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Next of kin represent significant resources in the care for older patients. The aim of this study was to describe and illuminate the meaning of the next of kin’s experiences during the transition of an older person with continuing care needs from hospital to home. The study has a phenomenological hermeneutic design. Individual, narrative interviews were conducted, and the data analysis was conducted in accordance with Lindseth and Norberg’s phenomenological hermeneutic method. Two themes and four subthemes were identified and formulated. The first theme: “Balancing vulnerability and strength,” encompassed the subthemes “enduring emotional stress” and “striving to maintain security and continuity.” The second theme: “Coping with an altered everyday life,” encompassed “dealing with changes” and “being in readiness.” Our findings suggest that the next of kin in striving to maintain continuity and safety in the older person’s transition process are both vulnerable individuals and significant agents. Thus, it is urgent that health care providers accommodate both their vulnerability and their abilities to act, and thereby make them feel valued as respected agents and human beings in the transition process.Key words: Relatives, adult, alteration, hospital care, home care, phenomenological hermeneutic study(Published: 5 March 2015)Citation: Int J Qualitative Stud Health Well-being 2015, 10: 26554 - http://dx.doi.org/10.3402/qhw.v10.26554

Background: Future challenges in many countries are the recruitment of competent staff in long-term care facilities, and the use of unlicensed staff. Our study describes and explores staff interactions in a long-term care facility, which may facilitate or impede healthy transition processes for older residents in transition. Methods: An ethnographic study based on fieldwork following ten older residents admission day and their initial week in the long-term care facility, seventeen individual semi-structured interviews with different nursing staff categories and the leader of the institution, and reading of relevant documents. Results: The interaction among all staff categories influenced the new residents’ transition processes in various ways. We identified three main themes: The significance of formal and informal organization; interpersonal relationships and cultures of care; and professional hierarchy and different scopes of practice. Conclusions: The continuous and spontaneous staff collaborations were key activities in supporting quality care in the transition period. These interactions maintained the inclusion of all staff present, staff flexibility, information flow to some extent, and cognitive diversity, and the new resident’s emerging needs appeared met. Organizational structures, staff’s formal position, and informal staff alliances were complex and sometimes appeared contradictory. Not all the staff were necessarily included, and the new residents’ needs not always noticed and dealt with. Paying attention to the playing out of power in staff interactions appears vital to secure a healthy transition process for the older residents. Keywords: Long-term care facility, Staff interactions, Transition, Complexity science, Resident, Ethnography. © 2015 Eika et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Published version of an article in the journal: Journal of Multidisciplinary Healthcare. Also available from the Publisher at: http://dx.doi.org/10.2147/JMDH.S51947 Open access Background: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes. Methods: A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach. Results: Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional culture. Conclusion: To meet the complex needs of the patients in a professional way, the home nursing leaders needed to be flexible and pragmatic in their administration of care. This involved utilizing available professional competence appropriately. The coordination and communication between the different organizational levels and units were pointed out as major factors requiring improvement.

Overganger er en naturlig del av livet, men kan være vanskelige og utfordrende. Eldre opplever ofte endringer i helse- og sykdomsstatus og denne type overganger kan være særlig utfordrende. Overgangene kan karakteriseres som risikoperioder i forhold til helse og velvære, og fører ofte til behov for sykepleie. Sykepleie skal bidra til at den enkelte mestrer endringene som oppstår på en best mulig måte. Et teoretisk rammeverk, med fokus på eldre pasienter i overgangsfaser, er utviklet med utgangspunkt i Meleis' teori om transitions (overganger). Rammeverket beskriver prosesser og faktorer som indikerer i hvilke grad pasienten mestrer overgangen, og sykepleiehandlinger som er hensiktsmessige i denne sammenheng. Dette kan bidra til større forståelse for overgangsprosesser hos eldre, og rammeverket kan derfor være fruktbart å anvende for sykepleiere og forskere i det geriatriske felt.

