| 1. |
- Andreassen Devik, Siri, et al.
(författare)
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Nurses’ experiences of compassion when giving palliative care at home
- 2020
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 27:1, s. 194-205
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Tidskriftsartikel (refereegranskat)abstract
- Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised.Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data.Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes.Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content.Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective.
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| 2. |
- Hammarström, Lars
(författare)
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Encounters with patients in forensic inpatient care : Nurses lived experiences of patient encounters and compassion in forensic inpatient care
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Forensic psychiatry is characterised by compulsory care and long hospital stays, where nurses care for patients with severe mental illness, who often have committed crimes. The main objective is to rehabilitate the patient to once again become a part of society by improving mental health and decreasing the risk of criminal relapse. This is mainly achieved through encounters with the patients. Encountering patients in forensic psychiatry means coming face to face with suffering and the duality of caring, doing what is best for the patient and protecting society.Aim: The purpose of the study was to obtain a deeper understanding of encounters with patients with mental illness in forensic inpatient care as experienced by nurses.Method: This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design. A total of 13 nurses working at a forensic psychiatric hospital in Sweden were recruited through a purposive sample to participate in the studies through narrative interviews. Study I was analysed with phenomenological hermeneutics in line with Lindseth and Norbergh (2004) in order to illuminate the lived experience of nurses’ encounters. Study II was a secondary supplementary analysis, which applied hermeneutics in line with Fleming, Gaidys, and Robb (2003) to gain a deeper understanding of nurses’ compassion in forensic psychiatry. The two studies were merged to provide a comprehensive understanding in this licentiate thesis.Findings: Study I illuminated the meaning of nurses’ lived experiences of encounters with patients with mental illnesses in forensic inpatient care, that is the nurses’ desire to do good despite being confronted with their own emotions as fear, humiliation, and disappointment. Encounters were also occasionally perceived as positive, awakening emotions of compassion, competence, pride, trust, satisfaction, and gratification regarding the patient’s recovery. However, a source of conflict was the struggle between doing what was best for the patient and protecting society. The study comprised of four themes: being frustrated, protecting oneself, being open-minded, and striving for control. Study II aimed to gain a deeper understanding of nurses’ compassion in providing forensic psychiatric inpatient care with three themes: recognising suffering and need for support, responding to patient suffering, and reacting to one’s own vulnerability. Abstracting to a main theme of being compassionate in forensic psychiatry which is described as an emotional journey, an ongoing inner negotiation between own vulnerability and expressions of suffering. This inner negotiation of making sense of patients’ plea and how they were perceived was crucial for determining the development of compassion rather than turning to control and rules as a means to protect oneself.Discussion: A interpretation of the studies (I, II) revealed two topics, being sensitive and responsive and keeping distance, which were reflected upon against the theoretical framework of Kari Martinsen. The studies showed that nurses faced a variety of encounters that forced them to face their own vulnerability and that trust could reduce power imbalances as well as help deal with societal, man-made constructs. The nurses’ encounters with incomprehensible expressions of suffering also show that nurses need to find a way to make room for “expressions of life”– taking a step back and turning their gaze inwards – in order to regulate their own emotions. This may better equip nurses to encounter patients with compassion and kindness rather than turning to norms and rules to protect themselves and guard their own vulnerability. Rather than distancing themselves from the patients, nurses can instead take a step back to come closer to their patients.
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| 3. |
- Hammarström, Lars, et al.
(författare)
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‘Fleeing’ as a Strategy for Navigating Resistance in Patient Encounters within Forensic Care
- 2023
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Ingår i: Healthcare. - : MDPI AG. - 2227-9032. ; 11:21
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the phenomenon of “fleeing the encounter when facing resistance” as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one’s emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers’ self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient’s lifeworld but also their own.
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| 4. |
- Hammarström, Lars, et al.
(författare)
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Meanings of carers’ lived experience of “regulating oneself” in forensic psychiatry
- 2022
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE This study aimed to illuminate the essential meanings of carers’ lived experience of regulating themselves when caring for patients with mental illnesses in forensic inpatient care.METHODS Qualitative analysis was used to analyse data from narrative interviews with open-ended questions conducted with nine carers, which were analysed using a phenomenological-hermeneutic approach.RESULTS Findings revealed three themes, “preserving oneself as a carer,” “building an alliance with the patient” and “maintaining stability in the community.” Carers not only regulated emotions related to patients but also the ward to facilitate a caring climate. For carers, encounters with patients meant facing expressions of suffering that evoked unwanted emotions. Regulating one’s emotions also meant being emotionally touched and facing one’s vulnerability.CONCLUSION Regulating oneself was a strategy used by carers to get closer to the patient and establishing a trusting relationship. Regulating oneself meant becoming aware of one’s shortcomings, not projecting them onto others, which may impair establishing relationships with patients and fulfilling the aim and caring task of forensic psychiatry. This study stresses the importance of carers being guided to manage their conflicting emotions and vulnerabilities and finding courage and an approach that allows a permissive climate of self-reflection.
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| 5. |
- Hammarström, Lars, et al.
