Scandinavian Journal of Caring Sciences

The aim of this study was to obtain evidenced-based knowledge about older persons in home care; we conducted a population-based study at 11 sites in Europe (2001/2002). This article focuses on urinary incontinence and need for help in home care. A sample of 4010 respondents 65 years or older were assessed by the Resident Assessment Instrument for Home Care. Urinary incontinence was defined as leakage once a week or more including use of catheters. A total of 1478 individuals had urinary incontinence, 45% men and 47% women. The use of pads ran from 29% to 52% between the sites. The associates of urinary incontinence were: moderate or severe cognitive impairment, dependency in toileting and other activities of daily living compared with less impaired; urinary infections, obesity and faecal incontinence. Caregivers to persons with urinary incontinence reported burden or stress more often then carers to nonurinary incontinence individuals (OR = 2.2, 95% CI 1.8-2.7). To enable older people with incontinence to stay at home with a better quality of life, they need caring assistance during toileting on a regular basis.

The overall aim of the study was to investigate if there was a relationship between health behaviour and sense of coherence (SOC) in pupils aged 14-15. A specific aim was to investigate if socioeconomic areas and sex could be related to health behaviour and SOC of these pupils. A cross-sectional study was conducted in a sample of pupils in grade eight selected from primary schools in Stockholm city with regard to socioeconomic area. The final sample of the study was 383: 196 girls and 187 boys. Two questionnaires, the Health Profile Scale measuring health behaviour and the Sense of Coherence Scale were used to collect data. Of the total group, girls had a significantly lower SOC mean score compared to boys. There were differences in health behaviour related to both SOC and sex. In comparison with boys, the girls showed a lower SOC in several health behaviours, e.g. breakfast, dinner, alcohol and bed-going habits. The pupils in the high socioeconomic area showed a low SOC score in several health behaviours. The findings in this study were that girls aged 14-15 had a lower SOC mean score compared to boys. The girls showed a lower SOC score related to several health behaviours. There were no significant differences in the SOC mean scores between the two socioeconomic areas.

The Perceived Stress Scale (PSS) is a representative instrument used to measure stress. The original PSS comprises 14 items (PSS-14) in two subscales, but 10- and 4-item versions are also available (PSS-10 and 4, respectively). The target populations of psychometric studies using the PSS have far mainly comprised college students, and the underlying constructs of the PSS versions are controversial: one factor vs. two factors and first order vs. second order. The aim of this study was to evaluate the psychometric properties of the Korean versions of the PSS-14, 10 and 4 (designated KPSS-14, 10 and -4, respectively) in patients with chronic disease. The PSS-14, 10 and 4 were translated into Korean using forward and backward translation. Factorial construct validity was tested using both exploratory and confirmatory factor analyses. Item convergent validity and item discriminant validity were tested. Concurrent validity was examined using the Center for Epidemiologic Studies-Depression scale. Known-groups validity was analysed using t-test and effect size. Reliability was tested using Cronbach's alpha and the intraclass correlation coefficient. Exploratory factor analysis supported a two-factor model for all Korean versions of the PSS, and confirmatory factor analysis indicated that the model fit the KPSS-10 well and the KPSS-4 only marginally. The testing of item convergent and discriminant validity revealed a 100% scaling success. As expected, all scores in the KPSS-14, 10 and 4 were moderately correlated with depression scores and differed significantly according to gender. The Cronbach's alpha for the KPSS-14 and 10 exceeded the criterion of 0.70. The intraclass correlation coefficient values of all three Korean versions were satisfied. The KPSS-10 exhibited a first-order, two-factor construct, and excellent reliability and validity were established for Korean patients with chronic disease. The psychometric properties of the shortest version, KPSS-4, were only marginally acceptable.

According to Swedish laws and regulations, registered nurses are required to document nursing care in the patient's record. In this exploratory study, nurses were asked to describe how they made their nursing records. The nursing process model was used as a framework. The findings show that a system for admission assessment was fairly common, regarding objectives and a nursing care plan together with a nursing discharge note; more than half of the wards studied recorded these aspects at least occasionally. Nursing diagnoses were seldom recorded in practice. The results reveal serious limitations and deficiencies in the practice of nursing documentation and the implementation of current laws and regulations. This underlines the importance of emphasizing nursing knowledge and nursing documentation in nursing training and practice.

Three cross-sectional time series studies, randomised and stratified for age and gender, were performed on children aged 2-17, studying their health and well-being. The studies were performed in the Nordic countries in 1984, 1996 and 2011. Long-term illness (LTI) and psychosomatic complaints (PSC) increased during the period. Data were collected from mailed questionnaires. Data of 1461 Swedish children from 2011 were used and compared with data from 1984 and 1996. Relationships between the health indicators (the absence of LTI, 13 diagnoses, the absence of PSC, six symptoms, six items of well-being) and 12 activities were analysed. A total of 83.2% of the children were healthy and 16.8% had at least one LTI, boys 19.1% and girls 14.5%. PSC increased from 18.6% in 1996 to 23.1% in 2011. The distribution was higher in girls. Girls were more active than boys during leisure time. 'Reading books', 'visiting friends', 'listening to music' and 'activity in organisations' were related to an absence of PSC, LTI and well-being. 'Surfing/blogging on the Internet' was negatively related to LTI, PSC and well-being. Multiple regression showed that that 'visits or is visited by friends' was related with a low probability for LTI and also with a high probability for well-being. In the logistic regression analyses, the following variables were seen as promoting health most: 'visits or is visited by friends' and 'is active in organizations' for children aged 2-17 years, especially for boys and well-being. The health of Swedish children declined between 1984 and 2011. Positive relationships were found between some activities and health as well as other activities related to ill health. The results suggest an increased focus on the activities that have positive relationships with health in order to promote health among children.

