The study reported in this paper focused on nursing students' learning and, in particular, their integration of caring science in theory and practice. An educational model incorporating educational drama was developed for implementation in three different teaching contexts within the nursing and midwifery study programmes at a Swedish college. A central aim was to understand the dynamics of educational drama in the healthcare context and its impact on learning and teaching. Using a phenomenological approach, seventeen students and six teachers were interviewed and their experience of drama as an educational method explored.

The research findings illustrate the meaning of learning and teaching that is sensitive to students' lifeworld experiences. In order to be a successful method for closing the gap between caring science theory and practice, not only the educational drama, but teaching in general, must be anchored in the lived world of the students - that is, their experiences of health and care. While embodied reflection, as a key factor in integrating theory and practice, was shown to be well supported by educational drama, it was also found that "the method" tends too readily to take over and govern teaching and learning. The findings of this study further indicate how learning in practice and embodied reflection can be supported by the inclusion of well-chosen caring science theory to cast light on caring practice dilemmas.

This chapter gives a Swedish perspective of the Dedicated Education Unit as a learning environment where caring and learning are united in ‘reflective tutoring’ at the University of Borås. The author discusses the overall purpose and structure of the Borås Dedicated Education Units, their scientific and philosophical bases and their focus on patient-centred student learning, reflection and research. She explains the key tutoring roles within the Borås Dedicated Educational Units, the lifeworld perspective of caring science that forms a frame of reference for learning and tutoring there and strategies that affirm and clarify the fundamental principle that caring and learning are parallel and common phenomena. She also describes the challenge for Borås Dedicated Education Units to focus on active patient care development through research, reflects on what is needed for successful tutoring, explains how Dedicated Education Units contain rich possibilities for concretising caring theory into practice and outlines six themes that characterise a Dedicated Education Unit from the students’ and tutors’ perspectives. The chapter concludes with the results of research evaluating the effectiveness of the DEUs as student clinical learning environments and suggests strategies for future development of the Borås Dedicated Education Units. © Springer Science+Business Media Dordrecht 2014.

The learning process in a professional education is characterized by the encounter between the student's own lifeworld and scientific knowledge in theory and in practice. Didactics is needed in order to be able to provide support for this meeting and create the conditions for a reflective process that strengthens the integration between the lifeworld and theoretical and practical knowledge. This paper presents an innovative research project where the aim was to develop a new didactic method in nursing education that makes it possible for the student to encounter both the theoretical caring science structure and the patient's lived experiences in his/her learning process. A reflective group supervision model for nursing students during clinical studies was developed and tested for the duration of two years. A teacher and a nurse led each group. The supervision started in patient narratives the students collected during their clinical practices and brought to the supervision sessions. The narratives were problematized and analysed in the supervision session using caring science terminology with the purpose of creating a unity of theory and lived experiences, thus developing a deeper understanding for the patient's situation and need. During the project, data were collected and analysed phenomenologically in order to develop knowledge of the students' reflection and learning when using the supervision model. The result shows that the students, with the help of this didactic method, have developed a better understanding of the patient and that they have had good use of the theoretical caring science in creating this understanding. They have learned to reflect more systematically and the examination has become more realistic to them as it is now carried out in a patient context. However, in order to reach these results some prerequisites are required. These can be summarized as the necessity of recognizing the students' lifeworld in the supervision process.

Scientific knowledge is characterized by abstract descriptions and structures, which are not identical to the lived reality. Scientific knowledge cannot directly be applied on the lived existence, without being transformed and adjusted to the individual’s very complex lifeworld. Learning in caring contexts is an encounter between the scientific knowledge of caring and the learner’s lifeworld. This encounter needs a support that has the potential to bring caring science to life and to start an intertwining process with the lifeworld that creates embodied knowledge. Lifeworld didactics are built on an approach about learning as an individual process and that learning takes its point of departure in the learner’s previous experiences, which accompanies the learning process. The challenges within lifeworld didactics are to be open and sensitive to the learner’s lifeworld and with tact support the development of a reflective attitude in the learning process. Lifeworld didactics strategies are of crucial importance in different caring contexts. This symposium presents three lifeworld led phenomenological research projects that have focused on acquiring caring science knowledge in caring contexts, more precisely it is the encounter between caring science and the lifeworld. The research is within the framework of lifeworld didactics, but the three projects each have a special focus.

