The ageing of the population is expected to lead to an increase in the prevalence of dementia. Providing support to informal caregivers is essential to promote their wellbeing and prevent serious caregiver burden. The aim of the study is to investigate whether differences occur between the initial and later stages of dementia in terms of (1) problems experienced by informal caregivers in the provision of care, (2) use of professional support by persons with dementia, (3) informal caregivers’ needs for additional professional support.
The data were collected within the framework of the Dutch National Dementia Program, which was instigated in 2005 by the Dutch Ministry of Health, Welfare and Sport to improve integrated care for people with dementia and their informal caregivers. This paper is based on data of a questionnaire survey among 1494 informal caregivers, collected between September 2007 and December 2008.
Most informal caregivers (98-99%) experienced problems in caring for a person with dementia, irrespective of the stage of the illness process. In later stages, informal caregivers more often experienced problems in their social networks. Most dementia patients (87-94%) received ambulatory professional support.
Since informal caregivers indicate a need for additional professional support in all stages of dementia, professional support should be provided during the entire illness process. Informal caregivers need advice on how to cope with symptoms of dementia, how to deal with behavior problems and receive more information about (early and advanced stages of) dementia and the supply of support.
Dementia; informal caregivers; illness stages; professional support; transition; survey.
This study examined spiritual coping (beliefs and practices) of depressed African American cancer patients through a comparison with depressed White cancer patients and non-depressed African American cancer patients.
Using mixed methods, 74 breast (n=41) and prostate (n=33) cancer survivors including 34 depressed and 23 nondepressed African Americans and 17 depressed Whites were interviewed. The interviews were audiotaped and transcribed. Qualitative data analysis identified themes that were coded. The codes were entered into SPSS software. The Fisher’s exact test was performed to examine group differences in self-reported spiritual coping.
Significantly more depressed African Americans questioned God when learning of a cancer diagnosis than the non-depressed African Americans (p=.03), but they did not differ from the depressed Whites in this regard (p=.70). Significantly more depressed African Americans reported having faith in God (p=.04), reading the bible (p=.02), and conversing with God (p=.01) than did the depressed Whites. They also reported praying alone (p=.01) more frequently than the depressed Whites who, on the other hand, reported praying with others (non-family members) together for one’s own health more frequently (p=.04).
Depression is associated with a deepening need for spirituality and it affects religious beliefs and practices more in African American than White cancer patients. Given its important role in the lives of African American cancer patients, spirituality may be utilized as a reasonable, culturally-based approach to better assess and treat depression in these patients.
African American; cancer; depression; race; pray; religion; spirituality.
Nurses are frequently exposed to dying patients and death in the course of their work. This experience makes individuals conscious of their own mortality, often giving rise to anxiety and unease. Nurses who have a strong anxiety about death may be less comfortable providing nursing care for patients at the end of their life. This paper explores the literature on death anxiety and nurses’ attitudes to determine whether fear of death impacts on nurses’ caring for dying patients. Fifteen quantitative studies published between 1990 and 2012 exploring nurses’ own attitudes towards death were critically reviewed. Three key themes identified were: i). nurses’ level of death anxiety; ii). death anxiety and attitudes towards caring for the dying, and iii). death education was necessary for such emotional work. Based on quantitative surveys using valid instruments, results suggested that the level of death anxiety of nurses working in hospitals in general, oncology, renal, hospice care or in community services was not high. Some studies showed an inverse association between nurses’ attitude towards death and their attitude towards caring for dying patients. Younger nurses consistently reported stronger fear of death and more negative attitudes towards end-of-life patient care. Nurses need to be aware of their own beliefs. Studies from several countries showed that a worksite death education program could reduce death anxiety. This offers potential for improving nurses’ caring for patients at the end of their life.
Attitudes; death anxiety; end of life care; spirituality; thanatophobia.
The language barrier is a significant obstacle for nurses who are not native English speakers to obtain information from international journals. Freely accessible online machine translation (MT) offers a possible solution to this problem.
To explore how Japanese nursing professionals use online MT and perceive its usability in reading English articles and to discuss what should be considered for better utilisation of online MT lessening the language barrier.
