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As a follow-up to a recent study which highlighted the existence of medical dominance in multi-disciplinary team (MDT) meetings, this paper presents research findings from an Australian study which shows that medico-centrism is a key cause of tension within MDTs. The findings are from a 1-year qualitative study in a regional hospital that explored the ethical decision-making of health professionals within an acute care medical unit. This exploration was conducted through an iterative, phenomenological, qualitative research methodology that consisted of open-ended interviews with a multi-disciplinary representation of health professionals and a sample of consumers for whom they care. The paper situates the notion of nursing advocacy within the context of medico-centrism and examines how the nursing profession interfaces with other disciplines. The findings indicate that the professional framework of nursing includes the language of advocacy, whilst the framework of doctors centres around the medical decision-making process. All professional groups made reference to the MDT as the modus operandi for patient-centred care. All participants noted that time and familiarity with patients and their families is essential for patient-centred care and this could be achieved through MDT collaboration. However, doctors who have scant time to spend with patients saw it as their responsibility to direct the decisions of the MDT and viewed the MDT as adding confusion to the decision-making process. Nurses reported that the limited amount of time spent by doctors in patient consultation translated into the need for advocacy. Professional and clinical confidence and experience are noted as necessary to successfully engage in the process of advocacy. The findings of this article indicate that the adoption of an advocacy role by nurses represents an important means through which MDT operation can be enhanced, medico-centrism limited and patient-centred care improved. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 203-211 Diabetes and end of life: ethical and methodological issues in gathering evidence to guide care Introduction: Providing palliative care for people with diabetes at the end of life is part of the chronic disease care trajectory, but end of life care is complex and the presence of diabetes further complicates management. Aim: The aim of the paper is to discuss the ethical and methodological issues encountered when undertaking research to develop guidelines for managing diabetes at the end of life and the strategies used to address the issues. Method: The issues emerged as we developed guidelines for managing diabetes at the end of life, which included conducting individual interviews with 14 people with diabetes requiring palliative care and 10 family members. A reflexive researcher journal was maintained throughout the guideline development process. The interview transcripts and researcher's journal were analysed to determine key methodological, ethical and researcher-related issues. Findings: Key themes were vulnerability of the sampling population, methodological issues included recruiting participants and ensuring rigor, ethical issues concerned benefit and risk, justice, autonomy, privacy, professional boundaries and informed consent. Researcher-related issues were identified such as managing participant distress and their own emotional distress. People were willing to discuss end of life diabetes management preferences. Conclusions: Undertaking research with people at the end of life is complex because of their vulnerability and the ethical issues involved. However, the ethical principles of autonomy and justice apply and people should be given the relevant information and opportunity to decide whether to participate or not. [ABSTRACT FROM AUTHOR]

The study's rationale: The Scandinavian nursing tradition is based on caring science as the ontological backdrop. This means that meeting the patient with openness and respect is essential in care. The experiences of an elderly woman receiving home nursing provide insight into a world many healthcare workers need to understand; meaning what is important in the encounter with the fragile old patient whose voice is not often heard in the society nor in research. Caring science with its person‐oriented care clashes with the New Public Management's ideal for municipal health care in Norway, at the expense of the needs of the elderly patients. Aims and objectives: This article aims to express the phenomenon of lived experience as presented by an elderly woman, more specifically her experience of care in home nursing run according to the principles of new public management. Methodological design: The article is based on an empirical narrative in the form of an individual qualitative research interview. Findings: The patient has needs that cannot be defined without the nurse having an ethical understanding of what may be important in the patient´s lifeworld. The core findings are: Feeling disregarded as a human being, Broken agreements, Surrendering in anonymous relationships and Each day is a different day with altered needs. Conclusion: The system of New Public Management sets a strain on the time at hand for the nurse to develop a relationship that acknowledges and supports the patient´s life courage. The ethical demand and care ethics can explain how the patient´s will to live can be preserved, and provide knowledge of how the caregiver can best attend to the patient's ways of expressing what is important to her. Nevertheless, within the time at disposal, the nurse has an opportunity to either marginalize or strengthen the old person´s dignity. [ABSTRACT FROM AUTHOR]

