Meaning of wellness in caring science based on Rodgers's evolutionary concept analysis

BACKGROUND

Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear.

AIM

To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science.

METHOD

Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms 'wellness', 'health', 'health care', and 'health care and wellness'; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria.

RESULTS

Based on the findings from this concept analysis, a definition of wellness was developed: 'a holistic and multidimensional concept represented on a continuum of being well that goes beyond health'. Implications for nursing practice were correspondingly presented.

CONCLUSION

Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.

Expecting parents’ use of digital sources in preparation for parenthood in a digitalised society – a systematic review

Background

In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

Question

The focus of this study was to explore expecting parents’ use of digital sources and how this influences their health during pregnancy.

Methods

A systematic review covered the thematic analysis of 39 articles.

Findings

The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents’ health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

Conclusion

Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

The concept, importance and values of support during childbearing and breastfeeding - A discourse paper

BACKGROUND

Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing.

AIM

The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites.

DESIGN

Discourse paper.

METHODS

This discourse paper is based on our own experiences and is supported by literature and theory.

RESULTS

Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.

Parents' Experiences of Receiving Professional Support Through Extended Home Visits During Pregnancy and Early Childhood-A Phenomenographic Study

Background: While becoming a parent can be challenging for all, it can particularly be challenging for those parents and children who are in a vulnerable situation—e.g., in families whose members have problems related to health, relationships, or socioeconomic status. It is essential for health care professionals to identify the more vulnerable families at an early stage. Home visits are one cost-effective way of identifying and supporting such families. This study describes the parental experiences of an intervention that involves professional support in the form of extended home visits. The aim of the study is to describe the parents' understanding of their experiences of receiving professional support through extended home visits both during pregnancy and the first 15 months of their child's life.

Methods/Design: A phenomenographic approach was used. Semi-structured interviews were conducted with 12 parents who had received the intervention. The interviews were analyzed using the seven-step phenomenography model described by Sjöström and Dahlgren.

Results: The following three descriptive categories emerged from the analysis: (1) conceptions concerning the meaning of the physical environment, (2) conceptions concerning extended home visits promoting feelings of self-confidence in the parental role, and (3) conceptions concerning extended home visits promoting parental participation and relations.

Conclusion and Clinical Implications: Extended home visits as a form of professional support appear to promote parental self-confidence in parenting ability, giving parents a feeling of security that facilitates conversation with professionals. Children and their entire families had natural roles during home visits, which allowed the children to behave more characteristically. Furthermore, the home visits were understood to facilitate social support through social activities at the child health center as well as integration into Swedish society for migrant parents. Professional support should be adjusted to the unique individual needs of parents, which demands a variety of supportive interventions—for example, reorganizing one or two of the regular clinical visits currently being scheduled as home visits instead.

Midwives' Experiences of Providing the "Inspirational Lecture" as a Care Intervention for Expectant Parents-A Qualitative Study

Background: In most Western countries, ordinary parental classes exist and have become a well-established form of professional support within midwifery care, even though some of these classes lack evidence of benefits for the parents. A Swedish randomized controlled trial including an intervention as a pilot study, revealed that a type of parental preparatory professional support provided for expectant parents, the “inspirational lecture,” showed a tendency to be beneficial for parents' birth experience, and their perceived quality of parental couple relationship. However, there is no previous research on the midwives' experiences from providing the inspirational lecture. Carrying out research on midwives' experiences from providing the lecture, could bring future opportunities to provide a work-integrated learning (WIL) related to professionals' skills, and the pedagogic used.

Aim: To elucidate midwives' experiences about providing the inspirational lecture as a care intervention for expectant parents.

Methods: Midwives were interviewed and data were analyzed using qualitative content analysis.

Results: The midwives strived to put childbirth into a comprehensive and manageable context for the expectant parents, during the inspirational lecture. For this, different approaches were used to make expectant parents understand how the parents themselves can be engaged participants in their own birth.

Conclusion and Clinical Implications: The midwives used the inspirational lecture to provide the expectant parents with knowledge about how they, as a parental couple, could cooperate and feel safe in relation to the upcoming birth. This could be understood as if the midwives were striving to facilitate the integrative power of the parental couple, which is the couples' ability to gather their joint power. These results can assist midwives and serve as a reference for providing parental classes for expectant parents with a focus on promoting both the parents' individual as well as mutual skills.

Effects of the "Inspirational Lecture" in Combination With "Ordinary Antenatal Parental Classes" as Professional Support for Expectant Parents: A Pilot Study as a Randomized Controlled Trial

Background: Both expectant mothers and their partners describe weaknesses in ordinary parental preparatory professional support provided internationally and nationally within Sweden. Therefore, it is necessary to develop the parental preparatory professional support provided by midwives for expectant parents within Sweden. This study will evaluate the effects on expectant parents of receiving a combination of an “inspirational lecture” and “ordinary antenatal parental classes” compared with only “ordinary antenatal parental classes.”

