Vårdandets symfoni: Fenomenet vårdrelation i skenet av två världsbilder
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(3) Linnaeus University Dissertations No 126/2013. V ÅRDANDETS SYMFONI. – fenomenet vårdrelation i skenet av två världsbilder. J UDY C HOW. LINNAEUS UNIVERSITY PRESS.
(4) Vårdandets symfoni – fenomenet vårdrelation i skenet av två världsbilder Akademisk avhandling för filosofie doktorsexamen i vårdvetenskap vid institutionen för hälso- och vårdvetenskap, Linnéuniversitetet, Växjö, Sweden, 2013 ISBN: 978-91-87427-17-6 Printed by: Elanders Sverige AB, 2013.
(5) Abstract Chow, Judy (2013). Vårdandets symfoni – fenomenet vårdrelation i skenet av två världsbilder (The symphony of care - the phenomenon of care relationships as reflected in two perspectives) Linnaeus University Dissertations No 126/2013. ISBN: 978-91-8742717-6. Written in Swedish with a summary in English.. This thesis 'The Symphony of Care’ consists of four studies focusing on care relationships between patients and professional caregivers. Care relationships are central to the health process and a fundamental element in caregiving. The term care relationship is widely used in caring science but lacks a clear definition, which can create misunderstanding and can constitute an obstacle when attempting to optimize care relationships. The aim of this thesis is to describe the phenomenon of care relationships in order to add to the body of knowledge in caring science. The main research questions are: What is a care relationship within the caring science field? How can a care relationship be optimized to improve its caring function, in order to promote health? The ontological foundation of this thesis is caring science. Phenomenology and Lifeworld theory are used as its epistemological bases. Reflective Lifeworld Research is used as a methodological approach. The four studies were conducted in different contexts and cultures- the first two empirical studies were performed in China and the remaining two, a metasynthesis and a secondary analysis, were carried out in a Swedish context. The results show that care relationships are temporary intentional relationships between a person who needs help and a helper. The purpose of this relationship is to support the patient in his/her dynamic health process, which is unique for each person in different times and contexts. Care relationships are fragile because the patient is vulnerable and the demand on the helper is great. It is an inter-human relationship between equals, which can at the same time be an asymmetric relationship due to the professionalism with the caregiver and the vulnerability with the patient. A care relationship is not independent, but is affected by internal factors such as the two individuals’ lifeworlds and external factors such as health policies, organization, economics, health culture and environment. To optimize the effectiveness of caring, the relationship and its surrounding need to be in harmony. The view of care relationships should be broadened to include the external resources in order to optimize their caring potential. Keywords: care relationship, China, Sweden, phenomenology, qualitative research, reflective lifeworld research, metasynthesis, secondary analysis, patient, professional caregiver, professional-patient relationship, transcultural care study..
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(7) This thesis is dedicated with love and gratitude to the memory of my two best friends.. They were a nurse and a patient when we first met. I would like to thank the late. Ip Tse Siu Fong葉謝少芳 for guiding me into this wonderful profession, and the late. Chan Chiu Ngor, Winnie陳翠娥 for teaching me how to live life.. How I wish that you could be here with me today!.
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(9) Acknowledgments When I decided to start my study as a PhD student a few years ago, I had prepared myself for several years of hard working onwards. Never in my wildest fantasy could I imagine that I would have so much fun and so many memorable moments in the years to follow. Many have contributed with their help in this thesis or transformed my time as a PhD student into many enjoyable and precious moments. I am indebted to Professor Karin Dahlberg, who invited me to conduct research and allowed me to take the time I needed to consider the offer, even if it had taken two years. I am also grateful for her guidance into the wonderful world of Phenomenology, Lifeworld Theory and the Reflective Lifeworld Research, in which I found myself at home. Those were the ways to conduct research which I was seeking in my previous years, but could not find. Thank you, Karin, also for all the trust and patience that you have given me and allowed my own way of being. I suppose that this is the main reason why my interest and joy in research did not fade away in all of these years. I am extremely lucky to have a knowledgeable, wise and open-minded supervisor like you. I would like to thank Stig Wenneberg who contributed an alternative perspective to this thesis. Stig is my only supervisor who is not a phenomenologist. He showed me the other perspective in this thesis and pointed out all the details in this thesis that a phenomenologist would have taken for granted. I would also like to thank him for his humor in his comments, which usually brought a laugh or a smile to the never-ending monotony of writing and redrafting. Thank you for constantly showing your interest in my research. To my third supervisor, Ulrica Hörberg, I would like to express my gratitude for your guidance in the phenomenology jungle. You put me back on the right track many times when I was about to get lost. I would also like to thank Ulrica for her sincerity and warmness, and for always being there when needed, for a sentence exchange or an emergency advice. Thank you for your encouragement at all times. Thank you for all the driving to Pajebo. I would also like to thank Shirin Sandström and Carina Elmqvist who motivated me to this PhD education adventure, and Björn Albin for his help in opening the doors for my research in China. Thanks also to Professor Pang Mei-che, Samantha, Professor Chen Jinxiu, Professor Chi Jianhuai and many other staff in the universities in Hong Kong and China that I visited. I thank them for their kind reception and their help. A special thanks to Ge Li for her help and support. To Professor Maria Berg, Professor Jan Bärmark, Professor Kerstin Peterson, Professor Carl-Magnus Stolt, Reet Sjögren who were the opponents.