In total, 250 randomly selected assistants and research associates at nursing colleges across Japan answered a questionnaire examining the current use of online MT and perceived usability among Japanese nurses, along with the number of articles read in English and the perceived language barrier. The items were rated on Likert scales, and t-test, ANOVA, chi-square test, and Spearman’s correlation were used for analyses.
Of the participants, 73.8% had used online MT. More than half of them felt it was usable. The language barrier was strongly felt, and academic degrees and English proficiency level were associated factors. The perceived language barrier was related to the frequency of online MT use. No associated factor was found for the perceived usability of online MT.
Language proficiency is an important factor for optimum utilisation of MT. A need for education in the English language, reading scientific papers, and online MT training was indicated. Cooperation with developers and providers of MT for the improvement of their systems is required.
Japanese nurses; language barrier; nursing literature; online machine translation; usability; questionnaire.
In July 2007 a Spinal Cord Unit was set up in Turin (Italy) within the newly integrated structure of the Orthopaedic Traumatologic Centre, warranting a multidisciplinary and professional approach according to International Guidelines. This approach will be possible through experimentation of a personalized care model. To analyze job satisfaction of health care professionals operating within the Spinal Cord Unit, preliminary to organizational change. Data collection was carried out by using questionnaires, interviews, shadowing. Results from quantitative analysis on the self-filled questionnaires were integrated with results from qualitative analysis. All the health care professionals operating in the field were involved. Positive aspects were the perception of carrying out a useful job, the feeling of personal fulfilment and the wish to engage new energies and resources. Problematic aspects included role conflict among staff categories and communication with managers. The positive aspects can be exploited to create professional practices facilitating role and expertise integration, information spreading and staff identification within the organization rather than team work. Data of job satisfaction and self efficacy of health care workers can be considered basic requirement before implementing an organizational change. The main challenges is multiprofessional collaboration.
Job satisfaction; spinal cord injuries; teamwork; nursing; rehabilitation; interprofessional relations.
Ambulatory blood pressure monitoring (ABPM) predicts cardiovascular risk and identifies white-coat and masked hypertension, efficacy of treatment and the circadian cycle of hypertensive patients.
To analyze the effectiveness of ABPM implementation thoughtout a nurse-driven training program.
Materials and Methodology:
Twenty eight professionals were involved in the study carried out in the primary care center of the metropolitan area of Barcelona that serves 34,289 inhabitants. The ABPM implementation program was driven by two nurses that held four education sessions. After a 2-year follow-up period, we assessed the outcome of attendance at the educational sessions. First, we evaluated whether the program increased the number of orders of ABPM. Second, we used a survey to evaluate to what extent the input of our educational sessions was understood by attendants. Third, we analyzed the effect ABPM results had on the treatment of patients with a bad control of their hypertension.
After the training sessions we found a 6-fold increase in the number of patients undergoing ABPM. We analyzed 204 hypertensive individuals: 41% dippers, 34% were non-dippers, 20% were risers and 5% were extremely dippers. According to our survey, 100% of attendants had a good practice regarding ABPM management. However only 27% of riser patients were studied with a second ABPM.
Specific training processes are needed for implementation of ABPM and an even more concentrated effort should be focused on training in the correct interpretation of ABPM results.
Ambulatory; blood pressure; cardiovascular morbidity; educational program; essential hypertension; primary care.
Kangaroo Care (KC) is an evidence-based nursing practice with many benefits for infants and parents. The purpose of this study was to describe parents’ experience of information and communication mediated by staff nurses before and during KC at neonatal wards.
Methodology and Participants:
A qualitative study with semi-structured interviews was performed. The sample consisted of 20 parents.
The results show that the information and communication were experienced as both optimal and suboptimal including following categories: initially conflicting emotions in relation to KC, participation and confidence in KC is evolving, strengthening preparation and context is decisive as well as parental sense and caution. The overall theme was that good preparation will contribute to a positive experience of KC.
