Nurses' attitudes towards family importance in nursing care across Europe.

AIMS AND OBJECTIVE: To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries. BACKGROUND: Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice. DESIGN: A cross-sectional survey across European countries. METHOD: A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results. RESULTS: There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score. CONCLUSION: Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes. RELEVANCE FOR CLINICAL PRACTICE: In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe.

Improving everyday life of people with dementia living at home: Health care professionals' experiences.

AIM: This study investigates what health care professionals experience is important for improving everyday life of people with dementia living at home. BACKGROUND: A prerequisite for living at home is that people with dementia and their relatives can handle everyday life together despite the challenges that dementia poses. METHODS: This qualitative study conducted focus group interviews (n = 14), and the data were analysed using qualitative content analysis. RESULTS: The analysis identified one theme-need for enhanced competence to develop and implement individual plans-and three categories: challenge in identifying cognitive decline; need to timeously facilitate an active and meaningful everyday life; and need for consistency, continuity and coordination in dementia home care. CONCLUSION: Increased expertise is needed among health care professionals to contribute to the development and implementation of individual plans in dementia home care. To achieve this, health care professionals' competence and how dementia home care is organized must be seen in conjunction. IMPLICATIONS FOR NURSING MANAGEMENT: Routines should be established for identifying cognitive failure early and providing support and guidance at the beginning of the process. There is a need for nurse managers to facilitate increased advanced competence regarding dementia care for a professional home care service and to consider how home services can be organized to ensure continuity and security for people with dementia and their relatives. Creating and implementing an individual plan which can be a starting point for identifying individual needs and wishes and for coordinating an individual user's services.

Experience of Managing Countertransference Through Self-Guided Imagery in Meditation Among Healthcare Professionals.

INTRODUCTION: As a part of the therapeutic relationship, a significant, well-established predictor of outcomes in psychiatric healthcare, healthcare professionals' emotional reactions to patients may affect treatment outcomes. AIM: The aim of our study was to explore and describe healthcare professionals' experiences with managing countertransference using skills from a training program on self-guided imagery in meditation (SIM). METHOD: Following an exploratory descriptive design, we conducted qualitative interviews with 10 healthcare professionals who care for patients with mental illness and subjected the collected data to thematic content analysis. RESULTS: Participants reported that SIM had helped them to manage countertransference and had prompted changes that we categorized into three themes: managing personal vulnerability, setting clearer boundaries, and practicing self-care. CONCLUSION: The results suggest that by cultivating wellbeing and dealing with unresolved inner conflicts, SIM can help healthcare professionals to manage countertransference.

Coping with Everyday Life for Home-Dwelling Persons with Dementia: A Qualitative Study.

AIM: This study aimed to gain insight into factors that influence everyday coping strategies as described by persons with early to intermediate dementia. BACKGROUND: Living with dementia presents difficulties coping with everyday life. This study focuses on coping with everyday life for persons with mild to moderate dementia in order to facilitate their ability to live at home. DESIGN: A qualitative study. METHODS: Individual interviews with 12 persons with dementia were conducted in their own homes. FINDINGS: Coping with everyday life can be influenced by the experience of the diagnostic process and by information about dementia. It can also be affected by stigmatization of persons with dementia, as well as by challenges in everyday life. In addition, challenges in receiving help may include poor continuity of services and healthcare staff with limited competence. By contrast, person-centered care led to positive experiences that supported everyday coping skills. Most of the respondents wanted to participate in day care several days a week. Other positive experiences were making new friends and participating in meaningful activities; such experiences could enhance to coping strategies. CONCLUSION: To strengthen everyday coping for persons with dementia living at home, there is a need for openness about the disease. Follow-up for persons with dementia must be carried out by reputable professionals trained and educated in dementia care. Finally, the municipalities must have contact persons, dementia coordinator/-team, who are available for persons with dementia at the time of diagnosis position and afterwards.

Patient experiences with videoconferencing as social contact and in follow-up from oncology nurses in primary health care.

Patients with various forms of cancer often have unmet psychosocial support needs. By interpretative phenomenological approach, this study aimed to acquire a deeper understanding of home-living patients with cancer's experience and meaning from videoconferencing in oncological nursing follow-up in primary healthcare and contact with networks. Six patients from rural Norway participated. Three themes emerged: (1) From skepticism to videoconferencing-enthusiasm; (2) Oncology nurses ensured tablet mastery and delivered close follow-up; and (3) Oncology nurses helped ensure general social support using videoconferencing. Oncology follow-up care in rural areas using videoconferencing may enhance care availability and provision of psychosocial support meeting patients' needs.

