Publications by authors named "Vibeke Lohne"

32 Publications

"The Worst Is the Worry": Importance of Preoperative Preparation of Preschool Children.

AANA J 2021 Aug;89(4):342-349

is employed by the University of South-Eastern Norway, Kongsberg, Norway.

Children often experience a high level of anxiety before anesthesia, which may lead to poor cooperation during anesthesia induction and negative consequences for the postoperative period. The aim of this study was to obtain knowledge that may improve practice in preparing preschoolers for anesthesia and surgery by analyzing nurse anesthetists' preoperative experiences with children. A focus group interview with nurse anesthetists was conducted. The interview was recorded and transcribed verbatim, and results were analyzed using qualitative text analysis. Three main themes were identified to relieve preschoolers' anxiety: "Making the unknown and scary harmless," "Using oneself," and "Having a lap to sit on." Findings indicate that explanation and preparation through play, as well as experiences of participation and coping, can safeguard children who are feeling anxious. The professional and personal qualities of a Certified Registered Nurse Anesthetist (CRNA) are important when managing pediatric patients' anxiety. It is essential that CRNAs have the ability to adapt the induction of anesthesia to suit the child individually (and parents). The parents constitute an important collaborator for CRNAs. Young children need explanations and knowledge about what is happening and what to expect. CRNAs should focus on codetermination and participation for preschool children undergoing anesthesia.
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August 2021

'Hope as a lighthouse' A meta-synthesis on hope and hoping in different nursing contexts.

Authors:
Vibeke Lohne

Scand J Caring Sci 2021 Mar 3. Epub 2021 Mar 3.

Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Postbox 4 St. Olavs plass. 0130, Oslo, N-0783, Norway.

Background: Hope has a contextual dimension and experiences of hope seem to be an important part of everybody's life irrespective of changing and challenging health conditions. However, less focus has been placed on the similarities and differences in the experiences of hope among patients and family caregivers in different contexts of suffering and health, such as the nursing contexts of acute and critical care, rehabilitation and long-term care and prevention and health promotion.

Aim: This paper focuses on experiences of hope and hoping in different clinical nursing contexts, based on a meta-synthesis of seventeen empirical studies on hope and hoping. These studies highlight experiences of hope and advance our theoretical and clinical understanding of the phenomenon.

Methodological Framework: This study on hope and hoping from seventeen empirical research studies was based on a meta-synthesis, by clarifying and modifying the essence of hope and hoping, aiming to identify the unique conditions in the different clinical contexts.

Results: A new understanding of the empirical findings emerged from the text: Hope means transformation and hope is indispensable in the acute and critical nursing context, and hope as an inner flame and hope as a lighthouse related to rehabilitation and long-term care. Hope means pushing limits and expanding hope was experienced in the context of prevention and health promotion.

Conclusions: According to the findings, dimensions of hope and hoping were always present but also influenced by contextual suffering and losses.

Implications For Practice: Hope means metaphorically a lighthouse, meaning a bright and shining centre, which must be promoted and protected in patients and their families.
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http://dx.doi.org/10.1111/scs.12961DOI Listing
March 2021

Human dignity research in clinical practice - a systematic literature review.

Scand J Caring Sci 2021 Dec 26;35(4):1038-1049. Epub 2020 Oct 26.

Oslo Metropolitan University, Oslo, Norway.

Background: This literature study describes caring science research on human dignity in different clinical practice. We already know a good deal about human dignity in nursing care but how do patients, nurses, healthcare professionals and next of kin experience human dignity in clinical practice?

Aim: To summarise studies on human dignity to gain a deeper understanding of how it can be achieved in caring science research and to gain a broader understanding of the differences and similarities across caring contexts. The aim was also to gain a broader understanding of the differences and similarities of human dignity across different clinical practice.

Method: The literature review re-analysed 28 empirical studies on human dignity are experienced from acute, psychiatric, elderly and rehabilitation care. The data analysis strategy was conducted in a systematic and critical way and consisted of a five-step method.

Result: Maintaining dignity was described when caregivers had the time and the will to see and listen to patient and had the courage to see what they did not want to see, allowing their inner powers to act with the purpose of doing good. In elderly care, it was important that elderly persons are involved as members of society and experience respect, confidence, security and charity. Indignity was described when caregivers did not allow patients to have their will and when they had unethical attitudes, ignoring patients and creating powerlessness. The feeling of being abandoned and not being taken seriously are also described in elderly care.

Conclusion: Findings show how caregivers fulfil their ethical responsibility by seeing, listening and being a part of the time and place. The will to do good includes the courage to preserve dignity and human value rests on being created as a human being. More research is needed about ethical and moral responsibility in clinical practice.
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http://dx.doi.org/10.1111/scs.12922DOI Listing
December 2021

Experiences with using an idiographic assessment procedure in primary mental health care services for adolescents.

Int J Qual Stud Health Well-being 2020 Dec;15(1):1763741

Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.