(10) in the different stages of this thesis, I would like to thank them for the valuable and constructive comments that they have contributed in this thesis. I would like to thank Gunilla Lindqvist and Johanna Norén for sharing all the ups and downs, and also for sharing the responsibilities as PhD student representatives at the HLK. It was fun to work with you two. And I wish good luck to Sofia and Ami who took over our posts there. And I would like to thank all the other members at the HLK for their kind considerations and cooperation. Thank you, Professor Margaretha Ekebergh, Professor Katarina Hjelm, Professor Eva Benzein, Professor David Brunt and all the other members at HLK. A special thanks to David for all the encouragement, constructive comments and kind words that has been given to me in all of these years and also for his help with the English texts. I am honored to work as one of the members in the Committee for Internationalization at Linnaeus University together with our chairman Nils Nilsson and Professor Catherine Legrand, Professor Maria Olaussen, Professor Marcelo Milrad, Anna Lund, Björn Albin, Karin Lundhgren and the other members of the Committee. I want to thank them for the positive atmosphere and the nice inspirations and cooperation that were created in the group. Special thanks to Catherine for all the good memories and advices in Dublin and Anna for the co-working in the exciting project Global Lounge for LNU. I would like to say thank you to all the past and present PhD students in the Department of Health Science at Linnaeus University for the fun and less funny periods of research. A big thanks to the blueberry gang: Anders, Susanne, Barbro, Anna for their companionship; and to Emina, AnnChristin, Camilla, Niklas, Esther, Fortunate, Bengt-Olof and many others for sharing this intensive but interesting period in life. Thank you for the laughter and tears that we shared. A special thanks to Lise-lott Ozolins for the laughter, encouragement, support and friendship in all of these years. Without the club members, Yushu Li, Sara Lin, Aihui Peng and Jane Yau, at the Chinese Lady’s PhD club at LNU, life would not be as meaningful and fun as a Chinese Female PhD student in Sweden. I would like to thank all of you for all the eating parties, memorable trips, the scientific and non-scientific discussions, inspirations and the genuine sharing of all kinds, including the expert knowledge in your fields. I am so happy to have you as my friends. Sincere thanks to Professor Bengt Fridlund, Mikeal Rask, Professor Terese Bondas, Clas Ekenstam, Annika Larsson Mauleson, Anita Bengtsson Tops, Kerstin Wikby, Mitsuru Suzuki, Christina Linderholt who showed their interest, and with all their encouragement and the kind words that were given at the different stages of the thesis. Many thanks to my overseas colleagues Jen Shangren and Bakary Njie for their interesting discussions and all those enjoyable moments that we shared. A special thanks to Åsa Roxberg, Sofia Almerud, Anna-Lena Norberg, Hock Khoe, Jane Yau, Helene Valdemarsson, Maarit Poikela Martin, Carina.
(11) Elmqvist for reading and commenting, and also for their help to improve the writing of my manuscript. I would like to thank Anna Kasén, Professor Barbara Paterson and Gunilla Carlsson for their inspirations. I would also like to give my thanks to Fyrklövern for their interesting and valuable course, ‘Att nyttiggöra forskning och vetenskap’. Thank you for the reflections and insights that were given and the great group spirit that was created in the class. Special thanks to Kjärstin and Emma. I wish good luck to our LNU group members, Henrietta, Anna, Sofia, Martin and Lars, for their PhD studies and their research. I am truly grateful for all the help that I have received from Lars Nordblom, David Newkumet, Christina Frisk, Eva Britt Granath and all the members of the Växjö Symphonic Orchestra for their help and participation in the photo on the front page of this thesis. A special thanks to Magnus Arnfelt for his beautiful citation which was used to end the thesis. Since I moved to Sweden, Växjö University, alias Linnaeus University has more or less become my second home. I am grateful for the opportunity to study and to conduct research in this charming university where everything seems possible. I would like to thank all the excellent administrative staffs in the Department of Caring Science. Kristina Julin, what would we PhD students do without you? Thank you Fatema, Dennis, Mikael, Madeleine, Kristina H, Björn M and many others. Special thanks to Ingrid Bonnevier who is always available for others. I would also like to thank Ingrid Runeson, Kerstin Gynnerstedt, David Brunt, Håkan Hallmer, Elisabeth Carlsson for their understanding and concern as leaders in the organization. A sincere thanks to all the knowledgeable librarians at the library of Linnaeus University for their help at the different stages in my research. A special thanks to Ingemar Gunnarsson for his help when needed. A very big thanks to many of my Chinese exchange students who shared their stories and time with me. Very special thanks to Du Dongyong, Li Zongyi, Chan Zewei and Liang Minyi for introducing many new and useful programs, apps and tools to me which made a PhD student’s life much more enjoyable and easy. I would like to thank many of my patients for their contribution. Many of them helped with suggestions, advice and tips for literature and in many other ways in this thesis. A big thanks to all of the participants in the empirical studies. I have learned a lot from you. I would like to express my great gratitude to my beloved family, my sisterin-law Lau Oi-kwan, my bother Chow Koon-yim, my beloved nephews Andy, Chi Shan, Aaron, and my parents in-law Ing-Margreth and Hans, for believing in me and always being there to offer their support and help. To my son, Kim, for his companionship to Hong Kong and China during my research periods. Much thanks and love to Magnus for the unconditional love, enormous patience, great support, the nice discussions and companionship. I.
(12) do know that I am lucky. By the way, thank you for putting all the å, ä and ö in their right places..
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