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Joshi M, Ásgeirsdóttir GH, Bakan M, Kodba Čeh H, Haugen DRF, Lunder U, Víbora Martín E, Morris B, Rasmussen BH, Romarheim E, Tripodoro V, van der Heide A, Veloso V, Yildiz B, Zambrano S, Strupp J, Voltz R. Dealing With Temporality in Patients With Life-Limiting Disease: An International Qualitative Study. QUALITATIVE HEALTH RESEARCH 2024:10497323241263751. [PMID: 39186945 DOI: 10.1177/10497323241263751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
The prospect of death influences people's thoughts about and how they deal with their remaining time. We aimed to understand whether patients with progressive, life-limiting diseases are oriented in the past, present, or future and how they deal with temporality. We conducted 57 in-depth interviews with end-of-life patients in 10 countries using thematic analysis at three levels (i.e., locally in three countries, with codes shared in the three-country subgroup, and in all 10 countries with a codebook that we developed). We found that the patients' thoughts were oriented toward all three time levels (i.e., past, present, and future). Complementing these levels, we identified another, namely, the future after death. Each time level included patients actively and passively dealing with their thoughts. Past themes were remorse and regret, nostalgia, and coming to terms with past choices; present themes were feeling grateful for being alive, a time for farewells, and living for the day; future themes were worries about the future, to miss out, hope, ideas about death and dying, and planning the near future; and future after death themes were not being there, worries about loved ones, and preparations for a future after death. A changed view on lifetime and avoidance of thinking about a certain time level related to several time levels, while desire to die fluctuated between levels and between acting on and feeling about it. Living for the day, worries about the future, and worries about the well-being of loved ones were common themes in all countries.
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Affiliation(s)
- Melanie Joshi
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Miša Bakan
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
| | - Hana Kodba Čeh
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
| | - Dagny Renata Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Urška Lunder
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
| | - Eva Víbora Martín
- CUDECA Institute for Training and Research in Palliative Care, CUDECA Hospice Foundation, Málaga, Spain
| | - Beth Morris
- Palliative Care Unit, University of Liverpool, Liverpool, UK
| | - Birgit H Rasmussen
- Institute for Palliative Care, Region Skane and Lund University, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Elisabeth Romarheim
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Vilma Tripodoro
- Instituto Pallium Latinoamérica, Buenos Aires, Argentina
- Atlantes, Global Observatory of Palliative Care, University of Navarra, Pamplona, Spain
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Verónica Veloso
- Institute of Medical Research A. Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | - Berivan Yildiz
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sofía Zambrano
- Department of Oncology, University Center for Palliative Care, Inselspital, Bern University Hospital, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Health Services Research, University of Cologne, Cologne, Germany
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Dewar J, Cook C, Smythe E, Spence D. An analysis of time conceptualisations and good care in an acute hospital setting. Nurs Inq 2024; 31:e12613. [PMID: 37927168 DOI: 10.1111/nin.12613] [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: 09/16/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
This study articulates the relationship between conceptualisations of time and the accounts of good care in an acute setting. Neoliberal healthcare services, with their focus on efficiencies, predominantly calculate quality care based on time-on-the-clock workforce management planning systems. However, the ways staff conceptualise and then relate to diverse meanings of time have implications for good care and for staff morale. This phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, temporal nature of care embedded in human relations. The study interviews involved 17 participants: 11 staff, 3 previous patients and 3 family members. Data were analysed iteratively to surface the phenomenality of temporality and good care. The following constituents of the data set are explored that together illustrate the relationship between the conceptualisations of time and the accounts of good care in an acute setting: patient time as a relational journey; patient time, sovereign time and time ethics and time, teamwork and flow. The findings are clinically significant because they offer a contrasting narrative about the relationship between time and care quality. The experiences of giving and receiving good care are indivisible from how temporality is experienced and the social relations within which care is embedded. Healthcare staff experience temporality differently from patients and families, a point that healthcare participants in this study appeared to comprehend and accommodate. For all parties involved in providing care or being the recipient of care, however, the capacity to be present was valued as a humanising ethic of care. Our study reinforces the importance of not creating presumptive binaries about which temporal structures are more or less humanising-there is a place for a fast-paced tempo, which can be experienced as being in the flow of human relations with one's team and on behalf of patients.
