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BACKGROUND: Advanced practice nurses (APNs) programs are career-development opportunities significant for nursing workforce retention as well as for the quality of patient care. Inconsistency regarding policy, education, titles, scope of practice, skills and competencies have been identified as major challenges in developing advanced practice nursing in Europe. APN roles and education are under development in the Nordic and Baltic countries. However, there is a lack of information on the current state in this region.OBJECTIVE: The purpose of this paper is to compare APN programs in the Nordic and Baltic countries to identify their commonalities and differences.DESIGN AND METHODS: This descriptive comparative study reviewed seven master's level APN programs in six Nordic and Baltic countries. Data was extracted from the programme by the expert teachers or leaders of the programmes (N = 9). Competencies recommended in the European Tuning Project (ETP) and the International Council of Nurses (ICN) guidelines on advanced practice nursing, were used to evaluate the programs. The same informants provided additional information on the current state of APN education in the country.RESULTS: The admission requirements were similar in the six countries but in two, clinical work experience is an entry requirement. There are two commonly identified APN roles: clinical nurse specialist (CNS) and nurse practitioner (NP). Most of the programs included all the EPT and ICN competencies. The main differences regarded prescribing competencies. All programmes included clinical training, but the methods on how it is implemented varies.CONCLUSION: The findings indicate that APN programs in the Nordic and Baltic countries correspond with the recommendations of the European Tuning Project and ICN guidelines. This is an important message for administrators, policymakers, and politicians, as well as the nursing community, on providing opportunities for APNs to practice to their full potential within each country as well as cross-country.TWEETABLE ABSTRACT: "APN programmes in the Nordic and Baltic countries correspond with international guidelines. Special attention is needed in future on the clinical training of APNs".

Purpose: The purpose of this study was to provide in-depth understanding of adolescents' and young adults' (AYAs') lived experiences of eating when they are at home between high-emetogenic chemotherapy sessions. Methods: The study was guided by van Manen's hermeneutic-phenomenological methodology. Eligible AYAs were 15-29 years old, diagnosed with either oncological or hematological cancer, treated with high-emetogenic chemotherapy, and Danish speaking. AYAs were recruited from three university hospital departments. Data were collected using semi-structured in-depth interviews. Results: Thirteen AYAs, aged 17-29 years, participated in the interviews via telephone or face-to-face in their homes. The essential meaning of the phenomenon of eating can be characterized by the overarching theme "Struggling to eat to survive" and unfolded through the following three themes: "Cooperating with a deceiving body", "Capturing moments of eating opportunities", and "Being loved and cared for at home". Conclusions: Struggling to eat was essential for survival and a fundamental existential challenge that required reflection and consciousness. AYAs experienced their deceiving bodies as a major concern, which challenged their ability to eat and forced them to develop strategies to capture moments of eating opportunities. AYAs kept hold of doing "something" themselves to maintain the slightest control of their own lives and thereby assist clinical outcomes and cure. However, AYAs had to struggle with food and start viewing food as a friend, not an enemy.

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。.

Introduction Early in-home care is increasingly being used in Scandinavian countries for clinically stable premature infants. Due to challenges with travel and hospital resources, alternative ways to support parents during early in-home care are being considered. The aim of this study was to test whether the proportion of mothers exclusively breastfeeding, parental confidence and mother–infant interaction increased after early in-home care with premature infants, and to compare the outcomes of in-home care involving the use of video communication and a mobile application with those of in-home care involving in-hospital consultations. Methods This study was conducted in four neonatal wards offering premature infant in-home care in Denmark. Premature infants were randomised using 1:1 block randomisation. During early in-home care, families had planned consultations two to three times a week, during which they received support from nurses: the intervention group had video consultations, while the control group had in-hospital consultations. Results The proportion of exclusively breastfeeding mothers at discharge was 66.7% in the intervention group vs 66% in the control group and decreased to 49.4% vs 55%, respectively, 1 month after discharge. No significant improvements were found in the intervention group compared with the control group. In the intervention group, some video consultations were changed to telephone consultations due to problems with the video function, or to in-hospital consultations due to infants’ requirement for medical services. No significant differences in secondary outcomes were observed. Discussion The study showed similar breastfeeding proportions at discharge. No unfavourable effects of video consultation compared with in-hospital consultation were found, indicating that video consultation could be a viable option and an important supplement during early in-home care. Trial registration ClinicalTrials.gov ID: NCT02581800.

