Being Caught in a Vicious Circle: An Interview Study of Individuals Suffering From Grade II-IV Hiatal Hernia.

Large paraesophageal hernias are related to life-threatening complications that warrant immediate surgery. Whether the long-standing chronic symptoms related to the disease in individuals without hernia incarceration motivate surgical treatment is still a subject for discussion. The aim of this study was to explore how individuals suffering from Grade II-IV hiatal hernia describe their symptoms and health, as well as how the disease affects their life. Semistructured interviews were performed with 22 individuals planning to undergo surgery for a large paraesophageal hernia. The data were analyzed using qualitative content analysis and resulted in one main theme "Being caught in a vicious circle" and six subthemes "Distressing and uncertain times," "The symptoms have seized control over my health," "Loss of energy and strength," "Strategies for managing daily life," "Loss of social life," and "Moments of hope despite failing health." Central to the participants' descriptions is their commitment to strategies for managing the ever-present and unpredictable symptoms that have seized control over their health. They were trapped in a hopeless and isolated existence, that is, a vicious circle, from which they were unable to escape. Despite the low incidence of volvulus and incarceration, the symptom burden and effect on general health motivate treatment in these individuals.

Facing an unexpected reality - oscillating between health and suffering 4-6 years after bariatric surgery.

BACKGROUND: Obesity is a significant public health problem that is on the increase worldwide, and treatment with bariatric surgery is becoming more and more common. This type of surgery has proved to be good for weight reduction and for preventing complications, but few studies have investigated patients' long-term experiences of health and suffering. AIM: To explore people's experiences of health after bariatric surgery. What are their thoughts about their life, body and sexuality? METHODS: This study is based on semi-structured interviews with eight women and eight men, 4-6 years after bariatric surgery. The data were analysed using qualitative content analysis and resulted in 5 main themes and 14 subthemes. RESULTS: The new body enabled a healthy life due to better treatment in society, enhanced self-esteem, the pleasure of purchasing clothes and the courage to become more sexually active. At the same time, the body could be experienced as so unfamiliar that their life was dominated by despondency, a lack of freedom and a feeling of being lost, which made them wish to return to their old body. CONCLUSION AND IMPLICATIONS: The participants received extensive information before as well as follow-up conversations up to one year after surgery. Nevertheless, they all experienced that changing from life as an obese person to a radically reduced body often meant a confrontation with an unexpected reality that oscillated between health and suffering. This indicates that preparedness for the life changes that bariatric surgery may entail is inadequate and that moving towards health and suffering takes its own time. Therefore, more time should be allocated to talking about how life is and can become in the long term, which may facilitate a dialogical, person-centred approach to the setbacks and situations each person needs to manage in order to improve her/his health.

The meaning of person-centred care in the perioperative nursing context from the patient's perspective - an integrative review.

AIMS AND OBJECTIVES: To determine the meaning of person-centred care from the patient's perspective and in the context of perioperative nursing. BACKGROUND: Person-centred care is used, but not defined in the perioperative context. The concept indicates an interest in the patient's own experience of health, illness, needs and preferences. As with many terms that are frequently used, there is a tendency for person-centred care to mean different things to different people in different contexts. DESIGN: Integrative Review. METHODS: A two-part search strategy was employed: first, a computerised database search of PubMed and CINAHL, using Medical Subject Headings and free terms to search articles dating from 2004-2014, was performed, and second, a hand-search of those articles' reference lists was performed. Twenty-three articles were selected, and an integrative review was conducted. RESULTS: Four themes were discovered: 'being recognised as a unique entity and being allowed to be the person you are', 'being considered important by having one's personal wishes taken into account', 'the presence of a perioperative nurse is calming, prevents feelings of loneliness and promotes well-being, which may speed up recovery' and 'being close to and being touched by the perioperative nurse during surgery'. CONCLUSIONS: Person-centred care means respecting the patient as a unique individual, considering the patient's particularities and wishes and involving the patient in their own care. Person-centred care also implies having access to one's own nurse who is present both physically and emotionally through the entire perioperative process and who guides the patient and follows up postoperatively, guaranteeing that the patient is not alone. RELEVANCE TO CLINICAL PRACTICE: By having a common understanding of the concept of person-centred care, the nurse anaesthetists' and theatre nurses' caring actions or concerns will be directed towards the patient, resulting in personalisation of care rather than simply defining the concept.

The experiences of parents of children with severe autism in connection with their children's anaesthetics, in the presence and absence of the perioperative dialogue: a hermeneutic study.

The aim of this study was to obtain an understanding of what parents of children with severe autism experience in connection with their child's anaesthetics, in the presence and absence of the perioperative dialogue. Twelve parents who had experience of their child receiving anaesthetics on one or more occasions took part in this study, in which anaesthesia care was organized as a perioperative dialogue. Data were collected by means of conversational interviews, and the text was interpreted using a hermeneutic approach. The hermeneutic text interpretation led to a new understanding based on the knowledge that in the absence of the perioperative dialogue, previous anaesthetics had meant the suffering of care by the following: a hopeless struggle, unspeakable suffering and a disgraceful scenario. However, continuity in the perioperative dialogue provided to be a way out of the suffering by being received by warm hands, being received by a known face and a subtle interplay between the child and nurse. Although health and well-being may be unobtainable goals in this special context of care, the findings provided ample descriptions of the positive effects of the perioperative dialogue, which is all the more valuable when dealing with children who will need repeated anaesthetics in the future.