The roles of the first-line nurse manager: perceptions from four perspectives.

AIM: To study the perception of the first-line nurse managers (FLNMs), registered nurses (RNs), assistant nurses (ANs) and head of departments (HDs) on the FLNM's current and desired roles. BACKGROUND: In the process of decentralization, the role of FLNM has changed from having overall responsibility for patients to having responsibility for the management of the ward. METHOD: Interviews with five FLNMs, five RNs, five ANs, and one HD were used. Qualitative content analysis was used to analyse the transcribed text. RESULTS: When describing the current roles, the FLNMs, RNs and ANs focused on the coordination of activities that contributed to a well-functioning service and care of patients as well as on the recruitment of, support to and development of the personnel. The HD focused on the FLNM's responsibilities towards the personnel, especially regarding empowerment and staff well-being. When describing desired roles, the FLNMs, RNs and ANs emphasized service on the ward while the HD underlined the development of services and co-operation with other nurse managers. CONCLUSION: The perception of the current and desired roles of the FLNM varied among the groups. The FLNMs, RNs and ANs reported a similar understanding which in turn differed from that of the HD who described fewer roles and focused on other areas.

Individual psychosocial support for breast cancer patients: a randomized study of nurse versus psychologist interventions and standard care.

In a prospective, randomized study, an individual psychosocial support intervention performed by specially trained oncology nurses, or psychologists, were compared with standard care. Consecutive primary breast cancer patients about to start adjuvant therapy (n = 179) were included. Data were supplied by the questionnaires European Organisation for Research and Treatment of Cancer Quality of Life Study Group Core Quality of life questionnaire with 30 questions (EORTC QLQ-C30) and Breast Cancer Module with 23 questions (BR23), the Hospital Anxiety and Depression Scale, Spielberger's State-Trait Anxiety Inventory, and the Impact of Event Scale before randomization and 1, 3, and 6 months later. Patient files provided data on utilization of psychosocial support offered in routine care. Global quality of life/health status, nausea and vomiting, and systemic therapy side effects were the subscales showing significant Group by Time interactions, favoring the interventions. Intervention groups improved statistically significantly more than the standard care group regarding insomnia, dyspnea, and financial difficulties. Nurse patients experienced less intrusion compared with the standard care group. All groups showed statistically and clinically significant improvements with time on several subscales. The intervention groups, however, improved to a greater extent. Fewer patients in the intervention groups used psychosocial hospital support compared with the standard care group. In conclusion, psychosocial support by specially trained nurses using techniques derived from cognitive behavioral therapy is beneficial for breast cancer patients and may be a realistic alternative in routine cancer care.

"Between Men": a psychosocial rehabilitation programme for men with prostate cancer.

The aim of this study was to evaluate the effect of psychosocial rehabilitation on newly diagnosed prostate cancer patients. The "Between Men" programme consisted of seven weekly sessions of physical training (Phys) alone, information (Info) alone or physical training plus information (PhysInfo). After diagnoses, patients (n = 211) were consecutively included, stratified and randomised to one of four groups: Phys, Info, PhysInfo or standard care control (C). A nurse specialised in urology, an urologist and a physiotherapist performed the interventions. Patients were followed up during one year with mailed standardised questionnaires. It could not be assumed that the "Between Men" programme had any effect on patients' anxiety and depression (HADS). Health-related quality of life (HRQOL) was associated with stage of disease but not with psychosocial intervention. Thus, Physical Function (PF), Role Function (RF) and Fatigue (FA) were inferior among patients with, than without, metastases of prostate cancer both at baseline and at the 12-month follow-up. This randomized study did not demonstrate any significant effect of psychosocial rehabilitation among prostate cancer patients. Considering the low rate (1/2), of included/eligible patients a less complicated design (intervention versus control) would have been preferred in order to increase power.

Comparison of a questionnaire commonly used for measuring coping with a daily-basis prospective coping measure.

