Being in togetherness: meanings of encounters within primary healtcare setting for patients living with long-term illness

Older persons' experiences of care encounters in their home: A multiple-case study

AIM

To explore and describe older persons' unique experiences of care encounters with home care nurses in a real-life context.

BACKGROUND

The increasing number of older persons in society contributes to increases in age-related impairments compromising their quality of life. Future care consists of "hospitals at home" where care encounters occur in a person's private domain, partly becoming a clinical workplace. Scant research has focused on how older persons experience care encounters with home care nurses and needs to be highlighted.

DESIGN

Multiple-case study.

METHODS

The cases relied on replication logic and five purposive sampled older persons were interviewed. Data were analysed using qualitative content analysis and differences within and between cases were explored and findings across the cases were replicated.

FINDINGS

The cross-analysis emerged in three categories: "Nursing routine rules the care encounters", "Lack of knowledge and information" and "Dependency on support from others".

CONCLUSIONS

Our research has found that older persons face challenges while receiving home care, including limited engagement in their care and the need for enhanced support. Implementing person-centred care in homes poses ethical challenges that require careful consideration. Home care nurses should prioritise understanding each patient individually, recognising them beyond their patient role, which necessitates more thorough and time-sensitive care encounters.

REPORTING METHOD

Findings were reported using COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Patients were interviewed and contributed with data for this study.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study emphasises the need to prioritise individualised care in home settings and listen to the voices of older individuals to enhance quality.

Patients Receiving Palliative Care and Their Experiences of Encounters With Healthcare Professionals

The study aimed to explore experiences of encounters with health care professionals among patients receiving palliative cancer care in specialist palliative care inpatient units. A qualitative explorative study design was conducted in a specialist palliative care inpatient setting. Data collection was implemented using semi-structured individual interviews (20 palliative care cancer patients) and analysed with inductive content analysis. Palliative care patients experienced both meaningful and disrespectful encounters with healthcare professionals. The meaningful encounters encompassed authentic and supportive experiences, while the disrespectful encounters included indifferent and inadequate experiences. Caring for a patient receiving palliative care requires care beyond tending to a patient's physical needs. Patients should be encountered holistically and as equal human beings without highlighting their roles as patients. The healthcare professionals and the organisations should also acknowledge the importance of time and effort spent for encounters and conversations with the patients instead of concentrating resources mainly on physical care.

Thoughts on the end of life in patients with oxygen-dependent chronic obstructive pulmonary disease: A qualitative interview study

AIM

The aim of the study was to deepen the current knowledge of how patients with chronic obstructive pulmonary disease and long-term oxygen treatment think about and expect end-of-life.

DESIGN

A qualitative design was used.

METHODS

A purposeful sample of 19 patients with oxygen-dependent chronic obstructive pulmonary disease was obtained from the Swedish National Registry on Respiratory Failure (Swedevox). Data was collected with semi-structured interviews and analysed using a hermeneutic approach.

RESULTS

The analysis revealed three themes: Living in the present without a future; difficulty talking about the uncertainty; and feeling anxious about leaving family behind. Participants indicated that healthcare professionals should invite them to mutual discussions as it was easier to reject an invitation if they could not talk right then, than to initiate a discussion themselves. Start of home oxygen or a deteriorating health status may be an important time to clinically address existential and end-of-life issues.

“You have to believe the patient”: What do people with fibromyalgia find helpful (and hindering) when accessing healthcare?

Background

Fibromyalgia (FM) is a complex, still poorly understood, and difficult-to-treat chronic pain condition for which many people struggle to find adequate care.

Aims

This study investigated the research question, "What do people accessing health care services for fibromyalgia perceive as helpful, hindering, and absent but desired?" with the aim of identifying clear, implementable changes for clinical practice.

Materials and methods

This study used the enhanced critical incident technique (ECIT), a qualitative research method that focuses on helping, hindering, and desired factors, to explore the health care experiences of 14 individuals (12 women and 2 men) diagnosed with FM.

Results

Using qualitative data analysis, results identified three categories of health care experiences: (1) systemic navigation, including financial and economic security; accessibility, flexibility, and continuity of care; and diversity of treatment options; (2) clinician-patient alliance, including invalidation and prejudice; therapeutic bond; and clinician-patient alignment on treatment plan; and (3) patient self-management strategies, including information-seeking and education, self-advocacy, social supports, symptom management strategies, and other coping strategies. Participants tended to conceptualize their health care concerns as a multilayered systemic problem.

