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Holdninger og smertelindring
Get PDFProblemstilling Hvilken påvirkning kan sykepleiers holdninger ha på smertebehandling til pasienter med ruslidelser?
Teoretisk perspektiv Oppgaven tar utgangspunkt i etikk i form av de yrkesetiske retningslinjer og de etiske prinsipper. Videre benyttes Helsepersonelloven og Pasient- og brukerrettighetsloven. Det teoretiske perspektivet trukket frem er Joyce Travelbee sin teori om mellommenneskelige forhold og relasjonen mellom sykepleier og pasient. Videre er Erving Goffman sin teori om stigma og avvikeres sosiale identitet benyttet.
Metode Oppgaven er utformet som en litteratur oppgave hvor det er tatt i bruk eksisterende forskning og teori for å belyse temaet. Databasene benyttet er PubMed og Oria. Søkeord benyttet er stigma, substance use disorder og nurse attitudes. Disse søkeordene ble kombinert med hospital ved bruk av AND. I Oria ble søkeordene smertelindring og rusmisbruker benyttet. Funnene fra litteratursøk settes opp mot litteratur, etikk og lovverk.
Drøfting Forskningen avdekker negative holdninger blant sykepleiere til pasienter med ruslidelser. Pasientene anses som manipulerende, potensielt aggressive og utfordrende å jobbe med. Videre ses det utfordringer knyttet til pasientenes formidling av smerte, og tilliten sykepleierne hadde til pasientene i denne sammenhengen. Det trekkes også frem positive holdninger. Funnene drøftes opp mot lovverk og etikk, sett i lys av teorigrunnlaget.
Konklusjon Funnene viser til de negative holdningers på virkning på smertebehandlingen. Sykepleierne oppga å ha lavere motivasjon og vilje til å pleie pasientene, og mangel på tillit gjorde at smertebehandlingen kunne bli redusert. De holdninger som kommer frem står i strid med både lovverk og etikk, og er en bidragsyter til en svekket relasjon mellom pasient og sykepleier. Det er nødvendig med mer forskning og fokus på feltet for å øke forståelsen for holdningers påvirkning
Avledning som smertelindring for barn
Get PDFProblemstilling: Hvilken betydning har avledning som ikke-medikamentell smertelindring ved nålrelaterte prosedyrer for barn på sykehus?
Teoretisk perspektiv: Oppgaven presenterer et teorigrunnlag som omfatter særlige kjennetegn ved barn som pasientgruppe og typiske utviklingstrekk for barn i alderen 0-5 år. Videre fremlegges teori angående barns opplevelse av smerte og betydningen det har for valg av avledningsmetode. Avslutningsvis presenteres teori om etiske og juridiske perspektiver, og om personsentrert sykepleie som vil ligge til grunn for besvarelsen.
Metode: Bacheloroppgaven er utarbeidet som en litterær oppgave og baserer seg på faglitteratur, forskningsartikler og juridiske og etiske perspektiver relevant for vår problemstilling. Vi har gjennomført strukturert søk. De fire hovedartiklene våre er presentert i en egen artikkelmatrise. En av dem er en systematisk oversiktsartikkel og de tre resterende er randomisert kontrollerte studier.
Drøfting: I drøftingskapittelet blir det drøftet følgende faktorer for å belyse problemstillingen med bakgrunn i teoretisk grunnlag og funn i forskning: reduksjon av fysisk smerte, reduksjon av emosjonell smerte, betydning av og for foreldre og reduksjon av uheldige konsekvenser. Avslutningsvis blir det drøftet veien videre for avledning som smertelindring. De utvalgte faktorene vil ses i lys av personsentrert sykepleie. Funn viser at avledning har en reduserende effekt på fysisk og emosjonell smerte.
Konklusjon: Avledning som smertelindring har flere positive betydninger som ikke- medikamentell smertelindring ved nålrelaterte prosedyrer til barn på sykehus. Både i form av å redusere fysisk og emosjonell smerte på en mer helhetlig måte, men også at den lærer barnet mestringsstrategier som kan brukes senere i livet. Avledning legger til rette for at barn og foreldre får mulighet til å delta mer i behandlingsforløpet, det reduserer uheldige konsekvenser og sparer helsevesenet for tid og ressurser på sikt
Many Patients with Persistent Pain One Year After TKA Report Improvement by 5-7 years: A Mixed Methods Study
Get PDFBackground
Approximately 20% of patients report pain 12 months after TKA. No studies have investigated patients’ experiences of living with persistent postsurgical pain 5 to 7 years after TKA by combining a qualitative and quantitative methodology. Question/purpose In a mixed-methods study, we explored
patients’ experiences of living with persistent pain up to 7 years after primary TKA. We asked: In a
subgroup analysis of patients who reported persistent pain 1 year after TKA surgery, how do patients live with persistent pain at the 5- to 7-year postoperative timepoint?
