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Becoming a parent changes one’s life, and existential questions arise. Time and being oscillate between joy and powerlessness, vulnerability, and self-confidence, between harmony and unpreparedness. Breastfeeding, one of the first skills new mothers try to master, can be joyful and painful. The aim of this study was to develop a deeper understanding of the phenomenon of initial breastfeeding complications as they are lived and experienced by mothers and how these mothers can be supported. Twelve mothers were interviewed, and a phenomenological lifeworld approach was used. Nourishing an infant and having initial breastfeeding complications can be understood by the essence and its constituents. Expectations are fulfilled, and expectations come to naught when complications are experienced such as wavering between powerlessness and joy and finding solutions through resistance. The results suggest that lifeworld-led caring may lead to deepened acknowledgment and the possibility for mothers to feel supported in their extreme situations.

Rationale: Experiences of the innovative method Reflective STRENGTH-Giving Dialogue (STRENGTH), which is grounded in a lifeworld perspective and developed to improve quality of care, is described in this study. Innovative thinking in developing health and social care, which may include digital solutions, is required to ensure a meaningful and dignified life in old age. Aim: The aim of this study was to describe experiences of the intervention Reflective STRENGTH-Giving Dialogue from the perspective of older persons living with long-term health problems. Method: Individual qualitative interviews were conducted with 27 older persons who participated in the intervention. The older persons wrote notes from each dialogue in booklets, and the booklets became part of the study data, analysed with a Reflective Lifeworld Research approach. Results: STRENGTH is experienced as an opportunity to reflect upon life and identify small and large life projects. Dialogues that lead to change in thoughts and actions influence the older persons' well-being, sense of balance, joy and meaning in life. There is an experience of STRENGTH as a starting point and a push to move forward in an effort to experience joy and meaning in life when living with long-term health problems. Conclusions: STRENGTH has the potential to contribute to quality improvement in person-centred care and enhance meaning in life for older persons living with long-term health problems. However, the use of a digital tool in this particular context poses challenges that must be considered. CC BY 4.0First published: 05 August 2020

Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life. Aim To explore parents´ experiences of living with a child with FC and its impact on everyday family life. Method A qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1–14 years affected by FC. Findings Shame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame. Conclusion FC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed. Practice implications Healthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC.

Background: Forensic psychiatric care (FPC) encompasses involuntary care and treatment of those who have committed a crime. On the one hand, FPC is constructed regarding the respect for the individual’s freedom and autonomy, and on the other hand, it is constructed on societal protection. Being a carer in FPC is intertwined with being faced with a distinct ethical dimension of care, as it involves caring for patients who are deprived of their freedom, meaning dealing with the tension of care and custody. Caring means often finding oneself in encounters with individuals with inevitable elements of rules, coercion, threats, and violence. In this complex environment, a caring relationship is to be established, which is intended to be built on trust, as a forensic nurse’s main purpose is creating wellbeing and care, based on the patient’s perspective. It is in the everyday encounters that occur often spontaneously that the carer–patient relationship should be established. It is in these encounters that the carer is given the opportunity to relive suffering. The encounter becomes the focal point where the lifeworlds of the carer and patient meet. Dealing with the duality of FPC and contradictory emotions requires a deeper understanding, which encourages to self reflect the meaning of these encounters and oneself as a carer. Aim: The overarching purpose of the thesis was to obtain a deeper understanding of carers’ lived experience of encounters with patients with mental illness in forensic inpatient care. Method: The thesis consists of four studies (I, II, III, IV) with qualitative design, based on ontological and epistemological reasonings of phenomenology and hermeneutics. The studies illuminated the lived experience and are conducted with phenomenological hermeneutics (I, III), hermeneutics (II), and reflective lifeworld research (IV). Findings: Encounters with patients are characterised with the duality of acting upon the patients’ needs and managing rules and norms stipulated in laws and regulations that govern FPC and societal protection. Encounters in FPC and being a carer is intertwined with being put in a position of power, where the carer also must be allowedviito be fragile and deal with vulnerabilities and not play a role. The encounter means being in a duality and having the insight of the tension of impressions of expressions of suffering, being in the “space in-between”. In this space, there is room and a possibility for carer’s personal growth, and achieving a phenomenological attitude and to truly embrace the patients’ lifeworld. Discussion: A comprehension of the studies (I, II, III, IV) revealed four topics, having trust or feeling distrust, being compassionate or being indifferent, having courage or being afraid, and being genuine or pretending. These were reflected upon against the theoretical framework of K. E. Lögstrup. The duality of FPC and the space in-between that arises in the encounter suggests that the carer is forced to be confronted with existential phenomena that constitutes one’s world. By being active in the space in-between and reflecting upon openness, the carer moves between this duality that exists in the continuum that the opposite phenomenon contains. The space in-between may become a place and a possibility for personal growth by being active and obtaining a phenomenological approach. This is obtained by an openness and consciousness to the impression by self-reflection to convey its meaning. If carers can do this by openness and compliance, there is a possibility for the encounter to become a place for personal growth, that encourages the sovereign utterances of life, and carers may to a greater extent understand themselves as well as patients’ expressions of suffering. Bakgrund: Rättspsykiatri (FPC) omfattar tvångsvård, behandling och omvårdnad av individer som begått brott. FPC är konstruerat ur avseende för respekten för individens frihet och autonomi, å andra sidan om samhällsskydd. Att vara vårdare i FPC är sammanflätad med att ställas inför en distinkt etisk dimension av vården, eftersom det handlar om att ta hand om patienter som är berövade sin frihet, det vill säga att hantera spänningen mellan omsorg och samhällsskydd. Omsorg innebär ofta att befinna sig i möten med individer med oundvikliga inslag av regler, tvång, hot och våld. I denna komplexa miljö ska en omtänksam relation etableras, som är tänkt att bygga på förtroende, då rättspsykiatrins huvudsakliga syfte är att skapa välbefinnande och utgå från patientens perspektiv. Det är i de vardagliga möten som ofta uppstår spontant, vård- och patientrelationen ska etableras. Det är i dessa möten vårdaren ges möjlighet att lindra lidande. Mötet blir samlingspunkten där vårdarens och patientens livsvärldar kan mötas. Att hantera dualiteten av FPC och motsägelsefulla känslor kräver en djupare förståelse som uppmuntrar till självreflektion angående innebörden av dessa möten och därmed sig själv som vårdare. Syfte: Det övergripande syftet med avhandlingen var att få en djupare förståelse av vårdares levda erfarenhet av mötet med patienter med psykisk ohälsa inom rättspsykiatrisk slutenvård ur vårdarnas perspektiv. Metod: Avhandlingen består av fyra studier (I, II, III, IV) med kvalitativ design, baserad på ontologiska och epistemologiska resonemang inom fenomenologi och hermeneutik. Studierna belyser den levda erfarenheten och är bedriven enligt fenomenologisk hermeneutik (I, III), hermeneutik (II) och reflekterande livsvärldsforskning (IV). Resultat: Mötet med patienter kännetecknas av dualiteten att agera utifrån patienternas behov och hantera regler och normer som fastställs i lagar och förordningar som styr FPC och samhällsskydd. Möten i FPC och att vara vårdare är sammanflätade med att försättas i en maktposition, där vårdgivaren också måste tillåtas vara skör och hantera sin sårbarhet och inte behöva spela enixroll. Mötet innebär att vara i en dualitet och ha insikten om spänningsfältet som uppstår i intrycken av uttryck för lidande, att vara i “mellanrummet”. Det är i mellanrummet, det finns utrymme och möjlighet för vårdarens personliga mognad att växa, genom att vara aktiv och anamma en fenomenologisk attityd som tillåter vårdaren att se patientens livsvärld. Diskussion: En förståelse av studierna (I, II, III, IV) avslöjade fyra områden, att ha tillit eller känna misstro, vara medkännande eller vara likgiltig, ha mod eller vara rädd och vara äkta eller låtsas, som sedermera reflekterades mot den teoretiska ramen av K. E Lögstrup. Dualiteten av FPC och utrymmet däremellan som uppstår i mötet, gör att vårdgivaren tvingas konfronteras med existentiella fenomen som utgör ens livsvärld. Genom att vara aktiv i mellanrummet och reflektera över öppenhet rör sig vårdaren mellan denna dualitet som finns i det kontinuum som de motsatta fenomenen innehåller. Mellanrummet kan möjligen bli en plats för personlig växt genom att vara aktiv och anamma ett fenomenologiskt förhållningssätt. Detta erhålls genom en öppenhet och medvetenhet för intrycket genom självreflektion för att förmedla dess mening. Om vårdare kan göra detta genom öppenhet och följsamhet finns det en möjlighet för mötet att bli en plats för personlig växt, som uppmuntrar de suveräna livsyttringarna och vårdare kan i större utsträckning förstå sig både själva samt patienters uttryck av lidande.