BACKGROUND: Much research have investigated the relation between stress and health, with focus on the role of coping as a moderator. The use of the concept of coping is in need of more stringency since it is often used in a more or less careless manner. A contributory cause of the confusion within the research field is the often-negligent interpretation of results from the Mental Adjustment to Cancer (MAC) Scale (i.e., results are discussed in terms of coping strategies instead of mental adjustment). Furthermore, checklists are often used in research but seldom specify the stressor that patients are attempting to cope with. METHODS: Consecutive patients newly diagnosed with gastrointestinal (GI) cancer were included in this study. Of 151 eligible patients, 95 (63%) participated. As soon as their physical condition so permitted, patients were asked to assess their coping by way of two methods: an instrument commonly used for measuring coping (MAC Scale) and a daily-basis prospective coping measure [Daily Coping Assessment (DCA)]. The study investigated the relations between these two methods, which are used to evaluate different ways of coping with cancer, and related these to specified stressful events and psychologic distress outcomes [Hospital Anxiety and Depression Scale (HADS)]. RESULTS: Among patients with GI cancers, a comparison of the DCA with the MAC Scale renders important differences regarding the use of coping strategies. Furthermore, coping as measured by the DCA is more clearly separated from both stressors such as psychologic aspects and psychologic distress outcomes as measured by the HADS. DISCUSSION: A comparison between the two measures renders differences regarding the use of coping strategies among patients with GI cancers. The daily-basis prospective coping measure seems to be better separated from both stressful events and psychologic distress outcomes. The DCA offers a promising alternative to the use of coping checklists. The difference between the measures is in accordance with the original intention that the MAC Scale be used to measure mental adjustment rather than coping (i.e., the results do not support the use of the MAC Scale as a coping measure).

Satisfaction, utilisation and perceived benefit of individual psychosocial support for breast cancer patients--a randomised study of nurse versus psychologist interventions.

OBJECTIVE: In a prospective, randomised study, individual psychosocial support performed by: (1) specially trained oncology nurses (INS) or (2) psychologists (IPS) were compared with respect to utilisation, satisfaction and perceived benefit. METHODS: Between December 1997 and December 1999, consecutive breast cancer patients (n=120) were included at start of adjuvant therapy (chemo-, endocrine and/or loco-regional radiotherapy). Data were collected by an extended version of the 'IPS-patient satisfaction questionnaire' within 1 week after termination of the support intervention. Questionnaires were also mailed to all patients 6, 12 and 18-24 months after inclusion. Levels of distress were collected with the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) questionnaires. RESULTS: The patients were highly satisfied with the individual psychosocial support intervention they received, irrespective of which profession provided the support. However, the patients in the INS group reported higher levels of benefit regarding disease-related problems, regardless if the patients at baseline reported low or high levels of distress. CONCLUSIONS: Patients were highly satisfied with an individual psychosocial support intervention. In areas dealing with somatic aspects, the group intervened by nurses were more satisfied than the one by psychologists. PRACTICE IMPLICATIONS: Individual psychosocial support by specially trained nurses is a realistic alternative in routine cancer care.

High prevalence of self-reported depressive mood during the winter season among Swedish senior high school students.

OBJECTIVE: There are few studies regarding the prevalence of seasonal variation in mood among children and adolescents. The main objective of this study was to estimate the prevalence of self-reported depressive mood during the winter season among Swedish adolescents and to investigate gender differences. Another aim was to analyze the factor structure and internal consistency of the Kiddie SPAQ (K-SPAQ), a pediatric version of the Seasonal Pattern Questionnaire (SPAQ). METHOD: All students 17 to 18 years old, registered in the second year of senior high school in Falun, a district in central Sweden, were screened with the K-SPAQ in January 2003 (response rate 87.3%, n = 756). RESULTS: The prevalence of self-reported depressive mood during the winter season was estimated at 20.1% (n = 151/751) and was higher among girls (25.5%) than boys (13.8%). Approximately 8% reported more severe depressive symptoms. Depressive mood during the summer was rare (0.1%, n = 1/751). Factor analysis of the General Seasonal Score items in the K-SPAQ revealed a two-factor structure. A Cronbach's alpha of 0.87 demonstrated a good internal consistency. CONCLUSIONS: Depressive symptoms during autumn and winter were common among Swedish senior high school students, especially among girls. This is probably an underdiagnosed condition among adolescents that ought to receive more attention from the health and school authorities.

Relevance of philosophy of life and optimism for psychological distress among individuals in a stage where death is approaching.

The purpose was to investigate the relevance of philosophy of life as well as optimism for the psychological distress among Swedish individuals in a stage where death is approaching. Sixty-nine persons were included; of these were 42 patients newly diagnosed with advanced gastrointestinal cancer and 26 were partners to these patients. The participants' philosophy of life was studied through a semi-structured interview. The interview statements were subjected to content analysis. Optimism was measured by the Life Orientation Test and psychological distress by the Hospitality and Depression Scale. The results showed that optimistic respondents had less psychological distress. Two aspects of philosophy of life had relevance for such distress. These were wondering about why the cancer had occurred and having a feeling of being able to live a good life having or living near a person with advanced cancer. In conclusion, the above-mentioned aspects of philosophy of life as well as optimism have relevance for psychological distress among these individuals, which stress the importance that health-care staff address both patients' and their partners' concerns about their philosophy of life.

