OBJECTIVE: This study aimed to illuminate meanings of person-centredness as narrated by nursing home managers in nursing homes rated as highly person-centred.
METHODS: A phenomenological hermeneutical approach was used.
METHODS: Twelve nursing home managers in 11 highly person-centred nursing homes in 7 municipalities in Sweden were included in this interview study. The findings were interpreted, reflected and discussed through the lens of Ricoeur.
RESULTS: Meanings of person-centredness could be understand as moving between doing and being through knowing, sensing, sharing and giving for person-centredness. These aspects contributed via knowledge, understanding, interaction and action that involved doing for and being with older persons through these caring dimensions. By moving between doing for, being with and being part of the overall nursing home narrative, knowing, sensing, sharing and giving could support the persons\' identity in different ways. This may also contribute to sense-making, preserving dignity and promoting self-esteem when aiming to provide a good life for older persons in nursing homes, within an ever-present ethical frame.
UNASSIGNED: This study illuminated meanings of person-centredness as narrated by nursing home managers. No patient of public contribution was investigated.

BACKGROUND: Aortic stenosis is the most common valvular disease, and its prevalence is increasing due to the ageing population. Transcatheter aortic valve replacement (TAVR) is the recommended method when treating frail, older patients. Knowledge of what motivates older patients to undergo TAVR is important, in order to meet patients\' expectations.
OBJECTIVE: The study aimed to explore the meaning of older patients\' motivation to undergo TAVR.
METHODS: The design was a qualitative study, analysed using a phenomenological hermeneutic approach. In-depth, semi-structured interviews with open-ended questions were conducted. Participants were selected from a specialist cardiology clinic in Sweden. Eighteen patients, six women and twelve men, aged 66-92, were recruited.
RESULTS: The analysis showed that patients who had agreed to undergo TAVR were deeply affected by their body\'s failure. Before the TAVR procedure, the participants were limited in their daily activities and experienced that their life was on hold. They experienced that they were barely existing. They were aware of their life-threatening condition and were forced to confront death. Yet despite an advanced age, they still had considerable zest for life. It was very important to them to remain independent in everyday life, and fear of becoming dependent had a strong impact on their motivations for undergoing TAVR.
CONCLUSIONS: Older patients\' motivations to undergo TAVR are strongly influenced by their fear of being dependent on others and their zest for life. Health care professionals need to support these patients in setting realistic and personalised goals.
CONCLUSIONS: Person-centered care actions could facilitate patients\' involvement in the decision about TAVR and strenghten patients\' beliefs in their own capabilities, before and after TAVR.

BACKGROUND: Growing care queues, reduced access to care and cancelled surgery are realities for some patients being treated with total hip or knee replacement surgery in Sweden. Most of the patients on the waiting lists have experienced pain and limited motion for a varying period of time, with a negative effect on their everyday lives. Overbooked surgical schedules are already contributing to the lengthy waiting times, but, with the addition of cancellations, longer waiting times will increase still further and may affect patients\' well-being.
METHODS: In the present study, we aimed to illuminate the experience of having planned surgery cancelled, based on narratives from 10 participants. The interview transcriptions were analysed using a phenomenological hermeneutic approach.
RESULTS: The comprehensive analyses revealed that the participants described the agony of being deselected and the additional impression of being excluded. Metaphors of being damaged and feeling physical pain were used and the interpretations referred to the cancellations as unpleasant. Additionally, the important relationship and the trust between the health workers and the patient were negatively affected by the cancellation.
CONCLUSIONS: After the cancellation, the participants expressed being vulnerable and from their perspective the cancelled surgery affected them deeply; in fact, much more than the healthcare workers appeared to understand. Therefore, information around the cancellation must be given respectfully and with dignity, in a dialogue between the patient and the healthcare workers. Taken together, to enable an opportunity to be involved in the continued care. The cancellations should be seen as an interruption, in which the patients\' chance of living a pain-free, active life is postponed.

