The journey between ideal and real: Experiences of beginners psychiatric nurses.

BACKGROUND: Understanding how novice nurses perceive their career in the psychiatric ward can be helpful for nurse educators and managers to gain insight into psychiatric nursing care and adding applicable knowledge to the development of support strategies for this group. The aim of this study was to describe and illuminate experiences of new graduated nurses working at a psychiatric ward in an Iranian context. MATERIALS AND METHODS: A descriptive phenomenology has been chosen. Participants with baccalaureate degrees in nursing were selected purposefully and they all had less than 6 months of work experience in psychiatric wards beforehand. The study was conducted at the Razi Hospital in Iran. Data were collected through unstructured individual in-depth interviews and analyzed according to the Colaizzi method by means of Husserlian phenomenology. RESULTS: Three main themes were found in this study, of which six sub-themes were constructed as follows: Being in the world of fear and complaint, which has been abstracted by having mixed feelings of conflict and compliant on entry to the psychiatric ward, doubt about adequacy of being a psychiatric nurse and working in psychiatric ward and a frightening and non-supportive environment; A sense of imprisoned and confined, which has been constructed by different experience with different environmental milieu in psychiatric ward, as a lock sense; Becoming a psychiatric nurse, which has been constructed as a sense of usefulness, a sense of sympathy and compassion for patients and a sense of professional identity. CONCLUSIONS: This study identified areas that require modification by providing insight into lived experiences of beginners' nurses as the value in psychiatric ward. New graduated nurses may face negative perceptions and feelings due to confrontation with a new environment, patients and colleagues as well as shortcomings in the preparation.

Nursing staff's understanding expressions of people with advanced dementia disease.

People with advanced dementia disease (ADD) are known to have communication difficulties and thus it presents a challenge in understanding the expressions of these people. Because successful communication presupposes cooperation at least between 2 individuals, both individual's actions must be acknowledged. The aim of this study is to describe nursing staff's ways of understanding the expressions of people with ADD when communicating with them. Interviews from 8 nursing staff were analyzed using qualitative content analysis. Two themes were constructed: "Being in communication" and "Doing communication." Being in communication means that nursing staff perceive people with ADD as being capable of communication. Doing communication means that nursing staff attempt different individualized strategies to understand what people with ADD communicate. Good care of people with ADD presupposes nursing staff that are willing and able to relate to other people and to maintain good care for people with ADD continuous education and supervision are needed.

Experiences of living with dementia: qualitative content analysis of semi-structured interviews.

AIMS AND OBJECTIVES: To describe people's experiences of living with dementia in Iran. BACKGROUND: A knowledge gap exists regarding the experiences of living with dementia in nonWestern contexts. This gap may be especially apparent within the Iranian context, where dementia research is relatively new. Deeper understanding about context-related experiences of dementia is a prerequisite for nurses' ability to provide adequate and meaningful care. DESIGN: Qualitative, cross-sectional design. METHODS: Qualitative content analysis of semi-structured interviews with people living with dementia in urban Iran (six women and nine men; 60-87 years old). RESULTS: The participants experienced their condition as a state of forgetfulness that was accompanied by losses and dependency on others. They wanted to feel good about themselves and feel important, but they continually struggled with matters such as a loss of accountability, feelings of futility and the frustration of others. Economic dependency and a lack of economic resources were sources of feelings of futility. CONCLUSION: Experiences of living with dementia in Iran included a substantial struggle to stay connected to the social world and to deal with dramatic life changes, aspects of living with dementia that seem to be universal. However, the feelings of financial burden and the experience of being nagged for their shortfalls by family members have seldom been described in other studies and seem to represent a cultural aspect of their experience. RELEVANCE TO CLINICAL PRACTICE: The results of the study call for further nursing efforts in supporting people living with dementia in their struggle with their altered lives and in retaining their connections to everyday life. Furthermore, their family members might benefit from specific nursing interventions including information about dementia and advice on how to help the family members with dementia to interact with others while exercising their individual strengths.

Difficulties in intraoperative care.

Difficult situations which occur intraoperatively have a direct impact on nurses working within the area. A study was undertaken focusing nurses' confrontations with difficult situations where the narrations from twelve nurses were taped. A phenomenological method was used to analyse this information and revealed how difficult intraoperative situations arise and how the nurses found different ways of handling these situations.

Rehabilitation experts' experience of community rehabilitation services for stroke survivors in Iran.

