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Background and aim: The aim of the present article was to elaborate on a research approach and method called 'lifeworld hermeneutics'. Significant to lifeworld hermeneutics is that interpretation is the main methodological instrument for explaining and understanding existential research questions and lived experiences. From a caring science perspective, this often refers to research that aims to gain a deeper understanding of existential phenomena and issues, such as existential meaning of health, well‐being, homelessness, lostness, suffering and ageing, as well as what it means to experience unhealthiness and illness, the need for care, and caring that responds to such needs. Design: Theoretical paper. Result: The article briefly covers ontology and epistemology that clarifies the meaning and importance of a lifeworld hermeneutic attitude. This is followed by suggestions for how to perform a lifeworld hermeneutic study, expressed in relation to methodological principles for the interpretation, validation and structuring of interpretations. Thereafter, follow reflections on how to use theoretical or philosophical support to develop and deepen existential interpretations. The findings of lifeworld hermeneutic research consist of existential interpretations where the researcher, with an open and pliable attitude towards the phenomenon and the aim of the study, clarifies, explains and suggests new ways of understanding participants' lived experiences; the researcher should maintain such an attitude towards their understanding of the phenomenon as well. Conclusion: The lifeworld hermeneutical approach and method described in this article makes it possible to further deepen the understanding and knowledge about existential issues that is relevant for caring and caring science. [ABSTRACT FROM AUTHOR]

To a great extent, older people in Sweden, often with extensive care needs, are cared for in their own home. Support is often needed from both family and professional caregivers. This study aimed to describe and analyse different aspects of health, functioning and social networks, and how they relate to formal and informal care in the home among older adults. Analyses were performed utilising data from the OCTO‐2 study, with a sample of 317 people living in Jönköping County, aged 75, 80, 85 or 90 years, living in their own homes. Data were collected with in‐person‐testing. Based on receipt of care, the participants were divided into three groups: no care, informal care only, and formal care with or without informal care. Descriptive statistics and multinomial regression analysis were performed to explore the associations between received care and different aspects of health (such as multimorbidity, polypharmacy), social networks (such as loneliness, number of confidants) and functioning (such as managing daily life). The findings demonstrate that the majority of the participants received no care at home (61%). Multimorbidity and polypharmacy were more common among those receiving some kind of care in comparison to those who received no care; moreover, those receiving some kind of care also had difficulties managing daily life and less satisfaction with their social networks. The multinomial logistic regression analyses demonstrated that age, functioning in daily life, perceived general health and satisfaction with the number of confidants were related to receipt of care, but the associations among these factors differed depending on the type of care that was received. The results show the importance of a holistic perspective that includes the older person's experiences when planning home care. The results also highlight the importance of considering social perspectives and relationships in home care rather than focusing only on health factors. [ABSTRACT FROM AUTHOR]

This study aimed to describe community-dwelling older adults' perceptions of health and well-being in life after retirement. This study is part of a larger project using a mixed-methods design to address lifestyles' influence on community-dwelling older adults' health. Individual semi-structured interviews were conducted with 18 older adults in age 70 to 95 years. Data were analysed according to a phenomenographic approach. The results encompass four categories describing variations in community-dwelling older adults' perceptions of health and well-being after retirement: feeling well despite illness and disease, interacting with and being useful for oneself and others, independently embracing opportunities and engaging in life, and maintaining a healthy lifestyle. The absence of illness and disease is not a clear prerequisite for a sense of health and well-being. To promote and preserve health and well-being after retirement, older adults strived for—and coached themselves to uphold—a balance in life, focusing on not burdening others. This life orientation after retirement must be acknowledged by society at large, especially from an ageist perspective, and in health and social care to preserve and promote health and well-being. [ABSTRACT FROM AUTHOR]

This study aimed to explain and understand the existential meaning of the finality of life from the perspective of healthy older adults. Participants were recruited from a major project on older adults' life situations. They were interviewed about their thoughts on the end of life, and their responses were interpreted using a lifeworld hermeneutic approach. The findings showed that thinking about the inevitable finality of life involves feelings of liberation, frightening thoughts, a comforting promise of something beyond death, acceptance of the concept of death as a companion in life and a desire to live. Philosopher Simone de Beauvoir's existential ideas about ageing and death were then used to further explain and understand the meaning of the finality of life and to support a comprehensive understanding. de Beauvoir suggests that when the temporal horizon of existence shrinks, one lives closer to the finality of life. For a comprehensive understanding, attributing meaning to the finality of life required the intertwining of reconciliation and displacement. The interpretations were further discussed using ideas from the fields of existential philosophy and caring science in order to develop a basis for caring practice. The conclusions suggested that professional health care for older adults would benefit from a lifeworld-led caring science approach that includes readiness for a caring dialogue that focuses on existential issues. [ABSTRACT FROM AUTHOR]

