Nordic Journal of Nursing Research

The purpose of the study was to describe cancer patients' experiences of and expectations on care related to pain. The design was explorative-descriptive. Nineteen cancer patients from different parts of Finland took part in the study. Data were collected by means of focus interviews and essays and analysed by qualitative content analysis. The results showed that the patients' experiences of pain related care can be described on a continuum between two extremes. The caring pole involves experiences of receiving pain relieving medication when needed, of personnel that gives care, support, assurance and information. The uncaring pole involves experiences of neglect of the mental and emotional aspect, experiences that the personnel does not prevent and relieve pain, neglects the patient's pain, does not give information and does not understand what it means to be in pain. The patients wanted pain to be relieved by medication, but they also emphasised the importance of contact and communication, of professional expertise and kindness, of an active assessment of the pain, and of receiving cognitive means for pain control. The patients saw respect for human beings and for the patient's integrity as an important aspect of pain related care.

The aim of this study was to develop, implement and describe counselling in groups as a method in clinical nursing in relation to patients with SLE. Further more, the purpose was to describe how participation in counseling could aid the patients to cope with health-related daily living challenges and strengthen their courage to live. The study was organized as action research. The analysis is based on six qualitative group interviews, three with patients and three with nurses, and on fieldnotes. Counselling of patients in groups was described as a method in clinical nursing which can aid coping, give support and encourage living. The nurses competency in both counselling and rheumatology nursing and medical treatment were their strength in realizing the group as a hybrid of reflectional and educational dialogues. The study revealed participation in counselling as discovering the common features in the individual experiences. A confidential communion encouraged living. Systematical reflection on action and personal experiences has increased understanding and knowledge of living with SLE. The study findings point to three areas of interest for this group of women suffering from SLE: tiredness for some to the point of fatigue, changed self-esteem and body image and the unpredictability of the disease and worries about the future. The study revealed that in relation to the above areas both cognitive, emotional and instrumental coping developed or improved through the period of the group.

During the 1990s patient classification has once more become a topical theme for nurse managers in the Nordic countries. At the Vasa Central Hospital in Finland a research project concerned with patient classification has been going on since 1994. This article has two aims: to present on the one hand a new system of patient classification, RAFAELA, developed at the Vasa Central Hopsital and on the other hand research results from a study on the content validity of a relatively new instrument for patient classification, the Oulu Patient Classification (OPC). The RAFAELA system is based on the OPC instrument and on the method of «Professional Assessment of Optimal Nursing Care Intensity Level» (PAONCIL). On the basis of earlier research on patient classification it can be noted that economic and administrative motives have dominated and that caring science has not consituted a clear theoretical point of departure. In this article the caring science basis for the development of the RAFAELA system and its structure as well as topical research results concerning the PAONCIL method are presented. The sample for the study of content validity consisted of 68 nurses, who by the aid of a validation instrument evaluated the content validity of the OPC basic manual. According to this panel of experts, patient classification by means of the OPC can be regarded as valid; the method is considered to give a realistic picture of the patient's nursing care intensity. But there are certain weaknesses that the expert panel think should be attended to, above all the content of subareas of needs 1 and 6 in the basic manual. The psychic and spiritual needs as well as the nursing care acitivities connected with these need to be clarified. The RAFAELA system constitutes an efficient instrument for managing nursing care and is at the same time a method by means of which the content of nursing care can be developed.

The purpose of this paper is to produce a Cognitive Orientation to Nursing measurement tool to increase nurse teachers' understanding and nursing students' consciousness of students' personal orientation to nursing. This understanding and consciousness might help teachers and students to understand that there are various reasons why people enter, stay in or leave the nursing profession. The instrument development process presented in this paper is based on the Cognitive Orientation to Nursing substantive theory. The measurement tool covers the content areas in the model. A panel of third year nursing students (n=25) assessed the readability, homogeneity, content validity, and test-retest stability of the measurement. The judges accepted all items in terms of clarity and content validity. The agreement on homogeneity with all but three items was above .60. Internal consistency testing (n = 184 nursing students) showed total scale theta of .80, satisfactory CVI and stability coefficients for all items, and construct validity as satisfactory for the final set of 15 items.

Adequate nutrition is crucial for frail and ill elderly. In Sweden, poor nutritional status among elderly in hospitals and in community care has been reported in mass media and study reports. A retrospective study of hospital records and community acts is here presented. Notes on nutrition of 94 patients (80 years>) during their last stay in acute somatic medical care were analysed. Also, community acts for those who had received home-care after discharge. Prospectively in addition, focusing the need for nutrition, one elderly person was observed and interviewed after discharge from hospital to community care in own home as a case study. Three questions were asked: 1) What was documented on nutritional needs during the acute medical care episode? 2) In case of home-care after discharge, what was documented on nutritional needs in community acts? 3) What actions for meeting demands for adequate nutrition is planned by community home-care services for an elderly client discharged from hospital to own home? In this sample notes on nutrition were made in 87 percent of the acute medical care patient records. In the community services acts, notes on nutrition were rare. In the case study, needs of high-energy food intake and psychological support during meals were not adequately planned for and met in home care. The conclusion is, that in order to undertake caring responsibilities for elderly, knowledge of nutritional needs, psychological and social support as well as documentation skills is necessary within all levels of care and important indicators of quality of care. At the community level, in plans for home care and in individual care of elderly clients, explicit and planned assessment must be made for nutritional needs and meal situation. Also, for the continuity of care between hospital and community care and evaluation.

