We compared online distributed information provided to patients with cancer in Scandinavian countries through the lens of governmentality. A secondary comparative qualitative analysis was conducted. Discourses in online patient information showed differences in governmentality techniques across the countries: Norway used a paternalist approach, Denmark an educative approach, and Sweden an individualistic approach and expected the patients to make the “right” decisions. Online information for patients with cancer in Denmark and Norway showed high professional and health care system involvement, whereas in Sweden, there was high patient involvement. There was almost no use of the person-centered approach among the online discourses

To describe surgical nurses’ strategies for enhancing their pain management proficiency.A qualitative design was used to conduct the study. The participants were forty surgical nurseswho had at least six years of nursing experience in caring for patients with pain. They responded toopen-ended questions based on a review of the policy documents concerning the main elements ofthe pain management programme to be implemented by surgical nurses. Three key themes emergedfrom the surgical nurses’ suggested strategies: partnering, disrupting, and becoming familiar withpain management competency concerns. Surgical nurses’ strategies in acute and chronic painmanagement nursing units included solving patients’ problems and promoting and enhancing painstrategies to address health challenges in organisations. The themes presented in the results includeenhancing pain management in nursing competencies. State-of-the-art healthcare technologies arebeing applied to pain management. Surgical nurses’ strategies should improve the quality of nursingcare, especially post-surgery recovery time. It is recommended to engage patients, their families, andmultidisciplinary care teams in other healthcare fields.

The aim of this study was to analyse how the patient is constructed and socially positioned in Swedish patient information. Corpus-assisted critical discourse analysis methodology was utilised on a sample of 56 online patient information texts about cancer containing a total of 126,711 words. The findings show an overarching discourse of informed consent guided by specific features to produce a patient norm that we name “the reasonable patient”, who is receptive to arguments, emotionally restrained and makes decisions based on information. Through the discourse of informed consent, the norm of the reasonable patient emerges, apparently to even out the imbalance of power between patient and professional, but in reality, more likely to construct a patient who is easily controlled and managed. When the self-responsibility towards health is incorporated into the everyday domestic spaces via digital health technologies, the ideas and concepts of the patient role need to be reconsidered based on these new conditions. We conclude that it is important for nursing researchers to broaden the research on patients to include the relationship of power created through language. This study demonstrates both methodological and empirical possibilities to do so

This is a report of a scoping review undertaken to obtain an overview of studies conducted on pain management education programs (PMEPs). The aim of this review was to describe existing research publications relating to PMEP to map how pain management practice training might directly influence surgical nurses in contributing to successful pain outcomes in patients. The initial search of electronic databases identified 40 articles according to the inclusion criteria and search strategy, which applied the following terms: ("Pain management education program") AND ^∗ OR ^∗ ("Nurses") AND ^∗ OR ^∗ ("Patient outcomes") AND ^∗ ("Mixed methods"). Titles, abstracts, and keywords were also searched for the term "Nurse education." After applying exclusion criteria, five relevant peer-reviewed articles were eventually selected for the final charting of the data. The search included articles published between January 2015 and March 2019. The results show that PMEPs employ a variety of computer-based simulation, web-based facilitation, and video materials based on an evidence-based approach in their syllabuses. PMEPs were shown to enhance practice by promoting improved skills in critical thinking, leadership, patient management, and health promotion. Additionally, these programs promote an ability to practice across a variety of inpatient and outpatient settings, wherein nurses' engagement in managing patients' pain increased after completing the PMEP. Research within PMEP indicates that these programs may contribute to promoting opportunities for new collaborations within multidisciplinary team projects. Additionally, further research initiatives are needed to explore various aspects of these programs to enhance the nursing skills required for effective pain management, such as computer-based simulation, web-based facilitation, and video materials. Moreover, research relating to PMEPs in low- and middle-income countries is scarce and warrants further study.

The critical reason for this study is the inadequate training received by surgical nurses in acute and chronic pain management nursing services for patients.

PURPOSE 

This study aimed to describe the core components of an effective pain management education programme (PMEP) for surgical nurses in Thailand.METHODS A three-round Delphi method was used. A panel of 40 experts advised regarding the essential components of an effective PMEP for surgical nurses.

RESULTS 

The core components of a PMEP were derived from experts’ panel consensus: (i) multidisciplinary collaboration, (ii) acquisition of innovative knowledge and training by healthcare teams, and (iii) consideration of individual differences when delivering pain management services. To enhance their pain management practices, nurses should adopt multimodal pain approaches that involve family roles and engage in active patient listening.

