Caring from the point of view of a Finnish mental health nurse: a life history approach

Legitimacy in legacy: a discussion paper of historical scholarship published in the Journal of Advanced Nursing, 1976-2011

AIMS

This paper presents a discussion of historical scholarship published in the Journal of Advanced Nursing.

BACKGROUND

The Journal of Advanced Nursing provides a forum for disseminating high-quality research and scholarship. For over 35 years, scholars have used the Journal of Advanced Nursing to disseminate research into aspects of nursing, including nursing history.

DATA SOURCES

The data source was Wiley Online electronic database for the Journal of Advanced Nursing for the period 1976-December 2011.

DISCUSSION

Relative to other academic concerns, nursing history represents a topic of limited concern to nursing scholars, as evidenced in published scholarship in the Journal of Advanced Nursing. The trends in historical scholarship in the journal have been on disciplinary development, the place and context of practice, and gendered relationships. While these are legitimate academic concerns, they suggest a lack of attention to clinical practice in historical research, that which confers social legitimacy on the discipline.

IMPLICATIONS FOR NURSING

Nursing derives its social legitimacy, in part, through its history, including reliable accounts of the legacy of nursing work in the development of healthcare systems. Disciplinary development in nursing is advanced by giving greater prominence to nursing history in nursing scholarship, including the history of nursing practice

CONCLUSIONS

Relative to other academic concerns, nursing scholarship affords little prominence to the topic of nursing history and less still to the history of practice, as evidenced in the outputs of one of nursing's major organs of scholarship. Not to assign due importance to the history of nursing and its practice demonstrates nursing's lack of disciplinary maturity.

A theoretical framework of caring in the Chinese context: a grounded theory study

AIM

This paper is a report of a study describing the components of nurse caring in the Chinese cultural context.

BACKGROUND

The expressions, dimensions and patterns of caring vary in different cultures. Caring is deeply embedded in the Chinese culture and nurses are told to care for patients as if they were related by blood. However, to put caring in a professional and practical context, it must extend meaning with a deeper philosophical inspiration that is transcendent and described to guide nursing practices.

METHODS

A grounded theory research design and the Delphi method were adopted. First, a total of 16 individual non-structured interviews were conducted with noted scholars on nursing education, clinical nursing, nursing administration, medical education and the humanities between January 2006 and June 2007. All interviews were audio recorded, transcribed and analysed using constant comparative data analysis. Secondly, 20 experts with the same inclusion criteria were recruited to conduct a two-round Delphi study to enrich and validate the theoretical framework of caring. Experts were asked to score 0 = disagree or 1 = agree for each listed item and its description in a scale. Consensus was considered when 90% or more agreement was reached. Data were collected from May 2007 to February 2009 and calculated for the agreement rates using SPSS version 11.0.

RESULTS

Four attributes of caring including attitude of caring, knowledge of caring, ability of caring and perceptions of caring were determined, along with 8 associated subcategories and 22 statements. Among them, caring attitude is central for presenting care in daily practice. Professional knowledge of nursing, the humanities and social science give the basic theoretical guidance for nurses to exhibit caring behaviour. In the education process, perceptions of giving and receiving care are the key factors for cultivating care.

CONCLUSIONS

The framework could be interpreted as a list of teaching objectives and could contribute to the further development of an integrated approach for teaching care in nursing curricula. It would also be beneficial for applying and evaluating care in the practice of clinical nursing and nursing education in the Chinese culture.

Concept Comparison of Caring and Social Support

PURPOSE

To explicate the similarities and differences between the concepts of caring and social support.

METHODS

Qualitative concept comparison.

FINDINGS

Similarities and/or subtle and substantive differences exist between caring and social support. Both concepts are characterized as dynamic interpersonal processes that involve sensitivity. Caring appears to lie within the purview of expert nurse providers, while social support is located primarily within the domain of lay providers. Social support is perfunctory and focused, whereas caring encounters are more intimate and holistic. Caring results in improved mental well-being for both recipients and providers, while improvements in mental health are limited to social support recipients. Unlike social support, physical well-being is an outcome of caring.