To support care for patients in an adequate way, Caring science theory and nursing practice need to be intertwined to bridge problematic dualisms such as mind and body, sense and sensibility, theory and practice, learning and caring. The overall aim in caring is to support wellbeing and to strengthen health and how this is achieved has been discussed extensively. However ways of overcoming such dualistic understandings are needed to pave the way for a care that is up to the task of responding to human possibilities and vulnerabilities within the complexity of existence.

In supporting patients, we argue that a range of aspects, inter-relational, intellectual, emotional and embodied need to be evoked and reflected upon by students as a beginning foundation for the incorporation of, and the intertwining of Caring science theory and practice. This intertwining draws on knowledge for ‘the head’, ‘the heart’, ‘the hand’ (Galvin & Todres, 2013) and can develop and support a particular sensibility and sensitivity both of which are needed within clinical and learning contexts.

In this presentation we will show the importance of a solid theoretical foundation drawn from Husserl’s lifeworld theory and theory of intentionality, Merleau-Ponty’s later philosophy concerning how everything is intertwined in existence, as well as Gadamer’s ideas about shared understandings and Gendlin’s work on embodied relational understanding. While we have drawn from all these phenomenological perspectives, we will show how they serve as a coherent direction for overcoming the dualistic consequences of ‘splits’ such as, between human and world, illness and well-being , caring and technology, learning and caring, youth and old age, life and death and so on (Dahlberg et al., 2009).

Such existential ways of understanding and well considered ‘didactic tools’ are needed to support this concern. We will share a number of illustrations from the lifeworld led care and education theme within EACS to contribute to such developments:

• Embodied interpretations shared as poems (Galvin & Todres, 2011)
• Using films to support the understanding of Caring science theory and practice (Hörberg, Ozolins & Ekebergh, 2011; Hörberg & Ozolins, 2012)
• Learning through students’ creating poems from their responses to film (Hörberg, Ozolins & Galvin)
• The intertwining of caring and learning in clinical settings illustrated through two examples: firstly, a ‘developing and learning care unit’ (Ekebergh, 2009, 2011; Holst & Hörberg, 2012, 2013) and secondly, as a student led health clinic (Ozolins & Elmqvist & Hörberg, 2013) both supported by structures specifically from the lifeworld perspective.

This paper could serve reflection on how to integrate Caring science theory with practice in order to develop new curricula and practice to take care of the pending dualisms and other obscuring influences, such as 21st century organisational structures and demands that are problematic in research, learning and caring.

Prehospital emergency care includes the care and treatment of patients prior to them reaching hospital. This is generally a field for the ambulance services, but in many cases firemen or police can be the ones to provide the first responses. The aim of this study was to describe and understand experiences of being the first responder on the scene of an accident, as described by policemen, firemen and ambulance staff. A lifeworld perspective was used in four different traumatic situations from southern Sweden. The data consisted of 13 unstructured interviews with first responders. The phenomenological analysis showed that experiences of being the first responder on the scene of an accident is expectations of doing a systematic course of action, dressed in the role of a hero, and at the same time being genuine in an interpersonal encounter. This entails a continuous movement between ‘being’ and ‘doing’. It is not a question of either – or, instead everything is to be understood in relation to each other at the same time. Five constituents further described the variations of the phenomenon; a feeling of security in the uncertainty, a distanced closeness to the injured person, one moment in an eternity, cross-border cooperation within distinct borders and a need to make the implicit explicit. This finding highlights the importance of using policemen and firemen in doing life support measures while waiting for the ambulance staff, and would in turn increase the importance of the relationship between the different professionals on the scene of an accident.

Aims and objectives.  Describe and understand the patient’s first encounter in emergency care at the emergency department, as experienced by the patient, next of kin and first providers from different professions.

Background.  The emergency department is most often described as having high levels of satisfaction with the quality of care delivered. Although the patients appreciate clinical competence, quick assessment and technical skills, a close connection between patient satisfaction and vulnerability has been shown.

