| 1. |
- Carlsson, Gunilla, et al.
(författare)
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Patients longing for authentic personal care: A phenomenological study of violent encounters in psychiatric settings
- 2006
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Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 27:3, s. 287-305
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Tidskriftsartikel (refereegranskat)abstract
- This article focuses on patients' violence against caregivers. Several studies show that violence and threats within the health care setting are an increasing problem. Encounters that become violent have been the issue of many debates but the phenomenon is still not fully understood. It is important to understand the course of events in violent encounters, both for the sake of the patients and the caregivers' well-being. The aim of this study was to describe the essence of violent encounters, as experienced by nine patients within psychiatric care. Guided by a phenomenological method, data were analyzed within a reflective lifeworld approach. The findings explicate violent encounters characterized by a tension between "authentic personal" and "detached impersonal" caring. "Authentic personal" patients are encountered in an undisguised, straightforward, and open way, and they sense unrestricted respect that caregivers would show another human being. In these encounters violence does not develop well. However, in caring that is "detached impersonal," the encounters are experienced by the patients as uncontrolled and insecure. These encounters are full of risks and potential violence. Copyright © Taylor & Francis Group, LLC.
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| 2. |
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| 3. |
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| 4. |
- Karin, Dahlberg, et al.
(författare)
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Reflective Lifeworld Research (2nd edition)
- 2007
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- This book explicates a reflective lifeworld research approach, based on phenomenological philosophy. The emphasis is on the lifeworld, the human intentionality and its capacity for seeing meaning and for reflection. The epistemological ideas presented in the book are transformed into an empirical research approach that serves as a guiding principle for research. The approach originates from the aim of allowing the phenomenon to guide the research by which the phe-nomenon and its meanings will be illuminated, understood and explicated, and is supported by an open and "bridled" attitude to the phenomenon and the research. Based on a solid epistemological presentation and ideas about how an open and "bridled" approach can be established, some methodological principles are outlined for data gathering as well as for descriptive and interpretive data analysis, respectively. Finally, general scientific concepts such as validity, ob-jectivity and generalisation are discussed in relation to the reflective lifeworld research approach.
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| 5. |
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| 6. |
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| 7. |
- Bremer, Anders, 1957-, et al.
(författare)
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Experiencing Out-of-Hospital Cardiac Arrest : Significant Others’ Lifeworld Perspective
- 2009
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 19:10, s. 1407-1420
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Tidskriftsartikel (refereegranskat)abstract
- When patients suffer out-of-hospital cardiac arrests (OHCA), significant others find themselves with no choice about being there. Afterwards they are often left with unanswered questions about the life-threatening circumstances, or the patient’s death, the emergency treatment and future needs. When it is unclear how the care, and the event itself will affect significant others’ well being, prehospital emergency personnel face ethical decisions. This study describes the experiences of significant others present at OHCA, focusing on ethical aspects and values. Using a lifeworld phenomenological approach, seven significant others were interviewed. The essence of the phenomenon of OHCA can be stated as: Unreality in the reality; Overwhelming responsibility; Inadequacy and limitation; Hope and hopelessness; Ethical considerations; Insecurity about the future; Trembling of life. These study findings show how significant others’ sense of unreality, inadequacy, and overwhelming responsibility at OHCA can threaten values deemed important for a good life.
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| 8. |
- Bremer, Anders, 1957-
(författare)
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När livet skakas om : patienters och närståendes erfarenheter av hjärtstopp utanför sjukhus
- 2008
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I Europa vårdar ambulanspersonal årligen cirka 300 000 människor med hjärtstopp. Ungefär en av tio överlever. Tidigare forskning har inte i någon större utsträckning berört hur överlevande patienter och närstående mår efteråt eller vilka etiska aspekter och problem som möter ambulanspersonal i dessa situationer. Med hjälp av en reflekterande livsvärldsansats är syftet med denna licentiatavhandling att beskriva vad det innebär att överleva hjärtstopp utanför sjukhus respektive närvara vid en nära persons hjärtstopp. Med utgångspunkt i det empiriska resultatet är syftet att belysa och diskutera etiska aspekter och problem av betydelse för ambulanspersonals vårdande ur ett normativt perspektiv.Avhandlingens empiriska resultat visar hur ogripbart det är att drabbas av hjärtstopp och hur uppvaknandet ur medvetslösheten innebär vilsenhet och kontrollförlust genom den minneslucka som tillfogats. Att överleva innebär därför ett sökande efter sammanhang