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In 2021, 10,841 abortions were carried out in Norway, of which 95.3% were medical abortions. In this phenomenological study, we explore women's experiences connected to performing a medical abortion at home. We conducted 22 interviews and analyzed the data using Giorgi's descriptive phenomenological method. Our analysis revealed four crucial constituents: The logical and sensible choice-doubt beneath the surface; Secrecy and the dubious comfort of hidden shame; Emotional distancing as a coping strategy; and Moving on-and revisiting the meaning of the abortion. We discuss and reflect on these findings drawing on insights from existential phenomenology and contemporary research.

Background: Persons living with aphasia have unique needs and challenges that would benefit from greater understanding among all health professionals. Aim: To explore which factors influence social dignity in persons with aphasia in their contact with healthcare professionals. Methods: A literature search was conducted in CINAHL, MEDLINE, Embase, PSYCINFO, ProQuest, Web of Science, ERIC and Epistemonikos. A total of 317 studies were read and eight were finally included. Qualitative content analysis methods were applied for data extraction and interpretation. Results: One overarching theme emerged: enabling person-centred communication among healthcare professionals. This covered two main themes – the experiences of empathy and of empowerment. The first of these is based on the subthemes of openness and awareness of feelings, and being acknowledged as a unique person. The second covers three subthemes: involvement in care and rehabilitation; capacity building to gain control and confidence in communication; and enabling communication in community aphasia groups. Conclusions: Healthcare professionals’ ability to safeguard the social dignity of persons with aphasia is contingent on enabling them to communicate in a person-centred manner. Without such communication, persons with aphasia may perceive that their feelings, uniqueness, involvement and confidence are being disregarded. Implications for practice: Outcomes for persons with aphasia are potentially better when healthcare professionals involve them empathetically and empower them in communication To promote person-oriented communication with persons with moderate or severe aphasia, healthcare professionals need to learn tailored skills from competent speech therapists Persons with aphasia and healthcare professionals require a supportive organisational environment for person-centred care. Without such support persons with aphasia are often not empowered to participate in communication

This is an open access article under the terms of the Creat ive Commo ns Attri butio n‐NonCo mmerc ial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. Aim: To illuminate the perceptions of hospital‐based midwives who support women suffering from moderate to severe fear of childbirth during an expected vaginal birth. Design: A qualitative descriptive and explorative study. Methods: Focus group interviews were conducted with 18 midwives representing four different hospitals in Norway. Results: Encountering fear of childbirth evoked the desire to protect and help, al‐ though the ability to provide optimal support was dependent on several circum‐ stances, several of which were beyond the midwives̕ control. The main theme “Midwives finding their own strength when encountering the vulnerability of women with fear of childbirth” consisted of two themes: “Being present” and “Being alone.” The midwives described being present as a prerequisite for continuity of care and af‐ firmation. The emphasis on continuity of care could give rise to a sense of loneliness and guilt during and after demanding situations in the birthing room.

The change of the anesthesia-, intensive-, surgery-, and oncological nursing postgraduate education into clinical-oriented master programs makes it necessary to increase the professional skills of nurse specialist clinical supervisors. A competence program for clinical supervisors (15 credits) was developed by a university in Norway from 2014 to 2015 in order to facilitate capacity building of academic and pedagogical knowledge. To illuminate nurse specialist clinical supervisors' learning components by implementing a competence program in clinical supervision. A qualitative document analysis of 44 written assignments made by 18 nurse specialist clinical supervisors participating in the competence program, which were collected from the University's electronic learning platform. One main theme and two themes emerged: Changes in the professional paradigm, Learning components that influence clinical supervisors' style and Learning components that have an impact on clinical supervisors' professional growth. This study provides valuable insight into the learning components in clinical supervision that have contributed to a change in the nurse specialist clinical supervision paradigm. The supervisors have formal competence to provide clinical supervision to postgraduate students at master level. The program confirms the value of educating nurse specialist clinical supervisors and we recommend that it should be continued and further evaluated.

When the master's degree in midwifery was introduced in Norway, clinical midwives with a professional diploma soon requested the possibility to upgrade their education to a master's degree. In 2014, a part-time master's program worth 40 ECTS credits was introduced at a Norwegian university. In this study, we aimed to explore clinical midwives' experiences of how taking a part-time master's program in midwifery was received at their workplace. We employed a qualitative research design and an explorative descriptive approach. A convenience sample consisting of 47 clinical midwifes with varying seniority was recruited in 2016 and 2017, and five focus group interviews were conducted at the end of the study programs. Systematic text condensation was used to analyze the data, generating three themes. The first concerns the midwives' experiences of learning new tools to advance their profession. Secondly, they expressed hope for support, but found that education was a private matter. Finally, they experienced that financial support depended on goodwill from their employers. The study demonstrates that a master's degree in midwifery can be instrumental to strengthen clinical practice, but also points towards the need to update and strengthen management and leadership to facilitate and implement new knowledge.

