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  • 1.
    Andreassen Devik, Siri
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Ctr Care Res, Steinkjer, Mid Norway, Norway.
    Enmarker, Ingela
    Ctr Care Res, Steinkjer, Mid Norway, Sweden.
    Hellzen, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    When expressions make impressions-Nurses' narratives about meeting severely ill patients in home nursing care: A phenomenological-hermeneutic approach to understanding2013In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 8, Art. no. 21880- p.Article in journal (Refereed)
    Abstract [en]

    Registered nurses (RNs) working in homecare encounter severely ill and palliative patients whose expressions may cause ethical challenges and influence their daily work. The aim of this qualitative study was to illuminate and interpret the meaning of nurses' lived experiences when meeting these patients. Narrative interviews were conducted with 10 RNs working in home nursing care. These interviews were audiotaped and transcribed verbatim to a text and interpreted by a phenomenological-hermeneutic method inspired by Ricoeur. The meaning of the RNs' lived experience of patients' expressions was formulated into four themes. The first theme, Being open for the presence of the Other, includes two subthemes: "Sensing vulnerability" and "Empathizing with." The second theme, Being satisfied, entails the subthemes, "Feeling exceptional" and "Being trusted." The third theme, Being frustrated, contains the subthemes, "Being disappointed" and "Being angry." The fourth and final theme, Being ambivalent, includes one subtheme: "Being generous or reserved." Patients' expressions that make impressions on nurses create emotional waves. Expressions leave impressions that call upon the nurse, and confront her with taking the risk of letting intuition and pre-reflexive feelings gain entry to her care. Allowing for the Other's presence is seen as a precondition, which means facing humanity and sensing a vulnerability in herself as well as in the Other. Understanding and balancing this emotional dimension in care seems to cause confusion and distress within the nurses. Realizing how their feelings may lead to either generosity or aloofness towards the patient is upsetting. Our interpretation suggests that these impressions echo confusion according to the role of being a professional nurse. There is a need to pay more attention to how the emotional dimension in care is understood and impacts the way nurses perform their professional role.

  • 2.
    Andreassen Devik, Siri
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Midnorway, Ctr Care Res, Steinkjer, Norway..
    Hellzén, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Enmarker, Ingela
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Midnorway, Ctr Care Res, Steinkjer, Norway..
    "Picking up the pieces'' - Meanings of receiving home nursing care when being old and living with advanced cancer in a rural area2015In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 10, 28382Article in journal (Refereed)
    Abstract [en]

    Rural home nursing care is a neglected area in the research of palliative care offered to older cancer patients. Because access to specialized services is hampered by long distances and fragmented infrastructure, palliative care is often provided through standard home nursing services and delivered by general district nurses. This study aimed to illuminate the lived experience and to interpret the meaning of receiving home nursing care when being old and living with advanced cancer in a rural area in Norway. Narrative interviews were conducted with nine older persons, and a phenomenological hermeneutic approach was used to interpret the meaning of the lived experience. The analysis revealed three themes, each with subthemes: being content with what one gets, falling into place, and losing one's place. The phrase picking up the pieces was found useful to sum up the meaning of this lived experience. The three respective themes refer to how the pieces symbolize the remaining parts of life or available services in their environment, and how the older persons may see themselves as pieces or bricks in a puzzle. A strong place attachment (physical insideness, social insideness, and autobiographical insideness) is demonstrated by the informants in this study and suggests that the rural context may provide an advantageous healthcare environment. Its potential to be a source of comfort, security, and identity concurs with cancer patients' strong desire for being seen as unique persons. The study shows that district nurses play an essential role in the provision of palliative care for older rural patients. However, the therapeutic value of being in one's familiar landscape seems to depend on how homecare nurses manage to locate it and use it in a more or less person-centred manner. Communication skills and attentiveness to psychosocial aspects of patient care stand out as important attributes for nursing in this context.

  • 3.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Struggle with a gap between intensive care units and general wards2009In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 4, no 3, 181-192 p.Article in journal (Refereed)
    Abstract [en]

    Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process-the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses' "struggling with a gap." The "gap" was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: Sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients' ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.

  • 4. Juuso, P.
    et al.
    Skär, L.
    Olsson, M.
    Söderberg, Siv
    Luleå University of Technology.
    Living with a double burden: Meanings of pain for women with fibromyalgia2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 3, 7184Article in journal (Refereed)
    Abstract [en]

    Living with fibromyalgia (FM) means living with a chronic pain condition that greatly influences daily life. The majority of people with FM are middle-aged women. The aim of this study was to elucidate meanings of pain for women with FM. Fifteen women with FM were interviewed about their pain experiences and a phenomenological hermeneutic interpretation was used to analyse the interview texts. The findings show that meanings of pain for women with FM can be understood as living with a double burden; living with an aggressive, unpredictable pain and being doubted by others in relation to the invisible pain. The ever-present pain was described as unbearable, overwhelming, and dominated the women's whole existence. Nevertheless, all the women tried to normalize life by doing daily chores in an attempt to alleviate the pain. In order to support the women's needs and help them to feel well despite their pain, it is important that nurses and health care personnel acknowledge and understand women with FM and their pain experiences. © 2011 P. Juuso et al.