Design.  A lifeworld research perspective was used in four different situations at the emergency department.

Methods.  The data consisted of 14 open-ended interviews with patients, next of kin and first providers.

Results.  The analysis showed that narratives of the past, present and future characterises the encounter where mutual narratives form a foundation for those involved in the encounter. Five constituents further described the variations; vague rules and conflicting expectations in the encounter, an encounter with the biological body, ‘courtesy encounters’, isolated in a timeless encounter, striving for meaning in the encounter.

Discussion.  Instead of expecting the patients to know the unwritten rules of the emergency department, the first providers could give clear information about expected waiting times and what to expect in the encounter. The challenge is to make a meaningful comprehensible context for all involved which can be generated in the interpersonal encounter.

Relevance to clinical practice.  The findings highlight the importance of disclosing the rules of the game by means of giving clear information which would give possibilities for the patient to maintain control, for strengthening the nurse’s role as the patients’ advocate and for strengthening the effort for an emergency department to become more of a learning organisation.

A common focus in research studies within the Emergency Department (ED) is physician patient relations, experiences of the triage model and nurses´ experiences of caring. Little has, however, been written about different first providers´ experiences of working on the “front line” at the ED. The aim of this study was to describe and understand experiences of being the first provider on the “front line” at the ED, as expressed by nurse assistants, registered nurses and physicians. A reflective lifeworld research approach was used in four different caring situations. The data consisted of eight open-ended interviews with first providers. The analysis showed that being the first provider on the “front line” at the ED entails a continuous movement between providing and responding through performing “life-saving” actions and at the same time create a good relationship with the patient and the next of kin. Five constituents further described the variations of the phenomenon. The readiness to save lives creates a perceived stress of time pressure and the first providers adopt different strategies to cope with the work. Instead of leaving the first providers to find their own way to cope with the complex situation, there are needs for a redesigning of the internal work process within ED organizations.

This research aims to deepen knowledge whether caring and learning are an intertwined phenomenon in Dedicated Educational Units (DEU). The context is psychiatric and orthopaedic care, and the research is based on caring science.The research question is this: What characterizes the relationship between caring and learning in a DEU? This will be illuminated from three perspectives; the student, supervisor and patient perspectives.The question for the student is this: What is it like to learn the nursing profession by caring for patients on a DEU? The question for the supervisor is this: What is it like to supervise nursing students on a DEU? And the final question is directed at the patient: What is it like to be cared for by nursing students in a DEU?The underpinning philosophical and theoretical perspectives are lifeworld theory, caring science and its didactics.The aim of this project is to develop a supervision model that views caring and learning as an intertwined concept with the potential to support students‟ learning processes as well as patients‟ caring processes.

Background

It is crucial for patients to be met by understanding in their vulnerability, to be treated by competence that ensure adequate care and met with an encouraging attitude to participate in their health process. They meet professional careers as well as students, but nevertheless the aim for caring is the same: to provide good and secure care for the patients, all in line with a caring science approach. A limit amount of studies illuminate patients’ experiences of receiving care from student nurses.

Aim

The aim was to describe how patients perceived being cared for by student nurses, in a clinical context

Method

The study has been performed with a Reflective Lifeworld Research approach founded on phenomenology. 11 lifeworld interviews were conducted with patients, recently discharged from an orthopedic Dedicated Education Unit. Data have been analyzed for meanings.

Results

Patients perceive that they are being carried along on the students' learning process like a journey together. This is characterized by a fluctuation between stable and unstable care from the students. Along this journey, patients are in need of a mutual invitation to participation, of genuine encounters, and essential support.

Conclusion

The patient-student-supervisor relationship is of importance for patients’ experience of being cared for by student nurses in a clinical setting. Genuine encounters between patient and student must be identified and can be stimulated by didactic support and reflection grounded in caring science with a lifeworld perspective. Supervisors have to support to both students and patients in order to create a safe environment in which caring and learning are intertwined. Students require patients in their learning process but patients’ vulnerability, need for participation, genuine encounters and essential support, must be taken into account.

