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Davis G, Gaskin K, Molnár G, Bentley J. Places of Farewell: A Scoping Review Exploring Factors Influencing the Choice of Place of Death for Children when Death is Expected. Compr Child Adolesc Nurs 2024; 47:1-19. [PMID: 38995682 DOI: 10.1080/24694193.2024.2374239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/18/2024] [Indexed: 07/13/2024]
Abstract
Progression of ill health and death trajectories is different for children with a non-oncology diagnosis. As previous research has focused primarily on children with cancer diagnoses, this scoping review explored what factors influence the parent and/or child's choice of place of death for a child with a non-oncological complex care condition, when death is expected. Eighteen papers were identified considering the preferred place of death. The findings were themed into 1. Diagnostic Factors; 2. Home Factors; 3. Socio-economic Factors; 4. Parent Factors. In conclusion, informed discussions with families that recognize the reason for, and the impact of their choices, are necessary not only for the preferred place of death but also end of life care.
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Affiliation(s)
- Gilda Davis
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, UK
| | - Kerry Gaskin
- School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Gyozo Molnár
- School of Sport and Exercise Science, University of Worcester, Worcester, UK
| | - Jackie Bentley
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, UK
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2
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Oksholm T, Gissum KR, Hunskår I, Augestad MT, Kyte K, Stensletten K, Drageset S, Aarstad AKH, Ellingsen S. The effect of transitions intervention to ensure patient safety and satisfaction when transferred from hospital to home health care-A systematic review. J Adv Nurs 2023; 79:2098-2118. [PMID: 36762670 DOI: 10.1111/jan.15579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/08/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
AIM The aim of this systematic review is to describe and evaluate the effectiveness of transition interventions to safeguard patient safety and satisfaction during patients' transition from hospital to home health care. DESIGN Systematic review. DATA SOURCES MEDLINE, Ovid Nursing Database, PsycINFO, EMBASE, CINAHL, Clinical Trials and SveMed+ was systematic searched in January 2019 and September 2020 to identify peer-reviewed papers. No language, geographical or publication date restrictions. REVIEW METHODS Cochrane Handbook for Systematic Reviews of Interventions was used. Data analysis focused on aggregated data and a descriptive synthesis. Risk of bias was rated using Cochrane risk-of-bias tool. RESULTS In total, 10,524 references were identified in the literature search, twenty-six articles were included. The interventions were divided into three main groups: (i). systematic patient education pre-discharge; (ii). establishment of contact with the local healthcare services pre-discharge and (iii). follow-up initiated by nurses from the hospital at home post-discharge. The studies either used one intervention or combined two or three interventions. We considered the intervention to improve patient safety or satisfaction when they reported statistically significant results. Only four interventions increased both patient safety and satisfaction, seven interventions increased patient safety and thirteen increased patient satisfaction. Interventions that appear to be quite similar, with the same duration, measured different effects on patients' satisfaction and safety. Interventions that ensured patient safety did not necessarily facilitate patient satisfaction and vice versa. CONCLUSION Interventions can improve patient safety and satisfaction during transfer. However, interventions that improve patient safety or satisfaction do not always match. IMPACT This review suggests that transition interventions can improve patients' safety and satisfaction. However, to compare the impact of future interventions is it important to use standardized measurement tools of satisfaction. There is a need to try out tailored interventions, where interventions are customized to the needs of each patient.
