Beyond objective measurements: Danish nurses' identification of hospitalized pediatric patients at risk of clinical deterioration - A qualitative study.

PURPOSE: While the use of Pediatric Track and Trigger Tools as a standard to discriminate high level of urgency in pediatric care has received considerable attention, less focus has been given to other important factors such as nurses' clinical observations and judgement. The purpose of this study was to explore nurses' observational practice and focus on which non-measurable signs and symptoms nurses find important when identifying inpatient pediatric patients at risk of clinical deterioration. DESIGN AND METHODS: This was an inductive qualitative study based on an interpretive description methodology. Data were obtained through participant observation of experienced nurses working in a Danish pediatric unit and focus group interviews with pediatric nurses. Field notes were taken, and focus group interviews were audio taped and transcribed. A thematic text condensation method was used to analyse data. RESULTS: Findings revealed the following four main themes of non-measurable signs and symptoms that nurses find important when identifying children at risk of clinical deterioration: Colour and skin tone; sounds; movement patterns; behavioural signs. CONCLUSIONS: This study suggest that pediatric patients show signs and symptoms that go beyond the objective measurements integrated in Pediatric Track and Trigger Tools and they should not be ignored as they are highly valuable to nurses who are responsible for observing inpatient pediatric patients at risk of clinical deterioration. IMPLICATIONS: More empirical research on nurses' observational practice is recommended, especially research to identify the signs and symptoms - both measurable and non-measurable - that are significant to nurses at the bedside.

Multiple perspectives and dialogue in understanding experiences of living with eating disorders: Two narratives-four unpackings.

BACKGROUND: This is a response to Conti et al.'s article, "Listening in the dark: why we need stories of people living with severe and enduring anorexia nervosa" (published in JED, 2016), and its call for relational metaphors and a relational approach to supplement the traditional medical/psychological diagnostic language used to describe the life experiences and complex emotions of people affected by an eating disorder. METHODS: Four authors with different backgrounds unpack two narratives, 'The Prima Donna with the Green Dress' and 'Breaking down the Wall', both narrated during fieldwork in multifamily therapy. The narratives are unpacked from the perspective of a therapist within multifamily therapy, a researcher who conducted the fieldwork, a researcher based in phenomenology and a researcher based in narrative inquiry. The authors enter into dialogue with the narratives, and with each other. RESULTS: The four authors focus on different elements within the narratives and understand them differently. One, focuses on strength and pride, and art expression as a different form of language for people living with an eating disorder. Another, on the experience of isolation, boundaries, and balancing openness and closedness. A third, sees the narratives as expressing a wish to see and be seen, and the fourth focuses on the absence of, and longing for, a shared space to explore. CONCLUSION: The aim is not to reach a correct or shared interpretation of the narratives but to explore how different perspectives may contribute to different insights, not only about one family in particular but about, more generally, the experiences of people living with an eating disorder. Our work shows the significance of engaging with multiple perspectives and dialogue as supplements to the traditional medical/psychiatric diagnostic language in both clinical practice and research.

In this article, four authors read and unpack two narratives from fieldwork in a multifamily therapy programme for adults with a severe eating disorder. The authors have different professional, theoretical and methodological backgrounds. The aim is not to reach a shared understanding of the narratives, but rather to explore how different perspectives contribute to different insights. Multiple perspectives and dialogue may shed light on people's experiences of living with a severe eating disorder in both clinical practice and research.

Invisible but sensible aesthetic aspects of excellence in nursing.

Based on a Lived Experience Description written by an experienced nurse in Denmark, this article offers an ontological and existential-phenomenological exploration of aesthetic dimensions of excellence in nursing. In the research of Patricia Benner and colleagues, excellence in nursing is described as a matter of intuitive pattern recognition based on clinical experience and narrative understanding. In this article, and based on phenomenological reflections and philosophical inspirations from the Danish philosopher Dorthe Jørgensen and the French philosopher Maurice Merleau-Ponty, I suggest an extended understanding of excellence in nursing, and I argue that the work and research of Benner seem to overlook ontological and aesthetic aspects of excellence in nursing. This article argues that aesthetic aspects of excellence in nursing can be comprehended as moments where nurses sense a surplus of meaning and moments where the nurse and the patient share and are subjected to communal and unfolding life phenomena. Aesthetic dimensions of being in nursing can, from an ontological approach, best be described as similar to the way human beings listen to a piece of music or to how artists try to give a voice to the world: as a resonant way of being and becoming within the moment.

The essence and meaning of aesthetics in patient care as experienced by nurses: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: This systematic review seeks to identify, appraise and synthesize available qualitative studies describing nurses' experiences of the essence and meaning of the phenomenon "aesthetics" in patient care.The specific purpose of the review is to examine the qualitative literature to describe nurses' experiences of the phenomenon "aesthetics" within patient care in healthcare settings.More specifically, from the nurses' perspectives, the aims are.