The purpose of this study is to describe how patients perceive being cared for by student nurses, in a clinical context in the form of a Dedicated Education Unit (DEU). The study has been performed with a Reflective Lifeworld Research (RLR) approach grounded in phenomenology. Lifeworld interviews were conducted with patients who had received care from student nurses on an orthopaedic dedicated education unit (DEU) and data have been analysed for meanings. The findings reveal how patients experience to be carried along as a part of the students' learning process. This is described in more detail via the constituents: a mutual invitation to participe, the importance of genuine encounters, and essential support. Patients experience both a stable and a less stable care in a learning environment and it is thus essential for them to be invited to be a part of both the students’ learning process and their own health process. The findings also highlight the key role of the supervisors for patients’ sense of security. Finally there are indications that concepts such as DEU with a lifeworld-led didactic, based on reflection on both the patients’ stories and the students’ experiences, can create learning environments that support patients’ health processes and also students’ learning processes.

Background: Clinical studies in nursing education ought to create conditions for the students to link theory to praxis.Previous research in this field focuses on the gap between theory and practice, learning environments, supervision andreflection connected to caring and learning. In addition there are studies that propose the concept of learning and caring asintertwined. The aim of this study is to describe how caring and learning is intertwined from a student perspective.Methods: The study was carried out using Reflective Lifeworld Research (RLR) with a phenomenological approach.Lifeworld interviews were conducted with students after their clinical placement on a Dedicated Education Unit (DEU).Results: The essential meaning is a movement where caring and learning fall into place which appears in an atmospherefilled with appealing challenges, but has to be sensitive to the students’ readiness. The atmosphere depends on their senseof security and how they experience confirming and affirming responses. Encountering the patient means that the studentscan gain a sense of the whole and the theory falls into place. The results also highlight how the student, in this atmosphere,has a desire to find a new role in a personal style.Conclusions: The study emphasizes the importance of supporting the students in understanding learning and caring asintertwined and not separated. A dualistic approach could harm the students’ aim to get the knowledge embodied. Thisholistic perspective requires a reflective attitude on caring and learning and has to be further developed in the didactics andsupervision.

Supervising student nurses in clinical praxis entails dealing with both caring and learning aspects. There is a dearth of research focusing on both the caring and learning aspects in supervision. The present study describes how caring and learning is intertwined in supervision. The study was performed with a Reflective Lifeworld Research approach and analyzed phenomenologically for meanings. Eight interviews were conducted with supervisors on an orthopedic-dedicated education unit. The findings reveal how supervisors constantly move in order to be either close to or standing back, adjusting to the students’ and the patients’ needs. This is described in more detail via the constituents: handling responsibility in constant movement, participating in a new and different way, coexisting with students creates meaning and development. The findings show that a reflective attitude in supervision, clear structure for daily activities, and a lifeworld-led didactics can promote a learning and caring environment. Supervisors’ demanding task requires pauses in order to maintain motivation among supervisors. A mutual link between supervisors, students and patients is crucial in order to create an environment where caring and learning are intertwined.

Background: Managers in clinical education units (CEUs) have the responsibility to facilitate evidence-based environments for both caring and learning. Promoting such environments might be challenging in times of financial constraints and organisation changes.

Objective: The purpose of this study was to describe how managers experience their responsibility to support the caring and learning environments in CEUs.

Methods: The study method followed the principles of Reflective Lifeworld Research (RLR) grounded in a phenomenological approach. The study was conducted at a hospital in Southern Sweden. Ten first- and second-line managers responsible for CEUs were interviewed. The interviews were conducted as reflective dialogues using an open, and bridled approach.

Results: The results show that clinical education unit managers regard the responsibility to support caring and learning environments as a challenging experience, elucidated in three themes: (1) to have or to take responsibility; (2) cooperation that supports and challenges; and (3) bringing it all together— a daily struggle.

Conclusions: In conclusion, the managers of CEUs need to be aware of the importance of common theoretical grounds for caring and learning. Caring and learning are more likely to be intertwined when responsibility is taken, when collaboration between actors is characterised by respect and when an awareness of the importance of reflection is present. Awareness of the importance of creating opportunities for reflection and mutual collaboration among the different actors involved could lead to improvements in nursing education and, therefore, improved patient care.

