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Existential issues among nurses in surgical care - a hermeneutical study of critical incidents
Department of Health Sciences, Mid Sweden University, Östersund, Sweden, and Health Care Sciences Post Graduate School at Karolinska Institute, Stockholm, Sweden.ORCID iD: 0000-0003-2853-0575
Mittuniversitetet, Inst. för Hälsovetenskap; Sahlgrenska Akademien, Götebrogs universitet.
Mittuniversitetet, Inst. för Hälsovetenskap.
2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 3, 569-577 p.Article in journal (Refereed) Published
Abstract [en]

Aims.

To report a qualitative study conducted to gain a deeper understanding of surgical nurses’ experiences of existential care situations.

Background.

Existential issues are common for all humans irrespective of culture or religion and constitute man’s ultimate concerns of life. Nurses often lack the strategies to deal with patients’ existential issues even if they are aware of them.

Design.

This is a qualitative study where critical incidents were collected and analysed hermeneutically.

Methods.

During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1–2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used.

Findings.

The majority of incidents concerned nurses’ experiences of caring for patients’ dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses’ personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care.

Conclusion.

Findings are interpreted and discussed in the framework of Buber’s philosophy of the relationships I-Thou and I-It, emphasizing nurses’ different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013. Vol. 69, no 3, 569-577 p.
Keyword [en]
Buber’s philosophy;cancer care;critical incident technique;existential issues;hermeneutic;nurses;surgical care
National Category
Nursing
Identifiers
URN: urn:nbn:se:du-10099DOI: 10.1111/j.1365-2648.2012.06032.xISI: 000315097200008OAI: oai:DiVA.org:du-10099DiVA: diva2:527737
Available from: 2012-05-22 Created: 2012-05-22 Last updated: 2015-10-26Bibliographically approved
In thesis
1. Existential issues in surgical care: Nurses’ experiences and attitudes in caring for patients with cancer
Open this publication in new window or tab >>Existential issues in surgical care: Nurses’ experiences and attitudes in caring for patients with cancer
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

Place, publisher, year, edition, pages
Mittuniversitetet, 2012
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 136
Keyword
cancer care, educational intervention, existential, nurses, surgical care
National Category
Health Sciences
Research subject
Hälsa och välfärd
Identifiers
urn:nbn:se:du-11708 (URN)978-91-87103-42-1 (ISBN)
Public defence
2012-01-13, F234, Östersund, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2013-01-16 Created: 2013-01-16 Last updated: 2015-10-26Bibliographically approved

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