This thesis explores the phenomenon of touch and describes its meaning in the healthcare context. Caring science theory based on a lifeworld approach forms the theoretical perspective of the dissertation and consequently the patient perspective is guiding the research. The ontological, epistemological and methodological framework of the thesis is phenomenology. The overall aim was to describe the phenomenon of touch in the healthcare context. Touch showed to be a phenomenon with several diverse aspects being differentially explicit in different contexts. Four empirical studies were therefore conducted in different contexts. Further, a synthesis of the empirical results was carried out to show the invariant meanings and structure of the phenomenon. Furthermore, a philosophical illumination of the results was carried out to further deepen and expand the understanding of touch related to healthcare. The phenomenon of touch is described as a complex caring movement, as an interplay between lived bodies forming a foundation to understand health, suffering, well-being, and care. The results show how touch has the power to both alleviate the patients’ suffering and to experience joy and deep connectedness, as well as how touch can frighten and cause or worsen suffering. In order to take advantage of the caring potential, the person who touches must be fully present in all senses of the word. Caring touch of different kinds can never be reduced to a “method”. It is much more than a mechanical and static act or a treatment. Moreover, touch that is objectifying may be understood as an obstacle or detrimental for the caring relationship and well-being since it lacks the necessary pliable interpersonal room. Such touch creates distance and alienation rather than closeness, trust and togetherness. If the potential of touch for caring is to be used and the threat of non-caring warded off, then the intentionality of touch must be balanced visavi the existential vulnerability of the individual. Therefore carers need to be open and attentive to the lifeworld of the patients to enhance their health-processes and avoid hurting them.

This thesis focuses on immigrants in Sweden. What experiences from the meeting with Swedish society do immigrants have and what meaning does the immigrant background have when they have been patients within the Swedish health and medical service? Former research about patients with an immigrant background can be divided into two perspectives. One which illuminates ethnically demarcated immigrant groups and specific needs. The other perspective has an individually adopted approach independently of the patients’ ethnical background. Here it is mainly the communication problems that are stressed, since these make it hard to understand the individual’s needs. The two empirical studies of the thesis start from an individualised perspective, a life world perspective. Research data have been collected through open interviews. The overall purpose was to develop a deepened understanding of what it means to live as an immigrant in Sweden and receive care. The aim of the pre-study was to examine immigrants’ experiences of participation in municipal home care. In the main study the overall purpose was used and two research questions were asked: What do persons with an immigrant background have to tell us about their situation in Swedish society? How does the situation as an immigrant in Sweden influence the experience of being a patient in Swedish health and medical care? The pre-study shows that participation means making demands and meeting caregivers who view the patient as an actor with the right to make his or her own decisions. One important postulate seems to be access to a good interpreter. To refrain from participation seems to be about adopting a passive attitude as a patient. It seems as if it is the caregivers who are the active ones and the ones setting the standards for the contents of the care. To experience not being invited to participation mainly seems to originate from the fact that the interviewees could neither understand nor make themselves understood. One consequence is that patients are just looked upon as carriers of a symptom. The main study shows that the interviewees’ existential existence as patients involves the whole life situation. Different forms of unsurmountable difficulties might reinforce each other. The ambition to establish oneself in a new home country might therefore be passivised. For patients with immigrant background earlier experiences from exposed situations seem to influence how the patients feel about their treatment. The additional knowledge is that problems seem to reinforce each other. Patients with an immigrant background must be treated as individuals. Every individual’s story has to be made visible. The thesis shows that caregivers ought to endeavour to understand the individual. To encourage dialogue, despite language problems, is of importance for the patient to be able to express his or her needs. The use of an interpreter may have a positive influence on these patients’ possibilities to exert an influence. This means that caregivers who consult an interpreter should build up their competence to communicate through an interpreter.