The conclusion is that most of the parents had positive experiences of KC. The information and communication from the staff nurses encouraged and motivated the parents to practice KC, in a sense that it was a natural way to get to know the infant, when the staff nurses were well versed in the method and coherent and supportive. Conflicting emotions emerged when staff nurses practised KC as a routine without deeper knowledge and skills of the method and its advantages as well as without sensitivity to parents’ vulnerable situation.
Communication; information; Kangaroo Care (KC); neonatal; parents experience.
Patients have the right to influence the care they receive, but their wish to participate in care decision-making is unclear.
This study investigates whether participation in nursing documentation influences patient participation in care decision-making, mastery, self-esteem, empowerment and depressive feelings among adult in-patients with chronic disease.
Materials and Methodology:
Adult patients (n=39) with chronic diseases were randomized. The intervention group participated in nursing documentation. Upon departure, patients filled in questionnaires about participation in care decision-making, mastery, self-esteem, empowerment and depressive feelings.
The majority of the patients preferred a collaborative or passive role regarding care decision-making. Lack of knowledge was one reason for non-participation. Having been diagnosed more than five years previously meant stronger empowerment.
It is a challenge for nurses to find strategies to assess patients’ wishes regarding participation in care decision-making. Nurses must support patients’ knowledge of their disease and empowerment.
Care decision-making; empowerment; knowledge; nursing documentation; participation; well-being.
The study explored beliefs about health and illness in Latin American migrants diagnosed with diabetes mellitus (DM) living in Sweden, and investigated the influence on health-related behavior including self-care and care-seeking behavior. Migrants are particularly affected in the diabetes pandemia. Beliefs about health and illness determine health-related behaviour and health but no studies have been found on Latin American migrants with DM. An explorative study design with focus-group interviews of nine persons aged 36-77 years from a diabetes clinic was used. Health was described from a pathogenetic or a salutogenetic perspective: ‘freedom from disease or feeling of well-being’, and being autonomous and able to work. Economic hardship due to expenses for medications and food for DM affected health. Individual factors such as diet, exercise and compliance with advice, and social factors with good social relations and avoidance of stress, often caused by having experienced severe events related to migrational experiences, were considered important for maintaining health and could cause DM. Disturbed relations to others (social factors), punishment by God or Fate (supernatural factors), intake of diuretics and imbalance between warmth and cold (natural factors) were also perceived as causes. A mix of biomedical and traditional explanations and active self-care behaviour with frequent use of herbs was found. It is important to assess the individual’s beliefs, and health professionals, particularly nurses, should incorporate discussions of alternative treatments and other components of explanatory models and co-operate with social workers to consider influence of finances and migrational experiences on health.
Beliefs about health/illness; Care-seeking behaviour; Diabetes mellitus; Latin Americans; migrants; self-care.
Global and regional data have shown that chronic airway diseases such as chronic obstructive pulmonary disease (COPD) and asthma are increasing in incidence and prevalence, with detrimental consequences to healthcare resources and the quality of life of patients. A firm diagnosis of COPD or asthma is important because the natural history, treatment, and outcomes differ between the two respiratory diseases. The aim of this review is to provide nurse practitioners (NPs) with the requisite facts to understand and improve the diagnosis and treatment of affected individuals.
Articles on the differential diagnosis, treatment, and management of COPD and asthma published in peer-reviewed journals were retrieved from PubMed. Evidence-based respiratory guidelines, World Health Organization disease-related data, and US prescribing information for different respiratory medications served as additional data sources.
NPs, along with other primary care professionals, form the frontline in diagnosing, treating, and managing COPD and asthma. Differentiating COPD from asthma has prognostic as well as significant therapeutic implications. Since NPs play a key role in diagnosing and managing patients with COPD and asthma, those with a comprehensive understanding of the diagnostic and therapeutic differences between the two diseases can help to lower the risks of exacerbations and hospitalizations, and improve the quality of life of these patients.
Asthma; bronchodilators; chronic obstructive pulmonary disease; inhaled corticosteroids; United States.
The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses’ experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care.
Encounters face-to-face; remote encounters; home-based nursing care; nurses; thematic content analysis.
To reports a study in which action research approach was utilised to introduce a new system of risk
assessment, based on traffic lights, into a community mental health team.
