Caring for family members following suicide: Professionals' experiences of responsibility.

BACKGROUND: When a patient commits suicide while hospitalized in the psychiatric ward, the mental healthcare professionals (MHCPs) who have had the patient in their care encounter the family members immediately following the suicide. Professionals who encounter the bereaved in this first critical phase may have a significant impact on the grieving process. By providing ethically responsible and professionally competent care, they have the opportunity to influence what can alleviate and reduce suffering and promote health in a longer perspective. AIM: The aim of this study is to investigate MHCPs' experiences in the encounter with family members who has been bereaved by suicide. METHODS: Data material consists of text from in-depth interviews with six MHCPs belonging to a total of five different psychiatric units in two hospitals. The findings have emerged through analysis using a hermeneutical approach based on Gadamer's philosophical hermeneutics. ETHICAL CONSIDERATIONS: The study was approved by the Ombudsman for Privacy of the Norwegian Social Science Data Services and is based on informed consent and confidentiality. FINDINGS: Three themes emerged: Confirming the suffering. Creating encounter through dialogue. Providing consolation and reconciliation. Findings illuminate how MHCPs understand their responsibilities and how they act in the encounter with the bereaved following suicide. CONCLUSION: The participants appear to be led by the responsibility that grows through witnessing the suffering of the bereaved. Encountering the family member's aggression and threats against staff members is an ethical challenge to the professional's ability to confirm the bereaved, create dialogue and provide consolation and reconciliation at the start of their grieving process. MHCPs need to be aware of the different reactions and needs of family members following suicide. More research is needed about how to provide sensitive and flexible care in ways that can be perceived as helpful for those left behind.

Residents' experiences of paternalism in nursing homes.

BACKGROUND: Interest in strengthening residents' autonomy in nursing homes is intensifying and professional caregivers' experience ethical dilemmas when the principles of beneficence and autonomy conflict. This increased focus requires expanded knowledge of how residents experience decision-making in nursing homes and how being subject to paternalism affects residents' dignity. RESEARCH QUESTION/AIM: This study explored how residents experience paternalism in nursing homes. RESEARCH DESIGN: This study involved a qualitative interpretive design with participant observations and semi-structured interviews. The interpretations were informed by Gadamer's hermeneutics. PARTICIPANTS AND RESEARCH CONTEXT: Eleven residents were interviewed after a period of participant observation in two nursing homes. ETHICAL CONSIDERATIONS: The study was performed in accordance with the Helsinki declaration. The Regional Ethics Committee (REK) permitted the researcher to perform participant observation in the nursing homes. The use of audio recordings of interviews was registered and supervised by Sikt - Norwegian Agency for Shared Services in Education and Research. The resident's consent was assessed continuously. Three interviews were terminated for ethical reasons. FINDINGS: The resident interviews revealed that residents found it obvious for caregivers to possess the decision-making authority in nursing homes. When residents explained their views, three main themes emerged: (1) To be included even though caregivers make the decisions, (2) Surrender to dependency, and (3) Adherence to nursing home norms. CONCLUSIONS: Residents submit to their caregivers and give caregivers the responsibility and function as leaders. Paternalism was experienced as dignifying in situations where it contributed to residents being able to live according to second order desires and values, and when it implied respect and appraisal of residents' capabilities. Paternalism was experienced as debasing when residents felt left out, and when residents felt that their capabilities were underestimated. This also included their capability to withstand paternalistic influence.

Katie Eriksson's caring theories. Part 1. The caritative caring theory, the multidimensional health theory and the theory of human suffering.

In this article, Katie Eriksson's caring theories including the caritative caring theory, the multidimensional health theory and the theory of human suffering are described. The assumptions and concepts, both etymologically and semantically investigated, are founded in ontology. Caring is a human natural phenomenon and patient means the suffering human being. In the caritative caring theory, the substance and core of caring is described as 'to care is to tend, play and learn in faith, hope and love'. The starting point is love, mercy, human kindness, compassion and a caring relationship. Caring is healing and sharing-a will to care, which is founded in faith and life energy. Caring promotes humanity and people's health, and thus a feeling of wholeness, integration, growth and inner freedom. The goal is to promote and protect health and life and alleviate suffering. Health means wholeness and holiness. Eriksson emphasises an ontological aspect of health, where the human being is seen as an inseparable being comprising a body, soul and spirit. To be healthy is to be whole and to feel whole, where wholeness means life itself. In the multidimensional perspective, the essence of health is vitality. Vitality is the innermost dimension of health; it is a force to energy in life, to joy and desire. Health is a dynamic movement between dimensions of becoming, being and doing. Eriksson seeks answers to the 'what' of suffering through concept analysis, but she also discusses the 'why' question. Each suffering is unique. There is a connection between suffering and desire, where suffering gives birth to an unsuspected life power that is not seen as having any other source than suffering itself. Desire and suffering make up the driving power for a person's being and formation into the person she is intended to become.

