Reflective Lifeworld Research Approach Research Articles

"Without IPS I Think I Would Really Fall Apart": Individual Placement and Support as Experienced by People With Mental Illness-Phenomenological Peer Research Study.

Having a job is an important component of recovery from mental illness and a source of economic, social, and health benefits. Most people experiencing severe mental illness (SMI) want to work but are excluded from employment opportunities. Employment specialists (ESs) working in individual placement and support (IPS) teams help persons struggling with SMI obtain competitive employment. This study is a qualitative phenomenological study of 10 IPS participants in the Norwegian context, serving to develop a deeper understanding of the IPS phenomenon as it is experienced in the everyday life of IPS participants. The study was designed as a peer research project including four members of a competence group with experience in IPS and SMI. The results, analyzed using the reflective lifeworld research approach, revealed four constituents: "Having a safety net along the way toward employment," "Feeling more like a person, not just a patient," "Brighter future," and "Going above and beyond employment support." IPS functions as an anchor in participants' journey toward employment. Strong and meaningful relationships with an ES seem crucial for IPS participants to gain the strength and confidence essential to engage in the job search. IPS participants experience various challenges in everyday life, resulting in ESs exceeding their vocational role to cover the unmet needs that health services seem unable to fully address. Closer coordination between vocational and health services, as well as a deeper focus on everyday life issues, will positively affect IPS participants' vocational outcomes and quality of life.

“Parents are our greatest asset but also our greatest challenge”: A Qualitative Study of Anesthesia Staff’s Experiences of Parental Presence During Anesthesia Induction

PurposeThe perioperative period is a stressful experience for both the child and their parents. Anesthesia staff generally have a positive attitude to the parental presence in the operating room. They can be a powerful resource in creating a caring environment, but they are challenged by limited time to establish a relationship. The present study describes the anesthesia staff’s experience of parental presence during their child’s anesthesia induction. DesignA descriptive design with a phenomenological approach. MethodsA total of 22 anesthesia staff from four Swedish hospitals were interviewed. The study has been carried out using a reflective lifeworld research (RLR) approach. FindingsThe following four constituents describe anesthesia staff’s experiences of parental presence: a conditional presence; a relationship that is secondary; a shared but two-part responsibility; and a need to demonstrate professionalism. ConclusionsParental presence is natural and essentially irreplaceable, as it creates security for the child. However, the results show that parental presence is not free of obligations and expectations. Designing for good perioperative care is important, and the staff plays a key role in cooperating with the parents to improve the quality of care.

Lived experiences of closeness to a person using Anabolic androgenic steroids a next of kin perspective

ABSTRACT Purpose Anabolic androgenic steroids (AAS) are used for their aesthetic and performance-enhancing effects and are associated with physical and psychological side effects. Behavioural changes/side effects as mood swings, aggressiveness, depression, potency problems, anxiety, and emotional coldness have been reported by next of kin to people using AAS. Methods This phenomenological study is based on the reflective lifeworld research approach. Interviews were conducted with twelve next of kin about their experiences of living close to persons using AAS. Results Next of kin to persons using AAS are particularly vulnerable because they experience little opportunity to influence their situation. Their given and safe context is lost, and their lives are circumscribed by feelings of insecurity, fear, powerlessness, and grief. Feelings of loneliness develop when their problems are not noticed by others and support is lacking from family and society. Conclusions Our research adds important knowledge on how the use of AAS affects next of kin. Understanding is required to approach the lifeworld of next of kin with flexibility and empathy in their difficulties and vulnerability. Healthcare professionals and other concerned professions need to be aware of next of kin existential needs to be able to meet and support them in their life situation.

Support in acute situations when a community health nurse is called: experiences of older patients, their significant others, and involved healthcare professionals- a qualitative interview study

BackgroundCare decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved.MethodsThe study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse.ResultsSupport in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence.ConclusionsThe advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.

Home care nurses lived experiences of caring relationships with older adults: A phenomenological study.

