Reliability testing of oxaliplatin-associated neurotoxicity questionnaire (OANQ), a pilot study.

PURPOSE: The purpose of this study was to test the reliability of the Swedish version of the Oxaliplatin-Associated Neurotoxicity Questionnaire (OANQ) administrated throughout a self-reported mobile phone-based system, a pilot study. METHODS: Twenty-three patients from two university hospitals and two regional hospitals who had been treated with oxaliplatin were included through purposive sampling between autumn 2013 to autumn 2014. A test-retest was performed through a mobile phone-based system, with a recall period of 1 h to determine the reliability of the questionnaire. RESULTS: Internal consistency was strong for the three domains of the scale (α > 0.840). The statistical analyses for the test-retest indicated that the OANQ was stable. Intraclass correlation (ICC) for symptom items and effect on daily activities items showed an overall excellent reproducibility at 69 and 83 %, respectively. The weighted kappa for symptom items and daily activities items showed an overall almost perfect agreement at 59 and 52 %, respectively. A paired samples t test did not reveal any significant differences between the two measures. CONCLUSIONS: The OANQ was tested and considered a reliable assessment for capturing the oxaliplatin-induced peripheral neurotoxicity (OIPN) in patients receiving oxaliplatin. However, further reliability testing of the OANQ is needed.

The next of kin experiences of symptoms and distress among patients with colorectal cancer: diagnosis and treatment affecting the life situation.

PURPOSE: To identify symptoms/distress among patients with colorectal cancer undergoing chemotherapy, from the viewpoint of the next of kin, and to establish whether there are any barriers to reporting these problems. METHODS: Individual face-to-face interviews with fourteen next of kin were conducted. Qualitative content analysis was used to analyse the transcripts. RESULTS: Three areas were identified: symptoms presented, barriers to reporting symptoms/distress, and influences on life for the next of kin. Nine symptoms were raised as most common by the next of kin. Almost all the next of kin denied that they had experienced any barriers to reporting symptoms/distress but some did exist, namely barriers to proper communication and barriers of time. The next of kin made another interpretation of barriers; they did not interpret it as hinder or obstacle. All next of kin talked to a large extent about how the patient's disease and treatment affected them as next of kin. It affected them psychologically, they had to re-valuate their life, and it influenced their social life. CONCLUSIONS: The symptoms reported during chemotherapy were similar to those found in other studies on patients. Barriers to reporting symptoms were mentioned, but not to a great extent. Although it was not the main purpose of the study, the next of kin raised concerns about the patient's disease and treatment and how it influenced next of kin life.

The influence of structure, process, and policy on HbA(1c) levels in treatment of children and adolescents with type 1 diabetes.

AIMS: To identify factors which improve glycaemic control measured as HbA(1c) in children and adolescents with diabetes treated at paediatric departments. METHODS: Through data from the Swedish paediatric diabetes quality registry, SWEDIABKIDS, five centres respectively with the lowest, highest, and largest decrease in centre mean HbA(1c) (Low, High, Decrease HbA(1c) centres) were identified. Diabetes team members completed questionnaires (109 of 128 responded) and reported team structure, process and policy. Open-ended questions were analysed with summative content analysis. RESULTS: Compared to the High HbA(1c) centres, the Low and Decrease HbA(1c) centres showed higher compliance with guidelines, although they had shorter professional experience and lower proportion of special diabetes-educated team members. A clear message was given and the centres aimed at a lower HbA(1c) target value. Team members were devoted, had a positive attitude and perception of a well-functioning team. Trends for higher mean insulin dose and larger centre size were found. High HbA(1c) centres gave a vague message and had a perception of lack of cooperation in the team. CONCLUSIONS: Team members' policy and approaches affect glycaemic control in children and adolescents. Team members need to be aware of their approach and of the importance of using resources within the team.

To feel like an outsider: focus group discussions regarding the influence on sexuality caused by breast cancer treatment.

The aftermath of breast cancer treatment, especially the sexual side effects, appears to be a neglected issue in developed society. The purpose of this study was to explore how middle-aged women treated for a breast cancer experienced their sexual identity connected to the community norms and values in the society as a whole. Three focus group interviews were conducted, with a total of 12 women. The discussions were analysed using qualitative content analysis. The main theme to feel like an outsider symbolises the women's situation after breast cancer treatment. They experienced their body in a wholly new unfamiliar way, which affected their sexuality in a deep and profound way. This feeling affected their female roles and overshadowed earlier experiences in life. All their female roles were suddenly vague and this was expressed in various ways across each of the four subthemes: to feel different, the unruly body, eroticism is not what it used to be and re-evaluating. From a nursing perspective, there appears to be a definite challenge to identify the women's own unique sexual needs in the rehabilitation transition and to use the skills from all team professionals to improve sexual health in this context.

