Certified Registered Nurse Anesthetists' Experiences of Nursing in Anesthesia Care: An Interview Study.

PURPOSE: The purpose of this study was to understand certified registered nurse anesthetists' (CRNAs) experiences of nursing in anesthesia care. DESIGN: An explorative qualitative study was conducted with inspiration from Ricoeur's hermeneutic phenomenological theory of interpretation. METHODS: Three focus group interviews were carried out with participants representing 5 anesthesiology departments from 3 hospitals in Denmark (a total of 14 participants). The participants were all CRNAs. The transcribed interviews were examined as one coherent text using a Ricoeur-inspired approach, in which the analysis was conducted on three levels: naive reading, structural analysis, and critical interpretation. FINDINGS: The structural analysis identified three themes relevant to the CRNAs' experiences of nursing: (1) the relationship with the patient, in which caring and professionalism are equally important; (2) differences between professions when sitting in the operating room; and (3) conflicts between production and caring. The study showed that CRNAs are aware of their professional identities as nurses and view anesthesia nursing as an integration of technical tasks and caring, in which the relationship with the patient and serving as the patient's representative are central. A major aspect of nursing is performed while the patient is anesthetized, and the CRNA attends to the patient's basic needs. The study also found that CRNAs find it difficult to define nursing in anesthesia care because of the overlapping tasks and skills between CRNAs and anesthesiologists. CONCLUSIONS: CRNAs are very aware of their professional identities as nurses. The professionalism involved in their relationships with patients is evident in the CRNAs' representation of the patients themselves.

The Use of Podcasts as Patient Preparation for Hospital Visits-An Interview Study Exploring Patients' Experiences.

INTRODUCTION: Podcasts have emerged as a promising tool in patient preparation for hospital visits. However, the nuanced experiences of patients who engage with this medium remain underexplored. OBJECTIVES: This study explored patients' experiences of receiving information by way of podcasts prior to their hospital visits. METHODS: Semi-structured interviews were conducted with patients with suspected chronic obstructive pulmonary disease (COPD), lung cancer, or sleep apnea. The method of data analysis chosen was thematic analysis. RESULTS: Based on data from 24 interviews, five key themes were identified: technical challenges in utilization of podcasts; individual preferences for information prior to hospital visits; building trust and reducing anxiety through podcasts; the role of podcasts as an accessible and convenient source of information; and enhancement of engagement and empowerment through podcasts. Additionally, the study highlighted the critical importance of tailoring podcasts' content to individual preferences to optimize the delivery of healthcare information. CONCLUSIONS: Podcasts can serve as a meaningful supplement to traditional information sources for patients. However, it is important to recognize that not all patients may be able to engage with this medium effectively due to technical challenges or personal preferences.

Patients' and relatives' experiences of cognitive impairment following an intensive care unit admission. A qualitative study.

BACKGROUND: Cognitive impairment poses a significant challenge following critical illness in the intensive care unit. A knowledge gap exists concerning how patients experience cognitive impairments. OBJECTIVES: The aim was to explore patients' and relatives' experiences of patients' cognitive impairment due to critical illness following an intensive care unit admission. METHODS: A qualitative multicentre study was conducted in Denmark with 3- and 6-month follow-ups using single and dyadic interviews. A phenomenological hermeneutic approach was adopted using a Ricoeur-inspired textual in-depth analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used. RESULTS: Three themes emerged from interviews with 18 patients and 14 relatives: 'It feels like living in a parallel world', 'Getting back to a normal everyday life with a vulnerable self', and 'Managing everyday life using self-invented strategies'. Patients used self-invented strategies to manage their vulnerability and newly acquired cognitive impairments when no help or support was provided specifically targeting their cognitive impairments. Not being as cognitively capable as they previously had been turned their lives upside down. Losing control and not being themselves made them vulnerable. Patients did not want to burden others. However, support from relatives was invaluable in their recovery and rehabilitation. CONCLUSIONS: Patients experienced multiple cognitive impairments affecting their adaption to everyday life. They strove to overcome their vulnerability using a variety of self-invented strategies and activities.

Validation of the Danish Version of the Fibromyalgia Impact Questionnaire Revised.