Methods/Design: This block randomized controlled trial included an intervention as a pilot study, in which expectant parents were randomized for (1) the inspirational lecture and ordinary antenatal parental classes (intervention group [IG]) (n = 66) or (2) ordinary antenatal parental classes (control group [CG]) (n = 60). Data collection with repeated questionnaires was conducted in the first week and 6 months after birth. Statistical analyses were conducted for participant characteristics, differences between parents within IG and CG, effects of the intervention, intention to treat, and internal consistency of the included measurements.

Results: The intervention showed a tendency to be gainful for one out of four outcomes related to birth experience, and parents' perceived quality of parental couple relationship consensus and sexuality and manageability. These results were more prominent for the partners. Parents within both the intervention and control groups reported decreased social support in the first 6 months after birth.

Conclusion and Clinical Implications: Overall, the concept of the inspirational lecture in combination with ordinary antenatal parental classes as parental preparatory professional support seems to be a valuable care intervention. However, this study was a pilot study and the results should therefore be interpreted with caution. More research is needed since childbirth and transition to parenthood are complex processes in need of comprehension.

First-Time Mothers Have a Desire to Be Offered Professional Breastfeeding Support by Pediatric Nurses: An Evaluation of the Mother-Perceived-Professional Support Scale

BACKGROUND

Although the World Health Organization recommends exclusive breastfeeding for six months, the rate of breastfeeding has decreased worldwide. Breastfeeding is the natural way of feeding a baby, but it is a process that has to be learnt. It is not unusual for problems to occur and hence support for breastfeeding is vital. The aim of this study was to explore first-time mothers' experiences of the breastfeeding support offered by pediatric nurses, as well as to develop and evaluate the Mother Perceived Support from Professionals (MoPPS) scale.

METHODS

A qualitative design involving both inductive and deductive approaches was chosen. Nine first-time mothers were interviewed regarding their experiences of the breastfeeding support offered by pediatric nurses. Semistructured interviews were conducted. The mothers were also asked to grade their experiences of breastfeeding support on the MoPPS scale. A qualitative content analysis was applied when analyzing the data obtained using both the inductive (interviews) and deductive (MoPPS scale) approaches.

RESULTS

The results revealed that the mothers felt the desire to breastfeed, although they all experienced some difficulties. They wanted the pediatric nurses to be perceptive and provide professional support based on their own experiences. When the pediatric nurses took time and booked extra appointments, the mothers felt supported. The inductive analysis resulted in one theme: "When wanting to breastfeed, mothers have a desire to be offered professional breastfeeding support". Two main categories were identified, namely "Mothers wanted but lacked breastfeeding support" and "Mothers received professional support." The deductive analysis of the MoPPS scale showed similar results, and the questions were perceived as relevant to the aim. The mothers considered it important that the pediatric nurses had sufficient knowledge about breastfeeding. It was also considered important that the pediatric nurses involved the mothers' partners in the breastfeeding support. Therefore, we suggest that these areas should be included in the MoPPS scale for pediatric nurses.

CONCLUSIONS

The MoPPS scale can be a useful tool for helping pediatric nurses to offer mothers professional breastfeeding support. Indeed, when offering breastfeeding support, pediatric nurses can use the items included on the MoPPS scale as guidance.

First-time fathers' experiences of professional support from child health nurses

Nowadays, in Sweden, fathers are expected to be active in their father role and to share caring responsibilities for their children equally with mothers. This active role of a father in a family can be challenging, especially for the first-time fathers. Child health nurses' support is an important factor for fathers to become confident caregivers. The Father Perceived Professional Support scale (FaPPS scale) can be used in nursing practice for better understanding father's needs of professional support. The aim of this study was to describe first-time fathers' experiences of the professional support received from child health nurses and to validate the instrument: 'FaPPS scale'. A qualitative design, with inductive and deductive approaches, was used in this study. Twelve first-time fathers participated in the semi-structured interviews, thereafter grading the FaPPS scale items and commenting on them. The fathers experienced nurses' support positively when nurses provided practical information and stimulated them to be involved in care of their children. In contrast, the support was experienced negatively because of nurses' lack of commitment, availability and adaptation to the fathers' individual needs. The fathers also felt inequality between the support received by fathers and by mothers. Although some fathers perceived it as negative, others considered it fair, believing that mothers needed more support. In addition, fathers expect nurses to actively offer support to them and supervise them in childcare. The fathers also needed meeting other parents, for example in parental groups. This study also indicates that FaPPS scale can be used both in research and clinical practice, though still needing further development.

