Background Altruism has historically shaped the ethos of nursing. However, the COVID-19 pandemic reignited nurses’ profound commitment to patient care, often at significant personal risk to own health and safety. This renewed dedication has prompted interest in whether altruism remains a vital component of nursing practice. Objective To clarify the meaning of professional altruism in nursing care. Design Catherine Norris’s five-step concept clarification method was employed. Methods A systematic search was conducted in November 2024 across the CINAHL, PubMed, MEDLINE, and PsycINFO databases using the terms altruism, altruistic, and altruistic behavior/behaviour in combination with nurses, nursing, and nursing care, resulting in the inclusion of 24 articles. Results Systemised descriptions of professional altruism yielded five categories: a willingness to act for others, a moral orientation, a motivational force, an unwavering professional expectation, and a valued, yet challenged and sometimes rejected phenomenon. Additionally, an operational definition of professional altruism in nursing care emerged: Professional altruism is a moral orientation toward fellow human beings in need of care, characterised by a willingness to prioritise the well-being of others over one’s own needs. While balancing the expectations, challenges, and personal consequences involved, professional altruism remains a core aspect of nursing care, responsibility, and practice. Conclusion Professional altruism is a central aspect of nurses’ professional identity and an essential element of nursing care. When acknowledged and supported, professional altruism can enhance both the quality of care and nurses’ well-being.

BACKGROUND:Many intensive care unit (ICU) nurses who were crucial to the frontline response during the COVID-19 pandemic left their employment during or after the pandemic. Studies exploring the experiences of these nurses are lacking. The aim of this study was to explore ICU nurses' course towards making the decision to resign from work in the ICU following the COVID-19 pandemic. METHOD:Advertisements on social media and a snowball sampling-inspired method were used to recruit 11 nurses from hospitals around Sweden who worked in an ICU during the pandemic and who then left employment. The participants were interviewed individually via telephone, online or in-person. An interview guide with a few open-ended questions was used to capture the nurses' narratives. The data were analysed using a phenomenological hermeneutical method. RESULTS:The nurses were tangled in paradoxes, described as three themes: 'To give it all and yet feel insufficient', 'To experience togetherness and yet feel lonely' and 'To prioritise others and yet need to eventually prioritise oneself'. The decision to end their employment was ambivalent but necessary, made with relief and no regrets, but with sorrow. During this decision-making process, there may have been a window of opportunity during which nursing management or the health care service might have influenced the outcome. CONCLUSION:The ICU nurses' decision to resign was influenced by a tangle of challenging paradoxes that entailed ambivalence. The course to the decision to resign was marked by hesitancy. While it is important to understand and support nurses' willingness to care for patients during a crisis and to acknowledge their suffering as it relates to their professional efforts, it is also essential to address their individual struggles and needs.

IntroductionStress-related ill-health like pain and exhaustion are demanding public health problems in Europe. In Sweden, women are particularly at risk to develop stress-related ill-health during a period in life that coincides with child-rearing years. When entering motherhood, Swedish women’s sick leave substantially increases. Yet, motherhood is rarely acknowledged in clinical encounters concerning pain and exhaustion although women suffer from these ailments more often than men. To incorporate motherhood as an existential dimension of health in the care of women living with pain and exhaustion might alleviate women’s suffering. But knowledge on women’s experiences of motherhood and health is scarce. Therefore, the aim of the study is to reach a deeper understanding of how women suffering from long-lasting pain and exhaustion experience their health in relation to motherhood.MethodsRicoeur’s interpretation theory has been applied to analyze 27 phenomenological interviews with 14 mothers suffering from long-lasting pain and exhaustion.ResultsThese women’s experiences shed light on how closely motherhood is interwoven with the experience of their health and suffering: The women’s suffering seems to be rooted in a relational vulnerability that has been uncovered during motherhood. Further, the women suffer from a burden of difficult life experiences and inner conflicts. Reconciliation with life is possible when women find an existential shelter, which offers ways to relate to their suffering making the own suffering more bearable.

