Nurses' challenges when supporting the family of patients with ALS in specialized palliative home care: A qualitative study

PURPOSE

Being a family member to someone who has amyotrophic lateral sclerosis (ALS) is demanding and often requires sacrificing a lot. Family members can experience fatigue, anxiety, guilt and need support. The aim was to explore registered nurses' (RNs') experiences of providing support to the families of patients with ALS within specialized palliative home care (SPHC).

METHODS

A qualitative explorative design. Interviews were conducted with RNs (n = 11) from five SPHCs in Sweden and analysed using qualitative content analysis.

RESULTS

The results emerged in the following categories:"To support in an increasingly difficult everyday life", based on the sub-categories: "Creating a trusting relationship", "Balancing between the needs of patients and their families", and "Sharing knowledge about dying to the families";"To support in emotionally challenging situations", based on the sub-categories: "Harbouring family members' difficult feelings", "Providing support even though the situation is unpleasant" and "Being able to give support by receiving confirmation and support from others".

CONCLUSIONS

RNs working in SPHC have an important role in providing support in several ways to the families of patients with ALS, through facilitating their everyday life and giving emotional support when needed, based on the needs of both patients and the families.

When caring becomes an art - how clinical gaze are perceived to be developed

PURPOSE

This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze.

METHODS

This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ).

RESULTS

Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context.

CONCLUSIONS

Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services

BACKGROUND

Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations.

AIM

This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home.

DESIGN

This study has a qualitative design with a lifeworld approach.

METHOD

A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70-93 years.

RESULTS

Care-dependent older persons' participation in prehospital emergency care means 'Entrusting life to professional caregivers' when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain.

CONCLUSION

Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living.

IMPLICATIONS FOR PRACTICE

Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.

Balancing power: Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel

BACKGROUND

Patient participation is considered to promote well-being and is, therefore, central in care contexts. Care-dependent older persons living at home constitute a vulnerable population with increased ambulance care needs. Care transfers risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness.

AIM

To illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel.

METHOD

A phenomenological hermeneutical method was used to analyse transcripts of narrative interviews with 11 ambulance personnel.

RESULTS

The ambulance personnel's lived experience of older persons' participation includes passive and active dimensions and involves a balancing act between an exercise of power that impedes participation and equalisation of power that empowers participation. The main theme 'Balancing dignity in relation to manipulating the body' included the themes Providing a safe haven and Complying with bodily expressions, which means shouldering responsibility for existential well-being and being guided by reactions. The main theme 'Balancing influence in relation to perceived health risks' included the themes Agreeing on a common perspective, Directing decision-making mandate, and Sharing responsibility for well-being, which means shouldering responsibility for health focusing on risks. Influence is conditional and includes performance requirements for both the older person and municipal care personnel.

CONCLUSION

Care-dependent older persons' participation in care from the perspective of ambulance personnel means recognising passive and active dimensions involving human dignity, the ability to influence care, and optimising care efforts through collaboration. This study provides a deepened understanding of the balancing of power involved in ambulance care determining participation, where power is equalised or exercised depending on personal engagement, health risks, and available care options. The knowledge provided holds the potential to improve ambulance care to benefit older persons in critical life situations.

A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services

Purpose

This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home.

Methods

An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure.

Results

Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS.

Conclusions

Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.

An integrative review of resilience among nursing students in the context of nursing education

AIM

This integrative review aimed to examine empirical research on resilience among nursing students in the context of nursing education. Resilience helps nursing students handle challenges, such as changing learning styles and experiencing their first clinical practice.

DESIGN

An integrative review.

METHODS

The search terms focused on resilience and health in nursing students and nursing education. The database used in this review were CINAHL Plus, PubMed and MEDLINE. The Mixed Methods Appraisal Tool appraised the studies' quality.

RESULTS

This study explored 52 records and revealed three current research focuses related to nursing students' resilience: (1) the concept and description of resilience, (2) the characteristics affecting resilience and (3) the mediating role of resilience in maintaining holistic health. Recommendations include adding a resilience topic to the nursing curriculum, providing resilience enhancement programs, examining the relationship between resilience and holistic health and exploring the influence of resilience about global health crises.

PUBLIC CONTRIBUTION

Resilience among nursing students plays a vital role in helping them to overcome adversities during their nursing education. Additionally, after graduation, nursing students can continue contributing to society as resilient Registered Nurses in the future.

