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Understanding the Importance of Values and Moral Attitudes in Nursing Care in Preserving Human Dignity

The purpose of this investigation was to explore when nursing becomes an art, and to develop a theory/model of nursing as art. The overall design of the investigation was qualitative, and phenomenological-hermeneutic. The five substantial categories in the theory/model are: Invitation and confirmation, encounter, values, moral attitude and demeanor, the act of good will, and aesthetic communication. One main finding of this nursing investigation based on the caring perspective was that values and a thoroughly moral attitude and demeanor are central when nursing becomes an art.

Patients’ Dignity in a Rehabilitation Ward: ethical challenges for nursing staff

The purpose of this study was to explore the challenges met by nursing staff in a rehabilitation ward. The overall design was qualitative: data were derived from focus interviews with groups of nurses and analyzed from a phenomenological-hermeneutic perspective. The main finding was that challenges emerge on two levels of ethics and rationality: an economic/administrative level and a level of care. An increase in work-load and the changing potential for patient rehabilitation influence the care that nurses can provide in rehabilitating patients, and therefore also affect patients’ feelings of self-worth and dignity. Some patients wish to maintain their independence and autonomy, whereas others seem to ‘lose themselves’. Independence and autonomy are associated with dignity, but their lack is contrary to it.

The lonely battle for dignity: Individuals struggling with multiple sclerosis

Much is known about the phenomenon of dignity, yet there is still a need for implementing this understanding in clinical practice. The main purpose of this study was to find out how persons suffering from multiple sclerosis experience and understand dignity and violation in the context of a rehabilitation ward. A phenomenological-hermeneutic approach was used to extract the meaningful content of narratives from 14 patients with multiple sclerosis. Data were collected by personal research interviews. The findings revealed three main themes: (1) ‘invisibly captured in fatigue’; (2) ‘fighters’ law: one who does not ask will not receive’; and (3) ‘dignity is humanity’. The essence of the findings in this study is that dignity is humanity. According to the participants, dignity requires time and is experienced only in a context of empathy and mutual confidence.

Postoperative pain and self-management: women’s experiences after cardiac surgery

AIM This paper is a report of a study to describe womens experiences and their self-management of postoperative pain after elective cardiac surgery. BACKGROUND Cardiac surgery involves several pain-sensitive areas, and untreated postoperative pain may lead to chronic pain. Early discharge requires increased patient participation in pain management. Women report more postoperative pain than men after cardiac surgery. METHODS Semi-structured interviews were conducted in 2004-2005 with 10 women 1-2 weeks after discharge from their first elective cardiac surgery. Qualitative content analysis was used to identify recurring themes. Pain diaries were used to record postoperative pain experiences 1-2 weeks before the interviews, providing more nuances to the experiences of pain and pain management. FINDINGS Postoperative pain experiences varied from no pain to pain all the time. Worst pain intensity was recorded as moderate or more. Pain experiences depended on what womens expectations of pain after cardiac surgery. None wanted to complain about their painful experiences. The women had needed for more individualized information about self-management of pain, and had difficulties remembering the information they had received. Most did not want to use pain medication, or waited to do so until pain was unbearable. CONCLUSION Patients need more individualized and gender-specific information before early discharge from cardiac surgery to improve self-management. More specific predischarge education on self-management using analgesics regularly might prevent pain ratings rising to a severe level after discharge home.

Dignity-preserving dementia care: A metasynthesis

Research indicates the essentiality of dignity as a vital component for quality of life, reconfirming the emphasis on dignity preservation in the international code of nursing ethics. Applying Noblit and Hare’s meta-ethnography, the aim of the study was to develop a theory model by synthesizing 10 qualitative articles from various cultural contexts, exploring nurse and allied healthcare professional perception/practice concerning dignity-preserving dementia care. “Advocating the person’s autonomy and integrity,” which involves “having compassion for the person,” “confirming the person’s worthiness and sense of self,” and “creating a humane and purposeful environment,” was identified as a primary foundation for dignity-preserving dementia care. “Balancing individual choices among persons no longer able to make sound decisions, against the duty of making choices on behalf of the person,” which involves “persuasion” and/or “mild restraint,” was considered a crucial aspect in certain situations. “Sheltering human worth—remembering those who forget” was identified as a comprehensive motive and core value within dignity-preserving dementia care.

