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Gråtens betydelse för patienter och närstående i palliativ hemsjukvård
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
2007 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Abstract [sv]

Abstrakt

Gråt är vanlig bland patienter och närstående men sällan studerat i palliativ vård. Gråten kan vara ett sätt för patienter och deras närstående att uttrycka sorg och hantera en situation fylld av stress som är orsakad av förluster, många allvarliga symtom och en nära förestående död.

Studiernas övergripande syfte var att bidra till en djupare förståelse för vilken betydelse gråten har för patienter och deras närstående i palliativ hemsjukvård: Vad innebär gråten och hur påverkar den de berörda? Bandinspelade intervjuer gjordes med 14 patienter med cancersjukdom och 14 närstående i palliativ hemsjukvård. För att få en djupare förståelse genomfördes arbetet med ett hermeneutiskt metodologiskt angreppssätt enligt Gadamer.

Resultatet visade att patienterna (studie I) beskrev olika dimensioner och funktioner av gråt; Intensiv och förtvivlad gråt för att ge uttryck för akuta behov: Stilla och sorgsen gråt som medvetet förlöste känslor; Tyst och tårlös gråt som en skyddande strategi. Som en tolkning av helheten sågs patienternas gråt (studie I) som ett sätt att uttrycka en inre känslomässig kraft, framkallad av olika faktorer, som orsakade förändringar i den nuvarande inre balansen. Genom att gråta öppet men också inombords skapades eller upprätthölls balansen. Studie (II) visade att de närstående upplevde att gråten var beroende av olika förutsättningar som attityder och mod, tid, trygghet, ärliga och tillitsfulla relationer. Omskakande och oroande händelser, utmattning i brist på egen tid och sympati från andra var omständigheter som utlöste gråten. De närstående försökte göra det bästa möjliga för patienten genom att anpassa eller dölja gråten, allt för att underlätta bördan och skapa en positiv motvikt till lidande och sorg. Tolkningen av helheten (studie II); närståendes gråt kunde vara ett uttryck för att dela något tillsammans för gemenskap, tröst och stöd eller att söka sig till ensamhet för enskildhet och återhämtning.

Sammanfattningsvis kan gråten ses som en copingstrategi eftersom den reducerar spänningar och skapar befrielse, upprätthåller balans, ger tröst, ny energi och tillfällen för enskildhet. Det är ett sätt att uttrycka lidande men på samma gång kräver gråten energi och ger känslor av skam.

En viktig del i professionens arbete bör därför vara att tillåta gråten, lyssna, vara närvarande, uppmuntra uttryck av känslor men också ge utrymme för enskildhet. Läkaren, sjuksköterskan och andra i teamet kan lindra patientens och närståendes känslor av skam och sårbarhet genom att bekräfta, legitimera olika uttryck för gråt och därmed skapa en tolerant, säker och trygg omgivning.

Abstract [en]

Abstract

Crying among patients and family members is common but seldom studied in palliative care. It could be one way of expressing grief and of coping with a stressful situation caused by loss, severe symptoms and the impending death.

The overall aim of the studies was to contribute to a deeper understanding about the significance of crying for patients and family members in a palliative care setting: What is the significance of crying and how does it influence those involved? Tape-recorded interviews with 14 patients with cancer disease and 14 family members in palliative home care were carried out. In order to gain a deeper understanding a hermeneutic methodological approach according to Gadamer was used.

The results (Study I) show that patients describe crying in different dimensions and functions; Intense and despondent crying as a way of ventilating urgent needs; Gentle, sorrowful crying as a conscious release of emotions; Quiet, tearless crying as a protection strategy. As an interpretation of the whole (Study I): for the patients, crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. The family members (Study II) perceived that crying was dependent on different prerequisites for crying such as attitude and courage, time, feeling secure, honest and trusting relationships. Uncertainty and turbulence situations, exhaustion due to lack of their own time and sympathy from others were circumstances that triggered crying. Family members tried to do the best possible for the patients by adapting or hiding their crying, in order to ease the burden and to create a positive counterbalance to suffering and grief. Interpretation of the whole (Study II): for the family members crying could be expressed as something to share with someone for support and consolation or an escape to solitude for integrity and respite.

