INTRODUCTION:Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture.BACKGROUND:The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of existence, as well as compassion in relieving suffering, and ontological interdependency.AIM:To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers.RESEARCH DESIGN:The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data.PARTICIPANTS AND RESEARCH CONTEXT:Focus group interviews with caregivers in nursing homes.ETHICAL CONSIDERATIONS:The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons.FINDINGS:Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture.DISCUSSION:Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture.CONCLUSIONS:Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others.

Background: In accordance with ethical guidelines for nurses, leaders for nurse services in general are responsible for facilitating professional development and ethical reflection and to use ethical guidelines as a management tool. Research describes a gap between employees’ and nurse leaders’ perceptions of priorities. Objective: The purpose of this article is to gain deeper insight into how nurses as leaders in somatic hospitals describe ethical challenges. Design and method: We conducted individual, quality interview with 10 nurse leaders, nine females and one male nurse aged 34–64 years. We used a hermeneutical approach to analyse the data. Ethical considerations: The participants received oral and written information about the study. Participation in the study was voluntary, and the participants were given the opportunity to withdraw. All of them gave written consent. The Norwegian Centre for Research Data approved the research project. In addition, the head of the hospitals gave permission to conduct our study. Findings: Four main areas were identified: deficient ethical language, conflicting demands on nurse leaders regarding staff management, concerns regarding young nurses’ ethical consciousness and restricting factors on the creation of a climate of ethics. The nurse leaders experienced considerable pressure. An unexpected finding was the lack of – and even disregard for – an ethical language. Discussion and conclusion: It is crucial to recognise ethics in all types of nursing approaches and to make it explicit. Ethical language must be implemented in nursing education. It must be recognised and used in clinical practice. Recommendations: We recommend further research be conducted into how nurses understand the concept of ethics and how to incorporate ethical principles into clinical nursing and nurse leadership.

AbstractThe purpose of this chapter is to illuminate different understandings of the concept of dignity and to discuss how we can make use of this knowledge to enhance human health. Dignity is viewed as a universal concept in health sciences and a feature necessary to promote health and alleviate suffering related to sickness and impending death. The ideas presented in this chapter are founded in a caring science paradigm where the human being is considered as a unique entity consisting of body, soul, and spirit. Caring science as referred to in this chapter has its scientific foundation in Gadamer’s ontological hermeneutics.Dignity is described in a historical perspective, and different meanings of dignity are clarified. Since health and dignity relate to one other, we have clarified the concept of health employing the texts of the Finnish theoretician Katie Eriksson. In order to illuminate the perspective of health promotion, we have also briefly described health in a salutogenic perspective according to the medical sociologist Aron Antonovsky. In clarifying dignity, the texts of well-known researchers from the Nordic countries and UK were employed. In reflecting on how we can make use of the knowledge of dignity and indignity to promote health, we have considered this matter in light of results of a major Scandinavian study. The main purpose of this study was to explore dignity and indignity of patients in nursing homes from the perspective of patients, family caregivers, and health personnel. The testimonies presented in this section are further interpreted employing mainly caring science and philosophical literature. Lastly, a short summary of some public policy efforts with the aim to preserve human dignity is offered.

We examined how caregivers experienced the influence of dementia on their relationships with afflicted family members. Family caregivers (n = 15; 11 women and four men; age 39–92 years) of people with dementia participated in semi-structured interviews. The data were analyzed according to Kvale and Brinkman. The analysis identified one overarching theme, experiences of companionship, and four subthemes, namely experiences of loss and loneliness; role change; communication alteration; and caring considerations and coping resources. The caregivers described their companionship with the family member, including warm feelings of reciprocity, as well as contradictory feelings, such as feelings of being burdened. They expressed a desire to continue caring for their relative and emphasized the positive aspects of their relationship. Knowledge about dementia, together with a good relationship with their ill family member, facilitated the caring role. These results highlight the importance of receiving information about dementia-related challenges and the implications of being a caregiver.

Background People with advanced cancer disease experience great bodily changes due to disease or treatment. They tend to feel ashamed when their bodies are subjected to such changes and they feel their dignity is threatened. Aim To explore the patients' experiences of the bodily changes in relation to dignity. Design The study has a hermeneutic qualitative design. Method Individual in-depth interviews and participant observations were conducted with 13 patients with advanced cancer disease at a hospice inpatient unit in Norway. Gadamer's ontological hermeneutics inspired the interpretation. Results and conclusion The patients' unpredictable, sick bodies forced the patients, or gave them the opportunity, to relate to their bodies in an honest way. The patients, living in interaction between suffering and health, strove to find dignity. The patients had a will to live and they experienced a love in their unruly bodies that both helped alleviate their suffering and give them an experience of enhanced dignity. It is important that nurses have insight into the consequences of bodily changes for the patients' experiences of dignity in health and suffering to provide good, dignified care.