  • 5.
    Kjällman Alm, Annika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Norbergh, Karl-Gustaf
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Hellzen, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    What it means to be an adult child of a person with dementia2013In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 8, Art. no. 21676- p.Article in journal (Refereed)
    Abstract [en]

    The prevalence of dementia as a disease has increased worldwide with advancing age and growing population numbers, affecting whole families. However, most previous research does not separate the spouses or cohabitants from the adult children, but instead regards all next of kin involved in the everyday care of the person suffering from dementia as caregivers. This has made it difficult to find previous research regarding what it means to be an adult child of a person with dementia, and as such, the aim of this study is to explore that topic. The method used was narrative interviews analysed using phenomenological hermeneutics. Our comprehensive understanding showed that to be an adult child of a person with dementia means being burdened with the responsibility to act on behalf of the diseased parent despite a deep sense of grief and loss, which leads to frustration and despondence. The adult children’s existence and reality are threatened not only by the loss of the parent but also by the possibility that one day they too may inherit the disease. This could be compared to a psychic crisis, which is defined as a situation that leads to radical changes in the afflicted person’s relationship to life and reality, or, simply, ‘‘an upset in a steady state’’. The findings suggest that adult children of people with dementia are in need of support for a substantial period of time in order to adapt to the fact that they have lost a parent who is still alive. They also need information about the disease and the process of diagnosis and treatment to feel more a part of the process, as well as understand the behavior and needs of their parent.

  • 6.
    Kristiansen, Lisbeth
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hellzén, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Swedish assistant nurses´experiences of job satisfaction when caring for persons suffering from dementia and behavioural disturbances: An interview study2006In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 1, no 4, 245-256 p.Article in journal (Refereed)
    Abstract [en]

    Job satisfaction is complex and is an important component in facilitating high quality nursing care. Behavioural and psychological symptoms of dementia (BPSD) can be clustered into one of five syndromes: psychosis, aggression, psychomotor agitation, depression and apathy, and comprise signs and symptoms of disturbed perception, thought content, mood or behaviour that frequently occur in patients with dementia. BPSD can cause tremendous distress both for the patients and for their caregivers and they have been seen as the most stressful aspect of care giving. Two registered nurses, 16 assistant nurses and two nursing assistants in Sweden talked about their job satisfaction when caring for residents suffering from dementia and BPSD. Thematic content analysis was conducted. The nurses' narrations indicate exposure, insufficiency, not being valued and doubt, as well as respect and importance and devotion towards the residents. One core theme was formulated: "Job satisfaction as a process moving between breaking down and occasionally building up the working person". A positive relationship with colleagues was the primary reason for nurses continuing to work at the group dwellings. The organization and resident behaviours were seen as very negative. Some nurses described insecurity in terms of how long they could continue to take rudeness, being spat at, being scratched or physically hit by residents, without "hitting back". In order to increase the well-being of the nurses, the pressure on them needs to be relieved. The development of leadership, education, supervision and reflection might be one possible way of reducing the prevalence of BPSD-related violence, enhancing job satisfaction and handling moral stress.

  • 7.
    Lilja, Lars
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hellzén, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Disconfirmed in one´s otherness: A comparison between the nurse´s view of the patient´s past, present and future and the patient´s own view of the past, present and future2007In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 2, no 3, 131-143 p.Article in journal (Refereed)
    Abstract [en]

    This study is part of a larger project, the aim of which is to elucidate “mental health nurses” attitudes towards their patients'. In this study, nurses' and patients' attitudes are described from the perspective of both parties using a qualitative approach. The informants were selected from a rehabilitation unit for young adults, below 40, suffering from psychosis at a psychiatric clinic that provides acute psychiatric care. The informant group consisted of three dyads: three patients with various diagnoses and three nurses with primary responsibility for the patients' daily care. The aim of this particular study was to extend our preliminary understanding of nurses' attitudes towards psychiatric patients in the context of psychiatric in-patient care, by elucidating the patient's “inner” picture of her/his past, present and future and the nurse's picture of the same patient's past, present and future. Data were collected and analysed using a phenomenological-hermeneutic approach and the narrative picturing technique. For each picture and group, 15 related sub-themes emerged, on the basis of which six themes were formulated. The findings show that the nurses overrate their own importance when it comes to the patient's well-being on the ward. All the nurses emphasize confirmation and safety as the basis of their nursing care, while in the patient's picture the nurses represent a replication of childhood demands, which probably means that nursing care risks becoming a continuation of the patient's childhood estrangement.

