The meaning of guilt and shame: A qualitative study of mothers who suffer from eating difficulties

The aim of this study was to illuminate and interpret guilt and shame expressed by mothers with eating difficulties (ED). The research question was: What is the meaning of guilt and shame experienced by mothers with ED? Experiences of guilt and shame in mothers with ED may be strong, yet concealed, and should be addressed when promoting women's mental health. The study design was explorative, and in‐depth interviews were conducted with eight mothers suffering from ED. The data were analysed by means of qualitative content analysis and interpreted according to a hermeneutic approach. The main theme ‘Struggling in silence with guilt and shame as a mother living with ED and trying to keep it secret’ was interpreted on two levels: emotional, ‘Feeling worried about failure and wanting to be successful’, and cognitive, ‘Having condemning thoughts about one's own sense of responsibility’. In addition, each theme contained two subthemes. Feelings and awareness of guilt and shame are strong; they vary between individuals and are intensified in mothers who suffer from ED. It is important for mental health nurses to help mothers with ED articulate such feelings in order to promote health.     

Assenting to exposedness – meanings of receiving assisted bodily care in a nursing home as narrated by older persons

Most older persons moving to a nursing home need to receive assisted bodily care, which means being in a position of vulnerability. However, few studies have explicitly focused on the meanings of receiving assisted bodily care from the older persons’ perspective. This study aimed to elucidate meanings of receiving assisted bodily care, as narrated by older persons living in a nursing home. Twelve men and women, aged 80 or older, living in a Swedish nursing home, participated in the study. Data were generated by narrative interviews and analysed with a phenomenological‐hermeneutical method. The regional ethics committee approved the study. In the analysis, one main theme emerged: ‘Assenting to exposedness’. This theme comprised five themes, ‘To have hope in hopelessness’, ‘To relinquish one's body into others’ hands’, ‘To be between power and powerlessness’, ‘To oscillate between one's own responsibility and demands’, ‘To be in an ongoing interaction’, and ten subthemes. In conclusion, receiving assisted bodily care means to be exposed, but not passively. Rather, it means to be self‐determinant for as long as possible, to perceive the body as lived. When the body must be relinquished to others, it might be objectified, leading to care‐suffering. To avoid this, the older persons use a certain competence, acquired through life, to decide when to take action or when to assent. However, this is but one of the several possible interpretations, which may be considered a limitation.     

Maintenance haemodialysis: patients' experiences of their life situation

Aim. The aim of this study was to examine how patients suffering from CKD on maintenance haemodialysis experience their life situation. The focus was on how treatment encroaches on time and space and how patients experience care. The rationale was that this knowledge is necessary to provide professional support that takes into consideration a person's whole life situation. Background. The experiences of patients with chronic kidney disease (CKD) undergoing maintenance haemodialysis have been studied in many quantitative studies, which translate patients’ subjective experiences into objectively quantifiable data. However, there are few qualitative studies examining the experiences of these patients’ life situation and expressing their experiences within the context of a nursing and caregiver's perspective. Method. Data were collected by interviews with 41 patients between the ages of 29 and 86 years who participated in the study. A content analysis was used to identify common themes that describe the patients’ experiences of their life situation. Results. Three main themes were identified, ‘not finding space for living’, ‘feelings evoked in the care situation’ and, ‘attempting to manage restricted life’. The first theme ‘not finding space for living’ consisted of two sub‐themes: ‘struggling with time‐consuming care’ and ‘feeling that life is restricted’. The second theme ‘feelings evoked in the care situation’ consisted of two sub‐themes: ‘sense of emotional distance’ and ‘feeling vulnerable’. Conclusions. The patients in this study indirectly expressed an existential struggle, indicating that encroachment of time and space were important existential dimensions of CKD. The findings indicated that caregivers were not always aware of this inducing a sense of emotional distance and a sense of vulnerability in the patients. Relevance to clinical practice. Caregivers in dialysis units have to consider haemodialysis patients’ experience of a sense of emotional distance in their relationship to caregivers. Nurses and doctors need to create routines within nursing practice to overcome this.     

