Högskolan i Skövde

Suffering and well-being are significant aspects of human existence; in particular, suffering and well-being are important aspects of patients’ experiences following diseases. Increased knowledge about existential dimensions of illness and healthcare experiences may be needed in order to improve care and reduce unnecessary suffering. Therefore, the aim of this paper is to illuminate the phenomenon of suffering experienced in relation to healthcare needs among patients in hospital settings in Sweden. In this study, we used a reflective lifeworld approach. The data were analysed with a focus on meanings. The results describe the essential meaning of the phenomenon of suffering in relation to healthcare needs. The patients were suffering during care-giving when they felt distrusted or mistreated and when their perspective on illness and health was overlooked. Suffering was found to arise due to healthcare actions that neglected a holistic and patient-centred approach to care. Unfortunately, healthcare experiences that cause patients to suffer seem to be something one needs to endure without being critical. The phenomenon can be described as having four constituents: to be mistreated; to struggle for one’s healthcare needs and autonomy; to feel powerless; and to feel fragmented and objectified. The study concludes that there are problems associated with patients experiencing suffering at the hands of healthcare providers, even if this suffering may not have been caused deliberately to the patient. Consequently, conscious improvements are needed to lessen the suffering caused by care-giving, as are strategies that promote more patient-centred care and patient participation.

Background: Work in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department. Methods: A phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care.Results: The findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem. Conclusion: The goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.

Aim: To describe first-year nursing student`s expereinces of witnessing death and providing end-of-life care. Methods: This study is a part of a larger longitudial prject. Interviews (n=17) were conducted with nursing students at the end of their fisrt year of education. To analyse the interviews (lived-expereince description), a thematic analysis, "a search for meaning" (Van Manen, 1997) was applied. Result: The results are presented within the framework of four separate themes: (1) The thought of death is more frightening than the actual epereince, (2) Daring to approach the dying patient and offering something of oneself, (3) The expereince of not sufficing in the face of death and (4) being confronted with one`s own feelings. Conclusion: Nursing students require continous support and opportunity to reflect and discuss their experiences about caring for dying patients and confronting death throughout the entirety of their education. In addition, teachers and clinical superviosors need t give support using reflective practice to help students to devlo confidence in their capacity for caring dying patients.

AIM: To describe Swedish first-year undergraduate nursing students' attitudes toward care of dying patients. Possible influences such as age, earlier care experiences, care education, experiences of meeting dying patients and place of birth were investigated.

METHOD: The Frommelt Attitude Toward Care of the Dying Scale (FATCOD) was used in six universities. Descriptive statistics and regression analysis were used.

RESULTS: Some 371 students (67.3%) reported overall positive attitude toward caring for dying patients (total mean FATCOD 119.5, SD 10.6) early in their first semester. Older students, students with both earlier care experience and earlier education, those with experience of meeting a dying person, and students born in Sweden reported the highest scores, a more positive attitude.

CONCLUSION: Age, earlier care experience and education, experiences of meeting a dying person and place of birth seems to affect students' attitudes toward care of the dying and need to be considered among nursing educators.

Nursing education needs to prepare students for care of dying patients. The aim of this study was to describe the development of nursing students' attitudes toward caring for dying patients and their perceived preparedness to perform end-of-life care. A longitudinal study was performed with 117 nursing students at six universities in Sweden. The students completed the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) questionnaire at the beginning of first and second year, and at the end of third year of education. After education, the students completed questions about how prepared they felt by to perform end-of-life care. The total FATCOD increased from 126 to 132 during education. Five weeks' theoretical palliative care education significantly predicted positive changes in attitudes toward caring for dying patients. Students with five weeks' theoretical palliative care training felt more prepared and supported by the education to care for a dying patient than students with shorter education. A minority felt prepared to take care of a dead body or meet relatives.

AIM: To describe nursing students' reasoning about emotionally demanding questions concerning the care of dying patients.

METHODS: The Frommelt Attitude Toward Care of the Dying (FATCOD) Scale was completed by students at the beginning of their education, and there was great variation in the responses to five items. At a follow-up measurement in the second year, an open-ended question, 'How did you reason when completing this question?', was added to each of the these five items. Qualitative content analysis was used to analyse the responses.

RESULTS: Of 140 students who completed the FATCOD, 111 provided free-text responses. The analysis of these responses revealed three themes: death perceptions, the students' understanding of their current situation, and the nurse's responsibility.

CONCLUSION: This study provides useful information on students' reasoning about emotionally demanding questions relating to the care of dying patients. Such knowledge is valuable in helping students to overcome their fear and fulfil their expectations concerning their future proficiency.

Background: Growing old involves many changes in life and implies an increased risks of illness and different forms of disabilities. Life may change in a radical way when a person gets a disease like dementia or moves to a nursing home due to disabilities or needs. In both cases, it often leads to an increased dependency on care where the patient becomes exposed and vulnerable and thereby at a higher risk for experiencing different forms of suffering.

