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Staats K, Jeppestøl K, Søvde BE, Brenne BA, Tarberg AS. End-of-life care at home: Dignity of family caregivers. Nurs Ethics 2024:9697330241241773. [PMID: 38587469 DOI: 10.1177/09697330241241773] [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: 04/09/2024]
Abstract
BACKGROUND Healthcare services are increasingly being shifted to home settings for patients nearing end-of-life. Consequently, the burden on family caregivers is significant. Their vulnerable situation remains poorly understood and there is little information available regarding their experiences of dignity. AIM This study seeks to understand the experiences of family caregivers related to dignity and loss of dignity, aiming to provide a deeper insight into their situation when caring for a home-dwelling family member nearing end-of-life. RESEARCH DESIGN AND PARTICIPANTS This exploratory study consists of a second analysis combining data from two primary studies, including 24 family caregivers of a family member nearing end-of-life, and is founded upon Gadamer's philosophical hermeneutics. ETHICAL CONSIDERATIONS Approval was obtained from the Norwegian Agency for Shared Services in Education and Research and was based on voluntary participation, informed consent, and confidentiality. RESULTS The following three main themes were identified: Having a meaningful existence within the living environment, being seen and valued as a family caregiver in relation with others and suffering in a space of loneliness. These contextual, relational, and existential perspectives were found to be closely interrelated. CONCLUSION AND FINAL CONSIDERATIONS The dignity of family caregivers was closely tied to being seen as unique individuals, not merely caregivers, thereby requiring healthcare professionals (HCPs) to understand their personal needs. This study highlights the emotional distress and loneliness family caregivers feel in their dual role within the healthcare system, thereby calling for HCPs to adopt an attitude of gentleness and recognition to impart dignity-preserving care in homecare practices.
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Solberg M, Berg GV, Andreassen HK. An emotional roller coaster - family members' experiences of being a caregiver throughout a cancer trajectory. Int J Qual Stud Health Well-being 2022; 17:2137965. [PMID: 36264025 PMCID: PMC9586637 DOI: 10.1080/17482631.2022.2137965] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose To explore family members’ experiences of caregiving throughout a cancer trajectory from diagnosis until around one year after chemotherapy and radiation treatment ended. Method We conducted a longitudinal qualitative study using in-depth interviews with 13 family members at one to three points of time: before, during, and after treatment. To analyse the interviews, we leaned on Braun and Clark procedure for thematic analysis. Result The analysis revealed three themes in family members’ experiences of being a caregiver to a cancer patient throughout a cancer trajectory. These were: (1) From the time of diagnosis—overwhelming and uncertain; (2) During and after treatment—invisible and not involved; (3) Throughout the cancer trajectory—an emotional roller coaster. Conclusion The results indicated that the family members felt invisible and not involved and they experienced being a caregiver throughout the cancer trajectory as an emotional roller coaster. Our empirical findings thus indicate that in cancer care, family perspectives are yet to be implemented in daily practice. This is in contrast to explicit goals in current health policies underlining support and involvement of family members as a core aspect in cancer care.
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Affiliation(s)
- Monica Solberg
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Innlandet Hospital Trust, Norway,CONTACT Monica Solberg Norwegian University of Science and Technology and Innlandet Hospital Trust
| | - Geir Vegard Berg
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Innlandet Hospital Trust, Norway
| | - Hege Kristin Andreassen
- Department of Health Siences in Gjøvik, Norwegian University of Science and Technology, Trondheim, Norway,Technoligy and the Artic University of Norway, Tromsø, Norway
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Bjerkmo L, Helgesen AK, Blix BH. Experiences of Being Significant Others to Older Adults with Frailty Living Alone in Rural Arctic Norway: A Qualitative Study. Healthc Policy 2022; 15:1283-1292. [PMID: 35800151 PMCID: PMC9255900 DOI: 10.2147/rmhp.s367079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Our aim in this study was to explore how significant others experience being “significant” to older adults living alone with frailty in rural Arctic areas in northern Norway. The proportion of older adults in the population is larger and growing faster in rural- than in urban areas. Due to out-migration of the younger generations, many significant others live far from the older adults. Methods Our results are based on a thematic analysis of semistructured interviews with ten persons identified as significant others by older adults in rural Arctic Norway. Results The analysis resulted in two main themes and five subthemes: 1. Restoring and maintaining balance in the older adult’s life with the following three subthemes: 1.1. balancing between the older adult’s capacity and the physical environment; 1.2. emotional support; and 1.3. balancing between the older adult’s need for help and the services offered; and 2. Maintaining balance in one’s own life with the following two subthemes: 2.1. family and working life; and 2.2. tensions between family members. The rural Arctic context in which the older adult lived was relevant to varying degrees in all themes. Conclusion Our results showed that experiences of being the significant other involve a continuous balancing act affected by the older adult’s life situation, the significant other’s own life and the rural Arctic context in which the older adult lives. Our study adds to previous conceptualizations of frailty as both a bodily and a relational phenomenon framed by materialities, the understanding of frailty as also a situated phenomenon.
