A qualitative study of family members' perspectives regarding decision-making for nursing home residents' care.

PURPOSE: We explored how family caregivers perceive decision-making regarding the care of nursing home residents. METHODS: This qualitative study used Flemming's Gadamerian-based research method. In person semi-structured interviews about decision-making concerning residents' care were conducted with 13 family members (nine women, four men) of residents of three Norwegian nursing homes. FINDINGS: The following themes emerged: Excessive focus on autonomy threatens resident wellbeing and safety. Resident wellbeing is the caregiver's responsibility. Resident wellbeing serves as a guiding principle. CONCLUSIONS: The family members of residents and the nursing home caregivers disagreed about the significance of upholding resident autonomy to respect residents' dignity. The family members held that not all instances where residents refused care reflect autonomy situations as care refusal often does not reflect the resident's true values and standards but rather, stems from barriers that render necessary care actions difficult. In situations where residents refuse essential care or when the refusal does not align with the residents second-order values, the family members suggested that caregivers strive to understand the causes of refusal and seek non-coercive ways to navigate it. Hence, the family members seemed to endorse the use of soft paternalism in nursing homes to safeguard residents' wellbeing and dignity.

Promoting dignity in nursing education - How educators manoeuvre to promote dignity.

BACKGROUND: Dignity is a core value in nursing. One of the objectives in nursing education is to promote dignity and contribute to the students' discovery of this value. Research shows that dignity in nursing education is threatened, due to lack of attention and an increasing problem with incivility. PURPOSE: The study aims to explore how nursing educators experience their contribution in promoting dignity in nursing education. METHOD: Five focus group conversations were conducted with nursing educators, and Gadamer's philosophical hermeneutics was chosen as the study's scientific theoretical approach. FINDINGS: The educators experienced that they promoted dignity by safeguarding the dignity in the nursing profession in general, by promoting the dignity of the nursing students in particular, and through promoting dignity in challenging situations. CONCLUSION: The study emphasizes the importance of promoting dignity in nursing education. It found that the nursing educators promoted dignity by safeguarding the dignity of both the nursing profession and the nursing students, and by manoeuvring judiciously between these two when there was disharmony between them. By manoeuvring challenging situations using discretion, the ethical demand will be given room. Dignity can then be fulfilled between people in harmony with professional, social and cultural norms, and in that way promote dignity in nursing education.

"You get tired of remaining in a state of fear"- professionals' experiences of self-care facing suicidality in psychiatric wards.

AIM: The aim of this study is to explore mental healthcare professionals (MHCPs) experiences related to own emotions when encountering patients at risk of suicide in psychiatric wards and their family members. METHODOLOGY AND METHODS, PARTICIPANTS AND RESEARCH CONTEXT: This study has a qualitative explorative design. Data consist of texts from twelve in-depth interviews with MHCPs belonging to six units in two psychiatric wards. Data were interpreted using a hermeneutical approach based on Gadamer's philosophical hermeneutics. FINDINGS: Through an interpretation process, three themes emerged: Enduring own emotions, Balancing emotional engagement and the need to rest, and Being together in the community of colleagues. CONCLUSION: This study shows the importance of being aware of own anxiety facing suicidality. MHCPs have to work emotionally and cognitively so that care is not guided by anxiety but by collaboration with the patient and his family members. The study highlights the need for a culture in the mental health service in which the MHCP can reflect on own emotional reactions and thoughts in a collegial environment characterized by openness, generosity and collaboration.

Individuals living with a liver transplant - a follow-up study exploring mental, emotional and existential issues 10 years after transplantation.

BACKGROUND: Going through a liver transplantation is by many recipients considered mentally and emotionally burdensome. AIM: The aim of this study was to explore individuals' mental, emotional and existential experiences living with a liver transplant during a period of approximately ten years. METHODOLOGICAL DESIGN: The methodology in this study is based on Gadamer's hermeneutics. Galvin and Todres' conceptual framework on well-being was applied in the interpretation process. RESEARCH METHODS: Both researchers conducted interviews, which took the form of conversations. We made use of Brinkmann and Kvales' three types of interpretation. ETHICAL ISSUES AND APPROVAL: The study was approved by the Ombudsman for Privacy of the Norwegian Social Data Services and is based on informed consent and confidentiality. RESULTS: Three themes emerged through interpretation: 1. From great suffering to gratitude and a humble attitude towards life. 2. From living in uncertainty to leading a normal life. 3. From hopelessness and anxiety to an indifferent attitude towards life. CONCLUSION: This study showed that the process of receiving a new liver and living with it, had changed most of the participants' attitudes towards life in a humble way. Some persons struggled with life and experienced depression anxiety, as well as lack of energy.