Background: Research suggests that nurses generally do not participate in ethical decision-making in accordance with ethical guidelines for nurses. In addition to completing their training, nurses need to reflect on and use ethically grounded arguments and defined ethical values such as patient's dignity in their clinical work. Objectives: The purpose of this article is to gain a deeper understanding of how nurses deal with ethical decision-making in daily practice. The chosen research question is "How do nurses participate in ethical decision-making for the patient?" Design and method: We use Gadamer's philosophical hermeneutics as well as Kvale and Brinkmann's three levels of understanding in interpreting the data material. Nine registered nurses were interviewed. Ethical considerations: The Ombudsman of Norwegian Social Science Data and the head of the hospital approved the investigation. The participants received both oral and written information about the study and they gave their consent. We informed the participants that the participation was voluntary and that they were free to withdraw at any point in the course of the study. The requirement of anonymity and proper data storage was in accordance with the World Medical Association Declaration of Helsinki (1964). The participants were assured that privacy, and confidentiality would be duly protected. Results: Four key themes emerged: (1) confusion in relation to professional and operational expectations of role, (2) ideal somnolence, (3) inadequate argumentation skills, and (4) compound pressure. Conclusion: Ethical ideals appear to be latent in the mindset of the participants; however, the main finding of this investigation is that nurses need to activate the ideals and apply them into practice. Furthermore, management needs to initiate professional reasoning and interdisciplinary discussions leading to common goals for patients.

Background: People with progressive cancer experience that their bodies change due to disease and/or treatment. The body is integral to the unity of the human being, a unity that must be perceived as whole if dignity shall be experienced. Relatives are in touch with the suffering bodies of their dear ones, physically, socially, mentally, and existentially, and thus the relatives’ experiences of the bodies of their dear ones might yield insight into the concept of dignity. Aim: The aim of this study is to explore relatives’ experiences of the patients’ bodily changes from a perspective of dignity. Research design and method: A total of 12 relatives from a hospice in Norway were interviewed. Gadamer’s ontological hermeneutics inspired the interpretation. Ethical considerations: The principles of voluntariness, confidentiality, withdrawal, and anonymity were respected during the whole research process. The Norwegian Social Science Data Services approved the study. Results and conclusion: The conversations about the body were conversations about ambivalent or paradoxical matters that shed light on the concept of dignity. The results show that the relatives got in touch with elements that otherwise would have remained tacit and unspoken, and which gave glimpses of a deeper truth, which might reveal the core of dignity. Furthermore, the relatives’ confirmation of the ambivalence might be understood as a strong ethical obligation to treat the other with dignity. The confirmation may also reveal the relatives’ unselfish love of the other, which can be understood as the core of ethics and ethos. Finally, the results reveal the relatives’ limited insight into their dear ones’ bodily changes, and we discuss the challenges of truly seeing the other. Body knowledge and the relationship between body and dignity as phenomena cannot be ignored and needs more attention and articulation in clinical nursing practice and in nursing research.

Sammendrag Hensikten med denne studien er å undersøke omsorgens betydning og uttrykk i møte med lidelse i en klassisk tekst. Den valgte teksten er Ivan Iljitsj’s død av Leo Tolstoj. Hermeneutisk lesning av tekst er anvendt som metodisk tilnærming. Gjennom lesningen er tre hovedtema tolket fram: å være seg selv nok – når man er uavhengig og usårbar; å være seg selv nok er ikke nok – når avhengighet og sårbarhet trenger seg på; å bli seg selv – når avhengighet og sårbarhet møter omsorg. Den klassiske teksten viser at omsorg kan få dårlige kår i mennesket. Den viser hvordan mennesket kan bli seg selv nok i sin streben etter egen nytelse og velbehag. Når menneskets behagelige liv forstyrres og sårbarheten vekkes, blir uavhengigheten utilstrekkelig, og en appell om å bli sett og møtt med omsorg melder seg. Omsorgen er tidløs i tiden.

