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Denna vårdvetenskapliga jubileumsskrift tar läsaren med på en resa genom den utveckling som skett av ämnet vid forskarutbildning i vårdvetenskap vid Växjö universitet. Många bäckar små… ett talesätt som kan illustrera det gemensamma arbete och den samlade kunskap som ligger bakom denna skrift. I skriften får vi stifta bekantskap med vårdvetenskapen i varierande kontexter alltifrån rättpsykiatri till akut- och hemsjukvård. Sammanställningen av den vårdvetenskapliga forskning som under denna femårsperiod har gjorts på IVOSA visar att vårdvetenskapen är en autonom vetenskap med en tydlig substans eller kärna. I kärnan finns patienten, och ämnet tar sin utgångspunkt i människors existens. Med fokus på människan som är i behov av vård framträder lidande, hälsa och välbefinnande som väsentliga begrepp. I bokens delar fördjupas och kontextualiseras vårdvetenskapen i skiftande vårdande liksom lärande miljöer. En vårdvetenskap med grund i ett patientperspektiv behövs såväl akademiskt som i vården för att anta både dagens och morgondagens utmaningar.

The aim of this study is to describe the experience of time as it presents itself at the place being situated when living with severe incurable disease and receiving palliative care. The empirical data consist of 26 open-ended interviews with 23 patients receiving palliative care at home, at a palliative day care, in a palliative bed unit in hospital or in a nursing home in Norway. A common meaning of a shifting space for living emerged from the analysis and was revealed through three different aspects: (i) Transition from a predictable to an unpredictable time: To live with severe incurable disease marks a transition to a changed life involving an ongoing weakened and altered body with bothersome symptoms making experience of time different and unpredictable. (ii) Transition between a safe and unsafe time: When time is unpredictable, feeling safe is revealed as essential to how time is experienced at the place being situated. (iii) To be in transition from a homely to a homeless existence: In a time of increased bodily weakness, unpredictable ailments and displacements, the sense of belonging to the place is revealed as significant to the experience of time. Not knowing where to be in a time of change is like an existential cry of distress where the foothold in existence is lost. The findings are discussed and interpreted as an embodied experience originating from the passage of time continually affecting life sometimes so fundamentally that it marks a transition to a changed space of life that is reflected in the experience of time.

This article presents findings from a phenomenological study exploring experience of time by patients living close to death. The empirical data consist of 26 open-ended interviews from 23 patients living with severe incurable disease receiving palliative care in Norway. Three aspects of experience of time were revealed as prominent: (i) Entering a world with no future; living close to death alters perception of and relationship to time. (ii) Listening to the rhythm of my body, not looking at the clock; embodied with severe illness, it is the body not the clock that structures and controls the activities of the day. (iii). Receiving time, taking time; being offered - not asked for - help is like receiving time that confirms humanity, in contrast to having to ask for help which is like taking others time and thereby revealing own helplessness. Experience of time close to death is discussed as an embodied experience of inner, contextual, relational dimensions in harmony and disharmony with the rhythm of nature, environment and others. Rhythms in harmony provide relief, while rhythms in disharmony confer weakness and limit time.

The aim of this study was to gain a greater understanding of the experiences of shame of next of kin in end-of-life care. Seventeen next of kin who had lost a family member were interviewed. A method inspired by Gadamer's hermeneutic approach was used to interpret possible experiences of shame and to discuss these interpretations. The result showed that next of kin's experiences of shame are linked to their perception of the remaining time and are guided by views on morality and what is right and wrong. Shame can occur when the next of kin are involved and actually cause harm to the family member as well as in situations that are beyond their control. Shame can also involve actions that have nothing to do with what they have actually done but is instead a shame that is placed on them by others, for example, health professionals or relatives. Shame is interpreted as experiences of ignominy, humiliation, and disgrace. Second-order shame is also found. It is important that health professionals are aware of these experiences of unhealthy shame when they meet and support next of kin in end-of-life care.

The theoretical viewpoint of the study was based on the fundamental motive in caring science, the suffering person and his/her health and life situation,which according to the philosophy of palliative care also includes the next of kin. The latter often wish to participatein the care of their loved ones and it is thus important for them to be able to make decisions that can generate a meaningful participation. Unfulfilled obligations or wrongdecisions, concerning their dying relative, can result in experiences of guilt and shame in relation to the care of the loved one. A semantic concept analysis can provide a deeper understanding of these concepts and create a deeper insight into what the concepts mean for the individual. Aim: The aim of the study was to elucidate the meaning of and the distinction between the concepts of guilt and shame. Methods: Semantic concept analysis based on Koort and Eriksson. Findings: The findings show that guilt and shame are two separate concepts. Guilt contains meaning dimensions of being the cause of and sin. Shame contains meaning dimensions of something that gives rise to shame and ability to experience shame. The synonyms for each concept do not overlap each other. Conclusion: The semantic analysis creates an understanding of the concepts ontologically and provides a basis for theoretical, contextual and clinical understanding and development.

