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  • 1.
    Afram, Basema
    et al.
    Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
    Verbeek, Hilde
    Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
    Bleijlevens, Michel
    Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
    Challis, David
    University of Manchester, Manchester, England UK.
    Leino-Kilpi, Helena
    University of Turku, Turku, Finland/Turku University Hospital, Turku, Finland.
    Karlsson, Staffan
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Soto, Maria
    Department of Geriatric Medicine, CHU Toulouse University Hospital, France.
    Renom-Guiteras, Anna
    School of Nursing Science, Faculty of Health, University of Witten/Herdecke, Germany.
    Saks, Kai
    Department of Internal Medicine, University of Tartu, Estonia.
    Zabalegui, Adelaida
    Nursing Hospital Clinic of Barcelona, Spain.
    Hamers, Jan
    Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
    Predicting institutional long-term care admission in dementia: a mixed-methods study of informal caregivers’ reports2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, no 6, p. 1351-1362Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate agreement between: (1) expected reasons and actual reasons for admission of people with dementia according to informal caregivers; (2) scores on measurement instruments prior to admission and the actual reasons for admission according to informal caregivers.

    Background: Timely admission of people with dementia is a crucial issue. Information is highly warranted on whether informal caregivers are capable of prior identification of causes of admission and, can thus be considered a reliable prospective source on causes of admission.

    Design: A cohort study among informal caregivers of people with dementia who made a transition to institutional long-term care.

    Methods: Qualitative data on the expected and actual reasons for admission were collected via open-ended questions at baseline and follow-up. Furthermore, at baseline, data were collected using measurement instruments to measure pre-admission characteristics. Interviews took place between November 2010-April 2012. After categorizing the answers, the agreement between the expected and actual reasons was calculated. Furthermore, bivariate associations were calculated between the actual reasons for admission and scores on corresponding measurement instruments.

    Results/Findings: For most informal caregivers, there was agreement between their statements on the expected reason and the actual reason for admission. A third of the caregivers showed no conformity. Bivariate associations showed that there is also agreement between the actual reasons for admission and scores on corresponding measurement instruments.

    Conclusion: Informal caregivers can be considered reliable sources of information regarding what causes the admission of a person with dementia. Professional care should anticipate informal caregivers' statements and collaborate with them to strive for timely and appropriate admission. © 2014 John Wiley & Sons Ltd.

  • 2.
    Ahlstav Mårtensson, Ulrica
    et al.
    Halmstad Hospital, Halmstad, Sweden.
    Erling-Hasselqvist, Nann
    Halmstad Hospital, Halmstad, Sweden.
    Boström, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Differences in pain and nausea in children operated on by Tonsillectomy or Tonsillotomy – a prospective follow-up study2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 4, p. 782-792Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the differences in postoperative pain, nausea and time of discharge in children 3–12 years old after Tonsillectomy or Tonsillotomy at the postanaesthetic care unit, children’s ward and at home. 

    Background: Tonsillectomy involves risk of bleeding, severe postoperative pain and nausea. Tonsillotomy is a less invasive method with lower risk of bleeding, postoperative pain and nausea according to previous studies.

    Design: A prospective, comparative follow-up study design.

    Method: From December 2008–April 2009 following parental agreement, 87 children in the ages 3–12 undergoing Tonsillectomy or Tonsillotomy participated. Visual analogue scale was used for children’s pain and nausea reports.

    Result: Significantly, fewer children operated on by the Tonsillotomy reported postoperative pain ‡ 3 according to the visual analogue scale than children operated on by the Tonsillectomy at the postanaesthetic care unit and the children’s ward. A statistically significant difference of postoperative nausea was only present during the care at the postanaesthetic care unit and children’s ward with fewer Tonsillotomy children reporting nausea ‡ 3. The time of postoperative care was shorter among the Tonsillotomy children in both the postanaesthetic care unit and the children’s ward. Postoperative pain and pain related difficulties in eating after discharge was significantly more present among the Tonsillectomy children compared with the Tonsillotomy children.

    Conclusion: The results of our study showed duration of postoperative pain and nausea in both groups, but indicated that Tonsillotomy is a more favourable alternative than Tonsillectomy in children. © 2012 Blackwell Publishing Ltd.

  • 3.
    Arvidsson, Susann
    et al.
    Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bergman, Stefan
    Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Faculty of Health Care and Nursing, Gjøvik University College, Gjøvik, Norway.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Bengtsson-Tops, Anita
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Experiences of health-promoting self-care in people living with rheumatic diseases2011In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 6, p. 1264-1272Article in journal (Refereed)
    Abstract [en]

    Aim: This paper is a report of a study that explores and describes the meaning of the phenomenon of health-promoting self-care as experienced by people living with rheumatic diseases.