Anabolic androgenic steroids are used by women to increase their muscle mass and because of their performance-enhancing effects. Despite permanent/high risk of side effects, knowledge is inadequate. Our aim has been to deepen understanding about women's use of anabolic androgenic steroids. This phenomenological study is based on the reflective lifeworld research (RLR) approach. Lifeworld interviews were conducted with 12 women, aged 21–56 years, about their experiences of using anabolic steroids. The results show that women experience a sense of pride when they successfully achieve their goals. This is the driving force, triggering tension between suffering and success. Our research adds important knowledge from a reflective lifeworld perspective and shows that women's use of anabolic androgenic steroids is a complex phenomenon. Understanding and knowledge are important in order to be able to meet and support women in their fears and difficulties.

Purpose This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel. Methods The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon. Results The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated. Conclusions The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.

The birthing room is a major workplace for midwives but how it influences them in practice is not enough investigated. Purpose: This study aimed to explore midwives´ experiences of how the birthing room affects them in their work to promote a normal physiological birth. Methods: A phenomenological reflective lifeworld research approach was used and included individual interviews with 15 midwives working at four different hospitals in western Sweden, and of which two also assisted at homebirths. The analysis focused on the meanings of the study phenomenon. Results: A birthing room can by its design either support a normal physiological birth or support a risk approach to childbirth. Four opposing constituents complete the essential meaning of the birthing rooms, and to which the midwives need to relate in their roles as guardians for normal birth: i) a private or a public room; ii) a home-like or hospital-like room; iii) a room promoting activity or passivity; iv) a room promoting the midwife´s presence or absence. Conclusions: The birthing room mirrors a pathogenic-oriented care approach. A presupposition for the work to keep the birth bubble intact is to protect the mother from disturbing elements both inside and outside the room.

Purpose: The aim of this study is to describe new fathers’ expectations of and experiences with municipal postnatal healthcare services. Methods: A phenomenological reflective lifeworld research (RLR) approach has been used. Ten fathers were interviewed about their expectations of and experiences with municipal postnatal healthcare services, and the data were analysed to elucidate a meaning structure for the phenomenon. Results: The essential meaning of the phenomenon of fathers’ expectations of and experiences with municipal postnatal health care described as going blindly into the women’s world. The essential meaning is further explicated through its four constituents: not knowing what to ask for, feeling excluded, seeking safety for the family and longing for care. Conclusions: Entering the postnatal period with sparse knowledge about the child and family healthcare services available is difficult for the fathers who do not know what to ask for and what to expect. The fathers’ feel excluded by the public health nurse, and the postnatal health care is seen as a mother–baby–public health nurse triad. The feeling of exclusion and inequality might be avoided if public health nurses focused both on mothers’ and fathers’ individual follow-up needs in the postnatal period and on seeing the newborn baby and the parents as a family unit.

Aim: The overall aim of this thesis is to describe and explore preventive measuresand risks for surgical site infections. Methods: Study I, a registry based and observational design study, includes 35 056cases analysed for risks for reoperation caused by periprosthetic joint infection afterelective total hip arthroplasty. Data are analysed with Cox regression. Study II is ahypothesis testing study and uses an experimental design. Comparative statisticswere used to compare contamination of agar plates after 15 hours for twoconditions: single drape covering or double drape covering. Study III, an interviewstudy that uses a reflective lifeworld research methodology, includes 15 operatingroom nurses who were interviewed regarding the phenomenon of intraoperativeprevention of surgical site infections. Study IV, also an interview study, includes 14orthopaedic patients who were interviewed regarding their experience with at-homepreoperative skin disinfection. Data were analysed using manifest content analysisaccording to Graneheim and Lundman. Results: Study I shows an increased risk of reoperation caused by periprostheticjoint infection after planned total hip arthroplasty for age, male sex, morbidity (ASAclass III-IV), obesity, lateral approach to the hip, general anaesthesia, and prolongedoperative time. Study II shows reduced contamination of agar plates after 15 hoursstorage with double drape covering compared to single drape covering. Study IIIshows that prevention of surgical site infections is a struggle against an invisible anddelayed threat. Another key finding is the importance of operating room nurseslegitimacy and collaboration within the operating team to prevent surgical siteinfections. Study IV describes the patients’ experiences with at-home preoperativeskin disinfection. The result points out obstacles with the procedure and theimportance of identifying those patients who are not suitable for self-care regardingthis preventive measure Conclusion: Safeguarding from surgical site infections is a mutual responsibility ofthe patient, caregivers, and perioperative healthcare leaders. Therefore, this complexphenomenon is difficult to assess. Prevention of surgical site infections needs to bea collaborative effort involving patient, caregivers, and perioperative healthcareleaders. The high-risk care of performing surgery requires confident and safeprofessionals in each position. Well-functioning teamwork and collaboration arekey factors for ensuring stability inside the operating room and providing conditionsfor safe care.

Purpose: The aim was to describe patients’ lived experience of warmth and coldness in connection with surgery. Methods: A reflective lifeworld research (RLR) approach founded on phenomenology and the methodological principles of openness, flexibility, and bridling were used. The data consisted of 16 in-depth interviews with patients from four hospitals in Sweden. Results: Warmth and coldness in connection with surgery means an expectation to maintain one´s daily life temperature comfort. When patients’ needs of temperature comfort is fulfilled it give a sense of well-being and calmness. Despite the body is covered there are feelings of vulnerability. When patients have the ability to change their own temperature comfort, they feel independent. Conclusion: The individual feeling of temperature comfort could be affected or changed to discomfort during the perioperative context, and an intervention is required to avoid suffering due to the care. An ability to independently influence one´s own temperature comfort can strengthen the patient, whereas the opposite entails suffering in silence. The phenomenon is also related to feelings of confidence about receiving the best care as well as being exposed and vulnerable. When the patient´s need of comfortable temperature is met then feelings of security and sense of well-being emerged.

Introduction Young men may struggle in life with challenges of various concerns about their identity and who they want to be in life. Many health issues arise from social norms and wider societal determinations and for today’s young men, following such norms poses a risk of losing oneself. An essential part of health are connected to the existential dimensions in life and concerns who you are, and how well you know and understand yourself. However; little is known about what it means for young men to live a life with existential concerns. Purpose and method The purpose of this phenomenological study, based on reflective lifeworld research (RLR), is to describe young men’s experiences of living with existential concerns for which they have sought support. Eight lifeworld interviews were conducted. Results The results essentially show that young men living with existential concerns describe their situations as living close to a bottomless darkness. This is further described according to four constituents: enduring everyday life, striving for a solution, hearing an inner self-critical voice, and wearing a hard shell. Conclusion We conclude that strengthening young men’s health processes requires healthcare professionals to create an atmosphere where young men feel safe talking about existential concerns without feeling exposed and vulnerable.

Aim: The overall aim of the thesis is to examine how young adults experiences life living with existential concerns and how well-being is enabled when living with existential concerns. Approach and method: A reflective lifeworld research (RLR) approach guided this dissertation’s methodological approach. Lifeworld interviews were performed in all four studies and analyses were conducted according to RLR principles: bridled attitude, openness, and compliance to the studies’ different phenomena. Study I describes healthcare professionals’ experiences of conversations with young adults experiencing existential concerns. Eleven lifeworld interviews (seven individual-, two pair- and two group interviews) were conducted with seventeen healthcare professionals from various fields. Data was analysed via phenomenological-based thematic meaning analysis. Studies II and III describes young adults’ experiences of existential concerns from the perspective of young women and young men; nine women (study II) and eight men (study III) participated. All interviews were individual lifeworld interviews. Study IV describes young adults’ experiences of enabling wellbeing in a life with existential concerns. Seventeen adults (same participants as study II and III) participated and all interviews were individual lifeworld interviews. Studies II, III, and IV were analysed by phenomenological analysis. Main results: The results show that the lives of young adults with existential concerns are significantly affected by these concerns. Existential concerns awaken vulnerability, characterized by feeling lost in life and living near a bottomless darkness in which life may seem unbearable. In such a vulnerable existence, there is a desire to find a place to rest, thereby enabling wellbeing. For young adults, vulnerability means having the courage to expose their life situation and innermost thoughts. In encounters with others, there is a risk of being condemned, neglected, identified as weak, or rejected. In a caring relationship between young adults and healthcare professionals, both young adults and healthcare professionals’ vulnerability to life’s fragility evokes. Courage means daring to expose one’s vulnerability and sharing one’s life story. Courage also means that healthcare professionals dare to remain in the caring relationship and listen to the young adult’s life story, no matter how dire or dark it seems. In order for the life story to stand out, a mutual invitation between young adults and healthcare professionals is required. The results show that the prerequisites for a caring relationship involve mutual vulnerability, courage, and invitation to reflect on life’s challenges. In a genuinely caring relationship, through existential confirmation, entails finding a place to rest that enables wellbeing when experiencing existential concerns as a young adult. Conclusion: The thesis contributes knowledge relating to how young adults experience life with existential concerns and, in turn, how wellbeing is enabled through the experiences of young adults and healthcare professionals. Existential concern is a complex phenomenon, involving vulnerability, courage, and the invitation to enable wellbeing. From a lifeworld theoretical perspective, we see an openness to existential dimensions in young adults’ life stories, providing guidance to caregivers in enabling young adults to find a place where they can be vulnerable and have an opportunity to recover. Disputationen sänds via videolänk, förinformation se kalendariet på hb.se/forskning.

