Parents' experiences with public health nursing during the postnatal period: A reflective lifeworld research study.

AIM: To describe mothers' and fathers' experiences with public health nursing and child and family health centre services in the postnatal period, both as a couple and as individuals. METHOD: A phenomenological reflective lifeworld research approach with a descriptive design was chosen. A purposive sample of 10 mothers and 10 fathers were interviewed twice, 1-2 and 6-8 weeks postpartum, using joint and individual interviews. By focusing on being open and flexible, the data were analyzed to elucidate a meaningful structure of the phenomenon. RESULTS: The findings revealed that parents' experiences with public health nurse (PHN) and Child and Family Health Centre (CFHC) services in the postnatal period are characterised by a longing to be seen and confirmed both as unique individuals and as a family by the PHN. Although an increased need for both lay and professional care is prominent during the postnatal period, the parents drew a varied picture of their experiences demonstrating that the CFHC services are focussing almost exclusively on mother and child. CONCLUSION: A public health nurse can contribute to strengthen parenthood and promote the family's health when the focus is on the new baby. Being cared for while learning to care for the baby is pivotal in a phase that involves both joy and vulnerability. This study adds knowledge concerning the importance of both parents being seen and confirmed by the PHN as unique individuals and a family unit in the postnatal period.

Relationships influencing caring in first-line nursing leadership: A visual hermeneutic study.

AIM: To explore and interpret relationships that influence caring in nursing leadership, in the context of Nordic municipal health care, from first-line nurse managers' perspectives. DESIGN AND METHOD: We chose a visual hermeneutic design. A three-stage interpretation process outlined by Drew and Guillemin, based on Rose, was used to analyse drawings and the following reflective dialogue from three focus groups, with a purposive sample of 11 first-line nurse managers. The study was conducted from February to May 2018. RESULTS: The findings demonstrated that first-line nurse managers struggled to balance their vision with administrative demands. Caring for patients implied caring for staff; however, they often felt as if they were drowning in contradictory demands. First-line nurse management could be a lonely position, where the first-line nurse managers longed for belonging based on increased self-awareness of their position within an organisation. Superiors' support enabled first-line nurse managers' in their primary aim of caring for patients. CONCLUSION: First-line nurse managers showed deep roots to their identities as nurses. Caring for patients included caring for staff and was their main concern, despite demanding reforms and demographic changes affecting leadership. Superiors' support was important for FLNMs' self-confidence and independence in leadership, so the first-line nurse managers can enact their vision of the best possible patient care. This study adds knowledge of the significance of caring in nursing leadership and the caritative leadership theory. IMPACT: In order to recognise FLNMs as vulnerable human beings and provide individual confirmation and support, a caring organisational culture is needed. FLNMs need knowledge based on caring and nursing sciences, administration and participation in formal leadership networks. These findings can serve as a foundation for developing educational programmes for nurse leaders at several organisational levels.

Unravelling the grief of involuntary pregnancy loss: A meta-ethnography of midwives' and nurses' emotional experiences.

BACKGROUND: Parents who experience involuntary pregnancy loss encounter nurses and midwives when requiring care. But the environment in which this attention is provided turns it into a stressful and challenging event that favours the concealment of emotions. Literature supports the development of compassion in nurses and midwives who tend to parents who experience pregnancy losses. AIM: To synthesise the emotional experiences of midwives and nurses when caring for parents who have suffered an involuntary pregnancy loss. METHOD: This is a synthesis of qualitative studies following Noblit and Hare's interpretive meta-ethnography. Eleven studies met the research objective and inclusion criteria. RESULTS: An overarching metaphor, 'Unravelling the grief of loss', accompanied by four major themes provided interpretive explanations to the experiences of midwives and nurses in caring for involuntary pregnancy losses: 'Pulling the thread' - looking for the meaning of loss; 'Yarn entanglement degree' - determinants for grief expression; 'Detangling tools' - focusing on the loss; and 'Fraying the thread' - moving away from the loss. DISCUSSION: The provision of whole care to these parents requires midwifery and nursing training and continued education. Furthermore, the organisational culture should prioritise the health and well-being of midwives and nurses. CONCLUSION: Midwives and nurses encounter the parents' loss in care and personally in various ways and give meaning to the loss conditioned by personal and professional determinants. They unravel the grief of loss by looking for the meaning, expressing their grief, focusing and moving away from the loss.

