Ge sjuksköterskor utrymme att göra kvalificerade bedömningar av patientens omvårdnadsbehov och låt dem också få gehör för de omvårdnadsinterventioner de föreslår. Det skulle inte bara bidra till att minska samvetsstress och arbetsrelaterad ohälsa hos sjuksköterskor utan också bidra till att de stannar i yrket, skriver sex forskare i vårdvetenskap.

Introduction: Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women's experiences of a prolonged passive second stage. Objective: To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women. Methods: A qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. Results: The analysis resulted in four themes: “An unknown phase” that entailed remaining in a phase that the women lacked an awareness of. “Trust and mistrust in the body's ability” represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme “Loss of control” included experiences of frustration, fatigue, and having to deny bodily instincts. “Support through presence and involvement” signifies support through the midwife's presence in the birthing room, although there were also descriptions of emotional or physical absence. Conclusions: The findings contribute to the understanding of prolonged labour based on women's lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour. 

The aim of this study is to understand how healthy, older adults in Sweden perceive their life situation after retirement. The study is based on a lifeworld approach, and a phenomenographic method was used. Eighteen participants were interviewed, and data were analysed according to the phenomenographic principle of qualitatively different categories. Two categories were developed. The first category, “perceptions that draw attention inward, towards one’s self”, was further described in three subcategories: Sense of decreased status in society, the desire to keep aging at a distance, and contemplation of one’s own existence. The second category, “perceptions that draw attention outward, away from one’s self” was further described in the following four subcategories: caretaking of family members, involvement in social relationships, finding of deep meaning in animals and nature and engagement with society. In the discussion, the findings are further illuminated through comparisons with concepts such as maturity, wisdom and gerotranscendence, and reflections on the findings ‘relevance to a caring context follow. The conclusion suggests this study can provide knowledge that will allow healthcare providers to bridge the gap between generations in order to provide high-quality care. However, for a more profound caring dialogue, for example, about the end of life, a deeper analysis is required.

PURPOSE This study aimed to describe community-dwelling older adults’ perceptions of health and well-being in life after retirement.

METHODS This study is part of a larger project using a mixed-methods design to address lifestyles’ influence on community-dwelling older adults’ health. Individual semi-structured interviews were conducted with 18 older adults in age 70 to 95 years. Data were analysed according to a phenomenographic approach.

RESULTS The results encompass four categories describing variations in community-dwelling older adults’ perceptions of health and well-being after retirement: feeling well despite illness and disease, interacting with and being useful for oneself and others, independently embracing opportunities and engaging in life, and maintaining a healthy lifestyle.

CONCLUSIONS The absence of illness and disease is not a clear prerequisite for a sense of health and well-being. To promote and preserve health and well-being after retirement, older adults strived for—and coached themselves to uphold—a balance in life, focusing on not burdening others. This life orientation after retirement must be acknowledged by society at large, especially from an ageist perspective, and in health and social care to preserve and promote health and well-being.

BREASTFEEDING AND EXPERIENCED EXPOSEDNESS IN PARTNER RELATIONSHIP

Ida Gustafsson RN, RM, Lecturer, PhD-student

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Gunilla Carlsson RN, PhD, Professor

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Katarina Karlsson RN, PhD

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Aleksandra Jarling RN, PhD, Lecturer

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Lina Palmér RN, RM, PhD, Associate Professor, Docent

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Background: About 110 000 children are born in Sweden annually. The vast majority of their mothers wish to breastfeed, and also initiate breastfeeding. An important factor for continued breastfeeding is support, especially from the partner. It is likely that lack of support can lead to perceived vulnerability in the partner relationship. Intimate partner violence (IPV) during pregnancy is in Sweden nearly as common as gestational diabetes and the frequency seems to rise postpartum. IPV is multifaceted and encompasses many types and degrees of violence. In a caring science perspective the experience of vulnerability and/or exposedness in partner relationship during breastfeeding (or breastfeeding desire) risks negatively affecting womens health and well-being, regardless of the reason or degree of exposedness. For care to be caring - that is, support health and well-being - knowledge is needed from the perspective of the exposed women. Previous lifeworld theoretical research has shown that breastfeeding may be experienced as an existential challenge and that exposedness to violence during the childbearing period means a long-lasting embodied experience. In this project, these two phenomena are intertwined into a common phenomenon - Breastfeeding in case of experienced exposedness in a partner relationship.

