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Existential issues in surgical care: Nurses’ experiences and attitudes in caring for patients with cancer
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet , 2012.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 136
Keyword [en]
cancer care, educational intervention, existential, nurses, surgical care
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-17414ISBN: 978-91-87103-42-1 (print)OAI: oai:DiVA.org:miun-17414DiVA: diva2:571240
Public defence
2012-12-13, F234, Östersund, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2012-11-22 Created: 2012-11-21 Last updated: 2012-11-30Bibliographically approved
List of papers
1. Existential issues among health care staff in surgical cancer care - Discussions in supervision sessions
Open this publication in new window or tab >>Existential issues among health care staff in surgical cancer care - Discussions in supervision sessions
2011 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 15, no 5, 447-453 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim was, through analysis of dialogues in supervision sessions, to explore if health care staff in surgical care discussed existential issues when caring for cancer patients. Method: A secondary analysis of the content of twelve tape-recorded supervision sessions (18 h) was conducted. The study analysed the dialogue content in supervision sessions involving a group of eight participants who worked at a surgical clinic at a county hospital in central Sweden. The sessions were held every third week during the course of one year. Results: The analysis showed that surgical health care staff contemplates existential issues. The staff discussed their existential dilemmas, which hindered them from meeting and dealing with patients' existential questions. This is illustrated in the themes: "feelings of powerlessness", "identifying with patients", and "getting close or keeping one's distance". The staff also discussed the fact that patients expressed existential distress, which is illustrated in the themes: "feelings of despair" and "feelings of isolation". Conclusions: This study shows that there are existential issues at a surgical clinic which health care staff need to acknowledge. The staff find themselves exposed to existential dilemmas when caring for cancer patients. They are conscious of patients' existential issues, but lack strategies for dealing with this. This study highlights a need to provide support to staff for developing an existential approach, which will boost their confidence in their encounters with patients

Keyword
Cancer care; Existential dilemmas; Existential issues; Health care staff; Qualitative secondary analysis; Surgical care
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-12922 (URN)10.1016/j.ejon.2010.11.010 (DOI)000297777100010 ()21159553 (PubMedID)2-s2.0-80055094081 (Scopus ID)
Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-12-11Bibliographically approved
2. Existential issues among nurses in surgical care - a hermeneutical study of critical incidents
Open this publication in new window or tab >>Existential issues among nurses in surgical care - a hermeneutical study of critical incidents
2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 3, 569-577 p.Article in journal (Refereed) Published
Abstract [en]

Aims.  To report a qualitative study conducted to gain a deeper understanding of surgical nurses’ experiences of existential care situations.

Background.  Existential issues are common for all humans irrespective of culture or religion and constitute man’s ultimate concerns of life. Nurses often lack the strategies to deal with patients’ existential issues even if they are aware of them.

Design.  This is a qualitative study where critical incidents were collected and analysed hermeneutically.

Methods.  During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1–2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used.

Findings.  The majority of incidents concerned nurses’ experiences of caring for patients’ dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses’ personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care.

Conclusion.  Findings are interpreted and discussed in the framework of Buber’s philosophy of the relationships I-Thou and I-It, emphasizing nurses’ different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.

Keyword
Buber’s philosophy;cancer care;critical incident technique;existential issues;hermeneutic;nurses;surgical care
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17410 (URN)10.1111/j.1365-2648.2012.06032.x (DOI)000315097200008 ()2-s2.0-84873992155 (Scopus ID)
Note

Publ online 2012

Available from: 2012-11-21 Created: 2012-11-21 Last updated: 2017-12-07Bibliographically approved
3. Surgical nurses’ attitudes towards caring for patients dying of cancer: a pilot study of an educational intervention on existential issues
Open this publication in new window or tab >>Surgical nurses’ attitudes towards caring for patients dying of cancer: a pilot study of an educational intervention on existential issues
Show others...
2014 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 23, no 4, 426-440 p.Article in journal (Refereed) Published
Abstract [en]

This is a randomised controlled pilot study using a mixed methods design. The overall aim was to test an educational intervention on existential issues and to describe surgical nurses' perceived attitudes towards caring for patients dying of cancer. Specific aims were to examine whether the educational intervention consisting of lectures and reflective discussions, affects nurses' perceived confidence in communication and to explore nurses' experiences and reflections on existential issues after participating in the intervention. Forty-two nurses from three surgical wards at one hospital were randomly assigned to an intervention or control group. Nurses in both groups completed a questionnaire at equivalent time intervals: at baseline before the educational intervention, directly after the intervention, and 3 and 6 months later. Eleven face-to-face interviews were conducted with nurses directly after the intervention and 6 months later. Significant short-term and long-term changes were reported. Main results concerned the significant long-term effects regarding nurses' increased confidence and decreased powerlessness in communication, and their increased feelings of value when caring for a dying patient. In addition, nurses described enhanced awareness and increased reflection. Results indicate that an understanding of the patient's situation, derived from enhanced awareness and increased reflection, precedes changes in attitudes towards communication.

Keyword
Existential, Intervention, Mixed methods, Pilot study, Randomised controlled study, Surgical nurses
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17411 (URN)10.1111/ecc.12142 (DOI)000337744500002 ()2-s2.0-84902550403 (Scopus ID)
Note

Published online 29 Jan 2014.

Available from: 2012-11-21 Created: 2012-11-21 Last updated: 2017-12-07Bibliographically approved
4. Surgical nurses’ work-related stress when caring for severely ill and dying patients with cancer after participating in an educational intervention on existential issues
Open this publication in new window or tab >>Surgical nurses’ work-related stress when caring for severely ill and dying patients with cancer after participating in an educational intervention on existential issues
2013 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 5, 546-553 p.Article in journal (Refereed) Published
Abstract [en]

AIM:

The aim of this study was to describe surgical nurses' perceived work-related stress in the care of severely ill and dying patients with cancer after participating in an educational intervention on existential issues.

METHODS AND SAMPLE:

This article reports a mixed methods pilot study of an education programme consisting of lectures and supervised discussions conducted in 2009-2010 in three surgical wards in a county hospital in Sweden. The concurrent data collections consisted of repeated interviews with eleven nurses in an educational group, and questionnaires were distributed to 42 nurses on four occasions.

RESULTS:

Directly after the educational intervention, the nurses described working under high time pressure. They also described being hindered in caring because of discrepancies between their caring intentions and what was possible in the surgical care context. Six months later, the nurses described a change in decision making, and a shift in the caring to make it more in line with their own intentions and patients' needs rather than the organizational structure. They also reported decreased feelings of work-related stress, decreased stress associated with work-load and feeling less disappointed at work.

CONCLUSIONS:

Results indicate that it may be possible to influence nurses' work-related stress through an educational intervention. According to nurses' descriptions, reflecting on their ways of caring for severely ill and dying patients, many of whom had cancer, from an existential perspective, had contributed to enhanced independent decision making in caring. This in turn appears to have decreased their feelings of work-related stress and disappointment at work.

Keyword
Cancer; Death; Educational intervention, Existential, Pilot study, Reflection, Stress, Surgical nurses
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17412 (URN)10.1016/j.ejon.2013.02.002 (DOI)000325600800006 ()23522827 (PubMedID)2-s2.0-84883825719 (Scopus ID)
Projects
Existentiellt stöd - intervention
Note

Published online March 2013

Available from: 2012-11-21 Created: 2012-11-21 Last updated: 2017-12-07Bibliographically approved

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