Being dependent on homecare potentially threatens a person's integrity and autonomy, particularly when people are dependent on help to manage basic bodily functions that involve intimacy and nudity, making the person vulnerable despite being in his or her own home. As the population continues to age and live longer, more people are expected to be dependent on homecare. The aim of this study was to investigate the phenomenon of dependence on homecare among people ageing at home. Individual in-depth interviews were used to explore 15 Danish and Norwegian homecare receivers’ experiences of dependence on homecare. Interview records were transcribed and analysed in a hermeneutical phenomenological process described by van Manen. First and foremost, the experience of dependence on homecare is a question of adaption. The older people in this study struggled to get used to their deteriorating body and at the same time they continuously had to negotiate to get care in accordance with their values. Being dependent on care could be experienced as being reduced to a task or a problem to be solved though the participants had a significant need for undivided mental attention. The presence of homecare staff in the participants’ homes could entail a change where the participants experienced that they lost control over the surroundings. According to the voices of the older people in this study, future homecare should be accommodated in an organisational set-up that gives priority to stability and continuity in the relation between the homecare receiver and the homecare staff. Also it is significant that homecare staff do not have a task-oriented approach to their job and are sensitive to the values of the homecare receivers.

Becoming dependent on homecare in old age is a radical life change that requires complex adaption. The purpose of this study was to explore the existential dimension of being dependent on homecare with a particular focus on what makes dependency bearable. In total, 15 older people living in Denmark or Norway were interviewed using a phenomenological approach. The material was analyzed employing Max van Manen’s meaning-giving approach coined “Phenomenology of practice.” During the analysis, four themes emerged: pure acceptance of an inevitable situation, acting independently as much as possible, negotiating to receive good care, and gratitude toward caring caregivers. The results point to a need for respectful and individualized homecare leveling out the subordinate position in which dependency on homecare tends to place older people.

Homecare nurses play a unique role in providing care during the follow-up after hospital discharge and in preventing readmission. The aim of this study was to explore the key challenges faced by homecare nurses in relation to caring for discharged patients. Data were collected through five focus group interviews with 29 Danish homecare nurses and subjected to inductive content analyses. The key challenges faced by homecare nurses fell into three themes: struggling to see the bigger picture, caring for patients from a distance, and compromising on professionalism. The findings demonstrated a paradox between the need for information and the struggle to access this information due to complicated infrastructures of information-sharing. Homecare nurses took on a substantial responsibility in providing the best possible care despite having limited information. Ironically, by taking on this responsibility, they implicitly contribute to covering up the problems of organisational and professional information flow.

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.

Background: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today’s hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual’s dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses’ options to act on the basis of ethical and moral grounds in the individual care situation. Aim: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. Method: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. Results: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse–patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. Conclusion: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses’ professional decision-making and forcing them to compromise basic nursing values.

Purpose This study explored how the phenomenon of meals appeared in the interrelationship between adolescents and young adults (AYAs) receiving high-emetogenic chemotherapy, their next of kin and health professionals in the clinical setting. Method Data were collected by 140 h of participant observation conducted to gain insights into the nature of how meals appeared in the interrelationship between 12 AYAs (age 15–29 years), their next-of-kin and health professionals. The AYAs were patients with oncological and haematological diseases recruited from three university hospital departments. Data analysis was guided by van Manen's hermeneutic-phenomenological approach. Results The essential meaning of the phenomenon may be characterized by the overarching theme; ‘Seeking the joy of meals in the shadow of treatment’ and the following three themes: ‘Meals as a necessary evil’ (AYAs); ‘Meals as a matter of love’ (next-of-kin); and ‘Meals in the shadow of medical treatment’ (health professionals). Conclusions Meals is a multi-facetted and complex phenomenon that has different meanings to AYAs, next-of-kin and health professionals. To the AYAs, meals emerged as a necessary evil in connection with which urges to eat occurred as glimpses of desire. Prominent feelings of powerlessness and food as love were highlighted by the next-of-kin, whereas food and meals appeared secondary to treatment for health professionals, reflecting the traditional biomedical paradigm. The findings revealed that adopting a holistic approach to AYAs concerning meals can have the potential to increase their food intake.

