Nurses' experiences of caring encounters with older people living in Swedish nursing homes

Aim. The aim of the study was to describe and interpret the meaning of nurses' experiences of caring encounters with residents in nursing homes. Background. Life for residents in nursing homes can be characterized as a process of decreased physical and psychological resources. Therefore, encounters with nurses are important activities for providing meaning and security for the residents. Research in this field has previously focused on communication, attitudes and job satisfaction, but gives limited knowledge about what the human encounters in this context mean for the nurses. Method. A hermeneutic method was used in this study. Interviews were conducted with 14 nurses from two nursing homes about their experiences of caring encounters. The transcribed interview texts were interpreted as a whole. Results. In the interpretation of the text concerning the meaning of nurses' experiences of encounters with resident's four themes and 11 subthemes emerged. The comprehensive interpretation mainly showed possible ways available being present, being significant and being aware of opportunities for the nurse to find meaning in the encounter with the resident, but impossible ways as being inadequately were also revealed. Conclusion. This study shows the importance of caring encounters between nurses and residents in nursing homes. The good encounters provide various possible ways for nurses to find meaning and a sense of communion with residents. However, bad encounters, described as being inadequate, were found to inhibit nurses from finding meaning in their encounters with residents. Relevance to clinical practice. Meeting the needs of older people in nursing homes requires special knowledge about the importance of the caring encounter. Therefore, nurses in this care context need supervision and continuous education in order to gain relevant knowledge about the meaning of caring encounters for themselves and residents.     

The experiences of the registered nurse caring for the person dying of cancer in a nursing home

This paper reports on research that set out to identify and describe the experiences of the registered nurse caring for the resident dying of cancer in a nursing home. The research method used was a qualitative single case study involving five registered nurses in one nursing home. Thematic analysis of data from unstructured interviews and reflective journals was used to explicate the nurses' experiences. Four major themes were extracted from the data. These themes were the exclusivity of the relationships, difficulties in the management of pain, the expectations of the registered nurse and the impact of caring. The nurses' experiences were loving, fascinating, compelling and rich. The overarching experience of the nurses came from the relationship they formed with the residents. A crucial finding in this study was that these registered nurses valued the elderly resident and developed meaningful relationships with them. All aspects of the relationships were unique and profound. However, the emotional involvement with the resident, multiple death losses, confrontation of personal losses, limited workplace support such as counselling, potentially places these registered nurses at emotional risk from burnout and complicated bereavement. The implications of these findings for nursing practice, education and research are discussed.     

Parent-nurse interactions: care of hospitalized children

BACKGROUND: An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations. AIM OF THE PAPER: To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children. METHODS: A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001. FINDINGS: Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed. CONCLUSION: Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.     

Exploring Spanish emergency nurses' lived experience of the care provided for suddenly bereaved families

AIM OF THE STUDY: To investigate the experience of emergency nurses caring for suddenly bereaved family members in the clinical setting, particularly after they are informed about the loss of a loved one. DESIGN/METHODS: Data was obtained from semi-structured interviews with seven emergency nurses drawn from emergency nursing staff working in a Spanish Hospital. Interviews were tape recorded, and hermeneutic-phenomenological analysis was applied to gain understanding from the emergency nurses' experiences. SETTING: The Accident and Emergency department in the Hospital Universitario Insular de Gran Canaria (Spain). Study undertaken in partial fulfillment of the main author's MSc (Department of Nursing and Community Health) at Glasgow Caledonian University. RESULTS: Several themes emerged from those interviews, which appeared to form the basis of the emergency nurses' reality: knowing, relationships, culture and reality. They showed the need to reflect on personal and professional experiences to facilitate personal growth, discover meaning for emergency nurses and examine the possible implications for clinical care. CONCLUSIONS: This study enabled both participants and the researcher to evaluate critically what was troublesome from their perspective and to identify sources of innovation and liberation within everyday practices.     

Implementing family-centred care: an exploration of the beliefs and practices of paediatric nurses.

