Search

This is a randomised controlled pilot study using a mixed methods design. The overall aim was to test an educational intervention on existential issues and to describe surgical nurses' perceived attitudes towards caring for patients dying of cancer. Specific aims were to examine whether the educational intervention consisting of lectures and reflective discussions, affects nurses' perceived confidence in communication and to explore nurses' experiences and reflections on existential issues after participating in the intervention. Fortytwo nurses from three surgical wards at one hospital were randomly assigned to an intervention or control group. Nurses in both groups completed a questionnaire at equivalent time intervals: at baseline before the educational intervention, directly after the intervention, and 3 and 6 months later. Eleven face-to-face interviews were conducted with nurses directly after the intervention and 6 months later. Significant short-term and long-term changes were reported. Main results concerned the significant long-term effects regarding nurses' increased confidence and decreased powerlessness in communication, and their increased feelings of value when caring for a dying patient. In addition, nurses described enhanced awareness and increased reflection. Results indicate that an understanding of the patient's situation, derived from enhanced awareness and increased reflection, precedes changes in attitudes towards communication. [ABSTRACT FROM AUTHOR]

This study's aim was to elucidate health-care staff experience of working on a locked acute psychiatric ward. In many countries changes in health care has contributed to fewer beds available in inpatient care, and a concentration of patients with severe psychiatric conditions. This implies a changing work environment in acute psychiatric care. Qualitative interviews with health-care staff (n = 10) were carried out on a ward for patients with affective disorder and eating disorder in a Swedish hospital. Qualitative content analysis was used. Four themes were identified from the data: 'undergoing changes in care delivery', 'feeling a need for security and control', 'managing the demands at work' and 'feeling a sense of responsibility'. This study adds to earlier research into how a sense of responsibility can place a significant burden on health-care staff working on a locked psychiatric ward and also contribute to increased control of patients. This study also shows that relationships and power structures among healthcare staff need to be addressed when organizational changes are made in care delivery. Further research is needed to reach a comprehensive understanding of care on locked acute psychiatric wards, including a development of nursing and medicine as knowledge domains in one common context. [ABSTRACT FROM AUTHOR]

This study aimed to analyse the outcomes of an educational intervention for family members living with a person with bipolar disorder. A longitudinal study was conducted comprising a 10-session educational intervention designed for families with members in outpatient mental health care. Thirty-four family members agreed to participate. Data were collected on five occasions, at baseline and during a 2-year follow-up through self-assessment instruments: the Carers of Older People in Europe Index, the Jalowiec Coping Scale-40, the Sense of Coherence questionnaire and the Social Adaptation Self-evaluation Scale. The results showed that the condition had a considerable negative impact on the family members as carers, but the educational intervention increased their understanding, which facilitated the management of their lives. A significant improvement in stress management was seen over time and social functioning was retained. The study showed that families living with one member with bipolar disorder benefited from the educational intervention in terms of increasing understanding of the condition and reducing stress. Mental health care needs to develop educational interventions further and offer the families support to strengthen their ability to manage with the situation. [ABSTRACT FROM AUTHOR]

Bipolar disorder (BD) is a severe illness that has a serious impact on the lives of those affected and on their families. The aim of this study was to elucidate what it means for family members to live with an adult person who has BD, with reference to their views concerning the condition of the person affected and the future. During 2005, 17 family members of people with the disorder were interviewed, and the data obtained were subjected to a qualitative content analysis. The findings showed that family members felt alone with their experiences and struggled to make sense of and to maintain normality, as their life was encroached on by the condition. Bearing the burden of responsibility and control made it difficult for family members to focus on their own future. To build hope, they needed opportunities to share their experiences with others, increased understanding of the condition, and relief from the burden they bore. This study underlines the importance of strengthening support holistically for family members living with an adult person with BD. Support and interventions concerning these families' needs have to be developed and should be provided by all mental health-care services. [ABSTRACT FROM AUTHOR]

The purpose of the study was twofold: to examine what type of daily stressful events post-menopausal woman with breast cancer experience during adjuvant chemotherapy and how bothersome these are and to identify coping strategies used by these women used to manage such stressful events. The patient group comprised 75 consecutively invited women (≥55 years of age) at two university hospitals and one county hospital in Sweden. The Daily Coping Assessment was used to collect data over time. Data were analysed both qualitatively and quantitatively. Six categories of stressful events were identified: ‘nausea and vomiting’, ‘fatigue’, ‘other symptoms’, ‘isolation and alienation’, ‘fear of the unknown’ and ‘being controlled by the treatment’. The first three categories were subsumed under the domain physical problems and the latter three under psychosocial problems. Almost 30% of the diary entries recorded no stressful event. Physical problems were three times as frequent as psychosocial problems. ‘Nausea/vomiting’ was the most frequently observed stressful event (21.6%). ‘Isolation and alienation’ and ‘fear of the unknown’ were less frequent, but when they occurred they were rated as the most distressing. Several coping strategies were used to manage each stressful event. The most common strategies were acceptance, relaxation and distraction. Religion was rarely used as a coping strategy. [ABSTRACT FROM AUTHOR]

Aim. The aim was to elucidate the lived experience of regular diabetes nurse specialist check-ups among patients with type 2 diabetes. Background. Diabetes care with diabetes nurse-led clinics in primary care has been established in Sweden since the 1980s. Information about patients' lived experience of these regular check-ups is important in the further development of diabetes nursing in primary care. Methods. Narrative interviews were conducted with 10 women and 10 men with type 2 diabetes regarding their lived experience in everyday life and the regular check-ups by the diabetes nurse specialist. A phenomenological-hermeneutic method inspired by Ricoeur was used in the analysis. Results. Patients'- with type 2 diabetes - lived experience of regular check-ups showed an overall positive influence on the patients' way of living with the disease by underpinning and developing their understanding and management of daily life. This influence was interpreted as an interlinked chain comprising the following elements; being confirmed, being guided within the disease process, becoming confident and independent and being relieved. Every link contained a positive influence from being dependent-independent, autonomous and a feeling of freedom in patients striving for an everyday life with a disease under control. Relevance to clinical practice. The development of diabetes-nurse-led clinics from the perspective of the patient must consider the patient's individual need for support and continuity with the diabetes nurse specialist. Consultations with collaborative partnership and specific expertise that is easy to access implied autonomous disease self-management in terms of patients' own control of the disease over time. In view of the increasing number of patients with diabetes, this could positively impact the availability of diabetes nursing care. [ABSTRACT FROM AUTHOR]

