is considered a source of comfort for older people living with this disease. Insights into the processes of existential meaning-making and resilience are seen as useful in order to increase our understanding of how older people adapt to adversity, and how their responses may help to protect them from some of the difficulties inherent to aging. Healthcare professionals can make use of this information in treatment planning and for identification of psychosocial and sociocultural resources to support older people and to strengthen patients' life resources.
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Hajdarevic S, Rasmussen BH, Hörnsten Å. You never know when your last day will come and your trip will be over – Existential expressions from a melanoma diagnosis. Eur J Oncol Nurs 2014; 18:355-61. [DOI: 10.1016/j.ejon.2014.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/20/2014] [Accepted: 03/26/2014] [Indexed: 11/16/2022]
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Udo C. The concept and relevance of existential issues in nursing. Eur J Oncol Nurs 2014; 18:347-54. [DOI: 10.1016/j.ejon.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/12/2014] [Accepted: 04/09/2014] [Indexed: 12/30/2022]
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Validation of a new instrument for self-assessment of nurses' core competencies in palliative care. Nurs Res Pract 2014; 2014:615498. [PMID: 25132989 PMCID: PMC4124716 DOI: 10.1155/2014/615498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/04/2014] [Accepted: 05/25/2014] [Indexed: 12/03/2022] Open
Abstract
Competence can be seen as a prerequisite for high quality nursing in clinical settings. Few research studies have focused on nurses' core competencies in clinical palliative care and few measurement tools have been developed to explore these core competencies. The purpose of this study was to test and validate the nurses' core competence in palliative care (NCPC) instrument. A total of 122 clinical nurse specialists who had completed a postbachelor program in palliative care at two university colleges in Norway answered the questionnaire. The initial analysis, with structural equation modelling, was run in Mplus 7. A modified confirmatory factor analysis revealed the following five domains: knowledge in symptom management, systematic use of the Edmonton symptom assessment system, teamwork skills, interpersonal skills, and life closure skills. The actual instrument needs to be tested in a practice setting with a larger sample to confirm its usefulness. The instrument has the potential to be used to refine clinical competence in palliative care and be used for the training and evaluation of palliative care nurses.
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Blegen NE, Eriksson K, Bondas T. Through the depths and heights of darkness; mothers as patients in psychiatric care. Scand J Caring Sci 2014; 28:852-60. [PMID: 24602202 DOI: 10.1111/scs.12122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/29/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study attempts to contribute to the knowledge of caring science and mental health care by means of a profound understanding of the patients' existential world when being a mother in receipt of psychiatric care, with focus on inner processes such as health and suffering. Mothers struggle to cope with the demands of the illness and the responsibility for their children. They see themselves through their children and regard the child as an important part of themselves. Mothers experience guilt and shame related to motherhood, and when they have to relinquish their responsibility as a mother, they consider themselves a failure. Despite a range of practical and emotional difficulties, motherhood involved extremely positive experiences, which provide a purpose as well as fulfilment and meaning in life. METHODOLOGY This study is rooted in philosophical hermeneutics inspired by Gadamer with an inductive-deductive-abductive approach. Interpretation of the data was made on different levels of abstraction described as rational, contextual, existential and ontological. The point of departure was the caring science theory about health and suffering and the hermeneutic philosophy of understanding. RESULT OF THE INTERPRETATION The interpretation revealed the mothers' experiences of health and suffering as a struggle between the darkness of suffering and their inner source of strength. In the light of the theory of caring, the conscience became visible as the bearer of the human being's inner ethos of love and compassion. Experiences of health and suffering were interpreted as a struggle between guilt and responsibility, where conscience emerged as the road from ontological guilt to responsibility that leads the human being to what is true, beautiful and good in life.
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Affiliation(s)
- Nina Elisabeth Blegen
- Department of Caring Science, Åbo Academy University, Vasa, Finland; Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Godskesen T, Nygren P, Nordin K, Hansson M, Kihlbom U. Phase 1 clinical trials in end-stage cancer: patient understanding of trial premises and motives for participation. Support Care Cancer 2013; 21:3137-42. [DOI: 10.1007/s00520-013-1891-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
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Caspari S, Aasgaard T, Lohne V, Slettebø Å, Nåden D. Perspectives of health personnel on how to preserve and promote the patients’ dignity in a rehabilitation context. J Clin Nurs 2013; 22:2318-26. [DOI: 10.1111/jocn.12181] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Synnøve Caspari
- Department of Nursing; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Trygve Aasgaard
- Department of Nursing; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Vibeke Lohne
- Department of Nursing; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Åshild Slettebø
- Faculty of Health and Sport; University of Agder; Kristiansand Norway
| | - Dagfinn Nåden
- Department of Nursing; Oslo and Akershus University College of Applied Sciences; Oslo Norway
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Noble H, Kelly D, Hudson P. Experiences of carers supporting dying renal patients managed without dialysis. J Adv Nurs 2012; 69:1829-39. [PMID: 23167619 DOI: 10.1111/jan.12049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2012] [Indexed: 11/28/2022]
Abstract
AIM To explore the impact of being a family carer to patients with stage 5 chronic kidney disease managed without dialysis. BACKGROUND Increasing numbers of patients with renal disease worldwide are making the decision not to embark on dialysis. This group has significant physical and psychological symptom burdens similar to or greater than those in advanced cancer patients. Little is known about the impact on family carers. DESIGN Exploratory, qualitative design. METHODS The study was undertaken with 19 carers caring for patients managed in a Renal Supportive Care Service in the UK between 2006-2008. Sixty-one semi-structured interviews and detailed field notes inform the analysis. FINDINGS 'Caring from diagnosis to death' was the overarching theme illustrated by three sub-themes: (i) Caregiver's plight - making sense of the disease and potential deterioration; (ii) Having to care indefinitely; and (iii) Avoiding talk of death. 'Caring from diagnosis to death' coincides with an original concept analysis of renal supportive care, which is considered an adjunct to the management of patients with renal disease at all stages of their illness. CONCLUSION There is a clear need for further research internationally and theory-based nursing interventions to support carers of patients managed without dialysis. The development of a holistic, integrated care pathway based on carer perspectives, which includes identification of information needs related to original diagnosis, associated comorbidities, treatment options, prognosis, and assistance in developing strategies to manage communication with patients as the end of life approaches, is required.
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Affiliation(s)
- Helen Noble
- Health Services Research, School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, UK.
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Rykkje LLR, Eriksson K, Raholm MB. Spirituality and caring in old age and the significance of religion - a hermeneutical study from Norway. Scand J Caring Sci 2012; 27:275-84. [DOI: 10.1111/j.1471-6712.2012.01028.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Udo C, Danielson E, Melin-Johansson C. Existential issues among nurses in surgical care--a hermeneutical study of critical incidents. J Adv Nurs 2012; 69:569-77. [PMID: 22591004 DOI: 10.1111/j.1365-2648.2012.06032.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS To report a qualitative study conducted to gain a deeper understanding of surgical nurses' experiences of existential care situations. Background. Existential issues are common for all humans irrespective of culture or religion and constitute man's ultimate concerns of life. Nurses often lack the strategies to deal with patients' existential issues even if they are aware of them. DESIGN This is a qualitative study where critical incidents were collected and analysed hermeneutically. METHODS During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1-2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used. FINDINGS The majority of incidents concerned nurses' experiences of caring for patients' dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses' personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care. CONCLUSION Findings are interpreted and discussed in the framework of Buber's philosophy of the relationships I-Thou and I-It, emphasizing nurses' different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.
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Affiliation(s)
- Camilla Udo
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
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