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Andersen LH, Løfgren B, Skipper M, Krogh K, Jensen RD. "They forget that I'm a human being"-ward round communication with older patients living with frailty and informal caregivers: a qualitative study. Eur Geriatr Med 2024:10.1007/s41999-024-01043-5. [PMID: 39227557 DOI: 10.1007/s41999-024-01043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 08/19/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE Skilful communication prompts quality patient care. Informal caregivers occupy a crucial role when caring for hospitalised older patients living with frailty. However, skilful communication with both patients and informal caregivers during ward rounds has not been studied. Thus, we aimed to explore communication preferences of patients and informal caregivers during ward rounds. METHODS We conducted semi-structured interviews with hospitalized patients and informal caregivers until information redundancy occurred. We used inductive coding of the transcribed interviews followed by a reflexive thematic analysis. RESULTS The study included 15 patients and 15 informal caregivers. Patients had a median age of 85 years (range 75-100 years) and seven patients were females. Informal caregivers' median age were 45 years (range 38-80 years) and 13 were females. Three themes were generated: (1) building relationships and conveying information, (2) alleviating informal caregiver strain and (3) sharing the decision-making process. Themes highlighted the importance of collaborative and empathetic approaches in healthcare interactions, emphasizing interpersonal communication skills, such as fostering professional relationships. The interviews unveiled informal caregiver burden stemming from disempowerment during hospital discharge process and managing mistrust within the healthcare system. The shared decision-making process should address patients' and informal caregivers' needs and circumstances. CONCLUSIONS Communication preferences of a population of older patients living with frailty and informal caregivers during ward rounds encompass interpersonal communication, demonstrating ample time, and being seen as a human being. Informal caregivers value being included in the decision-making process. Skilful communication includes for doctors to recognize informal caregivers' narratives and burdens.
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Affiliation(s)
- Lene Holst Andersen
- Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NE, Denmark.
- Department of Geriatric Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NE, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mads Skipper
- Postgraduate Medical Education, Region North, Viborg, Denmark
| | - Kristian Krogh
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Rune Dall Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- MidtSIM, Corporate HR, Central Denmark Region, Aarhus, Denmark
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Tacchini-Jacquier N, Monnay S, Bonvin E, Dubuis J, Verloo H. Relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave: a PREMs study in Valais Hospital, Switzerland. BMC Health Serv Res 2023; 23:1008. [PMID: 37726727 PMCID: PMC10510254 DOI: 10.1186/s12913-023-10013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, most countries introduced temporary visiting restrictions on the relatives of acute care hospital patients, whether or not they were infected with SARS-CoV-2. This affected relatives' psychological and emotional states and how closely they could be involved in their loved one's hospitalization. STUDY AIMS Investigate relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave and the support offered by Valais Hospital's healthcare staff. METHODS Relatives and patients who had been discharged between February 28 and May 13, 2020, were asked to complete a patient-reported experience measures (PREMs) questionnaire, whether or not they had been infected by SARS-CoV-2. Relatives were asked about how visiting restrictions had affected them, their perceptions of the severity of the COVID-19 pandemic, the quality of communication concerning their loved ones' health status during their hospitalization, and the information received from healthcare staff. Descriptive and inferential statistics were computed. RESULTS Of 866 PREMs questionnaires returned, 818 were analyzable, and 543 relatives had experienced visiting restrictions to their loved ones: 92 relatives (87%) of COVID-19 patients and 451 relatives (66%) of non-infected patients, with heterogenous effects on their psychological and affective status. Overall, whether or not relatives were subjected to visiting restrictions, they perceived themselves to be well treated, well informed, and that communication with hospital healthcare staff was satisfactory. However, relatives subjected to visiting restrictions reported significantly lower scores on the quality of communication than other relatives. The relatives of patients in gynecology/obstetrics and internal medicine wards were significantly more affected by visiting restrictions than were the relatives of patients in other wards. Numerous relatives subjected to visiting restrictions reported regular communication with their loved ones or with healthcare staff, at least once a day (n = 179), either via videoconferences using FaceTime®, WhatsApp®, Zoom®, or Skype® or via mobile phone text messages. CONCLUSION Visiting restrictions affected relatives differently depending on the wards their loved ones were hospitalized. Healthcare institutions should investigate the utility of visiting restrictions on patients, how they affect relatives, and how to improve personalized patient-relative communications. Future research should attempt to develop reliable, validated measurement instruments of relatives' experiences of acute-care visiting restrictions during pandemics.
