A new treatment for eating disorders combining physical exercise and dietary therapy (the PED-t): experiences from patients who dropped out.

Purpose: Eating disorders (ED) are complex and severe illnesses where evidence-based treatment is needed to recover. However, about half of the patients with ED do not respond to treatments currently available, which call for efforts to expand the portfolio of treatments. The aim of this study was to explore experiences from patients who dropped out of a new treatment for bulimia nervosa and binge ED, combining physical exercise and dietary therapy (PED-t).Methods: We conducted open-ended face-to-face interviews. The interviews were transcribed verbatim and the data were analysed with a phenomenological hermeneutical approach.Results: Three themes emerged: "standing on the outside", "unmet expectations" and "participation not a waste of time". Feelings of standing on the outside were elicited by being different from other group members and having challenges with sharing thoughts. Unmet expectations were related to treatment content and intensity, as well as the development of unhealthy thoughts and behaviours. Finally, some positive experiences were voiced.Conclusion: A need to clarify pre-treatment expectations and refining criteria for treatment suitability is indicated. The findings have contributed to the chain of clinical evidence regarding the PED-t and may lead to treatment modifications improving the treatment and thereby reducing drop out.

Quality dementia care: Prerequisites and relational ethics among multicultural healthcare providers.

BACKGROUND:: Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. PURPOSE:: The aim of this study is to illuminate multi-ethnic healthcare providers' lived experiences of their own working relationship, and its importance to quality care for people with dementia. RESEARCH DESIGN:: The study is part of a greater participatory action research project: 'Hospice values in the care for persons with dementia'. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation. PARTICIPANTS AND RESEARCH CONTEXT:: Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins. ETHICAL CONSIDERATIONS:: The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services. FINDINGS:: The results show that good working relationships, characterized by understanding each other's vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings. DISCUSSION:: The results are discussed in the light of Lögstrup's relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech. CONCLUSION:: The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance.

Ethics and quality care in nursing homes: Relatives' experiences.

BACKGROUND: A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients' relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. AIM: The aim of the study is to investigate relatives of persons with dementia's experiences with quality care in nursing homes. METHOD: The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological-hermeneutical method for the study of lived experiences. PARTICIPANTS AND RESEARCH CONTEXT: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. ETHICAL CONSIDERATIONS: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. FINDINGS: Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives' experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives experienced powerlessness, distrust and guilt. DISCUSSION: The results are discussed considering the concepts of trust, power and asymmetry. CONCLUSION: When asked about experiences with quality care, the relatives spoke both of expectations met and of expectations not met. Results in this study are important knowledge for developing units where performing quality care is the overall aim.

Minority healthcare providers experience challenges, trust, and interdependency in a multicultural team.

BACKGROUND: The nursing community in the Nordic countries has become multicultural because of migration from European, Asian and African countries. In Norway, minority health care providers are recruited in to nursing homes which have become multicultural workplaces. They overcome challenges such as language and strangeness but as a group they are vulnerable and exposed to many challenges. PURPOSE: The aim is to explore minority healthcare providers, trained nurses and nurses' assistants, and their experiences of challenges when working in a multicultural team in a Norwegian context. RESEARCH METHOD: The study has a qualitative design, using narrative interviews, and a phenomenological-hermeneutic analysis method to explore the experiences of challenges in dementia care. ETHICAL CONSIDERATIONS: The study was approved by The Norwegian Regional Ethics Committee, and the Norwegian Social Science Data Services. PARTICIPATION AND RESEARCH CONTEXT: Five informants from different African, Asian and European countries participated in the study. The study was conducted in a Norwegian nursing home, in a dementia care unit. FINDINGS: The results show that minority health care providers experience and find meaning in being a member of a team, they overcome challenges, characterized by the interdependency in the team, appreciating new cultural experiences and striving to belong. They must overcome challenges such as language problems and the feeling of strangeness. DISCUSSION: The findings are discussed considering Løgstrup's ethic of proximity, the ethical demand of trust, and interdependency. The ethical demand is an answer to a common, transparent, unspoken agreement to be met, seen, and understood. CONCLUSION: The study shows that cooperation in a multi-professional and multi-ethnic team is important, and secures the quality of care to persons with dementia. Further research is necessary to examine the relation between a multi-ethnic staff and the patients experiencing dementia. Further research is necessary to examine ethnicity, the relation between a multi-ethnic staff, the patients experiencing dementia and next of kin.

