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Aim and Objectives: To explore how chronic illness transforms the self when living with and managing chronic illness and what this means for their self and identity. We also discuss how people with chronic conditions could be supported by healthcare professionals to manage illness in daily life.

Background: Self-management recommendations from health care are commonly based on a biomedical understanding of the disease. People's experiences of how a condition affects them and adequate support are crucial for their outcomes in daily self-management.

Design: A narrative review.

Methods: A systematic search was undertaken during January 2021 across the databases MEDLINE, CINAHL, PsycINFO, Soc INDEX and Philosopher's Index. A quality appraisal of articles was performed. Our analysis was inspired by qualitative content analysis. The PRISMA Checklist 2020/EQUATOR guidelines was used to report the study.

Results: Twenty-eight peer-reviewed qualitative empirical articles focusing on self in a variety of chronic illnesses with relevance to nursing published from January 2010 to December 2020 were included. The main theme, Developing from an uncertain existence to meaning and wholeness, was built up by the five themes: Walking on an unstable ground; Being stalemated; Being involved with others for better or worse; Searching for meaning; and lastly, Modifying self and integrating a new way of living.

Conclusions: The results illuminate experiences that seldom are prioritized but need to be addressed by health professionals. Such experiences are oriented more towards the existential self rather than medical issues, why it is important to go beyond the medical lens.

Relevance to Clinical Practice: This is important knowledge for nurses aiming to support people with chronic illnesses. Nurses supporting people in self-management need to be aware that by teaching and encouraging people to revise their daily habits, they also work on the boundaries of their self-concept.

Patient or Public Contribution: No patient or public contribution.

Background: Considering cultural influences, it is important to study the perceptions and stress of conscience in different contexts. This study aimed to investigate the association between perceptions of conscience, stress of conscience, and burnout among nursing staff working in older people care settings in Tehran.

Methods: This was a descriptive, cross-sectional study. A total of 161 participants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire, and Oldenburg Burnout Inventory, 2019. All nursing staff working at the 20 contacted nursing homes agreed to participate in the study. The descriptive and inferential analysis was conducted through SPSS, using T-tests and one-way between-groups analysis of variance, Chi-square and t-tests, Cohen's d (d), Eta-squared (η2), and Phi coefficient (φ), Partial least squares regression (PLSR), jackknife approximate t-tests of the regression coefficients, and jackknife 95% confidence intervals of the regression coefficients.

Results: The nursing staff perceived their conscience mainly as an authority, asset, and warning signal. Impact of workload on family life was the most common source of stress for the nursing staff. Dealing with incompatible demands, the impact of workload on family life, witnessing insulated patients, inability to meet one’s standards in providing care, and perception of conscience as a burden were strongly associated with the burnout.

Conclusions: Perceiving conscience as a warning signal or authority may serve as a buffer against burnout among nursing staff. This study highlights the need for further exploration of perceptions of conscience in different cultural and social backgrounds.

Persons with advanced dementia disease (ADD), here labelled PADDs, are shown to preserve parts of their self, which hasopened up possibilities for involving them in their own care and establishing strategies for improving their communicationwith the surrounding world. Using the well-known theory of human development proposed by Erik and Joan Erikson, herelabelled EJET, can operate as an efficient structure for formal caregivers to support PADDs in reclaiming their space.However, very few studies have used EJET as a framework in improving formal caregivers’ competence and the quality ofcare. This article aims to demonstrate the feasibility of applying EJET in the care of PADDs through two examples of successfulapplication of this framework in interacting with PADDs in residential care settings. The examples demonstrate the significanceof competent caregivers and the important role of tailoring nursing care plans to specific situations of the PADDs in theirpresent and previous developmental phases.

In this paper, a phenomenological hermeneutical method for interpreting narrativetexts is proposed. Interviewees are asked to tell from their lived experience of participatingin life world phenomena. The interview texts are written down and analysed,inspired by the theory of interpretation of Paul Ricoeur, in three steps: a first,naïve reading, structural analysis and comprehensive understanding. The methodwas presented the first time in 2004. In this paper, the theory behind it is elaborated.Basic concepts like phenomenon, meaning, life world, lived experience and concretereflection are clarified, and the historical background of the method and its ontology,epistemology and methodology are explained.

Inner strength is a conceptualization of a human resource that is generally considered beneficial for health and well-being. Previously, it has been examined in qualitative and cross-sectional studies, but longitudinal data are lacking. The aim of this study was to examine how inner strength, health and function, well-being, and negative life events, namely crises and diseases, affect each other over time in old people. A longitudinal two-wave design was used with data from 2010 and 2016. A total of 4023 participants, living in Finland and Sweden, and born in 1930, 1935, 1940, or 1945 were included. Data were collected using the Inner Strength Scale, the Life Orientation Scale, a short version of the Geriatric Depression Scale, one item from the SF36, and five items from the Katz ADL-index. Structural equation modeling was used to test for cross-lagged effects. Crises and diseases were found to be a positive predictor of inner strength, a negative predictor of well-being, and to have no significant effect on health and function over time. Inner strength and well-being had a reciprocal positive relationship, and health and function was a positive predictor inner strength. The study expands findings by providing perspectives of inner strength across time indicating that inner strength in old people increases when they have to face a disease or crisis. From a health perspective, the present findings reinforce the importance of healthcare professionals' awareness and knowledge of the construct of inner strength.

Sirkka-Liisa Ekman, Professor Emeritus of Nursing at Karolinska Institutet, passed away on 3 September 2020 at the age of 77, surrounded by her immediate family. She was a giant in geriatric care and dementia care.

Background: More gender-theoretical studies are needed to gain a deeper understanding of what life circumstances make people sick or improve their health. The aim of the study was to gain a deeper understanding of social determinants of health by exploring gendered experiences in daily life among middle-aged women and men using the theory of gender relations.

Methods: Individual interviews with nine men and women were performed, focusing on what made them feel good or bad. Qualitative content analysis was used to analyse the data.

Results: A major theme in our interviews was the gendered health-promoting experiences related to having a job, which involved becoming someone, feeling appreciated at work and having control over work. Having good family relations was also health-promoting, in terms of supportive relations and becoming a parent. Ill-health was related to gendered adverse conditions at work (accidents, monotonous and stressful work tasks, being bullied) and in domestic life (demands, destructive partner relations, having children with problems).

Conclusions: Gendered determinants of health and ill-health were identified in both working and domestic life. Public health policy needs to challenge the gender order in society, which defines the gendered structure of the labour market as well as the gendered relations in domestic life.

Agency (individuality) and communion (togetherness) are vital to a positive sense of self. People with Alzheimer’s disease are at risk of experiencing diminished agency and decreased communion. Their family members’, especially their partner’s, view on their agency and communion is also likely to influence their sense of agency, communion, and self. In the present study, individual interviews with 10 people with Alzheimer’s disease and their spousal carers were qualitatively analysed to describe how in each couple the two spouses viewed the agency and communion of the person with Alzheimer’s disease from an individual perspective. The findings show that the carers generally described the agency of the person with Alzheimer’s disease as slightly weaker compared with the persons with Alzheimer’s disease themselves. The carers also appeared to have poor knowledge of what supported and threatened the sense of communion of the person with Alzheimer’s disease.