Screening for abdominal aortic aneurysm, a one-year follow up: an interview study.

The purpose of the present study was to investigate whether screening for abdominal aortic aneurysm (AAA) and the finding of an enlarged aorta cause worries and affect the living situations of men with aneurysms or of their families within a 12-month follow-up period. Men invited to ultrasound screening and having an enlarged aorta (>or=30 mm) were invited for an interview. In total, 10 men were interviewed. The semi-structured interview was conducted by using an interview guide. Data was analyzed by using an interpretative phenomenological method. Three themes were identified: (i) feeling secure being under superintendence; (ii) living as usual, but repressing thoughts; and (iii) feeling disillusionment due to negative outcome. Being given the message that an enlarged aorta was discovered at the screening was manageable; hence, continuing growth of the aorta led to some unpleasant feelings. The men were living as usual; however, they all had some reflections about having an AAA and that something could happen when they least expected it. They reported thoughts about the consequences of the enlarged aorta itself and the surgery. In a one-year retrospective interview, men who have had an aneurysm detected in a screening program for AAA reported feeling secure being under superintendence. The one finding in our study concerning worries and effects on life situation could be interpreted as disillusionment due to negative outcomes. Decisions to introduce screening for AAA in Sweden and other countries with ongoing programs should be considered to include guidelines for how to handle disillusionment.

Swedish student nurses' knowledge of health statutes: a descriptive survey.

BACKGROUND: The nurse's function, no matter the working area, is guided by ethical approaches, grounded in science and well-tried experiences, and has to be conducted according to national laws, statutes and instructions. AIM: To survey newly graduated Swedish nurses' knowledge about current statutes and laws that govern their healthcare system. METHOD: A questionnaire was developed from facts in relevant statutes and laws presented and used in the nursing education programmes. Following a pilot study testing the items, a 20-item questionnaire, with mostly open-ended questions, was distributed to student nurses in the last semester of their nursing education programme before graduation. RESULTS: One hundred and seventy-eight participants answered the questionnaire (response rate 59%). Only 29% of responses on all questions showed correct knowledge about the different statutes and laws that regulate their work as nurses. The best knowledge was found in the area of documentation (range 35-86%) and in the area of information (range 16-54%) on group scores. CONCLUSION: This survey concerning novice nurses' knowledge about statutes and laws showed great deficiencies. It was surprising to find that, on existing demands regarding nurses delegating medical tasks, not a single respondent presented a correct answer. Evidence-based knowledge was difficult to recognize. Nurses will be more conscious of their own limitations and more prepared to meet the reality of practice if there is emphasis on relevant statutes and laws during their education.

'A stronger and clearer perception of self'. Women's experience of being professional patients in teaching the pelvic examination: a qualitative study.

OBJECTIVES: To identify and describe the experience of being a professional patient (PP) in teaching the pelvic examination (PE). DESIGN: Qualitative study using in-depth interviews. SETTING: Participant's home, place of work or other place of choice. POPULATION: Thirteen female PPs who teach the PE to medical students and student midwives. METHOD: Semi-structured interviews analysed with an interpretive phenomenological approach. MAIN OUTCOME MEASURES: Five themes were identified during the analysis: 'embodied knowledge', 'promoting a proper approach', 'redrawing private boundaries', 'feeling confident' and 'doing something meaningful'. The essence 'experience of stronger and clearer perception of self' emerged from the themes and is the described structure of the lived experience of the women who are PP. CONCLUSIONS: Being a PP in this setting was beneficial for the women. They acquired increased knowledge about their bodies and PE procedure, which led to a new awareness of their own body. Contributing to students' learning in such an intimate examination procedure was rewarding and increased self-esteem.

Iranian student nurses' experiences of clinical placement.

BACKGROUND: Nursing as a practice-based profession requires that student nurses learn how to become professional in the clinical environment. Many studies have addressed student nurses' clinical learning and related problems, but few have explored the whole clinical experience of being a student nurse. AIM: To understand and gain deeper insight into Iranian student nurses' lived experience of clinical placement. METHOD: Five student nurses were interviewed about their clinical experience during clinical placement. The researchers analysed the verbatim transcripts using van Manen's phenomenological methodology, keeping in mind the recommended six research activities. FINDINGS: Five themes emerged by which the phenomenon of clinical experience could be illustrated. These themes were: caring-orientated relationships, attractive aspects of clinical experience, finding oneself in the clinical milieu, being supportive to classmates, and actualizing potential. Fourteen subthemes expanded and clarified the meaning of these themes. CONCLUSION: The attention paid and acknowledgement given to 'caring' and 'knowledge' by the student nurses showed that they are progressing toward their ultimate goal of being professional nurses. The student nurses' awareness of 'what is going on there?' and also support from other significant people facilitates the students' adaptation process and guarantees this progress.

