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Creating conditions for a sense of security during the evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study. BMC Geriatr 2019; 19:351. [PMID: 31842776 PMCID: PMC6915921 DOI: 10.1186/s12877-019-1372-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge. METHODS This study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data. RESULTS Five subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person's identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other's conditions. The person's self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed. CONCLUSION Conditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people's self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing.
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Årestedt K, Alvariza A, Boman K, Öhlén J, Goliath I, Håkanson C, Fürst CJ, Brännström M. Symptom Relief and Palliative Care during the Last Week of Life among Patients with Heart Failure: A National Register Study. J Palliat Med 2018; 21:361-367. [DOI: 10.1089/jpm.2017.0125] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences and Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalens Hospital, Stockholm, Sweden
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå, Sweden
- Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Joakim Öhlén
- Centre for Person-Centred Care and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ida Goliath
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Håkanson
- Department of Health Care Sciences and Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
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A Valuable but Demanding Time Family Life During Advanced Cancer in an Elderly Family Member. ANS Adv Nurs Sci 2016; 39:358-373. [PMID: 27618695 DOI: 10.1097/ans.0000000000000145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study explores experiences of elderly patients with cancer and their family members with regard to what is important and difficult in the family relationships during the palliative phase. Family group interviews were conducted with 26 families. The data were analyzed using qualitative content analysis. Three themes emerged: "Ensuring a positive final time together," "Avoiding tension and conflict," and "Concealing thoughts, feelings, and needs." The main theme, "A valuable but demanding time," indicates that although families find this phase of life challenging, they emphasize the importance of ensuring that this time is spent together in a positive way as a family.
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Henoch I, Carlander I, Holm M, James I, Kenne Sarenmalm E, Lundh Hagelin C, Lind S, Sandgren A, Öhlén J. Palliative Care Research - A Systematic Review of foci, designs and methods of research conducted in Sweden between 2007 and 2012. Scand J Caring Sci 2015; 30:5-25. [DOI: 10.1111/scs.12253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Ingela Henoch
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Maja Holm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Inger James
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Elisabeth Kenne Sarenmalm
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
| | - Carina Lundh Hagelin
- Medical Management Center; Department of Learning, Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
- Research and Development Unit in Palliative care; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Susanne Lind
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Anna Sandgren
- School of Health Sciences; Jönköping University; Jönköping Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linneaus University; Kalmar/Växjö Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC); University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
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Tightrope walkers suffering in silence: A qualitative study into the experiences of older parents who have an adult child with cancer. Int J Nurs Stud 2015; 52:1445-53. [PMID: 26094062 DOI: 10.1016/j.ijnurstu.2015.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/03/2015] [Accepted: 05/29/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Given the worldwide ageing of the population and the changes in the structure of society and family, the likelihood increases that older parents face a serious illness in an adult child and will even outlive their child. OBJECTIVES To gain insight into older parents' experiences, concerns, and dilemmas regarding their position and role as a parent of an adult child with cancer. DESIGN Qualitative interview design. SETTING A geriatric ward and four oncology wards of a university hospital, several nursing homes, local health service agencies. PARTICIPANTS Twenty-five parents (age range 65-91 years) of 22 adult children with cancer (age range 33-66 years) of differing stages and types (with a preponderance of breast cancer). METHODS Using a qualitative research methodology underpinned by grounded theory, we conducted semi-structured interviews with a fairly open framework. RESULTS Suffering in silence emerged as the core category encapsulating three interrelated balancing acts: (1) shielding their child while being shielded by their child, (2) being involved while keeping an adequate distance, and (3) shifting attentional priorities between their child, themselves, and others. The emotional interconnectedness between older parents and their adult child with cancer becomes tangible in the transformational process of their parental role and position described in the three balancing acts. CONCLUSIONS Faced with their child's illness and possible death, older parents experience overwhelming feelings often underestimated by their (close) environment. Nurses need to be susceptible for the needs and experiences of these older parents. For care by nurses to make a difference, their attention must be directed to how older parents can be invigorated in their parenthood while respecting the child's autonomy.
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Årestedt L, Benzein E, Persson C. Families living with chronic illness: beliefs about illness, family, and health care. JOURNAL OF FAMILY NURSING 2015; 21:206-31. [PMID: 25794513 DOI: 10.1177/1074840715576794] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Beliefs can be described as the lenses through which we view the world. With emerging illness, beliefs about the illness experience become important for nurses to understand to enhance well-being and healing. The aim of this study was to illuminate illness beliefs of families living with chronic illness. A qualitative design was chosen, including repeated narrative research interviews with seven Swedish families living with chronic illness. Hermeneutic analysis was used to interpret the transcribed family interviews. The result described beliefs in families, both within and across families. Both core beliefs and secondary beliefs about illness, family, and health care were revealed. Illness beliefs have importance for how families respond to and manage situations that arise from their encounters with illness. Nurses have to make space for and listen to families' stories of illness to become aware of what beliefs may support and encourage family well-being and healing. The Illness Beliefs Model provides a touchstone whereby nurses can distinguish both individual and shared beliefs within families living with chronic illness and provide ideas for family intervention if needed.
