Impact of an education program to facilitate nurses' discussions of existential issues in neurological care.

OBJECTIVES: Discussing existential issues is integral to caring for people with acute, progressive, or life-limiting neurological illness, but there is a lack of research examining how nurses approach existential issues with this patient group and their family members. The purpose was to examine the experiential impact of an educational program for nurses designed to facilitate discussions of existential issues with patients and family members in neurological wards. METHOD: Nurses in inpatient and outpatient care at a neurological clinic in Sweden were invited to participate in an education program about discussing existential issues with patients and their family members as related to neurological conditions. The evaluation of the program and of the nurses' view of discussing existential issues was conducted through focus groups before and after participation. The data were analyzed by qualitative content analysis. RESULTS: The program gave nurses a deeper understanding of existential issues and how to manage these conversations with patients and their family members. Both internal and external barriers remained after education, with nurses experiencing insecurity and fear, and a sense of being inhibited by the environment. However, they were more aware of the barriers after the education, and it was easier to find strategies to manage the conversations. They demonstrated support for each other in the team both before and after participating in the program. SIGNIFICANCE OF RESULTS: The educational program gave nurses strategies for discussing existential issues with patients and family members. The knowledge that internal and external barriers impede communication should compel organizations to work on making conditions more conducive, for example, by supporting nurses to learn strategies to more easily manage conversations about existential issues and by reviewing the physical environment and the context in which they are conducted.

Surgical nurses' attitudes towards caring for patients dying of cancer - a pilot study of an educational intervention on existential issues.

This is a randomised controlled pilot study using a mixed methods design. The overall aim was to test an educational intervention on existential issues and to describe surgical nurses' perceived attitudes towards caring for patients dying of cancer. Specific aims were to examine whether the educational intervention consisting of lectures and reflective discussions, affects nurses' perceived confidence in communication and to explore nurses' experiences and reflections on existential issues after participating in the intervention. Forty-two nurses from three surgical wards at one hospital were randomly assigned to an intervention or control group. Nurses in both groups completed a questionnaire at equivalent time intervals: at baseline before the educational intervention, directly after the intervention, and 3 and 6 months later. Eleven face-to-face interviews were conducted with nurses directly after the intervention and 6 months later. Significant short-term and long-term changes were reported. Main results concerned the significant long-term effects regarding nurses' increased confidence and decreased powerlessness in communication, and their increased feelings of value when caring for a dying patient. In addition, nurses described enhanced awareness and increased reflection. Results indicate that an understanding of the patient's situation, derived from enhanced awareness and increased reflection, precedes changes in attitudes towards communication.

"It's a balance between letting it influence life completely and not letting it influence life at all"--a qualitative study of migraine prevention from patients' perspective.

PURPOSE: The aim of this study was to elucidate migraine prevention from a patient perspective. METHOD: Twenty-one participants who suffered from migraine were interviewed and the data analysed by means of qualitative content analysis. RESULTS: The analysis revealed two categories; Avoiding migraine triggers and introducing migraine inhibiting strategies. In both categories, decisions were influenced by an appraisal of the advantages versus disadvantages, attitudes, support and knowledge. An overarching theme: "migraine prevention from the patients' perspective is a balance between letting it influence life completely and not letting it influence life at all" was identified from the interviews. CONCLUSIONS: As migraine is a chronic disorder that cannot be cured, merely relieved, prevention is of great importance. The present study highlights migraine prevention from the patients' perspective and the important issue of how much prevention is allowed to influence life. Either of the directions involves a risk that life can be controlled by migraine. Acceptance of the disease and allowing migraine prevention to influence life to some degree can be a way of regaining control. IMPLICATIONS FOR REHABILITATION: • Migraine prevention from the patients' perspective is described as a balance between letting it influence life completely and not letting it influence life at all, which in either direction can lead to a life controlled by migraine. • To take the patients' perspectives of the illness in consideration as well as finding the most suitable treatment, based on an appraisal of individual advantages versus disadvantages is important to meet the need of the patient and to improve migraine prevention. Increased knowledge about migraine prevention is imperative both in health care and for the individual patient. Support during prevention is requested by patients.