    Background: People with rheumatic diseases estimate health status as low and health belief and health status influence self-care behaviours. Several self-care behaviours are used in the efforts to mitigate the diseases.

    Method: The study had a descriptive phenomenological approach based on a reflective life-world perspective. Data were gathered in 2007 by unstructured open-ended interviews with 12 individuals living with rheumatic diseases.

    Findings: The meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care takes place against a background of continual hope and belief to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three inter-related constituents elucidated their experiences: dialogue, power struggle and choice. Self-care was experienced as dialogues with the body and with the immediate environment. In order to respond to signals from the body, power struggles were required to be entered into when fighting the diseases. Choices were required to be made and things that were beneficial for the body were prioritized.

    Conclusion: In this study, the meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care was a way of life. This meant to be ready to understand and respond to signals from the body. Self-care required dialogues, power struggles and choices. © 2011 Blackwell Publishing Ltd.

  • 4.
    Arvidsson, Susann
    et al.
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Faculty of Health Care and Nursing, Gjøvik University College, Gjøvik, Norway.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Tingström, Pia
    The Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 7, p. 1500-1514Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the effects of a self-care promoting problem-based learning programme for people with rheumatic diseases in terms of health-related quality of life, empowerment, and self-care ability.

    Background: Individuals with rheumatoid arthritis express a great need for education and support in adapting to the disease, but the average qualities of studies about patient education interventions are not high. There is no evidence of long-term benefits of patient education.

    Design: Randomized controlled trial.

    Methods: A randomized controlled design was selected with test at baseline, 1-week and 6-month post-interventions after completed the 1-year programme. The tests consisted of validity and reliability tested instruments. The participants were randomly assigned in spring 2009 to either the experimental group (n = 54) or the control group (n = 148). The programme was running alongside the standard care the participants received at a rheumatology unit. Parametric and non-parametric tests were used in the analyses.

    Results: The participants in the experimental group had statistically significant stronger empowerment after participation in the self-care promoting problem-based learning programme compared with the control group, at the 6-month post-intervention. Approximately, two-thirds of the participants in the experimental group stated that they had implemented lifestyle changes due to the programme.

    Conclusion: The self-care promoting problem-based learning programme enabled people with rheumatic diseases to improve their empowerment compared with the control group. It is important to continue to develop problem-based learning in patient education to find the very best way to use this pedagogical method in rheumatology care. © 2012 Blackwell Publishing Ltd.

  • 5.
    Boström, Barbro
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Sandh, Marie
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Lundberg, Dag
    Halmstad University, School of Social and Health Sciences (HOS).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Cancer-related pain in palliative care: patients' perceptions of pain management2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 45, no 4, p. 410-419Article in journal (Refereed)
    Abstract [en]

    Background: Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. Aim: The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. Method: Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. Findings: Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. Conclusion: The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.

  • 6.
    Brink, Eva
    et al.
    West University, Vänersborg, Sweden .
    Karlson, Björn W.
    AstraZeneca R&D, Mölndal, Sweden.
    Hallberg, Lillemor R-M
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Readjustment 5 months after a first-time myocardial infarction: reorienting the active self2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 53, no 4, p. 403-411Article in journal (Refereed)
    Abstract [en]

    Aim

    This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction.

    Background

    Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood.

    Method

    Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis.

    Findings

    Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping.

    Conclusion

    Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment.

  • 7.
    Broström, Anders
    et al.
    Linköping University.
    Strömberg, Anna
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Patients with congestive heart failure and their conceptions of their sleep situation2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 34, no 4, p. 520-529Article in journal (Refereed)
    Abstract [en]

    Aim:

    To describe, from a nursing perspective, how patients with CHF conceived their sleep situation.

    Background:

    Sleep disturbances are very common in patients with congestive heart failure (CHF). Polysomnographic studies have shown that the total duration of sleep is shorter and the sleep structure disturbed, with frequent arousals and sleep stage changes.

    Method:

    A qualitative descriptive design inspired by a phenomenographic approach was employed. Conceptions were collected through interviews with 20 strategically chosen CHF patients.

    Findings:

    The findings showed that the patients' sleep was affected by their daily activities, the disease itself and cardiac symptoms. The sleep disturbances gave effects such as fatigue, listlessness, loss of concentration and loss of temper. These effects led to a need for daytime sleep, seclusion, counselling and information. Patients handled their sleep disturbances through coping mechanisms related to developed patterns of daily life and through support from their psychosocial environment.

    Conclusions:

    Through an increased awareness of the causes of sleep disturbances in CHF patients, nurses can more effectively meet their caring needs and reduce the psychological stressors that patients develop. Information and education, both to patients and the next of kin, about the disease and the sleep situation, especially good sleeping habits, can help patients to better cope with sleep disturbances.

