Sharing the Same Reality, Healthy Relations Between Colleagues at Work: A Meta-Synthesis.

Introduction: Good relations are important at work, leading to well-being among coworkers. Since the latest research in nursing is mostly about bullying, and lateral violence, it was important to study what healthy relations mean. Objectives: The aim was to identify and synthesize qualitative studies that describe healthy relations, creating health and well-being between colleagues at work. Methods: A meta-synthesis approach, inspired by Sherwood's steps of analysis, was chosen for this study. Ten articles from three continents, comprising 230 participants, were included. Results: Two themes were identified as follows: (a) creating a mutual bond on a personal level and a permissive atmosphere through the human warmth; and (b) sharing togetherness in a greater whole, offering unconditional help and devoting themselves to taking care of each other. An overarching metaphor implicating the home/homeness was abstracted from the two themes: "Healthy relations between colleagues at work constitute the community as a common world, containing feelings of being at home, implying acting in an expression of the ethos and dignity, a culture created that makes the ideal form of healthy relations visible." Conclusion: Nurses find their meaning when they work in a permissive environment, and when they are allowed to be themselves. Such meaning can be found through their engagement with one another, by offering each other unconditional help. Good relationships lead to a place they call their home, where there is trust and friendship.

Managerial challenges faced by Swedish nurse managers in perioperative settings- a qualitative study.

BACKGROUND: Nurse managers need to create cultures that are worthy, not only of the commitment of everyone who comes to work but also of the trust of everyone who comes to be served. The aim of our study was to describe the challenges faced by Swedish nurse managers in a perioperative setting. METHODS: A qualitative study was conducted. The participants were chosen by convenience sampling, and individual in-depth interviews were conducted. Data were analysed by Systematic Text Condensation. The COREQ checklist was consulted throughout the study to optimise the quality. RESULTS: Nineteen nurse managers (all women) participated. Six themes were identified: "striving to treat employees with consideration and solicitude"; "the obligation to take care of each employee's individual needs"; "convincing others was an uphill battle", "finding solutions when things seem impossible"; "staff recruitment, allocation, and management"; "working with constantly changing planning". CONCLUSIONS: The nurse managers faced challenges because of the overwhelming amount of work tasks, with almost no time for reflection. Having carefully chosen tasks and a realistic time schedule for each work task, plus time to find one's own path to inner peace, are essential for nurse managers. Organisations that provide these prerequisites show that they care about their nurse managers. The results of this study indicate the need for time to reflect, as well as support from superior managers and from the human resources department.

Reaching a tipping point: Perioperative nurse managers' narratives about reasons for leaving their employment-A qualitative study.

AIM: To describe reasons why nurse managers in perioperative settings decide to leave their employment. BACKGROUND: Current literature has shown that perioperative nurse managers' reasons to leave their positions are formed through an interaction of factors. METHODS: Individual in-depth interviews were performed with seven nurse managers, all women, in perioperative settings in Sweden. Data were analysed using systematic text condensation. RESULTS: Five key themes were identified: (a) to end where I started, as a frontline nurse; (b) I wanted to develop further to the next level in my career; (c) I ran out of ideas; (d) I lost trust in my head manager and did not believe in the new organisation and (e) I had had enough of being offended by my superior manager and my employees. CONCLUSION: Nurse managers experienced feeling forced into a decision to leave because of being offended by their superiors or their employees. Furthermore, the findings indicate that nurse managers should be offered support from superior managers and the organisation together with time for discussions. IMPLICATIONS IN NURSING MANAGEMENT: The most essential element should be the influence of caritative leadership and the obvious expectation of being treated with dignity, respect and appreciation.

Nurse managers in perioperative settings and their reasons for remaining in their jobs: A qualitative study.

