Enabling care: Maggie's centres and the affordance of hope

This study explores the role of architecture in the affordance of hope for people with cancer. Specifically, it revisits 'enabling places' debates to understand the influence of spatial design in the experience of cancer care. Combining interviews and focus group data from two separate studies of visitors, volunteers, and staff members of Maggie's Centres, an organisation providing cancer support in the UK and internationally, the study investigates the emotional power of their buildings. In particular, we explore how Maggie's Centre buildings provide material, social, and affective resources for their users. We argue that Maggie's Centres help its visitors to orient themselves to their changing lives and uncertain futures in thoughtful ways and, thus, their buildings offer examples of the 'taking place' of hope.

"What Is the Matter With Me?" or a "Badge of Honor": Nurses' Constructions of Resilience During Covid-19

It has long been known that nursing work is challenging and has the potential for negative impacts. During the COVID-19 pandemic most nurses' working landscapes altered dramatically and many faced unprecedented challenges. Resilience is a contested term that has been used with increasing prevalence in healthcare with health professionals encouraging a "tool-box" of stress management techniques and resilience-building skills. Drawing on narrative interview data (n = 27) from the Impact of Covid on Nurses (ICON) qualitative study we examine how nurses conceptualized resilience during COVID-19 and the impacts this had on their mental wellbeing. We argue here that it is paramount that nurses are not blamed for experiencing workplace stress when perceived not to be resilient "enough," particularly when expressing what may be deemed to be normal and appropriate reactions given the extreme circumstances and context of the COVID-19 pandemic.

Nursing Staff Stress and Individual Characteristics in Relation to the Ward Atmosphere in Psychiatric In-Patient Wards

This study investigated the interplay between nursing staff stress, Mastery, Moral Sensitivity, individual characteristics and the ward atmosphere in psychiatric in-patient care. Data were collected through five questionnaires from 93 nursing staff. Multivariate analysis showed that Moral Strength, Moral Burden, Internal Demands, Perceived Stress and age were related to several factors of the ward atmosphere. We conclude that efforts to reduce stress levels and create a supporting ethical climate on psychiatric wards would be beneficial for both psychiatric nursing staff and their nursing practice.

The `Little Extra' That Alleviates Suffering

Nursing, or caring science, is mainly concerned with developing knowledge of what constitutes ideal, good health care for patients as whole persons, and how to achieve this. The aim of this study was to find clinical empirical indications of good ethical care and to investigate the substance of ideal nursing care in praxis. A hermeneutic method was employed in this clinical study, assuming the theoretical perspective of caritative caring and ethics of the understanding of life. The data consisted of two Socratic dialogues: one with nurses and one with nursing students, and interviews with two former patients. The empirical data are first described from a phenomenological approach. Observations of caregivers offering `the little extra' were taken to confirm that patients were `being seen', not from the perspective of an ideal nursing model, but from that of interaction as a fellow human being. The study provides clinical evidence that, as an ontological response to suffering, 'symbolic acts' such as giving the `little extra' may work to bridge gaps in human interaction. The fact that `little things' have the power to preserve dignity and make patients feel they are valued offers hope. Witnessing benevolent acts also paves the way for both patients and caregivers to increase their understanding of life.

Ruptures and sutures: time, audience and identity in an illness narrative

First-person accounts of the illnesses experienced by sociologists have taken hybrid experimental forms. I add my voice to this growing tradition with a story about the discovery and treatment of a soft tissue sarcoma in my thigh, chronicled in a journal I kept over many months. The fragments scribbled in the journal became the basis of an extended illness narrative. I interrogate features of the narrative itself, including the handling of time and imagined audiences - those I was writing for. The illness narrative traces how cancer transformed the many identities I enact on a daily basis and how the invisible labour of particular health workers enabled the restoration of several prized identities. These workers - radiation, occupational and physical therapists - are typically subordinated in the medical hierarchy and the interactional work that they do with patients to restore and reconfigure ruptured identities after serious illness needs attention in medical sociology.

Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire-family version

BACKGROUND

In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed.

SETTING

Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden.

METHOD

The Person-centred Climate Questionnaire-Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality--three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P.

AIM

The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context.

RESULTS

The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item-total correlations were >0.3 and <0.7.

CONCLUSION

In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.

The narrated, nonnarrated, and the disnarrated: conceptual tools for analyzing narratives in health services research

While analyzing the narratives of children receiving pediatric oncology treatment and their parents, we encountered three ways to look at their narratives: what was narrated, nonnarrated, and disnarrated. The narrated refers to the actors (characters) and events (scenes) individuals decided to include in the narration of their experiences, the nonnarrated are everything not included in narration, and the disnarrated are elements that are narrated in the story but did not actually take place. We use our reflection to illustrate how an integrative analysis of these different forms of narration can allow us to produce a holistic interpretation of people's experiences of illness. This approach is still in the early stages of development, but we hope this article can promote a debate in the field and lead to the refinement of an important tool for narrative analysis.

