Existential caring in the family health experience: a proposed conceptualization

Empirical realities and technological advances in the clinical practice context continuously call for ethical dialogue among healthcare providers. The nurse's voice of advocacy for humane caring grounded in an existential understanding of the complexities of the health experience remains a salient responsibility of moral agency. If nurses are to care for families, as society requires, then nurse caring, a phenomenon currently defined and understood primarily at the individual patient-nurse level, must be diligently and broadly explored in terms of its worth to guide nursing service with families. The purpose of this theoretical paper is to explore a conceptualization of care with families in the health experience that emanates from the philosophical tenets of existentialism and underpinnings of symbolic interactionism and is interpreted into action by the ethics of care. Current and classic literature, inclusive of philosophical and empirical works, provide the background for analysis of the following elements: existential caring orientation, family perspective, family-nurse interaction, construction of meaning, family meaning construction, nurse meaning construction, family-nurse co-construction of meaning and existential advocacy. Existential philosophy is understood as the basic underlying lens guiding the nurse in taking an existential caring orientation as depicted in the resultant conceptualization. Caring in the family health experience is best facilitated by a relational stance where the nurse acknowledges the family's unique perspective. Through the family-nurse interaction the nurse gains understanding of the family's perspective being constructed. Nursing practice with families confronting the empirical realities and technological advances of the new millennium will be enriched when moral agency includes ethical dialogue among healthcare providers and families. Existential advocacy with and for families grounded in the nurse's understanding of the family perspective enhances the context for moral agency.     

Pattern recognition as a caring partnership in families with cancer

Pattern recognition as a caring partnership in families with cancer The purpose of this study was to address the process of a caring partnership by elaborating pattern recognition as nursing intervention with families with cancer. It is based on Newman's theory of health as expanding consciousness within the unitary-transformative paradigm and is an extension of a previous study of Japanese women with ovarian cancer. A hermeneutic, dialectic method was used to engage 10 Japanese families in which the wife-mothers were hospitalized because of cancer diagnosis. The family included at least the woman with cancer and her primary caregiver. Each of four nurse-researchers entered into partnership with a different family and conducted three interviews with each family. The participants were asked to describe the meaningful persons and events in their family history. The family's story was transmuted into a diagram of sequential patterns of interactional configurations and shared with the family at the second meeting. Evidence of pattern recognition and insight into the meaning of the family pattern were identified further in the remaining meetings. The data revealed five dimensions of a transformative process. Most families found meaning in their patterns and made a shift from separated individuals within the family to trustful caring relationships. One-third of them went through this process within two interviews. The families showed increasing openness, connectedness and trustfulness in caring relationships. In partnership with the family, each nurse-researcher grasped the pattern of the family as a whole and experienced the meaning of caring. Pattern recognition as nursing intervention was a meaning-making transforming process in the family-nurse partnership.     

Going on a journey: understanding palliative care nursing

AIM: To describe the qualitatively different ways a group of Australian nurses understood their experience of being a palliative care nurse. DESIGN: The research approach chosen was phenomenography. Fifteen nurses caring for people in a specialist palliative care unit in regional Australia were interviewed and transcribed interview data were analysed in order to identify understanding of experience. FINDINGS: The research identified and described five ways of understanding the experience of being a palliative care nurse: doing everything you can; developing closeness; working as a team; creating meaning about life; and maintaining myself. CONCLUSION: The group of palliative care nurses involved in this research understood their experience as journeying with their patients through the final phases of the person's life. The journey involved the patient, his/her family and members of the healthcare team. The journey was described further as a process of personal development which influenced how nurses construct meaning about life and maintain a sense of self. The experiences described reveal a great deal about palliative care nursing and provide useful knowledge and insights to assist practitioners, managers and educators.     

Meaning-making for family carers in nursing homes

Kellett UM. International Journal of Nursing Practice 1998; 4: 113–119 Meaning-making for family carers in nursing homes This ontological hermeneutic study highlights the importance of understanding the human experience of family caring. In contrast to much family caregiving research which focuses upon the home care situation, this study involved in-depth audiotaped conversational interviews and observations with 14 family carers who continue to care within a nursing home context. Thematic analysis of the transcribed interviews/field notes uncovered a number of common themes of meaning which highlight the nature of family caring experience in nursing homes. Discussion of such findings will challenge practitioners to reconceptualise the nurse–resident–family carer relationship, appreciate the many ways in which a family member’s involvement in care provides meaning and significance in their lives, and understand family carers through a process of human relating which fosters families’ meaningful involvement in caring within a nursing home context.     