CONCLUSIONS 

The PMEP designed in this study, which adheres to international nursing training standards, promotes the competency of professional nurses.

Background: Prostate cancer is the most common form of cancer in men. Treatments affect the body and the sexuality. Men having sex with men (MSM) report stronger influence on sexuality and quality of life.

Aim: The purpose of the study was to describe the sexual health of MSM after prostate cancer treatment.Methods: Semi-structured interviews related to symptoms and issues, and the help received. Interviews were analyzed using content analysis.

Results: The following themes emerged during the analysis: A predominant heteronormative care, Unscripted sexualities, A window of peer support system emerged. The men described how their sexuality had been affected and hampered by the treatments they had received with bodily changes and less pleasure. However, they also described the benefit of being MSM, being accustomed to exploring new ways of expressing and exploring their sexualities due to a lack of sexual scripts. The treatment provided a new reason to explore new sexualities and sexual practices. In contacts with urology and oncology departments, they described a heteronormative environment. Albeit same-sex partners could be asked for in intake notes, no one reflected on what non-penovaginal sexuality could look like. Instead, their friends and ability to find alternative ways to valid information became important.

Conclusion: The result shows that predominantly heteronormative care exists for MSM where they had to rely on their MSM peers, but also exploring new sexual scripts.Caring in a changing world: MSM describe care that was well-meaning but heteronormative. The men described being MSM as something that had made them explore unscripted sexual practices and had given them a broader sexual repertoire that was helpful for their sexual health. More information on sexual health is needed for healthcare personnel to care for MSM in different life situations.

Purpose: The purpose of the study was to describe the sexual health of men having sex with men after prostate cancer treatment.

Methods: A snowball sampling was conducted via clinicians and gatekeepers to the community. After consenting to participate, a semi-structured interview was conducted based on a questionnaire related to symptoms and issues and the help asked for and received. The interviews were approximately one hour and took place via digital platforms. The interviews were transcribed verbatim and then analyzed using content analysis. The following themes emerged during the analysis: A predominant heteronormative care, A situation of suffering and possibilities, A window of peer support system emerged.

Results: The men described how their sexuality had been severely affected by their treatments. Bodily changes with decreased penis size, difficulties maintaining an erection, and less pleasure from anal sex. However, they also described the benefit of being men who had sex with men. They described being accustomed to exploring new ways of expressing and exploring their sexualities due to a lack of sexual scripts. The prostate cancer treatment had given them a new reason to explore new sexualities and sexual practices. In contacts with urology and oncology departments, both physicians and nurses, the men described a heteronormative environment. Albeit same-sex partners could be asked for in intake notes, no one reflected on what non-penovaginal sexuality could look like. Therefore, getting the appropriate care for the men after prostate cancer treatment did not involve erectile dysfunction medications was challenging. Instead, their friends and ability to find alternative ways to valid information became important.

Conclusion: The result shows that predominantly heteronormative care exists for men who have sex with men. The new insight of the treatment is regarded as a situation of suffering and new possibilities. To conclude, men who have sex with men describe care that was well-meaning but heteronormative. The men described being men having sex with men as something that had made them explore unscripted sexual practices and had given them a broader sexual repertoire that was helpful for their sexual health. Furthermore, the support they received emerged from a peer support system in their private life.

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.

Good health is a prerequisite for individuals to function in everyday life. The same applies to newly arrived immigrants, where good health is crucial for successful establishment. The aim of this study was to describe stakeholders’ experiences of how newly arrived immigrants’ health affects their opportunities to establish themselves in society. The study had a qualitative design where open-ended questions were analysed following Braun and Clarke’s guidelines for conducting a qualitative thematic analysis. The results consist of three themes: Mental health problems, disabilities, and tormenting concerns about absent family members; A precarious life situation related to housing, education, and income; and Deficiencies in responding to health challenges in organisations and in society. Stakeholders face health problems among newly arrived immigrants that they do not have the right skills to deal with. We argue for the presence of nurses in organisations working with newly arrived immigrants, and that nurses’ competence is necessary to capture their needs.