OBJECTIVE: This study explored paediatric nurses' perceptions of how they include and involve parents in the care of hospitalised children. DESIGN: This qualitative study used individual unstructured interviews to gather data, the data was analysed using thematic coding. SETTING: Paediatric wards within two regional area health services of New South Wales, Australia. SUBJECTS: Fourteen paediatric nurses were asked to describe their beliefs and practices regarding the clinical application of family-centred care. MAIN OUTCOME MEASURE: Paediatric nurses' beliefs and practices about family-centred care were explored in an effort to explain how the concept was implemented. RESULTS: The findings are presented as four interconnected themes. The first describes how participants either allocated tasks to parents or retained them, the second relates to the nurses' professional identity, the third theme identifies barriers and constraints to the implementation of family-centred care, while the fourth describes the nurses' beliefs about their responsibilities when delivering family-centred care. CONCLUSIONS: Together these findings suggest that while nurses endorse the concept of family-centred care, the implementation into practice is more problematic. While it is not possible to generalise these findings to other paediatric nurses, the authors believe the insight gained will resonate with paediatric nurses internationally. The findings from this study are being used as the basis for the development of clinical practice guidelines to assist paediatric nurses to more consistently apply the concepts of family-centred care to their practice.     

Destructive Whirlwind: nurses' perceptions of patients diagnosed with borderline personality disorder

Research suggests that nurses have negative perceptions and subsequently negative interactions with patients diagnosed as having Borderline Personality Disorder (BPD). However, this research is mainly quantitative in nature and does not allow nurses to speak freely about their experiences of working with this client group. The purpose of this study was to explore nurses' relationships with BPD patients from their own perspective. Semi-structured interviews were used to elicit the participants' experiences of BPD patients and thematic analysis was used to raise themes from the data. One core theme and four major themes were identified. The core theme was: 'Destructive Whirlwind', which refers to the nurses perceiving these patients as a powerful, dangerous, unrelenting force that leaves a trail of destruction in its wake. The major themes were: care giving; idealized and demonized; manipulation and threatening. The study concludes that nurses experience BPD patients in a negative manner. This can be attributed to the unpleasant interactions they can have with them and feeling that they lack the necessary skills in working with this group. The results also indicate that nurses want to improve their relationships with BPD patients.     

Assertive outreach nurses' experience of engagement

There are currently no studies available in the literature to highlight nurses' experiences of the assertive outreach (AO) engagement process. This study aimed to understand how AO nurses experience this process and what can be learned from it. The participants were five nurses working in a rural AO service in one county. Methodological considerations were rooted in the work of Martin Heidegger and the data analysed using the hermeneutic phenomenological thematic method. The data-gathering tool was semi-structured interviews. Seven major themes emerged to construct the nurses' understanding of their experience of assertive engagement. These were: (1) having time; (2) anticipatory persistence and tired dejection; (3) pressure, relief and satisfaction; (4) being the human professional confluence; (5) accepting anxiety and fear; (6) working and learning together; and (7) bringing the caring attitude. This paper focuses on the seven emerging themes and discusses the implications and recommendations for nurses practising in the AO setting.     

Exploring nurses' experiences of supporting a cancer patient in their search for meaning.

This article presents the findings from an interpretive phenomenology study looking at nurses' experiences of supporting cancer patients in their search for meaning. Eleven nurses were interviewed from a Medical Oncology Unit and a Bone Marrow Transplant Unit in a central London teaching hospital. Having analysed the interviews, six major themes were identified: the value of experience, understanding the search for meaning, the value of time, the relationships involved, caring and the skills used by nurses, and the difficulties nurses' experienced and the support they needed to continue this role. Like many aspects of nursing care that are intangible in nature, this aspect of care was seen as important and valuable to the nurses in the clinical environments of cancer care. The findings do not represent a definitive approach to this aspect of care, but offer an insight into nurses' experiences. In order to continue this aspect of cancer care, the findings suggest that nurses need support.     