To become dependent on professional support to accomplish the daily activities of life can be considered a turning point, involving a range of challenging changes in life. The purpose of the study was to describe the experiences of older homedwelling individuals in transition from self-supported to supported living from a lifeworld perspective. Five women and five men were interviewed, and a descriptive phenomenological design was used. The findings showed that an attitude of acceptance was an essential characteristic for this group. An attitude of acceptance comprised: flexibility and tolerance, recognition and hopes, and valuation of self and situation. Finding themselves in a situation they had to submit to, they took an attitude of acceptance. An attitude of acceptance implied acknowledgement of the situation as well as positivity and desires to manage. This attitude may represent a significant potential for improvement. Awareness of this is crucial to support older individuals in a healthy way through the transition process. An attitude of acceptance, however, also implied an acceptance of discontinuity in their lives, renunciations, and denigration of own needs. But this aspect of the acceptance was trivialized by the participants and not equally obvious. Insight into this complexity is vital to avoid ignorance of older individuals’ vulnerability in the transition process. Key words: Lifeworld, elder, phenomenological approach, support, transition(Published: 29 November 2011)Citation: Int J Qualitative Stud Health Well-being 2011, 6: 7914 - DOI: 10.3402/qhw.v6i4.7914

To become dependent on professional support to accomplish the daily activities of life can be considered a turning point, involving a range of challenging changes in life. The purpose of the study was to describe the experiences of older home-dwelling individuals in transition from self-supported to supported living from a lifeworld perspective. Five women and five men were interviewed, and a descriptive phenomenological design was used. The findings showed that an attitude of acceptance was an essential characteristic for this group. An attitude of acceptance comprised: flexibility and tolerance, recognition and hopes, and valuation of self and situation. Finding themselves in a situation they had to submit to, they took an attitude of acceptance. An attitude of acceptance implied acknowledgement of the situation as well as positivity and desires to manage. This attitude may represent a significant potential for improvement. Awareness of this is crucial to support older individuals in a healthy way through the transition process. An attitude of acceptance, however, also implied an acceptance of discontinuity in their lives, renunciations, and denigration of own needs. But this aspect of the acceptance was trivialized by the participants and not equally obvious. Insight into this complexity is vital to avoid ignorance of older individuals' vulnerability in the transition process.

To become dependent on professional support to accomplish the daily activities of life can be considered a turning point, involving a range of challenging changes in life. The purpose of the study was to describe the experiences of older homedwelling individuals in transition from self-supported to supported living from a lifeworld perspective. Five women and five men were interviewed, and a descriptive phenomenological design was used. The findings showed that an attitude of acceptance was an essential characteristic for this group. An attitude of acceptance comprised: flexibility and tolerance, recognition and hopes, and valuation of self and situation. Finding themselves in a situation they had to submit to, they took an attitude of acceptance. An attitude of acceptance implied acknowledgement of the situation as well as positivity and desires to manage. This attitude may represent a significant potential for improvement. Awareness of this is crucial to support older individuals in a healthy way through the transition process. An attitude of acceptance, however, also implied an acceptance of discontinuity in their lives, renunciations, and denigration of own needs. But this aspect of the acceptance was trivialized by the participants and not equally obvious. Insight into this complexity is vital to avoid ignorance of older individuals??vulnerability in the transition process.