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Affiliation(s)
- Jan Dewar
- Department of Nursing, Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology North Campus, Auckland, New Zealand
| | - Catherine Cook
- Department of Nursing, Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology North Campus, Auckland, New Zealand
| | - Elizabeth Smythe
- Department of Nursing, Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology North Campus, Auckland, New Zealand
| | - Deborah Spence
- Department of Nursing, Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology North Campus, Auckland, New Zealand
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Riegel B, Dickson VV, Vellone E. The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care. J Cardiovasc Nurs 2022; 37:515-529. [PMID: 35482335 PMCID: PMC9561231 DOI: 10.1097/jcn.0000000000000919] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care. OBJECTIVE The aim of this study was to describe the manner in which characteristics of the problem, person, and environment interact to influence decisions about self-care made by adults with chronic HF. METHODS This study is a theoretical update. Literature on the influence of the problem, person, and environment on HF self-care is summarized. RESULTS Consistent with naturalistic decision making, the interaction of the problem, person, and environment creates a situation in which a self-care decision is needed. Problem factors influencing decisions about HF self-care include specific conditions such as cognitive impairment, diabetes mellitus, sleep disorders, depression, and symptoms. Comorbid conditions make HF self-care difficult for a variety of reasons. Person factors influencing HF self-care include age, knowledge, skill, health literacy, attitudes, perceived control, values, social norms, cultural beliefs, habits, motivation, activation, self-efficacy, and coping. Environmental factors include weather, crime, violence, access to the Internet, the built environment, social support, and public policy. CONCLUSIONS A robust body of knowledge has accumulated on the person-related factors influencing HF self-care. More research on the contribution of problem-related factors to HF self-care is needed because very few people have only HF and no other chronic conditions. The research on environment-related factors is particularly sparse. Seven new propositions are included in this update. We strongly encourage investigators to consider the interactions of problem, person, and environmental factors affecting self-care decisions in future studies.
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Guldager R, Hansen PV, Ziebell M. Past, present and future, the experience of time during examination for malignant brain tumor: a qualitative observational study. Acta Neurochir (Wien) 2021; 163:959-967. [PMID: 33389116 DOI: 10.1007/s00701-020-04693-z] [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: 10/01/2020] [Accepted: 12/21/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary malignant brain tumor is a severe disease with a poor prognosis causing reduced life expectancy and possible alteration in the perception of time. The aim of this study was to gain deeper insight into the perception of time from the perspective of patients with brain cancer as they pass through the Danish Integrated Brain Cancer Pathway at a university hospital in Denmark. METHODS Data were generated by shadowing six patients and relatives during their visit to and hospitalisation in a neurosurgical department. RESULTS Through one constructed case, three perspectives of time were identified. The patient's perception of time during his illness, the healthcare system's perception of time and, finally, an ethical time perspective. The analysis showed a discrepancy between patients' and healthcare professionals' perception of time. Furthermore, the results revealed an ethical time dimension. CONCLUSIONS The findings contribute to a better understanding of the perception of time among seriously ill patients and may further healthcare professionals' awareness of how to support patients in achieving a more meaningful use of their remaining lifetime.
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Abstract
Introduction: The various health and social care services provided in a given local area (i.e., place-based) must not only deliver primary care in proximity to the population, but act upstream on the social determinants of health. This type of care, when provided in a holistic and integrated manner, aims to improve the physical and mental health—but also the well-being and social capital—of individuals, families, groups and communities. This type of approach is known as Integrated Community Care (ICC). Theory and methods: This article was developed from a non-systematic review of scientific and grey literature followed by a qualitative analysis and researcher reflections on ICC. Results: The article presents the core concepts of ICC, namely temporality, local area, health care, social care, proximity and integration. These concepts are unpacked and a conceptual diagram is set forth to put the dynamic links between the concepts into perspective. Discussion and conclusion: The purpose of the article is to provide a conceptual clarification of ICC. Three examples of practise (from Switzerland, Quebec [Canada] and Italy) are used as illustrations to provide a better understanding of ICC and to open up horizons.
