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PubMed1993

Theoretical discussion of a model of caring for persons with HIV infection.

A model of caring for persons with HIV infection is presented. The model, which identifies the characteristics of care as a holistic phenomenon, consisting of care actions and caring behaviours, was developed through a qualitative approach comparable to the ethnonursing method. The characteristics of care inherent in the model are validated through comparison with knowledge of care from selected historical, linguistic, and caring science sources as well as with care experiences, described in biographies of persons with HIV infection. It is proposed, that the model should be used for further investigation of caring for persons with HIV infection, for investigating caring for persons with other conditions, for teaching caring theory and practice, for planning of caring services and for policy formulation.

Empathy↗
PubMed1995

The helping encounter--occupational therapists' perception of therapeutic relationships.

The present paper deals with the art of occupational therapy in terms of therapeutic, helping relationships. The aim was to get a picture of how occupational therapists perceive the therapeutic encounter with their patients. Sixteen qualified occupational therapists, from various occupational areas, were interviewed and a qualitative approach was employed to analyze their description of therapeutic encounters in clinical settings. The qualitative analyses were performed with sensitization as the principle objective and a tentative theoretical model was formed, developed by three content categories; 1) Basic Professional-Oriented Helping; 2) Understanding-Oriented Helping; and 3) Action-Oriented Helping. The relationships between these categories constitute a dynamic complex pattern. One conclusion drawn from this model was that the therapists might have problems finding a balance between their aspiration for becoming professionalized and their belief in egalitarian patient-therapist relationships in the rehabilitation treatment sessions.

Attitude of Health Personnel↗
PubMed2004

Domestic strain: a hindrance in rehabilitation?

Long-term sick leave due to musculoskeletal disorders has increased, especially for women. The aim of this paper was to explore women's and men's descriptions of the private arena in relation to rehabilitation and sickness absence. This study is part of a larger project focusing on consequences of sick leave. Individual interviews were conducted in 1997 and 1998 with 20 women and men who had been long-term sick-listed in 1985 with musculoskeletal diagnoses. The data were analysed using Grounded theory in combination with gender analysis, which involved separately comparing men's and women's statements in order to find similarities and differences. According to the interviewees, factors in the private arena were closely associated with the rehabilitation process. Women described themselves as being responsible for the domestic work while men more often 'helped out' when asked to do so. Women and men described similar strategies to facilitate domestic work. Three dimensions of domestic life were identified, comprising division of domestic work and division of responsibility for domestic life and the amount of socio-emotional support or isolation at home. Using these dimensions, a 'domestic strain model' was developed. Our study indicates that long-term sick-listed women experiencing domestic strain would rather stay at home than return to work. Domestic strain involves inequities in the division of work and responsibilities and a lack of socio-emotional support at home. However, the model of domestic strain needs further empirical testing.

Adaptation, Psychological↗
PubMed2004

Dimensions of informal care and quality of life among elderly family caregivers.

The aim was to investigate dimensions of caregiving activities among elderly (75+) caregivers based on Nolan's model and to study the dimensions in relation to health-related quality of life (Short Form 12). Responses to a Swedish postal survey (n=4278, response rate 75-79 years old: 60%; 80-84: 56%; 85-89: 48% and 90+: 42%) showed that 783 persons (18%) were helping another person due to that person's impaired health, 41.6% women, mean age for women 81.8 years (SD 4.96) and for men 81.7 years (SD 4.32). The postal questionnaire included SF-12, demographic data and questions about caregiving activities derived from Nolan's model, social network and contacts with health care. Adapting their activities to be prepared if something happened (52%), having regular contact to prevent problems (35%), helping in contacts with the hospital (57%), helping with instrumental activities of daily living (49%), personal activities of daily living (14%), medical care (11%) and helping to improve functions (14%) were the activities reported. Adapting own activities, regular contact, weak economy and needing instrumental help with daily living oneself predicted low MCS12. The importance of early involvement on the part of the caregivers was emphasized.

Activities of Daily Living↗
PubMed2005

Curtailing: handling the complexity of body care in people hospitalized with severe COPD.