så att situationen kan ges mening och förklaring till tankar, känslor och upplevelser. Känslan av sammanhang nås via andra människors berättelser tillsammans med egna minnen. I det fortsatta livet finns existentiell rädsla och otrygghet där den egna identiteten och meningen i livet omvärderas i takt med en växande insikt om hur den egna kroppen påverkats av hjärtstoppet. Ibland upplevs kroppen som begränsad vilket skapar otrygghet och rädsla. I det fortsatta livet kan det finnas skuldkänslor för det inträffade likväl som att hjärtstoppet ses som en opåverkbar händelse. Men det finns även tacksamhet och glädje över välbefinnande och trygghet i ett förändrat liv där vardagliga sysslor ger tillvaron en viss stadga. Det passerade livshotet införlivas i ett liv där mänskliga relationer blivit än viktigare värden i ett gott liv.Närvaro vid en nära persons hjärtstopp omkullkastar känslan av kontroll. Allt upplevs overkligt, tiden tycks stanna upp och samtidigt är verkligheten extremt påtaglig. Förvåning övergår snabbt till ett kaos av tankar och känslor där panik, chock och fruktan griper tag. Verkligheten innebär ett överväldigande och ensamt ansvar där närstående känner sig otillräckliga. Väntan på professionell hjälp känns lång och det är en befriande känsla då ambulanspersonal anländer och övertar ansvaret. Samtidigt väcks hopp om att patienten ska överleva. För närstående är allt kaotiskt, ångestfyllt och omtumlande då de kastas mellan hopp och misströstan för att slutligen få ett overkligt och ogripbart besked om den nära personens överlevnad eller död. Livets grundvalar skakas om och uppmärksammar livets skörhet och att inget kan tas för givet. Efter händelsen finns obesvarade frågor och oro som riskerar att leda till ensamhet i sorg eller i en oro för den överlevandes framtid. Oavsett vilket, riskerar ensamheten att leda till uppoffring av egna och viktiga behov.I ett gott beslut balanseras etiska normer att rädda liv, rätten till värdig/god död, autonomiprincipen samt att göra gott och inte skada. Den övergripande normen vid hjärtstopp är att rädda liv. Att i det akuta skedet avgöra om patienten räddas till ett acceptabelt liv är svårt. Det empiriska resultatet ger dock stöd för att återupplivning bör göras vid behandlingsbara hjärtstopp samtidigt som resultatet visar hur svårt det är att dra en gräns för vad ett acceptabelt liv är. Undantagsvis är det goda beslutet att avstå från eller avbryta återupplivning, exempelvis vid förekomst av ett giltigt förhandsdirektiv. En värdig/god död är då det primära. Ett utökat etiskt ansvar för ambulanssjuksköterskor kan vara att de ges beslutsrätt för avbrytande av återupplivning. Ett annat ansvar handlar om möjligheten att främja ett gott liv för överlevande genom att efteråt bidra med kunskap som kan skapa förlorade sammanhang. Ansvaret för närstående kan innebära att meningslös återupplivning inte görs ”för deras skull” utan att deras behov möts på bättre sätt.
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| 9. |
- Bremer, Anders, et al.
(författare)
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To survive out-of-hospital cardiac arrest : a search for meaning and coherence
- 2009
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Ingår i: Qualitative Health Research. - : Sage Publications. - 1049-7323 .- 1552-7557. ; 19:3, s. 323-338
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Tidskriftsartikel (refereegranskat)abstract
- The primary responsibility of prehospital emergency personnel at out-of-hospital cardiac arrests (OHCA) is to provide lifesaving care. Ethical considerations, decisions, and actions should be based in the patient's beliefs about health and well-being. In this article, we describe patients' experiences of surviving OHCA. By using a phenomenological approach, we focus on how OHCA influences patients' well-being over time. Nine survivors were interviewed. Out-of-hospital cardiac arrest is described as a sudden and elusive threat, an awakening in perplexity, and the memory gap as a loss of coherence. Survival means a search for coherence with distressing and joyful understanding, as well as existential insecurity exposed by feelings of vulnerability. Well-being is found through a sense of coherence and meaning in life. The study findings show survivors' emotional needs and a potential for prehospital emergency personnel to support them as they try to make sense of what has happened to them.
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| 10. |
- Bremer, Anders, 1957-, et al.
(författare)
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To Survive Out-of-Hospital Cardiac Arrest : A Search for Meaning and Coherence
- 2009
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Ingår i: Qualitative Health Research. - Thousand Oaks, CA : Sage Publications. - 1049-7323 .- 1552-7557. ; 19:3, s. 323-338
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Tidskriftsartikel (refereegranskat)abstract
- The primary responsibility of prehospital emergency personnel at out-of-hospital cardiac arrests (OHCA) is to provide lifesaving care. Ethical considerations, decisions, and actions should be based in the patient’s beliefs about health and well-being. In this article, we describe patients’ experiences of surviving OHCA. By using a phenomenological approach, we focus on how OHCA influences patients’ well-being over time. Nine survivors were interviewed. Out-of-hospital cardiac arrest is described as a sudden and elusive threat, an awakening in perplexity, and the memory gap as a loss of coherence. Survival means a search for coherence with distressing and joyful understanding, as well as existential insecurity exposed by feelings of vulnerability. Well-being is found through a sense of coherence and meaning in life. The study findings show survivors’ emotional needs and a potential for prehospital emergency personnel to support them as they try to make sense of what has happened to them.