Based upon a brief outline of existential-phenomenological ontology we present a theoretical and practical understanding of humanbeing, which is suited for a methodologically reflected approach to qualitative research. We present the phenomenological distinction between threedimensions of corporeal intentionality(structural, generative and dialectic intentionality) that form elementary events and structures of meaning. Various aspects of human being are better scrutinized with these concepts of intentionality, such as the association of individual being or collective being (e.g. groups) with the less differentiated anonymity of human being. The aim of our framework is to support the qualitative researcher in grasping the experience of the human life in closer accord with how this being actually unfolds and is lived. Application of the presented framework is illuminated with empirical examples from educational, health and psychological contexts. Finally, we discuss the methodological implications that our approach has for qualitative investigations of human being.

In this paper, we discuss “the slow in the fast” related to care situations in a “fast-track” hospitalsetting were the length of patients’ stay has been reduced significantly. The discussion is basedon a narrative created from observations made in a postoperative care unit where patients areintensively observed and cared for during a very short time span.We found that within the phenomenological notions of lived time, lived space and livedillness, it is possible to create an imaginative space in time – to make a time warp. Despitebeing in a setting where the objective time measure dominates, the nurse can create a rhythmof her own in the room. Thus, acting slow in the quick meeting means that nurse-patientrelationship is characterized by calmness and quietness, the nurse’s engagement in the patient’ssuffering and her help to the patient to endure the present and hold the now.

To investigate what characterizes the process of becoming a user of an osseointegrated prosthesis following transfemoral amputation.The study is based on the descriptive phenomenological framework Reflective Lifeworld Research. Data were collected through in-depth interviews with seven participants who had undergone transfemoral implant surgery and currently used their osseointegrated prosthesis. Data were analyzed according to the guidelines given in Reflective Lifeworld Research.The essential meaning of becoming a user of an osseointegrated prosthesis is characterized by determination to achieve rehabilitation results as well as a struggle to get familiar with the new prosthesis. When familiar with the prosthesis, participants begin to experience radical improvements in their everyday life, compared to their life with the socket suspended prosthesis. The essential meaning is elaborated on in four constituents: Determination to achieve rehabilitation results with the short training prosthesis, struggling to get familiar with the osseointegrated prosthesis, experiencing improvements in everyday life and reconnecting with one's prior self-perception.All the participants experienced increased action space and a more positive outlook on life. However, it took determination and stamina to become a user of an osseointegrated prosthesis, and participants faced several challenges throughout this process. Consequently, it remains important to raise awareness of the difficulties faced during this process. Implications for Rehabilitation The findings from this study suggest an increased healthcare support to users of an transfemoral osseointegrated prosthesis in the period of rehabilitation and adjustment, as the results of being able to use the osseointegrated prosthesis may outweigh the obstacles of getting there. Implementation of long-term follow-up and psychosocial support initiatives may improve the adjustment process following osseointegration. Support of patients with an osseointegrated prosthesis may be facilitated through formation of specific rehabilitation groups together with increased use of information technology such as social media and relevant online communities which provide forums for interaction and dialog with people in similar situations.

The paper discusses two conflicting courses of development. One is a course of standardization founded on evidence-based recommendations. The other is a course of democratization based on patients’ involvement in care.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 as a set of rules that the patient must follow rigorously.We argue that, in the current standardized evidence-based practice, the proposed involvement of patients resembles empty rhetoric, and that values from evidence-based medicine are being lost in the transformation into this practice which potentially leads to a McDonaldization of nursing practice reflected as «one best way». To prevent a practice of «McNursing», 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 patients’ involvement.

