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The patient-practitioner relationship is fundamental to rehabilitation practice and patients’ health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study. We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis. We identified relational states and shifts in the clinical encounter 2–3 years post-surgery, described in themes: a) Playing by the Book – Making it Easier for Each Other, b) Down the Blind Alley – Giving up on Each Other, and c) Opposite Poles – Towards and Away from Each Other. The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter’s benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.IMPLICATIONS FOR REHABILITATIONIllness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly “notice, name and validate” emotions can promote the patient’s capacity to sustain self-care, lifestyle change, weight loss and health gains.Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter Illness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension. Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly “notice, name and validate” emotions can promote the patient’s capacity to sustain self-care, lifestyle change, weight loss and health gains. Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter

The purpose of this study was to explore moments during psychotherapy sessions in which clients experience that they have an opportunity to approach and engage with difficult topics and emotional experiences, with the aim of describing therapists' acts that support clients' in-session engagement.Two treatment sessions of 11 participants were videotaped and immediately followed by an in-depth semi-structured interview, using the interpersonal process recall (IPR) interview method. A follow-up interview was conducted 3 months after the final IPR interview. Participants' accounts were analyzed using thematic analyses.Five themes of engagement-supportive acts resulted from our analyses: 1. inviting the client by showing acceptance; 2. recognizing the clients' hints and try-out signs; 3. providing information on the process and evaluating clients' expectations; 4. actively helping the clients to notice and stay with difficult experience and 5. showing sensitivity to the client's needs for micropauses. We discuss these themes as acts of recognition.Clients found it was engagement-supportive when therapists implicitly and explicitly recognized the challenges of being in psychotherapy. This recognition could be achieved through the engagement-supportive acts described in the five themes. Therapists should continually make space for and seek a balance between different engagement-supportive acts.

The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants’ lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants’ narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger’s concept of homelikeness and Arthur Frank’s typologies of illness narratives. In conclusion listening to and acknowledging the patients’ lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients’ lived experience of critical illness and its aftermaths. acceptedVersion

The aim of the study was to investigate the role of inpatient treatment in the recovery process and explore how patients view hospitalization when looking back after 3 months. The study was developed within a framework of user-involved research; all stages of the research process involved cooperation with service user coresearchers. Fourteen patients were recruited, all of whom had been in inpatient treatment for at least 3 weeks. The findings are based on analyses of interviews with the participants 3 months after discharge. Three key themes reflected the participants’ experiences when looking back at their hospitalization 3 months after being discharged: (i) A break from everything “out there”; (ii) A safety net to catch me if I fall; and (iii) From being looked after to taking responsibility for yourself. The transition from being an inpatient to returning home can be hard. Findings suggest that belonging to a social network plays an important role in recovery, and that this might be a meaningful focus during admission.

This is the peer reviewed version of the following article: Gjengedal, E., Sviland, R., Moi, A. L., Ellingsen, S., Flinterud, S. I., Sekse, R. J. T., . . . Råheim, M. (2019). Patients’ quest for recognition and continuity in health care: time for a new research agenda? Scandinavian Journal of Caring Sciences, 33(4), 978-985, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/scs.12696. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. User involvement is important in democratization of health care and is assumed to contribute to better and more relevant research. Despite increased requirements for user involvement in research, more studies are still needed. This study aimed at exploring what research agenda people with varied health problems consider as important, based on their own experience. The study had a phenomenological approach with a qualitative design. The sample consisted of 23 informants; nine had been critically ill and 14 were suffering from chronic muscle pain. Data were collected in five focus group interviews and one individual interview. A phenomenological approach was used in analyzing the data. Written consent was obtained from all the participants, and ethical considerations were taken throughout the entire research process. Despite various experiences among the participants, a quest to be taken seriously over time by healthcare professionals emerged as a strong meaning structure in both groups. Based on these experiences, continuity across lifetime changes turned out to be an important research topic for future research. User involvement should be appreciated in all parts of the research process. A crucial prerequisite is that the users get the opportunity to bring their own experiences into the process.