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| 11. |
- Chow, Judy, 1954-, et al.
(författare)
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Encounter : A Swedish phenomenology study about caring relationship in China
- 2007
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Ingår i: The 13th Annual Qualitative Health Research Conference 2007. ; , s. 191-
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Konferensbidrag (refereegranskat)abstract
- Purpose of the Study The phenomenon in this study is “the caring relationship in China”. As Leininger says “Care is a universal phenomenon with diversities in forms, expression, meanings and patterns of care in different cultures” The Aim of this Swedish phenomenology study is to acquire an understanding of caring relationship through the Lifeworld experiences of the caregivers and the patients in China. The results of this study will later on be related to a study of Swedish caring relationsships Methods For this phenomenological study 9 patients, 10 medical and nursing staffs and 4 nursing tutors from 5 various medical and care units from two hospitals and a nursing school in Southern China were interviewed. Results The caring relationship in China shows a complex view of interpersonal relationship in a group setting where every contributor has a duty to perform for oneself and the other counterparts in the group. Mutual understanding in a caring relationship plays a very important role in getting the patient back into balance. This paper will take a closer look into the roles and functions of patients and caregivers in China. Conclusion The study shows that there is a fairly good match between the perspective of the patient and that of the caregiver in China. In a caring relationship, both sides have a responsibility to give their best to make the relationship work.
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| 12. |
- Chow, Judy, 1954-
(författare)
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Vårdandets Tao : En fenomenologisk studie om vårdrelationer i Kina
- 2008
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis researches the phenomenon ‘caring relationship’. The empirical studies in this thesis were carried out in China with the aim to describe the caring relationship in China through the lifeworld experiences of professional caregivers and patients. The result of this study will later on relate to a study of Swedish caring relationships. For this phenomenological study 9 patients, 10 medical and healthcare workers and 4 nursing tutors were interviewed. They were from 5 different medical and care units from two hospitals, one private clinic and a nursing school in Southern China. This study shows that caring relationship in China has many layers. Embedded in the basic interpersonal relationship is a ‘relationship of need’. The relationship carries a goal: to help the patient to restore a personal harmonic existence and regain the responsibility for their health. The relationship is temporary and normally ends when the goal is achieved. The relationship is initiated by the patients need for help. The two main actors in the caring relationship are the patient and the caregiver with their roles as care seeker and care provider. This study shows that to become a patient is a process of diminishing the natural ordinary self which makes the person feel vulnerable. Caregivers take a leading role which carries responsibility. They feel an obligation to use all their knowledge and resources for the benefit of the patients. They teach them how to live and how to stay healthy. A main function in the caring relationship is the transfer of knowledge. The caregivers feel the need to create a dialog to get access to the patients’ unique knowledge about themselves so that the caregiver’s general knowledge of health and care can be applied to the individual. Through the informal chats they share the patient’s experiences, emotions and history. It creates en opportunity for the interpersonal relationship to grow deeper and for the patient and the caregiver to meet as fellow human beings. In the Chinese caring relationship the patient’s family is included. It is considered to be every contributor’s duty to be responsible for oneself and for others. Mutual understanding and respect in a caring relationship are important in getting the patient back into balance.
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| 13. |
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| 14. |
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| 15. |
- Dahlberg, Karin M, et al.
(författare)
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Mental health literacy and attitudes in a Swedish community sample - investigating the role of personal experience of mental health care.
- 2008
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Ingår i: BMC public health. - : Springer Science and Business Media LLC. - 1471-2458. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mental ill health is a common condition in the general population, yet only about half of those with a mental disorder have treatment contact. Personal experience may affect attitudes, which in turn influence the help-seeking process. This study investigated differences in mental health literacy and attitudes among mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. METHOD: A postal screening questionnaire was sent to a random sample of the general population aged 20-64 in the county of Skaraborg, Sweden in order to ascertain mental health status and history of treatment contact; 3538 responded (49%). Face-to-face interviews were carried out in random sub samples of mentally healthy persons (n = 128) and in mentally ill persons with (n = 125) and without (n = 105) mental health care contact. Mental health literacy and attitudes to treatment were assessed using questions based on a vignette depicting a person with depression. Past month mental disorder was diagnosed according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). RESULTS: Two thirds failed to recognize depression in a vignette; recognition was equally poor in mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. In response to an open-ended question concerning appropriate interventions, one third suggested counselling and only one percent proposed antidepressant treatment. Again, proportions were similar in all groups. Persons with a history of mental health contact more often suggested that a GP would provide the best form of help. When presented with a list of possible interventions, those with a history of mental health contact were more positive to medical interventions such as antidepressants, hypnotics, and inpatient psychiatric treatment. When asked about the prognosis for the condition described in the vignette, persons with treatment contact were less likely to believe in full recovery without intervention; mentally ill without treatment contact were more optimistic. CONCLUSION: Mental health literacy, specially concerning attitudes towards interventions is associated with personal history of mental health care.