Katie Erikson's caring theories. Part 2. The theory of caritative caring ethics and the theory of evidence.

In this article, Katie Eriksson's theory of caritative caring ethics and the theory of evidence, are described. Both theories are anchored in caritas, that is love, mercy and compassion. The theory of caritative caring ethics was first described by Eriksson in 1995, where seven assumptions or basic categories were elaborated. These were: the human being's dignity, the care relationship, invitation, responsibility, virtue, obligation or duty, and good and evil. Eriksson's theoretical contribution is that she makes a distinction between caring and nursing ethics, between inner and external ethics, and between natural and clinical ethics. Concerning the theory of evidence, Eriksson claims that a multidimensional scientific view of evidence in caring that focuses on the patient's world is necessary and vital. To see, realise, know, attest and revise constitute the ontological definitions of the concepts of evidence and evident. The theories are united by the core concepts of testimony and witnessing the human being's suffering. Eriksson points out that it is in the ethical acts that deeds are formed, based on ethos. The anchorage in an ethos means to have firm value-loaded judgements of an inner motive. Moreover, the anchorage in ethos presupposes a personal and natural ethic. The good deeds are realised in the relationship between the patient and the carer, but the caring ethics is not a professional or external ethics. Caring ethics is an ontological inner ethics meaning fellowship and the right to exist, but it is the patient's world and reality that decides the foundation and starting point for caritative caring ethics in clinical practice. The ultimate purpose and goal of caring are to guarantee the patient's dignity and absolute value as a human being.

Dignity humiliation as experienced by wives caring for a home-dwelling husband with dementia.

In this study, we explored key sources that led wives who care for their husbands with dementia at home to experience dignity humiliation - an issue that affects the well-being of women around the world. Through hermeneutic interpretation of in-depth interviews, three key sources of this were identified: interpersonal experiences of people's indifference, curiosity and disrespectful attitudes; interpersonal experiences of limited access to healthcare services and incompassionate treatment by healthcare professionals, and; intrapersonal experiences of self-deprecation. Knowledge of key sources leading to dignity humiliation can be used to improve interdisciplinary healthcare practices and policy development, specifically relating to this group of caregivers.

Dignity in fragile older women receiving daily municipality care.

Background:Dignity is an important ideal in the nursing of older women who need municipal care. Dignity can be challenged when health is impaired by feeling grief and suffering associated with bodily changes and impaired functions.Aim and research questions:The study aimed to deepen the understanding of the meaning of dignity in the life of fragile older women who daily needed help from municipal care service. The research questions are: What is older women's experience of dignity, and what is it not to be met with dignity when needing service from municipality care?Research design: The study has a qualitative design, and the methodology is based on Gadamer's ontological hermeneutics. Ten women receiving municipal care, aged from 66 to 91 were interviewed in their home environments. Kvale and Brinkmanns' three levels of interpretation were applied in the analysis of the interviews: self-understanding, a critical understanding based on common sense, and theoretical understanding.Ethical considerations: The study follows the guidelines for good scientific practice according to the Declaration of Helsinki and was approved by the Norwegian Centre for Research Data.Results: The interviews revealed fragments of the women's unique life history. Two themes emerged from the interpretation: Confirming encounters provide human dignity; and Not being confirmed as a human being violates human dignity.Conclusions:For the women, dignity is about feeling seen and understood by the individual nurse and this takes place both in conversation and in bodily care. Not being seen or confirmed gives rise to suffering. The reason for this seems to be lack of competence on the part of the staff or little continuity.

Discovering dignity through experience: How nursing students discover the expression of dignity.