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Affiliation(s)
- N Tacchini-Jacquier
- Development of Nursing Practices Unit, Valais Hospital, 86, Avenue du Grand-Champsec, CH-1951, Sion, Switzerland
| | - S Monnay
- Social Affairs and Human Resources Specialist, Valais Hospital, 86, Avenue du Grand-Champsec, CH-1951, Sion, Switzerland
| | - E Bonvin
- Valais Hospital, 86, Avenue Grand-Champsec, CH-1951, Sion, Switzerland
| | - J Dubuis
- Valais Family Caregivers' Association, 19, Avenue de Tourbillon, CH-1950, Sion, Switzerland
| | - H Verloo
- Valais Hospital, HES-SO Valais/Wallis, 5, Chemin de L'Agasse, CH-1950, Sion, Valais, Switzerland.
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Hoffmann E, Andersen PT, Mogensen CB, Prinds C, Primdahl J. Relatives' negotiations with healthcare professionals during older people's admission in an emergency department: An ethnographic study. Nurs Open 2023; 10:6381-6389. [PMID: 37312450 PMCID: PMC10416047 DOI: 10.1002/nop2.1886] [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: 10/22/2021] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Relatives are recognised as important for older patients' care and treatment. Variations in relatives' opportunities to negotiate the quality and continuity of older people's care and treatment can potentially lead to inequality in older people's access to care and treatment. AIM This study aimed to examine relatives' opportunities and strategies for negotiation with health care professionals (HCPs) during the admission of older people to emergency departments in Denmark. MATERIALS AND METHODS We planned a qualitative ethnographical study employing a hermeneutic approach. Observations focused on social situations and interactions between relatives and HCPs. The analysis was guided by qualitative content analysis. RESULTS The analysis derived one main theme, attitude to action, containing three subthemes: frustration obtaining access, presenting the case and a powerful relationship. Being active appeared to be essential to achieving possibilities for negotiation with HCPs. DISCUSSION Inspired by Bourdieu, habitus, doxical values and institutional logics of relatives seem to affect their opportunities to negotiate with HCPs during older people's admission to an emergency department. CONCLUSION Active and proactive relatives seem to have better opportunities to negotiate with HCPs during older people's acute hospital admission than reactive, passive and hesitant relatives. The logic of public management and the medical profession seem to dominate and influence doxa in the EDs and put special demands on the relatives. This imbalance constitutes a risk of inequality in older people's access to health.
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Affiliation(s)
- Eva Hoffmann
- University College South DenmarkAabenraaDenmark
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- OPEN, Open Patient data ExplorativeRegion of Southern DenmarkOdenseDenmark
| | | | - Christian Backer Mogensen
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
| | - Christina Prinds
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
- Research Unit of Obstetrics and GynaecologyUniversity of Southern DenmarkOdenseDenmark
| | - Jette Primdahl
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
- Hospital SønderjyllandUniversity Hospital of Southern DenmarkAabenraaDenmark
- Danish Hospital for Rheumatic DiseasesUniversity Hospital of Southern DenmarkSønderborgDenmark
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Kumlin M, Berg GV, Kvigne K, Hellesø R. Dilemmas and deliberations in managing the care trajectory of elderly patients with complex health needs: a single-case study. BMC Health Serv Res 2022; 22:1030. [PMID: 35962337 PMCID: PMC9375356 DOI: 10.1186/s12913-022-08422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Today, the ageing population is larger than ever before, and people who are living longer with chronic illnesses and multimorbidity need support from multiple healthcare service levels. Similarly, healthcare systems are becoming increasingly specialised and fragmented. The World Health Organization has highlighted novel policies for developing integrated and person-centred services. However, patients, next of kin and health professionals face several challenges in managing healthcare during the care trajectory. Limited literature has addressed the challenges experienced by these groups. Therefore, this study aimed to identify the dilemmas and deliberations faced by patients, next of kin and health professionals during the care trajectory of elderly patients with complex healthcare needs. Method The study had a qualitative single-case design. The case was taken from a multi-case study exploring the care trajectory of elderly patients. The participants were the patient, their next of kin and the health professionals involved in the patient’s care trajectory. Data were obtained via observation and individual interviews conducted during the patient’s hospital stay and after the patient returned home. Results The dilemmas and deliberations in managing the care trajectory were divided into four main themes: the health professionals’ pursuit of appropriate and feasible healthcare services, the next of kin’s planning horizons, being the person left in limbo and reorganising the home for comprehensive healthcare. Conclusion The pursuit of a tailored and suitable healthcare service lead to a comprehensive mobilisation of and work by all actors involved. Having a comprehensive understanding of these conditions are of importance in developing an appropriate care trajectory for the elderly patient with complex need.
