Patients with haematological diseases are entitled to supportive care. Considering organisational and technological development, support in the form of caring communication provided through the web is today a possible alternative. The aim of this thesis was to examine the usefulness and importance of a web-based counselling service to patients with haematological diseases. The basis for the thesis was a development project funded by the Swedish Cancer Society, which provided an opportunity to offer patients communication with a nurse through a web-based counselling service. Four studies were performed from a patient perspective. Study I had a cross-sectional design, measuring occurrence of anxiety and depression, and these variables’ associations to mastery, social support, and insomnia among patients with haematological diseases. Study II was a qualitative content analysis focusing on conditions for provision and use of the web-based counselling service. Study III used a qualitative hermeneutical approach to focus on patients’ experiences of using the counselling service. Study IV was a qualitative deductive analysis examining how communication within the web-based counselling service can be caring in accordance to caring theory. The results revealed that females of 30-49 years of age are vulnerable to experiencing anxiety. Low sense of mastery and support are associated with anxiety and/or depression. Being able to self-identify the need for support as well as appreciate the written medium are necessary conditions for the web-based counselling service to be used. The counselling service must also be part of a comprehensive range of supportive activities and web-based services to be useful. The main importance of the communication is that the patient’s influence on the communication is strengthened, and that the constant access to individual medical and caring assessment can imply a sense of safety. When patients share their innermost concerns and search for support, nursing compassion and competence can substantiate in explicit written responses. A conclusion is that there is a caring potential in communication within a web-based counselling service. To make this form of communication possible, nurses should take possession of and ensure that this medium for communication is offered to patients. Nurses should also increase their knowledge of caring communication in writing and how this possibly can impact patients.

The principles of integrative nursing and caring science align with the unitary paradigm in a way that can inform and shape nursing knowledge, patient care delivery across populations and settings, and new healthcare policy. The proposed policies may transform the healthcare system in a way that supports nursing praxis and honors the discipline’s unitary paradigm. This call to action provides a distinct and hopeful vision of a healthcare system that is accessible, equitable, safe, patient-centered, and affordable. In these challenging times, it is the unitary paradigm and nursing wisdom that offer a clear path forward.

The nature of jobs is changing as the global economy force organizations to become competitive and more of a virtual organisation of which the focus is more on team work. It is natural to look after the sick, elderly, disabled and children though those who care for these people tend to be forgotten. This study is an investigation of one of these informal caregivers. The roads on this journey (study) with the various cross-roads, intersections, paths and tracks were explored by means of multiple qualitative approaches. The respondent received an active role to voice her story as transcribed in her diaries. She deconstructed it accordingly of which the complexities thereof was holistically processed by means of Gabek (GAnzheitliche BEwältigung von Komplexität – a holistic processing of complexity). The uniqueness of this story can not necessarily be generalised though it can be used to prospectively identify the needs of the respondent. This can lead to adverse research outcomes associated with caregiving and target them for a prevention-focused intervention for others. This will help employers and employees in the art of balancing family responsibilities and workplace outputs. / AFRIKAANS : Die aard van werk verander voortdurend namate die wêreldwye ekonomie organisasies dwing om al meer kompeterend mee te ding en ‘n spanbenadering te volg. Om siekes, oues van dae, kinders en gestremdes te versorg, is ‘n normale verantwoordelikheid in die samelewing, maar die versorgers self word afgeskeep. Hierdie studie fokus op die verhaal en belewenis van sodanige versorger. Die bane van die ondersoekreis met hulle verskeie kruispaaie, kruisings en spore is via veelvuldige kwalitatiewe weë ondersoek. Die respondent in die ondersoek het 'n aktiewe rol ingeneem om sodoende haar verhaal te verwoord deur middel van die dekonstruksie van haar dagboek. Die verweefde dinamiek hiervan is holisties prosesseer via die GABEK metodiek (GAnzheitliche BEwältigung von Komplexität –'n holistiese prossesering van kompleksiteit). Weens die uniekheid en subjektiwiteit van die verhaal, kan die spesifieke uitkomste hiervan nie noodwendig veralgemeen word nie, maar kan die behoeftes van die spesifieke informele versorger uitgewys word. Dit kan die weg baan vir wyer navorsing en moontlik lei tot sinvolle intervensie aan ander informele versorgers. Dit sal werkgewers en werknemers help in die fyn kuns om gesinsverantwoordelikhede en werksplek-uitsette sinvol te kan balanseer. / Dissertation (MCom)--University of Pretoria, 2010. / Human Resource Management / unrestricted