AIM:The aim of this study was to highlight community nurses' experiences of ethical dilemmas in palliative care.

BACKGROUND: There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence.

METHOD: Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis.

FINDINGS: The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients' end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals.

CONCLUSION: The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues' experience and deal with such issues.

This study illuminates how existential needs and spiritual needs are connected with health care ethics and individuals' mental health and well-being. The term existential needs is defined as the necessity of experiencing life as meaningful, whereas the term spiritual needs is defined as the need of deliverance from despair, guilt and/or sin, and of pastoral care. It discusses whether or not patients' needs are holistically addressed in Western health care systems that neglect patients' existential and spiritual needs, because of their biomedical view of Man which recognizes only patients' physical needs. It excludes a holistic health care which considers all needs, expressed by patients in treatment of mental illness. Addressing all needs is important for patients' improvement and recovery. For some patients, this is the only way to regain their mental health and well-being.

The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand’s aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors. 

Healthy ageing is a concept that concerns older persons' quality of life and is a key factor in promoting well-being. The older population in Thailand is growing. Isan (a region of north-eastern Thailand) has been reported as having one of the most rapidly increasing older populations in the country. In order to care for and promote the health of older people, healthcare providers should understand how healthy ageing is perceived by this target group. Although healthy ageing has been studied in different contexts as well as perspectives, no studies have previously focused on older persons' experiences of healthy ageing from a lifeworld perspective in Isan-Thai. Therefore, the aim of this study is to describe older persons' qualitatively different conceptions of healthy ageing in Isan-Thai culture. A phenomenographic approach with an epistemological base in lifeworld theory was used to disclose the various ways to conceptualize healthy ageing. Individual, qualitative interviews were conducted with 17 people aged 60 and above who live in Isan-Thai. The findings of this study revealed three categories of descriptions: "being independent in dependence,'' "being at peace,'' and "being a valuable person.'' This study also found family members, friends, healthcare providers, and religion important to healthy ageing in the Isan-Thai culture. Understanding how older people conceptualize healthy ageing is valuable for healthcare providers. They can apply these findings regarding healthy ageing in their fieldwork when caring for older people.

Healthy ageing has been studied in various contexts. However, no studies have focused on healthy ageing from the perspective of children or grandchildren, who are the main informal caregivers for older people in northeast Thailand, also referred to as the Isan region. Therefore, this study aimed to describe the conceptions of healthy ageing harboured by children and grandchildren caring for older people in northeast Thailand. A qualitative descriptive design was performed using a phenomenographic approach with an epistemological basis in the lifeworld theory to understand the varying conceptions of healthy ageing based on participants’ lived experience. We conducted in-depth interviews comprising open-ended questions to gain an understanding of the conceptions of healthy ageing held by 14 children and grandchildren of older persons in northeast Thailand. The data collected during these interviews were analysed using the phenomenographic analysis method. The results of our analysis indicated that the conceptions of healthy ageing can be categorized into the following four descriptive categories: being independent, not being afflicted by diseases or illnesses, being a giver and a receiver, and being wise. These findings highlight that healthy ageing entails autonomy, interdependence and wisdom and emphasize the importance of holistic view on the meaning of healthy ageing. Healthcare providers should understand the different meanings of healthy ageing from the perspectives of children and grandchildren of older people and integrate their perspectives when collaborating with them to promote healthy ageing. The findings of this study may facilitate further research and ensure the provision of support to the relatives of older people to promote healthy ageing in northeast Thailand. 

BACKGROUND:

There is a need for a short and easily administered scale, in the Swedish language, for assessing partner relationships in the health care of persons with cardiac disease.

PURPOSE:

To establish the reliability and validity of the Swedish version of the Relationship Assessment Scale (RAS).

DESIGN:

The present pilot study has a methodological design.

FINDINGS:

Content validity has been tested for relevance, clarity and readability. The scale was tested for construct validity with explorative factor analysis. The reliability was tested by internal consistency and test-retest analysis. The result showed a two-factor solution, which does not correspond to the original proposed one-factor solution. The factor analyses revealed two quite distinct factors of RAS, labelled "Relationship built on expectations and satisfaction of needs" and "Relationship built on love and devotion".

CONCLUSIONS:

The scale has satisfactory psychometric properties in terms of content validity, construct validity, homogeneity and stability in a population of persons with cardiac disease. Wider evaluations of the RAS for other populations and settings are recommended.