  • 8.
    Dellve, Lotta
    et al.
    Department of Public Health and Community Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Samuelsson, Lena
    Regional Rehabilitation Centre for Children and Adolescents, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Tallborn, Andreas
    Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fasth, Anders
    Institute for the Health of Woman and Children, Department of Paediatrics, Gothenburg University, Sweden.
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Stress and well-being among parents of children with rare diseases: a prospective intervention study2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 53, no 4, p. 392-402Article in journal (Refereed)
    Abstract [en]

    Aim:

    This paper reports a study to assess stress, well-being and supportive resources experienced by mothers and fathers of children with rare disabilities, and how these variables were affected by an intensive family competence intervention.

    Background:

    Despite diagnosis-specific studies, little overall knowledge exists about life-consequences for families of children with rare disorders.

    Method:

    We used a prospective design with baseline data and two follow-ups (at 6 and 12 months) after an intervention. The intervention aimed at empowering parents in managing their child's disability. Parents from all parts of Sweden visiting a national centre for families of children with rare disabilities were consecutively selected (n = 136 mothers, 108 fathers). Instruments of parental stress, social support, self-rated health, optimism and life satisfaction and perceived physical or psychological strain were used. Stratified analyses were carried out for mothers and fathers, and related to parental demands: single mothers, full-time employment, participation in a parent association, child's age and type of disability.

    Results:

    We found high parental stress, physical and emotional strain among mothers, especially among single mothers. Fathers showed high stress related to incompetence, which decreased after the intervention. Decreased strain was found among full-time working mothers and fathers after the intervention. Parents' perceived knowledge and active coping and mothers' perceived social support were increased at follow-up. Factors related to parents' overall life satisfaction (57–70% explained variance) changed after the intervention, from being more related to internal demands (perceived strain, incompetence and social isolation) to other conditions, such as problems related to spouse, paid work and social network.

    Conclusion:

    Parents, especially fathers and full-time working parents, may benefit from an intensive family competence programme.

  • 9.
    Engström, B.L.
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Women's views of counselling received in connection with breast-feeding after reduction mammoplasty2000In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 32, no 5, p. 1143-1151Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to generate a theoretical model of the experiences of women, who had undergone reduction mammoplasty, of counselling received in connection with breast-feeding. Data were collected through interviews with 12 breast-reduced women who had given birth to a child, and the material was analysed by means of the grounded theory method. Written permission to post notices at the child welfare centres had been obtained from the primary care managers. The women themselves applied for participation in the study. The results showed that their need for counselling from somebody who listened attentively to them and gave advice in connection with breast-feeding, was considerable. The women could have a feeling of self-reliance, ambivalence, acceptance or guilt, depending on the extent to which they perceived to have received counselling from their family members. At the same time, their experiences of the encounter with the nursing staff were of crucial importance. Lack of active listening and counselling from the nursing staff can be counterbalanced by support from relatives. However, when such support is not forthcoming, the nursing staff must be able to support the women in their role of a mother, which requires that education and supervision are given to the staff. The findings of the study can be used as a basis for further research into the need for support of the families concerned.

  • 10.
    Fluur, Christina
    et al.
    Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden.
    Bolse, Kärstin
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Strömberg, Anna
    Division of Nursing Sciences, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Sweden.
    Thylen, Ingela
    Division of Nursing Sciences, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Sweden.
    Spouses’ reflections on Implantable Cardioverter Defibrillator treatment with focus on the future and the end-of-life: a qualitative content analysis2014In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 8, p. 1758-1769Article in journal (Refereed)
    Abstract [en]

    Aim. To explore future reflections of spouses living with an implantable cardioverter defibrillator recipient with focus on the end-of-life phase in an anticipated palliative phase.

    Background. A history of or risk for life-threatening arrhythmias may require an implantable cardioverter defibrillator. Despite the life-saving capacity of the device, eventually life will come to an end. As discussion about preferences of shock therapy at end-of-life phase seldom takes place in advance, the implantable cardioverter defibrillator recipients may face defibrillating shocks in the final weeks of their lives, adding to stress and anxiety in patients and their families.

    Design. Qualitative study with in-depth interviews analysed with a content analysis.

    Methods. Interviews were performed with 18 spouses of medically stable implantable cardioverter defibrillator recipients during 2011–2012.

    Results. The spouses described how they dealt with changes in life and an uncertain future following the implantable cardioverter defibrillator implantation. Six subcategories conceptualized the spouses' concerns: Aspiring for involvement; Managing an altered relationship; Being attentive to warning signs; Worries for deterioration in the partner's health; Waiting for the defibrillating shock; and Death is veiled in silence.

    Conclusion. Despite the partner's serious state of health; terminal illness or death and the role of the device was seldom discussed with healthcare professionals or the implantable cardioverter defibrillator recipient. Open and honest communication was requested as important to support coping with an unpredictable life situation and to reduce worries and uncertainty about the future and end-of-life. © 2013 John Wiley & Sons Ltd.

