Patients’ experiences in the aftermath of suicidal crises

The aim of this study was to explore the experiences of being suicidal and the encounter with health care personnel. The research question was, ‘How did the suicidal patient perceive the encounter with health care personnel?’ Data were collected, analysed and interpreted using a hermeneutic approach. Qualitative research interviews were used to collect data. Participants included10 people: 4 women and 6 men aged 21-52 years. With the exception of one person, they had all experienced one or more suicide attempts. The study requires ethical considerations in planning, interviews as well as in the analysis process. Through a thematic analysis, three key themes emerged: (a) experiencing and not experiencing openness and trust, (b) being met and not met by someone who addresses the matter, and (c) being met on equal terms versus being humiliated. Results in this study may indicate a lack of willingness and courage to listen to what the suicidal person says and to trust him or he

Dignity in fragile older women receiving daily municipality care

Background:Dignity is an important ideal in the nursing of older women who need municipal care. Dignity can be challenged when health is impaired by feeling grief and suffering associated with bodily changes and impaired functions. Aim and research questions:The study aimed to deepen the understanding of the meaning of dignity in the life of fragile older women who daily needed help from municipal care service. The research questions are: What is older women’s experience of dignity, and what is it not to be met with dignity when needing service from municipality care? Research design: The study has a qualitative design, and the methodology is based on Gadamer’s ontological hermeneutics. Ten women receiving municipal care, aged from 66 to 91 were interviewed in their home environments. Kvale and Brinkmanns’ three levels of interpretation were applied in the analysis of the interviews: self-understanding, a critical understanding based on common sense, and theoretical understanding. Ethical considerations: The study follows the guidelines for good scientific practice according to the Declaration of Helsinki and was approved by the Norwegian Centre for Research Data. Results: The interviews revealed fragments of the women’s unique life history. Two themes emerged from the interpretation: Confirming encounters provide human dignity; and Not being confirmed as a human being violates human dignity. Conclusions:For the women, dignity is about feeling seen and understood by the individual nurse and this takes place both in conversation and in bodily care. Not being seen or confirmed gives rise to suffering. The reason for this seems to be lack of competence on the part of the staff or little continuity.publishedVersio

Crucial resources to strengthen the desire to live: Experiences of suicidal patients

Background: Suicidality is a life-and-death struggle in deep loneliness and psychological pain. There is a lack of knowledge about what could help the suicidal patients’ struggle for continued life. The aim of this study was to develop a deeper understanding of suicidal patients in the aftermath of suicidal attempts. The research question was ‘What resources in the person himself or herself and his or her surroundings are crucial in a suicidal crisis to maintaining the will to live and hope for life’? Methodology: The study has a hermeneutic approach and an explorative design. Data were collected using semi-structured interviews with 10 participants: men and women 21–52 years of age. The context was two emergency psychiatric units and one crisis resolution team. Ethical considerations: The participants signed an informed consent before the interviews were conducted. Findings: This article presents three themes: (a) becoming aware of the desire to live, (b) an experience of connectedness and (c) someone who cares. Discussion: The suicidal person’s awareness of wishes, dreams, hopes and will, but also of their feelings in the aftermath of the suicide attempt, seemed to play a crucial role in a suicidal crisis. Experiences of connectedness remind the person of the responsibility in his or her own life and in the lives of others and seemed to strengthen the urge to go on. Private and professional relationships seem to be crucial in stimulating the desire and hope to go on living. Conclusion: Becoming aware of the desire to live, being connected to others and experiencing someone who cares is necessary for life. Both private and professional networks seemed to be important resources that could remind the suicidal person of his or her own dignity as part of being huma

Discovering dignity through experience: How nursing students discover the expression of dignity

Introduction: Dignity is a core value in nursing. Nursing education shall prepare students for ethical professional practice and facilitate insight into the phenomenon of dignity and its significance. There is limited knowledge about how nursing students discover dignity in their education. Research aim: The aim of the study is to develop an understanding of how nursing students discover and acquire dignity. Research design: The study has a hermeneutic approach where qualitative interviews of nursing students were employed. The process of interpretation was inspired by text of Fleming, Gaidys and Robbs. Participants and research context: Nineteen nursing students agreed to be included in the study, representing six different campuses at three different educational institutions. All were in the final year of their study. The interviews took place at the educational institutions. Ethical considerations: The educational institutions facilitated recruitment of the students who signed voluntarily for participation and continuous informed consent. The study was approved by The Norwegian Center of Reporting Data (NSD). The research recommendations of the Declaration of Helsinki were followed. Findings: The nursing students discovered the expression and significance of dignity through experiences, gained through introspection and in interaction with others during the education. Discussion: The findings are discussed using Gadamer’s concept of experience and how experiences can create new insight. In particular, the students’ experiences with the inner ethical and external aesthetic dimension of dignity are discussed. Conclusion: The study shows that students discovered the inner ethical dignity through experiencing vulnerability, pride and shame. They discovered the external aesthetic dignity through incidents, where they experienced both to be confirmed and not to be confirmed, and through observation of good or bad role models. Crucial negative and positive experiences are important for discovering the expression and significance of dignity.publishedVersio

Nursing students experience of dignity during education

Poster presentert på 7th International Nurse Education Conference (NETNEP). 6.-9. mai 2018 i Banff, Canada