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Affiliation(s)
- Liselott Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Eva Benzein
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden Center for Collaborative Palliative Care, Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Carina Persson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden Center for Collaborative Palliative Care, Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
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Wallin V, Carlander I, Sandman PO, Ternestedt BM, Håkanson C. Maintaining ordinariness around food: partners’ experiences of everyday life with a dying person. J Clin Nurs 2013; 23:2748-56. [DOI: 10.1111/jocn.12518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Viktoria Wallin
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Skondal University College and Ersta Hospital; Stockholm Sweden
- Department of Learning; Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Per-Olof Sandman
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
| | - Britt-Marie Ternestedt
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
- Research, Development and Education Unit; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Cecilia Håkanson
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
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Van Humbeeck L, Piers RD, Van Camp S, Dillen L, Verhaeghe STL, Van Den Noortgate NJ. Aged parents' experiences during a critical illness trajectory and after the death of an adult child: a review of the literature. Palliat Med 2013; 27:583-95. [PMID: 23579261 DOI: 10.1177/0269216313483662] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Given the growing life expectancy, the likelihood increases that health-care providers are confronted with older people having an adult child with a life-limiting disease. AIM This literature review aimed to (1) explore the experiences of aged parents with regard to their position and role as a parent of an adult child with a life-limiting illness, (2) detect gaps in the existing literature and (3) make recommendations for future research. DESIGN A literature search of English articles, including both quantitative and qualitative designs. DATA SOURCES Four electronic databases and the reference lists of included studies. RESULTS In total, 19 studies (7 quantitative and 12 qualitative) were included. Few studies describe the experiences of older people whose adult child has cancer or has died of cancer. Existing studies are merely descriptive and give no concrete recommendations for health-care providers in daily practice. The studies suggest that aged parents carry deep burdens from the prospect of losing their adult child. Aged parents want to stay involved but need to reconfigure their parent role. As soon as the cancer diagnosis is disclosed, parents are confronted with a re-awakening of parental nurturing, which clashes with the autonomy of the adult child. Even after the adult child is deceased, older parents retain the image of themselves as parents. CONCLUSIONS There is a need for more in-depth research to understand the lived experience of these parents and what health-care providers can do to assist them.
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Dahlborg Lyckhage E, Lindahl B. Living in liminality--being simultaneously visible and invisible: caregivers' narratives of palliative care. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2013; 9:272-288. [PMID: 24295097 DOI: 10.1080/15524256.2013.846885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Palliative care is an integral part of care and takes place in many settings--including the home, special accommodations, and hospitals. However, research shows that palliative care often ends with a death in the hospital due to the heavy burden on the primary caregiver. This study explores the meaning of being the primary caregiver of a close one who is terminally ill and is based on qualitative interviews with six primary caregivers of a terminally ill individual at home. The findings are discussed in the light of the theoretical concepts of liminality, lived body, and power. A potential impending risk exists of being abandoned when one is the primary caregiver to a close one who is terminally ill. This situation calls for professional caregivers to take responsibility and to respond to these, often unspoken, needs. This is particularly important concerning bodily care and the medical treatment regimen. In addition, when friends and relatives are absent, there is an ethical demand on professional caregivers to compensate for this lack and to compensate for this need. Palliative home care demands care that is person-centered--including the individual's history, family and loved ones, and individual strengths and weaknesses.
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Benkel I, Wijk H, Molander U. Loved Ones Obtain Various Information About the Progression of the Patient’s Cancer Disease Which is Important for Their Understanding and Preparation. Am J Hosp Palliat Care 2012; 29:64-9. [DOI: 10.1177/1049909111412579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Inger Benkel
- Department of Geriatric Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Department of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ulla Molander
- Department of Geriatric Medicine, University of Gothenburg, Gothenburg, Sweden
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The Quality of Hospice Care Assessed by Family Members of Patients in a Finnish Hospice. J Hosp Palliat Nurs 2011. [DOI: 10.1097/njh.0b013e31821fc52f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ek K, Sahlberg-Blom E, Andershed B, Ternestedt BM. Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease. J Adv Nurs 2011; 67:1480-90. [PMID: 21375574 DOI: 10.1111/j.1365-2648.2010.05604.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone. BACKGROUND Chronic obstructive pulmonary disease affects an increasing number of people. Breathlessness, fatigue and dejection are common symptoms during the last years of life. METHOD Repeated qualitative interviews with four participants were conducted over an 8-month period in 2008. The data comprised 17 interviews, 15 telephone conversations and various field notes. A phenomenological hermeneutical method was used to interpret the text. FINDINGS The analysis resulted in two main themes and five sub-themes. The first main theme, Being subordinated to the sick body, implies that the body, assistive devices and entrusting oneself to the hands of others can both extend and restrict the living space. The second main theme, Protecting significant values of identity, encompasses both the struggle to maintain self-image and the awareness of one's own death. CONCLUSION Living alone with advanced chronic obstructive pulmonary disease is a challenging and complex phenomenon. The everyday life was characterized by a struggle to keep autonomy during a time of increasing dependency and need for help. A person-centred nursing care, built upon peoples' own experiences, may be one way to promote identity and dignity in patients even when they are close to death.
