Stakeholders' perceptions of value of nature-based interventions in promoting health in people with stress-related illness: a qualitative study.

Stress-related illness is a common and increasing cause for sick leave in Sweden. Spending time in nature reduces stress and promotes health and well-being. Accordingly, nature-based interventions (NBI) for people with stress-related illness have been developed and implemented in southern Scandinavia; however, such interventions are uncommon in the Circumpolar North. Previous studies have examined the effects and experiences of participating in NBI, but research about different stakeholders' perspectives on NBI is lacking. The aim of this study was to explore different key stakeholders' perceptions of the value of NBI in promoting health in people with stress-related illness. Data were collected through semi-structured interviews with 11 persons with stress-related illness experience, 14 healthcare professionals, and 11 entrepreneurs offering NBI. Qualitative content analysis resulted in four categories: Providing opportunity for recovery, Offering new perspectives and opportunity for reflection, Empowering balance and control in life, and Enabling one to overcome barriers. Although the study was conducted in a region where NBI is not widely implemented, the different stakeholders expressed similar perceptions of the value of NBI, indicating that NBI may be a valuable complement to health care which reaches people with stress-related illness needs and promotes their health.

Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study.

INTRODUCTION: Studies of older women's life transitions is rare but gains relevance as the aging population, with older women as the majority, expands. PURPOSE: To explore the meaning of a good life for older widows with extensive home care needs. MATERIALS AND METHODS: Semi-structured interviews were carried out with eleven women, aged 80 and over (82-95 years, mean 90) residing at home with extensive care needs (≥4 daily sessions, averaging 2.5-6 hours, mean 3). Data were analysed by reflexive thematic analysis. RESULTS: The theme "This Day in My Home, the frame of my life" reflects the women's experience of a good life. A good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. However, there were moments when life was merely about navigating daily challenges. During such days, the women felt trapped in time, unsafe and lonely. CONCLUSION: A day at home may seem static, yet it mirrors life's dynamism, evolving with shifting circumstances. Older widows navigate challenges while maintaining their sense of self, independence, and connection to home. These findings have implications for aged care, recognizing the multifaceted aspects of life and the centrality of home.

Close relatives' perspective of critical illness due to COVID-19: Keeping in touch at a distance.

AIM: To elucidate the meaning of being a close relative of a critically ill person cared for in intensive care during the initial phase of the COVID-19 pandemic. DESIGN: A narrative inquiry design following the COREQ guidelines. METHODS: Individual interviews with fifteen close relatives of patients critically ill with COVID-19 were analysed using phenomenological hermeneutics. RESULTS: The surreal existence of not being allowed to be near was emotionally difficult. While distancing due to restrictions was challenging, physicians' phone calls served as a connection to their relatives and brought a sense of security. Keeping notes helped them remember what happened and brought order to a chaotic situation. CONCLUSION: Close relatives feel secure when they receive regular information about their critically ill relative, not just when their condition worsens. They wish to be physically near to their critically ill person; when this is impossible, digital technology can provide support, but further accessibility developments are needed.

Experiences of a nature-based intervention program in a northern natural setting: A longitudinal case study of two women with stress-related illness.

PURPOSE: This study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting. METHODS: A longitudinal case study was conducted with two women participating in a nature-based intervention programme on a farm. Data were collected by semi-structured interviews, diaries, rating scales, and self-assessment. Qualitative data were analysed by qualitative content analysis and quantitative data are presented descriptively. RESULTS: The theme of finding a source for recovery and well-being permeates all categories. The participants perceived the farm and nature to be a calming refuge; they learned to be in the present and could manage the tasks. In togetherness with each other and the facilitator on the farm they felt understood and confident, experienced joy, and found opportunities for change. They gained knowledge and positive memories and found new approaches in life. Self-assessment questionnaires indicated improvements of functioning in everyday life and reduced stress-related exhaustion at the end of the NBI programme. CONCLUSIONS: Nature-based interventions lasting for a relatively short period seem to promote health and may be a complement to other treatments of stress-related illness. Further research is needed with a larger number of participants and in various natural settings.

Nature-based interventions to promote health for people with stress-related illness: An integrative review.

