Bjørg Christiansen

Understanding everyday life of morbidly obese adults-habits and body image

Background: Morbid obesity is a progressive, chronic condition associated with failed attempts at change and repeated relapses. Aim: There seems to be little previous research into the understanding of the everyday life of morbidly obese adults. We wanted to gain more knowledge about characteristics of eating habits and body image as well as motivational forces for change. Methods: A qualitative approach was chosen in order to gain insight into how morbidly obese adults experience everyday life. Qualitative interviews are well suited to provide insight into themes from the interviewees life story from the subjects’ own perspectives. To gain insight into such processes, a narrative approach that allowed the informants to give voice to their ways of doing, thinking and feeling in daily life, was adopted. The informants comprised seven women and four men aged of 26–56 years, recruited from a population of obese individuals who had participated in a weight reduction course. A hermeneutic approach was used where the research question was the basis for a reflective interpretation. Results: The following meaning-units were identified: to be perceived as overweight; and to see oneself as overweight. Ingrained habits: the struggle between knowing and doing; acting without knowing; and eating is soothing. Conclusions: Seeing oneself as an obese person is a gradual process that implied experiencing oneself as different from significant others, such as (slim) siblings and friends. To experience a gap between knowing and doing concerning food habits in everyday life indicates that informants value they have a choice. This is an important insight to consider when framing interventions to support this vulnerable group.

Developing supervision skills through peer learning partnership

Oslo University College, Faculty of Nursing places undergraduate students in peer learning partnerships: 3rd year students as tutors, and 1st year students as tutees during practical skill learning. A study was designed to investigate this peer learning project. One of the research questions in particular on the role of the tutors: How do 3rd year nursing students carry out their role as supervisors for 1st year students in the skills laboratory? The study had an exploratory design. Qualitative data was gathered by three members of a research team, using video recordings of the supervised sessions and focus group interviews with both 1st and 3rd year students. Data collection was repeated in 2006-2007-2008 in different groups of students. Four identified themes illustrate how the 3rd year students supervise during the performance of the procedures in the skills laboratory: Observe and guide, supportive attitude, identify with the patient, focus on theoretical knowledge. The results of this study indicate that apart from enhancing practical skill learning in 1st year students, the assignment in the skill laboratory also provided an arena for developing competence in supervision in third year students.

Cultivating authentic concern: exploring how Norwegian students learn this key nursing skill.

The importance of interpersonal and expressive qualities has long been recognized in nursing. Drawing on data from a qualitative study among nursing students in Norway, this article discusses how nursing students cultivate authentic concern with patients. Because the nursing role has become more ambiguous, it must be created and formed in a personal way. Nursing students need to learn how to use their subjectivity in a way that promotes caring and compassionate conduct.

Adolescents’ experience of complex persistent pain

Abstract Background and aims Persistent (chronic) pain is a common phenomenon in adolescents. When young people are referred to a pain clinic, they usually have amplified pain signals, with pain syndromes of unconfirmed ethology, such as fibromyalgia and complex regional pain syndrome (CRPS). Pain is complex and seems to be related to a combination of illness, injury, psychological distress, and environmental factors. These young people are found to have higher levels of distress, anxiety, sleep disturbance, and lower mood than their peers and may be in danger of entering adulthood with mental and physical problems. In order to understand the complexity of persistent pain in adolescents, there seems to be a need for further qualitative research into their lived experiences. The aim of this study was to explore adolescents’ experiences of complex persistent pain and its impact on everyday life. Methods The study has an exploratory design with individual in-depth interviews with six youths aged 12–19, recruited from a pain clinic at a main referral hospital in Norway. A narrative approach allowed the informants to give voice to their experiences concerning complex persistent pain. A hermeneutic analysis was used, where the research question was the basis for a reflective interpretation. Results Three main themes were identified: (1) a life with pain and unpleasant bodily expressions; (2) an altered emotional wellbeing; and (3) the struggle to keep up with everyday life. The pain was experienced as extremely strong, emerging from a minor injury or without any obvious causation, and not always being recognised by healthcare providers. The pain intensity increased as the suffering got worse, and the sensation was hard to describe with words. Parts of their body could change in appearance, and some described having pain-attacks or fainting. The feeling of anxiety was strongly connected to the pain. Despair and uncertainty contributed to physical disability, major sleep problems, school absence, and withdrawal from leisure activities. Their parents were supportive, but sometimes more emotionally affected than themselves. The adolescents described how they strived for normality and to not become an outsider. Being met with necessary facilitation from school was important, as well as keeping up with friends. These adolescents had all been treated by an interdisciplinary pain team, and stated that they had an optimistic view of the future, despite still having some symptoms. Conclusions The study provides new insights into adolescents’ own experiences of complex persistent pain occurring unexpectedly, developing dramatically over time, and influencing all parts of their everyday lives. The adolescents entered vicious cycles, with despair and decreased physical and social functioning, with the risk of isolation and role-loss. However, these young people seem to have a strong motivation to strive for normalcy. Implications These findings may encourage healthcare providers to perceive adolescents’ persistent pain through the lenses of a biopsychosocial approach. We suggest that further research into adolescents with persistent pain should include longitudinal studies of quality of life and gender perspectives.

NEW PATTERNS FOR EPISTEMIC ENGAGEMENT IN NURSING

This chapter examines knowledge work carried out by practising nurses with a focus on their efforts to develop, validate and secure knowledge. It takes as a point of departure that the logic of science comes forward in new ways and seeks to focus attention on the safeguarding of professional knowledge as a core responsibility.