: This article aims to explore counsellor experiences using an idiographic assessment procedure implemented in adolescent mental health services. The procedure, Assert, is based on asking the adolescents the question "What matters to you?" to define important topics to address in treatment.: Focus groups and interviews were conducted with counsellors who used Assert (N = 27), and the data were analysed with thematic analysis.: Five themes were identified: (a) "What Matters to You?" (b) "Professional Responsibility," (c) "Empowering the Adolescent," (d) "Practical Utility of Assert in Treatment," and (e) "The Implementation of Assert." Each theme had a number of associated sub-themes.: Assert was perceived by the counsellors as enhancing collaboration and conveying to the adolescents that the counsellors took their concerns seriously. It also provided structure by giving the sessions a concrete focus. However, some counsellors found it difficult to surrender control to the adolescents, and finding a balance between helping and directing the adolescents to define topics could be challenging at times. Assert was generally considered a useful and simple way to assess adolescents' concerns, and it was accepted by the counsellors as a positive contribution to their existing methods.
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http://dx.doi.org/10.1080/17482631.2020.1763741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301708PMC
December 2020

The significance of hope as experienced by the next of kin to critically ill patients in the intensive care unit.

Scand J Caring Sci 2021 Jun 4;35(2):521-529. Epub 2020 May 4.

Departement of Nursing, Oslo Metropolitan University, Oslo, Norway.

Aim: To examine and increase understanding of diverse aspects of hope as experienced by the next of kin when someone close to them is critically ill in intensive care unit (ICU).

Design: A qualitative study with a phenomenological approach.

Method: The data were collected through five in-depth interviews with next of kin at the ICU in Central Norway. Data were interpreted to gain a deeper understanding on hope in an acute and critical context.

Results: The analysis presents five main themes: (i) hope for survival, (ii) hope is fostered by signs of improvement, (iii) hope keeps fear for the worst at bay, (iv) hope that things will turn out well and (v) hope for the return to a normal life. Hope kept next of kin going during a difficult time and was strengthened when they saw their close family member responding positively to treatment provided by the ICU.
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http://dx.doi.org/10.1111/scs.12864DOI Listing
June 2021

A courageous journey: Experiences of migrant Philippine nurses in Norway.

J Clin Nurs 2020 Feb 3;29(3-4):468-479. Epub 2019 Dec 3.

Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.

Aims And Objectives: To explore how Philippine-educated nurses explain their choice of Norway as their migration destination and their experience with the credential assessment process in Norway.

Background: Norway has an increasing need for nurses, and nurses educated in non-EU countries are an important resource for the Norwegian health service. Philippine nurses compose the largest group of internationally educated nurses from outside the EU, but their Philippine nursing education is only credited as equivalent to 2 years in Norway. Migration is known to engender stressful experiences amongst migrant nurses, which may affect their health. However, studies on Philippine nurses' experiences of migrating to and working in Norway are lacking.

Design And Methods: The study used a hermeneutic design, conducting qualitative research interviews with ten Philippine nurses. All of them had a certification as auxiliary nurses, but not as registered nurses. The Consolidated Criteria for Reporting Qualitative Research is used.

Results: The nurses' choice of a migration country appeared to be both random and based on the opportunity to find well-paid work, as well as having acquaintances who had already migrated to Norway. The migrated Philippine nurses seemed experienced and competent. In Norway, they were disappointed as they felt undervalued. The nurses struggled to learn Norwegian, while striving for survival when acquiring jobs or accommodations. They were excluded from acting as legal nurses in the Norwegian healthcare system; they fulfilled the governmental requirements, but they were repeatedly rejected. The informants saw this as harsh, but still hoped to be successful.

Conclusions: There is a need to facilitate effective language training and a well-founded, predictable system of credentialing.

Relevance To Clinical Practice: Attention should be paid to the integration of immigrants and safeguarding and strengthening the professional competence the nurses bring with them.
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http://dx.doi.org/10.1111/jocn.15107DOI Listing
February 2020

Nudging in nursing.

Nurs Ethics 2019 Sep 26;26(6):1601-1610. Epub 2018 Jun 26.

OsloMet - Oslo Metropolitan University, Norway.

Nudging is a concept in behavioural science, political theory and economics that proposes indirect suggestions to try to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In this article, we examine current knowledge about how different decisions (rational and pre-rational decisions, major and minor decisions) are made and how this decision-making process pertains to patients. We view this knowledge in light of the nursing project and the ongoing debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing and healthcare in light of free will and patient autonomy alone. Sometimes, nurses must take charge and exhibit leadership in the nurse-patient relationship. From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients' decisions and actions must be in alignment with the nursing project and in accordance with patients' own values and goals.
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http://dx.doi.org/10.1177/0969733018779226DOI Listing
September 2019

Tension between freedom and dependence-A challenge for residents who live in nursing homes.

J Clin Nurs 2018 Nov 17;27(21-22):4119-4127. Epub 2018 Aug 17.

Oslo Metropolitan University, Oslo, Norway.

Aims And Objectives: To present results from interviews of older people living in nursing homes, on how they experience freedom.

Background: We know that freedom is an existential human matter, and research shows that freedom remains important throughout life. Freedom is also important for older people, but further research is needed to determine how these people experience their freedom. The background for this article was a Scandinavian study that occurred in nursing homes; the purpose of the study was to gain knowledge about whether the residents felt that their dignity was maintained and respected.

Design: The design was hermeneutic, with qualitative research interviews.

Method: Twenty-eight residents living in nursing homes in Denmark, Sweden and Norway were interviewed. Collecting tools used were an interview guide and also a tape recorder. Researchers in the three countries performed the interviews. The data were transcribed and analysed on three levels of hermeneutic interpretation.

