Life experiences after stroke among Iranian stroke survivors.

BACKGROUND: Stroke is a major cause of disability worldwide. It is a life-threatening and life-altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long-term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. AIM: To illuminate how stroke survivors experience and perceive life after stroke. METHOD: A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors. FINDINGS: The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio-economical situation and life disintegration. The core concept of life after stroke was functional disturbances. CONCLUSIONS: The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.

Nursing staff's perception of changes in patient transfer habits after a course - a phenomenological-hermeneutic study.

The objective of the study was to illuminate nursing staff's perception of changes after a course in patient transfer. The learning process took the form of self-experience focusing on the manner of supporting the patient to move independently. A total of 20 participants, who had answered a previously administered questionnaire, were chosen for interviews. The themes concerned the meaning of changing transfer habits. A phenomenological-hermeneutic analysis method showed that changes focused on the patient's body, the staff member's own body or cooperation with the patient. Awareness of one's own body and confidence in one's own ability seem to indicate differences in the manner of supporting the patient to move. The changes in transfer habits varied in content and meaning from person to person, depending on the focus during the transfer. These findings can contribute to an understanding of how change takes place after an educational intervention.

Elderly persons' experiences of living with venous leg ulcer: living in a dialectal relationship between freedom and imprisonment.

The aim was to illuminate elderly persons' experiences of living with venous leg ulcer. Fifteen persons 74-89 years of age with active leg ulcer were interviewed. Data were analysed utilizing a phenomenological-hermeneutic approach inspired by Ricoeur. The analysis includes dialectic movement between understanding and explanation of the text as a whole and its parts. In the structural analysis four themes were identified: emotional consequences of altered body image, living a restricted life, achievement of well-being in connection with a painful wound and bandage, and struggle between hope and despair with regard to a lengthy healing process. The comprehensive understanding indicated that the meaning of living with venous leg ulcer can be understood as a dialectal relationship between, on the one hand the feeling of being imprisoned in the body, the bandage and the home, and on the other hand, hope of freedom from a burdensome body. The results indicate that the concept, body of image, is vitally relevant to the caring of elderly people with venous leg ulcer. The study shows the importance of recognizing the persons' perceptions of their leg ulcers and the impact of these perceptions on well-being. Nurses can thereby anticipate problems and provide more sensitive care.

An exploratory study of clinical decision-making in five countries.

PURPOSE: To identify the cognitive processes nurses use in their decision-making in long- and short-term care settings in five countries, and the demographic variables associated with their decision-making. METHOD AND SAMPLES: The instrument used was a 56-item questionnaire that has been shown to be reliable in earlier studies. The sample consisted of five convenience samples of registered nurses working in either geriatric wards (n = 236) or acute medical-surgical wards (n = 223) in hospitals or nursing homes in Canada, Finland, Sweden, Switzerland, and the United States. FINDINGS: Five models of decision-making were identified on the basis of factor analysis. They represent both analytical and intuitive cognitive processes. Analytical cognitive processes were emphasized in information collection, problem definition, and planning of care, and intuitive cognitive processes were emphasized in planning, implementing, and evaluating care. Professional education, practical experience, field of practice, and type of knowledge were significantly associated with decision-making models as well as with country of residence of the participants. The highest proportion of analytically oriented decision-makers was found among nurses in long-term care, the decision-making of nurses in short-term care was more intuitively oriented. CONCLUSIONS: The results indicate that decision-making of participants varied from country to country and in different nursing situations. Future research should be focused on reasons for these differences, the relationship between the task and the nurses' type of knowledge, and how nurses use their knowledge to make decisions in different nursing situations.

Environmental influences on the experiences of people with Parkinson's disease.

This study elucidates environmental influences on lived illness experiences. For two consecutive years, persons with Parkinson's disease (PD) participated in 1 week of daily walking in the Swedish mountains. Daily, low-intensive walking that is free of intense effort or time pressures associated with group interaction characterized the week. Participants were interviewed 3 months after the mountain stay regarding experiences in the mountains, daily living, and how their experience in the mountains influenced their daily living after returning home. A phenomenological method was used for data analysis. Results point to the close connection between mind, body, and environment. The connection becomes highlighted when people are afflicted with sickness, such as PD, which causes impaired control of body language, impaired voluntary mobility, and lowered energy levels. The results also show how a social context in an environment with suitable physical challenges led to a change in individuals' perceptions of the manageability of their experienced sicknesses. These results provide a deepened understanding of how individuals with PD experience illness, its influences on daily life, and how a suitable environment opens opportunities for managing daily issues.

