Ingegerd Harder

What Makes a Phenomenological Study Phenomenological? An Analysis of Peer-Reviewed Empirical Nursing Studies

This article contributes to the debate about phenomenology as a research approach in nursing by providing a systematic review of what nurse researchers hold as phenomenology in published empirical studies. Based on the assumption that presentations of phenomenological approaches in peer-reviewed journals have consequences for the quality of future research, the aim was to analyze articles presenting phenomenological studies and, in light of the findings, raise a discussion about addressing scientific criteria. The analysis revealed considerable variations, ranging from brief to detailed descriptions of the stated phenomenological approach, and from inconsistencies to methodological clarity and rigor. Variations, apparent inconsistencies, and omissions made it unclear what makes a phenomenological study phenomenological. There is a need for clarifying how the principles of the phenomenological philosophy are implemented in a particular study before publishing. This should include an articulation of methodological keywords of the investigated phenomenon, and how an open attitude was adopted.

Dimensions of Post-Stroke Fatigue: A Two-Year Follow-Up Study

Background: The aim of this study was to examine the course of poststroke fatigue in a cohort of first-time stroke patients compared to the general population, and to identify clinically relevant features of post-stroke fatigue. Methods: We performed a follow-up study of 165 patients with first-time stroke admitted to acute stroke units at the Aarhus University Hospital, Denmark. A reference group of 1,069 persons was sampled from the general population. Fatigue was assessed using the Multidimensional Fatigue Inventory (MFI-20) covering five scales of fatigue (General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation, and Mental Fatigue). Results: Compared to the general population, stroke patients reported higher levels of Physical Fatigue. Minor or no differences were found for the other fatigue scales. Pathological fatigue, defined as a score ≧12 on the General Fatigue scale, was reported by 59% (95% CI: 51–66%), 44% (95% CI: 36–51%), 38% (95% CI: 31–46%), and 40% (95% CI: 32–48%) of stroke patients 10 days, 3 months, 1 year, and 2 years following hospitalization for stroke, respectively. Post-stroke fatigue levels decreased after three months and remained stable throughout the remainder of follow-up. Poor functional outcome was consistently associated with increased levels of fatigue. Conclusions: Post-stroke fatigue is a common condition primarily characterized by increased levels of Physical Fatigue. The pathological mechanisms underlying post-stroke fatigue and its clinical implications require further study.

Effect of early postnatal breastfeeding support: a cluster-randomized community based trial

Aim: To assess the impact of a supportive intervention on the duration of breastfeeding.

After colonic surgery: The lived experience of participating in a fast-track programme

Postoperative recovery can be accelerated and hospitalization reduced through fast-track programmes. However, documented knowledge is limited and primarily focusing on a medical perspective whereas the patients’ perspective lacks documentation. This study describes the lived experience of participating in a fast-track programme after colonic surgery. Sixteen patients were interviewed twice. The interviews were analysed using a descriptive phenomenological approach. Participating in a fast-track programme is characterized by a process where patients experience how the daily regimen works both with them and against them. To succeed in the overall goal of recovering fast according to the evidence-based care plan involves facing dilemmas and mobilizing courage and will to follow the regimen. Support from the professionals is crucial. The participants had a strong desire to comply and regain health; but this role of being a good and cooperative patient had a built-in asymmetric power relationship favouring the professionals’ expectations. The complexities of this power relationship were related to both patient factors and contextual factors, e.g. the daily regimen and hospital norms. Although patient participation in care is an accepted ideal, it is demanding and difficult to accomplish. More studies on fast-track programmes are needed, with special attention to patient autonomy and partnership.

Keeping their world together--meanings and actions created through network-focused nursing in teenager and young adult cancer care.

In the transition between dependent childhood and independent young adulthood, teenagers and young adults (TYAs) are extremely vulnerable when diagnosed with cancer and while undergoing treatment. Nurses working on a youth unit for patients aged 15 to 22 years developed a nursing program that aims at supporting these young patients and their significant others to maintain, establish, and strengthen their social network during the treatment period. This article presents a grounded theory study that explored how the network-focused program was perceived by TYAs with cancer and their significant others. A theoretical account is presented on the meanings and actions that the inherent processes and interactions created. Twelve TYAs and 19 significant others participated. Data were generated through interviews, observations, and informal conversations. Embracing the program and building strength were the 2 subcategories that linked to a core concept of keeping their world together. The findings show that nurses are in a unique position to enhance and support the efforts of these young patients and their significant others in connecting with the social network that extends beyond the family and includes the wider social network.

