Scandinavian Journal of Caring Sciences最新文献

Background: Despite advances in diabetes care, many people with Type 1 Diabetes (T1D) still experience persistent hyperglycaemia, leading to reduced quality of life and increased risk of long-term complications. For some, this hyperglycaemia is linked to factors like co-morbidities, socio-economic challenges, or low health literacy. However, for many, persistent hyperglycaemia remains clinically unexplained, indicating a gap in understanding the contributing factors.

Aim: To explore the lived experiences and everyday management of T1D among adults with clinically unexplained persistent hyperglycaemia (HbA1c ≥ 70 mmol/mol), with the goal of informing caring practices that support better health outcomes.

Methods: Using an anthropological approach, we conducted in-depth interviews with 19 adults. The interviews were digitally recorded and transcribed. Data was analysed using reflexive thematic analysis.

Results: The analysis identified four themes: (1) 'Embodied diabetes' described how the risk of low blood sugar shaped daily management as it could impact productivity and social interactions, highlighting the need for empathetic support. High levels were more tolerable, yet frustratingly unpredictable and perceived as 'unruly.' (2) 'Inescapable diabetes' described diabetes as a presence that had to be navigated alongside life's complexities and how the participants sought to balance immediate concerns that were often prioritised over perfect glucose levels, underscoring the importance of holistic care approaches. (3) 'Desire for normalcy' described the weighing between concealment and disclosure of T1D and the detailed planning required to integrate diabetes seamlessly into everyday life, suggesting a need for personalised care strategies. Finally, (4) 'Diverse interactions with the diabetes clinic' described experiences from sincere interactions to feelings of resignation. Clinical advice was sometimes dismissed due to perceived ineffectiveness or lack of relevance, indicating opportunities for improving patient-provider relationships.

Conclusion: This study highlights the complexities of daily diabetes management and emphasises the importance of a caring and holistic approach that incorporates the myriad obligations, concerns and desires that adults with T1D navigate and prioritise alongside or in competition with their disease. By understanding these lived experiences, healthcare professionals can better support patients through patient-centred care practices that address both medical and personal dimensions of living with T1D.

Introduction: Parents were routinely excluded when a child was hospitalised, a practice that continued from the end of the 19th century until the mid-20th century. The inclusion of parents became more frequent in the period leading up to the 1970s and 1980s, marking a gradual change from previous practice. Children whose parents were excluded during a hospitalisation were in a vulnerable situation. Today, those children are adults, and some have died. This study explores how these adults find meaning in their past experiences of having been hospitalised as children without their parents.

Method: The study employed a qualitative design with a hermeneutic phenomenological approach. Eleven adults provided written narratives.

Results: The findings show that the participants' adult lives are characterised to varying degrees by attachment and separation challenges. They also vacillate between trust and mistrust and have issues related to loneliness as a companion, being vulnerable, mastery of vulnerability and a life with physical limitations.

Conclusion: To varying degrees, the participants linked their emotional challenges to having been hospitalised without their parents when they were children. The majority described their adult lives as being different from the lives of other people, who do not have similar feelings.

Introduction: Alcohol use disorder (AUD) is a global concern with negative physical, psychological and social consequences. The ramifications of AUD extend beyond the individual and affect their family caregivers. Yet, the majority of existing research has primarily focused on individuals with AUD and interventions to encourage their abstinence rather than on their support systems.

Aim: In order to advance a holistic approach, research to address this gap is imperative to understand family caregiver concerns and needs for added support.

Method: We conducted a qualitative study using van Manen's hermeneutic phenomenological approach to uncover the meaning of family caregivers' lived experiences and capture the essence of their involvement in caring for a relative with AUD. A purposeful and snowball sample of family members (N = 10) living within the United States participated in a face-to-face or virtual, one-on-one audio-recorded interview and a second meeting for member checking the transcribed data. Participants received a $20.00 gift card as a token for their participation.

Results: Six major themes emerged from the description of participants' lived experiences: (1) traversing the peaks and valleys, (2) wandering in the unknown, (3) pointing fingers, (4) weathering the storm, (5) drawing a line and (6) looking back, looking in. Although participants experienced many challenges, they never relinquished and remained committed to their caregiver role. Steadfastly staying with their relatives through crises exemplifies commitment as described by Sister Simone Roach's Theory of Caring. Through the ups and downs, each participant found meaning from the experience, which aligned closely with Starck's Theory of Meaning.

Conclusion: This study has implications for nursing practice, public health policy and highlights the need for collaboration to address the existing challenges for family caregivers of relatives with AUD.