Photo-elicited conversations about meetings with a therapy dog as a tool for communication in dementia care: An observational study

INTRODUCTION

It is well-known that people with dementia living in residential care facilities spend most of their time not engaged in meaningful activities. Being involved in activities can improve their quality of life. Animal-assisted therapy is an activity that can evoke engagement and joy. Another way to create engagement and promote communication between people with dementia and caregivers is to use photos.

METHODS

In this observational study, the researchers combined animal-assisted therapy and photobooks in order to explore whether photos of people with dementia who were engaged in animal-assisted therapy could be used as a tool for communication in dementia care. Ten persons (4 men and 6 women; aged 72-92) with dementia were video recorded during photo-elicited conversations with a dog handler/assistant nurse. The recordings were conducted in two residential care facilities in Sweden during 2017-2018. Each participant was video recorded 2-4 times. The recordings were analysed using The Observed Emotion Rating Scale and The Observational Measurement of Engagement-OME Modified. In addition, the video recordings were interpreted from a hermeneutic perspective.

FINDINGS

The findings showed that the most frequently observed effects were pleasure and general alertness, and the participants were observed to be attentive most of the time. The most common attitude during the conversations was 'somewhat positive'. The hermeneutic interpretations were grouped into four themes: Conveys a structure for the conversation with an inherent beginning and ending; An opportunity to recognise oneself and recall a sense of belonging; Awakens emotions and creates fellowship and Entails confirmation and revitalises their identity.

CONCLUSION

Photobooks can be used by caregivers as a tool for meaningful and joyful communication with people with dementia, even those with severe dementia.

Nursing Faculties' Perceptions of Integrating Theory and Practice to Develop Professional Competence

BACKGROUND

Nursing faculties' perceptions influence nursing education. This article describes how nursing faculty perceive nursing students' development of professional competence by integrating theory and practice, and by examining how this context influences this integration.

METHOD

With a phenomenographic approach, interviews were conducted with nine participants and analyzed into qualitatively different categories of description.

RESULTS

The integration of theoretical and practical knowledge is perceived as a challenge or as naturally intertwined in the entire education, focusing mainly on individual prerequisites for learning. Perceptions of a common mission create coherence for students. Evident learning structures are needed, and there is a perceived discrepancy between nurses' competence and expectations in health care.

CONCLUSION

If the theory and practice gap could be perceived as a driving force for continuous learning, it could become an incentive for closer collaboration by creating structures for competence development that include individuals, teams, and organizations. [J Nurs Educ. 2022;61(5):236-241.].

The politicians' perspectives on participation in mammographic screening: an interview-based study from a region in Sweden

Background

Breast cancer is the most common cancer type among women globally. To facilitate early detection, all 40–74-year-old female residents of Sweden are invited to participate in a population-based mammographic screening programme. Approximately 20% of all invited women decline the offer, and if this is due to systematic differences that can be adjusted, it can indicate inequity in healthcare. Assessment of and being updated about the health and healthcare of the residents are largely the responsibilities of the self-governed regions in Sweden. The understanding of the residents’ health serves as a basis for decision making and priority setting. This study aims to describe how politicians representing a region in Sweden perceive women’s participation in mammographic screening and the politicians’ own possibility to promote such participation.

Methods

Qualitative thematic analysis was conducted on the data obtained from individual semi-structured interviews held in 2019. The interviewees comprised ten politicians (six women and four men, 38–71 years old) representing a sub-committee focusing on public health and healthcare issues.

Results

Two main themes have been identified: 1) expected actions and 2) expected conditions for acting, including a total of four sub-themes. According to the politicians, the expected actions, such as obtaining information and being updated about matters regarding mammographic screening, concern both the women invited to the screening and the politicians themselves. Additionally, for both the individual and the healthcare organisation, here represented by the politicians, expected actions entail a shared commitment to maintain health. The expected conditions for acting refer to the politician’s awareness of the factors influencing the women’s decision to undergo or refuse the screening and having the resources to enable taking actions to facilitate participation.

Conclusions

Expected actions and expected conditions for acting are tightly connected and entail some form of prioritisation by the politicians. Setting the priorities can be based on information about the purpose of the screening and an understanding of social determinants’ impacts on women’s decision to refrain from mammographic screening, as well as available resources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00576-6.