Learning in caring contexts could be illustrated as an encounter between the scientific knowledge of caring and thelearner’s lifeworld. This encounter needs a support that has the potential to bring caring science to life and to start anintertwining process with the lifeworld that creates embodied knowledge. The aim of this article is to illustrate themeaning of this encounter with help of a theoretical foundation and two examples of research projects with a reflective lifeworld research approach (RLR) founded on phenomenology. Both examples describe the student nurses’ perspective.One illustrates promoting learning through lifeworld-led supervision in pairs of students. The other illustrates learning environments that bridges the gap between theory and practice. These two examples show how the intertwining of caring science theory with lived experience required a certain learning and caring atmosphere that is open and sensitive for the lifeworld. In conclusion, lifeworld-led learning is more than learning per se. Lifeworld theory as a basis for supporting students’ learning could provide both a broadened and deepened understanding of the meaning of learning and also a greater understanding of how to support students’ learning.

Our general purpose is to show how a philosophically oriented theoretical foundation, drawn from a lifeworld perspective can serve as a coherent direction for caring practices in education. We argue that both caring and learning share the same ontological foundation and point to this intertwining from a philosophical perspective. We proceed by illustrating shared epistemological ground through some novel educational practices in the professional preparation of carers. Beginning in a phenomenologically oriented philosophical foundation, we will first unfold what this means in the practice of caring, and secondly what it means for education and learning to care in humanly sensitive ways. We then share some ways that may be valuable in supporting learning and health that provides a basis for an existential understanding. We argue that existential understanding may offer a way to bridge the categorisations in contemporary health care that flow from problematic dualisms such as mind and body, illness and well-being, theory and practice, caring and learning. Ways of overcoming such dualistic splits and new existential understandings are needed to pave the way for a care that is up to the task of responding to both human possibilities and vulnerabilities, within the complexity of existence. As such, we argue that caring and learning are to be understood as an intertwined phenomenon of pivotal importance in education of both sensible and sensitive carers. Lifeworld led didactics and reflection, which are seen as the core of learning, constitute an important educational strategy here.

This article describes how caring science can be a helpful foundation for caring practice and what kind of learning supportthat can enable the transformation of caring science into practice. The lifeworld approach is fundamental for both caringand learning. This will be illustrated in two examples from research that show the potential for promoting health and wellbeingas well as the learning process. One example is from a caring context and the other is from a learning context. In thisarticle, learning and caring are understood as parallel processes. We emphasize that learning cannot be separated from lifeand thus caring and education is intertwined with caring science and life. The examples illustrate how an understanding ofthe intertwining can be fruitful in different contexts. The challenge is to implant a lifeworld-based approach on caring andlearning that can lead to strategies that in a more profound way have the potential to strengthen the person’s health andlearning processes.

Coronary heart disease is a major cause of sudden death and morbidity in the developed world, as well as a cause of great suffering. Research within this area has primarily focused symptoms, risk factors and treatment. The aim of this paper was to explore women's experiences following a myocardial infarction (MI). Eight women were interviewed; the interviews were audiotaped and transcribed into text and analysed using a phenomenological approach. To explore the meaning that is experienced in the lived world of the patient a method of reflective lifeworld research, based upon phenomenological epistemology has been used. The results indicate that the body is vital for the women in their lifeworlds. After a MI the patient's natural and unreflective relationship with the body and the lived world is interrupted. Uncertainty about life and death as well as the body is experienced as a suffering in the women's lifeworlds. In relation to this, the women's existence is characterised by an uncertainty and a loss of context. It is through reconciliation with their bodies and their illnesses that the women can achieve a sense of well-being and harmony in life. In that process the women can re-establish a natural relationship with their bodies and lifeworlds.

In this article, the researchers explore women’s experiences of care and health process following a myocardial infarction(MI), with a particular focus on their experiences of well-being and participation. The phenomenon is illuminated from theapproach of reflective lifeworld research, and in order to obtain expressions of the women’s lived experiencephenomenological interviews were conducted. Participation and well-being are described as an experience of beinginvolved in one’s own health process. This entails that the women have the potential to influence and take responsibility fortheir own lives and their own bodies in a meaningful way for them. Participation is a condition for the women to deal withtheir health and their lives, and seems to improve the women’s sense of well-being. At the same time as they sense adependency on the health care professionals, they seek autonomy and a situation where they can find a new balance,including ‘‘the new’’ body and insecurity that the MI has brought with it. However, the findings also show that the women’sparticipation in the process of care and health, and their well-being, is a challenge for health care professionals. When theprofessionals are unable to encounter the women’s need of participation and desire to be met in their existential insecurity,well-being is affected.