INTRODUCTION: Dignity is a core value in nursing. Nursing education shall prepare students for ethical professional practice and facilitate insight into the phenomenon of dignity and its significance. There is limited knowledge about how nursing students discover dignity in their education. RESEARCH AIM: The aim of the study is to develop an understanding of how nursing students discover and acquire dignity. RESEARCH DESIGN: The study has a hermeneutic approach where qualitative interviews of nursing students were employed. The process of interpretation was inspired by text of Fleming, Gaidys and Robbs. PARTICIPANTS AND RESEARCH CONTEXT: Nineteen nursing students agreed to be included in the study, representing six different campuses at three different educational institutions. All were in the final year of their study. The interviews took place at the educational institutions. ETHICAL CONSIDERATIONS: The educational institutions facilitated recruitment of the students who signed voluntarily for participation and continuous informed consent. The study was approved by The Norwegian Center of Reporting Data (NSD). The research recommendations of the Declaration of Helsinki were followed. FINDINGS: The nursing students discovered the expression and significance of dignity through experiences, gained through introspection and in interaction with others during the education. DISCUSSION: The findings are discussed using Gadamer's concept of experience and how experiences can create new insight. In particular, the students' experiences with the inner ethical and external aesthetic dimension of dignity are discussed. CONCLUSION: The study shows that students discovered the inner ethical dignity through experiencing vulnerability, pride and shame. They discovered the external aesthetic dignity through incidents, where they experienced both to be confirmed and not to be confirmed, and through observation of good or bad role models. Crucial negative and positive experiences are important for discovering the expression and significance of dignity.

Dignity at stake in educational relations - The significance of confirmation.

INTRODUCTION: It is a goal in nursing education to promote students' dignity and facilitate this core value. Students' experience of dignity is shaped by the student-supervisor relationship. Literature shows limited knowledge about how nursing students experience their own dignity during education. RESEARCH AIM: The aim of the study is to develop an understanding of how nursing students experience their own dignity in relation to supervisors, and what significance these experiences have in education. RESEARCH DESIGN: Gadamer's philosophical hermeneutics was chosen as the approach, and narratives and qualitative interviews were conducted. The interpretation process was inspired by Fleming, Gaidys and Robbs. PARTICIPANTS AND RESEARCH CONTEXT: Nineteen nursing students in the final year of their education were included in the study. They represented six different campuses at three different educational institutions. The qualitative interviews took place at the educational institutions. ETHICAL CONSIDERATIONS: The research recommendations of the Declaration of Helsinki were followed. Access to the students was given by the educational institutions. All interested students signed a continuous informed consent. FINDINGS: Students' dignity was at stake in encounters with supervisors during education. Decisive for experience of dignity was the supervisor's ability to confirm the student through acknowledgment, reassurance and seeing them as individuals. Experienced dignity had a crucial impact on students' life courage and their ability to be present. DISCUSSION: The discussion emphasizes the vulnerable dignity of students, the importance of confirmation and the significance perceived dignity has. CONCLUSION: Students' experiences tilted between perceived dignity and offense, and placed students' dignity in a vulnerable position. Crucial for perceived dignity was the confirmation the students received from their supervisors. Perceived dignity gave the students courage and increased their ability to be present, which provided better opportunities for learning and development.

Dignity in relationships and existence in nursing homes' cultures.

INTRODUCTION: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. BACKGROUND: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of existence, as well as compassion in relieving suffering, and ontological interdependency. AIM: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. RESEARCH DESIGN: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. PARTICIPANTS AND RESEARCH CONTEXT: Focus group interviews with caregivers in nursing homes. ETHICAL CONSIDERATIONS: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. FINDINGS: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. DISCUSSION: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. CONCLUSIONS: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others.

Hermeneutic observational studies: describing a method.

There is a need to develop and use research observations in the clinical field, primarily to gain insight into and assess evidence of what comprises caring in a real-life situation and confirm what is actually taking place. In addition, assessments lead to a new and different understanding of what caring constitutes, thereby enabling the identification of what kind of care is being provided and is required. Such observations also enable the observer to perceive and verbalise caring. There are ongoing discussions, specifically in Nordic countries, on how to use caring science-based observations as a means of collecting and interpreting qualitative data through the application of a hermeneutic approach, which constitutes describing what has been seen and reporting on it by way of ethical obligation. This article contributes to the debate through the provision of additional content and by reflecting on the development and usability of hermeneutical research observations from a method and methodological perspective, thereby refining previous ideas and extending previous assumptions. The primary study objective was to report on the experience of utilising observations as a single data collection method for hermeneutic research with the aim of evaluating the interplay between intensive care unit (ICU) patients and their next of kin. A secondary objective was to highlight the impact of preknowledge and preunderstanding on the interpretation process. An intensive care context was assessed as the most appropriate, as the majority of patients are unable to engage in verbal narratives during ongoing treatment and care. The benefits of employing hermeneutic observation as well as interpretation and preunderstanding from a caring science perspective are considered.

