Emily's struggle for dignity: An idiographic case study of a woman with multiple sclerosis.

Dignity is one of the essential values and central concepts in nursing care. Dignity can be threatened due to radical life changes; therefore, this idiographic case study aimed to explore the sense of dignity experienced by a woman with multiple sclerosis. An interpretative phenomenological analysis was adopted, using data collected through a face-to-face semistructured interview with Emily, a 45-year-old woman. The study was approved by the local ethics committee. Six personal experiential themes were identified: To be ruled by a sick body; Silent progression; Loss of independence as a burden for the family; Will to fight for the meaning of life; Maintaining dignity-in-relation; Dignified care in a period of greater vulnerability. Emily's dignity is based on the effort to fight for a meaningful life, utilization of her full potential, maintain independence in activities of daily living and support in relationships. Continuous changes in functional ability, loss of self-control and an uncertain future have a negative impact on the experience of her dignity. In the context of dignified health care, she considers individual care and maintaining autonomy important. The idiographic case study can contribute to a better understanding of the experience of a woman suffering from multiple sclerosis. It is possible to carry out interventions that aim to support her dignity, improve her quality of life and contribute to individually oriented health care.

Trust in healthcare professionals of people with chronic cardiovascular disease.

BACKGROUND: Trust is an essential phenomenon of relationship between patients and healthcare professionals and can be described as an accepted vulnerability to the power of another person over something that one cares about in virtue of goodwill toward the trustor. This characterization of interpersonal trust appears to be adequate for patients suffering from chronic illness. Trust is especially important in the context of chronic cardiovascular diseases as one of the main global health problems. RESEARCH AIM: The purpose of the qualitative study was to gain a deeper understanding of how people with chronic cardiovascular disease experience and make sense of trust in healthcare professionals. RESEARCH DESIGN: Eleven semi-structured interviews with participants analysed using interpretative phenomenological analysis to explore in detail their lived experience of trust as a relational phenomenon. PARTICIPANTS AND RESEARCH CONTEXT: Participants with chronic cardiovascular disease were purposively recruited from inpatients on the cardiology ward of the university hospital located in central Slovakia. ETHICAL CONSIDERATIONS: The study was approved by the faculty ethics committee. Participants gave their written informed consent. FINDINGS FOUR INTERRELATED GROUP EXPERIENTIAL THEMES: Sense of co-existence; Belief in competence; Will to help; Ontological security with eight subthemes were identified. The findings describe the participants' experience with trust in healthcare professionals as a phenomenon of close co-existence, which is rooted in the participants' vulnerability and dependence on the goodwill and competence of health professionals to help with the consequence of (re)establishing a sense of ontological security in the situation of chronic illness. CONCLUSION: Findings will contribute to an in-depth understanding of trust as an existential dimension of human co-existence and an ethical requirement of healthcare practice, inspire patient empowerment interventions, support adherence to treatment, and person-centred care.

Nurses' Perception of Professionalism in Practice: A Review of Qualitative Studies.

Professionalism is a fundamental concept in nursing and a central aspect of nursing care. The review aimed to synthesize evidence presented in qualitative studies related to the perception of professionalism in nursing practice. Six main analytical themes were generated from primary studies included in the literature review: everyday practice, ethical aspects of nursing care, nurses' identity, nurses' professional growth, achieving autonomy, complexity of relationships. Presented themes are considered key elements of nursing professionalism, are closely interconnected, and support the multidimensional structure of professionalism in nursing. Nursing professionalism means providing high-quality care while upholding the values of integrity, accountability, and respect.

An interpretative phenomenological analysis of dignity in people with multiple sclerosis.