Fatigue after stroke: manifestations and strategies

Purpose: To describe how fatigue is experienced by stroke survivors, how they understand and deal with fatigue and how fatigue impacts their daily life. Method: A qualitative interview study was carried out as part of a larger longitudinal study investigating the prevalence, characteristics and contributing factors to post-stroke fatigue. Thirty-two participants (15 men and 17 women) were strategically sampled to explore the experiences of fatigue. Participants were interviewed at 6 months, 1 year and 2 years post-stroke. Data were analysed applying a Grounded theory approach. Results: Patients clearly described and differentiated their experience between: (1) tiredness as an ordinary life event and (2) fatigue as a post-stroke life condition. Three fatigue-transforming strategies were identified, being on a mission, settling for less and stalling. Stalling seemed to put the stroke survivors in a particularly vulnerable situation. Over time, some participants moved between these two tiredness/fatigue manifestations and their range of strategies. Conclusions: Post-stroke fatigue is a new life experience different from ordinary tiredness and seems to be a significant problem in the stroke survivors’ struggle to regain a new normalcy. Intervention studies are needed to reduce the impact of post-stroke fatigue on coping and recovery. Implications for Rehabilitation Fatigue is a common experience following stroke that may have major impact on rehabilitation, coping and quality of life. The experienced impact of fatigue varies widely. Stroke survivors exhibit different coping approaches and strategies to manage the consequences of fatigue. For some, fatigue threatens their ability to cope. Tailored educational and support programs are needed to support fatigued stroke survivors at risk.

The meaning of assisted feeding for people living with spinal cord injury: a phenomenological study

AIM This paper is a report of a study to explore the meaning of assisted feeding through the experiences of people with high cervical spinal cord injury. Background. Eating difficulties are known to affect a persons self-image and transform social lives. Little is known about the experience of assisted feeding as a permanent situation. METHOD Sixteen people with high cervical spinal cord injury were interviewed twice within a period of 18 months in 2005-2006. The second interview was combined with observation. Transcriptions of interviews and notes from the observations were analysed using the phenomenological guidelines by Dahlberg and colleagues. FINDINGS The essence of the phenomenon assisted feeding was described as a constructed pattern based on coordinated attention between the person with high cervical spinal cord injury and the helper. The constituents of the essence were: paralysis as a condition of life, facing the altered meal, reconciling with diminished bodily anchoring, sensitive cooperation between self and helper, realization of own values around meals, balanced use of meal-related devices and negotiating relationship with helpers. CONCLUSION Assisted feeding should be adjusted to each individual person. Fixed procedures or routines should be avoided and assistive devices used with care. We recommend that continuity in the cooperation between the parties involved in assisted feeding is given priority, and that personal standard and social norms around meals are acknowledged.

Early breastfeeding cessation: validation of a prognostic breastfeeding score.

Aim: To validate a simple breastfeeding score to identify mothers who stop breastfeeding within 4 months after birth.

Network-focused nursing development of a new concept.

Network-focused nursing—a new concept—was generated in a grounded theory study of nurses, teenager and young adults with cancer and their significant others. This article explores and clarifies the concept to prevent it from being normalized and taken for granted in everyday clinical practice and in the literature, and from being limited in growth and meanings. The integrated approach by Meleis combined with the Hybrid Model by Schwartz-Barcott and Kim are used for analysis. Antecedents, attributes and consequences are identified. Network-focused nursing has potential to advance nursing science and to be implemented in other areas of patient care.

Responsiveness and sensitivity of the Stroke Specific Quality of Life Scale Danish version

Purpose. To test responsiveness and sensitivity to change of the Stroke Specific Quality of Life Scale Danish version (SSQOL-DK) scores in patients following stroke. Methods. A follow-up study of 150 patients with first-ever stroke was used. Questionnaires on quality of life, fatigue, depression, and functional level were completed. Direction of change was categorised as deterioration, no change or improvement. Proportion of concordant classification with external criteria was assessed. Associations between differences in SSQOL-DK domains and the other instruments were estimated using Spearmans rank order correlation coefficients. Paired t-test was used to assess change in the SSQOL-DK domains in patients affected in that domain. Effect size and standardised response mean (SRM) were used to express domain responsiveness. Results. SSQOL-DK classified concordantly in 42.2 to 58.1%%, and misclassified from zero to 31.3%%. Changes in SSQOL-DK and in the corresponding measures correlated from (rs) 0.08 to  −0.58. Fatigue and domain energy in SSQOL-DK were negatively correlated. Effect size ranged from  −0.03 to  −0.53, SRM from  −0.02 to  −0.56 reflecting mild-to-moderate responsiveness in eight out of 12 domains. Conclusion. SSQOL-DK is mildly to moderately responsive and sensitive and can be used for descriptive purposes over time in groups of patients with mild stroke.