PURPOSE: Successful stroke rehabilitation is a complex process involving teamwork by members of several professions. The aims of this study were to explore the experiences of Iranian rehabilitation experts concerning community rehabilitation services for stroke survivors and obtain their opinions on how to further develop and improve these services. METHOD: A qualitative research method with grounded theory was used, including purposive and theoretical sampling. A constant comparative analysis was conducted. Data were gathered from 2 focus group discussions including 10 Iranian rehabilitation experts and 4 in-depth individual interviews. RESULTS: Nonintegrated rehabilitation services emerged as the core concept of the study. The explored concepts were identified as deficiently allocated budget, inadequate public insurance, lack of availability of rehabilitative care, negative public opinion, lack of consistency in care, and split services and professional separation. Areas identified for potential improvement included need to change policymakers' attitudes, need to refine rehabilitation in the health care system, need to establish a registration system, need to provide information and skills, and need to see the family as a whole. CONCLUSION: Experts should participate in educational rehabilitation programs to become more aware of current rehabilitation services within the community. Stroke survivors and their families should also participate in the rehabilitation programs as this would allow them to gain knowledge and skills for dealing with stroke management. This can help reduce problems, change public opinion, and eliminate mistrust between health care providers and families.

South Africans' experiences of being old and of care and caring in a transitional period.

This focused ethnographic study aimed to illuminate a group of South Africans' experiences of being old and of care and caring in a transitional period. With a growing number of older people in Africa, studies on the individual experiences may help to develop care which is more sensitively based on the needs for older people in a changing Southern Africa context. Data were collected through group and individual in-depth interviews and participant observations which involved 16 individuals, aged 52-76. Data were analysed using a qualitative content analysis. The study showed two interrelated themes reflections on life and ubuntu - an orientation towards others. Findings were discussed from the viewpoint of the theory of gerotranscendence, showing similarities as well as differences, possibly due to societal and cultural differences. Shortage of formal care for older people living in poor conditions in Southern Africa, gave rise to the discussion for the need of a contextualized development of gerontological care. To enhance knowledge on the theory of gerotranscendence and develop guidelines for nursing in home-based care/community-based care in a South African context may be a first step to support older people in their process towards gerotranscendence.

Nursing staff's communication modes in patient transfer before and after an educational intervention.

The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence. STATEMENT OF RELEVANCE: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer.

The hip and knee replacement operation: an extensive life event.

BACKGROUND: A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation. AIM: The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery. METHOD: A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants' experiences of the hip and knee replacement intervention across the entire perioperative period. FINDINGS: Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted. CONCLUSION: Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations.

Experiential health from an ageing and migration perspective: the case of older Finland-Swedes.

Research has shown that immigrants and minority groups tend to have a lower health status compared to the majority population. The Finnish immigrants in Sweden are no exception. The Finland-Swedes, i.e., persons living in Finland who have Swedish as their mother language, seem to be an exception, however. They have been found to have better health and longer life expectancy compared to the Finnish majority. Research on health among migrated Finland-Swedes is scarce. The aim of this study was to describe and deepen the understanding of how older Finland-Swedes living as immigrants in Sweden, as well as re-migrants in Finland, experienced their health. Data was collected through 39 qualitative interviews with 29 older Finland-Swedes aged 65 or more. Data was analysed through qualitative thematic content analysis. The analysis resulted in five themes: Ageing means becoming frail and closer to death; Despite frailty and old age it is possible to feel well and experience peace; Being grateful for health as a source of life; Health comes from inner strength and external sources; Migration meant a mental and physical burden to health. Overall, both ageing and migration were experienced as jeopardising health.

A difficult mission to work as a nurse in a residential care home--some registered nurses' experiences of their work situation.

The aim of the study was to describe Registered Nurses' (RNs) experiences of their work environment in residential care homes for older persons. Twelve RNs were interviewed and latent content analysis was used for analysing the data. The data were collected in the spring of 2006. The findings revealed that these RNs experienced a paradoxical work environment: feeling appreciated and valuable, whilst at the same time feeling underestimated and frustrated. They felt appreciated and valuable when they provided nursing care and trust and support to others. The RNs experienced a positive work environment when the border between social and nursing care were clear. They also felt frustrated when they were expected to 'be everywhere and to know everything', but at the same time they felt invisible and underestimated. They experienced themselves as 'lonely fixers', having the ability to solve practical problems when the older persons were discharged from hospital and expected to be able to provide specialist nursing care without having specialised competence and specialist staff team members. In conclusion, it is important that the RNs can identify the border for nursing care. When these are clear, the nursing care objectives are apparent and the RNs become more autonomous, visible and listened to. The manager should listen to and support the RNs, with continuous supervision and competence development being mandatory elements. It is a difficult task for RNs working in residential care homes to meet all of the expectations placed on them, resulting in a risk of moral distress, making mistakes and developing illnesses caused by stress.

The influence of caregiver singing and background music on vocally expressed emotions and moods in dementia care: a qualitative analysis.

