1
|
Gerdin AL, Hellzén O, Alm AK, Rising MH. Older persons' experiences of care encounters in their home: A multiple-case study. J Clin Nurs 2024; 33:2287-2297. [PMID: 38291544 DOI: 10.1111/jocn.17043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/22/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
AIM To explore and describe older persons' unique experiences of care encounters with home care nurses in a real-life context. BACKGROUND The increasing number of older persons in society contributes to increases in age-related impairments compromising their quality of life. Future care consists of "hospitals at home" where care encounters occur in a person's private domain, partly becoming a clinical workplace. Scant research has focused on how older persons experience care encounters with home care nurses and needs to be highlighted. DESIGN Multiple-case study. METHODS The cases relied on replication logic and five purposive sampled older persons were interviewed. Data were analysed using qualitative content analysis and differences within and between cases were explored and findings across the cases were replicated. FINDINGS The cross-analysis emerged in three categories: "Nursing routine rules the care encounters", "Lack of knowledge and information" and "Dependency on support from others". CONCLUSIONS Our research has found that older persons face challenges while receiving home care, including limited engagement in their care and the need for enhanced support. Implementing person-centred care in homes poses ethical challenges that require careful consideration. Home care nurses should prioritise understanding each patient individually, recognising them beyond their patient role, which necessitates more thorough and time-sensitive care encounters. REPORTING METHOD Findings were reported using COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION Patients were interviewed and contributed with data for this study. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE This study emphasises the need to prioritise individualised care in home settings and listen to the voices of older individuals to enhance quality.
Collapse
Affiliation(s)
| | - Ove Hellzén
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | | | | |
Collapse
|
2
|
Nishiya K, Takashima R, Shishido I, Yano R. Meaning of hygiene care for patients as perceived by clinical nurses through an interactive care process: A grounded theory approach. Jpn J Nurs Sci 2023; 20:e12538. [PMID: 37122078 DOI: 10.1111/jjns.12538] [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: 11/24/2022] [Revised: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023]
Abstract
AIM This study aimed to explore the meaning of hygiene care for patients from the perspective of nurses, who provide them with care through an interactive process. METHODS Sixteen registered nurses working in general wards for over 5 years were selected through purposive and snowball sampling. Individual semi-structured interviews were conducted between May and August 2021. Data were analyzed using a grounded theory approach, and the Consolidated Criteria for Reporting Qualitative Research was used to ensure quality and transparency. RESULTS The participants recognized the core category "realizing oneself alive here," where hygiene care energized patients and promoted their realization of "feeling alive." Hygiene care created "time of relief, temporarily forgetting the illness," and "restoring a sense of oneself." A situation of care also created an "opportunity to treat each other as unique individuals," "opportunity to face self," and "encouraging the recovery and disease-fighting process." CONCLUSIONS This study highlights the value of hygiene care provided by nurses to patients. The meaning of hygiene care conceptualized in this study should help build a conceptual framework for understanding the patient's experience and reaffirming the value of hygiene care.
Collapse
Affiliation(s)
- Kotone Nishiya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Risa Takashima
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Inaho Shishido
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| |
Collapse
|
3
|
Dignity in bodily care at the end of life in a nursing home: an ethnographic study. BMC Geriatr 2022; 22:593. [PMID: 35871666 PMCID: PMC9310487 DOI: 10.1186/s12877-022-03244-8] [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: 03/16/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nursing homes (NHs) are populated by the frailest older people who have multiple physical or mental conditions and palliative care needs that may convey the violation of dignity. Although dignity is a commonly used concept and a core value of end-of-life care, it is assumed to be complex, ambiguous, and multivalent. Thus, the aim of this study was to explore aspects of dignity in older persons’ everyday lives in a NH. Design A focused ethnographic study design. Methods Data consisted of 170 h of fieldwork, including observations (n = 39) with residents (n = 19) and assistant nurses (n = 22) in a Swedish NH. Interviews were undertaken with residents several times (in total, n = 35, mean 70 min/resident). To study dignity and dignity-related concerns, we used the Chochinov model of dignity to direct the deductive analysis. Results The study showed that residents suffered from illness-related concerns that inhibited their possibilities to live a dignified life at the NH. Their failing bodies were the most significant threat to their dignity, as loss of abilities was constantly progressing. Together with a fear of becoming more dependent, this caused feelings of agony, loneliness, and meaninglessness. The most dignity-conserving repertoire came from within themselves. Their self-knowledge had provided them with tools to distinguish what was still possible from what they just had to accept. Socially, the residents’ dignity depended on assistant nurses’ routines and behaviour. Their dignity was violated by long waiting times, lack of integrity in care, deteriorating routines, and also by distanced and sometimes harsh encounters with assistant nurses. Because the residents cherished autonomy and self-determination, while still needing much help, these circumstances placed them in a vulnerable situation. Conclusions According to residents’ narratives, important dignity-conserving abilities came from within themselves. Dignity-conserving interventions did occur, such as emphatic listening and bodily care, performed in respect for residents’ preferences. However, no strategies for future crises or preparing for death were observed. To protect residents’ dignity, NHs must apply a palliative care approach to provide holistic care that comprises attention to personal, bodily, social, spiritual, and psychological needs to increase well-being and prevent suffering.
