Scand J Caring Sci. 1995 ; 9(1): 17-27.

District nurses' stories of difficult care episodes narrated during systematic clinical supervision sessions.

PÃ¥lsson MB, Norberg A.

In systematic clinical supervision sessions 23 Swedish district nurses narrated 147 difficult care situations. The aim of the study was to illuminate their lived experiences of those situations. The following themes emerged in the analysis of the stories: coming too close to the patient; keeping and restoring patient's hope; conflicting opinions; feeling powerless; meeting unrealistic demands; patients' trust in alternative medicine; feeling disgust, shame and guilt; relations to patients' families; and communication gaps. The findings strongly emphasize that district nurses experienced problems in the home care of seriously ill patients. They must not only serve as containers for patients' emotional strain, but they also have to support relatives in their anxiety. However, findings also showed that there was often a balance between negative and positive dimensions in these meetings with dying patients and their families. It seems important to form support groups to help district nurses deal with demanding care situations and to relieve them of feelings and thoughts aroused in the provision of care. Support in the form of clinical supervision may impact the quality of care in a positive way.