It is just that people treat you like a human being: The meaning of dignity for patients with substance use disorders.

INTRODUCTION: Patients who suffer from substance use disorder (SUD) might receive services from different service providers in an opioid maintenance treatment programme (OMT) and have a widespread and complex need for nursing. BACKGROUND: Literature reveals that prejudices against people with SUD exist. There is a lack of studies exploring patients with SUD experiences of preserving their dignity in the encounter with healthcare staff. The aim of the study was to gain insight into the meaning of dignity for patients with SUD. METHODS: The research design was descriptive and interpretative. In the interpretation of qualitative in-depth interviews with six patients, a hermeneutical approach based on Gadamer (Truth and method, Sheed & Ward, London, UK, 1989) was used. RESULTS: Analysis resulted in three mains themes about the meaning of dignity: (a) The material dimension. (b) To be respected by others. (c) The inner experience. Factors enhancing dignity in the encounters were as follows: (a) Being respected and acknowledged. (b) Being cared for. (c) Knowledge and persistent relation. Factors depriving dignity were as follows: (a) Stigma and prejudice. (b) Insufficient relations and lack of confirmation. (c) Experiencing disrespectful/patronising attitudes and lack of knowledge. CONCLUSIONS: The material dimension of dignity containing an aesthetically aspect was important for these patients. Dignity was also experienced as strongly connected to respect. Dignity can be enhanced by treating patients with SUD with understanding and respect, and dignity can be inhibited through stigmatization of patients with SUD, as well as by caregivers' lack of knowledge. RELEVANCE TO CLINICAL PRACTICE: The study clarifies a need for more knowledge about SUD among healthcare staff, as well as promotes ethical awareness in encounters with patients regardless of their background.

Behavioural disturbances in patients with frontotemporal lobe degeneration focusing on caregiver burden at home and in nursing homes.

AIM AND OBJECTIVE: To explore the challenges faced by family caregivers of people with frontotemporal dementia and other forms of dementia affecting the frontal and temporal lobes causing behavioural disturbances through a qualitative approach with in-depth interviews. BACKGROUND: Studies of different forms of dementia involving degeneration of the frontal and temporal lobes have mainly focused on the neurophysiology and physiology of the disease and on caregivers' health. Few studies have described the challenges and burdens connected with everyday life and in relation to suitable nursing home placement that are faced by family caregivers. METHOD AND DESIGN: This study used a descriptive and explorative design. Eleven semi-structured interviews with family caregivers of patients from special units in four nursing homes were conducted in 2014. Data were analysed based on Kvale and Brinkmann's three contexts of interpretation: self-understanding, common sense and theoretical understanding. Checklist for qualitative studies: Standards for Reporting Qualitative Research (SRQR) http://www.equator-network.org/reporting-guidelines/srqr/ RESULTS: Two central themes were derived from the data: changes in behaviour and personality were perceived as incomprehensible, frightening and increasingly difficult to manage. Family caregivers experienced challenges in finding suitable care facilities when they were not able to continue providing home care. Due to behavioural disturbances and lack of relevant competencies among health personnel, family members were often moved between nursing homes. CONCLUSION: Pronounced personality and behavioural disturbances such as tactlessness and aggression in a family member with dementia are experienced by caregivers as stressful and burdensome and may lead to feelings of shame and guilt. A lack of suitable care facilities adds to the stress and difficulties of the families and entails an additional and unresolved burden. RELEVANCE TO CLINICAL PRACTICE: The study reveals a need for more knowledge among those organising health services as well as healthcare professional dealing with this patient category to ease the burden on next of kin.

Dignity work of older women caring for a husband with dementia at home.

In this study, we explored perceptions of dignity, and sources preserving dignity of six older Norwegian women caring for a home-dwelling husband with dementia. Through hermeneutic interpretation of in-depth interviews, "having personal integrity," "mastering everyday life," and "giving of one self" were identified as crucial intrapersonal aspects of dignity - while "acknowledging worthiness and uniqueness of each human being" was found to be an essential interpersonal aspect. Nine dignity-preserving sources identified suggests that the wives engaged in "dignity work" to preserve their own dignity as a caregiver, as well as to safeguard the dignity of their husbands who were vulnerable to dignity loss.

