Needs of carers participating in support groups and caring for a person with dementia: A focused ethnographic study.

AIMS: The aim is to explore and understand how support group participation meets carers' perceived needs for information and social and emotional support when caring for a person with dementia who lives at home. DESIGN: Focused ethnographic design. METHODS: Participant observations and semi-structured interviews with 25 carers were conducted. An inductive content analysis of the data was performed. FINDINGS: Two themes were identified: "Strengthening the sense of self" and "Managing uncertain benefits." CONCLUSION: Carers' level of information about dementia was partly met, thereby strengthening their sense of self and joy. Maintaining shared decision-making in financial matters was viewed as an expression of respect and reciprocity. Getting acquainted with peers and dementia coordinators was viewed as emotional and social support but was also used strategically to gain easier access to health care services. By fulfilling their needs, support group meetings became meaningful, which motivated carers to continue providing care.

Support groups for carers of a person with dementia who lives at home: A focused ethnographic study.

AIMS: To explore and understand carer participation in support groups when caring for a person with dementia who lives at home. DESIGN: Focused ethnographic design. METHODS: Participant observations and semi-structured interviews were conducted from January-December 2015. The data were collected from four support groups in the Danish primary healthcare system. Interviews were conducted with 25 carers. An inductive content analysis of the data was performed. RESULTS: Three themes were identified: emotional well-being due to peer and family support, emotional sense of togetherness despite hardships and emotional and ethical considerations in caregiving. CONCLUSION: Support group participation with positive peer interaction increases carer self-esteem and feelings of togetherness, and an awareness of maintaining the care receiver`s dignity and prevention of conflicts with families, resulting in an improvement in carer well-being, leading to increased motivation to continue caring. Carers who hid their group participation face a potential conflict with the care receiver. IMPACT: By sharing positive experiences, carers have increased self-esteem and feelings of togetherness, which can have a positive impact on their motivation to continue caring. Positive peer interaction encouraged a shift in focus from negative to positive experiences, resulting in an improvement in carer well-being. Joint group participation prevented conflicts in families. To protect the care receivers, carers kept support group participation a secret. Healthcare professionals could improve carer well-being by focusing on positive caring experiences in support groups.

Patients Scheduled for General Anesthesia: Betwixt and Between Worrying Thoughts and Keeping Focus.

PURPOSE: The purpose of the research was to explore the interaction between cancer patients and Registered Nurse Anesthetists (RNAs) before general anesthesia from the patients' perspective. DESIGN: Focused ethnography was used as method for data collection. METHODS: Surgical patients' interactions with the RNAs were observed during preparations for general anesthesia and further explored during an interview on the first or second postoperative day. Methodological concepts of Grounded Theory structured the analysis. FINDINGS: The core variable describes patients being in an intermediate position, not knowing the outcome of the anesthetic and surgical procedures. The core variable is elaborated by subcore variables describing patients' coping strategies and need for care. CONCLUSIONS: Patients' experiences of being cared for and supported in their coping strategies by RNAs will substantiate patients' predisposed confidence in the RNA and the anesthetic procedure. This will support patients in keeping focus in a highly technological environment.

Hospitalised patients' experiences during Negative Pressure Wound Therapy due to surgical site infection after vascular and cardiac surgery.

Surgical site infections that develop after vascular and cardiac surgery are often treated with Negative Pressure Wound Therapy (NPWT). Due to the severity of the infection and risk of bleeding, this NPWT often requires hospitalisation. Fourteen patients were selected for qualitative interviews to investigate their experiences and the meaning of patient participation during hospitalisation with NPWT. Results show that hospitalisation induces tension between an intrusion of privacy and being part of a community. Patients do not feel ill nor are considered ill. They feel minimised, lack participation and miss continuity, yet they still accept their circumstances by adjusting to hospital routines and treatment. The hospital's organisational framework compromises patient participation, yet patients still participate in supporting their own wound healing. They worry, are bored, lack a clear time horizon, and appear to be in an apathetic mood despite having significant time on their hands. In conclusion, the tension between a patient's privacy and sense of community, as well as involuntary participation in other patients' lives, compromises dignity and increases stress. Wound healing appears to be prolonged due to fasting, inactivity and stress. Self-reliant patients are at risk of being minimised and lack adequate emotional care, and the hospital's organisational framework hampers patient feelings of involvement and participation.

Danish Perioperative Nurses' Documentation: A Complex, Multifaceted Practice Connected With Unit Culture and Nursing Leadership.

Researchers have described the documentation practices of perioperative nurses as flawed and characterized by subjectivity and poor quality, which is often related to both the documentation tool and the nurses' level of commitment. Studies suggest that documentation of nursing care in the OR places special demands on electronic health records (EHRs). The purpose of this study was to explore how the use of an EHR tailored to perioperative practice affects Danish perioperative nurses' documentation practices. This study was a follow-up to a baseline study from 2014. For three months in the winter of 2015 to 2016, six participants tested an EHR containing a Danish edition of a selected section of the Perioperative Nursing Data Set. This study relied on realistic evaluation and participant observations to generate data. We found that nursing leadership was essential for improving perioperative nurses' documentation practices and that a tailored EHR may improve documentation practices.

