Background: The transition to parenthood is an overwhelming life event. From a theoretical perspective, tran- sition to parenthood is a developmental transition that contains certain phases and patterns.

Aim: This study aim was twofold (i) discover, describe and comprehend transitional conditions that parents per- ceive as facilitating and inhibiting during transition to parenthood and to (ii) use that knowledge to develop recommendations for professional interventions that sup- port and facilitate transition to parenthood.

Design: Meleis transition theory framed the study’s deduc- tive qualitative approach – from planning to analysis. Methods: In a secondary analysis, data were analysed (as per Meleis transition theory) from two studies that implemented interviews with 60 parents in Sweden between 2013 and 2014. Interview questions dealt with parents’ experiences of the transition to parenthood – in relation to experiences with parent-education groups, professional support and continuity after childbirth. Ethical issues: A university research ethics board has approved the research.

Results: These factors facilitated transition to parenthood: perceiving parenthood as a normal part of life; enjoying the child’s growth; being prepared and having knowledge; experiencing social support; receiving professional support, receiving information about resources within the health care; participating in well-functioning parent-education groups; and hearing professionals comment on gender dif- ferences as being complementary. These factors inhibited transition to parenthood: having unrealistic expectations; feeling stress and loss of control; experiencing breastfeed- ing demands and lack of sleep; facing a judgmental attitude about breastfeeding; being unprepared for reality; lacking information about reality; lacking professional support and information; lacking healthcare resources; participating in parent-education groups that did not function optimally; and hearing professionals accentuate gender differences in a problematic way.

Conclusion: Transition theory is appropriate for helping professionals understand and identify practices that might support parents during transition to parenthood. The study led to certain recommendations that are important for professionals to consider. 

Aim The aim of this study was to explore the meaning of family members’ experience of waiting in an intensive care context using Rodgers’ evolutionary method of concept analysis. Method Systematic searches in CINAHL and PubMed retrieved 38 articles which illustrated the waiting experienced by family members in an intensive care context. Rodgers’ evolutionary method of concept analysis was applied to the data. Findings In total, five elements of the concept were identified in the analysis. These were as follows: living in limbo; feeling helpless and powerless; hoping; enduring; and fearing the worst. Family members’ vigilance regarding their relative proved to be a related concept, but vigilance does not share the same set of attributes. The consequences of waiting were often negative for the relatives and caused them suffering. The references show that the concept was manifested in different situations and in intensive care units (ICUs) with various types of specialties. Conclusions The application of concept analysis has brought a deeper understanding and meaning to the experience of waiting among family members in an intensive care context. This may provide professionals with an awareness of how to take care of family members in this situation. The waiting is inevitable, but improved communication between the ICU staff and family members is necessary to reduce stress and alleviate the suffering of family members. It is important to acknowledge that waiting cannot be eliminated but family-centred care, including a friendly and welcoming hospital environment, can ease the burden of family members with a loved one in an ICU.

The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

Aim

The aim of this article was to introduce Fairclough's critical discourse analysis (CDA) in caring and nursing science, to provide a guide on how to perform such an analysis, and to describe the wider context of discourse epistemology.

Design

The article is designed as a methodological paper, including (a) epistemological roots of discourse analysis, (b) an overview of discourse analytical research within caring and nursing science which points out an increased trend, and (c) a guide to conducting a CDA.

Analysis

It is important that discourse analysis is available and accessible to nursing and caring researchers. Through the process of encircling discourses, valuable insight is given into fields that otherwise would be lost or would not be available.

Conclusion

Our summary stance is that discourse analysis as it is presented in this article is strongly advisable for use in nursing and caring sciences.

