| 1. |
- James, Inger, 1953-
(författare)
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Bakom rutinerna : kunskap och omvårdnadspraxis i mänskliga gränssituationer
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study how family members, next of kin, and healthcare professionals construct and use knowledge in nursing praxis in human boundarysituations.The study was carried out on a surgical ward at a university hospital in Sweden.Methodology: Study I: A case study; data concerning a family with six familymembers were collected over 10 months using interviews, conversations, and diary notations.Study II: A hermeneutic approach; interviews with 27 family carers were conductedsix to eight months after a family member’s death. Studies III, IV: a combinedethnographic and hermeneutic approach; participant observations (285 hours), informalconversations (190), and interviews (25) were conducted with 25 nurses and 18 assistant nurses.The main findings were: (I) The family members used beliefs to explain and understandcancer, dying and death. The beliefs were aggregated into eight main beliefs and fourthemes: cancer is a deadly threat/death is a liberator; death can be held at bay/death canbe lived near; dying is done alone/dying should not be done alone; and life has anend/life is endless. These beliefs appear to oscillate between seemingly contrastingpoles. (II) The family carers made their own assessment of their loved one’s conditionand situation. Their actions were characterized by struggling to get treatment, being leftbehind, being partners, keeping the illness at a distance, hovering beside their loved one,waiting for death, and being experts and protectors. The family carers used practicalwisdom, phronesis, regarding what care was the best, or least harmful, for their lovedone in the encounter with professional care. (III) The nurses constructed knowledgethrough greeting the patient, and reading the patient. By being sensitive, using humor,and emotional involvement, understanding was deepened. By being suspicious and selfcritical,interaction was sought with nurse colleagues, the patient, relatives, and the doctor,and additional knowledge was obtained. They strived to be one step ahead in theirefforts to attain an understanding of the patient´s situation. The knowledge nurses makeuse of can be related to the intertwined and embodied forms of theoretical knowledge,i.e., episteme, practical professional knowledge, i.e., techne, and practical wisdom i.e.,phronesis. (IV) The nurses created and used emotional knowing that could be interpretedin relation to various rooms of emotions, thoughts and actions. They strived to dothings correctly in the normative room; created a safe, secure milieu for patients andnext of kin in the safety-security room; and questioned their actions in the critical room.They created an affinity for co-operation that was of benefit in encounters with patientsin the nurses’ affinity room. And they demonstrated compassion for patients and next ofkin; this compassion was particularly evident in the closeness room.Conclusion: In praxis, construction and use of knowledge occurs that often takes placebehind the routines. This knowledge constitutes an important content in nursing. Thehermeneutic spiral can serve a pedagogic purpose in elucidating nursing and its differentforms of knowledge.
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| 2. |
- Edvardsson, David, 1973-
(författare)
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Atmosphere in care settings : Towards a broader understanding of the phenomenon
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the study is to understand and describe the phenomenon ‘atmosphere in care settings’ as experienced by patients, significant others and health care staff. The study consists of four papers, each of which illuminates various aspects of the phenomenon. Data consisted of observations and interviews with patients, significant others and staff (n=126) within a hospice, a geriatric, a medical and an oncology setting, and community care settings for older people. Narrative analysis, grounded theory, and phenomenological hermeneutics were used in a triangular fashion to analyse the data. The findings illuminate the phenomenon ‘atmosphere in care settings’ as being constituted by two interacting and interwoven dimensions: the physical environment and people’s doing and being in the environment. The physical environment is the first dimension, and five aspects were illuminated, namely the physical environment as a symbol; as containing symbols; as influencing interaction; as facilitating a shift of focus from oneself to the environment, and; as containing scents and sounds influencing experiences of at-homeness or alienation. People’s doing and being in the environment is the other dimension, and five aspects were illuminated, namely the experience (or absence of experience) of a welcoming; of seeing and being seen; of a willingness to serve; of a calm pace; and of safety. It was understood that people’s doing and being influences experiences of the physical environment and that the physical environment influences experiences of people’s doing and being. The comprehensive understanding illuminated that the phenomenon is not merely subtle qualities of the place for care, but an active part of care. Both the physical environment and peoples doing and being conveys messages of caring and uncaring. The atmosphere of a care setting can at best support experiences of at-homeness in relation to oneself, others and the surrounding world.
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| 3. |
- Halldorsdottir, Sigiridur
(författare)
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Caring and uncaring encounters in nursing and health care : Developing a theory
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of the present thesis was to develop a theory on caring and uncaring encounters within nursing and health care from the patient's perspective.Results of an analysis of two phenomenological studies (paper I), as well as research findings from five other phenomenological studies (papers II-VI), were used to develop the theory.Caring and uncaring can be conceptualized on a continuum symbolizing five basic modes of being with another, which, for example, involves a neutral mode of being with another, where the individual is perceived as neither caring nor uncanng.There are two major metaphors in the theory, that of the bridge, symbolizing the openness in communication and the connectedness experienced by the recipient of care in an encounter perceived as caring. The other metaphor is the wall, which symbolizes negative or no communication, detachment and lack of a caring connection, experienced by the recipient in an encounter perceived as uncaring.In the theory the importance of professional caring within nursing and health care is proposed, essentially involving competence, caring, and connection. The above-mentioned 'bridge' is developed through mutual trust and the development of a connection between the professional and the recipient. This connection is a combination of professional intimacy and a comfortable distance of respect and compassion -- professional distance. On the other hand, uncaring involves perceived indifference and incompetence, creating distrust, disconnection and the above-mentioned 'wall' of negative or no communication.The recipient of professional caring is influenced positively. Theconsequences, which are an increased sense of well-being and health, can be summarized as empowerment. Uncaring, however, has the negative consequences of decreased sense of well-being and health, which can be summarized as discouragement. Empowerment and discouragement in this context are defined as subjective experiences of the recipients of care.The importance of seeing the recipient in his or her inner and outer contexts is emphasized in the theory. The inner context involves perceived needs, expectations, previous experiences and sense of self, which in the perspective of the recipient of nursing can be summarized as both a sense of vulnerability and the need for professional caring. The perceived hospital environment comprises the recipient's outer context.It is concluded that nurses and other health professionals can, by theirprofessional caring or lack of it, be powerful sources of empowerment ordiscouragement to those whom they are pledged to serve.
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