Post-traumatic stress among Swedish ambulance personnel.

OBJECTIVE: Emergency workers, including ambulance personnel, must cope with a variety of duty related stressors including traumatic incident exposures. Little is known about the variables that might be associated with post-traumatic stress symptom in high risk occupational groups such as ambulance personnel. This study investigated the prevalence of post-traumatic stress disorder among Swedish ambulance personnel. METHODS: To estimate the prevalence of trauma related disorders, a representative group of 362 ambulance personal from the county of Västra Götaland in Sweden was surveyed through use of a Swedish version of Antonovsky's 13-item short version of Sense of Coherence Scale, to measure reactions to traumatic events two instruments were used, Impact of Event Scale (IES-15) and the Post Traumatic Symptom Scale (PTSS-10). A total of 223 of the ambulance personnel reported that they had had experience of what they described as traumatic situations. RESULTS: Of those who reported a traumatic situation 15.2% scored 31 or more on the IES-15 sub scale. Scores over 31 indicate a stress reaction with certain likelihood of post-traumatic disorder. On the PTSS-10 subscale 12.1% scored 5 or more, which indicates a relative strong reaction. The study indicates that lower sense of coherence predicts post-traumatic stress. Other predictors for the extent of traumatic stress were longer job experience, age, physical and psychological workload. CONCLUSIONS: The high prevalence of post-traumatic stress disorder symptoms in ambulance personnel indicates an inability to cope with stress in daily work. The strong relation between post-traumatic stress and Sense of Coherence Scale may be useful in predicting vulnerability for post-traumatic symptoms among recently employed ambulance service personnel. To prevent or reduce the upcoming of post-traumatic stress disorder symptoms it must be possible to take leave of absence, or for a longer or shorter time be transferred to non-emergency duties. This study presents a better understanding between post-traumatic stress and underlying factors among ambulance personnel.

A waste of life: fathers' experience of losing a child before birth.

BACKGROUND: The prenatal loss of an expected child entails parental despair and grief. The grief after a stillborn child is sometimes described as a "forgotten form of grief" and the fathers as the "forgotten mourners." Our aim was to describe how fathers experienced losing a child as a result of intrauterine death. METHOD: Eleven men were interviewed 5 to 27 months after the intrauterine death of their child during weeks 32 to 42 of pregnancy. The interviews were analyzed using a phenomenological methodology. RESULTS: After being informed of the infant's death, most fathers first wanted their partners to have a cesarean section, but all later thought that it would be right for the child to be delivered vaginally. A strong feeling of frustration and helplessness came over them during and after the delivery. Several men found meaning and relief in their grief by supporting their partner. Tokens of remembrance from the child were invaluable, and fathers appreciated that the staff collected these items, even if the parents declined them. The perceived prerequisite for resuming their everyday lives consisted of the support they received from the hospital staff and precious memories of the child. The most important comfort in their grief was a good relationship with their partner. Some fathers missed having a man to talk to both at the time of the stillbirth and subsequently. CONCLUSION: The fathers' general trust in life and the natural order was suddenly and unexpectedly severely tested by the death of their child, which they perceived as a terrible waste of life. They sought understanding as grieving men and fathers from both the hospital personnel and their partners, as well as from relatives. Being able to protect their partner and to grieve in their own way was important to the fathers.

Nurses' use of time in a medical-surgical ward with all-RN staffing.

AIMS: To investigate allocation of nursing time, organisation of nursing activities and whether or not allocation and organisation have changed over time. BACKGROUND: In a ward that changed to all-RN staffing, the nurses were encouraged to implement a patient-focused philosophy. The nurses perceived that they had difficulty in using the time available efficiently. METHODS: Non-participant observations were conducted with 2-year intervals. Ten consecutive weekdays were covered on two occasions. The study was carried out at a university hospital in Sweden. FINDINGS: Between observations, a significant change in the organization of the direct care had occurred, and the same tendency was found in patient administration and general management. The organization of work changed from a partly fragmented to a more coherent one. The time used for direct care and administrative activities increased between the two observations, while indirect care, personal and service activities decreased. CONCLUSION: It can be suggested that the nurses used their time efficiently and, over time, they developed a more coherent way of organizing nursing activities.