BACKGROUND:Based on existing confusion and a suggested contradiction regarding empathy and compassion in relation to caring science as well as in clinical health care.AIM:The aim of the study was to find a knowledge base for the development of clinical caring science for, empathy, sympathy altruism, and compassion and their mutual relationship.DESIGN:A theoretical paper.RESULTS:The text discusses the different concepts separately, considering their history, research, obstacles, and bias and then brings them together in a concept model. The conclusion shows that empathy, sympathy, and altruism have no contradictions. Instead, they together form an evident triad based on compassion. Compassion is a prerequisite and a basis for the others to work. In clinical application, empathy is metaphorically a quality coming from the head, sympathy from the heart and altruism from the hand, merged in an attitude of compassion as a motif to care. The paper also reflects on the possibilities to increase and develop a compassionate mood and capacity by education and training.

Background: In modern healthcare, the role of solidarity, altruism and the natural response to moral challenges in life-threatening situations is still rather unexplored. The COVID-19 pandemic provided an opportunity to obtain a deeper understanding of nurses’ willingness to care for patients during crisis. Objective: To elucidate clinical expressions of ontological situational ethics through nurses’ willingness to work during a pandemic. Research design, participants and context: A qualitative study with an interpretive design was applied. Twenty nurses who worked in intensive care unit at two Swedish hospitals during the first, second, and third waves of the COVID-19 pandemic were interviewed. The analysis was interpretative and applied a theoretical ethics perspective. Ethical considerations: The study was approved by the Swedish Ethical Review Authority and informed consent was obtained from all participants. Findings: From a philosophical perspective, the nurses expressed sovereign life expressions of mercy and compassion, which arose spontaneously in response to seeing vulnerable fellow humans. They referenced ‘‘the nurse inside me’’ and their choice of profession as motives to provide care. Ontological situational ethics in culture and norms were noted in the constructs of competence, responsibility, solidarity with colleagues and organization; and interest and learning were driving forces. Ethical demand was evident when nurses expressed ideas of meaningfulness in helping their fellow humans; but themes of ambiguity, exhaustion and unwillingness were also present. Conclusions: The nurses showed a high willingness to care for patients during a crisis. Responding to the ethical demand and to care for vulnerable human beings while risking their own health and lives could be interpreted as an inter-human vocation. These spontaneous altruistic actions saved the lives of many patients during the pandemic and need to be understood and supported

AIM:The aim of this study was to understand the lived experience of altruism and sacrifices among Swedish nurses working in intensive care units (ICU) during the COVID-19 pandemic.DESIGN:This was a descriptive phenomenological study.METHODS:The study was conducted between June 2020 and March 2021 and included 20 nurses who were directly involved in the ICU care of COVID-19 patients in Sweden during the pandemic. The text transcripts were analysed using Malterud's Systematic Text Condensation.FINDINGS:The analysis revealed four themes. The work situation changed from 1 day to another-the nurses were brutally confronted with a new and highly demanding situation. Adapting to the chaotic situation-despite fear, anguish and exhaustion, the nurses adapted to the new premises. They shouldered the moral responsibility and responded to the needs of the patients and the health care system since they had the competence. Being confronted with ethical and moral challenges-the nurses were overwhelmed by feelings of helplessness and inadequacy because despite how hard they worked, they were still unable to provide care with dignity and of acceptable quality. The importance of supporting each other-collegiality was fundamental to the nurses' ability to cope with the situation.CONCLUSIONS:Taken together, being exposed to a constantly changing situation, facing the anguish and misery of patients, families, and colleagues, and being confronted with a conflict between the moral obligation to provide care of high quality and the possibility to fulfil this commitment resulted in suffering among the nurses. Collegial back-up and a supportive culture within the caring team were important for the nurses' endurance.IMPACT:The study contributes an understanding of nurses' lived experience of working during the COVID-19 pandemic and highlights the importance of protecting and preparing nurses and nursing organisation for potential future crises.

