“Life on Hold”: A Qualitative Study of Patient Experiences with Outpatient Commitment in Two Norwegian Counties

In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients’ experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients’ daily lives were dominated by the agenda set by health care providers and many said they were subjected to control measures that resulted in a reduced quality of life. However, informants also spoke of positive experiences as outpatient commitment order patients, such as feeling safe and secure and having easy access to health care staff and services.     

Lack of resilience among very old men and women: a qualitative gender analysis

High degree of resilience has been described as an enduring positive view of life despite difficult circumstances during the aging process. How to become old and being old with low resilience have not been studied. The aim of this study was to illuminate experiences about becoming old and being old among very old people with low resilience. Interviews from very old women and men were analyzed using content analysis with the following themes identified: being out of it, emphasizing life experiences from the past, religious doubting, and accepting age. Except for religious doubting, the themes contained both similarities and variations between women and men. Our study showed that in spite of scoring low on the Resilience Scale (RS), very old persons can experience integration and well-being. However, the women seemed to be more vulnerable compared to men, and for them, it is important to strengthen social and relational possibilities for contributing to resilience.     

A life-breaking event: early experiences of the consequences of a hip fracture for elderly people

Objective: To explore and describe the consequences of an acute hip fracture as experienced by home-dwelling elderly people shortly after discharge from hospital.Design: Semi-structured interviews using the phenomenographic method.Subjects and setting: Eighteen subjects were interviewed in their own homes one month after discharge.Results: The interviewees described experiences of changes in their relation to the body, themselves, to others and to their whole life situation. These experiences were described as being limited in movement, having lost confidence in the body, becoming humble and grateful, respecting oneself and one's own needs, becoming more dependent on others, gaining more human contact and being treated in a friendly way by others, being secluded and trapped at home, feeling old, closer to death and having lost their zest for life, and taking one day at a time and being uncertain about the future.Conclusion: Experienced consequences of a hip fracture were multidimensional and involved dramatic changes in the interviewees' life situation, including existential thoughts and reappraisal of the years of life that remained. The results indicate that the fracture seemed not only to break the bone but also to cause social and existential cracks, as experienced in the early phase after the injury.     

Narratives of children with chronic illness about being comforted

The aim of the study was to examine how children with chronic illnesses narrate their experience of being comforted in hospital. During interviews, seven children, 4-10 years old described their experiences and made drawings. Thematic content analysis revealed following themes: being physically close to one's family, feeling safe and secure, staff being there for the children, and children being there for parents and siblings. Mother was identified as the most important comforter. The findings suggest that trusting in the staff's knowledge and professional skills is a prerequisite for children to feel "at home", and safe in hospital. Being close to one's family is even more important.     

Meanings of being old and living with chronic obstructive pulmonary disease

The aim of this study was to achieve a deeper understanding of the meaning of the lived experiences of elderly persons who are severely ill with chronic obstructive pulmonary disease (COPD) and in need of everyday care. Narratives from dialogues with six persons were interpreted using phenomenological-hermeneutic methodology. The structural analyses showed severe problems in daily life due to old age with a decaying body and dialectic experiences of resignation-contentedness, loneliness-connectedness, and being homeless-being at home. The interpreted whole reveals that life, suffering and comfort must be understood as an interlaced experience where ageing is just as important as the experience of illness. These elderly people's concerns and problems due to old age, a decaying body and being severely ill with COPD call for palliative and comfort care and thus challenge all professionals involved in their care.     

Elderly persons' experiences of striving to receive care on their own terms in nursing homes

Anderberg P, Berglund A-L. International Journal of Nursing Practice 2010; 16 : 64–68
Elderly persons' experiences of striving to receive care on their own terms in nursing homes
Elderly persons' participation in and decisions about their own care need more attention. The aim of this study was to gain a deeper understanding of elderly persons' experiences of care and help, and how their lives change in nursing homes. Fifteen elderly persons living in four nursing homes were interviewed about their experiences of needing care and help in their daily life. The interviews were analysed using van Manen's phenomenological approach. Elderly persons' experiences of care and help were described as: a balance between sorrow and relief, a struggle to maintain control and connectedness, managing to live in the present and yet worrying about the future, and an attempt to hide one's vulnerability in order to be accepted and create an inner calm in an exposed situation. In conclusion, important issues were raised concerning elderly persons' perspectives on care and help in daily life in nursing homes.     

