Registered nurses' reasoning process during care planning and documentation in the electronic health records: A concurrent think-aloud study.

AIMS AND OBJECTIVES: To explore the clinical reasoning process of experienced registered nurses during care planning and documentation of nursing in the electronic health records of residents in long-term dementia care. BACKGROUND: Clinical reasoning is an essential element in nursing practice. Registered nurses' clinical reasoning process during the documentation of nursing care in electronic health records has received little attention in nursing literature. Further research is needed to understand registered nurses' clinical reasoning, especially for care planning and documentation of dementia care due to its complexity and a large amount of information collected. DESIGN: A qualitative explorative design was used with a concurrent think-aloud technique. METHODS: The transcribed verbalisations were analysed using protocol analysis with referring phrase, assertional and script analyses. Data were collected over ten months in 2019-2020 from 12 registered nurses in three nursing homes offering special dementia care. The COREQ checklist for qualitative studies was used. RESULTS: The nurses primarily focused on assessments and interventions during documentation. Most registered nurses used their experience and heuristics when reasoning about the residents' current health and well-being. They also used logical thinking or followed local practice rules when reasoning about planned or implemented interventions. CONCLUSION: The registered nurses moved back and forth among all the elements in the nursing process. They used a variety of clinical reasoning attributes during care planning and nursing documentation. The most used clinical reasoning attributes were information processing, cognition and inference. The most focused information was planned and implemented interventions. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the clinical reasoning process of registered nurses during care planning and documentation should be used in developing electronic health record systems that support the workflow of registered nurses and enhance their ability to disseminate relevant information.

Professional competence development through interprofessional simulation-based learning assists perioperative nurses in postgraduation acute clinical practice situations: A qualitative study.

AIMS AND OBJECTIVES: To explore recently graduated perioperative nurses' experiences of interprofessional simulation-based learning during postgraduate education and investigate whether and how this learning approach contributed to the development of their professional competence in meeting acute clinical situations. BACKGROUND: Perioperative nursing requires specialised education that offers professional development to ensure high-quality nursing care and patient safety in acute situations. Interprofessional simulation-based learning exposes students to acute situations in a safe environment without the risk of harming the patient, and it prepares postgraduate nursing students for clinical practice. Despite extensive research regarding simulation-based learning, there is a lack of knowledge on what impact such training has on perioperative nursing students after graduation. DESIGN: An explorative qualitative design was used, and this study is reported in accordance with the COREQ guidelines. METHOD: Between March 2019-November 2020, 16 perioperative nurses participated in semi-structured individual interviews three to five months after their graduation from five different educational institutions. During their postgraduate education, they had participated in interprofessional simulation-based learning that included acute clinical situations. A phenomenological hermeneutical analysis was applied to the data involving three steps: naïve reading, structural analysis and comprehensive understanding. RESULTS: During the naïve reading, three themes emerged: competence in handling acute situations, competence in interprofessional teamwork and professional identity development. CONCLUSION: Interprofessional simulation-based learning in perioperative nursing education developed relevant and important competence, including professional identity development, among perioperative nursing students. As recent graduates, their professional competence was transferred to clinical practice and developed further. RELEVANCE TO CLINICAL PRACTICE: Findings indicate that interprofessional simulation-based learning is an important educational approach in perioperative nursing education. It is essential to use effective learning approaches to develop competencies that are transferable to clinical practice and improve perioperative nurses' performance as recent graduates. Therefore, interprofessional simulation-based learning should be implemented into perioperative nursing education.

Learning in nursing home placement: A phenomenological study of student nurses' lived experience.

AIM: To explore first-year student nurses' lived experience of learning in clinical placement in nursing homes. BACKGROUND: Nursing homes traditionally represent students' first clinical placement sites during nurse education, and nursing home residents' care needs can provide opportunities for student nurses to acquire both fundamental and specialised nursing skills. In clinical placements, students have opportunities to apply and integrate theoretical knowledge, practical skills and ethical competence in a clinical setting. DESIGN: A qualitative design with a hermeneutic phenomenological approach was employed and reported in accordance with the COREQ guidelines. METHODS: The study was undertaken at three nursing homes affiliated with one Norwegian university. Close observation (173 h) and in-depth individual interviews (n = 7) with first-year student nurses were conducted to explore their lived experience of learning. Data analysis was guided by van Manen's hermeneutic phenomenological approach. RESULTS: The essential meaning of the phenomenon of learning in clinical placements in a nursing home setting is characterised by four themes: (1) navigating a new and complex learning context, (2) being emotionally affected when facing sickness and frailty, (3) having a vital need for support and guidance and (4) being engaged in learning. CONCLUSIONS: The findings are discussed against the backdrop of educational learning theory. Learning in clinical placements in nursing homes is a multi-faceted and complex phenomenon related to the students' lived experience on the contextual, relational and individual levels. Overall, our findings demonstrate that learning in clinical placements is part of the process of professional identity development. RELEVANCE TO CLINICAL PRACTICE: The clinical practice arena should emphasise emotional support for student nurses, enhance their self-directed reflection and explicitly focus on the essence of nursing in nursing homes.