Aim: The purpose of the PhD-project is to develop in-depth knowledge of existential meanings of breastfeeding in case of experienced exposedness in a partner relationship (Study 1-2), and what it means to be cared for (Study 3), as well as to give care and support in this context (Study 4).

Methods: The project has a reflective lifeworld approach. Data has been collected through lifeworld interviews and written lifeworld stories and will be analyzed using a phenomenological or hermeneutical approach.

Results & Conclusion: The results and conclusions of the first study are expected to be completed in the summer of 2023 and will be presented at the conference.

Objective: The aim of this study is to obtain a deeper understanding of midwives’ lived experiences of caring for new mothers with initial breastfeeding difficulties.

Methods: A reflective lifeworld approach was used. Six midwives were recruited from a hospital in western Sweden. Data were collected via individual lifeworld interviews and analysed using phenomenological methods.

Results: The essential meaning can be described as a midwife’s wish to help new mothers reach their breastfeeding goals by trying to interact with them as individual women in unique breastfeeding situations. This wish constitutes a contradiction to the midwife’s own desire to succeed in enabling mothers to breastfeed and the perceived risk of failure as a midwife if the mothers decide not to breastfeed. This is further described by five constituents: striving to provide individualised care, collegial and personal responsibility both enables and prevents care, a struggle to be sufficient, an uphill struggle and mutual joy becomes the motivation to care.

Conclusions: Caring for new mothers with initial breastfeeding difficulties is a balancing act between the midwife’s personal desire to succeed in enabling mothers to breastfeed, the mothers’ wishes, the infants’ needs, the importance of collective collegial competence and the limitations in the health care organisation. This makes the midwife’s efforts to provide individualised care frustrating and demanding as well as motivating.

Breastfeeding is experienced as an existential journey, and breastfeeding difficulties put mothers in existentially vulnerable situations. For care to be caring, it must be based on the mother's breastfeeding story. Previous research show that healthcare professionals struggle to perform individualised breastfeeding care. The Existential Breastfeeding Difficulty Scale (ExBreastS) was developed to support an existential focus in caring dialogues and was introduced in child healthcare in Sweden. The aim of this study is to describe child healthcare nurses' lived experience of how the Existential Breastfeeding Difficulty Scale (ExBreastS) influences the caring dialogue. Seventeen child healthcare nurses with experience in using ExBreastS as a basis for caring dialogues with breastfeeding mothers were interviewed, in groups, pairs or individually. The interviews were analysed using a thematic analysis based on descriptive phenomenology. The results show that the caring dialogue becomes re-evaluated when using ExBreastS because existential aspects of breastfeeding is acknowledged. ExBreastS also visualises new perspectives of the mother's breastfeeding experiences. However, the use of ExBreastS also risks overshadowing the caring dialogue when the nurses focus too much on the instrument. The use of ExBreastS supports caring dialogues-and caring care-by highlighting the existential aspects of breastfeeding/breastfeeding difficulties and the uniqueness of every mothers' breastfeeding experience. However, the instrument sometimes evokes a vulnerability in the nurses that calls for support from the care organisation.

CLINICAL INTRODUCTION AND EVALUATION OF THE EXISTENTIAL BREASTFEEDING DIFFICULTY SCALE (EXBREASTS) IN THE CONTEXT OF CHILD HEALTH CARE

Ida Gustafsson RN, RM, Lecturer, PhD-student

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Malin Spångby RN, MNSc

Child Health Services, Region Jönköping County, Jönköping, Sweden

Ann Arvidsdal RN, MNSc

Child Health Services, Region Jönköping County, Jönköping, Sweden

Marie Golsäter RN, PhD, Docent

Child Health Services, Region Jönköping County, Jönköping, Sweden

CHILD Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden

Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden

Lina Palmér RN, RM, Associate Professor, Docent

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Background: Breastfeeding, both with and without perceived difficulties, can be experienced as an existential journey. Therefore, care needs to be based on the woman's breastfeeding story and carers need to be prepared to handle the existential questions that may arise. Previous research shows that healthcare professionals struggle with providing individually tailored care. The Existential Breastfeeding Difficulty Scale (ExBreastS) was developed based on lifeworld theoretical research on women's experiences of initiating breastfeeding with or without breastfeeding difficulties and was in this study introduced in child healthcare in a Swedish region. This was done to evaluate its ability to support child healthcare nurses to conduct existentially oriented caring dialogues with the breastfeeding story in focus. 