Objective: The concept of “invalidation” refers to the patient’s perception that the social environment does not recognize their medical condition. This study explores and describes invalidation experiences among Swedish patients with chronic widespreadpain with regard to sociodemographic and pain characteristics, impact of pain, self-reported health, and symptoms of anxiety and depressive.Methods: A cross-sectional design using questionnaires, including sociodemographic and pain variables, the Illness Invalidation Inventory (Likert scale items regarding 5 sources), the Hospital Anxiety and Depression Scale, and the Short-Form General HealthSurvey. Descriptive and univariate analyses were applied.Results: Of the 152 respondents, 91% were women. Swedish patients with chronic widespread pain experienced invalidation to a large extent from all sources. The highest scores for invalidation were reported from contacts with social services (68%), and the lowest from spouses (30%). Being younger (p < 0.006), having periodic pain (p = 0.011), and having had more frequent visits to a doctor in theprevious year (p = 0.007) were characteristics associated with higher invalidation scores. Experiences of invalidation were associated with worse selfreported mental health scores (r = –0.29 to –0.46).Conclusion: Since patients with chronic widespread pain frequently experience invalidation from the social environment, this further challenge in daily life must be taken into consideration in pain management within multimodal pain rehabilitation. LAY ABSTRACTPatient’s perception that the social environment does not recognize their medical condition may be defined as “invalidation”.This study explores invalidation experiences among Swedish patients with chronic widespread pain with regard to a range of sociodemographic and health factors. Questionnaires, including the Illness Invalidation Inventory, were sent by post to a sample of patients with chronic widespread pain. Most of the respondents were women. Swedish patients with widespread pain experiencedinvalidation to a large extent. The highest scores for invalidation were reported from contacts with social services, and the lowest from spouses. Being younger, having periodic pain, and having had more frequent visits to the doctor in the previous year were characteristics associated with higher invalidation scores. Experiences of invalidation were associated with worse mental health.Pain management within rehabilitation must thus take the patient’s experiences of invalidation from the social environment into consideration as an important aspect.

AIM:To investigate the necessity of an item reduction and to evaluate estimates of dimensionality, reliability and validity of the Health and Suffering Scale among two groups of women, one undergoing rehabilitation for exhaustion and long-lasting pain and one reference group. DESIGN:Psychometric evaluation of the scale using cross-sectional data. METHOD:The Health and Suffering Scale is a self-report scale which measures perceived suffering in relation to health on a semantic visual analogue scale. Classical and modern test theory were applied for item reduction and to explore estimates of reliability and validity. RESULTS:The Health and Suffering Scale was found to be unidimensional, nine of originally twenty items were part of a consistent factor structure and hierarchical order. These items were internally consistent, discriminated between patients and healthy respondents, and had an excellent level of separation of individuals experiencing various levels of health and suffering. Re-test reliability estimates were moderate.

Background Despite women are generally overrepresented in behavioral, mental, and musculoskeletal disorders, motherhood as a central part of women’s life is poorly understood in relation to exhaustion and long-lasting pain. Mothers’ health impairments imply suffering both for herself and her family. A profound understanding of health is needed taking mothers’ subjective health experience, their suffering and life situation into account to give women, their families and society better prerequisites to alleviate exhaustion and long-lasting pain. The aim of the study was to describe health and suffering of women and mothers undergoing rehabilitation for long-lasting pain and exhaustion and its correlation with perceived social support. Methods The study had a cross-sectional design with an exploratory approach. A main sample consisted of 166 women undergoing rehabilitation for exhaustion and long-lasting pain and a reference sample included 129 women working and studying within health care professions. Both samples included women with and without children. Women’s subjective health and suffering was assessed from a caring science perspective using the recently developed and validated Health and Suffering Scale. Two additional scales measuring exhaustion and social support were distributed among the two samples. Descriptive statistics and multiple linear regression models, including health and suffering and perceived social support, were analyzed. Results Mothers undergoing rehabilitation for pain and exhaustion reported significantly poorer health and more suffering compared to healthy mothers, but similar health and suffering when compared with childless women in rehabilitation. Health and suffering were correlated with perceived social support among both healthy and exhausted mothers. In both samples, the correlation between health and suffering and social support was stronger among mothers than among women without children. Conclusions Women and mothers living with exhaustion and long-lasting pain show signs of unbearable suffering and perceived insufficient social support. Social support from various sources particularly helps mothers to create meaning in life and make their suffering bearable. Hence, health care must address the fact that mothers are dependent on their immediate social environment and that this dependency interacts with their health and suffering on an existential level.

Women are overrepresented in pain rehabilitation. They seem to be more exposed to comorbidity between mental illness and diseases of the musculoskeletal system than men, implying that besides biopsychosocial factors, gender relations and cultural context should be considered. The aim of the study is to understand the lived experience of women with chronic pain from a caring science and gender perspective. Gadamerian philosophical hermeneutics has been used to analyze interviews from 21 women living with chronic pain in Sweden. The hermeneutical process revealed intertwined experiences of overperformance, loneliness, pain, and exhaustion. Women's experience of an overwhelming life situation and the significance of mutual dependency seem to be central to health and suffering in women with chronic pain. We suggest, contemporary health care to acknowledge women's health and suffering in relation to their life situation and prevailing gender roles.