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| 16. |
- Dahlberg, Karin
(författare)
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Psychiatric taboo? Mental health problems and help-seeking
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mental health disorders are common conditions in the general population, yet only about half of those with mental health problems have health care contacts for their problems. The pathway for help-seeking is complex, and may be influenced by socio-demographic factors, as well as more complex characteristics such as personality, attitudes and personal preferences. This thesis aimed to improve knowledge of factors associated with help-seeking for mental health problems. One focus was on lay people s opinions and expectations of mental health care. The present study was conducted in two stages. An initial postal questionnaire was distributed to a random sample of the general population aged 20-64 in Skaraborg, Sweden, to assess mental health status and history of treatment contact. Data from Skaraborg (n=3 538) was compared to questionnaire data from the PART study, Stockholm (n=10 441). Information from the questionnaire also served as basis for a stratified selection of subsamples. In stage II a total of 358 participants, 125 persons with symptoms of mental disorders with healthcare contact, 105 persons with symptoms of mental disorders without health care contact, and 128 mentally healthy participated in a face-to-face interview. The interview inclined a semi structured diagnostic interview (SCAN), a personality inventory (SSP), a vignette to assess mental health literacy, and open-ended questions about expectations concerning a hypothetical contact with mental health care. Data from the questionnaire stage showed that mental health problems were common in both the rural and urban area. Harmful alcohol use, however, was less common among rural women compared to their urban counterparts. Overall contact with health care was more often reported by urban residents, regardless of age, gender, or presence of mental health problems. Results from the interview stage: Personality traits such as Somatic Trait Anxiety and Stress Susceptibility were associated with help-seeking for mental health problems. Mental health literacy was poor among the respondents; only one third could correctly recognise depression from a vignette. A majority of the respondents were positive about counselling and psychotherapy. Persons with a history of mental health care contacts were more positive to medical interventions such as antidepressants, hypnotics, and admission to a psychiatric ward. Non help-seekers were more optimistic than help-seekers concerning the prognosis of depression without professional help. The quality of interaction between patient and provider was by far the most important theme when the respondents expressed their wishes concerning a hypothetical contact with health care for mental health problems. Only a minority expressed wishes for specific treatments. Urbanity was associated with overall utilisation of health care during the last year. Personality traits were associated with help-seeking. Persons with health care contact for mental health problems were more in tune with the professional point of view with rating interventions. The quality of interaction between patient and provider is highly important in health care contacts for mental health problems.
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| 17. |
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| 18. |
- Dahlberg, Karin, et al.
(författare)
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To use a method without being ruled by it: Learning supported by drama in the integrations of theory with healthcare practice.
- 2008
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Ingår i: Indo-Pacific Journal of Phenomenology. - : NISC (Pty) Ltd. - 2079-7222 .- 1445-7377. ; 8:Special edition: Phenomenology in Education - February, s. 1-20
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Tidskriftsartikel (refereegranskat)abstract
- The study reported in this paper focused on nursing students' learning and, in particular, their integration of caring science in theory and practice. An educational model incorporating educational drama was developed for implementation in three different teaching contexts within the nursing and midwifery study programmes at a Swedish college. A central aim was to understand the dynamics of educational drama in the healthcare context and its impact on learning and teaching. Using a phenomenological approach, seventeen students and six teachers were interviewed and their experience of drama as an educational method explored.The research findings illustrate the meaning of learning and teaching that is sensitive to students' lifeworld experiences. In order to be a successful method for closing the gap between caring science theory and practice, not only the educational drama, but teaching in general, must be anchored in the lived world of the students - that is, their experiences of health and care. While embodied reflection, as a key factor in integrating theory and practice, was shown to be well supported by educational drama, it was also found that "the method" tends too readily to take over and govern teaching and learning. The findings of this study further indicate how learning in practice and embodied reflection can be supported by the inclusion of well-chosen caring science theory to cast light on caring practice dilemmas.
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| 19. |
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| 20. |
- Dahlberg, Matz, et al.