Caring approach for patients with chest pain - Swedish registered nurses' lived experiences in Emergency Medical Services

Purpose: Encountering patients with chest pain iscommon for Registered Nurses (RNs) in Emergency Medical Services (EMS) who are responsible for the patient’s medical and nursing care . From a lifeworld perspective, bodily illness is related to existential suffering, requiring knowledge to asses the situation from a holistic perspective . The aim of this study is to describe the caring approach when RNs encounter patients with chest pain.

Methods: A phenomenological methodology to capture RNs’ lived experiences was chosen. Seven qualitative in-depth interviews were conducted at three ambulance stations in Sweden.

Results: The essence of the caring approach while encountering patients with chest pain comprises two constituents; “trust based on confidence and competence” and “the collegial striving towards the best possible care”. Trust is two-parted; trust in oneself, and striving towards gaining the patient’s trust . Competence and experience when combined, develop into confidence especially in stressful situations. The caring approach is nurtured in a well-functioning collegial team.

Conclusions: This study contributes to understanding the caring approach based on the specific patient’s lifeworld in holistic EMS care. By trusting oneself, the patient, and one’s colleague, RNs in EMS shift focus from medical-orientated care to a holistic lifeworld caring approach. . More research is needed on trust as a phenomenon in EMS, both from caregivers’ and patients’ perspectives.

Newly Graduated Swedish Nurses' Inadequacy in Developing Professional Competence

BACKGROUND

The learning process for student and recently graduated nurses during their transition to professional nursing is stressful and challenging. The aim of this study was to describe recent graduates' experiences of developing professional competence in their basic nursing program and during their first year.

METHOD

A qualitative descriptive design with an inductive approach based on interviews with 11 nurses, with a qualitative content analysis.

RESULTS

Recently graduated nurses experience shortages and struggle to develop their professional competence. They find that reflection is a fundamental tool in the process of professional competence development. The competence gap is not between theoretical and practical knowledge, but rather between the university and health care organizations.

CONCLUSION

Focusing on the intertwining of theoretical and practical knowledge can bridge the gap between these two organizations and create a foundation for lifelong learning of professional competence. Creating opportunities for reflection is central to the learning process. [J Contin Educ Nurs. 2020;51(2):65-74.].

Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden: a total population study

BACKGROUND

Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18-69 years requiring emergency care at home in Sweden.

METHODS

A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017-2018. One-sample χ² test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns.

RESULTS

Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59-0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68-0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40-1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46-2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28-1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R² = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ² = 232.56), and in the 08:00-11:59 interval (p < 0.001, χ² = 1224.08).

CONCLUSION

The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.

Perceptions of managers regarding prerequisites for the development of professional competence of newly graduated nurses: A qualitative study

AIM AND OBJECTIVES

To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1-year residency programme.

BACKGROUND

In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programmes to support the nurses' transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied.

DESIGN/METHODS

Qualitative, descriptive study with a data-driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used (see File S1).

RESULTS

Three themes emerged: (a) the nurses' relationships with their teams and patients, (b) expectations regarding the development of practical skills and leadership skills and (c) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the healthcare settings and the basic nursing programme.

CONCLUSIONS

There is a gap between the university and the healthcare settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence.

RELEVANCE TO CLINICAL PRACTICE

To overcome the gap between the university and the healthcare settings, the managers can facilitate nurses' continued learning by creating structures for reflection.

Non-participation in mammographic screening - experiences of women from a region in Sweden

Background

Understanding women’s life conditions regarding their non-participation in different health-promoting and disease-preventing activities is important as it may draw attention to potential areas for improvement in the healthcare sector. Mammographic screening, a disease-preventing service, facilitates early detection of any potential malignancies and consequently prompts initiation of treatment. The reasons for non-participation in mammographic screening can be understood from different perspectives, such as socioeconomic and lifestyle-related determinants of health. This study aims to gain a deeper understanding of women’s experiences and perceptions about non-participation in mammographic screening in a Swedish region with a single mammographic facility.

Methods

Data from individual semi-structured interviews, conducted in 2018 with eleven women between the ages of 48 and 73, were analysed by a qualitative content analysis.

Results

The findings reveal three main categories: 1) doubts regarding mammographic screening and its organisation, 2) sense and sensibility in the decision to refrain from mammographic screening, and 3) dependency and options. These three categories indicate aspects, such as the individual’s life situation, accessibility to the offered service, and the flexibility of the healthcare system, that need to be considered to improve the organisation of mammographic screening.