Oncology nurses' lived experiences of video communication in follow-up care of home-living patients: A phenomenological study in rural Norway.

PURPOSE: To explore the lived experiences of oncology nurses (ONs) during three months of virtual care provided through video conferencing (VC) in the follow-up care for home-living patients with cancer in rural Norway. METHOD: An exploratory study employing a descriptive phenomenological approach conducted with a purposive sample of four ONs working in primary health care in three municipalities. Individual interviews based on open-ended questions about the ONs' experiences of VC use in follow-up care were analyzed using methodology inspired by Clark Moustakas. The COREQ checklist was utilized in this study. RESULTS: ONs provided VC as a quality-promoting supplement to traditional follow-up. Their lived experiences of the phenomenon were described by the following themes: 1) Choice of VC based on care need considerations, 2) Use of VC on portable tablets facilitated contact and frequent follow-up, and 3) Adaption of relevant virtual care in person-centered and goal-oriented practice. CONCLUSION: The use of VC may contribute to accessible and frequent quality care and reduce the ONs' travel time for home visits. This study points to a need to individualize and assess the appropriateness of virtual care in challenging cancer situations. Furthermore, there is a need for larger-scale studies on how VC may influence quality care.

Informal caregivers and persons with dementia's everyday life coping.

This qualitative study explores informal caregivers' experiences of supporting persons with dementia's everyday life coping. In the future, there will be fewer health personnel, increased dementia prevalence and limited nursing home availability. Accordingly, close relatives may be compelled to assume greater care responsibilities. Knowledge concerning persons with dementia's everyday coping from the perspective of informal caregivers remains insufficient, despite these people's importance for those with dementia. This investigation analyses informal caregivers' perceived challenges and pleasures in providing care, how home health care affects everyday life coping and the factors that are most important to informal caregivers in supporting care receivers.

How Volunteers Contribute to Persons with Dementia Coping in Everyday Life.

INTRODUCTION: The society needs volunteers to fulfill its duty to ensure that people with dementia have active and meaningful everyday lives. Volunteers seem to experience their work as positive and meaningful for their own part, but we know less about what motivates volunteers to start working in home-dwelling dementia care and what motivates them to continue their engagement. This study seeks to close some of the knowledge gaps that exist regarding volunteers' engagement in activities for persons with dementia. AIM: The aim of this study was to explore what motivates volunteers to start engaging in volunteer work in home-dwelling dementia care and what motivates them to continue their engagement. METHODS: The study design was qualitative, using focus group interviews. Three focus group interviews (n=16) took place between May and June 2018. The text was analyzed using content analysis. RESULTS: Findings in this study indicate that the volunteers were motivated by the feeling of doing an important job for the persons with dementia and their relatives, and that they contribute to their coping with everyday life. Other motivating factors included feeling important to someone, gaining friendship, and sharing common interests. They also believed that they do an important job for the community to fulfill society's goal that people with dementia should stay home longer. However, the volunteers were confused about their role and ask for knowledge, peer support, and clarification of roles. CONCLUSION: To maintain motivation volunteers need to know what his/her role is. A volunteer can and shall not act as a substitute for a professional, only as a supplement, and the expectations must be addressed to all stakeholders: the health care service, the volunteer, the person with dementia, and their relatives, as we believe that this will contribute to diminishing misunderstandings.

Introducing Videoconferencing on Tablet Computers in Nurse-Patient Communication: Technical and Training Challenges.

BACKGROUND: This article examines personnel and patient experiences of videoconferencing (VC) trials on tablet computers between oncology certified nurses (OCNs) and patients with cancer who live at home. The study points to organizational pitfalls during the introduction process. In many different arenas, the use of VC has increased recently owing to improved Internet access and capacity. This creates new opportunities for contact between patients living at home and their nurses. Video conferencing presupposes knowledge about Internet access, training, and usability of technological equipment. The aim of this pilot study was to illuminate patients' and nurses' experiences of the technical functionality, usability, and training of tablet use in VC in primary cancer care. The results point to the drawbacks concerning the introduction of VC. METHOD: A pilot study with an explorative design was used to describe patients' and OCNs' experiences of technical functionality and usability of VC on tablet computers. After a three-month trial, data were gathered, focusing on both patients' and nurses' perspectives. Individual interviews with four female OCNs, aged 32-65 (mean 46), and six patients with cancer, two men and four women aged 49-78 (mean 69), were content-analyzed. RESULTS: The analysis revealed two main categories: network connectivity and tablet usability and training and educational pitfalls. CONCLUSION: When planning VC implementation, the organizational leadership should consider network access and stability, as well as individualized VC training on tablets. Ensuring patient safety should also be a priority. Further research should provide knowledge of technological and educational pitfalls, and possible implications of VC on the care quality of nursing.

