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To investigate patients' existential experiences in everyday life after a kidney transplantation with a living donor.A qualitative study anchored in a hermeneutic-phenomenological approach inspired by Ricoeur's theory of narrative and interpretation.Eleven patient interviews were conducted approximately 6 months after a kidney transplantation with a living donor. The interviews were conducted between August 2017-May 2019. Analysis and interpretation are based on Ricoeur's theory of interpretation.Four themes were identified: Experiencing bodily vulnerability while getting back to life; Feeling guilt while experiencing gratitude; Living in limbo while one's identity is changing; and Facing the future with hope while having reservations.This study reveals that patients experience multifaceted existential challenges in their everyday lives during the transition of the kidney transplantation process. Post-surgery complications for donors lead to feelings of guilt in patients; plus, they must adapt to a new existence, including a new identity. The patients feel they are in limbo, as they experience their existence as uncertain and their identity as unknown.The study highlights a need for developing a rehabilitation programme to address the individual and various existential challenges faced by patients who need to undergo a kidney transplantation.目的: 探讨活体供肾移植后患者日常生活中的生存体验。 设计: 受Ricoeur叙事和解释理论的启发, 进行了以诠释现象学方法为基础的质性研究。 方法: 在活体供体肾移植后约6个月, 对11名患者进行了访谈。访谈于2017年8月至2019年5月期间进行。根据Ricoeur的解释理论进行分析和解释。 结果: 确定了四个主题:在回归生活的同时感受生命的脆弱; 怀带感激之心的同时体味内疚感;体味身份变化所带来的边缘感;以及对未来充满希望, 同时又能够接受失望。 结论: 本研究揭示了在肾移植过程中, 患者在日常生活中经历了多方面的生存挑战。供体术后并发症导致患者产生负罪感; 另外, 患者必须适应新的生活、新的身份。患者感到自己处于边缘状态, 因为在体验到自身存在的不确定性的同时,感到对自己的身份不甚明了。 影响: 本研究强调了制定康复方案的必要性, 以解决需要接受肾移植患者所面临的个体和各种生存挑战。.

Aims and objectives: To investigate patients' existential experiences in everyday life prior to a kidney transplantation with a living donor. Background: Kidney transplantation is a well-established treatment for patients with end-stage kidney disease. The prevalence of patients living with end-stage renal disease is increasing. Simultaneously, kidney transplantations with a living donor are increasing. However, patients experience challenging existential aspects concerning kidney transplantation. Design: A qualitative study with a hermeneutic-phenomenological approach inspired by Ricoeur was chosen. Methods: Fourteen interviews with patients living with end-stage kidney disease were conducted 7–14 days before a planned kidney transplantation with a living donor. Analysis and interpretation were based on Ricoeur's theory of interpretation. We applied the Criteria for Reporting Qualitative Research (see Appendix S1). Results: Four themes were identified: living with subjective feelings of illness while objectifying the body; living in one's own world while the world outside goes on; feeling grateful while being concerned for the donor; and hoping for the best, while preparing for the worst. Conclusion: Patients' existential challenges are multifaceted. Patients articulate their kidney function in numeric terms, trying to make the invisible visible for themselves and others. Sustaining normality becomes important for patients, and the waiting time from donor evaluation to transplantation triggers excitement, hope and frustration. Relevance to clinical practice: The results increase insights into individuals' existential experiences in their everyday lives. Hereby, the results articulate the need for support from health professionals prior to a kidney transplantation.

AimTo discuss ethical and methodological challenges related to in-depth interviews with patients and partners when interviewed together or separately.BackgroundIncreased interest in exploring illness phenomena from both patients' and partners' perspectives has emerged. The decision about how to collect data is challenging. Patients and partners can be interviewed separately or together; in both scenarios researchers face complex questions of methodology and ethics. This paper contributes to the ongoing debate on individual or joint interviewing and the effect of absence/presence of the partner on data collection.DesignDiscussion paper that draws on data from three phenomenological studies.Data sourcesReferring to three cases from our phenomenological studies, we discuss the different types of ethical and methodological dilemmas faced when undertaking joint and separate interviews with couples. Furthermore, we discuss how the unexpected presence of the partner potentially influences the data gathered from the patient.Implication for nursingThe cases demonstrate the interrelatedness of ethics and methodology in studies based on in-depth interviews with couples. Nurse researchers may be caught up in a dilemma between ethical concerns and methodological considerations. We argue that the presence of the partner during an interview session might influence the data and favour expressions of shared rather than individual experiences of the phenomenon studied. Furthermore, we argue that ethical concerns must be given higher priority than methodology when interviewing couples.ConclusionAn increased awareness of the tension between ethical and methodological challenges in joint or individual interviewing with patients and partners is necessary, as this issue is underexposed.