This focused ethnographic study aims at describing encounters in the healthcare environment on a locked psychiatric ward. It was carried out in Sweden on an acute psychiatric ward for patients with affective and eating disorders. Data were collected through participant observations and informal interviews, and analysed by qualitative content analysis. The result shows that the healthcare environment on this locked psychiatric ward offered a space for encounters between people, in a continuum from professional care to private meetings and social events. It included joy and friendship as well as unintentional insights into other patients' suffering. The characteristics of the encounters formed three themes: the caring relationship, the uncaring relationship and the unrecognized relationship. The caring and the uncaring relationship concerned relationships between staff and patients or their next of kin. These revealed contrasting qualities such as respect and flexibility as well as lack of respect and mistrust. The unrecognized relationship theme visualized the patients' relationships with each other and included both supportive and intrusive elements that were probably significant for the outcome of care. The unrecognized relationship contributes with new knowledge about conditions for patients in inpatient care, and indicates that the patients' relationships with each other merit greater attention. [ABSTRACT FROM AUTHOR]

Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff. [ABSTRACT FROM AUTHOR]

BACKGROUND: Individuals with fibromyalgia (FM) frequently use health care services and experience only short-term improvements. They often feel that health care staff do not take them seriously. This increases the burden of living with the illness. AIM: To describe how men living with fibromyalgia-type pain experienced being patients in the Swedish health care system. METHOD: Narrative interviews with 14 men who fulfilled the American College of Rheumatology criteria for classification of fibromyalgia. Content analysis was used when analysing the data. RESULTS: The results are described using five themes. Theme I 'Feeling afraid of being looked upon as being a whiner' highlights how the men endured a lot of pain before they sought health care, and how difficult it was to find a receptive listener. Theme 2 'Feeling like a guinea pig' shows that the men's feelings were twofold; they wanted examinations, even if these made them feel that they were being exposed to numerous treatments without any cure. Theme 3 'Feeling hopeful' describes the hope for a cure after having been referred to a specialist clinic. Theme 4 'Feeling neglected' illustrates being looked upon as an uninteresting patient and theme 5 'Feeling no recovery' illustrates the pain relief they gained, but not the actual cure. CONCLUSION: Men with FM type pain experienced a long wait before treatment at a specialist clinic as well as no continuity and follow-ups in primary care and general hospitals. Encounters with engaged and skilful staff promoted the men's well-being despite the fact that no cure was available. Not being respected led to a feeling of being neglected despite the care received. Thus, the men had to accept the fact that they would never recover. [ABSTRACT FROM AUTHOR]

The aim of this study, which was undertaken in patients’ homes in Sweden, was to describe patients’ experiences in the self-management of continuous oxygen therapy and their view of managing their chronic disease. A phenomenological approach was used. Data were collected in interviews and analysis produced four categories. The findings show that the patients need help with relief for different physiological and psychological difficulties and from social isolation. The patients had insufficient resources for daily life. They were restricted to their homes, had mobility problems and were dependent upon a continuous life rhythm. Dependence upon another family member is therefore an important factor. But even with the presence of a significant other, social isolation is prevalent. [ABSTRACT FROM AUTHOR]

Forensic hospitals provide care for incarcerated patients who have committed a crime under the influence of serious mental illness. The care and (re)habilitation of the target group require highly competent staff and treatment strategies as well as purpose-built facilities that promote successful recovery. The aim of this study was to examine patients' experiences of place and space in new, purpose-built, evidence-based designed forensic psychiatric facilities in terms of supporting everydayness. A qualitative methodology was chosen. In total, 19 patients agreed to participate. Data were collected through photovoice (a combination of photographs and interviews) at three forensic hospitals, according to an evidence-based design and the concept of person-centred care in Sweden. The data were analysed through thematic content analysis. Four themes emerged from the data, revealing the patients' experiences of the new buildings: (i) having a private place, (ii) upholding one's sense of self, (iii) feelings of comfort and harmony, and (iv) remaining connected to one's life. The findings reveal that purpose-built environments can support everyday living and well-being and can create comfort. This is considered highly therapeutic by the patients. In conclusion, the findings of this study are of imperative importance in the design of health-promoting forensic hospitals., (© 2021 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Unlabelled: Nurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress., Aim: The aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer., Methods and Sample: Nurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured., Results: Eighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live., Conclusions: This study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Nurses' attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language., Objectives: The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients., Methods: A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used., Results: The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach α's. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients., Conclusions: Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses' attitudes toward caring for dying patients., Implication for Practice: Care culture might influence nurses' attitudes toward caring for dying patients; the benefits of education need to be explored.

