Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study.

PURPOSE: To explore whether patients with multiple myeloma changed their construct of health-related quality of life during treatment. PARTICIPANTS & SETTING: 14 participants were selected from 10 hematology-oncology departments in Denmark. METHODOLOGIC APPROACH: This interview study used a prospective, longitudinal, exploratory design. Semistructured interviews were conducted while participants were undergoing active treatment for multiple myeloma and six months after the baseline interview. Interviews were analyzed using systematic text condensation. FINDINGS: The overall theme at baseline was insecurity, and the overall theme at six months was coping. The following subthemes were also identified based on participants' description of their health-related quality of life: concerns about having a meaningful life, dealing with everyday limitations, and maintaining social networks; adjusting expectations to abilities; expanding social networks; and exploring a meaningful life. IMPLICATIONS FOR NURSING: Patients' ability to use coping strategies should be considered when screening for rehabilitation needs. During systematic in-depth symptom screening, unmet rehabilitation needs (e.g., physical functioning, fatigue, pain) may become apparent.

Nurses' experiences of caring for and managing hospitalized patients with schizophrenia and diabetes-An interpretative phenomenological analysis.

PURPOSE: The purpose of this study is to describe psychiatric nurses' and diabetes nurses' experiences of care with hospitalized patients with schizophrenia and diabetes. DESIGN AND METHODS: Eight psychiatric nurses and diabetes nurses were interviewed, and the data material was analyzed using interpretative phenomenological analysis (IPA). FINDINGS: The analysis showed that nurses lack knowledge about schizophrenia, diabetes, and intersectoral collaboration. It triggers feelings of uncertainty and incapacity. PRACTICE IMPLICATIONS: There is a need for more knowledge and organizational adjustments to underpin a more cohesive care to improve living conditions, so that patients may be able to self-manage their illnesses.

Improving management of psoriasis patients receiving biological treatment: A qualitative approach.

AIM: To investigate psoriasis patients' and healthcare professionals' experiences and perspectives of follow-up consultations. DESIGN: A qualitative study with a phenomenological-hermeneutic approach. METHOD: Participant observations of consultations and semi-structured interviews were conducted with patients receiving biological treatment, together with two focus groups with healthcare professionals, from June 2018-January 2019. Data were analysed using a qualitative structured approach based on Paul Ricoeur's philosophy of interpretation. RESULTS: Consultations had a strong biomedical and corrective approach focusing on lifestyle behaviour change, measurements and permanent routines. Healthcare professionals felt the need for enhanced competencies providing lifestyle behaviour change support and the possibility of providing patients more specific strategies. They were faced with a dilemma between lacking the right skills and having a professional duty. The frequent follow-up visits did not fit in with the patients' everyday lives.

Caregivers' Need for Support in an Outpatient Cancer Setting.

PURPOSE: To investigate the needs of caregivers for individuals with cancer and to gain insight into how to provide support for caregivers. PARTICIPANTS & SETTING: 47 caregivers for patients with cancer in an outpatient setting in Denmark. METHODOLOGIC APPROACH: This qualitative study used focus group interviews. Data were analyzed using a hermeneutics framework and Malterud's systematic text condensation. FINDINGS: Results of the nine focus groups showed the experiences of caregiving. Theme 1 was interdependence, which consisted of the subthemes responsibility, a moral obligation and loneliness and talking. The results also revealed a second theme, different needs for support, which contained three subthemes. IMPLICATIONS FOR NURSING: Caregivers for individuals with cancer do not distinguish their own needs and perspectives of support from those of the patients. Caregivers' need for support includes having support from peers, talking to healthcare professionals, and having personal time. Support of caregivers should allow for focusing on the family as a unit instead of solely addressing the patient.

Video-Based Patient Rounds for Caregivers of Patients With Cancer.

PURPOSE: To investigate caregivers' experiences and level of involvement with video-based patient rounds. PARTICIPANTS & SETTING: 17 caregivers of patients with cancer at Odense University Hospitals in Denmark. METHODOLOGIC APPROACH: Field observation and semistructured interviews were employed. Interpretative phenomenologic analysis was used for data analysis. 17 interviews with caregivers and 190 hours of observations were conducted. FINDINGS: Video-based patient rounds made it possible for caregivers to attend without being physically present at the hospital. This allowed flexibility in caregivers' daily lives. However, caregivers also noted limitations in the use of video, particularly when conversations with healthcare professionals included serious messages. In that context, physical presence was preferred. IMPLICATIONS FOR NURSING: This study highlights the importance caregivers place on involvement and how video-based patient rounds allow caregivers to participate without being physically present at the hospital. The structure of video-based patient rounds and the topic of conversation should be considered.

Broken expectations of early motherhood: Mothers' experiences of early discharge after birth and readmission of their infants.