Background Klinefelter syndrome (KS) is a sex chromosomal aneuploidy (47,XXY) affecting 1/660 males. Based on findings in Turner syndrome, we hypothesized that electrocardiogram (ECG) abnormalities would be present in males with KS. Objective To investigate ECGs in males with KS and compare with controls. Methods Case control study of 62 males with KS and 62 healthy males matched on age. The primary outcome parameter was a difference in the ECG presentation between the two groups. The ECGs were analyzed by one blinded examiner (intraobserver variability 0.2–2.1%). The QT-interval was measured using “teach-the-tangent” method excluding the U-wave. QTc was calculated using Bazett's equation, Hodges’ equation, and a linear regression model. Body mass index, abdominal fat, and muscle mass as well as sex hormone levels were secondary parameters. The prevalence of mutations in genes related to short QT syndrome was determined in participants with a QTc < 330 ms. Results Compared to controls, the QTc-interval was shorter (P = 0.02–0.06) in males with KS depending on the applied correction method. QTc was shortest among testosterone (T)-treated males with KS, while untreated and thus hypogonadal KS had QTc interval comparable to controls. No mutations in genes related to short QT syndrome were found. Conclusion We found short QTc interval in males with KS, with further shortening of the QTc interval by T. These results suggest that genes on the X chromosome could be involved in regulation of the QTc interval and that T treatment may aggravate this mechanism.

Recovering at home: participating in a fast-track colon cancer surgery programme Fast-track surgery programmes are examples of the changes in health care toward implementation of evidence-based practice, decreasing hospitalisation, and increasing demands on patients for self-care after discharge. Documented knowledge of fast-track programmes is primarily related to a medical perspective whereas the patients' perspective is lacking. The aim of this study was to explore the lived experience of participating in a fast-track programme after discharge from the patients' perspective. The study was carried out using a descriptive phenomenological approach. Sixteen patients having undergone colonic resection were interviewed twice. Participating in a fast-track programme after discharge is characterised as a transition process in which the patients change their focus from solely caring about overcoming the operation to being on a course of recovery. Following the fast-track daily regimen leads to a degree of tension in the patients' life world as the patients have to struggle against the body while also protecting it and caring for it. For the patients, the illness represented a fall from equilibrium into an existential limbo, and they needed to re-establish a sense of balance. Recovering from surgery and regaining strength was only one aspect of this process. Healthcare professionals need to pay more attention to the individual patient's lifeworld and to recognise the influence of lifeworld on the individual patient's recovery process.

This article focuses on the contrasting discourse practices and occupational cultures of engineers and marketing representatives, and argues that strong occupational cultures not only have different value systems, but also different discourse practices. To illustrate this point, the article offers authentic examples of how and why miscommunication occurs within a knowledge-intensive organization. Referring to the specialized discourse practices of engineers and technicians, the article argues that the discourse practices evolving around specialized functions may lead to repeated instances of miscommunication within the organization. To reduce miscommunication, the article argues the need for an interdisciplinary approach based on a combination of linguistic and cultural analyses.

Drawing on our previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence-based fast-track programmes. The aim of this paper is to analyse and discuss if and how it is possible to include patients’ individual perspectives in an evidence-based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardisation founded on evidence-based recommendations, which specify a set of rules that the patient must follow rigorously. The other is a course of democratization based on patients’ involvement in care. Referring to the analysis of the narrative we argue that, in the current implementation of evidence-based practice, the proposed involvement of patients resembles empty rhetoric. We argue that the principles and values from evidence-based medicine are being lost in the transformation into the current evidence-based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as ‘one best way’. We argue for reviving ethics of care perspectives in today’s evidence practice as the fundamental values of nursing may potentially bridge conflicts between evidence-based practice and the ideals of patient participation thus preventing a practice of ‘McNursing’.Key words: nursing practice, evidence-based practice, nursing theory, nursing theorists, ethics of care, hospital culture, patient participation, fast-track programme