The implementation of theoretical knowledge in clinical practice and the implementation of good clinical practice into theory have been of interest in caring science for the last 30 years. The aim of this article was to elaborate and discuss a methodology named clinical application research. The method is grounded in a hermeneutical design inspired by Gadamer's philosophy. The methodology, clinical application research, has been used in a research project A life in dignity and experiences from the researchers forms the bases for the elaboration and discussion. The project was performed in collaboration with residents, family caregivers and healthcare providers at six nursing homes in Scandinavia. The material for this article is based on the previous research, that is the results from 10 different articles showing the meaning of dignity and indignity in daily life in nursing homes. Data were generated from 56 individual interviews and 18 focus-group interviews with a total of 40 staff members with five to eight participants at every interview session. By reflection, interpretation and new understanding our results provide knowledge about dignity and how to preserve dignity for older people in an appropriate ethical way. The methodology was relevant for the research project A life in dignity and relevant to caring practice in nursing homes as it opens new possibilities and new ways of thinking when performing dignified care to older people.

AIMS AND OBJECTIVES To present results from interviews of older people living in nursing homes, on how they experience freedom. BACKGROUND We know that freedom is an existential human matter, and research shows that freedom remains important throughout life. Freedom is also important for older people, but further research is needed to determine how these people experience their freedom. The background for this article was a Scandinavian study that occurred in nursing homes; the purpose of the study was to gain knowledge about whether the residents felt that their dignity was maintained and respected. DESIGN The design was hermeneutic, with qualitative research interviews. METHOD Twenty-eight residents living in nursing homes in Denmark, Sweden and Norway were interviewed. Collecting tools used were an interview guide and also a tape recorder. Researchers in the three countries performed the interviews. The data were transcribed and analysed on three levels of hermeneutic interpretation. RESULTS To have their freedom was emphasised as very important according to their experience of having their dignity taken care of. The following main themes emerged: (a) Autonomy or paternalism; (b) Inner and outer freedom; and (c) Dependence as an extra burden. CONCLUSIONS Residents in a nursing home may experience the feeling of having lost their freedom. This conclusion has implications for healthcare professionals and researchers, as it is important for residents in nursing homes to feel that they still have their freedom. RELEVANCE TO CLINICAL PRACTICE In clinical practice, it is important and valuable for the staff to consider how they can help older people feel that they still have their freedom.

Background: Physical impairment and dependency on others may be a threat to dignity. Research questions: The purpose of this study was to explore dignity as a core concept in caring, and how healthcare personnel focus on and foster dignity in nursing home residents. Research design: This study has a hermeneutic design. Participants and research context: In all, 40 healthcare personnel from six nursing homes in Scandinavia participated in focus group interviews in this study. Ethical considerations: This study has been evaluated and approved by the Regional Ethical Committees and the Social Science Data Services in the respective Scandinavian countries. Findings: Two main themes emerged: dignity as distinction (I), and dignity as influence and participation (II). Discussion: A common understanding was that stress and business was a daily challenge. Conclusion: Therefore, and according to the health personnel, maintaining human dignity requires slow caring in nursing homes, as an essential approach.

BACKGROUND:The professional values presented in ethical guidelines of the Norwegian Nurses Organisation and International Council of Nurses describe nurses' professional ethics and the obligations that pertain to good nursing practice. The foundation of all nursing shall be respect for life and the inherent dignity of the individual. Research proposes that nurses lack insight in ethical competence and that ethical issues are rarely discussed on the wards. Furthermore, research has for some time confirmed that nurses experience moral distress in their daily work and that this has become a major problem for the nursing profession.OBJECTIVES:The purpose of this article is to obtain a deeper understanding of the ethical challenges that nurses face in daily practice. The chosen research questions are "What ethical challenges do nurses experience in their daily practice?"RESEARCH DESIGN:We conducted a qualitative interview study using a hermeneutical approach to analyzing data describing nurses' experiences. Ethical considerations: The Norwegian Social Science Data services approved the study. Furthermore, the head of the hospital gave permission to conduct the investigation. The requirement of anonymity and proper data storage in accordance with the World Medical Association Declaration of Helsinki was met.METHOD AND RESULTS:The context for the study comprised three different clinical wards at a university hospital in Norway. Nine qualified nurses were interviewed. The results were obtained through a systematic development beginning with the discovery of busyness as a painful phenomenon that can lead to conflicts in terms of ethical values. Furthermore, the consequences compromising professional principles in nursing care emerged and ended in moral blindness and emotional immunization of the healthcare providers. Emotional immunization occurred as a new dimension involving moral blindness and immunity in relation to being emotionally touched.

