Solveig Hauge

Older Norwegians’ understanding of loneliness

This interpretive study explored older peoples understanding of loneliness and what they considered appropriate and effective ways of dealing with it. Thirty elderly people were interviewed in-depth; 12 described themselves as “lonely” and 18 as “not lonely.” We found a striking difference in the way “lonely” and “not lonely” people talked about loneliness. The “not lonely” participants described loneliness as painful, caused by the persons negative way of behaving and a state they should pull themselves out of. The “lonely” participants also described loneliness as painful, and gave more detailed descriptions of loneliness as disconnection from others, from their former home and from todays society. The “lonely” participants were more reserved and subdued in trying to explain loneliness, attributing it partly to themselves, but mostly to the lack of social contact with important others. Some felt able to handle their loneliness, while others felt unable to cope. This study underlines the importance of subjective experiences in trying to understand a phenomenon like loneliness and of developing support for lonely older people unable to cope on their own.

Variations in older persons' descriptions of the burden of loneliness.

Research indicates that approximately one-third of older people over the age of 65 years report loneliness, with even higher rates among those aged over 85. Loneliness is associated with a variety of health issues, such as depression, anxiety, physical impairment and social isolation. The purpose of this paper is to describe the characteristics of the burden of loneliness, and investigate the variability in how it is described by older. In-depth interviews were conducted with 12 older people in autumn 2006 and spring 2007 in Norway. Participants aged from 70 to 97 years were recruited from a variety of backgrounds, and varied in health status and social status. The findings reported in this paper are based on hermeneutic analyses of the interviews. Our findings indicate that some of the participants experienced loneliness that they felt able to manage. They experienced a fluctuating loneliness that was linked to feeling valuable and having power and energy. However, another group described experiences of agonising loneliness. They felt a present and extensive loneliness, together with feeling less valuable and lacking in power and initiative. They seemed trapped in their loneliness, and unable to overcome their situation themselves. Our findings indicate that the burden of loneliness is experienced differently. For some older persons, the experience of loneliness is so severe that they urgently need help to manage their situation.

New quality regulations versus established nursing home practice: a qualitative study

BackgroundWestern governments have initiated reforms to improve the quality of care for nursing home residents. Most of these reforms encompass the use of regulations and national quality indicators. In the Norwegian context, these regulations comprise two pages of text that are easy to read and understand. They focus particularly on residents’ rights to plan their day-to-day life in nursing homes. However, the research literature indicates that the implementation of the new regulations, particularly if they aim to change nursing practice, is extremely challenging. The aim of this study was to further explore and describe nursing practice to gain a deeper understanding of why it is so hard to implement the new regulations.MethodsFor this qualitative study, an ethnographic design was chosen to explore and describe nursing practice. Fieldwork was conducted in two nursing homes. In total, 45 nurses and nursing aides were included in participant observation, and 10 were interviewed at the end of the field study.ResultsFindings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines and also that they always seemed to know what to do. Having routines and always knowing what to do mutually strengthen and enhance each other, and together they form a powerful force that makes daily nursing care a taken-for-granted activity.ConclusionNew regulations are challenging to implement because nursing practices are so strongly embedded. Improving practice requires systematic and deeply rooted practical change in everyday action and thinking.

The double embarrassment: Understanding the actions of nursing staff in an unexpected situation.

A nursing home is a complex multifactorial environment that influences the decisions and actions of nursing staff. Many of the actions performed by nursing staff appear to be straightforward or simple because they are repetitive, encompassing everyday activities such as helping a resident to get up in the morning, shower or get dressed. These daily activities are usually performed smoothly as part of normal care. This article draws on ethnographic data from a study of caring practices in a nursing home with the aim of investigating how a seemingly ordinary, but unexpected, event can develop into a chaotic situation. Staff appeared to have difficulty managing the situation, and they seemed to be disorganized in the application of their skills. First, we describe the situation in detail before investigating and discussing the situation to provide a deeper understanding of the complexity of nursing home practice.A nursing home is a complex multifactorial environment that influences the decisions and actions of nursing staff. Many of the actions performed by nursing staff appear to be straightforward or simple because they are repetitive, encompassing everyday activities such as helping a resident to get up in the morning, shower or get dressed. These daily activities are usually performed smoothly as part of normal care. This article draws on ethnographic data from a study of caring practices in a nursing home with the aim of investigating how a seemingly ordinary, but unexpected, event can develop into a chaotic situation. Staff appeared to have difficulty managing the situation, and they seemed to be disorganized in the application of their skills. First, we describe the situation in detail before investigating and discussing the situation to provide a deeper understanding of the complexity of nursing home practice.