Purpose: The purpose of this study is to illustrate a theoretical value framework for humanisation of healthcare, a lifeworld-led care that has the potential to support nurses in acute medical units in addressing and meeting both challenges and care needs expressed by patients suffering from alcohol use disorders. Providing care to these patients means working with a very divergent and complex group of patients. When hospitalised in an acute medical unit, nurses are often these patients' first encounter, which gives a unique opportunity to initiate and establish a successful care alliance. Method: The present study is a qualitative study based on an amplified secondary analysis of 25 pre-conducted interviews. Following a hermeneutic approach, the analysis was structured in accordance with the conceptual value framework for humanisation of care, drawing on the recognition of the patients' lifeworld as an aspect of importance. Findings: The study showed that while there were examples of humanising care guided by the patients’ lifeworld present, there were also situations of care that were dehumanising. Conclusion: When letting the patients’ perspective of well-being be the centre of care, the patients’ experience of meaningfulness and sincerity within the provided care was nurtured, and they felt more humanly met.

Background Research shows that suffering from back pain can be associated with great personal costs and that patients undergoing spinal fusion surgery experience particularly problematic illness trajectories and struggle with existential challenges related to living with pain for many years. Aim This study aims to explore how patients with back pain experience their illness trajectories and their interaction with the healthcare system. Method Data were collected through observations and semi-structured interviews. Data analysis was based on the French philosopher Paul Ricoeur's phenomenological hermeneutic theory of interpretation. Findings Before the spinal fusion surgery, back pain had a great negative influence on the patients' everyday lives. Insinuations of being a hypochondriac and having to hide their pain to avoid becoming a burden caused insecurity. Several patients experienced pain relieving effect when talking about their experiences. However, they felt that the healthcare professionals were pressed for time and were mainly interested in their physiological problems. Patients were left with a feeling of being mistrusted, powerlessness, insecurity and loss of identity. Conclusion Lifeworld-experiences are not given priority when dealing with patients suffering from back pain. To accommodate individual needs, aspects related to the patients' experiences of their illness trajectories should be taken into account regarding patient communication.

This paper reports on a qualitative study whose aim was to investigate nursing students’ learning experiences in two arenas. It is common practice all first-year nursing students to practise in a skills lab. In this study, students practised in either clinical settings or a skills lab. In the design, a phenomenological-hermeneutic approach was used. The setting was Course 2, a ten-week course including either two weeks on clinical placements or two weeks in a skills lab. The participants were six first-year students. Data were generated by participant observations and interviews and were interpreted according to Ricoeur’s theory of interpretation. Thefindingsindicatedthatstudentslearnednursingskillsinbotharenas. However,onclinicalplacements,studentsandpreceptors began nursing the patients after 20 minutes and students subsequently reflected on practice. In the skills lab, preceptors guided the students for up to an hour before they were ready to begin performing nursing. Students with previous nursing experience and activist learning style preferred to learn on clinical placements. Students with other learning styles – even one student with previous nursing experience – seemed to prefer learning in the lab, where they felt safe, as there was no risk of harm to patients. The conclusion was that, rather than all first-year students practising in the lab, it could be valuable to consider the students’ prior experience and preferred learning style in discussions of where to begin the learning trajectory in the nursing programme. KeyWords: Learning experiences, Nurse education, Qualitative research, Clinical education, Simulation lab, Learning styles

The pressure on homecare nursing in the Nordic countries has increased in recent years because of a reorganisation of healthcare systems that has put a focus on very early discharge from hospital as well as demographic changes. This article details an analysis of the findings of 13 published qualitative research reports about Nordic homecare nurses' experiences of their work. Using a process of meta-ethnography, the authors identify five themes within the primary research: home care as a professional practice on foreign ground; home care as a massive time constraint; home care as fair rationing; home care as relationships with relatives as fellow players or opponents; and home care as latent paternalism. These have two main implications for practice: homecare nurses should continuously be taught how to cooperate with partners who are emotionally involved; and also homecare nurses may benefit from training that focuses on the challenges of carrying out professional work in private settings