Conclusions

Participants described a medical system they perceived as poorly equipped to support their needs and tended to invalidate their health concerns. Helping experiences tended to be the result of unique efforts on the part of individual clinicians. Findings emphasize the importance of recognizing the complexities and psychological impact of pain, trusting clinician-patient relationships, multidisciplinary/interdisciplinary care within a biopsychosocial framework, and improved education and awareness around psychosocial aspects of FM and effective management of chronic pain.

Dignity encounters: the experiences of people with long-term illnesses and their close relatives within a primary healthcare setting

Aim:

To describe the experiences of dignity encounters from the perspective of people with long-term illness and their close relatives within a primary healthcare setting.

Background:

The importance of dignity as a concept in nursing care is well known, and in every healthcare encounter, the patient’s dignity has to be protected.

Methods:

A purposive sample of 10 people (5 couples) participated in this qualitative descripted study. One person in each of the couples had a long-term illness. Conjoint interviews were conducted and analyzed with an inductive qualitative content analysis.

Results:

The analysis resulted in three themes: i) Being supported by an encouraging contact; ii) Being listen to and understood; and iii) Being met with respect. Couples described being encountered with dignity as having accessibility to care in terms of being welcomed with their needs and receiving help. Accessibility promoted beneficial contact with healthcare personnel, who empowered the couples with guidance and support. Couples described a dignity encounter when healthcare personnel confirmed them as valuable and important persons. A dignity encounter was promoted their sense of feeling satisfied with the care they received and promoted safe care. Treated with dignity had a positive impact on the couples’ health and well-being and enhanced their sense of a good impression of the healthcare personnel within the primary health care.

Conclusions:

Healthcare personnel must regard and consider people with long-term illnesses and their close relatives’ experiences of dignity encounters to gain an understanding that enables them to support their needs and to know that the care is directed toward them.

Helpful factors in a healthcare professional intervention for low-back pain: Unveiled by Heidegger's philosophy

Low-back pain can be invalidating physically as well as mentally. Despite professional help to treat and prevent low-back pain, the pain often persists, and so do the problems related to low-back pain. An intervention that made it possible for a significant part of patients with low-back pain to improve health and well-being raised the question: Why was it possible to help some and not others? The aim of the present paper was to achieve a deeper understanding of factors patients experienced as helpful in professional support related to low-back pain. This was explored using a hermeneutic-phenomenological approach while analysing 20 interviews with patients with low-back pain purposively chosen interviews conducted in relation to the intervention. An analysis was made using Ricoeur's interpretation theory. Data on both positive and negative experiences were read and reflected upon. We found that healthcare professionals' adoption of a narrative approach facilitating the patient's perspective was perceived as helpful. Patients experienced this as being taken seriously; an experience that could be explained at a deeper, more nuanced level using Heidegger's philosophy. Facilitating the patient's perspective was conditional not only on the professional obtaining access to the patient's perspective but also on understanding and acknowledging the patient's existence. The challenge for healthcare professionals in this respect is to bridge the gap between the consultation's fact-focused concern with the medical implications of low-back pain and the patient's concern with the implications low-back pain has for his or her personal identity and life. Listening to the patient's perspective in itself supports the subjective recovery process, while also supporting the quality of patient-centred support and strengthening the patient's trust in its helpfulness.

The meaning of significant encounters in forensic care

BACKGROUND

Research in forensic psychiatric care focusing on person-oriented care is ambiguous about matters of quality. The encounters between a healthcare professional (HCP) and patient could influence how connections and relations emerge between the caregiver and the patient.

OBJECTIVES

To better understand caring aspects, this study explores significant encounters in forensic psychiatric care from the perspective of HCPs.

METHOD

This study is based on 34 written narratives from HCPs from two forensic psychiatric hospitals in Sweden. The narratives concern significant encounters with a patient. These narratives were analysed according to methodologies developed by phenomenological and reflective lifeworld research.