Nasjonalt så vel som internasjonalt står helsevesenet overfor store utfordringer knyttet til økningen av antall eldre. En av hovedutfordringene angår rekrutteringen av profesjonelle yrkesutøvere til eldreomsorgen (St.meld.nr.25 2005-2006). Negative holdninger til eldre og eldreomsorg vil gjøre det vanskelig å rekruttere og beholde nok sykepleiere i det geriatriske feltet. I tillegg vil det bli mangel på omsorgspersonell generelt. Samtidig rapporterer sykehjemsstudier at institusjonaliseringen utgjør en trussel mot selvfølelse, selvbilde og psyko-sosialt velvære hos pasientene. Flere forhold bidrar dermed til at kravene som stilles i St.melding nr. 25 Mestring, muligheter og mening, om at omsorgstjenestene må være gode og formidle omsorg gjennom både handling og holdning, kan bli vanskelige å oppfylle. Forskning viser at bruk av livshistorier som et pedagogisk virkemiddel har en bevisstgjørende effekt på den enkelte. Det å arbeidet med egne erfaringer, gjør oss mer oppmerksomme på hva som betyr mest i livene våre, og bidrar også til økt forståelse, større oppmerksomhet og engasjement i andre. I dette prosjektet er det satt fokus på en metode der omsorgspersonell ved et sykehjem deler egne erfaringer og livshistorier. Hensikten har vært å utprøve og vurdere en metode som kan videreutvikles og implementeres i utdanning og praksisfelt. Det overordnede målet er å bidra til bedre omsorg for pasienten, og til økt motivasjon for og i arbeidet med eldre. Studien har et kvalitativt beskrivende design, og et datagrunnlag som består av skriftelig fortellinger og notater fra refleksjonsgruppesamlinger. Funn viser at deltakerne fikk tilgang til noe unikt ved hverandre som enkeltpersoner gjennom å dele livshistorier og erfaringer. Dette gav dem en opplevelse av styrket selvfølelse og egenverd. Denne opplevelsen synes å ha berørt dem, også som omsorgsgivere. Mye tyder på at de ble mer oppmerksomme på pasientene som personer, mer vare for pasientenes opplevelse i situasjonen, og mer opptatte av å bli kjent med den enkelte pasienten som et helt og unikt menneske. Dette vil i så fall kunne bidra til å styrke pasientens identitet og opplevelse av verdi, samt legge grunnlaget for å tilrettelegge individuell pleie for den enkelte. Samtidig vil omsorgsutøverne kunne oppleve større engasjement i arbeidet. Det er derfor grunn til å arbeide videre med å utvikle og tilpasse denne ??etoden??til så vel utdanning som praksisfelt.

Ugifte mødre utgjorde en relativt ensartet gruppe i perioden 1916-1965, også i Telemark.. De aller fleste arbeidet i tjenesteytende arbeid uten krav til utdannelse. Fedrene til barna som ble født utenfor ekteskap tilhørte i overveiende grad den samme sosiale klassen som mødrene. De var arbeidere på fabrikker, anlegg, i skogen og på gårdsbruk. Utviklingen fra hjemmefødsler til fødsler som fant sted i ulike typer institusjoner av både privat og offentlig karakter, skjøt fart i Telemark som ellers i landet på 1900 tallet. Blant disse institusjonene var private fødehjem ledet av jordmødre. De fantes i ulike varianter i bygd og by. I Skien ble det etablert en rekke fødehjem fra 1920 tallet og framover. I Porsgrunn derimot kom det første fødehjemmet på begynnelsen av 1950 tallet. Fødehjemmene tok i mot gifte som ugifte fødende; noen av dem skilte seg ut ved å ta i mot ugifte kvinner fra andre deler av landet, spesielt på 1950 tallet. Overfor særlig de ugifte mødrene ivaretok fødehjemmene en rekke funksjoner. De ble et slags midlertidig tilfluktssted for kvinnene og etter hvert barna. De fungerte som arbeidssted, oppdragelses- og opplæringssted, men også som et rent, pent og fredelig hjem med muligheten for fellesskap og samvær med andre kvinner. Fødehjemmene hadde dessuten ofte en aktiv rolle i forhold til de barna som kvinnene enten valgte eller ble tvunget til å gi fra seg. Fødehjemmene hadde en aktiv rolle til langt inn i 1960 årene i Telemark.