The meaning of slow nursing in dementia care

Research literature in the dementia field lacks examples of ‘best-practices’ demonstrating concretely how it is possible to support the sense of coherence in people with dementia. The purpose of this study was to elucidate the nurses’ views concerning a caring approach that may support the sense of coherence in people with dementia. The data were collected through participant observation and focus group interviews during a four-month period in 2011. Sixteen registered nurses recruited from two Norwegian nursing homes participated in this study. The data were interpreted using a phenomenological-hermeneutical method. Three themes were identified: ‘being in the moment’, ‘doing one thing at a time’, and ‘creating joy and contentment’. An overall interpretation of these themes is described by the metaphor ‘slow nursing’, a caring approach that may lead to supporting the sense of coherence in people with dementia.

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.

When care situations evoke difficult emotions in nursing staff members: an ethnographic study in two Norwegian nursing homes.

BackgroundCaring practice in nursing homes is a complex topic, especially the challenges of meeting the basic needs of residents when their behaviour evokes difficult emotions. Cognitive and physical changes related to aging and disability can contribute to behaviours considered to be unacceptable. For example, resident behaviours such as spitting, making a mess with food or grinding teeth are behaviours that most people do not want to see, hear or experience. The aim of this study was to gain a deeper understanding of how nursing home staff members deal with such behaviours in care situations.MethodsThis article draws on ethnographic data to describe how nursing home staff members manage unpleasant resident behaviours. The study was based on two long-term units in two Norwegian public nursing homes. The Region’s Medical Ethics Committee and the Norwegian Social Science Data Services granted approval. In total, 45 participants (37 nursing aides and eight nurses) agreed to participate in this study. Ten of the participants were interviewed at the end of the field study.ResultsThis study indicates that nursing home staff members experience difficult emotions related to some residents’ behaviours. However, they found these feelings difficult to express and rarely verbalized them openly. In addition, they were characterized by a strong obligation to help all residents, despite their own feelings. Therefore, it appears that an inner struggle occurs as a part of everyday practice.ConclusionsDespite these difficult emotions, nursing staff members believed that they needed to manage their responses and continued to offer good care to all residents. These findings extend our understanding of this unarticulated part of nursing home practice.

“Saluting” perceived sense of coherence in people with dementia by nurses

Purpose – Nurses employed in nursing homes have a unique insight into the lives of people with dementia (PwD) and into the factors that may support and possibly enhance their sense of coherence (SOC). It is currently not known precisely which factors contribute to supporting the SOC in PwD; therefore, in order to address the paucity of research in this area, the purpose of this paper is to identify and present these factors as they were perceived by nurses. Design/methodology/approach – The study employed a qualitative explorative design. Participant observation and focus group interviews were the data collection methods. The participants were nurses employed in special dementia units from two Norwegian nursing homes. Data were analysed using qualitative content analysis. Findings – Data analysis highlighted a main category, with additional three generic categories. The main category, “creating order out of chaos” concerns the nurses’ explanations about how they could create order in the lives of PwD live...

Grindagutar på sjukeheim: Tilsette sin erfaring med kulturprosjekt

Grindagutar at nursing home: Employees experience with cultural project. Background: Culture activity contributes to holistic care for nursing home residents, and the employees are key personnel for success. Aim: Explore the employees’ experience putting culture projects into life in a nursing home. Methods: The material, based on four focus group interviews with employees in the nursing home, is categorized and analyzed through text condensation. Results: The culture projects created activity and were sources for thriving. However, not participating directly in the activity, the employees let the artists in, were available for them, and watched the patients during the performances. Their function as “door-openers/-keepers” resulted in hosting responsibility, leading to a position of confusion regarding the role as protectors for the patients. Main challenges were how to give feedback regarding whether the patients liked/disliked the performance, and the feeling of being trapped in a position as bystander rather than making the culture activity a common happening for the patients and the employees.

Interview of 15 Norwegian patients informed that there is no curative treatment for their cancer finds oscillation between feelings of suffering and striving for health.

Commentary on: SaeterenBLindströmUÅNådenD. Latching onto life: living in the area of tension between the possibility of life and the necessity of death. J Clin Nurs 2011;20:811–18.