A sociocultural health model for late-in-life immigrants.

This study develops a sociocultural health and illness model for Iranian late-in-life immigrants in Sweden by analyzing ways in which they perceive, experience, and explain their health situations. Fifteen Iranian immigrants, ages 55 to 80, were interviewed; data were analyzed using the interpretive-phenomenology method. The interviews revealed the following concepts: Reflections on the meaning of health were interpreted as cultural understanding of health. Reflections expressing knowledge about preventing illness and maintaining health were interpreted as proposed strategies and beliefs. Reflections expressing how to prevent illness and maintain health were interpreted as practical strategies, which were based on understanding of cultures and were contingent on immigration. Health care providers might use the resulting model to assist patients and families in appropriating cures and symptom management to support patients' sense of well-being.

Staff activities and behaviour are the source of many feelings: relatives' interactions and relationships with staff in nursing homes.

Family members do not give up their involvement in the life of their older relatives when they move to an institution. Relatives feel that it is they who take the initiative to establish a working relationship with the staff at the nursing home. Relatives want more spontaneous information from staff, particularly about residents' daily lives, and there is a need for relatives to have opportunities to talk with staff under relaxed conditions. Staff behaviour and activities towards residents and relatives are a source of many feelings for relatives. Relatives' understandings of the challenges faced by staff are not communicated to staff, nor are positive or negative experiences explicitly passed on to staff.

An education programme for individuals with Parkinson's disease.

An education programme for individuals with Parkinson's disease. People with Parkinson's disease (PD) have to face a lot of ongoing sickness - depending on limitations in daily life and society. Ability for optimal living demands knowledge about the sickness, medications, side-effects and knowledge about the best way to go on living with PD. In this study, 43 persons with PD participated in an outpatient programme based on the structure of connection model. The programme consisted of two weekly 2-h sessions for 5 weeks. Each session consisted of 1 h of dialogue and 1 h of physical performance. The two teachers in the programme were registered nurse and registered physiotherapist. The programme was evaluated with focus on participants' psychosocial situation, mobility and activity in daily living. Participating in the programme gave these individuals an improved psychosocial situation and improved mobility pattern. However, these improvements were not transferred to habitual daily life, which suggests that task-oriented training provides the best solution.

Health as continuity and balance in life.

Research on immigrant health emphasizes that the elderly are more vulnerable than other age groups in many immigrant populations. This study describes the meanings of health, illness, and disease for Iranian elderly immigrants in Sweden and their relationships with life disruptions. Analysis of interviews using an interpretive-phenomenological method illustrates that the participants, experience health as continuity and balance in life. Any disruption of this balance creates a sense of illness that is only partially related to the emergence of disease. Participants did not view health and disease as polarized. Rather, disease is just one component among many that may disrupt the experience of health. Health is perceived as a sense of well-being, can be achieved in spite of disease, and can be disrupted even in the absence of disease. This description of the meaning of health, disease, and illness contrasts with the Western biomedical perspective and is similar in its holism to various non-Western medical systems and complementary approaches. This knowledge can foster more culturally sensitive care.

Feeling old: being in a phase of transition in later life.

The aim of the study was to illuminate very old persons' experiences of feeling old in order to get a nuanced understanding of the ageing process in later life. Fifteen persons 85-96 years of age, living in their own homes, were interviewed in-depth. Data were analysed utilising a phenomenological-hermeneutic approach. Eight persons reported that they felt old. The experience of feeling old entailed four characteristics: being able to date the beginning of feeling old, fear of helplessness and of being unable to manage one's life situation, not recognising one's former self, and feeling different from others. These characteristics corresponded to the main properties of a transition process. The comprehensive understanding was that the very old persons who also felt old were in a phase of transition. The distinguishing qualities of those that felt old were also found to be in line with the dystonic dominance in the ninth stage designated by Joan Erikson of the previously described life cycle. Knowledge about transition processes and sensitivity to very old people's experiences of feeling old are of great importance to nursing in order to provide adequate health care services and prevent unhealthy transitions.