The meaning of "not giving in". Lived experiences among women with breast cancer.

This article explores the meaning to women with breast cancer of "not giving in". Giorgi's phenomenological method was applied, and data were collected through open interviews. Ten women with breast cancer participated. The analysis resulted in a general structure of the phenomenon studied, including six key constituents: accepting the challenge to go on living, working actively on the healing process, finding something important to live for, gaining insights about life itself, experiencing awareness and avoidance, and introducing radical change in life. The results are consistent with literature about strategies in facing death and development as human conditions. Understanding the phenomenon of "not giving in" seems to be crucial for nurses in helping women with breast cancer to mobilize the inner power to survive and develop as human beings.

Quality of life of women with systemic lupus erythematosus or rheumatoid arthritis: domains of importance and dissatisfaction.

The aim of this study was to increase understanding of the domains of life that are important to Swedish women with chronic rheumatic disease and to describe their dissatisfaction with these domains. Fifty women with Systemic Lupus Erythematosus (SLE) and 50 with Rheumatoid Arthritis (RA) were interviewed by telephone regarding their quality of life using five open-ended questions. Content analysis of their responses revealed nine categories: Health/wellness, Family/friends, Work, House/home/living environment, Social support/functional services, Hobbies/cultural activities, Sufficient income, Independence, Integrity/identity. Areas of importance correspond closely to those areas with which they were most dissatisfied. Although the domains identified in both groups were the same, SLE patients expressed more dissatisfaction with their perceived control over their bodies and understanding about their condition on the part of physicians and people in general. RA patients were more dissatisfied with areas of their lives that threatened their independence. Health care providers should be aware of these areas of dissatisfaction so that they can plan strategies to maximize patient quality of life.

To see or not to see. Perceptions of equality in a Swedish university hospital.

In order to examine the perceptions of sex equality among medical doctors (MDs) and registered nurses (RNs), a survey was conducted in a Swedish University Hospital in May 1995. A questionnaire was sent to 475 MDs and RNs of three different age groups. The results showed that women tend to have similar opinions irrespective of occupation and age, which differed significantly from those of men. Men believed that equality in general exists in the hospital, while women think the values and conditions in the workplace mainly benefit men. No evidence was found to indicate a change in the sex hierarchy within the health care system. Rather, the status quo will be maintained and gender stereotypes reinforced from one generation to the next.

Versatility--consequence of changing from mixed to all registered nurse staffing on a surgical ward.

BACKGROUND: Pressure on governments to reduce the costs of healthcare whilst improving the quality continue unabated throughout the developed world. As a consequence of budget cuts on a large Swedish University hospital, a decision to change from mixed nurse staffing to all registered nurses (RNs) in one surgical ward was made to evaluate if nursing costs could be reduced. AIM: This study was developed to gain a deeper understanding of the process of change in a hospital ward when all practical nurses were replaced by registered nurses. METHODS: A substantive theory was inductively derived, using a modified version of grounded theory methodology. FINDINGS: The change encouraged the nurses to become versatile. When the nurses adopted a patient focussed philosophy the content of their work changed and individualized care became possible. The versatility fostered a spirit of creativity, permitted a high degree of freedom of choice and increased the competence, but also led to some negative reactions in the form of complaints about weariness, lack of support and vulnerability with regard to the working environment. CONCLUSION: Versatility can be an opportunity for the nurses to expand their knowledge and develop nursing care but there is a risk that versatility results in weariness.

The professional identity of the nurse: concept analysis and development.