Purpose: Increasing recognition of chronic pain diseases, including Fibromyalgia, warrants the need for tools to monitor the impact of the disease as well as the efficacy of interventions. The Revised Fibromyalgia Impact Questionnaire (FIQR) has previously proved to be a valuable tool in both clinical and research settings. The study objective was to translate and validate the FIQR in Danish. Patients and Methods: A forward/backward translation, following the WHO-guidelines, was used to develop the Danish version of FIQR. The Danish translation of FIQR was answered by 101 patients suffering from fibromyalgia. The patients simultaneously answered the Hospital Anxiety and Depression Scale (HADS) and the 36-Item Short-Form Health Survey (SF-36) for validation. Results: The Danish FIQR showed excellent internal consistency, and reliability with Interclass Correlation Coefficients above 0.9. The correlations to HADS and SF-36 ranged from fair to very good. All results were found to have a p-value <0.05. Conclusion: The present version of the Danish FIQR presents a valid and reliable tool for monitoring the impact of fibromyalgia.

Assessment of quality of life for frail, elderly patients post-ICU discharge: a protocol for a scoping review.

INTRODUCTION: Rises in average life expectancy, increased comorbidities and frailty among older patients lead to higher admission rates to intensive care units (ICU). During an ICU stay, loss of physical and cognitive functions may occur, causing prolonged rehabilitation. Some functions may be lost permanently, affecting quality of life (QoL). There is a lack of understanding regarding how many variables are relevant to health-related outcomes and which outcomes are significant for the QoL of frail, elderly patients following discharge from the ICU. Therefore, this scoping review aims to identify reported variables for health-related outcomes and explore perspectives regarding QoL for this patient group. METHODS AND ANALYSIS: The Joanna Briggs Institute guidelines for scoping reviews will be employed and original, peer-reviewed studies in English and Scandinavian languages published from 2013 to 2023 will be included. The search will be conducted from July 2023 to December 2023, according to the inclusion criteria in Embase, MEDLINE, PsycINFO and CINAHL. References to identified studies will be hand-searched, along with backward and forward citation searching for systematic reviews. A librarian will support and qualify the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. In the event of disagreements, a third reviewer will adjudicate until consensus is achieved. Results will be presented narratively and in table form and discussed in relation to relevant literature. ETHICS AND DISSEMINATION: Ethical approval is unnecessary, as the review synthesises existing research. The results will be disseminated through a peer-reviewed publication in a scientific journal.

Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites.

OBJECTIVE: Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave. DESIGN: Cohort study. SETTING AND INTERVENTION: Five Danish hospitals. PARTICIPANTS: A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study. INTERVENTION: From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group. OUTCOME MEASURES: Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention). RESULTS: Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was -0.3% (95% CI -0.6% to -0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by -0.7% (95% CI -1.3% to -0.1%) in the intervention group. CONCLUSION: The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.

The Danish Pain Research Biobank (DANPAIN-Biobank): a collection of blood, cerebrospinal fluid, and clinical data for the study of neuroimmune and glia-related biomarkers of chronic pain.

Background: Chronic pain is a major health problem worldwide but the limited knowledge of its underlying pathophysiology impairs the opportunities for diagnostics and treatment. Biomarkers of chronic pain are greatly needed to understand the disease and develop new targets for interventions and drug treatments, and potentially introduce more precise diagnostic procedures. Much evidence points to a neuroimmune pathology for many chronic pain conditions and that important neuroimmune biomarkers exist in the cerebrospinal fluid (CSF) of patients with chronic pain. Systematic collection of CSF in large cohorts of chronic pain patients and healthy volunteers has proven difficult, however. We established the Danish Pain Research Biobank (DANPAIN-Biobank) with the aim of studying potential neuroimmune and glia-related biomarkers of chronic pain. In this paper, we describe the methods and the study population of the DANPAIN-Biobank. Methods: In this cross-sectional study, we included (I) participants with high-impact (HI) chronic pain from a tertiary, interdisciplinary pain center; (II) participants with osteoarthritic pain scheduled for arthroplasty surgery of the hip or knee at a regional hospital; and (III) pain-free volunteers. All participants completed a questionnaire assessing pain, functional impairment, anxiety, depression, and insomnia before samples of blood and CSF were extracted. Quantitative sensory tests were performed on participants with HI chronic pain and pain-free volunteers, and postoperative outcome scores were available on participants with osteoarthritic pain. Results: Of the 352 participants included, 201 had HI chronic pain (of which 71% had chronic widespread pain), 81 had chronic osteoarthritic pain, and 70 were pain-free volunteers. Samples were handled uniformly, and CSF samples were frozen within 30 minutes. Conclusions: We describe the content of the DANPAIN-Biobank, which is unique in terms of the number of participants (including pain-free volunteers), extensive clinical data, and uniformity in sample handling. We believe it presents a promising new platform for the study of neuroimmune and glia-related biomarkers of chronic pain.