"Navigation to prioritizing the patient" - first-line nurse managers' experiences of participating in a quality improvement collaborative.

BACKGROUND: First-line nurse managers are central to quality improvement work when changing work practices into better patient outcomes. Quality improvement collaboratives have been adopted widely to support quality management in healthcare services and shared learning. We have little knowledge of the first-line nurse managers' own perspectives concerning their need for support and knowledge in quality improvement work. Therefore, the aim of this study was to gain understanding of first line nurse managers' experiences in leading quality improvement work in their own organization when participating in a quality improvement collaborative. METHODS: An interpretive approach was chosen following Graneheim and Lundman's qualitative content analysis. Data was collected through three focus group interviews with first-line nurse managers representing different workplaces: the local hospital, a nursing home, and a homecare service in a rural area of Norway. RESULTS: "Navigation to prioritizing the patient" emerged as an overarching metaphor to describe the first-line nurse managers experiences of leading quality improvement work, based on three themes: 1) fellowship for critical thinking and prioritizing the patient; 2) mastering the processes in quality improvement work; and 3) the everyday reality of leadership as a complex context. CONCLUSIONS: A quality improvement collaborative encompassing knowledge transfer and reflection may create an important fellowship for health care leaders, encouraging and enabling quality improvement work in their own organization. It is crucial to invite all leaders from an organization to be able to share the experience and continue their collaboration with their staff in the organization. Continuity over time, following up elements of the quality improvement work at joint meetings, involvement by users, and self-development of and voluntary involvement in the quality improvement collaborative seem to be important for knowledge development in quality improvement. The supportive elements of the quality improvement collaborative fellowship were crucial to critical thinking and to the first-line nurse managers' own development and security in mastering the quality improvement work processes. They preferred prioritizing the patients in quality improvement work, despite haste and obstructive situations in an everyday context.

First-Line Nurse Managers' Challenges at the Crossroads of Norwegian Health Care Reforms.

Norwegian municipal health care has large public service offerings, funded by tax revenues; however, the current Norwegian welfare model is not perceived as sustainable and future-oriented. First-line nurse managers in Norwegian municipal health care are challenged by changes due to major political and government-initiated reforms requiring expanded utilization of home nursing. The aim of this theoretical study was to describe challenges the first-line nurse managers in a Nordic welfare country have encountered on the basis of government-initiated reforms and to describe strategies to maintain their responsibilities in nursing care. First-line nurse managers' competence, clinical presence, and support from superiors were identified as prerequisites to maintain sight of the patients in leadership when reforms are implemented. The strategies first-line nurse managers in Norwegian municipal health care use to implement multiple reforms, regulations, and new acts require solid competencies in nursing, leadership, and administration. Competence in nursing enables focus on the patient while leading the staff. Supports from superiors and formal leadership networks are described as prerequisites for managing the challenges posed by change and to persist in leadership positions.

Gaming the system to care for patients: a focused ethnography in Norwegian public home care.

BACKGROUND: With its emphasis on cost-reduction and external management, New Public Management emerged as the dominant healthcare policy in many Western countries. The ability to provide comprehensive and customized patient-care is challenged by the formalized, task-oriented organization of home-care services. The aim of this study is to gain deeper understanding of how nurses and the patients they care for, relate to and deal with the organizational systems they are subjected to in Norwegian home care. METHODS: The focused ethnographic design is based on Roper and Shapira's framework. Data collection consisted of participant observation with field notes and semi-structured interviews with ten nurses and eight patients from six home care areas located in two Norwegian municipalities. RESULTS: Findings indicate cultural patterns regarding nurses' somewhat disobedient behaviors and manipulations of the organizational systems that they perceive to be based on economic as opposed to caring values. Rigid organization makes it difficult to deviate from predefined tasks and adapt nursing to patients changing needs, and manipulating the system creates some ability to tailor nursing care. The nurses' actions are founded on assumptions regarding what aspects of nursing are most important and essential to enhance patients' health and ensure wellbeing - individualized care, nurse-patient relationships and caring - which they perceive to be devalued by New Public Management organization. Findings show that patients share nurses' perceptions of what constitute high quality nursing, and they adjust their behavior to ease nurses' work, and avoid placing demands on nurses. Findings were categorized into three main areas: "Rigid organizational systems complicating nursing care at the expense of caring for patients", "Having the patient's health and wellbeing at heart" and "Compensating for a flawed system". CONCLUSIONS: Our findings indicate that, in many ways, the organizational system hampers provision of high-quality nursing, and that comprehensive care is provided in spite of - not because of - the system. The observed practices of nurses and patients are interpreted as ways of "gaming the system" for caring purposes, in order to ensure the best possible care for patients.

