Desire to survive emotional pain related to self-harm: A Norwegian hermeneutic study

The aim of this study was to explore and interpret women's desire to survive emotional pain related to self-harm. Women who suffer from borderline personality disorder describe emotional pain as intense. Previous research indicates that self-harm is a way of obtaining emotional relief and offers an escape from unwanted emotions, thoughts, and/or distressing situations. An explorative, interpretative design was employed. The data were collected by means of in-depth interviews with a sample of women resident in Norway suffering from borderline personality disorder and were analyzed using a hermeneutic approach. The findings revealed one main theme, self-sacrifice, and two other themes, self-harm (a struggle to be relieved of responsibility) and a fear of intimacy versus intrusion. This study indicates that self-sacrifice appears to imply a longing for reconnection with the self and others. To preserve their self-image, the women require courage to survive the painful state of unworthiness.     

Nurse supervisors' views of their supervisory styles in clinical supervision: a hermeneutical approach

The purpose of this paper is to describe and analyse the nurse supervisors' styles with special focus on their actions in the supervision session, their expectations with regard to the 'ideal' supervisor and their 'visions' regarding effects of clinical supervision, as well as their views of ethics, rules and values that they are guided by in clinical supervision. This study used a hermeneutic approach in order to characterize nurse supervisor style. Data were collected by open-ended interviews with skilled and experienced nurse supervisors ( n= 18). The interpretation is that the supervisors' actions in clinical supervision may affect their ability to understand their actions. Whether a supervisor acts as the 'real' supervisor or attains to the level of the 'ideal' supervisor depends on her/his state of preparedness reached through reflection. The nurse supervisors' perceptions of styles are: striving to perfect the art of communication in the supervision session by using selected techniques; to assist in increasing the supervisees' self-esteem and autonomy by reflecting on essential themes in the supervision dialogue; and striving to attain the level of the 'ideal' supervisor, expressing a positive attitude to and motivation for theoretical and practical knowledge, and developing the supervisees' human attitudes.     

Daily assessment of stressful events and coping among post-menopausal women with breast cancer treated with adjuvant chemotherapy

The purpose of the study was twofold: to examine what type of daily stressful events post-menopausal woman with breast cancer experience during adjuvant chemotherapy and how bothersome these are and to identify coping strategies used by these women used to manage such stressful events. The patient group comprised 75 consecutively invited women (≥55 years of age) at two university hospitals and one county hospital in Sweden. The Daily Coping Assessment was used to collect data over time. Data were analysed both qualitatively and quantitatively. Six categories of stressful events were identified: 'nausea and vomiting', 'fatigue', 'other symptoms', 'isolation and alienation', 'fear of the unknown' and 'being controlled by the treatment'. The first three categories were subsumed under the domain physical problems and the latter three under psychosocial problems. Almost 30% of the diary entries recorded no stressful event. Physical problems were three times as frequent as psychosocial problems. 'Nausea/vomiting' was the most frequently observed stressful event (21.6%). 'Isolation and alienation' and 'fear of the unknown' were less frequent, but when they occurred they were rated as the most distressing. Several coping strategies were used to manage each stressful event. The most common strategies were acceptance, relaxation and distraction. Religion was rarely used as a coping strategy.     

Diabetes empowerment related to Pender's Health Promotion Model: A meta‐synthesis

Diabetes self‐management is a challenge for both clients and health‐care professionals. Empowerment plays a vital role in helping clients to achieve successful self‐management. This study adopted a meta‐ethnographic approach. Nine qualitative studies were synthesized in order to contribute to a deeper understanding of what clients perceive as being important in an effective empowerment strategy for diabetes self‐management. Four central metaphors that influenced empowerment were identified: trust in nurses' competence and awareness, striving for control, a desire to share experiences, and nurses' attitudes and ability to personalize. The lines‐of‐argument synthesis suggested the need for an evaluation system to appraise clients' diabetes knowledge, health beliefs, and negative emotions, as well as the outcome of interventions. Based on Pender's Health Promotion Model, this study emphasizes the fact that health‐care professionals need to understand and address modifiable behavior‐specific variables. The study suggests that an effective empowerment strategy would be to use activity‐related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients' health‐promoting behaviors.     

Developing the scope of practice and education for advanced practice nurses in Finland

Background:  The reorganization of Finnish healthcare services has required a restructuring of the areas of responsibility between healthcare professionals.
Aim:  To describe the need for Advanced Practice Nurses in Finland and the development process of a Master's programme in Health Promotion, Advanced Clinical Care.
Methods:  The study consisted of a survey of nurse managers (24) and focus group interviews with clinical nurse specialists (46).
Findings:  The expanded role includes advanced clinical skills and responsibility for health prevention and promotion, education, supervision, leadership, research and development.
Conclusions:  The legislation, scope and models have to be supported and further developed to promote the full scope of advanced practice.     

The concept of confidence – the nurse's perception

The purpose of this paper is to investigate a nurse's understanding of the concept of confidence and what a nurse thinks affects the experience of confidence in the patient relationship.
The project has a hermeneutic design using a research interview method. Nine nurses were interviewed. A hermeneutic approach was used in the analysis of the data. Interpretation of the data was linked to Segesten's model for confidence. Analysis of the data generated two major themes in relationship to the comprehension a nurse has of confidence. One theme was 'to feel comfortable, be relaxed'; the other was: 'feeling secure'.
The result shows that nurses' definition of confidence is dependent on two security-creating factors: the significance of a professional network of co-workers and the importance of confirmation of professional role and competence.