Social loneliness and isolation may be some of the consequences that older people experience regarding age-related changes and losses, and nurses should be engaged in identifying social networks and social needs in this group. The aims of this study were to describe perceived social provisions in a group of older home-dwelling care-dependent patients, and to explore the relationship between perceived social provisions, physical functioning, mental state and reception of formal and informal care. The sample consisted of 242 persons aged 75+ years from seven municipalities in southern Norway, all receiving home nursing. Data were collected by means of structured interviews. Social support was assessed using the revised Social Provisions Scale. Physical functioning was assessed using the Barthel Index, and mental state using questions about loneliness, depressive symptoms and anxiety. Types and frequencies of social network contacts and formal and informal care were registered. Descriptive statistics, Mann-Whitney U-tests, Cronbach's alpha coefficient and stepwise multiple regression were used in the analyses. In general, the level of perceived social provisions and togetherness in the study group was high, especially among women and the married. Decreased physical functioning and declined mental state were related to lower level of social provisions. The majority of the individuals had frequently contacts with several types of social networks, like friends, neighbours and religious communities, in addition to close family. Contact with these informal networks was found to be close related to perceived social support and togetherness. Reduced social provisions was related to increased amount of home nursing, which could indicate that demand for home care may work as a strategy to gain social contact. In this sense, dependence in daily life functioning could possibly contribute to social contact rather than reduce it. © 2010 The Authors. Journal compilation © 2010 Nordic College of Caring Science.

Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear.

Aim

To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science.

Method

Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms ‘wellness’, ‘health’, ‘health care’, and ‘health care and wellness’; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria.

Results

Based on the findings from this concept analysis, a definition of wellness was developed: ‘a holistic and multidimensional concept represented on a continuum of being well that goes beyond health’. Implications for nursing practice were correspondingly presented.

Conclusion

Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.

This study aimed to elucidate meanings of health–illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health–illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health–illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health–illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health–illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition.

BACKGROUND: When living with a chronic disease, the whole human being is affected and his/her experience of health challenged.AIM: This study had a dual aim: to obtain a new understanding of experiences of the body among persons suffering from the chronic neurological disease multiple sclerosis (MS) and how they come to terms with such experiences.

METHOD: A total of ten interviews were re-analysed using a hermeneutic approach.

RESULTS: The experiences of the body were revealed as 'Learning to fly with broken wings', comprising two themes: 'Getting to know the foreign body' and 'Building a new living space', both requiring reappraisal of time and space.

CONCLUSION: Living with a chronic disease such as MS means learning to fly with broken wings, which involves subordination to the body leading to a higher level of integration in the process of becoming towards health and well-being.

Nowadays, in Sweden, fathers are expected to be active in their father role and to share caring responsibilities for their children equally with mothers. This active role of a father in a family can be challenging, especially for the first-time fathers. Child health nurses’ support is an important factor for fathers to become confident caregivers. The Father Perceived Professional Supportscale (FaPPS scale) can be used in nursing practice for better understanding father’s needs of professional support. The aim of this study was to describe first-timefathers’ experiences of the professional support received from child health nurses and to validate the instrument:‘FaPPS scale’. A qualitative design, with inductive and deductive approaches, was used in this study.Twelve first-time fathers participated in the semi-structuredinterviews, thereafter grading the FaPPS scaleitems and commenting on them. The fathersexperienced nurses’ support positively when nursesprovided practical information and stimulated them to be involved in care of their children. In contrast, thes upport was experienced negatively because of nurses’ lack of commitment, availability and adaptation to the fathers’ individual needs. The fathers also felt inequality between the support received by fathers and by mothers. Although some fathers perceived it as negative, others considered it fair, believing that mothers needed more support. In addition, fathers expect nurses to actively offer support to them and supervise them in childcare. The fathers also needed meeting other parents, for example in parental groups.This study also indicates that FaPPS scale can be used both in research and clinical practice, though still needing further development.

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.

AIM: This study aimed to explore nursing personnel's health while working in end-of-life care.

INTRODUCTION: End-of-life care is challenging both for nursing personnel and for the healthcare organisation, as retaining nursing staff is difficult. Although end-of-life care involves the risk of burnout, it also encompasses protective factors that can lead to personal and professional development and satisfaction, and that can enable personnel to encounter their own inner selves. In order to focus on the health of nursing personnel we chose the theory of caritative caring as our theoretical perspective.