Introduction: Ageing is often associated with multiple long-term health problems influencing older persons' well-being in daily living. It is not unusual that the point of interest in research is often on the management of the actual health problem instead of being holistic and person-centred.Purpose: To describe the phenomenon of living with long-term health problems that influence daily living, from the older persons' perspective.Methods: Qualitative individual interviews were conducted with 34 older persons living with long-term health problems. The data were analysed using a Reflected Lifeworld Research (RLR) approach, grounded in phenomenology. Results: Life with long-term health problems entails living in a diminishing world. It entails living in uncertainty, not being able to trust one's own ability. The freedom to make decisions of your own is deprived by relatives and health-care providers. Living with long-term health problems entails being dependent on support in daily life and a strive to maintain meaningfulness in daily living.Conclusions: The results address a need for extended individual and holistic guidance and support in living with long-term health problems to increase the older person's sense of well-being and meaning in life. CC BY 4.0Contact: Cecilia Åberg cecilia.aberg@his.se School of Health Sciences, University of Skövde, P.O. Box 408, Skövde SE-541 28, SwedenThe study was funded by the School of Health Sciences, University of Skövde, Sweden and by the Skaraborg Institute for Research and Development, Sweden.

Introduction Young men may struggle in life with challenges of various concerns about their identity and who they want to be in life. Many health issues arise from social norms and wider societal determinations and for today’s young men, following such norms poses a risk of losing oneself. An essential part of health are connected to the existential dimensions in life and concerns who you are, and how well you know and understand yourself. However; little is known about what it means for young men to live a life with existential concerns. Purpose and method The purpose of this phenomenological study, based on reflective lifeworld research (RLR), is to describe young men’s experiences of living with existential concerns for which they have sought support. Eight lifeworld interviews were conducted. Results The results essentially show that young men living with existential concerns describe their situations as living close to a bottomless darkness. This is further described according to four constituents: enduring everyday life, striving for a solution, hearing an inner self-critical voice, and wearing a hard shell. Conclusion We conclude that strengthening young men’s health processes requires healthcare professionals to create an atmosphere where young men feel safe talking about existential concerns without feeling exposed and vulnerable.

Introduction Family-focused nursing has gained ground worldwide, and a range of healthcare systems are now practicing family-focused nursing, which has been shown to increase the quality of care. Even so, a lack of research remains into family-focused nursing for various groups of patients in clinical practice. Objectives The purpose of this study was to explore how family members (FMs) of patients with atrial fibrillation (AF) experienced a family-focused nursing intervention in a clinical outpatient setting. Methods This was a qualitative phenomenological interview study employing Reflective Lifeworld Research (RLR) to explore humans’ lived experiences. The data reported herein were derived from semi-structured interviews with seven FMs of patients with AF who participated in a clinical trial which tested a family-focused intervention in a Cardiology outpatient clinic treating patients with AF. The transcribed interviews were analyzed in four phases which is an iterative process as proposed by Dahlberg and Dahlberg. Findings The essence of the phenomenon was experiencing less panic and finding peace, which emerged from the following four patterns. (1) The FMs’ post-AF experience, (2) Enhanced understanding and knowledge of AF, (3) Personal interaction with a nurse specialist and (4) AF becomes manageable. A space facilitating reflection upon the disease and daily life with the disease was established through group sessions and family conversations. Conclusion A family-focused nursing intervention facilitated by specialized nurses with extensive communication skills filled a knowledge gap related to AF thereby reducing panic and increasing peace among FMs. Furthermore, the intervention facilitated family awareness of their resources to bring about change, regain balance, and enhance well-being in their everyday lives and initiated a healing process in the families. Future interventions for patients with AF should consider FMs as well as patients as an entity of care.

Being pregnant, giving birth, and becoming a mother the first months after birth, is for women with type 1 diabetes mellitus (T1DM) a period of difficult challenges. In order to identify their need of support from healthcare, the aim of this study was to describe healthcare during pregnancy, labour, birth, and up to 12 weeks after birth as experienced by Swedish women with T1DM. We used a phenomenological reflective lifeworld research approach, and made 1-2 individual interviews with ten women in late pregnancy and/or 2-3 months after. Transcribed interviews were analysed through focusing on the meanings of the study phenomenon. The results revealed how the diabetes disease, as well as the risks and responsibility that comes with it, become more visible during the period in question, due to a constant monitoring, performed by the woman herself as well as by the healthcare professionals. The essential meaning of the phenomenon is a need to share the burden of risks and responsibilities with healthcare professionals. The complex situation that these women are in, both as experts on their illness and care and in need of care, requires a care that make women feel capable and responsible, but at the same time offers support and relieve them of their responsibility when needed.

Purpose The aim of this study was to describe the phenomenon of undergoing colonoscopy as experienced by adolescents. Design This study was a qualitative study in which data were collected and analyzed in accordance with the methodological principles of Reflective Lifeworld Research with a phenomenological approach. Methods Face-to-face interviews were performed with 17 adolescents after undergoing the first colonoscopy. Results The phenomenon of undergoing colonoscopy as experienced by adolescents can be described as a collision between emotions and a desire to obtain answers to questions about the examination, as well as concerns about its result and the meaning of undergoing colonoscopy. The essential meaning is additionally described through its constituents: a sense of vulnerability, an opportunity for symptom explanation, and sensibility regarding information. Conclusions The results can be concluded in terms of the knowledge that for adolescents a colonoscopy means more than an examination. Although colonoscopy is not experienced as painful, it evokes different emotions that affect adolescents. Therefore, a psychological preparation, on an individual level, is required before the colonoscopy. Our results showed that adolescents need to understand the connection between their symptoms, their body, and the colonoscopy.

Bakgrund: Äldre människor är en återkommande patientgrupp på akutmottagningen. Vid sjukdom har den äldre ofta nedsatt förmåga och är sårbar. Det finns då en risk att autonomin inte tillgodoses och att värdigheten kränks. Forskning i ämnet visar att det finns en stor kunskapsbrist där ny forskning skulle kunna bidra till att förebygga orättvis behandling av äldre som drabbas av akut sjukdom. Syfte: Syftet med studien är att beskriva förhållningssätt till den äldre patientens autonomi när denne vårdas på akutmottagningen utifrån sjuksköterskors levda erfarenheter. Metod: Studien genomfördes med en reflekterande livsvärldsansats grundat i den fenomenologiska kunskapsteorin. Fenomenet i studien är “hantera autonomi”. Data samlades via intervjuer från två akutmottagningar. Resultat: Essensen av fenomenet att hantera den äldre patientens autonomi på akutmottagning är att brista i kunskap om autonomi, brista i förmåga till kritiska reflektioner avseende etiska problem och brista i förståelse av hur patientdelaktighet kan främjas i en otillåtande vårdmiljö. Förhållningssätt som främjar den äldre patientens autonomi och delaktighet är sköra och hindras av den försvårande vårdmiljön vilket skapar känslor av otillräcklighet. Resultatet beskrivs med innebördstema: Att prioritera i en stressig vårdmiljö, Att sträva att bevara autonomin, Att bedriva övertalning för patientens bästa, Att i akuta situationer tvingas bortse från patientens autonomi, Att ta beslut utifrån egna värderingar, Att ta beslut utan tillgång till patientens samtycke, Att utesluta och kränka patienten. Slutsats: Utifrån studiens resultat dras slutsatsen att sjuksköterskor på akutmottagningen behöver kunskapsutveckling i ett etiskt förhållningssätt samt förutsättningar i vårdmiljön för att kunna utföra god och rättvis vård. Background: Older people is a recurrent group of patients at the emergency department. The older patient often has impaired abilities during illness and is vulnerable. There is a risk that their autonomy isn’t satisfied and their dignity breached. Research shows that there is a gap in knowledge and new studies could contribute to prevent non equitable treatment of older people with acute illness. Aim: The aim of the study is to describe the approach to the autonomy of the older patient when cared for in the emergency department from the perspective of lived experience of nurses. Methods: The study was conducted with a reflective lifeworld approach based on a phenomenological knowledge theory. The phenomenon in this study is “handling of autonomy”. Data was collected through interviews from two emergency departments Findings: The essence of the phenomenon to deal with the older patients autonomy in the emergency department is lack of knowledge of autonomy, lack of ability of critical reflection regarding ethical problems and lack of understanding how patient participation can be encouraged in an non permissive care environment. Approaches that encourages the older patient’s autonomy and participation are fragile and are prevented by the aggrevating environment which creates feelings of inadequacy. The results are described by content themes: To prioritise in an stressful care environment, To strive to retain autonomy, To conduct persuasion for the patient’s best, To disregard patient autonomy due to emergent situations, To make decisions based on personal values, To make decisions without access to patient consent, To exclude and violate the patient. Conclusions: Based on the result of the study the conclusion is that nurses in the emergency department need knowledge development with an ethical approach as well as proper preconditions in the care environment to be able to perform good and equitable care.