The paradoxical body: A glimpse of a deeper truth through relatives' stories.

BACKGROUND: People with progressive cancer experience that their bodies change due to disease and/or treatment. The body is integral to the unity of the human being, a unity that must be perceived as whole if dignity shall be experienced. Relatives are in touch with the suffering bodies of their dear ones, physically, socially, mentally, and existentially, and thus the relatives' experiences of the bodies of their dear ones might yield insight into the concept of dignity. AIM: The aim of this study is to explore relatives' experiences of the patients' bodily changes from a perspective of dignity. RESEARCH DESIGN AND METHOD: A total of 12 relatives from a hospice in Norway were interviewed. Gadamer's ontological hermeneutics inspired the interpretation. ETHICAL CONSIDERATIONS: The principles of voluntariness, confidentiality, withdrawal, and anonymity were respected during the whole research process. The Norwegian Social Science Data Services approved the study. RESULTS AND CONCLUSION: The conversations about the body were conversations about ambivalent or paradoxical matters that shed light on the concept of dignity. The results show that the relatives got in touch with elements that otherwise would have remained tacit and unspoken, and which gave glimpses of a deeper truth, which might reveal the core of dignity. Furthermore, the relatives' confirmation of the ambivalence might be understood as a strong ethical obligation to treat the other with dignity. The confirmation may also reveal the relatives' unselfish love of the other, which can be understood as the core of ethics and ethos. Finally, the results reveal the relatives' limited insight into their dear ones' bodily changes, and we discuss the challenges of truly seeing the other. Body knowledge and the relationship between body and dignity as phenomena cannot be ignored and needs more attention and articulation in clinical nursing practice and in nursing research.

Hindrances to achieve professional confidence: The nurse's participation in ethical decision-making.

BACKGROUND: Research suggests that nurses generally do not participate in ethical decision-making in accordance with ethical guidelines for nurses. In addition to completing their training, nurses need to reflect on and use ethically grounded arguments and defined ethical values such as patient's dignity in their clinical work. OBJECTIVES: The purpose of this article is to gain a deeper understanding of how nurses deal with ethical decision-making in daily practice. The chosen research question is "How do nurses participate in ethical decision-making for the patient?" DESIGN AND METHOD: We use Gadamer's philosophical hermeneutics as well as Kvale and Brinkmann's three levels of understanding in interpreting the data material. Nine registered nurses were interviewed. ETHICAL CONSIDERATIONS: The Ombudsman of Norwegian Social Science Data and the head of the hospital approved the investigation. The participants received both oral and written information about the study and they gave their consent. We informed the participants that the participation was voluntary and that they were free to withdraw at any point in the course of the study. The requirement of anonymity and proper data storage was in accordance with the World Medical Association Declaration of Helsinki (1964). The participants were assured that privacy, and confidentiality would be duly protected. RESULTS: Four key themes emerged: (1) confusion in relation to professional and operational expectations of role, (2) ideal somnolence, (3) inadequate argumentation skills, and (4) compound pressure. CONCLUSION: Ethical ideals appear to be latent in the mindset of the participants; however, the main finding of this investigation is that nurses need to activate the ideals and apply them into practice. Furthermore, management needs to initiate professional reasoning and interdisciplinary discussions leading to common goals for patients.

Music Therapy and Physical Activity to Ease Anxiety, Restlessness, Irritability, and Aggression in Individuals With Dementia With Signs of Frontotemporal Lobe Degeneration.

The purpose of the current study was to evaluate whether a combined intervention of physical activity and music therapy could reduce anxiety, restlessness, irritability, and aggression among individuals with severe dementia. An exploratory design was used to evaluate a combined intervention of physical activity, music therapy, and daily walking. Interventions were systematically implemented for 8 weeks. Target groups were individuals with dementia with frontal lobe symptoms in institutional care. Primary outcome measure was the Brøset Violence Checklist (BVC). Four men and two women (mean age = 84.3 years) and their primary caretakers (n = 6) participated. The most prominent symptoms among participants at baseline were confusion, irritability, and verbal threats. The individual BVC total scores indicated significant improvements (p = 0.03). Implementation of individualized music therapy combined with increased physical activity for 8 weeks was a feasible intervention that reduced anxiety, restlessness, irritability, and aggression in the current study. [Journal of Psychosocial Nursing and Mental Health Services, 57(5), 29-37.].

