Evaluating Pictures of Nature and Soft Music on Anxiety and Well-Being During Elective Surgery.

BACKGROUND: Patients going through surgery being awake often have a sense of anxiety and need support to relax. OBJECTIVE: The aim of this study was to investigate whether looking at pictures of natural scenery could reduce anxiety and pain and increase relaxation and well-being being awake during the elective surgery. METHODS: This three-arm, randomized intervention study consisted of one group viewing pictures of natural scenery, one group listening to soft instrumental music, and one control group without distraction, all adult patients (n=174). The State Trait Anxiety Inventory short form and a visual analogue scale on well-being were used as well as sedation treatment if necessary. RESULTS: No differences related to anxiety after surgery were found among the three groups. When controlling for the effect of sedative treatment, however, patients without sedation had a lower degree of anxiety postoperatively (p=0.014). Younger patients had a higher degree of anxiety and lower degree of postoperative relaxation and well-being. CONCLUSION: Viewing pictures of natural scenery while being awake during elective surgery is as relaxing as listening to soft instrumental music. Offering nature scenery pictures for patients to view could be relaxing during the elective surgery.

Group meetings after critical illness-Giving and receiving strength.

INTRODUCTION: An increasing number of intensive care patients are surviving critical illness, but many develop mental, cognitive and physical impairments after discharge. Adapting to a new life situation, often with major challenges, implies the need of support. Therefore, it is important to develop interventions aimed at promoting recovery. OBJECTIVE: The aim was to describe former intensive care patients' feelings of sharing their experience of critical illness with other former patients. METHOD: Former intensive care patients (n = 17) participated in group meetings and wrote about their thoughts in a notebook after each group meeting. To deepen the understanding of the former patients' experience 11 of the former patients were interviewed. The notes in the notebooks and the interviews were analysed using qualitative content analysis. FINDINGS: Meeting others revealed to the former patients new dimensions of being critically ill, and they both gave and received strength from each other. The meetings were meaningful as they gained insight into other patients' lives, and realised what it meant to survive intensive care. CONCLUSIONS: The group meetings meant sharing experiences and understanding the process of survival after critical illness. Giving and receiving strength from others helped the participants to go further.

Living With Liver Cirrhosis: A Vulnerable Life.

Liver cirrhosis is a chronic liver disease. Patients with liver cirrhosis need to manage the symptoms of the disease and possible complications. Symptoms due to ascites, encephalopathy, and/or varices are hard to manage and live with. Self-care is necessary for coping with the symptoms and for improving the patient's life situation. The aim of this study was to explore the areas of life situation and self-care among patients suffering from liver cirrhosis with complications. Interviews with patients with liver cirrhosis (n = 13), seven women and six men (46-70 years), were performed. Data were analyzed using inductive content analysis. The experience of the patient's life situation was described from two aspects: vulnerability and reflection on life. Vulnerability was expressed as symptom experience, feelings of loneliness, preconceptions, and limits in daily life. In reflection on life, the patients expressed acceptance and sadness. Self-care dealt with (a) being responsible by observing symptoms and signs; (b) adhering to treatment, prescription, and advice; and (c) the need for more understanding of and information about the disease. When caring for patients with liver cirrhosis, it is important to identify symptoms and feelings and help patients individually to maintain health through self-care.

Picture book support for preparing children ahead of and during day surgery.

Aim To develop and evaluate the use of a specific picture book aiming to prepare children for anaesthesia and surgery. Methods An intervention comparing two different information methods before ear, nose and throat day surgery was performed. The intervention involved using a specific information sheet and a specific picture book. Parents (n=104) of children aged 2-12 years completed open-ended questions that were analysed with qualitative content analysis. They were divided into two groups: one group received routine information and one received routine information and the intervention. Findings The picture sheet and picture book were valuable aids to prepare small children for anaesthesia and surgery by explaining the procedures that would take place. The parents expressed that knowledge of the procedures made them and the child feel secure. Conclusion Peri-operative information through pictures supports children and their parents during day surgery and may be helpful in future healthcare visits.