护士关怀能力现状及影响因素调查

目的了解护士关怀能力现状及影响因素,为提高护士关怀能力提供依据。方法对某市3所三级医院共310名护士发放关怀能力量表进行调查。结果护士关怀能力得分（175．70±18．74）分,护士关怀能力较低;其影响因素包括年龄、职称、学历、科室。结论应加强护士关怀能力的培养,可以利用高年资护士的榜样作用带教低年资护士,各层次护理人文关怀教育都应当注重关怀实践,根据各科患者的关怀需求施予关怀。     

Negotiations about helpfulness--the relationship between formal and informal care in home care arrangements

Scand J Caring Sci; 2011; 25; 706–715 Negotiations about helpfulness – the relationship between formal and informal care in home care arrangements Background: Informal caregiving by family members is the most common way of caring for sick people at home. However, the number of care arrangements, in which both formal (nurses) and informal (family members) caregivers are involved, is considerable and increasing. Despite implicit assumptions in research that the involvement of nurses in home care arrangements is inherently beneficial, there is evidence that their involvement may have a destabilising effect. Aims: The purpose of this study was to investigate the relationship between nurses and family caregivers and its impact on the actual care that is provided. Method: Eighty‐eight interviews with family caregivers (n = 57) and nurses (n = 31) were conducted in Germany and analysed according to the Grounded Theory methodology. Findings: The relationship between formal and informal care is an encounter of two quite different perspectives that is focused on a negotiation process about caregiving work and the helpfulness of the actions taken and the interventions used. For family caregivers, it is determined by the goal of facilitating work and care for their sick family member. The nurses’ work is characterised by a process of shaping different realities in different homes. The results reveal the processes that lead to the involvement of nurses into home care arrangements and offer a deeper understanding of the negotiation processes between formal and informal caregivers. Conclusions: To provide sufficient support in home care, nurses need the ability to engage in negotiation processes that take the whole home care arrangement into account. Developmental work is needed to design services that are helpful for family caregivers.     

Seizing possibilities for positive family caregiving in nursing homes

Aims. This paper explores the ways family members reconstruct meaning through seizing possibilities for positive caregiving in nursing homes. Background. The importance of the ability of family caregivers to adapt and accommodate has been well documented in international family caregiving research. Through engagement in caregiving activities, families learn to modify, adapt and accommodate to changes in their situation and relationships. The support family caregivers experience in learning to accommodate change is crucial in enabling them to reconstruct positive aspects of caregiving in a long‐term aged care context. Method. In this study, a hermeneutic phenomenological approach was adopted informed by the philosophical world views of Heidegger and Gadamer. Data collected by in‐depth interviews and participant observations, from a purposeful sample of 14 family caregivers, underwent hermeneutic analysis. Results. Five shared meanings associated with seizing possibilities for positive caregiving were revealed: accommodating new and different ways of caring; feeling a part of the nursing home community; seeing the whole picture; learning to care in stress‐reducing ways and learning to seize possibilities for self. Conclusion. This paper illustrates how families, through caregiving experience in nursing homes, learn to become active managers, negotiating, accommodating and redeveloping a sense of future viewed with hope, strength and positive anticipation. Relevance to clinical practice. By highlighting what is attributed significance by families, a critical examination of the difficult issues which obstruct the development of meaningful partnerships among nurses, family and their relatives is facilitated. In particular, an examination of tensions at an ideological level supports the need for future research to focus its efforts on examining the ways of implementing nursing care that facilitates partnerships that incorporate and build upon positive and equal relations among staff, families and residents in the context of the nursing home setting.     

Essence of caring for a person dying

The present paper aims to illustrate the essence of caring through the philosophical lens of palliative care gained from one family's experience within a home environment. The narrative used provided a vehicle through which a family member recalled the experience of caring for her mother, who was dying. The essence of caring is portrayed by the use of exemplars gained from the narrative situated within a palliative context depicting both the person dying and the carer's perspective. The narrative offers the opportunity to better understand cultural knowledge, history and social practices from the perspective of the family unit, and to understand how families might be best supported by health professionals engaged in care delivery. The commitment demonstrated by family members in caring for a family member dying is significant and needs to be more valued as a contribution to our understanding of this life event. From the analysis of this family's experience, health professionals are afforded an insight into the diversity of needs that encompass the essence of care being provided in the home. This opportunity allows health professionals to gain further insight into this significant life event, leading to an enhancement of their practice and enabling them to be better equipped to meet the individual needs of family units.     

