Hur sjuksköterskor kan skapa goda vårdrelationer inom avancerad palliativ hemsjukvård

Good care relationships between nurses and patients are crucial for achieving good palliative care. How these relationships are created has not been specifically studied in palliative home care. The overall purpose of this thesis was to study (1) the abilities nurses use to create good care relationships; and (2) how good care relationships can be created with dying patients and their relatives in palliative home care. The thesis includes three studies presented in four papers. In Study I (Paper I), eight expert nurses in palliative home care were interviewed about which abilities they use to create good care relationships with the dying people The results highlight three abilities or concepts: (1) knowledge (theoretical, practical, and experiential); (2) the ability to be perceptive; and (3) the will to do good. In Study II (Paper II), nurses working in palliative home care reflected over these concepts in group supervision. The aim was to promote nurses’ ability to reflect on how to create caring relationships with dying patients and their relatives. This was done using an action research approach and, at the same time, testing the usefulness of the emerging theory based on the concepts from Study I. The concepts in the emerging theory were useful as a thinking tool. The nurses had developed their ability to reflect on how to create caring relationships with dying patients and their relatives in home care. The emerging theory was further developed. Study III is presented in papers III and IV. In Paper III, home care nursing encounters in palliative home care were studied through observations of nurses, patients, and caregivers. The purpose was to explore how nurses, patients, and relatives act in planned home care encounters in palliative home care. The results showed that a co-creative process could promote patients’ possability to reach vital goals at the end of life. The home care nursing encounters were characterized by reciprocity in a warm and caring atmosphere. By contrast, nurses’ lack of knowledge and time could affect the patients in a negative way, so that vital goals were not always reached in palliative home care. In Paper IV, the co-creative process was analyzed in three home care nursing relationships over time. The aim was to deepen the understanding of the co-creative process described in Paper III and to further explore how the care and the relationship were co-created. The data consisted of observations and interviews conducted in connection with each home care encounter. The results showed that the co-creative process was continuous and that solutions were created through sharing of knowledge. In the process of co-creation, several microprocesses occurred in parallel to promote the patient’s wellbeing. The co-creative process promoted good care relationships and good palliative care

Patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting in Norway

Patient or Public Contribution - Patients, relatives and nurses were involved in this study. Aim - The aim was to explore patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting after implementation of the Coordination Reform in Norway. Design - Secondary analysis of qualitative interviews. Methods - Data from interviews with 19 participants in a nursing home setting: severely ill older patients in palliative care, relatives and nurses. Data triangulation influenced by Miles and Huberman was used. Results - The overall theme was “Being in an unfamiliar and uncaring culture leaves end-of-life patients in desperate need of holistic, person-centred and co-creative care”. The main themes were: “Desire for engaging palliative care in a hopeless and lonely situation”, “Patients seeking understanding of end-of-life care in an unfamiliar setting” and “Absence of sufficient palliative care and competence creates insecurity”. The patients and relatives included in this study experienced an uncaring culture, limited resources and a lack of palliative care competence, which is in direct contrast to that which is delineated in directives, guidelines and recommendations. Our findings reveal the need for policymakers to be more aware of the challenges that may arise when healthcare reforms are implemented. Future research on palliative care should include patients', relatives' and nurses' perspectives

International Nursing. Caring in Nursing Leadership- A meta-ethnography From the Nurse Leader`s Perspective

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Att samskapa en god vård genom goda vårdrelationer för patienter i specialiserad palliativ hemsjukvård

I artikeln diskuterar jag resultatet av mitt avhandlingsarbete som, bland annat, är baserat på intervjuer och observationer av svårt sjuka patienter, närstående och sjuksköterskor inom specialiserad palliativ hemsjukvård. Syftet med avhandlingen var att undersöka hur goda vårdrelationer skapas. Tre förmågor hos expertsjuksköterskor framkom som centrala för att kunna skapa goda vårdrelationer, perceptivitet, kunskap och viljan att göra gott. Externa omständigheter, som regler i en organisation, kan inverka hindrande på sjuksköterskors perceptiva förmåga och möjlighet att skapa goda relationer till döende patienter. Det framkom att god palliativ vård samskapas samtidigt som goda vårdrelationer utvecklas. Goda vårdrelationer formades genom ett kontinuerligt kunskapsutbyte mellan sjuksköterska, patient och närstående där också möjligheter för patienter att nå vitala mål skapades trots svår sjukdom