This paper describes registered nurses' lived experiences of caring relationships in the context of homecare provision for older adults living in Denmark. With the growing ageing population throughout Europe, more older adults will require complex care solutions within already overburdened care systems. This development places demands on the competencies and organisation of homecare nurses, as they become key players in healthcare systems. Fostering caring relationships in homecare is a rewarding and valuable process that enhances the holistic and humanising aspects of caring for older adults. For a caring relationship to be truly caring, we must understand not only the subjective experience of such a relationship but also how it is experienced in relation to and shared with others. This study aimed to describe the essential meaning of the phenomenon of caring relationships in homecare for older adults based on the lived experiences of homecare nurses. Registered nurses working in homecare for older adults were interviewed, and a phenomenological analysis was conducted according to the methodological principles of the reflective lifeworld research approach. The essential meaning of the phenomenon is described as creating an existential and embodied space in which each patient's world is the foundation of caring. The constituents are as follows: caring for the whole person, a sense of 'at-homeness' through trusting 'the other', experiencing continuity as caring and prioritising the time to care. Caring competence in homecare for older adults relies on a nurse's ability to intertwine physical and existential care needs and articulate them in their daily work. A focus on the phenomenon of caring relationships brings value to and adds an extra layer to the discussion on caring competence.

“A Lonely Road to Walk Along” – The Experiences of Being a Next of Kin to a Woman in Need of Compulsory Psychiatric Inpatient Care

It is seldom that it is only the patient who is affected when someone is admitted to compulsory psychiatric inpatient care, the next of kin is usually also impacted. The aim was to describe the lived experiences of being a next of kin to a woman in need of compulsory psychiatric inpatient care. Ten next of kin were interviewed and the material was analyzed with a Reflective Lifeworld Research approach. The results show loneliness and feelings that their existence has collapsed. An emotional duality is described in the realization that the care is needed but they are devastated that the woman is there. A trust exists, but it changes when the next of kin are no longer a part of the care process.

Balancing between familiarity and professionalism in caring for older persons: A phenomenological study from the perspective of nursing students

AimTo describe the meaning of caring for older persons based on the experiences of nursing students in Greece. BackgroundThe present study is conducted based on a caring science perspective derived from a holistic viewpoint of human beings, aiming to support the well-being of older persons. In Greece, informal caregivers play an important role in caring for older people; however, as the population ages, the need for registered nurses specialising in caring for older people is also increasing. Previous research in other countries has reported a relative lack of interest in this field, which is a threat to the quality of care. To ensure an adequate number of new-generation nurses caring for older people, nursing students’ perceptions of the phenomenon of caring for older persons should be well understood and explored in a context where the number of long-term care beds and residential care facilities are low and where informal caregiving is common. DesignBased on Descriptive Phenomenology, in line with the Reflective Lifeworld Research (RLR) approach. MethodsA total of 12 nursing students at a university in Greece underwent in-depth lifeworld interviews online during June and July 2021 and March 2022; Interviews were transcribed verbatim and were analysed according to the principles of RLR that approaches the phenomena with openness and constant reflection. The participants were students in their fourth or fifth year of nursing education; they had previous experience in older person care and were not acquainted with the authors. ResultsThe results show the essential structure of the meaning of caring for older persons, where otherness consists of intertwined demanding and rewarding elements. The essence is further conveyed by three constituents: otherness of the older person: witnessing someone’s vulnerability; trustful caring: struggling with normative structures; and closeness and distance: balancing between familiarity and professionalism. ConclusionTo ensure quality of care for older persons in the future, an understanding of how nursing students describe their experiences of caring for older persons during education is important. Balancing between familiarity and professionalism highlights the need for further reflection on professionalism and dignity and identifying the norms and values helps to highlight particularities of the context and national healthcare system. Curricula focusing on cultivating students’ preunderstanding, regarding caring for older persons are required to promote a higher quality of care in the future. Caring science can contribute to a focus on a holistic perspective in caring for older people. Tweetable abstractThere is an ever-increasing need for educated nurses in the field of caring for older people. With the lack of interest in this field of nursing, the overall quality of care is impacted. This study describes the meaning of caring for older persons based on the experiences of nursing students in the Greek health care system.

