Older Adults Experiences of Reflective STRENGTH-Giving Dialogues: An Interview Study

Background: A major health problem that frequently accompanies old age is long-term pain, but pain must be acknowledged by older adults and health care providers. Interventions are needed to alleviate pain and suffering while holistically providing health care that promotes wellbeing. The intervention project, Reflective STRENGTHGiving Dialogues© (STRENGTH) was implemented to increase health and wellbeing among community dwelling older adults living with long-term musculoskeletal pain at home. Aim: The aim of this study was to describe the older adults\u27 experiences of the intervention Reflective STRENGTH-Giving Dialogue. Method: A life world hermeneutic approach was used in collection and analysis of data. Twenty community dwelling older adults participated were interviewed in their homes after the intervention. Findings: The findings consisted of five themes and showed that the older adults experienced the Reflective STRENGTH-Giving Dialogues as a continuous and trusting relationship that alleviates the pain and breaks the loneliness. They expressed it as a new way to talk about life with pain. The dialogues supported reflection and memory and resulted in a transition in orientation in life. Conclusion: The Reflective STRENGTH-Giving Dialogues helped the older adults to increase their intellectual, emotional, and physical engagement in daily living. The dialogues facilitated a transition in orientation from past to present, to the future, and from obstacles to opportunities. The dialogues were oriented towards enjoyments, meaning, courage and strength in life as a whole which promoted the older adults’ sense of well-being and vitality. The dialogues also facilitated carrying out small and large life projects. The Reflective STRENGTH-Giving Dialogues created a deepened caring relationship that contributed to an increased sense of security, strength and courage, all of which enhanced the potential for better health and wellbeing

From ethical approval to an ethics of care: Considerations for the inclusion of older adults in ethnographic research from the perspective of a ‘humanisation of care framework’

A deeper understanding of care demands the methodological finesse of qualitative research: we must observe, listen, and witness to expose what matters to care recipients. In this paper, we – a team of three: one early-career researcher and two supervisors – reflect on our experiences of designing and then seeking ethics approval for ethnographic research on care for older adults, many of whom demonstrate a lack of capacity to consent to research. Viewing experiences of well-being and dignity as embedded within interpersonal negotiations, this study privileges care home residents' daily life, looking to stories and observations of daily life to reveal the complexities of well-being in the care home setting. This paper emphasizes the importance of using qualitative research methods to gain a deeper understanding of care practices, particularly in the context of care for older adults with varying cognitive capacities. By privileging the daily life experiences of care home residents and employing the logic of process consent, we aim to include the voices of all participants, not just those who can provide written informed consent. However, obtaining ethics approval for this type of research presents several challenges, requiring careful negotiation and the inclusion of consultee advice. This paper highlights the tensions between procedural ethics and the need for better inclusion of vulnerable populations in ethnographic research on care. By addressing these challenges, we can move towards a more context-sensitive and humanised approach to research ethics that values the lived experiences of care recipients

Our land is like our children. Gendered livelihood strategies in South Wollo, Ethiopia

This anthropological study examines the complexity and importance of gender relations for livelihood activities and it looks at the way in which femaleheaded agricultural households in the Ethiopian highlands cope in an area renowned for livelihood vulnerability, drought and famine. It is based on ethnographic fieldwork which was carried out in South Wollo for a year. The thesis explores the many ideas, notions and values that underlie people’s subsistence behaviour and investigates how this is embedded in the context of land policy, economic systems and, importantly, relationships and morality. Relating to others means observing shared norms and values, and the gender order makes particular, morally charged expectations of how women and men of various ages and positions should behave. Gender has important implications for experience, knowledge and cultural conceptions and it is an organizing principle. This thesis shows however that the greatest difference in terms of poverty and vulnerability is not simply that between female-headed households and male-headed households. The ethnography presented demonstrates that it is relevant in understanding people’s livelihood strategies to consider how several factors work in a complex synergy. It stresses the importance to understand how people acquire resources and which ones they have access to but also to examine the way labour and economic transactions are embedded in social relations. Finally, there are also significant structural factors, such as the state, that nourish or constrain local spheres of action. The thesis shows that it is important to take note of gender differences in relations to key economic resources in local society, particularly in relation to rural development planning.Swedish text with English summary