Conclusion

Listening to the women’s voices regarding their experiences and perceptions about mammographic screening is important as individual characteristics and social circumstances interact with healthcare and affect the degree of participation.

Photo-Elicited Conversations about Therapy Dogs as a Tool for Engagement and Communication in Dementia Care: A Case Study

Understanding the inner life of people with dementia can be challenging and there is a need for new and different approaches. Previous research shows that people with dementia can experience emotions such as harmony, closeness, and joy as well as sadness and concern when interacting with a therapy dog. Simultaneously, memories of past episodes are brought back to life when the person interacts with the dog. This raises questions about whether photos of interaction with a dog can evoke memories or support people with dementia in communicating emotions in a corresponding way. The aim of this study was to explore photo-elicited conversations as a tool for engagement and communication in dementia care. Repeated video observations of photo-elicited conversations between a woman with dementia and a dog handler/assistant nurse were used to collect data. The video recordings were analyzed with a phenomenological hermeneutical method. The role of photo-elicited conversations as a tool for engagement and communication in dementia care is that the conversations can help the person with dementia to feel a sense of being situated and recall feelings of liveliness and belongingness, and thus supporting the person's sense of self. The results can be used to deepen nursing staff's understanding of using photo-elicited conversations in dementia care.

Experiences and perceptions about undergoing mammographic screening: a qualitative study involving women from a county in Sweden

PURPOSE

 An organized population-based mammographic screening programme aims for an early detection of potential breast abnormalities so that treatment can commence. Continuous participation and a high attendance rate are vital for an effective programme. It is important to understand the underlying reasons for participation in mammographic screening, should there be factors that are amendable within reason and could be adjusted. Therefore, the invited women are valuable sources of information. This study aimed at describing the experiences and perceptions about mammographic screening of women from three municipalities in a Swedish county.

METHOD

 Six semi-structured focus-group discussions, each with four to five participants, were held. Content analysis was then conducted.

RESULTS

 The screening procedure, such as staff professionalism, was covered. Other people's opinions and the woman's own understanding affected the women's decisions on whether or not to undergo the procedure. Structural conditions, such as travel time and financial issues, were sources of concern. However, the offer to perform mammographic screening was perceived with gratitude.

CONCLUSIONS

 Structural conditions, risk and time perceptions, the screening procedure, attitudes towards undergoing it and appreciation of its benefit may influence the women's continuous willingness to be screened, which in turn may affect public and individual health.

Parental conceptions of the rotavirus vaccine during implementation in Stockholm: A phenomenographic study

In 2014, Stockholm became the first Swedish county to introduce the rotavirus vaccine, which is given from as early as six weeks of age. The aim of this study was to describe parental conceptions of rotavirus infection and vaccination during its implementation as part of the child immunization program, as their support is vital for any new vaccine. The study followed a descriptive, qualitative design with a phenomenographic approach. Ten in-depth interviews with parents were conducted in Stockholm County, transcribed and analyzed to describe qualitatively different conceptions of rotavirus infection and vaccination. Four main categories were identified: to vaccinate without doubt, hesitant to vaccinate, risky to vaccinate, and unnecessary to vaccinate. All the parents had in common the desire to protect their children from suffering, either by vaccinating their child in order to avoid rotavirus infection or by not vaccinating their child because of concerns about the side effects. It is important that child health-care professionals understand the variations of conceptions that influence the parents' decisions and that these conceptions may differ considerably. Individualized parental information about rotavirus infection and vaccination would help to achieve a successful implementation of the vaccination program.

To be present, share and nurture: a lifeworld phenomenological study of relatives' participation in the suicidal person's recovery

In today's health care, participation is acknowledged as important. However, there is limited research on how relatives of patients at risk of suicide experience their opportunities to participate in care during periods when their close ones are subject to inpatient care. The aim of this study was to describe the phenomenon of participation, as experienced by relatives of persons who are subject to inpatient psychiatric care due to a risk of suicide. The study was conducted through a reflective lifeworld research (RLR) approach, based on phenomenological philosophy. Eight relatives of patients receiving care from professionals in a psychiatric specialist health care context in Sweden participated in phenomenon-oriented interviews. Data were analysed to elucidate a meaning structure of the phenomenon. The findings show that the phenomenon of participation was more associated with patients' recovery processes than with the caring process, and means "being actively involved in a process in which the person regains the desire to live". The meaning of participation is further described by its meaning constituents: struggling for being able to be present for the person at risk of suicide, being able to share everyday life, and nurturing sources for vitality. These insights into the meaning of participation highlight the importance of allowing supportive relatives to be a part of the patient's life, while the person is cared for in an inpatient hospital setting. Thus, participation enables relatives to be acknowledged as resourceful human beings in the patient's recovery process, and thereby facilitates a sense of being able to manage and share life itself together with the person. This means that mental health nurses need to recognize individual variations of relatives' participation processes, and take on the responsibility of acknowledging relatives' lifeworlds.

