Nurse leaders' perceptions of workload and task distribution in public healthcare: A qualitative explorative study.

BACKGROUND: Unreasonable workload and work-related stress can reduce nurse leaders' job satisfaction and productivity and can increase absence and burnout. Nurse leaders' workload in public healthcare settings is relatively unresearched. THE AIM: The aim of this study was to investigate nurse leaders' perceptions of workload and task distribution with relation to leading work tasks in public healthcare. RESEARCH DESIGN, PARTICIPANTS AND RESEARCH CONTEXT: A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N = 8). The method was inspired by content analysis. The COREQ checklist was used. ETHICAL CONSIDERATIONS: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. FINDINGS: Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload and Insufficient time for leadership mission. CONCLUSION: The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organising more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders' workload. Future research should focus on investigating workload and task distribution from nurses' perspectives. RELEVANCE TO CLINICAL PRACTICE: Through this study, greater understanding of workload and the diverse work of nurse leaders in a public healthcare setting has been revealed, which can be used to further develop the framework for nurse leaders' work.

Ethical sensitivity and compassion in home care: Leaders' views.

BACKGROUND: With an increasing older population, the pressure on home care resources is growing, which makes it important to ensure the maintenance of quality care. It is known that compassion and ethical sensitivity can improve the quality of care, but little is known about care leaders' perceptions on ethical sensitivity and compassion in home care and how it is associated with staff competence and thus quality of care. AIM: The aim of the study was to explore home care leaders' perceptions of ethical sensitivity and compassion associated with care quality in home care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT: A hermeneutical approach with a qualitative explorative design was used. The data consists of texts from 10 in-depth interviews with home care leaders. Content analysis was used as a method. ETHICAL CONSIDERATIONS: The study was conducted following the ethical guidelines of the Declaration of Helsinki and the Finnish Advisory Board of Research Ethics. Research ethics permission was applied for from a Research Ethics Board. FINDINGS: One overall theme and four subthemes were found. The overall theme was: "Compassion provides deeper meaning and ethical sensitivity provides means for knowing how to act". DISCUSSION: If nurses fail to be sensitive and compassionate with patients, good and high qualitative home care cannot be achieved. Ethical sensitivity and compassion can be seen as resources in home care but the organization and the care leaders need to provide the support for these to develop. CONCLUSION: This study provides an understanding of the meaning of ethical sensitivity and compassion as sources of strength and their link to quality of care in a home care context. Further studies could focus on how to build compassion and ethical sensitivity into home-based care and how to ensure adequate support for healthcare professionals' compassion and ethical sensitivity.

Moral distress experienced by care leaders' in older adult care: A qualitative study.

BACKGROUND: Many healthcare professionals have left their professions recently because of increased moral distress, and the COVID-19 pandemic has had a further major impact on the ever-changing healthcare environment. AIM: The purpose of the study was to examine care leaders' experiences of moral distress in their daily work in older adult care. METHODOLOGY: A qualitative design was used. The data consisted of texts from interviews with care leaders (N = 8) in an older adult care context. Content analysis was used to analyse the data. FINDINGS: Five themes emerged: (1) moral distress arises from a lack of time, (2) moral distress contributes to a sense of inadequacy but also a sense of responsibility, (3) moral distress arises from an imbalance in values, (4) increased knowledge and open discussion help reduce moral distress and (5) reflection, increased support and increased resources can reduce moral distress. CONCLUSION: Moral distress is something that care leaders, according to this study, experience daily in an older adult care context and it is considered to have increased. Care leaders can experience moral distress from a lack of time; patient-related, relative-related or other ethically difficult situations or an imbalance between own values and an organisation's, other caregivers', patients' and/or patients' relatives values. Increased staffing resources, more knowledge (training and lectures) and time for reflection individually, in groups or with an outside expert could increase care leaders' insights into and ability to reduce moral distress. Although situations that are characterised by moral distress are burdensome, care leaders have the opportunity to learn from such situations through reflection and discussion and can develop strategies for future ethical challenges. Future research could focus on exploring caregivers' experiences of moral distress.

Patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting in Norway.

