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Vidrörd av livet i dödens närhet: Att varda som människa och vårdare i vårdandets gemenskap
University West, Department of Health Sciences, Section for nursing - undergraduate level.ORCID iD: 0000-0003-1981-455X
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Touched by life in the proximity of death. : Becoming as a human being and health care provider in the caring communion (English)
Abstract [en]

The overall aim of the study is to create a theory model of "becoming" as a human being and health care provider in the caring communion at the end-of-life. The theoretical perspective of the study is caring science as it is developed at Åbo Academy University in Finland outlined in Eriksson's theory of caritative caring with focus on caring ethics. The thesis consists of four sub-studies reported as scientific articles and a summary section. The study has an overarching hermeneutic research approach. The sub-studies I-IV are reinterpreted from viewpoint of the overall question. Empirical assumptions could then be discerned from the substance of the four substudies, which raised questions. The answers to these questions were sought in dialogue with selected texts by Kierkegaard and resulted in a theory model. The theory model results in following theses: 1. To "become" as a human being is to remain in an endless guilt. Guilt is a form of love. It is guilt that give strength and willingness to act in love and mercy when caring for patients at the end-of-life. The guilt as love allows becoming as a human being to be at home in love and mercy. 2. The human being's courage is characterized as the willingness to obtain contact with the life of fellow human beings. This courage develops over time to stand for itself, with a foundation of belief in human beings, and resulting in a selfless, loving way to help the patients grieve and reconcile at the end-of-life. 3. To be "touched" can be illustrated as an inner awakening; an inner movement towards consciousness for the examination of the love for one another, and to love unselfishly. 4. The human being's evolution in its own understanding of life occurs in the care of another human being who is at the end-of-life, as well as to be at home in ethos, love and mercy. Becoming in this context means that the human being evolves to become responsive to the heart's inner voice; an inner strength and joy which opens to the eternal and holy. 5. To overcome external obstacles is characterized as serving human beings in a selfless love; a caring in love that has requirements that need to be expressed by what is true, beautiful and good for patients at the end-of-life. An awareness and understanding of what it means to become as a human being and health care provider in caring community can help health care providers to easily focus on the patient.

Place, publisher, year, edition, pages
Åbo: Åbo Akademi University Press, 2016. , 110 p.
Keyword [en]
Caring communion, caring science, caritative theory, end-of-life, health care provider, hermeneutics, becoming as human being
Keyword [sv]
Caritativ teori, hermeneutik, livets slutskede, vårdandets gemenskap, vårdvetenskap, människans vardande
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-9453ISBN: 978-952-12-3393-7 (tryckt)ISBN: 978-952-12-3394-4OAI: oai:DiVA.org:hv-9453DiVA: diva2:942164
Supervisors
Available from: 2016-06-23 Created: 2016-06-23 Last updated: 2016-06-23Bibliographically approved
List of papers
1. Community nurses' experiences of ethical dilemmas in palliative care: a Swedish study.
Open this publication in new window or tab >>Community nurses' experiences of ethical dilemmas in palliative care: a Swedish study.
2010 (English)In: International Journal of Palliative Nursing, ISSN 1357-6321, Vol. 16, no 5, 224-231 p.Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study was to highlight community nurses' experiences of ethical dilemmas in palliative care. BACKGROUND: There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence. METHOD: Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis. FINDINGS: The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients' end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals. CONCLUSION: The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues' experience and deal with such issues.