Risk management is a serious concern in community mental healthcare where there is less direct, real-time
supervision of clients than in other settings, and because inadequate management of risk can have fatal consequences
when service users are a risk to themselves and/or others.
An action research design was undertaken, using three phases of Look, Think and Act.
Data were collected between January and March of 2012. In the action research phases, qualitative data were
collected in focus groups with the team’s multi-disciplinary mental health professionals. Data were transcribed verbatim
and analysed thematically, which involved agreement of themes and interpretations by two researchers. The Look, Think
and Act phases guided the development of the project; team members worked collaboratively on the traffic light system,
implemented and evaluated it.
Themes were constructed that were discussed across the focus groups. These themes were: Ease of use; Risk
identification and management; Legal status; Different teams’ views of risk; Post-implementation evaluation.
Action research has been used to implement change in mental health risk management. Others internationally
would benefit from considering a Traffic Light System, and in using action research to implement it.
Risk management; risk assessment; community mental health; action research; traffic light system; qualitative
research, focus groups.
The caring relationship between the nurse and the person in need of nursing care has been described as a key concept in nursing and could facilitate health and healing by involving the person’s genuine needs. The aim of this study was to explore registered nurses’ experiences of their relationships with persons in need of home-based nursing care. Individual interviews with nurses (n=13 registered nurses and 11 district nurses) working in home-based nursing care were performed. A thematic content analysis was used to analyze the transcribed interviews and resulted in the main theme Good nursing care is built on trusting relationship and five sub-themes, Establishing the relationship in home-based nursing care, Conscious efforts maintains the relationship, Reciprocity is a requirement in the relationship, Working in different levels of relationships and Limitations and boundaries in the relationship. A trusting relationship between the nurse and the person in need of healthcare is a prerequisite for good home-based nursing care whether it is based on face-to-face encounters or remote encounters through distance-spanning technology. A trusting relationship could reduce the asymmetry of the caring relationship which could strengthen the person’s position. The relationship requires conscious efforts from the nurse and a choice of level of the relationship. The trusting relationship was reciprocal and meant that the nurse had to communicate something about themself as the person needs to know who is entering the home and who is communicating through distance-spanning technology.
Relationship; home-based nursing care; registered nurses; experiences; distance-spanning technology; interviews; thematic content analysis.
Despite the drive towards evidence-based practice, the extent to which research evidence is being implemented
in nursing practice is unclear, particularly in developing countries. This study was to assess the levels of perceived
barriers to and facilitators of research utilization in practice among Chinese nurses and inter-relationships between these
barriers and facilitators and their socio-demographic characteristics. A cross-sectional, descriptive survey was conducted
in 2011 with 743 registered nurses randomly selected from four general hospitals in China. They completed the Barriers to
Research Utilization and Facilitators of Research Utilization scales. Correlation tests were used to test the relationships
between the nurses’ perceived barriers and facilitators, their demographic characteristics and research training and
involvement. The Chinese nurses’ level of perceived barriers was moderate on average and lower than that in previous
research. Among the 10 top-ranked items, six were from the subscale ‘Organizational Characteristics’. Their perceived
barriers were correlated positively with age and post-registration experience and negatively with research training
undertaken. Junior diplomatic nurses reported a significantly higher degree of barriers than those senior ones with postgraduate
education. Higher and more diverse barriers to research utilization in practice are perceived by Chinese nurses
than those in Western countries and they are associated with a few socio-demographic factors. Future research on these
barriers/facilitators and their relationships with occupational and socio-cultural factors in Chinese and other Asian nurses
Cross-sectional survey; perceived barriers; perceived facilitators; research utilization; registered nurses; Chinese.