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Affiliation(s)
- Marianne Kumlin
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway. .,Innlandet Hospital Trust, Lillehammer, Norway. .,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Geir Vegar Berg
- Innlandet Hospital Trust, Lillehammer, Norway.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology Gjøvik, Gjøvik, Norway
| | - Kari Kvigne
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Ragnhild Hellesø
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Kongensgaard R, Hansen TK, Krogseth M, Gregersen M. Impact of involvement of relatives in early home visits by a hospital-led geriatric team. Geriatr Nurs 2022; 45:64-68. [PMID: 35338833 DOI: 10.1016/j.gerinurse.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate whether the involvement of relatives in home visits by a geriatric team post-discharge is associated with unplanned readmissions in severely frail patients living alone. METHODS A quality improvement project evaluating outcomes from routine care of patients who were severely frail, 65+ years, living alone, and visited at home by a geriatric team after discharge from acute hospital admission. We compared patients who did and did not have relatives attending the visit. Data were analyzed by logistic regression. RESULTS Of 437 patients with a mean age of 85.0 (±7.8) years 73% had severe comorbidity, 68% had a low functional ability, and 100 patients (23%) had relatives attending. Attendance of relatives was associated with a lower unplanned 30-day readmission rate (10% vs. 18%, adjusted odds ratio: 0.48 (0.23-1.00) p=0.05). CONCLUSION Results highlights the importance of involvement of relatives in care planning in the severely frail older patients living alone.
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Affiliation(s)
- Rikke Kongensgaard
- Department of Geriatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | | | - Maria Krogseth
- University of South-Eastern Norway, 3045 Drammen, Norway
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Rykkje L, Holm AL, Hem MH. Norwegian Nurses' Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis. SAGE Open Nurs 2021; 7:23779608211057938. [PMID: 34869863 PMCID: PMC8640321 DOI: 10.1177/23779608211057938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care. Therefore, quality in daily care for older people also depends upon the nurses’ ability to make complex, ethical decisions in their practice. Objectives To explore ethical challenges experienced by nurses caring for older people in clinical practice, and to provide examples of management for the challenges. Methods The data collected were written reflection notes by Norwegian continuous education students in advanced gerontology. Forty two of 83 notes were included and a thematic analysis in six steps was utilized. Findings There are three main themes: (1) meeting vulnerability, discomfort, and suffering, (2) collaboration with relatives, and (3) struggling to perform professional care. Conclusion Nurses strive to “do what is in the patients’ best interest”, and this is fostered through collaboration, professionalism, care, and presence. Nurses’ ethical competencies may develop when reflecting upon their own care performance. Building ethical competencies should be a priority in both nursing education and clinical practice. However, to improve care quality, nurses also need professional knowledge about older people care and ethical awareness should be supported by the workplace.