Aim: Describe child healthcare nurses’ lived experience of how ExBreastS influences the caring dialogue.

Methods: Lifeworld interviews were conducted with 17 child healthcare nurses about their experience of using ExBreastS to support caring dialogues with breastfeeding women. The interviews were conducted either individually, in pairs or in groups. The material was analyzed through thematic analysis based on descriptive phenomenology.

Results: The results show that ExBreastS contributes to the re-evaluation of the importance of the caring dialogue because the existential significance of breastfeeding is given more space. ExBreastS also makes new perspectives of the breastfeeding story visible for both woman and carer. However, if the instrument itself receives too much of the nurse’s focus, there is a risk that the caring dialogue will be overshadowed.

Conclusions: ExBreastS supports caring dialogues based on the breastfeeding story through its focus on the existential aspects of breastfeeding. However, this requires time, support from the organization and an awareness that caring dialogues can have no manual.

In this study, we highlight the importance of methodological creativity when researching existential phenomena in caring science. Our intention is to provide epistemological and methodological support that would encourage researchers to be creative when collecting data. One fruitful way to approach creativity involves basing one’s research on the epistemological and methodological ideas of lifeworld research. We will illustrate the usefulness of lifeworld research via examples from empirical caring science research and show how creativity may contribute to a profound understanding of patients’ experiences. Hopefully, this article will help other researchers be creative without losing epistemological foundations and scientific validity.

Abstract Aims and objectives The study aimed to describe how breathlessness is experienced by patients prior to prehospital care. Design A qualitative phenomenological design. Methods Lifeworld interviews were conducted with 14 participants. The analysis was carried out within the descriptive phenomenological framework. Results The essential meaning of the breathlessness phenomenon is described as an existential fear in terms of losing control over one?s body and dying, which involves a battle to try to regain control. This is further described by four constituents: being in an unknown body, striving to handle the situation, the ambiguity of having loved ones close and reaching the utmost border. Conclusions Patients describe a battling for survival. It is at the extreme limit of endurance that patients finally choose to call the emergency number. It is a challenge for the ambulance clinician (AC) to support these patients in the most optimal fashion.

Background

Breathlessness is a serious and distressing symptom and a common reason why patients require prehospital care by ambulance clinicians. However, little is known about how patients experience this care when they are in a state of breathlessness.

Aim

The aim of this study is to describe the lived experiences of being cared for by ambulance clinicians when experiencing breathlessness.

Methods

Fourteen lifeworld interviews were conducted with patients who experienced breathlessness and were cared for by ambulance clinicians. The interviews were analysed using a qualitative phenomenological approach.

Findings

The essential meaning of being cared for by ambulance clinicians when experiencing breathlessness is described in two ways: existential humanising care, in which the experience is that of being embraced by a genuine presence or existential dehumanising care, in which feeling exposed to an objectifying presence is the main experience. This meaning has four constituents: surrendering to and trusting in the care that will come; being exposed to an objectifying presence is violating; being embraced by a genuine presence is relieving; and knowing is dwelling.

Conclusion

The findings reveal that the ability of ambulance clinicians to provide existential humanising and trustful care, which is the foundation of professional judgement, was essential in how patients responded to and handled the overall situation when breathlessness.

Background: Dyspnoea is one of the most common reasons for patients contacting emergency medical services (EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet thesepatients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased risk of a time-sensitive final diagnosis and the risk of death.

Methods: A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the southwestern part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354 were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for uniquepatients with single occasions. Data were manually collected through both EMS- and hospital records and final diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed usingmultiple logistic regression and multiple imputations.

Results: Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis. The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses, approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic bloodpressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death.

Conclusions: Among patients with dyspnoea as the main symptom, age, previous medical history, deviating vital signs, ECG pattern, symptoms of pain, and a short delay until call for EMS are important factors to consider in the prehospital assessment of the combined risk of either having a time-sensitive diagnosis or death.