This study explores the lived experience of hospitalisation from the perspective of people with a mental health disorder. This hermeneutic-phenomenological study, which forms part of a larger qualitative serial inquiry, uses a participatory research design, with analysis inspired by interpretative phenomenological analysis. Fourteen participants were interviewed twice: first during hospitalisation and then again 3 months following hospital discharge. Findings are reported from the entire interview data set. Our findings suggest that mental health hospitalisation is a contradictory experience for patients. On one hand, our study participants experienced the hospital as a place where it is alright to be vulnerable, while on the other hand participants experienced hospitalisation as a burden of everyday stigma and signs of depersonalisation. We conclude that it is important to recognise that patients in need of inpatient treatment for mental illnesses are, in fact, people first and foremost. More reflective practice can be developed by shifting the focus to recovery-oriented practices to and open dialogue-based approaches.

Rationale The increasing number of frail home-dwelling older people has sharpened the focus on discovering and implementing suitable treatment and care in clinical practice, aiming to prevent loss of physical functioning and preserve their autonomy and well-being. People's embodied experiences may yield rich descriptions to help to understand frailty. Thoroughly understanding older people's individual perceptions is especially relevant because the numbers of home-dwelling older people are increasing, and people tend to develop more health problems and become frailer as they age. Their perspectives are important to develop knowledge and high-quality care. Aim To explore the lived experiences of frail home-dwelling older people. Methods We conducted a phenomenological study to obtain in-depth descriptions of the phenomenon. We interviewed 10 home-dwelling older adults (seven women and three men, 72–90 years old) in depth about their lived experience of frailty. We analysed the data using a hermeneutic phenomenological approach described by van Manen. Findings The lived experience of frailty is described in one essential theme: frailty as being in the borderland of the body, including three interrelated subthemes: (1) the body shuts down; (2) living on the edge; and (3) not giving up. Conclusions Our study gives insight into lived experiences with frailty among home-dwelling older people related to their own body. Older people's experience of meaningful activities strengthened their feeling of being themselves, despite their frail and deteriorating body. Healthcare providers must consider the strategies of frail older people to consider both their vulnerabilities and self-perceived strengths. The resources and deficits of frail older people present in the state of being frail need to be recognised. publishedVersion

Based in narrative phenomenology, this article describes an example of how lived time, self and bodily engagement with the social world intertwine, and how our sense of self develops. We explore this through the life story of a woman who lost weight through surgery in the 1970 s and has fought against her own body, food and eating ever since. Our narrative analysis of interviews, reflective notes and email correspondence disentangled two storylines illuminating paradoxes within this long-term weight loss process. Thea’s Medical Weight Narrative: From Severely Obese Child to Healthy Adult is her story in context of medicine and obesity treatment and expresses success and control. Thea’s Story: The Narrative of Fighting Weight is the experiential story, including concrete examples and quotes, highlighting bodily struggles and the inescapable ambiguity of being and having one’s body. The two storylines coexist and illuminate paradoxes within the weight loss surgery narrative, connected to meaningful life events and experiences, eating practices and relationships with important others. Surgery was experienced as lifesaving, yet the surgical transformation did not suffice, because it did not influence appetite or, desire for food in the long run. In the medical narrative of transforming the body by repair, a problematic relationship with food did not fit into the plot.

Purpose: To explore children’s experiences with testing, acquiring and using assistive devices.Methods: Nine children (six boys, three girls, 9–12 years old, with different physical disability and activity experience, participated in semistructured interviews. The interviews were audio-taped, transcribed and analysed using Systematic text condensation.Results: Assistive devices were reported to contribute to cope activities that the children otherwise would not have participated in. Several subjects listed the need for a shielded environment when adapting to new equipment. The children highlighted “independence in activities” and “having the opportunity to participate in activities with family and friends” as important for frequent use. Need for assistance and lack of localizations to perform the activities were listed as reasons for less frequent use.Conclusions: This study reveals that it is useful to map each child’s opportunities for independency, appropriate locations for performing the activ...

