Experiences of suffering among elderly hip-fracture patients during the preoperative period: patients' and nurse's perspective.

BACKGROUND: In Norway, 6000 patients were operated on due to hip fracture in 2016. Hip fracture results in increased suffering and often in a dramatic change in an older person's life. The experience of suffering in patients with hip fracture, or nursing staff's perception of it in the preoperative period, is sparsely studied. The perspective of the study was based on caring sciences. AIM: The aim of this study was to gain a deeper understanding of subjective experiences of suffering among elderly hip-fracture patients during the preoperative period, seen from the patients' and nurses' perspective. METHODOLOGICAL APPROACH: A Q-methodological approach was used. Forty statements (Q-sample), based on interviews and theory, were ranked in a forced-choice distribution curve from 'mostly agree' to 'mostly disagree', followed by postinterviews. Nine patients and five nurses participated. A by-person factor analysis in the form of principal component analysis with varimax and hand rotation was conducted. RESULTS: Three factors, also called viewpoints, emerged as follows: (i) 'Feeling safe through presence, trust and hope'; (ii) 'Feeling safe occurs when the patient is seen, met and informed'; and (iii) 'Feeling alone and angry at oneself'. A polarisation between participants occurred, since the youngest patients (median age 73), the oldest patients (median age 90) and the nurses were represented in each specific factor. CONCLUSION: There exist differences between how the nursing staff, the youngest and the oldest elderly patients experienced the preoperative period and what can enhance or alleviate their suffering. Where the youngest elderly communicated safety through trust and relatives' presence, the oldest elderly communicated insecurity in relation to staff and experienced severe pain and loneliness. Nursing staff and one patient emphasised the importance of seeing the patient in the first meeting to establish a feeling of security.

Views concerning patient dignity among relatives to patients experiencing psychosis.

BACKGROUND: Mental illness influences not only the suffering patient but often changes family life forever and results in experience of reduced dignity for both patients and relatives. AIM: The aim of this study was to reveal relatives' opinions regarding what is important for taking care of patients' dignity. PARTICIPANTS: Thirteen relatives of patients experiencing psychosis were recruited through a relatives' user organisation. RESEARCH DESIGN: The methodological approach is Q methodology. A Q sample of 51 statements was sorted in a quasinormal distribution curve. Postinterviews were conducted with all participants. RESULTS: Four viewpoints emerged described as 'value based', 'expectations', 'asymmetric' and 'nuanced'. CONCLUSION: Focus on overarching values such as honesty and respect, to involve patients and relatives in care, by reducing asymmetry between patients and staff, with staff taking total responsibility for a patient's situation when needed, all represent aspects of taking care of patient dignity.

The significance of small things for dignity in psychiatric care.

BACKGROUND: This study is based on the ontological assumption about human interdependence, and also on earlier research, which has shown that patients in psychiatric hospitals and their relatives experience suffering and indignity. AIM: The aim of this study is to explore the experience of patients and relatives regarding respect for dignity following admission to a psychiatric unit. RESEARCH DESIGN: The methodological approach is a phenomenological hermeneutic method. PARTICIPANTS AND RESEARCH CONTEXT: This study is based on qualitative interviews conducted with six patients at a psychiatric hospital and five relatives of patients who experienced psychosis. ETHICAL CONSIDERATION: Permission was given by the Regional Committee for Medical Research Ethics in Western Norway, the Norwegian Data Protection Agency and all wards within the hospital in which the patients were interviewed. FINDINGS: The analysis revealed one main theme: 'The significance of small things for experiencing dignity' and four subthemes described as follows - 'to be conscious of small things', 'being conscious of what one says', 'being met' and 'to be aware of personal chemistry'. DISCUSSION AND CONCLUSION: Staff members seem not to give enough attention to the importance of these small things. Staff members need to explore this phenomenon systematically and expand their own understanding of it.

Suffering related to dignity among patients at a psychiatric hospital.

This article discusses dignity from a Q-methodological study among patients at a psychiatric hospital. The aim of this study is to gain a deeper understanding of the subjective experiences of patients in a psychiatric hospital with respect to dignity. A Q-sample of 51 statements was developed. A total of 15 participants ranked these statements from those they most agreed with to those they most disagreed with. Post-interviews were also conducted. Principal Component Factor Analysis and varimax rotation followed by hand rotation produced the clearest results. Four different viewpoints emerged: being met as equal human being, experience of dignity despite suffering, suffering due to inferior feelings and suffering and fighting for one's own dignity. There seem to be variations in those with dignity-promoting experiences in Viewpoint 1 and to some extent in Viewpoint 2, to those with dignity-inhibiting experiences in Viewpoints 3 and 4.