Purpose: The aim of this study is to describe young women’s (16–25 years old) experiences of living with existential concerns for which they have sought support from healthcare professionals, teachers, family, or friends, among others. Methods: This phenomenological study is based on a reflective lifeworld research (RLR) approach. Nine young women were interviewed about their experience of living with existential concerns. Results: The results show the essential meaning of the phenomenon of “existential concerns” that can be described as living a life that is marked in a profound way by a feeling of being lost in an unknown terrain. To further understand the essential meaning, four constituents are described: the unpredictable body, longing for comprehension, playing a game, and longing to share one’s vulnerability. Conclusions: Young women with existential concerns are vulnerable, as they are profoundly influenced by these concerns. They have to navigate through daily life while trying to fit in and to make their situation comprehensible. These young women have a longing to share their existential concerns with a trustworthy person, while at the same time they fear revealing their existential concerns and risking being rejected by others. A lifeworld-led, caring science approach, intertwined with the results of the present study, has the potential to direct caring practice.

Fenomenologinis tyrimas – viena iškiliausių kokybinių tyrimų strategija, turinti ganėtinai skirtingą požiūrį į mokslinį griežtumą. Žinoma, fenomenologija, kaip ir kiti kokybiniai tyrimai pripažįsta bei laikosi įprastų mokslinio griežtumo reikalavimų – objektyvumo, validumo ir generalizavimo. Esmė yra ta, kad šių požymių raiška yra kiek kitokia. Minėti bruožai reiškiasi savitomis formomis, būdais bei yra atpažįstami iš fenomenologijai būdingų požymių. Vienas iš tokių požymių – reflektyvumas. Jis yra toks pats stiprus ir reikšmingas mokslinio griežtumo bruožas kaip ir įprasti. Reflektyvumas fenomenologiniame tyrime reiškiasi viso proceso metu – nuo tyrimo strategijos pasirinkimo, tyrimo instrumento konstravimo iki pat pabaigos. Jis reiškiasi tyrėjo atvirumu, jautrumu tyrinėjamo objekto atžvilgiu, savo paties, kaip tyrėjo, nuostatų, požiūrių bei veiksmų kritine refleksija ir savirefleksija. Šio straipsnio autorė pateikia konkrečių argumentų, paremtų filosofine, metodologine literatūra bei praktiniais pavyzdžiais, apie reflektyvumo sąsajas su moksliniu griežtumu taikant Reflektyvaus fenomenologinio tyrimo strategiją. Atvirumas, išankstinių nuostatų, žinojimo bei skubotų išvadų pažabojimas, refleksija ir savirefleksija – tai pagrindiniai šios tyrimo strategijos bruožai, liudijantys apie tyrimo mokslinį stiprumą. Šie bruožai turi stiprų ontologinį bei epistemologinį pamatą, pagrįstą E. Husserlio, M. Merleau-Ponty, H. G. Gadamerio ir kt. fenomenologinės filosofijos klasikų darbais. Metodologinis pagrindimas – švedų mokslininkės prof. K. Dahlberg, šios tyrimo strategijos autorės. Praktinės iliustracijos – Nyderlandų mokslininkės van Wijngaarden ir šio straipsnio autorės refleksijos apie tyrimo objekto, strategijos, tikslinių grupių pasirinkimą, tyrimo eigą ir rezultatus. Phenomenological research is one of the most prominent qualitative research strategies. It is quite different research approach in terms of scientific rigorousness. Being part of qualitative research, phenomenological research holds same attributes of rigorousness as all scientific research – objectivity, validity generalizability. Just those attributes manifest differently in a different types of research. One attribute – reflexivity of a researcher is a prominent feature of phenomenological research, that speaks for scientific rigorousness with a same strength as the rest attributes. The author of this paper argues that reflexivity of a researcher is one of major and strongest scientific attributes of a scientific rigor. Arguments come from reflective lifeworld research philosophy and methodology as well as original research illustrations from Lithuania and the Netherlands.

Purpose: The aim of the study was to describe how women with stress-related illness experience well-being in everyday life. Methods: The study was based on a reflective lifeworld research (RLR) approach and the methodological principles of openness, flexibility and bridling. Twelve women, aged 27–54 years, diagnosed with stress-related illness were included. Data were collected with lifeworld interviews based on photographs taken by the women relating to well-being in everyday life. The data were analysed for meaning. Results: Well-being emerged in situations where women could feel an unconditional beingness. This entails not having demands on oneself and includes some form of freedom from having to perform. The surroundings and supportive environments are important for this unconditional beingness to be present. In order to feel well-being in everyday life, the women need to balance their energy and find helpful tools that can achieve a balance in everyday life. Conclusions: Healthcare staff need to understand the importance of unconditional beingness in supportive environments for patients living with stress-related illness in order to support their health and well-being. It is also important to support patients in finding helpful tools that can aid them to achieve a balance in everyday life.

Persons who are subject to care due to suicidal thoughts and/or acts, are in a vulnerable situation, struggling with issues related to life and death as well as experiences of hopelessness and powerlessness. They may also experience themselves as a burden for their relatives. The relatives’ struggle for contributing to the loved person’s survival, can involve experiences of taking responsibility for things that are outside their control. Although research considering how suicidal persons and their relatives can be supported, when the person receives care in a psychiatric inpatient setting is sparse. There is also a need for research to form the basis for mental health nurses to enable caring interventions, with the potential of acknowledging the uniqueness of each individual person and their experiences. This thesis is based on a perspective of recovery as a process, where the persons experience themselves as capable of managing both challenges and possibilities in life and incorporate meaning into it. Experiences of being capable of managing problems in living are vital for this process. Thus, it is necessary to acknowledge the lifeworld as essential for personal recovery. The overall aim of this research was to develop, introduce and evaluate a caring intervention, to support suicidal patients’ recovery and health, and to support patients’ and their relatives’ participation in the caring process. Considering the complexity of such a caring intervention and the importance of recognizing multiple aspects of the phenomenon (i.e., recovery in a suicidal crisis), this research was conducted from a lifeworld perspective based on phenomenological philosophy. Two studies with reflective lifeworld research approach (I, II), a Delphi study (III), and a single case study with QUAL>quan mixed methods research approach (IV) were conducted. The developed caring intervention is characterized by “communicative togetherness”. This means that the nurse and the patient together explore how the patient’s recovery can be supported, as a way for the patient to reconnect with self and important others, and thereby being strengthened when challenged by problems in living. It was also concluded that it is more appropriate to acknowledge this as a caring approach, rather than describe it as a specific caring intervention. The final description of the findings comprise a preliminary guide to a personal-recovery-oriented caring approach to suicidality (PROCATS). This description highlights six core aspects of the caring approach. The overall aim of the PROCATS is to support suicidal patients’ recovery and health processes, even at the very edge of life. Although the findings indicate that the caring approach has potential to support suicidal patients’ recovery as well as support their relatives’ participation, there is a need for further evaluation of the PROCATS in a wider context.

Purpose: Previous research shows that the learning space is significant for students’ learning in pairs in clinical practice but does not explain the meaning of the phenomenon. The aim of this study is thus to explain and understand the learning space that occurs in the interaction between the patients, the pairs of nursing students, and the supervisors on a developing and learning care unit in Sweden. Method: The study has been carried out with a Reflective Lifeworld Research (RLR) approach founded on hermeneutics. A total of 39 informants, consisting of 16 patients, five pairs of students (10 students), and 13 supervisors, were observed and interviewed. Results: The results reveal that an interpersonal linkage between the patients, the students, and the supervisors is created within the learning space. A learning space, based on respect towards each other, creates the prerequisite for beneficial and supportive interactions that contribute to a deeper relationship. Conclusion: The phenomenon is complex due to its expandable nature and due to the fact that the learning space cannot be isolated from the surrounding environment. In order to exploit the potential of the learning space it is of importance to understand and consider the learning space as a whole.