Context: When a patient receives a cancer diagnosis, existential issues become more compelling. Throughout the illness trajectory, patients with cancer are cared for in oncology wards, by home care teams or in hospices. Nurses working with these patients are sometimes aware of the patients' existential needs but do not feel confident when discussing these issues., Objectives: To determine the effects of a training intervention, where the focus is on existential issues and nurses' perceived confidence in communication and their attitude toward caring for dying patients., Methods: This was a randomized, controlled trial with a training intervention comprising theoretical training in existential issues combined with individual and group reflection. In total, 102 nurses in oncology and hospice wards and in palliative home care teams were randomized to a training or non-training group. Primary outcomes, confidence in communication, and attitude toward the care of dying patients were measured at baseline, immediately after the training, and five to six months later., Results: Confidence in communication improved significantly in the training group from baseline (before the training) to both the first and second follow-up, that is, immediately after the training and five months later. The attitude toward caring for the dying did not improve in the training group., Conclusion: This study shows that short-term training with reflection improves the confidence of health care staff when communicating, which is important for health care managers with limited resources. Further studies are needed to explore how patients experience the communication skills of health care staff after such training., (Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this study was to describe surgical nurses' perceived work-related stress in the care of severely ill and dying patients with cancer after participating in an educational intervention on existential issues., Methods and Sample: This article reports a mixed methods pilot study of an education programme consisting of lectures and supervised discussions conducted in 2009-2010 in three surgical wards in a county hospital in Sweden. The concurrent data collections consisted of repeated interviews with eleven nurses in an educational group, and questionnaires were distributed to 42 nurses on four occasions., Results: Directly after the educational intervention, the nurses described working under high time pressure. They also described being hindered in caring because of discrepancies between their caring intentions and what was possible in the surgical care context. Six months later, the nurses described a change in decision making, and a shift in the caring to make it more in line with their own intentions and patients' needs rather than the organizational structure. They also reported decreased feelings of work-related stress, decreased stress associated with work-load and feeling less disappointed at work., Conclusions: Results indicate that it may be possible to influence nurses' work-related stress through an educational intervention. According to nurses' descriptions, reflecting on their ways of caring for severely ill and dying patients, many of whom had cancer, from an existential perspective, had contributed to enhanced independent decision making in caring. This in turn appears to have decreased their feelings of work-related stress and disappointment at work., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The aim of this study was to explore and interpret the meaning of residents' experiences of encounters with their relatives and other significant persons in nursing homes. Twelve residents in three different nursing homes in a western Sweden municipality were interviewed. The method used was hermeneutical text analysis. Three themes emerged in the interpretation of the text: being pleased, being someone, and being inconvenient. These themes were also described through seven subthemes: to be happy to have someone, to make someone else happy, going back in life, to be together in a community, not being alone, to be disconnected, and to be a burden. The study concludes that it is important for nurses in nursing homes to develop a deeper insight into what various social contacts can mean for residents. To develop this knowledge, it is important that nurses in nursing homes can be educated, and supported by clinical supervision, in relation to residents' experiences of encounters with relatives and other significant persons., (© 2012 Wiley Publishing Asia Pty Ltd.)

Objectives: This article describes the theoretical foundation and methodology used in a study intended to increase knowledge concerning informal caregivers' resources to health (in salutogenesis; General Resistance Resources, GRRs). A detailed description of how the approach derived from salutogenic theory was used and how it permeated the entire study, from design to findings, is provided. How participation in the study was experienced is discussed and methodological improvements and implications suggested., Method: Using an explorative, mixed method design, data was collected through salutogenically guided interviews with 32 Swedish caregivers to older adults. A constant comparative method of analysis was used to identify caregiver-GRRs, content analysis was further used to describe how participation was experienced., Findings: The methodology unraveled GRRs caregivers used to obtain positive experiences of caregiving, but also hindrances for such usage contributing to negative experiences. Mixed data made it possible to venture beyond actual findings to derive a synthesis describing the experienced, communal context of the population reliant on these GRRs; Caregivinghood. Participating in the salutogenic data-collection was found to be a reflective, mainly positive, empowering and enlightening experience., Conclusion: The methodology was advantageous, even if time-consuming, as it in one study unravelled caregiver-GRRs and hindrances for their usage on individual, communal and contextual levels. It is suggested that the ability to describe Caregivinghood may be essential when developing health-promoting strategies for caregivers at individual, municipal and national levels. The methodology makes such a description possible and suggested methodological improvements may enhance its usability and adaptability to other populations.

Purpose: The aim was, through analysis of dialogues in supervision sessions, to explore if health care staff in surgical care discussed existential issues when caring for cancer patients., Method: A secondary analysis of the content of twelve tape-recorded supervision sessions (18 h) was conducted. The study analysed the dialogue content in supervision sessions involving a group of eight participants who worked at a surgical clinic at a county hospital in central Sweden. The sessions were held every third week during the course of one year., Results: The analysis showed that surgical health care staff contemplates existential issues. The staff discussed their existential dilemmas, which hindered them from meeting and dealing with patients' existential questions. This is illustrated in the themes: "feelings of powerlessness", "identifying with patients", and "getting close or keeping one's distance". The staff also discussed the fact that patients expressed existential distress, which is illustrated in the themes: "feelings of despair" and "feelings of isolation"., Conclusions: This study shows that there are existential issues at a surgical clinic which health care staff need to acknowledge. The staff find themselves exposed to existential dilemmas when caring for cancer patients. They are conscious of patients' existential issues, but lack strategies for dealing with this. This study highlights a need to provide support to staff for developing an existential approach, which will boost their confidence in their encounters with patients., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: Patients' participation in care is crucial for assuring patients a high quality of care based on values such as autonomy. The patients are supposed to be actively involved in care and treatment, even though these situations are complex, as in the context of end-of-life-care. The aim in this study was to identify demographic and health-related variables' relation to patients' participation during the last three months in life as documented in patients' records., Method: The population in the present study consists of 229 patients from 49 municipalities in a county in Sweden. Data were collected from all available documentation about deceased patients who were ≥18 years of age at the time of death and who had received healthcare services during the last 3 months of their life., Results: This article demonstrates patients' participation in end-of-life care as it was noted in the patients' documentation. Demographic variables such as age, gender, and residence did not differ between those who participated and those who did not. Patients with dementia and disorientation were separated from those who were not disoriented. There was no information about the wishes of the patients with dementia and disorientation and they were not described as participating in care and treatment. Cognitive intact patients were participating significant more often. These patients had also more symptom describes in the records. These results can indicate that a patient's participation depends upon either the patient's cognitive capability or the healthcare professionals' competence to communicate and provide adequate documentation regarding patients' participation at end-of-life. The documentation about the participation of patients with cognitive dysfunction is poor and needs further investigation, to achieve the goal of dignified end-of-life care for all patients., Significance of Results: The results of the presents study call attention to the importance of finding innovative solutions to make patients with cognitive dysfunction involved in their care and treatment at end-of-life. Improvement of documentation showing patients' involvement in care is necessary, as is a discussion of how healthcare professionals can assure patients a high quality of care at end-of-life even if patients voices are not heard.