A qualitative study of how caseload midwifery is experienced by couples in Denmark.

BACKGROUND: Caseload midwifery is expanding in Denmark. There is a need for elaborating in-depth, how caseload midwifery influences the partner and the woman during childbirth and how this model of care influences the early phases of labour. AIM: To follow, explore and elaborate women's and their partner's experiences of caseload midwifery. METHODS: Phenomenology of practice was the analytical approach. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. Ten couples participated in the study. Most of the couples were observed from the onset of labour until childbirth. Afterwards, the couples were interviewed. FINDINGS: The transition from home to hospital in early labour was experienced as positive. During birth, the partner felt involved and included by the midwife. The midwives remembered and recognized the couple's stories and wishes for childbirth and therefore they felt regarded as "more than numbers". Irrespective of different kinds of vulnerability or challenges among the participants, the relationship was named a professional friendship, characterised by equality and inclusiveness. One drawback of caseload midwifery was that the woman was at risk of being disappointed if her expectations of having a known midwife at birth were not fulfilled. KEY CONCLUSIONS: From the perspective of women and their partners, attending caseload midwifery meant being recognised and cared for as an individual. The partner felt included and acknowledged and experienced working in a team with the midwife. Caseload midwifery was able to solve problems concerning labour onset or gaining access to the labour ward.

TIME - MAKING THE BEST OF IT! A Fieldwork Study Outlining Time in Endoscopy Facilities for Short-Term Stay.

AIM: This paper focus on nursing and time in endoscopy facilities for short-term stay aiming to explore aspects of time in this setting and how expectations from the healthcare organisation, patients and nurses are expressed and met when managing nursing time. BACKGROUND: Former research primarily focuses on the subject of time in the understanding of duration where having more time is closely associated with the ability to deliver better quality nursing care. The main concern is the nurses' increased number of tasks and the decreased length of time at their disposal. However, few studies describe nursing when time is sparse, and the possibility of providing individualised nursing within a very short span of time. DESIGN: Inspired by practical ethnographic principles, a fieldwork study was performed in high technology endoscopy clinics during 2008-2010. METHODS: Data triangulation included participant observation, participant reports and patients and nurses semi-structured interviews. RESULTS/FINDINGS: The issue of time was an interwoven part of life in the productive endoscopy units. The understanding of time related to the main category: 'Time - making the best of it', and the sub categories "Responsibility of time", "Information and preparation", and "Time wasters". CONCLUSION: The study underlines the possibility of combining the health care systems, patients and the nurses' perspectives on and expectations of how to spend nursing time in endoscopy settings. In successful patient pathways nursing maximize patient outcome, support the goals of the healthcare organisations, is reliable, assure, tangible, empathic and responsive, and is individually tailored to the patient's needs. The study contributes by underlining the importance of discussing not how to get more time in clinical practice but instead how to spend the time in the best way possible.

Content validation of the Tilburg Frailty Indicator from the perspective of frail elderly. A qualitative explorative study.

UNLABELLED: The Tilburg Frailty Indicator is a questionnaire with a bio-psycho-social approach, which measures frailty by 15 questions. A questionnaire about frailty should be in alignment with experiences of frail elderly themselves as a target population is an important source of knowledge in content validation. AIM: To validate the Tilburg Frailty Indicator on content in relation to the physical, psychological and social domain by exploring the experience of daily life of community dwelling frail elderly. METHODS: The design was a qualitative content validation study. The participants were acutely admitted frail elderly discharged to home and interviewed one week after discharge. A deductive content analysis, with categories structured in advance, was performed. RESULTS: A total of 422 meaning units were extracted from the transcriptions; 131 units related to the physical domain, 106 units to the psychological domain and 185 units to the social domain. 56 units were not linked into the existing structure of the questionnaire. 14 of 15 questions were confirmed from a target population perspective. The four issues pain, sleep quality, spirituality and meaningful activities that seem to be important elements for frail elderly were not directly covered by the questionnaire. DISCUSSION: It seems likely that the majority of important items related to frailty are covered in the questionnaire. The findings add to the scientific body of knowledge in relation to the validity of the questionnaire. Future research should investigate the importance of the four issues pain, sleep quality, spirituality and meaningful activities in relation to the screening of frailty.

The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital.

INTRODUCTION: Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. METHODS: The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. RESULTS: Four main categories were identified: "The system," "Keeping a social life," "Being in everyday life," and "Handling everyday life." These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less. CONCLUSION AND DISCUSSION: Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors.

Danish version of the Tilburg Frailty Indicator--translation, cross-cultural adaption and validity pretest by cognitive interviewing.

