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Möten mellan människor och teknologi: berättelser från intensivvårdssjuksköterskor och personer som ventilatorbehandlas i hemmet
Umeå University, Faculty of Medicine, Nursing.
2005 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
The meeting between people and technology : interpretation of the narratives of ICU nurses and ´people using ventilators in their own homes (English)
Abstract [en]

The overall aim of this thesis is to illuminate meanings of the relation between human beings, technology and care, as narrated by critical care nurses and people in need of home mechanical ventilation (HMV). The data are based on narrative research interviews with six intensive care nurses (I), 13 people who were about to start HMV (II), these 13 people were interviewed for a second time six to eight months after HMV had started (III), and nine persons with more than two years HMV experience (IV). The text was analysed using a phenomenological-hermeneutic research method as described by Lindseth and Norberg. The method is developed from the writings of the French philosopher Paul Ricoeur.

The findings illuminate meanings of nursing care in an intensive care unit (I) as undertaking the role of advocacy as a caring response to another human being. The basic condition for this caring response depends on the nurses' openness and sensitivity to the needs of patients or patients' next of kin. The nurses were aware of the influence of technology and tried to modify its negative effects. Meanings of becoming dependent on HMV (II) are interpreted and metaphorically expressed as "to get one's breath" and "to hold one's breath" respectively. On the one hand, breathing ensures the cellular oxidation process within the body, but on the other hand there can be "shortness of breath" in "spiritual breathing", and starting HMV will influence patients' whole life situation, body and spirit. After using a ventilator six to eight months, meanings of a life dependent on a ventilator was interpretd as either a closure or an opening of the lived body to oneself, other people and the world. This interpretation is illustrated by two images. A life on a ventilator at home is not to be seen as static being. On the contrary, it is a being which moves and changes over time. Being dependent on a ventilator and living at home, as narrated by adults with more than two years of HMV experience (IV), was interpreted as being able to rise above yourself and your personal boundaries in order to live a good life. These meanings are bound up with experiencing a vital force and interdependency, and despite fragility being able to reach others and the outside world. Design and function of technology had an impact on the lived body.

The comprehensive understanding of the four articles (I-IV) unfolded meanings of the relation between human beings, technology and care, as an interchange and a creation of physical and spiritual energy among humans and between human and technology. It could be an experience of the lived body being filled with as well as emptied of energy. This interpretation points at a call for the caring personnel to be attentive and to listen to the voices of the lived body in health and illness, and to bear witness to those who suffer. Technology acts between the person and the world and in order to be embodied, technology must be "transparent", i.e. beautiful and fit to its use.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2005. , 81 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 950
Keyword [en]
Nursing, critical care nursing, home mechanical ventilation, ventilator, home-nursing-professional, home health care, spiritual care, advocacy, testimony, qualitative-studies, phenomenological hermeneutics
Keyword [sv]
Omvårdnad
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-495ISBN: 91-7305-842-4 (print)OAI: oai:DiVA.org:umu-495DiVA: diva2:143604
Public defence
2005-04-29, 13:00 (English)
Opponent
Supervisors
Available from: 2005-04-08 Created: 2005-04-08 Last updated: 2009-11-19Bibliographically approved
List of papers
1. The role of advocacy in critical care nursing: a caring response to another.
Open this publication in new window or tab >>The role of advocacy in critical care nursing: a caring response to another.
1998 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, Vol. 14, no 4, 179-186 p.Article in journal (Refereed) Published
Abstract [en]

With the aim of clarifying critical care nursing, six critical care nurses, working in a Swedish intensive care unit (ICU) were each asked to narrate a care situation with which they had been satisfied or dissatisfied. The stories were tape-recorded and analysed using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. The themes uncovered in the analysis describe the nurse's role of advocacy as: to build a caring relationship, to carry out a commitment, to empower, to make room for and interconnect, to be a risk-taker, to be a moral agent and to create a trusting atmosphere conducive to recovery. The meaning of the role of advocacy lies in a moral and existential response to another human being, an expression of caring. Advocacy rests on the patient-nurse relationship and occurs as an outspoken demand of another human being whose autonomy is threatened. The results are discussed from the ethical perspectives of Lögstrup, Watson's concept of care, and existential advocacy as expressed by Gadow.