The Association Between Cognitive Functions and Psychological Factors in Patients with Severe COPD.

Purpose: Patients with COPD experience anxiety, depression, and stress more frequently than in the age and gender-matched general population. This cross-sectional study aimed to examine the relationship between cognitive functions and the psychological factors of anxiety, depression and stress among patients with COPD. Patients and Methods: Between January 2021 and January 2023, patients with severe COPD were recruited, along with age-matched controls. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS). The Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT), and a driving simulator were used to assess cognitive impairment. Hierarchical multiple linear regression analyses were used to explain the variance of the correlations. Results: In total, 80 patients (mean age = 64yrs) and 22 controls (mean age = 61yrs) participated in the study. Patients reported significantly higher levels of psychological symptoms compared to the controls (p ≤ 0.001). We found no differences in anxiety (p = 0.31), depression (p = 0.66) and stress (p = 0.37) between patients with and without cognitive impairment. However, stress showed to be a significant predictor of decreased attention (higher stress score resulted in decreasing CRT-index, indication a reduced stability in reaction time) (p = 0.02). Psychological factors did not explain additional variance in cognitive functions beyond sociodemographic factors such as age and sex. Conclusion: Psychological symptom levels are higher in COPD than controls and perceived stress among patients with COPD appears to be associated with decreased attention. However, psychological factors in general did not appear to contribute to the variance in cognitive functions beyond sociodemographic, physical, and self-perceived symptoms.

Pain relief after major ankle and hindfoot surgery with repetitive peripheral nerve blocks: A feasibility study.

BACKGROUND: Major ankle and hindfoot surgery (e.g., ankle, triple and subtalar arthrodesis) typically causes severe postoperative pain, especially the first two postoperative days. Current modalities of postoperative analgesic treatment often include continuous peripheral nerve blocks of the saphenous and sciatic nerves via catheters in order to extend the duration of pain- and opioid-free nerve blockade to 48 h. Unfortunately, the 48 h-efficacy of continuous infusion via a catheter is reduced by a high displacement rate. We hypothesised that one-time repetition of the single injection peripheral nerve blocks would provide effective analgesia with a low opioid consumption the first 48 postoperative hours. METHODS: Eleven subjects preoperatively received a popliteal sciatic and a saphenous single injection nerve block with a protracted local anaesthetic mixture. Surgery was performed under general anaesthesia. The one-time repetition of the single injection nerve block was carried out approximately 24 h after the primary nerve block. The main outcomes were pain and cumulative opioid consumption during the first 48 postoperative hours. RESULTS: Nine of the 11 (82%) patients had effective analgesia without opioids during the first 48 postoperative hours. Two patients each required a single dose of 7.5 mg of oral morphine equivalents after 43 h. CONCLUSION: One-time repetition of single injection saphenous and sciatic nerve blocks consistently provided effective analgesia practically without opioids for 48 h after major elective ankle and hindfoot surgery.

The association between socioeconomic factors and the success of decolonization treatment among individuals diagnosed with methicillin-resistant Staphylococcus aureus: A cohort study from 2007 to 2020.