Assisted personal body care (APBC) tends to be regarded as an unproblematic nursing activity with little professional challenge. For severely ill patient diagnosed with chronic obstructive pulmonary disease (COPD) daily bathing and washing is, however, a significant self-preserving activity that requires substantial efforts on the part of both patients and nurses. The aim of this study was to report on the complex pattern of APBC in hospitalized patients with severe COPD and highlight significant characteristics that should be considered in clinical practice in order to support patients' comfort and well-being. The study used a grounded theory design with a generative and constant comparative approach. The sample consisted of 12 cases of nurse-patient interaction, based on data from participant observation of sessions of APBC, measures of patient's perceived degree of breathlessness and individual interviews with patients and nurses after the sessions. Findings show that APBC in hospitalized patients with severe COPD is a complex integrated pattern of body care activities that can proceed with a greater or lesser degree of success. The main problem is how to keep the patient's breathing under control while optimizing comfort and well-being. Curtailing addresses this problem. Curtailing is a subtle, purposeful balancing of protection from breathlessness and promotion of patients' present and future functional capacity in order to preserve their integrity. The idea that body care is a simple task belonging to patients' private daily lives may obscure the importance of determining a mutual nurse-patient agenda and the professional nurse responsibility may consequently be nebulous. Finding in this study will contribute to the development of a comprehensive and detailed understanding of the APBC and suggest the need for further investigation of the interaction perspective.

Activities of Daily Living↗
PubMed2005

Being in an alien world: Danish parents' lived experiences when a newborn or small child is critically ill.

Parents of critically ill small children have received quite a lot of attention in nursing and allied health literature. However, no documented studies were found from Danish paediatric or neonatal contexts. The aim of the study therefore was to identify Danish parents' lived experiences during a newborn or small child's critical illness. The study was undertaken in a human caring perspective assuming that caring is primary and relational, and that persons are concerned when things matter to them. Thirteen parents were interviewed twice, and data were analysed following Van Manen's phenomenological methodology. The findings revealed that being a parent when a newborn or small child is critically ill resembled being in another world, alien from what they knew and had earlier experienced. The parents wanted to be close to the child, they were seeking for an understanding of what happened, and they felt inexperienced and insecure but at the same time they were attentive and vigilant. The sub-themes that were more prominent were 'a need to be there', 'What is going on?', 'being vigilant', 'being a spectator to your own life', and 'oscillating between hope and hopelessness'. The study implies that the staff needs to help the parents perceive some kind of meaning of what is going on, to instill hope despite not knowing the outcome, and to accept and respect the parents' style of coping with stress and concern for their sick child.

Adaptation, Psychological↗
PubMed2006

Assisting teens with asthma to take command.

To meet and work with teenagers may be a challenge for caregivers as adolescence is a period when youths try to establish autonomy. Although asthma is an increasing problem worldwide, few studies have addressed professional caregivers' motives and actions. Therefore, the aim of this study was to describe professional caregivers' strategies in their work with teenagers with asthma. Grounded theory, inspired by Glaser, was used to uncover the phenomenon. The informants were seven professional caregivers who worked at an eight-day asthma camp for teenagers in Sweden. Participant observations and interviews were used, and the first author collected the data and participated in the activities. Findings show that professional caregivers' core concern is to assist teenagers with asthma to take command. This core concern gives rise to five strategies: showing respect, being at hand, promoting own responsibility, promoting to exceed boundaries and promoting reflections. In professional caregivers' attempt to assist teenagers to take command some differences are seen in the way they support boys and girls. One conclusion drawn from our study is that the provisional theory of 'Assisting teenagers with asthma to take command' is not only suitable for professional caregivers working at asthma camps; it may, in some degree, also be used as a source of inspiration for professional caregivers in other settings.

Adaptation, Psychological↗
PubMed2006

Significance of fellow patients for patients with myocardial infarction.