Identifiers
urn:nbn:se:umu:diva-27760 (URN)10.1016/S0964-3397(98)80499-0 (DOI)9849244 (PubMedID)
Available from: 2009-11-19 Created: 2009-11-19 Last updated: 2009-11-19
2. On becoming dependent on home mechanical ventilation.
Open this publication in new window or tab >>On becoming dependent on home mechanical ventilation.
2005 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 49, no 1, 33-42 p.Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this paper is to illuminate meanings of becoming dependent on home mechanical ventilator treatment. BACKGROUND: People suffering from chronic alveolar hypoventilation and requiring home mechanical ventilation represent a small but increasing group in society, and are some of the most vulnerable individuals with chronic disabilities. METHOD: Thirteen people about to begin ventilator treatment at home were interviewed. Data were tape-recorded and analysed according to a phenomenological-hermeneutic method. FINDINGS: Findings revealed two contrasting meanings of being in the process of becoming dependent on a ventilator, interpreted as getting breath or holding breath. This interpretation is presented in two composite stories. CONCLUSIONS: The findings imply possibilities and deficiencies in meeting patients' existential needs, such as helping them to breathe spiritually by supporting them as they get their breath after such a life-changing event as becoming dependent on a ventilator.

Keyword
Adaptation; Psychological, Aged, Aged; 80 and over, Attitude to Health, Caregivers/*psychology, Female, Home Nursing/methods, Humans, Male, Middle Aged, Narration, Respiration Disorders/*psychology/rehabilitation, Respiration; Artificial/nursing/*psychology, Sweden/epidemiology
Identifiers
urn:nbn:se:umu:diva-6746 (URN)10.1111/j.1365-2648.2004.03261.x (DOI)15610379 (PubMedID)
Available from: 2007-12-17 Created: 2007-12-17 Last updated: 2009-11-19Bibliographically approved
3. On being dependent on home mechanical ventilation: depictions of patients' experiences over time.
Open this publication in new window or tab >>On being dependent on home mechanical ventilation: depictions of patients' experiences over time.
2006 (English)In: Qualitative Health Research, ISSN 1049-7323, Vol. 16, no 7, 881-901 p.Article in journal (Refereed) Published
Abstract [en]

In this study, the authors describe the meanings of experiences of being dependent on a ventilator (HMV) and living at home as narrated by 13 people who had been using a ventilator via a mask or tracheostomy for half a year. The analyses revealed various movements across time toward the goal of using the ventilator successfully, and some narratives depicted suffering caused by care. The analyses also yielded different representations of embodiment. These findings were abstracted into two contrasting meanings of the experience of using HMV over time: a closing in or an opening up of the lived body, oneself, to other people and to the world. The authors illustrate this interpretation with two images. Ignorance and negative attitudes on the part of professionals working and/or managing care in the patients' homes are interpreted as causing suffering and intensifying a closed-in mode of being.

Keyword
Aged, Aged; 80 and over, Female, Home Care Services, Humans, Interviews as Topic, Male, Middle Aged, Patient Satisfaction, Respiration; Artificial, Sweden
Identifiers
urn:nbn:se:umu:diva-6747 (URN)10.1177/1049732306288578 (DOI)16894222 (PubMedID)
Available from: 2007-12-17 Created: 2007-12-17 Last updated: 2009-11-19Bibliographically approved
4. Meanings of living at home on a ventilator
Open this publication in new window or tab >>Meanings of living at home on a ventilator
2003 (English)In: Nursing Inquiry, ISSN 1320-7881, Vol. 10, no 1, 19-27 p.Article in journal (Refereed) Published
Abstract [en]

Nine adults were interviewed in order to illuminate the meanings of being dependent on a ventilator and living at home. The data were analysed using a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur. Five main themes emerged through the analysis: experiencing home as a safe and comfortable space from which to reach out, experiencing the body as being frail, brave and resilient, striving to live in the present, surrendering oneself to and trusting others, and experiencing technology as a burden and a relief to the lived body. Meanings of being home on a ventilator were interpreted as maintaining autonomy and persistence in interaction with the ventilator and other human beings and being able to rise above yourself and your personal boundaries in order to live a good life. These meanings indicate that aesthetic and ethical values impact on the lived body. They are bound up with experiencing a vital force and interdependency, bringing safety and courage into daily life.

Identifiers
urn:nbn:se:umu:diva-4481 (URN)10.1046/j.1440-1800.2003.00160.x (DOI)12622801 (PubMedID)
Available from: 2005-04-08 Created: 2005-04-08Bibliographically approved

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