Mothers' experiences of feeding babies born with cleft lip and palate.

Cleft lip and palate (CLP) in newborns have implications for feeding. It might impede the child's attempts to seal around the nipple and to create intraoral pressure. Parents needed support and information about feeding after birth. Mothers' own experiences and how they coped with the challenges related to feeding have not been extensively studied. The aims of this study were twofold: to describe the experiences of feeding for mothers of children born with CLP and to elucidate how the mothers cope with the challenges related to feeding. A qualitative descriptive method and phenomenographic analysis were used to analyse the narratives. Twelve mothers of babies with CLP were strategically selected and interviewed. A semi-structured interview guide was used. Ethical approval for the study was granted by the local ethical committee. The findings resulted in two main categories and five subcategories. The first main category, Being a capable and good mother, included descriptions associated with the mothers' strong desire to do what was best for the child and about how they experienced feeding. The second main category, Coping with the challenges related to feeding, included descriptions of what the mothers perceived as important in order to cope with the challenges related to feeding; of how personal resources were used; of the significance of the father and close family; and of how healthcare professionals contributed. In conclusion, mothers of children born with CLP were in need of individual information by healthcare professionals with expertise, at the time of the diagnosis and until the feeding was manageable. Furthermore, the mothers' personal resources, the fathers and immediate family were of major importance for the mothers to cope with challenges related to feeding.

Patient's sexuality - a neglected area of cancer nursing?

PURPOSE: The purpose of this study was to describe nurses' conceptions of dialogues about sexuality with cancer patients. METHODS: The study was carried out using phenomenographic method. Ten nurses from different care contexts where nurses meet cancer patients in various phases of trajectory of care were interviewed. RESULTS: The analysis revealed one main category 'We should talk about sexuality - but we usually don't' and three descriptive categories consisting of nurses' qualitatively different conceptions of talks about sexuality: (1) nurses' attitudes, knowledge and skills are impacting, (2) patients' sexual problems are the basis for dialogues and (3) the ward environment is impacting. The main category was hierarchically ranged and could be further understood by the descriptive categories. CONCLUSION: The study showed that cancer patients' need of talks about and support regarding sexuality were conceived as being low during the whole trajectory of care. Despite this the nurses conceived that they should talk about sexuality with the patients, but due to own attitudes, knowledge and skills, as well as conditions in the ward environment they usually did not. Further studies are needed to clarify how cancer patients especially with non-sex specific diagnosis describe their sexual problems and needs of support in regard to sexuality. About what, when, how and by whom, cancer patients and their partners want information and supportive care related to sexuality need to be clarified.

Elderly persons' experiences of striving to receive care on their own terms in nursing homes.

Elderly persons' participation in and decisions about their own care need more attention. The aim of this study was to gain a deeper understanding of elderly persons' experiences of care and help, and how their lives change in nursing homes. Fifteen elderly persons living in four nursing homes were interviewed about their experiences of needing care and help in their daily life. The interviews were analysed using van Manen's phenomenological approach. Elderly persons' experiences of care and help were described as: a balance between sorrow and relief, a struggle to maintain control and connectedness, managing to live in the present and yet worrying about the future, and an attempt to hide one's vulnerability in order to be accepted and create an inner calm in an exposed situation. In conclusion, important issues were raised concerning elderly persons' perspectives on care and help in daily life in nursing homes.

Enjoying tactile touch and gaining hope when being cared for in intensive care--a phenomenological hermeneutical study.

Touch has been a part of the healing process in many civilisations and cultures throughout the centuries. Nurses frequently use touch to provide comfort and reach their patients. The aim of this study was to illuminate the meaning of receiving tactile touch when being cared for in an intensive care unit. Tactile touch is a complementary method including the use of effleurage, which means soft stroking movements along the body. The context used to illuminate the meaning of receiving tactile touch was two general intensive care units (ICUs). Six patients, who have been cared for in the two ICUs, participated in the study. A phenomenological-hermeneutical method based on the philosophy of Ricoeur and developed for nursing research by Lindseth and Norberg [Lindseth A, Norberg A. A phenomenological hermeneutical method for researching lived experience. Scandinavian Journal of Caring Sciences, 2004;18:145-53] was chosen for the analysis. Data consisted of narratives, which were analysed in three recurring phases: naïve understanding, structural analyses and comprehensive understanding. Two main themes were found: being connected to oneself and being unable to gain and maintain pleasure. The comprehensive understanding of receiving tactile touch during intensive care seems to be an expression of enjoying tactile touch and gaining hope for the future. This study reveals that it is possible to experience moments of pleasure in the midst of being a severely ill patient at an ICU and, through this experience also gain hope.