Collapse
|
4
|
Martinsen B, Norlyk A, Gramstad A. What Makes Dependency on Homecare Bearable? A Phenomenological Study. West J Nurs Res 2022; 45:388-394. [PMID: 36333891 DOI: 10.1177/01939459221135325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Becoming dependent on homecare in old age is a radical life change that requires complex adaption. The purpose of this study was to explore the existential dimension of being dependent on homecare with a particular focus on what makes dependency bearable. In total, 15 older people living in Denmark or Norway were interviewed using a phenomenological approach. The material was analyzed employing Max van Manen’s meaning-giving approach coined “Phenomenology of practice.” During the analysis, four themes emerged: pure acceptance of an inevitable situation, acting independently as much as possible, negotiating to receive good care, and gratitude toward caring caregivers. The results point to a need for respectful and individualized homecare leveling out the subordinate position in which dependency on homecare tends to place older people.
Collapse
Affiliation(s)
- Bente Martinsen
- Department of Public Health, Research Unit for Nursing and Healthcare, Aarhus University, Aarhus, Denmark
| | - Annelise Norlyk
- Department of Public Health, Research Unit for Nursing and Healthcare, Aarhus University, Aarhus, Denmark
| | - Astrid Gramstad
- UiT The Arctic University of Norway & Centre for Care Research, Tromso, Norway
| |
Collapse
|
5
|
van der Weele S, Bredewold F, Leget C, Tonkens E. What is the problem of dependency? Dependency work reconsidered. Nurs Philos 2021; 22:e12327. [PMID: 32935457 PMCID: PMC8243965 DOI: 10.1111/nup.12327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/26/2022]
Abstract
Dependency is fundamental to caring relationships. However, given that dependency implies asymmetry, it also brings moral problems for nursing. In nursing theory and theories of care, dependency tends to be framed as a problem of self-determination-a tendency that is mirrored in contemporary policy and practice. This paper argues that this problem frame is too narrow. The aim of the paper is to articulate additional theoretical 'problem frames' for dependency and to increase our understanding of how dependency can be navigated in practices of long-term care. It does so by way of an empirical ethical analysis of how care professionals tackle the problem of dependency in group homes for people with intellectual disabilities. The paper refers to these practices of mitigating the problem of dependency as 'dependency work', a phrase borrowed from Eva Kittay. The analysis of dependency work suggests that for care professionals, dependency is a threefold problem: one of self-determination, one of parity and one of self-worth. These findings suggest that patient autonomy cannot be a full solution to the problem of dependency in long-term care relations. But they also show that dependency as such is not a problem that can be solved, as attempts to mitigate it only serve to tighten the dependency relationship further. This is the paradox of dependency work.
Collapse
Affiliation(s)
- Simon van der Weele
- University of Humanistic StudiesKromme Nieuwegracht 29Utrecht3512 HDThe Netherlands
| | - Femmianne Bredewold
- University of Humanistic StudiesKromme Nieuwegracht 29Utrecht3512 HDThe Netherlands
| | - Carlo Leget
- University of Humanistic StudiesKromme Nieuwegracht 29Utrecht3512 HDThe Netherlands
| | - Evelien Tonkens
- University of Humanistic StudiesKromme Nieuwegracht 29Utrecht3512 HDThe Netherlands
| |
Collapse
|
6
|
Finding meaning in life: an exploration on the experiences with dependence on care of patients with advanced cancer and nurses caring for them. Support Care Cancer 2020; 28:4493-4499. [DOI: 10.1007/s00520-020-05300-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/09/2020] [Indexed: 01/10/2023]
|
7
|
|
8
|
Holmberg B, Hellström I, Norberg A, Österlind J. Assenting to exposedness – meanings of receiving assisted bodily care in a nursing home as narrated by older persons. Scand J Caring Sci 2019; 33:868-877. [DOI: 10.1111/scs.12683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Bodil Holmberg
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
| | - Ingrid Hellström
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Social and Welfare Studies Linköping University Norrköping Sweden
| | - Astrid Norberg
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Nursing Umeå University Umeå Sweden
| | - Jane Österlind
- Department of Health Care Sciences/Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
| |
Collapse
|
9
|
Sjöberg M, Edberg AK, Rasmussen BH, Beck I. Being acknowledged by others and bracketing negative thoughts and feelings: Frail older people's narrations of how existential loneliness is eased. Int J Older People Nurs 2018; 14:e12213. [DOI: 10.1111/opn.12213] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 08/13/2018] [Accepted: 09/24/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Marina Sjöberg
- Department of Care Science, Faculty of Health and Society; Malmö University; Malmö Sweden
- The Research Platform for Collaboration for Health, Faculty of Health Science; Kristianstad University; Kristianstad Sweden
| | - Anna-Karin Edberg
- The Research Platform for Collaboration for Health, Faculty of Health Science; Kristianstad University; Kristianstad Sweden
| | - Birgit H. Rasmussen
- The Institute for Palliative Care; Lund University and Region Skane; Lund Sweden
- Department for Health Sciences, Faculty of Medicine; Lund University; Lund Sweden
| | - Ingela Beck
- The Research Platform for Collaboration for Health, Faculty of Health Science; Kristianstad University; Kristianstad Sweden
- The Institute for Palliative Care; Lund University and Region Skane; Lund Sweden
- Division of Oncology, Department of Clinical Sciences Lund, Faculty of Medicine; Lund University; Lund Sweden
| |
Collapse
|
10
|
Sjöberg M, Beck I, Rasmussen BH, Edberg AK. Being disconnected from life: meanings of existential loneliness as narrated by frail older people. Aging Ment Health 2018; 22:1357-1364. [PMID: 28714734 DOI: 10.1080/13607863.2017.1348481] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study illuminated the meanings of existential loneliness (EL) as narrated by frail older people. METHOD Data were collected through individual narrative interviews with 23 people 76-101 years old receiving long-term care and services. A phenomenological hermeneutical analysis was performed, including a naïve reading and two structural analyses as a basis for a comprehensive understanding of EL. RESULT Four themes were identified related to meanings of EL: (1) being trapped in a frail and deteriorating body; (2) being met with indifference; (3) having nobody to share life with; and (4) lacking purpose and meaning. These intertwined themes were synthesized into a comprehensive understanding of EL as 'being disconnected from life'. CONCLUSION Illness and physical limitation affects access to the world. When being met with indifference and being unable to share one's thoughts and experiences of life with others, a sense of worthlessness is reinforced, triggering an experience of meaninglessness and EL, i.e. disconnection from life. It is urgent to develop support strategies that can be used by health care professionals to address older people in vulnerable situations, thereby facilitating connectedness.