PATIENT OR PUBLIC CONTRIBUTION: Patients, relatives and nurses were involved in this study. AIM: The aim was to explore patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting after implementation of the Coordination Reform in Norway. DESIGN: Secondary analysis of qualitative interviews. METHODS: Data from interviews with 19 participants in a nursing home setting: severely ill older patients in palliative care, relatives and nurses. Data triangulation influenced by Miles and Huberman was used. RESULTS: The overall theme was "Being in an unfamiliar and uncaring culture leaves end-of-life patients in desperate need of holistic, person-centred and co-creative care". The main themes were: "Desire for engaging palliative care in a hopeless and lonely situation", "Patients seeking understanding of end-of-life care in an unfamiliar setting" and "Absence of sufficient palliative care and competence creates insecurity". The patients and relatives included in this study experienced an uncaring culture, limited resources and a lack of palliative care competence, which is in direct contrast to that which is delineated in directives, guidelines and recommendations. Our findings reveal the need for policymakers to be more aware of the challenges that may arise when healthcare reforms are implemented. Future research on palliative care should include patients', relatives' and nurses' perspectives.

Ethos in Time: Nurse Theorist Katie Eriksson as Remembered by Dr. Jessica Hemberg.

The year 2022 is Nursing Science Quarterly's 35th year in publication, and we are dialoging with nurse theorists. We hope to uncover influences and origins of their theoretical thinking and hear about their current projects related to nursing science. In this scholarly dialogue column, we dialogue with Dr. Jessica Hemberg, a former nursing student of nurse theorist Dr. Katie Eriksson who was internationally known for her theory of caritative caring. In 1986, Professor Eriksson was invited to create a caring science academic program at Åbo Akademi University in Vaasa, Finland, which drew graduate students from all Nordic countries.Eriksson's work highlighted the uniqueness and dignity of the human being and the importance of protecting the vulnerable suffering human being. Dr. Eriksson passed away in 2019, and we are grateful to spend some time with one of her PhD students.

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.

Meaningfulness among frail older adults receiving home-based care in Finland.

Meaningfulness is a fundamental aspect in the promotion of frail older adults' health and well-being. From a salutogenic point of view, meaningfulness is a vital component of a sense of coherence (SOC), since having a strong SOC aids toward assembling the resources needed to cope with stressors and manage tensions with success. In order to respond to the challenges of population aging and the need to enable frail older adults to live at home for as long as possible, it is important to explore their meaningfulness in the context of home-based care. A salutogenic framework was used to study meaningfulness. The aim was to explore what promotes meaningfulness among frail older adults. The study uses a hermeneutical approach and has a qualitative design. In total, 17 frail older adults were interviewed. The data were analyzed by content analysis. The results uncovered four themes that the respondents considered important in enhancing meaningfulness in daily life: home care personnel, outdoor activities and green spaces, cultural activities and spirituality. Our study revealed the important role of home care personnel as a resource in promoting meaningfulness in the context of home-based care. Hence, this group should be given sufficient resources, knowledge and competence for enabling meaningfulness and thus a SOC amongst frail older adults.

Compassion fatigue as bruises in the soul: A qualitative study on nurses.

BACKGROUND: Nurses who are constantly being exposed to patients' suffering can lead to compassion fatigue. There is a gap in the latest research regarding nurses' experiences of compassion fatigue. Little is known about how compassion fatigue affects the nurse as a person, and indications of how it affects the profession are scarce. AIM: The aim of this study was to explore compassion fatigue experienced by nurses and how it affects them as persons and professionals. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT: A qualitative explorative approach was used. The data consisted of texts from interviews with seven nurses in various nursing contexts. Content analysis was used. ETHICAL CONSIDERATION: Ethical approval was sought and granted from an ethics committee at the university where the researchers were based, and written, informed consent was obtained from all the participants. FINDINGS: Five themes were discovered: Compassion as an empathic gift and compassion fatigue as a result of compassion overload, Compassion fatigue as exhausting the nurse as a professional and private person, Compassion fatigue as a crisis with potentially valuable insights, Compassion fatigue can be handled by self-care and focus on self, and Compassion fatigue is affected by life itself and multifaceted factors. DISCUSSION: Compassion stress and overload can lead to compassion fatigue. Compassion fatigue affects the nurse's ability to compassion, and the caring is no longer experienced in the same way; the nurses experienced it as being deprived of the gift of compassion. Compassion fatigue implicates a crisis with potentially valuable insights. CONCLUSION: Compassion fatigue can be symbolized as bruises in the soul, hurtful, but with time it can fade away, although it leaves a sense of caution within the nurse, which can affect the suffering patient.

