Maria Arman

Background: Based on existing confusion and a suggested contradiction regarding empathy and compassion in relation to caring science as well as in clinical health care.Aim: The aim of the study was to find a knowledge base for the development of clinical caring science for, empathy, sympathy altruism, and compassion and their mutual relationship.Design: A theoretical paper.Results: The text discusses the different concepts separately, considering their history, research, obstacles, and bias and then brings them together in a concept model. The conclusion shows that empathy, sympathy, and altruism have no contradictions. Instead, they together form an evident triad based on compassion. Compassion is a prerequisite and a basis for the others to work. In clinical application, empathy is metaphorically a quality coming from the head, sympathy from the heart and altruism from the hand, merged in an attitude of compassion as a motif to care. The paper also reflects on the possibilities to increase and develop a compassionate mood and capacity by education and training.

Aim: The aim of this study was to understand the lived experience of altruism and sacrifices among Swedish nurses working in intensive care units (ICU) during the COVID‐19 pandemic.Design: This was a descriptive phenomenological study.Methods: The study was conducted between June 2020 and March 2021 and included 20 nurses who were directly involved in the ICU care of COVID‐19 patients in Sweden during the pandemic. The text transcripts were analysed using Malterud's Systematic Text Condensation.Findings: The analysis revealed four themes. The work situation changed from 1 day to another—the nurses were brutally confronted with a new and highly demanding situation. Adapting to the chaotic situation—despite fear, anguish and exhaustion, the nurses adapted to the new premises. They shouldered the moral responsibility and responded to the needs of the patients and the health care system since they had the competence. Being confronted with ethical and moral challenges—the nurses were overwhelmed by feelings of helplessness and inadequacy because despite how hard they worked, they were still unable to provide care with dignity and of acceptable quality. The importance of supporting each other—collegiality was fundamental to the nurses' ability to cope with the situation.Conclusions: Taken together, being exposed to a constantly changing situation, facing the anguish and misery of patients, families, and colleagues, and being confronted with a conflict between the moral obligation to provide care of high quality and the possibility to fulfil this commitment resulted in suffering among the nurses. Collegial back‐up and a supportive culture within the caring team were important for the nurses' endurance.Impact: The study contributes an understanding of nurses' lived experience of working during the COVID‐19 pandemic and highlights the importance of protecting and preparing nurses and nursing organisation for potential future crises.

Objective: The concept of “invalidation” refers to the patient’s perception that the social environment does not recognize their medical condition. This study explores and describes invalidation experiences among Swedish patients with chronic widespreadpain with regard to sociodemographic and pain characteristics, impact of pain, self-reported health, and symptoms of anxiety and depressive.Methods: A cross-sectional design using questionnaires, including sociodemographic and pain variables, the Illness Invalidation Inventory (Likert scale items regarding 5 sources), the Hospital Anxiety and Depression Scale, and the Short-Form General HealthSurvey. Descriptive and univariate analyses were applied.Results: Of the 152 respondents, 91% were women. Swedish patients with chronic widespread pain experienced invalidation to a large extent from all sources. The highest scores for invalidation were reported from contacts with social services (68%), and the lowest from spouses (30%). Being younger (p < 0.006), having periodic pain (p = 0.011), and having had more frequent visits to a doctor in theprevious year (p = 0.007) were characteristics associated with higher invalidation scores. Experiences of invalidation were associated with worse selfreported mental health scores (r = –0.29 to –0.46).Conclusion: Since patients with chronic widespread pain frequently experience invalidation from the social environment, this further challenge in daily life must be taken into consideration in pain management within multimodal pain rehabilitation. LAY ABSTRACTPatient’s perception that the social environment does not recognize their medical condition may be defined as “invalidation”.This study explores invalidation experiences among Swedish patients with chronic widespread pain with regard to a range of sociodemographic and health factors. Questionnaires, including the Illness Invalidation Inventory, were sent by post to a sample of patients with chronic widespread pain. Most of the respondents were women. Swedish patients with widespread pain experiencedinvalidation to a large extent. The highest scores for invalidation were reported from contacts with social services, and the lowest from spouses. Being younger, having periodic pain, and having had more frequent visits to the doctor in the previous year were characteristics associated with higher invalidation scores. Experiences of invalidation were associated with worse mental health.Pain management within rehabilitation must thus take the patient’s experiences of invalidation from the social environment into consideration as an important aspect.