The aim of the study was to evaluate nurse specialist students’ views of clinical supervision (CS) and its influence on their professional competence development. An additional aim was to interpret the results and link them to non-technical skills and Patient Safety (PS) topics. The research question was: What are the benefits of clinical supervision focusing on non-technical skills in the area of PS? A cross-sectional study of 46 nurse specialist students was conducted by means of questionnaires and exploratory factor analysis. Factors that influenced the nurse specialist students’ competencies were: interpersonal, professional and communication skills in addition to awareness of ethical skills, the importance of teamwork and the benefit of involving patients and their family members in safe care. The results were linked to non-technical skills and PS competencies. Clinical supervision is crucial for the development of non-technical skills and PS competencies among nurse specialist students. However, finding time to reflect and learn from the supervision was reported to be a problem. Over half of the students stated they did not have enough time for supervision. Thus, there is a potential for quality improvement. We recommend that universities should provide formal educational programmes for supervisors focusing on the professional development of students, especially in the area of non-technical skills. In conclusion, CS should be prioritised by management and clinical leaders as it enhances PS.

This study is set in the context of the final phase of nurse specialist students’ (NSS) postgraduate education in surgical, oncological, anaesthesia and intensive care nursing at the University College in June 2015. The aim was to explore NSSs’ experiences of clinical supervision (CS) during their postgraduate clinical education. 46 NSS answered open-ended questions and their responses were analysed by means of a qualitative content analysis. The response rate was 82%. One main theme emerged: CS as a prerequisite for professional development and two domains: A reflective way of growing and learning through CS and The meaning of being and acting in a reflective and professional manner to ensure patient safety (PS). The results indicate that reflection is a crucial part of the NSS’ experiences of CS during their postgraduate clinical education. The supervisor’s ability to confirm the students, mutual trust and feeling safe in the relationship with the supervisor are of great importance. The students highlighted the value of continuity in CS and being supported yet challenged. The supervisor has great responsibility for the NSS’ development of professional clinical competence. The supervisor’s personal and professional skills, in addition to her/his ability to provide CS are important for PS as well as for professional and interdisciplinary teamwork. Acting in a reflective and professional manner is of great importance for ensuring PS. Although most of the students reported being sufficiently competent to ensure PS and agreed that CS and reflection are of great importance for PS, they wanted more time to reflect on their actions together with their supervisor. In conclusion, CS has the potential to lead to quality improvement. However, in order to enhance reflective practice, which is a prerequisite for CS and PS, we recommend closer cooperation between the university college and clinical supervisors, as well as a formal master level education for clinical supervisors.

Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license Resilience is a term commonly used to describe the ability to turn adversity into opportunities and learn from demanding situations. There seems to be a need to identify support strategies for developing resilience among nursing students in order to strengthen their professional practice. The aim of this review was to synthesize qualitative research exploring how resilience can be developed in nursing students. The review question was: How can nurse educators support students’ development of resilience? Relevant publications were identified by systematic data searches in May 2017 in the following electronic databases: MEDLINE, CINAHL, Scopus, Embase, PubMed, PsycInfo, Webb of Science, ProQuest, Academic and Eric. Eight qualitative research studies in English that explored resilience in the context of nursing education were included. Five descriptive themes emerged: Demonstrating caring relationships, Recognizing resources and power, Acknowledging uncertainty, Reframing burdensome experiences and Adjusting frames for learning. In addition, two overarching analytic themes emerged: An educational culture of trustworthiness and Readiness to care. In conclusion, a learning culture characterized by trustworthiness appears to be a catalyst for developing resilience in nursing students. A variety of support strategies in nursing education contribute to resilience in nursing students, thus influencing their readiness to care.