In conclusions crying can be seen as a way of coping, as in many cases it reduces tension and creates release, maintains balance, brings comfort, new energy and opportunities for privacy. It is a way of expressing suffering, but at the same time it consumes energy and creates feelings of shame.

As suitable interventions, professionals should therefore legitimise crying, listen, be present, encourage the expression of feelings but also provide time and space for privacy. Staff may ease the patient’s and family member’s feelings of embarrassment and vulnerability by confirming and legitimating crying expressions by creating a tolerant, secure and safe environment.

Place, publisher, year, edition, pages
Institutionen för samhälls- och välfärdsstudier , 2007. , 36 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 80
Keyword [en]
hermeneutic, palliative home care, patients, adaptation., Crying, emotions, family members
Keyword [sv]
Gråt, känslor, hermeneutik, närstående, palliativ hemsjukvård, patienter, anpassning
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-9731ISBN: 978-91-85831-64-7 (print)OAI: oai:DiVA.org:liu-9731DiVA: diva2:24125
Presentation
2007-09-13, Fornborgen, Vrinneviesjukhuset, Norrköping, 13:00 (English)
Opponent
Supervisors
Available from: 2007-09-28 Created: 2007-09-28 Last updated: 2015-06-10
List of papers
1. Crying: A force to balance emotions among cancer patients in palliative home care
Open this publication in new window or tab >>Crying: A force to balance emotions among cancer patients in palliative home care
2007 (English)In: Palliative & Supportive Care, ISSN 1478-9515, Vol. 5, no 1, 51-59 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Crying is a common but seldom studied phenomenon in palliative care. The aim of this study was to explore the significance of patients crying in a palliative care context.

Methods: Tape-recorded interviews with 14 cancer patients in palliative home care were carried out. To gain deeper understanding, a hermeneutic analysis and interpretation was used.

Results: Crying was described in different dimensions: (1) intense and despondent crying as a way of ventilating urgent needs, (2) gentle, sorrowful crying as a conscious release of emotions, and (3) quiet, tearless crying as a protection strategy. Crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. Crying may be something useful, which could create release and help reduce tension, but it may also have a negative impact as it consumes energy and creates feelings of shame.

Significance of results: Professionals need to understand the different levels of crying. In such situations sometimes comforting the patient may not be the best solution, as some may need privacy.

Keyword
Crying, Palliative care, Cancer, Emotions, Hermeneutic
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-14656 (URN)c (DOI)
Available from: 2007-09-28 Created: 2007-09-28 Last updated: 2015-06-10
2. Crying in solitude or with someone for support and consolation - experiences from family members in palliative home care
Open this publication in new window or tab >>Crying in solitude or with someone for support and consolation - experiences from family members in palliative home care
2008 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 31, no 5, 345-353 p.Article in journal (Refereed) Published
Abstract [en]

Crying has not been studied from the perspective of family members of patients in palliative care. The aim of this study was to explore the significance of family members crying in a palliative care context with special reference to factors that influence crying. Interviews were carried out with 14 family members of patients admitted to palliative care. A hermeneutic approach according to Gadamer was used. Three main categories emerged. (1) Before the start of crying, some prerequisites for crying had to be fulfilled, such as an allowing attitude and courage, time, feeling secure, honesty, and trusting relationships. These prerequisites did not cause crying themselves; rather crying emerged when triggering factors occurred. (2) Triggers for crying were circumstances that created uncertainty and turbulence (bad news), exhaustion due to lack of own time, and sympathy from others. (3) Family members tried to do the best possible by adopting or hiding their crying, to ease the patient's burden and to create a positive counterbalance to suffering and grief. As an interpretation of the whole, crying could be expressed as being shared with someone for support and consolation or escape to solitude for integrity and respite. As a conclusion, crying may be an efficient strategy for family members in palliative care to express their suffering and to gain new energy to continue.

Keyword
Adaptation, Cancer, Coping, Crying, Emotions, Family members, Hermeneutic, Palliative care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14657 (URN)10.1097/01.NCC.0000305758.66238.a1 (DOI)
Available from: 2007-09-28 Created: 2007-09-28 Last updated: 2017-12-13

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