Fear of humiliation inhibits women's care-seeking behaviour for long-term urinary incontinence

Most women with urinary incontinence (UI) do not seek professional help. Women's experiences of their behaviour when seeking care for incontinence are important to improve understanding by nurses and encourage as well as enable women to seek help. The aim of this study was to illuminate the meaning of women's lived experiences of their behaviour when seeking care for long-term UI. Thirteen women were interviewed (range 37-52 years) who had not sought professional help for incontinence. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Three themes evolved from data: being in an affected situation, having personal beliefs about seeking care and having desired expectations about care. Being in an affected situation, means that the women were negatively affected by their long-term incontinence. Living with shame, altered sexual relationships and a need for distancing have negatively influenced their care-seeking behaviour (CSB). Having personal beliefs about seeking care means that the women had their own beliefs regarding morally acceptable behaviour for seeking care because of incontinence. This led to a toning down of their problem and a minimization of the problem associated with incontinence as it was considered to be a normal consequence of pregnancy and childbirth. Having desired expectations about care means that the women had opinions relevant to the care and felt being asked about incontinence and an understanding atmosphere should be included. The conclusion is that fear of humiliation inhibited women from seeking care for long-term UI. The findings suggest that nurses should be precise when asking about women's experiences of UI because otherwise they do not bring it up. Additionally, CSB can help nurses to explain the experience and enable women to seek help for this manageable condition.     

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.     

Silent no more: elderly women's stories of living with urinary incontinence in long-term care

Urinary incontinence (UI) is a prevalent health issue affecting the quality of life of many elderly women living in long-term care. Minimal consideration has been given to understanding the lived experience from women's perspectives. Using one-to-one interviews, this study explored elderly women's experiences with UI while living in long-term care facilities. Data were analyzed using thematic analysis that revealed three themes related to the meaning of UI to the women, physical implications of UI, and institutional culture of UI in long-term care. Within these three themes, the women expressed common concerns. The results of this study provided information that could influence changes in nursing practice related to individualized UI care, empowering women experiencing UI, and dispelling ageism in long-term care. The study also suggests opportunities for improving health care education related to the quality of life of women who experience UI, and the need to make the experience more visible and openly discussed as a health issue rather than the traditional condition of aging.     

Dimensions of the impact of urinary incontinence on quality of life of affected women: a review of the English literature

Urinary incontinence (UI) is a condition encountered by many women in their middle ages and although it is not life threatening, it tremendously affects the quality of life (QOL) of affected women. The purpose of this review was to characterize the dimensions of women's QOL affected by UI. A systematic review of published literature reporting about primary studies was conducted using specific Medical Subject Headings (MeSH) terms: (urinary incontinence) and 1 – (quality of life), 2 – (outcome), 3 – (well‐being), 4 – (health outcomes), 5 – (women), 6 – (social well fair) and 7 – (signs and symptoms). This yielded 545 articles and 12 articles met the inclusion criteria. Searches were conducted from electronic databases including PubMed, CINHAL and SCOPUS. The studies included in the review used different measurements to reach conclusion about the effect of UI on QOL. All the studies emphasized that UI has a negative impact on at least two aspects of the affected woman's QOL. The results of the review show that UI negatively impacts women's QOL in four main dimensions such as physical health, mental health, sexual health and social well‐being. UI negatively impacts affected women's in various aspects of their life and to effectively address their health care needs it requires a multidisciplinary and holistic approach to their health care needs.     

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.     

Acute myocardial infarction in middle-aged women: narrations from the patients and their partners during rehabilitation.

The purpose of this study was to examine the meaning of lived experiences after an acute myocardial infarction (AMI) and being a partner to an afflicted woman, as it is narrated during rehabilitation. Nine women and their partners narrated their experiences three and twelve months after AMI. The interview texts were transcribed and then interpreted, using a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur. The result showed that their experiences of the illness contained two themes: 'rehabilitation needed' and 'loss of freedom' which contains eight sub-themes; 'adapting to it', 'struggling against it', 'living as normally as possible', 'having insight into how it can be', 'feeling guilty and ashamed about being weak', 'withholding feelings', 'feeling useless', and 'feeling fatigued and losing strength'. After further interpretation, the themes gave a deeper meaning of living with AMI and how it affects women and their partners. The women conceded that they felt distressed and vulnerable but struggled against the fear the illness means. The partner's role appears to be one of trying to adapt to the women's experiences of the illness. That the women withheld their feelings and did not talk about them indicates a lack of communication between the couples. As coronary care nurses often come very close both to the afflicted persons and the relatives they fill an important function in each patient's recovery. The nurses could help and prepare the patients and their relatives to understand better such feelings and reactions as could appear after discharge from hospital.     