The outcome of tactile touch on stress parameters in intensive care: a randomized controlled trial.

The study aimed to investigate the effects of a five-day tactile touch intervention in order to find new and unconventional measures to moderate the detrimental influence of patients' stressors during intensive care. The hypothesis was that tactile touch would decrease stress indicators such as anxiety, glucose metabolism, blood pressure, heart rate and requirements of sedative drugs and noradrenalin. A randomized controlled trial was undertaken with 44 patients, which were assigned either to tactile touch or standard treatment (a rest hour). Observations of the stress indicators were made before, during and after the intervention or standard treatment. The study showed that tactile touch led to significantly lower levels of anxiety. The circulatory parameters suggested increased circulatory stability indicated by a reduction in noradrenalin requirement. The results need to be further validated through studies with larger sample sizes.

The outcome of tactile touch on oxytocin in intensive care patients: a randomised controlled trial.

AIM: To explore the effects of five-day tactile touch intervention on oxytocin in intensive care patients. The hypotheses were that tactile touch increases the levels of oxytocin after intervention and over a six-day period. BACKGROUND: Research on both humans and animals shows a correlation between touch and increased levels of oxytocin which inspired us to measure the levels of oxytocin in arterial blood to obtain information about the physiological effect of tactile touch. DESIGN: Randomised controlled trial. METHOD: Forty-four patients from two general intensive care units, were randomly assigned to either tactile touch (n = 21) or standard treatment--an hour of rest (n = 23). Arterial blood was drawn for measurement of oxytocin, before and after both treatments. RESULTS: No significant mean changes in oxytocin levels were found from day 1 to day 6 in the intervention group (mean -3.0 pM, SD 16.8). In the control group, there was a significant (p = 0.01) decrease in oxytocin levels from day 1 to day 6, mean 26.4 pM (SD 74.1). There were no significant differences in changes between day 1 and day 6 when comparing the intervention group and control group, mean 23.4 pM (95% CI -20.2-67.0). CONCLUSION: Our hypothesis that tactile touch increases the levels of oxytocin in patients at intensive care units was not confirmed. An interesting observation was the decrease levels of oxytocin over the six-day period in the control group, which was not observed in the intervention group. RELEVANCE TO CLINICAL PRACTICE: Tactile touch seemed to reduce the activity of the sympathetic nervous system. Further and larger studies are needed in intensive care units to confirm/evaluate tactile touch as a complementary caring act for critically ill patients.

Preserving dignity in caring for older adults: a concept analysis.

AIM: This paper is a report of a concept analysis of the meaning of preserving dignity. BACKGROUND: Preserving dignity, especially when caring for older adults, is essential when giving nursing care. There is a lack of clarity about what kinds of caring activities lead to preserved dignity. METHOD: Data were collected using several databases (CINAHL, Age Info, Libris, Medline, Pub Med, Psyc INFO and Blackwell Synergy) covering the years 1990-2005. The keywords used were 'dignity', 'human dignity', 'preserving dignity', 'elderly', 'aged', combined with 'patients/persons', 'caring relation' and 'nursing'. The analysis covered 53 articles, dissertations, reports and textbooks. FINDINGS: Dignity may be defined as a concept that relates to basic humanity. Dignity consists of inherent and external dimensions, which are common for all humans and at the same time are unique for each person, relating to social and cultural aspects. The attributes of preserving dignity are individualized care, control restored, respect, advocacy and sensitive listening. Antecedents are professional knowledge, responsibility, reflection and non-hierarchical organization. The consequences are strengthening life spirit, an inner sense of freedom, self-respect and successful coping. CONCLUSION: Preserving an older adult's dignity is complex. By using the attributes in, for example, nursing documentation, the action and value of preserving dignity could be made visible as a professional nursing activity.

Satisfaction with caring and living conditions in nursing homes: views of elderly persons, next of kin and staff members.

