Perspectives on existential loneliness. Narrations by older people in different care contexts.

The aim was to explore existential loneliness in different long-term care contexts as narrated by older people. A qualitative secondary analysis was performed of 22 interviews with older people in residential care, home care, and specialized palliative care. The analysis started with naive reading of interviews from each care context. As these readings showed similarity with Eriksson's theory of the suffering human being, the three different concepts of suffering were used as an analytic grid. Our result indicates that suffering and existential loneliness are interrelated for frail older people. Some situations and circumstances that trigger existential loneliness are the same in the three care contexts while others differ. In residential and home care, unnecessary waiting, not feeling at home and not being encountered with respect and dignity can trigger existential loneliness while seeing and hearing others suffering can give rise to existential loneliness in residential care. In specialized palliative care, feelings of guilt and remorse are prominent in relation to existential loneliness. In conclusion, different healthcare contexts have various conditions for providing care that meet the existential needs of older people. Hopefully our results will be used as a basis for discussions in multi-professional teams and among managers.

Meetings are an Important Prerequisite for Flourishing Workplace Relationships.

Relationships among colleagues, managers, and care recipients are mutually important, and need to be highlighted in workplace health promotion. The aim was to explore prerequisites for flourishing workplace relationships in a municipal healthcare setting for old people. As part of this process, we explored the staff's suggestions on how work relationships could be improved. The study had a salutogenic and participatory approach, examining staff perceptions of what was required for flourishing relationships to be created, and their suggestions for the relationships to be more promotive. Four multi-stage focus groups, which met three times each, were conducted with staff (n = 26) in old age healthcare settings. A deductive analysis was performed, based on components of the flourishing concept: challenge, connectivity, autonomy, and competence. Informal and formal meetings at work were shown to build positively perceived relationships. The study describes meetings and relationships connected to the four components of flourishing. Suggestions for improving work relationships are also presented. This study contributes to workplace health promotion, and has a salutogenic and participatory focus on how to explore workplace relationships as a resource. The flourishing concept shows how workplace relationships can be explored as prerequisites for workplace health promotion.

Being a volunteer encountering older people's loneliness and existential loneliness: alleviating loneliness for others and oneself.

BACKGROUND: The increasing proportion of older people worldwide is challenging society and the healthcare sector to develop new solutions, such as involving volunteers, especially to combat loneliness among older people. Loneliness is a broad concept comprising, for example existential loneliness - a deep feeling of aloneness in the world. We know little about volunteers' experience of encountering older people's loneliness in general and existential loneliness in particular. Such knowledge is important in order to develop high-quality volunteering. AIM: This study aimed to describe volunteers' experience of becoming and being a volunteer, and encountering older people's loneliness in general and existential loneliness in particular. METHODS: This descriptive qualitative study is based on eight focus group interviews and twelve individual interviews with volunteers from different organisations, analysed using conventional content analysis. FINDINGS: Being a volunteer meant being a fellow human being, alleviating loneliness for others and oneself. Becoming a volunteer was a way of finding meaning, and volunteering made the volunteers feel rewarded and simultaneously emotionally challenged. Being a volunteer also meant acting on one's values, challenging boundaries when necessary. Encountering loneliness, including existential loneliness, required sensitivity to others' needs for both closeness and distance. CONCLUSION: Being a volunteer benefitted not only the older persons the volunteers met, but also the volunteers' own sense of meaning, by alleviating their own loneliness. Sharing existential thoughts and having meaningful conversations about life and death are challenging, but can contribute to the personal growth of the volunteers themselves. It is important to remember that not all volunteers are confident in having existential conversations, so it is important to pay attention to each volunteer's prerequisites and needs. In addition, there is a need for support to volunteers' engagement such as clarifying their role and clarifying the responsibility and expectations from health and social care.

Spouses' existential loneliness when caring for a frail partner late in life - a hermeneutical approach.

Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs.Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner.Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other.Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses' existential needs visible and to provide support based on their needs.

Assessment of Search Strategies in Literature-Review-Based Candidate Theses Within a Nursing Program.