The phenomenon of caring from the novice student nurse's perspective: a qualitative content analysis.

BACKGROUND: Caring has been seen as a nursing term/concept, including all the aspects that are used to deliver nursing care to patients. Sometimes caring has been conceptualized as a relational expression of human concern and as a collection of human activities that assists others. AIM: This study is to identify and describe the nature of the concept "caring" from the novice student nurse's perspective. METHODS: A total of 127 Swedish novice student nurses wrote comments in essay form to the question: "what is your image of the concept caring?" Data were analysed using qualitative content analysis, with the use of the theoretical framework: "doing" and "being". FINDINGS: Three categories of caring were identified as "doing", "being" and "professionalism". The phenomena of caring and the caring process could be illustrated as including hand (doing), heart (being) and brain (professionalism). CONCLUSIONS: It is now time to make care more visible as a principle of practice and of moral action. This could be explicit in a clear professional framework and incorporated more fully into nursing education programmes. Caring is to take care of the entire human being physically, emotionally and intellectually. Nurses need to use hand, heart and brain in order to fulfil their commitments.

What do women think about menopause? A qualitative study of women's expectations, apprehensions and knowledge about the climacteric period.

AIM: To identify and describe expectations, apprehensions and knowledge about the menopausal period and climacteric symptoms. METHOD: Data were collected by semi-structured interviews/discussions with a convenience sample of 39 women, all 47 years of age. Data interpretation and analysis were based on content analysis, but influenced by a qualitative approach. FINDINGS: These included women's expectations and feelings of freedom. Apprehensions were described as different climacteric symptoms, which were well known to the women through their own or other's experiences. The women were, to some extent, aware of the physical and psychological changes that follow the menopause. However, the women lacked knowledge about these changes or self-care activities that could prevent problems or mitigate symptoms. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Discussions on health with premenopausal women can increase their knowledge about a natural phase of life, the climacteric period. The study showed that nurses/midwives who have regular contact with some women during their life have an important role to play in providing information, as well as in the treatment of climacteric symptoms.

How next of kin experience palliative care of relatives at home.

Primary health care teams are the teams responsible nowadays in Sweden for the greater part of the home health care system, providing palliative care in the patient's home. If palliative care in the home is to be ethically defensible, it should be voluntary from the point of view of the next of kin and should be designed in such a way that he or she receives different forms of support during the care period. The purpose of this paper is to explore the meaning of palliative care in the home as experienced by the next of kin. The data consist of transcripts from interviews with the next of kin. Giorgi's phenomenological method was selected as the method/analysis for this study, because it focuses on uncovering the meaning of experiences of the participants by studying descriptions from their perspective. A feeling of insufficiency is the phenomenon, which permeates all the five themes: adjustment, awareness, being perceived as a person, emotional effects and feelings of uncertainty. Because the informal carer/next of kin is a significant contributor to palliative care in the home, it is important to promote feelings of control and also self-efficacy.

Critiquing bachelor candidates' theses: are the criteria useful?

Nursing education programmes should be at an academic level and connected to research. In Sweden, empirical studies are generally required in order to obtain a Bachelor's degree; hence, in some cases, these studies are replaced by a literature review. A study was conducted using 11 criteria. Thirteen theses produced in a department of nursing science were examined, elaborated and reproduced by reviewing international and national literature. Thereafter, the criteria themselves were scrutinized. Principal findings when critiquing the theses were that in eight theses the purpose was dearly identified and well defined in relation to the study accomplished; in three theses the purpose was indistinct and vague; and in two the definitions and research questions were lacking. The topic was relevant for the area of nursing in all theses. General problems identified were poor spelling and grammar, and unsatisfactory thesis structure. This article discusses whether criteria are useful when examining the Bachelor candidates' theses. The authors report that the criteria seemed to be useful, giving some guidance for scrutinizing theses and facilitating correspondence. Criteria could be appropriate guidelines for using to increase the quality of the theses as well as the quality of nursing.

You can do it if you set your mind to it: a qualitative study of patients with coronary artery disease.