Hospice care is characterised by individual care at the end of life. The patient is aware of the situation and Hospice staffs help patients and their relatives to accept the process and together plan for palliative care. When the patient dies the staff give support to the relatives. The aim of this study was to compare the perception of care between the patient and the relatives in a small hospice setting. Nine patients were interviewed and 58 relatives answered a questionnaire. Findings show that patients get good help with palliative care such as active treatment of pain and other symptoms of discomfort. The patients appreciate the individual caring delivered at Hospice. Relatives value the support from the staff when the patient dies and afterwards. A difference was found showing patient miss their normal bodies function while relatives think the patient particularly miss their home and families at the end of life. The study shows the importance of asking the patient himself of their opinion about caring and not only asking their relatives.

The focus of this literature study is the concept of coping from the perspective of nursing. For the analysis of Benner and Wrubel's model Fawcett's analytical structure was used. The paper describes how the nurse can use the model as a basis for guiding the patient towards successful coping with regard to well-being. The nurse interprets the experience of stress and assesses the coping requirements and the available coping resources on the basis of three questions: Coping with what? To what end? With what resources? An urgent complementary question should be how the patient copes with the illness-related stress. The nurse contributes to improving the well-being of the patient by understanding his or her perception of the illness situation and by supporting and reinforcing coping resources, mobilising hope and fostering a sense of meaning and coherence. All this is of particular importance when the illness is chronic. One conclusion deriving from the analysis is that the model needs to be completed with a clearer family perspective; another is that students and newly-qualified nurses need guidance and training in the interpretation of paradigm cases. Furthermore there is need for inductive, phenomenological research directed towards a deepening of Benner and Wrubel's model on the basis of patients' own experiences of stress, coping and caring.

Based on the qualitative study we carried out during the spring of 1996 (1), we thought it interesting to write about the experience we got through utilising a focus group, which is a method relatively seldom used in nursing research. Use of method in nursing research is an issue which keeps coming back. The debate concerns which methods are best suited to enlighten the subject's various perspectives, and especially, which methods are relevant in relation to research within the field of practice. Bojlen (2) maintains that focus groups represent a method attracting a growing interest in health research. It gives us a special reason to reflect on the various perspectives which can be meaningful for other people wishing to use this method. Questions such as who, how, and why are necessary methodical considerations — in focus groups as well. The article will with the help of situation pictures and examples describe experience from a focus group, in which the purpose is to ascertain the patients' thoughts and experience concerning living with rheumatism. Moreover, relations and interplay between the moderator and the assistant moderator are examined as well as the common investments required in the project's pilot phase and concluding work. Finally, the article describes the focus group's advantage when the chosen group is homogenous, with common experience providing access to rheumatic patients' everyday problems.

The perioperative-nursing model is grounded on the humanistic and caring-ethical assumption of the benefit of a well-informed patient as a way in the preparation for anaesthesia and surgery as well as a way of validate the perioperative care. The purpose of the study was, by asking the head nurses anaesthetist (HNA) validation, to examine current standard regarding the perioperative dialogue and whether the nurse anaesthetist (NA) participated in preoperative and postoperative visit on the ward as the theory of perioperative dialogue discribes. A questionaire was put to 97 anaesthetic departments and 65 answered (67%). Findings show that 89% HNA agreed fully or partially that the preoperative visit was an advantage for the patient. Yet did only 3% departments always perform such visit. The majority HNA (58%) answered that such visits did not occur at all due to: A. lack of resource (time, staff or economy), B. other staff category did perform the visit, C. late admission of the patient to the hospital, D. problem due to organisation or staff-schedules, E. lack of interest or resistance. Postoperative follow up by the NA on the ward was of occasional character. Periopera-tive dialogue had low priority, due to lack of resources. Research findings regarding the value of perioperative dialogue seemed to have difficulties to have impacts in Swedish hospital reality, due to tradition and structures of the management at the hospitals.

The purpose of this article is to show the relevance of dialogue philosophy, as it is conceived by the Existentialist philosopher Martin Buber, to healthcare and Caring Science, specially as the latter is defined in the Nordic Countries. The authors' thesis is that the contributions of dialogue philosophy are, inter alia, the following: 1) a concept of human being (hereafter Man) which is holistic, emphasizing Man's social nature and 2) an anthropological, epistemological and ethical foundation for both (i) a definition of health and sickness and (ii) the construction of a model for authentic communication between the caregiver and the patient. Concerning 1) (i), dialogue philosophy provides a holistic concept of Man, which permits one to distinguish between disease and illnese, two types of sickness, which may occur at the same time, but which sometimes occur independently of each other. The biomedical concept of sickness neglects this distinction and reduces all ill-health to disease. This is however detrimental to the patient's need of health- and socialcare. As to 2) (ii), dialogue philosophy distinguishes between two main types of knowledge: I-Thou- and I-It-knowledge. The latter designates a discursive knowledge of quantifiable and mea-sureable entities, whereas the former designates an intuitive knowledge of Man, that which philosophically speaking, is called ‘knowledge of other minds’. The authors hold that this distinction is very relevant to different levels of health care: diagnosis, relationship between health care professionals and patients, education and research.