År 2017 infördes ett nytt nationellt examensmål ”visa kunskap om mäns våld mot kvinnor och våld i nära relationer” enligt SFS 2017: 857, i högskoleförordningen (SFS 1993:100) för vissa utbildningsprogram, där sjuksköterskeprogrammet är inkluderat. Syftet med denna artikel är att presentera hur det nationella examensmålet har implementerats i sjuksköterskeprogrammet vid Röda Korsets Högskola. Först ges en översikt avseende relevanta undervisnings- och lärandeaktiviteter och hur de organiseras genom programmets utbildningsplan. I de avslutande reflektionerna presenteras den didaktiska Våga fråga och agera! -modellen. Modellen är en sammanfattning av Röda Korsets Högskolas tillvägagångssätt, det vill säga en stegvis progression i utbildningen från fakta, statistik, normer och värderingar, till att studenterna lär sig hur de kan upptäckta tecken på våld i komplexa kliniska situationer samt vikten av att ha mod att agera. Avslutningsvis är det vår uppfattning att ett tydligt upplägg är viktigt för att uppnå intentionerna med det nationella examensmålet, nämligen: Våga fråga och agera!

Nursing education has historically been designed in harmony with societal development. However, the world is becomingincreasingly complex, and we face ongoing global challenges. A new, progressive step towards a global nursing curriculum isneeded. This development is anticipated, and nursing students often request knowledge and perspectives that will preparethem to care in a sustainable way. To provide this and ensure equal health, intersectional perspectives must be at the foundationof future caring activities. There is thus a societal shift that makes it necessary to take a decisive step towards rethinking healththrough the lens of a sustainability paradigm.

Primary health prevention regarding social participation for newly arrived immigrants is needed to address challenges when responding to the needs of such immigrants in their new and vulnerable situation. The aim of this study was to describe social participation as reported by civil servants and volunteers working with newly arrived immigrants in Sweden. Open-ended data collected in a Delphi project targeting civil servants and volunteers working within the policy establishment programme was used. Qualitative content analysis was conducted. The findings show that several interacting factors contribute to resources that create perquisites for “going native in the community” and “being part of everyday life” as points of perquisites for how civil servants and volunteers elaborate on social participation for newly arrived immigrants. A focus on the “here and now” and avoiding measures that “put life on hold” are two points of aspects that generate possibilities for promoting social participation in health services.

Background: Several models for how to support students and provide them with the skills needed to write their degree projects have been proposed. However, few attempts have been made to present a general model for students' academic work based on reasoning and communication skills rather than memorizing and mimicking their supervisors during their independent degree project.

Objective: In the present paper, we propose a well-structured model that assists supervisors in promoting students' responsibility and autonomy, while at the same time maintaining a high level of support.

Presentation: We present a step-by-step protocol based on a partnership model with a contractual style that focuses on students' academic work with their own texts through a process of alternating between abstract and concrete writing. This protocol, which is called the ESRA (Escorting the Students into Responsibility and Autonomy) model, can be utilized regardless of the content, specific aim and scope of the individual student's degree project.

Discussion and conclusions: We argue that this model promotes high levels of engagement and assumption of responsibility among students, while also offering a feasible structure for ensuring the steps to empowerment and autonomy. Use of the ESRA model is suitable when a constructive interaction between students and supervisors is desirable as a tool to achieve the learning outcomes of the degree project. Thus, the proposed model is one step toward giving a new generation of nurses the skills and ability they need to adapt in the changing world of the 21st century and to make promoting health a core mission of their profession.

The ability to appropriately attend to refugee health needs in the countries that are receiving them is an enormous institutional challenge. The varying practicalities of administering refugee health services can affect a refugee’s mental health outcome during the adjustment period to their new home country. This is a report on a study undertaken to overview Delphi method approaches used to investigate the consensus by experts on the issue of refugees’ social participation in health services. The review was conducted from March to December 2018 by two evaluators utilizing a systematic search strategy in presently available electronic databases. Only Delphi studies concerning forced adult refugee’s social participation in health services were included, while studies that focused on children, minorities, immigrants, migrants, asylum seekers, etc., as well as studies that did not utilize the Delphi technique, were excluded. Ten peer-reviewed articles were included in the final charting of the data. The results show that Delphi approaches regarding refugee social participation have focused on important factors important for providing quality health care, health care priorities, barriers preventing social participation, and research priorities. The experts make clear that bureaucratic procedures, cross-cultural communication and empowerment, be taken into consideration when creating policies, in practice and in research. The conclusion is that by emphasizing the tacit knowledge of experts, the Delphi method can contribute to a deeper understanding of policy priorities and responsive health services.

