The living experience of surviving out-of-hospital cardiac arrest and spiritual meaning making.

AIM: To understand the meaning of surviving out of hospital cardiac arrest and its aftereffects among Greek-speaking survivors. DESIGN: Hermeneutical phenomenological method based on Martin Heidegger's philosophy. METHODS: Eight Greek-speaking out of hospital cardiac arrest survivors were recruited using purposive sampling method. Data collection and analysis using the seven stages of hermeneutic analysis described by Diekelman. Data were collected through semi-structured personal interviews with open-ended questions. RESULTS: Analysis revealed five themes: 'The unexpected attack', 'Experiencing a different world: Transformation of Body, Time, Emotion and Sensation', 'Restoration of the re-embodied self', 'Life transformation' and 'Personal transformation'. The themes are commensurate with transcultural components of Near-Death Experiences. Surviving out of hospital cardiac arrest was perceived as a 'divine gift' and a chance to continue 'living in a more conscious and meaningful way'. Despite participants' physical and psychosocial challenges, the narratives highlighted a newly acquired deep appreciation for the joy of life, living and others. Construction of meaning and a heightened spirituality seem central in reconstructing life after out of hospital cardiac arrest survivors. PATIENT OR PUBLIC CONTRIBUTION: Out of hospital cardiac arrest survivors reflected and described in-depth on their lived experiences of out of hospital cardiac arrest through a 60- to 90-min interview. In addition, the participants provided their feedback on the interpretation of the findings, confirmed the study findings, and ensured that the analysis reflected aspects of their individual experiences and were true to them.

Perceptions of critical and emergency department nurses regarding changes in their professional role.

Objective Preliminary investigation of the way Greek critical and emergency department nurses conceptualize changes in their professional role. Method A qualitative focus-group methodology was applied. Following purposeful sampling and informed consent of participants. Results Participated eight individuals. The need for enhancement of nurses' participation in decision-making in order for an actual change in their professional role to be achieved was the central theme of participants' narratives. Perceived advancements in professional role performance regarded: evidence-based practice; technology; education, knowledge; clinical skills; research; heightened nurse-physician collaboration. Perceived reasons why these advancements failed to enhance nurses' professional role were lack of meritocracy; competitive relationships; lack of support among nurses; insufficient managerial support; budget limitations. Conclusion Despite advancements in clinical practice, participants did not deem that their professional role was enhanced significantly, as participation in decision-making and control over practice remain limited. Interventions targeted to enhance nurses' participation in clinical decision-making, and overall professional autonomy are recommended.

Perceptions of critical and emergency department nurses regarding changes in their professional role / Percepção dos enfermeiros dos serviços críticos e de emergência em relação a mudanças no seu papel profissional / Percepciones de enfermeros en el departamento crítico y de emergencia en lo que se refiere a cambios en su papel profesional

ABSTRACT Objective Preliminary investigation of the way Greek critical and emergency department nurses conceptualize changes in their professional role. Method A qualitative focus-group methodology was applied. Following purposeful sampling and informed consent of participants. Results Participated eight individuals. The need for enhancement of nurses' participation in decision-making in order for an actual change in their professional role to be achieved was the central theme of participants' narratives. Perceived advancements in professional role performance regarded: evidence-based practice; technology; education, knowledge; clinical skills; research; heightened nurse-physician collaboration. Perceived reasons why these advancements failed to enhance nurses' professional role were lack of meritocracy; competitive relationships; lack of support among nurses; insufficient managerial support; budget limitations. Conclusion Despite advancements in clinical practice, participants did not deem that their professional role was enhanced significantly, as participation in decision-making and control over practice remain limited. Interventions targeted to enhance nurses' participation in clinical decision-making, and overall professional autonomy are recommended.