The nurse-patient relationship in the New Public Management era, in public home care: A focused ethnography.

AIM: The aim of this study was to gain deeper understandings of nurse-patient relationships in the New Public Management era, by exploring beliefs and practices of nurses and patients in Norwegian public home care. BACKGROUND: Organization of Norwegian home care services is based on New Public Management-ideologies, which have led to a rigidly formalized and task-oriented nursing practice that may jeopardize individual nursing care. Nurse-patient relationships have several positive effects on patients' health and well-being, but organizational boundaries and time pressure affect the quality of relationships. DESIGN: Focused ethnography. METHODS: Data were collected between November 2015-July 2016 using participant observation and semi-structured interviews with 10 nurses and eight patients in six different home care areas, in two Norwegian municipalities. Data analysis was based on Roper and Shapiras framework. FINDINGS: Findings demonstrate the continued importance of nurse-patient relationships in contemporary home care, while identifying extensive variations in the degree of closeness and emotional involvement. Organizational boundaries, time constraints, high workload, and disharmony between nurses "competence and patients" complex illnesses, influence practice in ways that reduce the significance of nurse-patient relationships and affect conditions under which they develop and evolve. Facing a system nurses perceive to function suboptimal, they govern practices based on their own professional assessments, and findings indicate cultural patterns in the way both nurses and patients prioritize to safeguard nurse-patient relationships. CONCLUSION: Home care cultures based on traditional nursing values continue, despite New Public Management influences, but a transition into New Public Management culture may, over time, influence the quality of nurse-patient relationships and meanings attributed to them.

Safeguarding the patient in municipal healthcare-A hermeneutic focus group study of Nordic nursing leadership.

AIM: This study illuminates the meaning and purpose of clinical presence in nursing leadership in municipal home care from the first-line nurse manager's own perspective. BACKGROUND: Being a first-line nurse manager in the context of home care is demanding due to demographic changes and an ever-increasing number of elderly suffering from chronic diseases. Leading in this context entails leading from a distance because patients live and receive care in their homes. First-line nurse managers express the importance of clinical presence. However, there is a paucity of studies from home care of the meaning and purpose of presence. The theory of caritative leadership and the model of caring in nursing leadership served as the starting point for this study. METHODS: Hermeneutic abductive approach using a purposive sample of three semistructured focus group interviews with 11 first-line nurse managers in home care in three Nordic countries. RESULT: This study shows that first-line nurse managers described the meaning and purpose of their clinical presence in home care as safeguarding the patient by taking overall responsibility for care, securing the patients' voices, building and maintaining trustful relations, and securing a sensible economy. CONCLUSION: Our findings indicate that clinical presence serves the purpose of taking the overall responsibility for care and safeguarding the patient. Presence is perceived a necessity to verify staff providing the best possible care. First-line nurse managers acted metaphorically as a shield to protect patient care, which is the main concern in their leadership. The findings add new knowledge to the significance of caring in nursing leadership and the theory of caritative leadership. IMPLICATIONS FOR NURSING MANAGEMENT: First-line nurse managers need to be clinically present in order to safeguard the patient and to fulfil their threefold responsibilities for the patient, the staff and the economy. This study might also contribute to the political discussion concerning why nurses has to be first-line nurse managers and cannot be replaced by economists.

