Lars Johan Danbolt

The power of consoling presence - hospice nurses’ lived experience with spiritual and existential care for the dying

BackgroundBeing with dying people is an integral part of nursing, yet many nurses feel unprepared to accompany people through the process of dying, reporting a lack of skills in psychosocial and spiritual care, resulting in high levels of moral distress, grief and burnout. The aim of this study is to describe the meaning of hospice nurses’ lived experience with alleviating dying patients’ spiritual and existential suffering.MethodsThis is a qualitative study.Hospice nurses were interviewed individually and asked to narrate about their experiences with giving spiritual and existential care to terminally ill hospice patients. Data analysis was conducted using phenomenological hermeneutical method.ResultsThe key spiritual and existential care themes identified, were sensing existential and spiritual distress, tuning inn and opening up, sensing the atmosphere in the room, being moved and touched, and consoling through silence, conversation and religious consolation.ConclusionsConsoling existential and spiritual distress is a deeply personal and relational practice. Nurses have a potential to alleviate existential and spiritual suffering through consoling presence. By connecting deeply with patients and their families, nurses have the possibility to affirm the patients’ strength and facilitate their courage to live a meaningful life and die a dignified death.

Intellectual disability and mental health problems: a qualitative study of general practitioners’ views

Objectives To investigate general practitioners’ (GPs) experiences in managing patients with intellectual disabilities (ID) and mental and behavioural problems (MBP). Design Qualitative study using in-depth interviews. Setting General practice in Hedmark county, Norway. Participants 10 GPs were qualitatively interviewed about their professional experience regarding patients with ID and MBP. Data were analysed by all authors using systematic text condensation. Results The participants’ knowledge was primarily experience-based and collaboration with specialists seemed to be individual rather than systemic. The GPs provided divergent attitudes to referral, treatment, collaboration, regular health checks and home visits. Conclusions GPs are in a position to provide evidence-based and individual treatment for both psychological and somatic problems among patients with ID. However, they do not appear to be making use of evidence-based treatment decisions. The GPs feel that they are left alone in decision-making, and find it difficult to find trustworthy collaborative partners. The findings in this study provide useful information for further research in the field.

“If I Didn't Have My Faith I Would Have Killed Myself!”: Spiritual Coping in Patients Suffering From Schizophrenia

Spirituality, religiousness, and existential thought were qualitatively investigated in six patients suffering from schizophrenia spectrum disorders. The present study is a deepening of a recently published quantitative investigation by Danbolt, Møller, Lien, and Hestad (2011). The patients in the present study were chosen on the basis of diversity as to how they experienced their spirituality to be of significance when coping with their disorder. The informants displayed many signs of spiritual struggle and transitional spiritual coping strategies, all of which seemed to be linked to hallucinatory experiences. Even though their spirituality met the criteria of religious delusions, the patients described their spirituality to have vital importance. The informants showed little spiritual preknowledge and seemed to be left alone without any clerical support in their spiritual struggle. This may underline the importance of including spiritual issues in the treatment of these patients.

The Personal Significance of Religiousness and Spirituality in Patients With Schizophrenia

Religiousness and spirituality were examined in patients with schizophrenia spectrum disorders. Features and subjective significance are described, and associations with psychopathological phenomena are analyzed. The majority of the patients reported that religiousness and spirituality serve a vital positive influence in their ability to cope with their disorder. This positive influence was observed less among those patients with more negative symptoms. The spiritual experience of a divine presence was a common part of spirituality for our respondents, independent of psychopathology, whereas more extraordinary spiritual experiences were associated with certain psychopathological symptoms. Religious patients ruminated less than nonreligious patients did on existential issues, especially regarding the meaning of life, which, together with self-acceptance, was among the key existential issues for these patients.

Does Death of a Family Member Moderate the Relationship between Religious Attendance and Depressive Symptoms? The HUNT Study, Norway

Background. The death of a family member is a stressful life event and can result in an increased level of depressive symptoms. Previous American research has shown inverse relationships between religious involvement and depression. European investigations are few and findings inconsistent; different contexts may have an important influence on findings. We therefore investigated the relationship between attendance at church/prayer house and depressive symptoms, and whether this relationship was moderated by the death of a close family member, in Norway. Methods. A population-based sample from the Nord-Trøndelag Health Study, Norway (HUNT 3, N = 37,981), was the population examined. Multiple regression and interaction tests were utilised. Results. Religious attendees had lower scores on depressive symptoms than non-attendees; death of a close family member moderated this relationship. The inverse relationships between attendance at church/prayer house and depressive symptoms were greater among those experiencing the death of an immediate family member in the last twelve months compared to those without such an experience, with mens decrease of depressive symptoms more pronounced than womens. Conclusion. In a population-based study in Norway, attendance at church/prayer house was associated with lower depressive symptoms, and the death of a close relative and gender moderated this relationship.

Ambiguous participation in older hospitalized patients: gaining influence through active and passive approaches-a qualitative study.

