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Encumbered by vulnerability and temporality: the meanings of trigger situations when learning to live with diabetes
Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.ORCID iD: 0000-0002-2135-2684
Karolinska institutet; Karolinska universitetsjukhuset; School of Health Sciences, City University, London, United Kingdom.
Umeå universitet.
Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 19-20, p. 2874-2883Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: The aim of the study was to illuminate the meanings of trigger situations experienced in everyday life when learning to live with diabetes.

BACKGROUND: Adults become active learners when faced with situations they do not know how to manage, triggering a need to understand something in a different way than before. Knowing more about experiential learning for persons living with diabetes is important for understanding how learning can be supported by health care.

DESIGN: A life-world approach with a phenomenological hermeneutical method, inspired by the philosophy of Paul Ricoeur.

METHODS: This method was used for interpreting transcriptions of interviews and consists of three stages: naïve understanding, structural analysis and a comprehensive understanding. Participants (n = 13), with either type I or type II diabetes, were interviewed on three different occasions over a three-year period after being diagnosed with diabetes.

RESULTS: When learning to live with diabetes, the meanings of trigger situations were described as 'the unpredictable body heightens insecurity with awareness of one's own dependability', 'losing control in unsustainable situations' and 'encumbered by vulnerability and temporality in earlier familiar situations'.

CONCLUSION:The meanings of trigger situations were to lose the smooth, unreflected way of managing an everyday life situation, interlaced with feelings of lost control of how to live with new insights of being vulnerable. Trigger situations meant an opportunity for learning, as well as being demanding, unplanned and with limited freedom of choice. Trigger situations presented life and body as unpredictable.

RELEVANCE TO CLINICAL PRACTICE: If healthcare professionals can identify the worries and questions raised in trigger situations, knowledge gaps can be identified and reflected on to stimulate learning.

Place, publisher, year, edition, pages
2016. Vol. 25, no 19-20, p. 2874-2883
Keywords [en]
Diabetes, Llife-world, Nursing, Patient learning, Phenomenological hermeneutical interpretation, Trigger situation
National Category
Nursing
Identifiers
URN: urn:nbn:se:esh:diva-4535DOI: 10.1111/jocn.13339PubMedID: 27478056OAI: oai:DiVA.org:esh-4535DiVA, id: diva2:799880
Note

Publication status in dissertation: Submitted

Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2023-10-24Bibliographically approved
In thesis
1. Living with diabetes: a lifelong learning process
Open this publication in new window or tab >>Living with diabetes: a lifelong learning process
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Living with diabetes, as a lifelong illness, is interlaced with learning and to face continual changes. However, the role of time in this learning process is not yet well understood. The overall aim of the thesis was to gain a deepened understanding of learning to live with diabetes for those recently diagnosed and over a three year period. The thesis, involving four studies where qualitative inductive content analysis (I, III) and phenomenological hermeneutical interpretation (II, IV) were used, has a lifeworld approach and a qualitative and longitudinal design. Thirteen persons, recently diagnosed with diabetes (type I or II), were interviewed on three different occasions over a three year period. All interviews focused on the experience of living with diabetes and situations where diabetes had to be taken into account. The aim of study I was to reach an understanding of how learning to live with diabetes is experienced in the first 2 months after diagnosis. The findings revealed to be taken over by a new reality, with a body that played a role in life with the health care service as a necessary partner. The aim of study II was to illuminate the meaning of learning to live with diabetes three years after being diagnosed. The findings revealed learning as making decisions through use of different sources of information and as solving the life-puzzle – a delicate balance to create a desired life. The aim of study III was to identify patterns in learning when living with diabetes, from recently being diagnosed, and over a 3-year period. In the findings five patterns were identified illuminating different learning processes emerging over time. A longer time living with diabetes did not per se mean increased satisfaction in living well with illness or increased confidence in understanding one’s own needs. The aim of the IV study was to illuminate the meanings of trigger situations in learning to live with diabetes. The findings revealed trigger situations, such as being encumbered by vulnerability and temporality in unsustainable situations with an unpredictable body and a life involving new concerns for the future. The thesis conducted that learning was an informal and ongoing everyday process in life. Time living with diabetes meant both an increased mastery of a changed life situation, but also increased difficulties in achieving well-being and with a dependency on health care. Hence, health care interventions must adhere to the individual’s needs and not be based on duration of illness. Understanding the body and the role of health care, as well as what facilitates and hampers learning, changed with time. It is therefore important that health care personnel illuminate the individual understanding and experiences of those living with diabetes as this was found to be important for the learning process as well as for their sense of well-being.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet, 2015. p. 81+bilagor
Keywords
Diabetes, Lifelong illness, Learning process, Transition, Self-management, Triggers, Lifeworld
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-4751 (URN)978-91-7549-814-0 (ISBN)
Public defence
2015-03-06, Aulan, Stigbergsgatan 30, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-06-26 Created: 2015-06-26 Last updated: 2020-10-12Bibliographically approved

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Kneck, ÅsaFagerberg, Ingegerd

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