BACKGROUNDPatients have reported unanticipated and transformative health changes in existential character after integrative healthcare rehabilitation. Although there are several instruments measuring patients' experiences of health, identified instruments do not sufficiently capture patients' experiences of health and suffering after integrative health care. From a caring science perspective, health and suffering are understood as an integral part of human life. The objective of this study was to develop a first version of an instrument to measure patients' experiences of health and suffering, focusing on existential signs.METHODSThis Swedish study used a methodological design with three iterative phases for instrument development. Firstly, an item pool was developed based on qualitative patient interviews (n = 64). Subsequently, the relevance of the items was explored in two rounds of cognitive patient interviews (n = 5 and n = 3). Finally, expert consultations (n = 5) were used to further refine the instrument. The construct of the instrument, its dimensions and domains emerged through the iterative development process.RESULTSThe first phase development of the instrument resulted in two inter-related overarching dimensions: existential signs of 'Health' and 'Suffering', characterised by five domains: 'Life passion and energy', 'Personal freedom', 'Relationships', 'Presence in life' and 'Meaning'. Instrument items were formulated using contemporary language and word pairs to reflect a movement and relation between health and suffering. The cognitive interviews and expert opinions helped refine items and domains.CONCLUSIONSThe dimensions, domains and items of the instrument 'Existential signs of health and suffering' are well represented in caring science theories. Further clinical implementation and evaluation of the instrument, including psychometric properties, will allow for greater diversity in terms of context generalisability and patient characteristics. The instrument is anticipated to be of value for evaluations in research, development of healthcare practice and theory development in caring science.

BACKGROUND:Clinical caring science will be described from a theory of science perspective.AIM:The aim of this theoretical article to give a comprehensive overview of clinical caring science as a human science-based discipline grounded in a theory of science argumentation.FINDINGS:Clinical caring science seeks idiographic or specific variations of the ontology, concepts and theories, formulated by caring science. The rationale is the insight that the research questions do not change when they are addressed in different contexts. The academic subject contains a concept order with ethos concepts, core and basic concepts and practice concepts that unites systematic caring science with clinical caring science. In accordance with a hermeneutic tradition, the idea of the caring act is based on the degree to which the theory base is hermeneutically appropriated by the caregiver. The better the ethos, essential concepts and theories are understood, the better the caring act can be understood. In order to understand the concept order related to clinical caring science, an example is given from an ongoing project in a disaster context.COMPREHENSIVE REFLECTION:The concept order is an appropriate way of making sense of the essence of clinical caring science. The idea of the concept order is that concepts on all levels need to be united with each other. A research project in clinical caring science can start anywhere on the concept order, either in ethos, core concepts, basic concepts, practice concepts or in concrete clinical phenomena, as long as no parts are locked out of the concept order as an entity. If, for example, research on patient participation as a phenomenon is not related to core and basic concepts, there is a risqué that the research becomes meaningless.

Background: For a long time, altruism was the basis for caring. Today, when society is more individualized, it is of interest to explore the meaning of altruism in nursing. Methods: In all, 13 nurses from a Swedish acute care setting participated in two focus group interviews performed as Socratic dialogues. Data were analyzed using a phenomenological hermeneutical method. Ethical considerations: Ethical issues were considered throughout the process according to established ethical principles. Informed consent was obtained from all participants, confidentiality regarding the data was guaranteed and quotations anonymized. Findings: Altruism created a sense of ambivalence and ambiguity, described as a rise of sovereign expressions of life caused by “the other’s” need, but also unwillingness to take unconditional responsibility for “the other.” Conclusion: Society’s expectations of altruism and nurses’ perception of their work as a salaried job collide in modern healthcare. Nurses are not willing to fully respond to the ethical demand of the patients. In case of a disaster, when nurses personal safety, life and health may be at risk, there might be reasons to question whether the healthcare organization would be able to fulfill its obligations of providing healthcare to an entire population.