Influencing aspects in nursing education on Swedish nursing students' choices of first work area as graduated nurses.

It is difficult to recruit RNs to positions in various areas of elder care. The aim of this study is to understand the meaning of Swedish nursing students' reasoning during education about where in the health care system they would like to work as RNs after graduation. The students were interviewed using the same guide at the end of each of their three academic years. In the second and the third year the students kept diaries about their clinical education. A phenomenological-hermeneutic method of analysis was used, and eight themes appeared vital for the students' choice of work area after graduation. The deeper interpretations of the results imply that the students received contradictory messages during the education in elder care. Students found that nurses working in this field were often isolated with no apparent support system, which in turn reinforced their own ambivalence and reluctance towards future work in elder care.

An ethnographic study of a day care center for Iranian immigrant seniors.

Late-in-life immigrants are often at risk for psychological stress and social isolation because of language problems, small social networks, and cultural differences from the host society. Community intervention programs can reduce such stress and isolation. In this article, the authors describe a Swedish municipality's culturally appropriate intervention program for elderly Iranian immigrants based on ethnographic data gathered during a 12 month period. The description includes the activities provided by the program and the experiences of the elderly Iranian immigrants who participate regularly in these activities. The findings document the positive impact of regular participation in the center's activities on the elders' well-being and health.

'We, not them and us?' Views on the relationships and interactions between staff and relatives of older people permanently living in nursing homes.

'We, not them and us?' Views on the relationships and interactions between staff and relatives of older people permanently living in nursing homes This study describes relatives' and staffs' experiences of each other in their relationships and interactions in connection with the care of old people with dementia living in nursing homes. The aim was to identify obstacles and promoters concerning these interactions. A qualitative method was used. Data were collected from 27 hours of observations of group discussions about relatives' and staffs' communication, interactions and experiences. Three different groups, with eight participants, relatives, staff and a group leader in each, met six times during a period of 3 months. Findings indicate that the experiences that relatives and staff have of each other are related to issues about influence, participation, trust and measures to avoid conflicts. These conclusions build on concrete descriptions about care, activities, competence, communication and visits given by research participants. Experiences of situations were sometimes contradictory between relatives and staff. This implies that the potential for cooperation between relatives and staff in care of the elderly is not fully utilized. Suggestions for enhancing the relationships between relatives and staff are: pre-planned informal, individual conversations between relatives and staff; development of ways to give regular two-way feedback about matters concerning the resident and the relationship between staff and relatives; giving staff credit for measures taken to facilitate relatives' involvement in the nursing home care; measures to improve documentation about families' involvement; and working together with minor practical tasks.

Health care experiences and beliefs of elderly Finnish immigrants in Sweden.

PURPOSE: To elucidate the experiences and beliefs of care of elderly Finnish immigrants living in Sweden (Sweden-Finns) in order to gain an understanding of the role ethnic background plays in these experiences and beliefs. DESIGN: 39 elderly Sweden-Finns living in Stockholm were interviewed. The data were analysed hermeneutically. RESULTS: On a surface level, the care in Sweden was culturally congruent to elderly Sweden-Finns' experiences and beliefs of care. However, care in Finland and the care providers with Finnish background were regarded as superior to Swedish caregivers, giving a deeper sense of familiarity and trust in anticipation of good care. IMPLICATIONS FOR PRACTICE: Culturally appropriate care with care providers sharing the same ethnic background is important for ethnic elderly persons in enabling familiarity and trust between staff and patients.

Caregiver-assisted music events in psychogeriatric care.

An ethnographic approach to the study of caregiver-assisted music events was employed with patients suffering from dementia or suspected dementia. The aim of this study was to illuminate the importance of music events and the reactions and social interactions of patients with dementia or suspected dementia and their caregivers before, during and after such events, including the remainder of the day. The results showed that the patients experienced an ability to sing, play instruments, perform body movements, and make puns during such music events. While singing familiar songs, some patients experienced the return of distant memories, which they seemed to find very pleasurable. During and after the music events, the personnel experienced bonding with the patients, who seemed easier to care for. Caregiver-assisted music events show a great potential for use in dementia care.

