Hit by the wave: The experiences of adult males living with lymphoedema.

Lymphoedema arises when the lymphatic system has been damaged and may occur secondary to cancer treatment. While much of the extant literature focuses on quality of life in females with breast cancer- related lymphoedema, this study explores the impact of living with lymphoedema secondary to cancer treatment in males. Semi-structured interviews were conducted with 13 male participants, aged between 50 to 85 years. Data collected were analysed using interpretative phenomenological analysis. The super-ordinate theme 'Hit by a wave' encompasses the profound impact of lymphoedema on the participants' quality of life. The males expressed body image concerns and struggled with feelings of frustration, anger, anxiety and depression. Physical changes such as weight increase, disrupted sleep, pain, swollen genitals and urinary difficulties were experienced. Changes in lifestyle were also expressed, such as an increased dependence on carers; work-related and role changes. Nevertheless, many participants endorsed the need to focus on the present moment and expressed a heightened appreciation of authenticity in life. By understanding the unique narratives of males with lymphoedema, health care practitioners together with patients can formulate care plans that truly resonate with the needs, concerns, and experiences of males living with lymphoedema.

Navigating the Storm to Recovery through the Pictorial Representations of Persons in the Recovery Phase from Unipolar Depression.

Depression is a highly complex mental illness that presents challenges, such as difficulties for persons with depression to communicate their experiences. This is compounded further by a paucity of in-depth and pictorial accounts on their experiences of the recovery process. The combination of pictorial representations and interviews with persons who are recovering from depression, may assist them in communicating these lived experiences. Five participants recovering from unipolar depression and who were in the late stages of recovery were recruited through purposive sampling. Data were collected through the conduction of art sessions, where participants pictorially represented their experience of living with depression and their road to recovery. Semi-structured interviews were then used to explore their artwork. The transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Two superordinate themes emerged from participants' interviews, namely: 'A New Me in Me' that incorporating changes in their identity, physical, emotional, and social experiences, and 'Life as an amalgamation of colour' describing their search for meaning and the importance of spirituality, hope, gaining control and positivity in the recovery process. The use of pictorial representations combined with interviews can add depth to participant narratives, that serve to enhance the therapeutic alliance between the patient-professional dyad.

Living on a razor's edge: Experiences of mothers caring for a son on synthetic cannabinoids in Malta.

Various studies have explored collectively the experiences of carers of individuals using illicit substances. Yet such experiences vary by gender, by relationship status to the substance user, by type of drug taken and whether the substance user lives within the same household. A hermeneutic phenomenological design was undertaken with five mothers of sons on synthetic cannabinoids (SC). These sons were receiving community mental health care following admission to hospital for episodes of drug-induced psychosis. Interview data were collected between August and October 2019. The transcribed texts were analysed using interpretative phenomenological analysis and interpreted using the Common-sense model. The superordinate theme 'Living on a Razor's edge' was extracted and consisted of two themes: 'A living Calvary' and 'Fighting a Lone battle'. The findings highlight the intense psycho-emotional suffering of the mothers, who experienced anxiety and fear relating to their welfare and that of the family; helplessness at not being able to communicate their concerns to their son and shame triggered by the judgmental attitude of others. Carers primarily associated the effects of SC such as psychotic episodes, to their sons being vulnerable individuals with mental health challenges rather than due to their drug habit. The mothers expressed feeling isolated as they could not turn to any family member or friends for support. The highly volatile and impulsive nature of their son further introduced a wedge between the female carer and her spouse, children, extended family and friends. Caring for a son on SC has a significant psycho-emotional and social impact on the mothers as informal carers. Hence, there is a need for a person-centred care approach to be provided, in which the shared understandings of the mothers narratives are explored and where their needs and concerns are integrated and addressed within a care plan.

Psychiatric hospital nurses' attitudes towards trauma-informed care.

