Standing alone on the frontline. The meaning of being a nurse in the archipelago-A phenomenological hermeneutical study.

AIM: The aim of this study was to illuminate the meaning of being a nurse in the archipelago. METHODOLOGICAL DESIGN AND JUSTIFICATION: A phenomenological hermeneutical design was applied, as there is a need to understand the lifeworld and the meaning of being a nurse in the archipelago. ETHICAL ISSUES AND APPROVAL: Approval was granted by the Regional Ethical Committee and local management team. All participants provided consent to participate. RESEARCH METHOD: Individual interviews were conducted with 11 nurses (Registered Nurses or primary health nurses). The interviews were transcribed, and the text was analysed by means of phenomenological hermeneutical method. RESULTS: The analyses ended in one main theme: Standing alone on the frontline, and three themes: 1. Combating sea, weather and the clock with the sub-themes: Fighting to give care to patients despite harsh conditions and Fighting against time; 2. Standing firm but wavering with the sub-themes: Embracing the unexpected and Calling out for support; and 3. Being a lifeline throughout the entire lifespan with the sub-themes: Having responsibility for the islanders and Having an intertwined private and work life. STUDY LIMITATIONS: The interviews may be considered few, but the textual data were rich and assessed suitable for the analysis. The text may be interpreted differently, but we deemed our interpretation as more probable than others. CONCLUSION: Being a nurse in the archipelago means standing alone on the frontline. Nurses, other health professionals and managers need knowledge and insight about working alone and the moral responsibilities thereof. There is a need to support the nurses in their lonely work. Traditional means of consultations and support could preferably be supplemented by modern digital technology.

"They Know Me and My Situation-Patients' and Spouses' Perceptions of Person-Centered Care in Hospital-at-Home Care".

Realization of person-centered care (PCC) is contextual. How is it perceived at hospital-at-home? Pairwise telephone interviews of patients (n = 27) and their spouses (n = 18) emerged in 4 themes. Care was found to be person-centered when both the principles and activities that underpin the concept PCC were realized.

Users' ambivalent sense of security with humanoid robots in healthcare.

Humanoid robots have already been shown to be useful in healthcare. To ensure successful interactions with humanoid robots, is it essential that the factors that influence users' sense of security be understood. Ensuring patients' sense of security is considered a key principle of good caring. The aim of this study was to illuminate users' sense of security with humanoid robots in healthcare. Twelve semi-structured interviews were conducted. The participants consisted of five women and seven men aged 24-77. Before being interviewed, the participants were shown a video vignette with Pepper, a fully developed humanoid robot, used in the daily care of patients. The data material was analyzed using qualitative content analysis. Most participants perceived the use of humanoid robots in healthcare to be both positive and negative. The overarching theme was: Ambivalent sense of security with humanoid robots in healthcare. The four categories revealed were: Humanoid robots are both reliable and unreliable, Humanoid robots are both safe and unsafe, Humanoid robots are both likable and scary, and Humanoid robots are both caring and uncaring. Here we increased knowledge of whether patients perceive a sense of security with humanoid robots in healthcare, including which fears users have. This is vital information that should be taken into consideration when further developing and introducing humanoid robots into the healthcare setting.

Art making and expressive art therapy in adult health and nursing care: A scoping review.

OBJECTIVES: While receptive art engagement is known to promote health and wellbeing, active art engagement has not been fully explored in health and nursing care. This review is to describe the existing knowledge on art making and expressive art therapy in adult health and nursing care between 2010 and 2020. METHODS: Relevant studies and grey literature were searched and identified between March 17 and April 10, 2020 from EBSCO, CINAHL, Medline and ERIC databases and a general Internet search. Following data charting and extraction, the data (n = 42 papers) were summarized and reported in accordance with PRISMA-ScR guidelines. RESULTS: In the included papers, both art making and expressive art therapy were seen in different health care and nursing contexts: yet not the home care context. The emphasis of art activities were group activities for chronically or terminally ill residents, adults aged 65 years or older. A focus on personal narrative was often seen, which may explain why art activities appear to be linked to acknowledging and building new strengths and skills, making meaning of experiences, personal growth, symptom alleviation, and communication; all used to foster collaboration between patients, patients' near-ones and health care professionals. CONCLUSIONS: Art activities appear to be suitable for every context and can promote personcenteredness and the measurement of nursing outcomes, and they should be considered an essential part of health and nursing care, nursing education and care for health care personnel.