The purpose of the study was to present both positive and negative experiences with respect to the significance of fellow patients for patients with myocardial infarction (MI), both inside and outside the hospital. Five focus group sessions were carried out, each having between four and six participants. A total of 25 patients with MI at an age of 40-71 participated. The analysis was carried out by the moderator and co-moderator of the focus groups. The results, which are elucidated by theories of social support, show a great amount of positive support in the interactions of patients, such as support from others in the same situation, a lot of humour, encountering true understanding and consideration, getting practical assistance, and benefiting from other patients' knowledge and experience as well as experiencing an increase in motivation. The participants also discussed negative experiences such as dramatic situations when fellow patients got worse and sometimes even died. Many patients were bothered by various kinds of noise and other disturbances. Insight into the significance of fellow patients will make health personnel able to encourage a patient environment that will strengthen positive and reduce negative effects of fellow patients on the health of each individual patient. One relevant measure would be involving former patients or starting up physical activity in groups. The findings show that the informal patient community among fellow patients is an important part of their social support system and thereby also may contribute to health and well-being.

Adult↗
PubMed2004

Will insured citizens give up benefit coverage to include the uninsured?

OBJECTIVE: To describe the willingness of insured citizens to trade off their own health benefits to cover the uninsured. DESIGN: Descriptive study of individual and group decisions and decision making using quantitative and qualitative methods. SETTING AND PARTICIPANTS: Twenty-nine groups of citizens (N = 282) residing throughout Minnesota. INTERVENTIONS: Groups participated in Choosing Healthplans All Together (CHAT), a simulation exercise in which participants choose whether and how extensively to cover health services in a hypothetical health plan constrained by limited resources. We describe individual and group decisions, and group dialogue concerning whether to allocate 2% of their premium to cover uninsured children in Minnesota, or 4% of their premium to cover uninsured children and adults. MEASUREMENTS AND MAIN RESULTS: While discussing coverage for the uninsured, groups presented arguments about personal responsibility, community benefit, caring for the vulnerable, social impact, and perceptions of personal risk. All groups chose to insure children; 22 of 29 groups also insured adults. More individuals chose to cover the uninsured at the end of the exercise, after group deliberation, than before (66% vs 54%; P < .001). Individual selections differed from group selections more often for the uninsured category than any other. Nevertheless, 89% of participants were willing to abide by the health plan developed by their group. CONCLUSION: In the context of tradeoffs with their own health insurance benefits, groups of Minnesotans presented value-based arguments about covering the uninsured. All 29 groups and two thirds of individuals chose to contribute a portion of their premium to insure all children and most groups chose also to insure uninsured adults.

Adult↗
PubMed1982

Induced disability in nursing home patients: a controlled trial.

Many performance deficits observed in institutionalized elderly patients may be the results of social and environmental factors rather than disease or the aging process. To test this hypothesis, 72 nursing home residents (mean age, 78 years) were randomly assigned to three groups for training in completion of a simple psychomotor task. In four training sessions, members of Group I ("helped") were given extensive assistance in completing the task; members of Group II ("encouraged only") were given verbal encouragement but minimal assistance; members of Group III ("no contact") received no training sessions and served as controls. All subjects were tested on proficiency in completion of the task (a simple jigsaw puzzle) before and after the intervention period. Completeness of performance by Group II improved during the study, but that of Group I deteriorated significantly (P = 0.04 between groups) to a level even below that of the control group (P = 0.03). Similar differences were found in speed of performance, with Group II performing best, Group I performing worst (P = 0.05), and the control group performing intermediately. Perception of task difficulty was greater (P = 0.02) and self-confidence was less (P = 0.06) for Group I than for Group II. The psychosocial environment of long-term facilities can have important effects on the competence of elderly patients. Excessive infantilization of residents and overly intrusive help in self-care beyond clinical requirements can lead to "learned helplessness," with further disability.

Activities of Daily Living↗
PubMed1982

The relationship of self-help networks to physical and psychosocial functioning.