  • 8.
    Mentsen Ness, Tove
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    Hellzen, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    Enmarker, Ingela
    Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    "Struggling for independence'': The meaning of being an oldest old man in a rural area. Interpretation of oldest old men's narrations2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, no 1, Art. no. 23088- p.Article in journal (Refereed)
    Abstract [en]

    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 naive 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.

  • 9.
    Mentsen Ness, Tove
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    Hellzén, Ove
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Enmarker, Ingela
    Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    "Embracing the present and fearing the future": the meaning of being an oldest old woman in a rural area2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, Art. no. A62- p.Article in journal (Refereed)
    Abstract [en]

    In Western countries, the number of older people receiving home nursing care is increasing, and in rural areas they are at additional risk because of the distance between people and health care facilities. The aim of this study was therefore to illuminate the meaning of being an oldest old woman living alone in a rural area and receiving home nursing care. A sample of 11 oldest old women living in rural areas in the middle of Norway was chosen for this study. Narrative interviews were conducted, and the data were analyzed using the phenomenological hermeneutic method. After a naïve reading and a structural analysis of the text, we identified four themes: being satisfied with life, being thankful, feeling vulnerable, and feeling secure. The comprehensive understanding implied that being an oldest old woman living alone in a rural area meant living in the intersection between embracing the present in solitude and fearing the future with additional declining health. Living in this complex situation meant to enjoy the present, but still fear the future, as the oldest old women knew their present life situations were limited. This challenging emotional situation meant using their inner strength by trying to be optimistic and seeing opportunities in present life, even if losses were many and extensive. By using their inner strength in facing losses and declining health, the oldest old women managed to appreciate aloneness as solitude, and find new meaning in life.

  • 10. Olsson, M.
    et al.
    Skär, L.
    Söderberg, Siv
    Luleå University of Technology.
    Meanings of being received and met by others as experienced by women with MS2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 1Article in journal (Refereed)
    Abstract [en]

    In order to elucidate meanings of being received and met by others as experienced by women with multiple sclerosis (MS) we conducted a qualitative inquiry. We interviewed 15 women with MS and analysed the interviews with a phenomenological hermeneutic interpretation. The findings were presented in two themes: experiencing oneself as a valuable person and experiencing oneself as diminished. Meanings of being received and met by others, as experienced by women with MS, can be understood as containing two dimensions where treatment from others can mean recognising oneself through confirmation, as well as being ignored due to missing togetherness with others. © 2011 M. Olsson et al.

  • 11.
    Storli, Sissel
    et al.
    University of Tromsø, Norway.
    Lindseth, Anders
    University of Tromsø, Norway; Bodø Regional University, Bodø, Norway.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. University of Tromsø, Norway.
    Being somwhere else - delusion or relevant experience: A phenomenological investigation into the meaning of lived experience from being in intensive care2007In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 2, no 3, 144-159 p.Article in journal (Refereed)
    Abstract [en]

    Patients' experiences of having been “elsewhere” during intensive care than in the intensive care unit (ICU) has traditionally been placed in a context with described pathological circumstances, such as brain dysfunction, and labeled with terms such as “unreal” and “delusional”. The aim of the study was to look more closely into this type of experience by turning to its meaning as reflected on by patients themselves. Through a phenomenological investigation based on follow-up and interviews with three patients, we found that the “delusions” were in fact filled with meaning. They mattered to the patients and were not to be dismissed as unreal because they were so inherently real in the lived body. The experiences were grounded in the patient's lifeworld and could be interpreted as expressions of basic aspects related to being human in the world. The phenomenological term “lived mood” emerged as one such aspect to which intensive care patients appear to surrender more readily than man does in daily existence. The notion of “being somewhere else” as meaningful and relevant experience challenges the explanatory model whereby such experiences are placed in a context with brain dysfunction.

  • 12.
    Vaismoradi, Mojtaba
    et al.
    Faculty of Professional Studies, Nord University, Bodø, Norway.
    Skär, Lisa
    Faculty of Professional Studies, Nord University, Bodø, Norway.
    Söderberg, Siv
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Bondas, Terese
    Faculty of Professional Studies, Nord University, Bodø, Norway.
    Normalizing suffering: A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, 31203Article in journal (Refereed)
    Abstract [en]

    Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people that stems from pain demands knowledge improvement through an integration of international knowledge. This study aimed to integrate current international findings and strengthen the understanding of older people's experiences of and perspectives on pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare's interpretative metaethnography approach was conducted. Empirical research papers from journals were collected from various databases. The search process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each in Iceland, Norway, the UK, and Australia. The older people's experiences of pain as well as perspectives on pain management from all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model using three themes of "identity of pain," "recognition of pain," and "response to pain." The metaphor of "normalizing suffering" was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society's common attitude that pain is unavoidable and therefore acceptable in old age in society-among older people themselves as well as those who are responsible for reporting, acknowledging, and relieving pain-must change. The article emphasizes that pain as a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition, healthcare staff require sufficient training to take a person-centered approach towards assessment and management of pain that considers all elements of pain.

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