BACKGROUND: Dignity is a fundamental concept in healthcare. The symptoms of multiple sclerosis have a negative effect on dignity. Understanding of lived experience of dignity in people with multiple sclerosis is crucial to support dignity in practice. RESEARCH AIM: The aim was to explore the sense of dignity experienced by people with multiple sclerosis. RESEARCH DESIGN AND PARTICIPANTS: An interpretative phenomenological analysis design was adopted, using data collected through face-to-face interviews with 14 participants. ETHICAL CONSIDERATIONS: The study was approved by the faculty Ethical Committee (No. EC 1828/2016). FINDINGS: Four interconnected superordinate themes emerged from analysis: Loss of a fully-fledged life: Violating the dignity-of-self; To accept and fight: Promoting the dignity-of-self; Contempt and rudeness: Indignity-in-relation; and Those who know and see, help: Promoting dignity-in-relation. The loss of former fully-fledged life has a dramatic impact on integrity and impaired dignity-of-self. Accepting illness and changed identity impaired by multiple sclerosis was the step that the participants considered to be important for reacquiring the sense of dignity. The participants encountered misunderstandings, prejudices, embarrassment, insensitive remarks, labelling, unwillingness and impersonal treatment as indignities. Acceptance of their condition, needed support, the feeling of being part of a group, sensitivity and the sharing of problems had a positive effect on their dignity. DISCUSSION: Continual changes in functional ability threaten an individual's identity and were experienced as violations of dignity. Based on this, participant's dignity-of-self was not a moral, but much more existential value. Acceptance of changed identity and fighting spirit were important for restoring their dignity-of-self. The misunderstandings, prejudices and unwillingness had a negative impact on their dignity-in-relation. On the other side, support from others in fighting promoted their dignity-in-relation. CONCLUSION: Dignity is manifested as a complex phenomenon of lived experience of people with multiple sclerosis and also an umbrella concept for providing good quality of person-centred care.

Dignity from the nurses' and older patients' perspective: A qualitative literature review.

INTRODUCTION: Dignity is one of the most important values sensitively perceived by patients in nursing care. Older patients have been identified as having a high risk of losing their dignity in institutional care. To promote optimum nursing care, a deeper insight into the problem of older patients' dignity is needed. AIM: The aim was to identify, analyse and synthesise the qualitative evidence of dignity views and factors affecting it from the nurses' and older patients' perspective in the context of nursing care and to compare synthesised finding from the both perspective. METHODS: A literature review of qualitative evidence was chosen as a study design. The ENTREQ statement was implemented to enhance transparency. The CASP - Qualitative checklist and the thematic synthesis for synthesised findings were used. The electronic databases Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE and PROQUEST were used to gather information for qualitative studies. RESULTS: A total of 306 papers were retrieved. Fourteen qualitative studies met the inclusion criteria and were included in the review after methodological quality assessment using CASP. Four main themes of dignity from nurses' perspective were synthesised: seeing the patient as a unique person, communication and privacy, involving the patient, and working culture and environment. From the patients' perspective, six main themes were synthesised: autonomy and control, privacy, relationships, care and comfort, communication and identity. The comparison shows that the key difference is that older patients highlighted the theme relationships and nurses underlined the theme working culture and environment. CONCLUSION: The model structures of the older patients' dignity from both the nurses' and patients' perspectives support the idea of a multidimensional structure of human dignity. The resulting model might be used in a nursing self-reflection, in the management of the institutions providing all-day care for the older people and in the education and practice.

The personal active aging strategies of older adults in Europe: a systematic review of qualitative evidence.