(författare)
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Is There a "Race-to-the-Bottom" in the Setting of Welfare Benefit Levels? : Evidence from a Policy Intervention
- 2008
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Ingår i: Journal of Public Economics. - : Elsevier BV. - 0047-2727 .- 1879-2316. ; 92:5-6, s. 1193-1209
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we investigate whether local governments react on the welfare benefit levels in neighboring jurisdictions when setting their own benefit levels. We solve the simultaneity problem arising from the welfare game by utilizing a policy intervention; more specifically, we use a centrally geared exogenous placement of a highly welfare prone group (refugees) among Swedish municipalities as an instrument. The IV estimates indicate that there exists a "race-to-the-bottom" and that the effect is economically as well as statistically significant; if the neighboring municipalities decrease their welfare benefit level by 100 SEK, a municipality decreases its benefit level with approximately 41 SEK. This result is robust to several alternative model specifications.
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| 21. |
- Dahlberg, Ulrica, 1972, et al.
(författare)
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Bokanmälningar
- 2009
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Ingår i: Nämnaren. - 0348-2723. ; :2009:3, s. 26-27
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 22. |
- Edmark, Karin, 1977-
(författare)
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Strategic Interactions among Swedish Local Governments
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Essay 1 (with Matz Dahlberg) investigates if local governments react on the welfare benefit levels in neighbouring jurisdictions when setting their own benefit levels. The IV estimates indicate that there exists a "race-to-the-bottom" and that the effect is economically as well as statistically significant.Essay 2 tests for strategic competition in public spending on childcare and primary education, and care for the elderly, in Swedish municipalities. The study is not limited to interactions in the same type of expenditure, but also allows for effects across expenditures. The results give no robust support for the hypothesis that municipalities react on the spending policy of neighbouring municipalities in the decision on own spending on care of the elderly, childcare and education.Essay 3 (with Hanna Ågren) uses data on Swedish local governments to test for strategic interaction in local tax setting. We make use of a number of indirect predictions from the theories of tax competition and yardstick competition in order to test for the presence of strategic interaction in these forms. The analysis provides strong evidence for spatial correlation in tax rates among Swedish local governments. Moreover, we find weak evidence of tax competition effects in the setting of tax rates.Essay 4 tests for a migration response to the implementation of stricter rules for welfare benefit receipt in Stockholm town districts. The hypothesis is that welfare benefit prone individuals will choose to live in a town district that has no program if they dislike the loss of leisure due to program participation more than they value the contents of the program, and vice versa. The results give weak indications of a negative effect of the program on the outmigration of welfare prone individuals.
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| 23. |
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| 24. |
- Frank, Catharina, 1961-, et al.
(författare)
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Patient participation in emergency care- A phenomenographic study based on patients' lived experience
- 2009
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Ingår i: International emergency nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 17:1, s. 15-22
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Tidskriftsartikel (refereegranskat)abstract
- International guidelines promote patient participation in health care. When patients participate in their care they experience greater satisfaction. Studies have shown that patients in emergency departments express dissatisfaction with their care, and it was therefore important to study how patients understand and conceptualize their participation. The aim of this study was to describe patients’ qualitatively different conceptions of patient participation in their care in an emergency department. Based on a lifeworld perspective, nine interviews were performed with patients in an emergency department. The phenomenographic analysis shows that participation by patients means contact with the emergency department staff in three categories of conceptions: being acknowledged; struggling to become involved; and having a clear space. The different conceptions of patient participation give us a deeper understanding of how patients may experience their care, and this result may provide a foundation for developing nursing practice and the quality of health care in line with international guidelines.
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| 25. |
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| 26. |
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| 27. |
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| 28. |
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| 29. |
- Holmgren, Karin, et al.
(författare)
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The vulnerable continent (PLATINA) : Historical perspectives on Africa´s climate, environment and societies
- 2009
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Ingår i: Meeting global challenges in research cooperation. - Uppsala : Uppsala University. - 9789197574198 ; , s. 585-596
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Konferensbidrag (refereegranskat)abstract
- Our research, based on studies of different climate archives from Tanzania, Mozambique and South Africa, contributes information on changes in climate and vegetation over the past 24000 years. This time perspective, reaching beyond the information available from instrumental records is needed for a better understanding of regional global climate dynamics and issues surrounding environmental change, throughout Africa, and is a prerequisite for increasing climate forecasting capabilities for the region. We argue that African people have vast experience from living in a variable climate and research on past interactions between climate and societies demonstrate the significance of lessons learnt for present situations. Our findings, underline the complex interactions between climate/environment and societies that may lead to different developments in time and space. Considering the so called vulnerable continent, extended investigations of how African communities cope with and adapt to climatically driven changes is needed to increase the capability to realise the potential as well as the limitations, of modern African communities to adapt to future climate change.
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| 30. |
- Hörberg, Ulrica, 1968-
(författare)
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Att vårdas eller fostras. Det rättspsykiatriska vårdandet och traditionens grepp
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context.