Factors related to long-duration pain and sick leave among Swedish staff working in the public health service.

The aim of the present study was to provide information about factors related to long-duration pain (LDP) (>3 months), sick leave (SL) and long sick leave (LSL) (>3 months) among staff in the community health services. The specific research question was: To what extent do data on activity, physical function, pain severity, psychological/cognitive factors, expectations of LDP, expectations to be working within 6 months and work satisfaction predict LDP, SL and LSL respectively? Logistic regression analyses were used to test predicted membership in the groups LDP, SL and LSL. In this context prediction refers to statistical prediction only, due to the cross-sectional design. Staff (n = 914) in the public health services in a medium-sized Swedish city completed a questionnaire during the spring of 2000. The results show that musculoskeletal pain and SL for this occupational group are common. Pain severity, expectations of LDP and fear-avoidance increased the odds of being in the LDP group, while kinesiophobia decreased the odds. Pain severity and kinesiophobia increased the odds of being in the SL group, while expectations to be working in 6 months decreased the odds. Only expectations to be working in 6 months predicted membership in the LSL group, decreasing the odds. Although some caution is warranted concerning the representativity of the sample, the results indicate that expectations about pain duration and ability to work are important psychosocial factors in LDP and LSL.

Food 21: a research program looking for measures and tools to increase food chain sustainability.

Food 21, an interdisciplinary research program encompassing the whole agro-food chain, was conducted in Sweden during 1997-2004. The challenges undertaken were to come up with environmental tools and solutions to existing nonsustainable practices along the entire food chain. This required close collaboration between the scientists and the food chain stakeholders. A set of goals characterizing sustainable food production is presented in this paper. Synthesis and systems analysis were the main tools used to analyze the sustainability of proposed changes. In this introduction we give an overview of the Food 21 concept and highlight some results. For example, we found that organic farming and organic products were not in general superior to conventional products and practices with respect to environmental impact and product quality. We also summarize the management experiences in this article, since we consider them to be rather unique and since they contributed to the overall success of the program.

Determinants of consumer behavior related to organic foods.

There have been many studies of what influences consumers in their decisions to purchase or consume organic foods, mainly concerned with fresh organic foods. These show a discrepancy between attitudes and behavior with people being positive about organic foods but often not purchasing them. This discrepancy seems to be explained by the fact that consumers do not consider "organically produced" to be an important purchase criterion, that organic foods are not perceived to surpass conventional foods regarding taste and shelf life (two qualities rated to be of great importance), and because of the perceived premium prices of organic foods. In two Swedish studies, health benefits were demonstrated to be more strongly related to attitudes and behavior toward organic foods than were perceived environmental benefits. A new European Union (EU) project will investigate the influences on both fresh and processed organic foods and investigate the role of moral, ethical, and affective influences on choice across eight EU countries.

Home transport and wastage: environmentally relevant household activities in the life cycle of food.

In environmental systems analysis of food production systems, the consumer phase (home transport, cooking, storing, and wastage) is an important contributor to the total life-cycle environmental impact. However, households are the least investigated part of the food chain. Information gathering about households involves difficulties; the number of households is large, and food-related activities are embedded in other household activities. In cooperation between researchers from environmental systems analysis and consumer research, Swedish households were surveyed by questionnaire, diary, and interviews. Data on home transport of food and wastage were collected. The average weekly driving distance was 28 to 63 km per household, depending on how trips made in conjunction with other errands are allocated. The wastage of prepared food ranged between 0 and 34% for different food categories, and wastage from storing between 0 and 164% (more food was discarded, e.g. by cleaning out a cupboard, than consumed). In both cases dairy products scored highest.

Personality traits as predictors of occupational performance and life satisfaction among mentally disordered offenders.

The study investigated to what extent personality traits, e.g. socialization, proneness for anxiety, aggression and hostility were associated with and predictive of self-reported and observed occupational performance and perceived life satisfaction among male mentally disordered offenders (MDOs). Also, subjects with psychopathic-related personality traits were compared with subjects without such traits regarding demographic data and dependent variables. The MDOs were included from the Swedish National Board of Forensic Medicine. A total of 55 subjects were visited at their hospital ward for data collection with the Karolinska Scales of Personality (KSP), Capability to Perform Daily Occupation (CPDO), Allen Cognitive Level Screen (ACLS) and the Manchester Quality of Life Scale (MANSA). Seven KSP scales and two KSP factors correlated significantly with the dependent variables. Regression analyses revealed that the KSP Socialization scale, the KSP Anxiety-proneness and Psychopathy factors were the most important predictors. Subjects with psychopathy differed from remaining groups by having more conduct disorders before 15 years, being more often brought up in outcasted families and less subjected to measures of pupil welfare activities. The life history was concluded to be important influencing occupational performance and life satisfaction. Subjects with high anxiety proneness should be given attention in treatment planning.