The aim of this paper is to highlight the concept of professional identity of the nurse in order to promote theoretical clarity and examine implications for nursing practice. A modification of the hybrid model for concept development was followed. Accordingly, the theoretical analysis of conceptualizations and corresponding theoretical frameworks were combined with empirical data gathered from the field, from semi-structured interviews with eight registered nurses. The sampling was strategic and continuous. Personal and interpersonal dimensions and socio-historical aspects of the concept were found in the literature review as well as in the interview data. Attributes, antecedents and consequences of professional identity of the nurse in relation to the identified dimensions were stated. The analysis ends with a comprehensive description of the concept. Further, the relations to the concepts of self-esteem, self-image, professionalism and professional self-image, as well as professional function and roles of the nurse, are outlined. Finally, the importance of the developed concept is discussed, and suggestions for further research are presented.

Elderly persons' social network and need for social support after their first myocardial infarction.

Social network and social support are phenomena suggested to be of importance to successful recovery from myocardial infarction. However, very few studies have been carried out, especially among the elderly, focusing on their social network and its ability to provide adequate support after myocardial infarction. The aim of this study was to examine elderly persons' social network and need for social support three months after their first myocardial infarction. The sample consisted of 128 persons between 65 and 94 years of age who answered a questionnaire. The results showed that the subjects, even the oldest ones, had an available social network and that they were satisfied with the support it provided. There was an increased need for social support after the myocardial infarction, especially for emotional support and appraisal, but also for instrumental aid and information. Despite these positive results indicating that elderly persons with myocardial infarction have a social network, whose members provide them with support, there may be a need for support also from persons outside this network. Assessment of social network characteristics and the need for social support as well as the provision of adequate information about additional support networks are important tasks for all health professionals.

Walking around in circles--the life situation of patients with asthma-like symptoms but negative asthma tests.

In-depth interviews were conducted with fourteen women with asthma-like symptoms but negative asthma tests. In collecting and analysing data the method of grounded theory was used. A core category emerged, Walking around in circles, and three main categories, Subjective Hyperreactivity, Social Limitations and Non Confirmation which elucidated the life situation and psychosocial processes involved in having the breathing disorder. The findings were characterised by numerous self-reinforcing vicious circles. The symptoms were especially associated with subjective hyperreactivity with strong sensitivity to odours, impaired ability to perform physical activities and mental stress, which in turn impose social limitations. These restrictions arouse feelings of social isolation and distress, which implies mental stress and thereby increased attention and sensitivity to adverse stimuli. The fact that the medical experts cannot offer diagnosis and treatment engenders feelings of confusion, non-confirmation and thereby anxiety which further aggravate the vicious circles described. Most informants considered that they had few coping strategies. Some stated that they had changed their strategies from being passive, taking no responsibility, to become more active, not caring about the reactions of others and taking the risk of being ill, favouring social contacts and thus minimising the impact of the disorder.

Patient advocacy--an essential part of quality nursing care.

In Sweden, patient advocacy has been the domain of "patient ombudsmen" employed exclusively for handling patient complaints. We were the first nurse researchers in Sweden to address the issue of patient advocacy as a part of nursing practice in three different research projects, based on narratives by nurses.

The family metaphor applied to nursing home life.

The family metaphor was applied to data from participant observations of 18 lucid nursing home patients in order to highlight how nursing home life influenced their experience of health. The instrumental activities in the nursing home were more routinised and specialised than in a family, but usually care was observed to be tender, loving and diligent. Further analysis revealed many factors, which may combine to disturb self-esteem and prevent efforts towards further maturation: loss of continuity to earlier self, collectivisation of activities, extreme dependence, embarrassing situations, child role, and constantly mild behaviour from staff.

"Catching my wavelength": perceptions of the excellent nurse.

The purpose of this article is to describe essential characteristics of an excellent nurse as perceived by women with breast cancer. A descriptive-exploratory research design was used, and 10 Danish women who had breast cancer surgery and treatment more than one year previously and who were still in secondary treatment but not hospitalized participated in semi-structured interviews. Four main concepts were identified: The excellent nurse was perceived as competent, compassionate, courageous, and concordant. Concordance was more important to the subjects than expected and was described as directly related to their perception of an excellent nurse and excellence in nursing.

Living with ulcerative colitis: experiences of adolescents and young adults.