Content and comprehensiveness in the nursing documentation for residents in long-term dementia care: a retrospective chart review.

BACKGROUND: Insight into and understanding of content and comprehensiveness in nursing documentation is important to secure continuity and high-quality care planning in long-term dementia care. The accuracy of nursing documentation is vital in areas where residents have difficulties in communicating needs and preferences. This study described the content and comprehensiveness of nursing documentation for residents living with dementia in nursing homes. METHODS: We used a retrospective chart review to describe content and comprehensiveness in the nursing documentation. Person-centered content related to identity, comfort, inclusion, attachment, and occupation was identified, using an extraction tool derived from person-centered care literature. The five-point Comprehensiveness in the Nursing Documentation scale was used to describe the comprehensiveness of the nursing documentation in relation to the nursing process. RESULTS: The residents' life stories were identified in 16% of the reviewed records. There were variations in the identified nursing diagnoses related to person-centered information, across all the five categories. There were variations in comprehensiveness within all five categories, and inclusion and occupation had the least comprehensive information. CONCLUSION: Findings from this study highlights challenges in documenting person-centered information in a comprehensive way. To improve nursing documentation of residents living with dementia in nursing homes, nurses need to include residents' perspectives and experiences in their planning and evaluation of care.

Dignity in relationships and existence in nursing homes' cultures.

INTRODUCTION: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. BACKGROUND: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of existence, as well as compassion in relieving suffering, and ontological interdependency. AIM: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. RESEARCH DESIGN: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. PARTICIPANTS AND RESEARCH CONTEXT: Focus group interviews with caregivers in nursing homes. ETHICAL CONSIDERATIONS: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. FINDINGS: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. DISCUSSION: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. CONCLUSIONS: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others.

A qualitative study of perioperative nursing students' experiences of interprofessional simulation-based learning.

AIM: To explore perioperative nursing students' experiences of interprofessional simulation-based learning to gain a deeper understanding of how this educational tool can be used to support students' learning and enable them to achieve the intended learning outcomes. BACKGROUND: Despite extensive research, it remains unclear what and how participants learn from interprofessional simulation-based learning. There is a need to specify how interprofessional simulation-based learning should be organised to support and promote learning processes, especially for postgraduate learners. In particular, there seems to be little evidence in the existing literature in the field of educating perioperative nurses, where advanced technical skills and high-quality nursing care are required. DESIGN: The study's qualitative and explorative design is reported in accordance with the COREQ guideline. METHOD: Between May-October 2019, thirty-four perioperative nursing students from four educational institutions participated in six focus group interviews, with four to eight students in each. All participants had previous experience of interprofessional simulation-based learning in acute settings. Data were transcribed verbatim and were then subjected to phenomenological hermeneutical analysis involving three steps: naïve reading, structural analysis and comprehensive understanding. RESULTS: Three themes were identified the following: customised interprofessional simulation-based learning; reality of the experience of interprofessional simulation-based learning; and preparedness for clinical practice. CONCLUSION: Customised interprofessional simulation-based learning was found to be of value to the participants and reflected their feeling of mental preparedness entering interprofessional simulation-based learning. Furthermore, participants' experience of reality when using the tool was a key theme that also impacted how prepared participants felt for clinical practice. RELEVANCE TO CLINICAL PRACTICE: The study findings contribute to the further expansion of interprofessional simulation-based learning in perioperative nursing education as a means of developing students' professional competence. This is essential knowledge, as professional practitioners must reflect on practice to further enhance that practice and patient safety.

Enablers of the successful implementation of simulation exercises: a qualitative study among nurse teachers in undergraduate nursing education.

