The Meaning and Purpose Scales (MAPS): development and multi-study validation of short measures of meaningfulness, crisis of meaning, and sources of purpose.

BACKGROUND: Meaning in life is multidimensional. It encompasses different qualities of meaning, such as meaningfulness, crisis of meaning, or existential indifference, as well as the sources from which people draw meaning, or purpose. For both research and practice, it is of high value to know not only the extent of meaningfulness, or its absence, but also its sources. How do these relate to meaningfulness and mental health? Are they accessible to people of different sociodemographic and economic backgrounds alike? For therapeutic and counseling practice, knowledge of experiences and sources of meaning is needed to support a clearer self-understanding in patients or clients and to encourage them to make authentic life choices. The Meaning and Purpose Scales (MAPS) presented here enable researchers and practitioners to gain insights into these dimensions of meaning in life, and, with only 23 items, to do so in a short time. METHODS: Using five independent and two follow-up samples with a total N of 7,500, this paper examined the MAPS' internal consistency, test-retest reliability, and convergent, divergent, criterion, factorial, and predictive validity. RESULTS: Principal axis factoring identified two meaning scales, Meaningfulness and Crisis of Meaning, and five purpose scales, Sustainability, Faith, Security, Community, and Personal Growth. The scales proved consistent, stable over four weeks and two months, and valid in multiple respects. In a representative German population sample, Personal Growth, Sustainability, and Community exhibited large, Faith and Security medium positive relationships with Meaningfulness, whereas Crisis of Meaning showed small to moderate negative correlations. Meaningfulness was positively, and Crisis of Meaning negatively predicted by age, partnership, parenthood, and religious affiliation. Financial hardship correlated positively with Crisis of Meaning and negatively with Meaningfulness, Community, and Personal Growth. Meaningfulness and Crisis of Meaning explained 21%, the sources of purpose 6% of additional variance in general mental distress (PHQ-4), beyond sociodemographics. Except for Faith (unrelated), all sources exhibited moderate negative correlations with the PHQ-4. CONCLUSION: As this series of studies demonstrates, the MAPS provide a highly economic and valid assessment of two qualities of meaning, Meaningfulness and Crisis of Meaning, and five sources of purpose: Sustainability, Faith, Security, Community, and Personal Growth.

Adolescents with developmental traumas in therapy in a child and adolescent mental health service, outpatient unit: experiences of daily living and expectations for therapy - a qualitative study.

Background: Developmental trauma has a profound effect on people's lives. There are few studies of the perceived difficulties and treatment needs of adolescents with developmental trauma. More studies are called for to explore the perspectives and experiences of these patients, especially adolescents. Method: Semi-structured interviews were conducted with eight adolescents with developmental trauma aged 14-18 years in a Child and Adolescent Mental Health Service, Outpatient Unit. The interviews were analyzed using systematic text condensation. Results: A main finding in this study regards the participants' understanding of why they needed therapy: symptom alleviation and coping tools. They expressed a need for talking with a safe and reliable adult who understood their situation. Their stories of daily functioning and bodily sensations align mainly with symptoms described for adolescents with developmental trauma. The study also shows that the participants' experiences of trauma affected their lives to a greater or lesser extent, in the form of ambivalence, avoidance, regulation, and coping strategies. They also described various physical problems, especially insomnia and inner restlessness. Their subjective stories revealed insights into their experiences. Conclusion: Based on the results, we recommend that adolescents with developmental trauma be allowed to express their understandings of their difficulties and their treatment expectations at an early stage of their therapy. An emphasis on patient involvement and the therapeutic relationship can increase their autonomy and control over their own lives and treatment.

Emotion regulation moderates the association between COVID-19 stress and mental distress: findings on buffering, exacerbation, and gender differences in a cross-sectional study from Norway.