Residents' experiences of paternalism in nursing homes.

BACKGROUND: Interest in strengthening residents' autonomy in nursing homes is intensifying and professional caregivers' experience ethical dilemmas when the principles of beneficence and autonomy conflict. This increased focus requires expanded knowledge of how residents experience decision-making in nursing homes and how being subject to paternalism affects residents' dignity. RESEARCH QUESTION/AIM: This study explored how residents experience paternalism in nursing homes. RESEARCH DESIGN: This study involved a qualitative interpretive design with participant observations and semi-structured interviews. The interpretations were informed by Gadamer's hermeneutics. PARTICIPANTS AND RESEARCH CONTEXT: Eleven residents were interviewed after a period of participant observation in two nursing homes. ETHICAL CONSIDERATIONS: The study was performed in accordance with the Helsinki declaration. The Regional Ethics Committee (REK) permitted the researcher to perform participant observation in the nursing homes. The use of audio recordings of interviews was registered and supervised by Sikt - Norwegian Agency for Shared Services in Education and Research. The resident's consent was assessed continuously. Three interviews were terminated for ethical reasons. FINDINGS: The resident interviews revealed that residents found it obvious for caregivers to possess the decision-making authority in nursing homes. When residents explained their views, three main themes emerged: (1) To be included even though caregivers make the decisions, (2) Surrender to dependency, and (3) Adherence to nursing home norms. CONCLUSIONS: Residents submit to their caregivers and give caregivers the responsibility and function as leaders. Paternalism was experienced as dignifying in situations where it contributed to residents being able to live according to second order desires and values, and when it implied respect and appraisal of residents' capabilities. Paternalism was experienced as debasing when residents felt left out, and when residents felt that their capabilities were underestimated. This also included their capability to withstand paternalistic influence.

Caring for family members following suicide: Professionals' experiences of responsibility.

BACKGROUND: When a patient commits suicide while hospitalized in the psychiatric ward, the mental healthcare professionals (MHCPs) who have had the patient in their care encounter the family members immediately following the suicide. Professionals who encounter the bereaved in this first critical phase may have a significant impact on the grieving process. By providing ethically responsible and professionally competent care, they have the opportunity to influence what can alleviate and reduce suffering and promote health in a longer perspective. AIM: The aim of this study is to investigate MHCPs' experiences in the encounter with family members who has been bereaved by suicide. METHODS: Data material consists of text from in-depth interviews with six MHCPs belonging to a total of five different psychiatric units in two hospitals. The findings have emerged through analysis using a hermeneutical approach based on Gadamer's philosophical hermeneutics. ETHICAL CONSIDERATIONS: The study was approved by the Ombudsman for Privacy of the Norwegian Social Science Data Services and is based on informed consent and confidentiality. FINDINGS: Three themes emerged: Confirming the suffering. Creating encounter through dialogue. Providing consolation and reconciliation. Findings illuminate how MHCPs understand their responsibilities and how they act in the encounter with the bereaved following suicide. CONCLUSION: The participants appear to be led by the responsibility that grows through witnessing the suffering of the bereaved. Encountering the family member's aggression and threats against staff members is an ethical challenge to the professional's ability to confirm the bereaved, create dialogue and provide consolation and reconciliation at the start of their grieving process. MHCPs need to be aware of the different reactions and needs of family members following suicide. More research is needed about how to provide sensitive and flexible care in ways that can be perceived as helpful for those left behind.

The body's dignity in integrative understanding of health in IBD - A hermeneutic approach to holistic care.