Myocardial infarction: narrations by afflicted women and their partners of lived experiences in daily life following an acute myocardial infarction

Background. The review of the literature showed that many people and their family members share feelings of distress after an acute myocardial infarction. Therefore, it is important to show how the illness affects the relationship in the couple's daily life when the closest relatives involved are men. Aim. The aim was to illuminate the meaning of lived experiences in daily life after an acute myocardial infarction, as narrated by afflicted women and their partners. Methods. Nine women and their partners narrated their experiences three and 12 months after an infarction. The interview texts were then interpreted, using a phenomenological hermeneutic method, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Two themes and eight sub‐themes were then extracted from the text. Results. The first theme was ‘living in a changed life situation’ with the sub‐themes: ‘showing consideration’, ‘taking responsibility’, ‘living side by side’ and ‘desiring what to do’. The second theme was ‘looking to the future’ with the sub‐themes: ‘feeling uncertain’, ‘feeling powerless’, ‘feeling limited’ and ‘feeling hope’. Conclusions. The results revealed that couples lived in a changed life situation, somewhat in ‘discordance’, and showed consideration to each other in order to protect the partner. There seemed to be a lack of verbal communication, but both women and their partners revealed that they sensed how their partners felt without verbal communication. In this ‘discordance’, couples may experience loneliness, in that they may not share feelings about the event and the situation it causes. Relevance to clinical practice. Women and their partner have specific needs in daily living following an acute myocardial infarction. Therefore, nurses should acknowledge the specific needs for the female patient and the partner more clearly.     

Construction of masculinities among men aged 85 and older in the north of Sweden

Aim. The aim was to analyse the construction of masculinities among men aged 85 and older. Background. All societies have a gender order, constructed from multiple ideas of what is seen as feminine and masculine. As the group of men aged 85 and older is increasing in size and their demand for care will increase, we must recognize the importance of studying these men and various discourses of masculinities. Design. Qualitative explorative. Methods. Qualitative content analysis was used to analyse thematic narratives. Masculinity theories provided the point of departure for the analysis. Results. The analysis coalesced into three masculinities. ‘Being in the male centre’, developed from subthemes as: taking pride in one's work and economic situation; being in the centre in relation to others; regarding women as sexual objects; and belonging to a select group. ‘Striving to maintain the male facade’ developed from subthemes as: emphasizing ‘important’ connections; having feelings of loss; striving to maintain old norms and rejecting the fact of being old. ‘Being related’ was formulated from subthemes as: feeling at home with domestic duties; being concerned; accepting one's own aging; and reflecting on life. Conclusions. Our study indicates the importance of being aware of the existence of multiple masculinities, in contrast to the generally unproblematic and unsubtle particular healthcare approaches which consider men as simply belonging to one masculinity. Relevance to clinical practice. Diverse masculinities probably affect encounters between men and healthcare providers and others who work with an older population and therefore our results are of importance in a caring context.     

Older patients' experience of dressing changes on venous leg ulcers: more than just a docile patient

Aim and objective. The aim of this paper was to describe the lived experiences of older patients with venous leg ulcers, during dressing changes as out patients with a focus of their concerns about care interventions. Research on wound care management has focused on treatment of venous leg ulcer, wound assessments and the choice of dressing material. Few studies have focused on the patients’ experience of dressing changes. Design. Fifteen older people with verified venous leg ulcers were recruited in a metropolitan area of Sweden. Data were collected with research interviews in the form of dialogue. Method. Data were analysed with an interpretative phenomenological method developed by Benner. Results. Twelve women and three men participated. The themes were: ‘being cared for with a skilful touch’, ‘feelings of belonging, continuity and affinity’, and ‘being suppressed into a state where one loses control, leading to feelings of discomfort’. The participants’ experiences varied. Some were satisfied and felt that there was a mutual understanding between caregivers and patients, while others were dissatisfied and felt objectified. Understanding the patients as human beings and considering illness as lived experience helped the care providers to perform skilful wound care, in an atmosphere of mutual understanding. Conclusion. The patients suffering from venous leg ulcers wanted to feel worthy of wound treatment and to meet skilful, confident and gentle nurses in a sharing atmosphere. Nurses must be perceptive to the individual's bodily experience of the leg ulcer. Relevance to clinical practice. Wound care requires a multidimensional clinical approach that involves not only medical and technical care strategies of dressings and bandages, but also aspects that concern the situated‐based illness experience that persons suffering from leg ulcers may face.     