Why Do Nurses Utilize Textual Knowledge Sources at Work

Aim. The aim of this paper is to shed light on why nurses utilize textual knowledge sources in a hospital workplace setting. The paper focuses on the following research question: Why do nurses utilize textual knowledge sources at work? Background. Knowledge utilization implies that nurses rely on knowledge sources that are regulated at a more general level. Knowledge utilization may be triggered by uncertainty or novelty in task requirements. Methods. The data derives from 10 semi-structured in-depth interviews with nurses, conducted during spring-05. Six of them also kept logs for two days during two weeks during the fall semester of 2005. In addition, a focus group interview with three of the nurses was conducted in the spring semester of 2006. Findings. The reasons for using textual knowledge sources seem to crystallize into three interrelated themes: To fill in gaps of knowledge needed to understand or solve problems at hand To verify and enhance skills A desire to strengthen their professional repertoire Conclusion. The reason for knowledge-utilization seems to encompass both instrumental and conceptual purposes. This area is in need of further exploration.

Undergraduate nursing students’ ability to empathize: A qualitative study

Background: Empathy is of great importance in nursing, as it helps us to see and meet the needs of patients and hence to care for patients in an appropriate way. Therefore, it is of great importance that nursing students and nurses develop their ability to empathize. Objective: The study aimed at gaining knowledge on what characterizes undergraduate nursing students’ ability to empathize with patients during their first practice in a nursing home. In addition, the aim of the study was to investigate what nursing students think is important with regard to upholding their ability to empathize with patients in a professional way. Research design: This research has a phenomenological and hermeneutic design, based on qualitative interviews. Participants and research context: A total of 11 undergraduate nursing students participated in interviews during or right after their first practice in a nursing home. Ethical considerations: Norwegian Social Science Data Services approved the study. Participants were informed that their participation was voluntary. The participants were also assured confidentiality, and they were informed that they could withdraw from the study at any time, without providing any reasons. Findings: What the findings show is that affective empathy is strong among undergraduate nursing students in their first practice. They think the emotions are important to be able to empathize, and they are afraid of becoming indifferent. At the same time, they are afraid that the feelings will hinder them from acting in a professional manner. Discussion: The findings are discussed in light of previous theories on empathy, and especially perspectives on empathy, emotions, and morality. Conclusion: Affective empathy seems to be strong among nursing students, and this may be of great importance to be sensitive to patients’ well-being. However, affective and cognitive empathy should be balanced if nurses will have to meet patients in a professional way.

Developing mature empathy among first-year students: The learning potential of emotional experiences:

Nursing students’ ability to develop mature empathy requires emotional work, usually associated with caring experiences in relation with patients and next of kin. This article is based on qualitative in-depth interviews with 11 first-year students, and the research questions were: What characterizes situations in a nursing home that evoke strong emotional reactions in first-year students? What is the learning potential of these experiences? Findings show that facing emotionally challenging situations during their first clinical placement in nursing education aroused strong feelings and commitment among the students. The students tried, however, to find ways to handle emotionally challenging situations both with support in scientific literature, as well as from experience. Nurses were important role models, but could also exemplify characteristics of less empathic behaviour. Developing ‘mature empathy’ requires emotional work so that the students learn to adapt themselves to what will be demanded of them as professional nurses. The findings of this and other studies should alert nurses as well as teachers to the importance of helping students develop empathy as part of their learning trajectory in nursing education.

Transitions of patients with traumatic brain injury and multiple trauma between specialized and municipal rehabilitation services—Professionals’ perspectives

Abstract Rehabilitation is a complex field requiring broad interprofessional and interorganizational collaboration. System-induced setbacks, such as rehospitalization and decreased quality of care, can occur when patients transition between services. The focus of this study is the rehabilitation of patients experiencing traumatic brain injury (TBI) and multiple trauma. The aim of the study was to explore rehabilitation professionals’ perspectives on interprofessional collaboration and coordination during transitions of patients with TBI and multiple trauma between specialized and municipal rehabilitation services. The study used a qualitative design based on a grounded theory approach. Data were collected at two specialized rehabilitation units through observation of interprofessional meetings and 16 semi-structured individual interviews with participating professionals. Eight focus group discussions were also conducted with professionals at the municipal rehabilitation services. Data were recorded, transcribed verbatim and analyzed using a constant comparative method. Core aspects of rehabilitation practice in specialized and municipal rehabilitation services were identified, together with possible barriers and facilitators of patient transitions between services. The core aspects of rehabilitation practice within the specialized rehabilitation units were interprofessional teamwork, a time-limited perspective on the rehabilitation process and an individualized approach based on specific needs, symptoms and signs. Within the municipal rehabilitation services, the core aspects of practice were multiprofessional teamwork, a long-term perspective on the rehabilitation process and a service-based approach to individual patients. Comprehensive and timely information transfers, joint meetings and videoconferences, and electronic patient records were considered transitional facilitators essential for seamless patient transitions between services.

Godt – eller godt nok? : hvordan opplever sykepleiere idealer og realiteter i utøvelsen av yrket?

Good work – or good enough? How do nurses perceive ideals and realities in the profession? The purpose of the study is to explore what it entails for nurses to perform good work. It may be challenging to maintain good work when demands of efficiency threaten professional and ethical ideals. How nurses describe expectations they set for themselves and others will also indicate their views on professional identity. The study is qualitative with a descriptive and explorative design, based on individual semi-structured interviews with eight nurses in specialist- and community health care. The data were analyzed in three different interpretational contexts, aiming at an insightful and valid understanding of the text. Findings show that good work was associated with responsible practice and a patient-centered approach. An obligation to update themselves is integrated into their professional identity. Findings show that we can no longer take for granted that nurses handle cross-pressures and value-conflicts in the profession.