OBJECTIVES: To examine associations between socioeconomic factors and (1) adherence to methicillin-resistant Staphylococcus aureus (MRSA) posttreatment follow-up swab sampling after 1 and 6 months and (2) successful decolonization treatment. DESIGN: Cohort study with 2 years of follow-up. Data on patients diagnosed with MRSA were extracted from a regional MRSA database and national registries. We used a cluster-based logistic regression model to estimate the adjusted odds ratios (aOR) and 95% confidence interval (CI) for associations between socioeconomic factors and decolonization treatment. SETTING: Danish primary health care. RESULTS: The rate of adherence to posttreatment follow-up swab sampling among 2,536 cases 1 month after decolonization treatment was 66% (95% CI, 64%-68%), and it decreased to 30% (95% CI, 28%-32%) after 6 months. Living in intermediate municipalities (76-159 inhabitants/km2) or having retired were associated with completed posttreatment follow-up swabs 1 month after decolonization treatment: aOR, 1.40 (95% CI, 1.2-1.74) and aOR, 2.67 (95% CI, 1.16-6.13), respectively. The rate of successful decolonization treatment 2 years after initiating treatment was 36% (95% CI, 34%-38%). Factors associated with successful decolonization treatment included individuals with higher education (aOR, 1.62; 95% CI, 1.22-2.15), early retirees (aOR, 1.63; 95% CI, 1.12-2.38), those living in intermediate municipalities (ie, 160-900+ inhabitants/km2; aOR, 1.35; 95% CI, 1.08-1.68), and those living in predominantly urban municipalities (ie, 160-900+ inhabitants/km2; aOR, 2.04; 95% CI, 1.5-2.76). CONCLUSIONS: Disparities in the effect of decolonization treatment and adherence to MRSA follow-up sampling among MRSA-positive individuals appear to be largely explained by the level of education, area of residence, and employment status.

Documenting care together with patients: the experiences of nurses and patients.

BACKGROUND: One way in which patients can participate in care is by taking part in medical documentation. Producing documentation together with patients has been found to decrease the amount of incorrect information, help patients to be involved, and promote shared decision-making. The aims of this study were to develop and implement a practice of producing documentation together with patients and to examine staff and patient experiences of this practice. METHODS: A quality improvement study was conducted from 2019 to 2021 at a Day Surgery Unit in a Danish University Hospital. Before implementing a practice of documenting together with patients, nurses' perceptions of doing documentation together with patients were examined via a questionnaire survey. After an implementation period, a similar follow-up survey with staff was conducted, together with structured patient phone interviews. RESULTS: A total of 24 nursing staff out of 28 (86%) filled in the questionnaire at baseline and 22 out of 26 (85%) at follow-up. A total of 61 out of 74 invited patients (82%) were interviewed. At baseline, the majority (71-96%) of participants agreed that documentation done together with the patient would contribute to increased patient safety, fewer errors, real-time documentation, patient involvement, visible patient perspective, correction of errors, more accessible information and less duplication of work. At follow-up, significant decreases in the staffs' positive perceptions of the benefits of documenting together with patients were found for all areas except for "real-time documentation" and "less duplication of work". Almost all patients found it okay that the nurses wrote up medical documentation during the interview, and more than 90% of patients found the staff responsive or very responsive and present during the reception interview. CONCLUSION: Before implementation of a practice of documenting together with patients, the majority of staff assessed such documentation as being beneficial, but a significant decrease in positive assessment was found at follow-up, with challenges such as feeling less connected with the patient and practical, IT-related issues being described. The patients found the staff to be present and responsive and felt that it was important to know what was being written in their medical record.

Patient-physician conversations about life-sustaining treatment: Treatment preferences and participant assessments.

OBJECTIVE: In 2019, the Danish parliament issued legislation requiring Danish physicians to clarify and honor seriously ill patients' treatment preferences. The American POLST (Physician Orders for Life-Sustaining Treatment) document could be a valuable model for this process. The aim of the study was to examine patients' preferences for life-sustaining treatment and participant assessment of a Danish POLST form. METHODS: The study is a prospective intervention based on a pilot-tested Danish POLST form. Participant assessments were examined using questionnaire surveys. Patients with serious illness and/or frailty from seven hospital wards, two general practitioners, and four nursing homes were included. The patients and their physicians completed the POLST form based on a process of shared decision-making. RESULTS: A total of 95 patients (aged 41-95) participated. Hereof, 88% declined cardiopulmonary resuscitation, 83% preferred limited medical interventions or comfort care, and 74% did not require artificial nutrition. The preferences were similar within age groups, genders, and locations, but with a tendency toward younger patients being more in favor of full treatment and nursing home residents being more in favor of cardiopulmonary resuscitation. Questionnaire response rates were 69% (66/95) for patients, 79% (22/28) for physicians, and 31% (9/29) for nurses. Hereof, the majority of patients, physicians, and nurses found that the POLST form was usable for conversations and decision-making about life-sustaining treatment to either a high or very high degree. SIGNIFICANCE OF RESULTS: The majority of seriously ill patients did not want a resuscitation attempt and opted for selected treatments. The majority of participants found that the Danish POLST was usable for conversations and decisions about life-sustaining treatment to either a high or a very high degree, and that the POLST form facilitated an opportunity to openly discuss life-sustaining treatment.