BACKGROUND: The majority of candidate theses in baccalaureate nursing programs in Sweden are written as literature studies. Being able to carry out a systematic and structured literature search is an essential part of thesis-related work. AIM: The aim of the current study was to investigate changes in nursing students' search strategies in candidate theses. METHODS: A retrospective, quantitative study design was obtained. Librarians (n = 2) and teachers (n = 4) randomly examined selected candidate theses (every third thesis, n = 89) from the years 2012, 2014, and 2016. RESULTS: The result showed a significant improvement over the years (from 2012 and 2014 to 2016) regarding the use of a sufficient number of synonyms, matching search terms to the respective database, use of the Boolean operator OR, and the use of subject headings and free text searches. Use of the title/abstract search largely disappeared. There was a significant change in the types of searches being done. The searches have become more structured in later years as the use of block searches increased significantly; in other words, more systematic and relevant searches have been done in recent years. CONCLUSION: The result of this study shows that the quality of the students' search strategies improved significantly during the studied years. It is recommended that search documents are used in both formative and summative assessments to evaluate students' search strategies. Educational development in the form of enhanced collaboration between librarians and teachers in nursing programs is recommended because it might help to develop student search strategies in literature-based candidate theses.

The context of care matters: Older people's existential loneliness from the perspective of healthcare professionals-A multiple case study.

AIM: To explore existential loneliness among older people in different healthcare contexts from the perspective of healthcare professionals. BACKGROUND: Professionals meet and care for older people in most care contexts and need to be prepared to address physical, psychological, social and existential needs. Addressing existential loneliness can be both challenging and meaningful for professionals and is often not prioritised in times of austerity. DESIGN: A multiple case study design was used. METHODS: Focus group interviews were conducted with healthcare professionals (n = 52) in home, residential, hospital and palliative care settings. The analysis was performed in two steps: firstly, a within-case analysis of each context was conducted, followed by a cross-case analysis. FINDINGS: Differences and similarities were observed among the care contexts, including for the origin of existential loneliness. In home care and residential care, the focus was on life, the present and the past, compared to hospital and palliative care, in which existential loneliness mainly related to the forthcoming death. The older person's home, as the place where home care or palliative care was received, helped preserve the older person's identity. In hospital and palliative care, as in institutional care, the place offered security, while in residential care, the place could make older people feel like strangers. Creating relationships was considered an important part of the professionals' role in all four care contexts, although this had different meanings, purposes and conditions. CONCLUSIONS: The context of care matters and influences how professionals view existential loneliness among older people and the opportunities they have to address existential loneliness. IMPLICATIONS FOR PRACTICE: Support for professionals must be tailored to their needs, their education levels and the context of care. Professionals need training and appropriate qualifications to address existential loneliness related to existential aspects of ageing and care.

Encountering existential loneliness among older people: perspectives of health care professionals.

PURPOSE: Existential loneliness is part of being human that is little understood in health care, but, to provide good care to their older patients, professionals need to be able to meet their existential concerns. The aim of this study was to explore health care professionals' experiences of their encounters with older people they perceive to experience existential loneliness. METHOD: We conducted 11 focus groups with 61 health professionals working in home care, nursing home care, palliative care, primary care, hospital care, or pre-hospital care. Our deductive-inductive analytical approach used a theoretical framework based on the work of Emmy van Deurzen in the deductive phase and an interpretative approach in the inductive phase. RESULTS: The results show that professionals perceived existential loneliness to appear in various forms associated with barriers in their encounters, such as the older people's bodily limitations, demands and needs perceived as insatiable, personal shield of privacy, or fear and difficulty in encountering existential issues. CONCLUSION: Encountering existential loneliness affected the professionals and their feelings in various ways, but they generally found the experience both challenging and meaningful.

Resources for work-related well-being: A qualitative study about healthcare employees' experiences of relationships at work.

AIMS AND OBJECTIVES: To explore municipal healthcare employees' experiences of relationships with care recipients and colleagues. The specific research questions were when do the relationships enhance well-being, and what prerequisites are needed for such relationships to occur? BACKGROUND: Employees in health and social care for older people often depict their work in negative terms, and they often take a high number of sick leaves. Despite the heavy workload, other employees express well-being at work and highlight social relationships as one reason for this. However, a greater understanding of how these relationships can act as resources for workplace well-being is needed. DESIGN: The design of the study was qualitative and exploratory. METHODS: Qualitative interview studies were conducted with 23 healthcare employees in municipal health care. Thematic analysis was used to analyse the data. RESULTS: Two themes were identified as resources for promoting relationships between employees and care recipients or colleagues: (a) Being personal-a close interpersonal relationship to a care recipient-and (b) Colleague belongingness-a sense of togetherness within the working group. Spending quality time together, providing long-term care and providing additional care were prerequisites for a close interpersonal relationship with care recipients. Trust, mutual responsibility and cooperation were prerequisites for a sense of togetherness within the working group. CONCLUSIONS: The findings provide an empirical base to raise awareness of relationships with care recipients and colleagues as health aspects. Relationships among employees in health care are vital resources that must be considered to create sustainable workplaces and consequently improve the quality of care. RELEVANCE TO CLINICAL PRACTICE: The results of this study advocate health promotion efforts based on interpersonal relationships at the workplace. Dialogues in the working groups, based on the employees' experiences of positive daily situations, may be a promoting method for the work-related well-being of the employees.