The meaning of dignity in nursing home care as seen by relatives

Background: As part of an ongoing Scandinavian project on the dignity of care for older people, this study is based on ‘clinical caring science’ as a scientific discipline. Clinical caring science examines how ground concepts, axioms and theories are expressed in different clinical contexts. Central notions are caring culture, dignity, at-home-ness, the little extra, non-caring cultures versus caring cultures and ethical context – and climate. Aim and assumptions: This study investigates the individual variations of caring cultures in relation to dignity and how it is expressed in caring acts and ethical contexts. Three assumptions are formulated: (1) the caring culture of nursing homes influences whether dignified care is provided, (2) an ethos that is reflected on and appropriated by the caregiver mirrors itself in ethical caring acts and as artful caring in an ethical context and (3) caring culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts. Research design: The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden. Ethical considerations: The principles of voluntariness, confidentiality and anonymity were respected during the whole research process. Findings: Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context. Discussion: Caring communion, invitation, at-home-ness and ‘the little extra’ are expressions of ethical contexts and caring acts in a caring culture. A non-caring culture may not consider the dignity of its residents and may be represented by routinized care that values organizational efficiency and instrumentalism rather than an individual’s dignity and self-worth. Conclusion: An ethos must be integrated in both the organization and in the individual caregiver in order to be expressed in caring acts and in an ethical context that supports these caring acts.

Implementation of a documentation model comprising nursing terminologies--theoretical and methodological issues.

AIMS To describe and discuss theoretical and methodological issues of implementation of a nursing services documentation model comprising NANDA nursing diagnoses, Nursing Intervention Classification and Nursing Outcome Classification terminologies. BACKGROUND The model is developed for electronic patient record and was implemented in a psychiatric hospital on an organizational level and on five test wards in 2001-2005. METHODS The theory of Rogers guided the process of innovation, whereas the implementation procedure of McCloskey and Bulecheck combined with adult learning principals guided the test site implementation. RESULTS The test wards managed in different degrees to adopt the model. Two wards succeeded fully, including a ward with high percentage of staff with interdisciplinary background. CONCLUSIONS Better planning regarding the impact of the organizations innovative aptitude, the innovation strategies and the use of differentiated methods regarding the clinicians individual premises for learning nursing terminologies might have enhanced the adoption to the model. IMPLICATIONS FOR NURSING MANAGEMENT To better understand the nature of barriers and the importance of careful planning regarding the implementation of electronic patient record elements in nursing care services, focusing on nursing terminologies. Further to indicate how a theory and specific procedure can be used to guide the process of implementation throughout the different levels of management.

The Phenomenon of Confirmation: An Aspect of Nursing as an Art

This article presents a theory model, “When Nursing Becomes an Art,” and discusses one part of the results, the substantial category invitation and confirmation. Researchers wanted to answer these superordinate questions: (a) What characterizes nursing as an art? (b) What does it take to practice nursing as an art? and (c) What does the practice of nursing as an art result in? The questions were answered through (a) a discussion of theory, consisting of a review of the reference literature on caring and nursing; (b) a semantic segment, consisting of a semantic analysis of the concept of art; and (c) an empirical segment, consisting of observations and qualitative research interviews with patients and nurses. Researchers developed the results into a theory model. The basic categories of the theory model are (a) invitation and confirmation, (b) encounter, (c) actualization of values, (d) the act of good will, and (e) aesthetic communication.

Aspects of indignity in nursing home residences as experienced by family caregivers

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life.

Encounter: A Fundamental Category of Nursing as an Art

The purpose of this article is to discuss one of the main findings of an investigation of nursing as an art: the category of encounter. The deepest encounter is understood as it is described by M. Buber (190), R. May (198), and U. Å. Lindström (194). The investigators concluded that the encounter is characterized by “nakedness,” being on the same wavelength, giving oneself over, and of deep solidarity and closeness. Also, one of the most human qualities finds its form in the encounter, when the person is in contact with his or her self. Third, the encounter can be healing, life-giving, and alleviating. Finally, both participants are first and foremost human beings. The meaning of the category of encounter is found to be consistent with the becoming level of K. Eriksson’s ontological suffering model (193, 195).