The study investigated clinical and social changes during an 18-month follow-up period in a group (n = 76) of schizophrenic outpatients admitted to a newly implemented outpatient psychosis team. Changes related to level of contact with the psychosis team were also examined as well as aspects of the content of the treatment interventions and work situation from a staff perspective. Structured face-to-face interviews with the patients were performed at baseline and after 18 months. The Camberwell Assessment of Need instrument, the Lancashire Quality of Life Profile and the Interview Schedule for Social Interaction were used on both interview occasions along with Global Assessment of Functioning Scale and Brief Psychiatric Rating Scale. Thematic open-ended questions were used in staff interviews. Psychiatric symptoms, number of needs and number of met needs decreased, and perceived quality of life improved for the total sample during the follow-up period. Patients only in contact with a psychiatrist in the psychosis team improved more in symptoms and spent fewer days in hospital during follow-up time compared with those who had combined psychiatric and supportive contacts, and were also more satisfied with their medication. Patients with a combined contact deteriorated in psychosocial functioning compared with the group only in contact with a psychiatrist. Some of the elements in treatment interventions and work situation as well as hindrances in providing community-based care adapted to the patients' needs were identified. Community-based psychiatric services, to a larger extent, need to embrace evidence-based interventions and to perform regular, structured and comprehensive need assessments in order to ensure the effectiveness of interventions. Attention should be paid to staff motivation and education as well as to providing practical guidelines, supervision and support.

This article provides a review of Finnish nursing research between 1958 and 1995. It is based on an analysis of the articles published in the Finnish Yearbook of Nursing from 1958-1988, in Nursing Science (Hoitotiede) from 1989-1995 as well as all licentiate and doctoral theses in nursing. The overview describes the content, sources of information and level of analysis in the works concerned.

Quantitative research on Therapeutic Touch (TT), published in referred nursing journals from 1985 to 1995, is reviewed. Therapeutic Touch is defined by Dolores Krieger, the founder of this nursing intervention. The authors of this Integrative Review examine what is known and not known to date in order to facilitate appropriate application of this modality in practice, and to offer recommendations for future research. Critical characteristics of eleven quantitative studies are identified and analyzed. These characteristics include: author/year/journal/title; study purpose (hypotheses); background/literature review/conceptual citations; sample selection method; study design/random assignment; independent variable/length of treatment/control and confounders; dependent variables/measurements; outcomes; study limitations; and implications for future research. After reviewing the studies, it is concluded that there is evidence to support the practice of Therapeutic Touch for the reduction of pain or anxiety. There is clearly a lack of congruity between the research statement, conceptual framework, operational definition of TT and the findings. This incongruity is discussed and incorporated in the recommendations for future research including outcome, theory-generating and theory-testing research.

Nursing, occupational therapy and physiotherapy are new as areas of research in the Nordic countries. Scandinavian Journal of Caring Sciences, the first scientific journal based in the Nordic countries for these research areas was established in 1987. In this article the first five volumes of the journal are reviewed. The study revealed a growing number of manuscripts submitted and an increase of pages per volume. Most articles came from nurses in Sweden. However, other disciplines were represented and papers came from all the Nordic countries and also from countries outside Scandinavia. In most articles patients were studied and both quantitative and qualitative approaches were used.

The Cambridge Worry Scale (CWS) is an instrument including 16 items measuring women's major worries during pregnancy. The aim of the study was to test the scale, translated into Swedish, on pregnant women in Stockholm. We also wanted to explore whether these women were worried about any item not included in the scale. An additional aim was to study possible variation in women's worries related to gestational week. Two hundred women were recruited. The average age was 31 years and 56% were primiparas. Gestational age ranged from 8 to 42 weeks, with a median of 28 weeks. The reliability of the scale was satisfactory (Cronbach's alpha coefficient 0.81). The major worries were about the baby's health, giving birth and miscarriage. These items, all related to pregnancy outcomes, were followed by worries about financial matters. An additional concern not included in the scale was about the maternity services in Stockholm, i.e. that the hospital would be overbooked, the staff being too busy or the medical safety not being guaranteed. Few women worried about their relationship with their partner or if he would be present at birth. Some of the items showed a pattern with a period of less worry in midpregnancy.

The aim of this work is to study the 10 year trends in the use and projected use of internet for health purposes in Norway. This includes more detailed analyses of changes in latter years, current uses, valuation as source of health information, reported effects and projected developments. Surveys on the use of the internet for health purposes have been conducted in Norway in the years 2000, 2001, 2003, 2005 and 2007. Representative samples were drawn from the population, and interviews were conducted by poll agencies using telephone (CATI). Internet use for health purposes in the Norwegian population has increased dramatically over the last 7 years from 19% in 2000 to 67% in 2007. If this trend continues, we estimate that 84% of the Norwegian population will be using internet for health purposes by the year 2010. Reading about health or illness is the most common activity, and the rated importance of the internet as a source of health information is increasing. The internet is also used more for ordering medicines and other health-related products. Forty-four per cent of those having used the internet for health purposes reported having searched for lifestyle-related information, and 40% reported having felt inspired to change health behaviour. The internet is an important source of health information, which is likely to increase in importance in the years to come. This study further underlines the potential of internet use for health promoting purposes, as well as the potential for exacerbating social disparities in health.

Nursing and caring research has followed various paths in different countries and there are diverse views regarding the central phenomena in nursing science. An overview of Nordic nursing and caring science from 1974 to 2000 revealed that conceptualizations and design of enquiry differed. It therefore was of interest to investigate the overall picture regarding more recent and present doctoral dissertations on this subject. The aim of this study was to investigate the locus of interest and the content of current nursing and caring research in Nordic doctoral dissertations within the field presented during 2003. A total of 26 doctoral dissertations were read and studied. The analysis was inspired by Kim's metaparadigmatic typology of four domains for structuring nursing knowledge. The investigation shows that the research in these dissertations, with some exceptions, was oriented towards phenomena belonging to the client domain (18 dissertations). Less knowledge has been gained in the client-nurse (two dissertations); four dissertations were categorized within the practice domain and environment domain includes two dissertations. The research conducted was primarily oriented towards pragmatic aspects and the practical application of knowledge, whereas basic research aiming at defining an autonomous science is exceptional. This means that scientific knowledge regarding and forming the discipline's unique perspective and value system could still be in evolution. A combination of a carefully and well-designed research practice, reflecting the need to further research and investigate new theoretical regions would appear to constitute the direction forward.

