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Atmosphere in care settings: Towards a broader understanding of the phenomenon
Umeå University, Faculty of Medicine, Nursing.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the study is to understand and describe the phenomenon ‘atmosphere in care settings’ as experienced by patients, significant others and health care staff. The study consists of four papers, each of which illuminates various aspects of the phenomenon. Data consisted of observations and interviews with patients, significant others and staff (n=126) within a hospice, a geriatric, a medical and an oncology setting, and community care settings for older people. Narrative analysis, grounded theory, and phenomenological hermeneutics were used in a triangular fashion to analyse the data.

The findings illuminate the phenomenon ‘atmosphere in care settings’ as being constituted by two interacting and interwoven dimensions: the physical environment and people’s doing and being in the environment. The physical environment is the first dimension, and five aspects were illuminated, namely the physical environment as a symbol; as containing symbols; as influencing interaction; as facilitating a shift of focus from oneself to the environment, and; as containing scents and sounds influencing experiences of at-homeness or alienation. People’s doing and being in the environment is the other dimension, and five aspects were illuminated, namely the experience (or absence of experience) of a welcoming; of seeing and being seen; of a willingness to serve; of a calm pace; and of safety. It was understood that people’s doing and being influences experiences of the physical environment and that the physical environment influences experiences of people’s doing and being. The comprehensive understanding illuminated that the phenomenon is not merely subtle qualities of the place for care, but an active part of care. Both the physical environment and peoples doing and being conveys messages of caring and uncaring. The atmosphere of a care setting can at best support experiences of at-homeness in relation to oneself, others and the surrounding world.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2005. , 189 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 941
Keyword [en]
Nursing, Narrative analysis, Grounded Theory, Phenomenological hermeneutics, Symbols, At-homeness, Environment
Keyword [sv]
Omvårdnad
National Category
Nursing
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning
Identifiers
URN: urn:nbn:se:umu:diva-406ISBN: 91-7305-807-6 (print)OAI: oai:DiVA.org:umu-406DiVA: diva2:143386
Public defence
2005-02-04, Aulan, Vårdvetarhuset, Umeå universitet, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2005-01-11 Created: 2005-01-11 Last updated: 2009-11-11Bibliographically approved
List of papers
1. Ward atmospheres of horror and healing: a comparative analysis of narrative
Open this publication in new window or tab >>Ward atmospheres of horror and healing: a comparative analysis of narrative
2003 (English)In: Health, ISSN 1363-4593, Vol. 7, no 4, 377-396 p.Article in journal (Refereed) Published
Abstract [en]

Aspects of a social setting profoundly influence personal experience in the setting. The purpose of our study was to further understand the phenomenon of ward atmosphere through a detailed case study. One narrator describes and contrasts two ward experiences, one where she lost her mother through death, and the other where she became a mother through birthing. Using classic storytelling forms, she develops a long narrative juxtaposing the two settings: one healing, the other horrifying. Close examination of narrative structure and aesthetics of the illness narrative shows how the narrator forges a discourse about the moral life - how healing should occur. Experiences in the two settings continue to have significance in her subjectivity. The research suggests aspects of ward atmosphere that warrant further investigation.

Keyword
aesthetics, healing, horror, narrative analysis, ward atmosphere
Identifiers
urn:nbn:se:umu:diva-4340 (URN)10.1177/13634593030074001 (DOI)
Available from: 2005-01-11 Created: 2005-01-11 Last updated: 2009-11-11Bibliographically approved
2. Sensing an atmosphere of ease: a tentative theory of supportive care settings.
Open this publication in new window or tab >>Sensing an atmosphere of ease: a tentative theory of supportive care settings.
2005 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 19, no 4, 344-353 p.Article in journal (Refereed) Published
Abstract [en]

Nightingale saw the art of nursing as providing an environment in which patients were offered the best conditions for nature to act upon them. However, we still have limited research-based understandings of care settings experienced as supportive by patients, significant others and staff. The aim of this study was to construct a theoretical understanding of processes contributing to supportive care settings. The authors used grounded theory design and the constant comparative method to analyse theoretically sampled interview and observational data from three different contexts of care. The tentative theory conceptualizes supportive care settings as sensing an atmosphere of ease, and five categories were recognized: experiencing welcoming; recognizing oneself in the environment; creating and maintaining social relations; experiencing a willingness to serve; and experiencing safety. Having one's expectations of the environment exceeded was a mediating factor in sensing an atmosphere of ease. Sensing an atmosphere of ease facilitated experiences of being able to locate oneself in familiar and safe surroundings; being able to follow one's own rhythm; being seen, acknowledged and cared about; and having possibilities of benefiting from beauty and contacts with others.