Cancer survivorship: existential suffering.

PURPOSE: This study aimed to explore and describe existential experiences after cancer treatment. METHOD: An exploratory phenomenological hermeneutical design was used following in-depth interviews with 21 people. RESULTS: The study revealed experiences of multifaceted suffering in the form of limitations in everyday life, inner struggles, and bearing the burden alone. CONCLUSIONS: Existential suffering after cancer treatment was revealed as like being in a process of transition, in an intermediate state, as moving between suffering and enduring, and alternating between alienworld and homeworld. A new and broader professional perspective is needed to establish rehabilitation services based on multifaceted experiences of suffering. This means a shift in focus from biomedical symptoms towards understanding of existential meaning for the person.

The core of Katie Eriksson's caritative caring theory - a qualitative study from a postdoctoral perspective.

BACKGROUND: For about 40 years, Katie Eriksson developed the caritative caring theory at Åbo Akademi University in Finland. However, a description regarding the most substantial concepts and the relationships between these is lacking and thus needs to be explored. AIMS: The aim of the study was twofold: to explore and describe central concepts in the development of caritative caring theory from a postdoctoral perspective and to uncover and explore the relationships between the concepts. METHODOLOGY: The design of the study was qualitative with a mixed method approach. The material was collected from a postdoctoral group (n = 38) mainly through electronic questionnaires. The texts were interpreted through manifest and latent content analysis. FINDINGS: The analyses generated five main categories including subcategories. The main categories were 'Caring' 'Ethos', 'Suffering' 'Health' and 'The human being'. The relation between the main concepts compiled as 'A tentative synthesis of the main concepts and the relationships between them'. CONCLUSION: This study contributes to an understanding of the most fundamental and valuable concepts in the development of caritative theory during its first 40 years according to postdoctoral researchers' perspectives. This study also displays that the concepts ethos and caring have the strongest relationship followed by that between caring and health, indicating the inner core of ethos and love within caring which bears the potential of enhancing the patient's well-being and health.

Experiences of longing in daily life and associations to well-being among frail older adults receiving home care: a qualitative study.

Purpose: All over the world, communities face the challenge of maintaining well-being among older adults. More specifically, understanding the resources required to establish and maintain well-being among community-dwelling older adults is an essential issue. Although longing from a caring science perspective is considered a driver for well-being, it has not yet been investigated among frail older adults. The aim of this study was to explore frail older adults' experiences of longing in daily life and the relation between longing and well-being from a caring science perspective. Method: The study uses a hermeneutical approach and follows a qualitative explorative design. The data comprises texts from 17 interviews with frail older adults and was analysed by content analysis. Results: The results uncovered three themes: Longing for social contacts; Longing for nature and Longing creativity, aesthetics, and music. Longing was positively related to well-being when the older adults were able to fulfil their longings. Conclusion: This study provides an understanding of the mechanisms of longing among frail older adults. Longing, here, is an inner resource for setting into motion the transition towards well-being. Further studies could focus on how frail older adults can be supported to combat the negative forms of longing in daily life.

Ethical competence in a profession: Healthcare professionals' views.

Aim: Ethical competence is a crucial component for enabling good quality care but there is insufficient qualitative research on healthcare professionals' views on ethical competence. The aim of this study was to investigate healthcare professionals' views on ethical competence in a student healthcare context. Design: A qualitative design and a hermeneutical approach were used. Methods: The material consists of texts from interviews with healthcare professionals (N = 10) in a student healthcare context. The method was inspired by content analysis. Results: One main theme and four subthemes emerged. The main theme was as follows: safeguarding the vulnerability of the other. The subthemes were as follows: using sensitivity to establish a trustful relationship, acting in an objective and flexible manner, using a reflective process in decision-making, and maintaining confidentiality and honesty. Future research should focus on investigating ethical competence from various perspectives in student health care, for example the student perspective or observational studies.

Caring from the heart as belonging-The basis for mediating compassion.

