Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to... more Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and thematic narrative analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and per...
Scandinavian journal of caring sciences, Jan 10, 2017
Pre-eclampsia can lead to premature birth aimed at saving mothers' and infants' lives. Fe... more Pre-eclampsia can lead to premature birth aimed at saving mothers' and infants' lives. Few studies have addressed how women with serious pre-eclampsia experience to become mothers to a premature infant. The aim was to describe the phenomenon of mothers' experience of being a seriously ill with pre-eclampsia and on the same time becoming a mother of a premature infant. A reflective phenomenological lifeworld approach with a descriptive design was used. Nine mothers were interviewed twice, between 6 and 24 days and 16 days to 16 weeks postpartum. The analysis was done by finding meaning units, and then contemporary clusters were made. The process was a movement between figure and background. The essence with its constituents emerged. Being a seriously ill mother of a premature infant requires journeying through physical and psychological suffering to be able to care and take responsibility for their beloved infants. The essence had the following constituents: conflicting f...
This study has two aims: firstly, to describe and interpret experiences of moral challenges in ev... more This study has two aims: firstly, to describe and interpret experiences of moral challenges in everyday nursing practice, as expressed in reflection groups, and secondly, to further interpret how healthcare professionals’ self-understanding can bring light to such challenges. Data consisted of eight reflection group conversations with healthcare professionals, and were analysed using a phenomenological hermeneutic approach. Three themes have been formulated: ‘Having to be affected in order to help the patient’, ‘Having to accept that colleagues do not always collaborate’, and ‘Having to endure organizational demands’. The comprehensive understanding highlights that despite healthcare professionals’ struggle with demanding aspects of caring for their patients, they strive to do good. The study concludes that supporting healthcare professionals when they experience moral challenges is important particularly because such challenges seem to involve a challenge to healthcare professional...
Background: The goal of the Cooperation Reform is to transfer a larger part of the health care se... more Background: The goal of the Cooperation Reform is to transfer a larger part of the health care service to the municipalities. The pressure is increasing on the health care service in the municipalities – especially on the home care service. Aim: To gain knowledge about how nurses experience and manage the challenges in their daily work in the home care service as a result of the new reform. Method: Grounded Theory. Data was collected through participating observation and qualitative interviews with 11 nurses in the home care service in two municipalities. Results: The main challenges of the nurses in the home care service are making difficult decisions in the clinical practice in the home care service. These decisions involve making valuations of ethical competence, and a follow-through of a complicated practice and priorities. Conclusion: This study shows how the Cooperation Reform has contributed to the increased pressure on the home care service – in the form of time reductions a...
Background: Patients in clinical settings are not lonely islands; they have relatives who play a ... more Background: Patients in clinical settings are not lonely islands; they have relatives who play a more or less active role in their lives. Objectives: The purpose of this article is to elucidate the ethical challenges nursing staff encounter with patients’ next of kin and to discuss how these challenges affect clinical practice. Research design: The study is based on data collected from ethical group discussions among nursing staff in a nursing home. The discussions took place in 2011 and 2012. The data were analysed and interpreted by using hermeneutic methodology. Ethical considerations: All the data have been anonymised and handled with confidentiality. Written informed consent was obtained from all participants. Findings: Ethical challenges relating to patients’ next of kin were found to be an issue frequently discussed in the groups. Our findings indicate that next of kin have different characteristics, categorised as ‘the professionals’ and ‘the shadows’. In this article, we wi...
The aim of this study was to generate knowledge about the ethical decision-making-processes nurse... more The aim of this study was to generate knowledge about the ethical decision-making-processes nurses and physicians are faced with on a neonatal unit. What ethical assessments are underlying decisions on whether to start, continue or stop medical treatment of very sick premature babies. A descriptive study design with field observations and in depth interviews was chosen. Strauss' & Glaser's qualitative, comparative method, Grounded Theory, was used to analyze the field observations and interviews. The theoretical framework was normative ethics; deontological ethics, utilitarianism, Aristotelian virtue-ethics theory and an ethics of proximity. The findings were discussed at the individual and the organizational levels. Furthermore, the findings seem to indicate that ethical decisions are somewhat ambivalent. Experience does not make these decisions easier. In situations of indecisiveness, decisions are based upon the sign-of-life of the babies. The findings seem to indicate that nurses and physicians use elements from all the different ethical positions. A tentative theoretical framework was discussed where the core variable seems to be ambivalence.