The aim was to describe satisfaction with the caring and living conditions of elderly persons in nursing homes, expressed by the elderly persons, next of kin and staff members. Elderly persons were interviewed about their caring and living conditions. Next of kin and staff members completed a questionnaire about satisfaction with caring and living conditions of elderly persons. The main results showed significantly low levels of satisfaction regarding: altered health, influence on care, rehabilitation and meaningful occupation, as expressed by the elderly persons. Next of kin stated low satisfaction with staff contacts, influence on care, rehabilitation from staff and meaningful occupation for their elderly relatives. Staff members expressed low satisfaction with influence on care and meaningful occupation. The results present important evidence to guide the heads of nursing homes and those responsible for elderly care, which will help to improve the caring and living conditions of elderly persons.

A transition from nurse to touch therapist--a study of preparation before giving tactile touch in an intensive care unit.

Tactile touch is a complementary therapy that is rarely undertaken in intensive care units (ICUs) in Sweden. This study was a part of a larger project that examines whether tactile touch can relieve the suffering of patients in the ICU. The aim of this study was to describe nurses' lived experience of preparation before giving tactile touch in an ICU. Four assistant nurses and one registered nurse, each with diplomas in tactile touch working at three different ICUs in Sweden, participated in the study. A phenomenological approach was chosen to achieve experience-based and person-centred descriptions. Data were collected through interviews and analysed following Giorgi's method. The main finding was that before providing tactile touch, the nurses needed to add the new role as touch therapists, to their professional one. The essential aspect being the transition from nurse to touch therapist. Findings included a general structure, with four constituents; a sense of inner balance, an unconditional respect for the patients' integrity, a relationship with the patient characterised by reciprocal trust, and a supportive environment. Furthermore, the study underlines the difficulties to integrate a complementary caring act, such as tactile touch, in a highly technological environment.

Different meanings of quality of life: a comparison between what elderly persons and geriatric staff believe is of importance.

The principle aim of this study was to obtain a more complete understanding of quality of life (QoL) through exploring different factors affecting that concept among elderly persons and staff members, combining mixed methods for validation of QoL categories and themes, and enlightening the meanings through some quotes. Elderly persons (n = 207) as well as members of geriatric staff (n = 48) answered the open-ended question 'what does quality of life mean to you?'. The elderly persons also answered questions on health, loneliness and social contacts. Descriptive statistics, Spearman rank correlation coefficient, content analysis and triangulation were used to evaluate the data. The findings revealed differences in the answers regarding what was considered most important for QoL. Staff members overestimated two of the categories, namely health and social network, while the elderly persons themselves emphasised being appreciated and living a good life. Staff members believed that elderly persons want to be seen, listened to and feel useful. The only category where staff members and elderly persons differed was 'how to be treated', where the elderly group did not find it as important as the staff members. Furthermore, elderly persons did not wish to be a burden to their family or society. In conclusion, elderly persons's own viewpoint is highly significant in care planning.

Vulvar pain, sexual behavior and genital infections in a young population: a pilot study.

BACKGROUND: To study the prevalence of pain during intercourse in a young population and analyze factors that may be associated with vulvar pain. METHODS: During a 2-month period, 172 women (aged 12-26 years) consulting four different adolescent health centres in Stockholm, Sweden, responded to a questionnaire concerning sexual habits, history of infections, and genital symptoms a priori vulvar pain. Multiple logistic regression model was used to evaluate the independent effects of the variables associated with vulvar pain. RESULTS: One-third of the women reported regular pain during and/or after intercourse. Having regular sexual intercourse before the age of 16 years and using oral contraception for more than 2 years were independent variables increasing the risk of vulvar pain. There was a correlation trend between vulvar pain and lack of sexual desire, recurrent candida infections, and urinary tract infections. However, there was no correlation to sexually transmitted diseases. More than 4 years of regular intercourse and coitus at least 4 times a week were factors that inversely correlated to vulvar pain. CONCLUSIONS: One-third of young women answering a questionnaire at adolescent health centres reported regular pain during and/or after intercourse. Early regular coitus and long-time use of oral contraceptives were factors associated with vulvar pain. Frequently rubbing a vulnerable mucosa may result in irreversible damage and vulvar vestibulitis syndrome.