Preceptorship influences Registered Nurses' (RNs) daily work to different degrees depending on nursing students' knowledge, and willingness to learn. Consequently, it is of the utmost importance to investigate how RNs assess nursing students in clinical education. The aim of this study was to describe RNs' perceptions of nursing students' preparation and study approaches at hospital workplaces, and to explore relationships between RNs' perceptions and their personal/clinical characteristics. A cross-sectional design was used. In 2006, 142 of 196 RNs at a Swedish hospital answered a questionnaire (response rate 72.5%). The majority of RNs (63-84%) rated students' study approaches highly and thought students comprehended the outcomes of learning. Fewer (45-49%), rated students as having adequate theoretical knowledge highly and were of the opinion that they had acquired knowledge about the unit. Statistically, non specialist nurses rated significantly higher compared with specialist nurses. Significant positive correlations were found between the RNs' perceptions of nursing students and their interest in preceptoring. The extent to which preparation programmes, established in collaboration between a university and a hospital, had improved preceptors and nursing students was not graded. Further descriptive and intervention studies are therefore needed., (Copyright 2009 Elsevier Ltd. All rights reserved.)

The aims of this study were to describe and compare quality of life before and after designation to a palliative homecare team in patients with different cancer diagnoses and to identify pre-designation predictors of post-designation global quality of life. We measured patients' quality of life 1 week before designation and 11 days (median time) after with the Assessment of Quality of life at the End of Life (Axelsson & Sjödén 1999). Of 163 eligible patients 63 participated without attrition. Patients' quality of life improved in the physical, psychological, medical and global areas. Six items significantly improved: hours recumbent during the day (P = 0.009), nausea (P = 0.008), anxiety (P = 0.007), getting hold of staff (P = 0.000), received care (P = 0.003) and global quality of life (P = 0.023). Depression/low in mood (r = 0.55) and meaningfulness (r = 0.70) associated to global quality of life. Furthermore, pain (P = 0.028) and meaningfulness (P = 0.028) predicted global quality of life. In the existential area, it is important to further explore how meaningfulness is associated to and predicts global quality of life.

The purpose of this study was to explore and interpret the meaning of relatives' experiences of encounters with nurses when visiting residents in nursing homes. Thirteen relatives of residents in three nursing homes in Sweden were interviewed. The interviews were tape-recorded and transcribed verbatim. The method used was hermeneutical text analysis. Four themes emerged in the analysis and interpretation of the whole text: 'being paid attention to', 'being ignored', 'being involved' and 'being safe and secure'. A further interpretation of the findings shows a deeper understanding of the meaning of relatives. This meaning was revealed as being invited into an encounter with nurses and gave a sense of community but the opposite was being ignored and left outside. This study gives a deeper understanding of the meaning of encounters between relatives and nurses in nursing homes; it also illuminates how these encounters also can affect the care of the residents. This new understanding can hopefully offer support for nurses during their encounters with relatives and optimise the ability to provide a positive outcome for residents in nursing homes.

Background: The deinstitutionalization of psychiatric care has led to a concentration of patients to fewer wards. This leads to difficulties in separating voluntarily and involuntarily admitted patients, and there is a risk that the interest in safeguarding patients' autonomy will decrease., Aims: The aim of this study was to elucidate the meaning care has to patients on a locked acute psychiatric ward. The study was performed on a ward for patients with affective and eating disorders who were admitted both voluntarily and involuntarily., Methods: Interviews were conducted and analysed using qualitative content analysis., Results: The results show that to the patients, care had contradictory qualities some alleviated their suffering while others contributed to stress. The alleviation from suffering originated from the experiences of strengthened integrity and self-determination, from being supported, and having a place of refuge on the ward. In contrast to this, there were experiences of being dependent and trapped because of lack of influence and choice, and being controlled., Conclusions: In conclusion, this qualitative study shows that to the patients, care can mean being disciplined in a way that risks undermining the alleviation of suffering that care can provide. It is thus important to be observant when it comes to manifestations of control in care. The study also shows that the support of fellow patients has a value as a complement to the care given by staff members and next of kin, something that needs to be further investigated.

The aim of this study was to describe the ways of living with major depression in families. Seven families with an adult member who suffered major depression participated, in all 18 participants. Data were collected from seven narrative group interviews, one with each family. A qualitative thematic content analysis was used and the text was coded according to its content and further interpreted into themes. Findings consist of five themes: 'Being forced to relinquish control of everyday life'; during depression the family members lost their energy and could not manage everyday life. 'Uncertainty and instability are affecting life'; everyday life in the families was unstable and emotions influenced the atmosphere. 'Living on the edge of the community': the families periodically lived in seclusion. 'Everyday life becomes hard'; everyday life was demanding for everyone in the family and the responsibility shifted between family members. 'Despite everything a way out can be found'; the families as a unit as well as individually had their own ways of coping and finding some kind of satisfaction within the bounds of possibility. The families' experiences were demanding. Children were aware of their parent's depression and were involved in managing everyday life and emotionally affected by the situation. This legitimates the need for nurses and other healthcare professionals to have a family's perspective on the whole situation and to include partners as well as children and take their experiences seriously when supporting and guiding a family. It is important to develop strategies which in particular include children in the planning, provision and receiving of care as well as unburden them with the responsibility. It is also important to support the family in their own coping strategies with a major depressive episode.

