| 1. |
- Mattsson, Janet, et al.
(författare)
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A qualitative national study of nurses’ clinical knowledge development of pain in pediatric intensive care
- 2012
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Ingår i: Journal of Nursing Education and Practice. - : Sciedu Press. - 1925-4040 .- 1925-4059. ; 2:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vulnerable children undergoing intensive care might still experience pain when they should not, due tonurses and pediatricians insufficient knowledge about how critical illness affects childrens’ signs of pain. How signs ofpain are learned in clinical practice might be one of the remaining aspects in nurses insufficient pain alleviation. In theworkplace learning is directed by what the units shared meaning finds as significant and meaningful to learn. However,what it is viewed as meaningful to learn about pain from the nurses’ perspective might not be meaningful from the child’sperspective. When working together in the PICU, nurses rely on each other and interact in many ways, and theirunderstanding is related to situated knowledge and facilitated by a personal reference group of colleagues. Professionalconcern, depending on culture, traditions, habits, and workplace structures forms the clinical learning patterns in thePICU. However little is known about nurses’ clinical learning patterns or collegial facilitation within the PICU. Theseassumptions lead to the aim of the study: to elucidate patterns in clinical knowledge development and unfold the role offacilitator nurses in relation to pain management in the PICU.Method: The study had a qualitative interpretive design approach using semi-structured interviews, analyzed withqualitative content analysis to elucidate both manifest and latent content.Results: The findings elucidates that the workplace culture supports or hinders learning and collaboration. Knowledgedevelopment within practice is closely connected to the workplace culture and to nurses’ significant networks. Thefindings also clarify that nurses needs to feel safe in the workplace and on an individual level to build and rely onsignificant networks that facilitates their own personal knowledge development. There is an ongoing interaction betweenthe learning patterns and the facilitation the significant networks offer.Conclusions: Nurses need to embrace effective learning about children’s pain from day one. Lack of a facilitatingstructure for learning, lack of assessment within clinical practice, and the focus on the individual nurses’ learning areremaining considerable problems when it comes to alleviating the vulnerable child’s pain. To increase the possibility ofpain alleviation in the clinical setting, it is of importance to attend to the caring culture and build a safe collaborative culture that is patient centered. This requires an environment that allows for open discussion, where questioning andreflecting is a natural part of the culture within the group. These factors need highlighting and thorough examination fromthe organization. Nurses focus on learning, and interact in a learning community of practice that is furthered when theyexperience a safe environment and find that their questions are taken seriously. Approaches to promote a scholarship ofnursing care are needed to develop clinical learning and, consequently, raise the quality of pain care.
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| 2. |
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| 3. |
- Mattsson, Janet
(författare)
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Uncovering pain and caring for children in the pediatric intensive care unit : nurses’ clinical approach and parent’s perspective
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The thesis has a standpoint in a synthesis of caring science and educationscience from a clinical perspective. Children in a Pediatric Intensive Care Unit (PICU) are in an exposed position, dependent on nurses to acknowledge their needs. The alleviation of children’s pain has been investigated from various perspectives, but undertreated pain remains a problem in the PICU. There is a preponderance of empirical evidence pointing toward the role of nurses in uncovering children’s pain and suffering. How nurses interpret the child’s expressions and judge the clinical situation influences their actions in the clinical care. In a PICU, the basis for nurses’ concerns and interpretation of what is meaningful in the nursing care situation are formed by professional concern, workplace culture, traditions, habits, and workplace structures. This influences how parents interpret the meaning of care as well. Patricia Benner’s theory on clinical judgment forms a reference framework for this thesis. The assumption is that children need to be approached from a holistic perspective in the caring situation in order to acknowledge their caring needs. A nurse’s clinical education and insights allow for the possibility to enhance the quality of care for children and parents in the PICU.Aim: To uncover clinical concerns, from caring and learning perspectives, in caring for children in the Pediatric Intensive Care Unit (PICU) from nurses and parents perspective.Methods: Qualitative methods were used in all studies to unfold and explore the phenomena in the nurses’ and parents’ everyday clinical life world. In Papers I and II, a phenomenographic method was adopted. In Papers III and IV, an interpretive phenomenological approach was adopted.Findings: Nurses that have a holistic view of the child and approach the child from a multidimensional perspective, with a focus on the individual child and his/her caring needs, develop a clinical “connoisseurship” and meet the parents’ expectations of the meaning of care. The nurses express that it is only when they focus on the child that subtle signs of pain are revealed. The meaning of nursing care, in the ideal case, is a holistic care where all aspects are integrated and the child as a person has first priority.Conclusion: The meaning of caring and children’s needs must become elucidated to improve the cultural influence of what can be seen as good nursing care within the PICU.