OBJECTIVE: To explore and gain in-depth understanding of how out-of-hospital cardiac arrest survivors experience the short- and long-term consequences on daily life.
METHODS: A qualitative exploratory design.
METHODS: A purposive sample of 32 survivors of out-of-hospital cardiac arrest. Data from six audiotaped focus group interviews were collected in either November 2018 or in March 2019. Analysis and interpretation of the transcribed texts was performed using a phenomenological-hermeneutic approach guided by Ricoeur for unfolding lived experiences.
RESULTS: Three narratives were identified. The survivors narrated how they in the early phase after the cardiac arrest experienced: (a) \'a fragmented memory at the mercy of the system\'. The analysis further showed how the participants were: (b) \'living in the shadow of anxiety and mixed feelings\' and with the: (c) \'lost sense of self\' up to several years after survival.
CONCLUSIONS: The participants in our study experienced distinct bodily impairments, suffering, and the lost sense of self in the return to daily life from early on to several years after resuscitation. There seem to be an urgent need for an early initiated post-arrest transitional care program led by an expert cardiac arrest nurse. In particular, the healthcare professionals need to pay attention to survivors in employment and with children living at home. Facilitated cardiac arrest peer support groups might minimize the long-term suffering, heighten the self-image, and install a new hope for the future.
CONCLUSIONS: To ease the post-arrest return to daily life for out-of-hospital cardiac arrest survivors it seems important that a transitional care program from the inhospital setting to the community consist of: (a) screening for and education on bodily losses at an early stage, (b) provision of support on the often prolonged emotional reactions, and (c) referring for further individual and targeted psychological and neurological follow-up and rehabilitation if needed.
目的: 探索并深入对医院外心脏骤停幸存者在日常生活中如何经历短期和长期后果的了解。 设计: 定性探索性设计。 方法: 32名医院外心脏骤停幸存者的目的性样本。2018年11月或2019年3月收集了六份焦点小组访谈录音数据。在Ricoeur的指导下, 采用现象学--解释学方法对转录文本进行分析和解释, 以展现生活经验。 结果: 确定了三种讲述: 幸存者讲述了他们在心脏骤停后早期阶段的经历: (a) ‘由系统支配的零碎记忆’。分析进一步显示了参与者的情况为: (b) ‘生活在焦虑和复杂情绪的阴影下’以及 (c) 在生存数年后‘失去自我意识’。 结论: 在我们的研究中, 参与者在从早期复苏到几年后恢复日常生活的过程中经历了明显的身体损伤、痛苦和自我意识的丧失。目前似乎迫切需要一个由心脏骤停专家护士领导的骤停后早期过渡护理项目。特别是, 医疗保健专业人员需要关注就业中的幸存者和家中有儿童的人。促进心脏骤停同伴支持小组可能会减少长期的痛苦, 提高自我形象, 并为未来树立新的希望。 影响: 为了缓解医院外心脏骤停幸存者骤停后恢复日常生活的困难, 从住院到社区的过渡护理计划似乎很重要, 其中包括: (a) 在早期阶段对身体损失进行筛查和教育, (b) 提供对经常性长时间的情绪反应的支持, (c) 如有需要, 可接受进一步的个人和针对性心理和神经方面的随访和康复。.

Sleeping difficulties are increasingly prevalent among adolescents and have negative consequences for their health, well-being, and education. The aim of this study was to illuminate the meanings of adolescents\' lived experiences of sleeping difficulties. The data were obtained from narrative interviews with 16 adolescents aged 14-15 in a Swedish city and were analyzed using the phenomenological hermeneutic method. The findings revealed four themes: feeling dejected when not falling asleep, experiencing the night as a struggle, searching for better sleep, and being affected the next day. The comprehensive understanding illuminates that being an adolescent with sleeping difficulties means it is challenging to go through the night and to cope the next day. It also means a feeling of being trapped by circumstances. As the adolescents\' lived experiences become apparent, the possibility for parents, school nurses, and other professional caregivers to support adolescents\' sleep increases.

OBJECTIVE: To explore perioperative nursing students\' experiences of interprofessional simulation-based learning to gain a deeper understanding of how this educational tool can be used to support students\' learning and enable them to achieve the intended learning outcomes.
BACKGROUND: Despite extensive research, it remains unclear what and how participants learn from interprofessional simulation-based learning. There is a need to specify how interprofessional simulation-based learning should be organised to support and promote learning processes, especially for postgraduate learners. In particular, there seems to be little evidence in the existing literature in the field of educating perioperative nurses, where advanced technical skills and high-quality nursing care are required.
METHODS: The study\'s qualitative and explorative design is reported in accordance with the COREQ guideline.
METHODS: Between May-October 2019, thirty-four perioperative nursing students from four educational institutions participated in six focus group interviews, with four to eight students in each. All participants had previous experience of interprofessional simulation-based learning in acute settings. Data were transcribed verbatim and were then subjected to phenomenological hermeneutical analysis involving three steps: naïve reading, structural analysis and comprehensive understanding.
RESULTS: Three themes were identified the following: customised interprofessional simulation-based learning; reality of the experience of interprofessional simulation-based learning; and preparedness for clinical practice.
CONCLUSIONS: Customised interprofessional simulation-based learning was found to be of value to the participants and reflected their feeling of mental preparedness entering interprofessional simulation-based learning. Furthermore, participants\' experience of reality when using the tool was a key theme that also impacted how prepared participants felt for clinical practice.
CONCLUSIONS: The study findings contribute to the further expansion of interprofessional simulation-based learning in perioperative nursing education as a means of developing students\' professional competence. This is essential knowledge, as professional practitioners must reflect on practice to further enhance that practice and patient safety.