Ethical sensitivity and perceptivness in palliative home care through co-creation

Background: In research on co-creation in nursing, a caring manner can be used to create opportunities whereby the patient’s quality of life can be increased in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. To promote quality of life, nurses must be sensitive to patients’ and their relatives’ needs in care encounters. Co-creation can be defined as the joint creation of vital goals for patients through the process of shared knowledge between nurses, patients and their relatives. Aim: The aim of this study was to explore nurses’ experiences of caring encounters and co-creation in palliative home care from an ethical perspective. Research design, participants, and research context: A hermeneutical approach was used. The material consisted of texts from interviews with 12 nurses in a home care context. The method was inspired by thematic analysis. Ethical considerations: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Findings: An overall theme, a main theme and four sub-themes emerged. Through ethical sensitivity and perceptivity, nurses can balance their actions in the moment and change their nursing care actions accordingto the patient’s wishes through co-creation in encounters. Here the time is crucial, as the time needed is unique to each patient. Discussion: The themes together can be considered prerequisites for good palliative home care. If nurses fail to be sensitive and perceptive in encounters with dying patients, good palliative home care cannot be achieved. Ethical sensitivity and perceptiveness can also be considered a part of nurses’ ethical competence. Conclusion: Patients’ dignity can be preserved through ethical sensitivity and perceptiveness, which is fundamental for good palliative care. Co-creation from patients’ perspectives should be the focus of future research

Creating theory : Encouragement for using creativity and deduction in qualitative nursing research.

Texts about theory in nursing often refer to theory construction by using inductive methods in a rigid way. In this paper, it is instead argued that theories are created, which is in line with most philosophers of science. Theory creation is regarded as a creative process that does not follow a specific method or logic. As in any creative endeavour, the inspiration for theory creation can come from many sources, including previous research and existing theory. The main idea put forward is that deductive qualitative research approaches should play a key role in theory creation. Furthermore, there is a need to differentiate between theory creation and theory justification. A model that emphasizes the creative aspects of theory creation and theory justification using qualitative approaches is presented. The model suggests that knowledge development is a deductive trial-and-error process where theory creation is followed by testing. Scientific theory creation and justification are presented as an iterative process that is deductive in that a testable hypothesis is derived from the theory. If the hypothesis is falsified, then the theory needs modification or might be altogether wrong. Several factors can block the creative process, both in theory development and in finding ways to test a theory in the justification phase. Some of these blockers are the idea of 'building blocks' and the inductive view of science often brought forward in nursing. Other blockers include striving for consensus and adherence to existing nursing philosophies and existing theories. Research and knowledge development are creative processes, and following predefined methods is not enough to ensure scientific rigour in qualitative nursing research

Patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting in Norway

Abstract Patient or Public Contribution Patients, relatives and nurses were involved in this study. Aim The aim was to explore patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting after implementation of the Coordination Reform in Norway. Design Secondary analysis of qualitative interviews. Methods Data from interviews with 19 participants in a nursing home setting: severely ill older patients in palliative care, relatives and nurses. Data triangulation influenced by Miles and Huberman was used. Results The overall theme was “Being in an unfamiliar and uncaring culture leaves end‐of‐life patients in desperate need of holistic, person‐centred and co‐creative care”. The main themes were: “Desire for engaging palliative care in a hopeless and lonely situation”, “Patients seeking understanding of end‐of‐life care in an unfamiliar setting” and “Absence of sufficient palliative care and competence creates insecurity”. The patients and relatives included in this study experienced an uncaring culture, limited resources and a lack of palliative care competence, which is in direct contrast to that which is delineated in directives, guidelines and recommendations. Our findings reveal the need for policymakers to be more aware of the challenges that may arise when healthcare reforms are implemented. Future research on palliative care should include patients', relatives' and nurses' perspectives

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