Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care. / <p>För avläggande av filosofie doktorsexamen i omvårdnad, som med</p><p>tillstånd av Fakultetsnämnden vid Fakulteten för samhälls- och livsvetenskaper vid</p><p>Karlstads universtitet framläggs till offentlig granskning fredagen den 18 april 2008 kl.10:00</p><p>M204, Högskolan i Borås.</p>

The present study focuses on the phenomenology of the violent encounter, and is to be understood as the study of the violent encounter as a phenomenon, i.e. as experienced. The overall aim is to elucidate, analyse and describe violent encounters within psychiatric care as experienced by carers and patients. Moreover, the study aims at promoting the development of a phenomenological research approach in caring science in general and elucidating tacit caring knowledge in particular. The thesis includes three empirical studies and one methodological study. The research is guided by a phenomenological and lifeworld theoretical approach. Research data consist of narratives and qualitative interviews, as well as reenactment interviews with carers and patients. Data are analysed for meaning. The analysis and synthesis of meaning are aimed at openness and meaning sensitivity through a reflective attitude characterised by the intent to bridle the process of understanding. The goal of the analysis is to describe the general structure of the phenomenon and its meaning constituents. The result shows that violence and threat do not evolve in “naked” caring, characterised by encounters where carers are able to touch their patients at the same time as being touched, speaking both literally and figuratively. It is through “naked” caring and caring touch that the carers are able to reach the patients and to give undisguised invitations to genuine presence. The possibilities of touch rely on the carers’ capacity to be authentic and to genuinely wish well. Violence is on the contrary nourished by touch without caring intention, or non-touch, i.e. caring where the reciprocity of touching and being touched is missing between patients and caregivers. In the discussion, the different meanings of the violent encounter are related to the philosophy of Merleau-Ponty and Lévinas. The philosophical dimensions of touch are investigated and it is discussed how the “naked” encounter can be understood from a phenomenological ethical standpoint. The discussion focuses on the caregivers’ vulnerability and the high demands they are subjected to. It is also argued that a foundation of caring science is needed in caring practice in order to make possible a development of a caring attitude that prevents violence.

Aim The overall aim of this thesis is to create knowledge about caring and learning as an intertwining phenomenon at a Dedicated Education Unit and how it can be developed. Approach and method A lifeworld approach, based on the phenomenological philosophies foremost derived from Husserl and Merleau-Ponty was used and carried out in lifeworld interviews and with meaning-oriented analysis in accordance with reflective lifeworld research. The participants were: 13 student nurses (study I), 11 patients (study II), 8 supervisors (study III) all from the same DEU in orthopedic care and 10 managers from various DEUs (study IV). Main findings Intertwined caring and learning is most evident in genuine encounters between students and patients, supported by supervisors and managers. The intertwining is created in appealing challenges where students feel safe and ready. In the encounter with the patient they gain a sense of the whole where they can find their personal style. Patients, who feel invited to participate, could describe the encounter with students as genuine and a new dimension in nursing care. These encounters are characterized by closeness, thoroughness, accessibility, acknowledgement and sensitivity. When the encounter is less genuine, supervisors constitute an essential support for stabilizing the care.  Supervisors constantly move in order to either stay close to or stand back, adjusting to the students’ and patients’ needs. Their demanding task as reflective supervisors requires pauses in order to maintain motivation. The managers’ daily struggle in a stressful and challenging reality is influenced by them either having or taking responsibility. Differences in approaches are shown in terms of more or less involvement and commitment in caring environment and educational issues.  Conclusions Genuine encounters are characterized by the core of both caring and learning and will thereby benefit both the students and the patients. Identifying and supporting genuine encounters is necessary for students, supervisors and managers. It is time to find ways to develop a unified view of how caring and learning can be intertwined.

Syrén, Susanne (2010). Det outsagda och ohörsammade lidandet. Tillvaron för personer med långvarig psykossjukdom och deras närstående (Being in the world with long term psychotic illness – the unspoken and unheard suffering), Linnaeus University Dissertations No 6/2010. ISBN: 978-91-86491-07-9. Written in Swedish with a summary in English. Aim: The overall aim of the thesis was to describe the lived experience of being in the world with long term psychotic illness. This is described from three perspectives; the perspective of persons diagnosed with long term psychotic disorder; the perspective of their relatives; and a family perspective. Method: Three studies were conducted guided by a reflective lifeworld approach grounded in phenomenology. The data were generated through individual, group, and family interviews. Data were analyzed for essential meanings of being in the world. Results: Persons with long term psychotic illness live in a borderland of paradoxes between the usual and unusual. For the ill persons the existence is incomprehensible and defenceless with feelings of not being at home in the body and in the world. They search for themselves in a care context that is contradictory, simultaneously good and hostile. These experiences are mostly unspoken, a struggle with doubts about having health or illness, what is good or evil, and about being usual or unusual. The relatives exist in a dilemma of the possible and impossible, a continual infinite struggle. Co-existing with their ill family member is a communion and a longing for togetherness is prominent. Relatives struggle with responsibilities for themselves and for their ill family member. In these unheard struggles the relatives yearn for participation in the formal care context. Family interviews with persons with long term psychotic illness and their relatives revealed a co-existence hovering between chaos and boredom while striving for a peaceful and quiet life. Thefamilies search for constancy and predictability in the presence of incomprehensible and threatening dangers. The experience of being a We balances the unshared meanings of being in the world and the loss of being able to experience and do things together. The experience of being a We keeps their individual existence and co- existence from falling apart.Conclusion: Persons with long term psychotic illness and their relatives have to withstand extensive existential suffering, which is unspoken and unheard. Formal caring should be existential caring, supporting the ill person’s comprehensibility and understanding of life, and feelings and experiences of being at home. Further, relatives should be acknowledged both as persons and carers and invited to participate in formal care. These results also point to the importance of strengthening feelings of togetherness and of being a We through systemic oriented existential conversations, where the ill person, their relative and a formal carer converse together.