BACKGROUND: There is a consensus that the aging population is beginning to impact on many facets of our life. They have more medical problems and the potential to "drain" the focus of the medical community, as well as national budgets with their accompanying medical bills. Personal strategies related to active aging will help us to better understand and identify how older adults in Europe prepare themselves for the natural process of aging and what are their personal approaches to active aging. OBJECTIVES: The objective of this review was to synthesize the best available evidence regarding the older adult's perspective on the personal strategies related to active aging among older adults in Europe. INCLUSION CRITERIA TYPES OF PARTICIPANTS: This review considered studies that included older adults (age over 55 years) who live in Europe. PHENOMENA OF INTEREST: This review considered studies that investigated older adults' perspectives on (any) personal strategies related to active aging. CONTEXT: Europe (considering "some similarity" in health care systems and retirement policies). TYPES OF STUDIES: This review considered any qualitative designs. SEARCH STRATEGY: A three-step search strategy was used to identify published and unpublished studies. The extensive search process was conducted in October 2014 and considered published and unpublished studies from the inception of databases until October 2014. Studies published in any language which had an abstract in English, Czech and Slovak languages were considered for inclusion in this review. METHODOLOGICAL QUALITY: Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION: Data were extracted from the papers included in the review by two independent reviewers using the standardized JBI-QARI data extraction tool. DATA SYNTHESIS: Data synthesis was performed using the meta-aggregation approach of meta-synthesis recommended by the Joanna Briggs Institute. RESULTS: Fourteen studies were included in this systematic review. From these 14 studies, 42 findings were extracted; findings were synthesized into four categories: (1) positive approach to life, (2) mental, social and physical activities, (3) adaptation, and (4) financial independence. Categories were synthesized into two synthesized findings: (1) if older adults adapt to changing situations and choose a positive attitude, they can find an active way to live and also a mission and meaning in their lives, (2) if older adults learn new activities, participate in exercise, keep balanced relationships and manage their financial resources, they will stay mentally, socially and physically active, and also financially responsible. CONCLUSIONS: If older Europeans learn new activities, participate in exercise, keep balanced relationships and manage their financial resources, they will stay mentally, socially and physically active, and also financially responsible.

Content validation of the nursing diagnosis acute pain in the Czech Republic and Slovakia.

PURPOSE: The main purpose of the study was to validate the defining characteristics of the nursing diagnosis acute pain in the Czech Republic and Slovakia. METHODS: This is a descriptive study. The validation process involved was based on Fehring's diagnostic content validity model. FINDINGS: Four defining characteristics were classified as major by Slovak nurses and eight defining characteristics were classified as major by Czech nurses. CONCLUSION: Validation of the nursing diagnosis acute pain in the Czech and Slovak sociocultural context has shown that nurses prioritize characteristics that are behavioral in nature as well as patients' verbal reports of pain. PRACTICE IMPLICATIONS: Verbal reports of pain and behavioral indicators are important for arriving at the nursing diagnosis acute pain.

Content validation of hopelessness in Slovakia and Czech Republic.

PURPOSE: The purpose of this study was to validate the content of nursing diagnosis hopelessness in Slovak and Czech social and cultural contexts. METHODS: The Fehring's Diagnostic Content Validity Model was used to measure the importance of diagnostic characteristics of hopelessness. FINDINGS: Only three NANDA characteristics and five Nowotny Hope Scale characteristics have reached the value of weighted average of the scores for defining characteristics. CONCLUSION: NANDA characteristics are concerned with the affective-behavioral dimension of hopelessness. Nowotny Hope Scale characteristics that reached high importance in our study are concerned with its cognitive-temporal dimension. IMPLICATIONS FOR NURSING PRACTICE: The defining characteristics of hopelessness identified in our study could be tested in the development of instrument to measure hope in clinical practice.

Quality of life and treatment satisfaction in the context of diabetes self-management education.

The aim of this study is to identify and compare factors affecting quality of life and treatment satisfaction in people attending the structured educational programme for patients with intensified insulin therapy. A sample of 104 patients was recruited from diabetes specialized centre between November 2006 and March 2007. For measure patient's quality of life, the Audit Diabetes Dependent Quality of Life questionnaire and for measure patient's satisfaction with their treatment regimen, the Diabetes Treatment Satisfaction Questionnaire status version was used. Treatment satisfaction has different variables or predictors from quality of life. Quality of life was affected by the number of reported diabetic late complications, type of insulin regimen, age and diabetes duration. Type of insulin regimen, the frequency of blood glucose self-monitoring and perceived frequency of hyperglycaemia demonstrated the significant association with treatment satisfaction. Our findings might help health-care professionals have a deeper understanding of the factors affecting quality of life and treatment satisfaction and thereby aid in the design of strategies to maintain or improve quality of life and treatment satisfaction.