  • 11.
    Jacobsson, Anna
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Group for Research on health promotion and disease prevention.
    Pihl, Emma
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Group for Research on health promotion and disease prevention.
    Mårtensson, Jan
    Halmstad University, School of Social and Health Sciences (HOS).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Emotions, the meaning of food and heart failure: a grounded theory study2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 46, no 5, p. 514-522Article in journal (Refereed)
    Abstract [en]

    Background:

    Many patients with heart failure have generalized wasting, referred to as cardiac cachexia. This leads to skeletal muscle wasting, impaired mobility, reduced functional capacity and poor prognosis. Patients with heart failure have symptoms that can affect their food intake, for example breathing difficulties, fatigue, nausea, loss of appetite, early feeling of fullness and ascites. These dietary problems and patients' nutritional status, can be significantly improved by means of simple nursing interventions.

    Aim:

    This paper reports a grounded theory study which developed a theoretical model of experiences of food and food intake among patients with heart failure.

    Methods:

    A descriptive and exploratory design, with a grounded theory analysis, was used. Data were collected in 2002 through interviews with 11 patients with heart failure. Findings. Two core categories emerged: emotions and the meaning of food. Psychosocial meaning could be associated with positive feelings of well-being, or negative feelings of sorrow. Physiological meaning could be associated with positive feelings of comfort or negative feelings of burden. Patients' experiences of food and eating changed during the development of the disease. Feelings of fatigue and lack of appetite gave rise to a feeling of deprivation because of missing both eating and the related social environment. This could lead to a loss of personal identity.

    Discussion:

    Although the findings of a qualitative study cannot be generalized, they raise important clinical nursing issues. With increasingly shorter hospital stays, these problems will need to be addressed by community healthcare staff and family carers. Therefore, all healthcare professionals need knowledge about heart disease and information techniques if they are to be able to give appropriate care to this group.

    Conclusion:

    Ignorance about food and eating can easily lead to malnourishment, with an increased risk of the patients falling into a vicious circle. Implications of the study for health care practice and research are identified.

  • 12.
    Johansson, Ingrid
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Hildingh, Cathrine
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Wenneberg, Stig
    Department of Health Sciences, Örebro University, Örebro, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Ahlström, Gerd
    Department of Health Sciences, Örebro University, Örebro, Sweden.
    Theoretical model of coping among relatives of patients in intensive care units: a simultaneous concept analysis2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 56, no 5, p. 463-471Article in journal (Refereed)
    Abstract [en]

    Aim: This paper reports the development of a theoretical model of relatives' coping approaches during the patient's intensive care unit stay and subsequent recovery at home by performing an analysis of concepts generated from two empirically grounded, theoretical studies in this area.

    Background: When supporting relatives of intensive care unit patients, it is important that nurses have access to evidence-based knowledge of relatives' coping approaches during the period of illness and recovery.

    Method: Simultaneous concept analysis was used to refine and combine multiple coping concepts into a theoretical model of coping. The concepts were generated in two previous empirical studies of relatives' coping approaches during mechanically ventilated patients' intensive care unit stays and recovery at home.

    Findings: The theoretical model was developed in 2004–2005 and illustrates the effectiveness of different coping approaches in relation to each other and to social support. Definitions summarizing each coping approach and containing the knowledge gained through the simultaneous concept analysis method were also formulated.

    Conclusion: This middle-range theory of relatives' coping approaches may make a valuable contribution to international intensive care unit nursing practice, especially as it is based on empirical studies and may therefore serve as a basis for the development of future clinical guidelines. However, the theoretical model needs to be empirically validated before it can be used.

  • 13.
    Karlsson, Staffan
    et al.
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Bleijlevens, Michel
    Maastricht University, The Netherlands.
    Roe, Brenda
    Edge Hill University/University of Manchester, UK.
    Saks, Kai
    University of Tartu, Estonia.
    Soto Martin, Maria
    Alzheimer's Disease Research and Clinical Center in Toulouse University Hospital, France.
    Stephan, Astrid
    Witten/Herdecke University, Germany.
    Suhonen, Riita
    University of Turku, Finland.
    Zabalegui, Adelaida
    Hospital Clinic of Barcelona, Spain.
    Hallberg, Ingalill Rahm
    Lund University, Sweden.
    Dementia care in European countries, from the perspective of people with dementia and their caregivers2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, no 6, p. 1405-1416Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate persons with dementia and their informal caregivers' views of inter-sectoral information, communication and collaboration throughout the trajectory of dementia care, in eight European countries.

    Background: Living with dementia and being next of kin to a person with dementia means having to live through stages that have different characteristics, needs, challenges and requirements.

