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  • 1.
    Andreassen Devik, Siri
    et al.
    Centre of Care Research, Mid-Norway, Steinkjer, Norway; Department of Nursing, Sweden University, Sundsvall, Sweden.
    Enmarker, Ingela
    Centre of Care Research, Steinkjer, Mid-Norway; Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    Hellzén, Per Ove
    Centre of Care Research, Steinkjer, Mid-Norway; Department of Nursing, Mid-Sweden University, Sundsvall, Sweden; Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    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, no 1, article id 21880Article 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.
    Centre of Care Research, Mid-Norway, Steinkjer, Norway; Department of Nursing, Mid-Sweden University, Sundsvall, Sweden.
    Hellzén, Ove
    Department of Nursing, Mid-Sweden University, Sundsvall, Sweden.
    Enmarker, Ingela
    Centre of Care Research, Mid-Norway, Steinkjer, Norway; Department of Nursing, Mid-Sweden University, Sundsvall, Sweden; Department of Health Sciences, Nord-Trøndelag University College, Stjørdal, 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, no 1, article id 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.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Giving advice to callers with mental illness: adaptation among telenurses at Swedish Healthcare Direct2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1633174Article in journal (Refereed)
    Abstract [en]

    Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system.

    Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing.

    Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions.

    Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking.

  • 4.
    Häggström, Marie
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    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, p. 181-192Article 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.

  • 5.
    Kristiansen, Lisbeth
    et al.
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall; Karolinska institutet, Stockholm.
    Hellzén, Ove
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    Asplund, Kenneth
    Institutionen för hälsovetenskap, Mittuniversitetet, Sundsvall.
    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, p. 245-256Article 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.

  • 6.
    Mentsen Ness, Tove
    et al.
    Department of Nursing, Mid-Sweden University, Östersund, Sweden; Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    Hellzén, Ove
    Department of Nursing, Mid-Sweden University, Östersund, Sweden.
    Enmarker, Ingela
    Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway; Centre of Care Research, Steinkjer, Mid-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, article id 25217Article 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.

  • 7.
    Mentsen Ness, Tove
    et al.
    Department of Nursing, Mid-Sweden University, Östersund, Sweden; Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    Hellzén, Ove
    Department of Nursing, Mid-Sweden University, Östersund, Sweden; Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway.
    Enmarker, Ingela
    Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway; Centre of Care Research, Steinkjer, Mid-Norway.
    ‘Struggling for independence’; the meanings of being an oldest old man in rural areas. 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, article id 23088Article 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 naïve reading and a structural analysis of the text, we identified three themes: feelings of insufficiency in everyday life, finding hope in life, and feeling reconciliation with life. The comprehensive understanding suggested that being an oldest old man living alone in a rural area means a struggle between a dependent existence and a desire to be independent. Living in the tension between independence and dependency is a complex emotional situation where one is trying to accept the consequences of life and loss—reconciling the wish to live with the fact that life will come to an end.

  • 8.
    Silvén Hagström, Anneli
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Criminology, Social Work.
    Toft, Teolinda
    Clinical Psychology in Healthcare, Department of Children's and Women's Health, Uppsala University, Uppsala, Sweden.
    "Together we are unbeatable": young sisters’ narration of a sibling’s cancer in personal blogs on the internet2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1586625Article in journal (Refereed)
    Abstract [en]

    Purpose: Siblings of children and young people diagnosed with cancer are commonly reluctant to talk about their experiences due to the circumstances of the illness situation. This article aims to bring voice to experience and inform practice by investigating what and how three young sisters narrate about their illness experiences in personal blogs on the Internet.

    Methods: A narrative methodology for the analysis of life storytelling was applied primarily to investigate the sister?s coping strategies and support needs.

    Results: The results show how the sisters constructed their own space for narration, with the main aims of expressing their feelings about the illness and seeking social support. The telling of their experiences along with encouraging comments from a supportive audience enabled a change in position from feeling neglected and silenced to being a recognized agent and caring sister. In addition, through their narrative coping the sisters went from powerless to powerful in their position in relation to cancer.

    Conclusion: The results highlight the need for siblings to be able to narrate experience in a supportive context, where the processing of their relationship with the ill sister/brother should be understood as an important element of their coping with cancer and death.

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