BACKGROUND: Stress-related illness is increasing and is a common cause of sick leave. Spending time in nature have a positive effect on health and well-being for instance by reducing stress. Specific programmes with nature-based interventions (NBI) with the intention to involve people in activities in a supportive natural environment have been developed for people with stress-related illness. AIM: To identify and summarise scientific studies of NBIs to promote health for people with stress-related illness. METHOD: The design used in this study is integrative literature review. Scientific studies focusing on any type of NBI for people with stress-related illness were sought in Cinahl, PubMed, PsycInfo, AMED and Scopus. In total, 25 studies using both qualitative and quantitative designs were included in the review. RESULT: The reviewed studies focused on garden or forest interventions. In the majority of the studies, NBIs were performed in groups, including individual activities, and the length of programmes varied. Interventions in natural environments have unique qualities for individualised, meaningful activities and interactions with others in a non-demanding atmosphere. NBIs offer restoration that reduces stress, improves health and well-being and strengthen self-efficacy and work ability. Connectedness with nature support existential reflections and people with stress-related illness can achieve balance in everyday life. CONCLUSION: In conclusion, NBIs may have advantages to promote health for people with stress-related illness and should therefore be considered as an alternative to those affected. Further research from different perspectives, including nursing, is needed to understand the possibilities of NBIs and how they can be integrated into practice.

Women's experiences of living with lipedema.

Lipedema is a chronic, progressive disease that almost exclusively affects women and often misdiagnosed as obesity or primary lymphedema. Research concerning lipedema is sparse, and there is a lack of studies focusing on women's experiences of living with the illness. We interviewed fourteen women with lipedema with the aim of describing their experiences of living with lipedema. Our results show that women felt controlled by their body, and were fat-shamed and viewed by others as a person who lacked character. They received unsupportive advice on how to manage from healthcare, and blamed themselves while striving to take responsibility.

The Meaning of Critical Illness for People Suffering From COVID-19: When a Frightening Unreality Becomes Reality.

The aim of this study was to elucidate the meaning of critical illness for people with COVID-19. This study used a qualitative design. Thirteen people who were critically ill with COVID-19 during 2020 and admitted to a COVID-19 intensive care unit in northern Sweden participated in the study. Data collection was conducted as individual interviews with a narrative approach, and data were analyzed with phenomenological hermeneutic interpretation. The participants did not think they would get critically ill with this unexpected illness. They experienced terrible nightmares where their relatives had been killed, and they missed their relatives both in their dreams and in reality, as they had not been allowed to be with them due to the virus. Gratefulness was described for surviving. Participants described thoughts of not being able to imagine going through this again. They felt fear and loneliness, as a terrifying unreality had become a reality.

Recovery despite everyday pain: Women's experiences of living with whiplash-associated disorder.

INTRODUCTION: Living with whiplash-associated disorders (WAD) means living every day under the influence of pain and limitations. As the incidence of WAD and the related intensity of pain are somewhat higher among women than men, the aim of the present study was to describe women's experiences of living with WAD. METHODS: A purposive sample of seven women participated in individual in-depth qualitative interviews, the transcripts of which were subjected to qualitative content analysis. RESULTS: The results of the analysis suggested six themes of women's experiences with WAD: living with unpredictable pain; trying to manage the pain; living with limitations; being unable to work as before; needing support and understanding; and learning to live with limitations. The findings showed that unpredictable pain limited women's strength to engage in activities of daily life and be as active as before. Support and understanding were important for their ability to manage changes in their daily lives. CONCLUSIONS: Pain considerably affects the daily lives of women with WAD, particularly by limiting their ability to perform activities and to enjoy their professional and social lives. As women with WAD need support with managing their daily lives, nurses and other healthcare personnel should adopt a person-centred approach, in order to support such women according to their individual needs and circumstances.

Ambulance nurses' experiences of deciding a patient does not require ambulance care.

AIM: To describe ambulance nurses' experience of deciding a patient does not require ambulance care. DESIGN: An inductive, empirical study with a qualitative approach. METHODS: Data collection was conducted through semi-structured interviews, and collected data were analysed with qualitative manifest content analysis. Data were collected during the spring 2017, and eight ambulance nurses participated. RESULTS: The findings are presented in one main category, which is "Not very ill but a difficult decision" with totally three subcategories. The ambulance nurse's experience of making the assessment when the patient has no need for ambulance care is like walking the balance of slack line. This means that the assessment can be both easy and very difficult but something that definitely requires experience, knowledge and dedication.

Experiences of striving to maintain daily life among women with osteoporosis.