The focus of this article is the research-process of the study We did what we could; he was such ... more The focus of this article is the research-process of the study We did what we could; he was such a ‘nice’ baby. My experiences as a field researcher and «grounded theorist» will be described and discussed. The aim of the study was to generate knowledge about the ethical decision-making-processes nurses and physicians are faced with on a neonatal unit. A descriptive study design with field observations and in depth interviews was chosen. A total of 120 hours of field observations were made over a period of 10 months at a teaching hospital in Norway. In addition, 22 in depth interviews were made with registered nurses and physicians. A semi-structured interview guide was made and each interview was tape recorded and later transcribed. Strauss' & Glasers' qualitative, comparative method, Grounded Theory, was used to analyze the field observations and interviews. Nud.ist data program (Non-numerical Unstructured Data Indexing Searching and Theory-building) was used in analyzing the data. The findings seem to indicate that ethical decisions are somewhat ambivalent. Experience does not make these decisions easier. In situations of indecisiveness, decisions are based upon the sign-of-life of the babies. A tentative theoretical framework was discussed where the core variable seems to be ambivalence.
This article will be concerned with the phenomenon of vitality, which emerged as one of the main ... more This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this
The aim of this study was to explore and reflect upon mental health nursing and first-episode psy... more The aim of this study was to explore and reflect upon mental health nursing and first-episode psychosis. Seven multidisciplinary focus group interviews were conducted, and data analysis was influenced by a grounded theory approach. The core category was found to be a process named ‘working behind the scenes’. It is presented along with three subcategories: ‘keeping the patient in mind’, ‘invisible care’ and ‘invisible network contact’. Findings are illuminated with the ethical principles of respect for autonomy and paternalism. Nursing care is dynamic, and clinical work moves along continuums between autonomy and paternalism and between ethical reflective and non-reflective practice. ‘Working behind the scenes’ is considered to be in a paternalistic area, containing an ethical reflection. Treating and caring for individuals experiencing first-episode psychosis demands an ethical awareness and great vigilance by nurses. The study is a contribution to reflection upon everyday nursing ...
The aim of this study was to generate knowledge about how parents who have been part of an ethica... more The aim of this study was to generate knowledge about how parents who have been part of an ethical decision-making process concerning a son or daughter in a neonatal unit experience life with a severely disabled child. A descriptive study design was chosen using 30 hours of field observations and seven in-depth interviews, carried out over a period of five months with parents who had been faced with ethical decisions concerning their own children in a neonatal unit. Strauss and Glaser’s constant comparative method was used for the analysis. The findings seem to indicate that these parents have an extremely tough life. Their relationships with their children are somewhat ambivalent. The children are very dependent on their parents, who in some ways both love and hate them. Too little rest and sleep and feeding the children are the most serious problems. The parents require respite facilities. The home can seem like a prison, from which it is impossible to escape. It is like having a ...
Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to... more Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and thematic narrative analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and per...
Scandinavian journal of caring sciences, Jan 10, 2017
Pre-eclampsia can lead to premature birth aimed at saving mothers' and infants' lives. Fe... more Pre-eclampsia can lead to premature birth aimed at saving mothers' and infants' lives. Few studies have addressed how women with serious pre-eclampsia experience to become mothers to a premature infant. The aim was to describe the phenomenon of mothers' experience of being a seriously ill with pre-eclampsia and on the same time becoming a mother of a premature infant. A reflective phenomenological lifeworld approach with a descriptive design was used. Nine mothers were interviewed twice, between 6 and 24 days and 16 days to 16 weeks postpartum. The analysis was done by finding meaning units, and then contemporary clusters were made. The process was a movement between figure and background. The essence with its constituents emerged. Being a seriously ill mother of a premature infant requires journeying through physical and psychological suffering to be able to care and take responsibility for their beloved infants. The essence had the following constituents: conflicting f...
This study has two aims: firstly, to describe and interpret experiences of moral challenges in ev... more This study has two aims: firstly, to describe and interpret experiences of moral challenges in everyday nursing practice, as expressed in reflection groups, and secondly, to further interpret how healthcare professionals’ self-understanding can bring light to such challenges. Data consisted of eight reflection group conversations with healthcare professionals, and were analysed using a phenomenological hermeneutic approach. Three themes have been formulated: ‘Having to be affected in order to help the patient’, ‘Having to accept that colleagues do not always collaborate’, and ‘Having to endure organizational demands’. The comprehensive understanding highlights that despite healthcare professionals’ struggle with demanding aspects of caring for their patients, they strive to do good. The study concludes that supporting healthcare professionals when they experience moral challenges is important particularly because such challenges seem to involve a challenge to healthcare professional...
Background: The goal of the Cooperation Reform is to transfer a larger part of the health care se... more Background: The goal of the Cooperation Reform is to transfer a larger part of the health care service to the municipalities. The pressure is increasing on the health care service in the municipalities – especially on the home care service. Aim: To gain knowledge about how nurses experience and manage the challenges in their daily work in the home care service as a result of the new reform. Method: Grounded Theory. Data was collected through participating observation and qualitative interviews with 11 nurses in the home care service in two municipalities. Results: The main challenges of the nurses in the home care service are making difficult decisions in the clinical practice in the home care service. These decisions involve making valuations of ethical competence, and a follow-through of a complicated practice and priorities. Conclusion: This study shows how the Cooperation Reform has contributed to the increased pressure on the home care service – in the form of time reductions a...
