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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]

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]

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]

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]

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 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]

This study illuminates existential consequences of being closely related to a person suffering from aphasia. Seventeen close relatives were interviewed and their narratives were interpreted with inspiration from Ricoeur, Levinas, Husserl, Winnicot, and Maurice Merleau-Ponty. The emerging interpretations resulted in four themes that illuminate a life characterized by lost freedom, staying, a new form of relationship, and growing strong together with others. An overarching theme suggests that a life together with an aphasic person means being used as a bridge between the aphasic person and the surrounding world. Moreover, it illuminates that a close relative to a person with aphasia is a person who does not leave, despite a heavy burden of lonely responsibility. It is concluded that community services need to fulfill their responsibility of providing support to informal caregivers as suggested by the Swedish lawmakers. [ABSTRACT FROM AUTHOR]

The aim is to describe how experiences of being an immigrant can influence the situation when becoming a patient in Swedish health care. A hermeneutic approach was used. Sixteen persons born in non-Nordic countries were interviewed. The data was analysed with an empirical hermeneutical method. The findings indicate that positive experiences (i.e., establishing oneself in a new home country) enhance the possibilities of taking part in caring situations and vice versa. Hence, there is a need for individually adapted care that takes one's whole life situation into consideration. Consequently, it is suggested that the concept, "cultural competence" merely serves the purpose of illuminating caregivers' need for categorisation. It does not illuminate individual needs in a caring situation. [ABSTRACT FROM AUTHOR]

Patient participation in healthcare is a neglected area of interest in the rather extensive amount of research on immigrant so-called Selma patients in Swedish health care as well as worldwide. The aim is to explore the phenomenon "patient participation" in the context of the Swedish health care from the perspective of immigrants non-fluent in Swedish. A phenomenological lifeworld approach was chosen. Data were collected from patients within a municipal home care setting in Sweden. Eight women agreed to participate. In seven interviews, an interpreter was necessary for the translation of the interview. Five authorized interpreters were used. Data were analysed in accordance to a descriptive phenomenological method for caring research. The analysis led to an essence of the phenomenon with three constituents, "to experience participation," "to refrain from participation," and "to be deprived of participation." Patient participation from the perspective of immigrant women means that patients are involved and active in their own health and caring processes. For these women, it is particularly important to have the opportunity to express themselves. Patient participation presupposes professional caregivers who act in a way that increases the patients' opportunities to take part. A skilled interpreter is often necessary in order to enable the patient participation. [ABSTRACT FROM AUTHOR]

The extensive suffering related to a complex life situation with bipolar disorder (BD) and the reported difference between care needs and the needs that are actually met implicates that there are still questions about management of life with BD that need to be answered. The present study therefore aims to describe the meaning of the conditions that enable a good life with BD. Ten persons, six women and four men (aged 30-61), diagnosed with BD were interviewed. A reflective lifeworld perspective based on phenomenological philosophy was used. The findings present the essential meaning of the conditions that enable a good life with BD as a dependence that empowers, which is further described by its constituents: "turning the course of life," "protecting oneself from running out of energy," "being needed," "being oneself through reliable others," "personal landmarks for navigating through life." A voluntary chosen dependence, as described in the present study, is a new approach of care that enables a good life with BD, while enhancing own power, freedom, and control. The conditions that enable a good life with BD are more than separate supporting measures. Therefore a holistic perspective is preferable while providing care for individuals with BD. [ABSTRACT FROM AUTHOR]

Living with Bipolar Disorder (BD) greatly affects the whole life; still the meaning of it is poorly explored from the perspective of the individuals actually living with it. The aim of this study is thus to explore the existential meaning of life with BD. Ten persons, six women and four men, (aged 30-61), diagnosed with BD were interviewed. A reflective lifeworld perspective based on phenomenological philosophy was used. The findings show that living with BD entails experiencing extra dimensions in all aspects of life, expressed in terms of a magnitude and complexity beyond that which is perceived as pertaining to normal life. The essential meaning of the phenomenon is further described by its constituents: “a specific intensity”, “a struggle to understand”, “an illness that is intertwined with one's whole being”. Living with BD means more for the individual than having episodes of depression and mania and must therefore be understood from a holistic perspective. Adequate care for persons with BD, therefore, includes places for safe and profound reflecting about existential issues, such as identity, trust and self-confidence. The present study recommends the caring services to change their ways to explain and talk about the BD illness. [ABSTRACT FROM AUTHOR]