This article illuminates the essence of Neonatal Intensive Care Unit (NICU) nurses’ attitudes in skin-to-skin care (SSC) practice for preterm infants and their parents. Health care providers are in a unique position to influence the dynamic between infants and parents, and SSC affects both partners in the dyad. The design is descriptively phenomenological in terms of reflective lifeworld approach. Eighteen Swedish, Danish, and Norwegian nurses from NICUs offering varied possibilities and extents of SSC participated. NICU nurses’ attitudes in SSC practice are ambivalent. The nurses consider the sensory, wellness, and mutuality experiences to be primary and vital and enact SSC as much as possible. But “as much as possible” is a broad and varied concept, and their attitudes are ambivalent in terms of not always facilitating what they consider to be the optimal caring conditions. The source of NICU nurses’ ambivalent attitudes in SSC practice is a complex interplay of beliefs, norms, and evidence, which have a multidisciplinary basis. The ambivalent attitudes are, to a great extent, the result of the need to balance these multidisciplinary concerns. This needs to be acknowledged in considering SSC practice, as well as acknowledging that clinical judgments concerning optimal SSC depend on parents and infants unlimited access to each other, which NICU nurses can influence.

This study explores the lived experience of losing a leg as described by the patients themselves post-discharge. Studies have documented that regardless of aetiology patients are faced with severe physical as well as psychosocial challenges post-amputation. However, only few studies explore in-depth the patients’ perspective on the various challenges following the loss of a leg. The study uses the phenomenological approach of Reflective Lifeworld Research (RLR). Data were collected from 24 in-depth interviews with 12 Danish patients. Data analysis was performed according to the guidelines given in RLR. The essential meaning of losing a leg is a radical and existential upheaval, which restricts patients’ lifestyle and irretrievably alters their lifeworld. Life after the operation is associated with despair, and a painful sense of loss, but also with the hope of regaining personal independence. The consequences of losing a leg gradually materialize as the patients realize how the loss of mobility limits their freedom. Patients experience the professional help as primarily directed towards physical care and rehabilitation. The findings show that the loss of a leg and, subsequently, the restricted mobility carry with them an existential dimension which refers to limitation of action space and loss of freedom experienced as an exclusion from life. Our findings demonstrate a need for complementary care and stress the importance of an increased awareness of the psychosocial and existential consequences of losing a limb.

The aim of this article is to articulate the essence and constituents of neonatal intensive care unit (NICU) nurses’ experiences in enacting skin-to-skin care (SSC) for preterm newborns and their parents. SSC is commonly employed in high-tech NICUs, which entails a movement from maternal–infant separation. Parents’ opportunities for performing the practice have been addressed to NICU staff, with attitude and environment having crucial influence. The study was carried out with a reflective lifeworld research approach. Data were collected in Denmark, Sweden, and Norway by open-dialogue interviews with a purposive sample of 18 NICU nurses to achieve the essence of and variation within the phenomenon. NICU nurses experience balancing what they consider preterm newborns’ current and developmental needs, with readiness in both parents for SSC. They share an experience of a change in the history of NICU care to increased focus on the meaning of proximity and touch for the infants’ development. The phenomenon of enacting SSC is characterized by a double focus with steady attention to signals from both parents and newborns. Thereby, a challenge emerges from the threshold of getting started as the catalyst to SSC.

Phenomena in caring science are often complex and laden with meanings. Empirical research with the aim of capturing lived experiences is one way of revealing the complexity. Sometimes, however, results from empirical research need to be further discussed. One way is to further abstract the result and/or philosophically examine it. This has previously been performed and presented in scientific journals and doctoral theses, contributing to a greater understanding of phenomena in caring science. Although the intentions in many of these publications are laudable, the lack of methodological descriptions as well as a theoretical and systematic foundation can contribute to an ambiguity concerning how the results have emerged during the analysis. The aim of this paper is to describe the methodological support for the further abstraction of and/or philosophical examination of empirical findings. When trying to systematize the support procedures, we have used a reflective lifeworld research (RLR) approach. Based on the assumptions in RLR, this article will present methodological support for a theoretical examination that can include two stages. In the first stage, data from several (two or more) empirical results on an essential level are synthesized into a general structure. Sometimes the analysis ends with the general structure, but sometimes there is a need to proceed further. The second stage can then be a philosophical examination, in which the general structure is discussed in relation to a philosophical text, theory, or concept. It is important that the theories are brought in as the final stage after the completion of the analysis. Core dimensions of the described methodological support are, in accordance with RLR, openness, bridling, and reflection. The methodological support cannot be understood as fixed stages, but rather as a guiding light in the search for further meanings.Key words: Philosophical examination, methodological support, reflective lifeworld research, phenomenology, caring science(Published: 26 February 2016)Citation: Int J Qualitative Stud Health Well-being 2016, 11: 30482 - http://dx.doi.org/10.3402/qhw.v11.30482

Aim The overall aim of this thesis is to create knowledge about caring and learning as an intertwining phenomenon at a Dedicated Education Unit and how it can be developed. Approach and method A lifeworld approach, based on the phenomenological philosophies foremost derived from Husserl and Merleau-Ponty was used and carried out in lifeworld interviews and with meaning-oriented analysis in accordance with reflective lifeworld research. The participants were: 13 student nurses (study I), 11 patients (study II), 8 supervisors (study III) all from the same DEU in orthopedic care and 10 managers from various DEUs (study IV). Main findings Intertwined caring and learning is most evident in genuine encounters between students and patients, supported by supervisors and managers. The intertwining is created in appealing challenges where students feel safe and ready. In the encounter with the patient they gain a sense of the whole where they can find their personal style. Patients, who feel invited to participate, could describe the encounter with students as genuine and a new dimension in nursing care. These encounters are characterized by closeness, thoroughness, accessibility, acknowledgement and sensitivity. When the encounter is less genuine, supervisors constitute an essential support for stabilizing the care. Supervisors constantly move in order to either stay close to or stand back, adjusting to the students’ and patients’ needs. Their demanding task as reflective supervisors requires pauses in order to maintain motivation. The managers’ daily struggle in a stressful and challenging reality is influenced by them either having or taking responsibility. Differences in approaches are shown in terms of more or less involvement and commitment in caring environment and educational issues. Conclusions Genuine encounters are characterized by the core of both caring and learning and will thereby benefit both the students and the patients. Identifying and supporting genuine encounters is necessary for students, supervisors and managers. It is time to find ways to develop a unified view of how caring and learning can be intertwined.

A majority of women in Sweden initiate breastfeeding but almost a quarter stop or wean the infant in the first few weeks after birth because of difficulties. In order to develop care that facilitates initiation of breastfeeding and enables mothers to realize their expectations concerning breastfeeding, it is necessary to understand what having severe breastfeeding difficulties means for women who experience them. The aim of this study is to describe the lived experiences of initiating breastfeeding under severe difficulties. A reflective lifeworld research design was used. Eight women, seven primiparous and one multipara, were interviewed within 2 months of giving birth. The essential meaning of the phenomenon is described as “Existential lostness as a mother forcing oneself into a constant fight”. This pattern is further explicated through its constituents; shattered expectations, a lost time for closeness, being of no use to the infant, being forced to expose oneself, and gaining strength through sharing. The results show that mothers with severe breastfeeding difficulties feel alone and exposed because of their suffering and are lost in motherhood. Thus, adequate care for mothers should enhance the forming of a caring relationship through sharing rather than exposing.

Treating patients with hard-to-heal wounds is a complex task that requires a holistic view. Therefore this study focuses on the nurse’s perspective with the aim on describing how community nurses experience the phenomenon the care of patients with hard-to-heal wounds. The method used was a reflective lifeworld approach. Seven qualitative interviews with community nurses were conducted. The findings show a tension between enriching and burdensome care. In this tension, the nurses try to find energy to reach harmony in their work through reflection, acceptance, and distance. This is further described by the constituents: ‘‘taking responsibility,’’ ‘‘showing respect for the whole person,’’ ‘‘being confident in order to offer confidence,’’ ‘‘seeing time and place as important.’’ The discussion highlights the importance for a nurse to find how to give ideal care in one’s duty but not beyond it. As a consequence the concept ‘‘compliance’’ needs to be challenged in order to promote confidence and mutual trust between nurses and patients. Confidence can be seen as a key, both for nurses and patients, and is dependent on good inter-professional cooperation, competence, and closure. Key words: Hard-to-heal wounds, nurse, home care, reflective lifeworld research, confidence(Published: 18 October 2010)Citation: Int J Qualitative Stud Health Well-being 2010, 5: 5415 - DOI: 10.3402/qhw.v5i3.5415

For most Swedish women, breastfeeding is an essential part of the childbearing period. Yet, the meaning of breastfeeding from women's perspective is scantily explored. Therefore, the aim of this study is to describe women's lived experiences of initiating breastfeeding within the context of early home discharge. Eight women, two primiparous, and six multiparous were interviewed within 2 months after birth. A reflective lifeworld research design based on phenomenological philosophy was used during the data gathering and data analysis. The results show that the phenomenon, initiating breastfeeding, in spite of good conditions, i.e., early home discharge, is complex and entails an existential challenge. The essential meaning of the phenomenon is conceptualized as, “A movement from a bodily performance to an embodied relation with the infant and oneself as a mother.” This pattern is further described in its five constituents: “Fascination in the first encounter,” “Balancing the unknown,” “Devoting oneself and enduring the situation,” “Seeking confirmation in the unique,” and “Having the entire responsibility.” Caring for women initiating breastfeeding entails, from a caring science perspective, to help the mother meet insecurity and strengthen confidence to trust her ability to breastfeed the newborn infant. According to these findings, it is suggested in the discussion that it is time for health care professionals to reject the idea of breastfeeding merely as meals or eating for the infant. Instead, they ought to embrace its origin, namely as a way to closeness between mother and infant.

