What Makes Dependency on Homecare Bearable? A Phenomenological Study

Becoming dependent on homecare in old age is a radical life change that requires complex adaption. The purpose of this study was to explore the existential dimension of being dependent on homecare with a particular focus on what makes dependency bearable. In total, 15 older people living in Denmark or Norway were interviewed using a phenomenological approach. The material was analyzed employing Max van Manen’s meaning-giving approach coined “Phenomenology of practice.” During the analysis, four themes emerged: pure acceptance of an inevitable situation, acting independently as much as possible, negotiating to receive good care, and gratitude toward caring caregivers. The results point to a need for respectful and individualized homecare leveling out the subordinate position in which dependency on homecare tends to place older people

Why Phenomenology Came Into Nursing:The Legitimacy and Usefulness of Phenomenology in Theory Building in the Discipline of Nursing

Phenomenology was introduced to the field of nursing in late ‘70s in the US and Scandinavia. Since then, phenomenology has developed as a commonly used approach within nursing research. However, during the past two to three decades, phenomenological nursing research has come under attack from scholars outside the field of nursing who question the credibility and usefulness of phenomenological nursing research. The aim of this discussion paper is twofold: 1) to illuminate why phenomenology was introduced by nurse scholars to develop theory and as a framework for empirical research in the US and Scandinavia; and 2) to discuss the legitimacy of applying a phenomenological approach in nursing research and practice today. The rationale behind advocating the integration of a phenomenological approach into nursing practice was to defend, apprehend and articulate the essence of caregiving in theory building within nursing. We claim these arguments are maybe even more important today. Using three examples of empirical phenomenological studies, we illustrate how these studies provide theoretically informed insights into existential aspects of care that guide caring practice and accordingly humanise practice. We argue that phenomenology provides the nursing profession with a humanly sensitive approach that challenges the current tendency within healthcare to emphasise an evidence-based, standardised approach to patient care that inclines to neglect each patient’s uniqueness. Nursing profession may lose its very raison d'être, i.e. to deliver humanly sensitive care, if nursing research ceases to address existential aspects of being a human. Thus, it is evident that phenomenological nursing studies have legitimacy and are important for developing theoretically informed insights that promote the discipline of nursing. Consequently, the value of phenomenological nursing research should be assessed based on the findings it provides that promote such knowledge. Hence, credibility and usefulness of phenomenological nursing research must be determined by the discipline itself.</p

Who cares? -The unrecognised contribution of homecare nurses to care trajectories

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Creativity in phenomenological methodology

Nursing research is often concerned with lived experiences in human life using phenomenological and hermeneutic approaches. These empirical studies may use different creative expressions and art-forms to describe and enhance an embodied and personalised understanding of lived experiences. Drawing on the methodologies of van Manen, Dahlberg, Lindseth &amp; Norberg, the aim of this paper is to argue that the increased focus on creativity and arts in research methodology is valuable to gain a deeper insight into lived experiences. We illustrate this point through examples from empirical nursing studies, and discuss how each of the above approaches allows for creative expressions and art-forms such as poetics, narratives and films, and hereby contributes to a profound understanding of patients’ experiences. This creativity generates extraordinary power to the process of understanding and it seems that creativity may support a respectful renewal of phenomenological research traditions in nursing research

Walking a tightrope - as a next-of-kin to an adolescent or young adult with cancer facing eating difficulties

Purpose: Eating difficulties cause reduced food intake and poor quality of life among adolescents and young adults (AYAs) with cancer. Therefore, next-of-kin eating support is crucial. The purpose of this study was to explore the lived experiences of being close to AYAs with cancer in the context of eating when they are at home between high-emetogenic chemotherapy (HEC) sessions. Method: In-depth interviews were conducted with 12 next-of-kin to AYAs (15–29 years old) with oncological or haematological diseases, treated with HEC. Van Manen’s hermeneuticphenomenological approach guided the design. Results: The essential meaning of the next-of-kin experiences is reflected in the overarching theme “Utilizing meals as an action-opportunity” consisting of two subthemes: ’Being on constant alert’ and “Walking a tightrope to maintain usual everyday life.” Conclusions: Findings revealed that utilizing meals as an action-opportunity towards AYAs’ food intake involved existential feelings including fear of losing their loved ones. Next-of-kin experienced that providing support through and with food was their only avenue of action. However, this sparked feelings of frustration and powerlessness.publishedVersio

Coming home: older patients’ and their relatives’ experiences of well-being in the transition from hospital to home after early discharge