Forensic psychiatric patients' experiences of participating in administrative court proceedings concerning the continuation of forensic psychiatric care.

Previous studies show that both staff and patients describe patient participation as a challenge in forensic psychiatry. One reason may be that the forensic psychiatric process is difficult to understand and is experienced as being slow and complex. The proceedings in an administrative court are a core element in forensic psychiatric care as it constitutes the legal authority that legitimizes the deprivation of liberty. A better understanding about how patients experience these proceedings can contribute with important knowledge about how forensic psychiatric care can be understood from a patient perspective. The aim of the study was to describe patients' lived experiences of participating in oral hearings in an administrative court concerning the continuation of their forensic psychiatric care. This is a phenomenological study performed in a Swedish context with a total of 20 interviews conducted with a Reflective Lifeworld Research (RLR) approach. The results reveal three themes; A significant, correct but meaningless formality; An imbalance of power within the hearings; and Existential and practical disorientation. The findings show how these court proceedings concerning the continuation of forensic psychiatric care are often experienced as challenging. This is partly due to the care structure in forensic psychiatry and that the purpose of the hearings is difficult to comprehend and is perceived as unjust by patients. Another challenge is of a more existential dimension, where the main character in a hearing is most likely in a situation that would be stressful for anyone. However, the focus on danger can make this experience even more intense. An increased transparency on this legal process along with more discussion and education for both patients and staff is called for based on the results.

A phenomenological interview study with patients being non-conveyed in the ambulance service

BackgroundNon-conveyed patients (i.e. patients who are not transported to a hospital after being assessed by ambulance clinicians) represent a significantly increasing proportion of all patients seeking ambulance care. Scientific knowledge about patients’ non-conveyance experiences is sparse. This study describes the lived experiences of non-conveyed patients in an ambulance care context.MethodsA reflective lifeworld research (RLR) approach founded on phenomenology is used. Data is derived from nine in-depth interviews with patients not conveyed by the ambulance service in a major Swedish region.ResultsPatients’ lived experiences of becoming acutely ill or injured and not conveyed by ambulance to a hospital are characterised by several dynamic movements: losing and regaining situational and bodily control, dependence and autonomy, external competence and inner knowledge, handing over and regaining responsibility, and fear and security.ConclusionsPatients’ lived experiences of non-conveyance are complex and versatile. Although non-conveyed patients initially experience strong fear and the loss of situational and bodily control, they gradually feel more secure when experiencing confirmation and trust, which evolves into insecurity and uncertainty. The non-conveyance situation’s complexity from a patient’s perspective implies the need for ambulance organisations to take measures to prevent further suffering. Non-conveyed patients must be taken seriously in their unique situations, requiring ambulance clinicians to reflect and act with a conscious ethical perspective before, during and after their visit.

Efficacy of mecobalamin (vitamin B12) in the treatment of long-term pain in women diagnosed with fibromyalgia: protocol for a randomised, placebo-controlled trial

IntroductionFibromyalgia causes long-term pain. It affects at least 2% of the population, the majority being women. In addition, extended symptoms corresponding to vitamin B12 deficiency occur. Findings from several studies...

The perspectives of patients, nursing students and supervisors on “the caring–learning space” – a synthesis of and further abstraction of previous studies

ABSTRACT The aim was to describe and gain a greater understanding of the phenomenon “caring-learning space” based on the perspectives of patients, nursing students, and supervisors in clinical practice contexts. A general structure of the phenomenon “caring-learning space” was created based on essential structures from five empirical studies. The analysis is based on a reflective lifeworld research approach (RLR). The “caring-learning” space shows itself in terms of interpersonal relationships between patients, students, supervisors, and other actors in the care environment. It is first when the learning space is accepted as a part of caring, that a “caring-learning space” is created. A flexibility and a receptivity are seen where the learning is allowed to become visible and be integrated in the caring processes when caring and learning to interact. A caring-learning space is established by the patient being the focal point, but also a co-creator in caring as well as learning regardless of her/his health status. This entails that the ”caring-learning space” exists when patients, students, supervisors and other healthcare professionals interact based on their ability and role in the space.

Existential loneliness and life suffering in being a suicide survivor: a reflective lifeworld research study

ABSTRACT Purpose The aim of the study was to describe the loss of a family member by suicide, based on the lived experience of suicide survivors. Methods A phenomenology study with a Reflective Lifeworld Research approach was conducted, consisting of sixteen interviews with eight suicide survivors. Results The essence of losing a family member by suicide encompasses experiences of involuntary and existential loneliness, life suffering, and additional burdens in a life that is radically transformed, comprising prolonged and energy-intensive attempts to understand. Life for the family member encompasses a constant fear of being judged and an ambiguous silence, where this silence can both lead to involuntary loneliness and be a source of support and fellowship. Support mechanisms inside the family fall apart, and it becomes obvious that the survivors’ experiences affect others. The loss also implies an active endeavour to maintain the memory of the deceased. Conclusions Based on these results, it is important for professionals to accept the survivors as suffering human beings early—from the point of the notification of death—and consider them as patients in need of compassionate care. Such support might reduce life suffering, counteract stigma and involuntary loneliness, and work simultaneously as suicide prevention.

Parents' experiences with public health nursing during the postnatal period: A reflective lifeworld research study.

To describe mothers' and fathers' experiences with public health nursing and child and family health centre services in the postnatal period, both as a couple and as individuals. A phenomenological reflective lifeworld research approach with a descriptive design was chosen. A purposive sample of 10 mothers and 10 fathers were interviewed twice, 1-2 and 6-8 weeks postpartum, using joint and individual interviews. By focusing on being open and flexible, the data were analyzed to elucidate a meaningful structure of the phenomenon. The findings revealed that parents' experiences with public health nurse (PHN) and Child and Family Health Centre (CFHC) services in the postnatal period are characterised by a longing to be seen and confirmed both as unique individuals and as a family by the PHN. Although an increased need for both lay and professional care is prominent during the postnatal period, the parents drew a varied picture of their experiences demonstrating that the CFHC services are focussing almost exclusively on mother and child. A public health nurse can contribute to strengthen parenthood and promote the family's health when the focus is on the new baby. Being cared for while learning to care for the baby is pivotal in a phase that involves both joy and vulnerability. This study adds knowledge concerning the importance of both parents being seen and confirmed by the PHN as unique individuals and a family unit in the postnatal period.

Everyday life with childhood functional constipation: A qualitative phenomenological study of parents' experiences

Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life. AimTo explore parents´ experiences of living with a child with FC and its impact on everyday family life. MethodA qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1–14 years affected by FC. FindingsShame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame. ConclusionFC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed. Practice implicationsHealthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC.

Daily life after healing of a venous leg ulcer: A lifeworld phenomenological study

ABSTRACT Purpose Venous leg ulcer is a recognized condition, affecting people globally. Ulcers mainly affect the elderly and recurrences are not uncommon. There is knowledge about life with venous leg ulcers, but the situation after healing is unexplored. This paper explores and describes meanings of experiences of daily life after healing of a hard-to-heal venous leg ulcer. Methods Lived experiences of 15 individuals with healed hard-to-heal venous leg ulcers generated data for this study. Interviews were recorded for analysis using a reflective lifeworld research approach. An essence emerged, further described by its constituents. Results Memories of a difficult time with leg ulcer were ever present, in a way becoming part of the self. A striving for control in daily life entailed a struggle to do what was best for the own body. After healing, a new normal emerged in daily life, a reality that encompassed the risk for a new ulcer. The body had changed physically, with marks alongside those from ageing, in a life that still went on. Conclusions For those who had healed from a venous leg ulcer, life had changed. Even if they referred to life as normal, it was not the same normal as before.

To embrace and be present: The lived experiences of nurse-led consultations in Sweden from the perspective of pediatric nurses

PurposeThis study describes the lived experiences of nurse-led consultations in pediatric emergency departments from the perspective of pediatric nurses. Design and methodsA descriptive qualitative study with a reflective lifeworld research approach was used to explore nurses' experiences of nurse-led consultations. The study was conducted through meaning-oriented individual interviews with ten pediatric nurses. ResultsThe results are grouped into four themes: (a) embracing the encounter and being touched by it; (b) having time to be present and committed; (c) having the ability and trusting in one's intuition; and (d) negotiating between families' wishes and the organization's guidelines. ConclusionsOur study shows that nurse-led consultations conducted in separate nurse-led reception areas promote a positive experience of the consultations from the perspective of pediatric nurses. In a nurse-led consultation, a nurse's confidence in their ability to provide care is connected to time, broad skills and knowledge, and a supportive organization. Practice implicationsAs the rising global population increases the demand for healthcare services, pediatric emergency departments must streamline their services to provide patient-safe, high-quality health care. Nurse-led consultations are an effective means of meeting these growing demands. This study contributes to an understanding of pediatric nurses' experiences at both the individual level and a more structured level, namely that families' wishes and an organization's guidelines do not always coincide.

Patients’ Experiences of Participation in High-Security, Forensic Psychiatric Care

The role of patient participation in forensic psychiatric care is unclear, but has been emphasised as important in recent research. This study aims to describe patients’ lived experiences of participation in high-security, forensic psychiatric settings. Sixteen patient interviews were performed in this phenomenological study and analysed with a Reflective Lifeworld Research approach (RLR). Results show that participation must be understood in relation to its opposite construct, non-participation. Participation can thus be explained as situations where non-participation is less visible. Actions to develop the training of patient-staff interactions for forensic psychiatric staff to promote patient participation are called for.

The best of both worlds - entering the nursing profession with support of a transition programme.

Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi-dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition. The phenomenological study aimed to describe newly graduated nurses' expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers. The study was based on seven group interviews with newly graduated nurses. The interviews utilised open-ended and follow-up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology. "Expectations of transition into the nursing profession via the Clinical Nursing Introduction Programme" is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge. Transitioning into the nursing profession via the Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.

Women's Experiences of Using Anabolic Androgenic Steroids.

Anabolic androgenic steroids are used by women to increase their muscle mass and because of their performance-enhancing effects. Despite permanent/high risk of side effects, knowledge is inadequate. Our aim has been to deepen understanding about women's use of anabolic androgenic steroids. This phenomenological study is based on the reflective lifeworld research (RLR) approach. Lifeworld interviews were conducted with 12 women, aged 21–56 years, about their experiences of using anabolic steroids. The results show that women experience a sense of pride when they successfully achieve their goals. This is the driving force, triggering tension between suffering and success. Our research adds important knowledge from a reflective lifeworld perspective and shows that women's use of anabolic androgenic steroids is a complex phenomenon. Understanding and knowledge are important in order to be able to meet and support women in their fears and difficulties.

Supportive conditions for sexual and perinatal wellbeing in women living with HIV in Sweden: A phenomenological study

ObjectivesWomen living with HIV have specific needs regarding sexuality, pregnancy, and childbirth. However, there is lack of knowledge about how these needs can be met. The aim of this study was to identify supportive conditions for sexual and perinatal wellbeing in women living with HIV in Sweden. MethodsA phenomenological reflective lifeworld research approach was used. Transcribed interviews with 18 women living with HIV in Sweden were analyzed focusing on the meanings of the study phenomenon. ResultsWhen living with HIV, “feeling safe with oneself and in relationships with others” is essential for sexual and perinatal wellbeing. This is constituted by having good overall health, being in a caring context, having access to high quality information about HIV, and being ensured the same rights as other women. ConclusionsThe study shows that women living with HIV have specific needs for the support of their sexual and perinatal wellbeing. This knowledge can be used by all those engaged in HIV care and HIV prevention in order to improve and implement supportive conditions for women living with HIV. It is important that all those involved in the care of women living with HIV constantly update their knowledge about HIV and women’s experiences of living with HIV in order to provide safe arenas and caring contexts that support the wellbeing of these women.