    Design: Qualitative research. Focus groups were conducted in England, Estonia, Finland, France, Germany, The Netherlands, Spain and Sweden.

    Methods: Persons with dementia and their informal caregivers (N = 137) participated in focus group interviews during 2011. Content analysis generated a tentative model of information, communication and collaboration for people with dementia and their caregivers, which was then tested.

    Results: The core finding was that information, communication and collaboration were to be focused on the persons with dementia and the informal caregivers. Entering into the trajectory of the disease and its consequences was addressed as an important point of departure. The relation to professional care required establishing a trusting relationship, tailor-made intervention and a single person or organization to contact. Professional knowledge and commitment, variation in service and care adapted to needs were important.

    Conclusion: As focus of care is on the person with dementia and their informal caregivers, a dyadic approach seems most suitable for dementia care. A trusting relationship and a specific person or organization to contact seem to be indicators of best practice, as does adaptation to the needs of the person with dementia and their informal caregiver. © 2014 John Wiley & Sons Ltd.

  • 14.
    Koslander, Tiburtius
    et al.
    Department of Nursing Health and Culture, University Trollhättan, Uddevalla, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    How the spiritual dimension is addressed in psychiatric patient-nurse relationships2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, no 6, p. 558-566Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports a study describing nurses' conceptions of how the spiritual dimension is addressed in psychiatric patient–nurse relationships.

    Background. In psychiatric care, it is essential that patient–nurse relationships be built on a holistic view. In this context, nursing research shows that there is a lack of integration of the spiritual dimension.

    Method. Twelve strategically selected psychiatric nurses were interviewed and analysed using a phenomenographic approach. The data were collected in 2003.

    Findings. The main findings were three descriptive categories: being a good carer, recognizing the spiritual dimension, and regarding the spiritual dimension as difficult to capture in patient–nurse relationships. The first descriptive category shows that nurses deal with spirituality by behaving as good carers. Those included in the second descriptive category reveal nurses who are aware of patients' spiritual needs and who deal with these needs in different ways. The third descriptive category consists of conceptions revealing lack of knowledge of patients' spiritual needs, both in abstract and real terms.

    Conclusions. Further research is needed to explore how patients describe their own spiritual needs, and how nursing staff can learn to be aware of and understand their own spirituality, thus enabling them to detect, discuss, clarify and deal with the concept of spirituality in patient–nurse relationships.

  • 15.
    Koslander, Tiburtius
    et al.
    Department of Nursing Health and Culture, West University, Vänersborg, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ conceptions of how the spiritual dimension is addressed in mental health care: a qualitative study2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 6, p. 597-604Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports a study to describe patients’ conceptions of how the spiritual dimension is addressed in mental health care.

    Background. Spirituality is a broad concept, and is highly subjective, multidimensional and difficult to define. Spirituality and religiousness are two separate concepts but have several common features. In mental health care, it is essential that nursing care be built on a holistic view, and the spiritual dimension has an important function in nursing care. The notion of spirituality is full of nuances, and in a multi-cultural society patients express their spirituality in different ways.

    Method. Data were collected by interviewing 12 strategically selected patients in mental health care and analysed according to a qualitative method inspired by the phenomenographic approach. The data were collected in 2003 in Sweden.

    Findings. Three descriptive categories emerged: patients wish to have their spiritual needs addressed; patients must see to it that their spiritual needs are addressed; patients lack confidence in nurses with regard to discussing spirituality. The findings show that patients actively sought the assistance of nurses to meet their spiritual needs. They turned their thoughts inwards and found community with other patients, while nurses often avoided addressing the spiritual dimension.

    Conclusion. Nurses should work actively to seek new knowledge about how they can address patients’ spiritual needs. It is also important that there be scope for discussing and reflecting on spiritual questions at the workplace. Additional research is needed to explore how knowledge about spirituality should be implemented in mental health care and nursing education.

  • 16.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Jönköping University, School of Health Sciences, Jönköping, Sweden & Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health Sciences, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Hospital, Oskarström, Sweden.
    Teleman, Annika
    Spenshult Hospital, Oskarström, Sweden.
    Bergman, Stefan
    Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 1, p. 164-175Article in journal (Refereed)
    Abstract [en]

    AIM: To compare and evaluate the treatment outcomes of a nurse-led rheumatology clinic and a rheumatologist-led clinic in patients with low disease activity or in remission who are undergoing biological therapy.

    BACKGROUND: Patients with chronic inflammatory arthritis treated with biological therapy are usually monitored by rheumatologists. Nurse-led rheumatology clinics have been proposed in patients with low disease activity or in remission.

    DESIGN: Randomized controlled trial.