BACKGROUND: Music and singing are considered to have a strong impact on human emotions. Such an effect has been demonstrated in caregiving contexts with dementia patients. OBJECTIVES: The aim of the study was to illuminate vocally expressed emotions and moods in the communication between caregivers and persons with severe dementia during morning care sessions. DESIGN: Three types of caring sessions were compared: the "usual" way, with no music; with background music playing; and with the caregiver singing to and/or with the patient. PARTICIPANTS AND SETTING: Nine persons with severe dementia living in a nursing home in Sweden and five professional caregivers participated in this study. METHODS: Qualitative content analysis was used to examine videotaped recordings of morning care sessions, with a focus on vocally expressed emotions and moods during verbal communication. RESULTS: Compared to no music, the presence of background music and caregiver singing improved the mutuality of the communication between caregiver and patient, creating a joint sense of vitality. Positive emotions were enhanced, and aggressiveness was diminished. Whereas background music increased the sense of playfulness, caregiver singing enhanced the sense of sincerity and intimacy in the interaction. CONCLUSION: Caregiver singing and background music can help the caregiver improve the patient's ability to express positive emotions and moods, and to elicit a sense of vitality on the part of the person with severe dementia. The results further support the value of caregiver singing as a method to improve the quality of dementia care.

Tradition in transition--intergenerational relations with focus on the aged and their family members in a South African context.

This study describes the intergenerational relations influence on the care of the aged in a transitional period expressed by a group of aged South Africans and their family members. Focused ethnographic research was carried out from 2001 to 2006 in a semi-rural area in central South Africa. Twenty-nine participants representing 16 families took part in multiple group interviews. The data was supplemented through individual interviews with 10 of the participants as well as home visits, participation in community activities, notes and video recording. The transcribed interview texts were analysed using qualitative content analysis. The study shows aspects of tradition in transition as reciprocal care between generations, the significance of traditional values and the impact of modernization on care. The findings reveal the on going transition in Africa influencing the role of the aged as well as the reciprocal care within the extended family. The study also discloses that in reciprocal relationships, family members do not necessarily have a biological bond and that revaluing of traditions can be seen as a response to social and economic change and as a tool to maintain influence. This ethnographic study contributes knowledge in the field of gerontological care, by illuminating the impact of transition on the role of aged as well as the caring of the aged in the extended family an important issue for health professionals caring for a growing number of older persons in Southern Africa and in countries with a large representation of minority groups from developing countries.

To both be like a captain and fellow worker of the caring team: the meaning of Nurse Assistants' expectations of Registered Nurses in Swedish residential care homes.

Aim.  To describe the expectations of and to illuminate the meaning of the Nurse Assistants' (NA) expectations of Registered Nurses (RN) who are responsible for the care of older people living in residential care homes in Sweden. Background.  Older people in Sweden who are provided with residential care are extremely frail and incapable of independent living. Therefore, when providing care, RN and NA encounter older people who require a great deal of care. An important precondition for the provision of satisfactory care is to have adequate collaboration between NAs and RNs and their expectations of each other. In this paper, the focus is on the NAs expectations of the RNs. Method.  The study is based on a qualitative approach and a phenomenological-hermeneutical method. Ten NAs were interviewed and asked to narrate as freely as possible, about their expectations of RNs. The narratives were audio taped and transcribed verbatim. The analytical process includes the following steps; naïve reading, structural analysis, comprehensive understanding and reflection. Results.  The RNs were expected to take responsibility for being fellow human beings and experts in providing care as well as always available to participate in caring. The RNs were expected to make stand-alone decisions and create a sense of safety for both older people and the NAs and have the courage to work alone and create a safe environment for both the older people and the NAs. The meaning of these expectations was that the RNs are like a captain in providing care, but at the same time, fellow workers. Conclusion.  When the RNs do not meet the NAs expectations, there is a risk of conflict and therefore also a risk that an unsafe environment being created when caring for older people.

The lived body and the perioperative period in replacement surgery: older people's experiences.

AIM: This paper is a report of a study to explore older people's experiences of their lived bodies during the perioperative period for a hip or knee replacement. BACKGROUND: Replacement surgery of a major joint for older people suffering from osteoarthritis is an established treatment in developed countries. Scientific knowledge is available on replacement surgery from several perspectives, but not about older people's experiences of the entire perioperative period of a replacement procedure. METHOD: A qualitative longitudinal study was conducted between 2002 and 2004. Audiotaped interviews were carried out with 12 older people, on five different occasions during the perioperative period. The data were analysed using latent qualitative content analysis. FINDINGS: The perioperative period of a hip or knee replacement can be regarded as a process of transition which includes six critical phases. The transition was supported with the dream of becoming as able-bodied as previously in life, by having surgery. In addition, our findings revealed that the care recipients lacked knowledge about the surgical intervention as a whole. CONCLUSION: The meaning of having joint replacement surgery was to overcome the confinement of living with a painful and unreliable body. Furthermore, care recipients struggled to regain a body in charge and control of their lives, yet from a new starting point. The care recipients were not prepared for the transitional changes through the perioperative period. Further research is needed to develop an appropriate programme for patient care during the perioperative period, in order to facilitate the process of transition.

