A planned but vulnerable pathway towards self-management following day surgery. Orthopaedic patients' experiences.

INTRODUCTION: An increasing share of surgical activity is organised as day surgery, thus giving more responsibility for care to patients and their next of kin. PURPOSE: To obtain increased understanding of orthopaedic day surgery patients' experiences with self-management. METHODS: A descriptive interview study. Eleven men and five women aged 18-78 years, who had undergone arthroscopic knee surgery in rural Norway participated in qualitative individual interviews during autumn 2018. Systematic text condensation was used as analysis strategy. RESULTS: The main theme a planned but vulnerable pathway towards self-management and five subthemes were highlighted. The interviewees were satisfied with most aspects of the day surgery. However, challenges in adapting oral and written information to self-management postdischarge, a need for further self-management support at home, and strenuous travel increased the strain. CONCLUSION: The written and oral information and support that was planned and provided by the hospital did not meet the patients' needs for self-management support postdischarge. The day surgery care pathway seemed to lack effective educational interventions for strengthening the patients' self-efficacy and control and to have potential for improvements.

COPD transitions in health and self-management: service users' experiences from everyday life.

Purpose: To explore how persons living with COPD experience transitions related to health, self-management, and follow-up from the healthcare services. Patients and methods: This study is part of a participatory research project. Six males and five females living with COPD, with a COPD assessment test score of 21-29, participated; all the participants were living at home. Data were collected in qualitative research interviews and analyzed using qualitative content analysis highlighting the participants' experiences. Results: The findings showed two main themes: "The struggle to keep going" and "The need for continuity and competent facilitation". The participants reported complex health transitions, with changes in roles and function, demanding exacerbations and critical events, and challenges with learning needed self-management. They expressed a great need for and had great benefit from, education, rehabilitation, and follow-up in their management of everyday life. Not all received offers in line with current guidelines. Conclusion: In-depth knowledge of patients' experienced COPD transitions offers clinicians guidance for the timing and quality of follow-up services. Life with COPD entails challenging transitions in health and self-management. Good rehabilitation and follow-up from the healthcare services are needed throughout the disease trajectory. Participation in self-management education and rehabilitation that include psychosocial aspects may facilitate health-enhancing transitions and improve self-management skills. Experienced lack of competence and flexibility among healthcare providers hinders trust and collaboration. Access to stable and competent follow-up in the primary health services may facilitate cohesive services and collaborative self-management.

Adolescents' perspectives on everyday life with obesity: a qualitative study.

PURPOSE: This study aimed to gain an in-depth understanding of the perspectives and life experiences of adolescents living with obesity. METHODS: Five adolescents living with obesity were involved in repeated interviews, and qualitative content analysis was performed. RESULTS: Three themes emerged: obesity as a multi-faceted and difficult to solve condition; obesity as a shameful and vulnerable subject; and bullying and fragile social relationships. Adolescents living with obesity described everyday life challenges as difficult to interpret and solve. Adolescents living with obesity perceived causes for obesity differently, and those who emphasised familial determinants seemed to face greater challenges. Lack of support from parents, trusted friends and health-care providers and bullying, shame, guilt and self-blame represented threats that decreased motivation for help seeking and successful life-style changes. The adolescents were ambivalent regarding disclosing their concerns and seeking help. The adolescents feared that health care providers would demand too much from them, and peers were perceived as a possible source of support. CONCLUSION: Care providers need to be skilled in assessing each individual's resources and interpretations of their condition, to be able to communicate in a respectful, patient-centred manner and to assist adolescents to explore their ambivalence and set their own realistic goals. More research is needed.

Self-rated health aspects among persons living with chronic obstructive pulmonary disease.

PURPOSE: To describe a cohort of chronic obstructive pulmonary disease (COPD) patients and perform a within-group comparison regarding self-management activation, social provision, and health status. PATIENTS AND METHODS: A cross-sectional survey including 116 persons. RESULTS: The sample comprised 65 men and 38 women, mean age 69 years. Fourteen percent reported very high impact of COPD on their health; 19% had received pulmonary rehabilitation offers, 39% had been offered self-management education, and 64% had acute hospital admissions due to COPD complications in the past year. Persons with COPD Assessment Test (CAT) scores ≥30 reported significantly poorer self-management activation and significantly lower social provision than those reporting CAT scores <30. Number of COPD years had no significant influence on COPD health care consultations or self-management activation. CONCLUSION: Persons with COPD reported decreasing social provision with increasing COPD years and poorer health status. Although COPD is a progressive disease, health status and self-management activation did not vary with number of COPD years. Those living with a very high COPD impact on health reported significantly lower self-management activation but fewer acute hospital admissions. PRACTICE IMPLICATIONS: COPD patients' need for pulmonary rehabilitation, self-management support, and social support should be assessed and appropriate services offered throughout the disease trajectory.

Social provision and loneliness among older people suffering from chronic physical illness. A mixed-methods approach.

