The impetus for this qualitative study was the premise expressed by lay people that nursing terminally ill cancer patients must be depressing and difficult to cope with. Its focus was nurses' stress and coping strategies, both secular and religious. Data was collected using a narrative life-story approach, and then Lazaruz and Folkman's coping theory and Pargament's theory on the psychology of religion were used during the analysis of the data. Several factors were identified, related to the individual and group levels, that influence a nurse's identity and professional development. A person's life orientation was suggested as a first concept for developing a professional paradigm that includes caritas as a main orienting factor. Directed by the nurse's secular and religious orientation, competence develops, making it possible to understand, analyze, manage, and appreciate the significance of the professional work of caring.
To identify factors which may influence attitudes to spiritual care, test the relevance of these identified influencing factors in a Swedish nursing context, and replicate a part of a previous study by Strang et al. (Journal of Clinical Nursing 2002;11:48-57) dealing with attitudes to spiritual care in a holistic perspective. A questionnaire was handed out to all nursing staff at a Swedish oncology clinic (n=93) excluding the radiation therapy ward. Data were obtained from 68 nurses or nursing auxiliaries.
(i) Literature review of international research reports concerning spiritual care in a nursing context. (ii) Construction of a questionnaire comprising 17 questions with given alternatives based on the previous literature study. (iii) Operationalization of the concept 'attitudes to spiritual care' into some more easily measurable questions through identification in earlier research reports of conceivable indicators of attitudes to spiritual care. (iv) Construction of a suggestion for a definition of the concept 'spiritual care' from the results of Strang et al. (2002) to be used in the questionnaire. (v) Statistical analysis of the data from the questionnaire and a comparison with previous studies.
The replicating part of the study are mainly in accordance with Strang et al. (2002) and lead to the conclusions that holistic care (i) is desirable, (ii) should include spiritual needs of the patients and (iii) is not yet realized in Swedish health care. The identified influencing factors are relevant in a Swedish nursing context. The factors influencing the largest number of indicators of attitudes to spiritual care are 'non-organized religiousness' and 'degree of comfort while providing spiritual care'. Other influencing factors are: 'belief in God', 'belief in life after death', 'organized religiousness', 'profession', and 'the perceived degree of education in spiritual care'.
Knowledge of attitudes towards spiritual care among nursing staff and factors influencing these attitudes will improve the possibilities of meeting the spiritual needs of patients.
BACKGROUND: The nursing literature is replete with articles on the function of clothing in preventing and controlling infections. However, although contemporary literature demonstrates intimate connections between clothing and identity, there is a lack of studies which illuminate the meanings associated with wearing patient clothing. OBJECTIVES: This study aimed to illuminate the meanings of wearing patient clothing as narrated by patients and nurses in Swedish care settings. DESIGN: The data collection was based on grounded theory. Interviews with patients (n=9) and staff (n=5) were drawn from a larger study and analysed with a phenomenological hermeneutical method. SETTINGS: Data was collected between 2001 and 2003 at a hospice, an in-patient geriatric unit, an acute medical unit, and an in-patient oncology unit in Sweden. RESULTS: The phenomenon of 'wearing patient clothing' was found to consist of four themes: (1) being comfortable and cared for; (2) being depersonalised; (3) being stigmatised; and (4) being devitalised. Interpreted in the light of philosophical literature on identity and symbols, the comprehensive understanding of wearing patient clothing is that it is a balancing between being a person and being a patient. Patient clothes were experienced as being comfortable and practical, but also as being stigmatising symbols of illness, confinement, and depersonalisation. CONCLUSIONS: The tension between patient clothing as being practical and comfortable and at the same time enabling feelings of being depersonalised and stigmatised suggests that nursing staff need to balance the practical benefits of these garments with the social and existential meanings they might have.
The aim of this study was to illuminate the way of being a family when one family member is in the midst of living and dying. A family systems frame and a life world perspective were used in interviews with five families. A qualitative analysis inspired by Giorgi revealed dialectic and dynamic processes in constant motion within and between the continua being in affinity-being in loneliness, being in power-being in helplessness, and being in continuity-being in disruption. When families were moving in the direction of being in affinity, power, and continuity, these seemed to be prerequisites for enduring their challenged life situation and for giving them a kind of repose. When the movements were in the opposite direction, existential and emotional suffering were manifested as individual embodied experiences such as depression and anxiety.
