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  • 1.
    Andreassen Devik, Siri
    et al.
    Centre for Care Research Mid-Norway, Norway; Nord University, Norway.
    Enmarker, Ingela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Hellzén, Ove
    Mid Sweden University, Sweden.
    Nurses’ experiences of compassion when giving palliative care at home2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed)
    Abstract [en]

    Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised. Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data. Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes. Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content. Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective. © The Author(s) 2019.

  • 2.
    Fen Tang, Ping
    et al.
    Kunming Medical College, Kunming, Province of Yunnan, China.
    Johansson, Camilla
    Örebro University, Örebro, Sweden.
    Wadensten, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Stig, Wenneberg
    Örebro University, Örebro, Sweden.
    Gerd, Ahlström
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Chinese nurses' ethical concerns in a neurological ward2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 6, p. 810-824Article in journal (Refereed)
    Abstract [en]

    Our aim was to describe Chinese nurses' experiences of workplace distress and ethical dilemmas on a neurological ward. Qualitative interviews were performed with 20 nurses. On using latent content analysis, themes emerged in four content areas: ethical dilemmas, workplace distress, quality of nursing and managing distress. The ethical dilemmas were: (1) conflicting views on optimal treatment and nursing; (2) treatment choice meeting with financial constraints; and (3) misalignment of nursing responsibilities, competence and available resources. The patients' relatives lacked respect for the nurses' skills. Other dilemmas could be traced to the transition from a planned to a market economy, resulting in an excessive workload and treatment withdrawal for financial reasons. Lack of resources was perceived as an obstacle to proper patient care in addition to hospital organization, decreasing the quality of nursing, and increasing moral and workplace distress. The nurses managed mainly by striving for competence, which gave them hope for the future.

  • 3.
    Hedman, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Uppsala University, Sweden.
    Häggström, Elisabeth
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Uppsala University, Sweden.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Sciences, Caring Science. Uppsala University, Sweden.
    Pöder, Ulrika
    Uppsala University, Sweden.
    Caring in nursing homes to promote autonomy and participation2019In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 1, p. 280-292, article id 969733017703698Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care.

    OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation.

    RESEARCH DESIGN: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed.

    FINDINGS: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people.

    DISCUSSION AND CONCLUSION: Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents in nursing homes.

  • 4.
    Häggström, Elisabeth
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Kihlgren, Annica
    University of Örebro, Örebro, Sweden.
    Experiences of caregivers and relatives in public nursing homes2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 5, p. 691-701Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was, by means of discussion highlighting ethical questions and moral reasonings, to increase understanding of the situations of caregivers and relatives of older persons living in a public nursing home in Sweden. The findings show that these circumstances can be better understood by considering two different perspectives: an individual perspective, which focuses on the direct contact that occurs among older people, caregivers and relatives; and a societal perspective, which focuses on the norms, values, rules and laws that govern a society. Relatives and caregivers thought that the politicians were sending out mixed messages: they were praising caregivers and relatives for their efforts, but at the same time the public health care sector was subjected to significant cutbacks in resources. Both caregivers and relatives were dissatisfied and frustrated with the present situation regarding the care of older persons in public nursing homes.

  • 5.
    Häggström, Elisabeth
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Mbusa, Ester
    Kilimanjaro Christian Medical College, Tanzania.
    Wadensten, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Nurses' workplace distress and ethical dilemmas in Tanzanian health care2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 4, p. 478-491Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe Tanzanian nurses’ meaning of and experiences with ethical dilemmas and workplace distress in different care settings. An open question guide was used and the study focused on the answers the 29 registered nurses’ supplied. The written answers were analysed with a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur. From the findings the theme, ‘Tanzanian registered nurses’ invisible and visible expressions about existential conditions in care’, emerged from the interpretation of the following sub-themes, which appeared from the structural analysis: (1) ‘Suffering from workplace distress’; (2) ‘Suffering from ethical dilemmas’; (3) ‘Suffering from maintaining a good quality of nursing’; (4) ‘Suffering from the lack of respect, appreciation, and influence’; (5) ‘Suffering from a heavy workload does not prevent the registered nurses from struggling for better care for their patients’. In this study, the deep analysis of the Tanzanian nurses’ work situations shows that on a daily basis, they find themselves working on the edge of life and death, while they have few opportunities for doing anything about this situation. One of the conclusions is that the nurses need professional guidance so they can get insight into and also be able to reflect on the situations they are in, while also being made conscious of the fact that they do not have to overload themselves with ethical dilemmas and workplace distress.