I1 World Congress for Integrative Medicine & Health 2017 - A global forum for exploring the future of comprehensive patient care Benno Brinkhaus1, Torkel Falkenberg2,3, Aviad Haramati4,5, and Stefan N. Willich1 1Institute for Social Medicine, Epidemiology and Health Economics, Charite – Universitatsmedizin Berlin, Berlin, Germany; 2Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Karolinska Institutet, Stockholm, Sweden; 3I C – The Integrative Care Science Center, Jarna, Sweden; 4Department of Biochemistry, Molecular and Cellular Biology, Georgetown University, Medical Center, Washington, DC, USA; 5Department of Medicine, Georgetown University Medical Center, Washington, DC, USA We are excited to present the abstracts of the keynote speakers, parallel sessions and oral and poster presentations of the World Congress on Integrative Medicine & Health (WCIMH 2017; http://www.ecim-iccmr.org/2017/) to be held in Berlin on May 3-5, 2017, which will be jointly convened by the European Society of Integrative Medicine (ESIM) and the International Society for Complementary Medicine Research (ISCMR). The Congress will take place in association with a number of national and international organizations from North America and other continents. Consequently, the congress will provide the most comprehensive global forum and perspective in the field of Complementary and Integrative Medicine in 2017. The congress goal is reflected in its tag line: The Future of Comprehensive Patient Care - Strengthening the Alliance of Researchers, Educators and Providers. We believe that by bringing together researchers, educators and providers, who are addressing various aspects of Integrative Medicine and health, we can build on the evidence obtained through research to inform clinical education and practice and thereby create a better platform for comprehensive patient care. The main themes of the Congress are: Clinical care: The practice of Integrative Medicine should be based on distinct definitions, should be informed by evidence and evolve from guidelines that are developed by experts from conventional and complementary medicine. Education: Academic leaders and health officials have called for future clinicians to possess the knowledge and skills to understand how Integrative Medicine can be incorporated into conventional care to improve the health of the public. Therefore, it is essential to share best practices in how to create robust curricular opportunities for medical students to experience systematic teaching of the principles, strengths and limitations of Integrative Medicine. Research: Within this Congress scientists will showcase the highest quality research worldwide in this field and will provide the state-of-the-science evidence base through plenary lectures, symposia and abstract presentations. Traditional healing systems (THS): Traditional healing practices and practitioners are an important and often underestimated part of health care. THS is found in almost every country in the world and the demand for its services is increasing. Research contributing to evidence informed decision making is imperative to develop a cohesive and integrative approach to health care that allows governments, health care practitioners and, most importantly, those who use health care services, to access THS in a safe, respectful, cost-efficient and effective manner. Arts and medicine: For the first time at a research congress, this theme will explore the important contributions of the arts (music, visual arts, dancing, etc,) for integrative therapeutic interventions to achieve optimal health and healing. Given the ambitious scope of this worldwide international congress, the four authors of the present editorial serve as co-presidents and they are guided by the International Organizing Committee consisting of many experts from around the world including Myeong S. Lee, Jianping Liu, Kenji Watanabe (from Far East Asia), Renee Street (Africa), Amie. Steel (Australia), Paulo Arturo Caceres Guido, Chin An Lin (South America), Heather Boon, Josephine Briggs, John Weeks (North America) and Abdullah Al-Bedah, Mohamed Khalil, Elad Schiff (Middle East and Israel). The programming for each of the five themes is directed by WCIMH 2017 theme