Results: To have their freedom was emphasised as very important according to their experience of having their dignity taken care of. The following main themes emerged: (a) Autonomy or paternalism; (b) Inner and outer freedom; and (c) Dependence as an extra burden.

Conclusions: Residents in a nursing home may experience the feeling of having lost their freedom. This conclusion has implications for healthcare professionals and researchers, as it is important for residents in nursing homes to feel that they still have their freedom.

Relevance To Clinical Practice: In clinical practice, it is important and valuable for the staff to consider how they can help older people feel that they still have their freedom.
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http://dx.doi.org/10.1111/jocn.14561DOI Listing
November 2018

Clinical application research through reflection, interpretation and new understanding - a hermeneutic design.

Scand J Caring Sci 2018 Sep 20;32(3):1157-1167. Epub 2018 Feb 20.

Oslo and Akershus University College of Applied Sciences, Oslo, Norway.

The implementation of theoretical knowledge in clinical practice and the implementation of good clinical practice into theory have been of interest in caring science for the last 30 years. The aim of this article was to elaborate and discuss a methodology named clinical application research. The method is grounded in a hermeneutical design inspired by Gadamer's philosophy. The methodology, clinical application research, has been used in a research project A life in dignity and experiences from the researchers forms the bases for the elaboration and discussion. The project was performed in collaboration with residents, family caregivers and healthcare providers at six nursing homes in Scandinavia. The material for this article is based on the previous research, that is the results from 10 different articles showing the meaning of dignity and indignity in daily life in nursing homes. Data were generated from 56 individual interviews and 18 focus-group interviews with a total of 40 staff members with five to eight participants at every interview session. By reflection, interpretation and new understanding our results provide knowledge about dignity and how to preserve dignity for older people in an appropriate ethical way. The methodology was relevant for the research project A life in dignity and relevant to caring practice in nursing homes as it opens new possibilities and new ways of thinking when performing dignified care to older people.
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http://dx.doi.org/10.1111/scs.12561DOI Listing
September 2018

A qualitative study of immigrant women on long-term sick leave and their experience of dignity.

Disabil Rehabil 2018 09 26;40(19):2242-2249. Epub 2017 May 26.

a Department of Nursing and Health Promotion , Oslo & Akershus University College of Applied Sciences , Oslo , Norway.

Purpose: The purpose of this study was to explore if and how immigrant women suffering from chronic pain experience and maintain their dignity, during rehabilitation.

Methods: The study was designed as a field study, with participant observation and in-depth interviews. Participant observations were carried out during a rehabilitation course for 14 immigrant women on an outpatient clinic at a rehabilitation hospital in southern Norway. In-depth interviews were performed after the rehabilitation period. Hermeneutic analysis was applied to interpret the data.

Results: Findings show that the immigrant women experienced dignity by being seen, respected and believed by family-members, healthcare personnel and other patients at the outpatient clinic. Moreover, they maintained their dignity through a sense of their own value, integrity, religious faith and hope for the future.

Conclusions: The immigrant women maintained and protected their dignity by finding strength, pride, and self-worth in their religion and through their family-members' affection. Taking responsibility for themselves and others and experiencing fellowship and equality with other women, they enhanced their dignity during their rehabilitation process. The caring attitudes and behavior of some healthcare personnel promoted patient dignity. They also gained hope and dignity by experiencing goodness, cultural competence, and sensitivity from healthcare personnel. Implications for rehabilitation This study shows that the family role is more important for the immigrant women than the role as an employee, although financial independence and being able to help relatives financially also were central. Fellowship and equality with other patients, together with a rehabilitation program, which is facilitated for different language levels, were understood as important factors for an effective recovery. Enough time to get to know the patients and cultural competence seems to be central components for the health care personnel to give efficient help to immigrants in rehabilitation. Immigrants from low/middle-income countries appear to apply their religiousness as a resource in their lives to a greater extent than native Norwegians do, and should be taken into consideration when planning and implementing rehabilitation programs for immigrants.
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http://dx.doi.org/10.1080/09638288.2017.1331379DOI Listing
September 2018

The significance of meaningful and enjoyable activities for nursing home resident's experiences of dignity.

Scand J Caring Sci 2017 Dec 2;31(4):718-726. Epub 2016 Dec 2.

Oslo and Akershus University College of Applied Sciences, Oslo, Norway.

Background: Living in a nursing home may be challenging to the residents' experience of dignity. Residents' perception of how their dignity is respected in everyday care is important.

Aim: To examine how nursing home residents experience dignity through the provision of activities that foster meaning and joy in their daily life.

Method: A qualitative design was used and 28 individual semistructured interviews conducted with nursing home residents from six nursing homes in Denmark, Norway and Sweden. The data were analysed with qualitative content analysis. Independent ethical committees in all participating countries granted their approval for the study.

Findings: The participants highlight two dimensions of the activities that foster experiences of dignity in nursing homes in Scandinavia. These two categories were (i) fostering dignity through meaningful participation and (ii) fostering dignity through experiencing enjoyable individualised activities.