Chronic widespread pain (CWP) is a disabling condition associated with a decrease in health. Illness beliefs are individual and are acquired during life. Constraining beliefs may prevent patients from regaining health. Understanding these patients’ illness beliefs may be a way to improve the health care they are offered. The aim of this study was to describe illness beliefs among patients with CWP and associations with self-reported health, anxiety and depressive symptoms, and impact of pain. In this cross-sectional study, questionnaires were sent by mail to 330 patients including socio-demographic information, the Illness Perception Questionnaire (IPQ-R), the Short-Form General Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using descriptive statistics, non-parametric tests and linear regression analyses. Patients experienced and related a high number of symptoms to CWP (mean (SD) 9 (3)). The patients believed their illness to be long lasting, to affect their emotional well being, and to have negative consequences for their lives. Some 72% reported having severe or very severe pain, and impact of pain according to SF-36 was negatively correlated to several illness beliefs dimensions, anxiety- and depressive symptoms. In regression analyses, the Identity, Consequences and Personal control dimensions of IPQ-R and Anxiety- and Depressive symptoms explained 32.6–56.1% of the variance in the two component scores of SF-36. Constraining illness beliefs in patients with CWP are related to worse health status, especially in cases of high number of physical or mental symptoms, beliefs of negative consequences or the illness affecting them emotionally. Identification and understanding of these beliefs may reduce patients’ suffering if they are taken into consideration in rehabilitation programs and in development of new evidence-based interventions aimed at increasing health in patients with CWP.

Syftet med studien var att genom en enskild berättelses nyanser uppnå ökad förståelse av upplevelsen av antroposofisk rehabiliterande vård vid långvarig smärta. Den kliniska kontexten för studien var sjukhuset Vidarkliniken. Resultaten ger en ökad förståelse för vad det kan innebära att som patient uppleva ”sig sedd”; att bli sedd av vårdare likväl som att få syn på sig själv, sina behov och sitt liv. Genom samtal, beröring och miljöns helande verkan har sammanhanget mellan människor återskapats och en (ny) plats för denna patients hela existens tar form. Detta väcker tankar om hur man med inspiration från den antroposofiska vården kan ge ökad och explicit plats för medmänsklighet, beröring, miljö och kontemplation i vårdplaner för personer med långvarig smärta.

Patienter med långvarig smärta är en grupp där behandlingen varierar och resultaten är sparsamma. En unik form av ”Multimodal rehabilitering” som innebär en kombination av fysiska, psykiska och socialt relaterade behandlingar har det integrativa antroposofiska sjukhuset, Vidarkliniken erbjudit alltsedan starten. I studien har 15 kvinnor, med smärtproblematik intervjuats efter behandling vid Vidarkliniken. Ett återkommande tema var att en brist på kontinuitet och helhetssyn som de upplevt i tidigare vårdkontakter, blev tillfredsställd. Att ha blivit sedd och omhändertagen med helhetssyn innebar en vändpunkt mot egen hälsorörelse. Artikeln avslutas med en genus-reflektion.

Background: Presence, concern, compassion and universal or ontological unity between human beings have emerged as crucial to the healthy development of people who have experienced disasters.Aim and objectives: The aim of this article was to present a new model for long‐term care following disasters. The objective of the model was to contribute to the readiness for long‐term care following disasters in professionals and nonprofessionals as a result of their understanding of the model.Design: A longitudinal qualitative study of Swedish tourists affected by the South East Asian tsunami in 2004 is the empirical base for this clinical model, which was developed within the framework of caring science.Methods: A hermeneutic method was used.Results: The model is based on the assumption that life issues are an important aspect of long‐term follow‐up after a disaster. The term ‘life issues’ refers to the following: existential questioning of life's content, values and priorities; people's relationships with each other; and the importance of health, suffering, love and death. Life issues also refer to the way in which survivors form a new understanding of life after a disaster experience. Existential care is based on a charitable attitude of compassion and mercy towards one's fellows, be they professionals, families or wider society. By presenting eight theses, the model provides an approach based on compassion that works as an existential dressing for survivors of disaster.Conclusions: The model gives a knowledge base and approach for the long‐term care of survivors, including practical advice.

The long‐term outcome of any intervention for people suffering from chronic pain relies on the patient's ability for self‐care. This study explores patient experiences of self‐care in relation to a rehabilitation programme at an anthroposophic clinic. In a qualitative interview study with a hermeneutic approach, individual interviews were conducted, recorded, transcribed verbatim and analysed. Interviews were conducted with ten women who were taking part in a year‐long rehabilitation programme for chronic pain and overlapping illness. The women told stories of suffering with a focus on lives that were not functioning well. In this context, pain is like secondary. For many, the experience of loving care at the clinic became a turning point, a chance to be vulnerable, to be recognised, to reflect and to begin life anew. Signs of self‐care could then be witnessed. The women described a process whereby they regained contact with their bodies and their fellow human beings; they were able to identify their needs and when to stand up for them. Everyday life at the clinic is guided by universal aspects of love, life and meanings. The care gives patients glimpses of a move towards community in contrast to past isolation, towards love in contrast to past alienation, and towards joy and inspiration in contrast to past suffering. Through receiving caritative and compassionate care, these women were able to identify their needs as a first step towards self‐care. In the context of chronic pain, self‐care needs to be more than advice, education and training. Health can be attained when the sufferer experiences what it is to be cared for. This study supports the potential of a caritative caring culture to help patients participate in a compassionate community both with others and with the self. This forms the basis for the reawakening of their natural self‐care ability.