Aim: The aim of this study was to elucidate and gain a deeper understanding of elderly patients’ experiences of suffering in relation to community care in nursing homes and home care services.

Materials and methods: A lifeworld hermeneutical approach was used. Phenomenological interviews and conversations with an open approach were conducted and analysed with a focus on meanings.

Findings: The findings were presented in four main themes; an absence of the other in care, an absence of dialogues, a sense of alienation and a sense of insecurity. The findings in this study revealed that persons who were cared for in nursing homes and home care services sometimes were exposed to an unnecessary suffering. The suffering sometimes was caused by various caring actions, that is, unnecessary suffering. The suffering caused by care that aroused was due to caregiver’s inability to be present, to show their face, and truly meet the patient.

Conclusion: Suffering from care increased the elderly patients’ feelings of insecurity, loneliness, and alienation; this seemed to be the foundation for patients’ experiences of being outside a human community. There was a lack of knowledge and understanding about the patient’s lifeworld.

The care of residents in nursing homes (special housing) is a major challenge for the nursing profession, especially as the population of older people has increased in recent decades. One important aim of this care is to promote the wellbeing and security of the residents. Encounters between residents, nurses and relatives are one important and frequent activity in the daily care of the residents. Available knowledge shows that the outcome of these encounters can affect the quality of care both in positive and negative ways. The meaning of these encounters is still a fairly unknown topic. The reason for conducting research on the meaning of encounters in nursing homes is mainly due to the lack of research with this focus and a need to improve understanding and knowledge about nursing home care with an emphasis on the meaning of encounters.

The aim of this thesis was to investigate the experiences of encounters between nurses, residents, their relatives and other significant persons in order to reach a deeper understanding of the meaning of these encounters in nursing homes. A hermeneutic method was used for all four studies in this thesis (I–IV). The hermeneutic method was inspired by Hans George Gadamer and his philosophical hermeneutics. The hermeneutic method provides opportunities to interpret the meaning of human language. All data from participants in this thesis were collected through open-ended interviews with nurses, residents and relatives in four nursing homes in a municipality in Western Sweden in 2004-2005. The interviews were tape-recorded and transcribed verbatim.

The main results of the original papers showed that the meaning of was interpreted and illuminated as the good encounter (I–IV) and the bad encounter (I–IV). In this thesis, encounters between people in nursing homes have been shown to be important for residents’ everyday life in terms of being visible and confirmed but also for nurses’ and relatives’ need to be visible and confirmed as significant persons in the care for the resident. Nurses play an important role in encounters with residents and their relatives in order to make the residents visible and to maintain his/her respect and dignity as a human being in the nursing home. It is therefore important for nurses to establish intentions for being able to contribute to the good encounter. Being present, attentive and open in the encounter with residents and their relatives and listening to their thoughts is the start of a caring action that will result in making the residents visible and confirmed.

It is of great importance to realize that there are both good and bad encounters in a nursing home context, which makes certain demands on the nurses’ competence to be able to meet the resident with an open mind as an effort to achieve the good encounter, which means to see the resident as someone belonging somewhere. Accordingly, it is an urgent matter to implement knowledge about the meaning of encounters in this caring context, knowledge that can probably be transferred to nurses working in other forms of long-term care. This thesis can be seen as a contribution to generating knowledge and providing new understanding that can facilitate the development of such nursing competence; knowledge in the art of caring that gives a deeper understanding of how fundamental each encounter can be for making residents and relatives visible and confirmed as an effort to maintain good quality in the care of residents in nursing homes.

Aim. This paper is a report of a study to illuminate and interpret the meaning of residents' experiences of encounters with nurses in nursing homes.

Background. A large number of older people suffer from illness and become dependent on other people in their daily living. These people are often in need of care in nursing homes. It is assumed that encounters between nurses and residents are of importance in how residents experience care in nursing homes.

Method. Twelve residents from three nursing homes in Sweden were interviewed in 2004–2005 about their experiences in encounters with nurses. The interviews were tape-recorded and transcribed verbatim. A hermeneutic method was used to describe and interpret the meaning of residents' experiences.

Findings. Three themes emerged: 'being somebody', 'being nobody' and 'being in a community'. The encounters had both positive and negative influences on residents, expressed as being somebody and belonging somewhere or being nobody and not being seen as a person or simply being left out of things. Encounters between residents and nurses have a mutual dependency where residents certainly have some influence on the relationship. The nurses have both an influence on the relationship and a professional responsibility for the outcome of encounters with residents.

Conclusion. The insights gained from the study can guide nurses in their encounters with residents in nursing homes so that they feel respected as unique human beings and part of a community.

Aim. The aim of the study was to describe and interpret the meaning of nurses' experiences of caring encounters with residents in nursing homes.

