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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.

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.

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.

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.

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.

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.

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.

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child’s horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child’s advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents’ ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as ‘‘balancing on a tightrope’’ in an unpredictable situation. Key words: Lived experience, caring science, younger children, phenomenology, reflective lifeworld research (Published: 12 March 2014) Citation: Int J Qualitative Stud Health Well-being 2014, 9 : 23063 - http://dx.doi.org/10.3402/qhw.v9.23063