Collapse
Affiliation(s)
- Marina Sjöberg
- a Department of Care Science, Faculty of Health and Society , Malmö University , Malmö , Sweden.,b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden
| | - Ingela Beck
- b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden.,c The Institute For Palliative Care , Region Skåne and Lund University , Lund , Sweden.,d Department of Clinical Sciences Lund, Division of Oncology, Faculty of Medicine , Lund University , Lund , Sweden
| | - Birgit H Rasmussen
- c The Institute For Palliative Care , Region Skåne and Lund University , Lund , Sweden.,e Department for Health Sciences, Faculty of Medicine, Unit of Older People's Health and Person Centred Care , Lund University , Lund , Sweden
| | - Anna-Karin Edberg
- b Department of Health and Society, The Research Platform for Collaboration for Health , Kristianstad University , Kristianstad , Sweden
| |
Collapse
|
11
|
Caspari S, Råholm MB, Saeteren B, Rehnsfeldt A, Lillestø B, Lohne V, Slettebø Å, Heggestad AKT, Høy B, Lindwall L, Nåden D. Tension between freedom and dependence-A challenge for residents who live in nursing homes. J Clin Nurs 2018; 27:4119-4127. [DOI: 10.1111/jocn.14561] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/23/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Bente Høy
- VIA University College; Aarhus Denmark
| | | | | |
Collapse
|
12
|
An Altered Eating Experience: Attitudes Toward Feeding Assistance Among Younger and Older Adults. Rehabil Nurs 2018; 45:97-105. [PMID: 29668532 DOI: 10.1097/rnj.0000000000000147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Feeding assistance is commonly used to alleviate mealtime difficulties and decrease risk. It is unclear how to best support the transition from independence to assisted feeding across the lifespan. The purpose of this exploratory study was to examine attitudes toward feeding assistance among healthy younger and older adults. DESIGN Qualitative study. METHODS A total of 17 younger and 19 older adults were interviewed following a simulated feeding (assisted and self-feeding) experience. Comments were coded for sensation (physical/emotional) and sentiment (positive/negative/neutral) and analyzed for common themes. FINDINGS All participants commented primarily on the physical aspects of feeding assistance. Younger adults were more likely than older adults to make negative comments, particularly as related to the loss of independence. All participants indicated difficulties/differences with the feeding process stemming from their own preferences not being realized. CONCLUSIONS/CLINICAL RELEVANCE Although all adults value independence in the aging process, younger adults may more negatively view receiving feeding assistance as a loss of independence. This suggests the need to redefine autonomy in the presence of increased dependence. It is also necessary to individualize the feeding process in order to incorporate individual identity into eating. Promoting interdependence as the consequence of feeding assistance, rather than dependence, can help support this time of transition and promote patient well-being.
Collapse
|
13
|
Angel S, Vatne S. Vulnerability in patients and nurses and the mutual vulnerability in the patient-nurse relationship. J Clin Nurs 2017; 26:1428-1437. [PMID: 27626897 DOI: 10.1111/jocn.13583] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the mutual vulnerability of patients and nurses, anticipating that an enhanced understanding of the phenomenon may help reduce vulnerability. BACKGROUND Patient vulnerability is a key issue in nursing, aimed at protecting the patient from harm. In the literature, vulnerability is described both from a risk perspective and a subjective perspective. This implies that the objective dimension of patient vulnerability does not necessarily reflect the patient's own perception of being vulnerable. However, external judgment may influence internal perception. Adding to this complexity, attention has also been drawn to the vulnerability of the nurse. DESIGN A definition deduced from central literature on vulnerability captures the complexity of objective versus subjective vulnerability. Based on the perspective of vulnerability in general, vulnerability in healthcare services shows how dependency may increase patient vulnerability. Further, despite education, training and supportive settings, patients may increase nurse vulnerability. The core of this mutuality is explored in the light of Martin Heidegger's philosophy of being. CONCLUSION The patient's need for help from the nurse opens the patient to engage in supportive and/or harmful encounters. Thus, dependency adds to the vulnerability related to health issues. The nurse's vulnerability lies in her engagement in caring for the patient. If failing to provide proper care, the nurse's existence as 'a good nurse' is threatened. This is exacerbated if the patient turns against the nurse. Therefore, the core of vulnerability seems to lie in the fact that the patient and the nurse are both striving to be the persons they want to be, and the persons they have not yet become. RELEVANCE TO CLINICAL PRACTICE Recognition of the mutual vulnerability in the patient-nurse relationship calls for collective acknowledgement of the demanding nature of caring relationships, for support and for a strengthening of professional skills.