AIMS AND OBJECTIVES: To elucidate the lived experience of how patients with alcohol use disorders experience being cared for when admitted to acute medical units.BACKGROUND: Alcohol use is health damaging and is identified as one of the major avoidable risk factors, and alcohol use disorder is classified among the most harmful, debilitating disease categories. Patients suffering from alcohol use disorders are characterised by complex problems and health pictures spawned by chaotic lifestyles. However, the experience of the hospitalisation from patients' perspective is poorly documented.DESIGN: The present study has a qualitative research design and is anchored in phenomenological and hermeneutical methodology, as described in reflective lifeworld research.METHODS: The data set consists of 15 in-depth interviews with patients suffering from alcohol use disorders admitted to an acute medical unit. A purposive sampling strategy was used, and the interviews were conducted as open dialogues. The study was reported in accordance with the consolidated criteria for reporting qualitative research.RESULTS: Being cared for when hospitalised was experienced as a two-stage process that changed throughout the hospitalisation from an experience of scheduled care experienced as caring to an experience of scheduled care experienced as non-caring. Four constituents further described the variable experiences: being in a safe haven, sharing a tacit but mutual goal, being in a chaotic space and being on your own.CONCLUSIONS: The study showed that being met in an authentic presence by nurses was a powerful tool that helped ease the hospitalisation. Patients suffering from alcohol use disorders call for an intentional and distinctive attentiveness and authentic presence from the nurses throughout their hospitalisation.RELEVANCE TO CLINICAL PRACTICE: Our findings highlight that patients suffering from alcohol use disorders call for an intentional and distinct attentiveness from nurses throughout the hospitalisation, where a possible transfer of attention is noticed and responded to in the care provided.

The aim of this study is to discuss the meaning of walking impairment among people who have previously been able to walk on their own. The study is based on findings from three different life situations: older people recovering after admission in intermediate care, people who have lost a leg, and people who live with Parkinson’s disease. The analysis of the data is inspired by Paul Ricoeur’s philosophy of interpretation. Four themes were identified: (a) I feel high in two ways; (b) Walking has to be automatic; (c) Every Monday, I walk with the girls in the park; and (d) I dream of walking along the street without sticks and things like that. The findings demonstrate that inability to walk profoundly affected the participants’ lives. Other problems seemed small by comparison because walking impairment was at the same time experienced as a concrete physical limit and an existential deficit.

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.

Patients with colorectal cancer are offered multi factual treatment which means long-term treatment followed by severe side effects. Within a phenomenological- hermeneutical frame of reference the aim of this study was to explore the patient’s perception of the challenges they experience during treatment for colonic cancer. Ten patients participated in the study. Data were collected through semi-structured interviews and analysed using the guidelines for meaning interpretation given by Kvale and Brinkmann. The analysis led to one dominating theme: endurance and four subthemes: coping with bodily changes; reorganization of everyday life; getting support from close relatives; seeing life from a different perspective. The patients struggled to endure both the on-going treatment and the changes in everyday life related to the disease and unpleasant side effects such as diarrhea. The findings demonstrate a need for an increased awareness of the impact of diarrhea on patients’ everyday life during treatment.

INTRODUCTION: Although premature infants and their parents are discharged earlier to inhomecare programmes, how to optimally support parents during this transition remains unknown. The aim of this study is to compare the effects of early inhomecare (PreHomeCare) including video consultations and mobile applications with those of inhospital consultations regarding breast feeding, parental confidence and parent-infant interactions.METHODS AND ANALYSIS: A randomised controlled intervention study will be conducted in four neonatal departments offering PreHomeCare (ie, premature infant inhomecare) in Denmark. Parents of hospitalised premature infants who fulfil the inclusion criteria for PreHomeCare will be randomised during hospitalisation to either the intervention (n=80) or control group (n=80) using 1:1 block randomisation. During PreHomeCare, the intervention group will receive a smartphone application with a video system and an infant scale, and the control group will receive usual care (ie, hospital consultations). Additionally, both groups will have planned nurse consultations two to three times a week: the intervention group through video consultations and the control group through inhospital consultations. Data collection will occur at inclusion/baseline, at the end of PreHomeCare and 1 month after discharge using questionnaires and hospital records. The primary outcome is the proportion of exclusively breastfed infants 1 month after discharge/end of PreHomeCare, the secondary outcomes are parent-infant interactions measured by the Mother and baby interaction scale and family confidence in caring for infants measured by the Karitane Parenting Confidence Scale. The process evaluation will consist of two qualitative studies: a field study and an interview study. Data collection will initially involve field observations of three scheduled video consultations with six families from the intervention group. These families will also be interviewed 1 month after PreHomeCare has ended.ETHICS AND DISSEMINATION: The project has been approved by the Regional Ethics Committee and the Danish Data Protection Agency.TRIAL REGISTRATION NUMBER: NCT02581800.

Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers’ premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers’ ethical preparation and to continually address and discuss cases from their own interviews.

Background During their decision-making process patients perceive surgery as a voluntary yet necessary choice. Surgery initiates hope for a life with less pain but also creates a feeling of existential insecurity in terms of fear, isolation and uncertainty. Aim The aim of this study was to explore how patients experience their situation from the point of making the decision to undergo spinal fusion surgery to living their everyday life after surgery. Method A phenomenological-hermeneutic study design was applied based on the French philosopher Paul Ricoeur's theory of interpretation. Data were collected through observations and semi-structured interviews. Findings The recommendation and decision to undergo spinal fusion surgery felt like a turning point for the patients and brought hope of regaining their normal lives, of being a more resourceful parent, partner, friend and colleague with no or less pain. Thus, deciding to undergo surgery created a brief feeling of relief. However, life with back pain had changed the patients' understanding of themselves. Consequently, some patients postoperatively experienced insecurity and a weakened self-image with difficulties creating meaning in their lives. Conclusion Being recommended and undergoing spinal fusion surgery initiates hope for a life with less pain and altered life conditions. At the same time, paradoxically, this creates a feeling of existential insecurity in terms of facing the surgery and the future to come. It is, therefore, important to recognise and include the patients' everyday life experiences concerning how they give (or may not give) meaning to their illness, i.e. their understanding of how it is affecting them. These aspects are essential for the patients' definition and re-definition of themselves and thus crucial to draw upon in the relationship and communication between patient and healthcare professional.

Autonomy is a key aspect for elderly patients associated with experiences of personal integrity and dignity. However, studies indicate that their self-determination can be threatened when they receive home care nursing. The purpose of the present study was to describe elderly patients’ lived experiences of autonomy in relation to home care nursing. Based on a phenomenological-hermeneutic approach, six interviews were conducted with patients aged between 77- 88 years. All patients were living at home and dependent on home care nursing. The findings revealed four themes: 1) The handing over of tasks to the nurse, 2) The influence of everyday routines, 3) Resisting or giving up, 4) Having to adapt to a regulating organization. The study concludes that autonomy is embedded in complex power relations at both individual and organizational levels, especially as patients experience both normal everyday routines and the nature of the organizational framework itself as overpowering and undermining their autonomy. Keywords: autonomy, self-determination, home care nursing, phenomenological hermeneutic approach.

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 contributes to the debate about phenomenology as a research approach in nursing by providing a systematic review of what nurse researchers hold as phenomenology in published empirical studies. Based on the assumption that presentations of phenomenological approaches in peer-reviewed journals have consequences for the quality of future research, the aim was to analyze articles presenting phenomenological studies and, in light of the findings, raise a discussion about addressing scientific criteria. The analysis revealed considerable variations, ranging from brief to detailed descriptions of the stated phenomenological approach, and from inconsistencies to methodological clarity and rigor. Variations, apparent inconsistencies, and omissions made it unclear what makes a phenomenological study phenomenological. There is a need for clarifying how the principles of the phenomenological philosophy are implemented in a particular study before publishing. This should include an articulation of methodological keywords of the investigated phenomenon, and how an open attitude was adopted.

This study aimed to explore how patients with liver cirrhosis experienced overt hepatic encephalopathy (HE), how patients' close relatives perceived having a relative with HE and how nurses described the challenges related to caring for patients with HE. The study was based on semi-structured interviews with eight patients, eight relatives and six nurses. The collected data were analysed according to Malterud's systematic text condensation. The analysis process identified four themes (loss, anxiety, dependence and isolation) for patients, five themes (powerlessness, taking control, support, on guard and information) for relatives and four themes (unpredictable nature, becoming familiar with patients, protecting oneself and doing right) for nurses. The findings reveal new perspectives on HE and can be said to provide an important contribution to gaining a deeper understanding of the experience and impact of HE.