Background. Life for residents in nursing homes can be characterized as a process of decreased physical and psychological resources. Therefore, encounters with nurses are important activities for providing meaning and security for the residents. Research in this field has previously focused on communication, attitudes and job satisfaction, but gives limited knowledge about what the human encounters in this context mean for the nurses.

Method. A hermeneutic method was used in this study. Interviews were conducted with 14 nurses from two nursing homes about their experiences of caring encounters. The transcribed interview texts were interpreted as a whole.

Results. In the interpretation of the text concerning the meaning of nurses' experiences of encounters with resident's four themes and 11 subthemes emerged. The comprehensive interpretation mainly showed possible ways available being present, being significant and being aware of opportunities for the nurse to find meaning in the encounter with the resident, but impossible ways as being inadequately were also revealed.

Conclusion. This study shows the importance of caring encounters between nurses and residents in nursing homes. The good encounters provide various possible ways for nurses to find meaning and a sense of communion with residents. However, bad encounters, described as being inadequate, were found to inhibit nurses from finding meaning in their encounters with residents.

Relevance to clinical practice. Meeting the needs of older people in nursing homes requires special knowledge about the importance of the caring encounter. Therefore, nurses in this care context need supervision and continuous education in order to gain relevant knowledge about the meaning of caring encounters for themselves and residents.

In university undergraduate nursing programmes, didactic strategies that enable students to learn nursing skills, solve problems and develop reflective and critical thinking and practice are needed. The aim of this study was to explore how different didactic strategies support nursing students’ experiences of learning during the first year of a reconstructed nursing curriculum.

Methods

This study employed a qualitative approach. The data were gathered through written narratives that were analysed using qualitative content analysis.

Results

Nursing students’ experiences of learning through different didactic strategies, were evident in the text. These perspectives were organised into the following themes: To focus on the patient perspective and paying more attention to others, Learning from discussions and reflections on one’s own learning, Training for the professional role and becoming more courage, and Gaining insights into nursing and increasing one’s self-awareness. The education increased the students’ self-awareness, which helped them to pay greater attention to patients and their relative. During the learning process, the students became more courageous, reflected and discovered their shortcomings.

Conclusion

Stated didactic strategies supported a broad base of knowledge on nursing and the professional role of nurses. Educators are challenged to strengthen meaningful learning in nursing and to facilitate the progression of nursing programmes.

The aim of this study was to explore and interpret the meaning of residents’ experiences of encounters with their relatives and other significant persons in nursing homes. Twelve residents in three different nursing homes in a western Sweden municipality were interviewed. The method used was hermeneutical text analysis. Three themes emerged in the interpretation of the text: being pleased, being someone, and being inconvenient. These themes were also described through seven subthemes: to be happy to have someone, to make someone else happy, going back in life, to be together in a community, not being alone, to be disconnected, and to be a burden.The study concludes that it is important for nurses in nursing homes to develop a deeper insight into what various social contacts can mean for residents. To develop this knowledge, it is important that nurses in nursing homes can be educated, and supported by clinical supervision, in relation to residents’ experiences of encounters with relatives and other significant persons.

The purpose of this study was to explore and interpret the meaning of relatives' experiences of encounters with nurses when visiting residents in nursing homes. Thirteen relatives of residents in three nursing homes in Sweden were interviewed. The interviews were tape-recorded and transcribed verbatim. The method used was hermeneutical text analysis. Four themes emerged in the analysis and interpretation of the whole text: 'being paid attention to', 'being ignored', 'being involved' and 'being safe and secure'. A further interpretation of the findings shows a deeper understanding of the meaning of relatives. This meaning was revealed as being invited into an encounter with nurses and gave a sense of community but the opposite was being ignored and left outside. This study gives a deeper understanding of the meaning of encounters between relatives and nurses in nursing homes; it also illuminates how these encounters also can affect the care of the residents. This new understanding can hopefully offer support for nurses during their encounters with relatives and optimise the ability to provide a positive outcome for residents in nursing homes.

Aim: To describe Swedish nursing students' perceptions of caring for dying people after the first year of a three year in a nursing programme at three university nursing schools in Sweden. Methods: Interviews (n = 17) were undertaken with nursing students at the end of their first year. A phenomenographic approach was used to design and structure the analysis of the nursing students' perceptions. Results: The analysis resulted in five categories: 1) from abstract to reality, 2) from scary to natural, 3) increased knowledge can give bad conscience, 4) time limits versus fear of end-of-life conversations, and 5) meeting with relatives. Conclusion: Nursing students need to be prepared both theoretically and within practice to encounter death and dying and to care for dying persons. By combining their theoretical knowledge of dying and death with their own encounters of death and dying people in practice, the students can be supported to develop an understanding of dying and death as a natural part of life rather than something frightening.