Aim: The aim of this study was to illuminate nurses' experiences of mediating compassion to patients in the home care context. Design: A phenomenological-hermeneutical approach was used. Methods: The data comprised of texts from interviews with 12 nurses in a home care context. Informed consent was sought from participants regarding participation in the study and the storage and handling of data for research purposes. Results: Four themes were seen: Encountering one another as human beings, Being in the moment, Bearing responsibility for the other and Being in a loving communion. The overall theme was Acting from one's inner ethos, heart of goodness and love. Mediating compassion as belonging can be interpreted as the "component" that holds the caring relationship together and unites the different levels of health as doing, being and becoming in the ontological health model. Further research should focus on revealing compassion from the perspective of patients.

Dealing with ethical and existential issues at end of life through co-creation.

BACKGROUND: In research on co-creation in nursing, a caring manner can be used to create opportunities for the patient to reach vital goals and thereby increase the patient's quality of life in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. Nurses must be extra sensitive to patients' and their relatives' needs with regard to ethical and existential issues and situations in home care encounters, especially at the end of life. AIM: The aim of this study was to explore nurses' experiences of dealing with ethical and existential issues through co-creation at the end of life in palliative home care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT: The material consisted of texts from interviews with 12 nurses in a home care context. A hermeneutical approach was used, and the method was inspired by a thematic analysis. ETHICAL CONSIDERATIONS: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Ethical permission to conduct the study was given from organizations that participated in this study. FINDINGS: A main theme and four subthemes emerged. The main theme was "Deep co-creative relationships are needed to manage ethical and existential issues at the end of life." A model was created to display the findings and relations between ethical issues and situations and the need for a deep trustful caring relationship to solve problems in palliative home care. DISCUSSION: Together, the themes can be considered as a tool for learning and dealing with ethical and existential issues at the end of life in home care. The themes can also be seen as a part of nurses' ethical competence within this context. CONCLUSION: The quality of life at the end of life can be improved through co-creation, despite difficult ethical and existential issues. Future research should focus on co-creation from the patients' perspective.

Ethical sensitivity and perceptiveness in palliative home care through co-creation.

BACKGROUND: In research on co-creation in nursing, a caring manner can be used to create opportunities whereby the patient's quality of life can be increased in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. To promote quality of life, nurses must be sensitive to patients' and their relatives' needs in care encounters. Co-creation can be defined as the joint creation of vital goals for patients through the process of shared knowledge between nurses, patients and their relatives. AIM: The aim of this study was to explore nurses' experiences of caring encounters and co-creation in palliative home care from an ethical perspective. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT: A hermeneutical approach was used. The material consisted of texts from interviews with 12 nurses in a home care context. The method was inspired by thematic analysis. ETHICAL CONSIDERATIONS: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. FINDINGS: An overall theme, a main theme and four sub-themes emerged. Through ethical sensitivity and perceptivity, nurses can balance their actions in the moment and change their nursing care actions according to the patient's wishes through co-creation in encounters. Here the time is crucial, as the time needed is unique to each patient. DISCUSSION: The themes together can be considered prerequisites for good palliative home care. If nurses fail to be sensitive and perceptive in encounters with dying patients, good palliative home care cannot be achieved. Ethical sensitivity and perceptiveness can also be considered a part of nurses' ethical competence. CONCLUSION: Patients' dignity can be preserved through ethical sensitivity and perceptiveness, which is fundamental for good palliative care. Co-creation from patients' perspectives should be the focus of future research.

Caring ethics as the foundation for cultural competence: views of health professionals working in student healthcare context.

BACKGROUND: Cultural competence is recognised as a leading component in the delivery of high-quality health care. However, a lack of concept clarity has led to lower quality and less effective healthcare provision for culturally diverse groups. Understanding of cultural competence in a healthcare context will be improved through the exploration of health professionals' perceptions of the matter. AIM: The aim of this study was to explore health professionals' perceptions of cultural competence in a student healthcare context. METHODOLOGY: The material consists of texts from interviews with ten health professionals in a student healthcare context. A hermeneutical approach was used, and the method was inspired by content analysis. FINDINGS: One main theme and four subthemes were seen. The main theme was 'Caring ethics as the foundation for enabling cultural competence', and the subthemes were 'Cultural competence as knowledge and acting accordingly with open-mindedness and respect', 'Cultural competence as being willing to understand and learn through a process', 'cultural competence as responsiveness and adaptability' and 'Cultural competence as humility and discretion'. CONCLUSION: Ethics can be considered a core component of cultural competence in student healthcare. In further research, a focus should be placed on cultural competence as perceived from other (e.g. students') perspectives.