Women's experiences of making healthcare decisions about their breast cancer: A phenomenological study

There are few studies about how healthcare decisions are made for women with breast cancer in China and this knowledge is vital, both to further develop person‐centered health care and to ensure that women have a voice in their healthcare decisions. This phenomenological study explored the meaning of women's lived experiences of making healthcare decisions about their breast cancer in China. Semistructured, in‐depth interviews were conducted with a purposive sample of eight women with breast cancer. Data were analyzed using Colaizzi's phenomenological analytic method. The results of this study identified four themes: authority and expertise, lack of knowledge, family support, and Chinese cultural and social influences. Women were deferential to medical authority and perceived expertise, but they wanted to be involved to a greater degree in healthcare decisions. It is important for health professionals to optimize women's participation in decision‐making by removing barriers and advocating on their behalf.     

The feeling of being trapped in and ashamed of one's own body: A qualitative study of women who suffer from eating difficulties

The aim of this study was to explore women's bodily experiences of suffering from eating difficulties (ED). The research question was: How do women who suffer from ED experience the bodily aspects related to their condition? Women suffering from ED experience problems in both the physical and emotional areas. Few qualitative studies have specifically addressed sufferers' bodily experiences related to ED. An explorative design was used. The data were collected by means of focus group interviews on the subject of ED‐related problems, guilt and shame, and being a mother. The interpretation of the qualitative data was inspired by hermeneutic content analysis. The main theme, ‘Powerful feelings of being trapped in and ashamed of one's own body’, comprised two themes: ‘The feeling of being trapped by overwhelming physical sensations’ and ‘The feeling of being ashamed of one's own body’. Bodily experiences were reported as strong. One clinical implication for nurses is to acknowledge this fact and make it possible for these women to articulate their difficulties, especially those connected to the feelings of being trapped and ashamed. Support groups focusing on these themes could be one way of assisting women and easing some of the negative feelings associated with ED.     

Fear of falling from a daily life perspective; narratives from later life

Fear of falling is a well-known condition in later life. The aim of this study was to illuminate the experiences and the meaning of fear of falling in a daily-life context. The method used was a qualitative study inspired by interpretive phenomenology. In narrative interviews, five community-dwelling women over 80 years of age told about their fear of falling from a daily-life perspective. The overall thematic analysis resulted in three main themes: the meaning of managing daily life necessities; keeping in contact with the outside; living with fear. The findings showed that to live with fear of falling was to discipline daily life, and to learn to live with the challenge of a vulnerable bodily condition and of losing control at different levels: from falling, from incontinence, from dirt and from the stigma of being in a humiliating situation. The women created a perception of independence while they were dependent on help and community care and on news from the outside. At an existential level, they coped with their fear by strengthening their will. The conclusion was that the older women studied accepted the condition of fear of falling. They shared the ability to cope in various ways with the limitations of their bodily capacity and their imbalance.     

Powerlessness,marginalized identity,and silencing of health concerns: Voiced realities of women living with a mental health diagnosis

Using a feminist qualitative approach, this study substantiated many earlier research findings that document how women with a mental health diagnosis experience unequal access to comprehensive health care compared to the general population. Accounts of this disparity are documented in the literature, yet the literature has failed to record or attend to the voices of those living with mental health challenges. In this paper, women living with a mental health diagnosis describe their experiences as they interface with the health‐care system. The participating women's stories clearly relate the organizational and interpersonal challenges commonly faced when they seek health‐care services. The stories include experiences of marginalized identity, powerlessness, and silencing of voiced health concerns. The women tell of encountered gaps in access to health care and incomplete health assessment, screening, and treatment. It becomes clear that personal and societal stigmatization related to the mental health diagnosis plays a significant role in these isolating and unsatisfactory experiences. Lastly, the women offer beginning ideas for change by suggesting starting points to eliminate the institutional and interpersonal obstacles or barriers to their wellness. The concerns raised demand attention, reconsideration, and change by those in the health‐care system responsible for policy and practice.     

'The intruder': spouses' narratives about life with a chronically ill partner

Aim. The aim of this study was to illuminate the meaning of middle‐aged spouse's experiences of living with a chronically ill partner. A purposive sample of four female spouses was selected for interviews using a narrative approach. Background. When someone is diagnosed with a chronic illness, it is easy to understand that a considerable number of devastating consequences follow, both for the afflicted as well as for the family. Families often feel neglected and that their problems and needs are underestimated, if they do not personally draw attention to this fact. Methods. A phenomenological hermeneutic method, inspired by the philosophy of Ricoeur, was used when interpreting the interview text. Results. The experiences of spouses living with a chronically ill partner often brought a feeling of detachment from their partner's lives. The women experienced changes in their relationships because of their partners’ disabilities; they had emotions of loneliness, despite living together as a couple. Through their actions, the women sought reassurance and support in order to maintain a meaningful partnership with their spouses and this is expressed in three themes: feelings of limitation, the struggle of everyday life and a striving for normalization. Conclusions. Middle‐aged women living with a chronically sick partner are still of an active disposition and regard themselves as still being in mid‐life. They wish to be loved as a wife and not as a care provider. Relevance to clinical practice. The findings from this study can help increase the knowledge and understanding of the problems and concerns encountered by middle‐aged spouses living with chronically ill partners and can be useful in the education and supervision of nurses and in relationship with relatives.     