Collapse
Affiliation(s)
- Sanne Angel
- Section of Nursing, Institute of Public Health, Aarhus University, Aarhus, Denmark.,Department for Health and Social Care, Molde University College, Molde, Norway
| | - Solfrid Vatne
- Department for Health and Social Care, Molde University College, Molde, Norway
| |
Collapse
|
14
|
Nilsson C, Lindberg B, Skär L, Söderberg S. Meanings of balance for people with long-term illnesses. Br J Community Nurs 2017; 21:563-567. [PMID: 27809585 DOI: 10.12968/bjcn.2016.21.11.563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to elucidate meanings of balance in everyday life for people with long-term illnesses living at home. People living with long-term illnesses are in need of help and support to manage their daily lives. Twelve adults with extensive needs for help and support were interviewed. A phenomenological hermeneutic interpretation was used to analyse the interview texts. The findings show that balance in everyday life for people with long-term illnesses means striving for independence through care and support in their surroundings. It was also important to be able to choose how their lives would be and to be with others who listened and understood them for who they are. By building a relationship with patients at an early stage of their illnesses, nursing staff have an opportunity to understand what people who are living at home with long-term illnesses need in order to achieve balance in their everyday lives.
Collapse
Affiliation(s)
- Carina Nilsson
- Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Birgitta Lindberg
- Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Siv Söderberg
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
| |
Collapse
|
15
|
Lindström I, Gaston-Johansson F, Danielson E. Documentation of Patients’ Participation in Care at the End of Life. Nurs Ethics 2016; 13:394-403. [PMID: 16838570 DOI: 10.1191/0969733006ne883oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to describe how patients’ participation in the care they received was documented in their health care records during the last three months of their lives. Two hundred and twenty-nine deceased adult persons were randomly identified from 12 municipalities in a Swedish county and their records were selected from different health care units. Content analysis was used to analyse the text. Four categories of patient participation were described: refusing offered care and treatments; appealing for relief; desire for everyday life; and making personal decisions. The most common way for these patients to be involved in their care at the end of their life was by refusal of the treatment and care offered. Characteristic of the different ways of participation were the diverse activities represented. The description of patients’ involvement in their life situation at this time indicated their dissociation from the health care offered more than consenting to it.
Collapse
Affiliation(s)
- Irma Lindström
- The Sahlgrenska Academy at Göteborg University, Institute of Nursing, Box 457, SE 405 30 Göteborg, Sweden.
| | | | | |
Collapse
|
16
|
Lützén K, Dahlqvist V, Eriksson S, Norberg A. Developing the Concept of Moral Sensitivity in Health Care Practice. Nurs Ethics 2016; 13:187-96. [PMID: 16526152 DOI: 10.1191/0969733006ne837oa] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills.
Collapse
Affiliation(s)
- Kim Lützén
- Ersta Sköndal University College, Stockholm, Sweden.
| | | | | | | |
Collapse
|
17
|
Yang R. Dependency in Critically Ill Patients: A Meta-Synthesis. Glob Qual Nurs Res 2016; 3:2333393616631677. [PMID: 28462328 PMCID: PMC5342646 DOI: 10.1177/2333393616631677] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 01/04/2016] [Accepted: 01/07/2016] [Indexed: 12/23/2022] Open
Abstract
By necessity, critically ill patients admitted to intensive care units (ICUs) have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a) antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b) attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c) outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients.