AIM: The study describes what helps nurse managers maintain the strength to keep going as leaders. BACKGROUND: Good leadership is important for the quality of patient care, patient satisfaction in care and efficiency. Many nurse managers stay on despite challenges at work. METHODS: Twelve nurse managers were interviewed. Data were analysed by systematic text condensation according to Malterud. RESULTS: The results were as follows: A-Walking side by side with my employees; B-Knowing that I mean something to my employees; C-Talking to myself-asking myself tough questions; D-Having someone to talk to, to decrease the feeling of being alone; E-Leading and managing in my own way-the fear of not succeeding is my motivation. CONCLUSION: The nurse managers built their own strategies to get through and get on when difficult situations arose. In order to succeed in leading their employees, the nurse managers gathered their inner strength through moving caritatively back and forth between the 'secret room' and the 'staff room' in the house of leadership. IMPLICATIONS IN NURSING MANAGEMENT: The manuscript gives insights into where nurse managers found sources of strengths in their everyday work. To realize their employees' strengths and motivation made a difference for nurse managers as a driving force. By having someone to talk to and by asking themselves tough questions, they were prepared for the challenges that came.

Interacting with parents in Sweden who hesitate or refrain from vaccinating their child.

The purpose of this study was to explore nurses' experiences of encountering parents who are hesitant about or refrain from vaccinating their child. A qualitative approach was chosen and data collected through individual, semi-structured interviews with 12 nurses. The text was analyzed using thematic analysis. Three themes emerged from the interviews: giving room and time for acknowledging parents' insecurity concerning vaccination, striving to approach the parents' position with tact, and a struggle between feelings of failure and respect for the parents' view. The findings indicate that it was crucial to give time, be tactful when meeting parents, as well as to appear credible and up-to-date. The nurses wanted to be open and respect the parents' views on vaccination but found it difficult and frustrating to be unable to reach out with their message because their quest was to protect the child.

I Stay-Swedish Specialist Nurses in the Perioperative Context and Their Reasons to Stay at Their Workplace.

PURPOSE: To investigate why nurse anesthetists and operating room nurses choose to stay in the same workplace. DESIGN: Qualitative design. METHODS: Individual interviews were conducted with 15 nurse specialists from four hospitals in Sweden. Two men and 13 women aged between 43 and 63 participated. Data were analyzed with systematic text condensation according to Malterud. FINDINGS: Three themes were identified. (1) Organizational stability contributed to low staff turnover, with good spirits between colleagues, representing everyone's equal value and resulting in a feeling of homelikeness. (2) Sustained development in one's own profession. (3) A humane head nurse who was at hand, who was a facilitator, who knew staff members, and eliminated obstacles for them. CONCLUSIONS: In a nonhierarchical and stable organization with a head nurse with caritative leadership skills, a welcoming working environment with opportunities for professional development is created. Thus, nurse specialists choose to stay, contributing to organizational development.

International Nursing: Caring in Nursing Leadership-A Meta-ethnography From the Nurse Leader's Perspective.

To explore and derive new conceptual understanding of nurse leaders' experiences and perceptions of caring in nursing. RESEARCH QUESTION: What is caring in nursing leadership from the nurse leaders' perspectives? There is a paucity of theoretical studies of caring in nursing leadership. Noblit and Hares interpretative meta-ethnography was chosen because of its interpretative potential for theory development. Caring in nursing leadership is a conscious movement between different "rooms" in the leader's "house" of leadership. This emerged as the metaphor that illustrates the core of caring in nursing leadership, presented in a tentative model. There are 5 relation-based rooms: The "patient room," where nurse leaders try to avoid patient suffering through their clinical presence; the "staff room," where nurse leaders trust and respect each other and facilitate dialogue; the "superior's room," where nurse leaders confirm peer relationships; the "secret room," where the leaders' strength to hang on and persist is nurtured; and the "organizational room," where limited resources are continuously being balanced. Caring in nursing leadership means nurturing and growing relationships to safeguard the best nursing care. This presupposes that leaders possess a consciousness of the different "rooms." If rooms are not given equal attention, movement stops, symbolizing that caring in leadership stops as well. One room cannot be given so much attention that others are neglected. Leaders need solid competence in nursing leadership to balance multiple demands in organizations; otherwise, their perceptiveness and the priority of "ministering to the patients" can be blurred.

I am quitting my job. Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job.

The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university- and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.

Patients´ Variations of Reflection About and Understanding of Long-Term Illness- Impact of Illness Perception on Trust in Oneself or Others.