The overall aim of the present thesis was to describe the meaning of living with heart failure as a middle-aged person. In particular, the relation between the persons’ life-situations and formal care was explored. An additional aim was to uncover the meaning of support as experienced by people living with heart failure in middle age. The study used a caring science perspective and a reflective lifeworld approach, founded on phenomenological philosophy. Interviews were used for data collection and data were analyzed using essence-seeking analysis. The thesis is based on four empirical studies and the results were synthesized into a general structure, presented in the thesis. The results of study I illuminate influences and changes to the life-situation that people living with heart failure in middle age can experience. The social world, i.e. intersubjective relationships, vocational situations, and formal care emerge as fundamental to the individuals, as well as the individuals’ own experiences of themselves and their body. The life-situation is frail and depicted by insecurity and uncertainty. The results of study II illuminate that people living with heart failure in middle age experience exposure and vulnerability in relation to formal care. While the context of formal care provides alleviation and medical treatments, the results at the same time revealed experiences of dependency and unclear participation. The results from studies III and IV clarify that support means to know that help is available concerning practical matters or flexibility at work. However, it also reveals that support means a sense of security or safety in relation to other people, such as friends, families, employees, and formal carers. Knowledge, and control are central aspects of the phenomenon of support in relation to heart failure. The phenomenon’s general structure illustrate that living with heart failure as a middle-aged person is depicted by ambiguity in relation to other persons, daily life and formal care. The general structure is intertwined with an altered experience of the body, and a life-situation in a borderland between health and illness. The phenomenon is illuminated by the meaning constituents: A borderland between health and illness, and A tension between what is supportive and what is not. The phenomenon’s outer horizon is understood as A changed body and a threat against life, meaning that the phenomenon stands out against a background of the limits which the body sets on the persons. The present study illustrates that support from others give people living with heart failure in middle age inner strength which they need if they are to adjust their life goals. However, the results also revealed that formal care at times is insufficient and the support which the patient’s need is forsaken. When people living with heart failure in middle age are to take on their own responsibilities for their health process they need information, knowledge and to be participating in care. Furthermore, formal carers need to focus more on the patient’s social roles and networks. A lifeworld-led perspective in formal care can unite a biomedical and a caring science perspective, and formal carers will be able to pay more attention to the patients’ changed life-situation rather than focusing the patient’s failing hearts.

Este estudo teve como objetivos: analisar o conceito de Espiritualidade a partir da Teoria do Cuidado Transpessoal proposta por Jean Watson e Discutir as relações entre Experiências da Consciência (Espirituais), nos campos de interação denominados pela teorista de Momento Presente, Campo Fenomenológico e Ocasião Real de Cuidado. Método: foi utilizado a Análise de Clarificação de Conceito, proposto por Wilson. As seguintes etapas foram seguidas: 1. Isolar as questões de conceito; 2. Encontrar as respostas certas; 3. Casos Modelo; 4. Casos Contrários; 5. Casos Relacionados; 6. Casos de Difícil Diagnóstico; 7. Casos Inventados; 8. O Contexto Social; 9. Anseios Basilares; 10. Resultados Práticos e 11. Resultados na Linguagem. As questões norteadoras para análise foram: a) Qual a natureza da Espiritualidade no Cuidado Transpessoal? e b) Espiritualidade se difere de Materialidade nas relações de cuidado, uma vez que a primeira exigiria diferentes níveis de interação para que uma dimensão mais sutil pudesse ser acessada?. Resultados: na Teoria do Cuidado Humano a Espiritualidade é concebida como o Mundo do Espírito, experienciado através de um campo fenomenológico de interação entre dois Seres caracterizado pela ocorrência de Experiências da Consciência (ou espirituais). Na Teoria do Cuidado Humano os antecedentes para Espiritualidade foram: Alma/Espírito, caracterizado por: Imortalidade, Imaterialidade, Essência, Auto Conhecimento, Consciencia e Energia Criativa; Individualidade, configurada por Alma/Espirito e Transcendencia física, mental e emocional e, por fim, Experiências da Consciência, indicada por: Intuição, Experiencia Espiritual/Sobrenatural/Metafísica/Mística. Os atributos encontrados para acessar à dimensão espiritual foram os dez Clinical Caritas Process. Também verificou-se que o Processo Interacional Paciente-Profissional é direcionado a partir da triade: Mente-Corpo-Espirito onde os resultados esperados estão relacionados à ocorrência de Ocasião Real de Cuidado, percebida pela Conexão a partir das Histórias de Vida, Dilatação da Percepção do Campo Fenomênico, Rupturas na relação espaço-tempo, culminando na Transpessoalidade e Processo de Cuidado Humano, evidenciado pelo Contato Profundo com o Outro e Consigo, Uso de Linguagem Pertinente para Descrever a Experiencia Vivida e, por fim, Sistematização do Plano de Cuidados a Partir dos Dados Obtidos da Experiência. / This study aimed to analyze the concept of spirituality from Human Caring Theory by Jean Watson and Discuss the relationship between Experiences of Consciousness (Spiritual), in the interaction field called by theorist of \'Present Moment, \'Phenomenological Field\' and \'Actual Caring Occasion. Method: Wilsons concept clarification was used. The following steps were followed: 1. Isolate questions of concept 2. Find the right answers; 3.Model Case 4. Contrary Cases 5. Related Cases 6. Borderline 7. Invented Cases 8. Social Context 9. Underlying anxiety 10. Practical Results and 11. Results in language. The guiding questions for analysis were: a) What is the nature of Spirituality in Caring? b) Spirituality differs from materiality in relations of care, since the first would require different levels of interaction for a more subtle dimension could be accessed\'. Methodological steps performed this study concluded that: the Theory of Human Caring Spirituality is conceived as the World of Spirit, experienced through a phenomenological field of interaction between two beings characterized by the occurrence of experiences of consciousness (or spirit). In Human Care Theory were the background for Spirituality: Soul/Spirit, characterized by: Immortality, Immateriality, Essence, Self Knowledge, Consciousness, and Creative Energy, Individuality, set by Soul /Spirit and Transcendence physical, mental and emotional, and finally, Experiences of Consciousness, indicated by: Intuition, Experience Spiritual/ Supernatural / Metaphysical / Mystical. The attributes found to access the spiritual dimension were the ten Clinical Caritas Process. It was observed that the Patient Process-Interactional Professional is directed from the triad: Mind-Body-Spirit where the outcomes are related to the occurrence of Care Real Deal, the perceived connection from Life Stories, dilatation of Perception Field phenomenal, breaks in the space-time, culminating in transpersonal Process and Human Care, evidenced by the Deep Contact with the Other and I can, Use of Language Relevant to describe the experience and, finally, Systematization Plan of Care Data Obtained from Experience