Challenges in everyday life among recently diagnosed and more experienced adults with type 2 diabetes: A multistage focus group study.

AIMS AND OBJECTIVES: To identify perceived challenges related to self-management among recently diagnosed adults and those with longer experience of type 2 diabetes as a foundation for the future development of a person-centred information and communication technology service. BACKGROUND: Learning self-management of type 2 diabetes includes mastering the skills required to complete complex emotional and physical tasks. A service developed with the participation of stakeholders may be an alternative way to meet rising needs for self-management. DESIGN: Qualitative descriptive design influenced by a participatory approach. METHODS: Multistage focus group interviews among one group of recently diagnosed (≤3 years, n = 4) adults and one group with longer experience (≥5 years, n = 7) of type 2 diabetes. RESULTS: Challenges in self-management in everyday life with type 2 diabetes were identified: understanding; developing skills and abilities; and mobilising personal strengths. Both groups described challenges in understanding the causes of fluctuating blood glucose and in developing and mobilising skills for choosing healthful food and eating regularly. The recently diagnosed group was more challenged by learning to accept the diagnosis and becoming motivated to change habits while the experienced group was mainly challenged by issues about complications and medications. CONCLUSION: Adults with diabetes have different needs for support during different phases of the disease. From a person-centred perspective, it would be desirable to meet individual needs for self-management on peoples' own terms through a technological service that could reach and connect to a large number of people. RELEVANCE TO CLINICAL PRACTICE: Diabetes nurses need to address the knowledge needs of patients with diabetes and support them in developing self-management skills. Consistent with person-centred care, practitioners should also encourage patients' abilities to mobilise their own personal strengths to maintain self-management.

Health and social care planning in collaboration in older persons' homes: the perspectives of older persons, family members and professionals.

Providing health and social care to older persons is challenging, since older persons often have multiple diseases and a complex health situation. Hence many professions and organisations are involved. Lack of interprofessional and interorganisational collaboration leads to fragmented care. Care planning meetings before hospital discharge have long been used to overcome this fragmentation, but meetings conducted at the hospital have limitations in identifying long-term needs at home. A new model for health and social care planning in collaboration (HSCPC) in older persons' homes was introduced in two Swedish municipalities. The aim of this study was to gain a deeper understanding of the HSCPC-meeting from the perspectives of older persons, family members, and professionals. Ten care planning meetings from two municipalities were consecutively included. Interviews in retrospect with ten older persons, eight family members, and ten groups of professionals who had attended the HSCPC-meeting at home were analysed with a hermeneutic approach. Four themes emerged: unspoken agendas and unpreparedness, security and enhanced understanding, asymmetric relationships, and ambiguity about the mission and need for follow-up. The comprehensive interpretation is that the professionals handled the HSCPC-meeting mainly as a routine task, while the older persons and family members viewed it as part of their life course. Older persons are in an inferior institutional, cognitive and existential position. However, meeting together in the home partly reduced their inferior position. Findings from this study provide some general suggestions for how HSCPC-meetings should be designed and developed: attention of power relations, the importance of meeting skills and follow-up.

Designing an ICT self-management service: suggestions from persons with type 2 diabetes.

This paper reports the wishes and needs of people with type 2 diabetes (T2DM) for a future information and communication technology (ICT) self-management service to help manage their condition and their everyday life. Diabetes is a chronic disease affecting more and more people and placing increasing demands on health care. The self-management of diabetes includes instrumental and, decision-making skills and skills in managing daily activities, which may be supported by an ICT service. In this study we used a participatory design including two sessions of Future Workshop (FW) as part of a larger research project on the self-management of diabetes. Adults with type 2 diabetes participated in two FW sessions in which their expressed wishes and needs for an ICT service all fell under the broad category of Acceptance of the diagnosis, with three other suggestions; Trust in partnerships, Communication, and Individualized information. The participants' experience of the FW as a democratic process and their appreciation of mutual learning contributed to these results, which are consistent with the aims of person-centred care.