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| 31. |
- Johansson, Annelie, 1973-
(författare)
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När kroppen sviker : -en livsvärldsstudie om kvinnors erfarenheter av hälsa, sjukdom och vård i samband med en hjärtinfarkt
- 2005
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis for a licentiate degree is a Caring Science lifeworld study the purpose of which is to describe women’s experiences of illness, health and care following a myocardial infarction. It consists of two studies (Papers I and II) which form the first part of a doctoral dissertation. Cardio-vascular disorders are a major public health problem today. Besides the impact these disorders have on public finances, a disease such as myocardial infarction entails suffering for the afflicted person. Current research indicates that women measure their health as lower than men following a myocardial infarction. There is still a lack of knowledge on how to understand women’s health process following a myocardial infarction, and how to provide them with the support needed to promote good health and well-being. Paper I explores women’s experiences of their lifeworld and body following a myocardial infarction. Paper II explores women’s experiences of the care and health process following a myocardial infarction, with a particular focus on their experience of participation. The method of reflective lifeworld research, based on phenomenological epistemology, is used to explore the meaning that is experienced in the lived world of the patient. This research finds that women describe that their lives come to a stand-still following a myocardial infarction. They perceive their bodies as having failed them, which entails existential uncertainty, meaning that the women no longer feel secure about their bodies or life, itself. Their suffering is difficult to understand, both for themselves and for those around them, and the women suffer in silence. Health-care professionals have the potential to promote health by supporting the women towards greater participation and independence in the health process. Participation, however, is not limited to concrete participation in care, but in offering health care based on women’s perspective of how their life situations changed following the illness. This will provide the women with the support they need to discover their own health promoting resources, and to become friends with their bodies and the life that follows a myocardial infarction.
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| 32. |
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| 33. |
- Johansson Sundler, Annelie, 1973-
(författare)
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Mitt hjärta, mitt liv : Kvinnors osäkra resa mot hälsa efter en hjärtinfarkt.
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis describes the phenomenon women’s health and illness experiences following a myocardial infarction (MI). The purpose of the thesis is to explore women’s experiences of their care and health processes, as well as their experiences of body, lifeworld and meaningful relationships related to the illness. A reflective lifeworld approach, based on phenomenological philosophy, is used. The thesis is comprised of four studies; three are based on interviews with a total of 26 women following an MI, followed by a fourth, theoretical, study.The first study explores women’s experiences of care and health processes following an MI, with a particular focus on well-being and participation (I). The findings show that an MI is an event that suddenly interrupts the ordinary life of the women. Participation is a sense of being involved in their own health and care processes, which may also encourage them to take responsibility for health promoting activities in a healthy and meaningful way.The second study explores women’s lifeworld experience of their bodies and lives following an MI (II). This study finds that an MI, as a major event in the women’s lives, influences and restricts their everyday activities over a long period of time. Following the illness, they live with an existential uncertainty about their life and the heart, and this feeling entails suffering for them.The third study explores the meaning of close relationships and sexuality to women’s health and well-being following an MI (III). The mmeaning of close relationships appears to be vitally intertwined with their long-term health process; both health processes and relationships are affected after an MI. The suffering following an MI can be compared to taking a fall, where meaningful close relationships can function as a safety net that catches the women in their fall.The fourth study is a concept development aimed at elucidating the meaning of the concepts uncertainty, control, secure and risk in relation to the thesis phenomenon and the findings of the empirical interview studies (IV). The existential uncertainty is an important matter in the women’s health processes. In these processes the concepts control, secure and risk play a central role. Women who have suffered an MI want to be as safe as possible in order to live well. The analysis illuminates a paradox, that the women’s ambition to achieve greater safety may lead them into an even greater experience of uncertainty.The conclusion is that women’s experiences of health and illness can be described as a journey characterized by existential uncertainty. The women’s lives go through different existential phases following an MI, which is a major event. They are not prepared for the reactions that this event causes and are in need of support and guidance to manage their illness experiences. If acknowledged and well met, the significance and meaning of the women’s reactions and experiences can give impetus and energy to their health processes.
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| 34. |
- Johansson Sundler, Annelie, et al.
(författare)
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The Meaning of Close Relationships and Sexuality : Women's Well-Being Following a Myocardial Infarction
- 2009
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Ingår i: Qualitative Health Research. - : Sage Publications. - 1049-7323 .- 1552-7557. ; 19:3, s. 375-387
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Tidskriftsartikel (refereegranskat)abstract
- Relationships and sexuality following heart attack (MI) have been studied; nevertheless, little is known about the meaning of social support and relationships to health and well-being after an MI. To our knowledge, no qualitative studies have further investigated the phenomenon. In this study we explore the meaning of close relationships and sexuality to women's health and well-being following MI. Ten women were interviewed using a reflective lifeworld approach and phenomenological epistemology. The meaning of women's close relationships following an MI appears to be closely intertwined with their long-term health process; both health processes and the relationships are affected. Suffering after an MI can be compared to taking a fall in that close relationships can become a safety net. Close relationships and sexuality are integrated into their lived bodies, and in that way have profound influence in their lifeworld experiences. Not all close relationships are intimate; however, all close and meaningful relationships can provide power and strength to the women's health processes. At the same time, these relationships also appear to drain energy and cause suffering.
