The meaning of "not giving in". Lived experiences among women with breast cancer.

This article explores the meaning to women with breast cancer of "not giving in". Giorgi's phenomenological method was applied, and data were collected through open interviews. Ten women with breast cancer participated. The analysis resulted in a general structure of the phenomenon studied, including six key constituents: accepting the challenge to go on living, working actively on the healing process, finding something important to live for, gaining insights about life itself, experiencing awareness and avoidance, and introducing radical change in life. The results are consistent with literature about strategies in facing death and development as human conditions. Understanding the phenomenon of "not giving in" seems to be crucial for nurses in helping women with breast cancer to mobilize the inner power to survive and develop as human beings.

Social support in self-help groups, as experienced by persons having coronary heart disease and their next of kin.

Self-help groups related to coronary heart disease constitute a network for support in which the members of the group have the opportunity both to receive and provide social support. The purpose of this study was to reach in-depth information from group members about lived experience of social support in a self-help group. A qualitative research method influenced by phenomenology was used and the findings showed a pattern of social support that can be described as a sharing of experience among confident equals, thanks to mutual feelings of caring and belonging, which in turn strengthens confidence. The group members' experience of social support show that the group constitutes a cornerstone in a network for support and contributes to well-being, coping ability and a build up of confidence at the prospect of a more promising future.

The family metaphor applied to nursing home life.

The family metaphor was applied to data from participant observations of 18 lucid nursing home patients in order to highlight how nursing home life influenced their experience of health. The instrumental activities in the nursing home were more routinised and specialised than in a family, but usually care was observed to be tender, loving and diligent. Further analysis revealed many factors, which may combine to disturb self-esteem and prevent efforts towards further maturation: loss of continuity to earlier self, collectivisation of activities, extreme dependence, embarrassing situations, child role, and constantly mild behaviour from staff.

Supervision as a focal point in nurse education: an exploratory study of its effects on the needs of student nurses.

This study reports the results of a 2 year follow up of the effects of experience of supervision on the personal needs of nursing students. Supervision was given during this period on a continual basis as a focal point of nursing education. Students were encouraged to relate critical incidents as starting points for the supervisory process. Students rated the quality of supervision in terms of its perceived effect on their sense of professional identity and on their self-confidence with respect to clinical work. A Swedish version of a standard personality questionnaire, the Edwards Personal Preference Schedule (EPPS), was given at the initiation of supervision and repeated 2 years later on its completion. The results of 48 students are presented. Two hypotheses relating to the global effects of supervision were not confirmed but the hypothesis concerning the effects of supervision to depend on its perceived quality was confirmed. As measured, the effectiveness of supervision was seen in statistically significant correlations between ratings of supervisory quality and changes reflecting an increased need for leadership and a diminished need for subordinance.

"Catching my wavelength": perceptions of the excellent nurse.

The purpose of this article is to describe essential characteristics of an excellent nurse as perceived by women with breast cancer. A descriptive-exploratory research design was used, and 10 Danish women who had breast cancer surgery and treatment more than one year previously and who were still in secondary treatment but not hospitalized participated in semi-structured interviews. Four main concepts were identified: The excellent nurse was perceived as competent, compassionate, courageous, and concordant. Concordance was more important to the subjects than expected and was described as directly related to their perception of an excellent nurse and excellence in nursing.

The caring moment and the green-thumb phenomenon among Swedish nurses.

People who have a special gift for gardening are sometimes described as having a green thumb. Likewise, some nurses have a green thumb for nursing. The aims of this study were to identify and describe the characteristics of green-thumb nurses and of caring situations. A descriptive-exploratory design was used, and 16 nurses, recruited by their superiors, participated in semi-structured interviews. The findings revealed that the green-thumb nurse is competent, compassionate, and courageous. The essence of the caring moment was identified as the green-thumb nurse's ability to act on the spur of the moment, using her competence, compassion, and courage.

[The caring moment and the "green thumb phenomenon" in Swedish nurses]. / Der "Pflegende Moment" (Caring Moment) und das "Grüne-Daumen-Phänomen" bei Pflegenden in Schweden.

The caring moment and the phenomenon of the green thumb for nursing in Sweden. People who have a special gift for gardening are sometimes described as having a green thumb. Likewise, some nurses have a green thumb for nursing. The aims of this study were to identify and describe the characteristics of green-thumb nurses and of caring situations. A descriptive-exploratory design was used and 16 nurses, recruited by their superiors, participated in semi-structured interviews. The findings revealed that the green-thumb nurse is competent, compassionate, and courageous. The essence of the caring moment was identified as the green-thumb nurse's ability to act on the spur of the moment, using her competence, compassion, and courage.

Patient advocacy--an important part of the daily work of the expert nurse.

