Aim: The aim is to develop knowledge about the phenomenon of leading care close to the patient in community home care from the perspectives of older person’s (aged 65 years and older), next of kin and registered nurses.   Background: When the home becomes the context for caring, it can be both a place for rest and worry. Demands are placed on the registered nurse, as responsible for leading a person-centred care guided by the older person’s expectations. However, research is limited on the phenomenon of leading care close to older persons in community home care. Methods: Results from four studies were further interpreted into a comprehensive understanding. The overall research process was guided by a qualitative descriptive and interpretative approach grounded in reflective lifeworld research. Findings: The comprehensive understanding illuminates that leading care close to the patient in community home care was found to consist of an ethical demand that came with the responsibility to lead the care through others in a space between closeness and distance. Leading care in a space between closeness and distance can be understood as leading between health and illness, between biology and existence and attuning to the older person’s autonomy and integrity, allowing the other to surrender to care with trust. Leading care can then mean maintaining an ethical approach in the meeting with the patient to preserve dignified care for older persons in need of care at home. Conclusions: The result from the comprehensive understanding highlights ethics, relations, responsibility, trust and confidence as essential structures for a leadership that is person centered. The knowledge gained can help us better understand the prerequisites for leading person-centered care in community home care and can contribute to improving the care for patients in an existentially vulnerable life situation.  

Aim

To explain and understand leading care close to older persons in community home care from the perspective of registered nurses (RNs).

Background

Leading care close to older persons in home care is an overlooked and not well-described phenomenon. In home care, specific demands are placed on the registered nurse, as responsible for leading care guided by the older person's expectations and desires.

Design

A reflective lifeworld hermeneutic approach grounded in the philosophy of phenomenology and hermeneutics. The study followed the COREQ checklist.

Methods

Individual interviews were conducted with nine RNs working in community home care in a community in western Sweden. The data were analysed with a lifeworld hermeneutic approach.

Results

The findings present four partially interpreted themes: leading with respect in a shared space, leadership that involves existential questions of life, balancing responsibility enables preservation of autonomy and challenges in maintaining a patient perspective. The partially interpreted themes conclude in a main interpretation: The patient perspective as an anchor when balancing responsibility for another person in an existential vulnerability of life.

Conclusion

Leading care means being both close to the patient and at a distance when caring is performed through the hands of others. Ethical demands are placed on RNs as they encounter the vulnerability of the older person.

Relevance to Clinical Practice

The findings can contribute to a greater understanding of the meaning of RNs as leaders and may have an impact for decision makers and policies to create conditions for leadership that contributes to dignified care for older persons in community home care.

Patient of Public Contribution

Registered nurses working in community home care participated in data collection.

Life is worth fighting for -a scooping review focusing life after intensive care from the perspective of older persons 

Background and Aim: The median age of patients admitted to intensive care is above 65 years in many countries. Intensive care contributes to prolonging life for critically ill older persons, but research underscores challenges to return to life as it was before. A scoping review were performed with the aim to determine how Health-Related Quality of Life, recovery and well-being are followed up in persons ≥65 years of age being cared for in an intensive care unit.

Methods: CINAHL, MEDLINE (Ovid) and PsycINFO databases were searched. 20 studies met the inclusion criteria. 

Results: Intensive care is challenging and patients' ≥80 years old admitted to the intensive care unit have a one-year mortality rate of around 60%. However, time seems to be an important factor, and for those surviving, life is perceived as acceptable after 1 year. Studies showed patients' willingness to be readmitted to the intensive care unit if necessary, indicating that life is worth fighting for. 

Conclusion: The result illustrates a lack of qualitative data in which the patients voice is the focus. Instead, the findings consist of quantitative data were the studies applied different tools for measurement. The diversity in study designs impacted the synthetisation of findings and the possibility of gaining a greater understanding of how life is experienced for older persons after intensive care. To better understand the older persons perspective there is a need for qualitative in-depth interview studies. 

