Integrative Care
Policy News

Research guides work in existential care

19 September, 2012 by Johanna Hök

Working with patients existential needs is not as hard as some may think, but requires genuine motivation and understanding. It is about doing concrete things to help patients find meaning during an often emotional life transition, says I C staff member and researcher Maria Arman, interviewed by the latest issue of  Vidarnytt.

Maria Arman is senior researcher in nursing care sciences and reader at Karolinska Institutet, Department of Neurobiology, Nursing Care and Society. She is also an affiliated start member at I C – The Integrative Care Science Center.

She conducts research in collaboration with Albertine Ranheim, reader at Mälardalens Högskola, and staff at Vidarkliniken, the anthrosophical hospital in Järna outside Stockholm, Sweden. Maria´s research deals with how existential care can be applied clinically.

Long-lasting effects
Currently, she is carrying out an in-depth study to develop concrete examples and clinically functional models for existential nursing in rehabilatative care, i.a. for cancer patients. Maria Arman´s interest in continuing to do research in this area is partly based on results from a previous comparative study showing that the quality of life of patients at Vidarkliniken was greater compared to a control group. And especially that these improvements lasted for a follow-up of one year.

– Few interventions demonstrate such a long-lasting effect. There is an interesting potential here that I don’t want to let go of, says Maria Arman.

Self-initiated healing
Many patients have testified to the fact that they have been able to reevaluate life, recuperate and embark upon a path towards self-initiated healing despite being ill.

The ongoing study is based on case descriptions from 65 caring situations described by health care staff of all kinds. The objective of the research project is to develop concrete examples and clinically useful models or work modes for existential nursing. Results will be presented during 2012 and 2013, and will hopefully also be included in a textbook.

Provides meaning in life change
There is more to existential care than simply being understanding and kind in general. Even though existential care is expressed in concrete ways, it touches on issues of the meaning of life, togetherness and loneliness, freedom and choice, love, guilt, dependence, life and death.

– Patients in the health care system are often in the middle of a life change and are very vulnerable, and the direction of this change is of crucial importance. Existential nursing often helps patients reevaluate their vision of life and get the strength and will to move on. Positive encounters can give people faith in there is something good about life even in difficult situations, says Maria Arman.

– Many patients say they feel seen by us as people. That is a big part of existential nursing, to see exactly what the patient needs and when, Maria Arman explains and gives examples.

Hands-on help
– It might be a question of sensitively dealing hands-on with situations where help is needed, for example assisting with matters of hygiene in a dignified manner. Taking care of the physical body is existential. Or it might involve facilitating and opening up a dialogue, which in turn affects the body. It entails noticing when patients want to talk to you and when they do not.

– The health care personnel have to understand the whole picture from the patient’s perspective and be aware of and open to their vulnerability and dignity.

Is existential care being left behind in health care generally?
– I  don´t want to be glib in answering yes to that question. A lot of people in the health care system both have the desire and the ability to understand these things. But my impression is rather than a lot of people think that these issues are more difficult than in fact they are and so they set up barriers to them. In fact, existential care is one of the most natural things one can provide.

Being objectified
However, at times, existential aspects are completely missing in health care, when it gets too technical and instrumental, Maria Arman emphasizes. Then there is a great risk that the patient becomes objectified and feels like an object.

–  This isn’t all up the individuals in the system. It is just as much a question of the provider needing to be part of an organization, a culture and an ethos, an attitude to human beings, which really make sure existential aspects become part of health care. Our research seeks to exemplify how to think and act around this.

Research for/as action
An interesting facet of this new research project is the choice of a faily uncommon research method in health care – applied research, a type of action research. Researchers work in the health care setting together with clinical colleagues in a research team. In this case together with physicians, nurses and therapists, altogether 12 people. This results in immediate competence development for the staff and also a chance to implement the results right away as well.

–  It’s a way of doing research which is good for the health care system and which the staff like. A typical problem is usually that researchers don’t link up with health care. Now researchers like us also include clinical aspects in the project upfront, which is very useful for us.

So far, the results of the ongoing research dovetails nicely with previous studies in Maria Arman’s research program “In the world of the patient”, the purpose of which is both to understand and to alleviate suffering in the patient’s lifeworld.

– I hope that others in health care will be keen to learn about and apply the results. The first step is to to want to work in a direction where the patient feels more seen. Then one can start considering formulating guidelines.

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