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Affiliation(s)
- Lena Bjerkmo
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
- Correspondence: Lena Bjerkmo, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway, Tel +4777644739, Email
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
- Faculty of Health, Welfare, and Organisation, Østfold University College, Halden, N-1757, Norway
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
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Glomsås HS, Knutsen IR, Fossum M, Christiansen K, Halvorsen K. Family caregivers' involvement in caring for frail older family members using welfare technology: a qualitative study of home care in transition. BMC Geriatr 2022; 22:223. [PMID: 35303816 PMCID: PMC8932075 DOI: 10.1186/s12877-022-02890-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/02/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Demographic, economic and organisational changes challenge home care services. Increased use of welfare technology and involvement of family members as co-producers of care are political initiatives to meet these challenges. However, these initiatives also involve ethical aspects. METHOD The aim of this qualitative study was to explore family caregivers' experience of involvement and possible ethical aspects of caring for frail older family members receiving home care services supported by welfare technology. This study used a qualitative explorative and descriptive design within a phenomenological-hermeneutical approach. Sixteen interviews with eighteen family caregivers were conducted. The participants were sons, daughters, siblings and spouses of frail older people receiving home care services with the support of welfare technology. Data were analysed using reflexive thematic analysis. The COREQ checklist was used. RESULTS The analysis led to five main themes. First, the family caregivers' experienced caring as meaningful but increasingly demanding concerning the changes in home care services. Second, they experienced a change in relationships, roles, tasks, and responsibilities related to more family involvement and the use of welfare technology. This also challenged their sense of autonomy. However, welfare technology helped them deal with responsibilities, especially safety. The family caregivers requested early involvement, dialogue for care decisions, more cooperation and support from health professionals. Third, the participants experienced that health professionals decided the conditions for co-production without discussion. Their need for information and knowledge about welfare technology were not met. Fourth, the family caregivers felt that the health professionals did not adequately recognise their unique knowledge of the care receiver and did not use this knowledge for customising the welfare technology to the care receiver and their families. Fifth, the family caregivers expressed concern about service and welfare technology inequality in home care services. CONCLUSIONS Co-production in the involvement of family caregivers in care is still not an integral part of home care service. Welfare technology was appreciated, but the family caregivers called for early involvement to ensure successful and safe implementation and use. More attention needs to be given to ethical concerns about the change in relations, transfer of tasks and responsibility, and risk of inequality.