Collapse
Affiliation(s)
- Rumei Yang
- University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
18
|
Piredda M, Bartiromo C, Capuzzo MT, Matarese M, De Marinis MG. Nursing care dependence in the experiences of advanced cancer inpatients. Eur J Oncol Nurs 2016; 20:125-32. [DOI: 10.1016/j.ejon.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 06/15/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
|
19
|
Piredda M, Matarese M, Mastroianni C, D'Angelo D, Hammer MJ, De Marinis MG. Adult Patients’ Experiences of Nursing Care Dependence. J Nurs Scholarsh 2015; 47:397-406. [DOI: 10.1111/jnu.12154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Michela Piredda
- Research Fellow, Tor Vergata University Rome, and Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | - Maria Matarese
- Associate Professor, Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | | | | | - Marilyn J. Hammer
- Assistant Professor; New York University College of Nursing; New York NY USA
| | | |
Collapse
|
20
|
Tobiano G, Bucknall T, Marshall A, Guinane J, Chaboyer W. Patients’ perceptions of participation in nursing care on medical wards. Scand J Caring Sci 2015; 30:260-70. [DOI: 10.1111/scs.12237] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Georgia Tobiano
- Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Qld Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety; School of Nursing and Midwifery; Deakin University; Melbourne Vic Australia
- Alfred Health; Melbourne Vic Australia
| | - Andrea Marshall
- Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Qld Australia
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients; Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Qld Australia
| | - Jessica Guinane
- School of Nursing and Midwifery; Deakin University; Melbourne Vic Australia
| | - Wendy Chaboyer
- Gold Coast University Hospital; Gold Coast Qld Australia
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients; Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Qld Australia
| |
Collapse
|
21
|
Claesson Lingehall H, Smulter N, Olofsson B, Lindahl E. Experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium: one year follow-up. BMC Nurs 2015; 14:17. [PMID: 25866476 PMCID: PMC4392811 DOI: 10.1186/s12912-015-0069-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/18/2015] [Indexed: 01/07/2023] Open
Abstract
Background Cardiovascular disease is common among old people and many undergo cardiac surgery. Scientific knowledge is available on cardiac surgery from several perspectives. However, we found few studies focusing on older patients’ experiences of cardiac surgery. The aim of this study was to illuminate experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium, a one year follow-up. Methods Qualitative interviews were conducted with 49 participants (aged ≥70 years) diagnosed with delirium after cardiac surgery. Data were collected in Sweden during 2010 through individual, semi-structured interviews in participants’ homes one year after surgery. The interviews were analyzed using qualitative content analysis. Results Four themes with sub-themes were formulated: Feeling drained of viability includes having a body under attack, losing strength and being close to death. Feeling trapped in a weird world describes participants having hallucinations, being in a nightmare and being remorseful for their behavior. Being met with disrespect includes feeling disappointed, being forced, and feeling like cargo. On the other hand, Feeling safe, including being in supportive hands and feeling grateful, points to participants’ experiences of good care and the gift of getting a second chance in life. Conclusions Even one year after cardiac surgery, participants described in detail feelings of extreme vulnerability and frailty. They also had felt completely in the hands of the health care professionals. Participants described experiences of hallucinations and nightmares during hospitalization. Cardiac surgery was a unique, fearful, traumatic and unpleasant experience yet could also include pleasant or rewarding aspects. It seems that health care professionals need deeper knowledge on postoperative delirium in order to prevent, detect and treat delirium to avoid and relieve the suffering these experiences might cause.
Collapse
Affiliation(s)
- Helena Claesson Lingehall
- Department of Nursing, Umeå University, Umeå, SE-901 87 Sweden ; Department of Surgical and Perioperative Science, Cardiothoracic Surgery Division, Umeå, SE-901 85 Sweden
| | - Nina Smulter
- Department of Nursing, Umeå University, Umeå, SE-901 87 Sweden ; Department of Surgical and Perioperative Science, Cardiothoracic Surgery Division, Umeå, SE-901 85 Sweden
| | | | | |
Collapse
|
22
|
Lykkegaard K, Delmar C. Between violation and competent care--lived experiences of dependency on care in the ICU. Int J Qual Stud Health Well-being 2015; 10:26603. [PMID: 25765881 PMCID: PMC4357638 DOI: 10.3402/qhw.v10.26603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/15/2022] Open
Abstract
This study explores the perceived meaning of dependency on care as experienced by intensive care patients. Research from non-intensive settings shows that dependency is often experienced negatively, but literature on the subject experienced by patients in the ICU is sparse. The study is based on in-depth qualitative semi-structured interviews of lived experience with three former patients admitted to an intensive care unit at a Danish university hospital. The in-depth interviews have been characterized as narratives. The main inspiration for the analysis method is Ricoeur's phenomenological hermeneutical interpretation theory. The study has found that dependency is experienced as difficult, and the relationship with the nurses seems to be ambivalent. The good relationship is experienced to make dependency easier, whereas negative experiences make it harder to cope with dependency. The participants deal with dependency by accepting negative experiences in gratitude for having recovered from critical illness. The findings might be influenced by studies being conducted in a western country setting where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.
Collapse
Affiliation(s)
| | - Charlotte Delmar
- Section for Nursing, Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.,University College Diakonova, Oslo, Norway;
| |
Collapse
|
23
|
Ness TM, Hellzen O, Enmarker I. "Struggling for independence": the meaning of being an oldest old man in a rural area. Interpretation of oldest old men's narrations. Int J Qual Stud Health Well-being 2014; 9:23088. [PMID: 24559548 PMCID: PMC3925815 DOI: 10.3402/qhw.v9.23088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 11/14/2022] Open
Abstract
The amount of older people receiving home nursing care is increasing; in rural areas, they are at additional risk because of the distance between people and health care facilities. No specific studies have been found about oldest old men living alone and receiving home nursing care and the meaning of living alone in one's own home. The aim of this study was therefore to illuminate the meaning of being an oldest old man living alone in a rural area and receiving home nursing care. A sample of 12 oldest old men living in rural areas in the middle of Norway was chosen for this study. Narrative interviews were conducted, and data were analyzed using the phenomenological hermeneutical method. After a naïve reading and a structural analysis of the text, we identified three themes: feelings of insufficiency in everyday life, finding hope in life, and feeling reconciliation with life. The comprehensive understanding suggested that being an oldest old man living alone in a rural area means a struggle between a dependent existence and a desire to be independent. Living in the tension between independence and dependency is a complex emotional situation where one is trying to accept the consequences of life and loss--reconciling the wish to live with the fact that life will come to an end.
