| 101. |
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| 102. |
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| 103. |
- Hov, Reidun, 1947-
(författare)
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Nursing care for patients on the edge of life : Nurses’ experiences of nursing care in intensive and nursing home related to questions of withholding or withdrawing curative treatment
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to deepen the understanding of nursing care for seriously ill patients on the edge of life in intensive care unit (ICU) and nursing home when questions were raised whether to withhold or withdraw curative treatment. Method: All studies were conducted in a qualitative frame of reference with interviews of nurses in two contexts in Norway; group interviews of 14 nurses in an ICU (study I, III), and individual interviews of 14 nurses in two nursing homes (study II, IV). Data were analysed with interpretative phenomenology (I, III, IV) and phenomenography (II). Findings: The nurses’ descriptions of the patients on the edge of life were interpreted as ‘being in a twilight zone’, a state between living and dying. The patients’ situation were understood to be very burdensome as they were mostly ‘voiceless’ and unable to call for, or refuse help and totally surrendered to other people’s devices. Their state was strained by extensive suffering; pains and bodily afflictions, loneliness, confusion and without control and dignity (I). Their need for nursing care was comprehensive (I, II) with an overall need for dignity (II), which included having the needs for preparedness, human relationship, comfort and safety met (II). The patients’ inabilities to express themselves clearly involved major challenges for nursing care (I - IV). Good nursing care was described as caring for the individual patient based on his/her situation and needs. The nurses experienced themselves to be of imperative importance for the patient’s living or dying (III, IV) and their interpretation of the patient’s condition was crucial (III). Their commitment and drive to help was high, they knew what good nursing care was for the patients (I - IV), and they were proud when they succeeded in their care (III, IV). An outstanding finding was the nurses’ experiences of ambiguity of both certainty and uncertainty. Being certain mostly seemed to concern nursing care related to the patient’s needs and situation (I, II), and uncertainty to what was ‘right’ to do with regards to withholding or withdrawing treatment (III, IV). They often experienced loneliness, too much responsibility, a vulnerable professional pride, and being pulled between opposite poles when they struggled to give good nursing care (I - IV), but too often they failed (II, IV). This demanding situation sometimes led to the nurses’ use of several self-protecting strategies. Whether the patients could receive good nursing care or not did not only depend on the single nurse, but was also anchored in opportunities and hindrances on a relational and an organisational level (I – IV). There were many congruities in patterns in the experiences of ICU - and nursing - home - nurses with regards to the situation and needs of patients on the edge of life, and good nursing care. Congruities were also found regarding being a nurse when caring for these patients, and nurses’ opportunities and hindrances for carrying out good nursing care. Conclusion: This thesis shows that nursing care was experienced as being of crucial importance to the patients on the edge of life, and the nurses knew very well what good nursing care was for them. However, the nurses’ opportunities to perform good nursing care depended on several preconditions and were restricted by hindrances on different levels, which have to be overcome in order to fulfil patients’ needs and nurses’ ambitions of giving good nursing care. As such, this thesis highlights a wide-ranging understanding of nursing care for these patients, which should challenge individual nurses, but also other health care workers, leaders and politicians.
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| 104. |
- Hov, Reidun, et al.
(författare)
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Nursing care for patients on the edge of life in nursing homes : obstacles are overshadowing opportunities
- 2013
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Ingår i: International Journal of Older People Nursing. - : Blackwell Publishing. - 1748-3735 .- 1748-3743. ; 8:1, s. 50-60
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Tidskriftsartikel (refereegranskat)abstract
- Background. Patients in nursing homes have comprehensive needs for nursing care and medical treatment. Most patients benefit from the treatment, but some are ‘on the edge of life’-in a borderland between living and dying with an unpredictable outcome, and questions are sometimes raised whether to withhold/withdraw curative treatment.Aim. The aim was to describe nurses’ conceptions of good nursing care, and how this could be carried out for patients on the edge of life in nursing homes.Design. In order to discover variations in the nurses’ understandings a phenomenographic approach was chosen. Phenomenography is concerned with qualitatively different ways of conceiving a phenomenon.Methods. Fourteen nurses from two nursing homes were individually interviewed twice. A phenomenographic analysis was used.Results. The outcome-space included two main categories. The first, ‘good nursing care is to meet patients’ needs for dignity,’ included three description-categories: needs for ‘preparedness’, ‘human relationship’ and ‘bodily comfort and safety’. The second, ‘opportunities were overshadowed by obstacles’ in carrying out nursing care encompassed three description-categories: ‘organisational factors,’‘relational factors’ and ‘personal factors’.Conclusions. This study shows nurses’ conceptions of the importance of good nursing care for comforting patients on the edge of life.Implications for practice. Several obstacles related to resources, communication, cooperation and nurses' professional strength and power need to be overcome if good nursing care can be performed.
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| 105. |
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| 106. |
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| 107. |
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| 108. |
- Jansson, Lilian, et al.
(författare)
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Interpreting Facial Expressions in Patients in the Terminal Stage of the Alzheimer Disease
- 1993
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Ingår i: Omega. - 0030-2228 .- 1541-3764. ; 26:4, s. 319-334
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Tidskriftsartikel (refereegranskat)abstract
- Videotaped interactions between each of two experienced caregivers and each of four patients in the terminal stage of the Alzheimer disease were interpreted. A hermeneutic approach was used to analyze the videotapes. It was possible to see the patients as capable of having experiences and of communicating them to their caregivers. The analysis made it possible to put together the observed communicative cues into a narrative for each patient. The study may contribute to the improvement of the care of severely demented patients by affecting caregivers' preunderstanding of these patients' experiences and communicative abilities.
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| 109. |
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| 110. |
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