Conclusion: Activities are important for residents to experience dignity in their daily life in nursing homes. However, it is important to tailor the activities to the individual and to enable the residents to take part actively. Nurses should collect information about the resident's preferences for participation in activities at the nursing home.
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http://dx.doi.org/10.1111/scs.12386DOI Listing
December 2017

Maintaining dignity in vulnerability: A qualitative study of the residents' perspective on dignity in nursing homes.

Int J Nurs Stud 2016 Aug 19;60:91-8. Epub 2016 Mar 19.

Oslo and Akershus University College of Applied Sciences, Oslo, Norway.

Background: Older people, living in nursing homes, are exposed to diverse situations, which may be associated with loss of dignity. To help them maintain their dignity, it is important to explore, how dignity is preserved in such context. Views of dignity and factors influencing dignity have been studied from both the residents' and the care providers' perspective. However, most of these studies pertain to experiences in the dying or the illness context. Knowledge is scarce about how older people experience their dignity within their everyday lives in nursing homes.

Aim: To illuminate the meaning of maintaining dignity from the perspective of older people living in nursing homes.

Method: This qualitative study is based on individual interviews. Twenty-eight nursing home residents were included from six nursing homes in Scandinavia. A phenomenological-hermeneutic approach, inspired by Ricoeur was used to understand the meaning of the narrated text.

Results: The meaning of maintaining dignity was constituted in a sense of vulnerability to the self, and elucidated in three major interrelated themes: Being involved as a human being, being involved as the person one is and strives to become, and being involved as an integrated member of the society.

Conclusion: The results reveal that maintaining dignity in nursing homes from the perspective of the residents can be explained as a kind of ongoing identity process based on opportunities to be involved, and confirmed in interaction with significant others.
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http://dx.doi.org/10.1016/j.ijnurstu.2016.03.011DOI Listing
August 2016

The Dialectical Movement Between Deprivation and Preservation of a Person's Life Space: A Question of Nursing Home Residents' Dignity.

Holist Nurs Pract 2016 May-Jun;30(3):139-47

Oslo and Akershus University College of Applied Sciences, Oslo, Norway (Drs Sæteren, Heggestad, Lohne, Caspari, Lindwall, Aasgaard, and Nåden); VIA University College, Horsens, Denmark (Dr Høy); University of Nordland, Bodø, Norway (Dr Lillestø); University of Agder, Kristiansand S, Norway (Dr Slettebø); Sogn og Fjordane University College, Sogndal, Norway (Dr Råholm); Stord/Haugesund University College, Stord, Norway (Dr Rehnsfeldt); and Karlstad University, Karlstad, Sweden (Dr Lindwall).

The aim of this study was to answer the question "What do nursing home residents do themselves in order to maintain their dignity?" Twenty-eight residents, 8 men and 20 women, aged 62 to 103 years, from 6 different nursing homes in Scandinavia were interviewed. The results showed that the residents tried to expand their life space, both physical and ontological, in order to experience health and dignity.
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http://dx.doi.org/10.1097/HNP.0000000000000145DOI Listing
January 2017

Fostering dignity in the care of nursing home residents through slow caring.

Nurs Ethics 2017 Nov 4;24(7):778-788. Epub 2016 Feb 4.

Oslo and Akershus University College of Applied Sciences, Norway.

Background: Physical impairment and dependency on others may be a threat to dignity.

Research Questions: The purpose of this study was to explore dignity as a core concept in caring, and how healthcare personnel focus on and foster dignity in nursing home residents.

Research Design: This study has a hermeneutic design. Participants and research context: In all, 40 healthcare personnel from six nursing homes in Scandinavia participated in focus group interviews in this study. Ethical considerations: This study has been evaluated and approved by the Regional Ethical Committees and the Social Science Data Services in the respective Scandinavian countries.

Findings: Two main themes emerged: dignity as distinction (I), and dignity as influence and participation (II).

Discussion: A common understanding was that stress and business was a daily challenge.

Conclusion: Therefore, and according to the health personnel, maintaining human dignity requires slow caring in nursing homes, as an essential approach.
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http://dx.doi.org/10.1177/0969733015627297DOI Listing
November 2017

Caught in suffering bodies: a qualitative study of immigrant women on long-term sick leave in Norway.

J Clin Nurs 2015 Nov 10;24(21-22):3266-75. Epub 2015 Aug 10.

Faculty of Health Science, Institute of Nursing, Oslo & Akershus University College of Applied Sciences, Oslo, Norway.

Aims And Objectives: This article explores the issues faced by immigrant women on long-term sick leave due to chronic pain, focusing on their personal perspectives on their daily lives, their bodies and their pain.

Background: An increasing number of immigrants in Norway present a challenge to the public health service, above all in relation to the health needs of immigrant women, many of whom risk having to take long-term sick leave due to chronic pain.

Design: This study has a qualitative design, with participant observation and in-depth interviews.

Methods: Participant observations were carried out from a sample of fourteen immigrant women in an outpatient clinic at a rehabilitation hospital. In addition, qualitative interviews were conducted after the rehabilitation period. A hermeneutic approach was used to understand the meaning of the narrated text.

Results: The analysis revealed one main theme, 'Bodies marked by onerous experiences', as well as two subthemes: 'It is in my body' and 'Invisible pain'. The immigrant women struggled with invisible, chronic pain, which they blamed on physically tiring workdays and stressful life situations. Furthermore, they felt that their experiences of discriminative attitudes at the workplace worsened their suffering.