Former Work Life and People With Dementia.

Twelve persons with dementia were interviewed about their former work lives. Their motivation for choosing their past work was influenced by values of their contemporary culture. Those who had come to terms with their illness had positive feelings about their past contributions in their former paid work. However, they often felt that unpaid work was taken for granted and not fully recognized by family or society. Some wrestled with accepting their illness; they were grieving their losses, regardless of former success. Caregivers may use parts of work narratives to elevate the self-esteem and quality of life of persons with dementia.

Self-guided Positive Imagery Training: Effects beyond the Emotions-A Loreta Study.

Previously we demonstrated that a 12-week lasting self-guided positive imagery training had a positive effect on the psycho-emotional state of healthy subjects and was associated with an increase in functional connectivity in the brain. Here we repeated the previous project, but expanded the study, testing the hypothesis that training can also affect cognitive functions. Twenty subjects (half of them with subthreshold depression according CES-D) participated in the program of positive imagery training for 12 weeks. The schedule began with group training for 2 days, followed by training at home. Evaluations of cognitive functions and electroencephalographic (EEG) activity were conducted during three examinations as follows: E0-baseline (1 month before the training); E1-pre-training and E2-post-training. CNS Vital Signs battery was used to test the following cognitive domains: verbal and visual memory, executive functions, cognitive flexibility, social acuity, non-verbal reasoning. EEGs (19-channel) were recorded at rest with closed eyes and analyzed with Low-resolution electromagnetic tomography software. One-way repeated measures ANOVA, followed by pairwise comparison showed a significant increase after training (E2 vs. E1; E2 vs. E0) in the number of correct hits for positive emotions received during perception of emotions test (POET); after the sample was split according to the initial presence of depressive symptoms, the effect was present only in the subgroup with subthreshold depressive symptomatology. Post-training (E2 vs. E1; E2 vs. E0) the number of correct answers on non-verbal reasoning test increased; this effect was observed only in the subgroup that does have any depressive symptoms. Comparison of EEG post-training vs. pre-training demonstrated a significant reduction in current source density (CSD) after the training in the left hemisphere (insular cortex, frontal and temporal lobes in delta, theta and alpha1 bands). The observed changes were presented only in the subgroup with initial subthreshold depressive symptomatology. A negative correlation was found between POET and CSD in the left insular cortex for theta band. No significant differences were observed when data from EEG and cognitive tests obtained during pre-training were compared with baseline values. Potential use of training for the rehabilitation of various disturbances with cognitive and emotional deficits is discussed.

Can the Psycho-Emotional State be Optimized by Regular Use of Positive Imagery?, Psychological and Electroencephalographic Study of Self-Guided Training.

The guided imagery training is considered as an effective method and therefore widely used in modern cognitive psychotherapy, while less is known about the effectiveness of self-guided. The present study investigated the effects of regular use of self-guided positive imagery, applying both subjective (assessment of the psycho-emotional state) and objective (electroencephalographic, EEG) approaches to research. Thirty healthy subjects participated in the cognitive imagery-training program for 12 weeks. The schedule began with group training with an instructor for 2 days, where the participants learned various techniques of positive imagery, after which they continued their individual training at home. Psychological and EEG evaluations were applied at the baseline and at the end of the training period. The impact of training on the psycho-emotional states of the participants was evaluated through: Center for epidemiologic studies- Depression (CES-D) 20 item scale, Satisfaction with life scale (SWLS) and General Self-Efficacy scale (GSE). EEGs (19-channels) were recorded at rest with eyes closed. EEG analysis was performed using Low resolution electromagnetic tomography (LORETA) software that allows the comparison of current source density (CSD) and functional connectivity (lagged phase and coherence) in the default mode network before and after a workout. Initial assessment with CES-D indicated that 22 participants had subthreshold depression. After the training participants had less prominent depressive symptoms (CES-D, p = 0.002), were more satisfied with their lives (SWLS, p = 0.036), and also evaluated themselves as more effective (GSE, p = 0.0002). LORETA source analysis revealed an increase in the CSD in the right mPFC (Brodmann area 10) for beta-2 band after training (p = 0.038). LORETA connectivity analysis demonstrated an increase in lagged coherence between temporal gyruses of both hemispheres in the delta band, as well as between the Posterior cingulate cortex and right BA21 in the theta band after a workout. Since mPFC is involved in emotional regulation, functional changes in this region can be seen in line with the results of psychological tests and their objective validation. A possible activation of GAMK-ergic system is discussed. Self-guided positive imagery (after instructions) can be helpful for emotional selfregulation in healthy subjects and has the potential to be useful in subthreshold depression.