OBJECTIVE: To identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care.
BACKGROUND: An increasingly complex and advanced primary healthcare system requires attention to the extent of nursing competence in municipal services. However, competence in complex and advanced care settings must be explored using perspectives which acknowledge the complexity of nurses\' performance.
METHODS: A phenomenological hermeneutic, qualitative approach with individual in-depth interviews was used. COREQ reporting guidelines have been applied.
METHODS: A sample of eight nurses and two physicians employed in municipal in-patient acute care units (MAUs) were purposively recruited to participate. Data were collected between May and June of 2017. Analysis and interpretation were conducted systematically in three steps: naïve reading, structural analysis and comprehensive understanding.
RESULTS: Two main themes were revealed. The first was the following: \"The meaning of the individual nursing competence\" including the themes \"Having competence in clinical assessments, decision-making, and performing interventions\"; \"Having competence to collaborate, coordinate and facilitate\"; and \"Being committed.\" The second was the following: \"The meaning of environmental and systemic factors for nursing competence,\" included the themes \"Having professional leadership\"; \"Having a sufficiently qualified staff\"; and \"Working in an open, cooperative and professional work environment.\"
CONCLUSIONS: Individual nursing competence in MAUs should include the capability to detect patient deterioration and to care for older patients in a holistic perspective. In addition, the professional environmental culture, supportive leadership and systemic factors seemed to be crucial to success.
CONCLUSIONS: This study illustrates the nurses\' responsibility for older patients\' safety and quality of care in the MAUs. These findings can act as a foundation for the development and adaptation of educational programmes to accommodate requirements for nursing competence in MAUs. The broad perspective of nursing competence can give directions for quality improvements in MAUs.

Caring for children with autism spectrum disorder (ASD) can be a demanding challenge to caregivers. The aim of this study was to learn what caring for children with ASD means to caregivers who live in rural Thailand. A hermeneutic phenomenological approach was used to analyze narrative data from interviews of five caregivers. Three themes emerged: (a) being sensitive to the word autism, (b) being trapped in a tunnel of distress, and (c) being the universe for the child. Healthcare professionals need to be sensitive to the caregivers\' cultural customs in order to meet their expectations in a respectful way.

OBJECTIVE: To explore, describe and understand former patients\' experiences of recovery from self-harm.
BACKGROUND: Previous research shows that a person\'s development towards a more secure self-image, mastery of their emotions, an understanding of what triggers self-harm and mastery of new ways to cope with problems are central to recovery. Recovery from self-harm is still a relatively new field of research.
METHODS: A phenomenological hermeneutical approach.
METHODS: Eight participants were interviewed in 2013. Inclusion criteria were as follows: to have committed no self-harm during the past 2 years, to have experienced recovery and to be 18 or older. We analysed data using a phenomenological hermeneutical method.
RESULTS: The findings resulted in three themes with subthemes. The first theme, the turning point, occurred at the start of the recovery process. Participants learned to choose life, verbally express their inner pain and reconcile with their life histories. In the second theme, coping with everyday life, participants learned how to choose alternative actions instead of self-harm and attend to their basic, physical needs. In the third theme, valuing close relationships and relationships with mental health nurses, participants learned to receive support from close relationships with others and mental health nurses. A tentative model illustrates the comprehensive understanding of the recovery process, described as an individual, prolonged learning process.
CONCLUSIONS: To achieve recovery, persons who self-harm need guidance and knowledge of how to realize a personal learning process. More research is needed on how mental health nurses can support individual transition processes and thereby facilitate recovery.

The aim of this study was to elucidate meanings of balance in everyday life for people with long-term illnesses living at home. People living with long-term illnesses are in need of help and support to manage their daily lives. Twelve adults with extensive needs for help and support were interviewed. A phenomenological hermeneutic interpretation was used to analyse the interview texts. The findings show that balance in everyday life for people with long-term illnesses means striving for independence through care and support in their surroundings. It was also important to be able to choose how their lives would be and to be with others who listened and understood them for who they are. By building a relationship with patients at an early stage of their illnesses, nursing staff have an opportunity to understand what people who are living at home with long-term illnesses need in order to achieve balance in their everyday lives.