Aim: This paper is a report of a study to compare Registered Nurses' experiences of acting as personal preceptors for nursing students in the year 2000 with the year 2006 and explores relationships between preceptors' experiences and personal/clinical characteristics., Background: Preceptoring is experienced as stressful and challenging. How successful preceptors are in this role depends largely on the support they receive. Knowledge about preceptors' experiences over time and in relation to a preceptor model is limited., Method: Data were collected by questionnaire in 2000 (n=113) and 2006 (n=109) with preceptor groups in a hospital in Sweden before and after introduction of a preceptor model. Data were analysed with descriptive and correlational statistics using parametric and non-parametric methods., Findings: Statistically significant improvements were noted in preceptors' experiences between 2000 and 2006. Statistically significantly more preceptors in 2006 reported that they felt prepared for their role and felt support from teachers, colleagues, chief nurses and enrolled nurses. Least improvement was seen in relation to the questionnaire items workload, constructive feedback and support in linking research results to practice. A strong positive relationship existed between preceptors' experiences of the preceptor role and the level of interest in preceptoring., Conclusion: The preceptor model offers a way to support and facilitate preceptors and to develop co-operation between university and hospital. Future research should focus on students' experiences, experiences of first-time preceptors, head preceptors and teachers from a longitudinal perspective.

Achieving bladder control is important for children and parents, but there is a shortage of knowledge about experiences from parents' points of view. The aim of this study was to describe parents' experiences of how their children achieved dryness. Twenty-two parents of 21 healthy children were interviewed about the process. The transcribed interviews were analyzed using the qualitative content analysis. How children achieve dryness, as reported mainly by their mothers, seems to be influenced by knowing the time had come, implementing new daily routines, the child's willingness, and a desire to be like others.

The aim of this study is to describe the meaning of living with bipolar disorder (BD) based on individuals' views of the illness and their future. Interviews were conducted with 18 participants who resided in Sweden and had been diagnosed with bipolar disorder. Qualitative content analysis was employed. The findings revealed that daily life of those with BD was characterized by insecurity and challenges of accepting, understanding, and managing the illness. Increased hope of being able to influence the condition and receiving support to achieve a stable structure in life facilitates the management of daily life. Further research is needed on the next of kins' experiences of living with persons with BD.

The purpose of the present study was twofold: first, to describe changes of Health-Related Quality of Life (HRQoL) during the adjuvant treatment among postmenopausal women with breast cancer; second, in the same population to identify the best predictors of Overall Quality of Life (QoL) after treatment, from perceived functioning, symptoms, emotional distress and clinical/demographic variables measured at baseline. The study group was 150 women (> or = 55 years of age) scheduled for adjuvant chemotherapy (CT, n=75) or radiotherapy (RT, n=75). They were examined before (baseline), during and after completing the treatment. Data about QoL, perceived functioning, symptoms and emotional distress were collected with the European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30, BR23 and Hospital Anxiety and Depression Scale (HADS) questionnaires. The general finding was that the adjuvant treatments were associated with decrease in overall QoL, physical and role functioning, anxiety and body image, as well as with increase in fatigue, dyspnoea, pain, nausea/vomiting, constipation and systemic therapy side effects measured over time. For women receiving CT, better emotional functioning and less pain at baseline predicted better overall QoL at the end of the treatment. For women receiving RT, better physical and emotional functioning, less breast symptoms and lower tumour stage at baseline predicted better overall QoL at the end of the treatment.

Objective: The aim of this paper was to describe lung cancer patients' experience of dyspnea and their strategies for managing the dyspnea., Methods: Semi-structured interviews with two main questions about dyspnea experiences and management were conducted with 20 patients with lung cancer, not amenable to curative treatment, who had completed life prolonging treatments. Data analysis was made with a descriptive, qualitative content analysis., Results: The two questions resulted in two domains with 7 categories and subcategories. The experience of dyspnea included four categories: 'Triggering factors' included circumstances contributing to dyspnea, which comprised physical, psychosocial and environmental triggers. Bodily manifestations were considered to be the core of the experience. 'Immediate reactions' concerned physical and psychological impact. The long-term reactions included limitations, increased dependence and existential impact concerning hope, hopelessness and thoughts of death. The experience of managing dyspnea included three categories: 'Bodily strategies', 'psychological strategies' and 'medical strategies'., Conclusion: Dyspnea experience is a complex experience which influences the life of the patients both with immediate reactions and long-term reactions concerning physical, emotional and existential issues in life and patients address this experience with managing strategies in order to take control of their situation, although they do not seem to be able to meet the existential distress they experience., ((c) 2007 John Wiley & Sons, Ltd.)

The aim of this study was to describe the dyspnea experience and examine its relation to other symptoms, personal and health-related factors and its predictors in patients with lung cancer. The subjects were 105 patients diagnosed with lung cancer, approached when active anti-tumour treatment was closed. The patients completed a battery of questionnaires about several aspects of dyspnea experience, intensity of other symptoms and coping capacity. Medical data including performance status were obtained from medical records. Above 50% of the patients perceived dyspnea. Coping capacity, performance status and other symptoms correlated with different aspects of dyspnea experience. Dyspnea dimensions and activity-related dyspnea correlated with anxiety, depression, fatigue and cough as well as negatively to coping capacity. Performance status correlated with dyspnea intensity and activity-related dyspnea. Lower coping capacity predicted dyspnea; additional predictors were higher levels of anxiety and fatigue. Dyspnea in this group of patients was a complex experience, including physical and psychological aspects and should preferably be assessed in a comprehensive way. A nursing intervention to decrease dyspnea experience and anxiety could use knowledge from this study about the importance of coping capacity to better help patients with lung cancer to cope in their palliative phase of the disease.

Aim: This paper is a report of a study to elucidate Registered Nurses' perceptions of their work and professional development 6 years after graduation., Background: Nursing education and health care has rapidly changed in the last two decades. Education and experience are important components in Registered Nurses' ability to promote a high quality of care, but a great deal depends on their work circumstances. This study emphasizes Registered Nurses' view of their work in health care, at a time in their career when they have several years of experience., Method: Data were collected in 2003 from in-depth interviews with 15 Registered Nurses 6 years after their graduation. The interviews were semi-structured and analysed with interpretive content analysis., Findings: The findings revealed two themes and five sub-themes. The first theme, An appropriate but demanding profession, consisted of two sub-themes: 'having found one's niche' and 'growing old in nursing may be difficult'. The second theme, A profession with opportunities and obstacles, consisted of three sub-themes: 'being aware of Registered Nurses' potential', 'having knowledge that is seldom made use of' and 'attaining professional growth is no matter of course'., Conclusion: Keeping Registered Nurses' satisfied and avoiding their dissatisfaction is crucial for both educators and employers. It is essential that employers give priority to Registered Nurses' time with patients and to motivate and support them in professional development. Further intervention studies regarding a change of the balance between obstacles and opportunities are needed.