Doctorate of Health Sciences / Abstract The aim of this study was to understand the meaning of caring as experienced by Arab Muslim nurses within the context of Arab culture. A qualitative approach using ethnographic methodology based on the approaches of Geertz (1973), Fitzgerald (1997) and Davies (1999) was used to develop a description that embeds the phenomena of the nurses’ meaning of caring within the cultural context. Good and Good’s (1981) meaning–centred approach was used to interpret the nurse’s explanatory models of health, illness and healing that inform the caring experience. This study conveys the cultural worlds of Arab Muslim nurses from Saudi Arabia, Lebanon, Jordan and Egypt while caring for Arab Muslim patients in Saudi Arabia. Data were collected over a four year period (2004-2007). Arab Muslim nurses have a religiously informed explanatory model where health is spiritual, physical and psycho-social well-being. Spirituality is central to the belief system where spiritual needs take priority over physical needs as a distinctive care pattern. The professional health belief system blends into the nurses’ cultural and religious belief system, forming a culturally distinct explanatory health beliefs system. This finding suggests that in non-Western health contexts, professional models are not dominant but incorporated into nurses’ indigenous worldviews in a way that makes sense within the culture. Caring is based on shared meanings between nurse and patient. Caring is an act of spiritualty and an action by the nurse to facilitate his or her own spirituality and that of the patient. In turn, the nurse receives reward from Allah for caring actions. A distinct ethical framework based on principles of Islamic bio-ethics guides the nurses in their caring. This research provides the missing link between Western professional nursing systems and Arab Muslim nurses’ caring models and contributes to the development of a caring model that is relevant to, and reflective of, Arab cultural and Islamic religious values. This caring model can provide direction for nurse education and the provision of care to Muslim patients, whether in Arab cultures, Islamic societies or with immigrant Muslim populations. In addition, it provides the basis for an Islamic nursing identity and a beginning point for improving the moral status and image of nursing in the Middle East.

Utilising an interpretive descriptive approach, this qualitative study explores and identifies how spouses and partners of stroke survivors sustain their own health and wellness. Recent literature has mainly focused on identifying psychological coping strategies thought to assist in adapting to the caring role. As a consequence, there is limited knowledge regarding the experiences of how spouses and partners attend to their own health and well-being. This study aimed to explore how spouses and partners sustain their own health and wellness while supporting a stroke survivor. Purposive and theoretical sampling strategies were used to guide recruitment. Semi-structured interviews were carried out with seven spouses and partners who were living with, and supporting a stroke survivor. A central theme with three sub-themes became apparent when examining spouses and partners’ experiences. The theme of Meeting Needs connects the three sub-themes, in that spouses’ and partners’ health and wellness appeared to be influenced by and intertwined with attending to the stroke survivors’ needs. The context of Being in a Relationship provided a rationale for prioritising the stroke survivors’ needs and was the first sub-theme. Secondly, Living Both Lives explains how spouses/partners were busy thinking and attending primarily to the stroke survivor’s daily requirements whilst also trying to attend their own needs. The third sub-theme, Uncertain Health encompasses how a spouse’s and partner’s well-being is connected to the stroke survivors’ health and their future concerns about being able to provide care if they themselves become sick. Therefore, these circumstances shaped their ability to attend to their own health and well-being. Whilst attending to the stroke survivor was at the forefront of their minds there were some strategies which spouses/partners utilised to support their own health and well-being. These were: creating time and space for themselves; talking with others; and comparing own lives against others who were seen to be worse or better off, in order to support their own emotional well-being. This study found that the participants struggled to prioritise and attend to their own health and well-being, as most of them was busy primarily attending to the stroke survivor’s needs. Overall, results suggest that exploring what spouses/partners think and do within the relationship could be valuable for health practitioners. Given that it is the intimate nature of being in a relationship that is the foundation for spouses/partners supporting the stroke survivor, it could also be important for services and health professionals to consider the well-being and needs of the couple, not just the stroke survivor.

