Scand J Caring Sci; 2012 The substance of love when encountering suffering: an interpretative research synthesis with an abductive approach Aim:  This study presents the results of an interpretative research synthesis undertaken to explore the essence of love when encountering suffering. The idea of caring as an expression of love and compassion belongs with ideas that have shaped caring for hundreds of years. Love and suffering are the core concepts in caring science and thus demand a basic research approach. Methods:  The synthesis was undertaken by the interpretation of 15 articles focusing on love in different aspects, but within a caring science perspective. The research process was guided by a hermeneutical perspective with an abductive approach. Results:  The substance of love, when encountering suffering, reveals itself in three themes: love as a holy power, love as fundamental for being and love as an ethical act, which are to be found, respectively, within three dimensions: love as holiness, love as a communion and love as an art. Love is a holy power and encompasses everything; it is the well of strength that heals. No human can exist without love: this points to the ethical responsibility one has as a neighbour. In the ethical act, love is evident in concrete caring actions. Conclusions:  The core of the substance of love within the three dimensions can be understood as agape. Agape connects and mirrors the dimensions, while at the same time it is clear that agape stems from and moves towards holiness, enabling love to be the ethical foundation when encountering suffering. Through the dimensions of love as communion and love as an art agape intertwine with eros forming caritas enabling the human being to move towards the dimension of holiness, which signifies becoming through suffering.

OBJECTIVE: To describe and interpret the perceptions and experiences of caring of immigrant new mothers from an intercultural perspective in maternity care in Finland. DESIGN: Descriptive interpretive ethnography using Eriksson's theory of caritative caring. SETTING: A maternity ward in a medium-sized hospital in western Finland. PARTICIPANTS: Seventeen mothers from 12 countries took part in the study. METHODS: Interviews, observations, and field notes were analyzed and interpreted. RESULTS: Most mothers were satisfied with the equal access to high-quality maternity care in Finland, although the stereotypes and the ethnocentric views of some nurses negatively influenced the experiences of maternity care for some mothers. The cultural background of the mother, as well as the Finnish maternity care culture, influenced the caring. Four patterns were found. There were differences between the expectations of the mothers and their Finnish maternity care experience of caring. Caring was related to the changing culture. Finnish maternity care traditions were sometimes imposed on the immigrant new mothers, which likewise influenced caring. However, the female nurse was seen as a professional friend, and the conflicts encountered were resolved, which in turn promoted caring. CONCLUSION: The influence of Finnish maternity care culture on caring is highlighted from the perspective of the mothers. Intercultural caring was described as universal, cultural, contextual, and unique. Women were not familiar with the Finnish health care system, and many immigrant mothers lacked support networks. The nurse/patient relationship could partly replace their support if the relationship was perceived as caring. The women had multiple vulnerabilities and were prone to isolation and discrimination if they experienced communication problems.

A reorientation is going on in caring science. It could be called a new key characterized by more humanistically oriented thinking, which gives new significance to caring science. The sounding board of the new key is to be found in its ontological core. Its progress depends on whether we will succeed in laying bare the core of caring and developing its fundamental concepts and main theory. We need to regain the hermeneutical approach to penetrate into the core. Caring today needs this knowledge to help the patient in an increasingly complex world.

There is a lack of research focusing directly on both patients' suffering and alleviated suffering in relation to care. The aim of this paper was to investigate the progression of suffering in relation to the encounter between the suffering person and the caregiver from the perspective of an understanding of life. The progression of suffering is assumed to be an existential 'sign' of the development of understanding of life as an ontological or spiritual entity, which demands a meaning-creating encounter between the patient and caregiver. The concept 'existential caring encounter' was used to describe how the encounter between patient and caregiver can create meaning in communion and thereby alleviate suffering by making it bearable. The study was carried out using an interpretive, hermeneutic approach. The study as a whole comprises three parts, and these include letter-writing and interviews. The findings are described by the following main theses:(a) a darkness in life understanding is existentially experienced as unbearable suffering and requires an encounter involving attentive care and confrontation;(b) the turning point means that the struggle of suffering begins; and (c) the encounter involves being meaning-creating in a communion in the struggle of suffering. An understanding of the patterns of unbearable and bearable suffering can be of help to the caregiver in caring for the patient by serving as a basis for meaning-creation in communion. This may thereby be a way of alleviating the patient's suffering by making it bearable during the progression of suffering.

The aim of this study was to explore the ethical foundations for a caring The analysis is based on the ethics of Paul Ricoeur and deals with questions such as what kind of person the nurse ought to be and how she or he engages in caring conversations with suffering others. According to Ricoeur, ethics (the aim of an accomplished life) has primacy over morality (the articulation of aims in norms). At the ethical level, self-esteem and autonomy were shown to be essential for a person (nurse) to act with respect and responsibility. The ethical relationship of a caring conversation was found to metrical, because of the passivity inflicted by suffering. This asymmetry was found to be potentially unethical if not balanced with reciprocity. In the ethical context, the caring conversation is one in which the nurse makes room through the ethos of caritas for a suffering person to regain his or her self-esteem, and thus makes a good life possible.