The nurse-patient relationship as a story of health enhancement in community care: A meta-ethnography.

AIM: To explore and improve our understanding of how nurse-patient relationships can enhance patients' health by synthesizing knowledge from published qualitative studies from both patients' and nurses' perspectives in community care. BACKGROUND: While primary research showing the health benefits of the nurse-patient relationship has been reported, this knowledge has not previously been synthesized. DESIGN: Meta-ethnography. DATA SOURCES: A comprehensive search of five relevant databases, without year limitation, was completed. Inclusion criteria were: peer-reviewed studies exploring patient and/or nurse perspectives in community care settings, using a qualitative approach and published in English in any country. REVIEW METHOD: Noblit and Hare's meta-ethnographic approach. RESULTS: Ten primary studies published between 1997 - 2014 met the research objective and inclusion criteria and were appraised as high quality using CASP. Included studies reported similar findings and reciprocal translational analysis was possible. Six core themes were identified: entering the patient's world; trusting and telling; identifying different needs and uncovering change; patients becoming masters of their own health; patients experiencing health in illness; and nurses going the distance. The core themes were synthesized into a metaphor of "the nurse-patient relationship as a story of health enhancement", which illustrates the meaning of the "common story" they create together. CONCLUSION: The findings help us better understand how the nurse-patient relationship may enhance the patient's health, not only with regard to illness, physical condition and treatment but also physical, emotional, mental and social well-being. The nurse-patient relationship also has the potential to strengthen the patient's own resources towards maintaining health.

Caregivers' perceptions of aggressive behaviour in nursing home residents living with dementia: A meta-ethnography.

AIM: To explore how formal caregivers perceive and interpret aggressive behaviour in nursing home residents living with dementia, by synthesizing knowledge from published qualitative studies. BACKGROUND: Nursing home caregivers are exposed to aggressive behaviour from residents living with dementia. The way caregivers perceive aggressive behaviour may affect their feelings and actions related to situations and thus nursing care. Knowledge about caregivers' perceptions of aggressive behaviour has previously not been synthesized. DESIGN: Noblit and Hare's interpretative meta-ethnography. DATA SOURCES: A systematic literature search in CINAHL, PubMed and Scopus supplemented by manual search strategies, were completed. Nine studies from five countries, published between 2001 - 2015, met the research objective and inclusion criteria and were included. FINDING: Five themes describing formal caregivers' perceptions and interpretation of residents' aggressive behaviour emerged: "A manifestation of the disease"; "a way to express themselves and their needs"; "a reaction to caregivers" attitude and approach"; "a reaction to a stressful and demanding environment"; and "an unavoidable situation that seems impossible to solve". Themes were synthesized into the metaphor: 'tailoring using unpredictable patterns' and visualized in a model. CONCLUSION: Caregivers perceive and interpret aggressive behaviour related to the resident's illness and person, the caregiver's attitude and approach, or a demanding environment. Further research and theoretical development is important, as shown by different perceptions and interpretations, as well as central definitions in research publications. The study informs evidence-based practice and health-policy by showing the importance of developing reflective relational nursing care, knowledge, and competence in nursing homes.

"Trapped in an Empty Waiting Room"-The Existential Human Core of Loneliness in Old Age: A Meta-Synthesis.

Loneliness in old age has a negative influence on quality of life, health, and survival. To understand the phenomenon of loneliness in old age, the voices of lonely older adults should be heard. Therefore, the purpose of this meta-synthesis was to synthesize scientific studies of older adults' experiences of loneliness. Eleven qualitative articles that met the inclusion criteria were analyzed and synthesized according to Noblit and Hare's meta-ethnographic approach. The analysis revealed the overriding meaning of the existential human core of loneliness in old age expressed through the metaphor "trapped in an empty waiting room." Four interwoven themes were found: (a) the negative emotions of loneliness, (b) the loss of meaningful interpersonal relationships, (c) the influence of loneliness on self-perception, and (d) the older adults' endeavors to deal with loneliness. The joint contribution of family members, health care providers, and volunteers is necessary to break the vicious circle of loneliness.