Anaesthesia nursing care during regional anaesthesia is characterized by the encounter between the ‘awake’ patient’s own lifeworld and the nurse anaesthetist’s knowledge in theory and in practice. This study aims to present an intraoperative caring model from the patient’s perspective that will facilitate nurse anaesthetists’ (NA) practice to enhance and support the ‘awake’ patient’s intraoperative well-being during surgery under regional anaesthesia. The model is underpinned by a synthesis based on interviews with patients, a philosophical reflection using Merleau-Ponty’s philosophy, and video recordings from orthopaedic surgeries under regional anaesthesia. The model can be used as a tool to encounter awake patients’ existential needs in the intraoperative situation and to further enlighten NAs about the possible impact of their proximity, interaction and communication behaviour in the delivery of intraoperative nursing care. The model can help NAs to access, understand and learn through lived experiences, thereby deepening their professional caring skills. The model is a way to get research knowledge ready for use by NAs to reflect on what gaps need to be filled between what nurses know (research) and do (practice).

Most knee or hip replacement surgery is performed under regional anesthesia, when patients are awake. Previous research has primarily focused on patients' experiences during general anesthesia. The aim of this study was to uncover the meaning of being awake during regional anesthesia and surgery. Nine interviews with patients undergoing knee or hip replacement surgery comprise the data. The phenomenological analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. Four interrelated constituents further elucidated the patients' experiences: balancing between proximity and distance in the operating theater, balancing between having control and being left out, my partly inaccessible body handled by others, and the significant role of the carer. Anesthesia providers and perioperative nurses need to understand the awake patients' intraoperative experiences to support and confirm them when they can no longer experience or have full access to their body.

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau-Ponty. Merleau-Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine-based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mindbodyworld continuum. The core of intraoperative care is to provide support and promote well-being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience.

Purpose: The purpose of this study was to interpret and describe the patient-nurse anesthetist (NA) interaction during regional anesthesia. Design: Video recordings conducted during orthopedic surgery at a surgical clinic in Sweden formed the basis for the study, in which three patients and three NAs participated. Methods: A hermeneutic analysis was conducted on the data. Finding: The findings of the analysis demonstrated that the NA was in either "present" presence or "absent" presence in the awake patient's visual field during surgery. The NA's professional actions at times dominated the patient's existential being in the intraoperative situation. The findings conveyed insights about the patient-NA interaction that open up possibilities for nurses to understand and reflect upon their own practice in an expanded way. Conclusions: Using video recordings for reflections enables development of professional skills that positively influence the care quality for patients during regional anesthesia.

In Sweden, school nurses are part of the School Health Service with the main objective of health promotion to support students' health and attainment of educational goals. The aim in this phenomenological study was to illuminate the experiences of school nurses in promoting the health and well-being of adolescent girls. Seventeen school nurses were interviewed, both in groups and individually, to facilitate personal disclosure and expressions from their lived experiences. To achieve their goal of improving the health of adolescent girls, school nurses require flexibility in their approach and in endeavoring to make a positive difference they experience many challenges. This study concluded that school nurses can tactfully provide adolescent girls with knowledge and health guidance adjusted to individual needs and empowering the individual girl to participate in her own health process.

The aim of this phenomenological study was to describe the phenomenon of health as experienced by adolescent girls in Sweden. Fifteen adolescent girls were interviewed with a focus on what made them feel well in their everyday life. This study reveals that the adolescent girl's health is a complex phenomenon interwoven with their lives. Health arises in meaningful contexts, in an adolescent girl's relations to others as well as in her ability to manage her life. Health is shaped in their everyday life and can be understood as a mood of "being" well that involves actions and practices. The results show that it is important to meet these girls from an open approach in order to support and strengthen their health and well-being. The health of adolescent girls can be supported, and it is a challenge for professionals, particularly school nurses, who meet these girls in everyday life to improve their health.