BACKGROUND: Simulation exercises are increasingly being used as a teaching method in the field of undergraduate nursing education. Thus, the present study sought to identify, describe and discuss enablers of the successful implementation of simulation exercises in undergraduate nursing education. METHODS: This study had a qualitative descriptive design and involved individual interviews conducted between November and December 2018 with six nurse teachers from three different university campuses in Norway. The transcribed interviews were analysed by means of a qualitative thematic analysis. RESULTS: The majority of the interviewees wanted to offer more simulation exercises as part of their respective undergraduate nursing education programmes. Moreover, creating a safe environment, facilitating student-centred learning and promoting reflection were all identified by the interviewees as enablers of the successful implementation of simulation exercises. CONCLUSIONS: The findings of this study indicate that nurse teachers consider simulation to be a valuable teaching method for improving students' learning outcomes. In addition, the findings could guide the future implementation of simulation exercises in undergraduate nursing education. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04063319 . Protocol ID: 52110 Nursing Students' Recognition of and Response to Deteriorating Patients.

Validity of a questionnaire developed to measure the impact of a high-fidelity simulation intervention: A feasibility study.

AIM: To evaluate the validity and responsiveness of a questionnaire developed to measure the impact of a high-fidelity simulation intervention. DESIGN: A pre- and postintervention design. METHODS: In August 2017, 107 participants completed a questionnaire measuring knowledge and perceived self-confidence pre- and postintervention. Validity of the questionnaire was determined by expert reviews, individual interviews and estimates of the changes in knowledge and perceived self-confidence. The changes were estimated by the differences between paired proportions of participants. The responsiveness of the ordered categorical item scores on self-confidence was evaluated by the measure of systematic group change and individual variations. RESULTS: The analysis of the interviews resulted in three themes: item content, item style and the administration of the questionnaire. An intervention effect on knowledge assessments was shown by the changes in paired proportions of participants with increased or decreased correct assessments (ranging from -25.5 - 24.8 percentage units). The responsiveness of the self-confidence scale was confirmed by evidence of post-intervention systematic group changes towards higher levels. CONCLUSION: This study provides useful experience for a forthcoming randomized controlled study to evaluate the effect of high-fidelity simulation on undergraduate nursing students' knowledge and self-confidence when assessing patient deterioration. IMPACT: Cause-and-effect relationship between simulation and learning is required to improve nursing education. A statistically significant rise in students' knowledge and levels of self-confidence after simulation were identified in this study. The study provided important aspects of future research study designs.

Critical issues for employees in inter-municipal health care services: a multiple case study.

BACKGROUND: Traditional, hierarchical government structures have recently been challenged by increased complexity, fragmented services and heavy public demand. When healthcare services become fragmented and decentralised, they require redesign. Inter-municipal cooperation is a strategy to deal with current challenges and future demographic changes. Few studies exist that can help us conceptualize challenges regarding employment in this context and inform managers in the involved municipalities. This study aims to identify critical issues for employees in inter-municipal health care services and to elaborate on how and why these issues are experienced. METHODS: A multiple qualitative case study was conducted with data from interviews, observation studies, a participant workshop and inter-municipal healthcare service project documents and reports. The study involved two districts in Norway and six cases including 17 informants. First, a within-case analysis was conducted for all cases; second, a cross-case analysis was conducted in each district to examine replication, contrasts and extension to emergent findings; and, eventually, replicated findings in Districts 1 and 2 were analysed across districts. RESULTS: Three critical issues were identified: support, differences, and geographical distances. Employees working in teams experienced fewer challenges than did those working as isolated individuals. CONCLUSIONS: Critical issues for employees represent an important aspect of inter-municipal cooperation, and additional research should be undertaken to inform future policy and practice.

Barriers to exchanging healthcare information in inter-municipal healthcare services: a qualitative case study.