The tsunami catastrophe, 26th December 2004, is one of a number of catastrophes that has stricken mankind. Climate reports forecast that natural disasters will increase in number in the future. Research on human suffering after a major catastrophe, using a caring science perspective, is scarce. The aim of the study was to explore the meaning of suffering and relieved suffering of survivors of the tsunami catastrophe, 26th December 2004. An explorative study design, inspired by the French philosopher Paul Ricoeur's hermeneutic-phenomenology, was used. Interviews made by the Swedish Television (SVT) in connection with the 1 year anniversary were carried out on site in the disaster area and in Sweden. The text analysis revealed four main themes: 'An incomprehensible event', 'A heavy burden', 'Help that helps', and to 'Being changed in a changed life situation'. The findings were mainly interpreted in light of Paul Ricoeur's thinking on suffering, quilt, forgiveness, time and narrative. The first year after the loss of loved ones in the tsunami catastrophe, 2004, was like starting an inner as well as an outer journey. This journey was experienced as living with the heavy burden of an incomprehensible event. Help that helped was mediated by consolers who endured the suffering of the other. An 'enduring courage' is a key moral virtue to encounter the alienation of the sufferer and how it in turn alienates from the sufferer. It is also important to recognize that the complexity of the world of those who have lost loved ones in major catastrophes includes possibilities for reconciliation with the loss. The reconciliation creates hope that opens up for being changed in a changed life situation.

Basic stimulation (BS) is a multimodal approach used in the intensive care unit (ICU) to help patients to perceive, move, communicate and learn. The concept was developed in Germany in the 1970s to help multi-handicapped children. It was adapted to nursing in the 1980s, and to critical care nursing in the 1990s. Little is known about the use of BS outside of Germany although it has been gaining momentum in German-speaking countries as well as Scandinavia. The aim of the present study is to describe the extent and application of BS at Danish ICUs in 2006. The study had a prospective, descriptive, qualitative, multicentre design. Data were generated from key-informant telephone interviews (n = 10). This study has shown that BS is dependent upon the personal interest of individual nurses. At most units the concept is rarely used, or used by only few practitioners, for only few patients, or only few of the elements of the technique are applied. The tenets of BS are similar to those of conventional nursing, and in some cases to health care in general. The concept shows promising potential for critical care nursing. It has, however, been introduced unsystematically at Danish ICUs and needs more management support, systematic implementation and clinical research.

The aim of this study was to gain a deeper understanding of effective coping in physical disability and/or chronic illness. Twenty-six well-adjusted adults with various disabilities were interviewed. The interviews focused on how they perceived they had managed to master problems encountered by their disability and their personal views about how one should act and think to manage a life with a disability. The protocols were content analysed according to grounded theory. Five categories were extracted--self-trust, problem-reducing actions, change of values, social trust and minimization. These categories clustered around two broader bipolar constructs--acknowledgement of reality vs. creation of hope and trust in oneself vs. trust in others. The different themes of coping complemented each other and tended to be used in different contexts in a flexible manner. Both the extracted categories and the core concepts have been extensively described in the coping literature, supporting their validity. The importance of understanding coping processes from the disabled's point of view is discussed.

A range of scales is available to measure health-related quality of life. Recently, established quality of life scales have been translated for use in a wide range of Western and non-Western cultures. One of the most widely used health-related quality of life scales for use with children is the PedsQL™ 4.0. In this paper, we describe the process of translating this scale into Arabic and establishing its reliability and validity. This paper has three aims: first, to explain the process of translating the PedsQL™ (4.0) self- and proxy-reports for the ages 8-12 and 13-18, from English into Arabic; second, to assess the reliability of the new Arabic version of the scale and third, to assess its validity. The scale was translated from English to Arabic and back-translated to ensure accuracy. The Arabic version was administered to healthy children and those with cancer and a range of chronic illnesses in Jordan. Statistical methods were used to test the psychometric properties (reliability and validity) of the Arabic version of the PedsQL™ (4.0) and its ability to discriminate between children in the above groups. Cronbach's alpha coefficients for child self- and parent proxy-reports exceeded 0.7 for the total scores, health summary scores and psychological health summary scores. Testing for discriminant validity showed that the healthy (control) group had a higher health-related quality of life than children and young people with cancer and chronic illness. The children with chronic illnesses had the lowest scores for physical, emotional and school functioning. Initial testing of the Arabic version of the PedsQL™ (4.0) suggests that the scale has satisfactory psychometric properties.

Scand J Caring Sci; 2010; 24; 693–699 The experience of being 30–45 years of age and depending on haemodialysis treatment: a phenomenological study The aim of this study was to describe how haemodialysis (HD) patients, between 30 and 45 years of age, experience their dependence on HD treatment. Nine patients undergoing HD treatment were interviewed. The transcribed texts were analysed according to Giorgi′s four basic principles. Being between 30 and 45 years of age and needing HD treatment meant experiencing a total lack of freedom, which was illuminated through the sub-themes: a sense of fear, dependency on caregivers, time lost in dialysis, feelings of loneliness and the stress of being on the waiting list for a new kidney. The participants felt that being dependent on HD treatment was ‘not a real life’ and that they were experiencing a double life of sorts: the life of dialysis versus their ordinary life outside treatment. The dependency on HD treatment was also expressed as a feeling that life ‘stood still.’ The results also indicate that the participants expected to encounter competent healthcare professionals, and they emphasised the importance of providing support for younger HD patients by focusing on their ability to cope with their life situation.