End-of-life issues experienced by the nurse-led rapid response team: An analysis of extent and experiences.

OBJECTIVES: To examine the frequency, clinical characteristics and nurse-led rapid response team experiences of calls that involve end-of-life issues. RESEARCH METHODOLOGY AND DESIGN: The study consisted of two parts: 1) a retrospective journal audit of registered rapid response team calls for 2011-2019 that involved end-of-life issues, and 2) interviews with intensive care rapid response team nurses. The quantitative data were analysed with descriptive statistics and the qualitative data with content analysis. SETTING: The study was conducted at a Danish university hospital. RESULTS: Twelve percent (269/2,319) of the rapid response team calls involved end-of-life issues. "No indication for intensive care therapy" and "Do not resuscitate" were the main medical end-of-life orders. The patients had a mean age of 80 years, and the main reason for the calls was a respiratory problem. Ten rapid response team nurses were interviewed, and four themes evolved from the analysis: "Uncertain roles for the rapid response team nurses", "Solidarity with ward nurses", "Lack of information" and "Timing of decision-making". CONCLUSION: Twelve percent of the rapid response team calls involved end-of-life issues. The main reason for these calls was a respiratory problem, and the rapid response team nurses often found their role uncertain and experienced lack of information and sub-optimal timing of decision-making. IMPLICATIONS FOR CLINICAL PRACTICE: Intensive care nurses working in a rapid response team often face end-of-life issues during calls. Therefore, end-of-life care should be included in training for rapid response team nurses. Furthermore, advanced care planning is recommended to secure high-quality end-of-life care and to decrease uncertainty in acute medical situations.

Patients' experiences of cognitive impairment following critical illness treated in an intensive care unit: A scoping review.

INTRODUCTION: Treatment with modern technology in an intensive care unit has increased critical illness survival. However, many patients are affected by their critical illness for months or years following discharge, as they experience cognitive impairments. Long-term cognitive impairments can severely affect patients' quality of life. Exploring patients' experiences on how and which cognitive impairments affect their everyday lives is important to improve planning of relevant research into interventions that may alleviate the burden of post-intensive cognitive impairments. AIM: To review the literature on patients' experiences of cognitive impairment following critical illness treated in an intensive care unit. METHODS: A systematic search was conducted in PubMed, Cinahl, PsycInfo and Embase in March-May 2021. References and citations in relevant studies were explored. The Covidence tool was used by two independent researchers to identify relevant studies for inclusion. The Mixed Methods Appraisal Tool was used for critical appraisal. The JBI methodology for scoping reviews and the PRISMA-ScR checklist were used (Supporting Information File 1). RESULTS: We identified 11 relevant qualitative and/or quantitative studies. Four themes were found: 'Experiencing poor memory', 'Managing everyday life', 'Unsupported by the healthcare system' and 'Strategies for support in recovery'. Patients used various strategies during their recovery and rehabilitation to regain independence and avoid being a burden. They needed information to support their recovery and rehabilitation; otherwise, they felt unsupported and betrayed by the healthcare system. CONCLUSION: Patients experienced various cognitive impairments following critical illness in the intensive care unit, affecting and challenging their quality of life and adaption to everyday life. RELEVANCE TO CLINICAL PRACTICE: Knowledge gained by exploring patients' experience of cognitive impairments following critical illness in the intensive care unit can contribute to improve clinical practice by targeting and optimising patients' rehabilitation process. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement in this scoping review.