Care of the child in a body cast

Caring for a child in a body cast is a stressful situation for most families and many families state they do not receive adequate information on how to care for their child. This paper presents a comprehensive guide on caring for a child in a body cast. It examines the physical care issues, transportation and cast care. An instrument for assessing the family’s ability to cope with caring for a child in a body cast is described, and further resources for parents and nurses are presented.     

Caring in an environment of change and casemix funding

Caring has been defined by nurses and consumers of health care as an integral component of nursing. Florence Nightingale was the first nurse to describe an ethos of caring, and since then other theorists and clinicians have continued to support and develop a philosophy of care. Studies have highlighted that patients and their families also value care. However, concerns have been expressed that the current health care ideology is making caring practices more difficult to enact. The new priorities in health care award financial management a place that has the potential to overtake the importance of caring in nursing. This discussion examines the options that nurses have to defend and promote a philosophy of care.     

Nurses' view of the family in psychiatric care

Aims. The aim of this study is to examine nurses’ view of the family in psychiatric care. Background. The families of people who are mentally ill carry a heavy burden. Research has shown that they experience sorrow, shame and guilt. They are often involved in informal caring and there is evidence of families playing an important role in the recovery of the patient. In spite of this, a great deal could still be made to create more family‐oriented care. This development depends to a large extent on nurses’ view of involving families in the care and the perceived value of family‐oriented work. Method. Four focus groups, with four to six carers in each group, were conducted. The recorded focus groups lasted 75–90 minutes and the data were transcribed and interpreted using content analysis. Results. The results present four themes: compassion for and understanding of close relatives, the carer as the recipient of negative feelings, difficulties and dilemmas in the meeting with close relatives and preconceptions of mental illnesses in the family and in society. The results were interpreted as meaning that the carers found themselves in something that can be described as a double‐bind situation. Conclusion. From analysis and interpretation, the conclusion is drawn that improved communication between nurses, patients and families could be a way to resolve the double‐bind situation. Relevance to clinical practice. To promote family health and also improve things for the patient, it can be argued, from the results of this study, that nurses should carefully consider whether and how to involve family members in care.     

A theory to guide families and carers of people who are at risk of suicide

Aims. The aim of this study was to explore family members’ and ex‐patients’ perceptions of caring for people who had previously attempted suicide. Background. Suicide is a major public health problem in Taiwan. Official figures demonstrate that suicide was one of the top 10 causes of death in the last eight years, with 18·8 per 100,000 people taking their own lives in 2005. The Taiwanese Government has set targets to reduce this rate. All members of the population play a role in the prevention of suicide, including families and carers of those at risk. Evidence is sparse on the role that families take in caring for members who have been discharged from hospital following a suicide attempt. Methods. Grounded theory using one‐to‐one tape‐recorded interviews were conducted with patients who had just been discharged from hospitals following a suicide attempt (n = 15) and family members (n = 15). Data were analysed using open, axial and selective coding. Results. The core category that emerged was ‘Impending burnout’, depicting family members’ experience of caring for people who had attempted suicide. Other key categories linked to and embraced within this core category were: on guard day and night, maintaining activities of daily living and creating a nurturing environment. Conclusion. Families and carers could use the emergent theory as a guide to caring for people at risk of suicide. Psychiatric nurses could use the theory as a framework to educate family members on enhancing the quality of care provided to this group of people. The theory could go some way towards reducing suicidal attempts and decreasing re‐hospitalisation rates. Relevance to clinical practice. The finding indicated that family members experienced difficulties when caring for those who had previously attempted suicide. Consequently, nurses have a pivotal role in educating families and carers on preventive strategies before suicidal patients are discharged from hospitals.     

Registered nurses'' experiences of caring for the elderly in different health-care areas

Caring for elderly patients is an undertaking for a majority of Swedish nurses in different health-care sectors. The purpose of the study was to understand how nurses experienced the meaning of caring for elderly patients after 2 years as Registered Nurses. Interviews were conducted with 20 nurses 2 years after graduation. Data were analysed with a phenomenological-hermeneutic method and resulted in two themes: (i) providing the elderly with a sense of trust; and (ii) commitment to elderly patients. Each theme was made up of four subthemes, expressing both positive and negative aspects. Caring for the elderly means that the core of caring is in focus. Nurses need a supportive context for their care of the elderly, especially when they experience that they or their staff cannot provide the optimal quality of care for the patients.