subcommittees involving some of the most highly regarded clinicians, educators and researchers in the world in this field (in alphabetic order): Linda Balneaves, Lesley Braun, Eva Bojner Horwitz, Gustav Dobos, Jeffery Dusik, David Eisenberg, Iva Fattorini, Eckhart G. Hahn, Suzanne B. Hanser, Frederick Hecht, George Lewith, Harald Matthes, Andreas Michalsen, Judy Rollins, Volker Scheid, Michael Teut, Robert Saper, Claudia M. Witt, Merlin Wilcox and Darong Wu. The Local Organizing Board is coordinated by M. Cree. We are very grateful to all organisations and individuals working diligently to making this first World Congress for Integrative Medicine & Health in 2017 a great success. We are also pleased to announce that the opening welcome will include the Director General for the World Health Organization, Dr Margaret Chan (on video). All plenary speakers are internationally recognized experts in the field of Complementary and Integrative Medicine such as Josephine B Briggs (US) and Merlin Willcox (UK) as keynote speakers for the theme traditional healing systems; Klaus Linde (Ger) and Michael Moore (UK) for the research theme; Lisa M Wong (US) and Tores Theorell (Sweden) will address the theme of arts and medicine; Darong Wu (China) and Jeffery A Dusek (US) are presenting on the theme of clinical care; and Aviad Haramati and David Eisenberg (both US) will close the Congress with presentations on education. In addition, more than 100 oral presentations in over 40 parallel sessions will be in the program to provide newly emerging data from recent research projects, experiences from new treatment aspects in clinical care, descriptions of new models of education in medicine, information about integration of traditional healing systems in health care systems and new aspects on the integration of arts in medicine. In addition, more than 400 posters will be presented in guided poster sessions during the three days of the Congress. To translate the congress goals and objectives into a tangible action for the field, a Berlin Agreement is being developed. With the title ‘Social and Self-responsibility in practicing and fostering Integrate Health and Medicine Globally,’ this document is meant to help shape the future of comprehensive patient care in Integrative Medicine, and addresses the responsibilities of all participants, including patients and citizens, physicians and all colleagues working in the healthcare system. The Berlin Agreement has been developed by the WCIMH 2017 congress presidents and the International Organizing Committee to create a document for further distribution to the scientific and clinical community and to health care stakeholders, decision makers, and politicians. We anticipate having the final version of the Berlin Agreement endorsed by a number of organizations prior to the Congress and also soliciting the support of congress at the WCIMH 2017 in Berlin. Our hope is that this document will provide an important impetus for further engagement world-wide after the Congress has concluded. Immediately before the start of WCIMH 2017 on Wednesday May 3rd 2017 there will be several high-quality pre-conference workshops covering all congress topics. Reflecting the political situation in recent years, especially in Europe, we have arranged for a unique half-day workshop on the topic: “Refugees with Chronic Diseases between the Middle-East and Europe: The Role of Traditional and Integrative Medicine in Bridging Gaps”, The speakers are all from the Middle East and Europe and will address how Integrative Medicine may serve as an important element to overcome the problematic health situation of refugees around the world. We are convinced that the field of Complementary and Integrative Medicine, including traditional healing systems and medicine and the arts, will benefit from The 2017 World Congress on Integrative Medicine & Health—a preeminent scientific international forum that is focused on highlighting advances in these thematic areas. We invite all practitioners, educators and researchers in the field of Integrative Medicine to come together, participate and engage together to make this Congress an exciting meeting for the successful advancement of Integrative Medicine across the globe.