Background: A Developing and Learning Care Unit (DLCU) is a model used in the clinical practice of student nurses that aims at bridging the gap between theory and praxis, by supporting nursing students’ learning through supervision in pairs. The aim of this study is to describe how patients experience being cared for by pairs of student nurses.Methods: The study is based on a reflective lifeworld research (RLR) approach founded on phenomenological traditions. Data was collected in lifeworld interviews of 17 patients cared for by pairs of student nurses. The data was explored and analysed for meaning.Results: To be cared for by student nurses, supervised in pairs entails being involved in the students’ learning and being met with responsibility and a willingness to care and learn. This means being made the centre of attention, being seen, taken seriously and being listened to as a valuable human being. The students’ care is shown to be more flexible and has a more open approach, in comparison to that of the ordinary staff, and they ‘do something extraordinary’ and give of their time.Conclusions: Pairs of students, who are supervised within a learning model that support students’ learning through reflection, can contribute to patient experiences of being given good care.

Aim : To explore and describe the essential meaning of lived experiences of the phenomenon: Everyday life during curative radiotherapy in patients with non-small-cell lung cancer (NSCLC). Background : Radiotherapy treatment in patients with NSCLC is associated with severe side effects such as fatigue, anxiety, and reduced quality of life. However, little is known about the patients’ experience of everyday life during the care trajectory. Design : This study takes a reflective lifeworld approach using an empirical application of phenomenological philosophy described by Dahlberg and colleagues. Method : A sample of three patients treated with curative radiotherapy for NSCLC was interviewed 3 weeks after the end of radiotherapy treatment about their experiences of everyday life during their treatment. Data were collected in 2014 and interviews and analysis were conducted within the descriptive phenomenological framework. Findings : The essential meaning structure of the phenomenon studied was described as “Hope for recovery serving as a compass in a changed everyday life,” which was a guide for the patients through the radiotherapy treatment to support their efforts in coping with side effects. The constituents of the structure were: Radiotherapy as a life priority, A struggle for acceptance of an altered everyday life, Interpersonal relationships for better or worse, and Meeting the health care system. Conclusion : The meaning of hope was essential during radiotherapy treatment and our results suggest that interpersonal relationships can be a prerequisite to the experience of hope. “Hope for recovery serving as a compass in a changed everyday life,” furthermore identifies the essentials in the patients’ assertive approach to believing in recovery and thereby enabling hope in a serious situation. Key words: Hope, lived experiences, lung cancer, nursing, open qualitative interviews, phenomenology, radiotherapy, Reflective Lifeworld Research (Published: 24 November 2015) Citation: Int J Qualitative Stud Health Well-being 2015, 10: 29397 - http://dx.doi.org/10.3402/qhw.v10.29397

Evidence confirms that nature-based therapy (NBT) has a positive effect on people with mental illnesses. However, there is a lack of evidence on the meaning of NBT for specific patient groups. The Nacadia® Therapy Garden was designed according to an evidence-based design process, and an NBT programme was developed. The aim of the study was to illuminate the phenomenon of participants’ lived experience of the NBT in Nacadia. Fourteen participants took part in semi-structured interviews (SSIs), and by way of reflective lifeworld research, the SSIs were analysed to identify and describe the meanings of the phenomenon. The essence of the phenomenon was found to be a process of adopting a searching approach to NBT and Nacadia to become familiar with the conditions. This familiarity stimulated the development of confidentiality and attachment to Nacadia. Feeling protected, safe, cared for, and not exposed was important, and motivated feelings of freedom, reduced demands, and increased the ability to access and try a spectrum of NBT activities. It encouraged participants to develop personal approaches and coping strategies to implement in their everyday lives for moving on.

Background The occurrence of obstetric anal sphincter injuries (OASIS) has increased in most high-income countries during the past twenty years. The consequences of these injuries can be devastating for women and have an impact on their daily life and quality of health. The aim of this study was to obtain a deeper understanding of midwives’ lived experiences of attending a birth in which the woman gets an obstetric anal sphincter injury. Methods A qualitative study using phenomenological lifeworld research design. The data were collected through in-depth interviews with 13 midwives. Results The essential meaning of the phenomenon was expressed as a deadlock difficult to resolve between a perceived truth among midwives that a skilled midwife can prevent severe perineal trauma and at the same time a coexisting more complex belief. The more complex belief is that sphincter injuries cannot always be avoided. The midwives tried to cope with their feelings of guilt and wanted to find reasons why the injury occurred. A fear of being exposed and judged by others as severely as they judged themselves hindered the midwives from sharing their experience. Ultimately the midwives accepted that the injury had occurred and moved on without any definite answers. Conclusions Being caught between an accepted truth and a more complex belief evoked various emotions among the midwives. Feelings of guilt, shame and the midwife’s own suspicion that she is not being professionally competent were not always easy to share. This study shows the importance of creating a safe working environment in which midwives can reflect on and share their experiences to continue to develop professionally. Further research is needed to implement and evaluate the effect of reflective practices in relation to midwifery care and whether this could benefit women in childbirth.

This article illuminates the essence of Neonatal Intensive Care Unit (NICU) nurses’ attitudes in skin-to-skin care (SSC) practice for preterm infants and their parents. Health care providers are in a unique position to influence the dynamic between infants and parents, and SSC affects both partners in the dyad. The design is descriptively phenomenological in terms of reflective lifeworld approach. Eighteen Swedish, Danish, and Norwegian nurses from NICUs offering varied possibilities and extents of SSC participated. NICU nurses’ attitudes in SSC practice are ambivalent. The nurses consider the sensory, wellness, and mutuality experiences to be primary and vital and enact SSC as much as possible. But “as much as possible” is a broad and varied concept, and their attitudes are ambivalent in terms of not always facilitating what they consider to be the optimal caring conditions. The source of NICU nurses’ ambivalent attitudes in SSC practice is a complex interplay of beliefs, norms, and evidence, which have a multidisciplinary basis. The ambivalent attitudes are, to a great extent, the result of the need to balance these multidisciplinary concerns. This needs to be acknowledged in considering SSC practice, as well as acknowledging that clinical judgments concerning optimal SSC depend on parents and infants unlimited access to each other, which NICU nurses can influence.

Aim: The overall aim of the thesis was to describe the experiences of awake patients during surgery under regional anesthesia. In addition, the aim was to develop a model for intraoperative care that can support and enhance patients’ well-being during the intraoperative period. Methods: Study I was a patient interview study guided by a reflective lifeworld approach. In study II a philosophical reflection of the findings from study I was carried out. In study III a hermeneutic approach inspired by Ricoeur and Gadamer was used in order to interpret video recorded material. In study IV a hermeneutic approach inspired by Gadamer was used to synthesize the findings in studies I-III transformed into an intraoperative caring model. Overall main findings: The analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. The proximity and presence of the nurse anesthetist (NA) anchors the patient in the present and strengthens the patient’s feeling of trust. The temporary disruption in the relationship between the body and the world due to regional anesthesia means that the patient’s being in the world is exposed to revolutionary experiences. Gaps between the patient’s experiences and the situation can be bridged over when the NA acts as the patient’s bodily extension and links the patient as a subject to the world in the intraoperative situation. From the patient’s perspective this calls for the NA’s proximity and genuine presence in the ‘intraoperative caring space’. When the NA’s performance of his/her professional duties clashes with the patient’s existential being in the intraoperative situation the need of present presence from the NA is crucial. Conclusions: The findings contribute to knowledge development about intraoperative care and raise awareness that care for the awake patient cannot be performed on formal routines that might disregard the uniqueness of each patient’s situation. The model can be used as a tool to encounter awake patients’ existential needs in the intraoperative situation and to further enlighten NAs about the possible impact of their proximity, interaction and communication behavior in the delivery of intraoperative nursing care.

