Kim Lützén

TRÖST: “en våg av välönskan och välbefinnande”: En kvalitativ undersökning om upplevelsen av tröst hos äldre personer

The development of nursing as a scientific discpline involves the identification and analysis of specific concepts that are relevant to the practice of nursing. The purpose of this study was to investigate and describe the phenomenon of comfort as experienced by people who have lived a long life. In-depth interviews were conducted with seven persons, aged 69 to 97. The interviews were transcribed and analyzed according to Giorgis phenomenological method. The findings indicate that the experience of comfort generates a feeling of meaning and well-being. Comfort is an interpersonal phenomenon. This means that feelings of security, alleviation from suffering, tranquility and hope is influenced by the persons abilility to receive comfort as well as by the individuals social surroundings. In nursing practice, the result of this study can be used to increase the care-givers understanding of the meaning of comfort and its dimensions and in turn, a rational basis for nursing actions.

Omvårdnadsdisciplinens teoretiska och metodologiska utveckling i Sverige: «Omvårdnad håller på att bli en vetenskaplig disciplin, hos oss är det självklart»

This is the first of two articles that aim at contributing to the understanding of the development of the nursing discipline in Sweden. The purpose of this part of the study was to describe the development on the theoretical level. The informants (12) represented four generations of nurse researchers. Data was collected by interviews and analysed by qualitative content analysis. The results showed that all generations considered the nursing discipline to have a unique perspective, core of knowledge or value system. Nursing theories had been used in research by all four generations as well as both qualitative and quantitative methods, although there seemed to be a growing emphasis on qualitative methods. The conception of nursing as an evolving, scientific discipline that still needs clarification was also common among the informants and all four generations stressed the importance of the clinical and practical interest of nursing. The differences between the generations concerned mainly the relationship to medical science, the research interests of the informants and their views of who is to conduct nursing research. In conclusion, the interviewees describe a picture of the nursing discipline as an evolving scientific discipline in its own right with a strong practical interest, still struggling with internal problems.

We may know ‘what’ person-centred care in nursing is and ‘why’, but what about the ‘how to’?:

After reading David Edvardsson’s ‘Notes on personcentred care: what it is and what it is not’, published in the June issue of this journal, I have decided to reflect on this excellent editorial. Firstly, I can’t refrain from commenting on the impressive and growing interest in adopting a person-centred approach in research as well as in medical and nursing care. When out of curiosity, I ‘googled’ ‘person centred nursing theory and practice’, my search results indicated there had been 830,000 hits on the subject, and without filtering the results, I am certain there is something about the concept of person-centred care that is attracting this attention. For example, it seems that substantial grants have enabled the development of person-centred care centres with the intention to individualize and improve continuity of care. Also connected to the evidence-based demand, research that has a personcentred care perspective is seemingly encouraged. It appears that research grant applications that do not have a convincing statement about how their research connects to personcentred care, may find themselves without funding. Furthermore, in the last year I have noticed how several submissions to this journal have at least one or two sentences about person-centred care, indicating there is an increased awareness about the topic and global interest in penetrating the meaning of person-centred care. By the time this issue ofNordic Journal of Nursing Research reaches you, an international conference on philosophy in nursing with a focus on person-centredness will have been held in August in Stockholm, Sweden, as well as a conference in Spain, held by the European Society for Person Centred Health Care.

Patient safety: A global goal for nursing research

This is the ninth issue of the Nordic Journal of Nursing Research, previously known in the Nordic countries as Vård i Norden. Before I comment briefly on the articles published in this issue, I want to extend a warm welcome to three new members to the Editorial Board: Professor Sally Chan is dean of the School of Nursing, at the University of Newcastle, NSW Australia; Professor Nancy Moules is at the Faculty of Nursing, University of Calgary, AB Canada; and Professor Henrik Eriksson is vice-dean of research at the Swedish Red Cross University College in Stockholm. Their international research expertise and excellent academic merits will enhance the journal’s aim of communicating Nordic nursing research globally. Publications by this journal of nursing research, with roots in other countries, can only have a positive effect on Nordic nursing research. The exchange of knowledge and research collaboration should be considered a ‘win-win’ situation. There are eight articles in this issue. To comment on these, I ask, are there any similarities in the studies? My attempt at a meta-analysis of the content of the articles, which was initially difficult, revealed that ‘patient safety’ may be an underlying theme in almost all the studies. Although the research questions and methodologies of the studies vary, the studies on pain, pressure damage caused by endotracheal tubes, telephone counselling, or the importance of a continuum of care involve several dimensions of safety. ‘Safety’ in the context of healthcare has different meanings. From a patient perspective it may mean feeling protected and secure, trusting that the care provided will not cause harm to oneself. That is, an existential dimension. From a nursing perspective, safety means that knowledge of and insight into the patient’s need to feel safe should guide how to respond to that need. I hope these articles inspire further empirical research within the domain of patient safety with the goal that both the patient and the nursing perspectives will be integrated into nursing practice and nursing education. This leads me to comment on the last article, ‘Research is not a ‘‘scary’’ word: Registered nurses and the barriers to research utilisation’. In this Australian study, most nurses found research articles difficult to understand. If registered nurses can neither understand nor read a research article about, for example, patient safety there is work to be done in overcoming barriers to research utilisation.