BACKGROUND: Patients' understanding of their illness is of great importance for recovery. Lacking understanding of the illness is linked with the patients' level of reflection about and interest in understanding their illness. OBJECTIVE: To describe patients' variations of reflection about and understanding of their illness and how this understanding affects their trust in themselves or others. METHOD: The study is based on the "Illness perception" model. Latent content analysis was used for the data analysis. Individual, semi-structured, open-ended and face-to-face interviews were conducted with patients (n=11) suffering from a long-term illness diagnosed at least six months prior to the interview. Data collection took place in the three primary healthcare centres treating the participants. RESULTS: The results show variations in the degree of reflection about illness. Patients search for deeper understanding of the illness for causal explanations, compare different perspectives for preventing complication of their illness, trust healthcare providers, and develop own strategies to manage life. CONCLUSION: Whereas some patients search for deeper understanding of their illness, other patients are less reflective and feel they can manage the illness without further understanding. Patients' understanding of their illness is related to their degree of trust in themselves or others. Patients whose illness poses an existential threat are more likely to reflect more about their illness and what treatment methods are available.

Strategies for healthcare professionals to facilitate patient illness understanding.

AIMS AND OBJECTIVES: To describe how healthcare professionals facilitate patient illness understanding. BACKGROUND: Healthcare professionals and patients differ in their illness understanding. If the information provided by healthcare professionals is not adapted to the patient's daily life, it may be unusable for the patient. Previous research has found that healthcare professionals should individualise the information to enable the patient to apply the knowledge to the personal situation and to develop illness understanding. However, little is known of how healthcare professionals can facilitate patient illness understanding. METHOD: A qualitative descriptive study based on individual, semi-structured, open-ended and face-to-face interviews was conducted with healthcare professionals (n = 11) concerning how they facilitate patients illness understanding. Three health centres were involved during the period of March to November 2014. The interviews were analysed with qualitative content analysis. RESULTS: The result identified a continuous and collaborative process with three strategies used by healthcare professionals to facilitate the patient's illness understanding: (i) assess the patient's illness understanding, (ii) interact with the patient to develop illness understanding and (iii) support the patient's personal development for illness understanding. The steps in the process depend on each other. CONCLUSIONS: The results of our analysis indicate that healthcare professionals can use the continuous and collaborative process to enhance the patient's self-care ability and turn his or her knowledge into action for improving illness understanding. RELEVANCE TO CLINICAL PRACTICE: The three continuous and collaborative process strategies involving pedagogical approaches can create conditions for healthcare professionals to obtain a holistic view of the patient's life and to be a key resource for person-centred care.

The meaning of person-centred care in the perioperative nursing context from the patient's perspective - an integrative review.

AIMS AND OBJECTIVES: To determine the meaning of person-centred care from the patient's perspective and in the context of perioperative nursing. BACKGROUND: Person-centred care is used, but not defined in the perioperative context. The concept indicates an interest in the patient's own experience of health, illness, needs and preferences. As with many terms that are frequently used, there is a tendency for person-centred care to mean different things to different people in different contexts. DESIGN: Integrative Review. METHODS: A two-part search strategy was employed: first, a computerised database search of PubMed and CINAHL, using Medical Subject Headings and free terms to search articles dating from 2004-2014, was performed, and second, a hand-search of those articles' reference lists was performed. Twenty-three articles were selected, and an integrative review was conducted. RESULTS: Four themes were discovered: 'being recognised as a unique entity and being allowed to be the person you are', 'being considered important by having one's personal wishes taken into account', 'the presence of a perioperative nurse is calming, prevents feelings of loneliness and promotes well-being, which may speed up recovery' and 'being close to and being touched by the perioperative nurse during surgery'. CONCLUSIONS: Person-centred care means respecting the patient as a unique individual, considering the patient's particularities and wishes and involving the patient in their own care. Person-centred care also implies having access to one's own nurse who is present both physically and emotionally through the entire perioperative process and who guides the patient and follows up postoperatively, guaranteeing that the patient is not alone. RELEVANCE TO CLINICAL PRACTICE: By having a common understanding of the concept of person-centred care, the nurse anaesthetists' and theatre nurses' caring actions or concerns will be directed towards the patient, resulting in personalisation of care rather than simply defining the concept.