This chapters discusses the power structures affecting access to healthcare and the quality of received care including factors like gender, ethnicity, social and economic status among others from an intersectional perspective. Structural changes are necessary to decrease the health inequalities and vulnerabilities during the pandemic. An intersectional approach helps to display the interactions of different power structures and social categories which put people at differential risk of infection and/or mortality of COVID-19. The intersectional approach should be used not only to understand the pandemic impact on people but also when planning the healthcare policies, care plans and support services.

The role of nurses in identifying and responding to family violence and violence against women has long been established. However, nurses’ readiness to fully assume this role remains low due to various barriers and the sensitive nature of the subject. As part of capacity building to address this problem, an additional national qualitative learning target, i.e., to “show knowledge about men’s violence against women and violence in close relationships”, was introduced into the Swedish Higher Education Ordinance for nursing and seven other educational programs between 2017 and 2018.

The aim of this paper is to describe how the national qualitative learning target is incorporated into the undergraduate nursing curriculum at the Swedish Red Cross University College. An overview of relevant teaching and learning activities and how they are organized is first presented, followed by the presentation of a proposed didactic model: Dare to Ask and Act! The model details a step-by-step progression from facts and figures, including the role of gender norms, to recognizing signs of abuse in complex clinical situations, as well as developing skills that enhance the courage to ask and act.

Due to the sensitive nature of violence victimization, the proposed model reflects the importance of making the subject a reoccurring theme in undergraduate nursing education in order to boost nursing students’ interests and confidence to “Dare to Ask and Act!”. The model also shows that making the subject a recurring theme can be achieved with minimal disruptions to and without overcrowding an existing curriculum.

Inclusive education, sustainable development, and core nursing values all share common goals of promoting diversity, equity, social justice, and inclusion. However, prevailing norms of exclusion may shape health systems and healthcare workers’ attitudes and threaten inclusive patient care. Ongoing global conflicts and violence resulting in growing patient diversity in terms of ethnicity and migration status have led to questions regarding healthcare systems’ preparedness for inclusive nursing. Diversity-rich classrooms and collaborative learning methods, like role play, are inclusive strategies that may be useful in nursing education. The purpose of this paper is to present lessons learned from incorporating role play about forced migration in inclusive nursing classrooms. Various diversity-rich nursing student groups participated in a two-hour role play on forced migration facilitated by youth volunteers from the Swedish Red Cross Society between 2017 and 2019. This study is based on the amplified analysis of qualitative data materials, in the form of notes and summarized feedbacks, obtained from evaluating the role play as a teaching-learning activity. Three themes were identified, specifically, knowledge exchange, existential reflections, and empathy evoked. Findings suggest that working collaboratively in an inclusive environment may improve nursing students’ understanding of the vulnerabilities created by forced migration and to be better prepared for promoting social justice for this group in health care settings. © 2020 by the authors.

People use the Web to seek health-related information and to discuss health issues with peers. Netnography, a qualitative research methodology, has gained the attention of researchers interested in people’s health and health issues. However, no previous reviews have accounted for how netnography is used in nursing research. The purpose of this mapping review was to generate a map of netnographic research in nursing. The search was conducted in PubMed, Academic Search Elite, the Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Scopus, and Web of Science. Data were extracted from 53 original articles. The results show an increasing trend in published netnographies over time; 34% of the total sample was published in 2021. Of the total, 28% originated from Sweden, and 81% had used a covert approach. In studies in which the researchers used more participatory designs, the time spent on online forums ranged between 4 weeks and 20 months. Informed consent is found to be an issue in netnographic studies. We discuss the fact that nursing researchers have used netnography to address a wide range of research topics of concern and interest, from self-care support in an online forum for older adults to nursing students’ perspectives on effective pedagogy. In line with the digital transformation in society in general, we discuss the fact that netnography as a research methodology offers great opportunities for nurse researchers to monitor new spaces and places that presuppose online methodological knowledge.

Fashion is a way to express identity and affiliations with specific social networks, and sociocultural organisations of health care facilities are no exception. Employees in hospitals must adhere to strictly regulated dress code policies, albeit shoes are one of few markers that are not regulated.

The aim of this study was to analyse the expressed team identity among healthcare staff by studying signs of personality traits they share with colleagues, as found in their choice of footwear. A total of 213 images of hospital footwear, posted on Instagram, were analysed utilising thematic content analysis.