his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Identifying deliberate self-harm in the young and its relationship with bullying victimization is an important public health issue. Methods. A systematic review was performed to explore evidence of the association between deliberate self-harm and school bullying victimization in young people, as well as the mediating effect of depressive symptoms and self-stigma on this association. An advanced search in the following electronic databases was conducted in January 2018: PubMed/Medline; CINAHL; PsycINFO; PsycARTICLES; Science Direct; Scopus, and Cochrane Library. Studies that fulfilled the inclusion criteria were further assessed for theirmethodological integrity. The Norwegian Knowledge Centre for Health Services tool was applied for cross-sectional studies and the Critical Appraisal Skills Programme instrument for the cohort studies. Only empirical quantitative studies published in the English language in peer reviewed journals during the last decade (2007-2018) aimed at exploring the association between deliberate self-harm and school bullying victimization in community-based schoolchildren with a mean age of under 20 years were included. Results. The reviewed cross-sectional and cohort studies (22) revealed a positive association between school bullying victimization and deliberate self-harm, including nonsuicidal self-injury, which remained statistically significant when controlled for the main confounders. The mediating role of depressive symptoms in the association between deliberate self-harm and school bullying victimization was confirmed. A dose-response effect was shown in the association between nonsuicidal self-injury and school bullying victimization, whilst the mediating effect of depressive symptoms needs to be further explored. No studies were found directly exploring the mediating effect of self-stigma in the association between deliberate self-harm and bullying victimization. Conclusion. Targeted interventions aimed at eliminating victimization behaviours within the school context are therefore proposed, as well as interventions to promote healthy parenting styles for the parents of schoolchildren. Moreover, school healthcare professionals should screen students involved in bullying for self-injury, and vice versa. This project has been funded by the Cyprus University of Technology (internal funding/research activity 319) and University College of Southeast Norway, The Centre for Women’s, Family and Child Health (internal funding).

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose: New mothers may question the nature of their motherly love after the birth. Most mothers find that feelings of affection come within a week from birth. However, some mothers are still struggling with this after many months. Many studies place strong emphasis on the importance of maternal affection for the development of the child. Few studies look into mothers’ experiences when maternal affection or love remains a struggle. Method: We present an interpretative synthesis based on a systematic analysis of five qualitative studies that report findings related to mothers’ stated inability to exhibit maternal affection. Result: In answer to our question “what characterizes the experiences of women who struggle with, or are unable to exhibit, maternal affection after birth”, we identified the uncertainty involved in imagining the unborn child, birth and maternal future, birth as a disillusionment, and the ensuing process of decreasing agency and increasing alienation. Especially a traumatic birth may lead to disillusionment. Conclusion: Health care workers and research can support a mother’s positive resolution of her struggle by promoting realistic and more open expectations for maternal affection as well as her sense of agency and ownership during birth and the early mother–child relationship.

Aim: To conduct a meta‐study of qualitative empirical research to explore the links between patient safety and fear of childbirth in the maternity care context. The review questions were: How are patient safety and fear of childbirth described? and What are the links between patient safety and fear of childbirth in the maternity care context? Design: Meta‐study. Data sources: The CINAHL, Cochrane, PubMed, Webb of Science, Proquest and Medline (Ovid) electronic databases were searched for articles published between June 2000‐June 2016. Review methods: A meta‐study of qualitative research with a thematic analysis followed by a synthesis. Results: Four descriptive themes emerged: “Physical risks associated with giving birth vaginally”; “Control and safety issues”; “Preventing psychological maternal trauma and optimizing foetal well‐being”; and “Fear of the transition to motherhood due to lack of confidence”. The two overarching analytical themes: “Opting for safety” and “An insecure environment breeds fear of childbirth”, represent a deeper understanding and constitute the synthesis of the links between patient safety and fear of childbirth. This meta‐study indicates the need for increased commitment to safe care and professional support to reduce risks and prevent unnecessary harm in maternity care. © 2018 The Authors. Nursing Open published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background: Most depressed older people in a suicidal state have mixed feelings, where the wish to live and the wish to die wage a battle. Aims: To explore and describe depressed older people’s experiences of being suicidal and their search for meaning. Method: Data were collected from 29 participants resident in the Rogaland and Vestfold districts of Norway, by means of individual interviews, after which a thematic analysis was performed. Results: For the participants in this study, the lived experiences of the situated meaning of survival after being suicidal comprised a main theme—”shadows from the past”—and two themes—”feeling that something inside is broken” and ”a struggle to catch the light.” Conclusion: Mental health-care professionals might be able to reduce the risk of suicide and perturbation by helping depressed older people to explore, resolve, and ultimately come to terms with their unresolved historical issues. Additional valuable strategies in primary care settings include encountering patients frequently, monitoring adherence to care plans, and providing support to address the source of emotional pain and distress. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