CONCLUSIONS

Caring and social support share common attributes and outcomes; however, they appear to be different processes that predominately exist in separate domains. Caring appears to reside within the professional paradigm of nursing, while social support exists primarily within the sphere of lay providers.

IMPLICATIONS

Nurses are encouraged to develop and use well-delineated conceptual frameworks to guide practice and research.

Meta-synthesis of caring in nursing

AIM

The aim of this investigation was to enhance the understanding of the concept of caring.

BACKGROUND

Despite many analyses and studies of caring, the concept is not fully understood. This lack of clarity is unsettling given that caring is suggested to be the essence of nursing and a component of nursing's guiding paradigm. Meta-synthesis methods offer a way to push the understanding of caring forward using existing research findings.

DESIGN

Qualitative meta-synthesis.

METHOD

Meta-synthesis and grounded theory strategies were adapted to synthesize findings from 49 qualitative reports and six concept analyses of caring.

RESULTS

Results from this work indicate that caring is a context-specific interpersonal process that is characterized by expert nursing practice, interpersonal sensitivity and intimate relationships. It is preceded by a recipient's need for and openness to caring, and the nurse's professional maturity and moral foundations. In addition, a working environment that is conducive to caring is necessary. Consequences include enhanced mental well-being among nurses and patients, and improvements in patients' physical well-being.

RELEVANCE TO CLINICAL PRACTICE

It appears that caring has the potential to improve the well-being of patients and nurses. It is recommended that healthcare agencies and educational institutions devote more resources to cultivate the caring among employees and students.

CONCLUSIONS

The findings explicate a cohesive process of caring. They provide insight into the human attributes and clinical milieu that are necessary for caring to emerge. They also offer clarity regarding the therapeutic benefits of caring.

Practical nurses in elder care and changes in Finnish society - a biographical study

BACKGROUND

Substantial changes in the socio-economic circumstances in Finnish society over the past century have resulted in major changes in the case of older people, and in the status of nursing staff who care for them.

AIM

The purpose of this study was to describe and analyse the work of practical nurses in elder care through the experiences and life cycles of two practical nurses with a long working experience.

METHODS

The data consisted of oral biographical narratives produced by the two nurses in repeated interviews. The data were analysed using inductive content analysis.

FINDINGS

The following chronological stages and periods of the work of the informants emerged as the core themes of elder care: (1) Collective institutionalized care in the 1950s-1970s: The lowest caste in training, obedient subordinates, undemanding service and routine work; (2) Elderly orientated institutionalized care in the 1980s and 1990s: From subordination to co-operation as an experienced nurse, recognizing the specific qualities of the elderly; (3) Prospects of elder care from the 1990s onwards: Returning to custodial care?

CONCLUSIONS

The themes are related to the more general changes that have taken place in Finnish society and health care. The future prospects of practical nurses seem challenging because the principles of social work and health care in Finnish society have shifted from institutionalization towards community care. As a consequence, practical nurses are required to have higher qualifications.

Differences and similarities in the perception of caring between Spanish and UK nurses

The aim of the present paper was to compare and contrast perceptions of caring in nursing between Spanish and UK nurses. There are no previous studies comparing directly the perceptions of caring across cultures in nursing. A survey method was used employing the 25-item Caring Dimensions Inventory. Data were Mokken scaled for comparison with data from a previous study and scores for common items on the 25-item Caring Dimension Inventory for Spanish and UK nurses were correlated. There were similarities and differences between Spanish and UK nurses' perceptions of caring: many similar items were incorporated into Mokken scales but the endorsement of items did not correlate. The present work demonstrates that it is possible to measure differences and similarities in perceptions of caring. The study design could be improved and such work could be valuable in cross-cultural work with nurses.