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.

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 Window Toward the World: Older Adults' Experiences of Becoming in Health and Developing as Human Beings Through Interacting With Others Using Real Video Communication.

The population in the Nordic countries, as well as globally, is increasingly becoming older. Concurrently, with an increased aging population, there is an increase in poor health and loneliness among older adults. The aim of this study was to uncover, from a caring science perspective, community-living older adults' experiences of interacting with others via real video communication. The study uses a hermeneutical approach. The material consists of interviews with older adults regarding their experiences of using real video communication. The texts were interpreted through hermeneutical reading. Study participation and data storage and handling for research purposes were approved by the participants when they provided their informed consent. Ethical permission to conduct this study was granted by a research board. The findings uncovered that welfare technology offers a metaphor-a window toward the world-that comprises the overarching core theme "Being in a movement toward becoming a unity as a human being," and 3 main themes: "Alleviating suffering through beating involuntary solitude," "Being in the world as an equal and dignified human being," and "Dedicating new perspectives and meaning in life." Welfare technology seems to be an important means to improve the quality of life for older adults living at home. Welfare technology enables older people to be in contact with other people in an easy way. Further research is needed to uncover issues of welfare technology from different perspectives.

Inner strength and its relationship to health threats in ageing-A cross-sectional study among community-dwelling older women.

AIM: To explore the relationship between inner strength and health threats among community-dwelling older women. BACKGROUND: Inner strength is described as a resource that promotes experiences of health, despite adversities. Inner strength and its dimensions (i.e. connectedness, creativity, firmness and flexibility) can be assessed using the Inner Strength Scale (ISS). Exploring attributes of weaker inner strength may yield valuable information about areas to focus on in enhancing a person's inner strength and may ultimately lead to the perception of better health. DESIGN: Cross-sectional questionnaire survey. METHODS: The study is based on responses from 1270 community-dwelling older women aged 65 years and older; these were collected in the year 2010 and describe the situation that still exists today for older women. The questionnaire included the ISS, background characteristics and explanatory variables known to be health threats in ageing. Data were analysed using descriptive and inferential statistics. RESULTS: Poorer mental health was related to weaker inner strength in total and in all the dimensions. Symptoms of depressive disorders and feeling lonely were related to three of the dimensions, except firmness and creativity respectively. Furthermore, poor physical health was associated with the dimensions firmness and flexibility. Other health threats were significantly related to only one of the dimensions, or not associated at all. CONCLUSION: Mental ill health has overall the strongest association with weaker inner strength. Longitudinal studies are recommended to confirm the results. However, the ISS does not only estimate inner strength but can also be a tool for discovering where (i.e. dimension) interventions may be most profitable.

Inner strength - associated with reduced prevalence of depression among older women.

OBJECTIVES: The aim of this study was to explore if inner strength is independently associated with a reduced prevalence of depression after controlling for other known risk factors associated with depression. METHODS: A population-based cross-sectional study was performed, where all women living in Åland, a Finnish self-govern island community in the Baltic Sea, aged 65 years or older were sent a questionnaire including the Geriatric Depression Scale and the Inner Strength Scale along with several other questions related to depression. Factors associated with depression were analyzed by means of multivariate logistic regression. RESULTS: The results showed that 11.2% of the studied women (n = 1452) were depressed and that the prevalence increased with age and was as high as 20% in the oldest age group. Non-depressed women were more likely to never or seldom feel lonely, have a strong inner strength, take fewer prescription drugs, feeling needed, being able to engage in meaningful leisure activities, as well as cohabit. CONCLUSION: Our results showed an association between stronger inner strength and being non-depressed. This can be interpreted to mean that inner strength might have a protective effect against depression. These findings are interesting from a health-promotion perspective, yet to verify these results, further longitudinal studies are required.

Walking on the edge: meanings of living in an ageing body and using a walker in everyday life - a phenomenological hermeneutic study.

BACKGROUND: In order to maintain one's state of health whilst growing older, the ability to walk is essential. AIM AND OBJECTIVE: The aim of this study was to illuminate the meanings of the lived experience of living in an ageing body and using a walker in daily life. METHODS: Narrative interviews were performed with seven older persons aged 79-95 years. The transcribed text was analysed using a phenomenological hermeneutic method. RESULTS: The key finding of the study was that the lived experience of living in an ageing body and using a walker in daily life was interpreted as 'walking on the edge' based on the themes 'Being vulnerable and dependent' and 'Being confident and independent'. CONCLUSIONS: The results highlight the importance of reflecting on this phenomenon as a health care professional while meeting the care needs of older persons who use walkers. IMPLICATIONS FOR PRACTICE: Nurses need to consider the walker as a personal and valued possession of the individual and handle the walker in agreement with the older person, placing the walker close at hand with the brakes locked to give secure support.