Today, healthcare services in gynaecology and obstetrics aim for women to be independent in care and to provide self-management. At this point, the nurse's role as an educator in gynaecology and obstetrics has gained importance, and the patient education process should be carried out in line with the needs and characteristics of women. Therefore, using new technologies in the planning and implementation of patient education will increase the quality of education by providing practical education in a systematic, fast, and easy way. The use of Spotify, one of the new technologies, in patient education in gynaecology and obstetrics will enable women to access education easily at any time, place, and even position. Preferring Spotify in patient education in gynaecology and obstetrics will enable women to gain independence and healthy behaviour by respecting themselves. The preference for Spotify as an innovative approach to patient education in gynaecology and obstetrics is of great importance in digital health applications. This commentary draws attention to the use of digital learning platforms (Spotify, podcasts, YouTube) in obstetrics and gynaecology.

Introduction: Challenges in mutual awareness in interprofessional collaboration (IPC) along with relational and cultural barriers among professionals disrupt flow and delay decision-making in trauma care. Thus, this study explores team behaviours within IPC in trauma teams during trauma alerts from the perspective of radiographers.

Methods: A qualitative approach was used with a critical incident technique (CIT) design applying interviews with radiographers within three hospitals in Sweden from May 2022 to May 2023. CIT analysis was conducted with an abductive approach, applying an IPC core competency framework.

Results: The results present collaborative requirements in trauma care from radiographers' perspective narrating a distribution of team behaviours within trauma team collaboration and fundamental skills in IPC. Behaviours within interprofessional values and ethics were the most reported incidents related to valuing radiographers' contributions to IPC in acute trauma care.

Conclusion: Exploring behaviour through critical incidents associated with core competencies of IPC highlights the importance of interprofessional values as a foundation for successful IPC in the trauma team. The results show deficiencies in inclusive behaviour, influenced by the hierarchical environment of IPC. Power imbalances in this setting are traced to differences in perceived value and shared understanding among team members, possibly rooted in professional identity and culture. A dedicated leader is argued, as the recognition of radiographers' scope of practice in trauma imaging, emphasising the significance of shared decision-making.

Clinical implications: The findings highlight organisational and relational coordination challenges for optimising competencies in IPC. IPC's success requires reinforcing values and ethics by empowering members' contributions and shared decision-making. This involves clarifying and recognising responsibilities, particularly for radiographers, ensuring their role in trauma imaging is respected and integrated into decision-making.

Introduction: Cerebrovascular diseases, such as transient ischaemic attack and stroke, are mainly caused by behavioural and metabolic risk factors. Effective patient counselling can address these risk factors and reduce the burden of stroke.

Methods: We aimed to describe the facilitators, barriers and possible solutions to improve the quality of counselling in patients with cerebrovascular diseases using a descriptive, qualitative approach. Semi-structured face-to-face interviews were conducted with 26 healthcare professionals at a single university hospital in Finland between August 2021 and March 2022. The data were analysed using deductive content analysis.

Results: The healthcare professionals identified facilitators, barriers and possible solutions to support the quality of counselling in five main categories: (1) background factors, (2) resources, (3) implementation, (4) sufficiency and (5) effects of counselling, and seven generic categories.

Conclusions: To improve the quality of counselling, new digital counselling solutions need to be developed. Solutions should be high-quality, consider the special needs of patients with cerebrovascular diseases, ease the process of information exchange between stakeholders and facilitate the workflow of healthcare professionals. Patients' access to health-related information, availability of electronic devices, patients' eHealth literacy skills and healthcare professionals' counselling skills should be supported to reduce the burden of stroke.

Background: Alcohol-related liver cirrhosis (ALC) is a life-threatening disease and both physically and mentally challenging. At diagnosis, ALC is often at an advanced stage, and symptoms of liver decompensation may be present. Life may be challenged by substance abuse, social problems, limited networks and stigma by the public and the healthcare system. Research on living with ALC is sparse.

Aim: To explore people's stories about life before and after diagnosis with ALC.

Methods: The study is empirical and inspired by a phenomenological approach. Six explorative narrative interviews about everyday life were conducted. The participants told their individual stories guided by one main question: 'What matters to you - tell me about yourself and your life'. Interviews were analysed using an inductive approach, identifying and describing main themes of the six stories.

Results: Six informants participated; four men and two women aged 46-76 years. Four participants were alcohol abstinent and for two, status was unknown. Number of years living with ALC varied from 1.5 to 16. One main theme, 'social life - social loss', and five sub themes 'alcohol stories', 'guilt and shame', 'the cirrhosis sequelae', 'moving on' and 'care and security' were identified. Themes were interrelated.