Background

In research the relationships between parents and their adolescent daughters have been viewed from problem oriented perspectives, usually exploring negative effects and health-related problems. Health and well-being are complex phenomena and knowledge is needed on how parents can support the health and well-being of their daughter.

Objectives

The aim of this study was to illuminate parents’ experiences of supporting the health and well-being of their adolescent girls.

Methods

A descriptive design with a phenomenological approach including interviews, individually or in group with ten mothers and five fathers was conducted.

Results

Supporting the health and well-being of adolescent girls was experienced as challenging. The parents needed to altering the parenting role: from being the one who had previously set the limits they needed to rethink and be available for support. In this process interplay, communication and trust were important to support the health and well-being of the girls in an efficient way. This meaning was further illuminated by four constituents: Balancing the need for control, maintaining a trusting relationship, interplay to facilitate their daughters’ transition to independence, and an ambiguous parenting role.

Conclusions

This study highlights the importance of parents being involved in the everyday life of their adolescent daughter to support her health and well-being. The parents’ ability to contribute to the health and well-being of their girl seemed in this study dependent on their ability to communicate and alter the parenting role with sensitivity to the lifeworld of the adolescent girl.

Adolescence is described by the Swedish National Board of Health and Welfare as the healthiest period in life. However, adolescent girls differ in that they self-report that their health decreases with age. The aim of this hermeneutical study was to describe the meaning of living conditions in relation to adolescent girls' health. Guided by principles of reflective lifeworld research, 15 interviews with adolescent girls were analysed. The result section consists of four narratives with their existential interpretations illustrating different ways of approaching living conditions and their meaning for health and wellbeing. The narratives are: Approaching everyday life in a balanced way-feeling harmonious; approaching everyday life with ambiguity-feeling confused; approaching everyday life as an intellectual project-striving for control; approaching everyday life as a struggle-feeling forlorn. In addition, a comprehensive understanding was developed by using the lifeworld dimensions: lived body, lived room, lived time, and lived relations. These dimensions may deepen the understanding of important parts of those living conditions which are meaningful for the girls' health and well-being. By using the dimensions, complex living conditions have been explored and the meaning of different parts clarified. The girls' thoughts and feelings are often ambiguous and sometimes contradictory, depending on the situation. The health of adolescent girls needs to be understood against the background of their experiences of living conditions. One way to support their health and well-being seems to be to supply them with forums where they can talk about their living conditions.

The aim of the present study is to explore interpersonal dimensions of the presence of older patients at team meetings.The theoretical foundation of the study is grounded in caring science and lifeworld phenomenology. The results from two empirical studies, that indicated the need for a more in-depth examination of the interpersonal relationships when an older patient is present at a team meeting, were further explicated by philosophical examination in the light of Heidegger and Merleau-Ponty’s philosophy. The empirical studies were performed in a hospital ward for older people, where the traditional rounds had been replaced by a team meeting, to which the patients were invited. The analysis of the general structure and philosophical examination followed the principles of reflective lifeworld research. The philosophical examination is presented in four meaning structures: mood as a force in existence; to exist in a world with others; loneliness in the presence of others;and the lived body as extending. In conclusion, professionals must consider patients’ existential issues in the way they are expressed by the patients. Existence extends beyond the present situation. Accordingly, the team meeting must be seen in a larger context, including the patients’ life as a whole, as well as the ontological and epistemological foundations on which healthcare is based.

