Mothers' experiences living with diastasis recti abdominis - an interview study.

BACKGROUND: Diastasis recti abdominis (DRA) is a common postpartum condition. Knowledge is scarce on how mothers perceive living with DRA. The interaction between healthcare providers and patients plays a significant role in shaping the healthcare service experience. Women suffering from typical women's diseases tend to experience not being taken seriously or listened to when seeking healthcare. The aim of this study was to explore mothers' experiences living with DRA. METHODS: Semi-structured individual interviews were conducted with six Norwegian mothers, age 32-41, presenting with a clinically significant DRA. Topics discussed were how the condition is experienced, how it affects different aspects of day-to-day life and experiences with healthcare services. The data was analyzed using systematic text condensation. RESULTS: DRA had an impact on everyday life among the mothers included in this study. Three major themes emerged: (I) The path to obtaining knowledge and understanding of DRA, (II) DRA - intertwined with health issues and physical limitations and (III) A changed belly - on self-image & social interactions. The mothers experienced uncertainties and frustration when trying to learn about DRA. The limited knowledge of the condition made it hard to differentiate if the experienced symptoms were caused by presence of DRA or from other health issues. Several mothers felt misunderstood. CONCLUSION: DRA is a multifaceted condition affecting many aspects of day-to-day life in various dimensions, like physical, emotional, and social. This study contributes to a wider understanding of living with DRA, which might guide healthcare professionals in providing support for mothers with this condition.

Persevering professionals: dilemmas of relationships and self-determination in work with people with intellectual disability - a multi-method study based on interpersonal process recall.

The article focuses on social educators' reflections on their own professional practice in encounters with people with intellectual disability receiving services. Drawing on Interpersonal Process Recall, a video-assisted method, together with a focus group interview, the study explores the experiences from in-situ encounters of five social educators employed in a Norwegian municipality. The key findings are that they view relationship-building as integral to their work, they grant primacy to the ideal of autonomy and they strive towards realizing this in their daily work. The study however displays how these emphases might lead to dilemmas, especially between the wish to support the service users' self-determination and the urge to protect them from harm. Of special note was how the service users' increasing use of social media was perceived as a particular challenge for social educators, who were left with an experience of being unable to protect.

The hamster wheel: a case study on embodied narrative identity and overcoming severe obesity.

Based in narrative phenomenology, this article describes an example of how lived time, self and bodily engagement with the social world intertwine, and how our sense of self develops. We explore this through the life story of a woman who lost weight through surgery in the 1970 s and has fought against her own body, food and eating ever since. Our narrative analysis of interviews, reflective notes and email correspondence disentangled two storylines illuminating paradoxes within this long-term weight loss process. Thea's Medical Weight Narrative: From Severely Obese Child to Healthy Adult is her story in context of medicine and obesity treatment and expresses success and control. Thea's Story: The Narrative of Fighting Weight is the experiential story, including concrete examples and quotes, highlighting bodily struggles and the inescapable ambiguity of being and having one's body. The two storylines coexist and illuminate paradoxes within the weight loss surgery narrative, connected to meaningful life events and experiences, eating practices and relationships with important others. Surgery was experienced as lifesaving, yet the surgical transformation did not suffice, because it did not influence appetite or, desire for food in the long run. In the medical narrative of transforming the body by repair, a problematic relationship with food did not fit into the plot.

Patients' quest for recognition and continuity in health care: time for a new research agenda?

User involvement is important in democratization of health care and is assumed to contribute to better and more relevant research. Despite increased requirements for user involvement in research, more studies are still needed. This study aimed at exploring what research agenda people with varied health problems consider as important, based on their own experience. The study had a phenomenological approach with a qualitative design. The sample consisted of 23 informants; nine had been critically ill and 14 were suffering from chronic muscle pain. Data were collected in five focus group interviews and one individual interview. A phenomenological approach was used in analyzing the data. Written consent was obtained from all the participants, and ethical considerations were taken throughout the entire research process. Despite various experiences among the participants, a quest to be taken seriously over time by healthcare professionals emerged as a strong meaning structure in both groups. Based on these experiences, continuity across lifetime changes turned out to be an important research topic for future research. User involvement should be appreciated in all parts of the research process. A crucial prerequisite is that the users get the opportunity to bring their own experiences into the process.