FINDINGS

The essence of a significant encounter is a temporal extended phenomenon that both precedes as well as is a consequence of the actual encounter as it occurs. The encounter is unforeseeable and being open to an encounter also means to be vulnerable as it is not predetermined how someone will respond. The significant encounter is an act of sharing, and HCPs may come to understand more about their patients as well as about themselves. Moreover, these encounters seem to create repercussions and hope for the future care.

CONCLUSIONS

The everyday activities of forensic psychiatric care are not trivial activities. Rather, they are important aspects of health care as these everyday encounters can deepen the relationship between the HCPs and their patients and help both the HCPs and their patients develop a sense of hope for the future.

Considering "the more" of patients suffering from alcohol use disorders. An illustration of acute nursing care from a lifeworld-led perspective

Purpose

The purpose of this study is to illustrate a theoretical value framework for humanisation of healthcare, a lifeworld-led care that has the potential to support nurses in acute medical units in addressing and meeting both challenges and care needs expressed by patients suffering from alcohol use disorders. Providing care to these patients means working with a very divergent and complex group of patients. When hospitalised in an acute medical unit, nurses are often these patients' first encounter, which gives a unique opportunity to initiate and establish a successful care alliance.

Method

 The present study is a qualitative study based on an amplified secondary analysis of 25 pre-conducted interviews. Following a hermeneutic approach, the analysis was structured in accordance with the conceptual value framework for humanisation of care, drawing on the recognition of the patients' lifeworld as an aspect of importance.

Findings

The study showed that while there were examples of humanising care guided by the patients’ lifeworld present, there were also situations of care that were dehumanising. Conclusion: When letting the patients’ perspective of well-being be the centre of care, the patients’ experience of meaningfulness and sincerity within the provided care was nurtured, and they felt more humanly met.

Factors of importance for developing a trustful patient-professional relationship when women undergo a pelvic examination

We examined gynecological teaching women's perception on what factors are important for developing a trustful patient-professional relationship when women undergo a pelvic examination. A qualitative research design was conducted with repeated focus group discussions. Our results show that healthcare professionals' communications skills can strengthen a trustful patient-professional relationship. Treating women with dignity could make them feel less vulnerable and make the relationship trustworthy based on respect. Thus, having the ability to identify factors important for a trustful relationship may support healthcare professional's ability to strengthen women's health issues. A trustful relationship might also affect quality of care.

Living with type 1 diabetes as experienced by young adults

AIM

Describe young adults` (19-30 years) experiences of living with Type 1 Diabetes (T1D).

BACKGROUND

Young adulthood is characterized by adaption to adult roles, gradual separation from parental support and leaving the parental home. Living with T1D in young adulthood raises challenges and concerns.

DESIGN

This study has a qualitative design.

METHODS

Semistructured interviews with 12 young adults living with T1D for 3-14 years, analysed with qualitative content analysis.

RESULTS

The analysis revealed contradictory ways of handling the illness, as is illuminated in two main categories (a) and five subcategories (b). Handling the situation and dealing with different opinions (a), (b) managing daily life, emotional roller coaster and general attitudes, own views and apprehensions, ignorance and lack of motivation. Most participants were motivated, had knowledge and were in control of their long-term illness. Planning and structure were an essential part of their daily life. The participants were anxious about losing control of their bodies, the situation, die or be a burden to other people.

Voices used by nurses when communicating with patients and relatives in a department of medicine for older people-An ethnographic study

AIMS AND OBJECTIVES

To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden.

BACKGROUND

Communication is an essential tool for nurses when working with older patients and their relatives, but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome.

DESIGN

An ethnographic design informed by the sociocultural perspective was applied.

METHODS

Forty participatory observations were conducted and analysed during the period October 2015-September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken, and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semistructured follow-up interviews were conducted with five nurses.

RESULTS

In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualised, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices, this indicates a shift in the orientation or situation.

CONCLUSION

The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved.

RELEVANCE TO CLINICAL PRACTICE

Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes.

"A body in transformation"-An empirical phenomenological study about fear-avoidance beliefs towards physical activity among persons experiencing moderate-to-severe rheumatic pain

Aims and objectives

To gain a better understanding of fear‐avoidance beliefs towards physical activity and body awareness in people experiencing moderate‐to‐severe rheumatic pain.

