Aim: To explore nursing students’ experiences of encountering patients’ existential concerns during clinical placements. Background: Existential concerns about the purpose of life, illness, and death are integral to human experience, and are common in healthcare. Illness disrupts life, intensifying these concerns and leaving patients in need of support. Nursing students often encounter these concerns during clinical placements, but their experiences in clinical settings are sparsely studied. Methods: Eleven second-year nursing students from a Swedish university participated in lifeworld interviews during clinical placements. These interviews were transcribed verbatim and analysed using reflective lifeworld research. Results: Encountering patients’ existential concerns is described as a process of becoming a nurse through uncertainty and shared experiences with patients. Encountering patients’ existential concerns is a transformative and emotional process. Despite theoretical preparation, these uncertain situations represent a challenge, as the tension between emotional engagement and clinical demands complicates their responses. These patient interactions foster compassion and deepen understanding of life's fragility, underscoring nursing's complexity—balancing competence with emotional presence. Encountering patients’ existential concerns is essential for students’ learning. This is further elaborated on in four constituents. Conclusions: Encountering patients’ existential concerns challenges students but creates personal and professional growth. Nursing students engage deeply in care, experiencing compassion that can evoke feelings of hopelessness and anxiety. They need educational support and preceptors’ guidance to reflect on these emotional encounters. Integrating existential reflection, self-compassion, and structured support helps them become professional and compassionate nurses. 

Background

There are little data on the impact of frailty on critically ill older patients treated in intensive care units (ICUs) and on their characteristics and outcomes. More understanding of the longitudinal health and recovery process is needed and of the recovery traits of older patients after intensive care.

Aim

This project aims to identify characteristics and outcomes in patients 65 years or older admitted to ICUs and to explore how health and recovery is experienced after discharge, with a special focus on frailty.

Study Design

This research project will conduct both retrospective and prospective data collection with a sample of approximately 3200 patients. This is a longitudinal, multicentre, prospective, observational research project with a nested cohort covering 12 months of admissions and comprising four studies. The first aims to map the characteristics of patients admitted to the ICUs, their treatments and their outcomes. The second will use questionnaires to assess their health and recovery process up to 18 months after discharge. The third and fourth studies aim to describe and understand their lived experiences using research interviews, with the fourth study including only frail patients.

Relevance to Clinical Practice

The project comprises studies that seek to identify the characteristics of older people admitted to ICUs, to examine how frailty impacts them and to understand what they experience during and foremost after intensive care. The project also aims to understand the facilitators and barriers to promoting health and recovery after discharge from ICUs and to contribute to the growing body of evidence supporting health and recovery initiatives. The results need to be spread and the knowledge sprung from this project may be implemented and used by intensive care unit clinicians.

Aim

This study aims to describe the existential reflections of patients in need of hospital care. Illness that requires hospitalisation can evoke existential reflections–such as uncertainty and altered self-perception–which confront patients with their vulnerability. This study seeks to provide insights into how patients experience and navigate these reflections, highlighting the importance of including existential reflections in caring.

Design

A phenomenological study using a reflective lifeworld research approach was conducted, following the consolidated criteria for reporting qualitative research checklist.

Method

Twelve patients were interviewed, and data were analysed using the reflective lifeworld research approach.

Ethics

The study was approved by the Swedish Ethical Review Authority and adhered to the Helsinki Declaration.

Findings

The essence is described as being in a vulnerable state while navigating towards existential security, as patients confront mortality and shifting roles. Feeling alone, waiting alone in a hospital room heightens emotional processing, amplifying reflections on illness and personal responsibility. Despite uncertainty, patients draw strength from past experiences, guiding them towards a new reality. Existential reflections emerge both indirectly and through direct contemplation.

Conclusions

A caring relationship that acknowledges existential reflections is crucial for the patient's possibility to adapt and live authentically. Prioritising existential reflections in health care enhances patients' well-being, resilience and purpose.

Introduction

Communication between older persons and nursing assistants is important in providing high-quality, person-centred home care. While previous research has reported on older persons' emotional concerns during home care conversations, there is a need to gain an in-depth understanding of emotional concerns' role in such conversations and how to support the older persons' comfort and well-being. Therefore, this study aimed to explore the nature and focus of emotional communication between older persons and nursing assistants in home care.

Methods

A descriptive qualitative design using observational data from 83 audio-recorded home care visits was used to identify and analyse sequences of distressing emotional communication, analysed through thematic analysis.