Diabetes mellitus is becoming pandemic, particularly affecting Sub-Saharan Africa, and the prevalence of complications is increasing. Diabetic foot disorders are a major source of morbidity and disability. Delay in the health care process due to patients’ beliefs may have deleterious consequences for limb and life in persons with diabetic foot ulcers. No previous studies of beliefs about health and illness in persons with diabetic foot ulcers living in Africa have been found. The aim of the study was to explore beliefs about health and illness among Ugandans with diabetic foot ulcers that might affect self-care and care seeking behaviour. In an explorative study with consecutive sample semi-structured interviews were held with 14 Ugandan men and women, aged 40-79, with diabetic foot ulcer. Knowledge was limited about causes, management and prevention of diabetic foot ulcers. Foot ulcers were often detected as painful sores, perceived to heal or improve, and led to stress and social isolation due to smell and reduced mobility. Most lacked awareness of the importance of complete daily foot care and seldom practised self-care. Health was described as absence of disease and pain. Many feared future health and related it to contact with nurses in the professional sector from whom they sought information, blood tests and wound dressings and desired better organised diabetes clinics offering health education and more opening hours. Many have an underutilised potential for self-care and need education urgently, delivered in well-organised diabetes clinics working to raise awareness of the threat and prevent foot ulcers.
Africans; attitudes to health/illness; beliefs about health/illness; care-seeking behaviour; diabetes mellitus complications; foot ulcer; self-care.
To examine beliefs about health, health risks and health expectations from the perspective of people diagnosed with a psychotic disorder
People with psychotic disorders have a threefold higher risk of developing physical health problems than the general population, and prevention of these problems is warranted. Examining patients´ health beliefs could help deepen our understanding of how to plan successful health interventions with this group.
Qualitative semi-structured interviews were conducted from November 2010 to October 2011 with 17 people with psychotic disorders. Data were analyzed using a qualitative content analysis.
An overall positive picture of health was found despite the fact that physical health was found to be hard to verbalize and understand. Health was mainly associated with psychological wellbeing, while health risks were found to be related to uncertain bodily identity, troublesome thoughts and inner voices, and exclusion from society. Interest in learning, and visions and goals of health seemed to increase awareness of health risks and health expectations, while not worrying could be viewed as a hindrance for health expectations.
There is a lack of expressed awareness of physical health risks, but such awareness is fundamental to performing life-style changes . Nurses thus have an important task to help patients understand and verbalize potential physical health risks, and to find out what motivates them to adopt health behaviors.
Health beliefs; health expectations; health promotion; nursing; psychotic disorder; qualitative interviews.
We aimed to explore and describe the factors involved in Iranian women heads of household’s health promotion activities. Grounded theory was used as the method. Sixteen women heads of household were recruited. Data were generated by semi structured interviews. Our findings indicated that remainder of resources (money, time and energy) alongside perceived severity of health risk were two main factors whereas women’s personal and socio-economic characteristics were two contextual factors involved in these women's health promotion
activities. To help these women improve their health status, we recommended that the government, non-governmental organizations and health care professionals provide them with required resources and increase their knowledge by holding training sessions.
Health promotion activities; Women heads of household; Women’s health; Grounded theory.
Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as “low status” in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time.
The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs.
We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description.
The results show similarities and differences over time in the RNs’ reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities.
An RN’s intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.
Beliefs; elderly care; registered nurse; nursing.
In Japan, the proportion of women aged 35 and older giving birth has greatly increased in recent years, and maternal age is continuing to increase. Advanced maternal age is a risk factor for abnormal delivery, as is hiesho (sensitivity to cold).
This study aimed to assess whether advanced maternal age and hiesho precipitate premature delivery, premature rupture of membranes, weak labor pains, prolonged labor and atonic bleeding.
The study design was a descriptive comparative study with a retrospective cohort group design. Subjects in this study were 2,810 Japanese women in hospital after childbirth. The research methods employed were a paper questionnaire and extraction of data from medical records.
Comparing the rate of occurrence of abnormal delivery among women aged 35 to 39 according to whether or not they had hiesho, results were premature delivery OR: 3.51 (95% CI: 1.66-7.43), premature rupture of membranes OR: 1.25 (95% CI: 0.90-1.74), weak labor pains OR: 2.94 (95% CI: 1.65-5.24), prolonged labor OR: 2.56 (95% CI: 1.23-5.26), and atonic bleeding, OR: 1.65 (95% CI: 0.14-2.40) when hiesho was present. Among women aged 40 and over, results were premature delivery OR: 5.09 (95% CI: 1.16-22.20), premature rupture of membranes OR: 1.60 (95% CI: 0.73-3.46), weak labor pains OR: 7.02 (95% CI: 1.56-31.55), prolonged labor OR:7.19 (95% CI: 1.49-34.60) and atonic bleeding OR: 2.00 (95% CI: 0.64-6.23).