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Affiliation(s)
- Heidi Snoen Glomsås
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
| | - Mariann Fossum
- Faculty of Health and Sport Sciences, Institute of Health and Nursing Science, University of Agder, Postboks 422, N-4604 Kristiansand, Norway
| | - Karin Christiansen
- Faculty of Health Sciences, Research Centre for Health and Welfare Technology, VIA University College, Hedeager 2, DK-8200 Aarhus, Denmark
| | - Kristin Halvorsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130 Oslo, Norway
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Claesson M, Jonasson LL, Josefsson K. Next of kin's experiences of registered nurses' leadership close to older adults in municipal home care in Sweden: an interview study. BMC Nurs 2021; 20:213. [PMID: 34715871 PMCID: PMC8554742 DOI: 10.1186/s12912-021-00745-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Next of kin to older adults over 65 years in municipal home care are concerned whether their older adults’ needs are being met. In municipal home care, the registered nurses’ leadership is important and complex, entailing multi-artist skills involving the older adults and their next of kin. Yet, little is known about next of kin’s experiences of registered nurses’ leadership. Thus, the aim of this study was to explore next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care. Methods Individual telephone interviews were conducted with next of kin (n = 11) of older adults from April to September 2020 in two municipalities in western Sweden. Data were analysed using qualitative content analysis. Results The results are presented with the theme, registered nurses do what they can, including two categories, interaction and competence, and the subcategories, relationship, communication, availability, responsibility, team leadership and cooperation. Registered nurses’ leadership was experienced as a balancing act between their commitments and what they were able to achieve. Conclusions Next of kin’s experiences of registered nurses’ leadership can contribute knowledge that will strengthen and prepare registered nurses for their leadership roles. This knowledge can support the development of policies for organisational preconditions that ensure quality and safe care to older adults in municipal home care.
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Affiliation(s)
- Maria Claesson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.
| | - Lise-Lotte Jonasson
- Department of Nursing School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Karin Josefsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.,Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
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Andersen HE, Hoeck B, Nielsen DS, Ryg J, Delmar C. Caring responsibility from the perspectives of older persons whose adult children are their caregivers. Int J Older People Nurs 2020; 15:e12335. [PMID: 32716593 DOI: 10.1111/opn.12335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/23/2023]
Abstract
AIM To describe lifeworld insights into the phenomenon of caring responsibility from the perspectives of persons aged 80+ years living alone with chronic illness, physical frailty and dependency on adult children. DESIGN A phenomenological inquiry inspired by Reflective Lifeworld Research. METHOD Semi-structured lifeworld interviews with 11 persons aged 80+ years were conducted following their discharge. The interviews lasted 35-83 min, were audio-recorded and transcribed verbatim. Both interviews and the analysis followed the epistemological and methodological principles of Reflective Lifeworld Research. FINDINGS We identified the essential meaning 'It means everything' and four constituents illuminating different aspects inherent in the complex phenomenon of caring responsibility; 'A life-constraining transition,' 'Trusting the children to fill the gaps and be the glue,' 'Tacit responsibility, agreement and acceptance' and 'Depending on the children and knowing they are burdened by you.' CONCLUSIONS Caring responsibility is based on a trusting relationship and tacit agreements indicating an understanding of interdependence and acceptance of dependence on adult children. However, a paradox appears when older persons express a deep-rooted perception of autonomy and independence as they have difficulties with their growing dependency and feelings of being burdensome. Older persons try to balance the continuum of autonomy, their existential self-image and actual capability. The practical part of caring responsibility seems to dominate and strongly affect the parent-child relationship because the child needs to take care of practical issues related to healthcare management and instrumental activities of daily living, leaving less time for meaningful togetherness. IMPLICATIONS FOR PRACTICE Older persons want their adult children to be involved and acknowledged when planning care and treatment because they often seem to serve as the 'glue' that makes it possible for the parent to remain in his/her own home.
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Affiliation(s)
- Helle Elisabeth Andersen
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark.,Health Sciences Research Centre, UCL, Odense, Denmark
| | - Bente Hoeck
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorthe Susanne Nielsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Migrant Health Clinic, Odense University Hospital, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Denmark
| | - Charlotte Delmar
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark.,Norway's Artic University, Tromsø, Norway.,VID, Helsefag, Bergen, Oslo, Norway
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Andersen HE, Hoeck B, Nielsen DS, Ryg J, Delmar C. A phenomenological-hermeneutic study exploring caring responsibility for a chronically ill, older parent with frailty. Nurs Open 2020; 7:951-960. [PMID: 32587713 PMCID: PMC7308672 DOI: 10.1002/nop2.467] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/17/2019] [Accepted: 02/16/2020] [Indexed: 11/07/2022] Open
Abstract
Aim To provide lifeworld insights into experiences of adult children with caring responsibility for an 80+-year-old chronically ill parent with frailty. Background Informal care is common in Nordic welfare countries; however, little is known about adult children's experience of caring responsibility in this setting. Design A phenomenological-hermeneutic study based on Reflective Lifeworld Research. Methods Diaries and semi-structured interviews with 12 adult children. Results Caring responsibility is identified as "a condition of life, filled with uncertainty." Three constituents contribute to this phenomenon: (a) balancing love, duty and reciprocity; (b) being the parent's advocate and manager; and (c) experiencing concerns and bodily strain. Conclusion Adult children work hard to provide care and enhance the well-being of their parent. Heidegger's concept 'Fürsorge' may help us understand how by showing how caring responsibility means balancing different roles vis-à-vis the parent, one's own life and the health and social systems. Caring responsibility changes the relationship between parent and child.