Aim: To explore next of kin's experiences and attitudes regarding information surrounding the introduction and use of technology to monitor residential home residents with dementia. Background: As our population ages, conditions increase health care and societal challenges. Digitalisation and welfare technology are important for developing health services for the ageing population; adapting information‐sharing and communication about these pics with those involved, such as next of kin, will become increasingly important for developing appropriate services. Design: This qualitative study has an exploratory and interpretative approach, using in‐depth interviews based on a hermeneutical–phenomenological perspective. Methods: During the process of implementing a variety of residential care monitoring technologies, data were collected primarily via semi‐structured, in‐depth interviews with care providers and next of kin. In addition to the individual interviews, one focus group interview was carried out with care providers. Results: Next of kin are a heterogeneous group who need differing types of information – and different styles of communication – to convey information about their relatives in residential care. General attitudes among the next of kin towards welfare technology were positive. Three analytic themes that illustrate the next of kin concerns emerged: (1) concern for safety, autonomy and ethics; (2) resistance and optimism towards technology; (3) information about the use of monitoring technology. Conclusion: Digital monitoring technology is increasingly being implemented in residential care. Next of kin are salient in this context. Accordingly, best practices for informing and communicating in a collaborative process must be developed. While some next of kin have resources and are able to be highly engaged, others are unable or unwilling to be active participants in their family members' lives. It is critical that care providers are aware that next of kin are a heterogeneous group. Our proposed profiles may prove helpful for giving the right information and attention to next of kin, and this may improve residential care services. Relevance to clinical practice: These findings may aid in the tailoring of information and communication systems to individual next of kin's needs and in improving residential care services. [ABSTRACT FROM AUTHOR]

Background: Maternal obesity is a global health concern that is associated with significant effects on both short‐ and long‐term health of both mother and child. However, maternal lifestyle interventions tend to focus solely on diet and physical activity in ways that disembody and disengage the social context in which women live their lives. Aims: The aim of this study was to explore the lived experiences of maternal obesity and delve into how experiences of the body and motherhood affect women's motivation for participating in a postpartum lifestyle intervention. Method: A qualitative study using in‐depth semi‐structured interviews based on participant‐generated photographs was used to allow the women to openly express their lived experiences of maternal obesity. The study emanated from a gynaecological department of a major Danish hospital, and five pregnant or postpartum women living with obesity participated. Interviews were audio recorded, transcribed and analysed using an Interpretive Phenomenological Approach. Results: The analysis identified an overall theme of ambivalence and four subthemes among the participating women. The themes reflected contrasting feelings where the obese body was simultaneously an arena for aesthetic failure, functional success and moral dilemmas. Experiences of weight stigma and moral accusations in healthcare settings further increased the women's sense of ambivalence and challenged their strong desire to lose weight. Conclusion: This study highlights an ambivalent and vulnerable situation of maternal obesity which makes moral sensitivity towards weight and body concerns crucial to consider in future maternal health interventions. Our data suggest that an emphasis on functionality and capability rather than aesthetics and measured ideals would be useful in providing care and support in postpartum lifestyle interventions for women living with obesity. [ABSTRACT FROM AUTHOR]

Nurses' distress in response to the professional experience of the neonatal loss and stillbirth care is poorly addressed in nursing practice; therefore, the purpose of this study is to explore nurses' experiences of labour of a stillborn baby. A qualitative approach with ten Registered Nurses from hospital birth units in northern Taiwan was used to investigate the stillbirth care experiences of nurses. Research data analysed by interpretative phenomenological analysis (IPA) were collected from eight digital recorded sessions of group dialogues, nurses' responses and feedbacks. Three main themes extracted from data include unfolding the suffering, engrossing in stillborn parents and demonstrating compassionate actions for the stillborn baby. Unfolding the suffering includes shame, guilt and disenfranchised grief. Engrossing in stillborn parents includes perceiving the mother's suppress sadness and empathising with the father's anger. Finally, demonstrating compassionate actions includes fulfilling the parents' needs to say goodbye to their stillborn baby and saying a personal goodbye to the dead baby. The finding of this study shows that the reflective group provided the space for nurses to unfold their suffering, share their emotion, and develop practical wisdom in caring for stillborn baby and the parents. The experience of nurse group conducting the reflecting dialogues could be a expository strategy to promote the nurse to provide the compassionate care actions. [ABSTRACT FROM AUTHOR]

Background: As an alternative to a professional interpreter, children or relatives often act as so‐called 'language brokers' in the healthcare sector. Litterature have demonstrated that the cultural context is significant for the potential outcome for child language brokers. For individuals from a collectivistic family pattern, it becomes natural and is often regarded as respectful, to assist older relatives day and night. Aim: Very little is known about young people providing informal translation services in a Scandinavian context. We therefore aimed to capture the lived experiences of bilingual health professionals, students and postgraduates who have experienced interpreting for family members in a healthcare setting. By interviewing bilingual health professionals, we aimed to obtain two perspectives, the translators and the professionals, in one interview. Results: Analysing the conditions, meanings and reasoning, it became possible for us to understand the young translators' situations and how their life conditions affected their reasons for action in certain ways and in certain conditions. The analysis revealed four main themes: (i) the importance of social relations and cultural conditions; (ii) the hidden burden of consequences for participants' health conditions due to the focus on health‐related consequences and emotionally difficult situations experienced by the participants; (iii) participants experienced limitations in language skills as a challenge; and (iv) being 'in between' in the encounter with the professional system. Conclusion: When family members interpret for the family, the family interpreter is at risk of being excluded by the family or being exposed to and involved in highly sensitive dilemmas that may forever impair normal family relations: health professionals should be aware of this and take professional responsibility. [ABSTRACT FROM AUTHOR]