The phenomenon, caring relationship, has been widely studied in earlier research. Nevertheless, empirical studies in hospital, concerning patients and nurses experiences of the actual phenomenon caring relationship are rare. The aim was to illuminate patients with long-term illness and nurses' experiences of the caring relationship. The data were collected from 13 interviews, seven patients and six nurses, which were then analysed using an interpretive phenomenological method. This study shows patients' and nurses' view of the phenomenon. The findings concerning patients' view were identified in themes --'Maintaining dignity' with subthemes: using one's own competence and being cared for by the team as well as 'A feeling of vulnerability' with subthemes: being cared for in a strained situation and being exposed, inquiring personal caring relationship. The findings concerning nurses' view were identified in the following themes: 'A purposeful striving' with subthemes: using one's own competence and being aware of limitations as well as 'An arduous compassion' with subthemes: giving care in a strained situation and being aware of what is needed. These findings show that patients and nurses were aware in their striving for trust through forming a caring relationship. Their striving was not enough to result in trust. The findings in this study are understood as patients need a personal caring relationship which enables the possibility of trust.

There is a lack of knowledge regarding graduate nurses' experiences of preparation in nursing education for their work in health care. The aim was to describe registered nurses' (RNs) perceptions of preparation in nursing education for their professional work and development in the nursing profession. The sample consisted of 339 RNs with 3 years experience taken from Swedish class registers for graduation in nursing education. A questionnaire was sent by post to 327 RNs. The response rate was 70.3%. The results (n=219) show that the most important domains of knowledge for RNs' work were biological science, medical science and nursing, whereas humanities and social science were less important. The importance of medical science was significantly lesser in community care and nursing in emergency care. Research methodology was of little importance for RNs' work. RNs could not make use of or conduct research in their work but research planning was significantly higher for those with extensive university education. This study mainly indicates that RNs need a stimulating work environment, including mentoring and support to enable continuous professional development in health care.

The aims of the study were to investigate lung cancer patients' quality of life (QoL) over time in a palliative setting and to determine how QoL is influenced by symptoms, coping capacity, and social support. One hundred and five consecutive patients with incurable lung cancer were included. A comprehensive set of questionnaires was used at baseline, including the Assessment of Quality of Life at the End of Life, Cancer Dyspnea Scale, Visual Analog Scale of Dyspnea, Hospital Anxiety and Depression scale, Sense of Coherence Questionnaire, and Social Support Survey, of which the first four were used also at three, six, nine, and 12 months. Dyspnea, depression, and global QoL deteriorated over time. Performance status, anxiety, depression, components of dyspnea, pain, and the meaningfulness component of coping capacity correlated with global QoL at all, or all but one follow-up measurements. In a multivariate analysis with global QoL as the dependent variable, depression was a significant predictor at four out of five assessments, whereas coping capacity, anxiety, performance status, pain, and social support entered the model at one or two assessments. Emotional distress and coping capacity influence QoL and might be targets for intervention in palliative care.

Aim: This paper is a report of a study to illuminate and interpret the meaning of residents' experiences of encounters with nurses in nursing homes. BACKGROUND; A large number of older people suffer from illness and become dependent on other people in their daily living. These people are often in need of care in nursing homes. It is assumed that encounters between nurses and residents are of importance in how residents experience care in nursing homes., Method: Twelve residents from three nursing homes in Sweden were interviewed in 2004-2005 about their experiences in encounters with nurses. The interviews were tape-recorded and transcribed verbatim. A hermeneutic method was used to describe and interpret the meaning of residents' experiences., Findings: Three themes emerged: 'being somebody', 'being nobody' and 'being in a community'. The encounters had both positive and negative influences on residents, expressed as being somebody and belonging somewhere or being nobody and not being seen as a person or simply being left out of things. Encounters between residents and nurses have a mutual dependency where residents certainly have some influence on the relationship. The nurses have both an influence on the relationship and a professional responsibility for the outcome of encounters with residents., Conclusion: The insights gained from the study can guide nurses in their encounters with residents in nursing homes so that they feel respected as unique human beings and part of a community.

Background: The challenges in the health care have given rise to a highly stressful work situation and a more complicated role for registered nurses (RNs). Qualitative studies about daily work as a whole is limited. It is therefore vital for future development of nursing knowledge and nursing education to recurrently investigate RNs' experiences of their ability to grasp and manage their daily work situation and to promote a high quality of care., Aim: The aim of this study was to describe RNs' experiences of their daily work., Methods and Participants: This follow up study was carried out involving 15 Swedish RNs 6 years after their graduation. Interviews, conducted with conversational strategy, were chosen for the data collection and content analysis was used to handle the interview texts., Results: The analysis resulted in a main theme 'to balance strain and stimulation', two themes and seven sub-themes. The first theme 'a stressful work situation' consisted of the sub-themes: 'to meet all demands', 'to be insufficient', 'to be unsure of oneself', and 'too little contact with patient'. The second theme 'a stimulating work situation' consisted of the sub-themes: 'to encounter patients and health care staff is enriching', 'to have the situation under control', and 'to have the skills necessary to be independent'. A pattern emerged throughout the themes, which showed that due to the increasing number of patients RNs' capacity for management, prioritising and planning out of team work, and performing exacting documentation diminished., Conclusion: The RNs' daily work has been illustrated as a scale of balance that oscillated between strain and stimulation; an oscillation towards strain could lead to a vicious circle. The RNs need support from the start through nursing education and continuously in profession. This is a crucial issue for nursing education and health care sector.

