This thesis is part of the INNOVATEDIGNITY Project (Action H2020 Marie Sklodowska Curie/Innovative Education Networks), funded by the European Commission (2019–2023). The project addresses the need for dignified care for older people in response to Europe’s ageing population. As the number of older adults increases, healthcare systems must adapt to ensure dignified care. Registered nurses and nursing students play crucial roles in caring for older persons, yet their lived experiences and the interplay of factors such as gender and cultural aspects of care have been underexplored. This thesis explores the meaning of caring for older persons through the lived experiences of nurses and nursing students in Greece and Sweden. 

Study I involves a systematic review of empirical data from 1993 to 2022, analysing the impact of gender on the nurse-patient relationship through a thematic synthesis of available studies. Study II uses phenomenology according to Reflective Lifeworld Research (RLR) principles to explore nursing students’ lived experiences of caring for older persons in Greece, based on lifeworld interviews with 12 students. Study III focuses on registered nurses in Greece, employing phenomenologically inspired qualitative thematic analysis of 10 lifeworld interviews to uncover the meaning of caring for older persons considering the influence of cultural and societal norms on caring. Study IV employs a phenomenological approach according to RLR through conducting lifeworld interviews with 19 registered nurses (10 in Greece and 9 in Sweden) to describe the essential meaning of caring for older persons based on their lived experiences. 

Study I identifies three key themes related to gender influences in the caring relationship between nurses and older persons uncovering the concept of vulnerability of the body, as well as normative understandings surrounding gender and sexuality, while considering the balance between closeness and distance in the nurse-patient relationship. Building on Study I and the identification of gender’s influence on caregiving dynamics, Study II delves into how nursing students perceive these dynamics in practice, particularly in balancing personal and professional roles. Study III expands on these findings, revealing how societal expectations in Greece shape the caregiving experience. Study IV reveals that the essential meaning of caring for older persons involves an embodied presence in space that allows for a movement in time. Nurses’ experiences highlight the need for flexibility and adapting multifaceted roles within institutional frameworks while emphasising the importance of understanding the existential dimension of care. 

These studies uncover both universal and culturally specific aspects of caregiving, providing critical insights that can shape nursing education and policy. By emphasising the need for gender and context sensitivity, this research has the potential to improve caregiving practices and outcomes for older people. This research highlights the importance of researching lived experiences deriving from different healthcare systems and cultures. By understanding the evolving dynamics, healthcare systems can better support nurses in delivering dignified, holistic care to older persons. The findings can guide improvements in care quality and dignified approaches for those involved in care, as well as supportive environments for nurses across varying healthcare systems.

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: 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. 

Globally, healthcare has become dominated by women nurses. Gender is also known to impact the way people are cared for in various healthcare systems. Considering gender from the perspective of how lived bodies are positioned through the structural relations of institutions and processes, this systematic review aims to explore the meaning of gender in the caring relationship between the nurse and the older person through a synthesis of available empirical data published from 1993 to 2022. CINAHL, PUBMED, EMBASE and Web of Science were searched from the beginning of each database's temporal range, and PRISMA guidelines were used for the screening, reviewing and selection processes of available records. A thematic synthesis of the available data resulted in three analytical themes: (i) vulnerability of the gendered body, (ii) norms and values related to gender and sexuality and (iii) balancing closeness and distance in the nurse-patient relationship. These themes are intertwined and represent different aspects of gender meaning in the nurse–patient relationship. This research shows that gender, through its influence on the gendered body, its relationship with power dynamics in the caring process, and its intersection with dimensions of identity, has a significant meaning for the experienced vulnerability in the nurse–patient relationship. This has implications for the well-being and sense of dignity of the older person as well as the nurse.