Background: Maintaining good mental health is important during a crisis. However, little attention has been given to how people achieve this, or how they evaluate emotions associated with stressors, such as the COVID-19 pandemic. This study aims to (1) investigate whether emotion regulation, in particular cognitive reappraisal and suppression, moderates the relationship between COVID-19 stress and general mental distress and (2) examine gender differences in the interrelations between COVID-19 stress, emotion regulation, and mental distress. Methods: Data from a population in Norway (n = 1.225) were collected using a cross-sectional survey during the early months of the COVID-19 pandemic. Emotion regulation was measured using the Emotion Regulation Questionnaire Scale (ERQ), COVID-19 stress with the COVID-19 Stress Scale, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS. Results: There was a strong association between COVID-19 stress and general mental distress (r = 0.61). The moderation analyses showed substantial moderation effects of cognitive reappraisal and suppression on the relationship between COVID-19 stress and mental distress. Cognitive reappraisal served as a buffer (p = 0.001) and suppression (p = 0.002) exacerbated the relation between COVID-19 stress and mental distress. Men had higher scores of suppression (p < 0.001), and women had higher scores of cognitive reappraisal (p = 0.025). The buffering effect of cognitive reappraisal presented itself only in women (p < 0.001), while the exacerbation effect of suppression appeared only in men (p < 0.001). Conclusion: The current study suggests that COVID-19 pandemic-related stress is easier to deal with for those who have the tendency to cognitively reappraise. In contrast, suppression is associated with symptoms of depression and anxiety. The prevention of mental distress can be supported by guiding people about the importance of using healthy emotion regulation strategies, as well as helping them to become more aware of the way they interpret and regulate their emotions. Gender differences in emotion regulation suggest gender awareness, e.g., tailored programs for men and women.

Therapists and the Topic of Meaning in Life in Their Encounters With Adolescents With Developmental Trauma: A Qualitative Study.

BACKGROUND: Meaning in life is important to achieve quality of life, psychological well-being and good mental health. Existential issues such as meaning in life have limited attention in mental health care and treatment for children and young people in Norway. People in crisis often ponder existential questions. We find little research on this topic in relation to therapists who work with adolescents with developmental trauma. The purpose of this study was to examine how meaning in life is understood and addressed from the perspectives of therapists working with adolescents struggling with trauma. METHOD: The study has a qualitative design, based on focus groups with therapists in mental health care for children and adolescents. The interviews were transcribed and analyzed using systematic text condensation. RESULTS: Therapists had limited professional experience and competence to address and explore meaning as a topic in therapy. Yet there was interest in the topic and they thought that young people with trauma experience may benefit from the incorporation of meaning perspectives into therapy. CONCLUSION: Therapists at a mental health outpatient clinic for children and adolescents found the topic of meaning important but challenging to involve in the treatment of adolescents with developmental trauma. There is a need for more research to enhance understanding of what it means to include meaning as a topic in child and adolescent psychiatry, and what may be the specific benefit and challenges involved.

How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study.

BACKGROUND: There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts. METHODS: Qualitative interview study, individual and focus group interviews, with altogether 30 nurses working in acute psychiatric wards in two mental health hospitals in Norway. Interviews were recorded and transcribed. A thematic analytic approach was chosen. RESULTS: While nurses sense a strong expectation to minimise the use of restraints/coercion, patients on acute psychiatric wards are being increasingly ill with a greater tendency to violence. This creates moral doubt and dilemmas regarding how much nurses should endure on their own and their patients' behalf and may expose patients and healthcare personnel to greater risk of violence. Nurses worry that new legislation and ideals may prevent acutely mentally ill and vulnerable patients from receiving the treatment they need as well as their ability to create a psychological safe climate on the ward. Furthermore, persuading the patient to stay on the ward can cause guilt and uneasiness. Inadequate resources function as external constraints that may frustrate nurses from realising the treatment ideals set before them. CONCLUSIONS: Mental health nurses working in acute psychiatric care are involved in a complex interplay between political and professional ideals to reduce the use of coercion while being responsible for the safety of both patients and staff as well as creating a therapeutic atmosphere. External constraints like inadequate resources may furthermore hinder the healthcare workers/nurses from realising the treatment ideals set before them. Caught in the middle nurses may experience moral distress that may lead to physical discomfort, uneasiness and feelings of guilt, shame, and defeat. Pressure on nurses and care providers to reduce or eliminate the use of coercion and reduction of health care spending are incompatible demands.

