Kerstin Segesten

Strength of motherhood: nonrecurrent breast cancer as experienced by mothers with dependent children

The experience of breast cancer in mothers of dependent children and the strategies these women use to handle their situation of illness in relation to the children was the focus of this study. Ten women with nonrecurrent breast cancer were interviewed using phenomenology as a theoretical framework. The findings reveal that the women needed to balance themselves from being needed and perhaps not existing, balancing between demands, a will to be strong and allowing herself to be sick, and balancing between telling the truth and protecting the children from the truth. The women had strategies to help them in this struggle. To carry on as usual and continue everyday life became very important to them. To do this they had to combine their own strength with support from others and try to turn things into a positive perspective. The essential meaning of living with breast cancer and having dependent children implied using the strength of motherhood to balance conflicting forces and thereby continuing everyday life. The clinical implications include awareness and support to maintain everyday routines and generate strength.

GPs and lesbian women in the consultation: issues of awareness and knowledge.

Objective - To study awareness of having lesbian women in the consultation among general practitioners (GPs) and their knowledge of lesbian health-related issues. Design - A mailed questionnaire study using closed and open-ended questions, with an analysis using both quantitative and qualitative methods. Setting - The city of Göteborg, Sweden. Subjects - GPs working in the city of Göteborg. Main outcome measures - Frequencies are presented for closed questions. Open-ended questions are categorised and illustrated by citations. Results - The response rate was 52%, but only 37% were aware of having had any lesbian patients despite many years in practice. Five per cent had ever asked their patients about sexual identity, and most questions concerning social network were put in terms of the heterosexual, nuclear family. Eleven per cent knew of any health issues relevant to lesbian women, but half of all informants declared an interest in learning more. Conclusion - Unreflected assumptions of heterosexuality and use of heterosexist concepts may work together in keeping the lesbian patient invisible to health care. Medical education needs to include issues of gender and sexual identity/orientation in the curriculum, and to address the health effects of marginalisation.

The meaning of traumatic events as described by nurses in ambulance service

Ambulance personnel are working with the injured and dead and are therefore exposed to a variety of stressors that can lead to the development of physical, psychological and social reactions. Stress among ambulance personnel can be regarded as a natural behaviour and reaction when experiencing a traumatic event. The aim of this phenomenological study is to uncover the essence of traumatic events experienced by Swedish ambulance personnel. Knowledge about such events contributes to the awareness of risk for post-traumatic stress symptom and serves as a platform for developing measures to handle such stress. In this study, written stories from 52 of 223 ambulance nurses and ambulance technicians describing an experienced traumatic event, are analysed by the method of van Kaam. Findings indicate that the nurses and technicians have a strong identification with the victims and it is impossible to prepare for events that are unforeseen and meaningless. To handle the overwhelming feelings of identification, the personnel have to gain understanding through talking about those feelings. Therefore it is important that ambulance management, following stressful events, provide the opportunity and time for ambulance personnel to share their feelings. Teaching ways of decreasing identification and emotional involvement with the victim may also be an effective preventive measure.

GPs' thoughts on prescribing medication and evidence-based knowledge: The benefit aspect is a strong motivator

Objective. To describe GPs’ thoughts of prescribing medication and evidence-based knowledge (EBM) concerning drug therapy. Design. Tape-recorded focus-group interviews transcribed verbatim and analysed using qualitative methods. Setting. GPs from the south-eastern part of Västra Götaland, Sweden. Subjects. A total of 16 GPs out of 178 from the south-eastern part of the region strategically chosen to represent urban and rural, male and female, long and short GP experience. Methods. Transcripts were analysed using a descriptive qualitative method. Results. The categories were: benefits, time and space, and expert knowledge. The benefit was a merge of positive elements, all aspects of the GPs’ tasks. Time and space were limitations for GPs’ tasks. EBM as a constituent of expert knowledge should be more customer adjusted to be able to be used in practice. Benefit was the most important category, existing in every decision-making situation for the GP. The core category was prompt and pragmatic benefit, which was the utmost benefit. Conclusion. GPs’ thoughts on evidence-based medicine and prescribing medication were highly related to reflecting on benefit and results. The interviews indicated that prompt and pragmatic benefit is important for comprehending their thoughts.

Enjoying tactile touch and gaining hope when being cared for in intensive care—-A phenomenological hermeneutical study

Touch has been a part of the healing process in many civilisations and cultures throughout the centuries. Nurses frequently use touch to provide comfort and reach their patients. The aim of this study was to illuminate the meaning of receiving tactile touch when being cared for in an intensive care unit. Tactile touch is a complementary method including the use of effleurage, which means soft stroking movements along the body. The context used to illuminate the meaning of receiving tactile touch was two general intensive care units (ICUs). Six patients, who have been cared for in the two ICUs, participated in the study. A phenomenological-hermeneutical method based on the philosophy of Ricoeur and developed for nursing research by Lindseth and Norberg [Lindseth A, Norberg A. A phenomenological hermeneutical method for researching lived experience. Scandinavian Journal of Caring Sciences, 2004;18:145-53] was chosen for the analysis. Data consisted of narratives, which were analysed in three recurring phases: naïve understanding, structural analyses and comprehensive understanding. Two main themes were found: being connected to oneself and being unable to gain and maintain pleasure. The comprehensive understanding of receiving tactile touch during intensive care seems to be an expression of enjoying tactile touch and gaining hope for the future. This study reveals that it is possible to experience moments of pleasure in the midst of being a severely ill patient at an ICU and, through this experience also gain hope.

