Long-term follow-up 3 years after a randomized rehabilitation study among radiated prostate cancer survivors.

PURPOSE: In the Rehabilitation of Prostate Cancer (RePCa) study, the intervention reduced early adverse effects in prostate cancer 6 months after radiotherapy. This 3-year follow-up study assesses late adverse effects, evaluates rehabilitative long-term effects and identifies patients who benefit the most. DESIGN: RePCa was a randomized clinical trial with multidisciplinary rehabilitation (n = 79) or usual care (n = 82). The intervention during the first 6 months consisted of consultations by nurses and physiotherapists focusing on psychosocial support and physical activity, respectively. Here we report the 3-year follow-up. Data consisted of disease-specific quality of life (EPIC-26), general quality of life (SF-12) and pelvic floor strength measured by electromyography. RESULTS: One hundred forty-three patients (92%) responded. The primary outcome urinary irritative sum-score was no longer significantly different between groups. In patients with moderate-severe urinary problems at baseline, we observed a significant long-term effect on the urinary irritative sum-score in favour of the intervention (+ 13.4 points P = .014). More patients had moderate-severe bowel problems in the control group (n = 10; 14%) compared to the intervention group (n = 2; 3%) (P = .016). Pelvic floor strength deteriorated significantly in both groups. CONCLUSION: The short-term rehabilitation was beneficial but of limited benefit in the long term for all patients. A significant and clinically relevant effect was found in irradiated prostate cancer patients with moderate-severe urinary problems at baseline. In both groups, pelvic floor strength was weakened during follow-up. IMPACT FOR CANCER SURVIVORS: Prior research showed patients benefit from early rehabilitation. Identification of patients with moderate-severe urinary problems followed by a focused rehabilitation during the first 6 months after radiotherapy results in long-term improvement. Radiated patients have to be aware of their pelvic floor strength. IMPLICATIONS FOR CANCER SURVIVORS: Patients can be informed that they benefit from early rehabilitation, and they cannot expect larger changes in adverse effects within the first years, but they have to be aware of their pelvic floor strength. Future rehabilitation studies could be applied mainly to patients with assessed rehabilitation needs after radiotherapy and intensified with long-term follow-up.

Effect of family nursing therapeutic conversations on health-related quality of life, self-care and depression among outpatients with heart failure: A randomized multi-centre trial.

OBJECTIVE: To evaluate the short-term (3 months) effects of family nursing therapeutic conversations (FNTC) on health-related quality of life, self-care and depression in outpatients with Heart failure (HF). METHODS: A randomised multi-centre trial was conducted in three Danish HF clinics. The control group (n = 167) received usual care, and the intervention group (n = 180) received FNTCs as supplement to usual care. Primary outcome was clinically significant changes (6 points) in Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score between groups. Secondary outcomes were changes in self-care behaviour and depression scores. Data were assessed before first consultation and repeated after three months. RESULTS: No statistically significant difference was found in the change of KCCQ, self-care and depression scores between the groups. KCCQ scores of patients in the FNTC group changed clinically significant in seven domains, compared to one domain in the control group, with the highest improvement in self-efficacy, social limitation and symptom burden. CONCLUSION: FNTC was not superior to standard care of patients with HF regarding health-related quality of life, self-care and depression. IMPLICATION FOR PRACTICE: Addressing the impact of the disease on the family, might improve self-efficacy, social limitation and symptom burden in patients with heart failure.

Male coping through a long-term cancer trajectory. Secondary outcomes from a RTC examining the effect of a multidisciplinary rehabilitation program (RePCa) among radiated men with prostate cancer.