The purpose of the study was to assess the reliability of the specific multiple sclerosis quality of life (MSQOL-54) instrument, which contains 54 items measuring quality of life, among Finnish multiple sclerosis (MS) patients. Nursing professionals evaluated the clarity and comprehensibility of the translated instrument, after which it was pilot-tested. The data were collected through a questionnaire survey in the spring 2004. Persons diagnosed with MS in 1999-2001 filled in the questionnaire (n = 100). The response percentage was 81%. The structural validity of the MSQOL-54 instrument was evaluated with factor analysis and the generic 15D quality of life instrument. The internal consistency of the instrument was measured with Cronbach's alpha, correlations and item analysis. According to the results, the structural validity of MSQOL-54 was good, and factor analysis yielded a clear-cut factorial model. More than half of the correlations between the comparable items of the 15D and MSQOL-54 instruments were moderate or better. The internal consistency of MSQOL-54 can hence be considered quite good: Cronbach's alpha coefficients calculated for the factors and their items ranged within 0.33-0.89. The alpha coefficient calculated for the whole instrument was 0.84. The internal consistency of MSQOL-54 was further confirmed by the results of an item analysis, which showed the correlation coefficients between the items of the different dimensions to be good (0.31-0.81). On the basis of the test results, the MSQOL-54 instrument is fairly reliable and suitable for assessing the health-related quality of life of MS patients. The reliability of MSQOL-54 should be evaluated further by a longitudinal study design in the future.

Background: An increasing number of women survive breast cancer and a majority return to work. However, findings based on mean values may conceal individual processes that need to be better understood to discuss meaningful rehabilitation. Aim: The purpose of this study is to describe the sick-leave pattern of a group of Swedish women with primary breast cancer but foremost to explore their ideas about what motivates and discourages their return to work. Method: Fifty-six women were repeatedly interviewed over a period of 18-24 months. Interview sections that clearly illustrated the women's experiences and ideas about work were categorized using the comparative similarities-differences technique. Findings: The average length of sick leave was 410 days (range 0-942). Six months after the first day of sick leave, 29% worked at least their previous service grade. At 12 months, 55% and at 18 months 57% did so. Those treated with chemotherapy had in average more than twice as large sick leave as those who did not. Three categories emerged. 'Motives for not returning to work' consists of four subcategories: 'I'm still too fragile to return to work'; 'My workplace is a discouraging place'; 'I took an opportunity to pause' and 'I've lost the taste for work'. 'Motives for returning' consists of two sub-categories: 'Work generates and structures my everyday life' and 'I miss my workplace'. Finally, 'Transition in work approach' reflects a changed approach to work. Conclusion: The meaning of work varies over time, but first and foremost work was regarded as an important part of the healing process as it restores the disruption of everyday life. Guidelines cannot be reduced to a linear relationship with biomedical variables but the individual context of everyday life must be considered.

In order to explore the manner in which parenthood was discussed in midwifery consultations, 58 video-recorded consultations were analysed. A content analysis revealed a variety of topics concerning conversation on parenthood--topics of an intimate nature and discussions from a societal perspective. Parenthood was not of primary importance in visits, which were mostly directed by the midwives. A phenomenological hermeneutic analysis of the meaning of being a mother revealed a complex and difficult situation of being both needed and dependent. The meaning of being a father revealed a struggle between distancing from and closeness to the child. The mate relationship was indicated as important and under strain. The metaphor of the 'spiders web', where the mother is the spider with the child mostly on her back, the father entering the web on her terms, summarizes the understanding. The results from this study could provide a basis for reflection on the status of the topic of parenthood, on the meaning of being a mother and a father disclosed in the consultations, and ultimately on the organization of ante- and postnatal midwifery care.

Zest for life refers to being satisfied with life and having the energy and courage to look for new experiences. Research into zest for life among older people is scarce, even though it is an important topic. Similarly related concepts such as life satisfaction, quality of life and purpose in life have received more attention. The aim of this study was to investigate zest for life and factors and variables associated with zest for life among 65- and 75-year-olds. A descriptive cross-sectional design was used, employing data from a cross-sectional survey in Northern Finland and Sweden with a total of 3372 respondents. Sociodemographic data were gathered: social contacts; helping relatives; activities; involvement in society; health; use of social services; economic situation; ageism; crises in life; and well-being. Logistic regression analysis was employed to examine independent factors associated with zest for life. A total of 2854 respondents (nearly 85%) reported having zest for life, with only 47 (1.4%) having no zest for life. Several factors were significantly associated with zest for life. Using logistic regression analysis, the following factors were found to be determinants of zest for life: no diseases (OR = 9.1), general health (OR = 6.1), not discriminated against due to age (OR = 5.4), no crises in life last year (OR = 7.0), experienced depression never/seldom (OR = 88.4) and experienced meaning in life (OR = 10.4). In general, 65- and 75-year-olds in Finland and Sweden have a zest for life. Even though the study sample shows that only a small number of respondents have no zest for life, zest for life is a concept worth investigating in that there exists a strong association between no zest for life and depression. Physical and psychological health and well-being are important determinates of zest for life and, seemingly, a determinate for successful ageing.

Women suffer more chronic pain in most Western countries than men, with considerable consequences for the sufferers. The aim of this phenomenological research was to study self-reported needs of women in chronic pain. The data consisted of ten in-depth interviews, which lasted from 60 to 120 minutes each, with five women in chronic pain, aged 36-53. Twelve needs were identified in the study, which were categorized into three clusters of needs or major quests: The quest to learn to live with the pain, which involves the need for diagnosis; the need to find effective treatment and keep the pain tolerable; the need for helpful advice and information and the need to take care of self and for a different pace and a new life pattern. The quest for support, caring and connection which involves the need for someone close who cares; the need to be connected to others and have someone to care for; the need for practical support e.g. financial support and household assistance and the need for professional support and caring. Finally, the quest for normalcy which involves the need to avoid the sick role and maintain a sense of dignity; the need to focus on personal strengths and prevent discouragement and depression; the need to be involved in decision-making regarding own care and treatment and the need to participate in family and social activities to fight isolation and loneliness. The overriding theme in all these quests is the quest for well-being; physically, mentally, emotionally and socially. Conflicting needs created five major dilemmas in the women's lives. Women in chronic pain may be seen in any clinical setting and health professionals need to be able to recognize their needs in order to be able to give effective care, to cooperate with them and empower them.