(författare)
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The path of compassion in forensic psychiatry
- 2020
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Ingår i: Archives of Psychiatric Nursing. - : Elsevier BV. - 0883-9417 .- 1532-8228. ; 34:6, s. 435-441
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to deepen our understanding of the concept of compassion in caring for patients with mental illness in forensic psychiatric inpatient care settings. Qualitative analysis was used to illuminate themes from interviews conducted with 13 nurses in a prior study. The audiotaped interviews, which had been transcribed verbatim, were analyzed following a hermeneutic approach. Results revealed the main theme of “being compassionate in forensic psychiatry is an emotional journey” and three themes. Overall, compassion was seen as a changeable asset, but also an obstacle when absent; sensitivity to one's own vulnerability is necessary to overcome that obstacle.
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| 6. |
- Hammarström, Lars, 1983-
(författare)
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“To see the person behind the crime, through the eyes of the person behind the keychain” : - Carers lived experiences of patient encounters in forensic inpatient care.
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Forensic psychiatric care (FPC) encompasses involuntary care and treatment of those who have committed a crime. On the one hand, FPC is constructed regarding the respect for the individual’s freedom and autonomy, and on the other hand, it is constructed on societal protection. Being a carer in FPC is intertwined with being faced with a distinct ethical dimension of care, as it involves caring for patients who are deprived of their freedom, meaning dealing with the tension of care and custody. Caring means often finding oneself in encounters with individuals with inevitable elements of rules, coercion, threats, and violence. In this complex environment, a caring relationship is to be established, which is intended to be built on trust, as a forensic nurse’s main purpose is creating wellbeing and care, based on the patient’s perspective. It is in the everyday encounters that occur often spontaneously that the carer–patient relationship should be established. It is in these encounters that the carer is given the opportunity to relive suffering. The encounter becomes the focal point where the lifeworlds of the carer and patient meet. Dealing with the duality of FPC and contradictory emotions requires a deeper understanding, which encourages to self reflect the meaning of these encounters and oneself as a carer. Aim: The overarching purpose of the thesis was to obtain a deeper understanding of carers’ lived experience of encounters with patients with mental illness in forensic inpatient care. Method: The thesis consists of four studies (I, II, III, IV) with qualitative design, based on ontological and epistemological reasonings of phenomenology and hermeneutics. The studies illuminated the lived experience and are conducted with phenomenological hermeneutics (I, III), hermeneutics (II), and reflective lifeworld research (IV). Findings: Encounters with patients are characterised with the duality of acting upon the patients’ needs and managing rules and norms stipulated in laws and regulations that govern FPC and societal protection. Encounters in FPC and being a carer is intertwined with being put in a position of power, where the carer also must be allowedviito be fragile and deal with vulnerabilities and not play a role. The encounter means being in a duality and having the insight of the tension of impressions of expressions of suffering, being in the “space in-between”. In this space, there is room and a possibility for carer’s personal growth, and achieving a phenomenological attitude and to truly embrace the patients’ lifeworld. Discussion: A comprehension of the studies (I, II, III, IV) revealed four topics, having trust or feeling distrust, being compassionate or being indifferent, having courage or being afraid, and being genuine or pretending. These were reflected upon against the theoretical framework of K. E. Lögstrup. The duality of FPC and the space in-between that arises in the encounter suggests that the carer is forced to be confronted with existential phenomena that constitutes one’s world. By being active in the space in-between and reflecting upon openness, the carer moves between this duality that exists in the continuum that the opposite phenomenon contains. The space in-between may become a place and a possibility for personal growth by being active and obtaining a phenomenological approach. This is obtained by an openness and consciousness to the impression by self-reflection to convey its meaning. If carers can do this by openness and compliance, there is a possibility for the encounter to become a place for personal growth, that encourages the sovereign utterances of life, and carers may to a greater extent understand themselves as well as patients’ expressions of suffering.
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| 7. |
- Hammarström, Lars, et al.
(författare)
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"You Know Where the Boundary Is When You Cross It"-A Phenomenological Understanding of Vulnerability as Experienced by Carers in Forensic Inpatient Care
- 2022
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Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 43:8, s. 712-720
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Tidskriftsartikel (refereegranskat)abstract
- In forensic nursing, carers must balance caring and limiting actions in encounters with patients. Interpreting suffering in others raises awareness of one's own vulnerability. Hence, the aim of this study was to describe the phenomenon of vulnerability as experienced by carers in forensic inpatient care. Nine participants were recruited at a major forensic hospital, and their narratives were analysed with a reflective lifeworld approach. The findings revealed that vulnerability was both a strength and a burden. Vulnerability comprised becoming aware of one's boundaries, being genuine and protecting oneself. Dealing with vulnerability enables carers to open up to patients.
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| 8. |
- Hellzén, Ove, 1954-, et al.