Self-organizing Development Teams for Innovative Nursing Care.

The purpose of this study was to describe the participation of nurses and nurse leaders in self-organizing teams formed to develop innovative nursing care. The theoretical perspective combines Bondas' caritative theory on nursing leadership with Waterman's and Dolan's work on ad hoc organizations. Seven self-organizing teams participated in a 2-year action research project. Data were collected through fieldwork, formal and informal individual and group interviews, and diaries. Analytical abstraction methodology described by Miles et al was used. The metaphor "overcoming the jet lag of bureaucracy" is based on 5 themes: struggling to design the new team; investing time and self; needing research and leadership support; evolving collegial collaboration, professional growth, and pride; and growing professional security and the will to continue education as a result of learning.

International Nursing: Caring in Nursing Leadership-A Meta-ethnography From the Nurse Leader's Perspective.

To explore and derive new conceptual understanding of nurse leaders' experiences and perceptions of caring in nursing. RESEARCH QUESTION: What is caring in nursing leadership from the nurse leaders' perspectives? There is a paucity of theoretical studies of caring in nursing leadership. Noblit and Hares interpretative meta-ethnography was chosen because of its interpretative potential for theory development. Caring in nursing leadership is a conscious movement between different "rooms" in the leader's "house" of leadership. This emerged as the metaphor that illustrates the core of caring in nursing leadership, presented in a tentative model. There are 5 relation-based rooms: The "patient room," where nurse leaders try to avoid patient suffering through their clinical presence; the "staff room," where nurse leaders trust and respect each other and facilitate dialogue; the "superior's room," where nurse leaders confirm peer relationships; the "secret room," where the leaders' strength to hang on and persist is nurtured; and the "organizational room," where limited resources are continuously being balanced. Caring in nursing leadership means nurturing and growing relationships to safeguard the best nursing care. This presupposes that leaders possess a consciousness of the different "rooms." If rooms are not given equal attention, movement stops, symbolizing that caring in leadership stops as well. One room cannot be given so much attention that others are neglected. Leaders need solid competence in nursing leadership to balance multiple demands in organizations; otherwise, their perceptiveness and the priority of "ministering to the patients" can be blurred.

Proud to be a nurse? Recently graduated nurses' experiences in municipal health care settings.

BACKGROUND: Recently graduated nurses are the future of the nursing profession and the municipal health care that will need nursing competency for an increasing number of frail elderly persons. This study is part of a larger project on newly graduated nurses where previous research indicated that building professional pride at their workplace could be important for remaining in the profession and in municipal health care. However, the recently graduated nurse's first job assignment in municipal health care can also be a critical period with cuts in their pride as nurses who may have an impact on nursing care for their patients. AIM: The aim of this study is to illuminate recently graduated nurses' experiences with professional pride in municipal health and care services. METHODS: A phenomenological hermeneutic approach was chosen to illuminate meaning. A purposive sample of eight recently graduated nurses working in nursing homes or home health care was chosen for this study with narrative interviews and diaries. FINDINGS: Three themes were identified: doing the good thing and doing what is right; being recognized and confirmed; and finally thriving in a community of practice. An important source of pride is the relation to patients. Recently graduated nurses build their professional pride in an active and social process in a community of practice. The first cut in their professional pride seems to take place when they were not recognized and confirmed as professional persons. CONCLUSION: Recently graduated nurses in municipal health care describe their professional pride as a complex phenomenon with relational, dynamic and collective dimensions. The cuts in their pride may hurt their identity and nursing care.

Older people's experiences of care in nursing homes: a meta-synthesis.

