When expressions make impressions—Nurses’ narratives about meeting severely ill patients in home nursing care: A phenomenological-hermeneutic approach to understanding

Abstract

Registered nurses (RNs) working in homecare encounter severely ill and palliative patients whose expressions may cause ethical challenges and influence their daily work. The aim of this qualitative study was to illuminate and interpret the meaning of nurses’ lived experiences when meeting these patients. Narrative interviews were conducted with 10 RNs working in home nursing care. These interviews were audiotaped and transcribed verbatim to a text and interpreted by a phenomenological-hermeneutic method inspired by Ricoeur. The meaning of the RNs’ lived experience of patients’ expressions was formulated into four themes. The first theme, Being open for the presence of the Other, includes two subthemes: “Sensing vulnerability” and “Empathizing with.” The second theme, Being satisfied, entails the subthemes, “Feeling exceptional” and “Being trusted.” The third theme, Being frustrated, contains the subthemes, “Being disappointed” and “Being angry.” The fourth and final theme, Being ambivalent, includes one subtheme: “Being generous or reserved.” Patients’ expressions that make impressions on nurses create emotional waves. Expressions leave impressions that call upon the nurse, and confront her with taking the risk of letting intuition and pre-reflexive feelings gain entry to her care. Allowing for the Other's presence is seen as a precondition, which means facing humanity and sensing a vulnerability in herself as well as in the Other. Understanding and balancing this emotional dimension in care seems to cause confusion and distress within the nurses. Realizing how their feelings may lead to either generosity or aloofness towards the patient is upsetting. Our interpretation suggests that these impressions echo confusion according to the role of being a professional nurse. There is a need to pay more attention to how the emotional dimension in care is understood and impacts the way nurses perform their professional role.

The nurse's role in palliative care: A qualitative meta‐synthesis

“…Other words for the nurses' role as being dedicated and present were to open oneself to the other . The study by Devik, Enmarker, and Hellzen () found that being dedicated meant being open to the presence of the other. To be open meant to experience the patients' lives, sensing their milieu and their history and context, and presupposes openness to the nurse's own existence and emotions.…”

Atuação do enfermeiro na atenção domiciliar: uma revisão integrativa da literatura

“…Furthermore, nurses' actions in HC involve reflective, not mechanistic, practice (35) . Thus, the need for reflection on the development of work in the home environment was identified (10,(14)(15)20,35) . Reflection is essential for recognizing weaknesses and/or limits in situations that demand resignification of work in home care.…”

“…In the relationship with caregivers, nurses act as facilitators, encouraging them to express their worries and experiences with patient care while searching for physical, emotional, and mental comfort for patients and caregivers (48) . Moreover, in interpersonal relationships, nurses present themselves as open to others (10) and are considered capable of caring with love, compassion, and confidence, acting as "counselors" because they listen and welcome families with their worries and fears (11) .…”

“…Relationship of help/Interaction (14,(17)(18)(19)(20)(24)(25)(29)(30)35,42,44,46,(48)(49)54) Emotional, mental, or psychological support (37,40,42,46,51,55) Communication (12,18,21,51,56) Relationship of trust (10,22,26,42,56) Negotiation (16,21,26,52) Respect (11,41,56) Dialog (20,26) and listening (18) Educational actions Guidelines for families, caregivers, and/or patients (13,19,25,27,29,32,36-40,44-46, 48,51,53) Development of teaching strategies (48) Learning about social resources (51) Training of patients, family, and neighbor network and other sectors for risk prevention in emergencies (38) Guidelines for other nurses (40) Care actions Medication management or infusion …”

Shareholding Networks for Care in Rural Thailand: Experiences of Older Persons and Their Family Members

“…In that light, our findings address fundamental structures and values built into healthcare practices. According to Devik et al [38], there is a great need to focus attention on the emotional dimension and how it influences healthcare and not only to focus on knowledge-based analyses of situations.…”