BACKGROUND: In recent years, inter-municipal cooperation in healthcare services has been an important measure implemented to meet future demographic changes in western countries. This entails an increased focus on communication and information sharing across organisational borders. Technology enables efficient and effective solutions to enhance such cooperation. However, the systems in the healthcare sector tend not to communicate with one another. There is a lack of literature focusing on communication and information sharing in inter-municipal healthcare services. The aim of this article is to investigate both the characteristics of communication and information sharing, and the factors that serve as barriers to communication and information sharing for employees in inter-municipal healthcare services. METHODS: In this study, a qualitative case study approach is used to investigate both characteristics of communication and information sharing, and factors enabling barriers to communication and information sharing for employees in newly established inter-municipal healthcare services. Data collection methods were individual interviews, focus group interviews, observation studies and a workshop. A total of 18 persons participated in the study. The interviews, observations and workshop were conducted over a period of ten months. RESULTS: Communication and information sharing practices were found to be complex and characterised by multiple actors, information types and a combination of multiple actions. Findings indicate that 1. IT capability and usability 2. Differences 3. Privacy, confidentiality and security and 4. Awareness are all factors enabling barriers to communication and information sharing in inter-municipal healthcare services. Specifically, these barriers were related to lack of EHR usability, inadequate workflow processes, digital systems incompatibility, the understanding of needs in different systems and knowledge and practices regarding privacy and confidentiality. CONCLUSION: By focusing on the context of inter-municipal cooperation when assessing communication and information sharing in healthcare services, this article contributes to close a gap in existing knowledge. The perspective of the employees provides useful insight, and findings can be relevant for future theory development and for managers and policymakers in inter-municipal services.

Tension between freedom and dependence-A challenge for residents who live in nursing homes.

AIMS AND OBJECTIVES: To present results from interviews of older people living in nursing homes, on how they experience freedom. BACKGROUND: We know that freedom is an existential human matter, and research shows that freedom remains important throughout life. Freedom is also important for older people, but further research is needed to determine how these people experience their freedom. The background for this article was a Scandinavian study that occurred in nursing homes; the purpose of the study was to gain knowledge about whether the residents felt that their dignity was maintained and respected. DESIGN: The design was hermeneutic, with qualitative research interviews. METHOD: Twenty-eight residents living in nursing homes in Denmark, Sweden and Norway were interviewed. Collecting tools used were an interview guide and also a tape recorder. Researchers in the three countries performed the interviews. The data were transcribed and analysed on three levels of hermeneutic interpretation. RESULTS: To have their freedom was emphasised as very important according to their experience of having their dignity taken care of. The following main themes emerged: (a) Autonomy or paternalism; (b) Inner and outer freedom; and (c) Dependence as an extra burden. CONCLUSIONS: Residents in a nursing home may experience the feeling of having lost their freedom. This conclusion has implications for healthcare professionals and researchers, as it is important for residents in nursing homes to feel that they still have their freedom. RELEVANCE TO CLINICAL PRACTICE: In clinical practice, it is important and valuable for the staff to consider how they can help older people feel that they still have their freedom.

Conflicting rationales: leader's experienced ethical challenges in community health care for older people.

BACKGROUND: Ethical challenges arise in all types of care, and leaders need to be aware of how to resolve these challenges. Healthcare systems tend to be organised around medical conditions, and the patient is often faced with a series of uncoordinated visits to multiple specialties. Ideally, care should be organised around the patient's needs. AIM: The purpose of this article was to highlight some ethical challenges perceived by leaders with responsibility for management and service distribution, finance and ensuring quality of community health services for older people. METHOD: This study had a qualitative design with a qualitative content analysis of one focus group with six leaders that met four times in total. Leaders from the community healthcare sector in one Norwegian municipality were included, representing both nursing homes and home-based health care. The study followed the intentions of the Declaration of Helsinki and standard ethical principles. The Norwegian Social Science Data Services approved the study. All participants voluntarily gave written informed consent. FINDINGS: The main theme that emerged from this study was the ethical challenge leaders felt in the form of an inherent conflict between a caring rationale versus economic or technological rationales. Four categories emerged: (i) Management: quality versus economy; (ii) Prioritisation: fair distribution of healthcare services; (iii) Responsibility: considering individuals' needs versus the needs of the whole community; and (iv) Welfare technology: possibilities and challenges. CONCLUSION: Leaders' responsibilities in community health care for older people need to strike a balance between ethical principles in the management of limited resources.

Clinical application research through reflection, interpretation and new understanding - a hermeneutic design.