RESUMO Objetivo Investigar preliminarmente a forma como os enfermeiros gregos de enfermagem crítica e de emergência conceituam as mudanças no seu papel profissional. Método Aplicou-se metodologia qualitativa de grupo focal. Após amostragem intencional e consentimento informado dos participantes. Resultados Participaram oito indivíduoas. A necessidade de reforçar a participação dos enfermeiros na tomada de decisões para que uma mudança real no seu papel profissional fosse alcançada foi o tema central das narrativas dos participantes. Avanços constatados no desempenho profissional: prática baseada em evidências; tecnologia; educação, conhecimento; habilidades clínicas; pesquisa; profunda colaboração enfermeiro-médico. As razões pelas quais esses avanços não conseguiram reforçar o papel profissional dos enfermeiros foram falta de meritocracia, relações competitivas, falta de apoio entre enfermeiros, apoio hierárquico insuficiente e limitações orçamentárias. Conclusão Apesar dos avanços na prática clínica, os participantes não consideraram que seu papel profissional foi aumentado significativamente, uma vez que a participação na tomada de decisões e no controle de sua prática permanece limitada. São recomendadas intervenções destinadas a reforçar a participação dos enfermeiros na tomada de decisões clínicas e a aumentar a sua autonomia profissional.

RESUMEN Objetivo Investigación preliminar acerca de la manera cómo los enfermeros griegos del departamento crítico y de emergencia conceptualizan los cambios en su papel profesional Método Una metodología de grupo focal cualitativa fue aplicada. Previo muestreo significativo y consentimiento informado de los participantes. Resultados Ocho individuos participaron. La necesidad de mejora de la participación de los enfermeros en la toma de decisiones a fin de proporcionar un cambio real en su papel profesional fue el tema central de las narrativas de los participantes. Avances percibidos en el papel estimado de desempeño profesional; prática basada en evidencias; tecnología; educación, conocimiento; habilidades clínicas; investigación; colaboración intensificada enfermero-médico. Razones percibidas por las que dichos avances fallan en mejorar en papel profesional del enfermero fueron la falta de meritocracia; relaciones competitivas; falta de apoyo entre los enfermeros; insuficiente soporte de gestión; limitaciones presupuestarias. Conclusión Pese a los avances en la práctica clínica, los participantes no consideran que su papel profesional haya mejorado significativamente, puesto que la participación en la toma de decisiones y su control sobre la práctica permanecen limitados. Se recomiendan intervenciones con vistas a incrementar la participación enfermera en la toma de decisiones clínicas e una autonomía profesional general.

The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study.

BACKGROUND: Research evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way. METHODS: A qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews. RESULTS: Several main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants' perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants. CONCLUSIONS: The present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.

'The patient is my space': hermeneutic investigation of the nurse-patient relationship in critical care.

BACKGROUND: The nurse-patient relationship has been postulated to lie at the core of nursing care. However, it is unclear how this concept applies in critical care, as a great majority of critically ill patients are unable to communicate. AIMS: Through a phenomenological hermeneutical perspective, we aimed to explore intensive care nurses' perceptions and meanings regarding their interpersonal relationship with critically ill individuals. METHODS: A Heideggerian hermeneutical approach was used to design the study and analyse the data, which were collected through repetitive interviews with 12 intensive care nurses. RESULTS: Critical care nurses report to experience deep relationships with patients, which seem to be mediated by the ongoing contact with patients' bodies. These relationships evoke intense feelings of love, empathy and care and affect how nurses perceive and make sense of their role and their world. The identified core theme of their experience is entitled 'syncytium', which describes a network of closely connected cells. According to participants' perceptions, nurse and patient affect each other reciprocally and are mutually dependent upon each other. In Heideggerian terms patients provide nurses with opportunities to experience 'authentic care' and they participate in their 'being-in-the-world', thus they are central in nurses' meanings about their role and existence. Other elicited themes that account for the perceived nurse-patient relationship include the spatiality/temporality of the relationship, nurses' perceptions and meanings attributed to their role and nurses' perceptions of death. CONCLUSIONS: Critical care nurses appear to experience their relationships with patients intensely. These relationships are invested with meanings and elicit powerful feelings over a shared course with patients. Patients are central in nurses' meaning-making process and role perception. RELEVANCE TO CLINICAL PRACTICE: These findings have implications for the educational preparation of critical care nurses and their psychological support.