Nursing documentation in inpatient psychiatry: The relevance of nurse-patient interactions in progress notes-A focus group study with mental health staff.

AIMS AND OBJECTIVES: To gain insight into mental health staff's perception of writing progress notes in an acute and subacute psychiatric ward context. BACKGROUND: The nursing process structures nursing documentation. Progress notes are intended to be an evaluation of a patient's nursing diagnoses, interventions and outcomes. Within this template, a patient's status and the care provided are to be recorded. The therapeutic nurse-patient relationship is recognised as a key component of psychiatric care today. At the same time, the biomedical model remains strong. Research literature exploring nursing staff's experiences with writing progress notes in psychiatric contexts, and especially the space given to staff-patient relations, is sparse. DESIGN: Qualitative design. METHODS: Focus group interviews with mental health staff working in one acute and one subacute psychiatric ward were conducted. Systematic text condensation, a method for transverse thematic analysis, was used. RESULTS: Two main categories emerged from the analysis: the position of the professional as an expert and distant observer in the progress notes, and the weak position of professional-patient interactions in progress notes. CONCLUSIONS: The participants did not perceive that the current recording model, which is based on the nursing process, supported a focus on patients' resources or reporting professional-patient interactions. This model appeared to put ward staff in an expert position in relation to patients, which made it challenging to involve patients in the recording process. Essential aspects of nursing care related to recovery and person-centred care were not prioritised for documentation. RELEVANCE TO CLINICAL PRACTICE: This study contributes to the critical examination of the documentation praxis, as well as to the critical examination of the documentation tool as to what is considered important to document.

Towards living within my body and accepting the past: a case study of embodied narrative identity.

This narrative case study, created from several qualitative sources, portrays a young woman's life experiences and an eight yearlong therapy process with Norwegian Psychomotor Physiotherapy (NPMP). It is analyzed retrospectively from an analytical angle, where NPMP theory is expanded with Løgstrup's phenomenology of sensation and Ricoeur's narrative philosophy. Understanding Rita's narrative through this window displayed some foundational phenomena in a singular way, illuminating embodied experiences in inter-subjective relationships in movement, sensation and time entwined. It illustrates how traumatic life experiences may cause pain, suffering and ruptured narratives with fragmented physical and sensuous reactions, chaos and loss of temporal coherence with consequences for a person's sense of identity. Rita's narrative also illuminates how intersubjective interaction has healing potentials when there is time and space for trust to emerge and to support new bodily-based experiences. Embodied sensuous experiences in present time may help clarify past and present and support chronology in narration and the sense of identity. With this exemplary case study, we argue that Løgstrup's and Ricoeur's thinking may add valuable perspectives to understanding suffering and healing processes in the field of embodied therapies like NPMP.

"Will I ever be a true woman?" An exploration of the experiences of women with vestibulodynia.

In this study we explored the experiences of Norwegian women living with vestibulodynia, a chronic disease affecting young women all over the world. Using a phenomenological approach we conducted in-depth interviews with eight women who had struggled with vestibulodynia for several years. Our findings reveal that their efforts to fulfill their partners' sexual desires as well as their own represented an encompassing ongoing process. In addition, we highlight the interrelationship between the intensity of vulvar pain experienced by individual women and decisions women make about prioritizing their own sexual needs.

Striving for a life worth living: stroke survivors' experiences of home rehabilitation.

BACKGROUND: For mild-to-moderate stroke survivors, early supported discharge from hospital, followed by home rehabilitation is preferred over conventional care. How this mode of service contributes to recovery from stroke survivors' perspective needs further investigation. AIM: The aim of this study was to explore mild-to-moderate stroke survivors' experiences with home rehabilitation after early supported discharge from hospital. METHODS: A qualitative interpretive interview design was used in the context of a randomised controlled trial. A purposive sample of eight participants (45-80 years) was followed by an ambulant team, and a specific healthcare team provided home rehabilitation. Data were analysed using interpretive description, systematic text condensation and coping theory. FINDINGS: A crucial determinant for the participants' hopes for a life worth living was the mutual confidence expressed in encounters with healthcare professionals and the participants' ability to make sense of their now-altered body. The professional caretakers' communication qualities and their ability to attend to individual needs were important. Help in processing the emotional reactions caused by a changed body and in socialising was requested by participants. Professional caretakers providing home rehabilitation should strive for a more flexible- and individually tailored service and should seek increased cooperation among stakeholders. CONCLUSION: The focus on therapeutic communicative qualities, bodily changes, emotional processes, social concerns and long-term follow-up should be increased in order to achieve a more beneficial experience for stroke survivors.