Conclusions: The chronic pain made the immigrant women suffer, because they experienced it as a threatening, incomprehensible and unreal force, without meaning or the ability to be controlled. Their own psychological distress exacerbated their pain.

Relevance To Clinical Practice: Immigrant women on long-term sick leave are likely to need special approaches that are closely adapted to their different backgrounds and their unique personal experiences. We recommend culturally appropriate family counselling and collaboration with employers at the women's workplaces.
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http://dx.doi.org/10.1111/jocn.12901DOI Listing
November 2015

A lonely life--A qualitative study of immigrant women on long-term sick leave in Norway.

Int J Nurs Stud 2016 Feb 3;54:54-64. Epub 2015 Apr 3.

University of Southern Denmark, Institute of Public Health, Odense, Denmark.

Background: This study focuses on the everyday life of immigrant women with chronic pain on long-term sick leave in Norway. Research has shown that rehabilitation of immigrant women with chronic pain might be challenging both due to their lack of linguistic competence, due to lack of sufficient confidence/trust in their employers and in health personnel and lack of knowledge/skills among health care personnel in meeting immigrants' special needs.

Objective: The objective of the study was to explore how immigrant women on long-term sick leave in Norway due to chronic pain experience their illness and their relationships at work and in the family.

Design: This article has a qualitative design, using participant observation and in-depth interviews.

Methods: Participant observations were carried out in an outpatient clinic and qualitative interviews were conducted after the rehabilitation period. A hermeneutic approach was used to understand the meaning of the narrated text. All the authors participated in the discussion of the findings, and consensus was obtained for each identified theme.

Settings: The research was conducted at an outpatient clinic at a rehabilitation hospital in the southern part of Norway. The clinic offers wide-ranging, specialized, multidisciplinary patient evaluations that last between 24 and 48h, followed by advice and/or treatment either individually or in a group, i.e. in a rehabilitation course.

Participants: Participants (immigrant women) who had been referred to the outpatient clinic and to a rehabilitation course were recruited. Fourteen African and Asian women were observed in two rehabilitation courses, and eleven of them agreed to be interviewed once or twice (3).

Results: The interpretation revealed the following two main themes: 'Shut inside the home' and 'Rejected at the workplace'. Based on the women's experiences, a new understanding emerged of how being excluded or not feeling sufficiently needed, wanted or valued by colleagues, employers or even by family members rendered their daily lives humiliating and lonely.

Conclusions: The immigrant women on long-term sick leave live in triple jeopardy: being ill and being lonesome both at home and at the workplace. This can be described as a vicious circle where the humiliating domestic and workplace-rejection might reinforce both the women's experience of shame and avoidance of telling anybody about their illness/symptoms, which then results in more days on sick leave during which they are again isolated and lonesome. There is a need for more research on multidisciplinary rehabilitation approaches designed to cater for immigrants' special needs.
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http://dx.doi.org/10.1016/j.ijnurstu.2015.03.017DOI Listing
February 2016

Family caregivers' experiences in nursing homes: narratives on human dignity and uneasiness.

Res Gerontol Nurs 2014 Nov-Dec;7(6):265-72. Epub 2014 Mar 31.

This qualitative study focused on dignity in nursing homes from the perspective of family caregivers. Dignity is a complex concept and central to nursing. Dignity in nursing homes is a challenge, according to research. Family caregivers are frequently involved in their family members' daily experiences at the nursing home. Twenty-eight family caregivers were included in this Scandinavian cross-country, descriptive, and explorative study. A phenomenological-hermeneutic approach was used to understand the meaning of the narrated text. The interpretations revealed two main themes: "One should treat others as one would like others to treat oneself" and "Uneasiness due to indignity." Dignity was maintained in experiences of respect, confidence, security, and charity. Uneasiness occurred when indignity arose. Although family caregivers may be taciturn, their voices are important in nursing homes. Further investigation of family caregivers' experiences in the context of nursing homes is warranted.
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http://dx.doi.org/10.3928/19404921-20140325-99DOI Listing
March 2015

The meaning of dignity in nursing home care as seen by relatives.

Nurs Ethics 2014 Aug 13;21(5):507-17. Epub 2014 Jan 13.

Oslo and Akershus University College of Applied Sciences, Norway.

Background: As part of an ongoing Scandinavian project on the dignity of care for older people, this study is based on 'clinical caring science' as a scientific discipline. Clinical caring science examines how ground concepts, axioms and theories are expressed in different clinical contexts. Central notions are caring culture, dignity, at-home-ness, the little extra, non-caring cultures versus caring cultures and ethical context - and climate.

Aim And Assumptions: This study investigates the individual variations of caring cultures in relation to dignity and how it is expressed in caring acts and ethical contexts. Three assumptions are formulated: (1) the caring culture of nursing homes influences whether dignified care is provided, (2) an ethos that is reflected on and appropriated by the caregiver mirrors itself in ethical caring acts and as artful caring in an ethical context and (3) caring culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts.

Research Design: The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden.

Ethical Considerations: The principles of voluntariness, confidentiality and anonymity were respected during the whole research process.

Findings: Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context.

Discussion: Caring communion, invitation, at-home-ness and 'the little extra' are expressions of ethical contexts and caring acts in a caring culture. A non-caring culture may not consider the dignity of its residents and may be represented by routinized care that values organizational efficiency and instrumentalism rather than an individual's dignity and self-worth.