Meaning-oriented thematic analysis grounded in reflective lifeworld research- A holistic approach for caring science research 

Background Caring science guided by a patient perspective contributes to an understanding of lived experiences of health, well-being, suffering, and existential issues related to a meaningful life. In targeting those areas there is a need to consider ontological and epistemological assumptions that have the potential to uncover aspects of human life. Despite the multiplicity of literature there are few descriptions of the importance of a research process, including ontological and epistemological considerations, that can guide researchers through the process of a meaning-oriented thematic analysis. Drawing from our experiences as researchers and supervisors to masters and doctoral students we outline a structure for meaning-oriented thematic analysis guided by Reflective Lifeworld Research. 

Key pointsWe argue for an approach towards thematic analysis that is meaning-oriented and involves a holistic perspective considering the entire research process. We highlights the importance of ontological and epistemological considerations when conducting a meaning-oriented thematic analysis. Research that is founded on the epistemology of the lifeworld can present existential issues important for caring and contribute to existential knowledge needed to understand the world of the patient.

Starting in a phenomenon of relevance for caring science, we argue for lifeworld interviews as a data collection method that can contribute to depth and meaning, and we will present a description of how structures of meaning can be outlined through a meaning-oriented thematic analysis, and illustrate how the thematic analysis can be integrated in the research process.

Implications for practice, education or research The article places meaning-oriented thematic analysis in a wider research process, considering all aspects from collection of data to the creation of meaning-oriented themes. The focus on meaning orientation gives voice to the patient and can play a pivotal role in accentuating the patient perspective as the fundamental core of caring. 

Background and Aim

The aim of the present article is to describe meaning-oriented thematic analysis grounded in reflective lifeworld research and to illustrate how the thematic analysis can be integrated in the research process. The article is a methodological paper, including ontological and epistemological assumptions for lifeworld theory. Research based on lifeworld theory is directed towards lived experiences and meanings in everyday life. Research that is founded on the epistemology of the lifeworld can present existential issues important for caring and qualitative research can in particular contribute to existential knowledge needed to understand the world of the patient. 

Design

Theoretical paper. 

Results

Starting with a phenomenon of relevance for caring science, the article argues for lifeworld interviews as a data collection method that can contribute to depth and meaning, and then presents a description of how structures of meaning can be outlined through a meaning-oriented thematic analysis. The research of lived experiences in caring science demands an approach that includes a reflective attitude during the methodological considerations. This article highlights the importance of ontological and epistemological considerations when conducting a meaning-oriented thematic analysis. 

Conclusion

The article places meaning-oriented thematic analysis in a wider research process, considering all aspects from collection of data to the creation of meaning-oriented themes.

In the evolving landscape of older person care, the imperative to explore holistic approaches persists, especially in regions with distinct societal norms around informal caregiving. The deeply ingrained tradition of familial caregiving, often led by female family members, has historically compensated for healthcare system gaps in less integrated systems. Hence, societal expectations may affect registered nurses’ experiences and impact the quality of care for older persons. This study aims to describe the meaning of caring for older persons in care settings in Greece. Ten in-depth interviews with registered nurses in older person care settings underwent qualitative thematic analysis. Four themes emerged from the analysis: (i) Living and bonding with older people as a basis for caring, (ii) Caring as a double-faced fulfillment, (iii) A sense of insufficiency in the caring relationship, and (iv) The encounter of existential issues creating loneliness. This research provides insights into the meaning of caring for older persons, highlighting the experiences of the closest professional caregivers of older individuals. A specific capture of the entanglement of cultural norms, societal expectations, and their impact on professional caregivers’ experiences may contribute to quality care provision in systems rooted in familial caregiving traditions. 

Aim

The aim of this meta-ethnography was to identify and synthesize qualitative studies focusing on older people’s and registered nurses’ interpretations of competence in home care. 