WHAT IS KNOWN ON THE SUBJECT?: Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service-users. Care delivered with this awareness is known as trauma-informed care (TIC). There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in-depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work-related traumas which interfere with their ability to provide TIC. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well-being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long-term clients. This would benefit service-users by ensuring MHNs are more trauma-informed. More research on attitudes towards TIC among MHNs is needed. ABSTRACT: Introduction Quantitative studies exploring trauma-informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used. Aim To examine nurses' TIC attitudes at a psychiatric hospital. Method A mixed-method design was used. One hundred and thirty-six MHNs completed the Attitudes Related to Trauma-Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used. Results MHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale "Causes" were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes "Awareness," "Unhealthy boundaries" and "Inhibition" emerged from qualitative analysis. Discussion Challenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long-term clients on the cycle of perpetuated trauma identified by previous research and MHNs work-related traumas. Implications for practice Identified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients.

Caring for a parent with pulmonary fibrosis in Malta: The lived experiences of daughters in mid-adulthood.

Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease that is on the rise globally. The disease is associated with significant morbidity and hence poses significant challenges for their informal carers, particularly daughters in mid-adulthood, who struggle with their own personal demands and that of their ill parents. Yet there is a dearth of literature on the experiences of these specific carers. Hence, the purpose of this study is to explore the lived experiences of daughters caring for a parent with pulmonary fibrosis within a community setting. This was explored using a phenomenological qualitative framework that was conducted between January and April 2017. Semi-structured audio-recorded interviews were conducted with six adult daughters who provided care to a parent having pulmonary fibrosis. Purposive sampling was used to recruit study participants. Transcribed data were analysed using Interpretative Phenomenological Analysis. Three main themes were extracted which communicate the essence of the daughters' lived experiences: "Walking on tiptoes", "Flooded by emotions" and "Shifts in family dynamics." Participants described experiencing the toll of being constantly vigilant for symptoms. They also expressed a range of emotions that included guilt, helplessness and worry related to their care experience. However, these emotional struggles were suppressed in order to present an external facade of strength and control. A shift in roles was also described where the daughters became the informal carers/support for both their ill and well parent, albeit in different ways. Caring for a person with pulmonary fibrosis is an emotional and life changing experience and hence, there is the need for individualised interventions that target the unique perceptions of these informal carers.

Reaching out for Help: Calls to a Mental Health Helpline Prior to and during the COVID-19 Pandemic.

The COVID-19 pandemic is a major health crisis associated with adverse mental health consequences. This study examined 2908 calls made to a national mental health helpline over a 10 month period, 2 months prior to (Pre-COVID) and 8 months during the pandemic phase, that incorporated the imposition of a partial lockdown, followed by the removal and reintroduction of restrictive measures locally. Data collected included reason/s for call assistance, gender, age and number of daily diagnosed cases and deaths due to COVID-19. In the Pre-COVID phase, calls for assistance were related to information needs and depression. With the imposition of a partial lockdown, coupled with the first local deaths and spikes in number of diagnosed cases, a significant increase in number of calls targeting mental health, medication management and physical and financial issues were identified. Following the removal of local restrictions, the number of calls decreased significantly; however, with the subsequent reintroduction of restrictions, coupled with the rise in cases and deaths, assistance requested significantly targeted informational needs. Hence, whilst calls in the initial phase of the pandemic mainly targeted mental health issues, over time this shifted towards information seeking requests, even within a context where the number of deaths and cases had significantly risen.

Service Users' Perception of the Therapeutic Milieu in a Mental Health Rehabilitation Unit.

Although the concept of the therapeutic milieu has been given prominence, the perceptions of care receivers in this regard are sparse. This study aimed to explore service users' perceptions of the therapeutic milieu in a mental health rehabilitation unit. The method used was document analysis of annual reports generated by the unit through data collection from the care receivers. Four themes were identified, namely, the 'physical environment', the 'structure of the therapeutic programme', 'relationships with the professionals' and the 'experience of living as a community'. The study contributed to previous research through meaningful ramifications for research, practice and education.