Facilitating early recovery of bowel motility after colorectal surgery: a systematic review.

AIMS AND OBJECTIVES: To determine how restored gastrointestinal motility can be accelerated after colorectal surgery. BACKGROUND: Regaining normal bowel functions after surgery is described as unexpectedly problematic. Postoperative ileus is expected after all surgery where the peritoneum is entered, and the length of surgery has little or no impact in terms of the duration of Postoperative ileus. There is some speculation about the best way to facilitate bowel motility after colorectal surgery. DESIGN: A systematic review. METHOD: The computerised databases Medline, Scopus and CINAHL were searched to locate randomised, controlled trials by using the following keywords: colorectal surgery, postoperative ileus, recovery of function and gastrointestinal motility. The systematic search was limited to studies published between January 2002-January 2012. Reference lists were also searched manually. RESULTS: A total of 34 randomised, controlled trials were included in the review. Recovery of gastrointestinal motility was accelerated when one of the following forms of treatment was administered: probiotics, early feeding in combination with multimodal regimens, pentoxifylline, flurbiprofen, valdecoxib, ketorolac, clonidine, ropivacaine, lidocaine or spinal analgesia. Gum chewing, preoperative carbohydrate loading, bisacodyl and Doppler-guided fluid management have an uncertain effect on bowel motility. The use of nonpharmacological interventions, intrathecal morphine, restricted fluid therapy and choline citrate yielded no significant acceleration in bowel motility. CONCLUSIONS: A multimodal treatment, where the use of morphine is restricted, seems to be the best way to accelerate the recovery of gastrointestinal bowel motility. However, more studies are required to optimise the multimodal protocol. RELEVANCE TO CLINICAL PRACTICE: The early return of bowel functions leads to quicker overall postoperative recovery, which may ease patient discomfort and decrease hospitalisation costs.

Can participation in documentation influence experiences of involvement in care decision-making?

INTRODUCTION: Patients have the right to influence the care they receive, but their wish to participate in care decision-making is unclear. AIM: 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. RESULTS: 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. CONCLUSION: 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.

Gender differences when using sedative music during colonoscopy.

Colonoscopy is a procedure often experienced as uncomfortable and worrying. Music has been reported to reduce discomfort during colonoscopy; however, no study in a Swedish setting has been found. The purpose of this randomized controlled trial was to analyze the effects of sedative music on patients' experience of anxiety, pain, relaxation, and well-being during colonoscopy. Prior to colonoscopy, adult patients (n = 120), aged 18-80 years, were randomly assigned to either an intervention group (n = 60) who listened to sedative instrumental music with 60-80 beats per minute during the colonoscopy or a control group. After the colonoscopy, both groups completed a questionnaire on anxiety, the State Trait Anxiety Inventory, and an anxiety Visual Analogue Scale. Pain, relaxation, and well-being were also measured with Visual Analogue Scales. Women in the intervention group had a lower level of anxiety during the colonoscopy than those in the control group (p = .007) and well-being was significantly higher in the intervention group, especially among men, than in the controls (p = .006 and p = .025, respectively). Men in the intervention group were more relaxed during the colonoscopy than those in the control group (p = .065). Listening to sedative music decreased anxiety among women and increased well-being among men during colonoscopy.

An obesity provoking behaviour negatively influences young normal weight subjects' health related quality of life and causes depressive symptoms.