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| 35. |
- Källerwald, Susanne
(författare)
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I skuggan av en hotad existens : Om den onödiga striden mellan biologi och existens i vården av patienter med malignt lymfom
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this thesis is to describe what it is like to suffer from malignant lymphoma and to highlight the care given to these patients. A reflective lifeworld approach, founded in phenomenological philosophy, has been used. Data have been collected using interviews and have been analyzed using essence-seeking analysis. The results are founded upon three empirical studies and a philosophical excursus. The results are presented in four sections.The thesis describes how patients with malignant lymphoma live in limbo characterized by existential uncertainties, partly caused by the mortal threat of the disease and by failings in the actions of the healthcare staff. Patients fear dying when suffering from malignant lymphoma, regardless of whether the disease is a genuine medical threat to their life. Thus, there is a substantial need for existential support for these patients. However, the results show that deficiencies in existential support can lead to patients feeling objectified, which in turn increases their existential uncertainties. Care that is solely directed towards the physiological body and excludes the human as a subject can be experienced as a disparagement.Care that includes the patients’ lifeworld provides alleviated suffering and a possibility for the patients themselves to take an active part in the health process. Despite the healthcare staff’s genuine ambition to alleviate the suffering, patients’ existential questions are met with a degree of conflict; on the one hand they are a natural part of healthcare, and on the other the questions are of such character that they are not part of professional healthcare. A healthcare culture that does not fully acknowledge the importance of existential questions appears to be one of the greatest obstacles to a holistic healthcare approach. Furthermore, there appears to be a lack of shared strategies among the healthcare staff when meeting the patients’ existential questions. A conflict arises in an unnecessary battle between biology and existence, which in turn increases the patients’ existential insecurities.Medical knowledge is insufficient in caring for patients with malignant lymphoma. An understanding of caring science is needed in order for the care to become caring and able to meet the needs as described by patients with malignant lymphoma. Healthcare staff most be provided with sufficient support to meet the patients’ existential questions. The organization of healthcare is characterised by being a culture in which existential questions are not given sufficient attention. It seems that healthcare staff give priority to medical/technical tasks rather than conversations of existential character.
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| 36. |
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| 37. |
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| 38. |
- Roxberg, Åsa, 1953-, et al.
(författare)
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In the midst of the unthinkable. A phenomenological life-world approach to the experiences of suffering and relieved suffering during the tsunami catastrophe, 2004.
- 2009
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - New York, NY : Informa Healthcare. - 1748-2623 .- 1748-2631. ; 4:1, s. 17-27
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to highlight the instantaneous experience of suffering and relieved suffering that was presented on the Swedish Television (SVT) by those who experienced the tsunami wave in Thailand, 26 December 2004. The selected TV-interviews were watched, transcribed and conducted with an empirical phenomenological analysis. A phenomenological lifeworld approach, inspired by the French philosopher Maurice Merleau-Ponty, was chosen for the theoretical framework. The findings showed three main features: the motion, the stillness and the shift in perspective. The motion comprised both the motion of the wave and the motion it caused the victims in terms of external as well as internal disorder. When the tsunami waves withdrew, it was followed by stillness. The feeling of being unreal was prominent, triggered by lack of information and endless waiting. Another prominent feature was the victims’ incapacity to answer ‘‘how long’’ they had suffered before being rescued. The tsunami catastrophe seemed to be a timeless event. Caring for other victims meant a shift in perspective in one’s own devastated world to that of another person. The shift between focus and comprehension, contributed to the making of life-saving decisions, for the victims themselves and for other victims. The findings were mainly reflected on from the perspective of the French philosopher Maurice Merleau-Ponty, for example the experience of time as an embedded and lived now. It was also reflected on from the perspective of the German philosopher Karl Jaspers as a limit-experience and as a fulfilment of love. A suggestion for further research is to investigate how suffering and relieved suffering is experienced and encountered when further time has passed.