Regardless of maternal age, the presence of hiesho is a risk factor that can precipitate premature delivery, premature rupture of membranes, weak labor pains, prolonged labor and atonic bleeding. Furthermore, hiesho coupled with advanced maternal age increases the incidence of premature delivery, weak labor pains and prolonged labor.
Maternal age; abnormal delivery; hiesho.
There is international concern about retention of student nurses on undergraduate programmes. United Kingdom Higher Education Institutions are monitored on their attrition statistics and can be penalised financially, so they have an incentive to help students remain on their programmes beyond their moral duty to ensure students receive the best possible educational experience.
to understand students’ and staff concerns about programmes and placements as part of developing our retention strategies.
This study reports qualitative data on retention and attrition collected as part of an action research study.
One University School of Nursing and Midwifery in the South West of England.
Staff, current third year and ex-student nurses from the adult field.
Data were collected in focus groups, both face-to face and virtual, and individual telephone interviews. These were transcribed and subjected to qualitative content analysis.
Four themes emerged: Academic support, Placements and mentors, Stresses and the reality of nursing life, and Dreams for a better programme.
The themes Academic support, Placements and mentors and Stresses and the reality of nursing life, resonate with international literature. Dreams for a better programme included smaller group learning. Vocation, friendship and resilience seem instrumental in retaining students, and Higher Education Institutions should work to facilitate these. ‘Vocation’ has been overlooked in the retention discussions, and working more actively to foster vocation and belongingness could be important.
Student nurse; retention; qualitative research; action research.
The purpose of this study was to explore the strategies used by nurse managers in Japan to facilitate the integration of newly graduate nurses (NGNs) into their clinical units.
The integration of NGNs into clinical units is an important issue for both NGNs and nurse managers because the first year of practice plays a vital role in a NGN’s career.
Data were generated through semi-structured interviews with 9 nurse managers in 9 acute care hospitals. Data analysis was conducted using a qualitative content analysis method.
Nurse managers used a total of 6 strategies: understanding the circumstances of NGNs, providing opportunities for experience and learning, supporting nurses who teach NGNs, facilitating self-learning, promoting awareness of being a nurse in the clinical unit, and strengthening the sense of comradeship in clinical units. Three of these strategies were particularly important for NGNs’ integration into clinical units: facilitating self-learning, promoting awareness of being a nurse in the clinical unit, and strengthening the sense of comradeship in clinical units. These strategies were described in this study.
The strategies adopted by nurse managers should be aimed at all nurses, not just NGNs, in order to strengthen the sense of comradeship in clinical units. This approach would create a supportive environment for the integration of NGNs into clinical units. The strategies presented in this study can be utilized not just by nurse managers but all senior nurses in the unit. NGNs can use these strategies to help them understand what they need to do to become a full member of their unit.
Clinical units; integration; newly graduated nurses; nurse managers; qualitative descriptive study; strategies.
The aim of this study was to explore relatives’ existential concerns when caring for a seriously ill family member as well as to describe interventions that meet these concerns.
In this integrative literature review we assessed and classified 17 papers, 12 qualitative and 5 quantitative. Literature was sought in the databases Cinahl, PubMed, Psykinfo and Web of Science in September 2009 and in March 2010. Search terms used in different combinations were: family, family caregiver, next of kin, relatives, palliative, palliative care, end-of-life care, existential, spirit*. Data were redrawn from the papers results/findings, and synthesized into a new descriptive content.
The results were categorized from 13 papers exploring relatives’ important existential concerns and 4 papers describing interventions aimed to support them in the existential area. A majority of the reviewed papers had been written in Sweden and concerned relatives of patients with cancer. One overarching theme, living in the presence of death, and three categories: responses to life close to death; support when death is near; and beyond the presence of death were created.