The problems associated with ulcerative colitis and its treatment have effects on adolescents and young adults dissimilar from as well as more profound than those on older individuals. Adolescents are confronted with problems such as biological, psychological and social changes as well as role changes related to peers and family. This inductive study aimed to describe the adolescents' experiences of living with ulcerative colitis. A total of 28 subjects were asked about their experiences both at the present time and at the time their first symptoms appeared. Verbatim transcribed thematized interviews were analysed according to a method influenced by the constant comparative method for grounded theory. Eight categories were grounded in the data, forming a model which describes the process from onset of disease to present time. The main variable identified was: reduced living space, a strategy to manage the new situation. Dependent on the reactions received from significant others, the outcome for the adolescents hovered between feelings of self-confidence and lack of self-confidence. If the adolescents experienced support, the living space was expanded again. The results might be of great value when caring for and assisting young persons with a chronic disease in general, and in particular when taking care of adolescents with a recently diagnosed inflammatory bowel disease.

Deputed power of medical control: the hidden message in the ritual of oral shift reports.

The exchange of oral shift reports between nurses is a prominent part of the everyday routine in a hospital ward. Increased awareness of the more or less explicit functions of such communication is likely to have a positive impact on the nursing profession. Oral shift reports in a nursing care system based on task allocation were therefore observed and analysed. Using an ethnographic approach, reports were tape-recorded, and nurses were interviewed regarding their experiences. During the shift report session, the nurses were found to receive ritually mediated deputed power of medical control from their colleague, but little attention was paid to nursing needs and measures. The nurses clearly demonstrated that they were caught in a system dominated by a medical paradigm that effectively obstructed the progress of nursing as a professional discipline in its own right.

Cardiac nurses' preparedness to use self-help groups as a support strategy.

Self-help groups are lay, mutual support groups in which people who share some long-term existential problems in their lives meet regularly to support each other empathetically. These groups can be viewed as supplementary sources of support outside patients' existing social networks. As such, it is of importance to be aware of them when planning nursing care. The aim of this study was to examine cardiac nurses' preparedness to use self-help groups as a support strategy. A qualitative research method was used and 12 registered nurses from two coronary care units were interviewed. The findings showed that nurses knowledge of social support, self-help groups and of patients' social circumstances as well as their attitudes to their own roles as nurses were of importance in their preparedness to use self-help groups as a support strategy. Lack of knowledge of social support and self-help groups affected the nurses' attitudes towards lay care and was probably the reason for not using self-help groups as a support strategy. Most of the nurses were well informed about their patients' social circumstances, they had an explicit family nursing approach and were not at all against further expansion of their nursing role. However, there is a need for education in innovative ways of working that respond to and interact with informal support networks if nurses are to be able to contribute to empowerment of their patients.

[The caring moment and the "green thumb phenomenon" in Swedish nurses]. / Der "Pflegende Moment" (Caring Moment) und das "Grüne-Daumen-Phänomen" bei Pflegenden in Schweden.

The caring moment and the phenomenon of the green thumb for nursing in Sweden. People who have a special gift for gardening are sometimes described as having a green thumb. Likewise, some nurses have a green thumb for nursing. The aims of this study were to identify and describe the characteristics of green-thumb nurses and of caring situations. A descriptive-exploratory design was used and 16 nurses, recruited by their superiors, participated in semi-structured interviews. The findings revealed that the green-thumb nurse is competent, compassionate, and courageous. The essence of the caring moment was identified as the green-thumb nurse's ability to act on the spur of the moment, using her competence, compassion, and courage.

Social support in self-help groups, as experienced by persons having coronary heart disease and their next of kin.

Self-help groups related to coronary heart disease constitute a network for support in which the members of the group have the opportunity both to receive and provide social support. The purpose of this study was to reach in-depth information from group members about lived experience of social support in a self-help group. A qualitative research method influenced by phenomenology was used and the findings showed a pattern of social support that can be described as a sharing of experience among confident equals, thanks to mutual feelings of caring and belonging, which in turn strengthens confidence. The group members' experience of social support show that the group constitutes a cornerstone in a network for support and contributes to well-being, coping ability and a build up of confidence at the prospect of a more promising future.