Survey process quality: a question of healthcare manager approach.

Purpose The purpose of this paper is to explore how healthcare first-line managers think about and act regarding workplace survey processes. Design/methodology/approach This interview study was performed at a hospital in south Sweden. First-line healthcare managers ( n=24) volunteered. The analysis was inspired by phenomenography, which aims to describe the ways in which different people experience a phenomenon. The phenomenon was a workplace health promotion (WHP) survey processes. Findings Four main WHP survey process approaches were identified among the managers: as a possibility, as a competition, as a work task among others and as an imposition. For each, three common subcategories emerged; how managers: stated challenges and support from hospital management; described their own work group and collaboration with other managers; and expressed themselves and their situation in their roles as first-line managers. Practical implications Insights into how hospital management can understand their first-line managers' motivation for survey processes and practical suggestions and how managers can work proactively at organizational, group and individual level are presented. Originality/value Usually these studies focus on those who should respond to a survey; not those who should run the survey process. Focusing on managers and not co-workers can lead to more committed and empowered managers and thereby success in survey processes.

Salutogenic resources in relation to teachers' work-life balance.

BACKGROUND: Experiencing work-life balance is considered a health promoting resource. To counter-balance the negative development of teachers' work situation, salutogenic resources need to be examined among teachers. OBJECTIVE: To examine resources related to teachers' experience of their work-life balance. METHODS: Using a cross-sectional design, a questionnaire was distributed to 455 teachers in compulsory schools in a Swedish community. A total of 338 teachers participated (74%). A multiple linear regression method was used for the analysis. RESULTS: Four variables in the regression model significantly explained work-life balance and were thereby possible resources: time experience at work; satisfaction with everyday life; self-rated health; and recovery. The strongest association with work-life balance was time experience at work. Except time experience at work, all were individual-related. CONCLUSIONS: This study highlights the importance of school management's support in reducing teachers' time pressure. It also emphasizes the need to address teachers' individual resources in relation to work-life balance. In order to support teachers' work-life balance, promote their well-being, and preventing teachers' attrition, we suggest that the school management would benefit from creating a work environment with strengthened resources.

Developing health and social care planning in collaboration.

Collaboration between different professions in community care for older people is often both difficult and complex. In this project, a participatory action research (PAR) was conducted in order to support the professions involved in the care for older people to develop individualized health and social care plans. Cases from daily work were discussed in different professional groups over a period of one year. A key finding was that lack of knowledge regarding the other professions' field of expertise and their underlying professional culture and values was a barrier in their collaboration. However, as the continuous reflective dialogue process progressed, the participants began to reflect more about the importance of collaboration as a prerequisite to achieve the best possible care for the recipient. This process of reflection led to the often complex needs of the care recipients being given a more central position and thus care plans being better tailored to each person's needs.

From a diagnostic and particular approach to a person-centred approach: a development project.

AIMS AND OBJECTIVES: To investigate changes over time in an interdisciplinary group that was engaged in development work regarding pain and pain assessment. BACKGROUND: The outcomes of nursing research do not always find their way to the daily care of patients. This is evident within, for instance, physical rehabilitation, where relieving patients' pain is a major challenge. To gain new understanding, develop and change, registered nurses have a great part in engaging their staff. DESIGN: A qualitative study using a participatory action research approach was used, and a hermeneutic analysis was conducted. METHODS: A group of three registered nurses, two assistant nurses and a physiotherapist took part in focus group sessions. This group was followed with seven repeated sessions during a period of five months from January 2010 until June 2010. A hermeneutic analysis was used. RESULTS: The participants changed their attitudes towards the patient in pain, their own caring role and the team's role towards a more person-centred care. CONCLUSIONS: Participation and reflection were key aspects as means to transfer knowledge into action and establish change. The participants came to the sessions, shared actively their experiences and expressed pride in the work they accomplished. This can be seen as an expression of a need to share and a joy to be working together in a person-oriented development area. In addition, the approach seemed to contribute to increased job satisfaction. RELEVANCE TO CLINICAL PRACTICE: The participants expressed that their work resulted in a changed approach to pain and pain assessment in their daily practice at the ward. The participants were actively engaged in enhancing their work with pain and pain assessment in their own daily practice and in implementing research-based knowledge.