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Bové HM, Lisby M, Brünés N, Norlyk A. Considering "the more" of patients suffering from alcohol use disorders. An illustration of acute nursing care from a lifeworld-led perspective. Int J Qual Stud Health Well-being 2020; 15:1783860. [PMID: 32600190 PMCID: PMC7482723 DOI: 10.1080/17482631.2020.1783860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose The purpose of this study is to illustrate a theoretical value framework for humanisation of healthcare, a lifeworld-led care that has the potential to support nurses in acute medical units in addressing and meeting both challenges and care needs expressed by patients suffering from alcohol use disorders. Providing care to these patients means working with a very divergent and complex group of patients. When hospitalised in an acute medical unit, nurses are often these patients' first encounter, which gives a unique opportunity to initiate and establish a successful care alliance. Method The present study is a qualitative study based on an amplified secondary analysis of 25 pre-conducted interviews. Following a hermeneutic approach, the analysis was structured in accordance with the conceptual value framework for humanisation of care, drawing on the recognition of the patients' lifeworld as an aspect of importance. Findings The study showed that while there were examples of humanising care guided by the patients’ lifeworld present, there were also situations of care that were dehumanising. Conclusion: When letting the patients’ perspective of well-being be the centre of care, the patients’ experience of meaningfulness and sincerity within the provided care was nurtured, and they felt more humanly met.
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Affiliation(s)
- H M Bové
- Research Center for Emergency Medicine, Aarhus University Hospital , Aarhus, Denmark.,Section for Nursing, Department of Public Health, Aarhus University , Aarhus, Denmark
| | - M Lisby
- Research Center for Emergency Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - N Brünés
- Amager og Hvidovre Hospital , Denmark
| | - A Norlyk
- Section for Nursing, Department of Public Health, Aarhus University , Aarhus, Denmark
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Caldas CP, Berterö C. Taking the responsibility in dementia care: A concept analysis about facticity. Nurs Open 2018; 5:310-316. [PMID: 30062024 PMCID: PMC6056445 DOI: 10.1002/nop2.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/02/2018] [Indexed: 11/08/2022] Open
Abstract
AIM The aim of this study is to develop a comprehensive definition of facticity, applicable to dementia nursing. METHODS Walker and Avant's Concept Analysis was used to analyse facticity. Published literature found in PubMed, CINAHL, PsycInfo, and Scopus using the search term facticity and nursing, as well as books and dictionaries and empirical data was used to clarify the concept. RESULTS Facticity in nursing dementia care is being in reality taking on responsibility to truth. Antecedents of facticity include persons occupied with caring a demented older person including full-time duties, often accompanied by resistive behaviours. They are overloaded both physically and psychologically. Being present and feeling compassion and nurturing the relationship with the demented older persons and in that way strengthen the caregiving process. CONCLUSION Nurses need to be aware that all human beings are living with facticity.
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Affiliation(s)
| | - Carina Berterö
- Division of Nursing ScienceDepartment of Medical and Health SciencesLinköping UniversityLinköpingSweden
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Malmström M, Rasmussen BH, Bernhardson BM, Hajdarevic S, Eriksson LE, Andersen RS, MacArtney JI. It is important that the process goes quickly, isn't it?" A qualitative multi-country study of colorectal or lung cancer patients' narratives of the timeliness of diagnosis and quality of care. Eur J Oncol Nurs 2018; 34:82-88. [PMID: 29784144 DOI: 10.1016/j.ejon.2018.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/21/2018] [Accepted: 04/06/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The emphasis on early diagnosis to improve cancer survival has been a key factor in the development of cancer pathways across Europe. The aim of this analysis was to explore how the emphasis on early diagnosis and timely treatment is reflected in patient's accounts of care, from the first suspicion of colorectal or lung cancer to their treatment in Denmark, England and Sweden. METHOD We recruited 155 patients in Denmark, England and Sweden who were within six months of being diagnosed with lung or colorectal cancer. Data were collected via semi-structured narrative interviews and analysed using a thematic approach. RESULTS Participants' accounts of quality of care were closely related to how quickly (or not) diagnosis, treatment and/or healthcare processes went. Kinetic metaphors as a description of care (such as treadmill) could be interpreted positively as participants were willing to forgo some degree of control and accept disruption to their lives to ensure more timely care. Drawing on wider cultural expectations of the benefits of diagnosing and treating cancer quickly, some participants were concerned that the waiting times between interventions might allow time for the cancer to grow. CONCLUSIONS Initiatives emphasising the timeliness of diagnosis and treatment are reflected in the ways some patients experience their care. However, these accounts were open to further contextualisation about what speed of healthcare processes meant for evaluating the quality of their care. Healthcare professionals could therefore be an important patient resource in providing reassurance and support about the timeliness of diagnosis or treatment.
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Affiliation(s)
- Marlene Malmström
- The Institute for Palliative Care, Lund University and Region Skåne, Sweden; Lund University, Department of Health Sciences, Lund, Sweden.
| | - Birgit H Rasmussen
- The Institute for Palliative Care, Lund University and Region Skåne, Sweden; Lund University, Department of Health Sciences, Lund, Sweden
| | - Britt-Marie Bernhardson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | | | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden; School of Health Sciences, City, University of London, London EC1V 0HB, United Kingdom; Department of Infectious Diseases, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Rikke Sand Andersen
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit of General Practice & Department of Anthropology, Aarhus University, Denmark
| | - John I MacArtney
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Saarnio L, Boström AM, Gustavsson P, Hedman R, Öhlén J. Temporally and spatially shaped meanings of at-homeness among people 85 years and over with severe illness. Int J Older People Nurs 2017; 13. [PMID: 28840645 DOI: 10.1111/opn.12165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to illuminate how meanings of at-homeness are temporally and spatially shaped by older people with severe illness. BACKGROUND At-homeness can be understood as a feeling of being metaphorically at-home while experiencing well-being. The research field of at-homeness among older people with severe illness is under researched and knowledge about how at-homeness is shaped by time and place is limited. METHOD Narrative interviews were conducted in Sweden with a total of twenty men and women who were aged 85 years or over and affected by severe illness. The narrative interviews were analysed based on a phenomenological hermeneutical method. RESULTS Meanings of at-homeness that were shaped temporally and spatially were interpreted, where time and place were shaped individually by other aspects and also interwoven. Two main inter-related themes were constructed: shaping at-homeness through relying on a familiar place and shaping at-homeness through continuous balancing between the past, present and future. CONCLUSION AND IMPLICATIONS At-homeness is temporally and spatially shaped in two ways: through a process over time, or momentarily, where older people's earlier experiences and expectations are interwoven with their experiences of place and the people around them. The results of this study would be applicable to similar societal contexts. For future research, it is important to continue to study how at-homeness can be promoted for severely ill older people, in specific situations and over time.
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Affiliation(s)
- Lotta Saarnio
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Health Care Sciences, Ersta sköndal University College, Stockholm, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Geriatric Medicine, Danderyd hospital, Stockholm, Sweden
| | - Petter Gustavsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ragnhild Hedman
- Department of Health Care Sciences, Ersta sköndal University College, Stockholm, Sweden
| | - Joakim Öhlén
- Centre for Person-Centered care, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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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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Ellingsen S, Roxberg Å, Kristoffersen K, Rosland JH, Alvsvåg H. Being in transit and in transition The experience of time at the place, when living with severe incurable disease - a phenomenological study. Scand J Caring Sci 2013; 28:458-68. [DOI: 10.1111/scs.12067] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 07/09/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Sidsel Ellingsen
- Department of Nursing and Health Care; Haraldsplass Deaconess University College; Bergen Norway
- Department of Public Health and Primary Care; Faculty of Medicine and Dentistry; University in Bergen; Bergen Norway
| | - Åsa Roxberg
- Department of Nursing and Health Care; Haraldsplass Deaconess University College; Bergen Norway
- School of Health and Caring Sciences; Linnaeus University; Växjö Sweden
| | | | - Jan Henrik Rosland
- Sunniva centre for palliative care; The Medical Department; Haraldsplass Deaconess Hospital; Bergen Norway
- Department of Surgical Sciences; Faculty of Medicine and Dentistry; University in Bergen; Bergen Norway
| | - Herdis Alvsvåg
- Department of Nursing and Health Care; Haraldsplass Deaconess University College; Bergen Norway
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