title: Existential issues among nurses in surgical care--a hermeneutical study of critical incidents.
abstract: OBJECTIVE
  To report a qualitative study conducted to gain a deeper understanding of surgical nurses' experiences of existential care situations. Background.  Existential issues are common for all humans irrespective of culture or religion and constitute man's ultimate concerns of life. Nurses often lack the strategies to deal with patients' existential issues even if they are aware of them.
  
  
  METHODS
  This is a qualitative study where critical incidents were collected and analysed hermeneutically.
  
  
  METHODS
  During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1-2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used.
  
  
  RESULTS
  The majority of incidents concerned nurses' experiences of caring for patients' dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses' personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care.
  
  
  CONCLUSIONS
  Findings are interpreted and discussed in the framework of Buber's philosophy of the relationships I-Thou and I-It, emphasizing nurses' different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.
authors.affiliation: Department of Health Sciences, Mid Sweden University, Östersund, Sweden. camilla.udo@miun.se
authors.forename: Camilla
authors.initials: C
authors.lastname: Udo
authors.forename: Ella
authors.initials: E
authors.lastname: Danielson
authors.forename: Christina
authors.initials: C
authors.lastname: Melin-Johansson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004644:Emotions; D005086:Existentialism; D013502:General Surgery; D006801:Humans; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology*; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D009732:Nursing Care; D036301:Qualitative Research; D012649:Self Concept; D055815:Young Adult