The results show that choice of footwear signals seven different personality traits: the anonymous, an understated conformist; the discreet standout, a subtle individualist; the doer on the move, an active and ready contributor; the naturist, a barefoot  enthusiast; the superior  tourist,  a  temporarily  elite  visitor;  the  outsider,  an unconventional maverick; and the legend, a battle-scarred veteran.

The child perspective, i.e. an adult understanding and viewing of a child, is frequently being discussed. However, it is open to individual interpretation as the concept is only vaguely defined. This paper focuses on factors characterising the child perspective held by adults in an organisation which treats and supports adults and children who endure mental illness as a result of war, torture, and/or life as refugees. A cross-sectional descriptive design involving qualitative data was used. Data were gathered at the Health and care department, Swedish Red Cross, through open-ended questions in a web-based questionnaire answered by 69 employees. Additionally, ten semi-structured interviews were conducted with key individuals who represented a variety of professional functions within the department. The data were combined to form a united data set used for analysis. A thematic analysis was undertaken, based on the descriptions by Braun and Clarke, and three major themes emerged. Two of these described the professionals’ perceptions in terms of a child perspective. The first, Considering the child as an individual, focused on how a child perspective encouraged the employees to create a friendly atmosphere and to seek out children’s perspectives. The second, Acknowledging the child’s rights, highlighted a view of the child perspective as involving the safeguarding of children and the provision of “voice”. The third theme, Ambiguity in implementation, described the operationalisation of the child perspective in daily work, illustrating both favourable and problematic factors. To conclude, the understanding gained by this paper could be used to raise awareness of, concretise and operationalise a child perspective in other organisations in which adults encounter children. Likewise, this understanding could be used for ongoing research, knowledge development and further discussions in terms of child-focused work and rights-related initiatives involving children.  

Det nya lärandemålet i sjuksköterskeutbildningen innebär att studenter ska visa kunskap om mäns våld mot kvinnor och våld i nära relationer. Målet illustrerar behovet av att medvetandegöra och problematisera normer kring kön, makt och relationer. Med utgångspunkt i erfarenheter från Högskolan Väst föreslår vi i denna artikel normkritik som ett arbetssätt i utbildningen och formulerar handfasta råd. Undervisning om normer och makt kan förflyttas från att vara en perifer fråga driven av eldsjälar till gemensamt kollegialt ansvar med en central placering i varje kurs. Råden kan användas av ledare och lärare som vill erbjuda en sjuksköterskeutbildning där studenters förmåga att fråga, agera och ge våldsutsatta kvinnor en röst är ett centralt inslag.

Background

Forced migrants fleeing conflict and violence face a high risk of mental health problems due to experiences before displacement, perilous journeys, and conditions in the new host societies. Asylum seekers seem to be in particularly vulnerable situations, indicated by higher prevalence rates of mental health problems compared to resettled refugees. Asylum seekers’ mental health is highly influenced by the conditions they face in host countries while awaiting a decision on their case. In Sweden, 40% of asylum seekers reside in state-provided accommodation centers during the asylum process. Collective accommodation centers for asylum seekers have been said to impose restrictive social conditions and to be associated with poorer mental health outcomes than other housing forms (e.g., self-organized housing). However, there seems to be a scarcity of qualitative studies exploring the experiences of asylum seekers in different contexts. The aim of this study was therefore to explore the experiences of asylum seekers and how they manage their mental wellbeing while living at accommodation centers in Sweden.

Methods

Fourteen semi-structured interviews with asylum seekers were conducted at two accommodation centers in Sweden. Participants were recruited using purposeful sampling and represented a diverse group of asylum seekers regarding age, background, and gender. The data was analyzed using content analysis.

Results

Three overarching categories were identified; 1) Frozen life, 2) Constant worrying and “overthinking”, and 3) Distractions and peer support. Participants experienced a state of being that could be characterized as a frozen life, which was associated with intense feelings of psychological distress, mostly described as manifesting itself in consuming patterns of ruminative thoughts, for instance overthinking and constant worrying. However, despite high levels of distress, participants demonstrated agency in managing negative mental health outcomes through self-care practices, peer support, and the development of care practices in caring for others in need.

Conclusion

This study offers new insights into the everyday challenges that asylum seekers at accommodation centers face. Furthermore, it offers valuable observations of how asylum seekers at accommodation centers cope through self-care practices, peer support, and care practices in caring for peers in need. In order to enable sustainable and empowering support, mental health and psychosocial support services must identify and address both challenges and strengths, be grounded in the lived reality of asylum seekers, and build on existing resources. Moreover, further policy work needs to be done to enable faster asylum processes.