The ability of 37 urinary incontinent 85-year old men and women to perform the 48-h pad test in their home environment was studied. Assessment of the magnitude of urinary incontinence by the 48-h pad test was compared with a subjective assessment, performed by the men and women themselves. Twenty-eight of the 37 men and women successfully performed the 48-h pad test. Early signs of dementia and defective vision were the main reasons for not completing the test successfully. The six women who considered their urinary incontinence to be slight had a maximum leakage per pad of 5.3 +/- 1.4 g. The corresponding figure for women with moderate incontinence was 48.8 +/- 12.3 g. None of the women considered their incontinence to be severe, even though eight of the women had a leakage per pad of greater than 30 g. Six men considered their incontinence to be moderate (25.0 +/- 8.1 g) and one man considered his incontinence to be severe (31 g/pad). Fourteen of the 28 men and women underestimated the magnitude of their urinary incontinence.

Scand J Caring Sci; 2013; 27; 13–19 Changes in sense of coherence in old age – a 5-year follow-up of the Umeå 85+ study Objective: This study aims to describe the changes in sense of coherence (SOC) over time and relate these changes to negative life events among very old people. Design: Prospective and longitudinal study. Subjects: 190 old women and men participated, of whom 56 could be included in the 5-year follow-up. Methods: The mean SOC score from the first and second data collection were compared using a paired sample t-test. The relationship between the index of negative life events and the changes on SOC score between the two data collections was investigate using linear regression. Main outcome measures: Antonovsky’s SOC scale and an index of negative life events including severe physical and mental diseases, various losses as losses of spouses, cognitive and functional ability. Result: For the whole group of subjects (n = 56), the SOC scores was higher (70.1 vs. 73.7, p = 0.029) at the second point measure. The most common negative life events at follow-up were loss of independence in activities in daily living and decrease in cognitive function. A significant correlation between the index of negative life events and changes in SOC over 5 years was found (p = 0.025). The more negative life events, the more decrease in SOC. Conclusion: We concluded that there is a risk of decreased SOC and thereby quality of life when negative life events accumulate among very old people. Nursing interventions might play an important role for maintaining and perhaps strengthening SOC among old people exposed to negative life events.

The aim of the present study was to investigate how abdominal aortic aneurysm (AAA) affects the patient's functional status, health and well-being. Forty-two consecutive patients at a university clinic were included. Twenty were operated on and 22 were on regular, conservative check-ups. The patients answered questionnaires regarding perceived functional status (Sickness Impact Profile, SIP), general health (Health Index, HI) and psychological well-being. Two reference groups were used. The non-operated patients scored significantly worse for functional status on the psycho-social subscale than the operated patients. In comparison with the reference group they had the worst scores for functional status on the overall SIP scale and the physical, eating and home-management scales. Regarding the HI, there was no difference between the patient groups themselves, but as a whole they had significantly lower scores than the reference group. Thus, the patients perceived their well-being as worse than a healthy reference group. In their attitudes to well-being, the non-operated patients, were significantly less hopeful than the operated patients. It is obvious that asymptomatic AAA has a significant effect on the patient's self-perceived, functional status and well-being, irrespective of the surgical or conservative management.

In this article, abduction is discussed as a possible way of developing an epistemology for an autonomous caring science based on an ontology that requires deeper understanding of the world of caring. The intention is to elicit a more distinct caring-scientific pattern of knowledge based on the innermost core and historical conditions of caring. Abduction makes it possible to perceive connections on a deeper level and to penetrate in a way that reveals a richness of meaning, reflecting the true being in the dynamic process which is expressed in clinical reality. In the tradition of knowledge developed by Peirce, a synthesis of Hume's and Kant's tradition of knowledge, abduction is a fundamental idea. Peirce sees abduction as an operation of thought in which the recognition of underlying patterns makes a complex reality comprehensible. We regard the triad of abduction, induction and deduction as the basis for developing a caring-scientific epistemology where abduction makes a synthesizing abstraction possible and may implement understanding of deeper patterns.

Aim: This study presents the results of an interpretative research synthesis undertaken to explore the essence of love when encountering suffering. The idea of caring as an expression of love and compassion belongs with ideas that have shaped caring for hundreds of years. Love and suffering are the core concepts in caring science and thus demand a basic research approach. Methods: The synthesis was undertaken by the interpretation of 15 articles focusing on love in different aspects, but within a caring science perspective. The research process was guided by a hermeneutical perspective with an abductive approach. Results: The substance of love, when encountering suffering, reveals itself in three themes: love as a holy power, love as fundamental for being and love as an ethical act, which are to be found, respectively, within three dimensions: love as holiness, love as a communion and love as an art. Love is a holy power and encompasses everything; it is the well of strength that heals. No human can exist without love: this points to the ethical responsibility one has as a neighbour. In the ethical act, love is evident in concrete caring actions. Conclusions: The core of the substance of love within the three dimensions can be understood as agape. Agape connects and mirrors the dimensions, while at the same time it is clear that agape stems from and moves towards holiness, enabling love to be the ethical foundation when encountering suffering. Through the dimensions of love as communion and love as an art agape intertwine with eros forming caritas enabling the human being to move towards the dimension of holiness, which signifies becoming through suffering.

The aim of this study was to increase the understanding of caring from a transcultural perspective and to develop the first outline of a theory. The theoretical perspective includes Eriksson’s theory of caritative caring. Texts on caring by the transcultural theorists, including Campinha-Bacote, Kim-Godwin, Leininger and Ray, are analysed using content analysis. The overall theme that resulted from this analysis was that caring is a complex whole. Three main categories of caring emerged: inner caring, outer caring and the goal of caring. Inner caring consists of caring is a relationship, and caring and culture are seen in different dimensions. Outer caring refers to caring affected by educational, administrative and social and other structures. The goal of caring consists of caring leading to change towards health and well-being. The main categories include categories and subcategories that are compared with Eriksson’s theory of caritative caring. A model for intercultural caring is generated abductively. Caring and culture appear in three dimensions: caring as ontology independent of context; caring as a phenomenon emphasised differently in different cultures; caring as nursing care activities is unique. Caring alleviates suffering and leads to health and well-being. This model describes caring from an intercultural perspective as a mutual but asymmetric relationship between the nurse and the patient, including the patient’s family and community. The patient’s cultural background and acculturation influence caring. The cultural background, cultural competence and organisation of the nurse also influence caring. Caring is seen as a complex whole. This study integrates Campinha-Bacote’s, Kim-Godwin’s, Leininger’s and Ray’s views of caring with Eriksson’s caritative caring and presents caring from a transcultural perspective in a new way as a model for intercultural caring, which can benefit nursing care, education, research and administration.