The aim of this article is to articulate the essence and constituents of neonatal intensive care unit (NICU) nurses’ experiences in enacting skin-to-skin care (SSC) for preterm newborns and their parents. SSC is commonly employed in high-tech NICUs, which entails a movement from maternalinfant separation. Parents’ opportunities for performing the practice have been addressed to NICU staff, with attitude and environment having crucial influence. The study was carried out with a reflective lifeworld research approach. Data were collected in Denmark, Sweden, and Norway by open-dialogue interviews with a purposive sample of 18 NICU nurses to achieve the essence of and variation within the phenomenon. NICU nurses experience balancing what they consider preterm newborns’ current and developmental needs, with readiness in both parents for SSC. They share an experience of a change in the history of NICU care to increased focus on the meaning of proximity and touch for the infants’ development. The phenomenon of enacting SSC is characterized by a double focus with steady attention to signals from both parents and newborns. Thereby, a challenge emerges from the threshold of getting started as the catalyst to SSC.Key words: Reflective lifeworld research, NICU nurses, Kangaroo Mother Care (KMC), Kangaroo Care (KC), proximity, skin-to-skin care (SSC), touch(Published: 11 July 2013Citation: Int J Qualitative Stud Health Well-being 2013, 8: 21370 - http://dx.doi.org/10.3402/qhw.v8i0.21370

This thesis 'The Symphony of Care' consists of four studies focusing on care relationships between patients and professional caregivers. Care relationships are central to the health process and a fundamental element in caregiving. The term care relationship is widely used in caring science but lacks a clear definition, which can create misunderstanding and can constitute an obstacle when attempting to optimize care relationships. The aim of this thesis is to describe the phenomenon of care relationships in order to add to the body of knowledge in caring science.The main research questions are: • What is a care relationship within the caring science field? • How can a care relationship be optimized to improve its caring function, in order to promote health? The ontological foundation of this thesis is caring science. Phenomenology and Lifeworld theory are used as its epistemological bases. Reflective Lifeworld Research is used as a methodological approach. The four studies were conducted in different contexts and cultures- the first two empirical studies were performed in China and the remaining two, a metasynthesis and a secondary analysis, were carried out in a Swedish context. The results show that care relationships are temporary intentional relationships between a person who needs help and a helper. The purpose of this relationship is to support the patient in his/her dynamic health process, which is unique for each person in different times and contexts. Care relationships are fragile because the patient is vulnerable and the demand on the helper is great. It is an inter-human relationship between equals, which can at the same time be an asymmetric relationship due to the professionalism with the caregiver and the vulnerability with the patient. A care relationship is not independent, but is affected by internal factors such as the two individuals' lifeworlds and external factors such as health policies, organization, economics, health culture and environment. To optimize the effectiveness of caring, the relationship and its surrounding need to be in harmony. The view of care relationships should be broadened to include the external resources in order to optimize their caring potential.

AimTo report a study of the lived experience of being a close relative to a patient with colon cancer participating in a fast-track programme.BackgroundStudies have documented that postoperative recovery can be accelerated and that hospitalization can be reduced through fast-track programmes. Due to the early discharge and the increasing demands on patients for self-care, patients' relatives seem to play a pivotal role in fast-track programmes. However, research is limited into how patients' close relatives are affected by and involved in the postoperative recovery process.DesignA descriptive phenomenological approach using Reflective Lifeworld Research.MethodsThe study was carried out within the descriptive phenomenological framework of Reflective Lifeworld Research. Data were collected in 2008 from in-depth interviews with twelve relatives.FindingsRelatives experienced a huge responsibility for both the patient's well-being and for the patient's compliance with the daily regimen. Relatives were caught in a conflicting double role. They were the extended arm of the health professionals but also the caring, supporting partner. A tension arose between relatives' desire to help the patient by taking an active part in the recovery process and the feelings of not always having the resources needed.ConclusionRelatives seem to suffer in silence as they bear the burden of the patient's diagnosis, the disruption of life, and the taken-for-granted responsibility for the patient's recovery process. From an existential perspective, this caring responsibility can be understood as ethical pain. Relatives should be seen as a distinct group with special caring needs of their own.

A majority of women in Sweden initiate breastfeeding but almost a quarter stop or wean the infant in the first few weeks after birth because of difficulties. In order to develop care that facilitates initiation of breastfeeding and enables mothers to realize their expectations concerning breastfeeding, it is necessary to understand what having severe breastfeeding difficulties means for women who experience them. The aim of this study is to describe the lived experiences of initiating breastfeeding under severe difficulties. A reflective lifeworld research design was used. Eight women, seven primiparous and one multipara, were interviewed within 2 months of giving birth. The essential meaning of the phenomenon is described as ‘‘Existential lostness as a mother forcing oneself into a constant fight’’. This pattern is further explicated through its constituents; shattered expectations, a lost time for closeness, being of no use to the infant, being forced to expose oneself, and gaining strength through sharing. The results show that mothers with severe breastfeeding difficulties feel alone and exposed because of their suffering and are lost in motherhood. Thus, adequate care for mothers should enhance the forming of a caring relationship through sharing rather than exposing. Key words: Breastfeeding difficulties, lived experience, caring science, phenomenology, reflective lifeworld researchCitation: Int J Qualitative Stud Health Well-being 2012, 7: 10846 - DOI: 10.3402/qhw.v7i0.10846

A starting point for this thesis is that patients’ learning has not received sufficient attention and thus has not featured in the study programmes in the field of caring. Focus has instead been placed on patients being given information and advice about their illness and treatment, advice that they are then expected to comply with. Too little attention has been paid to the individual who lives with his/her illness and who should be considered to have significant experiences. The overall aim has been to analyze and describe the phenomenon of learning to live with long-term illness as well as to develop a didactic model that can help carers to support patients’ learning processes. The theoretical perspective in the thesis is lifeworld theory, which permeates ontological, epistemological and methodological standpoints and also the view on learning. The design and carrying out of the research is based on a reflective lifeworld approach. The empirical study consists of interviews with people who live with different types of long-term illnesses. The learning that follows life with a long-term illness is generated in such a way as to respond to the will to live the well-known everyday life. A greater understanding of the empirical results has been achieved by a lifeworld philosophical elucidation, with a particular focus on learning turning points and the importance of reflection. Based on the empirical results, the lifeworld philosophical elucidation and the caring science lifeworld didactics a didactic model has been formulated. This model is entitled: The challenge – to take charge of one’s life with long-term illness. The model contains four theses: 1) Confronting one’s life situation and challenging to make a change, 2) Positioning oneself at a distance when creating a new whole, 3) Developing self-consciousness and taking responsibility, 4) Making learning visible with the aim of providing development and balance in life. The results in the thesis show that a genuine learning is something that differs from the learning of information and that the learning must be supported at an existential level based on the sufferer’s situation and for a long period of time.

For most Swedish women, breastfeeding is an essential part of the childbearing period. Yet, the meaning of breastfeeding from women’s perspective is scantily explored. Therefore, the aim of this study is to describe women’s lived experiences of initiating breastfeeding within the context of early home discharge. Eight women, two primiparous, and six multiparous were interviewed within 2 months after birth. A reflective lifeworld research design based on phenomenological philosophy was used during the data gathering and data analysis. The results show that the phenomenon, initiating breastfeeding, in spite of good conditions, i.e., early home discharge, is complex and entails an existential challenge. The essential meaning of the phenomenon is conceptualized as, ‘‘A movement from a bodily performance to an embodied relation with the infant and oneself as a mother.’’ This pattern is further described in its five constituents: ‘‘Fascination in the first encounter,’’ ‘‘Balancing the unknown,’’ ‘‘Devoting oneself and enduring the situation,’’ ‘‘Seeking confirmation in the unique,’’ and ‘‘Having the entire responsibility.’’ Caring for women initiating breastfeeding entails, from a caring science perspective, to help the mother meet insecurity and strengthen confidence to trust her ability to breastfeed the newborn infant. According to these findings, it is suggested in the discussion that it is time for health care professionals to reject the idea of breastfeeding merely as meals or eating for the infant. Instead, they ought to embrace its origin, namely as a way to closeness between mother and infant. Key words: Breastfeeding, lived experience, caring science, phenomenology, reflective lifeworld research(Published: 22 October 2010)Citation: Int J Qualitative Stud Health Well-being 2010, 5: 5397 - DOI: 10.3402/qhw.v5i3.5397