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Affiliation(s)
- Helle Elisabeth Andersen
- Department of Public Health NursingAarhus UniversityAarhusDenmark
- Health Sciences Research CentreUCLOdenseDenmark
| | - Bente Hoeck
- Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Dorthe Susanne Nielsen
- Health Sciences Research CentreUCLOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Migrant Health ClinicOdense University HospitalOdenseDenmark
| | - Jesper Ryg
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Department of Geriatric MedicineOdense University HospitalOdenseDenmark
| | - Charlotte Delmar
- Department of Public Health NursingAarhus UniversityAarhusDenmark
- Institut for Helse‐ og omsorgsfagNorway's Artic UniversityTromsøNorway
- VIDHelsefagBergenOsloNorway
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Viftrup DT, Hvidt NC, Prinds C. Dignity in end-of-life care at hospice: An Action Research Study. Scand J Caring Sci 2020; 35:420-429. [PMID: 32419195 DOI: 10.1111/scs.12872] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Safeguarding the dignity of patients at the end of life is a key objective in palliative care practice in Denmark. The concept of dignity and how it influences a dying persons' quality of life is thus influential in end-of-life care at hospices. However, what is meant by dignity, how dignity is understood and practiced by healthcare professionals in Danish hospices, and whether this relates to the patients' understandings and needs concerning dignity remains unanswered. AIM The aim of this study was to explore and improve dignity in care through an action research study with patients and hospice staff at two different hospices in Denmark. This was done by exploring how patients and healthcare professionals expressed their understandings and needs concerning dignity and involving participants in the research process with the goal of improving dignity in care. METHODS An action research method with reflection-of-praxis and action-in-praxis was applied. It was combined with methods of semi-structured individual interviews with twelve patients, five staff and nine focus-group interviews with staff. RESULTS Three themes emerged from the analysis of data. The themes were as follows: (1) being understood, (2) contributing and (3) holistic care. Deeper analysis indicated that staff understandings of dignity mostly focused on preserving patients' autonomy, whereas patients expressed needs for relational and spiritual aspects of dignity. Staff were mostly concerned about preserving patients' autonomy when providing dignity in care, however, through the action-in-praxis they increased their awareness on their own praxis and patients' needs and understanding concerning dignity. The theoretical model on dignity presented in the study also worked as a map to guide staffs' reflections on dignity in praxis and facilitated a broader focus on supporting and caring for patients' dignity in care. We believe this study has improved dignity in care at the two hospices involved in the study.
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Affiliation(s)
- Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Christina Prinds
- Institute of Clinical Research, Research Unit for Gynecology and Obstetrics, University of Southern Denmark, Odense C, Denmark.,University College South Denmark, Haderslev, Denmark
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Larsson H, Rämgård M, Kumlien C, Blomqvist K. Spouses' existential loneliness when caring for a frail partner late in life - a hermeneutical approach. Int J Qual Stud Health Well-being 2020; 15:1734166. [PMID: 32116141 PMCID: PMC7067191 DOI: 10.1080/17482631.2020.1734166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs. Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner. Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other. Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses’ existential needs visible and to provide support based on their needs.
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Affiliation(s)
- Helena Larsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Margareta Rämgård
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Christine Kumlien
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Kerstin Blomqvist
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
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