Older people may face many challenges and experience insecurity after discharge from hospital to home. To bridge the potential gap between general hospital and home, the concept of intermediate care (IC) was developed in the year 2000. IC aims to safeguard older people from being discharged to their home before they have sufficiently recovered. However, knowledge within this area is sparse, and the experience of older people in particular is yet to be explored. The aim of this study was to explore older people's experiences of being back home after a stay in an IC unit. Data were drawn from 12 interviews. Transcripts were analysed using a phenomenological approach. The essential meaning of being back home after a stay in an IC unit was characterised by uncertainty. Four constituents emerged: experiencing a state of shock about coming home, dependence on informal helpers, feeling a sense of isolation, and fearing loss of functional ability permanently.

In the UK, intermediate care (IC) is conceived as a range of service models aimed at ‘care closer to home’ and involves the expansion and development of community health and social services. Intermediate care in Denmark is more clearly defined, where approximately 45% of all the counties in Denmark have established a community-based IC unit in which public health-care services are offered to older people who have completed their hospital treatment. The impact of this organisational initiative is yet to be explored. In particular, the knowledge of the patient perspective is sparse and contradictory. The aim of the study was to explore how older people experience being in an IC unit after hospital discharge and before returning to their home. Data were drawn from 12 semi-structured interviews. Transcripts were analysed using a phenomenological approach. The essence of being in an IC unit was envisioned as ‘moments of conditional relief’ that emerged from the following constituents: ‘accessible, embracing care’, ‘a race against time’, ‘meals—conventions with modifications’, ‘contact on uneven terms’, ‘life on others’ terms’, and ‘informal but essential help’.

Rationale and aims: Research shows that back patients’ illness experiences affect their interaction with the healthcare system. It is important to examine the exact nature of these experiences in order to shed valuable light on how back patients perceive their illness and hospitalisation. The aim of this literature review is to gain a better understanding of back patients’ illness experiences and to identify, systematise and integrate the findings of different qualitative studies that may elucidate barriers and the consequences or focal points in connection with care and treatment. Methods: The methodology for this literature review is based on the thematic synthesis used by James Thomas and Angela Harden. The literature review also draws on the sociological theories and arguments of Ulla Harriet Jensen and Trine Dalsgaard in which health professionals biological perception of the individual dominates the healthcare system and translates into a certain way of perceiving and explaining illnesses and symptoms. Results: The thematic analysis shows that it is through experiences and memories that we create our identity and consciousness. Ignoring the illness experiences can therefore be seen as disregarding, the patient as a human being. With this in mind, it is easier to understand why back patients often feel marginalised and mistrusted in their interactions with the healthcare system. Respectfully including the patients’ experiences is fundamentally about acknowledging the back patient as a human being. Conclusions: A synthesis of the included studies demonstrates the need for healthcare professionals to pay attention to back patients’ narratives in order to acknowledge them as human beings. This acknowledgement involves an ethical dimension and a sense of responsibility, manifested as respectful inclusion of the patient’s experiences. The body can never be understood merely as a biological entity and therefore illness is far more than having symptoms, diagnoses and treatment. The synthesis thus proposes an acknowledgment of this and a more holistic approach.

Hepatic encephalopathy (HE) markedly reduces an individual's quality of life as measured by established scoring systems. However, the experiences of having HE that can be assumed to cause the loss of quality of life have not yet been examined. This study aimed to explore how individuals with cirrhosis experienced overt HE by means of an in-depth interview with a tailored semistructured interview guide and qualitative analysis. Eight patients with cirrhosis who had clinically recovered from disorientation, somnolence, and stupor due to episodic HE Grade II or III were interviewed. The collected data were analyzed using systematic text condensation, as described by K. Malterud (2012). The analysis process identified 4 themes, “multiple losses,” “anxiety,” “dependence on others,” and “social isolation,” which described the experiences of HE both during an episode and in recovery. We believe that these findings provide an important contribution to gain a deeper understanding of the widespread loss of quality of life caused by HE. Management of these individuals should involve procedures and attitudes targeted against the described experiences. However, more research is needed about the individuals' experiences of HE to further detail such efforts.