Background: Home healthcare services are becoming more complex as a result of changing demographics in society and patients having multiple health problems requiring advanced nursing care. Next of kin often experience that they put their own life on hold, and may feel that they stand alone when life takes an unexpected turn. Aim: The aim of this study was to explore next of kin's views of dignity in home healthcare services. Methods: This study has a qualitative approach and content analysis was applied. The purposeful sample consisted of next of kin to patients who received services from home healthcare or in nursing homes (n = 11). One focus group was conducted in 2016. Results: Five themes emerged from the data analysis concerning struggling for a dignifying care in home healthcare services: Indignity implies double vulnerability, desire for respect and recognition, experiencing responsibility for a dignifying life, undignifying care due to lack of competence, and the home as a common sanctuary is gradually lost. Conclusions: This study highlights the importance of ensuring dignity in care for patients living at home. Next of kin should be seen as a partner with the need for recognition and support. Maintaining human dignity for loved ones requires competence, respect and recognition. [ABSTRACT FROM AUTHOR]

Background: Intensive‐care unit (ICU) nurses have an important role in the recruitment of patients for scientific research and in the performance of clinical research. Aim: A study was conducted to examine ICU nurses' perceptions of ethics‐related aspects of ICU‐based research. The study focused on nurse attitudes and knowledge related to clinical research, with special emphasis on perceptions of the informed‐consent process in ICU research. Method: The study applied a descriptive qualitative approach, involving semi‐structured group interviews and theme‐based inductive content analysis. Subjects were ICU nurses (n = 28) at a university hospital ICU who had experience with research protocols applied in that unit. Findings: The nurses had mainly positive perceptions of clinical studies. They found research beneficial for future patients and for society. The nurses considered the information given to them about the studies inadequate. They were concerned about the fact that the consent for research is almost always obtained at the beginning of the ICU care, when patients and relatives are still in the crisis period. This limits the possibility of understanding and assimilating the information provided on the study. Conclusions: The role of ICU nurses in clinical studies should be more prominent and taken into account in the planning of ICU studies. [ABSTRACT FROM AUTHOR]

Background: Researchers are obligated to do no harm to participants of research. Conflicts in relationships can cause negative well‐being; therefore, insight is needed into the particular ethical considerations that arise when conducting joint interviews with close relatives or family members simultaneously in the healthcare setting. Aim: To collect and share knowledge related to ethical considerations conducting joint interviews. Design and methods: A literature review inspired by the integrative review method was performed. Data were retrieved through a structured search in PubMed, CINAHL and the Philosopher's Index and Academic Search Premier for articles published in English from 1980 to 2016 and included 18 articles, of a possible 2153. Article content was assessed line‐by‐line, and ethical considerations were extracted and organized in three subgroups regarding: Planning joint interviews; Conduction joint interviews and Reporting on joint interviews Findings: Participants should be offered the best terms for a constructive, on‐going relationship after the joint interview has ended. This obligates the researcher to ensure a safe environment during the joint interview and create a delicate balance between the needs of the participants, using nonconfrontational techniques that foster equal and neutral but dedicated attention to all parties, before, during and after the joint interviews. Conclusion: Specific ethical considerations should be taken into account before, during and after joint interviewing. Further research is needed before a final conclusion can be drawn. [ABSTRACT FROM AUTHOR]

Background Surgical care plays an important role in the acute hospital's delivery of safe, high-quality patient care. Although demands for effectiveness are high in surgical wards quality of care and patient safety must also be secured. It is therefore necessary to identify the challenges and barriers linked to quality of care and patient safety with a focus on this specific setting. Aim To explore situations and processes that support or hinder good safe patient care on the surgical ward. Method This qualitative study was based on a strategic sample of 10 department and ward leaders in three hospitals and six surgical wards in Sweden. Repeated reflective interviews were analysed using systematic text condensation. Findings Four themes described the leaders' view of a complex healthcare setting that demands effectiveness and efficiency in moving patients quickly through the healthcare system. Quality of care and patient safety were often hampered factors such as a shift of care level, with critically ill patients cared for without reorganisation of nurses' competencies on the surgical ward. Conclusions There is a gap between what is described in written documents and what is or can be performed in clinical practice to achieve good care and safe care on the surgical ward. A shift in levels of care on the surgical ward without reallocation of the necessary competencies at the patient's bedside show consequences for quality of care and patient safety. This means that surgical wards should consider reviewing their organisation and implementing more advanced nursing roles in direct patient care on all shifts. The ethical issues and the moral stress on nurses who lack the resources and competence to deliver good care according to professional values need to be made more explicit as a part of the patient safety agenda in the surgical ward. [ABSTRACT FROM AUTHOR]