High prevalence of self-reported winter depression in a Swedish county.

The prevalence of winter depression was unknown in Sweden, therefore prevalence figures of seasonal affective disorder (SAD) and subsyndromal SAD (S-SAD) were estimated. Age and gender differences, prevalence in the group of non-responders and some psychometric qualities of the Seasonal Pattern Assessment Questionnaire (SPAQ) were calculated. A modified version of the SPAQ was sent to a random sample of 2500 persons (response rate 66.3%, n=1657) between 18 and 64 years residing in Dalarna, a county in central Sweden. The sample was proportionally stratified according to age, gender and home municipality. The prevalence of winter SAD was estimated at 8% and S-SAD at 10.8%. It was approximately twice as common among women and younger persons. A total of 3.1% reported seasonal problems to be severe or disabling and 19.3% that everyday life was negatively affected. Experiencing seasonally changing depressive symptoms was common in the population. Factor analysis of the Global Seasonal Score resulted in one factor and the internal consistency was 0.88 (Cronbach's alpha). The results indicate that self-reported recurrent depression during winter is common in Sweden and should therefore receive more attention from health care authorities.

Substantial changes in life: perceptions in patients with newly diagnosed advanced cancer and their spouses.

There are few studies on patients' perceptions of their situation after being recently diagnosed with an advanced gastrointestinal cancer and those of their spouses. Fourteen patients and their spouses were interviewed separately. The interviews were analyzed using a phenomenographic approach. The analysis indicated that the response categories for patients and spouses were roughly the same, but the number of patients and spouses who made statements differed between categories. All informants perceived substantial changes in life. This included negative physical, mental, and practical changes as well as positive changes. Mental changes included 3 categories: despair, why, and uncertainty. The informants described several ways of handling these changes in life. The most frequently reported by patients were that "one shouldn't complain" and by spouses to "hope," and by all informants to "make the best of it." Other ways of handling the situation were reconciliation, avoidance, preparation for death, seeking support, and isolation. In conclusion, more patients than spouses seemed to accept their situation because fewer patients complained and instead prepared for death, whereas more spouses felt despair, used hope and avoidance, and were preoccupied with practical matters. These findings suggest that spouses are a vulnerable group and healthcare staff should be just as aware of their situation as that of the patients.

Swedish mothers and fathers of a child diagnosed with cancer--a look at their quality of life.

Quality of life was investigated among Swedish mothers (n = 118) and fathers (n = 83) of children on (n = 57) and off (n = 68) cancer treatment. Parents completed the Göteborg Quality of Life Instrument, measuring (a) burden of 30 symptoms organized as follows: depression, tension, head, heart-lung, metabolic, musculo-skeletal, and gastrointestinal-urinary symptoms, and (b) experience of well-being with regard to 18 items organized as follows: physical, social, and mental well-being. Fathers reported higher mental well-being than mothers and more mothers than fathers reported symptoms of depression. Within the same family (n = 70), mothers reported lower mental well-being and more symptoms than fathers. Parents of children on treatment (n = 92) reported lower social and mental well-being and more symptoms of depression than parents with children off treatment (n = 101). The findings suggest that fathers experience a better quality of life than mothers and that parents of children off treatment enjoy a better quality of life than parents of children on treatment.

Health-related quality of life among patients with ichthyosis.

Ichthyosis encompasses a heterogeneous group of hereditary skin disorders, which can be present at birth or develop in childhood. The aim of the present study was to investigate the Health related quality of life (HRQoL) of patients with ichthyosis. Two questionnaires (Dermatology Life Quality Index [DLQI], and the generic Short Form [SF] - 36) and a subjective measure of disease activity employing a visual analogue scale (VAS) were mailed to 144 patients. 122 patients aged 17-78 years responded. The median for DLQI was 5.0, which was significantly higher (worse) for Lamellar ichthyosis than for X-linked recessive ichthyosis. The SF-36 showed significantly lower (worse) scores for the study group in four of the eight dimensions compared to age- and gender-adjusted Swedish norm scores. No differences in SF-36 were found between men and women or between the different groups of ichthyosis. The results demonstrate that ichthyosis has an adverse effect on HRQoL.

Coping strategies of people with kidney transplants.