Background: When the ageing population increases, the burden and responsibility of close family members will likely increase. Those closely related who assume a great responsibility can be significantly affected in health, well‐being and daily life. Aim: This study aims to describe the life situation when family caregivers are imposed responsibility for an older person with complex care needs in their own home. Methods: In this Swedish qualitative study, ten family caregivers were strategically selected in order to achieve variations in the life situation. A reflective lifeworld research design based on phenomenological philosophy was used throughout the data collection with the lifeworld interviews and the analytic process. Findings: In terms of extensive responsibility, the life situation is complex and involves emotions that are difficult to manage. In essence, a paradoxical life situation is described which is experienced as both voluntarily and nonchosen at the same time. The responsibility never rests. The essential meaning is further illustrated with three constituents: loss of freedom, contradictory feelings and affected relationships. Conclusion: A life situation with extensive responsibility for an older family member interferes with the whole life situation with an impact on health and relationships with other people. The findings are crucial for professional caregivers in order to capture the nature of family support in a way that enables a meaningful life for both the family caregiver and the older person being cared for. Knowledge of this will give professional caregivers an increased awareness of the life situation of family caregivers and provide a better understanding of the support they are longing for, and, in some countries, such as Sweden, also are entitled to by law. [ABSTRACT FROM AUTHOR]

Development of T cell-directed immune checkpoint inhibitors (ICI) has revolutionized metastatic melanoma (MM) therapy, but <50% of treated patients experience durable responses. This phase I trial (NCT01946373) investigates the safety/feasibility of tumor-infiltrating lymphocyte (TIL) adoptive cell therapy (ACT) combined with dendritic cell (DC) vaccination in MM patients progressing on ICI. An initial cohort (5 patients) received TIL therapy alone to evaluate safety and allow for optimization of TIL expansion protocols. A second cohort (first-in-man, 5 patients) received TIL combined with autologous tumor lysate-loaded DC vaccination. All patients received cyclophosphamide/fludarabine preconditioning prior to, and intravenous (i.v.) IL-2 after, TIL transfer. The DC vaccine was given as five intradermal injections after TIL and IL-2 administration. [18F]-FDG PET/CT radiology was performed to evaluate clinical response, according to RECIST 1.1 (on the CT part). Immunological monitoring was performed by flow cytometry and T-cell receptor (TCR) sequencing. In the safety/optimization cohort, all patients had a mixed response or stable disease, but none durable. In the combination cohort, two patients experienced complete responses (CR) that are still ongoing (>36 and >18 months, respectively). In addition, two patients had partial responses (PR), one still ongoing (>42 months) with only a small bone-lesion remaining, and one of short duration (<4 months). One patient died early during treatment and did not receive DC. Long-lasting persistency of the injected TILs was demonstrated in blood. In summary, we report clinical responses by TIL therapy combined with DC vaccination in 4 out of 4 treated MM patients who previously failed ICI. [ABSTRACT FROM AUTHOR]

Purpose: To examine how written communication between patients with hematological diseases and a nurse within a web-based communication service can be caring. Design: The study is based on qualitative deductive content analysis of 109 written messages between 10 patients and a responding nurse. The evaluated nursing intervention is a web-based communication service where patients could request support from a responding nurse during 2 months of use. A structured theoretical matrix based on Swanson’s theory of caring including compassion, competence, and upholding trust is used for the analysis. Findings: Nursing compassion emerges when patients share personal matters and the nurse has an opportunity to explicitly display genuine interest and understanding. Nursing competence is required when patients ask for or are in need of information, advice, and emotional support. The nurse can uphold trust when compassion and competence are exhibited and patients share their innermost feelings. Conclusions: Web-based communication has the potential to contribute to holistic well-being according to Swanson’s theory of caring. The written word lasts, can be read repeatedly, and in connection with writing there is time for reflection. However, the lack of nonverbal cues makes it important that the nurse answers in a fully accurate and explicitly caring way. [ABSTRACT FROM AUTHOR]