Conclusion: An ethos must be integrated in both the organization and in the individual caregiver in order to be expressed in caring acts and in an ethical context that supports these caring acts.
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http://dx.doi.org/10.1177/0969733013511358DOI Listing
August 2014

Perspectives of health personnel on how to preserve and promote the patients' dignity in a rehabilitation context.

J Clin Nurs 2013 Aug 8;22(15-16):2318-26. Epub 2013 May 8.

Department of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.

Aims And Objectives: To explore how healthcare personnel comprehend the term dignity and what they do to attend to, preserve and promote the dignity of patients in the rehabilitation context.

Background: Literature reveals that knowledge exists concerning the nature of dignity. Literature is scant on how health personnel think the reasons may be when patients do not maintain their dignity or how caregivers might improve and strengthen their concern in preserving and promoting the patients' dignity in a rehabilitation context.

Design: The study was explorative and descriptive, with content analysis of gathered empirical data.

Methods: Qualitative focus group interviews with representatives from the staff at three different rehabilitation centres were carried out. Professionals within different occupations were represented at the meeting: nurses, ergonomists, physiotherapists, psychologists, medical doctors, social workers, auxiliary nurses and speech therapists.

Results: Dignity is promoted when the patient himself becomes an active agent, when the patient's feelings and thoughts are respected, when the family of the patient is included and listened to, when the patient is free to make critical comment, when members of staff are able to cope with the patient's disabilities and when the aesthetic environment is attended to and enhanced. Dignity is not promoted when health personnel override or dominate patients, when health personnel focus merely on the patient's diagnosis and not the sick person and when health personnel and/or relatives try to impose their own values.

Conclusion: The staff working in institutions to rehabilitate patients with head injuries and multiple sclerosis must be aware and sensitive to the importance of maintaining and supporting the patient's dignity and self-respect.

Relevance For Clinical Practice: The results from this project confirm the importance of acknowledging the patient's self-worth as a human being, unconditionally. This might be essential in promoting and preserving the patients' dignity.
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http://dx.doi.org/10.1111/jocn.12181DOI Listing
August 2013

Aspects of indignity in nursing home residences as experienced by family caregivers.

Nurs Ethics 2013 Nov 4;20(7):748-61. Epub 2013 Mar 4.

Oslo and Akershus University College of Applied Sciences, Norway.

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents' dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: 'A feeling of being abandoned'. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life.
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http://dx.doi.org/10.1177/0969733012475253DOI Listing
November 2013

The relationship between hope and caregiver strain in family caregivers of patients with advanced cancer.

Cancer Nurs 2012 Mar-Apr;35(2):99-105

Oslo University College, Faculty of Nursing, Norway.

Background: Today, family caregivers (FCs) are involved in all aspects of patient care. Hope influences one's ability to cope with stressful situations. However, little information is available on how FCs' levels of hope influence the strain they experience in their caregiving role.

Objectives: The purposes of this study were to describe the levels of hope and caregiver strain in FCs of patients with advanced cancer and examine the relationship between hope and caregiver strain in these FCs. In addition, differences in hope and caregiver strain associated with a number of demographic characteristics are described.

Methods: Family caregivers completed a demographic questionnaire, Herth Hope Index (HHI), and Caregiver Strain Index (CSI).

Results: Of the 112 FCs, the majority were female (60%) and spouses (94%), with a mean age of 63.1 (SD, 10.7) years. Mean HHI score was 36.8 (SD, 4.0). Approximately 20% of the FCs reported a high level of caregiver strain, and these FCs were younger. The prevalence of perceived strain across subscales of the CSI was highest for emotional adjustment (70%). No relationships were found between HHI total scores and any of the CSI subscale scores. However, FCs with lower HHI scores reported significantly higher levels of caregiver strain.

Conclusions: Findings from this study suggest that younger individuals may represent a high-risk group of FCs for both lower levels of hope and higher levels of caregiver strain.

Implications For Practice: Oncology nurses need to identify FCs at highest risk for increased strain and provide interventions to enhance hope and decrease perceived strain.
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http://dx.doi.org/10.1097/NCC.0b013e31821e9a02DOI Listing
April 2012

Qualitative study of pain of patients with chronic obstructive pulmonary disease.

Heart Lung 2010 May-Jun;39(3):226-34

Faculty of Nursing, Oslo University College, Oslo, Norway.

Objective: This study evaluated the pain experiences of patients with chronic obstructive pulmonary disease (COPD).

Sample: We studied 16 patients with severe COPD.

Design: A semistructured interview was performed to obtain information on patients' experiences with pain and the impact of pain on quality of life (QOL). Data were analyzed using the methodology of Kvale.

Results: Three main themes emerged: incomprehensible and unbearable pain; locked in my body and shut out from the world; and the vicious COPD circle. Patients reported moderate to severe pain located primarily in the shoulders, neck, upper arms, and chest. Patients reported a number of severe symptoms occurring simultaneously, and negatively affecting each other. Vicious circles of pain, breathlessness, sleep disturbance, and anxiety were described as exerting negative effects on patients' QOL.