Nursing students' reasoning about two fictitious elderly patient cases.

The aim of this study was to examine and describe how nursing students developed their reasoning and knowledge about the state of health of, and their possible actions regarding, two fictitious elderly patient case histories during their three-year education. The descriptions were audiotaped, transcribed verbatim and analysed by content analysis. The findings show a development in the students' reasoning concerning the more acute case, but no development in reasoning regarding the case of a confused person. This could be due either to a lack of education in gerontology and geriatrics, or to the students receiving limited guidance during their education on how to reason about and reflect upon different ways of approaching emerging problems. The findings could also be understood in the light of traditions and history in nursing education.

Unsettled, uncertain and striving to understand: toward an understanding of the situation of persons with suspected dementia.

The main purpose of this study was to understand the part played by clinical diagnosis in relation to persons with suspected dementia. Interviews were held with eight persons who had been evaluated clinically because of suspected dementia. A phenomenological-hermeneutic analysis inspired by Ricoeur's philosophy was performed. The findings revealed the overall meaning of "making sense" of early experiences of memory loss in terms of a clinical diagnosis by which participants are provided with a means of interpreting and ascribing some meanings to the changes in themselves. When a meaning cannot be established and the future is unknown, these experiences are found to pose an existential threat that projects into future existence. The study suggests that understanding how an informed diagnosis is comprehended by the client becomes essential when evaluating persons due to suspected dementia.

Swedish nursing students' transition into nursing during education.

The transition from student to nurse involves the influence of several different educational aspects. The aim of this study is to elucidate the transition to the role of a nurse, which Swedish nursing students underwent during their 3 years in nursing education, as described from the perspective of their experiences with elderly patients. Interviews were conducted with the students at the end of each academic year, and the students wrote diaries about their clinical education in the second and third years. The narratives were analyzed with a phenomenological-hermeneutic method, and six themes appeared vital for the transition into nursing. The study implies a continuous process during education, involving many aspects of the transition from a student with a genuine and natural interest to care for others to a registered nurse ready to take up her first position. Cooperation with other team members had a strong influence on the students.

Social dancing: a way to support intellectual, emotional and motor functions in persons with dementia.

Dementia causes serious impairments and the inability to perform those activities which give meaning to a person's life. Therefore, these persons are in need of professional nursing care interventions as well as a special supporting environment. In this study, social dancing has been regarded as a nursing intervention that supports persons with dementia in nursing home settings. The aim was to find out how persons with dementia functioned in social dance sessions, in order to understand the reasons behind the use of social dancing as a nursing intervention in a nursing home setting. Six persons with dementia were videotaped during four dance sessions in one nursing home. The qualitative content analyses were carried out deductively, using a guide developed from the variables in the Gottfries, Bråne and Steen rating scale (GBS scale). The findings show that, for persons with dementia, retained abilities were prominent in dancing. It was obvious that social dancing was supportive and seemed to have meaning to both patients and their carers. Social dancing seems to be a nursing intervention that supports patients' positive feelings, communication and behaviour. The carers' preunderstanding of the patients' levels of dementia and the wholeness of the situation was of importance.

Changes in motor performance in persons with Parkinson's disease after exercise in a mountain area.

For one week in autumn, over a period of three consecutive years, a total of 12 persons with Parkinson's disease (PD) participated in daily walks of about 4 kilometers in a mountain area in Sweden in order to train rhythm, balance and coordination on the soft heaths. These persons were 60-78 years of age and had been found to be between stage 1 and stage 3 on the Hoehn and Yahr Staging Scale. The aim of the study was to find out whether a week of daily walks in the Swedish mountains would affect the motor performance of persons with PD, objectively and quantitatively assessed by a computer-assisted, opto-electronic movement analysis program, the Posturo-Locomotor-Manual (PLM) test. As compared with those before the journey, the results showed improved motor performance both immediately after the walking week and also at 3 but not 6 months later. The first year of participation showed the most pronounced improvements. The results demonstrate a long-lasting improvement in decreased movement time, indicating enhanced general motor performance and also an improved simultaneous index (SI), indicating a possible effect on the central nervous system. These findings, along with participants' narratives about what they did after returning home, may be indicative of strengthened self-confidence.