AIM: To integrate the current international knowledge and enhance our understanding of the experiences of older people of being cared for in nursing homes. BACKGROUND: There is a lack of integrated knowledge to help face the challenge of providing care to older people in nursing homes. Understanding the experiences of older people regarding their own care leads to interventions for reducing older people's suffering, while living in nursing homes. METHODS: Keywords describing the experiences of being cared for in nursing homes were used to systematically search electronic databases for qualitative research articles. A meta-synthesis study employing the interpretative meta-ethnography approach devised by Noblit and Hare was carried out to analyse seven qualitative articles identified during the search process. FINDINGS: Seven studies included in this meta-synthesis were published between 2007 and 2015. The experiences of older people of being cared for in nursing homes were expressed by the metaphor 'retaining the meaning of being alive'. Older people wished for a homelike place where they would be delivered care with the consideration of all its humanistic aspects. While conflict between their expectations and organizational demands damaged this sought ideal, adjustment to life conditions and taking an active role led to a feeling of being alive. DISCUSSION: This meta-synthesis integrates our knowledge on organizational and administrative demands, and personal factors influencing the provision of individualized care in nursing homes. LIMITATIONS: The mental functionality of older people that suffer from dementia might impact on their ability to be involved in research and have a 'voice' in terms of their experience of being cared for in nursing homes. CONCLUSION AND IMPLICATIONS FOR NURSING: The institutional character of the nursing home restricts older people's decision-making. The challenge in nursing home care is to balance the tensions between the individual needs and the collective dimensions of care. IMPLICATIONS FOR NURSING POLICY: Nurse policymakers need to consider the ambience in nursing homes, develop a caring culture for the provision of a holistic care to older people and make the nursing home as close to a home as possible.

Through the depths and heights of darkness; mothers as patients in psychiatric care.

INTRODUCTION: This study attempts to contribute to the knowledge of caring science and mental health care by means of a profound understanding of the patients' existential world when being a mother in receipt of psychiatric care, with focus on inner processes such as health and suffering. Mothers struggle to cope with the demands of the illness and the responsibility for their children. They see themselves through their children and regard the child as an important part of themselves. Mothers experience guilt and shame related to motherhood, and when they have to relinquish their responsibility as a mother, they consider themselves a failure. Despite a range of practical and emotional difficulties, motherhood involved extremely positive experiences, which provide a purpose as well as fulfilment and meaning in life. METHODOLOGY: This study is rooted in philosophical hermeneutics inspired by Gadamer with an inductive-deductive-abductive approach. Interpretation of the data was made on different levels of abstraction described as rational, contextual, existential and ontological. The point of departure was the caring science theory about health and suffering and the hermeneutic philosophy of understanding. RESULT OF THE INTERPRETATION: The interpretation revealed the mothers' experiences of health and suffering as a struggle between the darkness of suffering and their inner source of strength. In the light of the theory of caring, the conscience became visible as the bearer of the human being's inner ethos of love and compassion. Experiences of health and suffering were interpreted as a struggle between guilt and responsibility, where conscience emerged as the road from ontological guilt to responsibility that leads the human being to what is true, beautiful and good in life.

Validity and reliability of the scientific review process in nursing journals - time for a rethink?

As pressure to publish increases in the academic nursing world, journal submission numbers and rejection rates are soaring. The review process is crucial to journals in publishing high quality, cutting-edge knowledge development, and to authors in preparing their papers to a high quality to enable the nursing world to benefit from developments in knowledge that affect nursing practice and patient outcomes and the development of the discipline. This paper does not intend to contribute to the debate regarding the ethics of reviewing, but rather seeks to explore notions of how the quality of the reviewing process can be enhanced to benefit authors, the reviewers, and the state of nursing knowledge. Furthermore, a call is made to editors to devise strategies for aiding reviewers to attain higher validity and reliability within the reviewing process by establishing clear standards and expectations and to ensure published work is judged against industry norms for quality.

Trapped in a maze: A meta-ethnography of women's experiences of alcohol use in pregnancy.