METHOD: A qualitative inductive research design with a hermeneutical approach was chosen to explore nursing personnel's health while working in end-of-life care. Two assistant nurses and six registered nurses with experience in end-of-life care at a palliative care unit participated. The study was approved by a Regional Ethical Review Board.

RESULTS: The results are presented on three levels: rational, structural and existential. In the rational level, fellowship and togetherness with colleagues, as well as being able to distinguish between private life and work were important for nursing personnel's strategies for maintaining their health. At the structural level, social togetherness, sharing emotions and being involved in each other's emotions were important for nursing personnel's health. The existential level showed that the nursing personnel's own existential situation was affected when their inner self was emotionally affected by the patients' suffering. The awareness of suffering, life and death made the nursing personnel feel inner security, both as nursing professionals and as human beings.

CONCLUSION: A common perspective based on a theory of caritative care may be helpful for retaining nursing personnel. While the study highlights nursing personnel's health while working in an end-of-life care context, the results may also be applicable to nursing professionals' health in other contexts.

Most patients in intensive care units suffer from critical diseases/injuries and are in need of life-saving medical treatment. Recovery after such diseases/injuries may be lengthy and may vary. Little is known about older patients' own assessment of recovery following intensive care. The aim of this study was to explore and describe older patients' experiences of recovery and need of care within 2 months following discharge from hospital after being cared for in an intensive care unit. Fifteen patients 65 years or older, who had received care in an intensive care unit, were telephone-interviewed 2 months following discharge. The interview texts were analysed using qualitative content analysis. Six themes were identified: 'Discharge – a matter of physicians' and nurses' decisions', 'Wanted to go home', 'Feeling well and feeling better, but...', 'Recovered or not, that is the question', 'In need of help from others' and 'In need of care'. Patients trusted in the medical experts' assessment of their condition as regarded hospital discharge, but they also stated that they wanted to go home, as soon as possible, to their own familiar and private environment. Patients did not see the hospital as a place for recovery. Patients claimed that they were used to taking care of themselves within the limits of their strength and energy. If they need help, they first of all turn to family members or relatives. Patients who reported comorbidity did not assess themselves as recovered, while others stated that they had recovered but also suffered from a variety of discomforting symptoms.

Background: In many Western countries as in Sweden, patients have legal right to participate in own care individually adjusted to each patient's wishes and abilities. There are still few empirical studies of patients' perceptions of barriers for participation. Accordingly, there is a need to identify what may prevent patients from playing an active role in own nursing care. Such knowledge is highly valuable for the nursing profession when it comes to implementation of individual patient participation. Aim and objective: To explore barriers for patient participation in nursing care with a special focus on adult patients with experience of inpatient physical care. Methodological design and justification: Data were collected through 6 focus groups with 26 Swedish informants recruited from physical inpatient care as well as discharged patients from such a setting. A content analysis with qualitative approach of the tape-recorded interview material was made. Ethical issues and approval: The ethics of scientific work was adhered to. Each study participant gave informed consent after verbal and written information. The Ethics Committee of Göteborg University approved the study. Results: The barriers for patient participation were identified as four categories: Facing own inability, meeting lack of empathy, meeting a paternalistic attitude and sensing structural barriers, and their 10 underlying subcategories. Conclusions: Our study contributes knowledge and understanding of patients' experiences ofbarriers for participation. The findings point to remaining structures and nurse attitudes that are of disadvantage for patients' participation. The findings may increase the understanding of patient participation and may serve as an incentive in practice and nursing education to meet and eliminate these barriers, in quality assurance of care, work organization and further research. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science

Background Chronic obstructive lung disease is a disease that is common among the smoking population. In Sweden, more women than men are smokers. The most effective treatment to improve the symptoms of COPD is to quit smoking but still many women continue to smoke, despite their illness. Aim The aim of this study was to describe how a group of smoking women with chronic obstructive lung disease (COPD) experienced their everyday life and their relationship to smoking. Method A qualitative study based on narratives from six women with COPD was conducted. The narratives focused on the women′s everyday life and their relationship to smoking. The interviews were analysed into four themes and a new story, based on these themes were constructed. Findings The new story describes a woman with COPD that knows what she must do but cannot find the power within herself to take action. She talks about herself like a young bird that is going fly for the first time. Conclusion The study indicates that these women need some form of individual help to find the inner strength that they lack. Their self-respect as well as their self-image needs to be boosted in order to strengthen their belief that they are going to cope without the cigarette.