Background: Dyspnoea (breathing difficulty) is among the most commonly cited reasons for contacting emergency medical services (EMSs). Dyspnoea is caused by several serious underlying medical conditions and, based on patients individual needs and complex illnesses or injuries, ambulance staff are independently responsible for advanced care provision. Few large-scale prehospital studies have reviewed patients with dyspnoea. This study aimed to describe the characteristics and final outcomes of patients whose main symptom was classified as dyspnoea by the prehospital emergency nurse (PEN).

Methods: This retrospective observational study included patients aged >16 years whose main symptom was dyspnoea. All the enrolled patients were assessed in the south-western part of Sweden by PENs during January and December, 2017. Of 7,260 assignments (9% of all primary missions), 6,354 fulfilled the inclusion criteria. Analysis was performed using descriptive statistics, and the tests used were odds ratios and Kaplan-Meier analysis.

Results: The patients mean age was 73 years, and approximately 56% were women. More than 400 different final diagnostic codes (International Statistical Classification of Diseases and Related Health Problems [ICD]-10^th edition) were observed, and 11% of the ICD-10 codes denoted time-critical conditions. The three most commonly observed aetiologies were chronic obstructive pulmonary disease (20.4%), pulmonary infection (17.1%), and heart failure (15%). The comorbidity values were high, with 84.4% having previously experienced dyspnoea. The overall 30-day mortality was 11.1%. More than half called EMSs more than 50 hours after symptom onset.

Conclusions:  Among patients assessed by PENs due to dyspnoea as the main symptom there were more than 400 different final diagnoses, of which 11% were regarded as time-critical. These patients had a severe comorbidity and 11% died within the first 30 days.

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.

Introduction

Young men may struggle in life with challenges of various concerns about their identity and who they want to be in life. Many health issues arise from social norms and wider societal determinations and for today’s young men, following such norms poses a risk of losing oneself. An essential part of health are connected to the existential dimensions in life and concerns who you are, and how well you know and understand yourself. However; little is known about what it means for young men to live a life with existential concerns.

Purpose and method

The purpose of this phenomenological study, based on reflective lifeworld research (RLR), is to describe young men’s experiences of living with existential concerns for which they have sought support. Eight lifeworld interviews were conducted.

Results

The results essentially show that young men living with existential concerns describe their situations as living close to a bottomless darkness. This is further described according to four constituents: enduring everyday life, striving for a solution, hearing an inner self-critical voice, and wearing a hard shell.

Conclusion

We conclude that strengthening young men’s health processes requires healthcare professionals to create an atmosphere where young men feel safe talking about existential concerns without feeling exposed and vulnerable.

Purpose: The aim of this study is to describe young women's (16-25 years old) experiences of living with existential concerns for which they have sought support from healthcare professionals, teachers, family, or friends, among others.

Methods: This phenomenological study is based on a reflective lifeworld research (RLR) approach. Nine young women were interviewed about their experience of living with existential concerns.

Results: The results show the essential meaning of the phenomenon of "existential concerns" that can be described as living a life that is marked in a profound way by a feeling of being lost in an unknown terrain. To further understand the essential meaning, four constituents are described: the unpredictable body, longing for comprehension, playing a game, and longing to share one's vulnerability.

Conclusions: Young women with existential concerns are vulnerable, as they are profoundly influenced by these concerns. They have to navigate through daily life while trying to fit in and to make their situation comprehensible. These young women have a longing to share their existential concerns with a trustworthy person, while at the same time they fear revealing their existential concerns and risking being rejected by others. A lifeworld-led, caring science approach, intertwined with the results of the present study, has the potential to direct caring practice.

Introduction:

This paper describes first-line department healthcare professionals’ experiences of conversations with young adults (16–25 years) who express existential concerns. Existential concerns encompass questions about the meaning of life and the choices people must make, and they are sometimes expressed during the period in which a child is becoming an adult. Sometimes the transition to adulthood can be difficult, and many young adults seek support from people in first-line departments, such as primary care providers, youth guidance centre personnel and student health service employees in high schools and universities. Conversations in which existential concerns are recognised may be important for preventing mental illness in the future.

Aim:

The study aimed to describe healthcare professionals’ lived experiences of conversations with young adults who express existential concerns.

Approach and methods:

This qualitative study utilises thematic meaning analysis. Interviews were conducted with healthcare professionals working in first-line departments, and data were analysed based on the principles of reflective lifeworld research. The study followed ethical codes of conduct and conformed to the ethical guidelines adopted by the Swedish Research Council.