The extensive suffering related to a complex life situation with bipolar disorder and the reported difference between care needs and the needs that are actually met implicates that there are still questions about management of life with bipolar disorder that need to be answered. The present study therefore aims to describe the meaning of the conditions that enable a good life with bipolar disorder. Ten persons, six women and four men, (aged 30 – 61), diagnosed with bipolar disorder were interviewed. A reflective lifeworld perspective based on phenomenological philosophy was used. The findings present the essential meaning of the conditions that enable a good life with bipolar disorder as a dependence that empowers, which is further described by its constituents: “turning the course of life”, “protecting oneself from running out of energy”, “being needed”, “being oneself through reliable others”, “personal landmarks for navigating through life”. A voluntary chosen dependence, as described in the present study, is a new approach of care that enables a good life with bipolar disorder, while enhancing own power, freedom and control. The conditions that enable a good life with bipolar disorder are more than separate supporting measures. Therefore a holistic perspective is preferable while providing care for individuals with bipolar disorder.

Wireklint Sundström, Birgitta, 2005. Prepared to be unprepared. A phenomeno-logical study of assessment with a caring approach and how it can be learned in the ambulance services.A focal point in this dissertation is that there is knowledge in the ambulance ser-vice that is experience-based, which has not always been made explicit, and that provides the foundation for the caregivers’ assessment of the patients and their needs for care. The first aim of the study was to describe and analyse the ambu-lance services with a focus on the phenomenon of assessment from the lifeworld perspective in the caring sciences. The second aim of the study was of an educa-tional nature where the object was to be able to draw conclusions about the learning process in the ambulance service in the light of the knowledge generat-ed by the empirical findings. Thus the aim was to create a synthesis consisting of didactic ideas that are based on the caring sciences and describing how assess-ment can be learnt and can support future caregivers in the ambulance services.Assessment in the ambulance service entails, on an overall level, having a natu-ral caring attitude that includes striving in two directions at the same time. These are that on the one hand the caregivers strive to bring order to that which is dis-ordered as soon as possible, to structure the unstructured, and in short define the indefinite in order to provide medical assistance. There is a need to quickly as-sess the patient’s condition and which measures are necessary. On the other hand the caregivers strive to let the indefinite wait a while in order to be able to meet the patient’s suffering. There is thus a desire to listen attentively to the individual patient.The essential meaning of assessment of patients in the ambulance services is that there are conflicting demands on assessment and care, which entails that the caregiver adapts him/herself to the prevailing care situation in a way that means being flexible and adaptable to the patient’s medical condition. The caregivers also have a flexibility and adaptability in relation to their colleague, which leads to a mutual interplay in the assessment. Assessment in the ambulance services also means that the caregivers are paradoxically prepared at the same time as be-ing unprepared, i.e. they are prepared for the unprepared. The assessment thus starts before the caregivers have reached the patient and the actual situation. Even if they “know” what awaits them, they do not really “know”. It becomes a dynamic struggle between on the one side the expectancy that feels certain and on the other the unknown in every new situation. The struggle contains a desire for control and effectiveness in a care practice full of surprises. / Kunskapscentrum PreHospen vid Högskolan i Borås, Institutionen för vårdvetenskap.

When students learn caring during clinical practice, the usual point of departure is thatcaring and learning coexist, as separate and parallel phenomena. There is, however, a needto study how caring and learning relate to one another, as well as when and how theyconverge. The aim of this dissertation is to describe how caring and learning converge inthe encounters between students and patients, in a dedicated educational unit withinpsychiatric care, as experienced by students, patients, and supervisors. Describing howsupervisory support can facilitate this is another aim. A reflective lifeworld approach basedon phenomenological philosophy has been applied. Data were collected through interviews,participant observations with follow-up interviews, and narrative diaries.The result shows that caring and learning converge in those encounters between studentsand patients which are characterized by reciprocity, wherein the patient’s narrative is thepoint of departure, complemented by the student’s listening and inquiring attitude. It ishere, that the desire for and pursuit of health and understanding, give the reciprocalinteraction power. The common desire of those involved to know, to become accustomedto the new and unfamiliar, as well as the presence of a feeling of responsibility for oneanother, create questions which in turn create opportunities wherein students and patientsare available to one another.The dissertation shows that learning in a caring context can be complex. Despite theirbeing prerequisites for one another, competition and conflicts can occur when the caringand learning perspectives are not equally attended to. When they are placed counter to oneanother, there is a risk that reciprocal interaction is hindered, which can cause loneliness forall involved. For convergence to occur most propitiously, those involved must exist in acaring and learning togetherness. Responsible and present supervisors are needed, whocreate possibilities for the perspectives to converge through maintenance and monitoring, sothat caring and learning receive equal space.A didactic concept has been developed based on the dissertation’s result, focusing on themeaning of creating forums where students’, patients’, and supervisors’ caringconsiderations and reflections can intertwine.