<p>The major aim was to explore perceived daily occupations in mentally disordered offenders (MDO) through occupational performance (OP) and social participation (SP) with descriptive, comparative and longitudinal designs. The 74 consecutively included MDOs were visited onsite for data collection. The following assessments were used: Capability to Perform Daily Occupation, Self-efficacy Scale, Importance scale, Allen Cognitive Level Screen, Interview Schedule for Social Interaction, Manchester Short Assessment of Quality of Life, Psycho/social and Environmental Problems, Global Assessment of Functioning Scale, assessment of Support and Service for Persons with Certain Functional Impairments and Karolinska Scales of Personality. Background factors were assembled from the individual forensic psychiatric investigation. The results indicate that MDOs had contradictive problems in OP, SP and lack of disability awareness. The MDOs and professionals had different appraisals of the MDOs’ OP and SP. Schizophrenic MDOs need substantial support for community dwelling. MDOs with psychopathic personality traits had more problems during upbringing, however, no perceived problems in OP and SP compared to the remaining group. Low Socialization, high Anxiety and psychopathy personality traits partially influenced perceived OP and SP. After one year of forensic psychiatric care, 60 % were still hospitalized and 32 % were community dwelling. Changes after one year of care consisted of higher satisfaction of OP and SP, 1/36 subject valued daily occupations higher and 5/36 subjects reported better social interaction. Although, there are some methodological weaknesses in this thesis (e.g. high attrition rate), the unique results should be taken into consideration. It is concluded that MDOs’ appraisal of their own capability has to be taken seriously in treatment and care. Also long treatment periods, targeting daily occupations from start and providing substantial individual support are necessary for successful transition into community dwelling for MDOs. This thesis contributes to extended knowledge of the MDOs’ daily occupations.</p>

No description available.

No description available.

The purpose of this thesis is to describe what it is like to suffer from malignant lymphoma and to highlight the care given to these patients. A reflective lifeworld approach, founded in phenomenological philosophy, has been used. Data have been collected using interviews and have been analyzed using essence-seeking analysis. The results are founded upon three empirical studies and a philosophical excursus. The results are presented in four sections. The thesis describes how patients with malignant lymphoma live in limbo characterized by existential uncertainties, partly caused by the mortal threat of the disease and by failings in the actions of the healthcare staff. Patients fear dying when suffering from malignant lymphoma, regardless of whether the disease is a genuine medical threat to their life. Thus, there is a substantial need for existential support for these patients. However, the results show that deficiencies in existential support can lead to patients feeling objectified, which in turn increases their existential uncertainties. Care that is solely directed towards the physiological body and excludes the human as a subject can be experienced as a disparagement. Care that includes the patients’ lifeworld provides alleviated suffering and a possibility for the patients themselves to take an active part in the health process. Despite the healthcare staff’s genuine ambition to alleviate the suffering, patients’ existential questions are met with a degree of conflict; on the one hand they are a natural part of healthcare, and on the other the questions are of such character that they are not part of professional healthcare. A healthcare culture that does not fully acknowledge the importance of existential questions appears to be one of the greatest obstacles to a holistic healthcare approach. Furthermore, there appears to be a lack of shared strategies among the healthcare staff when meeting the patients’ existential questions. A conflict arises in an unnecessary battle between biology and existence, which in turn increases the patients’ existential insecurities. Medical knowledge is insufficient in caring for patients with malignant lymphoma. An understanding of caring science is needed in order for the care to become caring and able to meet the needs as described by patients with malignant lymphoma. Healthcare staff most be provided with sufficient support to meet the patients’ existential questions. The organization of healthcare is characterised by being a culture in which existential questions are not given sufficient attention. It seems that healthcare staff give priority to medical/technical tasks rather than conversations of existential character.