At the International Nursing Congress in Montreal in 1929 American nursing leaders argued that nursing had to be founded on scientific knowledge. Science and nursing was eagerly discussed during the whole inter-war period. And the essential question was if nursing should be promoted as a moral-based practice or as a profession based on science. This article will discuss why science became such a significant topic in the development of nursing in the period between the two world wars. It is maintained that the arguments for science reflected professional ambitions, but also a strong wish to improve nursing including the education of nurses. It is further argued that the role of science and the impact it had on the development of nursing was due to various forces of both external and internal character. This was revealed in several ways, e.g. in the curriculum prepared by the Committee on Education of the International Council of Nurses in 1930. The article is based on one of the chapters in the thesis "Bergljot Larsson and modern nursing" (2002). In this connection both primary sources and secondary sources about this specific topic have been used in the existing discussions and analyses.

The calling has been fundamental in the development of skilled nursing. This development took place in a context claiming alliance to traditional female values; values that had much in common with those associated with the calling. Using the Norwegian nursing leader, Bergljot Larsson, as an example, this article will discuss the role of the calling in the modernization of nursing. It is argued that the calling had a contradictiory role, representing both an aid and an obstacle in the efforts that were made to modernize nursing. The article is based on the thesis "Bergljot Larsson and modern nursing" (2002). The approach is primarily that of historical biography, derived from a range of written sources. In this connection sources from the archives of the Norwegian Nursing Assocition and the early 20th century issues of the periodical Sykepleien have been of particular significance.

I 1908 søkte seks unge kvinner om å bli tatt opp som sykepleieelever ved Bratsberg Amts sykehus. Anna Berg fra Eidanger og Emma Johansen fra Gjerpen var de to heldige som fikk begynne. Bratsberg amt hadde fått sin første fagutdanning i sykepleie. Utdanningen var på ett år, men allerede i 1916 ble den treårig. På dette tidspunktet var det bare Kristiania Kommunale sykehuser (Ullevål) og Bergen Kommunale sykehuser som hadde opprettet treårige sykepleieutdanninger i Norge. Denne artikkelen setter fokus på både bakgrunnen, opptakten til og etableringen av sykepleierutdanningen i Bratsberg Amt. Den gir en kort omtale av hvem som begynte på sykepleierutdanningen og hva utdanningen bestod i. Siden sykepleierutdanningen ved Bratsberg amts sykehus var en av de første i landet som ble treårig, legges det særlig vekt på å framstille et bilde av nettopp den raske utviklingen sykepleierutdanningen hadde, fra å være ettårig da den startet i 1908, til å bli toårig i 1915 for så å bli ble treårig allerede fra 1916. I denne sammenheng settes det spesielt fokus på betydningen av enkeltpersoners initiativer og engasjement.

Dette essayet er skrevet i tilknytning til min doktorgradsavhandling om den norske sykepleiepioneren, Bergljot Larsson (1883 - 1968). Avhandlingen har en historisk biografisk tilnærming. Essayet har til hensikt å diskutere hvordan hermeneutikken kan bidra til å tolke den historiske tekst, og derved til å utvikle kunnskaper og forståelse for fortiden. Den filosofiske hermeneutikken og Gadamers perspektiv er spesielt vektlagt, men også den tradisjonelle hermeneutikken trekkes inn der hvor dette vurderes som interessant. Eksempler fra avhandlingen er brukt som utgangspunkt for vitenskapsteoretiske refleksjoner og diskusjoner. I essayet konkluderes det med at Gadamers syn på forståelse og fordommer gir retning på flere nivåer i arbeidet med det historiske kildematerialet; i utvelgelsen og arbeidet med kildene står bevisstgjøring av egne kunnskaper, holdninger og verdier relatert til temaet som skal utforskes sentralt. Gadamers perspektiv bidrar likeledes til å synliggjøre betydningen av å ha et avklart forhold til begrepet objektivitet. Ved å la seg inspirere av Gadamer kan en stå i fare for å framsette fortolkninger som bærer preg av vilkårlighet og subjektivitet, fordi egne fordommer fungerer som utgangspunkt for fortolkningene. ?penhet om de forutsetninger som ligger til grunn for fortolkningene er derfor en betingelse. Innenfor Gadamers hermeneutiske perspektiv framstår den historiske sannhet som relativ i forhold til tolkerens ståsted og posisjon.