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Affiliation(s)
- Linda Rykkje
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - Anne Lise Holm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Marit Helene Hem
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Mason TM, Reich RR, Musgrove R, Whiting J, Fusilero J. Nurse Attitudes: A Descriptive Study of Families' Importance in Inpatient Nursing Care. Clin J Oncol Nurs 2021; 25:563-570. [PMID: 34533519 DOI: 10.1188/21.cjon.563-570] [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: 11/17/2022]
Abstract
BACKGROUND Family support and patient outcomes are linked to nurses' attitudes toward families' importance in patient care. OBJECTIVES The purpose of this study was to characterize inpatient oncology nurses' attitudes toward families' importance in nursing care and determine characteristics related to these attitudes. METHODS A descriptive, cross-sectional design was used with a single set of measurements from inpatient oncology nurses at a comprehensive cancer center in the southeastern United States. Nurse characteristics were summarized using frequency and percentages. Time variables were summarized using median and interquartile range. There were five primary outcomes. FINDINGS Nurses considered the role of the family important, but level varied by FINC-NA item. Characteristics related to family importance overall included hospital unit and general approach to care.
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Affiliation(s)
- Tina M Mason
- H. Lee Moffit Cancer Center and Research Institute
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Hoffmann E, Andersen PT, Mogensen CB, Prinds C, Primdahl J. Relatives' negotiation power in relation to older people's acute hospital admission: A qualitative interview study. Scand J Caring Sci 2021; 36:1016-1026. [PMID: 34156115 DOI: 10.1111/scs.13012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/30/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Acutely admitted older people are potentially vulnerable and dependent on relatives to negotiate and navigate on their behalf. AIM This study aimed to explore relatives' experiences of their interactions with healthcare professionals during acute hospital admission of older people to derive themes of importance for relatives' negotiations with these professionals. METHOD A qualitative design was applied. Relatives of acutely admitted older people at two emergency departments in Denmark were interviewed (n = 17). The qualitative content analysis was guided by Graneheim and Lundman's concepts. RESULTS The analysis derived four themes: (a) Mandate, (b) Incentive, (c) Capability and (d) Attitude to taking action. These four sources of relatives' negotiation power can be illustrated in the MICA model. CONCLUSION Four themes were identified as important sources of relatives' negotiation power. Since the four sources of power potentially change according to the situation, relatives' negotiation power seems to be context dependent.
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Affiliation(s)
- Eva Hoffmann
- University College South Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative, Region of Southern Denmark, Odense, Denmark
| | | | - Christian Backer Mogensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Christina Prinds
- University College South Denmark, Aabenraa, Denmark.,Research Unit of Obstetrics and Gynecology, University of Southern Denmark, Odense, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
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Factors affecting quality of end-of-life hospital care - a qualitative analysis of free text comments from the i-CODE survey in Norway. BMC Palliat Care 2020; 19:98. [PMID: 32635903 PMCID: PMC7341649 DOI: 10.1186/s12904-020-00609-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background The ERANet-LAC CODE (Care Of the Dying Evaluation) international survey assessed quality of care for dying cancer patients in seven countries, by use of the i-CODE questionnaire completed by bereaved relatives. The aim of this sub study was to explore which factors improve or reduce quality of end-of-life (EOL) care from Norwegian relatives’ point of view, as expressed in free text comments. Methods 194 relatives of cancer patients dying in seven Norwegian hospitals completed the i-CODE questionnaire 6–8 weeks after bereavement; recruitment period 14 months; response rate 58%. Responders were similar to non-responders in terms of demographic details.104 participants (58% spouse/partner) added free text comments, which were analyzed by systematic text condensation. Results Of the 104 comments, 45% contained negative descriptions, 27% positive and 23% mixed. 78% described previous experiences, whereas 22% alluded to the last 2 days of life. 64% of the comments represented medical/surgical/oncological wards and 36% palliative care units. Four main categories were developed from the free text comments: 1) Participants described how attentive care towards the practical needs of patients and relatives promoted dignity at the end of life, which could easily be lost when this awareness was missing. 2) They experienced that lack of staff, care continuity, professional competence or healthcare service coordination caused uncertainty and poor symptom alleviation. 3) Inadequate information to patient and family members generated unpredictable and distressing final illness trajectories. 4) Availability and professional support from healthcare providers created safety and enhanced coping in a difficult situation. Conclusions Our findings suggest that hospitals caring for cancer patients at the end of life and their relatives, should systematically identify and attend to practical needs, as well as address important organizational issues. Education of staff members ought to emphasize how professional conduct and communication fundamentally affect patient care and relatives’ coping.
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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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