INTRODUCTION: Despite the recognized link between prenatal alcohol consumption and various congenital anomalies, the negative consequences for women's own health and family health, as well as the work done in healthcare to prevent alcohol in pregnancy, the acceptance of alcohol use during pregnancy persists in numerous communities around the world. Knowledge about women's alcohol use in pregnancy and how it relates to the social and cultural context they are part of is important to help and support women in abstaining during pregnancy. This meta-ethnography aims to offer a novel interpretation and conceptual understanding of the experiences of women who consume alcohol during pregnancy by synthesizing insights from existing qualitative studies. METHODS: An interpretative meta-ethnographic design was chosen based on a systematic literature search in seven electronic databases, and manual searches were conducted in 2023. The CASP checklist was used to assess the 18 included articles. RESULTS: In the synthesis, we use the metaphor of being trapped in a maze to illustrate the complexity of pregnant women's experiences of drinking during pregnancy. Women who drink alcohol during pregnancy are navigating the maze in a whirlwind of conflicting information and knowledge. The findings show how sociocultural norms form rigid pathways within the maze. In relation to their sociocultural context, women use several motives to justify the routes chosen within the maze. The competing information, knowledge and clashing norms within women's sociocultural contexts leave women to navigate alone in the maze. CONCLUSIONS: Alcohol in pregnancy needs to be conceptualized as an issue positioned at the intersection of social sciences and healthcare and needs to be handled accordingly, both through transdisciplinary research, by early prevention and multimodal interventions in healthcare and the broader society. Such interventions would benefit from drawing on knowledge about women's experiences with alcohol in pregnancy.

Public Health Nurses in an Internal Negotiation Process When There Is Concern About the Child's Care.

The aim of the study was to explore and describe how public health nurses at child health clinics experience and perceive the follow-up of children and families when there is concern about the child's care. The goal was to contribute to knowledge development to guide health-promoting nursing care for children and their families. Theoretical perspectives included health promotion, child-centered and family-centered care, in addition to nursing care. An exploratory qualitative design informed by a hermeneutic approach was used. Data were collected in 3 focus groups with 16 public health nurses and analyzed using latent content analysis. The findings detail public health nurses' internal negotiation processes in the follow-up of children and the family, and the ways these negotiation processes were influenced by various prerequisites, the approaches for follow-up, dilemmas that affected public health nurses' approaches, and prolonged dwellings on past responses to children and families of concern. The lack of routines and goals for follow-up, a dominant parental perspective, and ambiguity related to health promotion and disease prevention, all created challenges for the public health nurses. Based on these findings, a model of public health nurse's follow-up when there is concern about the child's care was developed for future research.

Skin-to-skin care for dying preterm newborns and their parents--a phenomenological study from the perspective of NICU nurses.

BACKGROUND: Consequences of separation between preterm newborns and their parents have been discussed in many aspects, thus skin-to-skin care (SSC) has become common practice in Scandinavian Neonatal Intensive Care Units (NICUs) since the 1980s. The International workshop on Kangaroo Mother Care (KMC), 2009, recommends implementation of continuous KMC as the gold standard pervading all medical and nursing care, based on empirical studies and clinical guidelines and they suggest that KMC may be used during terminal care in agreement with parents. Parents have a strong desire to be near their child and give support and emotional comfort when the condition of the child requires it, and it has been suggested that medical staff expect parents to be with the neonates, and therefore, encourages them to hold the neonate while it is dying. The practice of SSC at the end of life has been under-researched, however. AIM: The aim of this study, which is part of a larger study on neonatal nursing care, was to describe the phenomenon of how nurses enact SSC for dying preterm newborns and their parents. DESIGN: A phenomenological reflective life world design. SETTING AND PARTICIPANTS: A purposive sample of 18 nurses from three Scandinavian NICUs. FINDINGS: The essential meaning of the phenomenon was expressed as strong belief in the urgency of SSC in providing mutual proximity and comfort for dying preterm newborns and their parents. The nurses act upon this belief and upon an engagement in securing the best possible present and future experiences of being close, in which the SSC is understood as a necessary premise in achieving the intended optimal conditions. The findings are elaborated in relation to previous caring and nursing research and phenomenology. CONCLUSIONS: Skin-to-skin care for dying preterm newborns and their parents is the preferred caring practice among Scandinavian NICU nurses who consider it of major importance to facilitate proximity and comfort through SSC when the newborn is still alive. The authors suggest this practical knowledge from NICU nurses perspective to be acknowledged in discussions concerning end-of-life care for preterm newborns and their parents and we recommend more formal establishment of this practice. Further research is needed on parents' experiences of skin-to skin caring in this vulnerable end of life situation of 'being with' their dying newborn.