Ethical and cultural striving: Lived experiences of minority nurses in dementia care.

BACKGROUND: Nursing workforce in Western European health institutions has become more diverse because of immigration and recruitment from Asian, African, and East-European countries. Minority healthcare providers may experience communication problems in interaction with patients and coworkers, and they are likely to experience conflict or uncertainty when confronted with different cultural traditions and values. Persons with dementia are a vulnerable group, and the consequences of their illness challenge the ability to understand and express oneself verbally. The large number of minority healthcare providers in nursing homes underlines the importance to obtain better knowledge about this group's experiences with the care challenges in dementia care units. RESEARCH QUESTION: Can you tell about any challenges in the experiences in the encounter with persons suffering from dementia? Participants and research context: Five minority healthcare providers in a nursing home, in a dementia unit. All guidelines for research ethic were followed. Ethical consideration: The participants were informed that participation was voluntary, and they were guarantied anonymity. METHOD: We used a qualitative method, conducting individual interviews, using a narrative approach. In the analysis, we applied a phenomenological-hermeneutical method, developed for researching life experiences. FINDINGS: One theme and four subthemes: striving to understand the quality of care for persons with dementia. The subthemes: sensitivity to understand the patients' verbal and nonverbal expressions. To understand gratefulness, understand the patient as an adult and autonomous person, and understand the patient as a patient in a nursing home. Challenges comprise both ethical and cultural striving to understand persons with dementia. CONCLUSION: To care for persons with dementia in an unfamiliar context may be understood as a striving for acting ethically, when at the same time striving to adapt and acculturate to new cultural norms, in order to practice good dementia care.

Ethical challenges when intensive care unit patients refuse nursing care: A narrative approach.

BACKGROUND: Less sedated and more awake patients in the intensive care unit may cause ethical challenges. RESEARCH OBJECTIVES: The purpose of this study is to describe ethical challenges registered nurses experience when patients refuse care and treatment. RESEARCH DESIGN: Narrative individual open interviews were conducted, and data were analysed using a phenomenological hermeneutic method developed for researching life experiences. PARTICIPANTS AND RESEARCH CONTEXT: Three intensive care registered nurses from an intensive care unit at a university hospital in Norway were included. ETHICAL CONSIDERATIONS: Norwegian Social Science Data Services approved the study. Permission was obtained from the intensive care unit leader. The participants' informed and voluntary consent was obtained in writing. FINDINGS: Registered nurses experienced ethical challenges in the balance between situations of deciding on behalf of the patient, persuading the patient and letting the patient decide. Ethical challenges were related to patients being harmful to themselves, not keeping up personal hygiene and care or hindering critical treatment. DISCUSSION: It is made apparent how professional ethics may be threatened by more pragmatic arguments. In recent years, registered nurses are faced with increasing ethical challenges to do no harm and maintain dignity. CONCLUSION: Ethically challenging situations are emerging, due to new targets including conscious and aware critical care patients, leaving an altered responsibility on the registered nurses. Reflection is required to adjust the course when personal and professional ideals no longer are in harmony with the reality in the clinical practice. RNs must maintain a strong integrity as authentic human beings to provide holistic nursing care.

Older peoples' narratives of use and misuse of alcohol and psychotropic drugs.