Syrén, Susanne (2010). Det outsagda och ohörsammade lidandet. Tillvaron för personer med långvarig psykossjukdom och deras närstående (Being in the world with long term psychotic illness – the unspoken and unheard suffering), Linnaeus University Dissertations No 6/2010. ISBN: 978-91-86491-07-9. Written in Swedish with a summary in English. Aim: The overall aim of the thesis was to describe the lived experience of being in the world with long term psychotic illness. This is described from three perspectives; the perspective of persons diagnosed with long term psychotic disorder; the perspective of their relatives; and a family perspective. Method: Three studies were conducted guided by a reflective lifeworld approach grounded in phenomenology. The data were generated through individual, group, and family interviews. Data were analyzed for essential meanings of being in the world. Results: Persons with long term psychotic illness live in a borderland of paradoxes between the usual and unusual. For the ill persons the existence is incomprehensible and defenceless with feelings of not being at home in the body and in the world. They search for themselves in a care context that is contradictory, simultaneously good and hostile. These experiences are mostly unspoken, a struggle with doubts about having health or illness, what is good or evil, and about being usual or unusual. The relatives exist in a dilemma of the possible and impossible, a continual infinite struggle. Co-existing with their ill family member is a communion and a longing for togetherness is prominent. Relatives struggle with responsibilities for themselves and for their ill family member. In these unheard struggles the relatives yearn for participation in the formal care context. Family interviews with persons with long term psychotic illness and their relatives revealed a co-existence hovering between chaos and boredom while striving for a peaceful and quiet life. Thefamilies search for constancy and predictability in the presence of incomprehensible and threatening dangers. The experience of being a We balances the unshared meanings of being in the world and the loss of being able to experience and do things together. The experience of being a We keeps their individual existence and co- existence from falling apart.Conclusion: Persons with long term psychotic illness and their relatives have to withstand extensive existential suffering, which is unspoken and unheard. Formal caring should be existential caring, supporting the ill person’s comprehensibility and understanding of life, and feelings and experiences of being at home. Further, relatives should be acknowledged both as persons and carers and invited to participate in formal care. These results also point to the importance of strengthening feelings of togetherness and of being a We through systemic oriented existential conversations, where the ill person, their relative and a formal carer converse together.

The thesis describes the phenomenon women’s health and illness experiences following a myocardial infarction (MI). The purpose of the thesis is to explore women’s experiences of their care and health processes, as well as their experiences of body, lifeworld and meaningful relationships related to the illness. A reflective lifeworld approach, based on phenomenological philosophy, is used. The thesis is comprised of four studies; three are based on interviews with a total of 26 women following an MI, followed by a fourth, theoretical, study. The first study explores women’s experiences of care and health processes following an MI, with a particular focus on well-being and participation (I). The findings show that an MI is an event that suddenly interrupts the ordinary life of the women. Participation is a sense of being involved in their own health and care processes, which may also encourage them to take responsibility for health promoting activities in a healthy and meaningful way. The second study explores women’s lifeworld experience of their bodies and lives following an MI (II). This study finds that an MI, as a major event in the women’s lives, influences and restricts their everyday activities over a long period of time. Following the illness, they live with an existential uncertainty about their life and the heart, and this feeling entails suffering for them. The third study explores the meaning of close relationships and sexuality to women’s health and well-being following an MI (III). The mmeaning of close relationships appears to be vitally intertwined with their long-term health process; both health processes and relationships are affected after an MI. The suffering following an MI can be compared to taking a fall, where meaningful close relationships can function as a safety net that catches the women in their fall. The fourth study is a concept development aimed at elucidating the meaning of the concepts uncertainty, control, secure and risk in relation to the thesis phenomenon and the findings of the empirical interview studies (IV). The existential uncertainty is an important matter in the women’s health processes. In these processes the concepts control, secure and risk play a central role. Women who have suffered an MI want to be as safe as possible in order to live well. The analysis illuminates a paradox, that the women’s ambition to achieve greater safety may lead them into an even greater experience of uncertainty. The conclusion is that women’s experiences of health and illness can be described as a journey characterized by existential uncertainty. The women’s lives go through different existential phases following an MI, which is a major event. They are not prepared for the reactions that this event causes and are in need of support and guidance to manage their illness experiences. If acknowledged and well met, the significance and meaning of the women’s reactions and experiences can give impetus and energy to their health processes.

To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context.

The present study focuses on the caring of patients who have sexually abused children. To do research in a field that has been considered taboo has not been without problems. The conclusive factor for the decision to carry out the research was the fascinating and interesting paradox that, in spite of the caregivers having a mandate from the judicial system to do care for these patients, they do not understand how this care is to be given. The understanding of what caring for these patients can entail is based on the perspectives of the lifeworld of both the patients and the caregivers. The theoretical perspective in this dissertation is that of the caring sciences while the epistemological framework is phenomenology. Research data consist of qualitative interviews. The aim of the first study is to describe the patients’ suffering, and the aim of the second study is to describe the caregivers’ experiences of caring for these patients. The essential meaning of the suffering felt by the patients is described in terms of the patients’ acknowledgement and then betrayal of their yearning to be part of a close human fellowship. The meaning structure of “caring”, can be understood as being lost in an obscure and unknown landscape. It challenges the caregivers and occasionally arouses strongly unpleasant but also strongly threatening feelings. However when the caregivers gain clarity on how to care they are able to find their caring courage and hope, even for these patients. The findings thus show that caring for patients who themselves do not see any opportunity of taking a place among other adults is a great challenge. The study also shows that the support that is needed to be successful in caring for these patients is a caring culture that can permeate both patients and caregivers. These patients, whose criminal acts appear to be bizarre and strange, need to learn to be able to bear their suffering without losing their humanity. The philosophical intermediate chapter shows that it is the body image of the patients that prevents them from becoming whole, i.e. existing fully, by it playing the existential drama that leads to sexual abuse. It appears from this dissertation that in order for caring to be able to relieve the suffering felt by these patients, and thus prevent them from further abuse of children, then it is important as a caregiver to be able to allow the patients just to “be”. The research also shows that in order for caregivers to be able to understand what they receive from the patients they need support from both caring science and existential reflections. Such methods can help to clarify caring and to give possibilities for a freer and more creative thinking. Encountering and understanding different lifeworlds is necessary in order to give care based on a caring perspective. The patient group in the present study have been able to demonstrate this in a clearer way than has previously been done.

The present study focuses on the phenomenology of the violent encounter, and is to be understood as the study of the violent encounter as a phenomenon, i.e. as experienced. The overall aim is to elucidate, analyse and describe violent encounters within psychiatric care as experienced by carers and patients. Moreover, the study aims at promoting the development of a phenomenological research approach in caring science in general and elucidating tacit caring knowledge in particular. The thesis includes three empirical studies and one methodological study. The research is guided by a phenomenological and lifeworld theoretical approach. Research data consist of narratives and qualitative interviews, as well as reenactment interviews with carers and patients. Data are analysed for meaning. The analysis and synthesis of meaning are aimed at openness and meaning sensitivity through a reflective attitude characterised by the intent to bridle the process of understanding. The goal of the analysis is to describe the general structure of the phenomenon and its meaning constituents. The result shows that violence and threat do not evolve in “naked” caring, characterised by encounters where carers are able to touch their patients at the same time as being touched, speaking both literally and figuratively. It is through “naked” caring and caring touch that the carers are able to reach the patients and to give undisguised invitations to genuine presence. The possibilities of touch rely on the carers’ capacity to be authentic and to genuinely wish well. Violence is on the contrary nourished by touch without caring intention, or non-touch, i.e. caring where the reciprocity of touching and being touched is missing between patients and caregivers. In the discussion, the different meanings of the violent encounter are related to the philosophy of Merleau-Ponty and Lévinas. The philosophical dimensions of touch are investigated and it is discussed how the “naked” encounter can be understood from a phenomenological ethical standpoint. The discussion focuses on the caregivers’ vulnerability and the high demands they are subjected to. It is also argued that a foundation of caring science is needed in caring practice in order to make possible a development of a caring attitude that prevents violence.

When children endure needle-related medical procedures (NRMPs), different emotions arise for the child and his/her parents. Despite the parents’ own feelings, they have a key role in supporting their child through these procedures. The aim of this study is to describe the meanings of supporting children during NRMPs from the perspective of the parents. Twentyone parents participated in this study. A reflective lifeworld research (RLR) approach was used and phenomenological analysis was applied. The essential meaning of the phenomenon*supporting children during an NRMP*is characterized as ‘‘keeping the child under the protection of one’s wings,’’ sometimes very close and sometimes a little further out under the wingtips. The essential meaning is additionally described through its constituents: paying attention to the child’s way of expressing itself, striving to maintain control, facilitating the child’s understanding, focusing the child’s attention, seeking additional support, and rewarding the child. The conclusion is that parents’ ability to be supportive can be affected when seeing their child undergo an NRMP. To regain the role as the child’s protector and to be able to keep the child ‘‘under the protection of one’s wings,’’ parents need support from the staff.Key words: Needle-related medical procedures, lived experience, caring science, younger children, phenomenology, reflective lifeworld research(Published: 8 July 2014)Citation: Int J Qualitative Stud Health Well-being 2014, 9: 23759 - http://dx.doi.org/10.3402/qhw.v9.23759