The aim of this study was to investigate how the caring relationship is formed in a medical context. The data were collected using participant observation with field notes and analysed by an interpretive phenomenological method. The context circumstances in a medical milieu demanded exacting efficiency and risks to oppress the caring relationship, subsequently causing demands in nursing practice. Three themes of the caring relationship were identified as respect for each other and for themselves, responsibility to reach out to each other and engagement. Patients' and nurses' awareness in encounters drove the forming of a caring relationship that went beyond the individual nurse and patient. This study implicates the importance of an understanding of how context circumstances create the foundation of the caring relationship.

The aim of this study was to describe how patients' participation in the care they received was documented in their health care records during the last three months of their lives. Two hundred and twenty-nine deceased adult persons were randomly identified from 12 municipalities in a Swedish county and their records were selected from different health care units. Content analysis was used to analyse the text. Four categories of patient participation were described: refusing offered care and treatments; appealing for relief; desire for everyday life; and making personal decisions. The most common way for these patients to be involved in their care at the end of their life was by refusal of the treatment and care offered. Characteristic of the different ways of participation were the diverse activities represented. The description of patients' involvement in their life situation at this time indicated their dissociation from the health care offered more than consenting to it.

This study is a part of a larger project in which the aim is to illuminate the meaning of the caring relationship between patients and nurses in daily nursing practice. Empirical studies in this area inspired from the interpretive phenomenological method are not commonly used. The aim of this paper is to describe how an interpretive phenomenological method was used to illuminate the meaning of the phenomenon caring relationship in daily nursing practice. Data were collected during 16 nursing care proceedings using participant observation with field notes, and in addition to that two interviews, one patient and one nurse. The interpretation moved back and forth between the whole and the parts in a dialectic process. Initial interpretive understanding of interviews and field notes, meaning units and comprehensive understanding were presented. Themes from the patient's interviews were competence, lack of continuity, strain and vulnerability. Themes from the nurse's interviews were competence and striving. Themes from the field notes were interactions towards a goal. The use of interpretive phenomenology offered an opportunity for learning to understand the meaning of the phenomenon caring relationship in daily nursing practice with both strengths and limitations. This study gave an understanding of the phenomenon through the illumination of the patient's and the nurse's thoughts, feelings and actions in the nursing care proceedings that led to a more profound knowledge about how they together create an encounter through their unique competence.

This article illustrates the experience of 20 postmenopausal women with breast cancer who had received chemotherapy treatment. The interviews were of narrative nature and analyzed with content analysis. Four themes, including 12 subthemes, described these women's life during treatment as a journey from the negative experiences of fear of the unknown, affects on body and mind, to the more positive to get by, and a transformed life. The treatment was compared with an assault on the body, and the loss of their hair was experienced more negatively than the loss of a breast. The women described a feeling of imbalance in their relationships due to lack of support from those close to them. The support from healthcare professionals was experienced both positively and negatively, and many of the women revealed variation in the professional's attitude, knowledge, and empathy. The women who chose not to work during the treatment felt pressure from society and healthcare professionals to get back to work as soon as possible. For many, especially those in a leading position, this was experienced as very difficult. The women expressed a feeling of not being afraid of dying but wanted more time to prepare themselves.

Enhancing and assuring the quality of doctoral nursing programs is currently of major concern to promote growth in quality and quantity of research in nursing. The aims of the paper were to review the literature about evaluation of higher education with focus on doctoral programs in nursing, and to present a strategy to evaluate a doctoral nursing program. A search of literature in relevant databases was done using the keywords doctoral program, evaluation, nursing, program evaluation and higher education. From the review it is concluded that more systematic evaluations are necessary to guide the development of quality in nursing. Attention must be given to the curricula, competence in the faculty, the research activity and to the students' involvement in courses and research. Therefore, a strategy for evaluation should be ongoing, flexible, systematic and comprehensive. It should involve students, graduates, employers and faculty members in evaluation, include process and outcome data and give possibility for comparison to internal and external standards. The strategy developed aims to facilitate ongoing and future improvement of the doctoral nursing program. This process is dependent on a methodological pluralism of evaluation to detect what is of most weight for growth in the process of research and education.

The aim of this paper is to describe the development of a new education programme in public health for nurses in the European Union (EU). The project, 'Development of a Continuous Professional Education Programme for Nurses in Public Health', is described together with its background and aim, which is to contribute to the development of new competencies of nurses in nursing and public health. For the development of these competencies, the framework for the programme's guidelines is organized around core modules common for all EU countries and elective modules, based on national health needs and policies proposed by each country. An example of the implementation of the programme from Sweden, where the programme has already been offered, is also presented. In addition to the educational programme itself, the opportunities for networking for nurses and teachers from different countries resulting from this effort are discussed. Finally, the evolving nature of public health in nursing is presented in relation to the roles that nurses/midwives already perform in various countries and situations, in order to point out the potential of this programme's contribution to the promotion of health of all European citizens.

Background: The review of the literature showed that many people and their family members share feelings of distress after an acute myocardial infarction. Therefore, it is important to show how the illness affects the relationship in the couple's daily life when the closest relatives involved are men., Aim: The aim was to illuminate the meaning of lived experiences in daily life after an acute myocardial infarction, as narrated by afflicted women and their partners., Methods: Nine women and their partners narrated their experiences three and 12 months after an infarction. The interview texts were then interpreted, using a phenomenological hermeneutic method, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Two themes and eight sub-themes were then extracted from the text., Results: The first theme was 'living in a changed life situation' with the sub-themes: 'showing consideration', 'taking responsibility', 'living side by side' and 'desiring what to do'. The second theme was 'looking to the future' with the sub-themes: 'feeling uncertain', 'feeling powerless', 'feeling limited' and 'feeling hope'., Conclusions: The results revealed that couples lived in a changed life situation, somewhat in 'discordance', and showed consideration to each other in order to protect the partner. There seemed to be a lack of verbal communication, but both women and their partners revealed that they sensed how their partners felt without verbal communication. In this 'discordance', couples may experience loneliness, in that they may not share feelings about the event and the situation it causes., Relevance to Clinical Practice: Women and their partner have specific needs in daily living following an acute myocardial infarction. Therefore, nurses should acknowledge the specific needs for the female patient and the partner more clearly.