Nursing students' attendance at learning activities in relation to attainment and passing courses: A prospective quantitative study.

BACKGROUND: Students' motivation and ways of engaging in their schoolwork are important for their performance, including passing exams. Attendance at learning activities has also been argued to be of major importance, although no causal relationship with passing exams has been established in nursing education. OBJECTIVES: The aim of this study was to describe the impact of attendance at nonmandatory learning activities on attainment, in terms of passing or failing of exams, in nursing education courses including both mandatory and non-mandatory activities. DESIGN: A prospective quantitative design. SETTING: The nursing education programme at a Swedish university. PARTICIPANTS: Nursing students (n=361) from two courses and four classes within the nursing programme. METHODS: Attendance was registered at every non-mandatory teaching activity by asking the students to note their attendance on a list. Data such as sex, age, and whether the students had passed the exam were also collected for each course and each semester separately. RESULTS: Increased participation was associated with an increasing proportion of students passing the exam. The chance of passing the exam increased by 13% for every additional learning occasion attended. Logistic regression showed an OR of 5.4 for an attendance of 100%. CONCLUSIONS: An increase in attendance gave a higher proportion of exam passes. Encouraging students to attend non-mandatory learning activities could be of value, and potentially contribute to an increased graduation rate for nursing students.

Learning to fly with broken wings - forcing a reappraisal of time and space.

BACKGROUND: When living with a chronic disease, the whole human being is affected and his/her experience of health challenged. AIM: This study had a dual aim: to obtain a new understanding of experiences of the body among persons suffering from the chronic neurological disease multiple sclerosis (MS) and how they come to terms with such experiences. METHOD: A total of ten interviews were re-analysed using a hermeneutic approach. RESULTS: The experiences of the body were revealed as 'Learning to fly with broken wings', comprising two themes: 'Getting to know the foreign body' and 'Building a new living space', both requiring reappraisal of time and space. CONCLUSION: Living with a chronic disease such as MS means learning to fly with broken wings, which involves subordination to the body leading to a higher level of integration in the process of becoming towards health and well-being.

Growing as a Human Being--Obese Adolescents' Experiences of the Changing Body.

The aim of the presented study was to describe how obese adolescents experience themselves and their bodies and how their views changed as a result of participation in a weight loss program. A total of five adolescents were interviewed in this qualitative study. Data were analyzed by means of content analysis. One main theme emerged, "Growing as a human being", which comprised four themes based on 13 sub-themes. Being part of a weight loss program was a time of transition that led not only to weight reduction but also to a higher level of well-being and a feeling of dignity.

Feeling rejected or invited: experiences of persons seeking care advice at the Swedish Healthcare Direct organization.

AIM: Swedish Healthcare Direct is an organization staffed by registered nurses who act as telenurses and assess callers' need for care, taking both medical and personal aspects into account. They direct the care seeker to: emergency care (level I), a care center on duty (level II), their regular doctor (level III), or provide advice about self-care strategies (level IV). In this assessment process, the nurse and care seeker should reach mutual agreement. The aim and focus of the present study was to elucidate the care seeker's situation and experiences of the care received after being triaged and directed to level II, although the telenurse in fact assessed their medical problems as corresponding to level III. METHODS: A total of eight recent Swedish Healthcare Direct users were interviewed in this qualitative study. Data were analyzed by means of content analysis. RESULTS: Three themes emerged - "feeling trapped", "feeling disrespected", and "feeling invited" - comprising seven subthemes. CONCLUSION: Care seekers experienced suffering as well as struggling to be allowed to be a patient. When not met by an ethically correct stance, they continued to seek care. In contrast, when they encountered commitment and an ethically correct attitude, their health process began and they had no further need for contact.

Being altered by the unexpected: understanding the perioperative patient's experience: a case study.