The breath of life – Womens' experiences of breathing adapted radiation therapy

PurposeTo describe and analyze how women with breast cancer experience breathing adapted radiation therapy (BART) and to explore how women manage daily radiation therapy.MethodIndividual interviews were conducted with 20 women treated with BART for breast cancer concerning their perception of radiation therapy. The transcribed interviews were analyzed using qualitative content analysis.Results‘The breath of life’ was the overall theme, as the women experienced the breathing as a way in which to influence their treatment and thus their survival. ‘Participating in one's treatment, for good or ill’, was the main category with four subcategories, ‘Knowing one has done something good’, ‘Getting an extra bonus – healthwise’, ‘The experience of being in control’ and ‘Being in a high-technology environment’. The breathing technique became the strategy by which they could manage their treatment and gave them a sense of participation which led to a feeling of being in control. The women also felt that breathing benefited their health both mentally and physically. The high-technology environment was experienced as both hopeful and frightening.ConclusionSurvival or increasing the chances of survival, are of ultimate importance for a woman with breast cancer. BART requires commitment from the women, which was perceived as offering them an opportunity to participate in their own treatment, for their survival. Increasing the women's possibilities to participate in their treatment benefits their health and welfare during an otherwise turbulent time and allow the rehabilitation process to start during treatment.     

Leadership qualities when providing therapy for women who suffer from eating difficulties

rørtveit k. & severinsson e. (2012) Journal of Nursing Management  20, 631–639 Leadership qualities when providing therapy for women who suffer from eating difficulties Aim The aim of this study was to reflect on aspects of mental health nursing leadership qualities with special focus on the therapeutic process for women who suffer from eating difficulties (ED). Background Therapy for patients with ED involves motivating them to make meaningful changes. Leadership qualities in MHN should focus on the relationship with the patient and positive empowerment processes. Methods In-depth interviews were conducted with six women suffering from ED who had participated in art therapy. The interviews were analysed by means of an interpretative hermeneutic approach. Results A main theme ‘The mental health nurse as a formative and mindful leader in a group therapeutic relationship’ and two themes ‘Leading sensitively towards awakening the patients’ awareness of their pre-understanding’ and ‘Leading dialectically towards solving patients’ existential dilemmas’ were developed and comprised two aspects of leadership. Conclusion The nurse–patient relationship is influenced by the patients’ pre-understanding and existential dilemmas. Leadership qualities associated with being formative and mindful represent important aspects of this relationship and should be investigated and thematically described in greater detail in future research. Implications for nursing management The nurse–patient relationship should focus on clinical supervision, in order to strengthen the nurses’ leadership qualities in terms of being aware and dialectical.     

Understanding loneliness in the lived experiences of Iranian elders

Scand J Caring Sci; 2010; 24; 274–280
Understanding loneliness in the lived experiences of Iranian elders Elderly people are especially vulnerable to loneliness. Loneliness as an important phenomenon is correlated with a variety of emotional, physical and health‐related complications. However, a few studies have investigated the experience of loneliness from the perspectives of elderly people living in communities. The aim of this study was to explore the lived experiences of Iranian elders of loneliness. A qualitative study using phenomenological approach was employed with four men and nine women living in their own houses. In‐depth interviews were transcribed verbatim and analysed using hermeneutic methods. The emerged themes were ‘an aversive emotional state’, ‘isolated from intimate relationships’, ‘being deprived from social and external support systems’ and ‘being abused and neglected’. Our study findings support the view that the experience of loneliness creates an aversive emotional state which is associated with negative and painful feelings. In addition, it was revealed that lack of access to intimate relationships and supportive systems as well as the experience of being abused and neglected were major factors contributing to the feelings of loneliness among Iranian elders. In terms of recommendation for practice, worldwide nurses are expected to be knowledgeable about the factors which increase feelings of loneliness. Alternatively, they should develop coping mechanisms among elders with the cooperation of their family members; also, attract community attention in order to improve social services in both quality and quantity.     

Patients' experiences of hope and suffering during the first year following acute spinal cord injury

Aims and objectives. The aim of this study was to explore patients’ experiences of hope during the first year suffering from spinal cord injury. Background. There is a lack of substantial precision with regard to the concept of hope. Very few qualitative studies focusing on experiences of hope in spinal cord‐injured patients have been identified in the literature. In this study, ‘hope’ was defined as future oriented towards improvement. Design and methods. Data were collected by means of personal interviews (n = 10) at the participants’ homes in Norway. A phenomenological‐hermeneutic approach, inspired by Ricoeur, was used to extract the meaning of the patients’ experiences. The analysis was performed in several steps, as a hermeneutic process. Results. In this study, the findings revealed two main themes: ‘The Vicious Circle’ and ‘Longing’. The vicious circle constituted aspects of suffering, and the common hope experienced by the subjects was therefore to leave the vicious circle. Experiences of suffering were experienced as feelings of loneliness, impatience, disappointment, bitterness and dependency. The ‘Longing’ was based on the subject's former life and was the source of awaked new hopes, which again was experienced comforting. Conclusions. Experiences of suffering created hope and longing. The meaning of hope was to find a possible way out of the circle and the hoping was experienced as a comfort. Relevance to clinical practice. Implications to nursing practice are listening to the suffering and longing individual and comforting the suffering by pointing towards possible future roads of hope.     

