| 1. |
- Andersson, Niklas
(författare)
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När vårdande och lärande sammanfaller : Patienters, studenters och handledares erfarenheter av möten på en utbildningsvårdavdelning inom psykiatrisk vård
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- When students learn caring during clinical practice, the usual point of departure is thatcaring and learning coexist, as separate and parallel phenomena. There is, however, a needto study how caring and learning relate to one another, as well as when and how theyconverge. The aim of this dissertation is to describe how caring and learning converge inthe encounters between students and patients, in a dedicated educational unit withinpsychiatric care, as experienced by students, patients, and supervisors. Describing howsupervisory support can facilitate this is another aim. A reflective lifeworld approach basedon phenomenological philosophy has been applied. Data were collected through interviews,participant observations with follow-up interviews, and narrative diaries.The result shows that caring and learning converge in those encounters between studentsand patients which are characterized by reciprocity, wherein the patient’s narrative is thepoint of departure, complemented by the student’s listening and inquiring attitude. It ishere, that the desire for and pursuit of health and understanding, give the reciprocalinteraction power. The common desire of those involved to know, to become accustomedto the new and unfamiliar, as well as the presence of a feeling of responsibility for oneanother, create questions which in turn create opportunities wherein students and patientsare available to one another.The dissertation shows that learning in a caring context can be complex. Despite theirbeing prerequisites for one another, competition and conflicts can occur when the caringand learning perspectives are not equally attended to. When they are placed counter to oneanother, there is a risk that reciprocal interaction is hindered, which can cause loneliness forall involved. For convergence to occur most propitiously, those involved must exist in acaring and learning togetherness. Responsible and present supervisors are needed, whocreate possibilities for the perspectives to converge through maintenance and monitoring, sothat caring and learning receive equal space.A didactic concept has been developed based on the dissertation’s result, focusing on themeaning of creating forums where students’, patients’, and supervisors’ caringconsiderations and reflections can intertwine.
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| 2. |
- Dahlqvist, Vera, 1954-
(författare)
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Samvete i vården : att möta det moraliska ansvarets röster
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is twofold: first, to develop and validate questionnaires that could be used for investigating relationships between perceptions of conscience, moral sensitivity and burnout and second, to describe patterns of self-comfort used to ease stress and illuminate meanings of living with a troubled conscience. The thesis comprises five studies and is based on both quantitative and qualitative data.In study I, a questionnaire was constructed to assess perceptions of conscience; the Perceptions of Conscience Questionnaire (PCQ). This 15 item-questionnaire was distributed to 444 care providers. Statistical analyses of responses showed sufficient distribution and a stable six factor solution congruent with reviewed literature. The six factors were labelled: ‘the voice of authority’, ‘warning signal’, ‘demanding sensitivity’, ‘asset’, ‘burden’ and ‘depending on culture’. The findings suggest that the PCQ is a valid questionnaire. The aim of study II was further development of an existing questionnaire assessing care providers’ moral sensitivity, enabling its use in various care contexts. The revised nine-item questionnaire, the Moral Sensitivity Questionnaire Revised version (MSQ-R), was distributed to 278 care providers with various professional backgrounds. Statistical analyses of responses showed sufficient distribution and a three-factor solution congruent with reviewed literature. The three factors were labelled: ‘sense of moral burden’, ‘sense of moral strength,’ and ‘sense of moral responsibility.’ The findings suggest that MSQ-R is valid for use in various healthcare contexts. In study III, the PCQ, the MSQ-R and the Maslach Burnout Inventory (MBI) were distributed to a population of psychiatric care providers (n=101) to investigate relationships between perceptions of conscience and moral sensitivity and levels of burnout. The hierarchical cluster analysis shows two clusters with Pearson’s r >.50. Cluster A comprising items such as: being sensitive, interpreting and following the voice of conscience that warns us against hurting other or ourselves and developing as human beings was labelled ‘experiencing a sense of moral integrity’. Cluster B comprising items such as: feeling inadequate, doing more than one has strengths for, feeling always responsible, having difficulties to deal with wearing feelings, perceiving that conscience gives wrong signals and express social values, having to deaden one’ conscience, were all related to scores of the MBI subscales emotional exhaustion (EE) and depersonalisation (DP). Cluster B was labelled ‘experiencing a burdening accountability’. The results show that levels of ‘experiencing a burdening accountability’ are closely related to levels of being at risk of burnout.The aim of study IV was to describe patterns of self-comforting measures used to ease stress. The written accounts of 168 care providers and healthcare students were analysed by means of qualitative content analysis. The findings disclose two dimensions: an ability to use early learned measures to take care of oneself (ingression) and an ability to feel intimately related to life, other human beings and universe or God (transcendence). The findings provide valuable knowledge about self-comfort as a coping strategy. The aim of study V was to illuminate meanings of living with a troubled conscience. Ten psychiatric care providers, respondents of study III with various perceptions of conscience were interviewed. The interviews were interpreted using a phenomenological - hermeneutical method. The findings show that one meaning of living with a troubled conscience is being confronted with inadequacy and struggling to view oneself as ‘good enough.’ The comprehensive understanding indicates that inadequacy, both one’s own and that of organization one represents, infuse feelings of shame rather than feelings of guilt. Shame concerns one’s identity and need of reconciliation.Conclusions: The results reveal two ways of encountering a troubled conscience. One is being unable to interpret the ethical demand from a troubled conscience. This is indicated by connections between levels of moral burden and levels of burnout. The other way is being able to interpret the ethical demand and using one’s troubled conscience to develop practical wisdom. This means facing shame of feeling inadequate, reconciling images of the ideal self and self-contempt, and becoming realistic about what one can do. In this process comfort seems to be a mediator of reconciliation.
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| 3. |
- Edlund, Margareta, et al.
(författare)
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Concept determination of human dignity
- 2013
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 20:8, s. 851-860
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Tidskriftsartikel (refereegranskat)abstract
- This study presents findings from an ontological and contextual determination of the concept of dignity. Thestudy had a caritative and caring science perspective and a hermeneutical design. The aim of this studywas to increase caring science knowledge of dignity and to gain a determination of dignity as a concept.Eriksson’s model for conceptual determination is made up of five part-studies. The ontological and contex-tual determination indicates that dignity can be understood as absolute dignity, the spiritual dimension char-acterized by responsibility, freedom, duty, and service, and relative dignity, characterized by the bodily,external aesthetic dimension and the psychical, inner ethical dimension. Dignity exists in human beings bothas absolute and relative dignity.
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| 4. |
- Fischer Grönlund, Catarina, 1962-
(författare)
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Experiences of being in ethically difficult care situations and an intervention with clinical ethics support
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Studies show that healthcare professionals often experience ethical difficulties in their relations with patients, relatives, and other professionals and in relation to organisational issues, and these can sometimes be difficult to handle. Failing to act or to relate in accordance with one’s values for what is good and right might cause a troubled conscience that is connected to feelings of guilt and ill-being. Ethical issues related to the care of patients with end-stage renal disease have been described, but no studies in this context have been found that explore registered nurses’ (RNs’) and physicians’ experiences of being in ethically difficult situations that give rise to a troubled conscience. The importance of communicating ethical issues in order to understand and handle ethically difficult care situations has been emphasized. Various forms of clinical ethics support (CES) have been described and evaluated, but studies on the communication processes and the organisation of CES interventions are sparse and no study describing a CES intervention based on Habermas’ theory of communicative action has been found.Aim: The overall aim was to increase our understanding about being in ethically difficult care situations and about how communication concerning ethical issues in healthcare can be promoted. More specifically, the aim of studies I and II was to illuminate experiences of being in ethically difficult situations giving rise to a troubled conscience among RNs and physicians, while studies III and IV aimed to describe the communication of value conflicts (III) and the organisation and performance of a CES intervention (IV).Methods: In studies I and II narrative interviews with ten RNs (I) and five physicians (II), were performed in a dialysis care context. The interviews were analysed using a phenomenological hermeneutic approach. In studies III and IV, eight audio- and video-recorded and two audio-recorded sessions of the CES intervention, were conducted and sorted by the data tool Transana and analysed in accordance with a qualitative content analysis (III) and a qualitative concept- and data-driven content analysis (IV).Results: The RNs’ narratives (I) resulted in the theme ‘Calling for a deliberative dialogue’. Their narratives expressed feelings of uncertainty, solitude, abandonment, and guilt in complex and ambiguous ethically difficult situations. The narratives concerned the value conflict between preserving life by all means and preserving life with dignity. The physicians’ narratives (II) resulted in the themes ‘Feeling trapped in irresolution’ and ‘Being torn by conflicting demands’. Their narratives expressed feelings of uncertainty, solitude, abandonment and guilt related to the obligation to make crucial decisions and in situations when their ideals and the reality iii clashed. The analysis of the communication of value conflicts during the CES intervention inspired by Habermas’ theory of communicative action (study III) revealed a process of five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, revelation of the value conflict, enhancing realistic expectations of the patients and relatives, and seeing opportunities to change the situation instead of obstacles. The CES intervention (study IV) was organised as a framework with a given structure and an openness for variations to facilitate communicative action. Three courses of actions to reach a communicative agreement were identified and concerned the approach to achieve a permissive communication, opening up for extended views, and enhancing mutual understanding (IV).Conclusion: The results show that both RNs and physicians expressed feelings of uncertainty abandonment and loneliness in similar ethically difficult situations but from different points of view. They struggled with the same value conflicts and feelings, but they did not share their struggles with each other. The lack of communication and confirmation led to distrust and increased feelings of uncertainty. The CES intervention, inspired by Habermas’ theory of communicative action, offered the possibility of dealing with experiences of ethically difficult care situations. In the permissive atmosphere, the professionals helped each other to balance their ambiguity, frustrations, and powerlessness and came to an agreement about how to handle the value conflicts and how to act. The findings from this CES intervention constitute a step towards a CES method that is clearly described so that leaders can be educated and extended intervention studies with different kinds of data can be conducted in order to further develop knowledge about how to promote an inter-professional dialogue about ethical difficulties.
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| 5. |
- Gustafsson, Lena-Karin, 1966-
(författare)
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Försoning : ur ett vårdvetenskapligt perspektiv
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Avhandlingens övergripande syfte var att ur ett vårdvetenskapligt perspektiv belysa försoningens innebörder i förhållande till människans hälsa och lidande. Valet av perspektiv grundar sig på vårdvetenskapens ställningstaganden i relation till hälsa och lidande. De grundantaganden som varit forskningens utgångspunkt är att hälsa är mer än frånvaro av sjukdom, att hälsa innebär helhet och helighet, att lidande är en oskiljaktig del av livet samt att lidande och hälsa utgör varandras förutsättningar. Valet av perspektiv grundar sig dessutom på den kliniska vårdvetenskapens tankar om grundforskning vilken har som sin övergripande uppgift att forma ideal för vårdandet. Grundforskning inom klinisk vårdvetenskap syftar i första hand till utveckling av kunskap kring hälsa, lidande och vårdande samt förståelse för dessa fenomen i den kliniska situationen. Föreliggande forsknings övergripande frågeställningen var: Vad är försoningens innebörder? Denna frågeställning följdes av: Vad är försoning relaterat till hälsa och lidande? Forskningen har genomförts via fyra delstudier som alla skiftat gällande material och metod. Den övergripande metodologin har haft sin utgångspunkt i hermeneutik inspirerad av Paul Ricoeur. Den första delstudien är en metasyntes av aktuell forskning som berört försoning, medan den andra delstudien utgörs av en begreppsanalys av ordböcker. Delstudie tre består av skönlitterära texter som lyfter fram innebörder av försoning. Tolkningsprocessen i den tredje delstudien har följt en fenomenologisk hermeneutik riktning. Den fjärde delstudien är empirisk och utgår från berättelser om försoning. Dessa försoningsberättelser, från åtta kvinnor med personliga erfarenhet av sorg, har tolkats med utgångspunkt i en hermeneutisk narrativ ansats. Slutligen har en stillbild skapats utifrån förståelsen så som den framträder framför texten då avhandlingens olika delstudier gått i dialektik med varandra samt med tolkningsramen. Stillbilden utgör en belysning av försoningens innebörder i förhållande till människans hälsa och lidande. I denna visuella stillbild framträder två olika former av innebörder; De yttre formerna av försoningens innebörder belyser försoningens gestaltning och position i förhållande till hälsa och lidande. Försoning innehar en progressiv form som innebär en övergång från upplevelse av delar till helhet men också en helande process mellan dåtid och nutid samt utgör därmed en länk till framtiden. De inre formerna av försoningens innebörder belyser människans inre förhållande till hälsa och lidande. Försoningens innebörd kan ses som ett förenande genom härbärgerande av motsatser som tidigare varit skilda och omöjliga att rymma inom människan i en heterogens syntes.