Collapse
Affiliation(s)
- Tove Mentsen Ness
- Department of Nursing, Mid-Sweden University, Östersund, Sweden; Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway;
| | - Ove Hellzen
- Department of Nursing, Mid-Sweden University, Östersund, Sweden; Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway
| | - Ingela Enmarker
- Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway; Centre of Care Research, Steinkjer, Mid-Norway
| |
Collapse
|
24
|
Sandberg M, Jakobsson U, Midlöv P, Kristensson J. Case management for frail older people - a qualitative study of receivers' and providers' experiences of a complex intervention. BMC Health Serv Res 2014; 14:14. [PMID: 24410755 PMCID: PMC3897947 DOI: 10.1186/1472-6963-14-14] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 01/07/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Case management interventions have been widely used in the care of frail older people. Such interventions often contain components that may act both independently of each other and interdependently, which makes them complex and challenging to evaluate. Qualitative research is needed for complex interventions to explore barriers and facilitators, and to understand the intervention's components. The objective of this study was to explore frail older people's and case managers' experiences of a complex case management intervention. METHODS The study had a qualitative explorative design and interviews with participants (age 75-95 years), who had received the case management intervention and six case managers who had performed the intervention were conducted. The data were subjected to content analysis. RESULTS The analysis gave two content areas: providing/receiving case management as a model and working as, or interacting with, a case manager as a professional. The results constituted four categories: (1 and 2) case management as entering a new professional role and the case manager as a coaching guard, as seen from the provider's perspective; and (3 and 4) case management as a possible additional resource and the case manager as a helping hand, as seen from the receiver's perspective. CONCLUSIONS The new professional role could be experienced as both challenging and as a barrier. Continuous professional support is seemingly needed for implementation. Mutual confidence and the participants experiencing trust, continuity and security were important elements and an important prerequisite for the case manager to perform the intervention. It was obvious that some older persons had unfulfilled needs that the ordinary health system was unable to meet. The case manager was seemingly able to fulfil some of these needs and was experienced as a valuable complement to the existing health system.
Collapse
Affiliation(s)
- Magnus Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, Lund SE-221 00, Sweden
- The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, P.O. Box 187, Lund SE-221 00, Sweden
| | - Ulf Jakobsson
- Center for Primary Health Care Research, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden
- Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Malmö SE-205 02, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, Lund SE-221 00, Sweden
- The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, P.O. Box 187, Lund SE-221 00, Sweden
| |
Collapse
|
25
|
Lykkegaard K, Delmar C. A threat to the understanding of oneself: intensive care patients' experiences of dependency. Int J Qual Stud Health Well-being 2013; 8:20934. [PMID: 23809023 PMCID: PMC3697396 DOI: 10.3402/qhw.v8i0.20934] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 11/29/2022] Open
Abstract
This study examines the meaning of dependency on care as experienced by intensive care patients. Literature on the subject is sparse, but research from nonintensive settings shows that dependency is often experienced negatively. The study is based on in-depth qualitative semistructured interviews with three former patients characterized as narratives. The analysis is inspired by a phenomenological hermeneutical method. The study has found that dependency is experienced as difficult and that the experience seems to be attached to the relationship to oneself. Patients feel powerless and experience shame, their understanding of self is threatened, and they fight for independence in the course after intensive care. The findings might be influenced by the study being conducted in a Western country setting, where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.
Collapse
|
26
|
|
27
|
Axelsson L, Randers I, Jacobson SH, Klang B. Living with haemodialysis when nearing end of life. Scand J Caring Sci 2011; 26:45-52. [DOI: 10.1111/j.1471-6712.2011.00902.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Angel S. Vulnerable, but strong: The spinal cord-injured patient during rehabilitation. Int J Qual Stud Health Well-being 2010; 5. [PMID: 20927203 PMCID: PMC2950800 DOI: 10.3402/qhw.v5i3.5145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2010] [Indexed: 11/30/2022] Open
Abstract
A traumatic spinal cord injury affects the body to an extent that the patient requires the assistance of others to survive and recover. The rehabilitation phase puts the patient in a vulnerable position and involves a considerable amount of strength on the patient's part. The aim of this paper is to explore the vulnerability of the spinal cord patient and how this vulnerability connects to the necessary strength, as the patient struggles to survive the injury and get through the rehabilitation. The circumstances of 12 traumatic spinal cord-injured patients were observed in the rehabilitation unit and after discharge. A phenomenological–hermeneutic narrative approach applying Ricoeur's theory was used. Data were collected by field observation and interviews during the first 2 years after the spinal cord injury. The patient's strength during the rehabilitation was portrayed by their endurance and from their narratives of how they handled difficult situations. The patient's perception of vulnerability varied, and strength was mobilised as a response to the vulnerability to overcome the imbalance between demands and resources. Vulnerability should therefore refer to a person's experience of the situation rather than the person, as it may hinder the professionals' open, explorative approach towards the person.