BackgroundPatient participation is required by law in Norway and in several western countries. Current participation ideology is based on individualism, which may conflict with the older generation’s commonly held values of solidarity and community. Hence, different values and ideologies may come in conflict when older patients receive treatment and rehabilitation in geriatric wards. Participation is a guiding principle in rehabilitation. Criteria for admission of older patients to geriatric wards are complex health problems, acute illness and/or acute physical and/or cognitive functional failure. The ideal is an active and engaged patient. The aim of the study was to describe the difficulties experienced by older patients on acute geriatric wards when involving themselves with their own treatment and care.MethodsIn this qualitative study older patients were interviewed during hospitalization in geriatric wards and asked to tell about their experiences with participation. Data analysis was conducted using a phenomenological hermeneutic method.ResultsThe patients experienced difficulties in participating in decisions and care. They linked their difficulties to their own diminishing capabilities, and cited the ward’s busy schedule as a reason for abstaining from participation. However, despite their reservations, they did participate in decisions in different ways. Their participatory practices appeared ambiguous and they employed various strategies to put themselves in a position of influence. The most important of these involved their relatives. The patients delegated to family the tasks of seeking, receiving and giving information to the nurses and the staff, and, to some extent, for the dialogues with hospital staff about their needs and plan of care. The family appeared to accept the responsibility willingly.ConclusionsThe patients addressed their difficulties by authorizing family members to act and participate on their behalf. This underlines the family’s important role in patient participation and the role that nurses and other staff must play in collaborating with the patient and their family to facilitate participation independently of the patients’ performances of participation.

Residents’ and caregivers’ views on spiritual care and their understanding of spiritual needs in persons with dementia: A meta-synthesis

Aims To synthesize research that investigated how residents and caregivers view spiritual care, come to understand the spiritual needs of people with dementia, and how caregivers provide care congruent with peoples’ needs. Methods and study design Meta-synthesis using Noblit and Hare’s meta-ethnography. A synthesis of eight qualitative, empirical, primary studies that explored spiritual care in the context of dementia care was performed. Findings Spiritual care for persons with dementia was described in the forms of (i) performing religious rituals that provides a sense of comfort and(ii) coming to know the person, which provides opportunities to understand a persons meaning and purpose, and (iii) attending to basic needs provides an opportunity to appreciate others’ vulnerability and humanness. Conclusions Spiritual care intended to help persons with dementia to express their faith and religious beliefs, and help persons with dementia experience meaning in life, connectedness to self, God/deity and other persons.

Religiousness in First-Episode Psychosis

The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with their disorder, giving meaning to life as well as a relationship to a sacred figure. However, their religiousness often contained religious omnipotent delusions, and built on hallucinations, displayed an unsecure relationship to the sacred figure. From a psychiatric point of view, the misinterpretation of hallucinations as mystical experiences may reinforce their delusional system and cause an obstacle to recovery. This misinterpretation may also cause problems for patients’ religious coping. Our findings underline the importance of taking patients’ religiousness into account in psychotherapy.

Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: A qualitative study among family members

BackgroundThe drive towards patient involvement in health services has been increasingly promoted. The World Health Organisation emphasizes the family’s perspective in comprehensive care. Internationally there is an increased emphasis on what patients and their family tell about the hospital experiences. However, current literature does not adequately address the question of participation experiences among relatives of older hospitalized family members. There is a paucity of research with a generational perspective on relatives’ opportunities to exert influence. The aim of the study was to explore relatives’ experiences of opportunities to participate in decisions about the care and treatment of older hospitalized family members and whether there are different experiences of influence to the relatives’ age.MethodsThis was an explorative study applying individual qualitative interviews. The interviews were analysed following hermeneutic methodological principles. Two Norwegian geriatric wards participated: one at a university hospital and one at a local hospital. Twelve participants, six women and six men, were purposively selected. The relatives were aged from 36 to 88 (mean age 62) and were spouses, children and/or children-in-law of patients.ResultsThe relatives’ experienced opportunities to exert influence were distributed along a continuum ranging from older relatives being reactive waiting for an initiative from health professionals, to younger adults being proactive securing influence. Older “invisible” carers appeared to go unnoticed by the health professionals, establishing few opportunities to influence decisions. The middle-aged relatives also experienced limited influence, but participated when the hospital needed it. However, limited participation seemed to have less impact on their lives than in the older relatives. Middle-aged relatives and younger adults identified strategies in which visibility was the key to increasing the odds of gaining participation. The exceptional case seemed to be some older carers’ experiences of influencing decisions with the help of professionals.ConclusionsOur findings suggest that experiences of influence were limited regardless of age. However, the results indicated that participation among relatives decrease with age while vulnerability for not having influence seemed to increase with age. The problem of patient choice most clearly manifested among the older carers, which might indicate that the relatives’ age sets terms for opportunities to participate.

The illness reframing process in an ethnic-majority population of older people with incurable cancer: variations of cultural- and existential meaning-making adjustments

Increasing numbers of older people in Western countries are living with incurable cancer as a chronic disease, receiving palliative care from specialised healthcare contexts. The studys aim was to understand variations of cultural- and existential meaning-making adjustments in a Norwegian majority population of older people with incurable cancer. Semi-structured interviews from 21 participants, aged 70–88, were analysed according to three identified types of belief frames: atheistic/humanistic, religious, and spiritual. Kleinmans medical anthropology cultural framework was adapted and applied deductively together with a reframing metaphor concept in a four-part analytic process. Independent of the differences among the types of belief frames and heterogeneous illness reframing processes, changes in the existential cultural dimension seemed to facilitate psychosocial adjustments in relation to illness, daily living, relationships, and surroundings. The results point to the need for collecting and assessing the function of this type of patient information for better understanding the patients framework of interpretation, and for identifying treatment-planning resources.