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  • 1.
    Henoch, Ingela
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden .
    Browall, Maria
    Department of Neurobiology, Division of Nursing, Care Science and Society, Karolinska Institutet, Stockholm, Sweden .
    Melin-Johansson, Christina
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Danielson, Ella
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden .
    Udo, Camilla
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Johansson Sundler, Annelie
    School of Life Sciences, University of Skövde, Sweden .
    Björk, Maria
    School of Life Sciences, University of Skövde, Sweden .
    Ek, Kristina
    School of Life Sciences, University of Skövde, Sweden .
    Hammarlund, Kina
    School of Life Sciences, University of Skövde, Sweden .
    Bergh, Ingrid
    School of Life Sciences, University of Skövde, Sweden .
    Strang, Susann
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden .
    The Swedish Version of the Frommelt Attitude Toward Care of the Dying Scale: Aspects of Validity and Factors Influencing Nurses' and Nursing Students' Attitudes.2014In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 37, no 1, p. E1-E11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:: Nurses' attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language. OBJECTIVES:: The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients. METHODS:: A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used. RESULTS:: The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach α's. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients. CONCLUSIONS:: Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses' attitudes toward caring for dying patients. IMPLICATION FOR PRACTICE:: Care culture might influence nurses' attitudes toward caring for dying patients; the benefits of education need to be explored.

  • 2.
    Udo, Camilla
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Existential issues in surgical care: Nurses’ experiences and attitudes in caring for patients with cancer2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

  • 3.
    Udo, Camilla
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Danielson, Ella
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, Gothenburg, Sweden.
    Henoch, Ingela
    Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, Gothenburg, Sweden.
    Melin-Johansson, Christina
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Surgical nurses’ work-related stress when caring for severely ill and dying patients with cancer after participating in an educational intervention on existential issues2013In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 5, p. 546-553Article in journal (Refereed)
    Abstract [en]

    AIM:

    The aim of this study was to describe surgical nurses' perceived work-related stress in the care of severely ill and dying patients with cancer after participating in an educational intervention on existential issues.

    METHODS AND SAMPLE:

    This article reports a mixed methods pilot study of an education programme consisting of lectures and supervised discussions conducted in 2009-2010 in three surgical wards in a county hospital in Sweden. The concurrent data collections consisted of repeated interviews with eleven nurses in an educational group, and questionnaires were distributed to 42 nurses on four occasions.

    RESULTS:

    Directly after the educational intervention, the nurses described working under high time pressure. They also described being hindered in caring because of discrepancies between their caring intentions and what was possible in the surgical care context. Six months later, the nurses described a change in decision making, and a shift in the caring to make it more in line with their own intentions and patients' needs rather than the organizational structure. They also reported decreased feelings of work-related stress, decreased stress associated with work-load and feeling less disappointed at work.

    CONCLUSIONS:

    Results indicate that it may be possible to influence nurses' work-related stress through an educational intervention. According to nurses' descriptions, reflecting on their ways of caring for severely ill and dying patients, many of whom had cancer, from an existential perspective, had contributed to enhanced independent decision making in caring. This in turn appears to have decreased their feelings of work-related stress and disappointment at work.

  • 4.
    Udo, Camilla
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Danielson, Ella
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Melin Johansson, Christina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Existential Reflections among Nurses in Surgical Care2010In: Journal of Palliative Care, ISSN 0825-8597, Vol. 26, no 3, p. 228-229Article in journal (Refereed)
    Abstract [en]

    Objectives: To gain a deeper understanding of surgical nurses’ experiences of existential issues in cancer care.

    Methods: Written critical incidents were used to collect nurses’ descriptions and reflections of critical care situations involving existential issues. Individual face-to-face interviews were conducted as follow-up using semi-structured questions which were analysed with hermeneutical analysis.

    Preliminary results: The analysis showed that nurses in surgical care experience caring from different positions. Nurses either focus on the patient as a whole in the caring process or nurses focus more on medical information in the caring process. When focusing on the patient as a whole existential issues are considered to be a natural part of the caring process and nurses’ personal experiences help to enable encounters with the patients. When focusing more on the medical information in the caring process there was a transfer of responsibility to others, mainly the physicians.

    Preliminary conclusions: This study highlights that existential issues are indeed part of surgical cancer care derived from existential care situations. Nurses’ focus in the caring process differs. Nurses express different positions in caring and not all acknowledge patients’ existential issues as part of nurses’ responsibility. When lacking common strategies in the organization nurses derive existential caring strategies from personal experiences.

  • 5.
    Udo, Camilla
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Danielson, Ella
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Melin-Johansson, Christina
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Existential issues among nurses in surgical care - a hermeneutical study of critical incidents2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 3, p. 569-577Article in journal (Refereed)
    Abstract [en]

    Aims.  To report a qualitative study conducted to gain a deeper understanding of surgical nurses’ experiences of existential care situations.

    Background.  Existential issues are common for all humans irrespective of culture or religion and constitute man’s ultimate concerns of life. Nurses often lack the strategies to deal with patients’ existential issues even if they are aware of them.