Reconnecting with oneself while struggling between life and death: The phenomenon of recovery as experienced by persons at risk of suicide

The body of knowledge regarding health and recovery as experienced by patients at risk of suicide is limited. More research is needed into the meaning of recovery and what strengthens the desire to live. The aim of this study was to describe the phenomenon of recovery in a context of nursing care as experienced by persons at risk of suicide. In line with a reflective lifeworld research approach, 14 patients from a psychiatric clinic in Sweden participated in phenomenon-oriented interviews. Data were analyzed to describe the essence of the phenomenon. The results reveal that the phenomenon of recovery means 'reconnecting with oneself while struggling between life and death'. Three meaning constituents emerged: being in an expressive space and giving voice to oneself, regaining dignity through nurturing connectedness, and finding a balance in the tension between life and death. In conclusion, the meaning of recovery is to experience the ability to manage one's own life. Professional caregivers need to acknowledge patients' lifeworlds, in a way that enable patients to experience themselves as capable of managing their own lives. Professional caregivers should also facilitate the involvement of supportive relatives.

Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand

The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand’s aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors.

Physical mobility, physical activity, and obesity among elderly: findings from a large population-based Swedish survey

OBJECTIVE

To examine how physical activity and physical mobility are related to obesity in the elderly.

STUDY DESIGN

A cross-sectional study of 2558 men and women aged 65 years and older who participated in a population survey in 2012 was conducted in mid-Sweden with an overall response rate of 67%.

METHODS

Obesity (body mass index ≥30 kg/m²) was based on self-reported weight and height, and physical activity and physical mobility on questionnaire data. Chi-squared test and multiple logistic regressions were used as statistical analyses.

RESULTS

The overall prevalence of obesity was 19% in women and 15% in men and decreased after the age of 75 years. A strong association between both physical activity and obesity, and physical mobility and obesity was found. The odds for obesity were higher for impaired physical mobility (odds ratio [OR] 2.83, 95% confidence interval [CI] 2.14-3.75) than for physical inactivity (OR 1.63, 95% CI 1.28-2.08) when adjusted for gender, age, socio-economic status and fruit and vegetable intake. However, physical activity was associated with obesity only among elderly with physical mobility but not among those with impaired physical mobility.

CONCLUSION

It is important to focus on making it easier for elderly with physical mobility to become or stay physically active, whereas elderly with impaired physical mobility have a higher prevalence of obesity irrespective of physical activity.

Community Nurses’ Experiences Regarding the Meaning and Promotion of Healthy Aging in Northeastern Thailand

Purpose: Describe community nurses’ experiences regarding the meaning and promotion of healthy aging in northeastern Thailand. Method: Data were collected through five focus group interviews with 36 community nurses in northeastern Thailand. Latent content analysis was conducted to analyze the data. Findings: Healthy aging was characterized by the interconnection of older persons, older persons’ family members, and the community. Healthy aging was associated with two themes: “being strong” and “being a supporter and feeling supported.” The nurses’ experiences in promoting healthy aging were described by the themes “providing health assessment,” “sharing knowledge,” and “having limited resources.” Conclusions: The findings of this study provide a deeper understanding of the meaning of healthy aging from a holistic viewpoint. Community nurses must pay attention to older persons and their surroundings when planning how to promote healthy aging. Person-centeredness should be applied in practice to promote healthy aging. The current findings contribute useful information that should help policy makers develop healthy aging strategies in Thailand.

An Exploration of the Phenomenon of Formal Care from the Perspective of Middle-Aged Heart Failure Patients

BACKGROUND

Despite a considerable amount of research into heart failure there remains a divergence between the care available and patient's needs. The predominant biomedical perspective is more focused on the disease rather than the patient. In order to deliver formal care appropriate to the needs of middle-aged patients with moderate-severe HF it is imperative to gain the perspective of the individual patient.

AIMS

The aim of the current study was to explore and understand the phenomenon: Formal care as experienced from the perspective of middle-aged patients living with HF.