To compare nurses' and physicians' documentation of geriatric issues and explore double documentation and undocumented areas of importance in an acute care setting in two Nordic countries. 158 participants, aged 75+, of whom the Minimum Data Set for Acute Care (MDS-AC) instrument was conducted at admission and from which 56 variables were taken in comparison with notes from patient records documented by nurses and/or physicians in two acute care hospitals, in Finland and Iceland. Documentation of the impairment of personal Activities of Daily Living (ADL) was missing in 40-60% of the nurses' reports and 80-97% of the physician's reports. Even poorer was the documentation of the impairment of Instrumental Activities of Daily Living (IADL), of which 75% was not reported by the nurses and 85-96% by the physicians. Cognitive function was recorded in only 30-40% of the cases. The traditional patient record in acute care setting lacks several variables of functional abilities of the older patients. Nurses took more responsibility in the documentation of functional abilities, compared with physicians, but they could improve. Using a standardized instrument such as the MDS-AC can improve documentation and make a basis for a clearer delineation in responsibilities for documentation between nurses and physicians and thereby improve outcome of care.

The proportion of individuals with dementia is increasing in all kinds of institutions. Specialised day hospitals are now being developed as an alternative to long term care for the demented. Twelve day hospital wards, with 312 individuals suffering from dementia, were included in a study aiming to assess functional abilities and frequencies of participation in different activities. Eighty-nine per cent of the day hospital patients could be classified as having a dementia disease. Seventy-eight per cent of the population were dependent on some kind of help from a caregiver in the performance of ADL activities. The most common occupations that could be seen in the programmes were physical activities, entertainment, and personal care activities. The activities were often undertaken as large group activities, often including more than ten patients. The functional abilities that characterise the population are comparable with those of the population living in pensioners' service blocks with full board.

Background: Few studies have explored experiences and needs in relation to an induced medical abortion with the final treatment at home. Objective: To explore women’s and men’s experiences and needs related to care in the context of a home abortion as well as to elicit their views on contraception and prevention of unwanted pregnancies. Method: Qualitative interviews were carried out with 24 women and 13 men who had experienced a home abortion; they took place in Sweden during 2009/10. Results: Two overarching themes were identified: Autonomy– the decision to undergo an abortion and the choice of method were well considered by the woman, supported by the partner. The home environment increased their privacy and control, which helped them freely express and share their emotions. They were motivated to avoid a subsequent abortion and considered it an individual responsibility; however, contraceptive follow-up visits were rare. Dependence– a desire to be treated with empathy and respect by care providers and to receive adequate information. In the prevention of unwanted pregnancies, financial resources, improved communication/education and subsidized contraceptives were considered important. Conclusion: Home abortion increases autonomy, and women and partners demonstrate self-care ability. This autonomy, however, is related to dependence: a desire to be treated with empathy and respect on equal terms and to receive adequate information tailored to their self-care needs. Routines in abortion care should be continuously evaluated to ensure care satisfaction, safety and security as well as contraceptive adherence.

The aim of the study was to illuminate meanings of having had an induced abortion among young Swedish women. Narrative interviews were conducted with ten 18-20-year-old women 2-6 weeks after a medical or surgical abortion in the sixth to twelfth week of pregnancy. Data were analysed according to a phenomenological hermeneutic method. The study disclosed a multitude of complex meanings in the young women's lived experiences of induced abortion. Four themes were revealed: having cared for and protected the unimagined pregnancy, taking the life of my child-to-be with pain, being sensitive to the approval of others and imagining the taken away child-to-be. The results are discussed in light of Nussbaum's theory of development ethics. The young women's ability to be responsible for their choices regarding their own welfare and others' well-being in a life cycle perspective was disclosed, despite the pain inherent in the responsibility of taking the life of their own child-to-be. The young women's narratives were replete with ethical reasoning regarding existential matters related to their responsibility of choosing between induced abortion and parenthood and how to live their lives with this experience. Health-care professionals could promote young women's capability to be responsible, as well as the development of trust in their own fertility and constructive relationships with significant others. In the development of the prevention of unintended pregnancies and the sexual education of young people in Sweden existential dimensions of undergoing an abortion should be given attention.

In the last two decades family life and family planning have developed in a similar way in different European countries although legal and social background factors were very different in the past. Countries like Italy and Sweden are bipolar when compared. In this study nursing students' attitudes towards abortion and family planning in Italy and Sweden are described, to identify general characteristics of students that could be of interest to compare and to identify reasons for approval and/or disapproval of abortion. Some social characteristics of the students are similar, like fathers' profession/activity. Italian nursing students are more religious. Some factual knowledge is low in both samples. The nursing student's feelings, attitudes towards abortion are expressed differently in the countries. Many Italian students believe abortion is justified only on medical grounds, Swedish students indicate psychological effects as the most likely consequence both for woman and for man.

Although abortions are common, few researchers have explored the experiences of women related to abortions. The aim of this qualitative study was to analyse women's experiences of induced abortion from a feminist perspective. Five women aged 19-33 years were interviewed about 1 month after their abortion. The interviews were analysed using thematic content analysis from which the following themes were identified: experiences connected with the decision-making process, experiences connected with the abortion and experiences after the abortion. Childhood experiences of divided families, financial problems, being too young, and an insecure partnership influenced the women's decision to have an abortion. Ambivalence about abortion was strongly expressed throughout the process. Despite positive attitudes towards abortion in general, the women had negative attitudes towards their own abortion. They described receiving most support from their mothers and friends, in the decision-making process, and least from their partners. After the abortion the women gained a feeling of maturity and experience although their ambivalence persisted. One conclusion drawn from our study is that nurses and midwives need to be aware of women's complex experiences with abortions in order to support and empower women who seek an abortion.