Being in the situation of a significant other to a person with inoperable lung cancer

Little is known about how significant others experience their own situation when a family member becomes seriously ill. To illuminate the meanings of significant others' experiences of their situation after a family member had been diagnosed with inoperable lung cancer, we analyzed narratives from 12 significant others, using a phenomenological hermeneutic approach. Findings revealed 4 themes: feeling dislocated in life, being in an altered relationship, being in a struggle, and feeling secure. When reflecting on these findings, we considered the transition theories and works of Ricoeur and L?gstrup. The significant others' experiences indicated a transition process because of the changes brought about by the diagnosis of lung cancer and a struggle to endure and overcome difficulties and distress on the way to regaining a smooth functioning life. Furthermore, the diagnosis of lung cancer had altered the relationship toward the next of kin and meant not only feelings of increased closeness but also loss of intimacy and reciprocity. The significant others suffered in this process of transition, and healthcare professionals, who recognize the World Health Organization's definition of palliative care, may consider the findings of this study useful when reflecting on their care of families.     

Experience of siblings of children treated for cancer.

The aim was to obtain an understanding of the experience in everyday life of being a sibling when a brother or sister is receiving treatment for a cancer disease or has completed treatment. In order to illuminate the experience of the siblings themselves a phenomenological-hermeneutic method was used. Ten siblings were asked, in the form of a broad-based, open question, to tell about their experience of being the sibling of a brother or sister in this situation. There was an awareness of sibling-ship as a special relation since the brother or sister had got cancer. This feeling was very strong and close, and when needed the sibling admitted a protective and advocacy role. The siblings felt difficulties to always be loyal with the brother or sister needs and demands from other interests. They lived a new life and periods of ups and down following the condition of the brother or sister. Everyday life varied from joy to a life filled with worries and anxiety. Siblings experienced feelings of an existential nature, such as quality of life and death.     

Health–illness transition among persons using advanced medical technology at home

Scand J Caring Sci; 2011; 25; 253–261
Health–illness transition among persons using advanced medical technology at home This study aimed to elucidate meanings of health–illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self‐care while using different sorts of advanced medical technology at home, knowledge about health–illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self‐care at home, either using long‐term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health–illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health–illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health–illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition.     

A difficult mission to work as a nurse in a residential care home – some registered nurses' experiences of their work situation

The aim of the study was to describe Registered Nurses' (RNs) experiences of their work environment in residential care homes for older persons. Twelve RNs were interviewed and latent content analysis was used for analysing the data. The data were collected in the spring of 2006. The findings revealed that these RNs experienced a paradoxical work environment: feeling appreciated and valuable, whilst at the same time feeling underestimated and frustrated. They felt appreciated and valuable when they provided nursing care and trust and support to others. The RNs experienced a positive work environment when the border between social and nursing care were clear. They also felt frustrated when they were expected to 'be everywhere and to know everything', but at the same time they felt invisible and underestimated. They experienced themselves as 'lonely fixers', having the ability to solve practical problems when the older persons were discharged from hospital and expected to be able to provide specialist nursing care without having specialised competence and specialist staff team members. In conclusion, it is important that the RNs can identify the border for nursing care. When these are clear, the nursing care objectives are apparent and the RNs become more autonomous, visible and listened to. The manager should listen to and support the RNs, with continuous supervision and competence development being mandatory elements. It is a difficult task for RNs working in residential care homes to meet all of the expectations placed on them, resulting in a risk of moral distress, making mistakes and developing illnesses caused by stress.     

Lost in the present but confident of the past: experiences of being in a psycho-geriatric unit as narrated by persons with dementia

Aim. To illuminate meanings of being in a psycho‐geriatric unit. Background. There are known risks associated with moving persons with dementia from home to an institution, but little is known about how they experience being in psycho‐geriatric units. Method. Using open‐ended research interviews, six persons with mild to severe dementia were asked to narrate about their experiences in the hospital. The interviews were interpreted using a phenomenological hermeneutical method of analysis. Results. The comprehensive understanding of being in a psycho‐geriatric unit points towards an understanding of being lost in the present but confident of the past. The analysis showed that the participants appeared lost as they could not narrate where they were and why, but that they became confident when narrating about their previous life. The analysis also showed that being in the hospital meant sharing living space with strangers, invasions of private space and establishing new acquaintances. Being in the unit could also mean boredom and devaluation for participants. The interviews were interpreted in the light of narrative theory of identity: persons with dementia narrating about previous life experiences as to make claims of how to be interpreted by others; as persons instead of merely as ‘demented’ patients. Conclusions. Experiences of care narrated by persons with dementia present meaningful and useful information that can provide feedback to inform care practice. Relevance to clinical practice. Experiences of care from persons with dementia provide meaningful information about care and the doing and being of staff. Creating time for conversations with these persons may facilitate well‐being.     

Healing the wounded, neglected inner child of the past

Childhood experiences of the past can have a destructive effect on the present. The inner child in each person is the core of the personality that has been molded by the directions on how to act to be loved that the person receives in childhood. Painful experiences and lack of nurturing in dysfunctional families wound the inner child and contaminate adult experiences. Many persons with eating disorders have a wounded or neglected inner child that affects their adult lives. Characteristically, they demonstrate problems with trust, intimacy, addictive and compulsive behaviors, and codependence among others. Healing the inner child by grieving neglected childhood developmental needs is a long process, but one that improves the quality of one's life. Nurses, depending on their educational background and clinical skills, can help clients move toward understanding and healing the wounded, neglected inner child of the past.     

