Politically engaged mindset of everyday coping in relation to nursing values : A phenomenological-hermeneutic study of district nurses’ experiences

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Rehabilitation of the frail older adults in primary healthcare in rural areas: a scoping review protocol

Introduction Frail older adults are particularly vulnerable to functional decline and adverse outcomes because they lack the necessary resistance and ability to cope. Rehabilitation services for the frail older adults are thus vital and require clarification. The aim of this review is to identify and map the scope and breadth of literature regarding rehabilitation of the frail older adults to develop a holistic rehabilitation service in primary healthcare in rural areas. The concept of rehabilitation, how rehabilitation services are organised, how patients and next of kin are involved in planning and evaluating services during rehabilitation, as well as reported results will be identified and mapped. Methods and analysis This scoping review will be conducted based on the methodology developed by Arksey and O’Malley. The search strategy will aim to locate both published and unpublished studies in relevant databases. Key information sources include CINAHL, MEDLINE, Embase, ProQuest and Google Scholar. Data will be extracted from papers that all three reviewers have chosen to include in the review. All three reviewers will participate in screening, assessment and selection of studies against the inclusion criteria for the review and work in teams of two. The full text of selected citations will be assessed in detail against the inclusion criteria by the same teams. Data will be extracted from papers included in the scoping review by two of the reviewers. Modifications will be detailed in the full review report. Any disagreements that arise between two reviewers will be resolved through discussion or with the third reviewer’s mediation. A narrative summary of the findings will be presented accompanied by tables that reflect the objective of the review. Ethics and dissemination Data will be obtained only from already publicly available materials. Special ethical approval is, therefore, not required.publishedVersio

Palliativ enhet eller palliative plasser ved sykehjem i Stange kommune

Oppdragsgiver: Stange kommuneHøgskolen i Hedmark, avdeling for helse‐ og idrettsfag, institutt for sykepleiefag har på oppdrag fra Stange kommune utarbeidet foreliggende utredning om organisering av palliasjon i kommunen. Utredningen tar for seg hva palliasjon er, fordeler og ulemper ved henholdsvis palliative senger i ordinær sykehjemsavdeling og egen palliativ enhet og økonomi knyttet til de ulike alternativene. Palliasjon er aktiv behandling, pleie og omsorg for pasienter med uhelbredelig sykdom. Lindring av pasientens fysiske smerte og andre plagsomme symptomer, uavhengig av diagnose/sykdom, står sentralt. Målet er best mulig livskvalitet for pasienten og de pårørende. Dette innebærer at pasient og pårørende blir møtt og forstått i forhold til sin situasjon med uhelbredelig sykdom i familien. For å lykkes med palliasjon i kommunen kreves kompetanse hos personalet og tverrfaglig samarbeid – og samarbeid med spesialisthelsetjenesten i Sykehuset Innlandet HF. Det foreligger erfaring fra andre kommuner i Norge med både palliative enheter i sykehjem og palliative senger i eksisterende sykehjemsavdelinger. Noen har gått enda ”lenger” og etablert intermediær (1 ½‐linje) avdeling i sykehjem, og noen har etablert hospice‐enhet. Disse erfaringene, forutsatt at folketallet i kommunen er større enn 10 – 15 000 innbyggere, tilsier at palliativ enhet har flere fordeler enn palliative senger i eksisterende sykehjemsavdeling. Behandlingstilbudet i palliative enheter er kostbart i forhold til driften ved ordinære sykehjemsavdelinger, men billig i forhold til behandling i sykehus (Garåsen m.fl., 2003). I tråd med utspillene fra nåværende helseminister Bjarne Håkon Hansen den siste tiden, er det rimelig å anta at kommunen dermed vil få et utvidet ansvar i forhold til pasientgruppene med behov for palliasjon framover. Utfordringen er å ta stilling til på hvilken måte Stange kommune skal løse dette: Palliaitv enhet eller palliative senger i sykehjem? Hvilken kompetanse er nødvendig for å håndtere utfordringene? Hvilke økonomiske konsekvenser gir realisering og drifting av tiltaket som velges?Abstract: Hedmark University, Department of Health and Sports Sciences, Department of Nursing, has, on behalf of Stange Municipality, prepared the present report on the organization of palliative care in the municipality. The report addresses what palliative care is, the advantages and disadvantages of palliative beds in the ordinary nursing home ward and its own palliative care unit and finances related to the various alternatives. Palliative care is active treatment, nursing and care for patients with incurable disease. Relief of the patient's physical pain and other troublesome symptoms, regardless of diagnosis / illness, is the key. The goal isthe best possible quality of life forthe patient and the relatives. This meansthat the patient and relatives are met and understood in relation to theirsituation with incurable disease in the family. In order to succeed with palliative care in the municipality, the competence of the staff and interdisciplinary collaboration is required ‐ and collaboration with the specialist health service at Sykehuset Innlandet HF. There is experience from other municipalities in Norway with both palliative units in nursing homes and palliative beds in existing nursing home wards. Some have gone even “further” and established an intermediate (1 ½‐line) ward in a nursing home, and some have established a hospice unit. These experiences, provided that the population in the municipality is greater than 10 ‐ 15 000 inhabitants, indicate that the palliative care unit has more advantages than palliative care beds in the existing nursing home ward. The treatment offered in palliative care units is expensive in relation to the operation of ordinary nursing home wards, but cheap in relation to treatment in hospitals (Garåsen et al., 2003). In line with the proposalsfrom the reasent Minister of Health Bjarne Håkon Hansen recently, it isreasonable to assume that the municipality will thus have an expanded responsibility in relation to the patient groups with a need for palliation in the future. The challenge is to decide in which way Stange municipality will solve this: Palliaitv unit or palliative beds in nursing homes? What skills are needed to handle the challenges? What financial consequences does the realization and operation of the measure chosen have?publishedVersio