Aim: The aim of this study was to explore students’ experiences of physical education (PE) and to gain insight into what contributes to engaging them in PE. Methods: A total of 316 second-year high-school students from five schools participated by completing a school assignment. The data were analyzed according to content analysis. Findings: Two main themes were developed. The first was One-sided emphasis on performance, bodily skills, and assessment with the corresponding sub-themes: Skills and performance; and Assessment, tests, and grading. The second was Wish for play, respite, co-determination, and togetherness with the sub-themes: Play and spontaneity; Respite, Togetherness and cooperation; and Co-determination and engagement. Our findings reveal a wide range of student experiences with PE classes, from a welcome respite in an otherwise sedentary and theoretically dominated day at school and enjoying being physically active with classmates, to frustration about extensive use of tests, lack of mastery, and feelings of exclusion. Conclusion: To be consistent with the values of the Ministry of Education in Norway, we conclude that the content and mode of delivery of PE in schools would benefit from being rethought if the intent is to facilitate children to stay physically active. Norwegian physiotherapists are promoters of health and physical activity across the lifespan. As part of health services in schools, they are in a prime position to optimize the PE experience for students. publishedVersion

Few studies address the many challenges that are faced by staff and patients in the inpatient mental health context. In particular, there is a lack of research that explores first-hand patient experiences in order to establish what treatment practices best assist patient recovery and what are the barriers to these practices. This qualitative study, which utilises a user-involved research framework, collaborates with a co-researcher patient group throughout the study. Fourteen patients, all of whom had been in inpatient treatment for at least three weeks, were recruited to the study. Study participants were interviewed in-depth in the period September 2016 to March 2017. Data underwent a thematic analysis that was inspired by interpretative phenomenological analysis. A core theme of the findings was the importance of being recognised as a whole person, and the patient–professional relationship was regarded as a fundamental factor in fostering recovery, with two underlying themes: (i) a need to have one‘s self-identity recognised and supported, and (ii) an experience of ambivalence between needing closeness and distance. This study suggests ways nurses can give priority to interpersonal interactions and relationships with hospitalised patients over task-oriented duties, highlighting the need for nurses to balance patient competing needs for both closeness and distance. publishedVersion

Purpose: Losing weight and keeping it off for the long term is difficult. Weight regain is common. Experiences of successful non-surgical weight loss after severe obesity are largely unexplored. We know little about long-term weight loss processes, and how health care services can be of help to those living them. Methods: Drawing on in-depth interviews of 8 women and 2 men, the aim of this phenomenological study is to describe the experiences of adults who have been severely obese, who have lost weight and maintained weight loss for the long term (>5 years). Results: Findings show that after severe obesity, sustained weight loss has no endpoint, yet is always easy to end. Keeping weight off means committing to oneself, continuing profound changes and cultivating sensitivity towards oneself and others. A phenomenological understanding of sustained weight loss can inform professionals who deal with health issues and challenges occurring in the life of people leaving severe obesity. publishedVersion

To explore children's experiences with testing, acquiring and using assistive devices.Nine children (six boys, three girls, 9-12 years old, with different physical disability and activity experience, participated in semistructured interviews. The interviews were audio-taped, transcribed and analysed using Systematic text condensation.Assistive devices were reported to contribute to cope activities that the children otherwise would not have participated in. Several subjects listed the need for a shielded environment when adapting to new equipment. The children highlighted "independence in activities" and "having the opportunity to participate in activities with family and friends" as important for frequent use. Need for assistance and lack of localizations to perform the activities were listed as reasons for less frequent use.This study reveals that it is useful to map each child's opportunities for independency, appropriate locations for performing the activity and participation with friends, when considering obtaining assistive devices. Implications for Rehabilitation The use of assistive devices gives many children with physical disabilities the opportunity to participate in physical activity. Improving availability to assistive devices for physical activity should be a priority to help facilitate participation. Having opportunities to develop perceptions of competence may be essential for a child's long term participation in physical activity.

Bariatric surgery provides sustainable weight loss and increased quality of life for most, but not all patients. To increase the knowledge of this complex patient group and their needs during follow-up, we aimed to describe the essential meaning of bariatric surgery patients’ long-term experiences by using a phenomenological lifeworld approach. Eight patients were interviewed between 5 and 7 years after bariatric surgery. Life after bariatric surgery was described as living with tension, ambivalence, and reinforced attention toward one’s own body. The tension was related to embodied change and altered relations to the social world. The patients express an ongoing demand for control of health-related habits and practices, and to not lose control over the body again. Surgical weight loss and improved physical function do not necessarily mean changed health-related habits and practices in the long term. Experiencing weight regain is connected with emotional stress, shame, and self-contempt.