BACKGROUND AND PURPOSE: This article will convey a new understanding of health and disease as a coherent dimension where the whole body interacts with its natural environment. This understanding is linked to a theoretical framework and illustrated by reference to research with patient experiences with inflammatory bowel disease (IBD), with the disorders Crohn's disease and ulcerative colitis. Creating ecological sustainability towards a greener health service where the body has a higher intrinsic value is a growing concern. MATERIAL AND METHODS: The methodological approach is hermeneutic, whereby the results of one's own research are interpreted and reconceived through reflection towards a new understanding. Themes from patients' experiences are interpreted in light of the theoretical frame of reference of this article in order to achieve a new understanding. RESULTS: The further interpretation of the state-of-the-art article and empirical articles resulted in the following themes: 1. The lived body is understood as a coherent whole and a place of inner freedom. 2. The body in a lowered state of stress helps the patient to experience dignity and vitality. 3. An integrative understanding of health in terms of IBD brings dignity and wholeness to the body. CONCLUSION: This article sheds light on the connections between body knowledge, nutrition, dignity, and integrative understanding of health in acute and chronic IBD. In clinical practice, the connections may happen when giving the patient the opportunity for recovery by learning to listen to the body. Dignity is linked to both coping and expert help from clinically competent health professionals.

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.

Katie Erikson's caring theories. Part 2. The theory of caritative caring ethics and the theory of evidence.

In this article, Katie Eriksson's theory of caritative caring ethics and the theory of evidence, are described. Both theories are anchored in caritas, that is love, mercy and compassion. The theory of caritative caring ethics was first described by Eriksson in 1995, where seven assumptions or basic categories were elaborated. These were: the human being's dignity, the care relationship, invitation, responsibility, virtue, obligation or duty, and good and evil. Eriksson's theoretical contribution is that she makes a distinction between caring and nursing ethics, between inner and external ethics, and between natural and clinical ethics. Concerning the theory of evidence, Eriksson claims that a multidimensional scientific view of evidence in caring that focuses on the patient's world is necessary and vital. To see, realise, know, attest and revise constitute the ontological definitions of the concepts of evidence and evident. The theories are united by the core concepts of testimony and witnessing the human being's suffering. Eriksson points out that it is in the ethical acts that deeds are formed, based on ethos. The anchorage in an ethos means to have firm value-loaded judgements of an inner motive. Moreover, the anchorage in ethos presupposes a personal and natural ethic. The good deeds are realised in the relationship between the patient and the carer, but the caring ethics is not a professional or external ethics. Caring ethics is an ontological inner ethics meaning fellowship and the right to exist, but it is the patient's world and reality that decides the foundation and starting point for caritative caring ethics in clinical practice. The ultimate purpose and goal of caring are to guarantee the patient's dignity and absolute value as a human being.

Dignity at stake in educational relations - The significance of confirmation.

INTRODUCTION: It is a goal in nursing education to promote students' dignity and facilitate this core value. Students' experience of dignity is shaped by the student-supervisor relationship. Literature shows limited knowledge about how nursing students experience their own dignity during education. RESEARCH AIM: The aim of the study is to develop an understanding of how nursing students experience their own dignity in relation to supervisors, and what significance these experiences have in education. RESEARCH DESIGN: Gadamer's philosophical hermeneutics was chosen as the approach, and narratives and qualitative interviews were conducted. The interpretation process was inspired by Fleming, Gaidys and Robbs. PARTICIPANTS AND RESEARCH CONTEXT: Nineteen nursing students in the final year of their education were included in the study. They represented six different campuses at three different educational institutions. The qualitative interviews took place at the educational institutions. ETHICAL CONSIDERATIONS: The research recommendations of the Declaration of Helsinki were followed. Access to the students was given by the educational institutions. All interested students signed a continuous informed consent. FINDINGS: Students' dignity was at stake in encounters with supervisors during education. Decisive for experience of dignity was the supervisor's ability to confirm the student through acknowledgment, reassurance and seeing them as individuals. Experienced dignity had a crucial impact on students' life courage and their ability to be present. DISCUSSION: The discussion emphasizes the vulnerable dignity of students, the importance of confirmation and the significance perceived dignity has. CONCLUSION: Students' experiences tilted between perceived dignity and offense, and placed students' dignity in a vulnerable position. Crucial for perceived dignity was the confirmation the students received from their supervisors. Perceived dignity gave the students courage and increased their ability to be present, which provided better opportunities for learning and development.