BACKGROUND: There has been little research into coping process following renal transplantation, but it has been shown that health-related stress is not eliminated and that fear of rejection and economic factors are the most stressful issues. Coping strategies used have included prayer, looking at problems objectively, and trying to main control over the situation. AIM: The study was concerned with kidney transplant patients and their efforts to cope with problems posed by the transplantation and treatment. The aim was to describe and compare the use and perceived effectiveness of different coping strategies in people after kidney transplant with an age, gender and civil status-matched sample of the general Swedish population. METHODS: Coping was assessed by the Jalowiec Coping Scale and self-rated efficiency with visual analogue scales. From a total of 73 post-transplant patients, a consecutive series of 30 was compared with an age, gender and civil status-individually matched sample of the general Swedish population (n = 30). Data were collected from 1994 to 1997. RESULTS: The patient sample used significantly more optimistic, self-reliant, supportive and emotive coping than the general population sample. Evasive, emotive, and fatalistic coping were associated with low perceived efficiency in handling various aspects of the condition. STUDY LIMITATIONS: The study design does not permit causal conclusions and the patient sample was relatively small and non-randomly chosen, which could affect its external validity. CONCLUSIONS: The results suggest that assessment of coping strategies should be explored in clinical nursing practice so that nurses can encourage the use of those likely to be more useful, and discourage those with possible negative effects.

Quality of life in adults with congenital ichthyosis.

BACKGROUND: Little is known about the quality of life of people with congenital and generalized skin diseases. Describing life history and quality of life from an individual perspective could increase understanding of living with generalized congenital ichthyosis for nursing staff and others. AIM: The aim of our study was to illustrate how middle-aged and older people with lamellar ichthyosis or epidermolytic hyperkeratosis describe the effects of their disease on their quality of life. METHODS: Six women and four men aged 56-80 years participated. A global clinical assessment of the severity of the disease was performed. The Nottingham Health Profile (NHP) questionnaire was used to investigate quality of life. Participants were interviewed face-to-face about childhood and adulthood experiences of living with a skin disease. Interview data were analysed using content analysis. RESULTS: Interview data were assigned to two categories, childhood and adulthood, and organized under 16 themes. All interviewees reported that their skin disease had affected them negatively to varying degrees during their entire lives, and that the most problematic period was childhood. Coping strategies used during childhood were hiding of the skin and developing shyness. There were no correlations between objective signs of ichthyosis and the NHP scores. CONCLUSIONS: Congenital ichthyosis appears to affect several aspects of life negatively, and it is hoped that an understanding of the effects of the disease will lead to more efficient nursing care.

Patient-reported quality of life before, compared with after a DRG intervention.

OBJECTIVE: To evaluate the effects of the introduction of a payment system based on Diagnosis-Related Groups (DRG) on orthopedic patients' perceptions of quality of life after discharge. DESIGN: A prospective longitudinal study performed between 1992 and 1996. SETTING: Two surgical clinics in the County of Gävleborg, Sweden. STUDY PARTICIPANTS: The selection of patients was defined by surgical treatments/diagnoses, and by geographical area. Out of the 40 consecutively recruited patients per year from each hospital, >85% (n = 145 + 140 = 285) completed a questionnaire 1 week post-discharge, and >75% (n = 128 + 127 = 255) did so at a 6-week follow-up. MAIN OUTCOME MEASURE: The Swedish Health-Related Quality of Life Survey (SWED-QUAL) was used to assess quality of life. Straight factoral analyses of variance (ANOVAs) were performed to compare years of assessment in the same hospital/district. RESULTS: The results demonstrated no pattern of significant pre-post differences in patient-reported quality of life. In all years, most quality of life ratings were lower at 1 week compared with 6 weeks after discharge. These differences were probably the consequence of recently undergone surgery. CONCLUSION: The overall conclusion is that changes implemented in health care, including the DRGs, had no demonstrable impact on patient ratings of quality of life.

Attainment and importance of life values among patients with primary breast cancer.

The main aims of this study were to investigate the extent to which women with recently diagnosed primary breast cancer (N = 29) and matched control subjects without cancer (N = 29) differ in perceived attainment and importance of life values and to study prospectively life value ratings during 1 year in a large group of recent attendees at mammography screening (N = 706). Life values were assessed by a study-specific version of a life value questionnaire, including ratings of the perceived attainment and importance of seven life value dimensions. Women with a recent diagnosis of primary breast cancer were found to attribute significantly more importance to positive relations than healthy controls. No other differences between these groups were found regarding the attainment or importance of life values. Perceptions of life values were found to vary as a function of age, marital or cohabitation status, and parenthood, and to be stable over a 9-month period in screening attendees. The implications of the current findings for the understanding of women's psychological adaptation to breast cancer are discussed.