This study describes and interprets midwives' and public health nurses' perceptions of their experiences of caring for young women during pregnancy and early motherhood. A number of studies suggest that teenage pregnancy is associated with many adverse psychological, physical, social, and financial outcomes. Multistage focus group interviews were conducted with six professionals, and a qualitative content analysis was performed. The result of this descriptive and explorative study comprised one main theme, creating a trusting and committed relationship to support immature young women, characterized by two themes: searching for security and love in daily life and active involvement with "the children of their hearts". In summary, in order to support the young women, the informants used modeling as a strategy to achieve self-esteem, thus helping them to cope with daily life. Continuity of team supervision should be improved to enhance midwives' and public health nurses' professional roles.

Around 4.7 million European women experiencechildbirth annually (World Health Organization 2009).There are significant cross-European Union (EU) dif-ferences in maternity care cultures, philosophies, orga-nization, uptake and outcomes. Migrant womensexpectations of maternity care may be very different

lyberg a. & severinsson e. (2010) Journal of Nursing Management18, 383–390 Fear of childbirth: mothers' experiences of team-midwifery care – a follow-up study Aim The aim of this study was to illuminate mothers’ fear of childbirth and their experiences of the team-midwifery care model during pregnancy, childbirth and the postnatal period. Background Maternal anxiety and fear of childbirth lead to emotional suffering and affected women’s well-being. A previous negative experience of childbirth may result in postnatal depression or avoidance of future pregnancies. Methods This hermeneutic study comprised interviews with 13 women, which were audio-taped and transcribed verbatim, after which interpretative content analysis was performed. Ethical approval was granted. Results The findings revealed one main theme: The woman’s right to ownership of the pregnancy, childbirth and postnatal care as a means of maintaining dignity and three themes; Being aware of barriers and reasons for fear; Being prepared for childbirth and Being confirmed and treated with dignity by the midwife. Each theme contained several sub-themes. Conclusion The findings contribute insights into how midwives can be educated to reduce fear of childbirth and promote positive birth experiences, despite the existence of negative memories of previous births. Implication for nursing management In order to achieve continuity and a trusting relationship it is necessary to organise leadership and to adopt models that are flexible and support women’s health.

LYBERG A. & SEVERINSSON E. (2010) Journal of Nursing Management18, 391–399 Midwives' supervisory styles and leadership role as experienced by Norwegian mothers in the context of a fear of childbirth Aim The aim of the present study was to describe the midwives’ supervisory style and leadership role as experienced by pregnant women and new mothers in the context of a fear of childbirth. Background A service led by midwives can influence the quality of care. Methods The sample consisted of 13 mothers. Data were interpreted by means of qualitative content analysis. Results The findings revealed that the midwives’ supervisory styles were related to their ability to create a trusting and caring relationship, demonstrate problem-solving capacity, and showing willingness, preparedness and courage to support the women. The midwives’ leadership role was described as involving a crucial set of professional management skills and techniques. Conclusion The findings have strengthened the argument for the provision of continuity of care to women who are afraid of childbirth. Further studies should focus more specifically on the implementation of research in practice. Implication for nursing management It is necessary for midwives to demonstrate leadership in order to develop practice, predict challenges and changes, provide different care delivery models and acquire an evidence base for care. This also demands systematic supervision to improve care outcomes.

Depression has repeatedly been found to be a risk factor for completed suicide, particularly when coupled with a pervasive sense of hopelessness. The aim of this study was to evaluate depressed older persons’ suicidal experiences. Data were collected by means of individual in-depth interviews with nine informants living in two districts of Norway. A hermeneutic analysis was performed. One main theme: Going around in a circle and two themes: being alone without meaning in life and struggling to achieve reconciliation emerged from the analysis. An important implication for mental healthcare practice is the need to develop a person’s ability to shape and take control of her/his life. The healthcare organisation must be committed to a plan that sets out strategies enabling suicidal individuals to avoid the negative experience of meaninglessness. It was concluded that suicidal depressed elderly persons need help to escape from their desperate situation. More research is urgently required in order to prevent suicide in depressed elderly persons whose emotional pain is unbearable.

Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.