AIMS OF THE STUDY: To gain increased knowledge and understanding of what it means to be afflicted with coronary artery disease (CAD) and how it affects the life/lifestyle of the individual. BACKGROUND: Research has documented that education, counselling and behavioural interventions are important elements of cardiac rehabilitation and compliance with treatment. Compliance is generally better with medical treatment than with recommended lifestyle changes. Another influencing aspect is locus of control, i.e. people's own understanding of control is the foundation for the decisions patients make more or less consciously regarding compliance with caring/nursing, treatment and lifestyle changes. METHODS: Eight individuals with diagnosed coronary artery disease were interviewed about their life situation, and the opportunities and obstacles they encountered in making lifestyle changes. These interviews were transcribed and then analysed using a hermeneutic approach. FINDINGS: The findings included three areas: (1) The causes of coronary artery disease describing different factors, such as heredity, lifestyle and demands. (2) Difficulties in the work of rehabilitation, which was explained in terms of informants' feelings of confusion, uncertainty and sadness. (3) Successful rehabilitation consisted of two factors: the personality of the individual patient and external support. CONCLUSIONS: Patients may comply well with follow-up visits but less with lifestyle changes. By identifying different 'characteristics', 'prerequisites' and 'difficulties' that describe patients' compliance, it should be possible to make treatment more individual. Nurses have a significant role in supporting these patients since they are more accessible than physicians. Nurses also have a responsibility to work together with patients to empower them, in order to make their lifestyle changes and self-care activities manageable.

Compliance with hormone replacement therapy among Swedish women.

By means of a simple postal questionnaire, all women registered as hormone therapy patients (n = 241) at a gynaecological clinic were screened for reasons for receiving hormone therapy. They were also screened for their compliance in following the midwife's advice and information, as well as the gynaecologist's prescriptions. The majority of the women participating in this study contacted the clinic for climacteric symptoms. The time duration for using hormone therapy ranged from 1 month to 6 years. Those using a plaster or gel were asked why they should take progesterone pills. Forty per cent gave erroneous answers or did not know. Of these, 62% reported that they understood the oral information, whereas 60% reported that they understood the written information. Fifty-three per cent of the women stated that they would stop their hormone therapy if they did not feel well or increased in weight. New discoveries or information about benefits or risks were given by 22% as reasons affecting their decision. Compliance demands well-motivated and well-informed patients. The implication of the study result for practice is that there must be dialogue between the women and their midwife/ gynaecologist. It is important that the women feel they are receiving treatment which they have given their consent to, and that they feel and know that they are performing self-care. Midwives have recurrent contact with women during their life and have already established a relationship with them, which facilitates an individualized communication.

Altered sexual patterns after treatment for prostate cancer.

PURPOSE: The purpose of this study was to identify and describe the impact of prostate cancer and its treatment on men's sexuality and intimate relationships from the perspective of the men's lived experiences. DESCRIPTION OF THE STUDY: Ten men diagnosed with prostate cancer were interviewed. Verbal transcripts were analyzed using an interpretive phenomenological approach based on Heidegger's philosophy. RESULTS: "Altered sexual patterns" was identified as the major theme, which in turn was influenced by five minor themes: choice of consequences; age affecting sexual life; hope of improvement; acceptance of altered sexual life; and image of manliness. Choice of consequences showed that survival is paramount, as interviewees often felt that they were choosing between death or sexual dysfunction. Age affecting sexual life identified sexual dysfunction as caused by natural effects of aging. Hope of improvement showed that several men hoped for improvement in sexual function, although it had been years since their treatment. Acceptance of altered sexual life illustrated that the men often felt the need to accept their altered sex life, with their wives playing an important role in this acceptance. Finally, the theme image of manliness showed the men's attempts to acknowledge and cope with the changes in their self-image. CLINICAL IMPLICATIONS: It is important that healthcare professionals adopt a comprehensive approach in communicating information about prostate cancer treatment choices and potential side effects that includes the patient and his partner. Communication and counselling about treatment options, potential side effects, and potential strategies to manage side effects should be offered both at the time of diagnosis and at post-treatment follow-up.

Caring for and about cancer patients: identifying the meaning of the phenomenon "caring" through narratives.