BACKGROUND: The objective of this study was to examine if rehabilitation influenced self-reported male coping styles during and up to three years after treatment with radiotherapy for prostate cancer. MATERIALS AND METHODS: In a single-center oncology unit in Odense, Denmark, 161 prostate cancer patients treated with radiotherapy and androgen deprivation therapy were included in a randomized controlled trial from 2010 to 2012. The trial examined the effect of a multidisciplinary rehabilitation program within six months of treatment consisting of two nursing counseling sessions and two instructive sessions with a physical therapist (n = 79), or standard care (n = 82). As secondary outcomes coping was measured before radiotherapy, one month after radiotherapy (baseline), six month post-intervention (assessment) and three years after radiotherapy (follow-up) by the Mini-mental adjustment to cancer scale (Mini-MAC). The male coping styles towards the illness are expressed in five mental adjustment styles: Fighting Spirit, Helplessness-Hopelessness, Anxious Preoccupation, Fatalism and Cognitive Avoidance. Descriptive analysis and multiple linear regression analysis adjusting for the longitudinal design were conducted. RESULTS: Most coping styles remained stable during the patient trajectory but Anxious Preoccupation declined from before radiotherapy to follow-up in both intervention and control groups. After six months the intervention group retained Fighting Spirit significantly (p = 0.025) compared with controls, but after three years this difference evened out. After three years the intervention group had lower Cognitive Avoidance (p = 0.044) than the controls. Factors as educational level, and depression influenced the use of coping styles after three years. CONCLUSION: Multidisciplinary rehabilitation in irradiated prostate cancer patients retained the adjustment style Fighting Spirit stable after six months of radiotherapy, and in the long term reduced Cognitive Avoidance. Thus, the rehabilitation program supported the patient's active coping style and played down the passive coping style.

Validity and reliability of the Danish version of the 9-item European Heart Failure Self-care Behavior Scale.

OBJECTIVE: To assess the self-care of patients with heart failure (HF), reliable and validated instruments are needed. The aim of this study was to test the validity and reliability of the Danish version of the European Heart Failure Self-care Behavior Scale (EHFScBS-9) based on previous studies reporting 1, 2 and 3 factors, respectively. METHODS: A convenience sample of 147 patients with HF completed the EHFScBS-9. Psychometric properties of the Danish version of the EHFScBS-9 were tested with factor loadings, factor correlations and goodness-of-fit indices for four different measurement models based on confirmatory factor analysis. RESULTS: All of the items, except item 9 about regular exercise, demonstrated satisfactory item-total correlation ≥0.30. Regarding the fit of the models on the sample data, the most superior fit was observed for the two-factor solution in terms of root-mean-square error of approximation (RMSEA), goodness-of-fit index (GFI), adjusted GFI (AGFI) and comparative fit index (CFI), which all reached the predefined threshold value, except for the normed fit index (NFI) at 0.90. Factor score determinacy (FSD) for the four models tested was 0.88 for the one-factor solution, 0.54 and 0.87 for the two-factor model, 0.83-0.55 for the first three-factor model and 0.87-0.38 for the second three-factor model. CONCLUSIONS: The EHFScBS-9 questionnaire is a valid and reliable instrument to assess heart failure-specific self-care behaviours in a Danish population.

The Importance of Risk and Subgroup Analysis of Nonparticipants in a Geriatric Intervention Study.

Background. A major concern in intervention studies is the generalizability of the findings due to refusal of intended participants to actually take part. In studies including ill older people the number of those declining to participate may be large and the concern is therefore relevant. Objectives. To compare patients characteristics, rates of acute readmission, and mortality after one and six months among older persons who agreed and those who declined to participate in a randomized controlled trial and to describe subgroups of nonparticipants. Design. Comparative study based on a randomized controlled trial. Setting. University hospital in the Capital Region of Denmark. Participants. Patients ≥70 years discharged home after a short Emergency Department stay. 399 were requested to participate; 271 consented, whereas 128 refused. Results. Refusers were more likely to be readmitted (p < 0.001) or die (p = 0.006). The largest subgroup of refusers described as "too ill" had the highest risk of readmission (OR = 3.00, 95% CI = 1.61-5.47, p = 0.001) and of mortality within six months (OR = 3.50, 95% CI = 1.64-7.49, p = 0.002). However, this seems not to have affected the results of our randomized study. Conclusion. We recommend that intervention studies among older people or other fragile patient groups include analysis of relevant risk and subgroup analyses of refusers.

Seven- to nine-year-old children's own assessment of health-related quality of life is important in preventing overweight and obesity.