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| 6. |
- Gustafsson, Lena-Karin, 1966-, et al.
(författare)
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The meaning of reconciliation : Women’s stories about theirexperience of reconciliation with suffering from grief
- 2011
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley Blackwell. - 0283-9318 .- 1471-6712. ; 25:3, s. 525-532
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Grief can be seen as a form of suffering. In this study grief was not only defined as loss, but as the process of inner suffering caused of some kinds of loss. We must recognise the importance of increased understanding for patient reconciliation with grief to expand earlier formulated knowledge about health and suffering. The aim in this study was ti illuminate the meaning of reconciliation among women suffering from grief.Methods:A qualitative explorative design with a hermeneutic narrative approach was used to analyse and interpret the interviews. Caring theory abouth health, suffering and hermeneutical philosophy about understanding provided the point of departure for the analysis. The study was approved by an ethical research committé.Results:Findings reveal different plots that give light to the meaning of reconciliation in the different phases of analysis. In the Women´s narratives the meaning of reconciliation is a process to a new way of seeing, but also to opening and transition from the experience of grief and suffering to the experience of health and holiness.Conclusions: Reconciliation has a progressive form and the meaning of reconciliation cannot be seen as synonymous or homogenous but an understanding of reconciliation as a heterogenic synthesis of health and suffering. Understanding the reconciliation process will enable nurses to plan and provide professional care, based on caring science.
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| 7. |
- Holst, Hanna, 1985-
(författare)
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Det lärande utrymmet : lärande och vårdande möten mellan patienter, studentpar och handledare vid Utvecklande och Lärande Vårdenheter
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim is to create knowledge about how nursing students’ learning in pairs can be supported in order to create prerequisites for encounters that provide caring and learning support during clinical practice.Approach and method: A reflective lifeworld research (RLR) approach founded on the epistemology of phenomenology and hermeneutics was used. Based on interviews, diary entries and observations with patients, students and supervisors, descriptive and interpretive analysis in accordance with the RLR approach was performed.Main findings: Students’ learning in pairs is based on encountering and caring for the patients together. The responsibility of caring for the patients, which is given to the students by their supervisors, is based on supportive relationships that are characterized by movements between independence and cooperation. Supporting students learning in pairs is characterized by a reflective approach focusing on learning in togetherness, where the individual student is also reached and seen, providing opportunities for developing important abilities for learning and caring. Depending on the ability to show respect and to take responsibility a more or less supportive relationship between the patients, the students and the supervisors is created within the learning space.Conclusions: Supporting students’ learning in pairs is complex due to it taking place in a caring context, where respect must be given towards the patients, the students, the supervisors and other participants who are closely connected to the learning space. Since learning in pairs affects and interweaves learning and caring environments, a reduction to either one of them, learning or caring, is not possible but instead the learning space must be understood as a whole. Optimal conditions for learning in pairs are based on dynamic movements, which require a reflective supervising approach. If these conditions are missing, there is a risk of creating both fragmented caring and learning, where the patients ́ vulnerability and safety needs to be taken into account.Keywords: caring science; clinical practice; learning space; learning support; pairs of nursing students; reflective lifeworld approach
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| 8. |
- Hällgren Graneheim, Ulla, 1947-
(författare)
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Störande beteende i interaktionen mellan personer med demens och deras vårdare