Conclusion: Unrelieved pain appears to be a significant problem in patients with COPD. Research is warranted to determine if pain is clustered with other symptoms, and how these symptoms affect the clinical management of COPD.
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http://dx.doi.org/10.1016/j.hrtlng.2009.08.002DOI Listing
June 2011

The lonely battle for dignity: individuals struggling with multiple sclerosis.

Nurs Ethics 2010 May;17(3):301-11

Oslo University College, Oslo, Norway.

Much is known about the phenomenon of dignity, yet there is still a need for implementing this understanding in clinical practice. The main purpose of this study was to find out how persons suffering from multiple sclerosis experience and understand dignity and violation in the context of a rehabilitation ward. A phenomenological-hermeneutic approach was used to extract the meaningful content of narratives from 14 patients with multiple sclerosis. Data were collected by personal research interviews. The findings revealed three main themes: (1) 'invisibly captured in fatigue'; (2) 'fighters' law: one who does not ask will not receive'; and (3) 'dignity is humanity'. The essence of the findings in this study is that dignity is humanity. According to the participants, dignity requires time and is experienced only in a context of empathy and mutual confidence.
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http://dx.doi.org/10.1177/0969733010361439DOI Listing
May 2010

Dignity in the life of people with head injuries.

J Adv Nurs 2009 Nov 11;65(11):2426-33. Epub 2009 Sep 11.

Faculty of Nursing Education, Oslo University College, and Faculty of Health and Sport, University of Agder, Arendal, Norway.

Title: Dignity in the life of people with head injuries.

Aim: This paper is a report of a study conducted to determine how people who suffer from head injuries perceive respect for their dignity and to discover what patients mean by the concept of 'dignity'.

Background: We know something about what the phenomenon of dignity means. However, we still lack knowledge about how patients perceive dignity in their lives and how dignity may be fostered and supported.

Methods: Qualitative interviews were carried out during 2007 with 14 patients suffering from head injuries, diagnosed as having mild to moderate disability. The study was explorative and descriptive, with a content analysis.

Findings: Patients experienced their dignity as maintained when they were taken seriously, received appropriate information and were reality-oriented. They experienced their dignity as violated if they had been neglected or had encountered healthcare personnel who lacked knowledge, were sceptical about their stories, and where the patient experienced extra burden when they were mistrusted. The importance of adequate information was underscored. As interviewees said, head injuries do not show on the outside and people with head injuries do not have a high status in society.

Conclusion: Patients living with head injuries should be informed about consequences and be taught strategies for how to live with head injuries as early as possible after the injury in order to maintain dignity.
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http://dx.doi.org/10.1111/j.1365-2648.2009.05110.xDOI Listing
November 2009

Back to life again--patients' experiences of hope three to four years after a spinal cord injury--a longitudinal study.

Authors:
Vibeke Lohne

Can J Neurosci Nurs 2009 ;31(2):20-5

Faculty of Nursing, Oslo University College, Norway.

This paper presents narratives that focus on experiences of hope, told by 10 participants three to four years after suffering spinal cord injury. Experiences of hope are understood as vital, essential and dynamic aspects of human life and human health. This is the first study addressing patients' experiences of hope three to four years following spinal cord injury. This study has a descriptive, longitudinal design, and is part of a larger study on patients' experiences of hope three to four years following spinal cord injury (Lohne, 2001, 2006, 2008a, 2008b; Lohne & Severinsson, 2004a, 2004b, 2005, 2006). Data were collected at three points in time by personal interviews. A phenomenological approach inspired by Ricoeur (1976) was used to extract the meaningful content of the patients' experiences. Findings revealed three main themes: Life-related hopes (I), Body-related hopes (II), and Creative and expanding hopes (III). Results indicated that three to four years following injury, participants were focusing on life more than on hope due to improvements and adaptation to a new life.
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August 2009

The incomprehensible injury--interpretations of patients' narratives concerning experiences with an acute and dramatic spinal cord injury.

Authors:
Vibeke Lohne

Scand J Caring Sci 2009 Mar 18;23(1):67-75. Epub 2008 Sep 18.

The Faculty of Nursing, Oslo University College, Oslo, Norway.

Spinal cord injury is one of the most devastating incidents that can occur to an individual as it results in life being suddenly, dramatically, radically and long lastingly changed. Different studies show that a spinal cord injury is a stressful event, leading to physiological dependence, psychological and social illness and suffering, although the situation tends to improve over time. This study is a part of a larger longitudinal study. The aim of this study was to explore and interpret 10 individuals' experiences in connection with their acute and unexpected spinal cord injury. This qualitative study has a descriptive and explorative design and is a part of a larger study. A phenomenological hermeneutic approach inspired by Ricoeur was used to extract the meaningful content of the patients' narratives. In this study, the findings revealed three main themes: (I) 'the incomprehensible shock', (II) 'brave survivors' and (III) 'miracles, luck or coincidences?' The incomprehensible spinal cord injury was often experienced as a dramatic and unexpected shock in the middle of a pleasant occasion, and every participant felt immediately overwhelmed by emotional suffering, such as despair and panic, but also anxiety, confusion, sorrow, guilt, shame, fear, aggression or depression at the moment of injury. Some individuals immediately understood that they had become completely paralysed and that something was seriously wrong with their body. Many also experienced guilt or shame because of choices or decisions made immediately before the injury. Several of the narratives were illuminating participants that had been brave survivors and heroes and saved others (passengers or friends) during the injury, by preventing the car form driving out or by softening the fall of co-passengers, which also entailed more serious injuries to themselves. However, the fact of having survived was experienced as 'being lucky, after all'. They all repeatedly reflected on the accident, and their individual understanding of it changed over time, from, on the whole, as a perspective of a 'miracle' to 'just luck' or a coincidence' which also reflected the meaning and significance of what the injury really meant to their body and to their lives. And these reflections gave rise to different ways; they later on learned to live with their new lives. These important aspects, narrated by the brave survivors, have not been reported in the research literature earlier.
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http://dx.doi.org/10.1111/j.1471-6712.2007.00591.xDOI Listing
March 2009