Pulmonary Rehabilitation in patients with Interstitial Lung Disease: The effects of a 12-week programme.

BACKGROUND: The inclusion of Pulmonary Rehabilitation as part of the management of Interstitial Lung Disease, although being highly recommended in most recent guidelines, still has limited studies exploring the outcomes from such an intervention. The present study aims to contribute to the available literature by investigating the effects of a high intensity, 12 week PR programme on functional and quality of life measures in patients with a diagnosis of Interstitial Lung Disease. METHOD: ology: This paper reports outcomes of an observational, prospective, quasi experimental type of study. A total of 120 participants were recruited: 60 patients formed part of the active group, and another 60 patients were enrolled in an inactive group. Each participant was classified according to the modified Medical Research Council dyspnoea scale and placed in one of 5 categories (0-4) according to self-perceived breathlessness during daily activities. The following outcomes were measured: Lung function tests including plethysmography and diffusion capacity of carbon monoxide (DLCO), functional tests (6-min walking distance test, Dyspnoea Borg Scale) and health status measures (St George's Respiratory Questionnaire and Hospital Anxiety and Depression Score). RESULTS: A 12-week PR programme for patients with Interstitial Lung Disease, led to significant improvements in the active group of patients in the 6 min walking distance test, the modified Borg Scale, mMRC scores and in the health status measures. Lung function measures did not show any significant improvement following this intervention. CONCLUSION: This 12week Pulmonary Rehabilitation programme resulted in improvements in functional aspects for patients with Interstitial Lung Disease. Further studies are recommended as Pulmonary Rehabilitation for Interstitial Lung Disease may have an impact at both an individual level and at global organisational/financial levels.

Illness perceptions, depression and anxiety in informal carers of persons with depression: a cross-sectional survey.

PURPOSE: To examine the illness perceptions of informal carers of persons with depression, using the theoretical framework of Leventhal's Common-Sense Model (CSM) and to determine whether these illness perceptions are predictors of anxiety and depression, as measures of psychological well-being. METHODS: A cross-sectional survey was conducted with 94 Maltese individuals caring for a person with depression within a community setting. The informal carers completed the modified Illness Perception Questionnaire (IPQS-Relatives version) and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using descriptive statistics, Spearman's rank order correlations and ANCOVA regression models, to identify predictors of anxiety and depression respectively in the informal carers. RESULTS: The informal carers perceived depression as a cyclical condition, having negative consequences on both the patient and on themselves. Participants perceived the causes of depression to be mainly psychosocial in nature and generally viewed the treatment as effective. Caring for a person with depression was perceived as having a considerable negative emotional impact on them. Years of caring was identified as a predictor of anxiety accounting for 20.4% of the variance, and timeline chronicity beliefs, consequences (relative) and illness coherence were identified as predictors of depression, accounting for 56.8% of the variance. CONCLUSION: Illness cognitions are significant predictors of depression, thereby suggesting that cognition-based interventions may be effective in targeting depression in these informal carers. Thus, health professionals should explore the carers' personal understanding of the disease, their timeline beliefs and the perceived consequences of providing care, as they relate to their psychological well-being.

Being on the Frontline: Nurses' Experiences Providing End-of-Life Care to Adults With Hematologic Malignancies.

The aim of this study was to explore the experiences of nurses providing end-of-life care to patients with hematologic malignancies, in a hematology oncology setting, in an acute general hospital. A qualitative hermeneutic phenomenological design was used, and 2 sets of semistructured interviews were conducted with 5 female nurses. The transcribed texts were analyzed using Interpretative Phenomenological Analysis. Two main themes emerged: "battling against medical futility" and "struggling with the emotional burden of care." Nurses perceived that the transfer of these patients at end of life to intensive critical care settings, coupled with the particularly aggressive treatments and corresponding symptom burden, prevented them from experiencing a dignified death. Consequently, nurses struggled with a gamut of emotions that included feelings of helplessness, distress, and compassion fatigue. Providing nursing care at end of life was perceived to be particularly challenging with the younger patients or with those who reminded them of family members. The findings highlight the unique challenges experienced by these nurses and the need to support them in their work with patients having hematologic malignancies at end of life within a well-resourced setting.