The Enigma of Severe Mental Illness: a Swedish perspective

Today mental health professionals are challenged in supporting people with severe mental illness that live within their communities. The community treatment is, however, characterized by an uncertainty about how to best support them in their everyday lives, and professionals from different disciplines often have divergent opinions about the care. The aim of this study is to explicate the existential meaning of living with severe mental illness. Interviews with persons who relocated from an institutional setting to a community placement were analyzed within an interpretive approach. The results of the study found that people with severe mental illness experience an existential loneliness due to difficulties in changing previous suppositions about human relationships. They do not develop connections through shared new experiences with other people in their lives. One central implication of the findings is that because people with severe mental illness seem unable to benefit from new experiences, mental health nurses should consider relational aspects when planning, implementing, and evaluating nursing care.

The outcome of tactile touch on oxytocin in intensive care patients: a randomised controlled trial

AIM To explore the effects of five-day tactile touch intervention on oxytocin in intensive care patients. The hypotheses were that tactile touch increases the levels of oxytocin after intervention and over a six-day period. BACKGROUND Research on both humans and animals shows a correlation between touch and increased levels of oxytocin which inspired us to measure the levels of oxytocin in arterial blood to obtain information about the physiological effect of tactile touch. DESIGN Randomised controlled trial. METHOD Forty-four patients from two general intensive care units, were randomly assigned to either tactile touch (n = 21) or standard treatment--an hour of rest (n = 23). Arterial blood was drawn for measurement of oxytocin, before and after both treatments. RESULTS No significant mean changes in oxytocin levels were found from day 1 to day 6 in the intervention group (mean -3.0 pM, SD 16.8). In the control group, there was a significant (p = 0.01) decrease in oxytocin levels from day 1 to day 6, mean 26.4 pM (SD 74.1). There were no significant differences in changes between day 1 and day 6 when comparing the intervention group and control group, mean 23.4 pM (95% CI -20.2-67.0). CONCLUSION Our hypothesis that tactile touch increases the levels of oxytocin in patients at intensive care units was not confirmed. An interesting observation was the decrease levels of oxytocin over the six-day period in the control group, which was not observed in the intervention group. RELEVANCE TO CLINICAL PRACTICE Tactile touch seemed to reduce the activity of the sympathetic nervous system. Further and larger studies are needed in intensive care units to confirm/evaluate tactile touch as a complementary caring act for critically ill patients.

To be a helpless helpoholic / GPs' experiences of women patients with non-specific muscular pain

Objectives – To explore and describe what it means to be a GP meeting patients with non-specific symptoms. Design – Focus group interviews analysed in a phenomenological approach. Setting – GPs at two urban healthcare centres from a big city, a low socioeconomic area with mostly immigrants and a high socioeconomic area, and from a smaller town. Subjects – 14 GPs in 3 focus groups. Results – The essence of the study was the GPs’ feeling of being a “helpless helpoholic”. All GPs specified the patient with non-specific symptoms as a female patient with muscular pain. The key constituents were: inconsistent patient, insufficient tools, frustration, helplessness, and devotion to help. The tools were described as communication skills, biomedical education, and holistic perspective. Even if most informants were trained in communication skills, this did not help to avoid the feeling of helplessness. Conclusions – To be a “helpless helpoholic” may make the GPs less patient-centred and may create even more feelings of frustration and helplessness. This can be an important reason why consultations with female patients with non-specific muscular pain often fail.

Struggling for freedom - lived experiences of being a relative of a stroke survivor in the first six months after hospital discharge

The aim of this study was to illuminate the meaning of being a relative of a stroke survivor in the first six months after hospital discharge. The study is a part of a larger research project focusing on pedagogic strategies for relatives of stroke survivors. Qualitative interviews were performed with nine relatives of stroke survivors. The data were analysed by means of phenomenological hermeneutic analysis. In the analysis two main themes emerged; (1) awareness of the irrevocably altered life situation and (2) being strong in the altered life situation, which revealed that relatives are actively involved in “a struggle for freedom”, as they have no wish to adapt to the illness or its consequences. Instead, they want to choose their own way of life and write their own history. For that reason, they try to integrate the illness and its consequences by influencing and changing the stroke survivor, health professionals and their surroundings to suit their own needs. The results contribute to facilitating the health professionals’ work by showing that the relatives are free and independent human beings who have the capacity and power to create their own history. Focus should be directed towards identifying and supporting the relatives capacity to create history, and therefore, health professionals need to heed them.