Challenging the philosophy of partnership with parents: a grounded theory study

BACKGROUND: Parent participation is viewed as a pivotal concept to the provision of high quality nursing care for children and their families. Since the 1990's, the term 'partnership with parents' has increasingly been reported in the literature and adopted as a philosophy of care in most paediatric units in the United Kingdom. OBJECTIVES: To explore children's, parents', and nurses' views on participation in care in the healthcare setting. DESIGN: Using grounded theory, data were collected through in-depth interviews, and participant observation. Sample consisted of eleven children, ten parents and twelve nurses from four paediatric wards in two hospitals in England. RESULTS: Most nurses assumed that parents would participate in care and viewed their role as facilitators rather than 'doers'. Nurses reported that the ideology of partnership with parents did not accurately reflect or describe their relationships with parents. Parents could never be partners in care as control of the boundaries of care rested with the nurses. Parents felt compelled to be there and to be responsible for their children's welfare in hospital. CONCLUSIONS: The pendulum of parent participation has swung from excluding parents in the past to making parents feel total responsibility for their child in hospital. It is argued that the current models or theories on parent participation/partnership are inappropriate or inadequate because they do not address important elements of children's, parents' and nurses' experiences in hospital.     

The experiences of school nurses caring for students receiving continuous subcutaneous insulin infusion therapy.

Diabetes mellitus is the most common metabolic disorder in childhood. Today, children with diabetes are receiving new technologically advanced treatment options, such as continuous subcutaneous insulin infusion (CSII) therapy. School nurses are the primary health caregivers of children with diabetes during school hours. Therefore, it is important to determine their perceptions, resources, and resource needs when caring for students with continuous subcutaneous insulin infusion or insulin pump therapy. This study uses a phenomenological approach to examine the experiences of school nurses caring for students receiving insulin pump therapy. Eleven school nurses were interviewed using semistructured taped interviews. The nurses' responses indicated that they were "scared" when first caring for students with continuous subcutaneous insulin infusion therapy. However, they were able to work through their fear by using their resources and gaining more knowledge and hands-on experience with insulin pumps. The data also revealed that school nurses who were able to learn the language of continuous subcutaneous insulin infusion therapy and successfully deal with pump problems developed trusting and knowing relationships with students, teachers, and parents.     

'It's not like the wards'. Experiences of nurses new to critical care: a qualitative study

BACKGROUND: Critical care is both emotionally and intellectually challenging, yet little is currently known about the experience of nurses' new to this environment. AIMS: The aims of the study were to: 1. Explore the experience of nurses' new to critical care. 2. Identify what factors influence the nurses' experiences during this time. 3. Evaluate methods used to facilitate nurses' development such as education and preceptorship. METHODS AND PARTICIPANTS: This longitudinal qualitative study was undertaken using hermeneutic phenomenology and involved all nurses (n=14) recruited to the unit during two cohort intakes in 2002. Data collection was by means of semi-structured interviews at one, three and six months. All interviews were tape recorded, transcribed, and analysed for emerging themes and concepts. FINDINGS: Participants described a variety of unique experiences throughout the interviews, many of these related to four key themes: support, knowledge and skills, socialisation and moving on. There were also a number of key factors influencing these experiences including foundation programme, support, preceptors, staff and pre-requisites. Although strategies such as education and preceptorship were positively evaluated, areas for improvement were also identified. CONCLUSION: This study captures the unique experiences of nurses new to critical care and demonstrates the complexity of socialisation to the critical care milieu.     

Nurses'' experiences of caring for culturally and linguistically diverse families when their child dies

Nurses experience the care of a dying child and their family as a challenging but distressing event. In a paediatric intensive care unit (PICU), Melbourne, Australia, nurses expressed a concern that they may not be providing the most appropriate care when a cultural disparity exists between nurses and families experiencing the death of their child. A critically informed study was undertaken with six PICU nurses to explore their experiences of caring for a culturally and linguistically diverse family whose child had died. Three consecutive focus group interviews were conducted with the nurses to identify issues in this area of their nursing practice and to contemplate how their practice might be changed. The focus of this paper is on one particular finding of the study about the nurses' use of controlling practices to ensure families conformed to the established routines and values of the PICU staff.     