Collapse
Affiliation(s)
- Sanne Angel
- Department of Nursing Science, School of Public Health, Aarhus University, Aarhus C, Denmark
| |
Collapse
|
29
|
Dreyer PS, Steffensen BF, Pedersen BD. Living with severe physical impairment, Duchenne's muscular dystrophy and home mechanical ventilation. Int J Qual Stud Health Well-being 2010; 5. [PMID: 20689774 PMCID: PMC2915819 DOI: 10.3402/qhw.v5i3.5388] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2010] [Indexed: 11/14/2022] Open
Abstract
Aim To study life-experiences of people living with Duchenne's muscular dystrophy (DMD), home mechanical ventilation (HMV) and physical impairment. Background Since the introduction of invasive HMV in the late 1980s people with DMD in Denmark live longer and have the experience of adulthood and a high degree of physical dependency. Method Nineteen patients with DMD and invasive HMV were interviewed in 2007. The interviews were recorded, transcribed verbatim and analysed according to a method inspired by Ricoeur's theory of interpretation. Findings HMV not only extended the participants lifespan, it also gave them the capacity to live an active life. They were totally dependent in everyday living, but in spite of this, they did not see themselves as physically impaired. They realised that there were activities that were physically impossible, but they considered themselves to be just the same person they had always been. This dependency was described as “independent dependency”. Conclusion The lived-experience of physical impairment is found to be “independent dependency” in an active life. To solve problems with loneliness, society needs to work with prejudice and misunderstanding and for better physical accessibility to enable full participation.
Collapse
Affiliation(s)
- Pia S Dreyer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus Sygehus, Arhus C, Denmark
| | | | | |
Collapse
|
30
|
Gustafsson BÅ, Heikkilä K, Ekman SL, Ponzer S. In the hands of formal carers: Older patients’ experiences of care across the perioperative period for joint replacement surgery. Int J Orthop Trauma Nurs 2010. [DOI: 10.1016/j.ijotn.2010.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
31
|
Abstract
The purpose of this study was to describe people's experiences of being dependent on others for care in their final stage of life, as well as what they felt made their experience of being dependent easier or more difficult. The phenomenological-hermeneutical method was chosen, where data collection consisted of open-ended interviews with nine people undergoing palliative care at a hospice unit or at home. The meaning of being care dependent is described via the following themes: changed relationship with oneself and with others, striving to adapt oneself to the situation, obstacles, and opportunities along the way while dependent. The result is described as an effort, a journey from independence to moments where it was possible to rest and recuperate while struggling with care dependency. Nursing staff require knowledge and understanding of experiences with care dependency to make life easier for people during increasing dependency in the final stage of life.
Collapse
Affiliation(s)
| | - Birgitta Andershed
- Örebro University School of Health and Medical Sciences,
Örebro, Department of Palliative Care Research, Ersta Sköndal
University College, Stockholm, Sweden
| |
Collapse
|
32
|
Boggatz T, Dijkstra A, Lohrmann C, Dassen T. The meaning of care dependency as shared by care givers and care recipients: a concept analysis. J Adv Nurs 2008; 60:561-9. [PMID: 17973720 DOI: 10.1111/j.1365-2648.2007.04456.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper is a report of a concept analysis to identify a meaning of care dependency that can be shared by both care givers and care recipients. BACKGROUND Care dependency can be perceived from the care recipient's and the care giver's perspective. To allow for comparisons, both sides should share the same understanding of the concept. The current research about care dependency has focused on external assessment by nurses and suffers from a tendency to use the concept with different meanings. As a consequence, research on dependency may capture different phenomena. METHOD Walker and Avant's method for concept analysis served as the guideline for this study. The Medline, CINAHL and Cochrane databases were searched for the period 1996-2006 using the terms dependence, dependency, care dependence and care dependency. RESULTS Care dependency can be defined as a subjective, secondary need for support in the domain of care to compensate a self-care deficit. Functional limitations are a necessary antecedent and unmet needs are a possible consequence of care dependency. The conceptual difference between care dependency, functional limitations and unmet needs may be meaningless for study participants. They may better understand these differences if they are asked about all three phenomena in the same investigation. CONCLUSION Care givers and care recipients can agree on the suggested attributes of care dependency but may judge them in different ways. Self-assessed care dependency has the potential to challenge preconceptions of care givers about care dependency.
Collapse
Affiliation(s)
- Thomas Boggatz
- Department of the Education for Nurse and Paramedical Teachers and Nursing Science, Centre for Humanities and Health Sciences, Charité-Universitätsmedizin Berlin, Germany.
| | | | | | | |
Collapse
|
33
|
Santamäki Fischer R, Altin E, Ragnarsson C, Lundman B. Still going strong: perceptions of the body among 85-year-old people in Sweden. Int J Older People Nurs 2008; 3:14-21. [DOI: 10.1111/j.1748-3743.2007.00104.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Sørlie V, Torjuul K, Ross A, Kihlgren M. Satisfied patients are also vulnerable patients ? narratives from an acute care ward. J Clin Nurs 2006; 15:1240-6. [PMID: 16968428 DOI: 10.1111/j.1365-2702.2006.01352.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To illuminate the experience of being a patient and cared for in an acute care ward. BACKGROUND Patients may be the best source of information for assessing the quality of care in acute care wards. Studies often show that patients' satisfaction with their hospital stay is interpreted by managers and care providers as a measure for quality of care. DESIGN Ten patients were interviewed as part of a comprehensive investigation by four researchers into the narratives of five enrolled nurses (study No. 1--published in Nursing Ethics 2004), five Registered Nurses (study No. 2 published in Nursing Ethics 2005) and 10 patients (study No. 3) about their experiences from an acute care ward at one university hospital in Sweden. METHOD A phenomenological hermeneutical method (inspired by the French philosopher Paul Ricoeur) was conducted in all three studies. FINDINGS The patients are very satisfied with their treatment and care. They also tell about factors that they do not consider as optimal, but which they explain as compromises, which must be accepted as a necessary part of their stay in the ward. This study demonstrates a close connection between patient satisfaction and vulnerability. CONCLUSIONS It is important for all health care providers not to be complacent and satisfied when patients express their satisfaction with their treatment and care. This can result in losing the focus on the patients' vulnerability and existential thoughts and reflections which are difficult for them, and which need to be addressed. RELEVANCE TO CLINICAL PRACTICE The findings can be seen as a challenge for the health care providers as well as the organization to provide quality of care to patients in acute care ward. When listening to the patients' voice it makes it easier to be aware of the content of their vulnerability.