Comments on research ethics and nursing student projects

Since I became editor of NJNR, I have become more attuned to the discussions taking place concerning nursing student projects that should or should not involve patients. The main argument for including patients is that the project is conducted within the framework of an educational program. The argument against including patients refers to the country’s legislation concerning research that involves humans. In Sweden, empirical research that involves humans must be submitted to an ethical review board. Can there be exceptions to this legislation? More specifically, can an empirical study including patients conducted as a student project and not submitted to an ethical review board, be exempted? My answer to these questions is ‘no’ and I will briefly give some background. In many countries, the process of writing a scholarly paper as a degree requirement may revolutionize students’ perceptions of nursing and the scope of nursing knowledge. For most first-year students in a nursing program, courses in scientific theory and research methodology are new academic subjects. The intention of these courses is to conceptualize nursing as a profession and area of research. Correspondingly, to find out that nursing research is also published in international scientific journals triggers an astonishing reaction, yet an ambition to find out more. Although there may be exceptions, most studies at an undergraduate level do not involve empirical data including living persons or data protected by legislation, but are conducted as literature reviews of nursing research articles published in international journals. The completed paper is expected to demonstrate that the student has understood the basics of scientific theory and scholarly inquiry, and has the ability to conduct a literature search that includes a critical analysis of published work. Critical analysis includes reflecting on the fundamental principles of research ethics and determining whether these are followed or not in the articles selected for the literature review. The completed paper is finally evaluated according to the goals specified in the curriculum and its abstract or summary may be stored in respective university archives. At a more advanced level of education, such as a master’s program, the student may conduct an empirical study as a course requirement. Often the design of the study is time limited and builds on qualitative inquiry. The time limitation also disqualifies studies that require for example randomization and advanced statistical analysis. The choice of a qualitative design raises other questions that the master’s student may not be aware of at the beginning of planning the research. Let me give a hypothetical case as an example:

Omvårdnadsdisciplinens strukturella och informella utveckling i Sverige: «Vi höll ihop»

This is the second of two articles that aim at contributing to the understanding of the development of the nursing discipline in Sweden. This article will describe the development of nursing as a social system. Interviews and written accounts of experiences as nurse researchers representing four generations were transcribed. A qualitative content analysis of the material reveals that discipline of nursing as a social system has both informal and structural dimensions describing patterns of communication, collaboration and power relationships in each of these dimensions. These dimensions interact with each other in the development of nursing as a discipline. Compared to the first generation nurse researcher, the findings indicate that nurse researchers today may be experiencing difficulty in maintaining an informal supportive network that was significant in the early years of development of nursing as a science. The informal collaboration, patterns of communication and hierarchical system seem to be replaced by the formal structuring of nursing research.

En teoretisk tillämpning av Parse »Man-Living-Health« Teorin: Att förstå litiumbehandling

This article presents the theoretical application of Parses Man-Living-Health theory. The main objective is to offer an interpretation of and to clarify the theorys main principles, themes and concepts in the Swedish language. A hypothetical, and often occurring situation in psychiatric nursing practice has been chosen as an example of how the themes – meaning, rythmicity and co-transcendence could conceivably be applied as a guide for nursing action. It is well known that the patient with the diagnosis, manic depressive disorder, often finds Lithium treatment meaningless. The use of Parse theory may guide the nurse in helping the patient to express his values and beliefs in order to enhance quality of life. One of the emphases and perspectives of the theory is that the patient is the expert in knowing his own needs. The nurse should not impose her own values or make choices for the patient. In order to apply Parse theory, presupposes an understanding of the basic concepts in existentialism and phenomenology as well as a shared psychiatric ideology in the practical setting.: This article presents the theoretical application of Parses Man-Living-Health theory. The main objective is to offer an interpretation of and to clarify the theorys main principles, themes and concepts in the Swedish language. A hypothetical, and often occurring situation in psychiatric nursing practice has been chosen as an example of how the themes--meaning, rythmicity and co-transcendence could conceivably be applied as a guide for nursing action. It is well known that the patient with the diagnosis, manic depressive disorder, often finds Lithium treatment meaningless. The use of Parse theory may guide the nurse in helping the patient to express his values and beliefs in order to enhance quality of life. One of the emphases and perspectives of the theory is that the patient is the expert in knowing his own needs. The nurse should not impose her own values or make choices for the patient. In order to apply Parse theory, presupposes an understanding of the basic concepts in existentialism and phenomenology as well as a shared psychiatric ideology in the practical setting.