Narrative health research: Exploring big and small stories as analytical tools

In qualitative health research many researchers use a narrative approach to study lay health concepts and experiences. In this article, I explore the theoretical linkages between the concepts narrative and health, which are used in a variety of ways. The article builds on previous work that conceptualizes health as a multidimensional, positive, dynamic and morally dilemmatic yet meaningful practice. I compare big and small stories as analytical tools to explore what narrative has to offer to address, nuance and complicate five challenges in narrative health research: (1) the interplay between health and other life issues; (2) the taken-for-granted yet rare character of the experience of good health; (3) coherence or incoherence as norms for good health; (4) temporal issues; (5) health as moral practice. In this article, I do not present research findings per se; rather, I use two interview excerpts for methodological and theoretical reflections. These interview excerpts are derived from a health promotion study in the Netherlands, which was partly based on peer-to-peer interviews. I conclude with a proposal to advance narrative health research by sensitizing researchers to different usages of both narrative and health, and the interrelationship(s) between the two.

Lost in the present but confident of the past: experiences of being in a psycho-geriatric unit as narrated by persons with dementia

AIM

To illuminate meanings of being in a psycho-geriatric unit. Background. There are known risks associated with moving persons with dementia from home to an institution, but little is known about how they experience being in psycho-geriatric units.

METHOD

Using open-ended research interviews, six persons with mild to severe dementia were asked to narrate about their experiences in the hospital. The interviews were interpreted using a phenomenological hermeneutical method of analysis.

RESULTS

The comprehensive understanding of being in a psycho-geriatric unit points towards an understanding of being lost in the present but confident of the past. The analysis showed that the participants appeared lost as they could not narrate where they were and why, but that they became confident when narrating about their previous life. The analysis also showed that being in the hospital meant sharing living space with strangers, invasions of private space and establishing new acquaintances. Being in the unit could also mean boredom and devaluation for participants. The interviews were interpreted in the light of narrative theory of identity: persons with dementia narrating about previous life experiences as to make claims of how to be interpreted by others; as persons instead of merely as 'demented' patients.

CONCLUSIONS

Experiences of care narrated by persons with dementia present meaningful and useful information that can provide feedback to inform care practice.

RELEVANCE TO CLINICAL PRACTICE

Experiences of care from persons with dementia provide meaningful information about care and the doing and being of staff. Creating time for conversations with these persons may facilitate well-being.

Sense or no-sense: The nurse as embodied ethnographer

Researching in familiar environments brings about challenges as nurses are learned to tune out their senses to give expert nursing care, and contemporary nursing research using observations has been criticized for being disembodied--not often using senses other than sight. This article draws on experiences from a fieldwork study of palliative and aged care environments to show how a deliberate use of the senses can enhance the richness of nursing research and open up new avenues for investigation. Examples from a reflexive fieldwork journal are presented to demonstrate how sensate experiences was used in a reflexive process that led into areas that otherwise might have remained unexplored. The authors argue that the interplay between sensate experiences and analytical logic can bring the background to the foreground and provide new ways of making the familiar unfamiliar. In making sense of what residing in health care environments might mean, an embodied research activity is fruitful.

Caring or uncaring - meanings of being in an oncology environment

AIM

This paper reports a study illuminating meanings of being in the physical environment of an oncology centre as narrated by patients, significant others and staff.

BACKGROUND

The physical environment of hospitals can convey different messages. For example, landscape pictures, plants and comfortable chairs can convey positive messages, while sparsely decorated and run-down environments can convey negative values. Traditional healthcare environments may be experienced as unfamiliar, strange and alienating, fostering feelings of stress and vulnerability. The majority of research on care environments has employed experimental designs to test different environmental variables, for example sound, colour and architecture, in relation to patient outcomes such as recovery, pain and blood pressure. There is, however, little research-based understanding of the meanings of being in these environments.

METHODS

A phenomenological hermeneutic approach was applied to analyse 17 interviews with patients, significant others and staff carried out during the spring of 2004 at an oncology centre in Sweden.

FINDINGS

The physical environment was found to influence experiences of care in four ways: first, by being a symbol expressing messages of death and dying, danger, shame and stigma, less social value and worth; second by containing symbols expressing messages of caring and uncaring, life and death; third, by influencing interaction and the balance between being involved and finding privacy; and fourth, by containing objects that could facilitate a shift of focus away from the self: being able to escape the world of cancer, and finding light in the midst of darkness. The comprehensive understanding illuminates the physical environment as not merely a place for caring, but as an important part of caring that needs to be accounted for in nursing care.

CONCLUSION

To promote well-being among patients, we need to ask ourselves if the environment imposes rather than eases suffering. Our findings also suggest the importance of not limiting our conceptions of nursing to nurse-patient relationships, but of using the therapeutic potential of the total environment in nursing care.

Sensing an atmosphere of ease: a tentative theory of supportive care settings

Nightingale saw the art of nursing as providing an environment in which patients were offered the best conditions for nature to act upon them. However, we still have limited research-based understandings of care settings experienced as supportive by patients, significant others and staff. The aim of this study was to construct a theoretical understanding of processes contributing to supportive care settings. The authors used grounded theory design and the constant comparative method to analyse theoretically sampled interview and observational data from three different contexts of care. The tentative theory conceptualizes supportive care settings as sensing an atmosphere of ease, and five categories were recognized: experiencing welcoming; recognizing oneself in the environment; creating and maintaining social relations; experiencing a willingness to serve; and experiencing safety. Having one's expectations of the environment exceeded was a mediating factor in sensing an atmosphere of ease. Sensing an atmosphere of ease facilitated experiences of being able to locate oneself in familiar and safe surroundings; being able to follow one's own rhythm; being seen, acknowledged and cared about; and having possibilities of benefiting from beauty and contacts with others.