A mobile hospice nurse teaching team’s experience: training care workers in spiritual and existential care for the dying - a qualitative study

-Background Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients’ spiritual and existential suffering is therefore important. The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team’s experience with teaching and training care workers in spiritual and existential care for the dying in nursing homes and home care settings. Methods The team of expert hospice nurses participated in a focus group interview. Data were analyzed using a phenomenological hermeneutical method. Results The mobile teaching team taught care workers to identify spiritual and existential suffering, initiate existential and spiritual conversations and convey consolation through active presencing and silence. The team members transferred their personal spiritual and existential care knowledge through situated “bedside teaching” and reflective dialogues. “The mobile teaching team perceived that the care workers benefitted from the situated teaching because they observed that care workers became more courageous in addressing dying patients’ spiritual and existential suffering. Discussion Educational research supports these results. Studies show that efficient workplace teaching schemes allowexpert practitioners to teach staff to integrate several different knowledge forms and skills, applying a holisticknowledge approach. One of the features of workplace learning is that expert nurses are able to guide novices through the complexities of practice. Situated learning is therefore central for becoming proficient. Conclusions Situated bedside teaching provided by expert mobile hospice nurses may be an efficient way to develop care workers’ courage and competency to provide spiritual and existential end-of-life-care. Further research is recommended on the use of mobile expert nurse teaching teams to improve nursing competency in the primary health care sector. Keywords: Palliative spiritual care; Primary health care; Staff training; Phenomenological hermeneutica

The challenge of consolation: nurses’ experiences with spiritual and existential care for the dying-a phenomenological hermeneutical study

