Comparing parents' experiences of the attachment process within the first days after a premature birth reveals a striking contrast between the mother's experience of surrealism and the father's ability to be involved immediately after birth. Relevance to clinical practice. Parents' of premature children's different starting points should be acknowledged as professionals encourage parents to have early skin-to-skin contact with their premature infant.

The main research question addressed in this two-phase descriptive study was 'What are the values underlying nurses' professional identity as expressed through what is meaningful in nurses' work? The first phase was a survey of 767 randomly selected nurses with one, five, and 10 years of experience in nursing, and in the second phase data on work-meaning were obtained from a convenience sample of six nurses by in-depth interviews eliciting nurses' stories about providing care to patients. Content analysis of survey-data revealed that the nurses held both other-oriented and self-oriented values, i.e. moral and work values. Human dignity and altruism were the most prominent moral values, whereas the most significant work-values were intellectual and personal stimulation. The interview-data, analysed by means of hermeneutic and narrative analysis, revealed a greater diversity in value-expressions compared to the survey-data. Altruism, the moral orientation of care, was the overall philosophy, and human dignity appeared as a core value. The nine additional values appeared to be linked to human dignity either by arising from it and/or being aimed at preserving this basic value.

This article reports about a study of nurses' limit-setting in mental health and the rationality behind correcting and therapeutic limit-setting interventions. Based on action science design, the study comprised three phases; namely a descriptive, reflective and concluding phase. Qualitative data were collected from various data sources; namely participant observations, interviews and written narratives. Eleven nurses participated. The main findings relate nurses' limit-setting interventions to two simultaneous and conflicting perspectives. That is: the dominating perspective of correcting, aimed at changing patients' behaviour by external control through three nursing roles of caregiver, educator and gatekeeper; the weaker perspective of acknowledging, where patients are seen as capable of changing themselves from within. The nurse's role reflects compassion and values patients' integrity. The nurses' work was based on a rationality of coping, because of a balancing act between the two perspectives and conflicting intrapersonal feelings aroused in challenging encounters with patients and colleagues. In reflection groups, relational interventions were developed, grounded in wondering reflection. Patients were regarded as participants in an open dialogue with the aim of securing collaboration.

Acknowledging the need for parents and nurses to discuss the processes of involvement and detachment may contribute positively to the development of family-centred care in neonatal intensive care units.

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IntroductionHealth care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains.ChallengesIn this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’.DiscussionWe propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.

Change of lifestyle may be necessary for persons with chronic illnesses in order to manage their health situation and reduce symptom distress. Success in changing lifestyle partly depends on a person's self-efficacy beliefs. This cross-sectional study explores social support, physical activity, and illness perceptions in relation to self-efficacy in a sample with morbid obesity and in a sample with chronic obstructive pulmonary disease (COPD). The linear regression analyses showed that higher physical activity and less emotional response to illness were directly associated with higher self-efficacy among persons with obesity, while more social support; fewer perceived consequences from illness; and more understanding of the illness were directly associated with higher self-efficacy among persons with COPD. The results indicate that obese persons are likely to benefit from increasing physical activity and from receiving emotional support. Persons with COPD may be empowered by being able to utilize cognitive coping strategies and by receiving social support.

PurposeTo explore relationships of socio-demographic variables, health behaviours, environmental characteristics and personal factors, with physical and mental health variables in persons with morbid obesity, and to compare their health-related quality of life (HRQoL) scores with scores from the general population.MethodsA cross-sectional correlation study design was used. Data were collected by self-reported questionnaire from adult patients within the first 2 days of commencement of a mandatory educational course. Of 185 course attendees, 142 (76.8%) volunteered to participate in the study. Valid responses on all items were recorded for 128 participants. HRQoL was measured with the Short Form 12v2 from which physical (PCS) and mental component summary (MCS) scores were computed. Other standardized instruments measured regular physical activity, social support, self-esteem, sense of coherence, self-efficacy and coping style.ResultsRespondents scored lower on all the HRQoL sub-domains compared with norms. Linear regression analyses showed that personal factors that included self-esteem, self-efficacy, sense of coherence and coping style explained 3.6% of the variance in PCS scores and 41.6% in MCS scores.ConclusionPersonal factors such as self-esteem, sense of coherence and a high approaching coping style are strongly related to mental health in obese persons.