Findings:

The results are presented in three themes of meaning: searching for innermost thoughts requires being present, uncertainty about the unpredictable and awakening of one’s own existential concerns.

Conclusions and implications:

Healthcare professionals are affected when young adults express their existential concerns, and they need more support to strengthen their ability to stay present and create inviting atmospheres

Background 

What enables well-being when experiencing existential concerns as a young adult is an under-explored area of research. In order to address young adults’ existential concerns and provide caring support that builds their resilience to meet life challenges, the aim of the present study is to describe the meaning of enabling well-being as experienced by young adults living with existential concerns. 

Method 

This phenomenological study is based on a reflective lifeworld research. Seventeen young adults, nine women and eight men aged 17–27 years, were interviewed. The results is presented in an essential meaning and further explored with its variations and individual nuances of the phenomenon; enabling well-being.  

Ethics  

The study followed the research principles described in the Helsinki Declaration and the Swedish Research Ethics Guidelines. 

Result 

The essential meaning of enabling well-being, when experiencing existential concerns as a young adult, means finding a place to rest. Finding a place to rest means finding both movement and stillness in life to reflect upon one’s life story in order to understand oneself. The essence is further described in the following constituents: recovering in solitude, sharing one’s life story in everyday life, and reflecting one´s life story in a trusting and caring relationship. 

Conclusion 

This study contributes important knowledge from a caring science perspective to inform caring approaches in nursing. The results show that young adults enable their own well-being in many ways when experiencing existential concerns. When their existential concerns feel overwhelming, they need support from healthcare professionals. When young adults seek professional support, the professionals must be open and focus on the young adults’ life story. 

What enables well-being when experiencing existential concerns as a young adult is an under-explored area of research. In order to address young adults’ existential concerns and provide caring support that builds their resilience to meet life challenges, the purpose of the study is to describe the meaning of enabling well-being as experienced by young adults living with existential concerns. This phenomenological study is based on a reflective lifeworld research. Seventeen young adults, aged 17–27 years, were interviewed. The results is presented in an essential meaning and further explored with its variations and individual nuances of the phenomenon; enabling well-being. The essential meaning of enabling well-being, when experiencing existential concerns as a young adult, means finding a place to rest. Finding a place to rest means finding both movement and stillness in life to reflect upon one’s life story in order to understand oneself. The results also show that young adults enable their own well-being in many ways when experiencing existential concerns. When their existential concerns feel overwhelming, they need support from healthcare professionals. When young adults seek professional support, the professionals must be open and focus on the young adults’ life story to enable well-being. 

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.

Background: This paper describes registered nurses' lived experiences of caring relationships in the context of homecare provision for older adults living in Denmark. With the growing ageing population throughout Europe, more older adults will require complex care solutions within already overburdened care systems. This development places demands on the competencies and organisation of homecare nurses, as they become key players in healthcare systems. Fostering caring relationships in homecare is a rewarding and valuable process that enhances the holistic and humanising aspects of caring for older adults. For a caring relationship to be truly caring, we must understand not only the subjective experience of such a relationship but also how it is experienced in relation to and shared with others. Aim: This study aimed to describe the essential meaning of the phenomenon of caring relationships in homecare for older adults based on the lived experiences of homecare nurses. Approach and Methods: Registered nurses working in homecare for older adults were interviewed, and a phenomenological analysis was conducted according to the methodological principles of the reflective lifeworld research approach. Findings: The essential meaning of the phenomenon is described as creating an existential and embodied space in which each patient's world is the foundation of caring. The constituents are as follows: caring for the whole person, a sense of ‘at-homeness’ through trusting ‘the other’, experiencing continuity as caring and prioritising the time to care. Conclusion: Caring competence in homecare for older adults relies on a nurse's ability to intertwine physical and existential care needs and articulate them in their daily work. A focus on the phenomenon of caring relationships brings value to and adds an extra layer to the discussion on caring competence.

Aim: The overall aim of the thesis is to create knowledge about what it means for women to initiate breastfeeding and what consequences these meanings have from an existential perspective.