Life control of members of the Kainuu Martha Organization in Finland

The purpose of this study was to describe the life control of members of the Kainuu Martha Organization (the Marthas), based on their written autobiographic material. The study material consisted of written thematized autobiographies of members of the organization (n = 41). The material was analysed using qualitative content analysis with concepts of the health portrait. The Marthas were classified into three groups (member, participating and leading) on the basis of their participation in Martha activities. According to the generational categorization of Roos, the member Marthas represented the Finnish generations of well-being, structural change and shortage. They did not participate actively in the Martha activities. Their feeling of life control was based on the sense life made to them. The member Marthas emphasized the meaning of family in their lives. The participating Marthas represented the generations of structural change and shortage. They participated in the Martha activities as observers or by attending the functions of their local organizations. Their feeling of life control was related to a favourable attitude towards life and concern for their human relations. The leading Marthas represented the generation of shortage and participated actively in the Martha activities. They believed in the continuity of the Martha Organization in Kainuu. They had a strong feeling of life control. This manifested as an enterprising spirit in everyday life, which included a skill to live life as it occurred. The lives of the leading Marthas were characterized by a favourable attitude, a feeling of responsibility and initiative.

A midwife-public-health nurse's work in northern Finland, 1950-87

This paper describes the work of Jouki Nykänen, a midwife public-health nurse in northern Finland during the years 1950-87. The material for the study was collected by a biographical interview. On the basis of content analysis, the work of the interviewee consisted of the following phases: (i) midwife-public-health nurse in the district of Sevettijärvi (1950-58); (ii) municipal midwife in Pyhäntä (1958-60); and (iii) midwife-public-health nurse in the rural district of Karunki (1962-87). In Sevettijärvi, Jouki's work emphasised independent planning and implementation. In Pyhäntä, her health-care clinics were well organised. In Karunki, another midwife-public-health nurse working with Jouki made conditions flexible, with personal districts for the two nurses. During home visits, Jouki took care of the whole family, from the grandfather to the baby. The Finnish Public Health Act (1972) changed the character of Jouki's work. The number of home visits decreased and clinics, fragmented into several fields of health care, took the place of home visits, requiring efficiency and results. The results of the study showed the core of a midwife-public-health nurse's work in Finland in a changing historical and social context, as well as showing the changes in a midwife-public-nurse's work since the post-war years.

A childhood cancer sibling's oral history

The diagnosis of childhood cancer in a family member alters a sibling's life, including exposing a sibling to the side effects of cancer therapy, feelings of being displaced, and a possible misunderstanding of what is happening. The purpose of this oral history was to gain a better understanding of the recall and long-term effects of a younger sister's diagnosis of cancer at age 6 on the child's sibling, who was then 8 years old. Data were gathered from a 22-year-old sibling of a leukemia survivor through three taped and transcribed semistructured interviews. Themes emerged through the process of content analysis. Six themes: closeness, activity, fearfulness, anger, worry, and spirituality, emerged and were supported by thick descriptions.

Life after the mental hospital: the way of life of deinstitutionalized psychiatric patients

This article describes and analyses the way of life of deinstitutionalized long-term psychiatric patients in Northern Finland. The major focus of the paper is the central areas of life of the outpatients as one dimension of subjectivity. The data were collected by interviewing 25 discharged long-term psychiatric patients. The findings suggest that home was the central area of life for the outpatients but they differed in their relation to it. Some of the patients were actively building their home. For some others home was an asylum in which to hide from social life. Many patients had hobbies that only took place inside their homes. One of the problems that the outpatients had to face was lack of work. The elderly patients who generally regarded work as a virtue experienced difficulties in finding something to do in their modern suburban homes. Social participation was mostly labelled by the old and familiar hospital models. The patients had no new acquaintances. They kept contact with their former fellow patients.

The life situation of a long-term psychiatric patient: some restrictions in, and possibilities of, open care

This paper describes and analyses, from a sociocultural viewpoint, the ways of life of discharged long-term psychiatric patients in northern Finland. The paper focuses on subjectivity: control of life and fundamental experiences in life. The data consist of interviews with 25 outpatients who have moved to live in residential homes, rehabilitation centres or their own homes after receiving preparatory training in the psychiatric hospital. The findings suggest that the way of life of the outpatients did not significantly differ from that of other people belonging to the same generation of Finns. With respect to control of life, a conspicuous feature was the strong tendency to let themselves be led by others, and to self-sacrifice for the good of others. For the patients, independence was the best aspect of open care. Fear for being branded as a psychiatric case or as a former mental patient threatened the patients' external control of life. The central element of control of life of the Finns is work. The outpatients thought work a matter of honour and they did not find their present, inactive way of life satisfactory.