Mediating consolation with suicidal patients

Psychiatric nurses frequently encounter suicidal patients. Caring for such patients often raises ethical questions and dilemmas. The research question for this study was: 'What understandings are revealed in texts about consolation and psychiatric nurses' responses to suicidal patients?' A Gadamerian approach guided re-interpretation of published texts. Through synthesizing four interpretive phases, a comprehensive interpretation emerged. This revealed being 'at home' with self, or an ethical way of being, as a hermeneutic understanding of a way to become ready to mediate consolation with suicidal patients. Trustworthiness was addressed by means of the qualities of auditability, credibility and confirmability. This re-interpretation adds to nursing knowledge, enhances understanding of previous research findings, provides pre-understanding for further research and reveals the value of hermeneutic inquiry in nursing. It also deepens understanding of a published model of consolation. These understandings may help to guide nurses who are struggling with suicidal patients.     

Palliative care for patients with cancer: district nurses' experiences

AIM: This paper reports a study exploring district nurses' experiences of providing palliative care for patients with cancer and their families. BACKGROUND: There is an increasing demand for palliative care in the community, as many patients wish to die at home. District nurses are central to providing palliative care in the community, but there is a dearth of literature on district nurses' experiences in palliative care. METHOD: A Husserlian phenomenological approach was adopted with a purposive sample of 25 female district nurses. Data were collected using unstructured, tape-recorded interviews and analysed using Colaizzi's seven stages of data analysis. FINDINGS: Four themes were identified: the communication web; the family as an element of care; challenges for the district nurse in symptom management and the personal cost of caring. CONCLUSIONS: District nurses' experiences of providing palliative care to family units was challenging but rewarding. The emotive nature of the experience cannot be under-estimated, as many district nurses were touched by the varying situations. Whilst acknowledging the need to maintain an integrated approach to care, district nurses should be identified as the key workers in the complex situation of palliative care.     

A caring relationship with people who have cancer

Title.  A caring relationship with people who have cancer.
Aim.  This paper is a report of a study conducted to elucidate the meaning of a caring relationship with people with cancer.
Background.  A caring relationship becomes the most important focus of caregiving when treatment of the body has reached the limits where cure is no longer expected. Caring as perceived by people with cancer involves nurses having professional attitudes and skills in order to provide good care, including emotional and practical support.
Methods.  A phenomenological hermeneutic approach influenced by Ricoeur was used. Eight nurses working in an oncology unit in Iran were interviewed in 2007 about their experiences of caring relationships with people who have cancer.
Findings.  The findings were interpreted as getting involved in a mutual/demanding close relationship. Closeness demanded nurses to be present, to listen to patients, and to be compassionate. Closeness was also mutual and characterized both caregiving and receiving new insights into values in the nurses' own lives. The close relationship was at times frustrating when they were faced with situations that they could not handle and were out of their control.
Conclusion.  Closeness is an important foundation for caring, and acquires a special dimension in the care of people with cancer and their relatives. It derives from the personal and professional experiences of nurses in their own life stories. Nursing education should include a reflective approach in order to develop caring skills in oncology nursing that are not merely attuned to medical care.     

Patients' and nurses' experiences of the caring relationship in hospital: an aware striving for trust

The phenomenon, caring relationship, has been widely studied in earlier research. Nevertheless, empirical studies in hospital, concerning patients and nurses experiences of the actual phenomenon caring relationship are rare. The aim was to illuminate patients with long-term illness and nurses' experiences of the caring relationship. The data were collected from 13 interviews, seven patients and six nurses, which were then analysed using an interpretive phenomenological method. This study shows patients' and nurses' view of the phenomenon. The findings concerning patients' view were identified in themes --'Maintaining dignity' with subthemes: using one's own competence and being cared for by the team as well as 'A feeling of vulnerability' with subthemes: being cared for in a strained situation and being exposed, inquiring personal caring relationship. The findings concerning nurses' view were identified in the following themes: 'A purposeful striving' with subthemes: using one's own competence and being aware of limitations as well as 'An arduous compassion' with subthemes: giving care in a strained situation and being aware of what is needed. These findings show that patients and nurses were aware in their striving for trust through forming a caring relationship. Their striving was not enough to result in trust. The findings in this study are understood as patients need a personal caring relationship which enables the possibility of trust.