The implementation of theoretical knowledge in clinical practice and the implementation of good clinical practice into theory have been of interest in caring science for the last 30 years. The aim of this article was to elaborate and discuss a methodology named clinical application research. The method is grounded in a hermeneutical design inspired by Gadamer's philosophy. The methodology, clinical application research, has been used in a research project A life in dignity and experiences from the researchers forms the bases for the elaboration and discussion. The project was performed in collaboration with residents, family caregivers and healthcare providers at six nursing homes in Scandinavia. The material for this article is based on the previous research, that is the results from 10 different articles showing the meaning of dignity and indignity in daily life in nursing homes. Data were generated from 56 individual interviews and 18 focus-group interviews with a total of 40 staff members with five to eight participants at every interview session. By reflection, interpretation and new understanding our results provide knowledge about dignity and how to preserve dignity for older people in an appropriate ethical way. The methodology was relevant for the research project A life in dignity and relevant to caring practice in nursing homes as it opens new possibilities and new ways of thinking when performing dignified care to older people.

Developing a Serious Game for Nurse Education.

Future nursing education is challenged to develop innovative and effective programs that align with current changes in health care and to educate nurses with a high level of clinical reasoning skills, evidence-based knowledge, and professional autonomy. Serious games (SGs) are computer-based simulations that combine knowledge and skills development with video game-playing aspects to enable active, experiential, situated, and problem-based learning. In a PhD project, a video-based SG was developed to teach nursing students nursing care for patients with chronic obstructive pulmonary disease in home health care and hospital settings. The current article summarizes the process of the SG development and evaluation. [Journal of Gerontological Nursing, 44(1), 15-19.].

Participants' perceptions of an intervention implemented in an Action Research Nursing Documentation Project.

AIMS AND OBJECTIVES: The aim of this study is to describe healthcare professionals' experiences and perceptions of an intervention implemented in an action research project conducted to improve nursing documentation practices in four municipalities in Norway. BACKGROUND: Documentation of individualized patient care is a continuing concern in healthcare services and could impacts the quality and safety of healthcare. Use of electronic systems has made some aspects of documentation more comprehensive, but creation of an individualized care plan remains a pressing issue. DESIGN: A qualitative descriptive design was used. METHODS: An action research project was conducted between 2010-2012 to improve the content and quality of nursing documentation in community healthcare services in four municipalities. One year after the project was completed four focus group interviews were conducted with healthcare professionals, one for each involved municipality. Two unit managers were interviewed individually. Qualitative content analysis was used. RESULTS: Three themes emerged: healthcare professionals perceived competing interest; they experienced that they had to manage complexity and changes; and they highlighted a clear and visible leader as important for success. CONCLUSIONS: Quality improvement activities are essential. Healthcare professionals experience a complicated situation when electronic health record systems do not support workflow. Further research is recommended to focus on the functionality and user interface of electronic health record systems, and on the role of leadership when implementing changes in clinical practice. RELEVANCE TO CLINICAL PRACTICE: Stronger cooperation among policymakers, electronic health record system vendors, and healthcare professionals is essential for improving electronic health record systems and documentation practices. Involvement of end-users in these improvements can make a difference in the way the systems are perceived in the clinical workflow.

Digital recording as a teaching and learning method in the skills laboratory.

AIM AND OBJECTIVES: To obtain information on how nursing students react to, think about and learn from digital recording as a learning and teaching method over time. BACKGROUND: Based on the teaching and learning philosophy of the university college, we used digital recording as a tool in our daily sessions in skills laboratory. However, most of the studies referred to in the background review had a duration of from only a few hours to a number of days. We found it valuable to design a study with a duration of two academic semesters. DESIGN: A descriptive and interpretative design was used. METHOD: First-year bachelor-level students at the department of nursing participated in the study. Data collection was carried out by employing an 'online questionnaire'. The students answered five written, open-ended questions after each of three practical skill sessions. Kvale and Brinkmann's three levels of understanding were employed in the analysis. RESULTS: The students reported that digital recording affected factors such as feeling safe, secure and confident and that video recording was essential in learning and training practical skills. The use of cameras proved to be useful, as an expressive tool for peer learning because video recording enhances self-assessment, reflection, sensing, psychomotor performance and discovery learning. CONCLUSION: Digital recording enhances the student's awareness when acquiring new knowledge because it activates cognitive and emotional learning. The connection between tutoring, feedback and technology was clear. RELEVANCE TO CLINICAL PRACTICE: The digital recorder gives students direct and immediate feedback on their performance from the various practical procedures, and may aid in the transition from theory to practice. Students experienced more self-confidence and a feeling of safety in their performances.

The significance of meaningful and enjoyable activities for nursing home resident's experiences of dignity.