Background

The COVID-19 pandemic has made visible the scale of health disparities in society, highlighting how the distribution of infection and deaths differs between population subgroups within countries. Asylum seekers represent a potentially vulnerable group; early in the pandemic, concerns were raised about their housing situation, usually involving overcrowded, camp-like accommodations, and the effects of COVID-19 in relation to this. Hence, this study aimed to explore asylum seekers’ experiences of the COVID-19 pandemic while living at accommodation centers.

Methods

In this qualitative study, 14 semi-structured interviews were conducted with asylum seekers at two accommodation centers in Sweden. Participants represented a diverse group of asylum seekers in regard to age, educational background, and gender. Data were analyzed using qualitative content analysis.

Results

Experiences related to COVID-19 were highly dependent on the living situation at the accommodation centers and the experience of feeling unsafe in shared spaces. This was enhanced by the experiences of a challenging mix of COVID-19 messages where different understandings of COVID-19 and related measures existed, together with a feeling of loss of control and safety in shared rooms. Additionally, participants felt more isolated from the outside society and missed prior social activities. Adding to this experience of isolation was an increasing mistrust regarding the authorities’ pandemic response.

Conclusion

This study highlights the importance of understanding the specific challenges and vulnerabilities of asylum seekers at accommodation centers during the pandemic, shaped by their housing situation and legal status. The findings underscore the need for context-specific support, holistic disease prevention approaches, and tailored health communication strategies using diverse formats. Additionally, the findings emphasize the crucial need to identify and mobilize existing community resources in planning and implementing pandemic control measures. Furthermore, the study emphasizes governmental responsibility in providing secure housing, and to address long-term vulnerabilities beyond pandemics.

BACKGROUND: Patients who are suffering may be commonly encountered in health care. The growing use of telehealth implies that encounters with patients who are suffering may increasingly take place at a distance. "Distant suffering" is a concept coined within sociology to describe the suffering of far-away others. It is conceptualized as a paradox, as distance changes the relation between the witness of suffering and the suffering encountered. Impacts may include a potential detriment to the sufferer and ethical implications for the witness.

OBJECTIVE: To explore the concept of distant suffering and any relevance, implications, or important avenues for potential research within the healthcare sciences.

DESIGN: Rodgers' evolutionary concept analysis.

DATA SOURCES: Databases of Web of Science, Medline, CINAHL and PsycInfo were searched for the terms "distant suffering" or "mediated suffering".

REVIEW METHOD: Attributes, surrogate or related terms, antecedents, consequences, and uses of the concept were extracted and synthesized.

RESULTS: Thirty articles published within the past ten years were selected for review from the search results. "Distant suffering" was characterized as comprising 1) mediated far-away suffering, 2) a "recognizer" or witness, and 3) a potential role of a moderator. Antecedents include shared understandings and socially-influenced responses. Consequences include responses like empathy, compassion, pity, also indifference, cynicism and compassion fatigue.

CONCLUSIONS: Further research to explore distant suffering from healthcare sciences' perspective could uncover valuable insights for those suffering, for healthcare workers, and any who are exposed to it. An improved understanding of how distant suffering is conveyed and moderated could enable targeted reduction of exposure or improve response to distant suffering. Such knowledge could help diminish negative consequences for those suffering, for healthcare workers who are caring at a distance for those suffering, or for others who encounter distant suffering in their occupations or in daily life via media, social media, or digital communications.

TWEETABLE ABSTRACT: New analysis finds that exposure to distant suffering may have important implications for health and health care.

Background

Encountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers’ lived experiences of encountering patient suffering during telemental health care.

Methods

A qualitative phenomenological approach was used to uncover participants’ experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology.

Results

Telehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers’ lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief.

Conclusions

This study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to support providers for successful and rewarding telehealth care encounters.

Introduction

Tele–mental care is ubiquitous worldwide [1]. It is effective and even preferred by patients [2]. Yet, providers have expressed concerns that the technology limits conveying nonverbal cues [3,4] or impedes the therapeutic relationship [3,5]. These key aspects of communication and interpersonal connection in care could be described as types of distances, where spatial distance could prevent patient observation, and psychological distance may prevent effective interpersonal connection. Considering the growing use of tele–mental care and the relevance of these forms of distance for successful tele–mental care encounters, this study was conducted to explore these or other forms of “distance” that arise in providers’ descriptions of tele–mental care encounters.