Over the past two decades, patient advocacy has been recognized as a part of nursing. For the most part, the issue has been treated by means of theoretical reasoning and case studies. Narratives describing lived experiences of nursing by expert nurses from Sweden were analyzed in this study. The nurses were identified by their superiors as expert nurses, as having a special gift, a "green thumb" for nursing. One third of the narratives concerned patient advocacy situations. The analysis of the narratives showed that the patient advocacy situation is composed of the following elements: a powerless patient, a problem concerning the patient's own will or what is good for him or her, and an adversary. Further, it includes a trigger situation, and a prompt decision and action by the nurse. The nurse acts out of conviction, accepts an additional work load, and takes the risk of being punished.

Creating a Swedish top ten list of scientific nursing journals.

In the present paper preferences for and utilisation of scientific nursing journals were studied. Leading Swedish nurse researchers and American deans of top ranked university schools of nursing were asked to rank their ten most valued journals. Further, all articles with a nurse as the primary author and published in Scandinavian Journal of Caring Sciences, 1989-1993, were analysed for references to nursing journals. Three top ten lists were made based on Swedish preferences, American preferences and the number of times journals appeared on reference lists. A fourth list was based on Swedish preferences and appearances on reference lists.

Articles published in Scandinavian Journal of Caring Sciences between 1987 and 1991.

Nursing, occupational therapy and physiotherapy are new as areas of research in the Nordic countries. Scandinavian Journal of Caring Sciences, the first scientific journal based in the Nordic countries for these research areas was established in 1987. In this article the first five volumes of the journal are reviewed. The study revealed a growing number of manuscripts submitted and an increase of pages per volume. Most articles came from nurses in Sweden. However, other disciplines were represented and papers came from all the Nordic countries and also from countries outside Scandinavia. In most articles patients were studied and both quantitative and qualitative approaches were used.

The effects of professional group supervision of nurses--utilizing the nurse self description form.

All the registered nurses in two orthopaedic wards participated in a four-month period of professional group supervision. The main focus of the supervision was professional identity. The effect was measured by the Nurse Self Description Form, a 21-item paper-and-pencil form for nurses to judge themselves in comparison to other nurses. The nurses answered the form before and after the period of supervision. They increased their total scores significantly. Some single items were influenced more than others. The results argue in favour of group supervision as a useful mean of strengthening the professional identity of nurses.

Someone who cares--patients' experiences concerning health examinations.

The aim of this inquiry was to gain an understanding of laymen's experiences and opinions about general health check-ups. Medical experts often draw attention to unwanted effects, especially the risk of creating worry and of recommending and even giving unnecessary medical treatment. By using a qualitative research method with unstructured interviews we wanted to explore the participants' conceptions of health, their expectations before and their perceived benefits after health checks and whether the check-up gave rise to negative feelings. The participants held broad views on health and, possibly as a consequence, also great expectations of health check-ups. Consequences of the check-ups were that examinees felt encouraged to change their life style, had learnt to handle risk factors for disease, and after some time, reported feeling better. The individual attention and care, which in general did not differ from other caring situations described in the literature, was highlighted as an important factor for a positive result. Worries afterwards either did not exist or could be rationalized by knowing the causes of abnormalities and receiving guidance from the medical staff.

Deputed power of medical control: the hidden message in the ritual of oral shift reports.

The exchange of oral shift reports between nurses is a prominent part of the everyday routine in a hospital ward. Increased awareness of the more or less explicit functions of such communication is likely to have a positive impact on the nursing profession. Oral shift reports in a nursing care system based on task allocation were therefore observed and analysed. Using an ethnographic approach, reports were tape-recorded, and nurses were interviewed regarding their experiences. During the shift report session, the nurses were found to receive ritually mediated deputed power of medical control from their colleague, but little attention was paid to nursing needs and measures. The nurses clearly demonstrated that they were caught in a system dominated by a medical paradigm that effectively obstructed the progress of nursing as a professional discipline in its own right.

Professionalization--theoretical analysis of the implications for nursing practice.

The aim of the present paper is to examine ideas of professionalization, and to explore in what way they might give directions for the development of nursing practice. An examination of the literature on professionalization in social science reveals that the existing ideas of professionalization may be divided into two paradigms, denominated naïve paradigm and cynical paradigm. Both paradigms have been criticized on the grounds of being idealistic and ahistoric. A contemporary view has developed from this criticism, oriented towards the historical and social contexts of professions. The implications for nursing practice of this view brings into focus the development of nursing practice in relation to the public and the tradition of nursing. This view of professionalization contributes to a contemporary view of nursing practice, and an expanded idea of professionalization is discussed.

Physical health status in young subjects after colectomy: an application of the Roy model.