Patients' experiences of cognitive impairment following critical illness: a scoping review protocol.

INTRODUCTION: Critical illness and admission to an intensive care unit (ICU) can affect patients for months or years following discharge as many suffer from cognitive impairment. Long-term cognitive impairment affects patients' quality of life and ability to adapt to everyday life. Exploring their experiences on how and which cognitive impairments are affecting their everyday lives facilitates planning of relevant research on interventions that may serve to alleviate the burden of post-ICU cognitive impairment. The objective of this scoping review is to map the existing research on patients' experiences of cognitive impairment following critical illness. METHODS AND ANALYSIS: The methodology will follow the Joanna Briggs Institute guidelines for scoping reviews. The databases MEDLINE, CINAHL, PsycINFO and Embase will be searched to identify studies appropriate for inclusion. Any peer-reviewed original studies meeting the inclusion criteria and include statements from adult patients about how they experience cognitive impairment following critical illness and ICU admission will be considered. Studies published in English and Scandinavian languages will be included, with no further geographical or cultural limitations. The included studies will be screened by two independent researchers using a standardised data extraction tool and the Mixed Methods Appraisal Tool will be used for critical appraisal. The results will be presented in a tabular form, and data will be supported by narrative descriptions or a narrative summary. ETHICS AND DISSEMINATION: Since the scoping review methodology aims at synthetising existing research on patients' experiences of cognitive impairment following critical illness, the scoping review does not require ethical approval. The results will be disseminated though a peer-reviewed publication in a scientific journal.

Patient safety culture improvements depend on basic healthcare education: a longitudinal simulation-based intervention study at two Danish hospitals.

BACKGROUND: A growing body of evidence supports the existence of an association between patient safety culture (PSC) and patient outcomes. PSC refers to shared perceptions and attitudes towards norms, policies and procedures related to patient safety. Existing literature shows that PSC varies among health professionals depending on their specific profession and specialty. However, these studies did not investigate whether PSC can be improved. This study investigates whether length of education is associated with improvements in PCS following a simulation intervention. METHODS: From April 2017 to November 2018, a cross-sectional intervention study was conducted at two regional hospitals in Denmark. Two groups with altogether 1230 health professionals were invited to participate. One group included nurses, midwives and radiographers; the other group included doctors. A train-the-trainer intervention approach was applied consisting of a 4-day simulation instructor course that emphasised team training, communication and leadership. Fifty-three healthcare professionals were trained as instructors. After the course, instructors performed in situ simulation in their own hospital environment. OUTCOMES: The Safety Attitude Questionnaire (SAQ), which has 6 dimensions and 32 items, was used to collect main outcome variables. All employees from both groups were surveyed before the intervention and again four and nine months after the intervention. RESULTS: Mean baseline scores were higher among doctors than among nurses, midwives and radiographers for all SAQ dimensions. At the second follow-up, four of six dimensions improved significantly (p ≤ 0.05) among nurses, midwives and radiographers, whereas no dimensions improved significantly among doctors. CONCLUSION: Over time, nurses, midwives and radiographers improved more in PSC attitudes than doctors did.

Tapering of iatrogenic opioid use in patients with chronic non-malignant pain.

INTRODUCTION: Iatrogenic opioid use by patients with chronic malignant pain remains an important focus point. The positive effects of opioids seem to decline over time, whereas tapering will have positive effects in many patients. The purpose of the project was to optimise the process for patients with a wish or a need to taper opioids. METHODS: Patients were referred to a multidisciplinary pain treatment centre with the aim of tapering their opioid use. The use of opioids before and after the intervention at the pain treatment centre was registered. Questionnaires about quality of life, sleep quality and level of depression were completed before and after the study, participants were allowed to add comments to the questionnaires and interviews were conducted. RESULTS: A total of 22 patients participated. They had complex pain issues and had received opioids for a median period of nine years. The participants achieved a significant reduction of opioids (median 23 mg). Four patients completely stopped using opioids in the project period, four did not benefit from the project and two achieved reductions to the lowest dose possible allowing them to maintain an acceptable level of function. The remaining patients had a tapering plan to be continued in cooperation with their general practitioner. Most patients experienced the process as very satisfactory or satisfactory but achieved no measurable improvements in quality of life, sleep quality or level of depression. CONCLUSION: Even though the tapering of opioids had appeared difficult beforehand, a significant reduction in opioid consumption was achieved. FUNDING: The project was funded by the Danish Health Authority. TRIAL REGISTRATION: not relevant.