Purpose: The overall purpose of this project was to explore the transition into long-term care placement for older residents from different perspectives in order to maintain and enhance health and well-being, and inform practice and improve care. Methods: An ethnographic design used three sources of data, periodic participating observations, individual semi-structured interviews, and reading of relevant documents. The project comprises three studies. The aim of study I was to describe and explore the experiences of next of kin during the older residents’ transition into long term care placement. I interviewed ten next of kin to eight newly admitted residents. The next of kin talked about their experiences during the preparation period, the arrival day, and the first week after placement. The aim of study II was to explore and describe the staff’s actions during the initial transition process for the older residents into long-term care facility. In study III, the aims were to explore and describe the staff’s interactions during the older residents’ transition into long-term care facility, and explore how the staff interactions may influence their assistance and care of the older residents. In studies II and III, I followed through periodic participating observations, the staff who assisted ten new residents during the preparation period, arrival day, and the first week after placement. Moreover, I interviewed sixteen staff and the leader of the institutional services, and read relevant documents. Thematic analyses were used to analyze the data in studies I and III and content analysis inspired the analysis of study II. Main findings: What happened prior to the long-term care placement as well as what happened in the initial period in the nursing home influenced the experiences of the next of kin and relationships within the family (I). Moreover, it influenced staff’s actions and interactions, which ultimately influenced the older residents’ transition processes (II, III). The next of kin strove to handle the new situation. They kept on feeling responsible for their older family member, and provided continuity with their past life. Structural arrangements, such as the older family member having to share a private room with a co-resident and being moved about in the nursing home frustrated the next of kin. They did not expect much for themselves, apart from staff notice them and approach them during visits. This seldom happened, and they experienced little support from the staff (I). The next of kin and the staff were distant to each other and members from both groups expected the other to approach them. They appeared shy towards each other in this rural community where they knew of each other. In study II, staff’s actions varied from involvement with the new resident to ignorance. Some powerful influential forces on their actions were the management of the facility, individual staff’s formal position, traits, and enthusiasm, resident and staff mix, and local transparency. Both licensed and unlicensed staff were susceptible of performing poor assistance towards the new residents, which may contribute to directing the new resident towards vulnerability and risk. In study III, the staff interactions influenced the new residents’ transition process in complex ways. This study captures some descriptions and connections between micro and macro levels, and some power mechanism at play among the participants that may contribute to enhancing or inhibiting a smooth transition for the older residents and their next of kin. Organizational structures, staff’s formal position, and informal staff alliances were complex and paradoxical. Some powerful influential forces on the staff’s interactions were the previous health care setting, the management of the facility, the strong oral culture, individual staff’s formal position, personality and authority, resident and staff mix, the physician’s round, local transparency, and the taken-for-granted. The findings demonstrate the significance of every agent in the organization, and how each one may influence the staff’s work in unpredictable ways. When happening, the spontaneous staff interactions were “pockets of excellence” and contributed to maintaining the evolving needs of the new residents in the initial period. These interactions depended on dedicated permanent staff who involved everybody present for the best of the new residents, and on the mix of staff at any given time. During holidays with many supply staff, the involved permanent staff were unable to perform their work according to their own standards. Especially the part-time unlicensed supply staff seemed prone at disturbing the work of most permanent staff. Conclusion: Main areas of concern regarding both the next of kin and the staff were that they needed support and information, and clarify roles between them. Moreover, to maintain the health and well-being of the older residents and their next of kin during the transition involve focus on the playing out of power in staff actions and interactions. In this respect, this project shows some connections and dialectics between macro- and micro levels, which may influence on this: inter organizational level, organizational level, inter professional level, professional level and personal level, as well as contexts and circumstances at any given time. The findings show the importance of involving everybody to the best for the new resident and their next of kin. Combining complexity science with transition theory in nursing provide valuable insights for grass root-, management-, education-, research-, and policy levels how to improve the assistance of the older residents and their next of kin during transitions into longterm care placement. Digital fulltext not available