Pain Assessment Strategies in Home Care and Nursing Homes in Mid-Norway: A Cross-sectional Survey.

The prevalence of pain ranges from 27.8% to 86.5% in nursing homes and 42% to 50% in home care. Pain assessment is the first step toward effective pain management. The aim of this study was to explore the use of pain assessment strategies (verbal, numeric, and observation rating scales and standardized questions) in home care and nursing homes. The study was a descriptive cross-sectional survey. Health care providers who were responsible for the patients' medications replied to a questionnaire. In-home care and nursing homes in 11 randomly selected municipalities in Mid-Norway were included. Three hundred ninety-two individuals were included in this study (70% response rate): 271 (69%) from nursing homes and 121 (31%) from home care. The respondents working in home care had a higher educational level than those in working in nursing homes. Pain assessment instruments were not used frequently in nursing homes and home care. Verbal and numeric rating scales were used significantly more frequently in home care than in nursing homes. Registered nurses (RNs) in nursing homes used standardized questions significantly more often than did RNs in home care. RNs and social educators in home care self-reported less competence in treating the patients' total pain experience than did those in nursing homes. Workplace (working in home care) and regular training in the use of pain assessment tools explained more than 20% of the variation in the use of pain assessment tools. Regular training in the use of pain assessment tools is needed for health care workers in home care and nursing homes.

Differences in social support of caregivers living with partners suffering from COPD or dementia.

BACKGROUND: Future patients with chronic diseases will probably remain longer in their homes. To enable family caregivers to meet these challenges, public services and informal support are essential. OBJECTIVES: This study compared social support between home-dwelling caregivers of partners with chronic obstructive pulmonary disease or dementia. METHODS: A cross-sectional study of 206 caregivers. Professional aid was quantified by the services utilised. Informal support from family and friends was rated by the number of helping persons and the degree of social withdrawal. The Medical Outcomes Study Social Support Survey Form captured perceived social support. RESULTS: For both diseases, increased severity correlated with more utilisation of professional aid. The chronic obstructive pulmonary disease group perceived more social support, reported less social withdrawal and higher numbers of helping persons. Ill partners' aggressive behaviour reduced perceived support. The use of professional aid was negatively associated with the ill partner's level of self-care, and positively correlated with social withdrawal. Professional aid was more utilised by the dementia group and by men. CONCLUSIONS: Differences in caregivers' needs for social support were related to their partner's disease. IMPLICATIONS FOR PRACTICE: Counteracting social withdrawal, considering type of illness and gender differences may increase the quality of informal care.

Personality features, caring burden and mental health of cohabitants of partners with chronic obstructive pulmonary disease or dementia.

OBJECTIVES: The interplay between personality, mental health and type of disease in explaining caring burden was studied in home-dwelling cohabitants of partners with chronic obstructive pulmonary disease (COPD) or dementia. METHODS: A cross-sectional study including 206 participants with 80% response rate. Neuroticism was assessed by Eysenck Personality Questionnaire (EPQ) and externality by Locus of Control of Behaviour. The Relative Stress Scale evaluated caring burden. Mental health was determined by the General Health Quality (GHQ-28) questionnaire. RESULTS: Neuroticism and type of illness played a major role in explaining caring burden and mental health. In the COPD and dementia groups, 30.5% and 58.4%, respectively, were above the cut-off point for psychiatric caseness on the GHQ. Both groups had low scores for depression and high scores for social dysfunction, anxiety, insomnia and somatisation. Compared to the dementia group, the COPD group had lower scores and fairly stable levels on all subscales of the GHQ. Females had higher scores on somatic symptoms, anxiety and insomnia; they also reported higher scores on neuroticism and externality. CONCLUSION: Differences in personality and illness explained both caring burden and mental health among caregivers. To mitigate the caring burden and mental health problems among home-dwelling caregivers, public health services need to take into account the personality and gender of the caregiver, and also the disease of the ill partner.