The meaning of caring for people with malodorous exuding ulcers

Title. The meaning of caring for people with malodorous exuding ulcers. Aim. This paper is a report of a study to illuminate the meaning of caring for people with malodorous exuding ulcers. Background. Managing ulcers is complicated and consensus on assessment and treatment difficult to reach. Nurses need knowledge and skills to provide good care. They must stay close and be exposed to contamination and suffering. They must provide care without violating patients and we need to further explore this challenge. Method. A convenience sample of ten participants was recruited. Participants had experience of caring for people with malodorous exuding ulcers and were employed in primary health or hospital care in Sweden. Narrative interviews were conducted during late 2002 to early 2005 and interpreted using a phenomenological‐hermeneutic method. Findings. Themes were formulated: ‘Facing the wound’ when nurses reveal what is meant to be concealed and perceive patients’ vulnerability; ‘Facing one’s own defencelessness’ when feeling invaded, helpless and ashamed; ‘Struggling to shield one’s own defencelessness’ was achieved by striving to be in control, striving to endure and seeking a way out. ‘Struggling to shield patients’ vulnerability’ was about alleviating patients’ additional suffering by striving to spare patients, pushing boundaries, making uncomfortable decisions and sharing togetherness. When failing to shield their own defencelessness and patients’ vulnerability, nurses run the risk of experiencing desolation. Conclusion. Physical proximity and bodily suffering affect nurses. Caring for people with ulcers calls for improved interprofessional cooperation in order to provide the best treatments and care. Further education for these nurses is needed, as well as support from managements and organizations.     

Health as a movement between suffering of life and meaning in life for men who have experienced transitions in life

Background and Aim

Previous studies show that life transitions can have negative effects on men's lives and lead to health problems and meaninglessness in life. This study aims to deepen the understanding of men's health by exploring the movement between suffering of life and meaning in life when experienced life transitions.

Theoretical Framework

The study is anchored in Eriksson's caritative caring theory. Core concepts are health and the movement between suffering of life and meaning in life.

Methodology and Methods

The methodology is hermeneutical, and the study has a qualitative research design. Fifteen men from Norway participated in in-depth interviews in 2021. The interviews were analysed using reflexive thematic analysis.

Results

Four themes emerged in relation to the suffering of life; enduring separation from community, shame at being useless as a human being, grief over what has been lost in life, and being powerless and vulnerable in the face of a hopeless struggle. Three themes emerged in relation to meaning in life; realising what is most important in one's life gives strength, decision to live one's life brings joy in life and a positive attitude towards life gives freedom and awakens a new spark for life.

Conclusion

Suffering of life emerges as a separation from relationships and society and as a perceived uselessness as a human being losing faith, control and feeling like a burden erodes dignity and trigger feelings of shame, guilt and degradation. Suffering of life manifests as loss of drive and spark for life. Life has meaning through finding the good in oneself, coming to know and believe in oneself and seeing new possibilities which bring about a spark for life, gratitude, dignity and freedom. Health exists in the movement between suffering of life and meaning in life, in pausing, recognising vulnerability, prioritising and reorienting oneself.     

Touching the dead: Autoethnographical reflections about the researcher’s body in the field of death,dying, and bereavement

This essay presents an account of the influence of the researcher‘s body within qualitative death research. It suggests that appropriate reflection on the researcher‘s subjectivity should consider his or her own bodily performances and experiences. At the beginning I offer some introductory thoughts in this regard, referring to Plessner‘s distinction between ‘being a body‘ (Körper-haben) and ‘having a body‘ (Leib-sein). Here, I highlight the importance of autoethnographic approaches for the understanding of bodily experiences, such as sensations, perceptions and their aesthetics. To demonstrate the importance of considering the researcher‘s body within the research process, I then draw on my own autoethnographic material, discussing how I experienced in my body frightening and disturbing feelings while dealing with the dead. This material was collected during a six-month internship from April to September 2016 at a small funeral home in Thuringia, Germany. I explain how I was socialised regarding my bodily behaviour towards the dead years ago and how I acquired the knowledge that touching a corpse is often taboo; describe my bodily reactions when I saw a dead body for the first time during my internship and how these reactions influenced my fieldwork; relate how my senses and perceptions when first touching a corpse led to extreme responses that drew most of my attention to the haptic and sensual dimension, making me unable to notice other information in the field; and show how these bodily experiences crossed borders and influenced my life beyond my field research.     