    METHODS: A 12-month follow-up trial was conducted between October 2009 and August 2011, where 107 patients were randomized into two groups with a 6-month follow-up to a nurse-led rheumatology clinic based on person-centred care (intervention group; n = 53) or to a rheumatologist-led clinic (control group; n = 54). The hypothesis was that the nurse-led clinic outcomes would not be inferior to those obtained from a rheumatologist-led clinic at the 12-month follow-up. The primary outcome was disease activity measured by Disease Activity Score 28.

    RESULTS: A total of 47 patients in the intervention group and 50 in the control group completed the 12-month trial. The trial revealed no statistically significant differences between groups in mean change of Disease Activity Score 28, Visual Analogue Scales for pain, the Health Assessment Questionnaire, satisfaction with or confidence in obtaining rheumatology care.

    CONCLUSION: Patients with stable chronic inflammatory arthritis undergoing biological therapy could be monitored by a nurse-led rheumatology clinic without difference in outcome as measured by the Disease Activity Score 28. © 2013 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

  • 17.
    Mårtensson, J.
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Karlsson, J.E.
    Department of Cardiology, Ryhov County Hospital, Jönköping, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Female patients with congestive heart failure: how they conceive their life situation1998In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 28, no 6, p. 1216-1224Article in journal (Refereed)
    Abstract [en]

    Congestive heart failure (CHF) is a significant health problem for women, particularly elderly women. The risk factors for heart failure appear to be different in women than in men, with hypertension and diabetes playing a greater role in women and ischaemic heart disease a greater role in men. The aim of this study was to describe, from a nurse's perspective, how female patients with CHF conceive their life situation, interview questions were designed with a focus on five dimensions: biophysical, socio-cultural, emotional, intellectual and spiritual-existential. A qualitative method was used with a phenomenographic approach, as this approach examines aspects of the surroundings as they are conceived. Five categories emerged in the results: feeling content, feeling a sense of support, feeling a sense of limitation, feeling anxiety and feeling powerless. A sense of limitation regarding working capacity and being able to support those in their surroundings causes patients with CHF to experience anxiety due to feeling insecure about themselves and in relation to their surroundings. This may result in feelings of worthlessness in women with CHF, both concerning their own capacity and the fact that they feel they are a burden to those around them. Through nursing intervention, these patients can receive help to break this vicious circle of feeling limited and powerless. This can be done by encouraging them to verbalize their feelings and set realistic goals and expectations, and by increasing their knowledge and that of their families concerning CHF and its symptoms, with a focus on self-care and existing possibilities. These measures will make it easier for woman with CHF to maintain a hopeful perspective and a sense of control, competence, and self-esteem.

  • 18.
    Mårtensson, J.
    et al.
    Department of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
    Karlsson, J.-E.
    Department of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Male patients with congestive heart failure and their conception of the life situation1997In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 25, no 3, p. 579-586Article in journal (Refereed)
    Abstract [en]

    Patients with congestive heart failure (CHF) are an extensive group in Sweden both with regard to prevalence and number of medical care events. As the age of the population and survival after myocardial infarction are increasing, the incidence of CHF is also on the rise. The aim of this study is to describe, from a nurse's perspective, how male patients with CHF conceive their life situation. Interview questions were designed with a focus on five dimensions: the biophysical, the socio-cultural, the emotional, the intellectual, and the spiritual-existential. A qualitative method was used with a phenomenographic approach as it examines aspects of the surroundings as conceived, In the results, six categories emerged: feeling a belief in the future, gaining awareness, feeling support from the environment, feeling limitation, feeling a lack of energy and feeling resignation. The mental and physical lack of energy which patients feel easily leads to limited working capacity and social activities. This limitation may cause patients with CHF to believe that neither they nor their environment can influence their life situation and there is a risk that these patients become resigned, In order to help them get out of this vicious circle of limitation and resignation, it is important that the nurse teaches them self-care and shows them the possibilities that exist in everyday life, With increased awareness of their life situation, patients may adapt to their CHF and see that it is possible to improve their future themselves.

  • 19.
    Nordgren, Stina
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Patients' perceptions of self-determination as expressed in the context of care2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 35, no 1, p. 117-125Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study was to describe patients' perceptions of how self-determination finds expression in the context of care.

    Background

    Self-determination is an important concept within health care as well as an important patient right. New legislation on patient rights in Sweden and Europe is aimed at increased patient self-determination.

    Design and method

    Data were collected through semi-structured, tape-recorded interviews with 17 strategically chosen patients within somatic care and analysed using a method inspired by phenomenography.

    Results

    The analysis found three descriptive categories of the informants' perceptions: trusting, accepting and a feeling of powerlessness. The patients expressed a great sense of trust and confidence in the care provided and they accepted the health care procedures. At the same time, they expressed a feeling of powerlessness because of not being part of decision-making, as well as lacking knowledge and information about treatment strategies. The patients wished to have the right of more self-determination but lacked the strength and knowledge to be able to influence their own care.