Coping with moral distress on acute psychiatric wards: A qualitative study.

BACKGROUND: Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands. METHODS: Qualitative individual and focus group interviews were conducted. ETHICAL CONSIDERATIONS: Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed. PARTICIPANTS AND RESEARCH CONTEXT: Thirty nurses working within acute psychiatric wards in two mental health hospitals. RESULTS: Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not 'bringing problems home' after work or loyally doing as told and trying to make oneself immune. Colleagues and work climate were important for choice of coping strategies. DISCUSSION: Nurses' coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price. CONCLUSIONS: It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience.

Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey.

BACKGROUND: An internal locus of control (LoC I) refers to the belief that the outcome of events in one's life is contingent upon one's actions, whereas an external locus of control (LoC E) describes the belief that chance and powerful others control one's life. This study investigated whether LoC I and LoC E moderated the relationship between COVID-19 stress and general mental distress in the general population during the early months of the COVID-19 pandemic. METHODS: This cross-sectional survey study analysed data from a Norwegian (n = 1225) and a German-speaking sample (n = 1527). We measured LoC with the Locus of Control-4 Scale (IE-4), COVID-19 stress with a scale developed for this purpose, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS. RESULTS: The association between COVID-19 stress and general mental distress was strong (r = .61 and r = .55 for the Norwegian and the German-speaking sample, respectively). In both samples, LoC showed substantial moderation effects. LoC I served as a buffer (p < .001), and LoC E exacerbated (p < .001) the relation between COVID-19 stress and general mental distress. CONCLUSIONS: The data suggest that the COVID-19 pandemic is easier to bear for people who, despite pandemic-related strains, feel that they generally have influence over their own lives. An external locus of control, conversely, is associated with symptoms of depression and anxiety. The prevention of mental distress may be supported by enabling a sense of control through citizen participation in policy decisions and transparent explanation in their implementation.

Creating room for evidence-based practice: Leader behavior in hospital wards.

The integration (routinizing and sustaining) of evidence-based practice (EBP) into hospital management is a key element for improving patient safety and ensuring better patient outcomes. Hospital managers and clinical leaders play crucial roles in this integration. Interactions between leaders and integration context influence the improvement's quality, but leader-based actions that are effective for improving nursing practice remain unclear. The relationship between leaders could also either hinder or enable this implementation process. The aim of this study was to generate a theory about patterns of leader behavior that leaders are engaged in when attempting to integrate EBP in a clinical setting. We used a classic grounded theory methodology to generate a substantive EBP theory. In this study, through participant observation, we observed 63 nurses (15 specialist, 39 registered, and 9 assistant nurses). From these, five ward leaders (two head nurses, one assistant head nurse, and two teaching nurses) participated in individual interviews, and 18 clinical nurses participated in four focus groups. "Creating room for EBP" emerged as a theory for explaining the way in which the leaders attempted to resolve their main concern: How to achieve EBP treatment and care with tight resources and without overextending the nurses. Creating room for EBP encompasses a process of interactions, including positioning for, executing, and interpreting responses to EBP.

Evidence-based practice integration in hospital wards-The complexities and challenges in achieving evidence-based practice in clinical nursing.

AIM: Exploring the processes involved in two different strategies to integrate evidence-based practice into nursing practice. DESIGN: Classical grounded theory methodology was used. METHODS: Data were collected through 90 hr of observation and 4 focus groups among clinical nurses in two different hospital wards. RESULTS: We identified a multidimensional evidence-based practice integration framework that illuminates the complexities involved in the integration process. The dimensions were approaches to evidence-based practice, positions of evidence-based practice and levels of evidence-based practice. The interactions between the dimensions gave five combinations; an explicit evidence-based practice performed as a parallel to daily work at the systems level, an implicit evidence-based practice integrated into daily work at the systems level, an explicit evidence-based practice integrated into daily work at the individual level, an explicit evidence-based practice integrated into daily work at the systems level and an implicit evidence-based practice integrated into daily work at the individual level.

Caught Between Expectations and the Practice Field.