BACKGROUND: Studies revealed that misuse of drugs and alcohol is an increasing phenomenon among older people (aged 65 years and above), and we know that such misuse is a risk factor for mortality and morbidity. Furthermore, we do not know to what extent older people have experiences, understanding and knowledge about the use and misuse of alcohol and psychotropic drugs. AIM: To investigate older peoples' experiences with and reflections on the use and misuse of alcohol and psychotropic drugs among older people. METHOD: Qualitative interviews with 16 older people were performed during 2013 and 2014. The sample included informants aged from 65 to 92 years from 11 municipalities. The data were analysed by using the phenomenological hermeneutic method. FINDINGS: The first theme that arose from the informants' narratives was to be a part of a culture in change that details the informants' experiences with and reflections on the cultural changes regarding the use and misuse of alcohol and psychotropic drugs. This theme is divided into three subthemes: to use and attitudes toward use, to trivialise use and risks of use, and to disclaim responsibility for use and misuse. The second theme, to explain use and misuse involved reasons for the use and misuse of alcohol and psychotropic drugs. It included the subthemes: to be afraid, to be lonely, and to be informed. CONCLUSION: The study revealed that most informants had experiences with the use of alcohol and psychotropic drugs, but disclaimed any challenges with their use. The use was trivialised and seen as something older people just do. They disclaimed responsibility for their own psychotropic use as their general practitioners were defined as the responsible persons. Moreover, the study showed that the informants had poor knowledge about the risk of use and misuse of alcohol and psychotropic drugs.

Ethical challenges: Trust and leadership in dementia care.

INTRODUCTION: To meet and take care of people with dementia implicate professional and moral challenges for caregivers. Using force happens daily. However, staff also encounter challenges with the management in the units. Managing the caretaking function is also significant in how caretakers experience working in dementia care. PURPOSE: The purpose of this study is to explore the caregiver's experiences with ethical challenges in dementia care settings and the significance of professional leadership in this context. METHOD: The design is qualitative, and data appear through narrative interviews. A total of 23 caretakers participated in the study. The transcribed interviews were subjected to a phenomenological-hermeneutical interpretation. ETHICAL CONSIDERATIONS: The respondents signed an informed consent for participation prior to the interviews. They were assured anonymity and confidentiality in the publication of the data. Ricoeur's method for interpretation ensures anonymity as the researcher relates to the data as one collective text. The study is part of a larger research project in ethics, in its entirety approved in line with the Helsinki Convention. RESULTS: The findings show that the caretakers experienced inadequacy. Some of them described a negative work atmosphere where they experienced that their leaders did not take them seriously. Because of this, informal negative sub-groups functioned as an exclusive debriefing arena. Some of the informants described the opposite experience where the leaders actively supported them. DISCUSSION: The analyses of the findings are discussed in light of the concepts of trust and mistrust in leadership. CONCLUSION: There is a correlation between the leadership and the caregivers' experience of being in difficult situations.

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.

The power of consoling presence - hospice nurses' lived experience with spiritual and existential care for the dying.

BACKGROUND: Being with dying people is an integral part of nursing, yet many nurses feel unprepared to accompany people through the process of dying, reporting a lack of skills in psychosocial and spiritual care, resulting in high levels of moral distress, grief and burnout. The aim of this study is to describe the meaning of hospice nurses' lived experience with alleviating dying patients' spiritual and existential suffering. METHODS: This is a qualitative study. Hospice nurses were interviewed individually and asked to narrate about their experiences with giving spiritual and existential care to terminally ill hospice patients. Data analysis was conducted using phenomenological hermeneutical method. RESULTS: The key spiritual and existential care themes identified, were sensing existential and spiritual distress, tuning inn and opening up, sensing the atmosphere in the room, being moved and touched, and consoling through silence, conversation and religious consolation. CONCLUSIONS: Consoling existential and spiritual distress is a deeply personal and relational practice. Nurses have a potential to alleviate existential and spiritual suffering through consoling presence. By connecting deeply with patients and their families, nurses have the possibility to affirm the patients' strength and facilitate their courage to live a meaningful life and die a dignified death.

Responsible but unprepared: experiences of newly educated nurses in hospital care.

The purpose of this study was to highlight the experience of being newly educated nurses working in internal medicine and surgical units. The nurses were asked to recount their initial work experiences using a narrative approach. A phenomenological hermeneutic method developed for life experience research was applied in the analyses. The study participants were surprised by the discrepancy between the ideals and the theoretical and practical knowledge gained during their nursing education, and the assigned hospital tasks designated as routine care. Prominent features of this were a focus on medical diagnostics and treatment, task orientation and efficiency. Holistic nursing was not felt to be a priority within the unit. This led to frustration and feelings of inadequacy and unpreparedness. They also felt that the responsibility was overwhelming. The findings described are discussed in the context of related publications.