(författare)
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A Meta-Ethnographic Review of Forensic Psychiatry Inpatient Care. Nursing Staff Experiences of the Nurse-Patient Encounter
- 2023
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Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 44:12, s. 1226-1236
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this review was to synthesise qualitative research into how nurses perceive and experience encountering patients in forensic inpatient care. Review method This review followed the steps of meta-ethnography developed by Noblit and Hare. Data sources Twelve studies, published from 2011 to 2021, were identified through a search of relevant databases in December 2021. Findings The synthesis revealed three third-order and 10 second-order constructs during the translation of concepts in the studies. These are: Adopting the patient’s perspective (liberation, comprehension and resistance), Action (security, trust, flexibility and predictability) and Activation (afraid or safe, involved or indifferent and boundaries). Further, a line of argument was developed which indicates that in forensic psychiatry inpatient care, nurses experience having to deal with internal and external resistance that affects their freedom of choice in the creation of a caring relationship. Conclusion The encounter is experienced as a continuous process in which the foundation is laid for the encounter (approach), the encounter unfolds and develops (action) and the nurse experiences the encounter (activation). The process is intertwined with and takes place in a context where care is influenced by the duality of the task (task), the culture of care (context), the patient’s expression (patient) and the nurse’s own impression of the patient’s expression (oneself). Implications Professional communities should support initiatives that can strengthen nurses’ self-awareness and provide opportunities for reflection on practice, which will both benefit the resilience of the nursing staff and the quality of care for patients in this setting.
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| 9. |
- Voraroon, Supaporn, 1977-, et al.
(författare)
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Participation in Shareholding Networks for the Care of Older People in Rural, Thailand
- 2021
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Ingår i: Psychology and Education. - 1553-6939. ; 58:2, s. 2587-2602
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Tidskriftsartikel (refereegranskat)abstract
- Given the lack of knowledge about rural-dwelling older adults’ experiences with health-promoting activities in shareholding network. The purpose of the study reported here was to explore older adults’ experiences with health promotion in shareholding network for the care of older people living in rural areas. Qualitative research methodology were used in-depth interviews and conducted with 15 older members of shareholding network in Thailand during 2017, and interview transcripts were subjected to content analysis guided by the World Health Organization’s theoretical framework for health promotion. Among the results, knowledge, fellowship and dignity were identified as general elements of health-promoting experiences, and activities organised by the shareholding network reflected the four categories of health-promoting elements proposed by the World Health Organization: empowerment to control health, participation in society, self-determination and shared responsibility. The results indicate that activities in the shareholding network contributed to the support provided by peer volunteers, which has potential to be an effective strategy for increasing activity among older adults, particularly ones who are inactive and socially disengaged. Conclusion, shareholding network for thecare of rural-living older people seem to promote a culture of volunteerism that holistically satisfies individual older person’s needs in the process of strengthening his or her self-care.
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| 10. |
- Voraroon, Supaporn, 1977-
(författare)
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Participation in shareholding networks for the care of older persons in rural Thailand : Older persons’ and relatives’ experiences
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore how older persons and family caregivers experience taking part in shareholding networks related to health promotion activities for older people in rural areas in Thailand. The thesis had a qualitative research design and is based on original articles (I-IV). Data were collected through paired interviews with older persons and their relatives (I), individual interviews with older persons (II), and by narrative interviews (III-IV). Qualitative data was analyzed with content analysis, phenomenological hermeneutics, and phenomenological philosophy. Study I showed that older persons and their family members experienced outsider status and disregard for older persons` individuality in the community, when participating in shareholding networks. The theme of outsider status described shortcomings in healthcare encounters and the theme of disregard described the lack of engagement of authorities and caregivers in older persons’ care. The concept of participation emerged as a framework for understanding interviewees’ experiences. Local authorities, older individuals, and their family members should engage in dialogue in order to support healthcare based on shared understanding. Study II identified four categories that reflected expressions of health promotion elements in shareholding networks activities: empowerment to control health, participation in society, self-determination, and shared responsibility. All of this can be seen as an important part of a health process. The results indicated that shareholding networks activities contributed to peer volunteering support that has potential to be an effective strategy for increasing activities in older adults, particularly among those who are inactive and socially disengage. Shareholding networks for the care of older people in rural areas seems to promote and preserve volunteerism that satisfies the individual old person's needs—from a holistic perspective—as a way to strengthen self-care. Study III found that older person’s lived experiences with participation in shareholding networks entailed both positive meaning and negative meaning. The participation could be understood as being satisfying, being valuable, being frustrating, and being boring. Study IV showed that participating in shareholding networks activities entails an always-present existence of aging intertwined with life. Its constituents further described the essential meaning of the phenomenon: “experience of improved self-management”, “feeling of increased self-esteem”, and “bridging the gap in the care of older people”. Participation in shareholding networks activities meant keeping contact with oneself and being able to have a life that corresponds to how one perceives oneself to be and must therefore be understood from a holistic perspective that satisfies the individual older person’s needs in the process of strengthening self-care. This thesis concluded that participants experienced benefits when they participated in shareholding networks for the care of older people in rural areas. Participation improved their health, increased their independence and their self-care ability, as well as strengthened their feelings of dignity. Health professionals should initiate a dialogue with shareholding participants to develop a cooperating model of care focusing on the participants` needs. Healthcare must be based on shared understandings and reflections on existential issues such as identity, trust, self-confidence and dignity.
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