The aim of the thesis is, from a caring science perspective including a caring theology perspective, to illustrate the meaning of the phenomenon consolation and how consolation relates to suffering and care. Two studies were completed where staff and elderly care receivers were interviewed and a third study focused on an analysis of consolation as it is presented in the Book of Job in the Old Testament. These studies deal with carers’ experiences of consolation and consoling, elderly care receivers’ experiences of consolation, and Job’s experience of consolation. Phenomenology and hermeneutics form the basis for the methodological approach. A phenomenological-hermeneutic method, inspired by Paul Ricoeur, has been used for the text analyses. The thesis alsocovers significant aspects of poetical and religious texts. The metaphors that occur in the interview studies with the carers and the elderly are analysed in order to take care of the excess of meaning that, according to Ricoeur, can be expressed in metaphors. The result show five overall meanings: The contradictory consolation, The bonding consolation, The mute and rigid consolation, The uncontrolled consolation and The restful consolation. A caring consolation is contradictory in the sense that it entails that the sufferer on the one hand passes on his or her suffering to someone else and on the other hand that the suffering can be returned to be suffered. Consolation can thus entail suffering. The bonding consolation is present, i.e. is with the sufferer and is based on that person’s suffering. This consolation is characterised by a close fellowship, a feeling of being understood at a deeper level. The results also reveal a consolation that is mute and rigid. This consolation does not respond to the sufferer’s experience of his or her suffering, is shapeless and therefore unable to follow the suffering. An example of a mute, rigid and non-caring consolation is the consolation of the friends in the Book of Job. This consolation is not capable of consoling because it does not correspond to where Job is, i.e. in his experience of his suffering. A caring consolation is also uncontrolled because it is on the one hand spontaneous and on the other hand helps the sufferer to lose control over the suffering. To lose control entails, amongst other things, the sufferer giving up trying to understand suffering and instead lets that which is incomprehensible be incomprehensible. A consoling and health-bringing rest in or from the struggle with suffering presents itself by giving up what in various ways is tied to the suffering. The result as a whole is interpreted from a caring science perspective with the following important concepts: caring relationship, faith, health and sacrifice. Consolation as health is considered on the basis of a theoretical model inspired by Katie Eriksson’s ontological health model. The research is also illustrated from a philosophical-ethical perspective, mainly based on the work of Emmanuel Levinas.

The purpose of this theoretical article is to discuss the existential and universal feature of suffering-as illustrated by Job's suffering in the Book of Job in the Bible and by the survivors of the 2004 Asian tsunami catastrophe-and to highlight its significance for health care. Further, the study is aiming at contributing to health professionals' understanding of patients' suffering. The sources are narratives, comprising Job's book, TV interviews 1 year after the tsunami catastrophe and the survivors' autobiographies. The methodological approach is a philosophical analysis. The existential, universal, ontological and epistemological aspects of suffering are carefully scrutinized to unveil the universal and existential versus culture-specific features of suffering. Based on the results, the authors' recommendations are (1) a holistic concept of the patient and health care has to seriously consider suffering in all its complexity because when a person is in pain, it is not his/her body but the whole person as a unity of body, psyche and spirit that suffers and (2) suffering should be seen as the most central concept of health care, which should provide treatment for physical pain and all dimensions of suffering: physical, social, mental and spiritual aspects. © 2014 Springer Science+Business Media New York.

The aim of the study was to explore the meaning of consolation as experienced by Job in the Book of Job and as presented in literature and how consolation relates to suffering and care. The study's theoretical design applied Ricoeur's view on phenomenology and hermeneutics. The resulting themes were as follows: consolation that is present, that originates in confrontation, that keeps suffering at a distance, that does not alleviate suffering, that originates in experience from giving comfort, and that facilitates a change of perspective. The authentic and caring consolation accepts the sufferer's incomprehensible "otherness" but however provides no answers about how to console.