Purpose To illuminate the experience of nurses providing health care to undocumented migrants in a voluntary network. Methods and sample In a qualitative study, semistructured interviews were conducted with RNs regarding their experience of providing health care to undocumented migrants within a voluntary network. The interview transcripts were analysed using the inductive method of content analysis. Findings Three main categories emerged - structural inadequacy, ethical dilemmas and challenges, and personal impact and insights. The informants were driven by a strong ethical approach and a great sense of responsibility as human beings and as nurses. Conclusion Engaging with the voluntary network allowed the informants to cope with their frustration and feelings of inadequacy which emerged when confronted with institutionalised injustice in the conventional healthcare system. [ABSTRACT FROM AUTHOR]

Changes in the scope of health research in the last 50 years require evidence to support assumptions about what constitutes harm and benefit to research participants. The aim of this study was to investigate the actual benefits and harm individuals experienced while participating in potentially distressing qualitative research. Data were collected via semi-structured interviews and subjected to thematic analysis. Five themes emerged: (i) motivation to participate, (ii) expectations of participation, (iii) sources of harm, (iv) mitigating harm and (v) benefits of participation. Results indicated that all participants benefited through participation in the qualitative research. Most participants also reported varying degrees of distress during the interviews, but did not consider this harmful. In contrast, dissemination of the findings did constitute an unexpected source of potential harm for the participants and researcher. It is concluded that for these participants, distress during qualitative interviewing is not in itself harmful, and that participant information sheets need to reflect the harms and benefits of participation more accurately in a user-friendly format. Furthermore, the sensitivity with which research is disseminated needs to be considered as a fundamental protection for participants from unwarranted criticism by third parties. Recommendations include that researchers conducting interviews have specific personal and professional attributes relevant to the participant group, and that transcripts/raw data should not be sent automatically to participants. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 427-435 Care as a matter of courage: vulnerability, suffering and ethical formation in nursing care The aim of the study was to explore nurses' experience of how their own vulnerability and suffering influence their ethical formation and their capacity to provide professional care when they are confronted with the patient's vulnerability and suffering. Care is shaped in the meeting between human beings. Professional care is informed by the patient's appeal for help as it is expressed in the meeting. Ethical formation is understood as a personal ethical and existential process, resulting in the capacity to provide professional care. A nurse must have the sense of being a complete human being with own personal attributes and sensitivity in order to be able to relate to other people. The study is based on qualitative interviews with 23 experienced nurses from Sweden, Finland and Denmark. The analyses and interpretation were carried out in line with Steinar Kvale's three levels of interpretation. The study clarifies that ethical formation is a union of the nurse's personal attributes and professional qualifications and that ethical formation is developed over time. Moreover, it also demonstrates that the nurse's personal and professional life experiences of vulnerability and suffering influence ethical formation. Vulnerability and suffering have proven to be sensitive issues for nurses, like a sore point that either serve as an eye-opener or cause the development of blind spots. Furthermore, vulnerability, suffering and the sore points are seen to shape the nurse's courage in relation to care. Courage appears to be a significant unifying phenomenon that manifests itself as the courage to help patients face their own vulnerability and suffering, to bear witness to patients' vulnerability and suffering and to have faith in oneself in arguing for and providing professional care. Courage thus seems to play a significant role in nurses' ability to engage in care. Nurses' own vulnerability, suffering and sore points seem to shape their courage. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2010; 24; 533–540 Clinical prioritizations and contextual constraints in nursing homes - a qualitative study Aim: The aim of the study was to describe nurses’ and physicians’ experiences of prioritization factors in nursing homes. Background: What are the experiences of health care personnel when prioritizing treatment and care for elderly residents in nursing homes? Little research has been done in this area, yet with the growing elderly population and limited health care budgets there can be little doubt about its relevance. Method: The study was conducted through semi-structured interviews with 13 physicians and nurses in six nursing homes. The interviews were analysed by manifest content analysis based on first- and second-level categories describing relevant factors. The categories were developed after preliminary readings of the texts. Results: This study revealed that there was a complex set of contextual constraints which influenced the care provided. There were three main findings: (i) some overall challenges related to providing good care to nursing home residents; these in turn influenced (ii) prioritizing dilemmas and (iii) factors influencing prioritization decisions. Discussion: Contextual constraints and higher level prioritizations seem to play a key role in clinical prioritizations in nursing homes. The combination of implicit rationing and the factors described as most predominant in the clinical prioritizations in nursing homes may result in inadequate and unjust health care services for some of the nursing home residents. In particular, those patients who do not speak up or do have comprehensive needs are at risk of being neglected. [ABSTRACT FROM AUTHOR]