The Tilburg Frailty Indicator (TFI) is a self-administered questionnaire with a bio-psycho-social integrated approach that measures the degree of frailty in elderly persons. The TFI was developed in the Netherlands and tested in a population of elderly Dutch men and women. The aim of this study was to translate and culturally adapt the TFI to a Danish context, and to test face validity of the Danish version by cognitive interviewing. An internationally recognized procedure was applied as a basis for the translation process. The primary tasks were forward translation, reconciliation, back translation, harmonization and pretest. Pretest and review of the preliminary version by cognitive interviewing, were performed at a local community center and in an acute medical ward at the University Hospital in Aalborg, Denmark respectively. A large agreement regarding meaning of the items in the forward translation and reconciliation process was seen. Minor discrepancies were solved by consensus. Back translation revealed unclear wording in one matter. The harmonization committee agreed on a version for cognitive interviewing after revision of minor issues and thirty-four participants were interviewed. Two issues became evident and these were revised. The cognitive interviews and final lay-out resulted in minor adjustments as text type size, specific font, and lining for optimizing readability. In conclusion, we consider the TFI to be translated in such rigorous manner that the instrument can be further tested in clinical practice. The overall objective of the questionnaire being to identify frailty and improve the interventions relating to frail elderly persons in Denmark.

Interruptions in clinical nursing practice.

AIMS AND OBJECTIVES: To report a descriptive study of interruptions in hospital nurses' work and discuss their consequences for nursing work. BACKGROUND: Interruptions negatively affect procedures, work flow and patient safety. They disturb the emotional atmosphere, reflective processes and the interaction with patients. The constant rearranging of priorities forced by interruptions are a source of frustration to nurses and may lead to a feeling of being pressed for time that results in reduced job satisfaction and stress-related symptoms. DESIGN: An ethnographic study. METHODS: Observation of five nurse's work over three weeks in January 2007 and qualitative interviewing of two nurses. RESULTS: Nurses were interrupted primarily by brief question-answer exchanges between nurse colleagues. Grouped by task, interruptions during medicine preparation in the ward's drug storage room were the most frequent, while the patients were responsible for fewer interruptions than was any other group. Nurses regarded some interruptions as unavoidable, others as avoidable, while the perception of other professional groups as the primary instigators of interruptions was not corroborated. CONCLUSIONS: Interruptions confront nurses with a dilemma between being accessible to others and remaining focused in order to 'see the big picture'. Nurses' professional 'groundedness' seems to determine their ability to retain a state of equilibrium in a field of unnecessary interruptions and to prevent interruptions from occurring. RELEVANCE TO CLINICAL PRACTICE: The study contributes new knowledge to the discussion of issues concerning organisation, management, training and clinical work, including nurse's ability to 'see the big picture'. It further seeks to clarify conditions for nursing that take into account professional standards and values as well as mutual understanding between colleagues.

Leading nurses in dire straits: head nurses' navigation between nursing and leadership roles.

AIM: The present study reports selected findings from a doctoral study exploring the negotiation between nursing and leadership in hospital head nurses' leadership practice. BACKGROUND: The importance of bringing a nursing background into leadership is currently under debate. In spite of several studies of nursing and clinical leadership, it is still unclear how nurses' navigate between nursing and leadership roles. METHOD: An 11-month-long ethnographic study of 12 head nurses' work: five worked at a first line level and seven at a department level. RESULTS: At the first line level, leadership practices were characterized by an inherent conflict between closeness and distance to clinical practice; at the department level practises were characterized by 'recognition games'. On both levels, three interactive roles were identified, that of clinician, manager and a hybrid role. CONCLUSIONS: Where clinician or manager roles were assumed, negotiation between roles was absent, leading to reactive, adaptive and isolated practices. The hybrid role was associated with dialectical negotiation of roles leading to stable and proactive practices. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leadership practises depend on leaders' negotiation of the conflicting identities of nurse and leader. Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity.

Seeing the big picture in nursing: a source of human and professional pride.

AIM: This article presents a discussion of the meaning of the phenomenon of seeing the big picture in nursing. BACKGROUND: Seeing the big picture is a frequent expression among Danish nurses. It is used when trying to understand a situation in its wider context. However, it has a rather imprecise meaning that might lead to misunderstandings. DATA SOURCES: This paper draws on studies undertaken in the mid 1990s and the early 2000s, but with the current discussion developed in the context of contemporary nursing. DISCUSSION: Seeing the big picture indicates a desire to do good for patients' and staff. This desire expressed through saying 'I need to see the big picture' is discussed to be a backbone in nursing and nursing leadership and a source of human and professional pride. There is, however, a dilemma if nurses overlook needs of patients that require immediate actions and if a nurse leader does not intercept staff members in crisis. The pride is oscillating between seeing the here-and-now and seeing the long-term in the big picture. CONCLUSION: We assumed seeing the big picture had to do with practical knowledge. Wonder and reasoning, however, brought us to virtues. Seeing the big picture as mentioned among nursing leaders and clinical nurses demonstrates human and professional pride. The study is useful in organizational, clinical and educational settings in updating policies for nursing, enlarging nurses understanding of practice and training students in understanding nursing practice.