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The encounter between informal and professional care at the end of life
Örebro University, School of Health and Medical Sciences. (Omsorg i livets slut)
Örebro University, School of Health and Medical Sciences. (Omsorg i livets slut)
Ersta Sköndal Högskola . (Omsorg i livets slut)
2009 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 2, 258-271 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to obtain and describe in-depth knowledge about family carers' experiences of the encounter, in a hospital, between informal and professional care at the end of life. A hermeneutic approach was chosen, and we conducted interviews with 27 family carers 6 to 8 months after their loved one's death. In the encounter, the family carers made their own assessment of their loved one's condition and situation. The professionals' attitudes could both promote and impede the interaction between the two forms of care. Family carers' care actions were characterized by struggling to get treatment, being left behind, being partners, keeping the illness at a distance, hovering beside their loved one, waiting for death, and being experts and protectors. The main interpretation of the findings is that family carers possess practical knowledge about what care is the best, or least harmful, for their loved one. This can be linked to what Aristotle called phronesis.

Place, publisher, year, edition, pages
London: SAGE , 2009. Vol. 19, no 2, 258-271 p.
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-9539DOI: 10.1177/1049732308329309ISI: 000262612500009PubMedID: 19092139OAI: oai:DiVA.org:oru-9539DiVA: diva2:291515
Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2014-12-17Bibliographically approved
In thesis
1. Bakom rutinerna: kunskap och omvårdnadspraxis i mänskliga gränssituationer
Open this publication in new window or tab >>Bakom rutinerna: kunskap och omvårdnadspraxis i mänskliga gränssituationer
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study how family members, next of kin, and healthcare professionals construct and use knowledge in nursing praxis in human boundarysituations.The study was carried out on a surgical ward at a university hospital in Sweden.Methodology: Study I: A case study; data concerning a family with six familymembers were collected over 10 months using interviews, conversations, and diary notations.Study II: A hermeneutic approach; interviews with 27 family carers were conductedsix to eight months after a family member’s death. Studies III, IV: a combinedethnographic and hermeneutic approach; participant observations (285 hours), informalconversations (190), and interviews (25) were conducted with 25 nurses and 18 assistant nurses.

The main findings were: (I) The family members used beliefs to explain and understandcancer, dying and death. The beliefs were aggregated into eight main beliefs and fourthemes: cancer is a deadly threat/death is a liberator; death can be held at bay/death canbe lived near; dying is done alone/dying should not be done alone; and life has anend/life is endless. These beliefs appear to oscillate between seemingly contrastingpoles. (II) The family carers made their own assessment of their loved one’s conditionand situation. Their actions were characterized by struggling to get treatment, being leftbehind, being partners, keeping the illness at a distance, hovering beside their loved one,waiting for death, and being experts and protectors. The family carers used practicalwisdom, phronesis, regarding what care was the best, or least harmful, for their lovedone in the encounter with professional care. (III) The nurses constructed knowledgethrough greeting the patient, and reading the patient. By being sensitive, using humor,and emotional involvement, understanding was deepened. By being suspicious and selfcritical,interaction was sought with nurse colleagues, the patient, relatives, and the doctor,and additional knowledge was obtained. They strived to be one step ahead in theirefforts to attain an understanding of the patient´s situation. The knowledge nurses makeuse of can be related to the intertwined and embodied forms of theoretical knowledge,i.e., episteme, practical professional knowledge, i.e., techne, and practical wisdom i.e.,phronesis. (IV) The nurses created and used emotional knowing that could be interpretedin relation to various rooms of emotions, thoughts and actions. They strived to dothings correctly in the normative room; created a safe, secure milieu for patients andnext of kin in the safety-security room; and questioned their actions in the critical room.They created an affinity for co-operation that was of benefit in encounters with patientsin the nurses’ affinity room. And they demonstrated compassion for patients and next ofkin; this compassion was particularly evident in the closeness room.Conclusion: In praxis, construction and use of knowledge occurs that often takes placebehind the routines. This knowledge constitutes an important content in nursing. Thehermeneutic spiral can serve a pedagogic purpose in elucidating nursing and its differentforms of knowledge.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 104 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 27
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-9542 (URN)978-91-7668-711-6 (ISBN)
Public defence
2010-01-22, Hörsal P2, Örebro universitet, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2014-12-17Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
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