Keyword
Adult, Aged, Aged; 80 and over, Attitude to Health, Empathy, Female, Health Facility Environment, Humans, Interviews as Topic, Male, Middle Aged, Observation, Professional-Patient Relations, Psychological Theory, Sweden
Identifiers
urn:nbn:se:umu:diva-6701 (URN)10.1111/j.1471-6712.2005.00356.x (DOI)16324058 (PubMedID)
Available from: 2008-01-11 Created: 2008-01-11 Last updated: 2009-11-11Bibliographically approved
3. Caring or uncaring - meanings of being in an oncology environment.
Open this publication in new window or tab >>Caring or uncaring - meanings of being in an oncology environment.
2006 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 55, no 2, 188-197 p.Article in journal (Refereed) Published
Abstract [en]

AIM: This paper reports a study illuminating meanings of being in the physical environment of an oncology centre as narrated by patients, significant others and staff. BACKGROUND: The physical environment of hospitals can convey different messages. For example, landscape pictures, plants and comfortable chairs can convey positive messages, while sparsely decorated and run-down environments can convey negative values. Traditional healthcare environments may be experienced as unfamiliar, strange and alienating, fostering feelings of stress and vulnerability. The majority of research on care environments has employed experimental designs to test different environmental variables, for example sound, colour and architecture, in relation to patient outcomes such as recovery, pain and blood pressure. There is, however, little research-based understanding of the meanings of being in these environments. METHODS: A phenomenological hermeneutic approach was applied to analyse 17 interviews with patients, significant others and staff carried out during the spring of 2004 at an oncology centre in Sweden. FINDINGS: The physical environment was found to influence experiences of care in four ways: first, by being a symbol expressing messages of death and dying, danger, shame and stigma, less social value and worth; second by containing symbols expressing messages of caring and uncaring, life and death; third, by influencing interaction and the balance between being involved and finding privacy; and fourth, by containing objects that could facilitate a shift of focus away from the self: being able to escape the world of cancer, and finding light in the midst of darkness. The comprehensive understanding illuminates the physical environment as not merely a place for caring, but as an important part of caring that needs to be accounted for in nursing care. CONCLUSION: To promote well-being among patients, we need to ask ourselves if the environment imposes rather than eases suffering. Our findings also suggest the importance of not limiting our conceptions of nursing to nurse-patient relationships, but of using the therapeutic potential of the total environment in nursing care.

Keyword
Adult, Aged, Aged; 80 and over, Attitude to Health, Existentialism, Female, Health Facility Environment, Humans, Male, Middle Aged, Neoplasms/*psychology, Oncologic Nursing, Privacy/psychology, Professional-Patient Relations, Self Concept, Symbolism
Identifiers
urn:nbn:se:umu:diva-6762 (URN)10.1111/j.1365-2648.2006.03900.x (DOI)16866811 (PubMedID)
Available from: 2007-12-17 Created: 2007-12-17 Last updated: 2009-11-11Bibliographically approved
4. Meanings of giving touch in the care of older patients: becoming a valuable person and professional
Open this publication in new window or tab >>Meanings of giving touch in the care of older patients: becoming a valuable person and professional
2003 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 12, no 4, 601-609 p.Article in journal (Refereed) Published
Abstract [en]

Touch is central to nursing and health care workers frequently touch their patients, consciously or unconsciously in their interactions with them. Most literature has studied touch from a patient perspective, thus inquiry about professionals' experiences are rare. The aim of this study was to illuminate meanings of giving touch in nursing care of older patients. To understand the meaning of lived experiences of giving touch in care of older patients, interviews with 12 health care professionals in northern Sweden were analysed using a phenomenological-hermeneutic approach influenced by the philosophy of Ricoeur. The findings show that giving touch in the care of older patients is a transforming experience, where one suddenly perceives oneself as both a valuable person and professional who no longer powerlessly confronts patients' haunted and disrupted bodies, but who, by means of touch, has gained power to ease this suffering. The experience also transforms the way one regards older patients. Instead of seeing a severely demanding patient suffering from dementia and/or pain, one is able to see the person behind the disease as a human being, like oneself. A relationship described as calm, friendly and humane is created between caregiver and patient when giving touch, a relationship that transcends the moment of touch and influences one's way of caring. This understanding is presented using the theoretical framework of the philosophy of Marcel. Giving touch has the power to shed new light on health care professionals' experiences of caring for older patients suffering from dementia and/or pain, giving them the power to be a valuable person and professional.

Keyword
health care professionals, lived experience, older patients, phenomenological-hermeneutics, touch
Identifiers
urn:nbn:se:umu:diva-4343 (URN)10.1046/j.1365-2702.2003.00754.x (DOI)12790874 (PubMedID)
Available from: 2005-01-11 Created: 2005-01-11 Last updated: 2009-11-11Bibliographically approved

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