    Conclusions

    Patients' perceptions of self-determination suggest that, in their encounters with the professional care, knowledge is expressed as power. The feeling of a lack of self-determination can be reduced by help and support from a nurse who allocates time for communication in order to learn the patient's needs and reach a mutual understanding.

  • 20.
    Oleni, Magnus
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Johansson, Peter
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Nursing care at night: An evaluation using the night nursing care instrument2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 47, no 1, p. 25-32Article in journal (Refereed)
    Abstract [en]

    Introduction Night nurses carry overall nursing responsibility for approximately half the time that patients spend in hospital. However, there is a paucity of literature that focuses on nursing care provided at night. Aim The aim of this study was to evaluate nursing care provided at night from the perspective of both nurses and patients. Methods The study, which had an evaluative and a comparative design, was carried out using the Night Nursing Care Instrument at a hospital in southern Sweden. Nurses (n = 178) on night duty were consecutively selected, while the patients (n = 356) were selected by convenience sampling. Results The results showed a statistically significant difference between nurses' assessments and patients' perceptions of the nursing care provided at night in nursing interventions (P < 0.0001). In the areas of medical interventions and evaluation, no statistically significant differences were found between nurses and patients. For eight of 11 items, patients reported that they were satisfied (greater than or equal to80%) with the nursing care provided at night. Conclusions These findings suggest that night nurses need to improve their ability to assess patients' needs for nursing care at night. A first step in this direction is for them to become aware of how patients perceive night nursing. As a second step, nurses need to increase their knowledge of which nursing actions promote patients' rest at night.

  • 21.
    Saks, Kai
    et al.
    Department of Internal Medicine, University of Tartu, Estonia.
    Tiit, Ene-Margit
    University of Tartu, Estonia.
    Verbeek, Hilde
    CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands.
    Raamat, Katrin
    Regionaalhaigla, Palliative Care Service, Tallinn, Estonia.
    Armolik, Angelika
    Foundation of Mental Health Care Centre, Tartu, Estonia.
    Leibur, Jelena
    Tallinn Diaconal Hospital of the Estonian Evangelical Lutheran Church, Estonia.
    Meyer, Gabriele
    Medical Faculty, Institute for Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, Germany.
    Zabalegui, Adelaida
    Hospital Clinic of Barcelona, Spain.
    Leino-Kilpi, Helena
    Department of Nursing Science, University of Turku, Finland.
    Karlsson, Staffan
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Soto, Maria
    Geriatrics Department, Gerontopole, Toulouse University Hospital, France.
    Tucker, Sue
    Personal Social Services Research Unit, University of Manchester, UK.
    Most appropriate placement for people with dementia: individual experts' vs. expert groups' decisions in eight European countries2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, no 6, p. 1363-1377Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the extent of variability in individuals' and multidisciplinary groups' decisions about the most appropriate setting in which to support people with dementia in different European countries. Background: Professionals' views of appropriate care depend on care systems, cultural background and professional discipline. It is not known to what extent decisions made by individual experts and multidisciplinary groups coincide. Design: A modified nominal group approach was employed in eight countries (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the UK) as part of the RightTimePlaceCare Project. Methods: Detailed vignettes about 14 typical case types of people with dementia were presented to experts in dementia care (n = 161) during November and December 2012. First, experts recorded their personal judgements about the most appropriate settings (home care, assisted living, care home, nursing home) in which to support each of the depicted individuals. Second, participants worked in small groups to reach joint decisions for the same vignettes. Results: Considerable variation was seen in individuals' recommendations for more than half the case types. Cognitive impairment, functional dependency, living situation and caregiver burden did not differentiate between case types generating high and low degrees of consensus. Group-based decisions were more consistent, but country-specific patterns remained. Conclusions: A multidisciplinary approach would standardize the decisions made about the care needed by people with dementia on the cusp of care home admission. The results suggest that certain individuals could be appropriately diverted from care home entry if suitable community services were available. © 2014 John Wiley & Sons Ltd.

  • 22.
    Verbeek, Hilde
    et al.
    Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands.
    Meyer, Gabriele
    School of Nursing Science, Faculty of Health, Witten/Herdecke University, Germany & Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-University Halle-Wittenberg, Germany.
    Challis, David
    Personal Social Services Research Unit, Faculty of Medical and Human Sciences, University of Manchester, UK.
    Zabalegui, Adelaida
    Fundacíó Privada Clinic per la Recerca Biomedica, Hospital Clinic of Barcelona, Spain.
    Soto, Maria
    Geriatrics Department, INSERM U 1027, Toulouse University Hospital, France.
    Saks, Kai
    Department of Internal Medicine, University of Tartu, Estonia.
    Leino-Kilpi, Helena
    Department of Nursing Science, Faculty of Medicine, University of Turku, University Hospital Turku, Finland.
    Karlsson, Staffan
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Hamers, Jan
    Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands.
    Inter-country exploration of factors associated with admission to long-term institutional dementia care: evidence from the RightTimePlaceCare study2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, no 6, p. 1338-1350Article in journal (Refereed)
    Abstract [en]

    Aim: To explore inter-country variation of factors associated with institutionalization of people with dementia.