The thesis describes the phenomenon women’s health and illness experiences following a myocardial infarction (MI). The purpose of the thesis is to explore women’s experiences of their care and health processes, as well as their experiences of body, lifeworld and meaningful relationships related to the illness. A reflective lifeworld approach, based on phenomenological philosophy, is used. The thesis is comprised of four studies; three are based on interviews with a total of 26 women following an MI, followed by a fourth, theoretical, study. The first study explores women’s experiences of care and health processes following an MI, with a particular focus on well-being and participation (I). The findings show that an MI is an event that suddenly interrupts the ordinary life of the women. Participation is a sense of being involved in their own health and care processes, which may also encourage them to take responsibility for health promoting activities in a healthy and meaningful way. The second study explores women’s lifeworld experience of their bodies and lives following an MI (II). This study finds that an MI, as a major event in the women’s lives, influences and restricts their everyday activities over a long period of time. Following the illness, they live with an existential uncertainty about their life and the heart, and this feeling entails suffering for them. The third study explores the meaning of close relationships and sexuality to women’s health and well-being following an MI (III). The mmeaning of close relationships appears to be vitally intertwined with their long-term health process; both health processes and relationships are affected after an MI. The suffering following an MI can be compared to taking a fall, where meaningful close relationships can function as a safety net that catches the women in their fall. The fourth study is a concept development aimed at elucidating the meaning of the concepts uncertainty, control, secure and risk in relation to the thesis phenomenon and the findings of the empirical interview studies (IV). The existential uncertainty is an important matter in the women’s health processes. In these processes the concepts control, secure and risk play a central role. Women who have suffered an MI want to be as safe as possible in order to live well. The analysis illuminates a paradox, that the women’s ambition to achieve greater safety may lead them into an even greater experience of uncertainty. The conclusion is that women’s experiences of health and illness can be described as a journey characterized by existential uncertainty. The women’s lives go through different existential phases following an MI, which is a major event. They are not prepared for the reactions that this event causes and are in need of support and guidance to manage their illness experiences. If acknowledged and well met, the significance and meaning of the women’s reactions and experiences can give impetus and energy to their health processes.

<p>Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care.</p>

The present study focuses on the caring of patients who have sexually abused children. To do research in a field that has been considered taboo has not been without problems. The conclusive factor for the decision to carry out the research was the fascinating and interesting paradox that, in spite of the caregivers having a mandate from the judicial system to do care for these patients, they do not understand how this care is to be given. The understanding of what caring for these patients can entail is based on the perspectives of the lifeworld of both the patients and the caregivers. The theoretical perspective in this dissertation is that of the caring sciences while the epistemological framework is phenomenology. Research data consist of qualitative interviews. The aim of the first study is to describe the patients’ suffering, and the aim of the second study is to describe the caregivers’ experiences of caring for these patients. The essential meaning of the suffering felt by the patients is described in terms of the patients’ acknowledgement and then betrayal of their yearning to be part of a close human fellowship. The meaning structure of “caring”, can be understood as being lost in an obscure and unknown landscape. It challenges the caregivers and occasionally arouses strongly unpleasant but also strongly threatening feelings. However when the caregivers gain clarity on how to care they are able to find their caring courage and hope, even for these patients. The findings thus show that caring for patients who themselves do not see any opportunity of taking a place among other adults is a great challenge. The study also shows that the support that is needed to be successful in caring for these patients is a caring culture that can permeate both patients and caregivers. These patients, whose criminal acts appear to be bizarre and strange, need to learn to be able to bear their suffering without losing their humanity. The philosophical intermediate chapter shows that it is the body image of the patients that prevents them from becoming whole, i.e. existing fully, by it playing the existential drama that leads to sexual abuse. It appears from this dissertation that in order for caring to be able to relieve the suffering felt by these patients, and thus prevent them from further abuse of children, then it is important as a caregiver to be able to allow the patients just to “be”. The research also shows that in order for caregivers to be able to understand what they receive from the patients they need support from both caring science and existential reflections. Such methods can help to clarify caring and to give possibilities for a freer and more creative thinking. Encountering and understanding different lifeworlds is necessary in order to give care based on a caring perspective. The patient group in the present study have been able to demonstrate this in a clearer way than has previously been done.