-Background: A majority of people in Western Europe and the USA die in hospitals. Spiritual and existential care is seen to be an integral component of holistic, compassionate and comprehensive palliative care. Yet, several studies show that many nurses are anxious and uncertain about engaging in spiritual and existential care for the dying. The aim of this study is to describe nurses’ experiences with spiritual and existential care for dying patients in a general hospital. Methods: Individual narrative interviews were conducted with nurses in a medical and oncological ward. Data were analyzed using a phenomenological hermeneutical method. Results: The nurses felt that it was challenging to uncover dying patients’ spiritual and existential suffering, because it usually emerged as elusive entanglements of physical, emotional, relational, spiritual and existential pain. The nurses’ spiritual and existential care interventions were aimed at facilitating a peaceful and harmonious death. The nurses strove to help patients accept dying, settle practical affairs and achieve reconciliation with their past, their loved ones and with God. The nurses experienced that they had been able to convey consolation when they had managed to help patients to find peace and reconciliation in the final stages of dying. This was experienced as rewarding and fulfilling. The nurses experienced that it was emotionally challenging to be unable to relieve dying patients’ spiritual and existential anguish, because it activated feelings of professional helplessness and shortcomings. Conclusions: Although spiritual and existential suffering at the end of life cannot be totally alleviated, nurses may ease some of the existential and spiritual loneliness of dying by standing with their patients in their suffering. Further research (qualitative as well as quantitative) is needed to uncover how nurses provide spiritual and existential care for dying patients in everyday practice. Such research is an important and valuable knowledge supplement to theoretical studies in this field. Keywords: Nurses’ challenges, Spiritual, Existential, Care, Dying patients, Hospitals, Phenomenological hermeneutica

A mobile hospice nurse teaching team’s experience: training care workers in spiritual and existential care for the dying - a qualitative study

Background Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients’ spiritual and existential suffering is therefore important. The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team’s experience with teaching and training care workers in spiritual and existential care for the dying in nursing homes and home care settings. Methods The team of expert hospice nurses participated in a focus group interview. Data were analyzed using a phenomenological hermeneutical method. Results The mobile teaching team taught care workers to identify spiritual and existential suffering, initiate existential and spiritual conversations and convey consolation through active presencing and silence. The team members transferred their personal spiritual and existential care knowledge through situated “bedside teaching” and reflective dialogues. “The mobile teaching team perceived that the care workers benefitted from the situated teaching because they observed that care workers became more courageous in addressing dying patients’ spiritual and existential suffering. Discussion Educational research supports these results. Studies show that efficient workplace teaching schemes allowexpert practitioners to teach staff to integrate several different knowledge forms and skills, applying a holisticknowledge approach. One of the features of workplace learning is that expert nurses are able to guide novices through the complexities of practice. Situated learning is therefore central for becoming proficient. Conclusions Situated bedside teaching provided by expert mobile hospice nurses may be an efficient way to develop care workers’ courage and competency to provide spiritual and existential end-of-life-care. Further research is recommended on the use of mobile expert nurse teaching teams to improve nursing competency in the primary health care sector. Keywords: Palliative spiritual care; Primary health care; Staff training; Phenomenological hermeneutica

Ambiguous participation in older hospitalized patients : gaining influence through active and passive approaches – a qualitative study

Background: Patient participation is required by law in Norway and in several western countries. Current participation ideology is based on individualism, which may conflict with the older generation’s commonly held values of solidarity and community. Hence, different values and ideologies may come in conflict when older patients receive treatment and rehabilitation in geriatric wards. Participation is a guiding principle in rehabilitation. Criteria for admission of older patients to geriatric wards are complex health problems, acute illness and/or acute physical and/or cognitive functional failure. The ideal is an active and engaged patient. The aim of the study was to describe the difficulties experienced by older patients on acute geriatric wards when involving themselves with their own treatment and care. Methods: In this qualitative study older patients were interviewed during hospitalization in geriatric wards and asked to tell about their experiences with participation. Data analysis was conducted using a phenomenological hermeneutic method. Results: The patients experienced difficulties in participating in decisions and care. They linked their difficulties to their own diminishing capabilities, and cited the ward’s busy schedule as a reason for abstaining from participation. However, despite their reservations, they did participate in decisions in different ways. Their participatory practices appeared ambiguous and they employed various strategies to put themselves in a position of influence. The most important of these involved their relatives. The patients delegated to family the tasks of seeking, receiving and giving information to the nurses and the staff, and, to some extent, for the dialogues with hospital staff about their needs and plan of care. The family appeared to accept the responsibility willingly. Conclusions: The patients addressed their difficulties by authorizing family members to act and participate on their behalf. This underlines the family’s important role in patient participation and the role that nurses and other staff must play in collaborating with the patient and their family to facilitate participation independently of the patients’ performances of participation