Methods
This follow-up study was part of a longitudinal study of pain, symptoms, and health-related quality of life in
patients who underwent TKA for osteoarthritis. The present study targeted a subgroup of patients (22% [45 of 202]) identified in the longitudinal study who reported no improvement inpain interferencewithwalkingat 12months after surgery. Inclusion criteria were: all 31 patients in this subgroup
who attended their 5-year follow-up at the hospital and lived within a 2-hour drive from the hospital. Eight patients declined or were unable to participate due to illness or death. Hence, the final sample consisted of 23 patients (13 women and 10 men). The participants’ mean age at surgery was 666
10 years. There were no differences in sociodemographic baseline data between the 23 included and the 22 excluded participants. A mixed-methods approach was employed, in which the quantitative data were followed up and investigated with qualitative interviews. Instruments used were the Brief
Pain Inventory preoperatively, 12 months, and 5 years after surgery, as well as a semistructured interview guide. The individual interviews were conducted at one timepoint 5 to 7 years postsurgery to capture how pain was experienced at that timepoint. The interviews were audiorecorded, transcribed, and analyzed using qualitative content analysis.Meaning units were identified, condensed, and sorted into subthemes that
were interpreted and abstracted into themes, guided by the research question. With a small sample, the quantitative analysis focused on descriptive statistics and nonparametric statistics when comparing demographics of included and nonincluded patients. In addition, two multivariate mixed models for repeated measures were employed to estimate within‐patient and between‐patient variations as well as to
assess the effect of time on the pain outcomes.
Results
Pain with walking decreased from 12 months to 5years postoperatively (estimated mean score 7 versus 4, difference of means -3 [95% CI -5 to -2]; p < 0.001). Pain with daily activity decreased from 12 months to 5 years postoperatively (estimated mean score 6 versus 3, difference of means -3 [95%CI -4 to -1]; p < 0.001). Pain intensity (average pain) decreased from 12 months to 5 years postoperatively
(estimated mean score 5 versus 4, difference of means -1[95% CI -3 to 0]; p = 0.03). The results are presented as point estimates rounded up to whole numbers. The qualitative data
analysis yielded three themes: persistent limitations afterTKA, regained wellness over time, and complexity in physicalchallenges. Intermittent pain with certain movements
resulted in limitations with some activities in everyday lifeand seemed to persist beyond 5 years. Multiple painful body sites and presence of comorbidities seemed to interfere with
regained wellness over time.
Conclusion
In this subgroup of patients experiencing postsurgicalpersistent pain 12 months after primary TKA, persistent postsurgical pain still limited certain activities for the participants, although pain seemed to be less influential in their everyday lives after 5 years to 7 years. Clinicians may use these findings to inform and guide patients with delayed improvements in pain into more realistic expectations forrecovery, rehabilitation, and strategies for coping with pain and impaired function. However, it is imperative to rule out
other reasons for pain in patients reporting pain 12months and longer after surgery and and to be attentive of possible changes in pain over time.publishedVersio
Intensive care nurses’ experiences using volatile anaesthetics in the intensive care unit: An exploratory study
Get PDFObjective: To explore the experiences intensive care nurses have with volatile anaesthetics in the intensive care unit.
Research methodology and design: A qualitative exploratory and descriptive design was used. Data were collected in 2019 from individual interviews with nine intensive care nurses, who were recruited using purposive sampling. Data were analysed using systematic text condensation.
Setting: The study was undertaken in two general intensive care units from different university hospitals in Norway where volatile anaesthetics were utilised.
Findings: Three categories emerged from the data analysis: experiencing the benefits of volatile anaesthetics; coping with unfamiliarity in handling volatile anaesthetics; and meeting challenges related to volatile anaesthetics in practice.