This is a copy of the publisher’s PDF originally published in Open Journal of Nursing, and self-archived in this institutional repository in accordance with publisher's policy. Background: Social capital has been described as a person’s sense of belonging as a result of the number and type of relationships she/he has, in which trust and reciprocity are especially important. Aim: To illuminate older persons’ experiences of social capital and depressive ill-health after implementation of the CCM. Methods: Data were collected from nine participants resident in two districts of Norway by means of individual in-depth interviews. A qualitative hermeneutic analysis was performed. Results: Two overall themes, desire for a guardian and a wish for independence despite being dependent, and two themes emerging from the analysis. The first theme—searching for protection was based on three sub-themes overwhelmed by the emotional pain of other people, a sense of exclusion and worries about the future, while the second theme—the need for a relationship with trustworthy persons comprised two sub-themes, namely, emotional pain was not understood and powerlessness to change the situation. The result of this study highlights the need for greater understanding on the part of healthcare professionals of how older persons manage their social relationships. Healthcare professionals require more knowledge about how negative self-beliefs held by older persons suffering from emotional pain, which can lead to reduced ability to trust other people. Another consequence is that fear of being dependent on other people can result in unwillingness to admit the need for help. Conclusion: This study highlights the lack of social capital in older persons who suffer from depressive ill-health. The implementation of the CCM does not appear to improve the situation. Older persons need to be more aware of their social needs and productive interactions in order to protect themselves and obtain support from their social network.

The aim of this paper is to deepen the understanding of depressed elderly persons’ lived experiences of physical health problems. Individual in-depth interviews were conducted with 15 depressed elderly persons who suffer from physical health problems. A hermeneutic analysis was performed, yielding one main theme, living with stigma, and three themes: longing to be taken seriously, being uncertain about whether the pain is physical or mental, and a sense of living in a war zone. The second theme comprised two subthemes, feeling like a stranger and feeling dizzy, while the third had one subtheme: afraid of being helpless and dependent on others. Stigma deprives individuals of their dignity and reinforces destructive patterns of isolation and hopelessness. Nurses should provide information in a sensitive way and try to avoid diagnostic overshadowing. Effective training programmes and procedures need to be developed with more focus on how to handle depressive ill health and physical problems in older people.

This study describes and interprets midwives' and public health nurses' perceptions of their experiences of caring for young women during pregnancy and early motherhood. A number of studies suggest that teenage pregnancy is associated with many adverse psychological, physical, social, and financial outcomes. Multistage focus group interviews were conducted with six professionals, and a qualitative content analysis was performed. The result of this descriptive and explorative study comprised one main theme, creating a trusting and committed relationship to support immature young women, characterized by two themes: searching for security and love in daily life and active involvement with "the children of their hearts". In summary, in order to support the young women, the informants used modeling as a strategy to achieve self-esteem, thus helping them to cope with daily life. Continuity of team supervision should be improved to enhance midwives' and public health nurses' professional roles.

To illuminate midwives' and public health nurses' perceptions of managing and supporting prenatal and postnatal migrant women in Norway.Migrant women are affected by social inequalities and likely to have had experiences during and after the migration process that could influence their physical, mental and social well-being.Multistage focus group interviews were conducted and data were analysed in accordance to conventional interpretative qualitative content analysis.The overarching theme 'Managing and supporting educational, relational and cultural diversity in maternity care' was characterized by two themes 'Health challenges' and 'Cultural challenges'. Each theme contained several subthemes. The interviews revealed that Norwegian maternity care is not adjusted to migrant women's needs. The management is the same for everybody who avails of the service.The Norwegian model for managing cultural diversity in maternity care needs to be developed. Capacity building and a closer cooperation between maternity care services is necessary. IMPLICATIONS FOR MIDWIVES AND NURSING MANAGEMENT: Maternity care requires reflection at several levels to reduce disparities in individual health. In order to ensure continuity and a trusting relationship, it is necessary to organize leadership and adopt flexible models that support migrant women's health.

The aim of the present study was to describe the midwives' supervisory style and leadership role as experienced by pregnant women and new mothers in the context of a fear of childbirth.A service led by midwives can influence the quality of care.The sample consisted of 13 mothers. Data were interpreted by means of qualitative content analysis.The findings revealed that the midwives' supervisory styles were related to their ability to create a trusting and caring relationship, demonstrate problem-solving capacity, and showing willingness, preparedness and courage to support the women. The midwives' leadership role was described as involving a crucial set of professional management skills and techniques.The findings have strengthened the argument for the provision of continuity of care to women who are afraid of childbirth. Further studies should focus more specifically on the implementation of research in practice.It is necessary for midwives to demonstrate leadership in order to develop practice, predict challenges and changes, provide different care delivery models and acquire an evidence base for care. This also demands systematic supervision to improve care outcomes.