Approach and method: A lifeworld approach based on the epistemology of phenomenology and hermeneutics was used. Lifeworld interviews and meaningoriented analysis in accordance with the chosen lifeworld approach were performed. A synthesis and a philosophical analysis were carried out that facilitates an understanding of the existential meaning of initial breastfeeding and its consequences as a whole.

Main findings: Initiating breastfeeding, when it functions well, entails an existential challenge, a movement from a bodily performance to an embodied relationship with the infant and with oneself as a mother. When breastfeeding is experienced as being severely difficult, it entails an existential lostness as a mother, forcing her into a constant fight with herself, the infant, and others in order to find her way into motherhood. Severe breastfeeding difficulties can evoke existential vulnerability, forcing the mother to continue breastfeeding despite the difficulties, while hoping to be confirmed as a good mother; a fear of breastfeeding may be a consequence. Existential security is a necessary condition for continued breastfeeding whilst insecurity and fear of breastfeeding can lead to ceased attempts to breastfeed when experiencing severe initial difficulties. Initial breastfeeding and motherhood are intertwined in a way that affects the woman’s existence as a mother.

Conclusions: Initial breastfeeding is a complex phenomenon that is more than just a biological adaptation or a cultural issue; it touches on and evokes existential aspects of being a woman and a mother. Though anchored in both biology and culture, breastfeeding cannot be reduced to one or the other: it is both. There is a struggle between biology and culture that has existential consequences for women’s experiences of breastfeeding, the breastfeeding decision, and the women’s existence as a mother. There is a need for health professionals to look beyond the statistics of breastfeeding and consider the existential dimensions of breastfeeding-as-lived when encountering mothers wanting to breastfeed.

Bakgrund: Amningssvårigheter innebär en risk för tidigt amningsavslut och minskad tillit till den egna förmågan att amma. Kvinnor som ammar sitt första barn kort tid riskerar också amma nästa barn kort tid eller inte alls, likaså tyder befintlig forskning på att amningssvårigheter kan vara en riskfaktor för att inte amma ett framtida barn. För att ytterligare förstå hur tidigare amningssvårigheter påverkar kvinnors framtida amning behövs forskning ur kvinnors perspektiv.

Syftet: Syftet är att förklara och förstå hur tidigare amningssvårigheter påverkar framtida amning så som det erfas av kvinnor.

Metod: Studien utgår från en reflekterande livsvärldsansats med hermeneutisk analysmetod. Datainsamlingen genomfördes i form av en eller flera individuella livsvärldsintervjuer med åtta kvinnor som upplevt stora amningssvårigheter. Totalt 15 intervjuer ingår.

Resultat: Huvudtolkningen visar att tidigare upplevda amningssvårigheter innebär ett existentiellt trauma för den enskilda kvinnan. I traumat utkristalliseras två möjliga vägar för framtiden; antingen utvecklas en amningsrädsla som innebär att framtida amning är otänkbart eller så uppstår en amningslängtan som innebär en möjlighet för amning i framtiden. Huvudtolkningen baseras på följande deltolkningar: Skrämmande tillvaro som måste undvikas, Kroppen som härbärge gör det svårt att glömma, Lockad av närhet och nytta men skrämd av distans, Erfarenhet ger beredskap att ta kommandot, Att våga igen kräver bearbetning samt Omformulering gör det möjligt att gå vidare

.

Konklusion: Kvinnor som upplevt tidigare amningssvårigheter bär med sig en negativ amningsupplevelse i form av ett förkroppsligat minne som etsats sig fast vilket får betydelse för tankar om och möjligheter till amning i framtiden. Det betyder att amningen både berör kvinnor efter avslutad amning och inför en framtida amning

.

Kliniska implikationer: Vård av kvinnor med tidigare amningssvårigheter bör riktas mot ett vårdande där amningsupplevelser bildar utgångspunkten och som möjliggör reflektion kring dessa.

Background: Almost all mothers in Sweden initiate breastfeeding but many cease during the first weeks after birth. In order to understand why it is important to research the meanings of the initial stage of breastfeeding and in which ways these meanings contribute to mothers’ breastfeeding decisions.

Aim: The overall aim of the thesis is to create knowledge about what it means for women to initiate breastfeeding and what consequences these meanings have from an existential perspective.

Approach and method: A lifeworld approach was used. Lifeworld interviews and meaning oriented analysis were performed.