The battle between hoping and suffering: a conceptual model of hope within a context of spinal cord injury.

Authors:
Vibeke Lohne

ANS Adv Nurs Sci 2008 Jul-Sep;31(3):237-48

The Faculty of Nursing, Oslo University College, Oslo, Norway.

The aim of this longitudinal study was to explore 10 patients' experiences of the meaning they attribute to the substance of hope and the process of hoping during the first 3 to 4 years following a spinal cord injury. This qualitative study is a synthesis of three empirical studies of hope and the overall aim was to deepen the understanding of the phenomenon of hope, based on the text representing the main contextual findings, to develop a theoretical framework on hope within a context of spinal cord injury, illustrated in the conceptual model. In correspondence with Ricoeur, this conceptual model, which was developed from a new understanding, based on a new text of the phenomenon of hope, develops a new and deeper understanding of the meaning of hope. Findings revealed 9 themes: universal hope, uncertain hope, hope as a turning point, the power of hope, boundless creative and flexible hope, enduring hope, despairing hope, body-related hope, and existential hope. The conceptual model was derived from these themes, illustrated as The Battle between Hoping and Suffering and The Road of Hope. The interpretations also revealed a distinction between being in hope and having hope, and having a hope of improvements was the main focus at the early stage of rehabilitation, whereas being in hope as being just fine was the main focus after 3 to 4 years of rehabilitation.
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http://dx.doi.org/10.1097/01.ANS.0000334287.19473.5cDOI Listing
October 2008

The power of hope: patients' experiences of hope a year after acute spinal cord injury.

J Clin Nurs 2006 Mar;15(3):315-23

Institute of Nursing and Health Science, University of Oslo, Norway.

Aims And Objectives: The aim of this present study was to explore patients' experiences of the meaning they attribute to hope and hoping a year after acute spinal cord injury.

Background: Nursing literature is pointing towards the importance of having hope for a healthful living. However, the concept of hope has preliminarily been defined in an abstract and general way and is therefore difficult to grasp.

Design And Methods: This qualitative study has a longitudinal and descriptive-explorative design. Data were collected by personal interviews (n = 10) one year after acute spinal cord injury. A phenomenological-hermeneutic approach, based on the philosophy of Ricoeur, was used to extract the essences of the patients' experiences.

Results: The findings resulted in one main interpretation: 'The Power of Hope', and two sub-themes: 'Will, Faith and Hope' and 'Hoping, Struggling and Growing'. The power of hope was interpreted as the individual having experienced the meaning a year after the injury, mainly expressed through will power.

Conclusions: This study shows that experiences of hope were important to all participants, providing energy and power to the process of struggling because hope is necessary for further progress and personal development. Relevance to clinical practice. Nursing interventions should be mainly directed towards emotional and motivational strategies to promote the will power and personal growth through learning experiences.
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http://dx.doi.org/10.1111/j.1365-2702.2006.01301.xDOI Listing
March 2006

Patients' experiences of hope and suffering during the first year following acute spinal cord injury.

J Clin Nurs 2005 Mar;14(3):285-93

Institute of Nursing Science, University of Oslo, Løkkalia 4, N-0783 Oslo, Norway.

Aims And Objectives: The aim of this study was to explore patients' experiences of hope during the first year suffering from spinal cord injury.

Background: There is a lack of substantial precision with regard to the concept of hope. Very few qualitative studies focusing on experiences of hope in spinal cord-injured patients have been identified in the literature. In this study, "hope" was defined as future oriented towards improvement.

Design And Methods: Data were collected by means of personal interviews (n = 10) at the participants' homes in Norway. A phenomenological-hermeneutic approach, inspired by Ricoeur, was used to extract the meaning of the patients' experiences. The analysis was performed in several steps, as a hermeneutic process.

Results: In this study, the findings revealed two main themes: "The Vicious Circle" and "Longing". The vicious circle constituted aspects of suffering, and the common hope experienced by the subjects was therefore to leave the vicious circle. Experiences of suffering were experienced as feelings of loneliness, impatience, disappointment, bitterness and dependency. The "Longing" was based on the subject's former life and was the source of awakened new hopes, which again was experienced comforting.

Conclusions: Experiences of suffering created hope and longing. The meaning of hope was to find a possible way out of the circle and the hoping was experienced as a comfort.

Relevance To Clinical Practice: Implications to nursing practice are listening to the suffering and longing individual and comforting the suffering by pointing towards possible future roads of hope.
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http://dx.doi.org/10.1111/j.1365-2702.2004.01088.xDOI Listing
March 2005
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