Shyness and openness--common ground for dialogue between health personnel and women about sexual and intimate issues after gynecological cancer.

In this article we explore shyness and openness related to sexuality and intimacy in long-term female survivors of gynecological cancer, and how these women experienced dialogue with health personnel on these issues. Further analysis on two core themes, based on empirical data presented elsewhere, inspired continued theoretical and philosophical thinking drawing on Løgstrup's expressions of life and unified opposites. The findings show that gynecological cancer survivors and health personnel share common ground as human beings because shyness and openness are basic human phenomena. Health personnel's own movement between these phenomena may represent a resource because it can help women to handle sexual and intimacy challenges following gynecological cancer.

Changing bodies, changing habits: women's experiences of interval training following gastric bypass surgery.

Patients undergoing weight-loss surgery are increasingly encouraged to change their lifestyles. Dietary interventions combined with physical exercise interventions are regarded as the most effective way to ensure that they do not regain the weight they have lost. Little research however, has been done on how patients who have had the surgery actually experience the process of changing their exercise habits. To help fill this gap, we investigated the experiences of women participating in a group-based rehabilitation program designed to radically transform these habits. Based on participant observation, and our interviews with 11 women in the program, we were able to identify a variety of potential benefits and negative consequences in group training, organized according to the interval principle. We also found that the experiences of these women were closely related to their views on how significantly the surgery had changed their lifestyle. Based on the experiences related by these women, we believe that the "effectiveness" of standardized group-based interventions for patients undergoing weight-loss surgery should be reconsidered. Some of the women in our study viewed the group-based standardized training intervention positively; others resisted it. Our research leads us to conclude that this type of program could be more successful if the forms of activity and their intensity were customized to meet the needs and desires of each participant.

Re-embodying eating: patients' experiences 5 years after bariatric surgery.

Health experts advise and expect patients to eat healthily after bariatric surgery. For patients, difficulties with eating might have been a long-standing, problematic part of life-a part that is not necessarily healed by surgery. Empirical research on patients' experiences of eating practices after bariatric surgery is lacking. Aiming to contribute to the development of clinical practice, we explored meanings attached to eating in the long term and sought descriptions of change and bodily sensations. We interviewed 14 patients at least 5 years after bariatric surgery. The surgical restriction forced changes in the way patients sensed their own body in eating, but the uncertainty related to maintaining weight loss in the long term remained. Meanings attached to eating transcended food as choices situated in a nourishment and health perspective, and were not necessarily changed. Eating was an existential and embodied practice, which remained an ambiguous and sensitive matter after surgery.

To be held and to hold one's own: narratives of embodied transformation in the treatment of long lasting musculoskeletal problems.

This study elaborates on narrative resources emerging in the treatment of longlasting musculoskeletal and psychosomatic disorders in Norwegian psychomotor physiotherapy (NPMP). Patients' experiences produced in focus group interviews were analyzed from a narrative perspective, combining common themes across groups with in depth analysis of selected particular stories. NPMP theory expanded by Løgstrup's and Ricoeur's philosophy, and Mattingly's and Frank's narrative approach provided the theoretical perspective. Patients had discovered meaning imbued in muscular tension. Control shifted from inhibiting discipline and cognitive strategies, towards more contingence with gravity and sensation, and increased freedom to be what and who they were. Trust, time, open speech, and being respectfully listened to were described as therapeutic pre-conditions. The body was experienced as the source of their voice as their own. As tension patterns transformed, novel experience in sensation appeared to feed narrative imagination, reshaping past plots, embodied identity and future prospects. NPMP was disclosed as a treatment integrating detection, battle and repair as narrative subplots, but the core narrative was the journey of transformation. Novel embodied narrative resources nourished the quest for a life and identity in tune with the body as one's own.