There is an urgent demand for large-scale studies using accurate methodology, as well as a need to design qualified investigations regarding the effects of various interventions, and to determine which interventions are the most effective in supporting relatives who experience existential distress manifested physically and/or psychologically. There is also a considerable demand for educational interventions among professionals in various healthcare settings to increase their knowledge regarding existential concerns among relatives.
Cancer; end-of-life care; family; incurable illness; nursing; review.
Epidemiologic data indicate that chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Patients with poorly managed COPD are likely to experience exacerbations that require emergency department visits or hospitalization—two important drivers contributing to escalating healthcare resource use and costs associated with the disease. Exacerbations also contribute to worsening lung function and negative outcomes in COPD. The aim of this review is to present the perspective of nurse practitioners and physician assistants in terms of providing the pharmacologic and non-pharmacologic modalities needed to treat current and prevent future exacerbations. Major respiratory guidelines recommend treatment of acute exacerbations with short-acting bronchodilators, oral corticosteroids and antibiotics, as appropriate. Supplementary oxygen and/or ventilatory support may also be beneficial to selected patients. Treatments to minimize the risk of future exacerbations should include maintenance pharmacotherapies, risk-reduction measures (e.g. smoking cessation, influenza and pneumonia vaccinations), pulmonary rehabilitation, self-management support and follow-up care.
COPD; exacerbations; follow-up care; nurse practitioner; physician assistant.
Cognitive impairments influence the possibility of persons with dementia to remember daily events and maintain a sense of self. In order to address these problems a digital photo diary was developed to capture information about events in daily life. The device consisted of a wearable digital camera, smart phone with Global Positioning System (GPS) and a home memory station with computer for uploading the photographs and touch screen. The aim of this study was to describe professional caregiver’s perceptions on how persons with mild dementia might experience the usage of this digital photo diary from both a situation when wearing the camera and a situation when viewing the uploaded photos, through a questionnaire with 408 respondents. In order to catch the professional caregivers’ perceptions a questionnaire with the semantic differential technique was used and the main question was “How do you think Hilda (the fictive person in the questionnaire) feels when she is using the digital photo diary?”. The factor analysis revealed three factors; Sense of autonomy, Sense of self-esteem and Sense of trust. An interesting conclusion that can be drawn is that professional caregivers had an overall positive view of the usage of digital photo diary as supporting autonomy for persons with mild dementia. The meaningfulness of each situation when wearing the camera and viewing the uploaded pictures to be used in two different situations and a part of an integrated assistive device has to be considered separately. Individual needs and desires of the person who is living with dementia and the context of each individual has to be reflected on and taken into account before implementing assistive digital devices as a tool in care.
“Ageing in place”; assistive digital device; dementia; factor analysis; perceptions.
Patients’ non-adherence to immunosuppressant treatment after organ transplantation may lead to organ failure, graft loss and death. Non-adherence among Swedish kidney transplant recipients has not previously been studied. Hence the aim of this study was to explore non-adherence among Swedish kidney transplant recipients by using self-report instruments as well as testing the hypothesis that there is a difference in self-reported symptoms, beliefs about medicine and social support between respondents with or without self reported non-adherence.
Materials and Methodology:
In the present cross sectional study 250 renal transplant recipients participated by replying to a questionnaire. Two validated instruments were included, one on beliefs about medicine (the BMQ©), the other on nonadherence (the BAASIS©).
Only 46 % never failed to follow the medical treatment with respect to taking the drugs, dosage or timing (>2 hrs from prescribed time). Timing was the most frequently reported deviation (48 %). Forty-seven patients (16 %) had failed taking at least one dose of the prescribed immunosuppressants during the past four weeks. Four individuals had reduced the prescribed doses. Only one reported taking a ‘drug holiday’. Nine participants reported stronger concerns than necessities for immunosuppressive medication. For the BMQ the necessity scores were extremely high while the scores for concern were low. Risk behaviour identified by the BAASIS had no association in risk attitudes as identified in the BMQ. The only factor relating to non-adherence was lack of social support (p=0.022).
In general adherence was high. Identification of the exceptions remains a challenge.
The BAASIS; the BMQ; immunosuppression; kidney transplant; life-long treatment; non-adherence; self-report instruments.