Conclusion: The intensive care nurses had positive experiences related to administering volatile anaesthetics in the intensive care unit and responded positively to the prospect of using it more often. Because volatile anaesthetics were rarely used in their units, the participants felt uncertain regarding its use due to unfamiliarity. Collegial support and guidelines were perceived as pivotal in helping them cope with this uncertainty. The participants also experienced several challenges in using volatile anaesthetics in the intensive care unit, with ambient pollution being regarded as the main challenge.acceptedVersio
Fun and a meaningful routine : the experience of physical activity in people with dementia
Get PDFBackground: Physical activity is important to health and wellbeing. People with dementia are less physically active than their cognitively healthy counterparts. Reasons for this are multifaceted, and are thought to be social, psychological, and physiological. People with dementia often use services such as home care, day care centres and nursing home, and according to the stage of disease they are less or more dependent on other people to take part in activities. To develop appropriate services to this patient group, their needs and preferences regarding physical activity must be recognized. The aim of the study was therefore to provide insight into experiences with physical activity in people with dementia.
Methods: The current study is part of a larger research project on needs in people with dementia. The main project included qualitative semi-structured interviews with 35 persons with dementia. 27 of the participants talked about their experience with physical activity. In the current study, the relevant findings on this theme were analysed separately. A phenomenological hermeneutic research design was applied.
Results: The analysis revealed three main categories regarding experiences with physical activity. To be physically active provided positive experiences such as feelings of mastering and post-exercise euphoria. To be physically active was meaningful. The daily walk was an important routine to many, and it gave meaningful content to the day. Keeping up with activities confirmed identity. Lastly, to be active was perceived as challenging. Participants described different barriers to being physically active such as a decline of physical function, lack of motivation and being dependent on others to go out.
Conclusions: Many of the participants expressed that being physically active was important to them. It is essential that informal and formal carers are aware of the role physical activity plays in the lives of many people with dementia, so that appropriate measures can be taken to assure continued active living in order to preserve health and quality of life.publishedVersio
The facilitation of user-involvement for people with dementia as experienced by health care professionals : a qualitative study using focus groups
Get PDFObjective: The main objective of this study was to explore how health care professionals experience adaptation of user-involvement for people with dementia receiving health and social care.
Method: A qualitative explorative design was used with eight focus groups as the method of data collection. A total of 49 health care professionals were included representing a variety of professions, municipal and specialized health services, and all health regions of Norway. The transcribed focus group interviews were analyzed using qualitative content analysis following six steps to identify categories and the overall theme.
Results: Six main categories were identified: 1) facilitation of self-determination, 2) challenges of reduced or lack of awareness, 3) family caregivers’ concern and protection, 4) open communication, 5) establishing a trustworthy relationship, and 6) clarifying expectations. To maintain independent lives for people with dementia, health care professionals must facilitate and support shared decision-making using an open and trustworthy communication.
Conclusion: To facilitate user-involvement, health care professionals need to develop and implement strategies that consider the perspectives of people with dementia and support the relationship between people with dementia and their informal caregivers.publishedVersio
Exploring reported distress before and pain during needle insertion into a venous access port in children with cancer
Get PDFBackground: Venous access port is commonly used during cancer treatment in children, yet little is known about how children experience such needle insertion
procedures.
Aim: To study distress before and pain after venous access port needle insertion among children and adolescents with cancer. A second aim was to explore associations between their self-report
of procedure-related distress and pain with proxy reports by parents and nurses.
Method: The sample included 43 children/adolescents, aged 1–16
years with cancer, treated at two Norwegian university hospitals. The patient, parent(s), and the nurse
performing the procedure completed developmentally appropriate 11-point distress
and pain scales before and immediately after the venous access port procedure. Data
were analysed using descriptive statistics and non-parametric correlations.
Ethical issues: The ethical code of conduct was followed and conformed to the ethical
guidelines adopted by the Regional Committee for Medicine and Health Research and the data protector officer at the hospitals.
Results: For the youngest children (1–5
years), the median distress proxy score was
8 (range 0–9) and pain proxy score 4 (range 0–10).
Median distress and pain scores
for children aged 6–12 years were 3 (range 0–9)
and 1 (range 0–10), respectively,
and for the adolescents (age 13–16)
0 (range 0–6) and 1 (range 0–5), respectively.
Patients’ self-reported distress and pain correlated highly with parents’ (distress: rho = 0.83, p < 0.001, pain: rho = 0.92, p < 0.001) and with nurses’ proxy ratings (distress: rho = 0.89, p < 0.001, pain: rho = 0.88, p < 0.001).