Syftet med studien var att genom en enskild berattelses nyanser uppna okad forstaelse av upplevelsen av antroposofisk rehabiliterande vard vid langvarig smarta. Den kliniska kontexten for studien var sjukhuset Vidarkliniken. Resultaten ger en okad forstaelse for vad det kan innebara att som patient uppleva ”sig sedd”; att bli sedd av vardare likval som att fa syn pa sig sjalv, sina behov och sitt liv. Genom samtal, beroring och miljons helande verkan har sammanhanget mellan manniskor aterskapats och en (ny) plats for denna patients hela existens tar form. Detta vacker tankar om hur man med inspiration fran den antroposofiska varden kan ge okad och explicit plats for medmansklighet, beroring, miljo och kontemplation i vardplaner for personer med langvarig smarta.

Scandinavian Journal of Caring SciencesVolume 30, Issue 2 p. 215-216 Guest EditorialFree Access The justification of caring science Arne Rehnsfeldt RN, PhD, Arne Rehnsfeldt RN, PhD Professor [email protected] Stord/Haugesund University College, Stord, NorwaySearch for more papers by this authorMaria Arman RN, RNM, PhD, Maria Arman RN, RNM, PhD Associate professor [email protected] Karolinska Institutet, Huddinge, SwedenSearch for more papers by this author Arne Rehnsfeldt RN, PhD, Arne Rehnsfeldt RN, PhD Professor [email protected] Stord/Haugesund University College, Stord, NorwaySearch for more papers by this authorMaria Arman RN, RNM, PhD, Maria Arman RN, RNM, PhD Associate professor [email protected] Karolinska Institutet, Huddinge, SwedenSearch for more papers by this author First published: 27 May 2016 https://doi.org/10.1111/scs.12348Citations: 4AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL This journal is living thanks to the efforts of the first generation of Nordic caring and nursing scientists. We have to be grateful for all of this work that has contributed significantly to today′s situation with caring science as an academic discipline in every university, with professors and many scholars all contributing to good research and health care. The term caring science is used here in order to demonstrate that the discipline is not related to a specific profession. The concept nursing science is problematic as it may indicate that it is nurses that do research, but if nursing is seen in the present participle form with the same meaning as caring, nursing science is interchangeable with caring science. In the field of empirical research, one can see a huge development in international collaborations, in advanced method development and also in the amount of international scientific publications from Nordic scholars in caring science. At the same time, a tradition of basic research and theory development in health care has grown in the Nordic countries. Alongside this positive development accounted for above, we also see a worrying tendency that many scholars almost deny that there exists a discipline of caring science worldwide and have very little knowledge of its base of ontology, theories and concepts. Also in the clinical field, caring science is seldom a basis for patient care, at least not in the Nordic countries. It is said that the scientific perspective is too far away from what happens in the clinical field. Why is this so? One reason for not accepting caring science as an (autonomous) discipline is that the scientific subject and the profession are mixed together. If the professional perspective is dominant, it seems more natural to build the science from a multidisciplinary perspective with different subjects as medicine, psychology, sociology, etc. On the other hand, if we have a disciplinary perspective on caring science, it is the ontology and ethos that primarily defines the scientific subject and gives focus to the research performed and theory development. If, for example, the goal of the discipline is to protect life and health, caring science can mainly do this by protecting the inner or existential life and health of the patient. Medicine protects life and health by medical measures and should do so. Caring science is justified by finding its own disciplinary point of departure and from there on defining its field of research. 'Clinical caring science' as a scientific discipline situated closer to the praxis field than caring science is a way to transcend the theory–praxis gap. It studies clinical expressions of the theory base. Also, observed clinical phenomena are transferred back to the discipline in order to deepen the understanding of the phenomenon and thereby use this understanding for better patient care by application of that knowledge. Katie Eriksson, Kari Martinsen and Karin Dahlberg, scientists from Finland, Norway and Sweden, respectively, have with co-researchers contributed significantly to a theoretical basis of caring science, with a special focus on what we have chosen to call 'the Nordic tradition of caring science' 1. The research accounted for in the Nordic tradition of caring science shows how accurate a disciplinary perspective is in modern times. All three scholars concentrate on caring science as a human science as a basis for both patient care and science. A human science perspective with its close connection to existential matters and professional natural care (close to the natural lived experiences of the patients, relatives, etc.) gives caring science, a societal justification as no other discipline studies clinical phenomena from this perspective. In the article, it is concluded that it is relevant to talk about a Nordic tradition, where a joint view on the science′s core ontology and ethics seems to correspond. A human science perspective is essential to all three scholars with the patient and his/her world of health and suffering as a basis for a caring with openness, pliability, compassion and seeing with the heart′s eye. As authors, we conclude that this Nordic tradition with values, concepts and theoretical development will continue to grow and form basis for future research in caring science. Also research on self-care shows the importance of a disciplinary perspective. An example of this inspired by the Nordic caring science tradition is the empirical research where the concept of 'self-care' is studied, interpreted and discussed in women with chronic pain 2.Clinical data showed that the concept self-care had to be problematized as the clinical phenomena did not fit in with the concept. Clinical expression showed that compassion as a caring science concept had to be added in order to understand the existential transfer from passivity to self-care in the patients. Self-care is extended from Orem′s theory with an existential view and interpretation, saying that the relationship with caregivers and a caring environment seemed to be crucial for transition from passivity to self-care. In the article 'Dressing an existential wound' 3, people′s suffering and health in a long-term care perspective have been studied in the context of a disaster. Without research questions and interpretation of collected data from a caring science perspective, it would have been a fragmented understanding of data. This shows the accuracy of a clinical caring science perspective that is related to practice. The essential understanding of people's needs in a long-term period of time is expressed in eight theses, all aimed to understand how a natural and existential care can be given flexibly and naturally in a long-term perspective. In this project, caring science′s ontology and conceptual base have worked closely together with empirical data in a hermeneutic process. A conclusive remark that must be made is that caring science needs a renaissance in the minds of all scholars and caregivers, in order to enhance caring to an optimal level. References 1Arman M, Ranheim A, Rydenlund K, Rytterström P, Rehnsfeldt AW. The Nordic Tradition of Caring Science: The Works of Three Theorists. Nurs Sci Q 2015; 28: 288– 96. 2Arman M, Hök J. Self-care follows from compassionate care - chronic pain patients' experience of integrative rehabilitation. Scand J Caring Sci 2015. doi:10.1111/scs12258. [Epub ahead of print] 3Rehnsfeldt A, Arman M. Dressing an existential wound (DEW) – a new model for long-term care following disasters. Scand J Caring Sci 2015. doi: 10.1111/scs.12273. [Epub ahead of print] Citing Literature Volume30, Issue2June 2016Pages 215-216 ReferencesRelatedInformation