Background: Previous studies have examined manageability and meaningfulness in amyotrophic lateral sclerosis (ALS), but there is a lack of studies examining the comprehensibility of ALS among patients and their spouses. Aim: This qualitative retrospective study aimed to illuminate patients' and spouses' experiences of comprehensibility in ALS from a long-term perspective, when symptoms appeared before diagnosis, and when the diagnosis was given and in life after diagnosis. Methods: Individual semi-structured interviews with 14 patients and 13 spouses were performed. The transcribed interviews were subjected to qualitative content analysis. Findings: Through the whole disease process, patients and spouses feared the unknown regardless of whether they comprehended the disease or not. They described that they before diagnosis felt uncertainty. It was problematic to comprehend what was wrong and what the deterioration implied. At the diagnosis, they described feelings of losing their foothold. Long-term after diagnosis, they still lived in fear and looked for reasons why they were afflicted. Conclusions: Findings of similar experiences in comprehensibility between patients and spouses strengthen the importance of support and information to both parties. Since they hovered between comprehensibility and incomprehensibility during the whole disease process, it is important that their questions, fears and worries are met, from the first visit at hospital and through the whole process. Multiprofessional teams, such as ALS teams and palliative teams can from a holistic perspective increase the possibility of meeting their needs in their unique situation.

Background: In most families with familial cancers, mutations have not been demonstrated; thus, healthy individuals cannot be tested for mutation status. As a consequence, many persons at risk of familial cancer live with an unknown, but presumably high, risk of developing cancer.Aim: The aim of this study was to describe individuals’ perceptions of living with an increased isk of colorectal and gynaecologic cancer where the gene mutation is unknown.Methods: Interviews were conducted with 30 individuals with familial colorectal cancer. These ersons have no known mutation and therefore should be considered presumptive carriers. In onnection with the interviews, all participants were offered to take part in a surveillance programme consisting of a colonoscopy and gynaecological examinations. The interview ranscriptions were analysed by the use of qualitative content analysis.Results: Two themes emerged from the analyses: first, living under a threat with two ubthemes, threat awareness and distancing oneself from the threat. The second theme, living with uncertainty, was divided into four subthemes: influencing one’s family, being on the safe side, facing emotions evoked by examinations and trust and disappointment to the medical services.Conclusion: These persons live with a lifelong uncertainty with a varying intensity depending on what happens throughout the life trajectory. They have no diagnosis or patient group to elate to; therefore, the entire situation is often perceived as abstract. Thus, providing nformation and counselling needs to be more deeply elucidated, and we need to address both ituational and existential ways of uncertainty. This will, however, require professionals of all disciplines to understand the meaning of uncertainty and help ensure that its adverse effects re decreased with adequate nursing interventions.

The study’s rationale: Patients’ influence in health care through participation, freedom of choice and information, is laid down in laws, national and local directives. In nursing care situations, the degree to which a patient participates depends on the nursing staff. Accordingly, hindrances for patient’s participation during nursing care is an important question for the nursing profession. Aims and objectives: The aim was to focus on Swedish Registered Nurses opinion of hindrances for patient participation in nursing care and to uncover the informants’ perspectives in depth. Methodological design and justification: The study was limited to inpatient somatic care and has a qualitative approach. Data were collected through seven focus group interviews with 31 Registered Nurses from five hospitals. An analysis of the tape-recorded interview material was made, combining elements of content analysis with aspects of the Grounded Theory approach. Ethical issues and approval: The ethics of scientific work was followed. The participants gave informed consent. Verbal and written information was given as a guarantee that all information would be treated confidentially outside the focus group. Formal approval by ethical committee was not required according to national and local directives. Results: Hindrance for patient participation in nursing care comprised three themes: Competence, Influence of significant others and Organization and work environment, and their seven underlying subthemes. Conclusions: The study clarified factors, which individually or combined may be hindrance for patient participation in nursing practice. Professional nurses must be able to find a balance for their patients’ participation in nursing care activities through identification and coping with the hindrances. The three themes and seven subthemes here identified, can be used in patient care and its’ evaluation, like also quality assurance of care and work organization and in nursing education. For further development replication studies are needed, like additional studies of patients and significant others. © 2005 Nordic College of Caring Sciences.