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| 39. |
- Svanström, Rune, 1959-
(författare)
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När livsvärldens mönster brister : erfarenheter av att leva med demenssjukdom
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is focusing on the lived experience of dementia. Both living with a partner as well as living alone. There is no unequivocal picture of how it is to live with dementia and few studies have been carried out in homes of afflicted persons. A deeper understanding of how it is to live with dementia can be a good starting-point for caring and the organisation of care. The aim of this thesis is to describe, clarify and explain the lived experience of dementia from a lifeworld theoretical point of view. Another aim is to illuminate how decision makers look upon persons with dementia, their life and their care. Interviews and observations have been used to collect data. Participating informants have been couples with one partner suffering from dementia, persons with dementia living alone, politicians, administrators and social workers. Data was analysed with a phenomenological and a hermeneutical approach. To live as a couple where one part has dementia (study 1) implies to live in a heteronomous existence where both the person with dementia and the partner become strangers in a world that should be the most well-known and familiar. The couple’s existence is narrowed and controlled by the impact of the dementia disease and the existence is characterised of hopelessness and homelessness. To live alone with dementia (study 2) means to live with a broken identity when the person with dementia gradually loses the memory of himself and his life. It becomes a life where the world of the individual is reduced to a quiet background that does not demand attention. The person with dementia does not longer know how he or she should relate to the world. The existence is characterised by a strong sense of loneliness and only a vague knowledge of the situation. The person with dementia longs for other people and gets a sense of boredom in the existence. The comprehensive interpretation (study 3) shows that life with dementia is characterised by a gradual loss of meaning in life due to a disturbed intentionality. With disturbed intentionality the person with dementia gets increasingly more difficulties in understanding the meaning of the use of everyday objects. The person with dementia fights this and tries to create meaningfulness in the existence – something which gets very difficult and strenuous in time, since even the easiest everyday chores have to be thought through to make sense and even to be accomplished. The effort can in time become overpowering for the person with dementia who then stops doing the chores and becomes passive. Politicians, administrators and social workers (study 4) are well aware that dementia gives suffering to the afflicted and the partner. The care is not designed to meet their needs for home care, and the decision makers don’t know how to change this. The person with dementia becomes like an object when the social workers don’t includes them in a dialogue about their needs and care. The partner is left alone in solving difficult problems and in making difficult decisions. The theory of intentionality can help the professionals in the care of persons with dementia. By helping the cared-for-person to ‘stretch the intentional threads’ the caregivers can give the person a possibility to be rooted in the world. A care that supports intentionality and identity and reaches all the way in to the homes of the person with dementia would improve their situation and increase their well-being. This is possible when engaging the person in every-day chores that promote meaning. This kind of care contributes to the possibility for the person with dementia to be rooted in language, time and space.
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| 40. |
- Wireklint Sundström, Birgitta, 1951-
(författare)
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Förberedd på att vara oförberedd : En fenomenologisk studie av vårdande bedömning och dess lärande i ambulanssjukvård
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Wireklint Sundström, Birgitta, 2005. Prepared to be unprepared. A phenomeno-logical study of assessment with a caring approach and how it can be learned in the ambulance services.A focal point in this dissertation is that there is knowledge in the ambulance ser-vice that is experience-based, which has not always been made explicit, and that provides the foundation for the caregivers’ assessment of the patients and their needs for care. The first aim of the study was to describe and analyse the ambu-lance services with a focus on the phenomenon of assessment from the lifeworld perspective in the caring sciences. The second aim of the study was of an educa-tional nature where the object was to be able to draw conclusions about the learning process in the ambulance service in the light of the knowledge generat-ed by the empirical findings. Thus the aim was to create a synthesis consisting of didactic ideas that are based on the caring sciences and describing how assess-ment can be learnt and can support future caregivers in the ambulance services.Assessment in the ambulance service entails, on an overall level, having a natu-ral caring attitude that includes striving in two directions at the same time. These are that on the one hand the caregivers strive to bring order to that which is dis-ordered as soon as possible, to structure the unstructured, and in short define the indefinite in order to provide medical assistance. There is a need to quickly as-sess the patient’s condition and which measures are necessary. On the other hand the caregivers strive to let the indefinite wait a while in order to be able to meet the patient’s suffering. There is thus a desire to listen attentively to the individual patient.The essential meaning of assessment of patients in the ambulance services is that there are conflicting demands on assessment and care, which entails that the caregiver adapts him/herself to the prevailing care situation in a way that means being flexible and adaptable to the patient’s medical condition. The caregivers also have a flexibility and adaptability in relation to their colleague, which leads to a mutual interplay in the assessment. Assessment in the ambulance services also means that the caregivers are paradoxically prepared at the same time as be-ing unprepared, i.e. they are prepared for the unprepared. The assessment thus starts before the caregivers have reached the patient and the actual situation. Even if they “know” what awaits them, they do not really “know”. It becomes a dynamic struggle between on the one side the expectancy that feels certain and on the other the unknown in every new situation. The struggle contains a desire for control and effectiveness in a care practice full of surprises.
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