Scheduled care—As a way of caring: A phenomenological study of being cared for when suffering from alcohol use disorders

Abstract

Aims and objectives:To elucidate the lived experience of how patients with alcohol use disorders experience being cared for when admitted to acute medical units.Background: Alcohol use is health damaging and is identified as one of the major avoidable risk factors, and alcohol use disorder is classified among the most harmful, debilitating disease categories. Patients suffering from alcohol use disorders are characterised by complex problems and health pictures spawned by chaotic lifestyles. However, the experience of the hospitalisation from patients' perspective is poorly documented. Design:The present study has a qualitative research design and is anchored in phenomenological and hermeneutical methodology, as described in reflective lifeworld research. Methods:The data set consists of 15 in-depth interviews with patients suffering from alcohol use disorders admitted to an acute medical unit. A purposive sampling strategy was used, and the interviews were conducted as open dialogues. The study was reported in accordance with the consolidated criteria for reporting qualitative research. Results:Being cared for when hospitalised was experienced as a two-stage process that changed throughout the hospitalisation from an experience of scheduled care experienced as caring to an experience of scheduled care experienced as non-caring.Four constituents further described the variable experiences: being in a safe haven, sharing a tacit but mutual goal, being in a chaotic space and being on your own. Conclusions:The study showed that being met in an authentic presence by nurses was a powerful tool that helped ease the hospitalisation. Patients suffering from alcohol use disorders call for an intentional and distinctive attentiveness and authentic presence from the nurses throughout their hospitalisation. Relevance to clinical practice: Our findings highlight that patients suffering from alcohol use disorders call for an intentional and distinct attentiveness from nurses throughout the hospitalisation, where a possible transfer of attention is noticed and responded to in the care provided. K E Y W O R D S acute care, hospital care, nursing care, phenomenology, qualitative study, quality of care, substance abuse | 1175 BOVÉ et al.

Do the carers care? A phenomenological study of providing care for patients suffering from alcohol use disorders

“…Our findings support these assumptions and may explain why participants at times experienced that they were left with no other choice than making the patient fit into the organizational framing of care. Bove et al (2018) alone find that patients suffering from AUD who were admitted to an acute medical unit felt left alone and that scheduled care tended to prevent nurses from being attentive and connecting with these patients. Norlyk, Haahr, Dreyer, and Martinsen (2017) also note that the standardization of care may be in conflict with the perspective of considering the uniqueness of the individual patient in nursing practice, thus leading to a McDonaldization of nursing practice, reflected as 'one best way' and a 'one-size-fits-all attitude' to care.…”

“…Norlyk, Haahr, Dreyer, and Martinsen (2017) also note that the standardization of care may be in conflict with the perspective of considering the uniqueness of the individual patient in nursing practice, thus leading to a McDonaldization of nursing practice, reflected as 'one best way' and a 'one-size-fits-all attitude' to care. Bove et al (2018) alone find that patients suffering from AUD who were admitted to an acute medical unit felt left alone and that scheduled care tended to prevent nurses from being attentive and connecting with these patients. This illustrates the importance of allowing nurses to be creative in determining how best to provide care and ensuring the integration of patient perspectives into the care provided.…”

“…These are typically intended to motivate and provide resources for patients to help moderate the alcohol intake and, through, for example, motivational interviewing, influence and encourage patients to decide to change drinking patterns and/or habits (Bager & Vilstrup, 2010;Tanner-Smith & Lipsey, 2015). Bove, Lisby, and Norlyk (2018) found that patients suffering from AUD admitted in AMUs feel over-looked and are often not the nurses' main concern. Research also demonstrates that prejudice and negative stereotypes about this population are prevailing among nurses, causing barriers to services by reducing the nurses' willingness to provide care (Chung, Chan, Yeung, Wan, & Ho, 2003;Indig et al, 2009;Skinner, Roche, Freeman, & Mckinnon, 2009).…”

Considering “the more” of patients suffering from alcohol use disorders. An illustration of acute nursing care from a lifeworld-led perspective

“…Recent research elucidates that healthcare professions need to be aware of the need for mental health and psychosocial support to patients suffering from AUD who repeatedly attend emergency departments (Parkman et al, 2017). Also, research has emphasized that this patient group calls for an authentic presence characterized by an intentional attentiveness from the nurses to help ease the acute medical hospitalization (Bové et al, 2018). Thus, the above studies indicate that within the current focus and organization of care in the AMUs, an increased attention towards the individual patient's perspective is essential.…”

“…The value framework of lifeworld-led care addresses the vulnerability of human existence and points out a direction for a sensitive practice of care that emphasizes the individual's lifeworld and experience of well-being and does not solely focus on the absence of illness; "[…] something less measurable but keenly felt" (p. 1). In an acute caring context, this framework seems highly relevant as research highlights that both patients and healthcare professionals are requesting increased attention to the uniqueness of the individual (Bové et al, 2018(Bové et al, , 2019.…”