The use of metaphors in non-Hodgkin's lymphoma patients undergoing chemotherapy.

AIM: The aim of this study was to explore the use of metaphors by non-Hodgkin's lymphoma (NHL) patients undergoing chemotherapy in a haematology ward setting. BACKGROUND: There is a dearth of literature exploring the use of metaphors in people with cancer undergoing aggressive treatment. Hence, this study aims to explore the use of metaphors in NHL patients undergoing chemotherapy and additionally, examining whether the use of such metaphors has an empowering/disempowering effect. DESIGN: A qualitative design was used. METHODS: The participants were six adult patients diagnosed with NHL and undergoing chemotherapy. Data collection was undertaken between July 2016-December 2016. Each participant was interviewed twice using semi-structured interviews. The data were analysed using Pragglejaz method for finding metaphors. FINDINGS: The participants used metaphors 17 times per 1,000 words to describe their experience of undergoing chemotherapy for NHL. The metaphors cited focused on aspects relating to "war", "prison" and a "journey". CONCLUSIONS: The findings demonstrate that certain metaphors used by the study participants, such as those pertaining to "war" or a "journey", concur with those described in narratives of people with cancer in general. However, the use of the "prison" metaphor by NHL patients undergoing chemotherapy relates particularly to their context of being isolated while undergoing treatment for fear of infection. Consequently, there is the need to interpret metaphors in relation to the specific type of illness and context. Furthermore, the findings of this study suggest that the impact of metaphors in empowering/disempowering people with cancer depends on the unique interpretation of the individual patient.

The lived experience of patients with non-Hodgkin's lymphoma undergoing chemotherapy.

PURPOSE: Patients with non-Hodgkin's lymphoma face many challenges when undergoing chemotherapy. However, there is a dearth of literature targeting the experiences of this patient group. Hence, the aim of this study was to explore the lived experience of patients with non-Hodgkin's lymphoma during the initial stages of chemotherapy (i.e. from commencement to mid-treatment). METHOD: This study adopted a qualitative research design. Semi-structured interviews were conducted with six adult patients having non-Hodgkin's lymphoma and undergoing chemotherapy. Data collection was undertaken between July 2016 and December 2016. The interviews were audio-recorded and transcribed verbatim. The data was analysed using Interpretative Phenomenological Analysis. RESULTS: Three themes emerged: 'Living an emotional rollercoaster', 'Becoming dependent on others' and 'Facing an uncertain future'. This study highlights that, whilst undergoing chemotherapy, the participants experienced a rollercoaster of emotions, such as fear, relief, acceptance and depression, in addition to physical dysfunction. Moreover, two participants described feeling so overwhelmed emotionally that they even considered committing suicide. Nevertheless, all the participants stated that they hoped that their life would revert back to normal on completion of their treatment. CONCLUSIONS: The findings of this study may help guide the formulation of interventions that target the needs of patients undergoing chemotherapy for non-Hodgkin's lymphoma. Such interventions may include the introduction of community services where health care providers can provide domestic support to these patients. Additionally, the information generated can also inform hospital policies, such as the introduction of screening programs to monitor for psychological distress in this patient group during treatment.

Health status of COPD patients undergoing pulmonary rehabilitation: A comparative responsiveness of the CAT and SGRQ.