Background: Patients in clinical settings are not lonely islands; they have relatives who play a ... more Background: Patients in clinical settings are not lonely islands; they have relatives who play a more or less active role in their lives. Objectives: The purpose of this article is to elucidate the ethical challenges nursing staff encounter with patients’ next of kin and to discuss how these challenges affect clinical practice. Research design: The study is based on data collected from ethical group discussions among nursing staff in a nursing home. The discussions took place in 2011 and 2012. The data were analysed and interpreted by using hermeneutic methodology. Ethical considerations: All the data have been anonymised and handled with confidentiality. Written informed consent was obtained from all participants. Findings: Ethical challenges relating to patients’ next of kin were found to be an issue frequently discussed in the groups. Our findings indicate that next of kin have different characteristics, categorised as ‘the professionals’ and ‘the shadows’. In this article, we wi...
The aim of this study was to generate knowledge about the ethical decision-making-processes nurse... more The aim of this study was to generate knowledge about the ethical decision-making-processes nurses and physicians are faced with on a neonatal unit. What ethical assessments are underlying decisions on whether to start, continue or stop medical treatment of very sick premature babies. A descriptive study design with field observations and in depth interviews was chosen. Strauss' & Glaser's qualitative, comparative method, Grounded Theory, was used to analyze the field observations and interviews. The theoretical framework was normative ethics; deontological ethics, utilitarianism, Aristotelian virtue-ethics theory and an ethics of proximity. The findings were discussed at the individual and the organizational levels. Furthermore, the findings seem to indicate that ethical decisions are somewhat ambivalent. Experience does not make these decisions easier. In situations of indecisiveness, decisions are based upon the sign-of-life of the babies. The findings seem to indicate that nurses and physicians use elements from all the different ethical positions. A tentative theoretical framework was discussed where the core variable seems to be ambivalence.
The focus of this article is the research-process of the study We did what we could; he was such ... more The focus of this article is the research-process of the study We did what we could; he was such a ‘nice’ baby. My experiences as a field researcher and «grounded theorist» will be described and discussed. The aim of the study was to generate knowledge about the ethical decision-making-processes nurses and physicians are faced with on a neonatal unit. A descriptive study design with field observations and in depth interviews was chosen. A total of 120 hours of field observations were made over a period of 10 months at a teaching hospital in Norway. In addition, 22 in depth interviews were made with registered nurses and physicians. A semi-structured interview guide was made and each interview was tape recorded and later transcribed. Strauss' & Glasers' qualitative, comparative method, Grounded Theory, was used to analyze the field observations and interviews. Nud.ist data program (Non-numerical Unstructured Data Indexing Searching and Theory-building) was used in analyzing the data. The findings seem to indicate that ethical decisions are somewhat ambivalent. Experience does not make these decisions easier. In situations of indecisiveness, decisions are based upon the sign-of-life of the babies. A tentative theoretical framework was discussed where the core variable seems to be ambivalence.
This article will be concerned with the phenomenon of vitality, which emerged as one of the main ... more This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this
The aim of this study was to explore and reflect upon mental health nursing and first-episode psy... more The aim of this study was to explore and reflect upon mental health nursing and first-episode psychosis. Seven multidisciplinary focus group interviews were conducted, and data analysis was influenced by a grounded theory approach. The core category was found to be a process named ‘working behind the scenes’. It is presented along with three subcategories: ‘keeping the patient in mind’, ‘invisible care’ and ‘invisible network contact’. Findings are illuminated with the ethical principles of respect for autonomy and paternalism. Nursing care is dynamic, and clinical work moves along continuums between autonomy and paternalism and between ethical reflective and non-reflective practice. ‘Working behind the scenes’ is considered to be in a paternalistic area, containing an ethical reflection. Treating and caring for individuals experiencing first-episode psychosis demands an ethical awareness and great vigilance by nurses. The study is a contribution to reflection upon everyday nursing ...
The aim of this study was to generate knowledge about how parents who have been part of an ethica... more The aim of this study was to generate knowledge about how parents who have been part of an ethical decision-making process concerning a son or daughter in a neonatal unit experience life with a severely disabled child. A descriptive study design was chosen using 30 hours of field observations and seven in-depth interviews, carried out over a period of five months with parents who had been faced with ethical decisions concerning their own children in a neonatal unit. Strauss and Glaser’s constant comparative method was used for the analysis. The findings seem to indicate that these parents have an extremely tough life. Their relationships with their children are somewhat ambivalent. The children are very dependent on their parents, who in some ways both love and hate them. Too little rest and sleep and feeding the children are the most serious problems. The parents require respite facilities. The home can seem like a prison, from which it is impossible to escape. It is like having a ...
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