Main findings: Initiating breastfeeding, when it functions well, entails an existential challenge. When breastfeeding is experienced as being severely difficult, it entails an existential lostness as a mother, forcing her into a constant fight in order to find her way into motherhood. Severe breastfeeding difficulties can evoke existential vulnerability, forcing the mother to continue breastfeeding, while hoping to be confirmed as a good mother; a fear of breastfeeding may be a consequence. Existential security is necessary for continued breastfeeding whilst insecurity and fear of breastfeeding can lead to ceased breastfeeding when experiencing severe initial difficulties. Initial breastfeeding and motherhood are intertwined in a way that affects the woman’s existence as a mother.

Conclusions: Initial breastfeeding is a complex phenomenon that is more than just a biological adaptation or a cultural issue; it touches on and evokes existential aspects of being a woman and a mother which have consequences for women’s experiences of breastfeeding and breastfeeding decision.

For most women in Sweden, breastfeeding is an essential part during the childbearing period. Nearly all women initiate breastfeeding but, due to different reasons, almost one fourth of the women stop or wean breastfeeding the first weeks or months after birth. That is often earlier than they had expected. Therefore few women follow the recommendations on breastfeeding. Until now, in-depth knowledge that aims to understand the meaning of initiating breastfeeding from women’s perspective is scantily explored. In order to develop care that enables mothers to breastfeed as recommended, or as long as they want to, it is thus necessary to complement previous research and explore breastfeeding from the percpective of the women.

PURPOSE:

Experiencing breastfeeding difficulties poses a risk for early cessation of breastfeeding and decreases the likelihood of breastfeeding a future child. To further understand breastfeeding outcomes, the aim of this study is to explain the phenomenon of breastfeeding difficulties in order to understand how women's previous experiences of breastfeeding difficulties relate to their decisions about future breastfeeding.

METHODS:

A reflective lifeworld hermeneutical approach was adopted. The study consisted of 15 lifeworld interviews with eight women who had previously experienced difficulties with initial breastfeeding.

RESULTS:

Previously experienced breastfeeding difficulties represent an existential breastfeeding trauma in an individual woman's life, from which there are two intertwined pathways for future breastfeeding: a fear of breastfeeding, which renders the idea of future breastfeeding unthinkable, and a longing for breastfeeding, which increases the likelihood of future breastfeeding. Fear and longing are intertwined in ambiguous ways in an individual woman's life.

CONCLUSION:

Women with previous breastfeeding difficulties may bring negative breastfeeding experiences with them, which are etched into the woman's being as a mother as an embodied memory. A lifeworld-led caring science perspective as a foundation for care can contribute to the development of caring practices, which grasp the existential nature of the breastfeeding trauma.

Background: The majority of new mothers in Sweden initiate breastfeeding but many experience initial difficulties. This experience is an important cause of early breastfeeding cessation. To increase understanding, there is a need to explore the lived experiences of the breastfeeding decision.

Aim: The aim is to explain and understand how the breastfeeding decision is influenced by the meaning of severe initial difficulties.

Methods: A lifeworld hermeneutical approach was used. The study was conducted by lifeworld interviews with mothers who experienced severe difficulties with initial breastfeeding.

Results: Mothers who experience severe difficulties with initial breastfeeding feel both overtaken and violate; by their infants and their bodies but also by their anger, expectations, loneliness and care from health professionals. These feelings of being overtaken and invaded provoke an existential crisis and place mothers at a turning point in which these feelings are compared and put in relation to one another in the negotiation of the breastfeeding decision. This decision depends on the possibility of feeling secure with the breastfeeding relationship. Mothers’ responsibility for the mother-infant relationship guides the decision. If insecurity dominates, this can, in severe cases, create a feeling of fear of breastfeeding making it necessary to cease breastfeeding.

Conclusions: This study highlights how women are situated in a complex cultural and biological context of breastfeeding that has existential consequences. Unresolved feelings of insecurity and fear of breastfeeding is a serious barrier to further breastfeeding. Health care professionals need to be aware of this existential situation and its effects on the breastfeeding decision when caring for mothers having initial breastfeeding difficulties.

Background:The majority of new mothers in Sweden initiate breastfeeding and many experience initial difficulties. This experience is an important cause of early breastfeeding cessation. To increase understanding, there is a need to explore the lived experiences of the decision to continue or cease breastfeeding. The aim of this study is therefore to explain and understand how this decision is influenced by the meaning of severe initial difficulties.