Background: Volunteer crisis line responders are a valuable resource for suicide prevention crisis lines worldwide. Aim: The aim of this study was to gain a deeper understanding of how volunteers operating a diaconal crisis line in Norway experienced challenges and how these challenges were met. Method: A qualitative, explorative study was conducted. A total of 27 volunteers were interviewed through four focus groups. The material was analyzed using systematic text condensation. Results: The greatest challenge to the volunteers was the perception of a gap between their expectations and the practice field. The experience of many volunteers was that the crisis line primarily served a broad ongoing support function for loneliness or mental illness concerns, rather than a suicide prevention crisis intervention function. Limitations: The focus group design may have made the participants more reluctant to share experiences representing alternative perspectives or personally sensitive information. Conclusion: The findings of this study suggest that a uniform response to callers using crisis lines as a source of ongoing support is warranted and should be implemented in volunteer training programs.

"Keeping on track"-Hospital nurses' struggles with maintaining workflow while seeking to integrate evidence-based practice into their daily work: A grounded theory study.

BACKGROUND: Evidence-based practice is considered a foundation for the provision of quality care and one way to integrate scientific knowledge into clinical problem-solving. Despite the extensive amount of research that has been conducted to evaluate evidence-based practice implementation and research utilization, these practices have not been sufficiently incorporated into nursing practice. Thus, additional research regarding the challenges clinical nurses face when integrating evidence-based practice into their daily work and the manner in which these challenges are approached is needed. OBJECTIVES: The aim of this study was to generate a theory about the general patterns of behaviour that are discovered when clinical nurses attempt to integrate evidence-based practice into their daily work. DESIGN: We used Glaser's classical grounded theory methodology to generate a substantive theory. SETTINGS: The study was conducted in two different medical wards in a large Norwegian hospital. In one ward, nurses and nursing assistants were developing and implementing new evidence-based procedures, and in the other ward, evidence-based huddle boards for risk assessment were being implemented. PARTICIPANTS: A total of 54 registered nurses and 9 assistant nurses were observed during their patient care and daily activities. Of these individuals, thirteen registered nurses and five assistant nurses participated in focus groups. These participants were selected through theoretical sampling. METHODS: Data were collected during 90h of observation and 4 focus groups conducted from 2014 to 2015. Each focus group session included four to five participants and lasted between 55 and 65min. Data collection and analysis were performed concurrently, and the data were analysed using the constant comparative method. RESULTS: "Keeping on track" emerged as an explanatory theory for the processes through which the nurses handled their main concern: the risk of losing the workflow. The following three strategies were used by nurses when attempting to integrate evidence-based practices into their daily work: "task juggling", "pausing for considering" and "struggling along with quality improvement". CONCLUSIONS: The "keeping on track" theory contributes to the body of knowledge regarding clinical nurses' experiences with evidence-based practice integration. The nurses endeavoured to minimize workflow interruptions to avoid decreasing the quality of patient care provided, and evidence-based practices were seen as a consideration that was outside of their ordinary work duties.

Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: a qualitative study among family members.

BACKGROUND: The drive towards patient involvement in health services has been increasingly promoted. The World Health Organisation emphasizes the family's perspective in comprehensive care. Internationally there is an increased emphasis on what patients and their family tell about the hospital experiences. However, current literature does not adequately address the question of participation experiences among relatives of older hospitalized family members. There is a paucity of research with a generational perspective on relatives' opportunities to exert influence. The aim of the study was to explore relatives' experiences of opportunities to participate in decisions about the care and treatment of older hospitalized family members and whether there are different experiences of influence to the relatives' age. METHODS: This was an explorative study applying individual qualitative interviews. The interviews were analysed following hermeneutic methodological principles. Two Norwegian geriatric wards participated: one at a university hospital and one at a local hospital. Twelve participants, six women and six men, were purposively selected. The relatives were aged from 36 to 88 (mean age 62) and were spouses, children and/or children-in-law of patients. RESULTS: The relatives' experienced opportunities to exert influence were distributed along a continuum ranging from older relatives being reactive waiting for an initiative from health professionals, to younger adults being proactive securing influence. Older "invisible" carers appeared to go unnoticed by the health professionals, establishing few opportunities to influence decisions. The middle-aged relatives also experienced limited influence, but participated when the hospital needed it. However, limited participation seemed to have less impact on their lives than in the older relatives. Middle-aged relatives and younger adults identified strategies in which visibility was the key to increasing the odds of gaining participation. The exceptional case seemed to be some older carers' experiences of influencing decisions with the help of professionals. CONCLUSIONS: Our findings suggest that experiences of influence were limited regardless of age. However, the results indicated that participation among relatives decrease with age while vulnerability for not having influence seemed to increase with age. The problem of patient choice most clearly manifested among the older carers, which might indicate that the relatives' age sets terms for opportunities to participate.