Dignity in fragile older women receiving daily municipality care.

Background:Dignity is an important ideal in the nursing of older women who need municipal care. Dignity can be challenged when health is impaired by feeling grief and suffering associated with bodily changes and impaired functions.Aim and research questions:The study aimed to deepen the understanding of the meaning of dignity in the life of fragile older women who daily needed help from municipal care service. The research questions are: What is older women's experience of dignity, and what is it not to be met with dignity when needing service from municipality care?Research design: The study has a qualitative design, and the methodology is based on Gadamer's ontological hermeneutics. Ten women receiving municipal care, aged from 66 to 91 were interviewed in their home environments. Kvale and Brinkmanns' three levels of interpretation were applied in the analysis of the interviews: self-understanding, a critical understanding based on common sense, and theoretical understanding.Ethical considerations: The study follows the guidelines for good scientific practice according to the Declaration of Helsinki and was approved by the Norwegian Centre for Research Data.Results: The interviews revealed fragments of the women's unique life history. Two themes emerged from the interpretation: Confirming encounters provide human dignity; and Not being confirmed as a human being violates human dignity.Conclusions:For the women, dignity is about feeling seen and understood by the individual nurse and this takes place both in conversation and in bodily care. Not being seen or confirmed gives rise to suffering. The reason for this seems to be lack of competence on the part of the staff or little continuity.

Dignity humiliation as experienced by wives caring for a home-dwelling husband with dementia.

In this study, we explored key sources that led wives who care for their husbands with dementia at home to experience dignity humiliation - an issue that affects the well-being of women around the world. Through hermeneutic interpretation of in-depth interviews, three key sources of this were identified: interpersonal experiences of people's indifference, curiosity and disrespectful attitudes; interpersonal experiences of limited access to healthcare services and incompassionate treatment by healthcare professionals, and; intrapersonal experiences of self-deprecation. Knowledge of key sources leading to dignity humiliation can be used to improve interdisciplinary healthcare practices and policy development, specifically relating to this group of caregivers.

Discovering dignity through experience: How nursing students discover the expression of dignity.

INTRODUCTION: Dignity is a core value in nursing. Nursing education shall prepare students for ethical professional practice and facilitate insight into the phenomenon of dignity and its significance. There is limited knowledge about how nursing students discover dignity in their education. RESEARCH AIM: The aim of the study is to develop an understanding of how nursing students discover and acquire dignity. RESEARCH DESIGN: The study has a hermeneutic approach where qualitative interviews of nursing students were employed. The process of interpretation was inspired by text of Fleming, Gaidys and Robbs. PARTICIPANTS AND RESEARCH CONTEXT: Nineteen nursing students agreed to be included in the study, representing six different campuses at three different educational institutions. All were in the final year of their study. The interviews took place at the educational institutions. ETHICAL CONSIDERATIONS: The educational institutions facilitated recruitment of the students who signed voluntarily for participation and continuous informed consent. The study was approved by The Norwegian Center of Reporting Data (NSD). The research recommendations of the Declaration of Helsinki were followed. FINDINGS: The nursing students discovered the expression and significance of dignity through experiences, gained through introspection and in interaction with others during the education. DISCUSSION: The findings are discussed using Gadamer's concept of experience and how experiences can create new insight. In particular, the students' experiences with the inner ethical and external aesthetic dimension of dignity are discussed. CONCLUSION: The study shows that students discovered the inner ethical dignity through experiencing vulnerability, pride and shame. They discovered the external aesthetic dignity through incidents, where they experienced both to be confirmed and not to be confirmed, and through observation of good or bad role models. Crucial negative and positive experiences are important for discovering the expression and significance of dignity.

Katie Eriksson's caring theories. Part 1. The caritative caring theory, the multidimensional health theory and the theory of human suffering.