Cocreation as a Caring Phenomenon: Nurses' Experiences in Palliative Home Care.

A new concept in palliative care, cocreation, appears to be a part of caring in nursing but has not yet been explored as a caring phenomenon. The aim was to, from a caring science perspective, explore how cocreation can be experienced as a phenomenon by nurses working in palliative home care. A hermeneutical approach and thematic analysis were used. The material consisted of texts from in-depth interviews with 12 nurses in a home care context. Informed consent regarding study participation and the storage and handling of data for research purposes were sought from participants. One main theme and 4 subthemes emerged. Cocreation can be viewed as an essential part of caring and being involved in patients' health and holistic care is a profound endeavor. Further research should focus on illuminating cocreation from patients' perspectives.

Working in home healthcare and suggestions for development.

In order to describe nurses' experiences of working in home health care and their suggestions for the development of this public health-care sector, interviews with 18 home health-care nurses were analyzed with qualitative thematic content analysis. The nurses perceived the working shifts either affirmative or non-affirmative, depending on the contextual and organizational factors affecting nurses' workload. The more the nurses perceived they could influence their work, the more engaged they were in patient-related nursing activities, patient-centeredness, collaboration, and forward planning. Several concrete suggestions for the development of home healthcare on the organizational, interprofessional, team and individual levels were given.

A vision of ethics in efficient occupational healthcare.

BACKGROUND:: Occupational healthcare is nowadays more and more regulated by economic demands of gain and efficiency. AIM AND RESEARCH QUESTIONS:: The aim of this study is to reach a new understanding of ethics in occupational healthcare by uncovering this from occupational healthcare nurses' own views. The research questions are as follows: (1) What is the core of an ethical value base in occupational healthcare? (2) What does it mean for occupational healthcare nurses to fulfill their ethical value base in occupational healthcare? RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT:: The study uses a hermeneutical approach. The context of the study is occupational healthcare. The material was collected through interviews with four occupational healthcare nurses in Finland. The texts were interpreted through hermeneutical reading. ETHICAL CONSIDERATIONS:: The data storage, study participation, and data handling for research purposes were approved by the participants when they provided their informed consent. FINDINGS:: The study revealed that the core of ethical values in occupational healthcare is something universal that concerns justice, honesty, and faithfulness. To fulfill the ethical value base means to continuously strive toward the inner core of love and bravely choose to listen to the this core in the name of the client and the universal good even if it involves a struggle or a sacrifice. DISCUSSION:: The ethical value base is not primarily tied to profession but is something that is general and universal. Nor do ethics and the implementation of ethical values stand in opposition to, for example, external values such as demands for efficiency and economic gain. However, ethics may promote efficiency. CONCLUSION:: The fulfillment of nurses' ethical value base in occupational healthcare requires that ethics first and foremost is allowed to enter the leadership and is prioritized on a leadership level. Creating caring cultures that encourage openness and support ethical discussions is fundamental.

"Homeless in life" - loneliness experienced as existential suffering by older adults living at home: a caring science perspective.

BACKGROUND: Due to physical impairments and functional limitations, older adults receiving home care can be considered especially vulnerable to loneliness. To understand how society can provide support that enhances vulnerable individuals' quality of life, it is important to explore loneliness and its underlying causes in older adults. AIMS: To contribute to a deeper understanding of caring science theory, the aim of this study was to use a caring science perspective to explore and understand experiences of suffering from loneliness in older adults receiving home care. The research questions are as follows: What phenomena are associated with the experience of suffering from loneliness in older adults receiving home care? How can this experience be understood? METHODOLOGY: A hermeneutical approach was used. The material was collected through interviews with 17 older adults about their quality of life, including their experiences of loneliness. The texts were interpreted through latent content analysis. FINDINGS: The findings resulted in one main category and three subcategories. The main category was as follows: Being homeless in life-loneliness expressed and primarily stemming from existential suffering. The subcategories were as follows: Loss of communion with one's partner or other loved ones, Loss of meaningful social activities due to isolation and Loss of health due to frailty and vulnerability. All categories were described and implications for practice discussed. CONCLUSION: This study contributes to an understanding of experiences of suffering from loneliness in older adults receiving home care, with relevance for the healthcare context as well as for what a community or society should focus on when addressing these important issues.