oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Bakom rutinerna: kunskap och omvårdnadspraxis i mänskliga gränssituationer
Örebro University, School of Health and Medical Sciences. (Omsorg i livets slut)
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. , p. 104
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 27
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-9542ISBN: 978-91-7668-711-6 (print)OAI: oai:DiVA.org:oru-9542DiVA, id: diva2:291528
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: 2017-10-18Bibliographically approved
List of papers
1. A family's beliefs about cancer, dying, and death in the end of life
Open this publication in new window or tab >>A family's beliefs about cancer, dying, and death in the end of life
2007 (English)In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 13, no 2, p. 226-252Article in journal (Refereed) Published
Abstract [en]

The purpose of this case study was to describe the beliefs over time of a Swedish family and individual family members about cancer and death and how these beliefs affected their daily lives. Data were collected over 10 months using interviews, conversations, and diary notations. The beliefs were aggregated into eight main beliefs and four themes: Cancer is a deadly threat/death is a liberator, death can be held at bay/death can be lived near, dying is done alone/dying should not be done alone, and life has an end/life is endless. These beliefs appear to oscillate between seemingly contrasting poles. Some beliefs were shared by all family members, whereas others were described by only one or more members of the family. The complexity of daily life in families experiencing life-shortening illness underscores the need of individualized nursing care with openness to difference and collaboration as guiding principles.

Keywords
Adult, Aged, Attitude to Death, Decision Making, Family/*psychology, Female, Gastrointestinal Neoplasms/*psychology, Humans, Interviews as Topic, Middle Aged, Sweden, Terminal Care
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-4422 (URN)10.1177/1074840707300849 (DOI)17452604 (PubMedID)
Available from: 2008-03-11 Created: 2008-03-11 Last updated: 2017-12-14Bibliographically approved
2. The encounter between informal and professional care at the end of life
Open this publication in new window or tab >>The encounter between informal and professional care at the end of life
2009 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 2, p. 258-271Article 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
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-9539 (URN)10.1177/1049732308329309 (DOI)000262612500009 ()19092139 (PubMedID)
Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2017-12-12Bibliographically approved
3. Knowledge constructions in nursing practice: Understanding and integrating different forms of knowledge
Open this publication in new window or tab >>Knowledge constructions in nursing practice: Understanding and integrating different forms of knowledge
2010 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 20, no 11, p. 1500-1518Article in journal (Refereed) Published
Abstract [en]

In this combined ethnographic and hermeneutic study we examined which forms of knowledge nurses make use of and how they construct knowledge. We collected data using participant observations, informal conversations, and interviews. Nurses' knowledge construction took the form of a hermeneutic spiral, a journey in which the nurses moved up and down and horizontally, and in which they created understanding. The nurses constructed knowledge from reading the patient's record, the brief oral handover report, greeting the patient, and reading the patient. By being sensitive, using humor, and emotional involvement, they deepened their understanding. By being suspicious and self-critical, they sought interaction with nurse colleagues, the patient, doctor, and relatives, and obtained additional knowledge. They strove throughout the journey to be one step ahead in their efforts to attain an understanding of the patient's situation. We can relate the knowledge nurses make use of to intertwined forms of episteme, techne, and phronesis

Place, publisher, year, edition, pages
London: Sage, 2010
Keywords
ethnography, Gadamer, hermeneutics, knowledge construction, nurse practitioners, nursing, Ricoeur
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-9540 (URN)10.1177/1049732310374042 (DOI)000283250900008 ()
Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2018-04-19Bibliographically approved
4. Emotional knowing in nursing practice: in the encounter between life and death
Open this publication in new window or tab >>Emotional knowing in nursing practice: in the encounter between life and death
2010 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 2, article id 5367Article in journal (Refereed) Published
Abstract [en]

Patients, next of kin and nurses in surgical wards often raise existential questions in the encounter between life and death. Nurses' emotional knowing at this encounter is crucial. Consequently, this study's purpose was to analyse and describe nurses' emotional knowing to reveal (a) how this knowing is expressed in daily work and (b) what emotions, thoughts and actions this knowing includes. This study used combined ethnographic and hermeneutic methodologies. Data were collected using participant observations, informal conversations and interviews. We found that nurses' emotional knowing could be interpreted in relation to various rooms of emotions, thoughts and actions. Nurses' judgements formed these rooms. They strived to do things correctly in the normative room; created a safe, secure milieu for patients and next of kin in the safety–security room; and questioned their actions in the critical room. They created affinity for co-operation that benefitted encounters with patients in their affinity room. And they demonstrated sensitivity and compassion to patients and next of kin; sensitivity and compassion were particularly evident in the closeness room. In our main interpretation, we found that nurses' judgements in various rooms (emotional knowing) constitute an expression of practical wisdom (phronesis) in nursing practice.

Place, publisher, year, edition, pages
Järfälla, Sweden: Co-Action Publishing, 2010
Keywords
Emotional knowing, ethnography, critical hermeneutics, nurses, assistant nurses, nursing practice, phronesis
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-9541 (URN)10.3402/qhw.v5i2.5367 (DOI)000281886700013 ()20640014 (PubMedID)2-s2.0-84873993867 (Scopus ID)
Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2018-04-19Bibliographically approved

Open Access in DiVA

fulltext(2259 kB)1449 downloads
File information
File name FULLTEXT01.pdfFile size 2259 kBChecksum SHA-512
18a5bc26637e79ddf77d18d0f7b3772c4ffc6d5d0951127e549c782d7b9d17739430ead35c8c6495fc0edced840695f5b6f9007a56bd64ff8299d41164b4a855
Type fulltextMimetype application/pdf
cover(1609 kB)83 downloads
File information
File name COVER01.pdfFile size 1609 kBChecksum SHA-512
ba7a276454e8f1fa9a0eb27942a87fb8ec549cc7223026bffcfb0804416c4a73409160b673f6f8f5aa0062b43fe2d5e181be82c228ec82692e672e87417d1914
Type coverMimetype application/pdf
spikblad(658 kB)31 downloads
File information
File name SPIKBLAD01.pdfFile size 658 kBChecksum SHA-512
830f5dca184cf2949ff697970a6d2f141fee63bf92e70cf1e9236dd1b0a64057a1a5444d934c1d2c5592540eb9460b2c59d8765d82321cb1d3f3c4bc0296f0c5
Type spikbladMimetype application/pdf

Authority records BETA

James, Inger

Search in DiVA

By author/editor
James, Inger
By organisation
School of Health and Medical Sciences
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 1449 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 1589 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf