Reflective Lifeworld Research Research Articles

Meaning-oriented thematic analysis grounded in reflective lifeworld research-A holistic approach for caring science research.

The aim of the present article is to describe meaning-oriented thematic analysis grounded in reflective lifeworld research and to illustrate how the thematic analysis can be integrated in the research process. The article is a methodological paper, including ontological and epistemological assumptions for lifeworld theory. Research based on lifeworld theory is directed towards lived experiences and meanings in everyday life. Research that is founded on the epistemology of the lifeworld can present existential issues important for caring and qualitative research can in particular contribute to existential knowledge needed to understand the world of the patient. Theoretical paper. Starting with a phenomenon of relevance for caring science, the article argues for lifeworld interviews as a data collection method that can contribute to depth and meaning, and then presents a description of how structures of meaning can be outlined through a meaning-oriented thematic analysis. The research of lived experiences in caring science demands an approach that includes a reflective attitude during the methodological considerations. This article highlights the importance of ontological and epistemological considerations when conducting a meaning-oriented thematic analysis. The article places meaning-oriented thematic analysis in a wider research process, considering all aspects from collection of data to the creation of meaning-oriented themes.

Voices Unheard: A Reflective Lifeworld Research Study of Older Arabic-Speaking Female Migrants and Their Experience of Existential Loneliness.

Existential loneliness (EL) is an unavoidable, deeper sense of loneliness. EL has been described as disconnection from life and the universe, experienced even in the presence of family and friends. Meaninglessness, loss of health and significant others seem to trigger older persons EL. Older Arabic-speaking women are a large migrant group in Sweden and there is a lack in knowledge about their experience of EL. Therefore, this study aimed to describe the phenomenon of EL as experienced by older Arabic-speaking female migrants. This study was based on a phenomenological approach known as reflective lifeworld research (RLR). Ten older migrated Arabic-speaking women were included in the study. Lifeworld interviews were conducted to collect data. The data were analysed in accordance with the phenomenological RLR principles of openness, flexibility and bridling. This study shows that EL is experienced when there is a lack of attachment to place and people. EL is experienced more distinctively in the beginning of the migration process. It was difficult sharing feelings of EL with anyone. Feelings of meaninglessness occurred when entering a new lifeworld and triggered EL. EL was however attenuated when being able to practise their religion. Lack of attachment to place and people as well as feelings of meaninglessness brought existential loneliness to the fore for the older Arabic-speaking female migrants. There was a collision of lifeworlds not at least by the fact moving as a Muslim woman to one of the most secular countries in the world. Practising their religion attenuated their EL. To promote better health for this group of women, it is of importance to be aware of EL and its mode of expression. It is crucial to let the voice of older Arabic-speaking female migrants be heard and to be aware of their experience of EL and its mode of expression in order to promote better health. Further, educational training for nursing professionals and nursing students needs to be provided to develop skills how to be aware of and address EL.

“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.

Coming home: older patients’ and their relatives’ experiences of well-being in the transition from hospital to home after early discharge

ABSTRACT Background This study aims to investigate the lived experience of well-being among older patients and their relatives in the transition from hospital to home after early discharge. Research has shown that the transition brings severe challenges to their everyday lives. However, to date, there has been a lack of research focusing on the lived experiences of well-being during this process. Methods The data collection and analysis followed the phenomenological approach of Reflective Lifeworld Research. Ten in-depth interviews with older patients and their relatives were conducted in Austria up to 2–5 days after hospital discharge. Results The essential meaning of the phenomenon of well-being in the transition from hospital to home is marked by security and confidence to face the challenges following the discharge. Four constituents emerged: being calm and in alignment with the homecoming, being in familiar surroundings at home—a sense of belonging, striving towards independence—continuity of life and having faith in the future. Conclusion Our findings point to the importance of recognizing the vulnerability associated with the transition from hospital to home, as it impacts the existential aspects of space and time. Facilitating a sense of continuity and belonging can foster well-being during this critical period.

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.

'Fleeing' as a Strategy for Navigating Resistance in Patient Encounters within Forensic Care.

The aim of this study was to describe the phenomenon of "fleeing the encounter when facing resistance" as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one's emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers' self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient's lifeworld but also their own.

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.

Extinguishing the Fire at Both Ends: The Dual Family-Caregiving Stress of the Sandwich Generation of China’s “4-2-2” Families

China’s fertility policy and population aging have produced many “4-2-2”–structured sandwich families, placing the sandwich generation under dual caregiving stress. Through reflective lifeworld research and multilevel interviews with 14 “4-2-2” families, we confirmed that the essence of “dual stress” was the competing responsibilities of caring for older adults and children. This essence can be further illustrated by the vulnerability of the cared-for, lack of emotional resources, socio-educational anxiety, and family livelihood pressure. In addition, the dual stress can jeopardize the well-being of the sandwich generation as family caregivers. However, this dilemma can be alleviated by intergenerational support-balancing, alternative digital-technology, and complementary social-care strategies. Understanding the lifeworld of sandwich families presents practical approaches and policy implications for caregiving-support systems.

Foreign movement in one’s own body: Patients’ experiences of being awake while treated with catheter ablation—a phenomenological study

ABSTRACT Purpose To address the consequences of living with supraventricular tachycardia and to improve the quality of treatment, there is a need to highlight patient experiences of treatment with catheter ablation. Therefore, the aim was to describe the phenomenon of catheter ablation, as it is experienced by patients being treated awake. Methods A descriptive design was applied based on a reflective lifeworld research founded on phenomenological epistemology. Interviews were conducted between December 2021 and Mars 2022 with seven women and five men, three to twelve months after they underwent catheter ablation. Results Patients undergoing catheter ablation while awake during treatment, which includes experiences of relying on others expertise, being actively passive, and striving to be cured. It entails experiences of having a foreign object moving in one’s body and heart and can be endured through strategies of mainly shifted one’s mental focus. Conclusions The effort of undergoing a catheter ablation procedure is worthwhile as the confirmation of a physical curable condition that opens a future with possibilities instead of the obstacle in daily life that tachycardia entails. For the patients, an informative and caring conversation was needed that would have provided the support they lacked before and during the ablation.

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.

Supporting recovery in persons with stress-related disorders: A reflective lifeworld research study of health care professionals in primary health care in Sweden

ABSTRACT Purpose The study aimed to describe primary health care professionals lived experiences of supporting recovery in persons with stress-related disorders. Methods This study was based on a phenomenological approach known as reflective lifeworld research (RLR). Seventeen health care professionals working in primary health care were included in the study. Lifeworld interviews were conducted to collect data. The data were analysed in accordance with the phenomenological RLR principles of openness, flexibility and bridling. Results Health care professionals experienced supporting recovery as a complex process with a need for a tailored approach, regardless of profession. In an alliance, the health care professionals encounter the persons where they are based on their own narratives about their life situation. In an interpersonal platform, the health care professionals use a lingering and flexible approach. Support is provided by encouraging existential reflection and learning as well as guiding the person to consider their own needs. This supports the person’s quest for a sustainable recovery process in his/her life situation. Conclusions We conclude that supporting recovery requires a genuinely person-centred care in which elements of existential care are crucial. Primary health care for persons with stress-related disorders could benefit from the development of additional research and models for such an approach.

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.

Short- and Long-Term Outcomes of Community-Based Art Education among Students in Higher Education

Advocating for the academic value of community-based art education requires empirical evidence that students are not just participating in community-building activities, but also effectively learning content. Unfortunately, little is known about the short- and long-term cognitive outcomes on student participants, particularly in higher education. Based in a phenomenological methodology with a reflective lifeworld research design, this longitudinal study seeks to understand the interwoven cognitive and social outcomes of participating in community-engaged art projects among college students. Informed by a theoretical framework in which CBAE situates learning in authentic social contexts, findings suggest that it may be decisively poised to yield short- and long-term educational benefits in which student learning deepens through the development of social connectedness. These findings expand the possibilities for collaboration as a pedagogical model for inclusive postsecondary education.

"Bringing new life in": Hope as a know-how of not knowing.

We offer a theoretical and empirical exploration of parental or guardian hope through an enactive, ecological, and reflective lifeworld research framework. We examine hoping as a practice, or know-how, by exploring the shape of interviewees' lives as they prepare for lives to come. We pursue hoping as a necessarily shared practice-a social agency-rather than an individual emotion. One main argument is that hoping operates as a kind of languaging. An enactive-ecological approach shifts scholarly conversations around hope, in part by including voices of non-scholars and considering lifeworld factors like class privilege. We aim to identify particular impediments to or facilitators of hope, which may be thought of as classes of restrictive and generative thought-shapers, respectively. Results from our qualitative study indicate that uncertainty is deeply salient to hoping, not only because hope as a concept entails epistemic limits, but more vitally because not knowing, when done skillfully and when supported through education and some degree of socio-economic security, leaves room for others to reframe utterances, and so for the family or community to resist linguistic enclosure.

Experiences of undergoing venous leg ulcer management: A reflective lifeworld research study.

Venous leg ulcers have multiple consequences for the patient. Ulcer management can be lengthy and recurrence is common. As the patient is the expert on their experiences and life, the aim of the present study was to describe patients' lived experiences of undergoing management for a venous leg ulcer. The study encompassed 16 phenomenological interviews. The analysis led to a description of the phenomenon's essence, further described by three constituents. The essential meaning of the phenomenon is described as being in an oscillation between hope and despair. Ulcer management is challenging for the patient, who feels unseen and lives with doubts during the management period. This study is considered enriching as it puts words to the patients' suffering during ulcer management and shows that reliable relationships and competence can reduce patient doubts. This knowledge should enable improvement of patient care and treatment during ulcer management.