Quality care for persons experiencing dementia: the significance of relational ethics.

The degree of success in creating quality care for people suffering from dementia is limited despite extensive research. This article describes healthcare providers' experience with the ethical challenges and possibilities in the relationship with patients suffering from dementia and its impact on quality care. The material is based on qualitative, in-depth individual narrative interviews with 12 professional healthcare providers from two different nursing homes. The transcribed interview texts were subjected to a phenomenological-hermeneutical interpretation. To provide quality care to patients with dementia, the healthcare providers emphasized the importance of sensing and understanding the patients' emotional and bodily expressions through sentient attentiveness and recognition of the patient as a person. They also described reciprocity of expressions in the relationship where the patient recognized them both as persons and healthcare providers. The analyses of the findings are, inter alia, discussed in light of Løgstrup's relational philosophy of ethics.

Lesbian women's experiences with healthcare providers in the birthing context: a meta-ethnography.

OBJECTIVE: to explore research knowledge about lesbian women's experiences with health-care providers in the birthing context. METHOD: a systematic search for relevant qualitative studies in selected databases identified 13 articles of sufficient quality. The findings were synthesized using a meta-ethnographic approach as described by Noblit and Hare. SYNTHESIS AND FINDINGS: issues related to covert or overt homophobia and prejudice were demonstrated and were sometimes mediated by subtle mechanisms that were difficult to understand and to manage. On the other hand, small gestures of support were described to make a huge difference. A lack of knowledge was demonstrated, contrasted by staff showing a positive and informed attitude. Disclosure was an important issue, but due to the risk involved the women demonstrated a need to be in control. Finally, being acknowledged, both as individuals and as family were considered vital. In this regard, it was essential to recognize and include co-mother as equal parent and to look upon lesbian sexuality as normal and natural. KEY CONCLUSIONS: midwives' emotional involvement in the situation is significant for moral perception of the women's intimate citizenship, even when they are distressed by lesbian sexuality. IMPLICATIONS FOR PRACTICE: our findings reveal the importance of including sexuality as an issue deserving reflection in maternity wards, whether or not this might cause unrest in midwives who do not feel comfortable with intimate citizenships beyond mainstream.

Time ethics for persons with dementia in care homes.

The purpose of this study was to explore situations experienced by 12 health-care providers working in two nursing homes. Individual interviews, using a narrative approach, were conducted. A phenomenological-hermeneutical method, developed for researching life experiences, was applied in the analysis. The findings showed that good care situations are experienced when the time culture is flexible, the carers act in a sovereign time rhythm, not mentioning clock time or time as a stress factor. The results are discussed in terms of anthropological and sociological theory: time as event and action and flexible time cultures. Care settings for persons with dementia represent many challenges, such as a heavy workload and time strain. Time ethics is a construction, understanding time used in caring for persons suffering from dementia, which involves a mature, responsible and flexible nursing approach to these patients.

Dealing with fear - from the perspective of adolescent girls with cancer.

BACKGROUND: Previously fears in adolescents with cancer has been identified in relation to medical procedures, death, altered appearance and as having an overall influence on life, but to our knowledge young people's perspectives on dealing with fear have not been previously investigated. PURPOSE: To examine adolescents' perspectives on dealing with cancer related fear. METHODS AND SAMPLE: Six girls participated in qualitative interviews focussing on their fear and and how they dealt with it. Data were analysed by means of qualitative content analysis. RESULTS: The results revealed two perspectives. First, the adolescents' own personal battle with fear. Second, they reported that they were not alone with their fear, as they shared it with significant others. An environment characterized by emotional presence helped them to deal with their fear, as well as prevented it from occurring. CONCLUSIONS: There is a need for staff and parents to be vigilant to the adolescents' need to feel cared for and allow them the opportunity to deal with their own fear, as at times they want to manage in their own way. Young patients have resources to cope with their fears and therefore should not be viewed as victims, but as young people with a great amount of competence, who benefit from a supportive environment.

