Hospital readmission: Older married male patients' experiences of life conditions and critical incidents affecting the course of care, a qualitative study.

BACKGROUND: Despite the frequency of hospital readmissions, there is still a relatively incomplete understanding of the broader array of factors pertaining to readmission in older persons. Few studies have explored how older persons experience readmission and their perceptions of circumstances affecting the course of care. Research indicates that males experience poorer health outcomes and are at higher risk of readmission compared to women. AIM: To explore life conditions and critical incidents pertained to hospital readmission from the perspective of older males. METHODS: The study used a qualitative explorative design using the Critical Incident Technique. A purposive sample of four males aged 65-75 were recruited from two internal medical wards. Data were collected through narrative double interviews. The study was registered by the North Denmark Region's joint notification of health research (ID 2008-58-0028). FINDINGS: The analysis revealed four themes of life conditions: 'Ambiguity of ageing', 'Living with the burden of illness', 'Realisation of dependency' and 'Growing sense of vulnerability and mortality'. Critical incidents comprised four areas: 'Balancing demands and resources in everyday life', 'Back home again - a period of recovery', 'Care interaction' and 'Navigating within and between healthcare system(s)'. CONCLUSION: This study illustrated the interconnectedness, dynamics and complexity of life conditions and critical incidents that over time and across diverse healthcare sectors affected the course of care in older persons. Hospital readmissions seem related to a complex web of interacting life conditions and critical incidents rather than growing age or specific illnesses.

A qualitative study of how caseload midwifery is experienced by couples in Denmark.

BACKGROUND: Caseload midwifery is expanding in Denmark. There is a need for elaborating in-depth, how caseload midwifery influences the partner and the woman during childbirth and how this model of care influences the early phases of labour. AIM: To follow, explore and elaborate women's and their partner's experiences of caseload midwifery. METHODS: Phenomenology of practice was the analytical approach. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. Ten couples participated in the study. Most of the couples were observed from the onset of labour until childbirth. Afterwards, the couples were interviewed. FINDINGS: The transition from home to hospital in early labour was experienced as positive. During birth, the partner felt involved and included by the midwife. The midwives remembered and recognized the couple's stories and wishes for childbirth and therefore they felt regarded as "more than numbers". Irrespective of different kinds of vulnerability or challenges among the participants, the relationship was named a professional friendship, characterised by equality and inclusiveness. One drawback of caseload midwifery was that the woman was at risk of being disappointed if her expectations of having a known midwife at birth were not fulfilled. KEY CONCLUSIONS: From the perspective of women and their partners, attending caseload midwifery meant being recognised and cared for as an individual. The partner felt included and acknowledged and experienced working in a team with the midwife. Caseload midwifery was able to solve problems concerning labour onset or gaining access to the labour ward.

A qualitative study of how caseload midwifery is constituted and experienced by Danish midwives.

OBJECTIVE: the aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit. This led to two research questions: 1) What constitutes caseload midwifery from the perspectives of the midwives? 2) How do midwives experience working in caseload midwifery? DESIGN AND SETTING: phenomenology of practice was the analytical approach to this qualitative study of caseload midwifery in Northern Denmark. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. PARTICIPANTS: thirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and were interviewed at a later occasion. FINDINGS: being recognised and the feeling of doing high quality care generate high job satisfaction. The obligation and pressure to perform well and the disadvantages to the midwives׳ personal lives are counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self-governing model within the public hospital, without losing the technological benefits of a modern birth unit. Midwives in caseload midwifery worked on welcoming and including all pregnant women allocated to their care; even women/families where relationships with the midwives were challenging were recognised and respected. KEY CONCLUSIONS: caseload midwifery is a work-form with an embedded and inevitable commitment and obligation that brings forward the midwife׳s desire to do her utmost and in return receive appreciation, social recognition and a meaningful job with great job satisfaction. There is a balance between the advantages of a meaningful job and the disadvantages for the personal life of the midwife, but benefits were found to outweigh disadvantages. IMPLICATIONS FOR PRACTICE: In expanding caseload midwifery, it is necessary to understand that the midwives׳ personal lives need to be prepared for this work-form. The number of women per full time midwife has to be surveilled as job-satisfaction is dependent on the midwives׳ ability of fulfilling expectations of being present at women׳s births.

"The ambiguous transforming body"--A phenomenological study of the meaning of weight changes among women treated for breast cancer.

BACKGROUND: Changes in weight and body-shape are well known side effects among women treated for breast cancer. Caring for these women requires knowledge of how they perceive these bodily changes. However, knowledge on weight changes and how such changes influence the women's perception of their bodies and selves is limited. OBJECTIVE: To describe the essential meaning of the phenomenon of changes in weight and body-shape in women treated for breast cancer and how these changes influence the women's perception of body and self. DESIGN: The study design is guided by existential phenomenology as a unifying framework and descriptive life-world research as the methodological approach. Data consisted of 12 individual interviews. SETTING: The study was conducted at a department of oncology at a Danish university hospital in 2014. PARTICIPANTS: Women with changes in weight and body-shape were invited to participate in the study for purposeful selection. Inclusion procedure took place when the women attended the outpatient clinic at one year follow-up. RESULTS: The essential meaning "The ambiguous transforming body--between a luxury problem and fear of recurrence"' was formed by three interrelated constituents: (1) the body--a demanding stranger; (2) fighting to be the master in one's own life, and (3) accepting the bodily changes. CONCLUSION: Weight changes may induce a feeling of being in transition between a former well-known body and a current strange demanding body. Interpreting the bodily changes in the light of being alive, the weight changes appeared as a luxury problem. However, knowing that excess fat can cause breast cancer, the women are caught in a dilemma because the medication is supposed to contribute to long-term survival and at the same time is a possible contributor to weight gain. Being alive but unable to avoid bodily changes, the changes influenced the women's self-perception as autonomous agents and provoked self-blame, shame and feelings of ungratefulness. Thus, relieving the burden of changes in weight and body shape is not only a question of appearance, but encompasses the desire for life and anxiety of death.