While health care professionals advise those who have undergone weight loss surgery (WLS) to increase their levels of physical activity, research suggests that often this is not achieved. This paper explores the experiences of ten Norwegian women as they engaged in physical activity several years after weight loss surgery (WLS). In contrast to the existing literature, which explores physical activity post-WLS largely in terms of quantitative data and measurable outcomes, the present study sought to explore women’s lived experiences of physical activity, including the meanings they ascribed to different forms of activity and how such meanings changed over time. The research participants, all of whom had undergone WLS more than five years earlier, described (during individual interviews) the meanings they attached to becoming physically active, as well as the different activities and movement practices they engaged in, from interval training to mountain hiking and yoga. For all the women, maintaining and increasing their level of physical activity was challenging. On the one hand, engaging in exercise after weight loss improved their sense of joy and well-being and expanded their opportunities to move and act. On the other hand, during physical activity they needed to be constantly alert to symptoms of post-surgical side-effects, including variable energy levels, digestive problems and acute illness episodes. As the women explored their new capacities, it seemed to be important for them to explore various forms of physical activity in order to find the form of exercise which best suited them or which they most enjoyed. In some cases, they constructed new meanings around activities which, prior to surgery, had seemed onerous and bereft of pleasure. We argue that such insights will benefit health professionals who provide advice on physical activity at different post-surgical stages, sometimes to persons seriously concerned about regaining weight. publishedVersion

The prevalence of obesity and severe obesity has increased rapidly in Norway since the 1980’s. Severe obesity is a medically introduced term for large body weight that is connected to health risk and impaired quality of life. The health care services can offer people with severe obesity an interdisciplinary assessment and possibly a weight loss intervention, although not necessarily bariatric surgery. Bariatric surgery is an option in severe obesity, and seems to be the most efficient intervention in terms of providing sustainable weight loss and reduction in comorbidities for the majority of patients. However, surgery involves risk and long-term outcomes, and complications beyond 1- 2 years are currently scarcely reported in research. The aim of this study is to explore patients’ long-term experiences with bariatric surgery. The study has a qualitative design and is grounded in phenomenology. Data was produced by in-depth interviews more than five years after surgery. Seven women and 13 men with different backgrounds participated. The participants were aged 28-60 at the time of the interview. All of them had undergone a combined surgical procedure, called Duodenal Switch, which provides most substantial weight loss and carries a somewhat higher risk of complications when compared to other surgical procedures. The data consists of the patients’ experiences after bariatric surgery processes, as recalled and described in the interviews. The analysis was inspired by Giorgi’s phenomenological method. The process of reflexivity has been emphasised throughout the whole research process. The findings are presented in three separate articles. The first article presents findings based on the first eight interviews. The article concentrates on the intertwining of change and altered social encounters and negotiation of embodied identity after surgery. In the second article, findings based on the first 14 interviews describe eating as an existential and situated practice which remained a sensitive issue after surgery. The third article reports the 13 male participants’ experiences after bariatric surgery, and describes agency as pivotal for the men’s self-understanding. Thus, bariatric surgery was experienced as a radical intervention, yet deeply meaningful because it gave access to actively engage with the world and others. “Carrying the weight of uncertainty” constitutes a common and essential theme of the long-term experiences, across the presented findings. Despite sufficient weight loss and comorbidities in remission, the patients lived with health problems, illness, complications and worries about the future connected to body weight and health.

Health experts advise and expect patients to eat healthily after bariatric surgery. For patients, difficulties with eating might have been a long-standing, problematic part of life—a part that is not necessarily healed by surgery. Empirical research on patients’ experiences of eating practices after bariatric surgery is lacking. Aiming to contribute to the development of clinical practice, we explored meanings attached to eating in the long term and sought descriptions of change and bodily sensations. We interviewed 14 patients at least 5 years after bariatric surgery. The surgical restriction forced changes in the way patients sensed their own body in eating, but the uncertainty related to maintaining weight loss in the long term remained. Meanings attached to eating transcended food as choices situated in a nourishment and health perspective, and were not necessarily changed. Eating was an existential and embodied practice, which remained an ambiguous and sensitive matter after surgery.