BACKGROUND: Living in a nursing home may be challenging to the residents' experience of dignity. Residents' perception of how their dignity is respected in everyday care is important. AIM: To examine how nursing home residents experience dignity through the provision of activities that foster meaning and joy in their daily life. METHOD: A qualitative design was used and 28 individual semistructured interviews conducted with nursing home residents from six nursing homes in Denmark, Norway and Sweden. The data were analysed with qualitative content analysis. Independent ethical committees in all participating countries granted their approval for the study. FINDINGS: The participants highlight two dimensions of the activities that foster experiences of dignity in nursing homes in Scandinavia. These two categories were (i) fostering dignity through meaningful participation and (ii) fostering dignity through experiencing enjoyable individualised activities. CONCLUSION: Activities are important for residents to experience dignity in their daily life in nursing homes. However, it is important to tailor the activities to the individual and to enable the residents to take part actively. Nurses should collect information about the resident's preferences for participation in activities at the nursing home.

How school nurses experience and understand everyday pain among adolescents.

BACKGROUND: Pain problems are a rapidly growing health problem found among both children and adolescent, and about 15-30% have reported chronic pain problems. School nurses in Norway meet adolescents with various ailments, including pain. Yet research on how school nurses perceive the pain experienced by adolescents is limited. The aim of the present study was to explore how school nurses explain and experience the everyday pain of adolescents. METHOD: A qualitative study with an explorative design comprising five focus group interviews. Each group consisted of three to five school nurses. Seventeen female school nurses in five junior high schools in Norway, age range 29-65 years participated. To cover the issues a semi structured interview guide was used. The transcribed text was analysed with qualitative content analysis. RESULTS: The experience of school nurses with adolescents' pain in everyday life is mainly that pain is a social, physical, and psychological phenomenon. School nurses experienced that everyday pain is reflecting: 1) high expectations, 2) difficult relationships and traumatic experiences and 3) an unhealthy lifestyle. School nurses have ambivalent attitudes to medicalisation of pain. CONCLUSION: Despite of a biopsychosocial understanding of pain, the school nurses maintained referral practice of medical examinations, with the results that many adolescents became shuttlecocks in the health system. Although the school nurses´ were sceptical of the tendency towards medicalization in society, it appears that they actually help maintain this tendency.

Fostering dignity in the care of nursing home residents through slow caring.

BACKGROUND: Physical impairment and dependency on others may be a threat to dignity. RESEARCH QUESTIONS: The purpose of this study was to explore dignity as a core concept in caring, and how healthcare personnel focus on and foster dignity in nursing home residents. RESEARCH DESIGN: This study has a hermeneutic design. Participants and research context: In all, 40 healthcare personnel from six nursing homes in Scandinavia participated in focus group interviews in this study. Ethical considerations: This study has been evaluated and approved by the Regional Ethical Committees and the Social Science Data Services in the respective Scandinavian countries. FINDINGS: Two main themes emerged: dignity as distinction (I), and dignity as influence and participation (II). DISCUSSION: A common understanding was that stress and business was a daily challenge. CONCLUSION: Therefore, and according to the health personnel, maintaining human dignity requires slow caring in nursing homes, as an essential approach.

Family members' lived experiences of everyday life after intensive care treatment of a loved one: a phenomenological hermeneutical study.

AIMS AND OBJECTIVES: To illuminate relatives' experiences of everyday life after a loved one's stay in an intensive care unit. BACKGROUND: Relatives of intensive care patients experience considerable stress that can have a long-lasting effect on their everyday lives. Relatives frequently report anxiety, depression and complicated grief as a result of their experiences in the intensive care unit. DESIGN: A qualitative design was chosen. METHODS: Thirteen relatives were interviewed 3 months to 1 year after the discharge or death of an intensive care unit patient. A phenomenological hermeneutical method was used to explore family members' lived experiences upon returning home after their loved ones' stay in the intensive care unit. RESULTS: Two themes emerged from the analysis of the data: (1) changes in everyday life and emotional reactions, and (2) managing changes and need of support and follow-up from the ICU. CONCLUSIONS: Family members experience changes in emotions, roles and responsibilities after returning home. They must maintain control of themselves and adapt to the changes to face the future. They cope by using their personal resources and support from others. Some are in further need of follow-up from the intensive care unit staff. RELEVANCE TO CLINICAL PRACTICE: Nursing education could focus increasingly more on the significance of communication and personal support, which helps family members cope during patients' stay and experience a sense of personal strength when returning home. Further research should address how to identify and support those with special needs after the intensive care unit stay.