Fluctuation between Powerlessness and Sense of Meaning : A Qualitative Study of Health Care Professionals’ Experiences of Providing Health Care to Older Adults with Long-Term Musculoskeletal Pain

Background: There is an increasing number of older adults living with long-term musculoskeletal pain and related disabilities. These problems are frequently unrecognized, underreported, and inadequately treated. Since many older adults desire to remain at home for as long as possible, it is important that individualized and holistically tailored care is provided in these settings. However, there is a complexity in providing care in this context. The aim of this study was to describe health care professionals’ experiences of providing health care to older adults living with long-term musculoskeletal pain at home. Methods: The phenomenon, “To provide health care to older adults living with long-term musculoskeletal pain at home”, was studied using reflective lifeworld research (RLR) which is based on phenomenological epistemology. Ten health care providers (nurse, physiotherapists, and occupational therapists) were interviewed and data was analysed. Results: The health care professional’s emotions fluctuated between powerlessness and meaningfulness. Needs, opportunities, understanding and respect had to be balanced in the striving to do good in the provision of health care in differing situations. Caring for older adults with long-term pain required courage to remain in the encounter despite feelings of insecurity and uncertainty about the direction of the dialogue. The essence of caring for older adults with long-term pain consisted of the following constituents: Sense of powerlessness; striving to provide good health care; and understanding and respect. Conclusions: The findings indicated that the health care professionals strived to do good and to provide health care that was holistic and sensitive to the older adults’ needs. A significant sense of powerlessness in the situation was experienced by the health care professionals. These findings address and support the need to develop methods that can be used to guide health care providers who support older adults in the context of their homes

Health care professionals' experiences of possibilities and constraints in caring for older adults living with long-term pain in community home care

Caring for a growing population of older adults with complex health problems in their homes is part of every-day work for many health care professionals in the world. This qualitative interview study explores the way health care professionals perceive possibilities and constraints when caring for older adults living with long-term pain in community home care in Sweden. The study aims to understand the relationship between health care professionals' subjective experiences and social structures such as the organization of care and shared norms and values in regard to their perceived space of action. Findings provide insight into how institutional structures such as organization and time, conflate with cultural notions, norms, and ideals, and how these enable and constrain health care professionals in their daily work but also create dilemmas. Findings suggest centering the meaning of structuring aspects in social organizations as a tool for reflection on priorities, improvement, and development in care settings

Suffering in silence : a qualitative study of older adults’ experiences of living with long-term musculoskeletal pain at home

Long-term musculoskeletal pain is a major, disabling, and often undertreated health problem among the increasing number of older adults worldwide. However, there is limited knowledge of community-dwelling older adults’ experiences of living with this type of pain. The aim of the study was to deepen the understanding of the phenomenon: how older adults experience living with long-term musculoskeletal pain at home. The study design was an inductive qualitative Reflective Lifeworld Research approach grounded in phenomenological epistemology. Data were obtained from 20 community-dwelling older adults, aged 72–97 years. Data were collected through open-ended interviews and analyzed to understand the meanings of the phenomenon. The essence of the phenomenon entailed suffering in silence and encompassed the following constituents: loneliness and restrictions in daily living; ways to endure and distract from pain; not being taken seriously; fear of the future; and valuing joy and meaning in life. Living with long-term musculoskeletal pain restricts access to the world and leads to a suffering in silence. Finding ways to endure and distract from pain and to focus on issues that give joy and meaning in life is predominant in efforts to balance restraints from pain in life. Suffering is reinforced by loneliness, a sense of not being taken seriously by health care providers and fear of an uncertain future. It is necessary to foster increased attentiveness and sensitivity in meeting the needs of each older adult and provide a care that alleviates suffering and preserves and promotes health and well-being