This study, using a hermeneutic approach, is based on data from four focus group interviews with 25 Swedish teenagers participating, ranging from 18-19 years of age. The aim is to gain a deeper understanding of teenagers' values and attitudes towards sexually transmitted infections (STIs) and sexual risk-taking. The teenagers seem to seek an excuse to fend off responsibility and deny their sexual risk-taking, an excuse provided by drunkenness. Under the influence of alcohol, teenagers are not too shy to have sex but remain embarrassed to talk about condom use. It seems as though the dialogue feels more intimate than the intercourse when it comes to protecting ones sexual health. To be able to act out in this sexual risk-taking the teenager often views the partner in a one-night-stand as an object, as opposed to a love relationship where they view their partner as subject, a person they care for. Engaging in sexual risk-taking often starts at a club where the teenagers go out to socialize and drink alcohol. They then play a game and a part of the game is to pretend that they do not play a game. In this game, certain rules are to be followed and the rules are set up by the girl, mainly to protect the romantic image of being carefully selected and thereby protected from being stigmatized as “sluts” or “whores”. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the existential consequences of aphasia and the struggle to regain the ability to communicate. Data were collected by means of interviews, published books and diaries from four women and five men, who varied in type of aphasia and time since cerebral lesion. Data were interpreted in accordance with a lifeworld hermeneutic approach. The findings led to six interpretations, which serve as a base for a comprehensive understanding and which indicate that the intentional, non-verbal act when something is recognized as something is not affected by aphasia. Aphasia affects the world of symbols, which is necessary for interaction with others. It is connected, therefore, with feelings of alienation, inferiority and shame in social settings. Losing one's ability to recognize symbols thus makes it essential to cope with existential loneliness. The outcome, a sense of community or alienation, appears to depend on the quality of interpersonal relations. The results thus demonstrate that interaction and communication are important aspects of professional care giving. [ABSTRACT FROM AUTHOR]

Our aim in this study was to analyze and describe young Swedish women's experiences of living with genital warts. Interviews with 10 young women, aged 16-21 years, were interpreted within a lifeworld hermeneutic tradition. The women experience themselves as victims of a disgusting disease. Furthermore, they appear to disregard the fact that their own lifestyles could be a risk factor for contracting venereal infections. On the other hand they get to know their bodies better after the gynecological examinations where the treatment begins. Their loss of innocence is considerable; thus it seems fair to compare this experience with earlier epochs' ideas about loss of virginity due to the first intercourse. Consequently the young women also start looking at themselves as adults, and they take responsibility for the consequences of their sexuality. [ABSTRACT FROM AUTHOR]

Today mental health professionals are challenged in supporting people with severe mental illness that live within their communities. The community treatment is, however, characterized by an uncertainty about how to best support them in their everyday lives, and professionals from different disciplines often have divergent opinions about the care. The aim of this study is to explicate the existential meaning of living with severe mental illness. Interviews with persons who relocated from an institutional setting to a community placement were analyzed within an interpretive approach. The results of the study found that people with severe mental illness experience an existential loneliness due to difficulties in changing previous suppositions about human relationships. They do not develop connections through shared new experiences with other people in their lives. One central implication of the findings is that because people with severe mental illness seem unable to benefit from new experiences, mental health nurses should consider relational aspects when planning, implementing, and evaluating nursing care. [ABSTRACT FROM AUTHOR]

Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre. Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden. Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient’s lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the “voice of the lifeworld” enables the patient to feel trust. Conclusion: Trust in the early chain of healthcare entails caregivers’ ability to pay attention to both medical and existential issues in compliance with the patient’s information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language. [ABSTRACT FROM PUBLISHER]