Methods: A lifeworld hermeneutical approach was used for the study. The study was conducted in Sweden with eight mothers who experienced severe difficulties with initial breastfeeding. All except one were interviewed on two different occasions resulting in fifteen interviews. The interviews were conducted between 2010 and 2013.

Results: Mothers who experience severe difficulties with initial breastfeeding feel both overtaken and violated not only by their own infants and their own bodies but also by their anger, expectations, loneliness and care from health professionals. These feelings of being overtaken and invaded provoke an existential crisis and place mothers at a turning point in which these feelings are compared and put in relation to one another in the negotiation of the decision to continue or cease breastfeeding. This decision thus depends on the possibility of feeling secure with the breastfeeding relationship. If insecurity dominates, this can, in severe cases, create a feeling of fear of breastfeeding that is so great that there is no alternative but to stop breastfeeding.

Conclusions: Existential security in the breastfeeding relationship seems to be an underlying factor for confidence and therefore a necessary condition for continued breastfeeding when having severe initial breastfeeding difficulties. Unresolved feelings of insecurity may be a serious barrier to further breastfeeding that can result in a fear of breastfeeding. Such fear can force the mother to cease breastfeeding. This study highlights how women are situated in a complex cultural and biological context of breastfeeding that has existential consequences for them. An existential crisis forces mothers into a turning point for the breastfeeding decision. In the existential crisis, mothers’ responsibility for the mother-infant relationship guides continuing or ceasing breastfeeding.

For most Swedish women, breastfeeding is an essential part of the childbearing period. Yet, the meaning of breastfeeding from women's perspective is scantily explored. Therefore, the aim of this study is to describe women's lived experiences of initiating breastfeeding within the context of early home discharge. Eight women, two primiparous, and six multiparous were interviewed within 2 months after birth. A reflective lifeworld research design based on phenomenological philosophy was used during the data gathering and data analysis. The results show that the phenomenon, initiating breastfeeding, in spite of good conditions, i.e., early home discharge, is complex and entails an existential challenge. The essential meaning of the phenomenon is conceptualized as, “A movement from a bodily performance to an embodied relation with the infant and oneself as a mother.” This pattern is further described in its five constituents: “Fascination in the first encounter,” “Balancing the unknown,” “Devoting oneself and enduring the situation,” “Seeking confirmation in the unique,” and “Having the entire responsibility.” Caring for women initiating breastfeeding entails, from a caring science perspective, to help the mother meet insecurity and strengthen confidence to trust her ability to breastfeed the newborn infant. According to these findings, it is suggested in the discussion that it is time for health care professionals to reject the idea of breastfeeding merely as meals or eating for the infant. Instead, they ought to embrace its origin, namely as a way to closeness between mother and infant.

For most women, breastfeeding is an essential part of the childbearing period. Yet, the meaning of breastfeeding from women’s perspective is scantily explored. Therefore, the aim of this study is to describe women’s lived experiences of initiating breastfeeding.

For most women, breastfeeding is an essential part of the childbearing period. Yet, the meaning of breastfeeding from women’s perspective is scantily explored. Therefore, the aim of this study is to describe women’s lived experiences of initiating breastfeeding within the context of early home-discharge in Sweden.

A majority of women in Sweden initiate breastfeeding but almost a quarter stop or wean the infant in the first few weeks after birth because of difficulties. In order to develop care that facilitates initiation of breastfeeding and enables mothers to realize their expectations concerning breastfeeding, it is necessary to understand what having severe breastfeeding difficulties means for women who experience them. The aim of this study is to describe the lived experiences of initiating breastfeeding under severe difficulties. A reflective lifeworld research design was used. Eight women, seven primiparous and one multipara, were interviewed within 2 months of giving birth. The essential meaning of the phenomenon is described as "Existential lostness as a mother forcing oneself into a constant fight". This pattern is further explicated through its constituents; shattered expectations, a lost time for closeness, being of no use to the infant, being forced to expose oneself, and gaining strength through sharing. The results show that mothers with severe breastfeeding difficulties feel alone and exposed because of their suffering and are lost in motherhood. Thus, adequate care for mothers should enhance the forming of a caring relationship through sharing rather than exposing.