BACKGROUND AND AIM: Today, mothers are discharged early after birth, and national monitoring shows an increase in readmission of infants. Readmission of the infant might diminish the possibility of bonding and weaken maternal confidence in taking care of the infant. The aim was to explore how new mothers experience the time from birth to being discharged after readmission with their infants. DESIGN: A phenomenological and hermeneutic study. Data were collected through telephone interviews. The study followed the COREQ requirements and was conducted in the Region of Southern Denmark in a University Hospital setting. Convenience sampling was applied, and eight mothers were included from November 2015-February 2016. Seven were interviewed. RESULTS: The data analysis revealed the following six themes: "Early discharge," "Being at home," "Readmission-shock or relief," "Problems with breastfeeding in early motherhood," "Empowering or disempowering guidance" and "Back home with broken expectations." These six themes were all covered by the overall theme: "Broken expectations of a tranquil beginning of early motherhood." CONCLUSIONS: Our study points out that mothers wish for a tranquil beginning with their infants at home. Some already experienced problems at home, while others first were confronted at the check-up at the outpatient clinic. Yet the common denominator was that the mothers experienced broken expectations regarding early motherhood when facing readmission. Readmission may influence the initial process either positively or negatively, depending on how the mothers experience their challenges and how the healthcare professionals support them. This highlights the importance of the way in which healthcare professionals support new mothers when they are readmitted. The study emphasises the importance of maternal feelings of security and confidence in their maternal role, as they are closely connected to the process of becoming a mother.

Early breastfeeding problems: A mixed method study of mothers' experiences.

OBJECTIVES: Breastfeeding problems are common and associated with early cessation. Still length of postpartum hospital stay has been reduced. This leaves new mothers to establish breastfeeding at home with less support from health care professionals. The objective was to explore mothers' perspectives on when breastfeeding problems were the most challenging and prominent early postnatal. The aim was also to identify possible factors associated with the breastfeeding problems. METHODS: In a cross-sectional study, a mixed method approach was used to analyse postal survey data from 1437 mothers with full term singleton infants. Content analysis was used to analyse mothers' open text descriptions of their most challenging breastfeeding problem. Multiple logistic regression was used to calculate odds ratios for early breastfeeding problems according to sociodemographic- and psychosocial factors. RESULTS: Up to 40% of the mothers had experienced early breastfeeding problems. The problems were associated with the mother, the infant and to lack of support from health care professionals. Most prominent problems were infant's inability to latch on (40%) and mothers having sore, wounded and cracked nipples (38%). Pain often occurred when experiencing breastfeeding problems. Factors associated with the problems were primiparity, lower self-efficacy and lower self-perceived knowledge of breastfeeding. Mothers with no or short education reported less frequently breastfeeding problems. CONCLUSIONS: Breastfeeding problems occurred frequently in the early postnatal period and often caused breastfeeding to be painful. Health care professionals should prepare mothers to deal with possible breastfeeding problems. New support options should be reviewed in an early postnatal discharge setting.

Participatory design methods in telemedicine research.

Healthcare systems require a paradigm shift in the way healthcare services are delivered to counteract demographic changes in patient populations, expanding technological developments and the increasing complexity of healthcare. Participatory design (PD) is a methodology that promotes the participation of users in the design process of potential telehealth applications. A PD project can be divided into four phases including: the identification and analysis of participant needs; the generation of ideas and development of prototypes; testing and further development of prototypes; and evaluation. PD is an iterative process where each phase is planned by reflecting on the results from the previous phase with respect to the participants' contribution. Key activities of a PD project include: fieldwork; literature reviewing; and development and testing. All activities must be applied with a participatory mindset that will ensure genuine participation throughout the project. Challenges associated with the use of PD include: the time required to properly engage with participants; language and culture barriers amongst participants; the selection of participants to ensure good representation of the user group; and empowerment. PD is an important process, which is complemented by other evaluation strategies that assess organisational requirements, clinical safety, and clinical and cost effectiveness. PD is a methodology which encourages genuine involvement, where participants have an opportunity to identify practical problems and to design and test technology. The process engages participants in storytelling, future planning and design. PD is a multifaceted assessment tool that helps explore more accurately clinical requirements and patient perspectives in telehealth.

Parental experiences of early postnatal discharge: A meta-synthesis.

OBJECTIVE: the aim of this study was to investigate new parents׳ experiences of early postnatal discharge. DESIGN: a meta-synthesis including 10 qualitative studies was conducted using Noblit and Hare׳s method of meta-synthesis development. SETTING: qualitative studies performed in western countries from 2003-2013 were included. PARTICIPANTS: the 10 included studies involved 237 mothers and fathers, first time parents as well as multiparous. FINDINGS: we identified four overlapping and mutually dependent themes reflecting the new parents׳ experiences of early postnatal discharge: Feeling and taking responsibility; A time of insecurity; Being together as a family; and Striving to be confident. The mothers׳ and fathers׳ experiences of responsibility, security and confidence in their parental role, were positively influenced by having the opportunity to be together as a family, receiving postnatal care that included both parents, having influence on time of discharge, and getting individualised and available support focused on developing and recognising their own experiences of taking care of the baby. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the new parents׳ experiences of early discharge and becoming a parent were closely related. Feeling secure and confident in the parental role was positively or negatively influenced by the organisation of early discharge. This underscores the importance of the way health professionals support new mothers and fathers at early postnatal discharge.