Aim and objective: To describe the meaning of the phenomenon home care from the perspective of older persons who live alone with multimorbidity. Background: In line with worldwide changing demographics, conditions for older people in need of home care are changing. In Sweden there is a stay‐in‐place policy and older people are expected to live and be cared for in their own home as long as possible. Home care, instituted by different laws, is a challenge affecting the older person when the private home becomes a workplace. Design: This study uses a qualitative design with a lifeworld approach. Methods: The study having been conducted in Sweden in 2016, the researchers interviewed 12 older persons that live alone and receive home care. Data were analysed using qualitative content analysis. Results: The findings illustrate four sub‐themes: adapting to a caring culture, feeling exposed, unable to influence care and forced relations. The overall theme reveals that older people experience a life‐changing situation when receiving home care and they become a guest in their own home. Conclusions: Becoming older with increased needs means to disrupt one's life when one's private home becomes a public arena. The gap between an older person's rights by law and the older person's experiences of receiving home care needs to be highlighted to meet the oncoming challenges in providing a home care that includes participation of the older themselves. Only then can care be offered that enables older people to have a sense of control and experience their home as their own. Implications for practice: The findings emphasise the need to view older people as being self‐determinant and independent. Older people receiving home care need to be seen as individuals, and their entire life situation should be considered by also acknowledging the important role played by relatives and caregivers. [ABSTRACT FROM AUTHOR]

To meet the Swedish healthcare legislation’s requirements for evidence-based care, a work model for reflection has been developed, called a reflective team (RT). Because this RT model can be perceived as either a competitor of or a complement to caring supervision, this case study aims to explore what distinguishes these two in psychiatric care. Five members of one RT who are psychiatric nurses with previous experiences in caring supervision were interviewed. The transcribed interviews were analysed according to phenomenography. The findings reveal three qualitatively separated categories, which describe differences in focus, competencies, and relationships between confirmation and demands. It is concluded that an RT by no means replaces supervision. Instead, both can contribute to care improvement by complementing each other and increasing the professionalism of psychiatric nurses. [ABSTRACT FROM PUBLISHER]

A reflective team (RT) is a team of professional carers who reflect on a specific caring issue under the direction of an RT leader. The goal for the reflective process is to accomplish care improvement based on research and proven experience, and the first step is to reflect upon the competence that already exists in the context in which RT takes place. This study aims to bring previous unarticulated competence in caring for people living with dementia to the surface after it has been reflected during RT sessions. Ten assistant nurses who work closely with patients who have dementia and attend RT sessions on a regular basis were interviewed about their competence for caring for people living with dementia. Using a phenomenographic analysis, two qualitatively separate categories emerged: general caring skills and dementia-specific caring skills. It was concluded that specific skills in caring for people living with dementia build in caring skills and that tacit knowledge can be explicit and be expressed when it has been reflected in RT. [ABSTRACT FROM PUBLISHER]

A reflective team (RT) is a team of professional carers who reflect on a specific caring issue under the direction of an RT leader. The goal for the reflective process is to accomplish care improvement based on research and proven experience, and the first step is to reflect upon the competence that already exists in the context in which RT takes place. This study aims to bring previous unarticulated competence in caring for people living with dementia to the surface after it has been reflected during RT sessions. Ten assistant nurses who work closely with patients who have dementia and attend RT sessions on a regular basis were interviewed about their competence for caring for people living with dementia. Using a phenomenographic analysis, two qualitatively separate categories emerged: general caring skills and dementia-specific caring skills. It was concluded that specific skills in caring for people living with dementia build in caring skills and that tacit knowledge can be explicit and be expressed when it has been reflected in RT. [ABSTRACT FROM PUBLISHER]

Background Needle-related medical procedures (NRMPs) are something that all young children need to undergo at some point. These procedures may involve feelings of fear, pain and anxiety, which can cause problems later in life either when seeking healthcare in general or when seeking care specifically involving needles. More knowledge is needed about supporting children during these procedures. Aim This study aims to explain and understand the meaning of the research phenomenon: support during NRMPs. The lived experiences of the phenomenon are interpreted from the perspective of younger children. Method The analysis uses a lifeworld hermeneutic approach based on participant observations and interviews with children between 3 and 7 years of age who have experienced NRMPs. Results The research phenomenon, support for younger children during NRMPs, is understood through the following themes: being the centre of attention, getting help with distractions, being pampered, becoming involved, entrusting oneself to the safety of adults and being rewarded. A comprehensive understanding is presented wherein younger children experience support from adults during NRMPs in order to establish resources and/or strengthen existing resources. Conclusions The manner in which the child will be guided through the procedure is developed based on the child's reactions. This approach demonstrates that children are actively participating during NRMPs. Supporting younger children during NRMPs consists of guiding them through a shared situation that is mutually beneficial to the child, the parent and the nurse. Play during NRMP is an important tool that enables the support to be perceived as positive. [ABSTRACT FROM AUTHOR]