Ambiguous participation in older hospitalized patients: gaining influence through active and passive approaches-a qualitative study.

BACKGROUND: Patient participation is required by law in Norway and in several western countries. Current participation ideology is based on individualism, which may conflict with the older generation's commonly held values of solidarity and community. Hence, different values and ideologies may come in conflict when older patients receive treatment and rehabilitation in geriatric wards. Participation is a guiding principle in rehabilitation. Criteria for admission of older patients to geriatric wards are complex health problems, acute illness and/or acute physical and/or cognitive functional failure. The ideal is an active and engaged patient. The aim of the study was to describe the difficulties experienced by older patients on acute geriatric wards when involving themselves with their own treatment and care. METHODS: In this qualitative study older patients were interviewed during hospitalization in geriatric wards and asked to tell about their experiences with participation. Data analysis was conducted using a phenomenological hermeneutic method. RESULTS: The patients experienced difficulties in participating in decisions and care. They linked their difficulties to their own diminishing capabilities, and cited the ward's busy schedule as a reason for abstaining from participation. However, despite their reservations, they did participate in decisions in different ways. Their participatory practices appeared ambiguous and they employed various strategies to put themselves in a position of influence. The most important of these involved their relatives. The patients delegated to family the tasks of seeking, receiving and giving information to the nurses and the staff, and, to some extent, for the dialogues with hospital staff about their needs and plan of care. The family appeared to accept the responsibility willingly. CONCLUSIONS: The patients addressed their difficulties by authorizing family members to act and participate on their behalf. This underlines the family's important role in patient participation and the role that nurses and other staff must play in collaborating with the patient and their family to facilitate participation independently of the patients' performances of participation.

Spiritual care to persons with dementia in nursing homes; a qualitative study of nurses and care workers experiences.

BACKGROUND: Spiritual care for people with dementia who are in nursing homes is one aspect of the holistic care provided by nurses. A number of studies have explored the concepts of spirituality and religiosity, but fewer studies describe how nurses provide spiritual care in practice. The Purpose of the study was thus to investigate how nurses and care workers can provide spiritual care for people with dementia who live in nursing homes. METHODS: This is a qualitative study with an exploratory design using a phenomenological-hermeneutic approach. Interviews were conducted in eight focus groups with 31 nurses and care workers in 4 Norwegian nursing homes. RESULTS: The nurses were unsure about whether they actually provided spiritual care. Through discussions in the focus groups, a new understanding and insight was developed. The spiritual care that the nurses provided included: (1) integrating spiritual care into general care, described as 'physical touch' and 'responsiveness and intuition'; (2) spiritual care in terms of togetherness, described as 'being present' and 'sensitivity in communication'; and (3) spiritual care as providing meaningful activities for everyday life, described as 'facilitating activities' and 'meeting the residents' religious needs'. CONCLUSIONS: This study demonstrates the need for nurses and care workers to discuss and reflect on how to understand and describe spiritual care for people with dementia in practice. There is a need to develop and expand the knowledge about how to teach carers to recognize resident's spiritual needs and expressions of spirituality and to establish a comprehensive view of spiritual care for people with dementia in nursing homes.

The challenge of consolation: nurses' experiences with spiritual and existential care for the dying-a phenomenological hermeneutical study.