The aim was to study how, and to what degree, health-related quality of life (HRQOL), as assessed by children and their mothers, was related to overweight and obesity among children aged seven to nine years. Mother-child pairs of 149 non-overweight, 95 overweight and 16 obese children participated. We assessed HRQOL by the children's self-report and parent proxy report module of the PedsQL™ 4.0 Generic Core Scales. We found that non-overweight children scored HRQOL slightly higher than overweight ones but significantly higher than did obese children. The same pattern was seen for the mothers' proxy HRQOL score and mothers in general scored higher than the children did. The results indicate that mothers in general were not sufficiently aware of how overweight and obesity affect their children's HRQOL. The psychosocial dimension of HRQOL was the most important aspect for the children. Thus, there is a need for information of mothers/parents about the impact of overweight and obesity on children's HRQOL. Such intervention by health professionals may among other interventions help to prevent and reduce overweight and obesity among children and thus help to increase the children's HRQOL throughout their lives.

Nurses' experience of using an application to support new parents after early discharge: an intervention study.

Background. A development towards earlier postnatal discharge presents a challenge to find new ways to provide information and support to families. A possibility is the use of telemedicine. Objective. To explore how using an app in nursing practice affects the nurses' ability to offer support and information to postnatal mothers who are discharged early and their families. Design. Participatory design. An app with a chat, a knowledgebase, and automated messages was tried out between hospital and parents at home. Settings. The intervention took place on a postnatal ward with approximately 1,000 births a year. Participants. At the onset of the intervention, 17 nurses, all women, were working on the ward. At the end of the intervention, 16 nurses were employed, all women. Methods. Participant observation and two focus group interviews. The data analysis was inspired by systematic text condensation. Results. The nurses on the postnatal ward consider that the use of the app gives families easier access to timely information and support. Conclusions. The app gives the nurses the possibility to offer support and information to the parents being early discharged. The app is experienced as a lifeline that connects the homes of the new parents with the hospital.

The development of family nursing in Denmark: current status and future perspectives.

Over the past 12 years, a strong foundation for family nursing has been built in Denmark, with rapid growth in the past 3 years. A review of nursing research conducted in Denmark and published between 2002 and 2013 found 15 studies that examined family phenomena. The majority of the studies used descriptive methods with data collected from surveys and interviews involving family members either together or individually. Only five of the studies examined interventions that included families' perspectives about the intervention being evaluated. Several current research projects lead by Danish nurses examine the implementation of family nursing knowledge to clinical settings. Integration of family nursing theory has begun in Denmark in undergraduate and graduate nursing curricula and in May 2013, the Danish Family Nursing Association was officially established. Infrastructure and financial conference support has made it possible to invite Nordic and international colleagues to meet in Denmark, which, reciprocally, expands understanding and support for family nursing within the country. Further collaboration between Danish nurse researchers, educators, and administrators will help sustain the growth of family nursing science and its application in family-focused nursing practice.

Continuity in care trajectories of older chronically ill patients in a battlefield of competing rationales.

BACKGROUND: Continuity is crucial when caring for older chronically ill patients. Research has shown that the integration of patients' own perspectives on their situation is of utmost importance for continuity and quality of care. Studies have, however, demonstrated a number of problems with health professionals' communication concerning older patients, leading to lack of continuity and integration of the patient perspective in care and treatment. In spite of these problems being well investigated, they continue to prevail. OBJECTIVES: To examine conditions for continuity and integration of the patient perspective in older, chronically ill patients' care as reflected in nursing staff's communication about the patients. DESIGN: Explorative Participatory Action Research (PAR). SETTING: An acute, general medical ward at a Danish university hospital. PARTICIPANTS: Hospital and municipality nurses (n = 29). Nursing records (n = 12). METHOD: Field studies: observations, interviews, nursing records audits and logs. Data were subject to manifest and latent content analysis. RESULTS: Participants were aware of the importance of ensuring continuity, a comprehensive approach and integration of the patient perspective in care trajectories of older, chronically ill patients. Although they adhered to these ideals, they rarely pursued them in practice. Hindering factors were: organisational values, episodic focus on patients and lack of time. They felt caught in a value conflict between nursing professional values and system values, which caused a feeling of powerlessness, maintaining status quo in their clinical practice. CONCLUSION: The prevailing episodic focus and the competing rationales on the ward constituted a barrier to continuity and integration of the patient perspective in a comprehensive way.