In order to describe how women with osteoporosis strive to maintain daily life we interviewed 11 women using a reflective lifeworld approach based on phenomenological analysis. Osteoporosis is a major public health concern in the Western world, and is predominant among women. Our findings indicated that meanings of striving to maintain daily life imply a belief in oneself and one's own capabilities. The women expressly speak out for themselves as a way of finding reconciliation without giving in to the illness. Women with osteoporosis expect to gain support early in the course of their illness. They require advice on how to manage the disease as well as support for striving to maintain daily living. Therefore, it is crucial that the women not only are given information about the disease. Equally important is to establish continuity in healthcare encounters, and that health care offers support founded in the women's lived experiences with focus on their capacities.

Experiences of suffering multiple trauma: A qualitative study.

OBJECTIVES: In an effort to strengthen health care professionals' ability to anticipate and address multiple trauma patients' needs, this study aims to explore the experience of suffering from multiple trauma. DESIGN: This is a qualitative descriptive study. Nine interviews were analysed using content analysis. SETTING: The study included patients who had been registered in the Swedish Intensive Care registry [SIR] due to suffering multiple trauma. FINDINGS: The analysis revealed one theme, A detour in life, based on three sub-themes: (a) Feeling lost and not knowing what to expect, (b) Striving to get life back on track and (c) Dealing with 'dead ends' during rehabilitation. The theme showed that those who suffered multiple trauma did not know what to expect of their recovery and they expressed experiencing a lack of understanding and guidance from healthcare professionals. As it was important to focus on the present and find ways to move on in life, they sought for other ways to find direction in matters of rehabilitation and care. CONCLUSIONS: A shared understanding is essential in order to define a person's needs. By setting short-term goals and improving documentation, healthcare professionals across the trauma recovery continuum could more easily gain insight of their patients' needs and address them with supportive guidance.

Specialist ambulance nurses' experiences of births before arrival.

BACKGROUND: Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards. AIM: This study describes the experiences of specialist ambulance nurses with BBA. METHOD: A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed. Data were analysed with thematic content analysis. FINDINGS: The analysis revealed three categories that were compiled into a theme of feeling fright and exhilaration. The findings showed that BBA causes feelings of anxiety and stress. The experience is also associated with joy and relief when the baby is born. Childbirth is a situation for which specialist ambulance nurses feel less prepared, lack of knowledge, and wish for more education. CONCLUSION: Specialist ambulance nurses face challenges in the pre-hospital care environment during BBA, with long distances, a lack of equipment aboard the ambulance, and no assistance from midwives. To feel secure in the complex role that is required when assisting with a BBA, specialist ambulance nurses should be given the opportunity to receive scenario training.

The helicopter as a caring context: Experiences of people suffering trauma.

INTRODUCTION: When emergency medical services (EMS) are needed, the choice of transport depends on several factors. These may include the patient's medical condition, transport accessibility to the accident site and the receiving hospital's resources. Emergency care research is advancing, but little is known about the patient's perspective of helicopter emergency medical services (HEMS). AIM: The aim of this study was to describe trauma patients' experiences of HEMS. METHOD: Thirteen persons (ages 21-76) were interviewed using an interview guide. Data were analyzed using qualitative content analysis. FINDINGS: The analysis resulted in three themes: Being distraught and dazed by the event - patients experienced shock and tension, as well as feelings of curiosity and excitement. Being comforted by the caregivers - as the caregivers were present and attentive, they had no need for relatives in the helicopter. Being safe in a restricted environment - the participants' injuries were taken seriously and the caregivers displayed effective teamwork. CONCLUSION: For trauma patients to be taken seriously and treated as 'worst cases' enables them to trust their caregivers and 'hand themselves over' to their care. HEMS provide additional advantageous circumstances, such as being the sole patient and having proximity to a small, professional team.

Experiences of nursing patients suffering from trauma - preparing for the unexpected: A qualitative study.

SETTINGS AND OBJECTIVES: A midsize hospital in the north of Sweden with a high-tech intensive care unit and space for up to 10 patients, with an attached postoperative ward for up to 15 patients. The wards are manned by critical care nurses who are also responsible for carrying a trauma pager. When the alarm goes off, the critical care nurse leaves her/his duties and joins a trauma team. The aim of the study was to describe critical care nurse's experiences of nursing patients suffering from trauma. METHOD: A qualitative descriptive design was used. Data were collected through four focus group discussions with 15 critical care nurses analysed using qualitative content analysis. FINDINGS: One theme: Preparing for the unexpected with four subthemes: (1) Feeling competent, but sometimes inadequate; (2) Feeling unsatisfied with the care environment; (3) Feeling satisfied with well-functioning communication; and (4) Feeling a need to reflect when affected. CONCLUSIONS: Nursing trauma patients require critical care nurses to be prepared for the unexpected. Two aspects of trauma care must be improved in order to fully address the challenges it poses: First, formal preparation and adequate resources must be invested to ensure delivery of quality trauma care. Secondly, follow-ups are needed to evaluate care measures and to give members of the trauma team the opportunity to address feelings of distress or concern.