Scand J Caring Sci; 2012 The experiences of parents of children with severe autism in connection with their children's anaesthetics, in the presence and absence of the perioperative dialogue: a hermeneutic study The aim of this study was to obtain an understanding of what parents of children with severe autism experience in connection with their child's anaesthetics, in the presence and absence of the perioperative dialogue. Twelve parents who had experi ence of their child receiving anaesthetics on one or more occasions took part in this study, in which anaesthesia care was organized as a perioperative dialogue. Data were collected by means of conversational interviews, and the text was interpreted using a hermeneutic approach. The hermeneutic text interpretation led to a new understanding based on the knowledge that in the absence of the perioperative dialogue, previous anaesthetics had meant the suffering of care by the following: a hopeless struggle, unspeakable suffering and a disgraceful scenario. However, continuity in the perioperative dialogue provided to be a way out of the suffering by being received by warm hands, being received by a known face and a subtle interplay between the child and nurse. Although health and well-being may be unobtainable goals in this special context of care, the findings provided ample descriptions of the positive effects of the perioperative dialogue, which is all the more valuable when dealing with children who will need repeated anaesthetics in the future.

Socio-emotional well-being, established through nurturing relationships and community experiences, enables children and adults to evolve into caring, nonviolent, emotionally healthy citizens. This paper analyses purposefully selected development texts, authored by three prominent contributors of socio-economic development discourse: the United Nations, the World Bank and the International Monetary Fund. On the basis of a socio-emotional capacity development framework that draws from research produced in the areas of developmental psychology, biopsychology, brain research and peace psychology, the study evaluates texts' tendencies to make socio-emotionally conducive -- or neglectful -- programme recommendations. The study finds that United Nations conference reports indirectly acknowledge the relevance for socio-emotional enablement and protection, in the context of discussions related to human and children's rights, education or women's empowerment. However, they only marginally discuss the need to foster socio-emotional well-being as a human capacity development rationale per se. The International Monetary Fund, while acknowledging responsibility for the social conduciveness of macro-economic development interventions, does not address socio-emotional capacity development issues. The World Bank's strategic plan and other strategy papers touch on issues of socio-emotional capacity development only tangentially. The study concludes that the discourse communities authoring the selected development texts largely ignore the question of socio-emotional capacity development. Their discourses 'background' discussions about the kind and nature of social structures necessary for nurturing socio-emotional enablement. Developmental psychologists are challenged to 'infect' socio-economic development discourse by calling for the effective integration of the theme of socio-emotional well-being into socio-economic development publications.

The purpose of the present study was to quantify factors which contribute to the absenteeism of nursing personnel and affect staffing patterns. Absenteeism in a general hospital was studied for the period 1975-1990 in relation to the number and level of nursing personnel, the number of discharged patients in the same period, and the existing relevant policy. The variables were analyzed by the multiple regression method having an initial estimator the existing situation in 1990 and what is expected for the year 2000. The results showed that the mean value days of absenteeism for each registered and assistant nurse in 1975 was 22.4 days and in 1990, 51.9 days, sickness raised from 12.6 days in 1975 to 16.6 in 1990, maternity from 9.1 in 1975 to 25.3 in 1990, educational leave for registered nurses was 0.02 in 1975 and 3.8 in 1990 and for assistants 2.1 in 1985 and 17.3 in 1990 due to the new policy, and social fringe benefits raised from 0.71 days in 1975 to 3.65 in 1990. The expected rate of absenteeism by the year 2000 will be 67 to 83 days per person, an increase by 56% in relation to 1990 data.

Introduction: Care culture is an important contextual factor in care practice. Care culture refers to a process of creating meaning out of tradition, horizon and bildung. The care culture is often taken into consideration in situations that go beyond the everyday routine, such as cases of abuse. In Sweden, health care professionals are obliged to document and report any suspected bad conditions. Although the reports have the potential to communicate underlying values and assumptions about the care culture, such studies have not been performed. Aim: The aim of this study was to understand how elderly care abuse in institutions could be understood from a care culture perspective. Design and methods: A hermeneutic documentary analysis was conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. The hermeneutic analysis followed a four-stage process: selecting and reading the text, setting out the context, closing the hermeneutic circle, and finally creating a conceptual bridge towards a critical understanding from a phenomenological lifeworld perspective. Findings: The care of the elderly in the municipality was based on a social culture that placed residents' needs at the centre. Following routines were considered important in preventing mistreatment and were intended to ensure that all patients were treated fairly and equally. Care was described as task oriented and often lacking in interpersonal relations. From a phenomenological lifeworld perspective, it was interpreted that in the municipalities' care of the elderly, there was a focus on elderly people's freedom at the expense of the vulnerability aspects of well-being. Conclusion: Raising awareness of the care culture underlying abuse could help to improve understanding of care practice. Change may be only possible when reflected on the existing perspectives underpinning the care culture, and integrate them into a broader framework for caring.

Swedish general practitioners’ awareness of elderly patients at risk of or actually suffering from elder abuse The aim of this study was to describe the awareness among Swedish general practitioners (GPs) of elderly patients at risk of or suffering from abuse during a 12-month period. A questionnaire was sent to 110 GPs working in one regional health care district in Sweden, and 59% answered and returned the questionnaire. Seventy-seven per cent of the GPs reported having one patient at risk of abuse and or neglect, and 25% were aware of patients who were subjected to verified or suspected elder abuse. Risk situations commonly involved patients with dementia, carers with problems of their own or who felt angry about the burden of caring, or paid carers who were unable to meet the needs of the elderly person. There were GPs who had contact with colleagues, district nurses and others, as well as those who had few or no contacts at all. It is important to take seriously the large number of GPs who have elderly patients in situations where there is a risk of abuse or neglect. If elder abuse is not primarily a medical problem – it is essential that there should be a clearly identified authority to which GPs can refer cases.