Collapse
Affiliation(s)
- Venke Sørlie
- Institute of Nursing and Health Sciences, University of Oslo, Oslo, Norway.
| | | | | | | |
Collapse
|
35
|
Berghammer M, Dellborg M, Ekman I. Young adults experiences of living with congenital heart disease. Int J Cardiol 2006; 110:340-7. [PMID: 16226816 DOI: 10.1016/j.ijcard.2005.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 04/28/2005] [Accepted: 08/05/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Advances in care have improved the longevity and quality of life for children with congenital heart disease; however, many of them need lifelong highly qualified specialist care. The cardiac lesion involved may not always be the patient's main problem; issues related to quality of life may dominate. AIM To explore and gain a deeper understanding of young adults experiences of living with congenital heart disease in order to enhance the quality of care provided by the health care system. METHOD Transcribed in-depth interviews were analysed using a phenomenological-hermeneutic method. Six adults with congenital heart disease, aged 22-39 years old, were included in the study. RESULTS Analyses yielded two themes, having the disease and living with illness, both originating from the main theme of ambivalence. The interviewees were ambivalent in how they viewed themselves, how they faced their daily life and how they dealt with their encounters with the health care system. They had to strike a balance between being different and not being different; being sick and being healthy; revealing their congenital heart disease or hiding it and living with a hidden handicap. They also had to cope with the disease and with the health care system. CONCLUSION Young adults with congenital heart disease are ambivalent. They have a strong wish to be healthy and they might hide their symptoms from the healthcare personnel and sometimes even from themselves. A psychosocial preparedness when meeting these patients is necessary.
Collapse
Affiliation(s)
- Malin Berghammer
- Department of Paediatrics, The Queen Silvia Children's Hospital, Paediatric Growth and Research Centre, and Grown-Up Congenital Heart Unit, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden.
| | | | | |
Collapse
|
36
|
Lomborg K, Bjørn A, Dahl R, Kirkevold M. Body care experienced by people hospitalized with severe respiratory disease. J Adv Nurs 2005; 50:262-71. [PMID: 15811105 DOI: 10.1111/j.1365-2648.2005.03389.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The paper gives a theoretical account of experiences of assisted personal body care (APBC) in hospitalized patients with severe chronic obstructive pulmonary disease (COPD). BACKGROUND Body care has been identified as a central but underestimated area of nursing. Hospitalized patients with severe COPD suffer from breathlessness on exertion and are dependent on help with personal body care. Studies have described patient strategies for managing breathlessness and preferences regarding nursing care during hospitalization. Yet the problems that patients can experience because of their inability to manage personal body care by themselves have not previously been explored. This study explored patients' experiences of being assisted with personal body care. METHODS A grounded theory methodology was used with a convenience sample of 12 patients. Data were gathered from participant observation of sessions of APBC, in-depth interviews after the observed sessions and measurement of breathlessness perceived by patients before and after the sessions. FINDINGS The patients perceived body care as a significant daily activity that needed to be carried out in order to preserve their integrity. Dependency and breathlessness, however, impeded the performance of body care activities and patients were struggling for self-preservation. They managed APBC by using a threefold strategy of not letting go, coping with dependency, and minimizing the risk of escalating breathlessness. Two dilemmas were identified as being inherent to the strategy. CONCLUSION Increased knowledge of the complexities involved in providing assistance might improve nurses' ability to facilitate patients in managing APBC. Dependency is a central issue to address in order to support patients' efforts to preserve integrity and resolve dilemmas inherent to the strategy they use.
Collapse
Affiliation(s)
- Kirsten Lomborg
- Department of Nursing Science, Aarhus University, Aarhus, Denmark.
| | | | | | | |
Collapse
|
37
|
Abstract
This study seeks to explore narratives of care-related violations for patients with life-threatening illness receiving palliative care. Narratives told in dialogues with the researcher were processed phenomenologically hermeneutically. Four structures of meanings are described: focal points in recalling the experiences, experienced consequences of being violated, relationships causing violation, and personal struggling. The phenomenon of care-related violations means a complex experience of suffering as being abandoned, confronted with hopelessness, and further wounded. This experience may be directed toward readiness to share, introspectiveness, willingness to comprehend the incomprehensible, the riskiness of facing others, and attentiveness to acts of caring. It can be experienced in various relationships to professionals, family members and friends, to the mass media, and to welfare systems. Care-related violating episodes reveal the vulnerability of the person who is already suffering and makes him or her still more wounded, when actually comfort is expected. To receive affirmation in the state of fragility with increased suffering provoked by care-related violations can contribute to a transformation from human degradation into dignity, finding meaning, or reaching reconciliation in suffering.
Collapse
Affiliation(s)
- Joakim Ohlén
- Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|