For several decades nurses have been using the terms "caring" and "nursing." Caring, considered to be a universal phenomenon, has been seen as a nursing term, including all aspects of delivering nursing care to patients. Ten registered nurses selected from hematologic, oncologic, and lung medicine wards were asked to narrate one situation in which they had been able to supply good caring and one situation wherein they had not been able to provide good caring for the patient. To identify the meaning of the caring phenomenon as experienced and expressed by nurses working with patients who have cancer, a qualitative analysis using phenomenologic hermeneutics was used. The narrated interviews, tape-recorded and transcribed verbatim, were analyzed, and a theme was interpreted: developing and maintaining a helping-trusting interpersonal relationship. Five subthemes also were identified: creating an interaction with the patient and the next of kin, acting to satisfy the needs of the patient and next of kin, feeling frustration in the role of caring, being affected by time aspects, and developing self and acquiring insight. It is in caring that nurses and patients connect with one another, are fulfilled, and experience growth. If they work actively with this perspective, nurses will feel fulfilled, not frustrated.

Transition to becoming a leukaemia patient: or putting up barriers which increase patient isolation.

When two or more persons, e.g. nurses and patients, act together interaction takes place. The expectations of nurses and their definition of the patient's illness status affect their behaviour towards the patient and how they practice nursing. The aim of this study was to examine the interaction between adults with leukaemia and their nurses and how this interaction affected the individual. Grounded theory method guided the data collection and analysis. Four adults with leukaemia and their nursing staff were observed for 124 h in a haematological ward. The core category emerging from the data was transition--the individual passing from one phase to another. This denotes a change in role relations, in expectations and in abilities. The individual makes their transition in three stages. First, the person seeks out information in the corridors and at the same time tries to maintain social status. Next, the patient accepts the disease in the confines of their room and feels insecure in a totally new situation and role. Finally, the leukaemia patient isolates themselves within the confines of the bed, and becomes aware of the leukaemia and its side-effects.

Explaining different profiles in quality of life experiences in acute and chronic leukemia.

There is a need to understand and explain why quality of life (QOL) is experienced and viewed differently by those with acute and chronic leukemia. A total of 23 adults with either acute or chronic leukemia were interviewed about their experience of QOL. Adults with acute leukemia described QOL as a positive attitude to life, whereas those with chronic leukemia described QOL as life satisfaction. In order to elucidate why there are differences in their experience of QOL, a qualitative text analysis was used. The narrated interviews, tape-recorded and transcribed verbatim, were interpreted based on the following three questions: Why are there differences in these individuals' description of QOL? What are they talking about? Which phenomenon are they describing? The findings were interpreted, "a feeling of uncertainty," which made the difference to their experience of QOL. This uncertainty was expressed in different forms and could be seen in different degrees. Uncertainty is an important factor affecting the QOL of these adults. Nurses who work with these patients have a major role to play in minimizing uncertainty by offering coping skills to deal with feelings and improving QOL since QOL is one of the outcomes of nursing care.

A substantive theory of quality of life of adults with chronic leukaemia.

The person with chronic leukaemia is living with a chronic and life-threatening disease. The aims of this study were to gain a deeper understanding of what individuals with chronic leukaemia consider QOL to be and to give the concept of QOL a theoretical and empirical significance relevant to nursing care. Fifteen adults with different forms of diagnosed chronic leukaemia have been interviewed about their experience of QOL. Verbatim transcripts were analysed using constant comparative analysis. The emerging core category was life satisfaction. Under this construct there were four categories; self-esteem, interpersonal relationships, performance ability and social ability. Changed QOL was described in two ways. First, coping was the core category for living with chronic leukaemia. The strategies were action, denial and hope. Second, QOL was seen as individual perception, experience of a positive attitude to life and self-contemplation.

How child health care nurses view a mother-infant relationship. A qualitative study.

Too many children in Sweden grow up under difficult circumstances. Every child should have the opportunity to grow up to be a confident person. We know today that the new-born child is able to influence its surroundings. The main purpose of child health care in Sweden is to reduce mortality, morbidity and disability in children, and also to reduce any detrimental effects on the family. Child Health Care (CHC)-nurses provide community and security for parents and children in developing relationships. The aims of this study were to identify how CHC-nurses view a mother-infant relationship, and how they can improved this relationship. Ten CHC-nurses were interviewed about mother-infant relationships. Verbatim transcripts were analysed using constant comparative analysis. The emerging core category was interplay. Under this construct there were two categories; maternal ability and signals from the infant. Different substantive codes were given under these categories, viz. body language, vocal language, poor health, expectations and life situation. In describing how to improve the mother-infant relationship, promoting an understanding of interplay was the core category. Three categories/strategies were perceived; visualize, respect and demonstrate. The results were then compared with the literature. This study indicates that interplay is of greatest importance in a mother-infant relationship.