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The concept of caring is reported to be an important factor in the teacher-student relationship. However, this concept has not been widely explored in the context of the teacher-student relationship in physical education. The purpose of this study was to gain insights into students' perceptions of physical education teachers' caring. The researcher sought to describe the perceptions students had in regard to caring behaviors exhibited by their physical education teachers. Twelve eighth-grade students from a local middle school in Southwest Virginia participated in this study. The research questions were investigated using a qualitative research design that included semi-formal interviews and field observations. The results indicated that multiple opportunities existed for the physical education teachers to demonstrate caring behaviors toward their students. The students described their perceptions of physical education teachers' caring along dimensions of content and pedagogy and interpersonal relationships. The researcher determined that factors existed that facilitated and presented barriers to the caring process. Facilitators of caring in physical education included the nature of the class, flexibility in teacher expectations, and class activities. Barriers to caring were revealed as length of time with the teacher, student personalities, role of the teacher/coach, and class size. Furthermore, physical education teachers' caring was determined to be a positive factor in students' attitudes toward physical education and their participation in physical education class. The results did not indicate a clear pattern of responses based on the skill level of each participant. Directions for future research on the concept of caring as it relates to physical education are discussed. / Ph. D.

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Narratives are used to explore personal beliefs and assumptions about caring in one's personal and professional life. This dissertation recognizes the process of caring is interpretative and evolves from personal experience. I address issues of caring within the practice of nursing and nursing education from a feminist perspective. I begin with my own personal narrative in which I seek to uncover my own caring essence as a basis for inquiring into issues of caring and feminism in nursing education. Theoretical constructs from educational nursing and feminist literature are explored to develop a personal model of caring within nursing education. Nursing students must be educated within a caring learning environment so they can develop a caring stance with patients. Dialogue within teacher-student interaction is at the center of such an environment. This dialogue encourages authentic presence with students that leads to an intuitive knowing. Nursing students need to learn to let their intuitive sense guide the use of technology. Of course, that means educating their intuitions. Autobiographical vignettes are used to reflect on the experience of a nurse educator as caring guides teaching-learning activities in a nursing curriculum. Caring within clinical teaching encourages reflection and increases self-awareness. Clinical teaching is seen as an opportunity to unite theory and practice. It encourages students to be receptive to patients and places value on contextual experiences. An examination of contextual experience shows that care is relational and encourages connections with others. Care is sustained through relationships that give voice to nursing students and patients. This process of giving voice makes caring more visible to others. This visibility allows nurses to celebrate caring occasions and validates worth of caring in nursing. Caring practices within nursing education help students recognize the power within themselves to institute change. Nurse educators must encourage students to care for themselves. This process will help them stay in touch with what they need as individuals as they provide care to others. / Ph. D.