National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-2622 (URN)20679970 (PubMedID)
Available from: 2010-08-20 Created: 2010-08-20 Last updated: 2016-06-23Bibliographically approved
2. Community nurses' experiences of ethical problems in end-of-life care in the patient's own home.
Open this publication in new window or tab >>Community nurses' experiences of ethical problems in end-of-life care in the patient's own home.
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2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, 831-838 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To gain a deeper understanding of community nurses' experiences of ethical problems in end-of-life care in the patient's own home. METHOD: Ten female nurses from five different communities with experience of end-of-life care were interviewed. A hermeneutic approach inspired by Gadamer was used to analyse the qualitative data from the interviews. FINDINGS: In the first step of interpretation, two themes emerged: Uncomfortable feelings and Lack of cooperation and in the second step, one theme Lack of security emerged. Finally, the overall interpretation revealed the theme Feelings of loss of control in end-of-life care in the patient's own home. CONCLUSION: The nurses exhibited commitment and a desire to do good when caring for patients in the end-of-life phase, even if they sometimes experienced feelings of lack of control. This implies that, when confronted with care-related issues, they have the power to both act and react. This study aimed to increase understanding of ethical problems that arise in end-of-life care in the patient's own home and revealed the need to take the patients', relatives' and nurses' perspectives on health and suffering into consideration to ensure good end-of-life home care.

Keyword
control, cooperation, end-of-life, ethical problem, Gadamer, hermeneutics, home car, security, nursing
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-4758 (URN)10.1111/j.1471-6712.2012.01087.x (DOI)000328140200007 ()23067002 (PubMedID)2-s2.0-8488659516 (ScopusID)
Available from: 2012-10-25 Created: 2012-10-22 Last updated: 2016-06-23Bibliographically approved
3. A Qualitative Metasynthesis From Nurses’ Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care
Open this publication in new window or tab >>A Qualitative Metasynthesis From Nurses’ Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care
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2015 (English)In: International journal for human caring, ISSN 1091-5710, Vol. 19, no 1, 40-48 p.Article in journal (Refereed) Published
Abstract [en]

This metasynthesis aimed to translate, interpret, and present a synthesis of qualitative studies from nurses' perspectives dealing with ethical dilemmas and ethical problems in end-of-life care and to gain a deeper understanding of the phenomena. Nurses and other care professionals need to gain a deeper understanding and alleviate the suffering of patients through evidence-based practice end-of-life care. The metasynthesis, inspired by Noblit and Hare, generated an overarching metaphor, The Loving Eye. The Loving Eye illustrates how nurses are deeply involved with patients as human beings and connotes an inner responsibility to struggle for patients' best interests and wishes at the end of life. With The Loving Eye, nurses can see and feel patients' need to be confirmed, comforted, and healed approaching the end of life.

Keyword
caring, end-of-life care, ethical dilemmas, ethical problems, evidence-based care, metasynthesis, nurses' experiences
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-9235 (URN)10.20467/1091-5710-19.1.40 (DOI)
Available from: 2016-03-17 Created: 2016-03-17 Last updated: 2016-06-23Bibliographically approved
4. Reflecting on one's owns death: the existential questions that nurses face in end-of-life care
Open this publication in new window or tab >>Reflecting on one's owns death: the existential questions that nurses face in end-of-life care
2016 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, 1-10 p.Article in journal (Refereed) Published
Abstract [en]

When registered nurses care for patients at the end of life, they are often confronted with different issues related to suffering, dying, and death whether working in hospital or community care. Serious existential questions that challenge nurses' identities as human beings can arise as a result of these situations. The aim of our study was to describe and gain a deeper understanding of nurses' existential questions when caring for dying patients. Focus-group interviews with registered nurses who shared similar experiences and backgrounds about experiences in end-of-life care were employed to gain a deeper understanding about this sensitive subject. Focus-group interviews were performed in hospice care, in community care, and in a palliative care unit in western Sweden. A qualitative hermeneutic approach was employed to interpret the data. Nurses' existential questions balanced between responsibility and guilt in relation to their patients, between fear and courage in relation to being professional caregivers and fellow human beings, and between hope and despair in relation to the other's and their own death. Nurses in end-of-life care experience various emotions from patients related to things physical, spatial, and temporal. When nurses encounter these emotions as expressing a patient's suffering, they lead to challenges of balancing between different feelings in relation to patients, as both professional caregivers and fellow human beings. Nurses can experience growth both professionally and as human beings when caring for patients at the end of life.

Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2016
Keyword
Existential questions, end-of-life care
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-9452 (URN)10.1017/S1478951516000468 (DOI)
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Available from: 2016-06-23 Created: 2016-06-23 Last updated: 2016-12-02Bibliographically approved

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