Background This study aims to investigate the lived experience of well-being among older patients and their relatives in the transition from hospital to home after early discharge. Research has shown that the transition brings severe challenges to their everyday lives. However, to date, there has been a lack of research focusing on the lived experiences of well-being during this process. Methods The data collection and analysis followed the phenomenological approach of Reflective Lifeworld Research. Ten in-depth interviews with older patients and their relatives were conducted in Austria up to 2–5 days after hospital discharge. Results The essential meaning of the phenomenon of well-being in the transition from hospital to home is marked by security and confidence to face the challenges following the discharge. Four constituents emerged: being calm and in alignment with the homecoming, being in familiar surroundings at home—a sense of belonging, striving towards independence—continuity of life and having faith in the future. Conclusion Our findings point to the importance of recognizing the vulnerability associated with the transition from hospital to home, as it impacts the existential aspects of space and time. Facilitating a sense of continuity and belonging can foster well-being during this critical period

After colonic surgery: The lived experience of participating in a fast-track programme

Postoperative recovery can be accelerated and hospitalization reduced through fast-track programmes. However, documented knowledge is limited and primarily focusing on a medical perspective whereas the patients' perspective lacks documentation. This study describes the lived experience of participating in a fast-track programme after colonic surgery. Sixteen patients were interviewed twice. The interviews were analysed using a descriptive phenomenological approach. Participating in a fast-track programme is characterized by a process where patients experience how the daily regimen works both with them and against them. To succeed in the overall goal of recovering fast according to the evidence-based care plan involves facing dilemmas and mobilizing courage and will to follow the regimen. Support from the professionals is crucial. The participants had a strong desire to comply and regain health; but this role of being a good and cooperative patient had a built-in asymmetric power relationship favouring the professionals' expectations. The complexities of this power relationship were related to both patient factors and contextual factors, e.g. the daily regimen and hospital norms. Although patient participation in care is an accepted ideal, it is demanding and difficult to accomplish. More studies on fast-track programmes are needed, with special attention to patient autonomy and partnership

The experience of dependence on homecare among people ageing at home

Being dependent on homecare potentially threatens a person’s integrity and autonomy, particularly when people are dependent on help to manage basic bodily functions that involve intimacy and nudity, making the person vulnerable despite being in his or her own home. As the population continues to age and live longer, more people are expected to be dependent on homecare. The aim of this study was to investigate the phenomenon of dependence on homecare among people ageing at home. Individual in-depth interviews were used to explore 15 Danish and Norwegian homecare receivers’ experiences of dependence on homecare. Interview records were transcribed and analysed in a hermeneutical phenomenological process described by van Manen. First and foremost, the experience of dependence on homecare is a question of adaption. The older people in this study struggled to get used to their deteriorating body and at the same time they continuously had to negotiate to get care in accordance with their values. Being dependent on care could be experienced as being reduced to a task or a problem to be solved though the participants had a significant need for undivided mental attention. The presence of homecare staff in the participants’ homes could entail a change where the participants experienced that they lost control over the surroundings. According to the voices of the older people in this study, future homecare should be accommodated in an organisational set-up that gives priority to stability and continuity in the relation between the homecare receiver and the homecare staff. Also it is significant that homecare staff do not have a taskoriented approach to their job and are sensitive to the values of the homecare receivers

Living with clipped wings&#x2014;Patients&#x2019; experience of losing a leg

This study explores the lived experience of losing a leg as described by the patients themselves post-discharge. Studies have documented that regardless of aetiology patients are faced with severe physical as well as psychosocial challenges post-amputation. However, only few studies explore in-depth the patients&#x2019; perspective on the various challenges following the loss of a leg. The study uses the phenomenological approach of Reflective Lifeworld Research (RLR). Data were collected from 24 in-depth interviews with 12 Danish patients. Data analysis was performed according to the guidelines given in RLR. The essential meaning of losing a leg is a radical and existential upheaval, which restricts patients&#x2019; lifestyle and irretrievably alters their lifeworld. Life after the operation is associated with despair, and a painful sense of loss, but also with the hope of regaining personal independence. The consequences of losing a leg gradually materialize as the patients realize how the loss of mobility limits their freedom. Patients experience the professional help as primarily directed towards physical care and rehabilitation. The findings show that the loss of a leg and, subsequently, the restricted mobility carry with them an existential dimension which refers to limitation of action space and loss of freedom experienced as an exclusion from life. Our findings demonstrate a need for complementary care and stress the importance of an increased awareness of the psychosocial and existential consequences of losing a limb