'To be able to support her, I must feel calm and safe': pregnant women's partners perceptions of professional support during pregnancy

Background

Professional support does not always meet the needs of expectant fathers or co-mothers. The way in which professional support is offered during pregnancy varies internationally, depending on the country. In order to attain a greater understanding of partners’ experiences of professional support, it is necessary to further illuminate their perceptions of it. The aim of this study was therefore to explore pregnant women’s partners’ perceptions of professional support during pregnancy.

Methods

Qualitative research design. Partners of pregnant women were interviewed during gestational week 36–38. Individual semi-structured interviews were used to explore the partners’ perceptions. The data was analysed using a phenomenographic approach. The study was performed in a county in south-western Sweden; the data collection was conducted from November 2014 to February 2015. Fourteen partners (expectant fathers and co-mothers) of women who were expectant first-time mothers with singleton pregnancies, were interviewed.

Results

The findings of the study are presented through four descriptive categories: Ability to absorb adequate information; Possibility to meet and share with other expectant parents; Confirmation of the partner’s importance; and Influence on the couple relationship. Using a theoretical assumption of the relationship between the categories showed that the fourth category was influenced by the other three categories.

Conclusions

The partners perceived that professional support during pregnancy could influence the couple relationship. The partners’ ability to communicate and to experience togetherness with the women increased when the expectant couple received professional support together. The support created also possibilities to meet and share experiences with other expectant parents. In contrast, a lack of support was found to contribute to partners’ feelings of unimportance. It was essential that the midwives included the partners by confirming that they were individuals who had different needs for various types of professional support. The partners perceived it easier to absorb information when it was adequate and given with a pedagogic that made the partners become interested and emotionally engaged.

Swedish school nurses’ experiences in supporting students with type 1 diabetes in their school environment

Students with type 1 diabetes (T1D) need to take responsibility for their T1D and need professional support from school nurses. This study describes school nurses’ experiences in supporting students with T1D in school. A qualitative approach was used. After purposive sampling, six school nurses were interviewed and data were analyzed with qualitative content analysis. For professional support, a network around the student was enabled constituting of a continuous dialogue and responsibility and preparedness. For professional support a mutual commitment from the student, parents, and the school nurse was needed which was built from initiating participation and security, the school nurse’s ability to be present and available and on school nurse’s perceived competence. The conclusion of the study, and its practical implication, is that school nurses’ ability for professional support of students with T1D varied in relation to their perceived competence in nursing science as well as their ability to enable, strengthen and sustain teamwork and family–school team meetings.

Nurses and midwives professional support increases with improved attitudes - design and effects of a longitudinal randomized controlled process-oriented intervention

Background

Becoming parents for the first time is challenging. Mothers need both social and professional support to handle these challenges. Professionals’ attitudes affect quality of care and support. So to improve professional support, an intervention consisting of a process-oriented training was performed. Due to the positive results of the intervention there is a need to illuminate the methodological approach further. The overall aim was therefore to describe a methodological approach to improve and evaluate health care professionals’ attitudes toward breastfeeding and parental support in order to improve quality of care in childbearing.

Methods

This study was a longitudinal randomized control intervention study, in which groups of mothers received care in childbearing from midwives and child health nurses. These health professionals had gone through a process-oriented training, or not. In order to improve attitudes of health professionals the training was based on evidence, practical skills and reflective processes (both private and professional experiences) in relation to breastfeeding and parental support. Included in the longitudinal study were health professionals from five intervention municipalities n = 36 and health professionals from five control municipalities n = 45. All mothers who fulfilled the inclusion criteria were consecutively identified from the hospital register and asked to participate in the study. Mothers who accepted to participate were included in the interventions group (n = 206) or control groups (n = 162, n = 172 respectively) based on which municipality they belonged to.

Results

The results of the process-oriented training improved the professionals’ attitudes toward breastfeeding and parental support. These improved attitudes in health professionals increased intervention-group mother’s satisfaction with professional and social support. Intervention-group mother’s relation to and feelings for their baby as well as breastfeeding was also improved.

Conclusion

These results stress the importance of professionals’ attitude in quality of care during childbearing, as well as pointing to the possibility to improve professionals’ attitudes with a process-oriented training.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR), trial registration: ACTRN12611000354987.