An expression of love--midwives' experiences in the encounter with lesbian women and their partners.

AIM: This paper is a report of a descriptive study of midwives' lived experiences of caring for lesbian women and their partners. BACKGROUND: A growing body of qualitative studies describes lesbian women's experiences of maternity care. Studies about midwives' caring experiences in the encounter are needed to improve care for lesbian women and their partners. METHOD: A qualitative study, using a phenomenological-hermeneutical method influenced by Ricoeur was conducted. Eleven midwives were recruited by snowball method. Interviews were conducted in 2009 and participants were encouraged to share events in their midwifery practice encountering lesbian women. FINDINGS: The midwives described the lesbian love-relationship as strong and caring, but including elements of difference which could make the couple vulnerable. It was important for midwives to acknowledge their own attitudes and culturally sensitive non-verbal communication; also to consider the co-mother's needs and role as different compared with those of fathers. Although caring for lesbian couples was seen as unproblematic, midwives described experiences of ambivalence or anxiety in the encounter and they had noticed that some couples had had negative experiences with maternity care. CONCLUSION: Studies are required to map content, consequences and coping strategies regarding the ambivalent or uncertain caring situations and to assess a co-mother's particular role and needs during pregnancy, labour and the postnatal period to provide tailored care for lesbian couples.

Ethical challenges in nursing emergency practice.

AIM: The aim of this study is to illuminate nurses' experiences of being in ethically difficult situations in an emergency ward. BACKGROUND: Nurses working in emergency practice are frequently faced with ethical issues and challenges in their work. Many studies have been conducted concerning ethical challenges, but no empirical studies related to ethics in emergency wards in Norway have been carried out. DESIGN: A qualitative interview study was conducted. METHOD: Five registered nurses were interviewed about their experiences in an emergency ward in a hospital in Norway. The concept of ethically difficult situations was not defined that the question was left open for the respondents themselves to define what they experienced as ethically difficult. A phenomenological hermeneutical method was used. RESULTS: The most salient point revealed by the study is the enormous difficulty associated with the prioritisation of tasks and the attendant sense of responsibility which this entailed, particularly in the case of nurses in charge. The narratives reveal the vulnerability of the nurses in ethically challenging situations. CONCLUSIONS: Despite the pressure of responsibility for their patients, the nurses enjoy a sense of satisfaction in their work. Those recognising the ethical dimension in their own professional practice are unable to hide behind others and thus evade their share of the responsibility. RELEVANCE TO CLINICAL PRACTICE: Nurses with similar experiences may find the results credible recognising the descriptions or interpretations and seeing them in relation to similar situations. Nurses working on medical and surgical wards, in nursing homes and community care may also feel a great responsibility, difficulties in prioritising and a lack of time for the patients.

Parental handling of fear in children with cancer; caring in the best interests of the child.

The aim of this study was to gain a deeper understanding of how parents of children with cancer handle the fear in their children. Fifteen parents of 11 children participated in focus-group interviews. Data were analyzed by a phenomenological hermeneutical method. The results suggest that the parents' handling was equivalent with caring in the best interests of the child. This included striving for the security and well-being of the child up to a certain point where the parents instead used their authority to maintain the child's physical health rather than trying to prevent or relieve the child's fear.

Dignity of older people in a nursing home: narratives of care providers.

The purpose of this study was to illuminate the ethically difficult situations experienced by care providers working in a nursing home. Individual interviews using a narrative approach were conducted. A phenomenological-hermeneutic method developed for researching life experience was applied in the analysis. The findings showed that care providers experience ethical challenges in their everyday work. The informants in this study found the balance between the ideal, autonomy and dignity to be a daily problem. They defined the culture they work in as not supportive. They also thought they were not being seen and heard in situations where they disagree with the basic values of the organization. The results are discussed in terms of Habermas's understanding of modern society. Care settings for elderly people obviously present ethical challenges, particularly in the case of those suffering from dementia. The care provider participants in this study expressed frustration and feelings of powerlessness. It is possible to understand their experiences in terms of Habermas's theory of modern society and the concept of the system's colonization of the life world.