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| 4. |
- Mattsson, Janet Yvonne, et al.
(författare)
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Caring for children in pediatric intensive care units : An observation study focusing on nurses' concerns
- 2013
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Ingår i: Nursing Ethics. - London : Sage Publications. - 0969-7330 .- 1477-0989. ; 20:5, s. 528-538
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Tidskriftsartikel (refereegranskat)abstract
- Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses’ concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing—here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children’s needs unmet; parent-oriented nursing care—here, the nursing care emphasizes the parents’ needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation—here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit.
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| 5. |
- Mattsson, Janet Yvonne, et al.
(författare)
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Meaning of caring in pediatric intensive care unit from the perspective of parents : a qualitative study.
- 2014
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Ingår i: Journal of Child Health Care. - : Sage Publications. - 1367-4935 .- 1741-2889. ; 18:4, s. 336-345
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Tidskriftsartikel (refereegranskat)abstract
- When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment.
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| 6. |
- Mattsson, Janet Yvonne, et al.
(författare)
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Uncovering pain in critically ill non-verbal children : nurses' clinical experiences in the paediatric intensive care unit
- 2011
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Ingår i: Journal of Child Health Care. - : Sage Publications. - 1367-4935 .- 1741-2889. ; 15:3, s. 187-198
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Tidskriftsartikel (refereegranskat)abstract
- Critically ill paediatric patients are frequently exposed to pain that is required to be assessed and treated effectively. The most reliable resource for assessing pain is the child itself, but children in the paediatric intensive care unit (PICU) are commonly unable to communicate their needs, requiring professional caregivers to uncover and interpret pain. However, nurses and paediatricians do not have sufficient knowledge of how critical illness affects childrens' signs of pain. The aim of this study was to illuminate clinical experiences of pain in the PICU; describing nurses' perceptions of expressions of pain in non-verbal, critically ill 2-6 year old children. The participants were 17 experienced PICU nurses. Data were analysed according to the phenomenographic method and three qualitatively different main categories, gained from clinical experience, emerged: changes in the measurable parameters; perceived muscular tension; and, altered behaviour. Furthermore, contrasting the categories revealed two diverse perspectives to focus pain: measure-oriented and patient-oriented. Subtle expressions of pain were recognised when focus was patient-oriented. These findings support the necessity of actively looking for pain deriving from various perspectives and considering diverse caring needs when doing so. Acknowledging pain makes pain visible.
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| 7. |
- Olsson, Louise
(författare)
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Hopp hos döende patienter med cancer i palliativ hemsjukvård
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hope is meaningful and very important for people – even for people at the last days of their lives. Health professionals can sometimes describe hope in terms of hope for a cure, which may lead to feelings of hopelessness or empty hope for a patient with an incurable disease. In research, there is very little written about hope in the palliative home care context, even more so from the patient’s perspective. The aim of this project was to study how hope changes over time in cancer patients at the palliative phase, and to study the strategies used to cope with these changes. This was studied from the patients’ own perspective and in a home care context, but with the ambition of developing the results into a model or theory.Grounded Theory was the chosen research approach. Two sets of tape-recorded interviews were made with 11 patients in specialized palliative home care – a total of 20 interviews. The patients were also asked to write diaries about changes in their everyday feelings of hope within a 4-week period. Measurements of hope (HHI-S) and symptoms (ESAS) were also made at three occasions. Constant comparison of data was made during the analysis.The results showed that patients’ hope changed over time. Hope was described as a process involving a glimmering core of hope untouched by external circumstances (Study I). Hope was described in different processes, creation of a convinced hope, creation of simulated hope, collection and maintaining moments of hope and gradually extinct hope. The dying patient’s hope can be described as a gradual and successive adaptation process. Strategies for maintaining life were expressed to preserve the meaning in life, to communicate with others about life and death, to involve "fellow travelers" and to change focus. The strategy of preparing for death involved; taking responsibility for the future and seeing possibilities of living on even after death (Study II). The strategies were parallel to, and dependent on each other. It is important that health professionals understand the patient’s own strategies for maintaining life/hope, as well as the patient’s own preparations for death, so that hope is never taken away despite preparations at the end of life.In summary, hope can be interpreted as a changing process over time – a process that can change quickly, but is based on an inviolable core that is not easily moved by external circumstances. It is important that the health care personnel realize that patients simultaneously prepare for their deaths even as they try to maintain hope. Deeper understanding of what hope can mean for a patient can decrease the risk of hope being taken away during one’s final days.