Balancing uncertainty and acceptance: understanding Chinese women's responses to an abnormal cervical smear result

Aims and objectives. The aims of this study were to examine the responses of Hong Kong Chinese women receiving an abnormal smear result and to compare any differences in responses depending on the diagnosis of the abnormal smear. Background. The implementation of cervical screening programmes has resulted in an increasing number of women receiving an abnormal smear result requiring cytological surveillance or referral for colposcopy. Evidence suggests that women frequently misunderstood such results, believing that they already have cancer. However, little is known about the responses of Chinese women in this situation. Design. An exploratory qualitative study. Methods. Face‐to‐face semi‐structured tape‐recorded interviews were undertaken with 66 women sampled opportunistically from an urban centre of a major non‐governmental service provider. Amongst this sample, 22 women required cytological surveillance, 20 required treatment for vaginitis and 24 were referred for colposcopy. Thematic analysis was undertaken of the translated interviews within and across groups to identify categories and themes illustrating women's responses to an abnormal smear result. Findings. An important difference in the comparison of the data sets was that of women's understanding of the cause of the abnormal result. Women with vaginitis understood the cause of their abnormality, whereas those in the other groups remained unclear about their abnormality, generating feelings of fear and uncertainty. Trust in practitioners influenced women's acceptance of the result. Conclusions. Although responses of Chinese women are similar to those in other population groups, with those referred for colposcopy experiencing greater anxiety than those undergoing cytological surveillance, balancing feelings of uncertainty and acceptance influenced Chinese women's responses to their abnormal results and allowed them to make sense of their result in their everyday life. Trust in the practitioner was essential to the acceptance of their result. Relevance to clinical practice. Such findings highlight implications for nursing practice, in particular developing information‐giving strategies and targeted information to help women manage feelings of uncertainty. The importance of trusting professional relationships in determining women's acceptance of an abnormal result is also highlighted. The findings suggest nurses working with Chinese women should consider the underlying influence of culture on women's beliefs and actions.     

Prevalence of urinary incontinence in older Korean women

Worldwide prevalence of any type urinary incontinence (UI) in women 20 years and over is estimated to be over 275 million in 2013 and the 4th International Consultation on Incontinence expects it to increase to over 300 million in 2018. While UI in women is considered to be an aging and public health issue with global implications, most research cited in the UI literature comes from English language sources. The absence of information from many Asian and other countries may be due to reliance on scientific reports written in English by editorial policies, authors of systematic literature reviews and other researchers. Moreover, the financial costs and time constraints associated with translation and dissemination of findings into English language journals could act as dissemination barriers. Therefore, the purpose of this study was to describe the current state of knowledge about prevalence and correlates of UI in Korean older women from non‐English language sources. Twelve research articles, two research monographs and one master's thesis, and data on UI abstracted from South Korea's 2008 National Health Insurance Cooperation Reports were reviewed in full. The prevalence of UI in women 60 years and older ranged from 11·2% to 76·3%. Personal, physical and psychological factors were found to be associated with UI including age, income and educational level, presence of comorbidities, body mass index, depression, anxiety and cognitive impairment. There was little difference between rural and urban dwelling older women in help‐seeking behavior: 93.8% rural and 90.5% urban dwelling older women sought no help for their incontinence. Inclusion of reports from non‐English sources is considered as an important contribution to better understanding of the worldwide epidemiology of UI in older women.     

Living as a family in the midst of chronic illness

Aims and objectives

The aim of the study was to illuminate the meaning of lived experience of living as a family in the midst of chronic illness.

Background

Chronic illness implies a change for both the individual and the family. In this changed situation, all family members seem to benefit from sharing experiences and receiving support. Current research highlights the individual patient's or family member's perspectives on chronic illness, but family systems nursing (FSN) studies are warranted.

Design

A qualitative design with a FSN approach was chosen.

Method

Repeated qualitative narrative interviews with seven families living with chronic illness were performed. A phenomenological hermeneutic analysis, inspired by Ricoeur, was used to interpret the data.

Results

The phenomenon can be described as an ongoing movement towards well‐being. The results included two themes and five sub‐themes. The first theme was ‘Co‐creating a context for living with illness’ with the subthemes; ‘learning to live with the expressions of illness’ and ‘communicating the illness within and outside the family’. The second theme was ‘Co‐creating alternative ways for everyday life’ with the subthemes; ‘adapting to a new life rhythm’, ‘altering relationships’ and ‘changing roles and tasks in the family’.

Conclusions

Living as a family in the midst of chronic illness can be described as an ongoing process where the family members co‐create a context for living with illness. They also co‐create a context for alternative ways of everyday life.

Relevance to clinical practice

Knowledge about lived experience of living as a family in the midst of chronic illness can help nurses to adopt a FSN care perspective. This can increase the chances of taking advantage of the ways family members manage situations together, as well as highlight resources within the family.