A previous study indicated that patient narratives include experiences of suffering caused or increased by health-care encounters. The aim of this study was to interpret and understand the meaning of patients' experiences of suffering related to health care from an ethical, existential and ontological standpoint. Sixteen women with breast cancer in Sweden and Finland took part in qualitative interviews analysed with a hermeneutic, interpretive approach. The outcome showed that suffering related to health care is a complex phenomenon and constitutes an ethical challenge to health-care personnel. The women's experiences of suffering related to health care tended to be of similar seriousness as their experiences of suffering in relation to having cancer. In an ethical, existential and ontological sense, suffering related to health care is basically a matter of neglect and uncaring where the patient's existential suffering is not seen and she is not viewed as a whole human being.

The purpose of this investigation was to explore when nursing becomes an art, and to develop a theory/model of nursing as art. The overall design of the investigation was qualitative, and phenomenological-hermeneutic. The five substantial categories in the theory/model are: Invitation and confirmation, encounter, values, moral attitude and demeanor, the act of good will, and aesthetic communication. One main finding of this nursing investigation based on the caring perspective was that values and a thoroughly moral attitude and demeanor are central when nursing becomes an art.

The aim of this study was to increase understanding of how individual patient care and the ethical principles prescribed for nursing care are implemented in nursing documentation. The method used was a metasynthesis of the results of 14 qualitative research reports. The results indicate that individualized patient care is not visible in nurses' documentation of care. It seems that nurses describe their tasks more frequently than patients' experiences of their care. The results also show that the structure of nursing documentation and the forms or manner of recording presupposed by the organization may prevent individual recording of patient care. In order to obtain visibility for good patient-centred and ethical nursing care, an effort should be made to influence how the content of nursing care is documented and made an essential part of individual patient care. If the content of this documentation does not give an accurate picture of care, patients' right to receive good nursing care may not be realized.

The aim of the study was to evaluate the content of nursing care records and the usefulness of the instrument used for their evaluation. The evaluation involved 70 patient records from seven acute special care inpatient units. The evaluation instrument used was based on Phaneuf's Nursing Audit as further developed by Lukander. The nursing records in all the care units evaluated was very good or good. However, some deficiencies were found, for instance, regarding patient teaching and recording patients' own opinions. The method proved adequate for evaluating the content of patient records.

BACKGROUND AND RATIONALE: The underlying assumption was that the aesthetics of the hospital surroundings are often neglected. AIMS: This article is the first part of a larger study into the aesthetics of general hospitals. The aim of the study is to throw light on the influence of aesthetics on the health and well-being of patients and the professional personnel, and to examine how aesthetic considerations are dealt with. We present a survey of how the aesthetic dimension is planned and it is considered important in the strategic plans of Norwegian general hospitals. METHODS: Data were sampled by analyzing the strategic plans of somatic hospitals. Sixty-four of 86 hospitals responded (74%). Concepts were categorized in a matrix of 11 main categories, each with subcategories. The method was quantitative, in that the analyzed material was amenable to counting. RESULTS: Very few concrete guidelines or directions for the aesthetic dimension have been included in written documents. This indicates that the aesthetic area is a neglected field in the directions for the daily management of hospitals. CONCLUSIONS: The research available today on the contribution of environmental aesthetics to health, rehabilitation, and well-being suggests that it is important to have concrete guidelines recorded in strategic plans. This field concerns the maintenance of high quality in the caring professions.

BACKGROUND: The first part of this comprehensive study examined and analyzed strategic plans for the general hospitals in Norway. The concern was to discover the way in which the aesthetic dimension is taken into consideration and what guidelines the strategic plans provide. The result showed a general lack of guidelines, and it was therefore decided to ask patients how they would characterize and evaluate the aesthetics in their environments. AIM: The aim of the second part of the study was to find out how the patients evaluate the aesthetics in the general hospitals, and to ascertain their opinion as to how aesthetics influences health and wellness. The theoretical background for the investigation was based on literature studies from the caring sciences, philosophical theories, and results of international research. The purpose of this article is to present the results from the second part of the study addressing the human need for aesthetics in the surroundings and in life in general. The investigation was carried out at 6 general hospitals in Norway. METHODS: A questionnaire was constructed in which the patients were asked to give their opinion on the aesthetics in the hospital environment and the influence aesthetics might have on health and wellness. The questionnaire contained 22 main questions, each with detailed and specific subquestions. For instance, concerning the question about "art," patients were asked to evaluate paintings, pictures, tapestries, sculptures, decorations, mosaic works and water decorations, fountains, etc. FINDINGS: The results in general showed that aesthetic surroundings are important for health and wellness, according to the patients' opinion. The aesthetics in the hospital environment was evaluated and generally considered to be less than satisfactory by the patients. They felt that the aesthetic issues are not attended to as well as they would have liked. CONCLUSION: In summary it can be concluded that according to the patient experiences, the aesthetic area is a neglected field, and it is important to focus more on this field to understand what high-quality patient care should embrace.