Do families after early postnatal discharge need new ways to communicate with the hospital? A feasibilility study.

OBJECTIVE: the length of the postnatal hospital stay in Denmark as well as globally has been radically reduced over the past 10-20 years and this raises the challenge of finding new ways of providing observation and support to families discharged early, that they otherwise would be provided as inpatients. AIM: this study is to identify the nursing support needs of new parents and their infants during the first seven days post partum, by drawing on the experiences of all stakeholders' in early postnatal discharge from hospital, and thereby gaining new knowledge to investigate further whether telemedicine is a viable option in providing the required support. DESIGN: this article describes the first phase of a participatory design process. A qualitative approach guided the research process and the data analysis. Data were collected from participant observation, qualitative interviews with the new parents, focus groups interviews and a workshop attended by the new parents and health-care professionals. PARTICIPANTS AND SETTING: the total number of participants in this study was 37; nineteen parents and 18 health-care professionals from one hospital and three municipalities in Denmark. FINDINGS: the investigation findings highlighted, amongst other aspects, the importance of individualised postnatal follow-up in which families have increased access to the health-care professionals and are provided with timely information tailored to their specific needs. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the present study underscored that the families experiencing early discharge were not provided with seamless individualised follow-up support. They requested more availability from the health-care system to respond to their concerns and questions during the postnatal period. They experienced a barrier in attempting to contact health-care professionals following hospital discharge and they asked for new ways to communicate that would eliminate that barrier and meet their needs for more individualised and timely information and guidance.

Childhood Overweight Dependence on Mother-Child Relationship.

The causes of childhood overweight are numerous and inter-related. The mother-child relationship is of great significance for the child's health. Previous studies have found patterns of dysfunctional interaction in families with obese children. Therefore, development of childhood overweight could be due to the mother-child relationship. The aim of this study was to investigate how, and to what degree, the mother-child relationship, assessed by the mothers, was related to overweight among children aged seven to nine years. The study was a cross sectional case-controlled one. It included 111 overweight and 149 non-overweight seven to nine year old children and their mothers. Weight status was determined according to the International Obesity Task Force reference for children Body Mass Index, age and gender adjusted. An interviewer-administered questionnaire was used to categorize the mother-child relationship as: complementary, asymmetrical, symmetrical or symbiotic prototypes. There was no difference in mother-child relationships - characterized by the prototypes - between the overweight and non-overweight mother-child pairs. Therefore, we conclude that the mother-child relationship has no bearing on the child's weight status according to the prototypes. It is suggested that it is more the culture, or the universal phenomenon of expressing love through food, than the mother-child relationship, which influences the development of childhood overweight, or that the mothers are not capable of assess the true attachment style between themselves and their children.

Identifying factors significant to continuity in basic palliative hospital care-from the perspective of patients with advanced cancer.

Based on the research method grounded theory and semistructured patient interviews at home following hospitalization, the aim was to provide information on issues relating to the identification and alleviation of patients' physical and emotional problems, understood as continuity in palliative care. The interviews were based on selected problems that patients found significant. The results are distilled into the core category disheartening interactions and four categories: falling outside the professional framework, not being seen as a person, unidentified/unmet need for guidance and involvement, and patient strategy-minimizing conflict. The categories are significant in generating and maintaining continuity in basic palliative care.

Testing a two step nursing intervention focused on decreasing rehospitalizations and nursing home admission post discharge from acute care.

Older adults are at high risk of readmission on discharge from the Acute Medical and Emergency Department (ED). This study examines the effect of a two-stage nursing assessment and intervention to address older adults' uncompensated problems and thus intend to prevent readmission and functional decline. A randomized controlled study was conducted. Included were 271 patients aged 70 and over admitted to an ED. A brief standardized nursing assessment and intervention was carried out after discharge and at follow-up. No effect was found on readmission to hospital, admission to nursing home, or death but the intervention group was less likely to be at risk of depression after 180 days. Whether this method can be recommended needs further study as well as knowledge is needed as to the organization and to reveal older adults' experiences on follow-up after ED stay.

Action competence obstacles to managing childhood overweight: in-depth interviews with mothers of 7- to 9-year-old children.