Conclusion: Stories about life with ALC mainly concern social losses and managing daily life and the physical consequences of the disease. In general, the participants seemed to live in the present and did not bring up the future. Though living with a life-threatening disease, they did not talk about death or dying.

Objective: To evaluate the effectiveness of a theory-based, Real-time-online Education and Support with Telephone follow-ups (REST) programme for primiparous women on their breastfeeding outcomes over 6 months postpartum.

Study design: Randomised controlled trial.

Methods: Convenience sampling was used to recruit 150 low-risk primiparous mothers, and then they were randomly assigned into intervention and control groups by computerised block randomisation. Participants received a 3-month real-time online educational and support programme across antepartum and postpartum period or usual care only (75 mothers per group). Primary outcomes were exclusive breastfeeding (EBF) rate and breastfeeding self-efficacy (BSE); and secondary outcomes were predominant and partial breastfeeding rate, formula feeding rate, mothers' postnatal depression score, infant's morbidity, and EBF duration at 2 and 6 months postpartum, as well as breastfeeding initiation rate.

Results: Then, 72 of 75 mothers (96%) successfully completed the REST programme. They had a significantly higher EBF rate, longer EBF duration, and greater increase in BSE, when compared to the control group at the two posttests (except the EBF rate at 6 months postpartum). Overall, the REST was highly valued by all participants on providing detailed useful information and regular postnatal follow-ups with prompt and practical advice.

Conclusions: The REST effectively improved BSE and EBF duration of the primiparous participants over 6 months postpartum and EBF rate at 2 months postpartum. With strong commendations from primiparous mothers, the REST with prenatal and postnatal online breastfeeding support to these mothers can be offered to address breastfeeding and infant-care needs.

Implications for patient care: The findings indicate that the REST conducted from prenatal to 2 months postpartum can be feasible and useful to provide adequate breastfeeding education and support in current maternal care setting under limited staff and resources. Online platforms can be used for future antenatal breastfeeding talks.

Trial registration: ClinicalTrials.gov identifier: NCT04741425.

Aims: To investigate the current status of psychological dysfunction in family members of elderly patients following an intensive care hospitalisation to determine the influencing factors and provide a basis for developing relevant caring strategies.

Background: Due to the physiological changes associated with advanced age, elderly patients are at increased risk of admission to the intensive care unit (ICU) admission. The experience of intensive care can place significant psychological strain on the families of elderly patients. However, the attention devoted to post-intensive care syndrome-family (PICS-F) psychological dysfunction and the level of caring services provided to their families are inadequate. Investigating the psychological disorders of elderly patients' family members with PICS-F represents a crucial step in improving the quality of caring services.

Methods: A convenience sampling method was used to recruit 440 family members of elderly patients who were transferred out of three ICUs in a tertiary A comprehensive hospital in Shandong Province from July 2023 to February 2024. The evaluation tools included the General Information Questionnaire, the Perceived Social Support Scale, the Simplified Coping Style Questionnaire, the Hospital Anxiety and Depression Scale and the Post-Traumatic Stress Disorder Checklist Civilian Version. Multiple logistic regression analysis was used to investigate the influencing factors of psychological dysfunction in family members after the patients' ICU stay.

Patient or public contribution: The research subjects were recruited to complete the surveys face-to-face or by telephone.

Results: The incidence of psychological disorders among elderly patient family members after the ICU stay was 54.80%. Multiple logistic regression analysis results revealed that the following variables were associated with psychological illnesses after intensive care unit stays: family gender, monthly income per capita of family members, the level of perceived social support and coping style.

Conclusions: The incidence of psychological disorders in the family members of elderly patients after ICU was relatively high. Medical staff should strengthen the observation of the psychological status of the family members and take targeted measures based on relevant influencing factors to enhance their level of caring services and prevent or reduce the occurrence of PICS-F psychological disorders.

Background and aim: The transition to motherhood is a life-changing period with dilemmas relating to meaning and relationships. These experiences are described as individual and can be related to existential questions and relationships with family and others, as well as whether healthcare professionals, when meeting with becoming mothers, miss promoting existential aspects. This study aimed to illuminate the meaning of becoming a mother during the transition to motherhood.

Methodological design: The study used an explorative design with a phenomenological hermeneutic approach. Data were collected through open-ended interviews with 22 mothers, eight of whom were pregnant at the time of the interview.

Results: The meaning of becoming a mother was experienced as being profoundly touched and changed. By a sense of belonging and being present in the moment, mothers open up to the possibility of being profoundly emotionally affected, which is understood as essential to their meaning of becoming a mother.

Conclusion: This study reveals that mothers experience intense emotions that can make them vulnerable and open to change, which seems to promote their development of themselves.