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| 8. |
- Arman, Maria, et al.
(författare)
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Caregiving for existential wellbeing : existential literacy. A clinical study in an anthroposophic healthcare context
- 2013
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Ingår i: International Practice Development Journal. - 2046-9292. ; 3:1, s. 1-15
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Tidskriftsartikel (refereegranskat)abstract
- Background and context: The occurrence of existential caregiving as a natural element of healthcare is the focus of this research. According to the literature, there is a lack of understanding of this issue, from a theoretical as well as a clinical point of view. In this design ‘existential’ and ‘spiritual’ are seen as synonymous and without religious association. Existential questions are regarded as questions about life, death, meaning, love, vulnerability, responsibility and dependence. The context for the project is an integrated anthroposophic hospital that offers rehabilitation for patients with cancer.Aims and objectives: With the support of an anthroposophic and caring scientific view of human beings, and by using concrete examples, the aim is to develop and deepen an understanding of existential care for patients in life-decisive phases in the care and rehabilitation of cancer. Clinical application research was used in cooperation with academic researchers and clinically active colleagues. Eleven clinicians from varying professions and two researchers collaborated over the course of two years. The data used came from 65 case reports of significant care situations experienced by the team members. A joint interpretive qualitative analysis led to the formulation of the findings.Conclusions: Existential caregiving in practice requires an ‘existential literacy’, using the metaphor of human life as a text or a book whose contents are legible only for the one versed in the language. In order to gain a complete understanding of caregiving, an ability to read a suffering human’s language and decipher its meaning is essential. The patient’s narrative might open up a caregiver’s awareness in a single illuminating moment. An authentic and listening attitude together with an active restriction of one’s own suppositions increase the possibility of providing existential care. Compassion and professional judgement function as the caregiving compass and ‘lexica’ for existential care.Implications for practice:An understanding of existential caregiving moments implies a developed insight into and sensitivity for the patient’s signs and needsExistential caring moments have countless variations, while bodily and intimate situations are sometimes found to be an opening to spontaneous, trustful interactions. Such moments could be learning moments if reflected and sharedFor training in the ability to ‘read the patient’, clinical reflections in groups where existential literacy is collectively sought are an optionClinical application research can allow caring scientific theory and healthcare research to be implemented in practice immediately, which may enhance quality of care and ultimately benefit the patient
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| 9. |
- Lassenius, Oona, et al.
(författare)
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Moving toward Reclaiming Life : Lived Experiences of Being Physically Active Among Persons with Psychiatric Disabilities
- 2013
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Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 34:10, s. 739-746
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Tidskriftsartikel (refereegranskat)abstract
- There is abundant documentation in research about the significant relationship between physical activity and mental health, but there is still more to be learned about what can enhance motivation to become more physically active. Fourteen persons with psychiatric disabilities were interviewed about their experiences of being physically active, and data was analyzed using a phenomenologicalhermeneutic method. Five themes emerged: Capability for Living, Liberation from a Heavy Mind, Companionship in Being in Motion, Longing for Living One’s Life, and Struggling with Limitations. The interpreted meaning of being physically active was to be moving toward reclaiming one’s life.
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| 10. |
- Lassenius, Oona, et al.
(författare)
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Self-reported health and physical activity among community mental healthcare users
- 2013
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Ingår i: Journal of Psychiatric and Mental Health Nursing. - : Wiley. - 1351-0126 .- 1365-2850. ; 20:1, s. 82-90
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to survey the self-reported health and physical activity in a sample of community mental healthcare users in a city of Sweden. The study was conducted through a cross-sectional design with participants requested to fill out a self-report questionnaire. Participants (n =103) were persons with psychiatric disabilities living in residential psychiatric settings and/or participating in daily activities provided by community mental healthcare services. The results showed that the group is affected with serious risk factors, such as high body mass index, low rated extent and frequency of physical activity and low self-estimated general state of health. Even though some difficulties associated with the answering process of this questionnaire emerged, these self-reported results clearly confirm the fact that persons with psychiatric disabilities constitute a vulnerable group in need for health-promoting caring activities and interventions.
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