This qualitative phenomenological study interviewed seven mothers to overweight children and six mothers to non-overweight children aged 7 to 9 years old about their views and experiences with preventing and managing overweight in their children. The essence was that the mothers felt responsible for their children's habits, including those leading to overweight. They also felt that competent and had the opportunity to take preventive measures against child overweight but they did not always have the energy to do so. Even resourceful mothers required support from nurses and health professionals. Our results contribute to better understanding how to approach, motivate and support mothers to draw on their own competencies to benefit their children's weight and health.

Living alone, obesity and smoking: important factors for quality of life after radiotherapy and androgen deprivation therapy for prostate cancer.

BACKGROUND: While effective treatment of prostate cancer with radiotherapy and hormones increase survival, adverse effects may reduce quality of life (QoL). The aim of this study was to investigate frequency and severity of self-assessed late adverse effects, and identify the patients most exposed. MATERIAL AND METHODS: QoL of 317 cancer survivors with primary stage T1-T3 prostate cancer treated with conformal radiotherapy (70-78 Gy) and androgen deprivation therapy was analyzed by using SF-12 and EPIC-26 questionnaires. Patients were stratified into three groups, filling out the questionnaires 1-2, 2-3, and 3-4 years after radiotherapy. Differences between groups were tested with ANOVA and the χ(2) test. The influence of marital status, severe obesity, smoking, stage of disease, and applied dose of radiotherapy on QoL was evaluated with multiple linear and logistic regression analyses. RESULTS: Of 337 patients, 317 (94%) answered the questionnaire. The sexual and hormonal summary scores in the EPIC significantly improved during time since radiotherapy (p < 0.001). Current smoking had a negative effect on SF-12 Physical Component Summary (PCS) and the Mental Component Summary (MCS) scores, on EPIC bowel overall bother (OR 7.8; p = 0.003), on EPIC mean urinary incontinence scores, and on the sexual domain. Severe obesity had a negative influence on SF-12 PCS and vitality. Severe obesity also was a negative predictor for moderate-to-severe problems in the EPIC urinary incontinence, and in the hormonal domain. Living alone was associated with lower SF-12 PCS, MCS scores, and SF-12 general health, social functioning, and the EPIC hormonal domain. The stage of disease or the radiation dose had no statistically significant impact on QoL. CONCLUSION: Results showed significant negative associations between smoking, severe obesity and living alone on self-assessed late adverse effects after radiotherapy for prostate cancer. This information may guide rehabilitation.

Gynecological cancer patients' differentiated use of help from a nurse navigator: a qualitative study.

BACKGROUND: Fragmentation in healthcare can present challenges for patients with suspected cancer. It can add to existing anxiety, fear, despair and confusion during disease trajectory. In some circumstances patients are offered help from an extra contact person, a Nurse Navigator (NN). Scientific studies showing who will benefit from the extra help offered are missing. This study aims to explore who could benefit from the help on offer from a nurse appointed as NN in the early part of a cancer trajectory, and what would be meaningful experiences in this context. METHODS: A longitudinal study with a basis in phenomenology and hermeneutics was performed among Danish women with gynecological cancer. Semi-structured interviews provided data for the analysis, and comprehensive understanding was arrived at by first adopting an open-minded approach to the transcripts and by working at three analytical levels. RESULTS: Prior experience of trust, guarded trust or distrust of physicians in advance of encountering the NN was of importance in determining whether or not to accept help from the NN. For those lacking trust in physicians and without a close relationship to a healthcare professional, the NN offered a new trusting relationship and they felt reassured by her help. CONCLUSIONS: Not everyone could use the help offered by the NN. This knowledge is vital both to healthcare practitioners and to administrators, who want to do their best for cancer patients but who are obliged to consider financial consequences. Moreover patients' guarded trust or distrust in physicians established prior to meeting the NN showed possible importance for choosing extra help from the NN. These findings suggest increased focus on patients' trust in healthcare professionals. How to find the most reliable method to identify those who can use the help is still a question for further debate and research.

Geriatric nursing assessment and intervention in an emergency department: a pilot study.

