Heideggerian structures of Being-with in the nurse-patient relationship: modelling phenomenological analysis through qualitative meta-synthesis.

Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse-patient relationship. We firstly considered and secured the most relevant Heideggerian elements to nurse-patient Being-with (Dasein-with, circumspection, solicitude, and discourse). Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode (task-orientated busyness, existential abandonment, rough handling and deficient modes of concern in potentially violent encounters), and the authentic self-mode (seeking connection [knowing], and openness [unknowing], which exposed their emotional vulnerability). Through circumspection (making room for, deseverance and directionality), technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement (solicitude) was expressed through either leaping-in care (also perceived as 'power over') or leaping-ahead care (moving the patient towards independence). There was a place for both inauthentic (idle talk) and authentic discourse (including non-verbal and spiritual discourse) that nurses wove through the ontic everydayness of nursing tasks.

Hermeneutic Phenomenological Study of Military Nursing Officers.

BACKGROUND: Nurses working in military trauma teams often work in hostile and remote locations. They are faced with the burden of carrying out their duties while ensuring the safety of their patients and themselves in areas of conflict and humanitarian crisis. The stories and experiences of military nurses often go untold. In a phenomenological study, six Australian Defence Force Nursing Officers share their stories of working as members of military trauma teams. OBJECTIVES: The aim of this study was to gain an understanding of the lived experiences of nursing officers when working as a member of a military trauma team. METHODS: A hermeneutic phenomenological approach was used to conduct this research. In-depth interviews were conducted with six participants. RESULTS: The following themes were identified: telling their stories; the role-who we are and what we do; the environment-it is so different; training-will it ever fully prepare you; working in teams-there's no "I" in team; and leadership-will the real leader please stand up! DISCUSSION: This study has provided an insight into the experiences of six Australian military nurses working in trauma teams-experiences that were rarely given voice outside the military. Central to this experience is the need to have these stories told.

The experiences of ICU patients during follow-up sessions--a qualitative study.

OBJECTIVE: Evidence supports the recommendation for follow-up session(s) for patients after discharge from an intensive care unit (ICU). The aim of these follow-up sessions is to allow patients to express and discuss their experiences and problems following their time in an ICU. To optimise the knowledge gained from the follow-up session experience, it is necessary to describe how patients experience these sessions. The aim of this study was to describe how ICU-patients, experience a follow-up session. DESIGN/SETTING: This study adopted a qualitative design utilising semi-structured interviews, and which examined the experiences of seven men and five women. Qualitative content analysis was utilised. FINDINGS: The participants stated that the information gained from these sessions, which had previously seemed unclear to some of them, was, on the whole, now clarified and confirmed. A discernible difference was found between participants who were cared for on a general ward and those who were cared for on a rehabilitation ward and also were offered a meeting with a counsellor, following discharge their from the ICU. The findings also indicated that participants who were not offered psychosocial support showed a greater need for a follow-up session. CONCLUSION: This study has highlighted the need for increasing collaboration between intensive care staff and staff in other units to provide support to this patient group in order to reduce their suffering post intensive care experience.

The well-being of relatives of patients with atrial fibrillation: a critical incident technique analysis.

BACKGROUND: The well-being of relatives of patients having chronic heart diseases (CHD) has been found to be negatively affected by the patient's condition. Studies examining relatives of patients with atrial fibrillation (AF) indicate that their well-being may be affected in a similar manner, but further research is needed. AIM: To explore and describe critical incidents in which relatives of patients experience how AF affects their well-being and what actions they take to handle these situations. DESIGN AND METHOD: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 19 relatives (14 women and five men) of patients hospitalised in southern Sweden due to acute symptoms of the AF. RESULTS: The well-being of relatives was found to be affected by their worries (patient-related health), as well as the sacri-ficing of their own needs (self-related health). In handling their own well-being, these relatives adjusted to and supported the patient (practical involvement), along with adjusting their own feelings and responding to the mood of the patients (emotional involvement). CONCLUSION: The well-being of relatives of patients with AF was affected depending on the patients' well-being. In their attempt to handle their own well-being, the relatives adjusted to and supported the patients. Further research is needed in order to evaluate the effects of support to relatives and patients respectively and together.

Empowering the registered nurses of tomorrow: students' perspectives of a simulation experience for recognising and managing a deteriorating patient.

BACKGROUND: Recognising and responding to patients who are deteriorating are key aspects to improving outcomes. Simulations provide students with exposure to deteriorating patient scenarios and the role of nurses in such events. The number of programmes seeking to provide best possible simulation experiences is growing exponentially. Robust evaluation of these experiences is crucial to ensure maximum benefit. OBJECTIVES: To assess the impact of a deteriorating patient simulation experience on students' technical and communication skills; and to determine if differing study programmes and years of previous nursing experience influenced students' responses and experiences. METHODS: A convenience sample of final year nursing students (N=57) in a medical-surgical course at a large urban university completed a descriptive pre/post simulation survey rating their technical skills and communication abilities in recognising and responding to patient deterioration. Changes in pre/post scores were analysed including influence of study programme (3-year, 2-year Enrolled Nurse, 2-year Graduate Entry); gender; and years nursing experience (beyond course clinical practicum). RESULTS: Statistically significant improvements in post-simulation survey scores were demonstrated for combined student group data. Students with greater years of nursing experience had statistically higher scores than those with less experience in both pre- and post-surveys. Specific improvements were identified for: assessing a deteriorating patient; and in seeking help from the medical officer or external service. CONCLUSIONS: All student groups gained benefit in participating in a deteriorating patient simulation. For this group, greater years of prior nursing experience led to higher pre- and post-survey scores. The learning activity provided students an experience of the importance of recognising and responding to an acute situation in a timely manner which may be recalled in subsequent clinical situations.