Clinical challenges and ongoing role changes for primary health-care nurses.

OBJECTIVE: To investigate the perceptions of primary health-care nurses (PHNs) about clinical demands and future challenges. METHOD: Qualitative content-analysis of open questions from a questionnaire. A total of 121 PHNs from health-care districts in northern Sweden filled in a questionnaire during a mandatory educational day. RESULTS: Key issues that were raised included: defending the specific professional role of the PHNs; strengthening their self-governance and authority; and ensuring adequate care in the future through education that focuses more on nursing practice than on academic work. CONCLUSION: To ensure that the role of the PHN continues to develop, it is necessary to enable them to articulate, discuss, and evaluate their profession and to learn, in concrete forms, how to implement science in clinical practice.

Inner strength in relation to functional status, disease, living arrangements, and social relationships among people aged 85 years and older.

Inner strength is described as an important resource that promotes well-being. We used data from a sample of 185 people in the Umeå 85+ cohort study to relate inner strength and its attributes to objective health variables. The Resilience, Sense of Coherence, Purpose in Life, and Self-Transcendence scales were used to assess aspects of inner strength, and strong correlations between the scales were found. Prevalence of heart failure, chronic obstructive pulmonary disorder, osteoporosis, or diagnosed depression was associated with low inner strength. Significant relationships were also found between high inner strength and various measures of social relationships. Participants with a higher degree of inner strength had better physical health and more satisfying social relationships. The promotion of inner strength should be a major aim of geriatric nursing.

Inner strength--a theoretical analysis of salutogenic concepts.

BACKGROUND: Theoretical and empirical overlaps between the concepts of resilience, sense of coherence, hardiness, purpose in life, and self-transcendence have earlier been described as some kind of inner strength, but no studies have been found that focus on what attributes these concepts have in common. OBJECTIVES: The objective of this study was to perform a theoretical analysis of the concepts of resilience, sense of coherence, hardiness, purpose in life, and self-transcendence, in order to identify their core dimensions in an attempt to get an overarching understanding of inner strength. PRINT METHOD: An analysis inspired by the procedure of meta-theory construction was performed. The main questions underlying the development of the concepts, the major paradigms and the most prominent assumptions, the critical attributes and the characteristics of the various concepts were identified. RESULTS: The analysis resulted in the identification of four core dimensions of inner strength and the understanding that inner strength relies on the interaction of these dimensions: connectedness, firmness, flexibility, and creativity. These dimensions were validated through comparison with the original descriptions of the concepts. CONCLUSION: An overarching understanding of inner strength is that it means both to stand steady, to be firm, with both feet on the ground and to be connected to; family, friends, society, nature and spiritual dimensions and to be able to transcend. Having inner strength is to be creative and stretchable, which is to believe in own possibilities to act and to make choices and influence life's trajectory in a perceived meaningful direction. Inner strength is to shoulder responsibility for oneself and others, to endure and deal with difficulties and adversities. This knowledge about inner strength will raise the awareness of the concept and, in turn, hopefully increase our potential to support people's inner strength.

Still going strong: perceptions of the body among 85-year-old people in Sweden.

Background. Studies on the lived experience of an aging body are scarce. Aim and objectives. The aim of this study was to illuminate the experiences of the body among elderly people. Design. This study is part of the Umeå 85+ Study, a cross-sectional investigation into successful aging and threats against successful aging. The present study has an explorative design. Methods. The text from 40 thematic interviews with 85-year-olds was analysed using qualitative content analysis. Results. Two themes and seven subthemes were developed. The theme: Still going strong encompassed the subthemes of Exercising and being active, Caring for one's body, Standing on one's own two feet and Feeling healthy. The theme: Adapting to a failing body encompassed the subthemes of Not being able to perform activities and manage by oneself, Feeling fatigued and Compensating for bodily decline. Conclusions. The participants felt that the body was still a source of pleasure, in spite of its defects. Assistive devices were important for the maintenance of independence when the body declined. Relevance to clinical practice. When caring for elderly people with declining bodily function, it is important to have appropriate and well-tested equipment in readiness.