Exploring Professional Support Offered by Midwives during Labour: An Observation and Interview Study

Support in labour has an impact on the childbirth experience as well as on childbirth outcomes. Both social and professional support is needed. The aim of this study was to explore professional support offered by midwives during labour in relation to the supportive needs of the childbearing woman and her partner. The study used a qualitative, inductive design using triangulation, with observation followed by interviews. Seven midwives were observed when caring for seven women/couples in labour. After the observations, individual interviews with midwives, women, and their partners were conducted. Data were analysed using hermeneutical text interpretation. The results are presented with three themes. (1) Support as a professional task seems unclear and less well defined than medical controls. (2) Midwives and parents express somewhat different supportive ideas about how to create a sense of security. (3) Partner and midwife interact in support of the childbearing woman. The main interpretation shows that midwives' supportive role during labour could be understood as them mainly adopting the "with institution" ideology in contrast to the "with woman" ideology. This may increase the risk of childbearing women and their partners perceiving lack of support during labour. There is a need to increase efficiency by providing support for professionals to adopt the "with woman" ideology.

An exploration and description of student midwives' experiences in offering continuous labour support to women/couples

AIM

to explore and describe the student midwife's experiences in offering continuous labour support.

DESIGN

a qualitative research design was chosen. Each student midwife offered continuous labour support to five women/couples and wrote narratives about each of these occasions. Written narratives from 11 student midwives were analysed using qualitative content analysis.

FINDINGS

when student midwives offer continuous labour support to women/couples, they try to establish rapport. When this works, their presence, their sense of confidence and their ability to offer reassurance increase. If establishing rapport does not work, students experience a sense of powerlessness, a need for reassurance and a lack of confidence.

KEY CONCLUSIONS

offering continuous labour support to women and/or their partners made the students aware of the importance of establishing rapport, and it made them realise the impact that their mere presence in the room could have. The students had a need for reassurance which could hamper their efforts to establish rapport. Experiencing a lack of confidence made students focus more strongly on their clinical skills and on their perceived role as a student midwife.

IMPLICATIONS FOR PRACTICE

this study can initiate discussions about how student midwives learn to be supportive, as well as about the role models that students encounter during their clinical training in Sweden.

Histopathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast – Results from the Swedish randomised trial

AIM

The primary aims were to study risk factors for an ipsilateral breast event (IBE) after sector resection for ductal carcinoma in situ of the breast (DCIS) in a trial comparing adjuvant radiotherapy to no therapy and to assess predictive factors for response to radiotherapy. Secondary aims were to analyse reproducibility of the histopathological evaluation and to estimate correctness of diagnosis in the trial.

SETTING

A randomised trial in Sweden (the SweDCIS trial), including 1046 women with a median of 5.2 years of follow-up in a population, offered routine mammographic screening.

METHODS

A case-cohort design with a total of 161 cases of IBE (42 of those being members of the subcohort) and 284 sampled for the sub-cohort. Ninety five percent of the participants' slides could be retrieved and were re-evaluated by three experienced pathologists.

RESULTS

Low nuclear grade (NG 1-2) and absence of necrosis halves the risk of IBE in both irradiated and non-irradiated patients. Lesion size, margins of excision and age at diagnosis did not modify these associations. The presence of necrosis modified the effect of radiotherapy: relative risk was 0.40 with necrosis present and 0.07 with necrosis absent (p-value for interaction 0.068). In all subsets of prognostic factors, radiotherapy conferred a substantial benefit. The risk factors for in situ and invasive IBE were similar. The agreement between pathologists was moderate (kappa=0.486). Correctness of diagnosis in the subcohort of SweDCIS was 84.8%.

CONCLUSION

Although nuclear grade and necrosis carry prognostic information, we could not define a group with very low risk after sector resection alone. Radiotherapy has a protective effect in all substrata of risk factors studied. The interaction between the presence of necrosis and radiotherapy is a clinically and biologically relevant research area.

Necrotizing sialometaplasia of the lip simulating squamous cell carcinoma

A case of necrotizing sialometaplasia of the lip in an 68-year-old pipe smoker is described. Necrotizing sialometaplasia is a self-healing non-neoplastic disease probably of ischaemic nature. Thirty-nine cases of sialometaplasia are described in the literature up to early 1979. These cases appeared in the palate, nasal cavity, gingiva, lip, hypopharynx and maxillary sinus. Six cases have also been reported from major salivary glands. Histologically there is necrosis of mucous cells with partial replacement by squamous epithelium. This entity has often been mistaken for squamous or mucoepidermoid carcinoma. One has to be familiar with the existence of necrotizing sialometaplasia in ordeg surgery.

Peliosis hepatis as a result of endogenous steroid hormone production

A case of peliosis hepatis in a 3 year old child with steroid hormone producing adreanl tumour is presented. The diagnosis of the adrenal tumour and peliosis hepatis was settled on the basis of surgical material examination. This case of peliosis hepatis due to endogenous steroid production lends more support to the earlier reported cases of iatrogenically produced peliosis due to exogenous steroid treatment.