    Background: There is an urgent need for evidence on whether factors associated with admission to institutional dementia care are applicable across healthcare systems, as increasing evidence suggests that these factors could be country-specific.

    Design: A prospective cohort study.

    Method: Primary data were collected in eight European countries, at baseline and after 3 months follow-up (November 2010–April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223 patients lived at home and were at risk of institutionalization. Associations between care setting (institution vs. home) and factors shown to influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were studied.

    Results: Considerable differences were found between the eight countries in characteristics of people with dementia who had been recently admitted to ILTC. However, caregiver burden appeared the most consistent factor associated with institutionalization in all analyses. Indications for the importance of independence in activities of daily life were found as well, although country differences may be more prominent for this factor.

    Conclusion: Evidence was found for two common factors, crucial in the process of institutionalization across countries: caregiver burden and independency in activities of daily life. However, this study also suggests that admission to institutional dementia care is context-specific, as wide variation exists in factors associated with institutionalization across countries. Tailored best-practice strategies are needed to reflect variations in response to these needs. 

    © 2015 John Wiley & Sons Ltd.

  • 23.
    Wennström, Berith
    et al.
    Department of Anaesthesia, Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden.
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Bergh, Ingrid
    Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Use of perioperative dialogues with children undergoing day surgery2008In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 62, no 1, p. 96-106Article in journal (Refereed)
    Abstract [en]

    Aim.

    This paper is a report of a study to explore what it means for children to attend hospital for day surgery. 

    Background.

    Hospitalization is a major stressor for children. Fear of separation, unfamiliar routines, anaesthetic/operation expectations/experiences and pain and needles are sources of children's negative reactions. 

    Method.

    A grounded theory study was carried out during 2005–2006 with 15 boys and five girls (aged 6–9 years) scheduled for elective day surgery. Data were collected using tape-recorded interviews that included a perioperative dialogue, participant observations and pre- and postoperative drawings. 

    Findings.

    A conceptual model was generated on the basis of the core category 'enduring inflicted hospital distress', showing that the main problem for children having day surgery is that they are forced into an unpredictable and distressful situation. Pre-operatively, the children do not know what to expect, as described in the category 'facing an unknown reality'. Additional categories show that they perceive a 'breaking away from daily routines' and that they are 'trying to gain control' over the situation. During the perioperative period, the categories 'losing control' and 'co-operating despite fear and pain' are present and intertwined. Post-operatively, the categories 'breathing a sigh of relief' and 'regaining normality in life' emerged. 

    Conclusion.

    The perioperative dialogue used in our study, if translated into clinical practice, might therefore minimize distress and prepare children for the 'unknown' stressor that hospital care often presents. Further research is needed to compare anxiety and stress levels in children undergoing day surgery involving the perioperative dialogue and those having 'traditional' anaesthetic care.

  • 24.
    Widäng, Ingrid
    et al.
    Jönköping University.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Self-respect, dignity and confidence: conceptions of integrity among male patients2003In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 42, no 1, p. 47-56Article in journal (Refereed)
    Abstract [en]

    Background.

    Integrity is a complex and important concept in ethical reasoning and in nursing care. Integrity is part of being a human being, a wholeness, and in this sense it also refers to health. Preserving patients' integrity is an important aspect of nursing care, as a number of situations arise in which they can feel threatened or violated. Integrity can also refer to acting according to general ethical principles and rules, i.e. moral integrity.

    Aim.

    The aim of this Swedish study was to describe how male patients conceive integrity.

    Methods.

    Seventeen male patients were strategically selected for interviews, which were analysed by a phenomenographical approach.

    Findings.

    The patients expressed 12 different conceptions of integrity that were summarized into three description categories: self-respect, dignity and confidence. This means that patients give themselves integrity when they believe in themselves, have the courage to set boundaries, have control over themselves and their situation, and have the possibility of being alone. Caregivers can preserve a patient's integrity by seeing him as trustworthy and as a whole person, and by showing respect. Confidence in a caring situation is characterized by trust in professionals, a balance between patients' and the caregivers' wishes, patient participation, the possibility of being free and confidentiality of information.

    Discussion.

    Integrity could be described as what something 'is' and as a 'relationship' with oneself and others. It is imperative that caregivers are aware of patients' conceptions of integrity in order to identify and preserve their integrity and also so that they treat them in accordance with moral integrity. The findings are limited to male patients, and questions about female patients' conceptions are raised.

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