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

Interprofessional simulation to improve patient participation in transitional care

This is an accepted version of the article. The original is available at http://onlinelibrary.wiley.com/doi/10.1111/scs.12341/abstract;jsessionid=1AF42118605EDBD498F7DFCF4900C430.f03t01.Background: Educating and training healthcare professionals is known to improve the quality of transitional care for older adults. Arranging interprofessional meetings for healthcare professionals might be useful to improve patient participation skills in transitional care. Aim: To describe the learning activities used in The Meeting Point programme, focusing on patient participation in transitional care, and assess whether they increase healthcare professionals’ awareness of and competencies relating to patient participation in the transitional care of older patients. Design: Data were collected as part of an educational intervention programme, The Meeting Point, including three seminars on ‘Patient participation in the transitional care of older patients’ and four follow-up meetings. Participants were nurses, care assistants, doctors, physiotherapists, patient coordinators and administrative personnel from hospital, nursing homes and home-based care services. Method: The Meeting Point was organised around four pillars: introduction, teaching session, group work activity and plenary discussion. Qualitative data included log reports, summaries of meetings, notes from group work activities, and reports from participants and from follow-up meetings. Results: Feedback from participants shows that they were satisfied with meeting healthcare professionals from other units of care. A film scenario was perceived relevant for group work activity and useful in focusing participants’ attention to patient participation. Follow-up meetings show that some nursing home wards, the emergency department and one medical ward at the hospital continued with ongoing work to improve quality of care. Efforts included implementation of an observational waiting room with comfortable chairs, planning for discharge in hospital admission, a daily patient flow registration system and motivational interviewing during admission to nursing home. Conclusions: The description of the learning activities used at The Meeting Point seminars shows that they were useful to increase awareness of and competencies on patient participation in transitional care.acceptedVersio

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

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

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

An observational study of older patients' participation in hospital admission and discharge - exploring patient and next of kin perspectives

Aims and objectives. To explore older patients’ participation during hospital admission and discharge. Background. Patient participation is suggested as a means to improve the quality of transitional healthcare. Older people with chronic diseases, physical disabilities and cognitive impairments often need to transfer from primary to hospital healthcare and vice versa. Design. This study adopts a participant observational research design. Methods. Participant observations of 41 older patients (over 75 years of age) during hospital admission and discharge were conducted in two hospitals in Norway (in 2012). The observations included short conversations with the patient and their next of kin to capture their participation experiences. Systematic text condensation was used to analyse the data material from the field notes. Results. Varying degrees of information exchange between healthcare professionals and patients, and a lack of involvement of the patient in decision-making (in admission and discharge) were observed and experienced by patients and their next of kin. The next of kin appeared to be important advocates for the patients in admission and provided practical support both during admission and discharge. Data suggest that patient participation in admission and discharge is influenced by time constraints and the heavy workloads of healthcare professionals. Patients’ health conditions and preferences also influence participation. Conclusions. Several issues influence the participation of the older patients during hospital admission and discharge. Participation of the older patients needs continuous support from healthcare professionals that acknowledges both the individual patient’s preferences and their capacity to participate. Relevance to clinical practice. Study findings report discrepancies in the involvement of older people and their next of kin. There is a need to increase and support older patients’ participation in hospital admission and discharge.publishedVersio

Investigating pore to pore exchange in systems saturated with water and oil

Relaxation Exchange Spectroscopy (REXSY) has not previously been performed on samples containing different liquids. We present a pulse sequence that combines a Pulsed Gradient Spin Echo with REXSY, which we call PGSE-REXSY. Using this pulse sequence it is possible to separate the signals from two liquid components, here oil and water, simultaneously present within a sample due to the difference in diffusion properties. A REXSY analysis can then be performed on the individual liquids. The technique is very relevant to applications in petroleum research, and could potentially be used to determine how the mobility of one liquid is influenced by the presence of the other. We also show that compared to a two-dimensional Inverse Laplace Transform, a discrete multi-exponential component model is more robust when performing a quantitative analysis of REXSY data