In many parts of the world the prevalence of a sedentary lifestyle in combination with high consumption of food has increased, which contributes to increased risk for becoming overweight. Our primary aim was, in an intervention, to examine the influence on health related quality of life (HRQoL) and mood in young normal weight subjects of both sexes, when adopting an obesity provoking behaviour by increasing the energy intake via fast food and simultaneously adopting a sedentary lifestyle. A secondary aim was to follow-up possible long-term effects on HRQoL and mood 6 and 12 months after this short-term intervention. In this prospective study, 18 healthy normal weight subjects (mean age 26±6.6 years), mainly university students were prescribed doubled energy intake, and maximum 5000 steps/day, during 4 weeks. An age and sex matched control group (n=18), who were asked to have unchanged eating habits and physical activity, was recruited. Before and after the intervention questionnaires including Short Form-36, Hospital Anxiety Depression scale, Center of Epidemiological Studies Depression scale, Sense of Coherence and Mastery scale were completed by the subjects in the intervention group and by the controls with 4 weeks interval. Six and 12 months after the intervention the subjects underwent the same procedure as at baseline and the controls completed the same questionnaires. During the intervention, subjects in the intervention group increased their bodyweight and developed markedly lower physical and mental health scores on Short Form-36 as well as depressive symptoms while no changes appeared in the controls. The increase of depressive symptoms was associated with increases of energy intake, body weight and body fat. When followed up, 6 and 12 months after the intervention, physical and mental health had returned completely to baseline values, despite somewhat increased body weight. In conclusion, adopting obesity provoking behaviour for 4 weeks decreases HRQoL and mood in young normal weight subjects. The effect is temporary and when followed up 6 and 12 months after the short-term intervention no remaining influence is found.

Young healthy individuals develop lack of energy when adopting an obesity provoking behaviour for 4 weeks: a phenomenological analysis.

During the past 20 years, a sedentary lifestyle has become more common and simultaneously the consumption of energy-dense food has increased. These are two major risk factors associated with the increase of overweight and obesity, which is found in all ages over the world. The low well-being reported by obese individuals could be associated with increased food intake or it might be a specific consequence of obesity and lack of physical fitness. The aim of this study was to describe the experience of the phenomenon, adopting an obesity provoking behaviour, by increasing energy intake and simultaneously having a sedentary lifestyle for 4 weeks in healthy, normal-weight individuals of both genders. Eighteen healthy individuals (12 men and 6 women; median age 23, range 21-44 years) were included in an intervention, with a doubled energy intake and a maximum physical activity of 5000 steps per day during 4 weeks. After completing this intervention the participants were interviewed and asked to describe their experience during the past 4 weeks. A phenomenological approach was used to gain understanding of the phenomenon and analyses of the transcripts were performed in four steps according to Giorgis' method. The main essence of the phenomenon, adopting an obesity provoking behaviour, was found to be lack of energy, related to emotional life, relations and life habits. Lack of energy emerged from five structures: influenced self-confidence, commitment to oneself and others, managing eating, feelings of tiredness and physical impact. These five structures were manifested through 12 constituents. These lifestyle changes decreased the sense of well-being in nonobese healthy individuals of both genders.

Patients' perspective of factors influencing quality of life while living with Crohn disease.

Crohn disease is a chronic inflammatory bowel disease of unknown etiology. The chronic, relapsing nature of Crohn disease produces physical, psychological, and social stress. The disease occurs early in life, and the effects of Crohn disease on daily life are associated with symptom burden; thus, managing their disease and coping with its impact is a lifelong process for sufferers. This study was undertaken to identify and describe the meaning of quality of life in patients with Crohn disease. Using a grounded theory methodology, 11 interviews were performed with 6 men and 5 women, 29-83 years of age, all suffering from Crohn disease. The experience of quality of life was associated with limitations in daily activity, the major theme that emerged from the analysis. Quality of life varied depending on how the patient managed limitations related to the symptoms of the disease. The categories of self-image, confirmatory relations, powerlessness, attitude toward life, and sense of well-being were conceptualized as the dominant themes derived from the data. When caring for these patients, it is important to identify limitations and provide support so that patients are able to maintain a daily life that can be perceived as normal and routine.

Addressing spouses' unique needs after cardiac surgery when recovery is complicated by heart failure.