Totally changed, yet still the same: patients' lived experiences 5 years beyond bariatric surgery.

Bariatric surgery provides sustainable weight loss and increased quality of life for most, but not all patients. To increase the knowledge of this complex patient group and their needs during follow-up, we aimed to describe the essential meaning of bariatric surgery patients' long-term experiences by using a phenomenological lifeworld approach. Eight patients were interviewed between 5 and 7 years after bariatric surgery. Life after bariatric surgery was described as living with tension, ambivalence, and reinforced attention toward one's own body. The tension was related to embodied change and altered relations to the social world. The patients express an ongoing demand for control of health-related habits and practices, and to not lose control over the body again. Surgical weight loss and improved physical function do not necessarily mean changed health-related habits and practices in the long term. Experiencing weight regain is connected with emotional stress, shame, and self-contempt.

Living in a changed female body after gynecological cancer.

In this article we elaborate on how living in a changed female body after gynecological cancer is experienced 5 to 6 years after treatment. Based on a phenomenological life-world perspective, 32 interviews with 16 women showed that changes involved dealing with unfamiliarity related to experiences of bodily emptiness, temperature fluctuations, sex-life consequences, vulnerability, and uncertainty. Findings are discussed in relation to Svenaeus's perspective on illness as an unhomelike being-in-the-body and being-in-the-world. This perspective could spur health personnel to improve patient information and dialogue and thus facilitate a process leading to more familiarity and homelikeness for patients during treatment and follow-up.

Weight loss surgery as a tool for changing lifestyle?

This article critically explores the tension between perceptions of weight loss surgery as a last resort and as a tool. This tension stems from patients' doubt and insecurity whether expectations for a healthy life will come through. Thus, even after surgery, traditional weight loss methods, including diets and exercise, are considered paramount. Drawing on a series of interviews with Norwegian women, we argue that the commercialization of weight loss surgeries as well as the moral stigmas attached to such operations serve to perpetuate this tension. More specifically, the women were advised to leave their old habits behind, and embrace a healthier and more active lifestyle. In such a climate, we argue that undergoing surgery without subsequently embodying dietary and exercise norms is hardly an option. On the contrary, these become a moral obligation that modern women need to relate to--and perhaps negotiate--in order to repudiate stigmas attached to weight loss surgeries as a quick fix for those incapable of losing weight in the "proper" manner.

Dis-appearance and dys-appearance anew: living with excess skin and intestinal changes following weight loss surgery.

The aim of this article is to explore bodily changes following weight loss surgery. Our empirical material is based on individual interviews with 22 Norwegian women. To further analyze their experiences, we build primarily on the phenomenologist Drew Leder`s distinction between bodily dis-appearance and dys-appearance. Additionally, our analysis is inspired by Simone de Beauvoir, Merleau-Ponty and Julia Kristeva. Although these scholars have not directed their attention to obesity operations, they occupy a prime framework for shedding light on different dimensions of bodily change. In doing so, we were able to identify two main themes: The felt "inner" body versus the visible "surface" body and the "old" body versus the "new" body. In different, though interconnected ways, these main themes encompass tensions between changes the women experienced as contributing to a more "normal" and active life, feeling more accepted, and changes that generated ambivalence. In particular, their skin became increasingly problematic because it did not "shrink" like the rest of the body. On the contrary, it became looser and looser. Moreover, badsmelling folds of skin that wobbled, sweated and chafed at the smallest movement, aprons of fat hanging in front of their stomachs, batwing arms, thick flabby thighs and sagging breasts were described as a huge contrast to the positive response they received to their changed body shape when they were out and about with their clothes on. At the same time, they expressed ambivalence with regards to removing the excess skin by means of plastic surgery. Through their own and other women`s experiences they learned removing the excess skin by means of surgery could be a double-edged sword. By illuminating the experiences of the ones undergoing such changes our article offers new insight in a scholarly debate predominated by medical research documenting the positive outcomes of weight loss surgery.

Living through gynaecological cancer: three typologies.