The challenge of consolation: nurses’ experiences with spiritual and existential care for the dying-a phenomenological hermeneutical study

Background: A majority of people in Western Europe and the USA die in hospitals. Spiritual and existential care is seen to be an integral component of holistic, compassionate and comprehensive palliative care. Yet, several studies show that many nurses are anxious and uncertain about engaging in spiritual and existential care for the dying. The aim of this study is to describe nurses’ experiences with spiritual and existential care for dying patients in a general hospital. Methods: Individual narrative interviews were conducted with nurses in a medical and oncological ward. Data were analyzed using a phenomenological hermeneutical method. Results: The nurses felt that it was challenging to uncover dying patients’ spiritual and existential suffering, because it usually emerged as elusive entanglements of physical, emotional, relational, spiritual and existential pain. The nurses’ spiritual and existential care interventions were aimed at facilitating a peaceful and harmonious death. The nurses strove to help patients accept dying, settle practical affairs and achieve reconciliation with their past, their loved ones and with God. The nurses experienced that they had been able to convey consolation when they had managed to help patients to find peace and reconciliation in the final stages of dying. This was experienced as rewarding and fulfilling. The nurses experienced that it was emotionally challenging to be unable to relieve dying patients’ spiritual and existential anguish, because it activated feelings of professional helplessness and shortcomings. Conclusions: Although spiritual and existential suffering at the end of life cannot be totally alleviated, nurses may ease some of the existential and spiritual loneliness of dying by standing with their patients in their suffering. Further research (qualitative as well as quantitative) is needed to uncover how nurses provide spiritual and existential care for dying patients in everyday practice. Such research is an important and valuable knowledge supplement to theoretical studies in this field

The power of consoling presence - hospice nurses ’ lived experience with spiritual and existential care for the dying

This is an Open Access peer-reviewed scientific article originally published in the journal BMC Nursing. You can access the article by following this link: http://www.biomedcentral.com/bmcnurs/. The article is published under the Creative Commons Attribution License 4.0. Please consult BioMed Central's license agreement: http://www.biomedcentral.com/authors/license.Background: Being with dying people is an integral part of nursing, yet many nurses feel unprepared to accompany people through the process of dying, reporting a lack of skills in psychosocial and spiritual care, resulting in high levels of moral distress, grief and burnout. The aim of this study is to describe the meaning of hospice nurses’ lived experience with alleviating dying patients’ spiritual and existential suffering. Methods: This is a qualitative study. Hospice nurses were interviewed individually and asked to narrate about their experiences with giving spiritual and existential care to terminally ill hospice patients. Data analysis was conducted using phenomenological hermeneutical method. Results: The key spiritual and existential care themes identified, were sensing existential and spiritual distress, tuning inn and opening up, sensing the atmosphere in the room, being moved and touched, and consoling through silence, conversation and religious consolation. Conclusions: Consoling existential and spiritual distress is a deeply personal and relational practice. Nurses have a potential to alleviate existential and spiritual suffering through consoling presence. By connecting deeply with patients and their families, nurses have the possibility to affirm the patients’ strength and facilitate their courage to live a meaningful life and die a dignified death. Keywords: Dying, Spiritual and existential care, Hospice nursing, Consolation, Phenomenological hermeneutical stud

Overvekt hos gravide – en utfordring i svangerskapsomsorgen

The purpose of this study is to gain knowledge about the challenges midwives and public nurses are experiencing in health prevention and health promotion to obese pregnant women, and their reflections regarding the need for change in practice.Method: The study has a qualitative exploratory design. Data was created by multistage focus group interviews and analyzed inspired by Lundman and Granheim’s content analysis. The focus groups consisted of midwives and public health nurses.Results: The informants were aware that obesity in pregnancy may cause complications for both mother and child, but they experienced obesity and lifestyle changes as challenging in antenatal care. Weight and body were perceived as something vulnerable. Informants found it hard to talk about weight because they were afraid of reactions from the pregnant women. They also expressed insecurity regarding their own expertise when it comes to communication and nutrition. Informants expressed the need for more interdisciplinary cooperation between different health workers in community health. They experienced such cooperation difficult to achieve