One hundred fifty-eight elderly persons living in retirement hotels and apartments were classified by being receivers or givers of help to their neighbors into four groups: givers, getters, both (GG), or neither (NGG). The aim was to determine whether the groups differed in personal characteristics, physical functioning, or psychologic adjustment at baseline and six months later. The groups did not differ in personal characteristics. The NGG group (N = 55) functioned significantly less well, both physically and psychosocially. At six months, with baseline scores adjusted, the givers had fewer illnesses and the GG group had better self-esteem. Thus, subjects did not change significantly in other variables. Efforts to enhance the ability of the NGG group to form social networks, if applied cautiously, may help to improve their overall adjustment.

Aged↗
PubMed1989

Stereotypes of professional roles.

To determine the current public image of the nursing profession, this survey investigated the nature of stereotyping. Subjects approached in a shopping mall (N = 110) were asked to rate the degree to which 12 characteristics typify individuals in 14 professions. The results indicate that the public image of the nurse continues to turn on feminine and nurturant characteristics. The need for increased public awareness that nurses are scholars and leaders is underscored. Asserting the right to practice may produce a new stereotype of the nurse as intelligent and autonomous.

Adolescent↗
PubMed1992

The practice of empowerment and coercion by expert public health nurses.

This article describes the dialectic of public health nursing responsibility to empower families in self care as well as the nursing responsibility to evoke authority as needed to protect children from violence and neglect. Through qualitative study of expert home visiting public health nurses' anecdotes (N = 95), these apparently contradictory activities were discovered to co-exist in helping relationships. The synthesis of the apparent contradictions applies community rather than autonomy as the fundamental moral guide.

Child Advocacy↗
PubMed1993

A Heideggerian hermeneutical analysis of survivors of incest.

The phenomenological study described in this paper examined the lived experience of adult women survivors of childhood incest. Self-identified incest survivors (N = 5) participated in non-structured, audiotaped interviews. Subsequent transcripts were analyzed by a team of researchers using Heideggerian phenomenology to identify common meanings and themes in the texts. The major findings of the study suggested two constitutive patterns of lived experience among incest survivors: "Remembering As a Coming of What Has Been" and "Care: Reconstituting a Sense of Me."

Adaptation, Psychological↗
PubMed1997

Balancing engagement and detachment in caregiving.

PURPOSE: To investigate how caregivers balance engagement with detachment to cope with cumulative demands and losses. DESIGN: Qualitative, descriptive. Population, formal and informal caregivers in the United States. A sample of 14 was studied between 1992 and 1994. METHODS: Data were collected in open-ended interviews, then were coded and analyzed using grounded-theory methods. Credibility and fittingness were established. RESULTS: Caregivers who balance engagement and detachment can affect outcomes without needing to control outcomes. Such caregivers are pragmatic and make conscious choices based on their emotional needs. They set and maintain limits and boundaries and are able to monitor the balancing process while recognizing the importance of practicing self-care. CONCLUSIONS: The longer and more intense a caregiver's involvement, the more important it is to learn to balance engagement and detachment. Caregivers may need to learn effective balancing skills.

Adaptation, Psychological↗
PubMed2003

Social capital, health, and health disparities.

PURPOSE: To synthesize the empirical evidence that links social capital to population health with the aim of identifying implications for health disparities research. METHODS: A literature search of PubMed and CINAHL databases from January 1990 to June 2002 was done using the search term "social capital." In addition, tables of contents of applicable journals from January 1997 to June 2002 were searched. Reference lists were examined for additional empirical and theoretical articles related to social capital and health. Eighty-four articles were retrieved for review and 19 articles met inclusion criteria. FINDINGS: Although most reseachers concluded that their findings supported an association between social capital and health, all research was descriptive, without conceptual development. This gap resulted in (a) lack of distinction of the concept as an attribute of a geographic space or as an individual attribute, (b) problematic use of operational variables, and (c) limited theoretical exploration of causal linkage. These deficits limit the usefulness of the concept for health disparities research. CONCLUSIONS: The lack of conceptual development diminishes the usefulness of social capital as a variable for public health research. However, the empirical evidence is sufficient to warrant further work to advance the concept in relation to population health and health disparities.

Attitude to Health↗