Patients' experiences of well-being when being cared for in the intensive care unit-An integrative review.

OBJECTIVE: The aim of this integrative review was to identify facilitators and barriers to patients' well-being when being cared for in an ICU setting, from the perspective of the patients. BACKGROUND: To become critically ill and hospitalised in an ICU is a stressful, chaotic event due to the life-threatening condition itself, as well as therapeutic treatments and the environment. A growing body of evidence has revealed that patients often suffer from physical, psychological and cognitive problems after an ICU stay. Several strategies, such as sedation and pain management, are used to reduce stress and increase well-being during ICU hospitalisation, but the ICU experience nevertheless affects the body and mind. DESIGN; METHODS: Since research exploring patients' sense of well-being in an ICU setting is limited, an integrative review approach was selected. Searches were performed in CINAHL, Medline, Psych Info, Eric and EMBASE. After reviewing 66 studies, 12 studies were included in the integrative review. Thematic analysis was used to analyse the studies. The PRISMA checklist for systematic reviews was used. RESULTS: The results are presented under one main theme, 'Well-being as a multidimensional experience-interwoven in barriers and facilitators' and six sub-themes representing barriers to and facilitators of well-being in an ICU. Barriers identified were physical stressors, emotional stressors, environmental disturbances and insecurity relating to time and space. Facilitators were meeting physical needs and activities that included dimensions of a caring and relational environment. CONCLUSION: Our main findings were that experiences of well-being were multidimensional and included physical, emotional, relational and environmental aspects, and they were more often described through barriers than facilitators of well-being. RELEVANCE FOR CLINICAL PRACTICE: This integrative review has shown that it is necessary to adopt an individual focus on patient well-being in an ICU setting since physical, emotional, relational and environmental stressors might impact each patient differently.

Beneficial self-management support and user involvement in Healthy Life Centres-A qualitative interview study in persons afflicted by overweight or obesity.

BACKGROUND: Relapse is high in lifestyle interventions involving behavioural change and weight loss maintenance. The purpose of lifestyle self-management interventions offered at Healthy Life Centres (HLCs) is to empower the participants, leading to self-management and improved health. Exploring beneficial self-management support and user involvement in HLCs is critical for quality, improving effectiveness and guiding approaches to lifestyle change support in overweight and obesity. OBJECTIVE: The aim of this study was to explore how persons afflicted by overweight or obesity attending lifestyle interventions in Norwegian HLCs experience beneficial self-management support and user involvement. METHOD: Semi-structured in-depth interviews were conducted with 13 service users (5 men and 8 women). Data were analysed using qualitative content analysis. RESULTS: One main theme was identified: regaining self-esteem and dignity through active involvement and long-term self-worth support in partnership with others. This main theme comprised four themes: (a) self-efficacy through active involvement and better perceived health, (b) valued through health-care professionals (HPs) acknowledgement, equality and individualized support, (c) increased motivation and self-belief through fellowship and peer support; and (d) maintenance of lifestyle change through accessibility and long-term support. CONCLUSION: Service users' active involvement, acknowledgement and long-term self-worth support from HPs and peers seem to support self-management and user involvement and may be some of the successful ingredients to lifestyle change. However, prolonged follow-up support is needed. A collectivistic and long-term perspective can integrate the importance of significant others and shared responsibility.

Qualitative evaluation in nursing interventions-A review of the literature.

Aim: To identify and synthesize qualitative evaluation methods used in nursing interventions. Design: A systematic qualitative review with a content analysis. Four databases were used: MEDLINE, PsycINFO, Embase and CINAHL using pre-defined terms. The included papers were published from 2014-2018. Methods: We followed the guidelines of Dixon-Woods et al., Sandelowski and Barroso, the Critical Appraisal Skills Programme qualitative checklist and The Confidence in the Evidence from Reviews of Qualitative Research Approach. Results: Of 103 papers, 15 were eligible for inclusion. The main theme Challenging complexity by evaluating qualitatively described processes and characteristics of qualitative evaluation. Two analytic themes emerged: Evaluating the implementation process and Evaluating improvements brought about by the programme. Conclusion: Different qualitative evaluation methods in nursing are a way of documenting knowledge that is difficult to illuminate in natural settings and make an important contribution when determining the pros and cons of an intervention.

Breast cancer survivors' experiences of dealing with information during and after adjuvant treatment: A qualitative study.