METHODS

The study was performed using a lifeworld perspective. Data was collected in seven unstructured interviews with middle-aged people living with moderate-severe HF. Data was analysed using a phenomenological approach.

RESULTS

Formal care, as experienced by middle-aged patients living with moderate to severe HF, means hope to once again be able to have access to life. However, the meaning of formal care is ambiguous, which signifies that care means both health and suffering at the same time. The essence's meaning constituents are: dependency of care, surrender to care and unclear participation.

CONCLUSION

The experience of formal care means both well-being and suffering at the same time. Patients' suffering in relation to formal care can be reduced if formal carers act from an ethical patient perspective point of view and if carers regard patients' lived experiences.

Healthy ageing in Isan-Thai culture--A phenomenographic study based on older persons' lived experiences

Healthy ageing is a concept that concerns older persons' quality of life and is a key factor in promoting well-being. The older population in Thailand is growing. Isan (a region of north-eastern Thailand) has been reported as having one of the most rapidly increasing older populations in the country. In order to care for and promote the health of older people, healthcare providers should understand how healthy ageing is perceived by this target group. Although healthy ageing has been studied in different contexts as well as perspectives, no studies have previously focused on older persons' experiences of healthy ageing from a lifeworld perspective in Isan-Thai. Therefore, the aim of this study is to describe older persons' qualitatively different conceptions of healthy ageing in Isan-Thai culture. A phenomenographic approach with an epistemological base in lifeworld theory was used to disclose the various ways to conceptualize healthy ageing. Individual, qualitative interviews were conducted with 17 people aged 60 and above who live in Isan-Thai. The findings of this study revealed three categories of descriptions: "being independent in dependence," "being at peace," and "being a valuable person." This study also found family members, friends, healthcare providers, and religion important to healthy ageing in the Isan-Thai culture. Understanding how older people conceptualize healthy ageing is valuable for healthcare providers. They can apply these findings regarding healthy ageing in their fieldwork when caring for older people.

Being in a critical illness-recovery process: a phenomenological hermeneutical study

AIMS AND OBJECTIVE

The aim of this study was to describe and interpret the essential meaning of the lived experiences of being in a critical illness-recovery process after a life-threatening condition.

BACKGROUND

The critical illness-recovery process after a life-threatening condition takes several years and does not only include patients' experiences during intensive care. Previous research has mainly focused on what critically ill patients recall. However, from a phenomenological point of view, experiences are more than memories alone. To plan and perform relevant health care and social support for patients who have survived a life-threatening condition, a more profound understanding about their lived experiences is needed.

DESIGN AND METHOD

In this qualitative study, a phenomenological hermeneutical approach was used. Interviews were conducted with seven patients, two to four years after they had received care in an intensive care unit in Sweden.

RESULTS

The comprehensive understanding of the results shows that the critical illness-recovery process after a life-threatening condition means an existential struggle to reconcile with an unfamiliar body and with ordinary life. This can be understood as an 'unhomelikeness' implying a struggle to create meaning and coherence from scary and fragmented memories. The previous life projects, such as work and social life become unfamiliar when the patient's fragile and weak body is disobedient and brings on altered sensations.

CONCLUSIONS

Patients who survive a life-threatening condition have an immense need for care and support during the entire critical illness-recovery process, and also after the initial acute phase. They need a coherent understanding of what happened, and support to be able to perform their changed life projects.

RELEVANCE TO CLINICAL PRACTICE

Supporting and caring for patients' recovery from a life- threatening condition involves recognising the patients' struggle and responding to their existential concerns.

Rest: A Health-Related Phenomenon and Concept in Caring Science

Rest is a health-related phenomenon. Researchers have explored the phenomenon of rest, but further concept development is recommended. The aim of my study was to develop and describe a concept of rest, from interviews with a total of 63 participants about their lived experiences of rest. I performed the developing process in two stages: first with descriptive phenomenology and second with a hermeneutic approach. The concept of rest is comprised of the essences of both rest and “non-rest,” and there is a current movement between these two conditions in peoples’ lives. The essence of rest is being in harmony in motivation, feeling, and action. The essence of non-rest is being in disharmony in motivation, feeling, and action. The essences reveal some meaning constituents. Health care professionals and researchers can use the concept as a frame of reference in health care praxis and in applied research.