BackgroundInterlinked aspects, as demographic changes, accentuation on home-based community care, increase the amount of informal caregivers to older adults. To preserve and enhance their health are subsequently essential and a reoccurring topic on political agendas. How this may be achieved is vividly debated and mainly focused on elimination of risks and stresses associated with caregiving. Within health promotion, the salutogenic approach focusing on resources to health is recognised and this approach was used to acquire necessary knowledge to enhance caregivers' health 'the salutogenic way'.AimTo present Generalised and Specific Resistance Resources (GRRs/SRRs) described by caregivers as stemming from themselves and their carerecipients.MethodologyTo unravel caregivers' GRRs/SRRs, a theory-driven, explorative design guided by definitions of GRRs/SRRs was utilised. Data were collected through salutogenically guided interviews with 32 Swedish caregivers in one municipality. Inductively, data were analysed using content analysis to identify each caregiver's SRRs and thereafter deduction to identify the population's GRRs.FindingsThe synthesis of findings, caregivinghood, encompasses several domains of GRRs seemingly involved in caregivers' movements towards health. In the caregiver domain, 'Being someone significant in my own eyes' unites the essence of having access to GRRs stemming from oneself and 'Being "blessed" with a co-operative co-worker' that of having access to GRRs stemming from the carerecipient. This may be the core in an orientation to life which creates positive life experiences, since it enables caregivers to find a 'fit' between the possible and desired when resolving challenges.Conclusion and implicationsHealth-promoting initiatives should be conducted as partnerships between formal and informal sources due to the versatility of GRRs. It also seems essential to empower both parties so that they may make sense of their situation and use their available GRRs/SRRs in this 'joint venture' of managing. Thereby, their motivation to continue the journey through Caregivinghood may be enhanced.

In salutogenic theory, individual/contextual, immaterial/material characteristics enabling movements towards health are labelled Specific and Generalised Resistance Resources, SRRs/GRRs, and characteristics counteracting such movements Specific and Generalised Resistance Deficits, SRDs/GRDs. The aim of this paper was to present SRDs and GRDs described by caregivers as stemming from themselves and their care recipient. Guided by salutogenic theory, an explorative design was used to collect data through interviews with 32 Swedish informal caregivers. During the theory-driven analysis, SRDs were unravelled using within-case approaches. To be able to unite them as GRDs across cases, a serviceable GRD definition was developed from the existing theoretical GRR definition. In findings, SRDs are visualised in citations and GRDs described in detail. Caregivers' experiences of SRDs/GRDs are presented as themes: 'Experiencing personal deficiencies', when stemming from themselves; and 'Struggling with an uncooperative co-worker', when stemming from their care recipients. Findings indicate that if these themes dominate a caregiver's view of life, she/he seems to have reached the 'breaking point' when caregiving ends due to lack of usable SRRs/GRRs. To prolong the time until this occurs, support, making otherwise unusable SRRs/GRRs usable, is needed. When designing this type of 'salutogenic' support, it seems essential to involve the target group (e.g. caregivers, care recipients), to ascertain what their SRRs/GRRs and SRDs/GRDs may consist of. Such knowledge regarding SRRs/SRDs could be used to design individualised support, and regarding GRRs/GRDs to design generalised support at group level. This study suggests how such new knowledge regarding resistance resources and deficits could be acquired.