Smertebehandling av rusmisbrukere innlagt i sykehus

Bakgrunn: Smertebehandling til opioidavhengige er krevende fordi opioidavhengighet stimulerer nevropsykologiske, atferdsmessige og sosiale responser, som igjen forsterker smerteopplevelsen og kompliserer adekvat smertelindring. Helsepersonells kunnskaper, rutiner og holdninger er faktorer som kan påvirke smertebehandling til opioidavhengige. Hensikt: Kartlegge helsepersonells handlinger, kunnskaper og holdninger til opioidavhengige med smerte innlagt i norske sykehus. Metode: Beskrivende tverrsnittsdesign basert på en survey med et hensiktsmessig utvalg. Av 435 utsendte spørreskjema ble 312 besvart (72 prosent). Utvalget besto av sykepleiere og leger ved kirurgisk, medisinsk, intensiv- og anestesiavdelinger ved fire sykehus. Resultater: Et mindretall (38 prosent) av respondentene oppga at de kartla pasientenes rusmisbruk. Om lag halvparten (47 prosent) svarte at de ga pasientene opioidsubstitusjon for å forhindre abstinenser. Femtito prosent anvendte aldri smertekartleggingsverktøy. Resultatene viste et egenvurdert kunnskapsnivå på under 3,0 (fempunktsskala med 5 som høyeste verdi). Flertallet (56,1 prosent) av sykepleierne og en sjettedel (15,8 prosent) av legene følte seg manipulert av opioidavhengige pasienter. Et mindretall (20,8 prosent av sykepleierne og 26,3 prosent av legene) trodde på pasientens smerteformidling. Godt over halvparten av respondentene (55,7 prosent av sykepleierne og 73,7 prosent av legene) var enige i påstanden om at opioidavhengighet er en sykdom. Konklusjon: Fordi helsepersonells holdninger til en viss grad synes å trekke pasientens troverdighet i tvil, er det behov for videre studier for å undersøke om opoidavhengige pasienter faktisk får adekvat smertebehandling når de er innlagt i sykehus

Hvordan kan samtale bidra til å lindre lidelse og fremme helse hos kvinner med fødselsdepresjon?

Background and purpose: Ten to fifteen per cent of new mothers suffer from postnatal depression. The purpose of this study is to increase our understanding about how to use conversation to alleviate these women’s suffering and help them to regain their health. Method: The article is based on a literature study of articles and publications gathered from the databases Medline and Cinahl. The results are interpreted in a caring science perspective, more specifically Katie Erikssons theories on health and suffering. The methodology is based on Gadamer’s hermeneutic philosophy. Results and conclusion: 1) The Edinburgh Postnatal Depression Scale (EPDS) as starting point and tool for conversation; 2) Using active listening and confirming skills; 3) Offer the woman opportunities to talk about feelings and experiences. Being conscious of one’s own ethos yields the public health nurse courage and strength to relate to and confirm the women’s suffering giving them time and space to suffer to gain reconciliation

Pårørendes rolle som ressurs og samarbeidspartner: En Studie med fokus på pårørende til pasienter med demenssykdom i sykehjem/ Family members' role as resources and collaborating partners: A study focusing on dementia and long-term stay in a nursing home

Aim: To bring knowledge about how relatives can serve as a resource and cooperate with nursing home staff in giving care to patients with dementia and behavioural symptoms. Background: Studies suggests that family members want to retain the role of caregivers also after institutionalization of a family member with dementia. We have little knowledge about how family caregivers and nursing home staff develop a collaborative relationship. Methods: The study has a descriptive and explorative design. Data were collected via II semi-structured, audiotaped interviews with family members. The analysis is based on Kvale and Brinkman's three levels of interpretation. Findings: Relatives were to a little degree included as a resource for nursing home staff, and they missed a continuous dialog with health personnel in charge of the care. The transition from the role of being an active, responsible caregiver to someone that was not involved and familiar with the daily needs of their family member was perceived as difficult. Conclusion: Relatives may be an important resource in the planning of long-term care for their family members. Conscious inclusion and collaboration with relatives can help them remain in their role as caregivers and prevent them from feeling disclosed

Behavioural disturbances in patients with frontotemporal lobe degeneration focusing on caregiver burden at home and in nursing homes.

Aim and objective To explore the challenges faced by family caregivers of people with frontotemporal dementia and other forms of dementia affecting the frontal and temporal lobes causing behavioural disturbances through a qualitative approach with in‐depth interviews. Background Studies of different forms of dementia involving degeneration of the frontal and temporal lobes have mainly focused on the neurophysiology and physiology of the disease and on caregivers’ health. Few studies have described the challenges and burdens connected with everyday life and in relation to suitable nursing home placement that are faced by family caregivers. Method and design This study used a descriptive and explorative design. Eleven semi‐structured interviews with family caregivers of patients from special units in four nursing homes were conducted in 2014. Data were analysed based on Kvale and Brinkmann's three contexts of interpretation: self‐understanding, common sense and theoretical understanding. Checklist for qualitative studies: Standards for Reporting Qualitative Research (SRQR) http://www.equator-network.org/reporting-guidelines/srqr/ Results Two central themes were derived from the data: changes in behaviour and personality were perceived as incomprehensible, frightening and increasingly difficult to manage. Family caregivers experienced challenges in finding suitable care facilities when they were not able to continue providing home care. Due to behavioural disturbances and lack of relevant competencies among health personnel, family members were often moved between nursing homes. Conclusion Pronounced personality and behavioural disturbances such as tactlessness and aggression in a family member with dementia are experienced by caregivers as stressful and burdensome and may lead to feelings of shame and guilt. A lack of suitable care facilities adds to the stress and difficulties of the families and entails an additional and unresolved burden. Relevance to Clinical Practice The study reveals a need for more knowledge among those organising health services as well as healthcare professional dealing with this patient category to ease the burden on next of kin.publishedVersio

Dignity in relationships and existence in nursing homes’ cultures

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others.publishedVersio