BACKGROUND: A majority of people in Western Europe and the USA die in hospitals. Spiritual and existential care is seen to be an integral component of holistic, compassionate and comprehensive palliative care. Yet, several studies show that many nurses are anxious and uncertain about engaging in spiritual and existential care for the dying. The aim of this study is to describe nurses' experiences with spiritual and existential care for dying patients in a general hospital. METHODS: Individual narrative interviews were conducted with nurses in a medical and oncological ward. Data were analyzed using a phenomenological hermeneutical method. RESULTS: The nurses felt that it was challenging to uncover dying patients' spiritual and existential suffering, because it usually emerged as elusive entanglements of physical, emotional, relational, spiritual and existential pain. The nurses' spiritual and existential care interventions were aimed at facilitating a peaceful and harmonious death. The nurses strove to help patients accept dying, settle practical affairs and achieve reconciliation with their past, their loved ones and with God. The nurses experienced that they had been able to convey consolation when they had managed to help patients to find peace and reconciliation in the final stages of dying. This was experienced as rewarding and fulfilling. The nurses experienced that it was emotionally challenging to be unable to relieve dying patients' spiritual and existential anguish, because it activated feelings of professional helplessness and shortcomings. CONCLUSIONS: Although spiritual and existential suffering at the end of life cannot be totally alleviated, nurses may ease some of the existential and spiritual loneliness of dying by standing with their patients in their suffering. Further research (qualitative as well as quantitative) is needed to uncover how nurses provide spiritual and existential care for dying patients in everyday practice. Such research is an important and valuable knowledge supplement to theoretical studies in this field.

A mobile hospice nurse teaching team's experience: training care workers in spiritual and existential care for the dying - a qualitative study.

BACKGROUND: Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients' spiritual and existential suffering is therefore important. The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team's experience with teaching and training care workers in spiritual and existential care for the dying in nursing homes and home care settings. METHODS: The team of expert hospice nurses participated in a focus group interview. Data were analyzed using a phenomenological hermeneutical method. RESULTS: The mobile teaching team taught care workers to identify spiritual and existential suffering, initiate existential and spiritual conversations and convey consolation through active presencing and silence. The team members transferred their personal spiritual and existential care knowledge through situated "bedside teaching" and reflective dialogues. "The mobile teaching team perceived that the care workers benefitted from the situated teaching because they observed that care workers became more courageous in addressing dying patients' spiritual and existential suffering. DISCUSSION: Educational research supports these results. Studies show that efficient workplace teaching schemes allowexpert practitioners to teach staff to integrate several different knowledge forms and skills, applying a holisticknowledge approach. One of the features of workplace learning is that expert nurses are able to guide novices through the complexities of practice. Situated learning is therefore central for becoming proficient. CONCLUSIONS: Situated bedside teaching provided by expert mobile hospice nurses may be an efficient way to develop care workers' courage and competency to provide spiritual and existential end-of-life-care. Further research is recommended on the use of mobile expert nurse teaching teams to improve nursing competency in the primary health care sector.

A qualitative study of nurses' attitudes towards' and accommodations of patients' expressions of religiosity and faith in dementia care.

AIMS: To investigate nurses' attitudes towards and accommodations of patients' expressions of religiosity and faith in dementia care. BACKGROUND: Holistic care for people with dementia addresses patients' religiosity and faith. Nurses' accommodations of patients' religiosity have not been studied extensively even though nurses report a lack of experience and knowledge regarding religious care. DESIGN: This study has a qualitative research design. METHODS: Eight focus group interviews with 16 nurses and 15 care workers in four Norwegian nursing homes were conducted from June 2011-January 2012. The interview text was analysed using van Manen's hermeneutic-phenomenological approach and Lindseth and Nordberg's structural analysis. FINDINGS: The following three main themes reflected the nurses' and care workers' attitudes towards and accommodations of patients' expressions of religiosity and faith: (i) embarrassment vs. comfort, described in the sub-themes 'feelings of embarrassment' and 'religiosity as a private matter'; (ii) unknown religious practice vs. known religious practice, described as 'religious practice that was scary' or 'religious practice that was recognizable'; and (iii) death vs. life, described as 'difficulty talking about death 'or 'focusing on life and the quality of life'. CONCLUSION: Nurses and care workers were uncertain and lacked knowledge of the patients' expressions of religiosity and faith in terms of both their substance and their function. Nurses struggled with ambivalent feelings about patients' religious expressions and with unclear understanding of the significance of religiosity. These challenges compromised person-centred and holistic care on several occasions.