Culturally congruent care for older people: Finnish care in Sweden.

An increasing number of older people belong to minority and immigrant groups. This calls for new models on the subject of how to provide culturally adjusted care for these populations. The aim of this study is to describe how cultural congruency is used in care for older Finnish immigrants in order to promote their well-being. The study was conducted with an ethnographic design, based on participant observations and interviews among residents, staff, and visitors in the Finnish Home in Sweden. In the core of the cultural congruency is the use of the Finnish language, and the fact that both residents and staff have Finnish backgrounds. In addition to this, Finnish customs and celebrations, popular culture, and topics of discussion, are actively used in order to create a common ground for communication and shared understanding of the individual person. Cultural congruency, based on the residents' mother language, shared ethnic background with staff, and shared customs creates a common ground for communication and an understanding. This enables caring relationships, which, in turn, increases the residents' well-being.

"We clean our houses, prepare for weddings and go to funerals": daily lives of elderly Africans in Majaneng, South Africa.

This ethnographic study aims to identify and describe how a group of elderly African people in South Africa experience their daily life and related concerns and interests. Data were collected through group interviews involving 16 elderly persons and complementary field observations. The data were analysed using a qualitative content analysis. From the analysis following sub-themes emerged: 1. Lack of basic resources; 2. Routines in daily life; 3. Experience of unsafe conditions; 4. "The disease"-HIV/AIDS. The results have been discussed according to the following themes: keeping normality and changing society. The study illuminates the varied experiences in daily life, including lack of basic resources, experience of unsafe conditions, and the HIV/AIDS pandemic and its consequences for the elderly as contributors to the extended family.

Patients experiencing local anaesthesia and hip surgery.

AIMS AND OBJECTIVES: The aim of this study was to show what the experience of local anaesthesia and a surgical situation meant to patients. BACKGROUND: Many patients who receive local anaesthesia will remain awake during surgery. The very fact of staying awake causes psychological and psychosocial needs. These needs must be met and it is therefore important to identify them. DESIGN/METHOD: Seven patients (aged 61-79) experiencing local anaesthesia and hip surgery (hip replacement surgery or repair of fractured hip) were interviewed. An interpretive phenomenological method developed by Benner was used to extract the experience of what it means to be in local anaesthesia and surgery. One paradigm case is used to illustrate the results. RESULTS: Results show that the well-being and comfort of patients is compromised by challenges such as severe pain and long waits, which may be experienced as endless and which leave the patient thinking of nothing else. By contrast, the experience of trust helps the patient to feel control even in situations where the treatment is hard to grasp. CONCLUSIONS: The results highlight that local anaesthesia and surgery force patients to overcome and handle experiences of pain, trust and distrust as well as feelings of alienation and unreality. RELEVANCE TO CLINICAL PRACTICE: The results illustrate the patient's needs, as seen from the patient's perspective. A shared experience makes it possible to understand, and thus to recognize, the required qualitative care to facilitate and to help the patient to remain in control and face the psychological challenges presented by anaesthesia care and surgical situations.

Physicians' expectations regarding registered nurses caring for older people living in sheltered housing, retirement homes and group dwellings.

The aim of this study was to illuminate the meaning of the physicians' expectations regarding registered nurses who are responsible for the care of older people living in sheltered housing, retirement homes and group dwellings. A phenomenological-hermeneutic method was used for the analysis. Twelve physicians from two municipalities in Sweden were interviewed. The naive reading of the interviews characterizes the physicians' expressed views of nurses by using metaphors such as "the extended arm", "gatekeeper" and "belonging to a no-man's land". In the structural analysis, explanations of the metaphors are given. The new understanding was that the physicians also expect registered nurses to be able to switch between keeping a distance and being close to older people. When registered nurses have this skill, the physicians have a "we" feeling towards the nurse. The paper provides insights into the physician-nurse relationship, in the context of residential care in Sweden.

Counteracting fragmentation in the care of people with moderate and severe dementia.

Symptoms such as amnesia, agnosia, apraxia, and aphasia may lead to a fragmented experience and actions among people with moderate and severe dementia. The aim of this study was to explore the interactions where fragmentation occurred and how caregivers counteract fragmentation. The observation notes from participant observations were analyzed using interpretive content analysis. Fragmentation was noted if the patients showed that they did not recognize what was going on, the people involved, the things used in the action, or did not recognize themselves in the situation. Care providers could counteract fragmentation by a caring based on attentive interest in the interaction, valuing the person behind the dementia disease, using an individual perspective considering the impact of the dementia disease, and striving for mutual interpretation of the shared situation. Caring based on these assumptions could help the patients to keep their world together.