Routine screening for intimate partner abuse (IPA) has been recommended within health-care settings. However, the instruments and methods that are most effective in detecting abuse continues to be debated in the literature. To evaluate the effectiveness of two screening procedures/methods, a self-reporting questionnaire and an interview, in detecting women abuse within an emergency department (ED) and a high-risk prenatal care clinic (HRPCC). Comparison was made related to missing data based on the frequency of missing data. Cross-sectional design was used in the study. Data were collected at one time in 2006, over a period of 7 months, from 101 women seeking health-care services at an ED and 107 pregnant women in their first trimester attending a HRPCC. Two methods were used, a self-reporting instrument and a face-to-face interview with a nurse or a midwife to compare the frequency of women's disclosure of abuse. A variety of prior and current abuse experiences were disclosed by each method. The women however disclosed physical abuse more often in the face-to-face interview. The women at the ED disclosed emotional and sexual abuse by an intimate partner more often when using the self-reporting instrument; but the women at the HRPCC disclosed the same ratio of emotional and sexual abuse regardless of the method used. The face-to-face interview had fewer missing data regarding disclosure of abuse. Contradictory to what has previously been reported in the literature, there were no clear-cut results found regarding which of the methods were more effective in revealing abuse; rather, for some of the women, disclosure was based on a combination of the two methods used and the type of abuse inquired about. Implications might focus on using different methods within different clinical settings, e.g. face-to-face interviews at an ED, but questionnaire(s) at a HRPCC; or by using the mixed methods approach within the same clinical setting. Such a decision should however be based on the purpose of screening for women abuse and on how and in what way clinicians and researchers would intervene with the women.

Scand J Caring Sci; 2013; 27; 422–432 Repressed and silent suffering: consequences of childhood sexual abuse for women’s health and well-being Research results indicate that psychological trauma in childhood caused by child sexual abuse can have serious and widespread consequences for health and well-being. The purpose of this study was to examine the consequences of childhood sexual abuse for women’s health and well-being. The research methodology was phenomenology. Seven women with a history of childhood sexual abuse were interviewed twice with 1–6 months interval. For all the women, the abuse started when they were between 4 and 5. All of them were repeatedly violated and traumatized ever since then and were even still being victimized at the time of the interviews. The main result of the study is that time does not heal all wounds. All the women described great repressed and silent suffering in all aspects of life, and the abuse is still seriously affecting them and their loved ones. As children, they had learning problems, experienced bullying and had unexplained physical symptoms. In adulthood, they have been suffering multiple physical and psychological symptoms: five of them have fibromyalgia; all of them have been suffering chronic and widespread pain; they have all been dealing with depression and difficulty with close connections, and they all have trouble trusting others. Because they were kids, they have been using the health service to a great extent but without adequate help. It is important for health professionals to know the symptoms and consequences of childhood sexual abuse to be able to respond to adult survivors in a supportive and caring way. More effective therapeutic measures have to be developed to decrease their suffering.

This study aimed at describing cases of elder abuse reported by witnesses, intervention offered and opinions of further intervention strategies. Home service personnel from various parts of Sweden reported 97 cases. The abused person was a women in 75% of the cases. Many of the abused persons were physically and psychologically handicapped. In most of the cases the perpetrator was a spouse or a child and in one third of the cases they had a caregiving responsibility. Psychological abuse together with financial exploitation was most frequently reported. The perpetrators' possibilities to profit financially from the abused and the family conflicts were commonly reported to be contributory causes. In 75% of the cases intervention was offered. The Swedish welfare system has no specific intervention strategies in case of abuse of the elderly and therefore more possibilities to intervene and more research concerning intervention are needed.

Previous studies indicate that childhood sexual abuse can have extensive and serious consequences. The aim of this research was to do a qualitative study of the consequences of childhood sexual abuse for Icelandic mens health and well-being. Phenomenology was the methodological approach of the study. Totally 14 interviews were conducted, two per individual, and analysed based on the Vancouver School of Phenomenology. The main results of the study showed that the men describe deep and almost unbearable suffering, affecting their entire life, of which there is no alleviation in sight. The men have lived in repressed silence most of their lives and have come close to taking their own lives. What stopped them from committing suicide was revealing to others what happened to them which set them free in a way. The men experienced fear- or rage-based shock at the time of the trauma and most of them endured the attack by dissociation, disconnecting psyche and body and have difficulties reconnecting. They had extremely difficult childhoods, living with indisposition, bullying, learning difficulties and behavioural problems. Some have, from a young age, numbed themselves with alcohol and elicit drugs. They have suffered psychologically and physically and have had relational and sexual intimacy problems. The consequences of the abuse surfaced either immediately after the shock or many years later and developed into complex post-traumatic stress disorder. Because of perceived societal prejudice, it was hard for the men to seek help. This shows the great need for professionals to be alert to the possible consequences of childhood sexual abuse in their practice to reverse the damaging consequences on their health and well-being. We conclude that living in repressed silence after a trauma, like childhood sexual abuse, can be dangerous for the health, well-being and indeed the very life of the survivor.

To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat. Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated. Concept analysis as developed by Walker and Avant. The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat. Abuse in health care is defined by patients' subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients' perspective, and patient satisfaction does not offer room for patients' abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon. Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.

The aim of the present study was to assess the trustworthiness of previously reported stories about elder abuse narrated by 21 district nurses (DNs) regarded as witnesses. Firstly, the stories were coded as to whether they were based on direct observation, hearsay or a mixture, and whether there were whole stories or story fragments. Secondly, they were coded and classified regarding a modification of the characteristics of reality developed from statement reality analysis. The DNs' single stories matched most of the characteristics. The results indicate that the DNs' stories are a reliable account of a personally experienced real event. Witnesses' stories are important sources in revealing phenomena, such as elder abuse. It also seems important to develop usable methods further.

We aimed to investigate which factors make a mentor mother support programme for abused women successful. We used semi-structured interviews with abused women and focus group discussions with the mentor mothers to evaluate their experiences and needs within a mentor support programme (MeMoSA). Fourteen abused women were interviewed 6 months after the support programme ended. Mentor mothers participated in two focus group discussions. Abused women emphasised that nonjudgmental listening, equivalence, involvement and bonding are important factors for successful support. Mentor mothers described that empathy, availability, persistence and advocacy fitted the needs of women best to empower them and help them to cope with their violent situation at home. A safe place to meet each other was also an important factor. A good relationship, tailored support provided by home visiting, advocacy and safety are required to effectively help abused women. MeMoSA, a home-visiting support programme, is a promising valuable new support programme in primary care for abused women.