Background

Rheumatoid arthritis and psoriatic arthritis are long‐term conditions with pain as the prominent symptom. Health‐promoting physical activity is recommended and can have an analgesic effect. High self‐rated pain has previously been reported to be associated with increased fear‐avoidance behaviour in relation to physical activity. Body awareness, which includes attentional focus and awareness of internal body sensations, could be valuable in the nursing care of long‐term diseases.

Design

Empirical phenomenological.

Methods

An empirical phenomenological psychological method was applied. The interviews took place between autumn 2016–spring 2017 with 11 informants (eight women and three men, age range 44–71 years) who were diagnosed with rheumatoid arthritis (n = 7) or psoriatic arthritis (n = 4), with a disease duration ranging from 3–35 years. The mean visual analogue scale score in the study sample was 60 mm.

Results

Three typologies were identified: “My relatively fragile physical status”, “I am an active creator” and “Part of something bigger than myself.”

Conclusions

The current findings indicated that pain anticipation and fear‐avoidance beliefs towards physical activity sometimes affected the behaviour of individuals with long‐term rheumatic pain syndromes. People experiencing moderate‐to‐severe rheumatic pain tended to focus on their fragile physical and emotional state. By adopting a more favourable attitude towards the self, the body could be restored to a state of calm and balance.

Relevance to clinical practice

The current findings are relevant for healthcare professionals engaged in health‐promotion clinical practice.

Meanings of encounters for close relatives of people with a long-term illness within a primary healthcare setting

BACKGROUND

Encounters play an important role in the relationship between healthcare personnel and the close relatives of people with a long-term illness.AimThe aim of this study was to elucidate the meanings of encounters for close relatives of people with a long-term illness within a primary healthcare setting.

METHODS

Interviews using a narrative approach were conducted with seven women and three men, and the phenomenological hermeneutic method was used to interpret the interview texts.

RESULTS

The structural analysis revealed three major themes: being confirmed as a family, being informed of the care, and being respected as a valuable person. Close relatives stated that they wanted to be confirmed as a family and have a familiar and trusting relationship with healthcare personnel. They valued being informed concerning the care of the ill person so that they could give support at home. It was also important to be compassionately viewed as an important person in a welcoming atmosphere based on respect and dignity.

Patients' complaints regarding healthcare encounters and communication

Aim

To explore patient-reported complaints regarding communication and healthcare encounters and how these were responded to by healthcare professionals.

Design

A retrospective and descriptive design was used in a County Council in northern part of Sweden. Both quantitative and qualitative methods were used.

Methods

The content of 587 patient-reported complaints was included in the study. Descriptive statistical analysis and a deductive content analysis were used to investigate the content in the patient-reported complaints.

Results

The results show that patients' dissatisfaction with encounters and communication concerned all departments in the healthcare organization. Patients were most dissatisfied when they were not met in a professional manner. There were differences between genders, where women reported more complaints regarding their dissatisfaction with encounters and communication compared with men. Many of the answers on the patient-reported complaints lack a personal apology and some of the patients failed to receive an answer to their complaints.

Experiences of encounters with healthcare professionals through the lenses of families living with chronic illness

AIMS AND OBJECTIVES

To describe and explore the experience of healthcare encounters in families living with chronic illness.

BACKGROUND

Living with chronic illness is a family concern and often includes frequent encounters with healthcare professionals. These encounters affect how persons with illness and family members handle everyday life. Disease-related explanations are perceived by healthcare professionals as being of higher importance than the actual experience of illness, even though patients are concerned with issues involving their everyday life.

DESIGN

A descriptive design with a qualitative approach.

METHODS

Narrative family interviews were conducted with twelve families, using a qualitative content analysis.

RESULTS

One main category was indicated following analysis, specifically "The impact of an accompanying family member." Additionally, three subcategories were revealed; "The importance of collaboration," "Mutual understanding," "A desire to be confirmed in one's illness".

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

Having a participating family member increased the sense of power in families during encounters with healthcare professionals. This participation constitutes a level of support, making it easier for families to handle everyday life due to illness. Family members are, in most cases, included in discussions and decisions, both before and after encounters, and it should be a natural for healthcare professionals to invite them to the encounter too. This is an offer that may not fit every family, but the person with illness or the family should at least have the opportunity to choose.