This study focused on older patients participating in a team meeting (TM) in a hospital ward in Sweden. A process had taken place on the ward, in which the traditional round had developed into a TM and understanding what participating in a TM means for the older patient is necessary for the development of care that facilitates older patient’s participation. The aim of this study was to describe the caring, as experienced by the older patients on a ward for older persons, with a specific focus on the team meeting. A reflective lifeworld research (RLR) design was used. Fifteen patients, 12 women and three men (mean age of 82 years) were interviewed while they were hospitalized in a hospital ward for older people. In the essential meaning of the phenomenon, the TM is described as being a part of a wider context of both caring and life. The need for hospitalization is an emotional struggle to overcome vulnerability and regain everyday freedom. The way in which the professionals are able to confirm vulnerability and create a caring relationship affects both the struggle for well-being and the possibilities for maintaining dignity. The essence is further explicated through its constituents; Vulnerability limits life; Life is left in the hands of someone else; Life is a whole and Space for existence. The result raises concern about how the care needs to be adjusted to older people’s needs as lived bodies. The encounter between the carer and the patient needs to be developed in order to get away from the view of the patient as object. An expanded vision may open up for existential dimensions of what brings meaning to life. One way, as described by the patients, is via the patient’s life stories, through which the patients can be seen as a whole human being.

Although the importance of patient participation is acknowledged in today’s healthcare, many challenges remain beforepatient participation can become an integral part of care provision. The ward round has traditionally been the forum forcrucial decisions about patient care, but often with limited possibilities for patient participation. As part of the process ofimproving patient participation, the round in the present study has been replaced by a team meeting (TM) to which thepatient has been invited. The aim of this study is to highlight nurses’ experiences of older patients’ participation in TMs.The research process was guided by the principles of phenomenological reflective life world research. Data were collected in a Swedish hospital, in a ward specializing in older patients. Nine nurses, who had invited and planned for a patient toparticipate in TMs and/or had experienced TMs in which patients participated, were interviewed. The essential meaning ofpatient participation in the TM, as experienced by the nurses, is that patient participation can be supported by a saferelationship in which the patient can make his or her voice heard. Participation is challenged by the patients’ vulnerability and by the subordinated role assigned to the patient. The essential meaning is further described by its constituents: ‘‘the need for a guide,’’ ‘‘patient participation challenged by structures,’’ and ‘‘creating space for the whole human being.’’ In conclusion, the nurse plays a core role in guiding the patient in an unfamiliar situation. The meaning of patient participationin the TM needs to be discussed by professionals so that the patient perspective is present.

The aim: To conduct a follow up study to measure registered nurses’ time of direct patientcare after implementation of patientfocused care(PFC).

Background: PFC is an organizational model with the objective to increase both patient participation and health care effectiveness. After areconstruction of wards to single bedrooms in a hospital south of Sweden. PFC was implemented to increase time for direct patientcare inorder to better meet patients’ needs.

Method: Time measured observations were conducted. 20 registered nurses were observed in four different wards at a 525-bed hospital insouth of Sweden after implementation of PFC.

Findings: In a workday of 8,5 hrs, registered nurses spend 6,8 hrs (79,8 %) with work related to patients. Time for directcare was 2 hrs(23,8 %) and time for indirect care was 4,8 hrs (56 %). Indirect care consists of categories such as documentation, report and medical round.

Conclusion: In comparison before implementation of PFC, time for patientrelated care increased by 10,8 %. However, time is spent mainlyat patient indirectcare activities. It is important to also focus on a change of culture in the organization to succeed with an implementationof PFC.

BackgroundThe environment of an intensive care unit (ICU) is, in general, stressful and has an impact on quality of care in terms of patient outcomes and safety. Little is known about nurses' experiences, however, from a phenomenological perspective with regard to the critical care settings as a place for the provision of care for the most critically ill patients and their families. AimThe aim of this study was to explore nurses' lived experiences of ICU bed spaces as a place of care for the critically ill. Design and methodsA combination of qualitative lifeworld interviews and photos-photovoice methodology-was used when collecting data. Fourteen nurses from three different ICUs participated. Data were analysed using a phenomenological reflective lifeworld approach. FindingsAn outer spatial dimension and an inner existential dimension constitute ICU bed spaces. Caring here means being uncompromisingly on call and a commitment to promoting recovery and well-being. The meanings of ICU bed spaces as a place of care comprise observing and being observed, a broken promise, cherishing life, ethical predicament and creating a caring atmosphere. Conclusions and relevance to clinical practiceThe architectural design of the ICU has a great impact on nurses' well-being, work satisfaction and the provision of humanistic care. Nurses need to be involved in the process of planning and building new ICU settings. There is a need for further research to highlight the quality of physical environment and its impact on caring practice.