This study explores the lived experiences of individuals who are suffering from recurrent depression. Open interviews were conducted in Sweden with ten participants aged 19-67. Guided by the phenomenological method of Giorgi, data were analyzed within a Reflective Lifeworld Approach. The findings revealed a pattern of meaning, described as being alienated from oneself and others. Depression is described as an insidious disorder and participants described their experiences variously as elusive, extensive, complex, contradictory, paradoxical and stated that depression pervaded the person's whole lifeworld, involved both body and soul, and affected relationships with others. Relationships with others could be the reason for both wanting to live or to die. How best to confirm this form of suffering is something of a challenge to mental health care professionals. [ABSTRACT FROM AUTHOR]

Objective: To investigate patients who called the emergency medical services (EMS) for primary healthcare (PHC) problems. Design: A retrospective and exploratory patient record study from an EMS perspective, comparing two groups: those who were potential candidates for PHC and those who were not. All data were gathered from EMS and hospital records. Settings: The study was completed at the EMS and five hospital areas in the western region of Sweden. Subjects: The patients (n = 3001) who called the EMS in 2011. Data were missing for 10%. Main outcome measures: The frequency and the clinical characteristics of the patients who called the EMS and were actually potential candidates for PHC. Results: Of a total of 2703 patients, a group of 426 (16%) were assessed as potential candidates for PHC and could thus be treated at a level of care other than the emergency department. Patients who were classified as suitable for PHC were found at all priority levels and within all symptom groups, but were younger and healthier than the other group. Conclusion: Numerous patients seeking help from the EMS do not end up at the most appropriate level in the healthcare system. Implications: In the EMS, guidelines are needed to enable pre-hospital emergency nurses to assess and triage patients to the most appropriate level of healthcare.Key pointsPatients calling the emergency medical services do not always end up at an appropriate level of healthcare.In total, 16% of patients were identified by the Swedish emergency medical services as potential candidates for primary healthcare.These patients were younger and healthier than those needing care at the emergency department.They were found at all priority levels and within all symptom groups. [ABSTRACT FROM PUBLISHER]

Background: The majority of new mothers in Sweden initiate breastfeeding and many experience initial difficulties. This experience is an important cause of early breastfeeding cessation. To increase understanding, there is a need to explore the lived experiences of the decision to continue or cease breastfeeding. The aim of this study is therefore to explain and understand how this decision is influenced by the meaning of severe initial difficulties. Methods: A lifeworld hermeneutical approach was used for the study. The study was conducted in Sweden with eight mothers who experienced severe difficulties with initial breastfeeding. All except one were interviewed on two different occasions resulting in fifteen interviews. The interviews were conducted between 2010 and 2013. Results: Mothers who experience severe difficulties with initial breastfeeding feel both overtaken and violated not only by their own infants and their own bodies but also by their anger, expectations, loneliness and care from health professionals. These feelings of being overtaken and invaded provoke an existential crisis and place mothers at a turning point in which these feelings are compared and put in relation to one another in the negotiation of the decision to continue or cease breastfeeding. This decision thus depends on the possibility of feeling secure with the breastfeeding relationship. If insecurity dominates, this can, in severe cases, create a feeling of fear of breastfeeding that is so great that there is no alternative but to stop breastfeeding. Conclusions: Existential security in the breastfeeding relationship seems to be an underlying factor for confidence and therefore a necessary condition for continued breastfeeding when having severe initial breastfeeding difficulties. Unresolved feelings of insecurity may be a serious barrier to further breastfeeding that can result in a fear of breastfeeding. Such fear can force the mother to cease breastfeeding. This study highlights how women are situated in a complex cultural and biological context of breastfeeding that has existential consequences for them. An existential crisis forces mothers into a turning point for the breastfeeding decision. In the existential crisis, mothers' responsibility for the mother-infant relationship guides continuing or ceasing breastfeeding. [ABSTRACT FROM AUTHOR]

Background Working as a nurse in a war zone entails providing a unique form of care, and it is important to be well prepared before and during an international assignment. To improve organized preparations it is necessary to understand how nurses previously engaged in a military mission experienced their preparations. Objective The aim of this study is to describe military nurses' experiences of preparations for a mission, including factors that contribute to their being meaningful. Methodology The data comprises eight interviews with Swedish military nurses who served in Afghanistan. The results are analyzed using a qualitative content analysis. Meaning units are condensed into codes which, via subcategories, form categories. The categories are abstracted into an overall theme. Results The results highlight the importance of recognizing challenges and making informed choices. The overall theme shows that adequate preparation promotes an accepting attitude. Conclusions It is concluded that organized preparation for care in a combat environment should stimulate realistic reflection without entrapping one in negative thinking. [ABSTRACT FROM AUTHOR]

Many mothers initiate breastfeeding, but some of these experience difficulties. This study has two aims in order to contribute to the development of optimal care for these mothers: firstly to explain and understand the existential meanings of one mother’s severe initial breastfeeding difficulties and how these meanings affected her continued breastfeeding and secondly, to reflect on a method for applying lifeworld hermeneutics to research on complex breastfeeding phenomena. This is an approach that acknowledges and focuses on the concrete and lived existence and what it means for humans. Within this approach, humans are understood as whole human beings interacting in the world. The study was conducted using lifeworld interviews with Anna, focusing on meanings of her difficult lived experience of initial breastfeeding. The existential interpretation suggests that such an experience can evoke existential vulnerability, a vulnerability that becomes evident in shameful feelings, such as dislike of breastfeeding, aversion to the milk-producing body and anger towards the child. Anna continued breastfeeding as a way to rid herself of the shame, hoping to be confirmed as a good mother. Such an experience may have negative consequences for the mother-child relationship and it can create fear for future breastfeeding. This study concludes that carers should be aware of individual existential dimensions for breastfeeding mothers. [ABSTRACT FROM AUTHOR]

Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work [ABSTRACT FROM AUTHOR]

The article presents a study which discusses the association of 25-hydroxyvitamin (OH) D and Epstein-Barr nuclear antigen-1 (EBNA-1) in multiple scleorosis (MS). It mentions several methods used in the study including the SPSS ver. 19.0., enzyme-linked immunosorbent assay, and matched logistic regression. Results show that 25(OH)D and EBNA-1 can be considered as risk factors for MS.

The article presents a study which investigates if vitamin A levels were incorporated with the risk of multiple sclerosis (MS) . It states that the retinol binding protein (RBP) and high sensitivity C -reactive protein (hs-CRP) levels in the collected biobank blood samples from MS cases and controls were measured. Results show that RBP levels within the second quintile were associated with a lower MS risk and there is no effect on MS risk in the offspring by gestational RBP levels.

The article discusses study which aims to investigate the impact of laboratory defined tobacco use on risk of multiple sclerosis. The study employs biobank blood samples, immunoassay, and matched logistic regression. Results reveal smoking is a risk factor for multiple and has the advantage of using analyses of cotinine levels in samples collected before disease onset.

The aim of this study was to elucidate the existential meaning of being closely related to a person with bipolar disorder. A qualitative, descriptive, and explorative design with a phenomenological meaning-oriented analysis was used. The findings reveal a paradoxical, existential exposure of close relatives to a person with bipolar disorder, being both needed and rejected whilst being overshadowed by the specific changeable nature of bipolar disorder. Psychiatric health care services are recommended to consider changes in attitudes and structures that may facilitate close relatives' participation in the care and treatment of persons with bipolar disorder. [ABSTRACT FROM AUTHOR]

A majority of women in Sweden initiate breastfeeding but almost a quarter stop or wean the infant in the first few weeks after birth because of difficulties. In order to develop care that facilitates initiation of breastfeeding and enables mothers to realize their expectations concerning breastfeeding, it is necessary to understand what having severe breastfeeding difficulties means for women who experience them. The aim of this study is to describe the lived experiences of initiating breastfeeding under severe difficulties. A reflective lifeworld research design was used. Eight women, seven primiparous and one multipara, were interviewed within 2 months of giving birth. The essential meaning of the phenomenon is described as ''Existential lostness as a mother forcing oneself into a constant fight''. This pattern is further explicated through its constituents; shattered expectations, a lost time for closeness, being of no use to the infant, being forced to expose oneself, and gaining strength through sharing. The results show that mothers with severe breastfeeding difficulties feel alone and exposed because of their suffering and are lost in motherhood. Thus, adequate care for mothers should enhance the forming of a caring relationship through sharing rather than exposing. [ABSTRACT FROM AUTHOR]