The meaning of reconciliation: women’s stories about their experience of reconciliation with suffering from grief

The meaning of dignity when the patients' bodies are falling apart

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.

'Best fit' caring skills of an interprofessional team in short-term goal-directed reablement: older adults' perceptions

This paper reports a study conducted to illuminate older adults' perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults' reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver-patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care.

Being in a critical illness-recovery process: a phenomenological hermeneutical study

AIMS AND OBJECTIVE

The aim of this study was to describe and interpret the essential meaning of the lived experiences of being in a critical illness-recovery process after a life-threatening condition.

BACKGROUND

The critical illness-recovery process after a life-threatening condition takes several years and does not only include patients' experiences during intensive care. Previous research has mainly focused on what critically ill patients recall. However, from a phenomenological point of view, experiences are more than memories alone. To plan and perform relevant health care and social support for patients who have survived a life-threatening condition, a more profound understanding about their lived experiences is needed.

DESIGN AND METHOD

In this qualitative study, a phenomenological hermeneutical approach was used. Interviews were conducted with seven patients, two to four years after they had received care in an intensive care unit in Sweden.

RESULTS

The comprehensive understanding of the results shows that the critical illness-recovery process after a life-threatening condition means an existential struggle to reconcile with an unfamiliar body and with ordinary life. This can be understood as an 'unhomelikeness' implying a struggle to create meaning and coherence from scary and fragmented memories. The previous life projects, such as work and social life become unfamiliar when the patient's fragile and weak body is disobedient and brings on altered sensations.

CONCLUSIONS

Patients who survive a life-threatening condition have an immense need for care and support during the entire critical illness-recovery process, and also after the initial acute phase. They need a coherent understanding of what happened, and support to be able to perform their changed life projects.

RELEVANCE TO CLINICAL PRACTICE

Supporting and caring for patients' recovery from a life- threatening condition involves recognising the patients' struggle and responding to their existential concerns.

[Experiencing rejection and disappointments from the health system while living with chronic pain during aging]

Objective To describe the experience of older adults with chronic pain in health services. Methods Qualitative, grounded theory type study of 25 elderly residents with chronic pain in the cities of Medellin and Bogota. In-depth interviews were used to collect the data. The analysis was done using the tools of grounded theory as layed out by Strauss and Corbin. Results This study reported 5 main categories where it is possible to glimpse how the elderly perceive, at first, support from members of the medical team when they bothered to seek solutions to their health problems. Over time, however, when pain is exacerbated into a "crisis", they began to experience the disappointments and suffering associated with health systems, as well as recriminations. This leads them to choose the option of distancing themselves from the health system. This makes the elderly lose trust in doctors and interest in seeking out health services. . Conclusions The study provided a description of the experience of older adults with chronic pain when accessing health services. They experience the disappointments and rejections that are a product of worsening symptom exacerbations. The elderly are in need of humanized care that can in one way or another maked their experience of chronic pain more bearable.

Mental health nurses responding to suffering in the 21st century occidental world: accompanying people in their search for meaning

Much of contemporary health and mental health practice pays little attention to suffering, and when it does, invariably suffering is conflated with pain. Within such views, the health care practitioner ought to be concerned with removing or stopping the suffering as, for many parts of the occidental world at least, suffering is regarded as antagonistic to the pursuit of happiness. However, it has been recognized since ancient times that the experience of suffering can give rise to growth. This view sees suffering as an inevitable aspect of the human condition and experience; as something that might need to be endured, minimized, relieved, explored for meaning and maybe even learned from. The former conceptualization of suffering leaves little, if any, room for the sufferer to be to be proud of his suffering and to consider it ennobling rather than degrading, and such views are highly congruent with the increased pathologizing of 'everyday life' and with that, the inexorable proliferation of pharmacological 'treatment'. Accordingly, we assert that there is a clear need for Psychiatric/Mental Health nurses to re-think their views of suffering and consider how they might help the person discover meaning in the experience; how they might accompany the individual on his/her suffering journey. We therefore identify a range of approaches and interventions that Psychiatric/Mental Health nurses can use when attempting to help those experiencing mental health-related suffering.

Blessed alienation: the Christian monastery as a caring and restorative environment

Being mentally ill is often associated with experiencing alienation from society because sensations are not easily shared with others. Modern health care leads us to pose many questions. Some sufferers search and find their way to monasteries as they did centuries ago. We interviewed six persons staying in a monastery to understand the meaning of health and care in a monastic environment in contemporary Sweden. We analyzed the transcripts by means of a hermeneutic approach and discovered that the helping effect of the monastery was based on its contradictory/paradoxical structure that corresponded to the lifeworld of a person suffering from mental illness. The monastery was a place where one could be different but equal, and simultaneously provided freedom within boundaries, calmness and intensity, privacy and relations, demands and confirmation. This facilitated experiences of health and wholeness, necessary to manage the challenges of recovery.

Undignified care

Patient dignity in involuntary psychiatric hospital care is a complex yet central phenomenon. Research is needed on the concept of dignity’s specific contextual attributes since nurses are responsible for providing dignified care in psychiatric care. The aim was to describe nurses’ experiences of violation of patient dignity in clinical caring situations in involuntary psychiatric hospital care. A qualitative design with a hermeneutic approach was used to analyze and interpret data collected from group interviews. Findings reveal seven tentative themes of nurses’ experiences of violations of patient dignity: patients not taken seriously, patients ignored, patients uncovered and exposed, patients physically violated, patients becoming the victims of others’ superiority, patients being betrayed, and patients being predefined. Understanding the contextual experiences of nurses can shed light on the care of patients in involuntary psychiatric hospital care.