Conclusion: There were individual age differences in experienced distress/pain associated
with venous access port needle insertion, with a trend for younger children to experience higher levels of distress/ pain than the older children. Children's self-report of distress/ pain concurred with both parental and nurse proxy reports.publishedVersio
Humanizing and dehumanizing intensive care: Thematic synthesis (HumanIC)
Get PDFBackground: Critical illness and the intensive care unit can be a terrifying experience
to patients and relatives and they may experience the extreme life-saving
measures as
dehumanizing. Humanizing intensive care is often described as holism or dignity, but
these abstract concepts provide little bodily resonance to what a humanized attitude
is in concrete situations.
Objective: To explore what contributes to patients' and relatives' experience of intensive
care as humanized or dehumanized.
Design: Thematic synthesis.
Materials: Findings from 15 qualitative papers describing patients' and/or relatives'
perceptions of humanizing or dehumanizing care.
Methods: A systematic literature search of PubMed, CINAHL, Scopus and EMBASE
from 1 January 1999 to 20 August 2022 identified 16 qualitative, empirical papers
describing patients' and relatives' experiences of humanizing or dehumanizing intensive
care, which were assessed using Critical Appraisal Skills Programme Qualitative
Checklist, 15 papers were included and analysed using Thematic Synthesis and
Ricoeur's model of the text.
Findings: Intensive care was humanized when patients felt connected with healthcare
professionals, with themselves by experiencing safety and well-being
and with their
loved ones. Intensive care was humanized to relatives when the patient was cared
for as a unique person, when they were allowed to stay connected to the patient and
when they felt cared for in the critical situation.
Conclusion: Patients and relatives experienced intensive care as humanized when
healthcare professionals expressed genuine attention and supported them through
their caring actions and when healthcare professionals supported patients' and relatives'
opportunities to stay connected in the disrupted situation of critical illness.
When healthcare professionals offered a connection to the patients and relatives, this
helped them hold on and find meaning.publishedVersio
A multicenter international prospective study of the validity and reliability of a COVID-19-specific health-related quality of life questionnaire
Get PDFPurpose: To develop and validate a health-related quality of life (HRQoL) questionnaire for patients with current or previous coronavirus disease (COVID-19) in an international setting. Methods: This multicenter international methodology study followed standardized guidelines for a four-phase questionnaire development. Here, we report on the pretesting and validation of our international questionnaire. Adults with current or previous COVID-19, in institutions or at home were eligible. In the pretesting, 54 participants completed the questionnaire followed by interviews to identify administration problems and evaluate content validity. Thereafter, 371 participants completed the revised questionnaire and a debriefing form to allow preliminary psychometric analysis. Validity and reliability were assessed (correlation-based methods, Cronbach’s α, and intra-class correlation coefficient). Results: Eleven countries within and outside Europe enrolled patients. From the pretesting, 71 of the 80 original items fulfilled the criteria for item-retention. Most participants (80%) completed the revised 71-item questionnaire within 15 min, on paper (n = 175) or digitally (n = 196). The final questionnaire included 61 items that fulfilled criteria for item retention or were important to subgroups. Item-scale correlations were > 0.7 for all but nine items. Internal consistency (range 0.68–0.92) and test–retest results (all but one scale > 0.7) were acceptable. The instrument consists of 15 multi-item scales and six single items. Conclusion: The Oslo COVID-19 QLQ-W61© is an international, stand-alone, multidimensional HRQoL questionnaire that can assess the symptoms, functioning, and overall quality of life in COVID-19 patients. It is available for use in research and clinical practice. Further psychometric validation in larger patient samples will be performed.publishedVersio
Brazilian undergraduate nursing students’ critical thinking need to be increased: a cross-sectional study
Get PDFObjectives: To map Brazilian undergraduate nursing students’ critical thinking level and investigate the correlation between selected sociodemographic data and critical thinking domains.
Methods: In this descriptive cross-sectional study, participants’ (N=89) critical thinking was assessed using the Health Science Reasoning Test. Correlation between critical thinking domains and sociodemographic data was assessed using the Pearson correlation coefficient.
Results: The overall results showed a moderate level of participants’ critical thinking (mean = 70.7; standard deviation 5.7). A poor performance was identified in 5 of the 8 critical thinking domains. A significant positive correlation was found between education period and critical thinking (p<.001).
Conclusions: Poor level in students critical thinking domains may lead to negative consequences for their learning outcomes. Further studies should be carried out to confirm our results, in addition to investigation of teaching methods that encourage and ensure the development of students’ critical thinking skills during nursing education.publishedVersio