The St. George's Respiratory Questionnaire (SGRQ) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) are the measures used to assess health status. This study aims to examine the responsiveness of these tools by severity of dyspnoea category in patients with COPD. Forty-nine COPD patients who underwent a 12-week pulmonary rehabilitation (PR) programme were assessed at baseline, 12 weeks and at 28-week follow-up. Patients were categorized into two groups by severity of dyspnoea category (i.e. mild to moderate (modified Medical Research Council (mMRC) 1-2) and severe to very severe (mMRC 3-4)) using the mMRC dyspnoea scale. Effect size (ES) was computed as estimates of responsiveness. The SGRQ demonstrated greater responsiveness by total sample (SGRQ, ES = 0.87; CAT, ES = 0.75) and for the mMRC 3-4 category (SGRQ, ES = 0.91; CAT, ES = 0.76) on completion of PR. At 28-week follow-up, overall comparable responsiveness of the CAT and SGRQ was identified by total sample (SGRQ, ES = 0.75; CAT, ES = 0.74) and by severity of dyspnoea category. The symptom, impact and activity domains of the SGRQ showed good responsiveness, with greater ESs obtained overall for the mMRC 3-4 category. On completion of PR, the SGRQ demonstrates a greater responsiveness with COPD patients, especially in relation to the mMRC 3-4 category, while both the CAT and SGRQ show comparable responsiveness on follow-up.

Existing But Not Living: Experiences of Long-Term Caregivers of Individuals With Unipolar Depression.

The shift in care from long-term hospitalization of individuals with mental illness to the community places a greater onus of responsibility on informal caregivers. The purpose of the current study was to explore the lived experiences of long-term caregivers of individuals with unipolar depression. A qualitative phenomenological methodology was used and two sets of semi-structured interviews were conducted with nine informal caregivers. Data were transcribed following Giorgi's phenomenological method. The following three themes were identified: Flooded by Emotions, Personal Growth and Satisfaction, and Psychosocial Effects and Challenges. Caregivers described adapting by adjusting their behavior to avoid conflict with care recipients. These adjustments had a detrimental effect on their well-being, where they described that they were "existing but not living." These findings highlight the need for ongoing support, which should be tailored to the unique needs and concerns of individuals who are providing long-term care to individuals with depression. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 16-21.].

Being diagnosed with cancer: The experiences of patients with non-Hodgkin's lymphoma.

AIMS AND OBJECTIVES: To explore the lived experiences of patients on receiving a diagnosis of non-Hodgkin's lymphoma. BACKGROUND: Persons with non-Hodgkin's lymphoma are often diagnosed with cancer when at an advanced stage. This may arise due to a lack of screening programmes and delays in help seeking as the symptoms experienced are fairly nonspecific in nature. Consequently, receiving an unexpected diagnosis of non-Hodgkin's lymphoma may pose a psychosocial challenge to the individual. DESIGN: An exploratory qualitative phenomenological design was used. METHODS: Six adult patients diagnosed with non-Hodgkin's lymphoma were recruited and participated in two semi-structured interviews at different timepoints. Transcribed texts were analysed using interpretative phenomenological analysis. RESULTS: Three main themes emerged: "Emotional reaction to the diagnosis," "Struggling with a lack of understanding" and "Searching through past experiences." Most of the participants expressed shock, disbelief and fear at the news of being diagnosed with non-Hodgkin's lymphoma. A sense of relief was expressed by one participant, who could now provide a label to the pain experienced. CONCLUSIONS: This study highlights the responses of patients with non-Hodgkin's lymphoma on receiving a diagnosis. These responses are influenced by their knowledge about the illness, type of symptoms experienced, their own personal circumstances and the manner in which the diagnosis was given. RELEVANCE TO CLINICAL PRACTICE: Nursing care relates to an understanding of the patients' experiences. By reflecting on these findings, nurses are empowered to communicate with persons who have received a diagnosis of non-Hodgkin's lymphoma in a patient-sensitive manner, which establishes a relationship of trust and respect.

The Experience of Living With an Ileoanal Pouch: An Interpretative Phenomenological Analysis.