The tsunami catastrophe, 26th December 2004, is one of a number of catastrophes that has stricken mankind. Climate reports forecast that natural disasters will increase in number in the future. Research on human suffering after a major catastrophe, using a caring science perspective, is scarce. The aim of the study was to explore the meaning of suffering and relieved suffering of survivors of the tsunami catastrophe, 26th December 2004. An explorative study design, inspired by the French philosopher Paul Ricoeur's hermeneutic-phenomenology, was used. Interviews made by the Swedish Television (SVT) in connection with the 1 year anniversary were carried out on site in the disaster area and in Sweden. The text analysis revealed four main themes: 'An incomprehensible event', 'A heavy burden', 'Help that helps', and to 'Being changed in a changed life situation'. The findings were mainly interpreted in light of Paul Ricoeur's thinking on suffering, quilt, forgiveness, time and narrative. The first year after the loss of loved ones in the tsunami catastrophe, 2004, was like starting an inner as well as an outer journey. This journey was experienced as living with the heavy burden of an incomprehensible event. Help that helped was mediated by consolers who endured the suffering of the other. An 'enduring courage' is a key moral virtue to encounter the alienation of the sufferer and how it in turn alienates from the sufferer. It is also important to recognize that the complexity of the world of those who have lost loved ones in major catastrophes includes possibilities for reconciliation with the loss. The reconciliation creates hope that opens up for being changed in a changed life situation.

The aim of this study was to highlight the instantaneous experience of suffering and relieved suffering that was presented on the Swedish Television (SVT) by those who experienced the tsunami wave in Thailand, 26 December 2004. The selected TV-interviews were watched, transcribed and conducted with an empirical phenomenological analysis. A phenomenological lifeworld approach, inspired by the French philosopher Maurice Merleau-Ponty, was chosen for the theoretical framework. The findings showed three main features: the motion, the stillness and the shift in perspective. The motion comprised both the motion of the wave and the motion it caused the victims in terms of external as well as internal disorder. When the tsunami waves withdrew, it was followed by stillness. The feeling of being unreal was prominent, triggered by lack of information and endless waiting. Another prominent feature was the victims' incapacity to answer "how long" they had suffered before being rescued. The tsunami catastrophe seemed to be a timeless event. Caring for other victims meant a shift in perspective in one's own devastated world to that of another person. The shift between focus and comprehension, contributed to the making of life-saving decisions, for the victims themselves and for other victims. The findings were mainly reflected on from the perspective of the French philosopher Maurice Merleau-Ponty, for example the experience of time as an embedded and lived now. It was also reflected on from the perspective of the German philosopher Karl Jaspers as a limit-experience and as a fulfilment of love. A suggestion for further research is to investigate how suffering and relieved suffering is experienced and encountered when further time has passed. Key words: Tsunami, catastrophe, suffering, relieved suffering, care, phenomenology, lifeworld

The purpose of this study was to evaluate the psy- chometric properties of a Swedish version of The Krantz Health Opinion Survey (KHOS). A conven- ience sample of 79 persons (47 men and 32 women) was recruited from The Heart and Lung Patients’ National Association at ten local meeting places in different areas in Sweden. The questionnaire was examined for face and content validity, internal con-sistency and test-retest reliability. The findings showed that the Swedish version of KHOS is accept- able in terms of face and content validity, internal consistency and test-retest reliability over time among 79 individuals >65 years of age and with a cardiac disease. In conclusion, wider evaluations of the psy- chometric use of KHOS for other populations and settings are recommended.

The patients' sexual life after a myocardial infarction is important for his/her quality of life. In spite of this, many patients are in doubt regarding their sex life after a myocardial infarction (MI) and the sexual information received, and counselling from health care providers has been seen to be insufficient. The purpose of this study was to evaluate the psychometric properties of 'The 25-item Sex after MI Knowledge Test' in a Swedish context. A convenience sample was recruited. The scale was translated into Swedish and completed by 79 former patients from The Heart and Lung Patients' National Association on two occasions, with an interval of 2 weeks. The scale was tested for face and content validity, internal consistency and test-retest reliability. The result in this study indicates that the instrument has good face and content validity and displayed a moderate internal consistency (alpha 0.61). The instrument showed some level of instability in test-retest reliability with 60% of the items presenting moderate or strong agreement between the test and retest. Further studies that use this instrument in larger and more diverse samples are thus needed.

The aim of the study was to gain a greater understanding of the experiences of guilt of the next-of-kin in end-of-life care. Seventeen next-of-kin who had lost a loved one were interviewed with a focus on possible experiences of guilt. A Gadamerian-based hermeneutic approach to interpret these experiences was used. The interpretation showed that next-of-kin’s experiences of guilt emanated from a situation where the next-of-kin had a moral view on what was the right thing to do, it could also originate from a wish to do the best possible for the dying person out of love for this person. The situation could also involve both these aspects.  The way in which the situation was handled, could, if the next-of-kin felt that s/he did not fulfill her/his commitments, omitted or neglected the dying person or was the cause of something, lead to experiences of guilt. The situation of being next-of-kin in end-of-life care is complex and demanding, something that health professionals are and should be aware of. Acknowledgement of experiences of guilt can help the next-of-kin in their adaptation to the end-of-life situation as a whole and maybe also give useful tools to support next-of-kin through bereavement.