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Affiliation(s)
- Kristina Ek
- School of Health and Medical Sciences, Örebro University, Sweden.
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A discourse of silence: professional carers reasoning about death and dying in nursing homes. AGEING & SOCIETY 2011. [DOI: 10.1017/s0144686x10000905] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTNursing homes are a setting in which death and dying is common. How death and dying is articulated and the actions that take place in a nursing home constitute a discourse that guides the staff in their work. The aim of this study was to explore the discourse of death and dying in nursing homes from the perspective and understanding of the staff. The study draws on Foucault's discourse analysis. Data are from five focus-group discussions held with 28 staff of four different nursing homes in Sweden. The findings show that the discourse had three characteristics: (a) dying was silent and silenced, (b) emotions were pushed into the background, and (c) attentiveness to death arose after the moment of the elderly person's death. The structure of the discourse was characterised by a movement between two positions, avoiding and confronting death, the main focus being on avoidance. The articulation and practices of silence highlight a need to regard dying as a process that requires attention. One way to ensure appropriate attention could be to instil the philosophy of palliative care in nursing homes, including training and support for the staff in their work. The study demonstrates that nursing-home staff need more knowledge and support to enable them to feel that they do a good job.
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Marshall A, Bell JM, Moules NJ. Beliefs, suffering, and healing: a clinical practice model for families experiencing mental illness. Perspect Psychiatr Care 2010; 46:197-208. [PMID: 20591127 DOI: 10.1111/j.1744-6163.2010.00259.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Mental illness often changes families' lives and relationships forever. A Family Systems Nursing framework is proposed for working collaboratively with families. CONCLUSIONS The Illness Beliefs Model (Wright & Bell, 2009) offers clinicians ways to target illness beliefs that may perpetuate or, alternatively, soften suffering. PRACTICE IMPLICATIONS We have learned from families that it is often not the family member with the illness who is suffering most, but rather, other family members. The complexity of "relational suffering" challenges mental health nurses to acquire knowledge and skills to work with families to soften physical, emotional, relational, and spiritual suffering.
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Affiliation(s)
- Amy Marshall
- Walk-In Mental Health, South Calgary Health Centre, Calgary, Alberta, Canada.
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Sand L, Olsson M, Strang P. What are motives of family members who take responsibility in palliative cancer care? ACTA ACUST UNITED AC 2010. [DOI: 10.1080/13576270903537690] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Saveman BI. Family nursing research for practice: the Swedish perspective. JOURNAL OF FAMILY NURSING 2010; 16:26-44. [PMID: 20145285 DOI: 10.1177/1074840709360314] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This article offers a synthesis of the significant developments and progress of family nursing in Sweden. A review was conducted to locate Swedish family nursing research produced over the past 10 years. CINAHL, Medline, and PubMed were the primary databases used to locate approximately 75 family nursing studies conducted in Sweden. The majority of the studies used descriptive methods with data collected from surveys and interviews involving nurses and family members either together or individually. Only a few of the studies examined family nursing interventions. This article also reports the results of a recent survey of Swedish nurses that examined how family nursing is used in practice. After 10 years of creating a strong foundation for family-focused nursing in Sweden, there is still a need for nurse researchers, educators, and administrators to collaborate in the implementation of family nursing to practice.
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James I, Andershed B, Ternestedt BM. The encounter between informal and professional care at the end of life. QUALITATIVE HEALTH RESEARCH 2009; 19:258-271. [PMID: 19092139 DOI: 10.1177/1049732308329309] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to obtain and describe in-depth knowledge about family carers' experiences of the encounter, in a hospital, between informal and professional care at the end of life. A hermeneutic approach was chosen, and we conducted interviews with 27 family carers 6 to 8 months after their loved one's death. In the encounter, the family carers made their own assessment of their loved one's condition and situation. The professionals' attitudes could both promote and impede the interaction between the two forms of care. Family carers' care actions were characterized by struggling to get treatment, being left behind, being partners, keeping the illness at a distance, hovering beside their loved one, waiting for death, and being experts and protectors. The main interpretation of the findings is that family carers possess practical knowledge about what care is the best, or least harmful, for their loved one. This can be linked to what Aristotle called phronesis.
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