Nurses' and care workers' experiences of spiritual needs in residents with dementia in nursing homes: a qualitative study.

BACKGROUND: The aim of the study was to investigate nurses' and care workers' experiences of spiritual needs among residents with dementia in nursing homes. Nurses claim to practice holistic nursing. Nevertheless, there is little knowledge about how to recognise spiritual needs in residents with dementia. METHODS: The study was conducted using a qualitative method with an exploratory design. Eight focus- group interviews in four Norwegian nursing homes were performed from June 2011 - Jan 2012. Using open-ended research questions, a total of 31 participants were asked to share their understanding and experiences regarding residents' spiritual needs. The interviews were analysed using a phenomenological - hermeneutical method. RESULTS: The nurses' and care workers' experiences of residents' spiritual needs were related to three main themes; i) The need for serenity and inner peace, described as "contemplative and restful moments" and "calmness due to familiarity", ii) The need for confirmation, described as "love and proximity" and iii) The need to express faith and beliefs, described as "participate in worship and prayers" and "approaching death". The comprehensive analyses revealed that the nurses believe the residents' spiritual needs were linked to the residents' previous sources of finding meaning, in relation to inter-personal, intra-personal and trans-personal dimensions in residents' lives. CONCLUSIONS: Nurses' and care workers' experiences of spiritual needs in people with dementia are very similar to the findings for the general population regardless of the severity of the dementia. The study's relevance to clinical practice indicates the importance of developing more knowledge about how people with dementia in nursing homes express spiritual needs and how to observe and interpret such needs.

Intellectual disability and mental health problems: a qualitative study of general practitioners' views.

OBJECTIVES: To investigate general practitioners' (GPs) experiences in managing patients with intellectual disabilities (ID) and mental and behavioural problems (MBP). DESIGN: Qualitative study using in-depth interviews. SETTING: General practice in Hedmark county, Norway. PARTICIPANTS: 10 GPs were qualitatively interviewed about their professional experience regarding patients with ID and MBP. Data were analysed by all authors using systematic text condensation. RESULTS: The participants' knowledge was primarily experience-based and collaboration with specialists seemed to be individual rather than systemic. The GPs provided divergent attitudes to referral, treatment, collaboration, regular health checks and home visits. CONCLUSIONS: GPs are in a position to provide evidence-based and individual treatment for both psychological and somatic problems among patients with ID. However, they do not appear to be making use of evidence-based treatment decisions. The GPs feel that they are left alone in decision-making, and find it difficult to find trustworthy collaborative partners. The findings in this study provide useful information for further research in the field.

[Memorial services after major accidents]. / Minnegudstjeneste etter større ulykker.

BACKGROUND: Memorial services in the acute phase after major accidents have been common in Norway since the late 1980ies. We have examined such services from the aspect of liturgy, rite and as help to cope in a crisis. This paper focuses mainly on the last item: What importance does the memorial service have for the participants? MATERIAL AND METHOD: We have interviewed nine bereaved and one rescuer who were involved in four accidents and participated in memorial services thereafter. Transcriptions of the interviews were coded in accordance with inductive code categories and were reorganized in a thematic structure that formed a basis for further analyses. RESULTS: For the bereaved, the situation was characterized by strong emotions and impressions. Some reported a great need to participate in the service; others were ambivalent due to emotional exhaustion and existential distress. Lighting candles and reading names created the strongest memories and were emphasized as important for handling the crisis. The participants experienced the church room as appropriate to enfold their emotions. The rituals helped to confirm reality and release grief, and they helped them to cope with emotional and existential aspects. INTERPRETATION: A memorial service is not therapy as such, but can be understood as a collective ritual response to an extensive crisis experience. Those who participate would also engage in rituals to deal with other emotionally and existentially challenging situations (i.e. funerals). Participation in the service seemed to reduce feelings of helplessness; it connected the individual to the community and contributed to create order in a chaotic situation.