Homecare nurses’ lived experiences of caring relationships with older adults: A phenomenological study

Introduction: This paper describes registered nurses’ lived experiences of caring relationships in the context of home care for older adults living in Denmark. As populations throughout Europe are aging, more older adults will need complex care solutions within overburdened care systems. This development places demands on the competencies and organisation of homecare nurses as they become key players in the healthcare system. Caring relationships in home care is a rewarding and valuable process that enhances the holistic and humanising aspects of caring for older adults. In order for a caring relationship to be caring, we must understand not only the subjective experience of that caring relationship but also how that caring relationship is experienced in relation to and shared with others. Aim: To describe the essential meaning of the phenomenon of caring relationships in home care for older adults, based on the lived experiences of homecare nurses. Approach and methods: Interviews were conducted with registered nurses working in home care for older adults, and a phenomenological analysis was conducted according to the methodological principles of the reflective lifeworld research approach. Findings: The essential meaning of the phenomenon is described as creating an existential and embodied space in which the world of the patient is the foundation of caring. The constituents are as follows: caring for the whole person, a sense of at-homeness through trusting ‘the other’, experiencing continuity as caring and prioritising the time to care. Conclusion: Caring competence in home care for older adults relies on a nurse’s ability to intertwine physical and existential care needs and articulate them in his or her daily work. A focus on the phenomenon of caring relationships brings value to and adds an extra layer to the discussion on caring competence

“A becoming in the meeting”: the interpretations of competence in home care from the perspectives of older people and registered nurses – a meta-ethnography

Aim The aim of this meta-ethnography was to identify and synthesize qualitative studies focusing on older people’s and registered nurses’ interpretations of competence in home care.  Methods The meta-ethnography followed the six phases developed by Noblit and Hare (1988).  Results In Phase 6, the translation process of the included studies, three themes were identified: i) temporality—the feeling of being of value; ii) dignity—a person, not just a patient; and iii) mutuality of being—togetherness. A synthesis was developed, and the phrase “a becoming in the meeting” emerged.  Conclusion The sense of becoming includes progress, which means becoming something other than before in relation with others and refers to what constitutes the meeting between the older person and the registered nurse working in home care. Competence originates from becoming in the meeting, and registered nurses should therefore value what they do and hold on to this aspect of caring competence that centres on a caring relationship. It is important for registered nurses working in home care to be able to cultivate a caring relationship.INNOVATEDIGNITY The European Union’s Horizon 2020 Research and Innovation Programme (MSCA-ITN-2018 under grant agreement number 813,928)</p

Gender influences on caring, dignity, and well-being in older person care: A systematic literature review and thematic synthesis

Globally, healthcare has become dominated by women nurses. Gender is also known to impact the way people are cared for in various healthcare systems. Considering gender from the perspective of how lived bodies are positioned through the structural relations of institutions and processes, this systematic review aims to explore the meaning of gender in the caring relationship between the nurse and the older person through a synthesis of available empirical data published from 1993 to 2022. CINAHL, PUBMED, EMBASE, and Web of Science were searched from the beginning of each database’s temporal range, and PRISMA guidelines were used for the screening, reviewing, and selection processes of available records. A thematic synthesis of the available data resulted in three analytical themes: i) vulnerability of the gendered body, ii) norms and values related to gender and sexuality, and iii) balancing closeness and distance in the nurse-patient relationship. These themes are intertwined and represent different aspects of gender meaning in the nurse–patient relationship. This research shows that gender, through its influence on the gendered body, its relationship with power dynamics in the caring process, and its intersection with dimensions of identity, has a significant meaning for the experienced vulnerability in the nurse–patient relationship. This has implications for the well-being and sense of dignity of the older person as well as the nurse