| 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. |
- 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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| 3. |
- 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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| 4. |
- 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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