Life with an unwelcome guest – caring in a context of protracted bodily pain

Protracted bodily pain is a phenomenon that often affects a human being's whole life. Care of human beings with protracted pain is challenging because pain is not always measureable, and the experiences of pain are subjective, unique and shapeshifting. Therefore, the aim is to highlight what protracted bodily pain signifies for the human being, and human beings' experiences of what is caring in a context of protracted bodily pain. Four informants with protracted bodily pain took part in a focus group interview. The interview was analysed by using a qualitative content analysis with a hermeneutic approach. The findings show that protracted pain renders human beings speechless, limits and robs them of their lives. The pain is described as a domineering, unpleasant and unwelcome guest. The pain can change the human being's personality and creates feelings of guilt. Uncertainty about the origin of the pain as well as a nonchalant treatment or not being believed intensifies the pain. Human being experience mastering the pain, encounters with caregivers who can ease the burden, community with others and finding that little something extra in everyday life is experienced as caring. From a caring science perspective, the relation between protracted pain and suffering is obvious. Suffering emerges as illness suffering, as life suffering and as suffering caused by care. Professional as well as natural caring is important in a context of protracted bodily pain. The human being longs to encounter caregivers who are courageous enough to lay themselves on the line. Community with people who are prepared to share the burden eases the heavy burden that pain brings to life, it brings hope and relief.     

The Stories of Physicians,Registered Nurses and Enrolled Nurses about Ethically Difficult Care Episodes in Surgical Care

Twenty physicians, 19 registered nurses (RN), and 20 enrolled nurses (EN) working in surgical care in Sweden narrated their experences of being in ethically difficult care situations. All three professional groups disclosed a strong wish to help patients. The narrations of the physicians and the ENs indicated that they were very much involved in their patients, while most of the RNs' stories were narrated from a distanced onlooker's perspective and disclosed a lot of moral outrage, mainly directed towards physicians. The physicians were the only group that emphasized the importance of acting in accordance with science and proven experience. Like RNs they emphasized the importance and difficulty of telling the truth to the patients and their families and being open to one's own and others' harsh experiences. RNs and ENs emphasized the patient's right to a death with dignity and the difficulties connected with being with dying patients, and they also described feelings of powerlessness and neglect of patients related to a heavy work load. ENs narrated difficulties related to providing patients with individualized but fair care.     

The experience of becoming a grandmother to a premature infant – a balancing act,influenced by ambivalent feelings

Aims and objectives. To explore and describe the experience of becoming a grandmother to a premature infant. Background. Becoming a grandmother involves a new perspective of life. Grandmothers of sick infants find themselves in a new situation with an adult child undergoing serious stress. Few studies have approached the grandmothers’ own experience of becoming a grandmother to a premature infant. Design. A qualitative content analysis was used. Methods. Eleven women, 52–66 years of age, who were grandmothers to premature infants born at a gestational age of 25–34 weeks, were interviewed during 2010. The infants were less than three years old at the time of the interview. The interviews were analysed with qualitative content analysis. Results. The overall theme was a balancing act. Two categories of experience were identified: emotional experiences and a new role. ‘Emotional experiences’ was related to the first meeting, ambivalent feelings and confidence in care. ‘A new role’ was related to the subcategories supportive, a balance of involvement and limitations. Conclusions. To become a grandmother to a premature infant was experienced as a balancing act influenced by ambivalent feelings of joy, fear and worry. The grandmothers sensed the seriousness of the situation at the same time as they wanted to be happy about the newborn infant. They worried about their adult child’s as well as the premature infant’s health but put their own needs aside. The grandmothers’ new role was a balance between being involved and supportive without disturbing. Relevance to clinical practice. Neonatal intensive care unit staff should be open to grandmothers’ needs and acknowledge them as an obvious support for the immediate family of a premature infant. The grandmothers need guidance and information about what to expect concerning the infants health, the parents situation and their own role.