Decision-making conversations for life-sustaining treatment with seriously ill patients using a Danish version of the US POLST: a qualitative study of patient and physician experiences.

OBJECTIVE: To explore patients' and physicians' perspectives on a decision-making conversation for life-sustaining treatment, based on the Danish model of the American Physician Orders for Life Sustaining Treatment (POLST) form. DESIGN: Semi-structured interviews following a conversation about preferences for life-sustaining treatment. SETTING: Danish hospitals, nursing homes, and general practitioners' clinics. SUBJECTS: Patients and physicians. MAIN OUTCOME MEASURES: Qualitative analyses of interview data. FINDINGS: After participating in a conversation about life-sustaining treatment using the Danish POLST form, a total of six patients and five physicians representing different settings and age groups participated in an interview about their experience of the process. Within the main research questions, six subthemes were identified: Timing, relatives are key persons, clarifying treatment preferences, documentation across settings, strengthening patient autonomy, and structure influences conversations. Most patients and physicians found having a conversation about levels of life-sustaining treatment valuable but also complicated due to the different levels of knowledge and attending to individual patient needs and medical necessities. Relatives were considered as key persons to ensure the understanding of the treatment trajectory and the ability to advocate for the patient in case of a medical crisis. The majority of participants found that the conversation strengthened patient autonomy. CONCLUSION: Patients and physicians found having a conversation about levels of life-sustaining treatment valuable, especially for strengthening patient autonomy. Relatives were considered key persons. The timing of the conversation and securing sufficient knowledge for shared decision-making were the main perceived challenges.KEY POINTSConversations about preferences for life-sustaining treatment are important, but not performed systematically.When planning a conversation about preferences for life-sustaining treatment, the timing of the conversation and the inclusion of relatives are key elements.Decision-making conversations can help patients feel in charge and less alone, and make it easier for health professionals to provide goal-concordant care.Using a model like the Danish POLST form may help to initiate, conduct and structure conversations about preferences for life-sustaining treatment.

Balancing responsibilities, rewards and challenges: A qualitative study illuminating the complexity of being a rapid response team nurse.

AIM AND OBJECTIVE: To explore Rapid Response Team nurses' perceptions of what it means being a Rapid Response Team nurse including their perceptions of the collaborative and organisational aspects of the rapid response team (RRT). BACKGROUND: For more than 20 years, RRT nurses have been on the frontline of critical situations in acute care hospitals. However, a few studies report nurses' perceptions of their role as RRT nurses, including collaboration with general ward nurses and physicians. This knowledge is important to guide development and adjustment of the RRT to benefit both patients' safety and team members' job satisfaction. DESIGN: Qualitative focus group interviews. METHODS: A qualitative approach was applied. Throughout 2018 and across three regions and three acute care settings in Denmark, eight focus group interviews were conducted in which 27 RRT nurses participated. Transcribed interviews were analysed using inductive content analysis. Reporting of this study followed the COREQ checklist. RESULTS: One overarching theme 'Balancing responsibilities, rewards, and challenges' was derived, comprising six categories: 'Becoming, developing and fulfilling the RRT nurse role', 'Helping patients as the core function of RRT', 'The RRT-call at its best', 'The obvious and the subtle RRT tasks', 'Carrying the burden of the RRT', and 'Organisational benefits and barriers for an optimal RRT'. CONCLUSION: Being a RRT nurse is a complex task. Nurses experience professional satisfaction and find it meaningful helping deteriorating patients. The inadequate resources available to train general ward staff how to manage basic clinical tasks are an added stress to nurses. RELEVANCE TO CLINICAL PRACTICE: Organisational managers need a better understanding of the necessary staffing requirements to attend patients' needs, train staff and handle the increasing acuity of ward patients. Failure to do so will be detrimental to patient outcomes and compromise RRT nurses' job satisfaction.