The purpose of this study is to illuminate the significance of bodily changes of patients in the palliative care based on the nurses' perspective. Further how nurses may help patients' reconciliation with their changing body, if possible. Data were collected through qualitative interviews with eight nurses working at hospices in Norway. A hermeneutic approach was used for data interpretation. The results are summarized in two main topics: The importance of bodily changes and nurses' contribution in the process of reconciliation. Patient`s experiences are described as being trapped in an "alien body", as bodily suffering in terms of disgust, as shame and loathing, and as the decay of their body reminding the patients of the seriousness of death. The nurses are concerned about supporting patients to experience coherence and meaning in life by inviting them to conversations, individual care, use of touch/massage in care and highlighting the beauty in and around the patient. The study reveals that nurses have insufficient knowledge of the body's importance in the palliative phase.

The aim of this study was to answer the question “What do nursing home residents do themselves in order to maintain their dignity?” Twenty-eight residents, 8 men and 20 women, aged 62 to 103 years, from 6 different nursing homes in Scandinavia were interviewed. The results showed that the residents tried to expand their life space, both physical and ontological, in order to experience health and dignity.

Objective: To explore Somali new mothers’ experiences with the Norwegian health care system and their experienced needs during the hospital stay and the postpartum period. Methods: A qualitative design with individual semistructured interviews. Qualitative content analysis was used to analyze the transcripts from the interviews. Results: Ten women aged 25 to 34 years were interviewed. The women had lived in Norway 4-16 years and had 1-4 children. Analyses of the interviews indicated that there were cultural differences between Somalia and Norway, and that these affected the women during pregnancy and childbirth. Four main categories were central in the women’s stories: (1) inadequate integration into Norwegian society; (2) need for and fear of a caesarean delivery; (3) family support around the postpartum period; and (4) support from health services. Conclusion: Even though these women lived in Norway, their language skills were poor and they were poorly integrated into Norwegian society. Health professionals should use an interpreter when dealing with Somali women with poor language skills, especially when discussing issues relating to birth and the hospital stay. To help integrate these women into society, they should be encouraged to learn the Norwegian language. Well-child clinics should offer immigrant mothers the opportunity to participate in maternity groups to strengthen their social relationships and to integrate better. Public health nurses play an important role in supporting immigrant mothers. The findings of this study will help broaden the understanding of the support immigrant women need during the hospital stay and the postpartum period.

The aim of this study was to answer the question "What do nursing home residents do themselves in order to maintain their dignity?" Twenty-eight residents, 8 men and 20 women, aged 62 to 103 years, from 6 different nursing homes in Scandinavia were interviewed. The results showed that the residents tried to expand their life space, both physical and ontological, in order to experience health and dignity.

BACKGROUND:Living in a nursing home may be challenging to the residents' experience of dignity. Residents' perception of how their dignity is respected in everyday care is important.AIM:To examine how nursing home residents experience dignity through the provision of activities that foster meaning and joy in their daily life.METHOD:A qualitative design was used and 28 individual semistructured interviews conducted with nursing home residents from six nursing homes in Denmark, Norway and Sweden. The data were analysed with qualitative content analysis. Independent ethical committees in all participating countries granted their approval for the study.FINDINGS:The participants highlight two dimensions of the activities that foster experiences of dignity in nursing homes in Scandinavia. These two categories were (i) fostering dignity through meaningful participation and (ii) fostering dignity through experiencing enjoyable individualised activities.CONCLUSION:Activities are important for residents to experience dignity in their daily life in nursing homes. However, it is important to tailor the activities to the individual and to enable the residents to take part actively. Nurses should collect information about the resident's preferences for participation in activities at the nursing home.

The purpose of this article is to present findings from a major research project focusing on gaining a deeper understanding of health and suffering due to serious cancer disease from the perspective of patients. This study used a hermeneutic design and 14 qualitative research interviews of 6 Norwegian patients with advanced, progressive cancer are the basis for the interpretation. As a result of the hermeneutical process, patients’ life struggle appeared as a threefold battle against time and annihilation, toward being accommodated and confirmed, and to be restored and reconciled.

School bullying is a serious problem affecting the victims in their daily lives at school. The aim of this study was to investigate whether support groups were able to help the victims of bullying to overcome their victim status and to explore what it means to be a member of a support group. An exploratory qualitative design, with individual and focus group interviews, was used. The sample consisted of 19 schoolchildren, aged 12-13 years, 3 of whom were victimized. Six individual interviews and three focus group interviews were conducted. Findings show that support groups contribute to the cessation of bullying and improvements remain 3 months later. The support groups experience feeling important and helping others. It is important for the school nurse and teachers to follow up with victimized children, in collaboration with their parents, to help the victim to no longer be a victim and to take control.