AIMS AND OBJECTIVES: The aim of this qualitative study is to highlight how women experienced living through gynaecological cancer. BACKGROUND: The increasing number of long-term survivors after cancer has created a greater need for knowledge about how patients live through the illness. DESIGN: A qualitative design, with a phenomenological-hermeneutical perspective, provided the framework for the study. METHOD: Thirty-two unstructured in-depth interviews with 16 women were conducted. Each woman was interviewed twice: one year apart, and five and six years after treatment, respectively. Stepwise meaning condensation was used to analyse the data. RESULTS: Based on the women's first-hand stories about their experiences with cancer, we identified three typologies, describing different ways in which the women negotiated encountering and living through cancer. These typologies are the emotion- and relationship-oriented women, the activity-oriented women and the self-controlled women. CONCLUSIONS: There are substantial differences regarding how women process the experience of cancer. The findings add valuable knowledge about the impact cancer can have on women's lives and can be of help for nurses who support patients during treatment and follow-up. RELEVANCE TO CLINICAL PRACTICE: Understanding different ways women can experience living through cancer is fundamental for the development and improvement of cancer care. Allowing time for the women to talk with nurses about their cancer experiences could be essential during treatment and follow-up. Nurses can support the women by listening to their stories, accepting their emotions and informing them in detail. The findings in this study imply that strengthening nurses' listening and conversational competence can be of importance for supporting patients after cancer. By building on the women's own stories, it might be possible to create a follow-up process that is individually tailored for each cancer patient.

Touched in sensation--moved by respiration: embodied narrative identity--a treatment process.

The aim of this theoretical article is to elaborate on the underpinning of Norwegian psychomotor physiotherapy (NPMP). With a narrative and hermeneutic point of departure, we explore the unfolding of a 10-year-long treatment by analysing a particular narrative from this treatment context in relation to some foundational perspectives on movement, sensation and time. A woman in her late thirties suffering from muscular tensions and pain, depression, anxiety and anorexia, came for NPMP. The investigation of her treatment experience is based on the journal written by her physiotherapist and first author of this article. We suggest that new experiences in movement and sensation as well as changes in movement patterns can contribute to retuning in sensation and restructuring of narrative time. Feeding the fictional space and narrative fantasy with new experiences in movement and sensation can help counteracting delusional ideas and assist changes, supporting embodied narrative identity. Ingrid's experience is discussed in the light of Trygve Braatøy's understanding of muscular functions, Knud E Løgstrup's phenomenology of sensation and Paul Ricouer's narrative time.

Communication as negotiation processes in long-term physiotherapy: a qualitative study.

PURPOSE: The purpose of this study was to describe communicative patterns about change in demanding physiotherapy treatment situations. METHODS: A multiple case study of eleven treatment courses was carried out, based on in-depth individual interviews, focus group interview, personal notes and repeated video-recordings. To compare communication within and over sessions, a two-step procedure was applied: identification of communication patterns and detailed analysis of selected dialogues from video-recorded sequences. FINDINGS: One main communicative pattern was identified: Seeking for common ground--demanding negotiating process. This pattern was interrupted by short episodes of two types of challenges; the pattern of ambivalence and uncertainty, and the pattern of impatience and disagreement. Communication between the participants appeared as a demanding and complex process of negotiations during the treatment processes. The physiotherapists' sensitivity of and ability to negotiate the tasks, the emotions related to tasks and the nature of the relationships, seemed to facilitate change. The patients' and the physiotherapists' capacity to bear and come through demanding situations created new ways of interaction. CONCLUSION: The demanding situations may generate a potential for the development and the improvement of treatment outcomes. Understanding such episodes as open and dynamic, in contrast to defining the patient as demanding, suggests a useful perspective for treatment.

A complex reminding: The ethics of poetry writing in dementia care.

Interest in the potential benefits of poetry writing in dementia care has been increasing. Various practical projects, as well as research articles, have highlighted how poetry can acknowledge the words of persons with dementia, and increase well-being. In this article, the authors present a poetry writing project in dementia care in Norway, and argue for how poetry as a genre involves lyrical as well as ethical aspects. The aim of this article is to show how linguistic and ethical sensibility can illuminate the poetic possibilities of the everyday language of persons with dementia. Through a close reading of selected poems from the poetry writing project, the authors show how poetry writing can give an increased understanding of the resources in the everyday language of persons living with dementia. Poetry can open up alternative forms of expression and agency, and thereby support the narrative citizenship of persons with dementia.