The Workplace Experiences of Women with Fibromyalgia.

PURPOSE: Fibromyalgia (FM) is a common pain syndrome that mostly affects women. Chronic pain and other symptoms often chalenge work for women with FM. This study aimed to explore how women with FM experience their work situations. METHOD: A purposive sample of 15 women with FM was interviewed with in-depth qualitative interviews. Data were analysed using a hermeneutic approach. RESULTS: The results revealed that women with FM experienced incapacity to work as they had previously and eventually accepted that their work life had changed or reached its end. Since their work had great significance in their lives, feelings of loss and sorrow were common. Women who were working, unemployed, or on sick leave described feelings of fear for their future work situations. CONCLUSIONS: Women with FM greatly value their work. Their wish to perform work as before is however, not consistent with their abilities. As such, women with FM need support in continuing to work for as long as possible, after which they need support in finding new values in life.

Meanings of being received and met by others as experienced by women with fibromyalgia.

Fibromyalgia (FM) is a common chronic pain syndrome that mostly affects middle-aged women. Our aim with this study was to elucidate meanings of being received and met by others as experienced by women with FM. Interviews with a narrative approach were conducted with 9 women. We analyzed the transcribed interviews with a phenomenological hermeneutical interpretation. The findings revealed two themes: being seen as a malingerer and being acknowledged. Meanings of being received and met by others, as experienced by women with FM, can be understood as a movement between the two perspectives. When they were acknowledged, their feelings of security and trust increased, but the women could not rely on this because others received and met them in such an unpredictable manner.

Health-related quality of life and sense of coherence among people with obesity: Important factors for health management.

OBJECTIVES: The purpose of this study was to evaluate whether health-related quality of life and levels of sense of coherence among people with obesity are correlated with body mass index, age, and gender. METHODS: A cross-sectional, descriptive research design was used. Subjects (n = 157) were selected from a sample of participants in an ongoing survey and had a body mass index >30 kg/m(2). Data were collected using the Short Form-36 Health Survey and the Sense of Coherence Scale. RESULTS: The mean body mass index of women was higher than that of men. Compared to men, a greater proportion of women had a low sense of coherence. There was a significant relationship between low physical health and high body mass index. Female gender and older age correlated with a low sense of coherence and showed a significant association with high body mass index. CONCLUSION: To increase the health-related quality of life, people with obesity need support to help manage their life situation based on their individual needs and personal resources.

The significance of FM associations for women with FM.

PURPOSE: Living with fibromyalgia (FM) means living with a long-term pain syndrome that is invisible to others. Support and understanding from others seem to be important to managing the affected daily life. The aim of this study was to describe the significance of FM associations for women with FM. METHODS: Data collection was carried out through focus group discussions with seventeen women with FM. Data were analyzed through thematic content analysis. RESULTS: The findings show that women experienced associations for people with FM as important as they gave access to contacts with others with similar experiences. Their need of togetherness was fulfilled at the association and they described being strengthened by the support received. Because of the lack of information and knowledge about FM, the association was described as an important venue for getting and mediating information about the illness. CONCLUSIONS: At the association the women seem to be empowered, which increases their ability to manage their daily lives despite the limitations imposed by FM. Healthcare personnel could not satisfy the women's needs and to manage to support women with FM. There is a need for communication based on a shared understanding between the women and healthcare personnel. IMPLICATIONS FOR REHABILITATION: This study highlighted the need for communication based on a shared understanding between people with chronic illness and healthcare personnel to support and strengthen women with FM in their daily lives. The FM associations meet the needs for togetherness, confirmation, and information that the women with FM in this study described and healthcare personnel could not satisfy. Healthcare personnel can learn from FM associations how to empower women with FM in their everyday lives.

Meanings of feeling well for women with fibromyalgia.

The researchers' focus in this study was to elucidate meanings of feeling well for women with fibromyalgia (FM). We obtained narrative interviews with 13 women with FM and used a phenomenological-hermeneutic interpretation to analyze the interview texts. Our interpretation of the findings shows that for women with FM meanings of feeling well can be understood as having strength to be involved. The women's experiences of feeling well meant being in control, having power, finding one's own pace, and experiencing feelings of belonging.