Purpose: To elucidate the meaning of anthroposophic practitioners' conceptualizations of caring for persons living with chronic pain.Methods: Interviews were conducted with 15 practitioners working with rehabilitation of persons with chronic pain at an anthroposophic hospital in Sweden. The interviews were analyzed using a phenomenological hermeneutical method.Findings: When practitioners discussed patient care, they used a shared language with particular concepts. Concepts, such as "trauma," "self," and "life intention," were interpreted as a means of understanding persons with pain and their current life situation. The meaning of the concepts also had explicit or implicit implications for the caring process, e.g., the concept "caring shelter" referred to an inherent and continuous part of the caring culture enabling patients' own exploration of their life and suffering and the meaning of their pain in the context of their lives.Conclusions: The practitioners' use of a conceptual language is here interpreted as a sign of a shared "caring culture" that enabled them to understand patients and their suffering from an existential perspective. A reciprocal understanding within a caring culture may extend the abilities of practitioners to engage in a dialog with patients about life and health as intertwined with the phenomenon of pain.Implications for rehabilitationIn the rehabilitation process, health practitioners' language may contribute to shaping a caring culture that emphasis an understanding of patients' needs of health.Shared concepts in rehabilitation might increase health practitioners' possibilities to support patients from broader and more personalized perspectives, involving not only biopsychosocial aspects but also existential dimensions.The shared conceptual understanding of anthroposophic practitioners in this study may serve as an example to practitioners in other pain rehabilitation settings, developing a contextual understanding of their central concepts, and caring values.

BACKGROUND:Patients who sustain a motor vehicle accident may experience long-term distress, even if they are uninjured or only slightly injured. There is a risk of neglecting patients with minor or no physical injuries, which might impact future health problems. The aim of this study was to explore patients' subjective experiences and perspectives on pain and other factors of importance after an early nursing intervention consisting of "caring touch" (tactile massage and healing touch) for patients subjected to a motor vehicle accident with minor or no physical injuries.METHODS:A mixed method approach was used. The qualitative outcomes were themes derived from individual interviews. The quantitative outcomes were measured by visual analogue scale for pain (VAS, 0-100), sense of coherence (SOC), post-traumatic stress (IES-R) and health status (EQ-5D index and EQ-5D self-rated health). Forty-one patients of in total 124 eligible patients accepted the invitation to participate in the study. Twenty-seven patients completed follow-up after 6 months whereby they had received up to eight treatments with either tactile massage or healing touch.RESULTS:Patients reported that caring touch may assist in trauma recovery by functioning as a physical "anchor" on the patient's way of suffering, facilitating the transition of patients from feeling as though their body is "turned off" to becoming "awake". By caring touch the patients enjoyed a compassionate care and experience moments of pain alleviation. The VAS pain ratings significantly decreased both immediately after the caring touch treatment sessions and over the follow-up period. The median scores for VAS (p < 0.001) and IES-R (p 0.002) had decreased 6 months after the accident whereas the EQ-5D index had increased (p < 0.001). There were no statistically significant differences of the SOC or EQ-5D self-rated health scores over time.CONCLUSIONS:In the care of patients suffering from a MVA with minor or no physical injuries, a caring touch intervention is associated with patients' report of decreased pain and improved wellbeing up to 6 months after the accident.TRIAL REGISTRATION:ClinicalTrials.gov Id: NCT02610205 . Date 25 November 2015.