The purpose of this study was to explore the lived experiences of individuals living with an ileoanal pouch. A qualitative, phenomenological methodology was used to elicit detailed accounts of the impact of living with an ileoanal pouch. Ten individuals having an ileoanal pouch, formed as a consequence of ulcerative colitis, participated in the study. Semistructured interviews were conducted and analyzed using interpretative phenomenological analysis. The following 4 themes emerged from the analysis: "a flood of emotions"; "changed body image"; "changes in lifestyle"; and "intimacy and sexual relationships." Participants indicated that their quality of life after surgery has improved because they were no longer suffering from the devastating symptoms of ulcerative colitis. However, a considerable number of these participants disclosed that they are still living a restricted lifestyle and reported profound changes not only in their physical self but also in their social and sexual relationships. By acknowledging these experiences, healthcare professionals have the potential to improve the psychological, sexual, and social care that these individuals receive.

Coping with non-Hodgkin's lymphoma: a qualitative study of patient perceptions and supportive care needs whilst undergoing chemotherapy.

PURPOSE: Research to date on patients with non-Hodgkin's lymphoma has focused on the physical and psychological impact of undergoing chemotherapy. However, there is a dearth of studies targeting the coping strategies in this patient group. This article addresses the dearth in literature by exploring the coping strategies and supportive care needs of patients with non-Hodgkin's lymphoma whilst undergoing chemotherapy. METHODS: An exploratory qualitative phenomenological design was used. Six adult patients with non-Hodgkin's lymphoma and who were receiving chemotherapy were each interviewed twice using semi-structured interviews, which were audio-recorded. The data was transcribed verbatim and analysed using interpretative phenomenological analysis. RESULTS: Four themes emerged which outline how patients with non-Hodgkin's lymphoma cope with the challenges of undergoing chemotherapy. These are as follows: 'Interpreting life through a different lens', 'Wearing a mask', 'Suppressing thoughts about chemotherapy' and 'Support along the journey'. CONCLUSIONS: This article provides insight into the coping strategies and supportive care needs of patients with non-Hodgkin's lymphoma and who are undergoing chemotherapy. Some participants described attributing a new meaning to life, while others tried suppressing thoughts about cancer and chemotherapy. Additionally, some participants described hiding their true feelings by 'wearing a mask' in an effort to avoid distressing their families and consequently themselves. Nevertheless, all the participants emphasised the importance of support from health care providers, family and friends. These results provide insight which may guide future support services and interventional research aimed at assisting patients with non-Hodgkin's lymphoma to cope with the challenges of undergoing chemotherapy.

Facilitators and barriers to treatment with haemodialysis among persons in mid-adulthood: an interpretative phenomenological analysis.

BACKGROUND: The quality of life of persons on haemodialysis (HD) is often limited by the restrictions imposed by their medical regimen. These restrictions may negatively influence patients' adherence to their treatment. Therefore, in an effort to improve patients' adherence to treatment, there is the need to explore the patients' perceptions of facilitators and barriers in relation to their experience of HD. AIM: The purpose of the study was to explore the perceived barriers and facilitators of the HD experience of persons in mid-adulthood. PARTICIPANTS AND DESIGN: A qualitative design was used. Semistructured interviews were conducted with seven participants in the mid-adulthood phase (40-65 years). The transcribed texts were analysed using an Interpretative Phenomenological Analysis approach. RESULTS: Three main themes were identified from the analysis: 'social network outside the renal unit', 'the renal setting as a context' and 'qualities relating to staff'. Facilitators identified include: support from family and work colleagues, caring and knowledgeable staff and consultation with patients when planning out the treatment schedule. Barriers to treatment include: discomfort with the needling process, intrusion of HD on family time, lack of privacy in the renal unit and staff that do not take their concerns seriously. CONCLUSION: This study demonstrated the need for healthcare professionals to allocate time and space, where persons on HD may discuss personal issues that relate to their care experience in a private care setting. By identifying and exploring the barriers and facilitators of patients on haemodialysis, healthcare professionals may formulate individualised care plans which may improve patients' adherence to their HD treatment.