  • 6.
    Moe, Aud
    et al.
    Nord-Trøndelag University College, Norway.
    Hellzén, Ove
    Nord-Trøndelag University College, Norway.
    Enmarker, Ingela
    Nord-Trøndelag University College, Norway.
    The meaning of receiving help from homenursing care2013In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 7, p. 737-747Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to illuminate the meaning of receiving help from home nursing care for the chronically ill, elderly persons living in their homes. The study was carried out in Norway. Data were collected by narrative interviews and analysed by phenomenological hermeneutic interpretations. Receiving help from home nursing care sometimes meant ‘Being ill and dependent on help’. Other times it meant ‘Being at the mercy of help’. It could also mean ‘Feeling inferior as a human being’. Sometimes help was given by nurses who were respectful and proficient at caring for an elderly person, while at other times nurses seemed to be incompetent and worked with a paternalistic attitude without respect for privacy. Receiving help also meant elderly persons wanted to be regarded and approached as equal human beings, supported in the courage to meet challenges in life.

  • 7.
    Silén, Marit
    et al.
    Hälsohögskolan, Högskolan i Jönköping.
    Kjellström, Sofia
    Hälsohögskolan, Högskolan i Jönköping.
    Christensson, Lennart
    Hälsohögskolan, Högskolan i Jönköping.
    Sidenvall, Birgitta
    Hälsohögskolan, Högskolan i Jönköping.
    Svantesson, Mia
    Vårdvetenskapligt forskningscentrum, Örebro läns landsting.
    What actions promote a positive ethical climate?: A critical incident study of nurses' perceptions2012In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, no 4, p. 501-512Article in journal (Refereed)
    Abstract [en]

    Few qualitative studies explore the phenomenon of positive ethical climate and what actions are perceived as promoting it. Therefore, the aim of this study was to explore and describe actions that acute care ward nurses perceive as promoting a positive ethical climate. The critical incident technique was used. Interviews were conducted with 20 nurses at wards where the ethical climate was considered positive, according to a previous study. Meeting the needs of patients and next of kin in a considerate way, as well as receiving and giving support and information within the work group, promoted a positive ethical climate. Likewise, working as a team with a standard for behaviour within the work group promoted a positive ethical climate. Future research should investigate other conditions that might also promote a positive ethical climate.

  • 8.
    Silén, Marit
    et al.
    Uppsala universitet, Centrum för forsknings- och bioetik.
    Ramklint, Mia
    Uppsala universitet, Psykiatri, Akademiska sjukhuset.
    Hansson, Mats G
    Uppsala universitet, Centrum för forsknings- och bioetik.
    Haglund, Kristina
    Uppsala universitet, Psykiatri, Akademiska sjukhuset.
    Ethics rounds: An appreciated form of ethics support2014In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, p. 1-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection.

    AIM: The aim of this study was to gain a deeper understanding of how the ethics rounds were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff.RESEARCH DESIGN:An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews.

    PARTICIPANTS AND RESEARCH CONTEXT: A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed.

    ETHICAL CONSIDERATIONS: The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards.

    FINDINGS: The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work.

    DISCUSSION: A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care.

    CONCLUSION: By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues.

  • 9.
    Silén, Marit
    et al.
    Högskolan i Jönköping, HHJ, Avd. för omvårdnad.
    Svantesson, Mia
    Örebro universitet, Hälsoakademin.
    Ahlström, Gerd
    Nurses' conceptions of decision making concerning life-sustaining treatment2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 2, p. 160-173Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.

  • 10.
    Svantesson, Mia
    et al.
    Örebro University, Örebro, Sweden; University of Warwick, Coventry, West Midlands, England.
    Silén, Marit
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala university, Uppsala, Sweden.
    James, Inger
    Örebro University, Örebro, Sweden.
    It’s not all about moral reasoning: Understanding the complex content of Moral Case Deliberation2018In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 25, no 2, p. 212-229Article in journal (Refereed)
    Abstract [en]

    Background:

    Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain.

    Objective:

    To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces.

    Methods:

    A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority.

    Ethical considerations:

    No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation.

    Findings:

    Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%).

    Conclusion:

    The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

  • 11.
    Wadensten, Barbro
    et al.
    Uppsala universitet, Vårdvetenskap.
    Wenneberg, Stig
    Växjö universitet, Institutionen för vårdvetenskap och socialt arbete.
    Silén, Marit
    Hälsohögskolan i Jönköping.
    Ping Fen, Tang
    Ahlström, Gerd
    Hälsohögskolan i Jönköping.
    A cross-cultural comparison of nurses' ethical concerns2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 6, p. 745-760Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare Swedish and Chinese nurses' experiences of ethical dilemmas and workplace distress in order to deepen understanding of the challenges neuroscience nurses encounter in different cultures. Qualitative interviews from two previously performed empirical studies in Sweden and China were the basis of this comparative study. Four common content areas were identified in both studies: ethical dilemmas, workplace distress, quality of nursing and managing distress. The themes formulated within each content area were compared and synthesized into novel constellations by means of aggregated concept analysis. Despite wide differences in the two health care systems, the nurse participants had similiar experiences with regard to work stress and a demanding work situation. They were struggling with similiar ethical dilemmas, which concerared seriously ill patients and the possibilities of providing good care. This indicates the importance of providing nurses with the tools to influence their own work situation and thereby reducing their work-related stress.

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