The impact of shareholding networks for facilitating care in rural Thailand

This study explored the existential meaning of being a participant in shareholding networks for the care of older people in Thailand. Ten older persons were interviewed about their experiences of participating in the networks. A reflective lifeworld perspective based on phenomenological philosophy was used. The findings show that participating in shareholding network activities entails an always-present existence of aging intertwined with life. Its constituents further describe the essential meaning of the phenomenon: “experience of improved self-management”, “feeling of increased self-esteem”, and “bridging a gap in the care of older people”. Participation in shareholding network activities means keeping contact with oneself and being able to have a life that corresponds to how one perceives oneself to be and must therefore be understood from a holistic perspective. The present study recommends that older persons’ need for support include places where safe and profound reflection on existential issues.     

广东梅州城区老年人生活质量的调查研究

目的探索梅州山区城区的老年社区健康保健的有效策略。方法随机抽查城区1100名老年人,通过问卷访问的方式调查。结果发现44.8%的老年人对自己的生活质量较满意,39.0%的人认为满意,14.3%的人不满意。结论梅州山区老年人的生活质量不容乐观。     

Staying in 'the stream of life': rehabilitation of older people in their own homes following total hip replacement

Background.  According to World Health Organization (WHO), rehabilitation should be based on the person's entire situation with a focus on body functions, level of activity, participation and environment. But different types of investigations show an unclear concept of rehabilitation in professional nursing.
Aims and objectives.  This study aims to identify older persons' (≥75 years of age) experiences of the rehabilitation process after total hip replacement.
Design and methods.  Qualitative interviews were undertaken with six persons who were rehabilitated in their own homes following total hip replacement. The interviews were guided by Max van Manen's phenomenological methodology with its focus on the life world as described through patients' experience of time, space, body and interpersonal relations.
Results.  Staying in the stream of life confirmed the importance of the life world. What is essential in the rehabilitation process is to get back into everyday life as soon as possible and participate in activities which are meaningful and which are linked to being at home where 'you can be who you are'. The home is the framework for being in the stream of life, and it provides the centre of gravity for the people's welfare.
Conclusion.  Staying in the stream of life is about being the author of one's own meaningful life. It takes into account life phenomena embodied in the maintenance aspect of health care; dignity in relation to identity and integrity; and an understanding of the dialectical relation between frailty and strength.
Relevance to clinical practice.  Rather than focusing exclusively on patient participation and goal-directed activity, nursing actions should integrate life phenomena as key aspects of rehabilitation with older people in their own right.     

Elderly persons' experiences of living with venous leg ulcer: living in a dialectal relationship between freedom and imprisonment

The aim was to illuminate elderly persons' experiences of living with venous leg ulcer. Fifteen persons 74-89 years of age with active leg ulcer were interviewed. Data were analysed utilizing a phenomenological-hermeneutic approach inspired by Ricoeur. The analysis includes dialectic movement between understanding and explanation of the text as a whole and its parts. In the structural analysis four themes were identified: emotional consequences of altered body image, living a restricted life, achievement of well-being in connection with a painful wound and bandage, and struggle between hope and despair with regard to a lengthy healing process. The comprehensive understanding indicated that the meaning of living with venous leg ulcer can be understood as a dialectal relationship between, on the one hand the feeling of being imprisoned in the body, the bandage and the home, and on the other hand, hope of freedom from a burdensome body. The results indicate that the concept, body of image, is vitally relevant to the caring of elderly people with venous leg ulcer. The study shows the importance of recognizing the persons' perceptions of their leg ulcers and the impact of these perceptions on well-being. Nurses can thereby anticipate problems and provide more sensitive care.     

Psychosocial disadvantages in the lives of persons with long-term mental illness living in a Swedish community

The aim of this study was to gain in-depth knowledge of how persons with long-term mental illness experience their everyday situation, in order to identify potential psychosocial obstacles to a meaningful existence. The focus was on psychosocial aspects, such as contact with others and the quality of these contacts. An ethnographic design was used, in order to provide an inside perspective. Four persons with long-term mental illness participated in the study. Three open-ended interviews, at 1-week intervals, were conducted with each informant. Analysis of transcribed material consisted of naive reading and content analysis guided by the investigators' understanding of the psychiatric context. Three themes were generated: feeling lonely but being unable to establish friendships; knowledge of what to do but lacking initiative; and awareness of the need for support but not wanting to be subject to control. These themes reflect contradictions between thoughts, feelings and actions, which seem to contribute to a psychosocial disadvantage in the life of persons with long-term mental illness.