Social support and its association with health-related quality of life among older patients with chronic heart failure.

BACKGROUND: Social support is generally known to influence health-related quality of life (HRQoL), but this association is not well explored among older patients with chronic heart failure. AIMS: (1) To describe social support in older patients with chronic heart failure in relation to gender. (2) To investigate if age, gender, cohabitation, perceived financial situation, and disease severity are associated with social support. (3) To investigate if social support is associated with HRQoL after controlling for age, gender, and disease severity. METHODS: Data were collected in a sample of 349 patients (≥ 65 years) with chronic heart failure. Patients' HRQoL was measured with the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. The Interview Schedule for Social Interaction measured social support. Data were analysed with descriptive statistics, repeated-measure ANOVA, and multiple linear regression analyses with robust standard errors. RESULTS: Social support was generally rated high, although being a man, living alone, perceiving a problematic financial situation, and high disease severity (NYHA) were associated with lower levels of social support. Age was not associated with social support. Social support was generally associated with HRQoL, in particular the emotional dimensions. CONCLUSION: Taking social support into account when caring for older patients with heart failure can be of importance for improving or maintaining HRQoL.

How to make a workplace health promotion questionnaire process applicable, meaningful and sustainable.

BACKGROUND: In workplace health promotion, a questionnaire could be of great use. Unfortunately, fatigue regarding answering questionnaires has recently become greater than before. An action research approach could be a possible way of increasing employee participation. AIM: This study reports an attempt to explore key aspects for participation in, and commitment to, a workplace health promotion questionnaire process. METHOD: The study was conducted at two wards in a Swedish hospital. Data was collected during an action research process. Data were analysed with regard to a framework of questions. FINDINGS: The three key aspects for participation in, and commitment to, a workplace health promotion questionnaire process were: an applicable questionnaire, a meaningful questionnaire process and a continuous and sustainable questionnaire process. A structure is presented as practical advice to managers, describing how such a process could be established to be applicable, meaningful and sustainable. CONCLUSION: This study has identified key aspects and prerequisites for questionnaire processes. The prerequisites - share decision-making, involve a core group and follow a structure - are discussed and proposed for managers and workgroups to consider in further workplace health promotion questionnaire processes. IMPLICATIONS FOR NURSING MANAGEMENT: The key aspects and prerequisites presented could provide a stimulating standpoint or advice, useful for planning and accomplishing workplace questionnaire processes.

Sense of security - searching for its meaning by using stories: a Participatory Action Research study in health and social care in Sweden.

AIM: The aim of this study was to make sense of the Swedish concept 'trygghet' by using stories from daily life in a Participatory Action Research project. BACKGROUND: In Sweden, attempts to implement core values to ensure high quality health and social care for older people are given high priority and concepts such as security and dignity are often used. As concepts are abstract they are difficult to transform into practical work. DESIGN: One group of six assistant nurses and one group of five Registered Nurses working in a municipality participated in Story Dialogue Method and four older women were interviewed. RESULT: 'Trygghet' was found to be an internal sense - an intrinsic state based on faith and trust in oneself and others called Sense of security. External factors that strengthened Sense of security were to be part of a community, to recognize and be familiar with things and situations and to use various kinds of aids. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: A prerequisite for the professionals being able to support the care receivers adequately is that they have a sense of security themselves, and that they are allowed to operate in a system that facilitates for the care receivers to maintain trustworthy and reliable relations over time.

What happens when you involve patients as experts? a participatory action research project at a renal failure unit.

Although there is a trend towards developing health care in a patient-centred direction, changes are usually planned by the professionals without involving the patients. This paper presents an ongoing participatory action research project where patients with chronic renal failure, nurses at a specialist renal failure unit, a hospital manager and a researcher worked together to develop patient-centred care. The project combined the expertise of patients in their own experiences of living with a chronic condition with the professional expertise of nurses, the manager and the researcher. As the workload on the unit was uneven, the development work needed to be low in intensity but long-term. Based on a number of dialogues in focus groups, four main development areas were identified; access to test results, prerequisites for postponing the progress of the illness, general awareness and understanding of living with chronic renal failure, and family-focused care. A number of changes have been planned or implemented, such as developing a prototype for a web-based feed-back system, expanding patient education to newly diagnosed patients, steering the nurses' role towards a guiding and family-focused function, and planning a digital story-telling workshop. Involving committed people who have the mandate to change practices were prerequisites for success.