Background: In Sweden women with newly diagnosed breast cancer are admitted to surgical wards in order to undergo surgery and receive postoperative care. On these wards, nursing staff take care of women both with newly diagnosed breast cancer and those with cancer in advanced stages. Nurses have to meet the varying needs of patients and their relatives., Aim: To describe nurses' opinions of the need for care and support for women and their relatives in connection with surgery for breast cancer, as well as their own need for support on a surgical ward., Methods: Thirty-one nurses from a surgical ward participated in semi-structured interviews. The interviews were tape-recorded and transcribed verbatim. Thereafter a step-by-step, qualitative content analysis was carried out., Results: The nurses described the need to talk and receive information as being the most important among women and their relatives, as well as among themselves. Only a few nurses mentioned the need for physical care among the women. Contact with relatives was described as being almost nonexistent. There was a discrepancy between what nurses described as important needs and how these needs were provided for., Conclusion: This study shows that what the nurses described as being the most important needs, and the way how these needs were provided for, was more often seen from a theoretical point of view with few examples of self-experienced situations in the daily care. Needs among women and their relatives seemed to be not fully known to nurses and therefore, possibly, were not met. Nurses themselves had a pronounced need for support, which was sometimes unsatisfactorily met.

Chronic pain is a major health problem in Sweden because of its consequences in daily life. Fourteen men with fibromyalgia-type pain were interviewed regarding their experiences. A phenomenological hermeneutic method was used to interpret the transcribed interviews. Three major themes emerged: experiencing the body as an obstruction, being a different man, and striving to endure. Overall, the meaning of men's lived experience of chronic pain was experienced as change in the body, self, and relationships. Striving to live life required achieving balance during both calm and difficult phases of the illness--struggling for a tolerable existence. Information from this study could provide guidelines for health care staff members to give empathic and supportive care to men living with a long-term illness.

Aim: The purpose of this study was to illuminate the meaning of lived experiences during the acute phase of an acute myocardial infarction (AMI)., Method: Ten women (< 60 years old) afflicted with AMI narrated their experiences during their stay in the coronary care unit (CCU). The interview texts were interpreted using a method with a phenomenological hermeneutic approach, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Three themes were then extracted from the text., Findings: One theme was 'oneself as vulnerable' with the subthemes: 'the feeling of being dependent upon others', 'the feeling of being insulted' and 'the feeling of being a troublesome person'. Another theme was 'oneself as distanced', with the subthemes: 'not facing the reality', 'captive in an unreal situation', and 'inhibition out of concern for others'. The last theme was: 'oneself as making sense' with the subthemes: 'acquirement of some insight' and 'discovery of a new meaning with life'., Conclusion: The reported comprehensive understanding revealed the phenomena guilt and shame. These, in combination with the experience of being in an unreal situation and the withholding of feelings may have led to a deterioration of communication. It seems that relatives and the staff at CCU were not allowed to share the burden of being afflicted with an AMI.

The purpose of this study was to describe the content of caregivers' (health care professionals') presentation of care situations as told at supervision sessions. For 1 year, 21 caregivers in a surgical ward of a county hospital in the middle of Sweden participated in a clinical supervision session 2 hours every third week. The participants in the supervision sessions were divided so as to form three mixed groups composed of registered nurses, practical nurses, physiotherapists, and physicians. The purpose of the supervision sessions was to give caregivers the opportunity to reflect on different care situations in a way that contributed to the development of patient care. The 38 supervision sessions were tape-recorded and transcribed verbatim. The transcripts were analyzed using a qualitative content analysis. The caregivers described difficult care situations focusing on the feelings of patients, relatives, and caregivers, with an emphasis on the caregivers' being dominant. Difficult care situations were described as giving caregivers feelings of discomfort, powerlessness, and reduced self-esteem. These feelings were described as arising in connection with caring for women with advanced breast cancer and other seriously ill patients in an organization lacking clear goals and rules. This study found that supervision sessions offering an opportunity to reflect on the difficult care situations are important for caregivers. These sessions seem therefore to be of vital importance for the future development of cancer care on the surgical ward.

The aim of this study was to illuminate the meaning of skilled nurses' and physicians' lived experiences in their encounters with men suffering from long-term, non-malignant pain of at least 6 months duration. Seventeen nurses and four physicians participated in the study. A phenomenological-hermeneutic method was used. In the analysis three themes, 'needing to be manly', 'struggling for relief from pain' and 'needing human support' emerged. The phenomenon 'confirmation' was especially important in all three themes. This study indicates that confirmation of the theme 'needing to be manly' means that nurses' and physicians' must have such a relationship with these men that they really feel respected. Confirmation of the theme 'struggling for relief from pain' means that the care givers must convince these men that they really believe each unique individual's narratives. Confirmation of the theme 'needing human support' means that nurses and physicians have to behave in such a way that these men are convinced that the caregivers really care about them. When the men felt confirmation they dared to disclose their pain experiences more honestly. This is a preliminary prerequisite for nurses' and physicians' potential to help these men.

The purpose of this study was to examine the meaning of lived experiences of caring for people affected by acute myocardial infarction. Thirty-four registered nurses at a Coronary Care Unit in the north of Sweden narrated their experiences of this specialized care of inpatients. The interview texts were transcribed and then interpreted using a phenomenological-hermeneutic method, inspired by the philosophy of Ricoeur. Two groups of texts were identified. One comprised 'narratives about the patient' within which were the themes: 'distancing oneself from what is happening' and 'showing oneself as vulnerable'. The other was 'narratives about caring', with the themes: 'reading of', 'adapting', 'coming close' and 'helping'. Various views on caring were disclosed and interpreted with reference to Martin Buber's philosophy. A comprehensive understanding of caring as oscillations between the poles distance and relation was formulated.