Methods

The meta-ethnography followed the six phases developed by Noblit and Hare (1988). 

Results

In Phase 6, the translation process of the included studies, three themes were identified: i) temporality—the feeling of being of value; ii) dignity—a person, not just a patient; and iii) mutuality of being—togetherness. A synthesis was developed, and the phrase “a becoming in the meeting” emerged. 

Conclusion

The sense of becoming includes progress, which means becoming something other than before in relation with others and refers to what constitutes the meeting between the older person and the registered nurse working in home care. Competence originates from becoming in the meeting, and registered nurses should therefore value what they do and hold on to this aspect of caring competence that centres on a caring relationship. It is important for registered nurses working in home care to be able to cultivate a caring relationship.

Aims

In the present study, we aimed to determine how Health-Related Quality of Life (HRQoL), recovery (function and capacity in daily life) and well-being are followed up and characterised in persons ≥65 years of age who were being cared for in an intensive care unit (ICU).

Design

A scoping review.

Methods

CINAHL, MEDLINE (Ovid) and PsycINFO databases were searched in October 2021. 20 studies met the inclusion criteria. The scoping review followed the principles outlined by Arksey and O'Malley, and the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) checklist and Joanna Briggs Institute (JBI) framework were used.

Results

Results are presented under five subheadings: Study characteristics, Type of studies, Methods for follow-up, health-related quality of life, and Recovery. Time seems to be an important factor regarding HRQoL among older patients being cared for in an ICU, with most elderly survivors perceiving their HRQoL as acceptable after 1 year. Nevertheless, several studies showed patients' willingness to be readmitted to the ICU if necessary, indicating that life is worth fighting for.

Patient or Public Contribution

Due to the design of the study, this study involves no patient or public contribution.

Aim: To describe the meaning of caring for older persons based on the experiences of nursing students in Greece. Background: The present study is conducted based on a caring science perspective derived from a holistic viewpoint of human beings, aiming to support the well-being of older persons. In Greece, informal caregivers play an important role in caring for older people; however, as the population ages, the need for registered nurses specialising in caring for older people is also increasing. Previous research in other countries has reported a relative lack of interest in this field, which is a threat to the quality of care. To ensure an adequate number of new-generation nurses caring for older people, nursing students’ perceptions of the phenomenon of caring for older persons should be well understood and explored in a context where the number of long-term care beds and residential care facilities are low and where informal caregiving is common. Design: Based on Descriptive Phenomenology, in line with the Reflective Lifeworld Research (RLR) approach. Methods: A total of 12 nursing students at a university in Greece underwent in-depth lifeworld interviews online during June and July 2021 and March 2022; Interviews were transcribed verbatim and were analysed according to the principles of RLR that approaches the phenomena with openness and constant reflection. The participants were students in their fourth or fifth year of nursing education; they had previous experience in older person care and were not acquainted with the authors. Results: The results show the essential structure of the meaning of caring for older persons, where otherness consists of intertwined demanding and rewarding elements. The essence is further conveyed by three constituents: otherness of the older person: witnessing someone's vulnerability; trustful caring: struggling with normative structures; and closeness and distance: balancing between familiarity and professionalism. Conclusion: To ensure quality of care for older persons in the future, an understanding of how nursing students describe their experiences of caring for older persons during education is important. Balancing between familiarity and professionalism highlights the need for further reflection on professionalism and dignity and identifying the norms and values helps to highlight particularities of the context and national healthcare system. Curricula focusing on cultivating students’ preunderstanding, regarding caring for older persons are required to promote a higher quality of care in the future. Caring science can contribute to a focus on a holistic perspective in caring for older people. Tweetable abstract: There is an ever-increasing need for educated nurses in the field of caring for older people. With the lack of interest in this field of nursing, the overall quality of care is impacted. This study describes the meaning of caring for older persons based on the experiences of nursing students in the Greek health care system.