BACKGROUND: Cardiac surgery places extensive stress on spouses who often are more worried than the patients themselves. Spouses can experience difficult and demanding situations when the partner becomes critically ill. OBJECTIVES: To identify, describe, and conceptualize the individual needs of spouses of patients with complications of heart failure after cardiac surgery. METHODS: Grounded theory using a mix of systematic coding, data analysis, and theoretical sampling was performed. Spouses, 10 women and 3 men between 39 and 85 years, were interviewed. RESULTS: During analysis, the core category of confirmation was identified as describing the individual needs of the spouses. The core category theoretically binds together three underlying subcategories: security, rest for mind and body, and inner strength. Confirmation facilitated acceptance and improvement of mental and physical health among spouses. CONCLUSIONS: By identifying spouses' needs for security, rest for mind and body, and inner strength, health care professionals can confirm these needs throughout the caring process, from the critical care period and throughout rehabilitation at home. Interventions to confirm spouses' needs are important because they are vital to the patients' recovery.

Perceptions of registered and enrolled nurses on thirst in mechanically ventilated adult patients in intensive care units-a phenomenographic study.

BACKGROUND: Thirst is a commonly experienced source of discomfort among patients receiving mechanical ventilation during intensive care. Dehydration, endotracheal tubes, electrolyte disturbances and the use of various medicines can contribute to the feeling of thirst. At present, the knowledge of nurses' perceptions of the feelings of thirst in mechanically ventilated patients are limited. PURPOSE: The purpose of this study was to describe registered and enrolled intensive care nurses' perceptions of the feelings of thirst in mechanically ventilated adult patients and to investigate the interventions to reduce thirst. METHOD: Ten registered intensive care nurses and 10 enrolled nurses, aged 32-59 years, were interviewed. They all had at least one year's experience in caring for adult, mechanically ventilated patients. The data were analysed using a phenomenographic methodology. FINDINGS: Four categories of perceptions among registered and enrolled nurses, regarding thirst in mechanically ventilated patients were identified: reasons for thirst, signs of thirst, preventing or reducing thirst and the perception that patients had no feelings of thirst. CONCLUSIONS: Registered and enrolled nurses wish to reduce sources of discomfort among their patients but they do not always realise that patients feel thirst and therefore relieving it has a low priority among staff. Relieving thirst is a human need that must be recognised in nursing education and on intensive care units.

Psychosocial status and health related quality of life in relation to the metabolic syndrome in a Swedish middle-aged population.

BACKGROUND: The Metabolic Syndrome (MS) is a combination of risk factors related to increased risk of cardiovascular disease. Psychosocial factors and stress have been suggested to be important determinants. AIM: To analyse how psychosocial factors, perceived stress and health related quality of life are related to MS, and assess if observed associations are dependent of life-style. METHODS: A cross-sectional study of a random sample of 502 men and 505 women aged 45-69, from southeast Sweden, including fasting blood samples, blood pressure, anthropometrics, self-reported data of life-style, psychosocial status and health related quality of life (SF-36). Linear regression models were adjusted for age and, in a second step, also for life-style. RESULTS: Men and women with MS reported lower levels of physical activity, lower scores on physical and social dimensions of SF-36, and women with MS reported stronger effect of social change compared to those without MS (p<0.05), but we found no differences for mental health or perceived stress. The major part of observed associations was lost after adjustment for effects of life-style. CONCLUSION: Our data speak against a direct effect of social stress on MS via psychological strain but suggest an indirect pathway via a sedentary life-style.

Having knowledge of metabolic syndrome: does the meaning and consequences of the risk factors influence the life situation of Swedish adults?

The underlying causes of metabolic syndrome (MS) are uncertain. Knowledge from those who have experience of this syndrome should provide new insight. The aim was to explore the meaning and consequences of MS. Thirteen Swedish adults with MS, aged between 33 and 82 years, were interviewed. The interviews were analyzed using constant comparative analysis, which is the basis of grounded theory. The core category for the meaning and consequences of having the risk factors of MS consisted of the recurrence of behavior. The participants attempted to balance their insight into the causes and consequences by referring to their normal life, lifestyle, and fatalistic approach to life. Attention needs to be paid to the attitudes of the individuals with MS, as well as the known risk factors and their consequences, in order to facilitate a long-term lifestyle change in these individuals.