The purpose of this research was to understand the meaning of caring as narrated, lived, moral experience. Forty-five good nurses experienced in the care of patients in surgical, medical and geriatric wards were interviewed. They described their experience of; caring, caring abilities, the worthwhile of caring, the strength related to caring and narrated situations (n=88) in which they had experienced that their caring had made a difference to the patient. Surgical nurses described care and cure as an integrated whole, medical nurses described care as integrated with the patients' social context and geriatric nurses described care as enhancing the autonomy of patients (I). The nurses' narrated, lived, experiences of caring situations revealed ways of intervening and interacting with the patient including caring actions (II). Eighteen good nurses experienced in the care of cancer patients were also interviewed. Their narrated, lived experiences of morally difficult care situations i.e. situations where it had been hard to know what was the right and good thing to do for the patient (n=60), revealed that relationships with their co-workers were very important for their possibility to act according to their moral reasoning and feelings(III). The situations for the nurses were either disclosed as overwhelming or possible to grasp. When narrating about these situations the nurses used different terms about themselves and their co-workers (One, They, I and We). The nurses viewed the patients either as a task to be accomplished or as a valuable unique person. In the latter situations ethical demands were interpreted, judged and acted upon (IV). Interpretations of these nurses' skills in managing morally difficult care situations disclosed two levels; one group of nurses who described positive paradigm cases, liberating maxims and disclosed open minds, while the other group described negative paradigm cases, restrictive maxims and revealed closed minds. The latter nurses were mostly the nurses who disclosed in Paper III that they used the term "one" about themselves and "they" about their co-workers (V).en patients recently cared for at surgical and medical wards were interviewed(IV). They narrated lived experiences of receiving/not receiving the help they needed or wanted when suffering from pain and anxiety/fear. The patients revealed that the most important thing for them to feel cared for in these situations was to be listened to, taken seriously and trusted, if they were not treated in this way the patients revealed that they felt they were in the hands of somebody who was uncaring. The findings are interpreted within the framework of Paul Tillich's philosophy concerning love, power, justice and courage, thereby showing the tension between these phenomena in the narrated, lived, moral experience. Light is also thrown on the dynamics of openness, vulnerability, fallibility, forgiveness, affirmation as well as powerlessness, meaninglessness, insufficiency, dissociation and exclusion. Reflections are made concerning practical wisdom. / <p>S. 1-60: sammanfattning, s. 61-151: 6 uppsatser</p> / digitalisering@umu

<p>Att ena dagen vara frisk och mitt i livet och nästa dag drabbas av akut och allvarlig sjukdom leder för patienten till en känsla av kaos. Under vårdtiden ska sjuksköterskan hjälpa patienten genom detta kaos och förbereda patienten för att lämna sjukhuset och fortsätta med sitt liv. Detta görs genom vårdande samtal som syftar till att informera om sjukdomen, riskfaktorer och livsstilsförändringar. Samtalen har också en stödjande funktion.</p><p>Syftet med examensarbetet är att utifrån hjärtinfarktpatienters upplevelser beskriva innebörden av det vårdande samtalet med sjuksköterskan. Det teoretiska perspektivet är det vårdande samtalet. Data utgörs av intervjuer med tio hjärtinfarktpatienter cirka två veckor efter utskrivningen. Lindseth och Norbergs (2004) fenomenologiska hermeneutiska metod användes vid analysen av berättelserna. Resultatet visar att samtalen innebär en möjlighet för patienten att få kunskap om sjukdomen men för att samtalet ska hjälpa patienten vidare kan det inte standardiseras utan det måste fördjupas. Patienten måste få känna att sjuksköterskan har tid att lyssna och vara närvarande för att delaktighet ska uppnås. Först då kan samtalet djupna och få den vårdande innebörd som är så viktig för patienten.</p> / <p>That one day be healthy and in the middle of the life and the next day suffering from acute and severe illness leads for the patient to a sense of chaos. During the time at the hospital the nurse will help the patient through this chaos and prepare the patient to leave hospital and get on with his life. This is done through caring conversation, which aims to provide information on the disease, risk factors and lifestyle changes. The caring conversations also have a supporting role.</p><p>The aim of the study is to, on the basis of the heart infarction patient’s perspective, describe the meaning of nurse’s conversation. The frame is the caring conversation. Data consists of interviews with ten heart infarction-patients two weeks after discharge from the hospital. The methodological approach was phenomenological- hermeneutic as described by Lindseth and Norberg (2004). The result showed that the conversation means an opportunity for the patient to get knowledge about the disease, but the conversation can not be standardized if the patient should get help to get on with his life. The patient must feel that the nurse have time to listen, being present and involve the patient in the conversation. At that time, and not before that, the conversation turns to the caring conversation that means so much for the patient’s recovery.</p>