In this article, Katie Eriksson's caring theories including the caritative caring theory, the multidimensional health theory and the theory of human suffering are described. The assumptions and concepts, both etymologically and semantically investigated, are founded in ontology. Caring is a human natural phenomenon and patient means the suffering human being. In the caritative caring theory, the substance and core of caring is described as 'to care is to tend, play and learn in faith, hope and love'. The starting point is love, mercy, human kindness, compassion and a caring relationship. Caring is healing and sharing-a will to care, which is founded in faith and life energy. Caring promotes humanity and people's health, and thus a feeling of wholeness, integration, growth and inner freedom. The goal is to promote and protect health and life and alleviate suffering. Health means wholeness and holiness. Eriksson emphasises an ontological aspect of health, where the human being is seen as an inseparable being comprising a body, soul and spirit. To be healthy is to be whole and to feel whole, where wholeness means life itself. In the multidimensional perspective, the essence of health is vitality. Vitality is the innermost dimension of health; it is a force to energy in life, to joy and desire. Health is a dynamic movement between dimensions of becoming, being and doing. Eriksson seeks answers to the 'what' of suffering through concept analysis, but she also discusses the 'why' question. Each suffering is unique. There is a connection between suffering and desire, where suffering gives birth to an unsuspected life power that is not seen as having any other source than suffering itself. Desire and suffering make up the driving power for a person's being and formation into the person she is intended to become.

"Embracing is the most important thing we can do" - Caring for the family members of patients at risk of suicide.

AIM: This study explores mental health personnel's experiences in the encounter with family members of patients at risk of suicide so as to develop a deeper understanding of the content of caring. METHODOLOGY: Data were collected using semi-structured interviews with 12 participants and were analysed and interpreted using a model inspired by the philosophical hermeneutics of Gadamer. The context was psychiatric wards. FINDINGS: Through a thematic analysis, four themes emerged: Acknowledgement as a premise for involving family members. Embracing with the family members' feelings and reactions. Strengthening hope in a situation entailing a serious risk of suicide. Providing reassurance to family members in transitional situations. CONCLUSION: Witnessing the family members' suffering and needs is understood as arousing a sense of responsibility in the participants and triggering various care strategies such as listening, embracing, strengthening hope and providing reassurance.

Hermeneutic observational studies: describing a method.

There is a need to develop and use research observations in the clinical field, primarily to gain insight into and assess evidence of what comprises caring in a real-life situation and confirm what is actually taking place. In addition, assessments lead to a new and different understanding of what caring constitutes, thereby enabling the identification of what kind of care is being provided and is required. Such observations also enable the observer to perceive and verbalise caring. There are ongoing discussions, specifically in Nordic countries, on how to use caring science-based observations as a means of collecting and interpreting qualitative data through the application of a hermeneutic approach, which constitutes describing what has been seen and reporting on it by way of ethical obligation. This article contributes to the debate through the provision of additional content and by reflecting on the development and usability of hermeneutical research observations from a method and methodological perspective, thereby refining previous ideas and extending previous assumptions. The primary study objective was to report on the experience of utilising observations as a single data collection method for hermeneutic research with the aim of evaluating the interplay between intensive care unit (ICU) patients and their next of kin. A secondary objective was to highlight the impact of preknowledge and preunderstanding on the interpretation process. An intensive care context was assessed as the most appropriate, as the majority of patients are unable to engage in verbal narratives during ongoing treatment and care. The benefits of employing hermeneutic observation as well as interpretation and preunderstanding from a caring science perspective are considered.

Behavioural disturbances in patients with frontotemporal lobe degeneration focusing on caregiver burden at home and in nursing homes.

AIM AND OBJECTIVE: To explore the challenges faced by family caregivers of people with frontotemporal dementia and other forms of dementia affecting the frontal and temporal lobes causing behavioural disturbances through a qualitative approach with in-depth interviews. BACKGROUND: Studies of different forms of dementia involving degeneration of the frontal and temporal lobes have mainly focused on the neurophysiology and physiology of the disease and on caregivers' health. Few studies have described the challenges and burdens connected with everyday life and in relation to suitable nursing home placement that are faced by family caregivers. METHOD AND DESIGN: This study used a descriptive and explorative design. Eleven semi-structured interviews with family caregivers of patients from special units in four nursing homes were conducted in 2014. Data were analysed based on Kvale and Brinkmann's three contexts of interpretation: self-understanding, common sense and theoretical understanding. Checklist for qualitative studies: Standards for Reporting Qualitative Research (SRQR) http://www.equator-network.org/reporting-guidelines/srqr/ RESULTS: Two central themes were derived from the data: changes in behaviour and personality were perceived as incomprehensible, frightening and increasingly difficult to manage. Family caregivers experienced challenges in finding suitable care facilities when they were not able to continue providing home care. Due to behavioural disturbances and lack of relevant competencies among health personnel, family members were often moved between nursing homes. CONCLUSION: Pronounced personality and behavioural disturbances such as tactlessness and aggression in a family member with dementia are experienced by caregivers as stressful and burdensome and may lead to feelings of shame and guilt. A lack of suitable care facilities adds to the stress and difficulties of the families and entails an additional and unresolved burden. RELEVANCE TO CLINICAL PRACTICE: The study reveals a need for more knowledge among those organising health services as well as healthcare professional dealing with this patient category to ease the burden on next of kin.