Results

In this study, four themes were described illustrating how emotional communication between older persons and nursing assistants during home care visits creates opportunities for empathy: (1) recognising empathic opportunities, (2) identifying subtle and vague signs of emotional distress, (3) expressing needs for emotional support, and (4) striving to restore comfort in challenging conversations.

Conclusions

Conversations about older persons' emotions and worries can be complex. The findings indicate a fine line between meaningfulness and discomfort in emotional sequences. Expressions of emotional distress provide empathic opportunities that call for attentiveness and sensitivity from nursing assistants, implying a need for education and training in person-centred communication.

Implications for Practice

Emotional communication acknowledging empathic opportunities enhances person-centred care by promoting trust, comfort, and well-being. Ultimately, emotional communication reinforces the importance of empathy in home care and creates space for emotional interactions, leading to more supportive relationships.

Background

Across the world, people live in regions affected by violence and conflict. Societal tensions contribute to warlike situations, including mass shootings, gang violence, and civil warlike conditions. These conflicts impact people's lives by creating a constant threat of violence that can erupt at any moment. Older adults, in particular, are often left behind in conflict zones, placing them at heightened risk of becoming direct victims of violence and war crimes. This study adopts a phenomenological perspective to explore older persons lived experiences of violence, both as direct victims and as witnesses.

Aim

The aim is to gain deeper insights into older persons' experiences of living in close proximity to war or warlike situations, and to understand how these experiences affect health and well-being.

Method

A meta-ethnographic approach, based on Noblit and Hare’s (1988) methodology, was used. Databases were searched for relevant studies. Studies included participants aged 60 years and older who were exposed to war, warlike conditions, terrorism, shootings, gang-related violence, or civil warlike situations.

Findings

The studies encompassed various regions around the world and identified several key themes: Being and becoming in a horror-filled existence, Facing an Impossible Choice Between Staying or Leaving, An increased fragility created by the loss of Governmental and Societal Support, and Maintaining Normality in Abnormal Situations.

Conclusion

For older adults, living in war or warlike situations profoundly affects daily life and adds unique challenges to their suffering. Separation from loved ones, the breakdown of healthcare services, and remaining in conflict areas significantly increase the vulnerability. However, older adults have also shown resilience and can serve as valuable resources within their communities during crises. Given that older persons are often left behind in war zones and thus at higher risk of being targeted, it is crucial to include competencies for caring for older persons in educational interventions designed for crisis and conflict scenarios. It is also essential to raise awareness about the unique challenges faced by older adults in war and conflict situations and to develop strategies that ensure the continuity of care, even under extreme conditions.

Purpose

The aim of this study is to describe the essential meaning of the phenomenon of caring relationships in home care for older adults in Denmark, based on their lived experiences of caring relationships with home care nurses.

Methods

Ten older adults receiving home care from registered nurses were interviewed, and a phenomenological analysis was conducted according to the methodological principles of the reflective lifeworld research approach.

Results

The essential meaning of the phenomenon is described as “being in an in-between state in which one's existential freedom is enabled or restricted”. This involves being forced to relate and adapt to home care nurses as freedom givers or freedom takers. This is explored further in the three constituents; Space for authenticity and vulnerability, creating conditions for existential freedom, and being in an in-between space between knowing and not knowing.

Conclusions

The phenomenon of caring relationships adds an important aspect to understanding well-being in home care for older adults. To live well in old age, existential concerns must be placed at the core of caring and older adults must be given the possibility to act freely and authentically in order not to feel like an object of care.

Older persons often stay in conflict zones, abandoned by younger generations and neglected by the government, putting them at risk of becoming victims of violence. This meta-ethnographic study aims to review and synthesise qualitative research on violence in contexts of war and armed conflicts as experienced by older persons and explore how violence in war and armed conflicts affects the health and well-being. Databases (CINAHL, PsychINFO, Web of Science, and Scopus) were searched for studies with a qualitative approach and participants aged≥55 years. Twenty qualitative studies were included, describing experiences of persons from seven countries. Guarding the past and ensuring a future was established as an overarching metaphor in a lines-of-argument synthesis, accompanied by five themes: To endure a violent situation; Home - the heart of existence; To witness a fragile family line; Alienated and abandoned by society- adding insult to injury and Maintaining normality in an abnormal situation. Through interpretation, an understanding emerges of how separation from loved ones, the breakdown of healthcare services, and remaining in conflict areas can significantly increase vulnerability, while simultaneously demonstrating the resilience of older persons and their willingness to serve as resources within their communities

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.