The aim of this study was to describe the long-term physical health status after colectomy in 30 young subjects with ulcerative colitis, 11 of whom had ileostomies. The subjects, aged between 14 and 31 years of age, were assessed post-operatively for their physical health status. In assessing physiological adaptation in these subjects four basic needs were the foci: nutrition, elimination, activity and rest, and protection. Adaptation problems related to nutrition, elimination, activity/rest and protection were found in four, 17, 17 and three subjects respectively. Nine out of 30 had pain that influenced their daily life. Six out of 30 subjects had no adaptation problems at all. Nineteen subjects found their health to be 'excellent' or 'good' despite the adaptation problems reported.

The professional identity of the nurse: concept analysis and development.

The aim of this paper is to highlight the concept of professional identity of the nurse in order to promote theoretical clarity and examine implications for nursing practice. A modification of the hybrid model for concept development was followed. Accordingly, the theoretical analysis of conceptualizations and corresponding theoretical frameworks were combined with empirical data gathered from the field, from semi-structured interviews with eight registered nurses. The sampling was strategic and continuous. Personal and interpersonal dimensions and socio-historical aspects of the concept were found in the literature review as well as in the interview data. Attributes, antecedents and consequences of professional identity of the nurse in relation to the identified dimensions were stated. The analysis ends with a comprehensive description of the concept. Further, the relations to the concepts of self-esteem, self-image, professionalism and professional self-image, as well as professional function and roles of the nurse, are outlined. Finally, the importance of the developed concept is discussed, and suggestions for further research are presented.

Nurses' use of time in a medical-surgical ward with all-RN staffing.

AIMS: To investigate allocation of nursing time, organisation of nursing activities and whether or not allocation and organisation have changed over time. BACKGROUND: In a ward that changed to all-RN staffing, the nurses were encouraged to implement a patient-focused philosophy. The nurses perceived that they had difficulty in using the time available efficiently. METHODS: Non-participant observations were conducted with 2-year intervals. Ten consecutive weekdays were covered on two occasions. The study was carried out at a university hospital in Sweden. FINDINGS: Between observations, a significant change in the organization of the direct care had occurred, and the same tendency was found in patient administration and general management. The organization of work changed from a partly fragmented to a more coherent one. The time used for direct care and administrative activities increased between the two observations, while indirect care, personal and service activities decreased. CONCLUSION: It can be suggested that the nurses used their time efficiently and, over time, they developed a more coherent way of organizing nursing activities.

Patient advocacy--an essential part of quality nursing care.

In Sweden, patient advocacy has been the domain of "patient ombudsmen" employed exclusively for handling patient complaints. We were the first nurse researchers in Sweden to address the issue of patient advocacy as a part of nursing practice in three different research projects, based on narratives by nurses.

Living with ulcerative colitis: experiences of adolescents and young adults.

The problems associated with ulcerative colitis and its treatment have effects on adolescents and young adults dissimilar from as well as more profound than those on older individuals. Adolescents are confronted with problems such as biological, psychological and social changes as well as role changes related to peers and family. This inductive study aimed to describe the adolescents' experiences of living with ulcerative colitis. A total of 28 subjects were asked about their experiences both at the present time and at the time their first symptoms appeared. Verbatim transcribed thematized interviews were analysed according to a method influenced by the constant comparative method for grounded theory. Eight categories were grounded in the data, forming a model which describes the process from onset of disease to present time. The main variable identified was: reduced living space, a strategy to manage the new situation. Dependent on the reactions received from significant others, the outcome for the adolescents hovered between feelings of self-confidence and lack of self-confidence. If the adolescents experienced support, the living space was expanded again. The results might be of great value when caring for and assisting young persons with a chronic disease in general, and in particular when taking care of adolescents with a recently diagnosed inflammatory bowel disease.

Cardiac nurses' preparedness to use self-help groups as a support strategy.

Self-help groups are lay, mutual support groups in which people who share some long-term existential problems in their lives meet regularly to support each other empathetically. These groups can be viewed as supplementary sources of support outside patients' existing social networks. As such, it is of importance to be aware of them when planning nursing care. The aim of this study was to examine cardiac nurses' preparedness to use self-help groups as a support strategy. A qualitative research method was used and 12 registered nurses from two coronary care units were interviewed. The findings showed that nurses knowledge of social support, self-help groups and of patients' social circumstances as well as their attitudes to their own roles as nurses were of importance in their preparedness to use self-help groups as a support strategy. Lack of knowledge of social support and self-help groups affected the nurses' attitudes towards lay care and was probably the reason for not using self-help groups as a support strategy. Most of the nurses were well informed about their patients' social circumstances, they had an explicit family nursing approach and were not at all against further expansion of their nursing role. However, there is a need for education in innovative ways of working that respond to and interact with informal support networks if nurses are to be able to contribute to empowerment of their patients.