The present paper focuses on the process of understanding the patient in the context of perioperative caring and reports a story narrated by a perioperative nurse as well as her emerging understanding of the patient prior to surgery at an operating department. This qualitative case study had a dual purpose; firstly, to describe how the perioperative nurse's understanding of the patient emerged and, secondly, to establish how the researcher interpreted the situation. As a perioperative nurse and researcher, the author is both the narrator and interpreter. To date we have rarely discussed the fact that, in a perioperative context, the patient might feel ashamed of his/her body, even before arriving at the operating department. This new understanding emerged from the hermeneutical dialogue in the present study.

Experiences of spirituality and spiritual values in the context of nursing - an integrative review.

Spirituality is often mistakenly equated with religion but is in fact a far broader concept. The aim of this integrative review was to describe experiences of the positive impact of spirituality and spiritual values in the context of nursing. The analysis was guided by Whittemore and Knafl's integrative review method. The findings revealed seven themes: 'Being part of a greater wholeness', 'Togetherness - value based relationships', 'Developing inner strength', 'Ministering to patients', 'Maintaining one's sense of humanity', 'Viewing life as a gift evokes a desire to 'give back'' and 'Achieving closure - life goes on'. It is difficult to draw definite conclusions, as spirituality involves many perspectives on various levels of awareness. However, spirituality was considered more inclusive, fluid and personal. Furthermore, it emerged that spirituality and spiritual values in the context of nursing are closely intertwined with the concept of caring.

Nursing students' perspectives on the patient and the impact of the nursing culture: a meta-synthesis.

AIM: To explore and interpret how nursing students develop their understanding of the patient as a human being. BACKGROUND: Understanding the patient is the main characteristic of good, caring performance. In addition, nurse leaders play an active role in creating a culture in which nursing students can flourish and improve. METHOD: This meta-synthesis was based on Noblit and Hare's meta-ethnography. RESULTS: The overarching metaphor was interpreted as the nursing students' capacity for compassion. Two central metaphors were revealed, based on how nursing students developed their understanding of the patient as a human being. These central metaphors were labelled 'The open door', comprising seven key metaphors and 'The closed door' based on two key metaphors. CONCLUSION: During practical training, the students observed both virtuous and unkind nurses. Virtue is a skill that can be taught, but not all students were able to learn it. Some students acquired the ability to reflect on ethical issues, while others did not. Therefore, good role models are of major importance. IMPLICATION FOR NURSING MANAGEMENT: The nurse leader should function as a facilitator in the students' efforts to gain the capacity to face the suffering patient and to develop an understanding of the patient's situation.

Suffering and suffering with the other - the perspective of perioperative nurse leaders.

AIM: To capture and interpret meanings of suffering from the perspective of perioperative nurse leaders. BACKGROUND: There are few studies focusing on suffering and the meaning of being a nurse leader in a perioperative context. METHOD: Hermeneutic interpretation of interviews with nurse leaders. RESULTS: A main theme of suffering emerged as learning and non-learning. Suffering as learning comprised 'struggling to come to terms with being misunderstood', 'struggling to wait patiently to be allowed to help', 'struggling to manage daily tasks' and 'struggling to be worthy of the trust of superiors'. Suffering as non-learning comprised 'feeling alone when in charge', 'feeling guilty about not managing daily tasks', 'feeling mistrusted by superiors', 'feeling unfairly criticized', 'feeling humiliated owing to loss of responsibilities' and 'feeling unable to help'. CONCLUSION: Suffering is good when the mission of caring is mastered and the nurse leader feels recognized as unique and trustable, leading to his or her sense of dignity being preserved. Suffering is evil when the mission of caring is threatened, when questioned and not considered a unique and trustable person, leading to loss of dignity. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders' suffering needs to be acknowledged and a caring culture that permeates the entire organization should be developed.

The perioperative dialogue: holistic nursing in practice.

This article is a synthesis of 2 qualitative studies focusing on patients', anesthetists', and operating-room nurses' experiences of the perioperative dialogue and employing grounded theory as the method of analysis. The aim of the synthesis was to achieve a new holistic understanding of health in the perioperative dialogue. The synthesis highlights the importance of being in communion in a continuous whole due to continuity of care for the creation of health in both patients and nurses.