It is just that people treat you like a human being: The meaning of dignity for patients with substance use disorders.

INTRODUCTION: Patients who suffer from substance use disorder (SUD) might receive services from different service providers in an opioid maintenance treatment programme (OMT) and have a widespread and complex need for nursing. BACKGROUND: Literature reveals that prejudices against people with SUD exist. There is a lack of studies exploring patients with SUD experiences of preserving their dignity in the encounter with healthcare staff. The aim of the study was to gain insight into the meaning of dignity for patients with SUD. METHODS: The research design was descriptive and interpretative. In the interpretation of qualitative in-depth interviews with six patients, a hermeneutical approach based on Gadamer (Truth and method, Sheed & Ward, London, UK, 1989) was used. RESULTS: Analysis resulted in three mains themes about the meaning of dignity: (a) The material dimension. (b) To be respected by others. (c) The inner experience. Factors enhancing dignity in the encounters were as follows: (a) Being respected and acknowledged. (b) Being cared for. (c) Knowledge and persistent relation. Factors depriving dignity were as follows: (a) Stigma and prejudice. (b) Insufficient relations and lack of confirmation. (c) Experiencing disrespectful/patronising attitudes and lack of knowledge. CONCLUSIONS: The material dimension of dignity containing an aesthetically aspect was important for these patients. Dignity was also experienced as strongly connected to respect. Dignity can be enhanced by treating patients with SUD with understanding and respect, and dignity can be inhibited through stigmatization of patients with SUD, as well as by caregivers' lack of knowledge. RELEVANCE TO CLINICAL PRACTICE: The study clarifies a need for more knowledge about SUD among healthcare staff, as well as promotes ethical awareness in encounters with patients regardless of their background.

The meaning of dignity when the patients' bodies are falling apart.

BACKGROUND: People with advanced cancer disease experience great bodily changes due to disease or treatment. They tend to feel ashamed when their bodies are subjected to such changes and they feel their dignity is threatened. AIM: To explore the patients' experiences of the bodily changes in relation to dignity. DESIGN: The study has a hermeneutic qualitative design. METHOD: Individual in-depth interviews and participant observations were conducted with 13 patients with advanced cancer disease at a hospice inpatient unit in Norway. Gadamer's ontological hermeneutics inspired the interpretation. RESULTS AND CONCLUSION: The patients' unpredictable, sick bodies forced the patients, or gave them the opportunity, to relate to their bodies in an honest way. The patients, living in interaction between suffering and health, strove to find dignity. The patients had a will to live and they experienced a love in their unruly bodies that both helped alleviate their suffering and give them an experience of enhanced dignity. It is important that nurses have insight into the consequences of bodily changes for the patients' experiences of dignity in health and suffering to provide good, dignified care.

Dignity work of older women caring for a husband with dementia at home.

In this study, we explored perceptions of dignity, and sources preserving dignity of six older Norwegian women caring for a home-dwelling husband with dementia. Through hermeneutic interpretation of in-depth interviews, "having personal integrity," "mastering everyday life," and "giving of one self" were identified as crucial intrapersonal aspects of dignity - while "acknowledging worthiness and uniqueness of each human being" was found to be an essential interpersonal aspect. Nine dignity-preserving sources identified suggests that the wives engaged in "dignity work" to preserve their own dignity as a caregiver, as well as to safeguard the dignity of their husbands who were vulnerable to dignity loss.