    Design.  This is a qualitative study where critical incidents were collected and analysed hermeneutically.

    Methods.  During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1–2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used.

    Findings.  The majority of incidents concerned nurses’ experiences of caring for patients’ dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses’ personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care.

    Conclusion.  Findings are interpreted and discussed in the framework of Buber’s philosophy of the relationships I-Thou and I-It, emphasizing nurses’ different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.

  • 6.
    Udo, Camilla
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Melin Johansson, Christina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Danielson, Ella
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Health care staff’s discussions of existential issues in cancer care2010In: Changing Health. 6th International Conference on Social Work in Health and Mental Health. 28th June - 2nd July 2010, Dublin, Ireland., 2010Conference paper (Refereed)
    Abstract [en]

    Objectives: A qualitative study was made to explore healthcare staff’s discussions about existential issues when caring for patients with cancer on a surgical ward, as described in supervision sessions.

    Methods: Secondary content analysis of twelve tape-recorded supervision sessions was used. The sessions lasted for two hours every third week during one year. The supervision sessions were conducted at a surgical clinic in a county hospital in the middle of Sweden. Twenty-one participants, 25 to 55 years of age (MD=38) who had worked on a surgical clinic for 1 to 30 years (MD=10) participated.

    Findings: The analysis showed that reflections about existential issues do exist among healthcare staff in surgical wards. There are barriers, in staff themselves as well as in the organisation hindering them to encounter patients’ existential needs which is illustrated by the domain: “Health care staff’s discussions of their existential  dilemmas” and the themes “feelings of powerlessness”, “identifying with patients”, and “getting close or keeping a distance”. Staff observed that patients have existential needs which are illustrated by the domain: “Health care staff’s discussions of patients’ existential distress” and the themes “being in despair” and “feelings of isolation”.

    Conclusions:  This study shows that healthcare staff in surgical wards is conscious of patients’ existential distress. Yet staff lack strategies to encounter patients’ existential issues. There is a need for knowledge about the meaning of existential issues and education for staff working in a surgical ward and how to encounter patients’ existential needs.

  • 7.
    Udo, Camilla
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Melin-Johansson, Christina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Danielson, Ella
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Existential issues among health care staff in surgical cancer care - Discussions in supervision sessions2011In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 15, no 5, p. 447-453Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was, through analysis of dialogues in supervision sessions, to explore if health care staff in surgical care discussed existential issues when caring for cancer patients. Method: A secondary analysis of the content of twelve tape-recorded supervision sessions (18 h) was conducted. The study analysed the dialogue content in supervision sessions involving a group of eight participants who worked at a surgical clinic at a county hospital in central Sweden. The sessions were held every third week during the course of one year. Results: The analysis showed that surgical health care staff contemplates existential issues. The staff discussed their existential dilemmas, which hindered them from meeting and dealing with patients' existential questions. This is illustrated in the themes: "feelings of powerlessness", "identifying with patients", and "getting close or keeping one's distance". The staff also discussed the fact that patients expressed existential distress, which is illustrated in the themes: "feelings of despair" and "feelings of isolation". Conclusions: This study shows that there are existential issues at a surgical clinic which health care staff need to acknowledge. The staff find themselves exposed to existential dilemmas when caring for cancer patients. They are conscious of patients' existential issues, but lack strategies for dealing with this. This study highlights a need to provide support to staff for developing an existential approach, which will boost their confidence in their encounters with patients

  • 8.
    Udo, Camilla
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Health Care Sciences Post Graduate School Karolinska Institute Stockholm Sweden .
    Melin-Johansson, Christina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Henoch, Ingela
    Institute of Health and Care Sciences The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Axelsson, Bertil
    Department of General Surgery Östersund Hospital Östersund Sweden .
    Danielson, Ella
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Institute of Health and Care Sciences The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden .
    Surgical nurses’ attitudes towards caring for patients dying of cancer: a pilot study of an educational intervention on existential issues2014In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 23, no 4, p. 426-440Article in journal (Refereed)
    Abstract [en]

    This is a randomised controlled pilot study using a mixed methods design. The overall aim was to test an educational intervention on existential issues and to describe surgical nurses' perceived attitudes towards caring for patients dying of cancer. Specific aims were to examine whether the educational intervention consisting of lectures and reflective discussions, affects nurses' perceived confidence in communication and to explore nurses' experiences and reflections on existential issues after participating in the intervention. Forty-two nurses from three surgical wards at one hospital were randomly assigned to an intervention or control group. Nurses in both groups completed a questionnaire at equivalent time intervals: at baseline before the educational intervention, directly after the intervention, and 3 and 6 months later. Eleven face-to-face interviews were conducted with nurses directly after the intervention and 6 months later. Significant short-term and long-term changes were reported. Main results concerned the significant long-term effects regarding nurses' increased confidence and decreased powerlessness in communication, and their increased feelings of value when caring for a dying patient. In addition, nurses described enhanced awareness and increased reflection. Results indicate that an understanding of the patient's situation, derived from enhanced awareness and increased reflection, precedes changes in attitudes towards communication.

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