Striving for purity : interviews with people with malodorous exuding ulcers and their nurses

Sammanfattning: The overall purpose of this thesis is two-fold; to illuminate the meaning of living with ‘impurity’ in terms of malodorous exuding ulcers, and the meaning of caring for people with ‘impure’ bodies in institutions and in people’s homes. The thesis comprises four papers based on studies using qualitative methods. To illuminate nursing care as narrated by 27 retired care providers in northern Sweden, seven audio recorded group dialogues were performed (I). The transcribed group dialogues were analysed using a hermeneutic approach. The findings formulated as cleanliness, order and clear conscience point to purity. By cleaning patients and their surroundings repeatedly, by preserving order in various ways and by keeping a clear conscience, nurses committed to preserving purity. This study opened up for questions concerning the meaning of ‘impurity’ and‘purity’ in nursing today leading to papers II-IV. Learning about ‘purity’ is possible through studying ‘impurity’. Audio recorded narrative interviews were performed to illuminate the meaning of living with malodorous exuding ulcers (II) and the meaning of caring for people with malodorous exuding ulcers (III). A phenomenological-hermeneutic method was used to analyse the nine transcribed interviews with patients (II) and 10 transcribed interviews with nurses (III). The comprehensive understanding of living with malodorous exuding ulcers (II) was formulated as being trapped in a debilitating process that slowly strikes one down. There is a longing for wholeness and purity. When finding consolation, i.e., encountering genuineness and feeling loved, regarded and respected as fully human despite ulcers, patients feel purified. The comprehensive understanding of caring for people with malodorous exuding ulcers (III) was formulated as being exposed to, and overwhelmed by suffering that is invading. One runs the risk of experiencing desolation when one cannot make the ulcers and malodour disappear and fails to protect patients from additional suffering. To illuminate nurses’ reflections on obstacles and possibilities providing care as desired by people with malodorous ulcers (IV), six nurses from a previous study (III) were interviewed. An illustration with findings from paper II was shown and participants were asked to reflect on obstacles and possibilities providing the care desired by patients. The 12 audio recorded transcribed interviews were analysed using qualitative content analyses. The interpretations were presented as one theme ‘striving to do ‘good’ and be good’. The sub-themes related to the obstacles were ‘experiencing clinical competence constraints’, ‘experiencing organisational constraints’, ‘experiencing ineffective communication’, ‘fearing failure’ and ‘experiencing powerlessness’. The sub themes related to possibilities were ‘spreading knowledge on ulcer treatments’, ‘considering wholeness’ and ‘creating clear channels of communication’. The meaning of living with ‘impurity’ in terms of malodorous exuding ulcers, and the meaning of caring for people with ‘impure’ bodies in institutions and in patients’ homes is interpreted as striving for purity. Patients experience impurity when feeling dirty, losing hope, and not being respected and regarded as fully human. Nurses experience impurity when failing to shield patients’ vulnerability and their own defencelessness, and when facing obstacles preventing them from providing good care and being good nurses. Both patients and nurses may experience purity through consolation. For nurses, mediating consolation presupposes being consoled by being recognised for their challenging work, being respected and included in multiprofessional teams supported by the health care organisation and the leaders. Then patients can become consoled, and feel restored and fully human again despite their contaminated body.