AIMS AND OBJECTIVES: To describe breast cancer (BC) survivors' experiences of participating in a 2-day educational programme (Breast Cancer School, BCS) and their critical reflection on information received during and after adjuvant treatment. The following research questions guided the study. How do BC survivors experience their participation in an educational programme? How do BC survivors experience the information trajectory during and after adjuvant treatment? BACKGROUND: BC is the most prevalent cancer among women in Norway. BC survivors have a substantial need for information about the disease, treatment and recovery. During the past few years, BC treatment in Norway has changed from inpatient- to outpatient-based treatment. Oncology nurses and oncologists are obliged to provide patients and their families with information, which has necessitated reorganisation of the procedures for providing information. New arenas such as the Breast Cancer School (BCS) offer the opportunity to learn from experts and fellow patients. DESIGN: Qualitative, descriptive design. METHODS: Focus groups with 20 BC survivors after having participated in the BCS were used to enable critical reflection. The COREQ checklist was followed to ensure rigour in the study. RESULTS: Two themes emerged from qualitative analysis: Balancing between the need for and the fear of information and Moving from a safe structure to lonely recovery. We identified differences between BC survivors in diversity, uniqueness and need for information. Continuity and expert knowledge provided by a primary oncology nurse and oncologists were highlighted as important. CONCLUSION: The study reveals the need for information tailored to each BC survivor's unique needs. The BC survivors expressed both the need for and the fear of information. BCS takes both a systematic and individual approach to provide expert information, dialog and the opportunity to meet with fellow patients. The transition from the structure of the treatment to lonely recovery after the most intensive treatment was perceived as unsafe and challenging. BC patients' experiences must be continuously valued and used to improve educational programmes, care and treatment. Oncology nurses play an important part in the information chain and continuity. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of including BC survivors in the design and evaluation of educational programmes. The provision of information and supportive care with continuity between oncology nurses and oncologists through the trajectory of treatment and care is crucial.

Interprofessional trust in emergency department - as experienced by nurses in charge and doctors on call.

AIMS AND OBJECTIVES: The aim of this study was to describe that which characterises interprofessional trust in a Norwegian emergency department, as expressed by nurses in charge and doctors on call. BACKGROUND: Interprofessional trust requires knowledge of and skills in interprofessional collaboration. It also requires established trust in fellow collaborators, as well as in the work environment and in the more comprehensive system in which the work is conducted. Nurses in charge and doctors on call who collaborate in the context of an emergency department do so under changing conditions in terms of staff composition and work load. DESIGN: The study was designed in a qualitative, inductive and sequential manner. METHOD: Data were collected from September-November 2013 through four focus group interviews and was analysed by means of qualitative content analysis. RESULTS: The data revealed two themes that were characteristic of interprofessional trust: 'having relational knowledge' and 'being part of a context'. Together, the themes can be understood as equally important to contextual collaboration. A model of interprofessional trust between an individual level and system level was developed from the results. CONCLUSION: The study indicates that interprofessional trust is a changeable phenomenon that has great impact on the possibility for development at an individual level and at a more abstract system level. RELEVANCE TO CLINICAL PRACTICE: Interprofessional trust can be improved by focusing on trust-building activities between staff at the individual level and between staff and organisation at the system level. Supportive activities such as continuous interprofessional education are suggested as valuable to the development and maintenance of trust.

Working with local nurses to promote hospital-nursing care during humanitarian assignments overseas: experiences from the perspectives of nurses.

AIMS AND OBJECTIVES: To describe how Norwegian expatriate nurses engaged in humanitarian assignments overseas experience working with the local nurses promoting nursing care in the hospital ward. BACKGROUND: Western countries have a long tradition of providing nurses with expert knowledge in nursing care for humanitarian projects and international work overseas. Studies from humanitarian mission revealed that health workers rarely acknowledge or use the local knowledge. However, there is a lack of studies highlighting expatriate nurses' experiences working with local nurses to promote nursing care in the hospital ward. DESIGN: This study applies a descriptive explorative qualitative design. METHODS: The data were collected in 2013 by means of seven semi-structured interviews and analysed using qualitative content analysis. FINDINGS: The data analyses revealed three themes related to the expatriate nurses' experiences of working with the local nurses to promote nursing care in the hospital ward: (1) Breaking the code, (2) Colliding worlds and (3) Challenges in sharing knowledge. The findings reflect different challenges when working with the local nurses. CONCLUSION: Findings indicate valuable knowledge gained about local nursing care and the local health and educational system. They also demonstrate challenges for the expatriate nurses related to the local nursing standard in the wards and using the local nurses' experiences and knowledge when working together. RELEVANCE TO CLINICAL PRACTICE: The findings can inform nurses, humanitarian organisations and institutions working overseas regarding the recruitment and the preparation of nurses who want to work cross- culturally or in humanitarian missions overseas.