AIM: To describe and test a model for structured nursing assessment and intervention to older people discharged from emergency department (ED). BACKGROUND: Older people recently discharged from hospital are at high risk of readmission. This risk may increase when they are discharged straight home from an ED as time pressure requires staff to focus on the presenting problem although many have complex, unresolved, care needs. METHOD: A prospective descriptive pilot study was conducted. Older people aged 70 and over and at risk of adverse health and functional outcome were included. INTERVENTION: At discharge, and at 1 and 6 months follow-up, a brief standardised nursing assessment (ISAR 2) developed by McCusker et al. was carried out. The focus was on unresolved problems that required medical or nursing intervention, new or different home care services or comprehensive geriatric assessment. After assessment, the nurse made relevant referrals to the geriatric outpatient clinic, community health centre, general practitioner or made arrangements with next of kin. RESULTS: One hundred and fifty people participated, mean age was 81.7. At discharge, they had a mean of 1.9 unresolved problems, after 1 month 0.8, and after 6 months 0.4. Older people receiving home care services increased from 79% at discharge to 89% at 1 month and 90% at 6 months follow-up. CONCLUSION: ISAR 2 works well in a Danish ED setting and intercepts older peoples' problems. It seems that unresolved problems decrease when a nurse assesses and intervenes at discharge from ED, and at follow-up. However, a randomised controlled test should be carried out to confirm this. IMPLICATIONS FOR PRACTICE: Nursing assessment and intervention should be implemented in the ED to reduce older peoples' unrevealed problems.

The impact on self-efficacy of different types of follow-up care and disease status in patients with rheumatoid arthritis--a randomized trial.

OBJECTIVE: To explore the impact from different types of outpatient care, demographic and disease related variables on self-efficacy beliefs (SE) in patients with established rheumatoid arthritis (RA) after completing an educational program. METHODS: 287 adult RA outpatients with low disease activity and moderate physical disability from two Danish rheumatology clinics were randomized for follow-up care. (1) planned rheumatologist's consultations, (2) a shared care model without planned consultations, (3) planned nursing consultations. The participants' SE were assessed by the Danish versions of the rheumatoid arthritis self-efficacy questionnaire (RASE) and the arthritis self-efficacy scale (ASES). Data were collected at baseline, 3 months and one-year follow up and were explored in random intercept models. RESULTS: Following an educational programme the nursing group increased or stabilized their SE during the first year compared to the medical and the shared care group. SE in the shared care group did not differ significantly from the medical group. No difference between the groups was seen in disease activity at any time. CONCLUSION: Nursing consultations provide opportunities for maintenance of the patients' SE after patient education. PRACTICE IMPLICATIONS: Implementation of nursing consultations as part of follow-up care in patients with stable RA is recommended.

Newly qualified nurses--experiences of interaction with members of a community of practice.

AIM: To explore newly qualified nurses' (NQN) interaction with members of community of practice (CoP) and how it affects their participation in the CoP. BACKGROUND: The entry of NQNs into the health care service is problematic which can result in NQNs leaving the profession within the first years of their career. Studies indicate that interaction between NQNs and their colleagues has an important influence of the way in which the NQNs experience their participation in the community of practice. METHODOLOGY: Nine NQNs participated in the study. The data collection took place six months after graduating and the data were generated by participant observation and individual interview. The data were analysed inspired by Ricoeur's interpretation theory. RESULTS: Most of the participants expressed satisfaction in their job. They were employed in CoPs characterised by dialogue and with interest in NQNs as a professional as well as a private person. Participants who expressed some dissatisfaction in their job situation were employed in CoPs with less dialogue and with less interest in NQN. Uncertainty about their own capacity and less professional discussions results in NQNs repeatedly asking for specific answer to their questions. CONCLUSION: Mutual social and professional interest and acceptance increased NQNs' experience of being valued members of the CoP. Higher levels of dialogue and cohesion within the CoP corresponded with more active participation by NQNs and gave them a greater sense of security. Relevance for Clinical Practice NQNs' participation in a COP is influenced by the extent to which they are included in both professional and social interactions and afforded the opportunity to contribute with knowledge and experience from their nursing studies. Furthermore, the study indicates that NQNs' experience of social cohesion within the community appears to increase their professional performance.