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med avhandlingen var att belysa innebörden i interaktionen mellan personer med demens och så kallat störande beteende och deras vårdare. I delstudierna I och II deltog en kvinna med frontallobsdemens och störande beteende (Ruth) respektive en kvinna med schizofreni, demens och störande beteende (Alice) och deras vårdare. Fjorton respektive 30 deltagande observationer samt sex respektive sju reflekterande samtal med vårdare genomfördes. Texterna tolkades med hjälp av kvalitativ innehållsanalys. I delstudie III gjordes narrativa intervjuer med sex vårdare och i delstudie IV genomfördes 10 informella samtal med tre personer med demens och störande beteende. Dessa texter tolkades med hjälp av fenomenologisk hermeneutisk metod. Innebörden i interaktionen mellan personerna med demens och störande beteende och deras vårdare handlar om att befinna sig i kaos och pendla mellan motsatser: att känna sig hemlös och hemma och att ”vara herre ”och ”vara slav”. Vårdarna upplever konflikter mellan att göra gott för individen och/eller kollektivet samt mellan de demensdrabbades beroende och önskan om självbestämmande. Såväl personerna med demens och störande beteende som deras vårdare pendlar mellan att känna sig hemlösa och hemma. Ruth lever i en fragmenterad värld där hon slåss för att skydda sitt revir. Hon kämpar också för att bli bekräftad samtidigt som hon bekräftar andra. Vårdarna bekräftar henne genom att möta henne i hennes värld. Alice lever i en tudelad värld där hon pendlar mellan ”himmel och helvete”. Hon misstror vårdarnas avsikter och slåss för sitt liv men hon visar också sin uppskattning och bekräftar vårdarnas ansträngningar. Även vårdarna upplever en tudelad värld. Innebörden i att leva med demens och störande beteende på institution handlar om att vara omgiven av oordning, fångad av begränsningar, satt åt sidan men också räknad med. Vårdarna befinner sig också i kaos och förstår inte vad det störande beteendet betyder. De upplever att de är fråntagna initiativet och känner sig utmattade och hjälplösa. Då och då upplever de att de har kontroll och känner sig dugliga och accepterade. Vårdarna pendlar mellan att ”vara herre” och ”vara slav”. Dialektiken mellan herre och slav handlar om kampen för ömsesidig bekräftelse. När vårdaren möter den demensdrabbade i sin egen (vårdarens) värld reduceras personen med demens till ett objekt. Därmed objektifierar vårdaren också sig själv. När vårdaren möter personen med demens i hans eller hennes värld, betraktar vårdaren den demensdrabbade som en betydelsefull person vars existens är viktig att bekräfta. Därmed känner sig också vårdaren betydelsefull. I hemmastaddheten bekräftas både personen med demens och vårdaren och kampen mellan herre och slav övergår i en Jag- Du relation. Störande beteenden är beteenden som inte bekräftar den andre. När vårdarna inte blir bekräftade upplever de personerna med demens vara störande och när personerna med demens inte blir bekräftade upplever de vårdarna vara störande. Bekräftelse uppstår i interaktioner som präglas av hemmastaddhet medan störande beteende visar sig i interaktioner som kännetecknas av hemlöshet.
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| 9. |
- Rundqvist, Eva, et al.
(författare)
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Power as authority - concept determination from a Christian and a caring science perspective
- 2006
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Ingår i: International Journal for Human Caring. - 1091-5710. ; 10:4, s. 39-44
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to deepen the understanding and the knowledge of the concepts and phenomena of power and authority from the standpoint of caring science. An ontological determination of the character of the concepts is carried out where a hermeneutic interpretation is made of texts in the Old and the New Testaments in the Bible. The findings show how a human being's power is the authority to hold every living thing in trust, to tend to and care for life. Serving one's fellow-being is the purpose for anyone using this authority.
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| 10. |
- Rydenlund, Kenneth, et al.
(författare)
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Hermeneutic caring conversations in forensic psychiatric caring
- 2019
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 26:2, s. 515-525
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Tidskriftsartikel (refereegranskat)abstract
- In forensic psychiatric care, a hermeneutic caring conversation between caregivers and patients can improve health outcomes. The hermeneutic approach entails starting from the whole and involves openness for what is shown as well as paying attention to the different parts. One way to deepen these conversations is to take advantage of both the caregivers and the patients life experiences.
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