Patient participation in emergency care - a phenomenographic analysis of caregivers' conceptions

AIMS AND OBJECTIVES

The aim of this study was to describe caregivers' conceptions of patient participation in an emergency care unit.

BACKGROUND

Patient participation is an important goal in health care. Patients who are given the opportunity to participate in care situations are able to influence care in a way that is more beneficial to them. Patients' participation in caring has been studied in different contexts, but little health care research has been conducted into patient participation in the emergency care unit. Patients treated in emergency care units sometimes express dissatisfaction with their care situation and it would therefore be important to find out how caregivers in emergency care experience patient participation.

DESIGN

A phenomenographic research method based on life world theory was used in the study.

METHOD

Data were collected from 11 caregivers with experience of working in an emergency department. The caregivers were from different professions: three physicians, four nurses and four auxiliary nurses.

RESULTS

The caregivers' conceptions of patient participation can be divided into three different descriptive categories: caregivers offer the opportunity for participation, patients demand participation and mutual participation.

CONCLUSIONS

The study adds knowledge that caregivers' different qualitative conceptions of patient participation are mainly conditional from caregivers.

RELEVANCE TO CLINICAL PRACTICE

Mutual participation is perceived occasionally and often unexpectedly, when the right circumstances occur, despite international and national guidelines that lay down the need for patient participation.

Municipal night nurses' experience of the meaning of caring

The aim of this study was to elucidate municipal night registered nurses' (RNs) experiences of the meaning of caring in nursing. The research context involved all night duty RNs working in municipal care of older people in a medium-sized municipality located in central Sweden. The meaning of caring in nursing was experienced as: caring for by advocacy, superior responsibility in caring, and consultative nursing service. The municipal night RNs' experience of caring is interpreted as meanings in paradoxes: 'being close at distance', the condition of 'being responsible with insignificant control', and 'being interdependently independent'. The RNs' experience of the meaning of caring involves focusing on the care recipient by advocating their perspectives. The meaning of caring in this context is an endeavour to grasp an overall caring responsibility by responding to vocational and personal demands regarding the issue of being a RN, in guaranteeing ethical, qualitative and competent care for older people.

Reflective practice in nursing care: Embedded assumptions in qualitative studies

Qualitative nursing researchers have long recognized that reflective practice (RP) seems to be a valuable tool in nursing care. The aim of the present meta-study was to analyse current qualitative research on RP in nursing care, in order to create and synthesize the knowledge and the understanding of registered nurses' RP. Using a meta-study synthesis approach, embedded assumptions were identified in qualitative studies that have influenced the way researchers have interpreted and made sense of RP in nursing care. Despite empirical focus in research on RP in nursing care, it was found that assumptions about RP were predominantly based on theory. The reflective movement within the practice of nursing care has mainly a constructivist epistemology, based on learning from experience. The individual nurse's RP capability is essential in providing and improving ethical and holistic nursing care.

Living with moderate-severe chronic heart failure as a middle-aged person

In this article the authors describe a study focusing on middle-aged persons living with chronic heart failure (CHF), a group with which few studies have been conducted. They used the lifeworld perspective to focus on persons' lived experiences of the phenomenon, that is, living with moderate-severe CHF as a middle-aged person. They interviewed 7 middle-aged persons (4 men, 3 women; aged 38 to 65 years) and analyzed the data obtained using a phenomenological approach. The phenomenon's essence is described as a life situation characterized by a failing body, a life constantly under threat, a rapidly changing health condition, and an altered self-image, which implies that the persons live in a changed life situation. The essence was further illuminated by three meaning constituents: an ambiguity of the body, losing track of life, and balancing life. Knowledge from this study will help caregivers understand and support patients with this debilitating condition.

The woven fabric - a metaphor of nursing care: the major subject in nursing education

The woven fabric - a metaphor of nursing care: the major subject in nursing education Society's future needs regarding health care present challenges to traditional nursing education. Today, the ambition is to create a nursing role that is appropriate to people's health care needs rather than the needs of the health care system. In nursing education, the major subject - nursing care - is central. Accordingly, there is a need for a consistent and clear articulation of this subject as well as the nursing profession. The aim of the present study was to interpret and describe the major subject, its content and structure in the nursing programme at Mälardalen University. With a hermeneutic approach an interpretation and application emerged as a metaphor of nursing care - the woven fabric. In this structure concepts function as bridges linking theory and practice, whereby it is possible to integrate different aspects of knowledge in order to think, feel and act nursing care.