Tension between freedom and dependence-A challenge for residents who live in nursing homes.

AIMS AND OBJECTIVES: To present results from interviews of older people living in nursing homes, on how they experience freedom. BACKGROUND: We know that freedom is an existential human matter, and research shows that freedom remains important throughout life. Freedom is also important for older people, but further research is needed to determine how these people experience their freedom. The background for this article was a Scandinavian study that occurred in nursing homes; the purpose of the study was to gain knowledge about whether the residents felt that their dignity was maintained and respected. DESIGN: The design was hermeneutic, with qualitative research interviews. METHOD: Twenty-eight residents living in nursing homes in Denmark, Sweden and Norway were interviewed. Collecting tools used were an interview guide and also a tape recorder. Researchers in the three countries performed the interviews. The data were transcribed and analysed on three levels of hermeneutic interpretation. RESULTS: To have their freedom was emphasised as very important according to their experience of having their dignity taken care of. The following main themes emerged: (a) Autonomy or paternalism; (b) Inner and outer freedom; and (c) Dependence as an extra burden. CONCLUSIONS: Residents in a nursing home may experience the feeling of having lost their freedom. This conclusion has implications for healthcare professionals and researchers, as it is important for residents in nursing homes to feel that they still have their freedom. RELEVANCE TO CLINICAL PRACTICE: In clinical practice, it is important and valuable for the staff to consider how they can help older people feel that they still have their freedom.

Discovering the ethos of serving in nursing leadership from the first half of the 20th century in three Nordic countries - an idea-historical research approach.

The history of ideas may contribute to an awareness and an opening up of deep-seated currents of thought that have shaped the inner core of the caring culture and an ethical value base - the ethos of serving in nursing leadership. This article studies how serving as an ethos is represented, which becomes visible and evident in Sophie Mannerheim's, Bertha Wellin's and Bergljot Larsson's nursing leadership. This article also seeks to describe the main features of the idea-historical research approach the way in which it is represented within the caring science-tradition. An idea-historical methodological approach informed by Gadamer's philosophy was used for the hermeneutical interpretation within a caring science perspective. Primary and secondary historical sources were explored in the light of nursing praxis and serving. Three general idea patterns were discovered: the innermost room of the heart as the idea of serving, the action of the hand as acts of love and a cultivation of the head towards nursing leadership. These ideas open for a new vision that can bring out new patterns for action in the present and in the nursing leadership of the future.

Longing - a dynamic power in the becoming of health when suffering from cancer.

BACKGROUND: The aim of the study was to gain understanding of existential longing in health and suffering as experienced by persons who have been affected by a cancer disease. The theoretical perspective of the study is K. Eriksson's theory of Caring Science. METHOD: Qualitative interviews with nine women with cancer were transcribed and interpreted using Gadamer's ontological hermeneutics. RESULTS: Four perspectives of longing when suffering from cancer are presented: Longing as a source to call upon for survival, Longing for the life prior to the illness, Longing directed towards deeper relations in everyday life, and Transcending longing moves towards the ultimate fulfilment. INTERPRETATION: The overall interpretation led to the following thesis about the dimension of longing in the human being: Longing is becoming in a movement towards reconciliation of life, and, Longing is becoming in a movement towards transcending life. CONCLUSION: The results show that there seems to be a dynamic power in longing that can transform suffering and create health.

Clinical application research through reflection, interpretation and new understanding - a hermeneutic design.

The implementation of theoretical knowledge in clinical practice and the implementation of good clinical practice into theory have been of interest in caring science for the last 30 years. The aim of this article was to elaborate and discuss a methodology named clinical application research. The method is grounded in a hermeneutical design inspired by Gadamer's philosophy. The methodology, clinical application research, has been used in a research project A life in dignity and experiences from the researchers forms the bases for the elaboration and discussion. The project was performed in collaboration with residents, family caregivers and healthcare providers at six nursing homes in Scandinavia. The material for this article is based on the previous research, that is the results from 10 different articles showing the meaning of dignity and indignity in daily life in nursing homes. Data were generated from 56 individual interviews and 18 focus-group interviews with a total of 40 staff members with five to eight participants at every interview session. By reflection, interpretation and new understanding our results provide knowledge about dignity and how to preserve dignity for older people in an appropriate ethical way. The methodology was relevant for the research project A life in dignity and relevant to caring practice in nursing homes as it opens new possibilities and new ways of thinking when performing dignified care to older people.