AIMS: To describe and compare the perceived social provision for a group reporting never feeling lonely with that of a group reporting feeling lonely and to explore the meaning of loneliness. SUBJECTS: Participants (N = 101) were recruited from geriatric wards. Inclusion criteria were as follows: aged 65 years or more, the absence of dementia, one or more chronic physical disorders and plans to be discharged from the hospital to their home. The mean age was 81.3 years (range: 65-96 years), 68% were women, and 66% lived alone. MEASURES: Assessments of social provisions and loneliness were collected by a subjective report using the Social Provision Scale (SPS), and the Montgomery-Aasberg Depression Rating Scale (MADRS) was used to assess depression. The participants were also asked whether they felt lonely and were then asked to describe the meaning of loneliness if they had indicated feeling lonely. Narratives were then condensed by the participants into short sentences. RESULTS: Seventy-five per cent of the participants reported feeling lonely, of these 54% were living alone, and 18% identified with depression. Three subscales of SPS scores were significantly lower in the lonely group: attachment (p < 0.001), a sense of reliable alliance (p = 0.001) and the obtaining of guidance (p = 0.01). The overall view of the experience of loneliness was dominated by emptiness and negative emotions. The following themes were identified: Emotions were dominated by sadness, anxiety and restlessness, anger and guilt. Relationships were dominated by being left alone, being confined and feeling useless. Existential dimensions were characterised by emptiness, endless boredom, isolation and the potential for change. CONCLUSION: The study shows that loneliness is prevalent among older people suffering from chronic physical illness and confirms the complexity of the concept. A mixed-methods design contributed to nuanced and detailed information about the meaning of loneliness.

Patients' experiences of health transitions in pulmonary rehabilitation.

People who live with chronic obstructive pulmonary disease (COPD) experience major changes in health. Coping with the illness and caring for themselves places extensive demands on them. Thus, pulmonary rehabilitation (PR) is recommended as a means to facilitate healthy transitions in everyday life with COPD. This study explores the experience of patients with COPD in terms of their transitions in health during and after PR. The research was inspired by interpretive phenomenology. Thirty-three individual qualitative interviews were conducted with eighteen patients recruited from Norwegian PR units. A thematic analysis of the interviews was performed. The interviewees described participation in PR as a time of increasing awareness of opportunities for health and well-being with strengthened hope. The year following PR was dominated by their ongoing challenge to acknowledge limitations and explore opportunities in everyday life. Continuation of healthy transitions was facilitated by peer and professional support. The study highlights the personal resources that patients with COPD have access to in order to promote their own health. The study also highlights their vulnerability during illness and rehabilitation. The findings critique time-limited PR and support the current trends towards patient-centred rehabilitation efforts that incorporate user involvement and self-management education.

Experiences of self-blame and stigmatisation for self-infliction among individuals living with COPD.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major health problem estimated to become the third leading cause of death and the fifth leading cause of disability by 2020. Tobacco control is the most effective protective intervention, and it serves as a key element in patient counselling. However, a focus on tobacco control may cause unintended and adverse effects to individuals who already suffer from the disease. AIM: The current study aims to understand how patients with COPD experience daily life in a society with heavy emphasis on tobacco control. METHOD: The design was longitudinal and descriptive. The sample included thirteen men and five women with COPD, recruited from pulmonary rehabilitation units. Data were collected by means of qualitative interviews and analysed using qualitative content analysis with search for meanings. FINDINGS: The main theme was a feeling of being exiled in the world of the healthy, because of self-blame and society's stigmatisation of COPD as a self-inflicted disease. The participants experienced feelings of disgrace through subtle blame and a lack of support from their social network, health care encounters and larger society. This seemed to increase illness-related strain and a need for defensive actions. LIMITATIONS: A small convenience sample, local cultural influence, the study's wide scope and lack of health professionals' views must be considered. CONCLUSION: This study illuminates the challenge of how to combine health advice on smoking cessation with nonblaming psycho-social support throughout the course of COPD. An awareness of the potential for stigma, the nature of nicotine dependence and broadened causal explanations for the disease may improve the ability of caregivers to address patient strain and its negative association with coping and well-being. Dilemmas in health communication concerning COPD patients' experience of stigma and negative emotional response should be further explored.

'Belonging'. 'Patients' experiences of social relationships during pulmonary rehabilitation.

AIM: To unpack and interpret descriptions of experiences of social relationships during pulmonary rehabilitation (PR) for people living with chronic obstructive pulmonary disease (COPD). METHOD: Inspired by interpretive phenomenology, individual qualitative interviews were conducted twice with 18 persons from COPD rehabilitation units in two general hospitals. Qualitative content analysis was performed. RESULTS: Analysis of the interviews revealed the overarching theme of belonging. The participants emphasised social integration in rehabilitation groups as well as support from peers and health-care personnel as important dimensions of social relationships with regard to PR. Active participation in and engagement with the groups provided opportunities for patients to share their knowledge, encouraged mutual trust, and support and increased self-confidence, and motivation for self-care and further social participation. Integration in the groups and perceived support during PR made coping and adaptation easier and had a positive effect on quality of life. CONCLUSIONS: Patients' perspectives on PR were strongly influenced by certain facets of social relationships, such as social integration and social support. Patients', peers' and health-care professionals' strategies to promote social support and social integration should be further explored in the future, both in different contexts and for longer periods of time.