We believe that holistic medicine can be used for patients with mental health disorders. With holistic psychiatry, it is possible to help the mentally ill patient to heal existentially. As in holistic medicine, the methods are love or intense care, winning the trust of the patient, getting permission to give support and holding, and daring to be fully at the patient's service. Our clinical experiences have led us to believe that mental health patients can heal if only you can make him or her feel the existential pain at its full depth, understand what the message of the suffering is, and let go of all the negative attitudes and beliefs connected with the disease. Many mentally ill young people would benefit from a few hours of existential holistic processing in order to confront the core existential pains. To help the mentally ill patient, you must understand the level of responsibility and help process the old traumas that made the patient escape responsibility for his or her own life and destiny. To guide the work, we have developed a responsibility scale going from (1) free perception over (2) emotional pain to (3) psychic death (denial of life purpose) further down to (4) escape and (5) denial to (6) destruction of own perception and (7) hallucination further down to (8) coma, suicide, and unconsciousness. This scale seems to be a valuable tool to understand the state of consciousness and the nature of the process of healing that the patient must go through.
Previously, fear in adolescents with cancer has been sparsely described from an emic perspective. The aim of this study was to illuminate fear in adolescents with personal experience of cancer. The participants were six adolescent girls between the age of 14 and 16 years who were no longer under active treatment for cancer but still went for regular check-ups. Open interviews were conducted. Data were analysed according to the phenomenological hermeneutic method. In the result one main theme was identified: 'an embodied fear--a threat to the personal self'. This theme was built up by three separate but intertwined themes: ;experiencing fear related to the physical body', 'experiencing existential fear' and 'experiencing fear related to the social self'. In the comprehensive understanding the fear was interpreted from youth cultural aspects as well as a holistic perspective. The importance of professionals taking the whole person and their situation into account when meeting the fear is underlined.
Nurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress.
The aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer.
Nurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured.
Eighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live.
This study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs.
Treatment with corticosteroids often results in increased appetite, reduced nausea and improved well-being in patients with advanced metastatic cancer. Therefore, we have studied the existential impact of starting corticosteroid treatment as symptom control in this patient group using qualitative content analysis with both a descriptive and an interpretative focus. Ten patients were interviewed before and after 1 week of treatment with 4 mg betamethasone. Prior to treatment, patients reported distressing symptoms, deterioration and diminished autonomy, symbolising threat and death. Corticosteroid treatment produced symptom relief in the majority of the patients. They reported enhanced physical abilities and experienced feelings of a more normalized life and strengthened autonomy, symbolising health and hope. This transfer from threat to hope has important existential consequences in end-of-life care and should be addressed when communicating goals of treatment and care with the patient and family.
The aim was to obtain an understanding of the experience in everyday life of being a sibling when a brother or sister is receiving treatment for a cancer disease or has completed treatment. In order to illuminate the experience of the siblings themselves a phenomenological-hermeneutic method was used. Ten siblings were asked, in the form of a broad-based, open question, to tell about their experience of being the sibling of a brother or sister in this situation. There was an awareness of sibling-ship as a special relation since the brother or sister had got cancer. This feeling was very strong and close, and when needed the sibling admitted a protective and advocacy role. The siblings felt difficulties to always be loyal with the brother or sister needs and demands from other interests. They lived a new life and periods of ups and down following the condition of the brother or sister. Everyday life varied from joy to a life filled with worries and anxiety. Siblings experienced feelings of an existential nature, such as quality of life and death.
BACKGROUND: The policy that older people should be able live in their own homes in spite of extensive care and social service needs means that close family members are increasingly involved in help provision. Ways must be found to facilitate their situation. Their participation in the needs assessment of their next of kin may be crucial. OBJECTIVES: The aim of the study was to illuminate close family members' experience of having an older next of kin becoming in need of public home help, their participation in the needs assessment procedure and the decisions about their next of kins' public home help. PARTICIPANTS: The sample was 27 close family members (mean age 63, range 42-93 years) chosen by their older needs-assessed next of kin. METHODS: An interview using a thematic interview guide formed an everyday dialogue jointly constructed by the interviewer and the interviewee. Thereafter an interpretative content analysis was conducted on the transcribed interviews. RESULTS: One overarching category was illuminated: "Feeling disconfirmed or confirmed in the needs assessment, when feeling pressed by the responsibility and struggling to balance the needs of the family." Four principal categories with sub-categories were derived: (1) Experiencing existential ruminations and the need to help. (2) Help giving and receiving as a difficult balance between needs. (3) Feeling overlooked or acknowledged as having an influence on the needs assessment. (4) Hopes about the home help being fulfilled or dashed. CONCLUSION: The findings imply that the main focus is on the help seeker, overlooking the contribution of family members representing and providing help. A more holistic needs assessment approach is required with a framework and working methods that involve and support the family as a whole.