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Affiliation(s)
- Trine Oksholm
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Karen Rosnes Gissum
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Irene Hunskår
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | | | - Kristin Kyte
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Kari Stensletten
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Sigrunn Drageset
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sidsel Ellingsen
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Hov R, Bjørsland B, Kjøs BØ, Wilde-Larsson B. Pasienters opplevelse av trygghet med palliativ omsorg i hjemmet. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/issn.2387-5984-2021-01-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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4
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Wieringa G, Dale M, Eccles FJR. The experience of a sample of individuals in the United Kingdom living in the pre-manifest stage of Huntington's disease: An interpretative phenomenological analysis. J Genet Couns 2021; 31:375-387. [PMID: 34374465 DOI: 10.1002/jgc4.1497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022]
Abstract
This paper explores the experience of ten individuals living in the UK who were in the pre-manifest stage of Huntington's disease (HD), a genetic neurodegenerative condition. Data were gathered using semi-structured interviews and analyzed using interpretative phenomenological analysis. Three themes were reported from the data: 'feeling limited by time', 'the perception of stalling time', and 'making the most of time', all highlighting the way in which time holds significant meaning when living in the pre-manifest stage of HD. This study has highlighted the difficulties experienced by individuals when adjusting to the pre-manifest stage of HD. Feeling able to manage their anxieties and dealing with ongoing uncertainty related to future deterioration was key to supporting their wellbeing, facilitated by factors such as positivity and hope. Individuals may benefit from counseling which supports them to develop proactive coping strategies to manage their anxieties and acceptance of an uncertain future.
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Affiliation(s)
- Gina Wieringa
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Maria Dale
- Leicestershire Partnership NHS Trust, Adult Mental Health Psychology, Leicestershire, UK
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
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Miller EM, Porter JE, Barbagallo MS. The Physical Hospital Environment and Its Effects on Palliative Patients and Their Families: A Qualitative Meta-Synthesis. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:268-291. [PMID: 34355608 DOI: 10.1177/19375867211032931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To review the latest qualitative literature on how the physical hospital environment affects palliative patients and their families. BACKGROUND People with a life-limiting illness may receive palliative care to improve their quality of life in hospital and may have multiple admissions as their illness progresses. Yet, despite a preference for a death at home, more than half of the dying population will receive end-of-life care in hospital. The physical hospital environment consists of ambiance, aesthetics, and architectural factors, and it is well known that the hospital's acute wards are not a homely environment. Demand is increasing for the physical environment to be improved to better meet the needs and demands of palliative and end-of-life patients and their families. METHOD Combining thematic analysis and meta-ethnography methodologies, 12 international qualitative papers were analyzed and synthesized by the three authors. RESULTS Findings resulted in the development of the SSAFeR Place approach that incorporates the concepts that are important to palliative and end-of-life patients and their families by describing an environment within the acute or palliative care units that feels safe, is private, customizable, and accommodates family; is a space to share with others, is homelike in ambiance and aesthetics, and is conducive for reflection. The concepts of identity, belonging, and safety are connected to the notions of home. CONCLUSIONS To provide person-centered care and to move the focus toward the palliative approach of comfort and quality of life, attention to room size, layout, aesthetics, and ambiance is needed.
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Affiliation(s)
- Elizabeth M Miller
- School of Health, 1458Federation University Australia, Churchill, Victoria, Australia
| | - Joanne E Porter
- School of Health, 1458Federation University Australia, Churchill, Victoria, Australia
| | - Michael S Barbagallo
- School of Health, 1458Federation University Australia, Churchill, Victoria, Australia
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Abstract
BACKGROUND Cancer treatment is increasingly provided on an outpatient basis, which may challenge patients and caregivers coping with illness and adverse effects at home. A telephone consultation is an accepted type of healthcare provision to support patients and prevent adverse outcomes when their capacity to self-manage is inadequate. Whether this option for help sufficiently supports patients needs further investigation. OBJECTIVES The aim of this study was to explore patients' and caregivers' experience of calling an oncological emergency telephone. METHODS The study applies a phenomenological hermeneutic approach with 12 semistructured interviews. Patients and caregivers who had called the oncological emergency telephone within the last 2 months were included. The interview texts were analyzed by content analysis. RESULTS Patients and caregivers perceive the emergency telephone as a lifeline that they consider calling when the patient's condition changes from what they understand as normal to what they perceive as abnormal. They would rather call "one time too many than one time too few" if their resources are inadequate to ensure their safety. The tone, attitude, and professional competency of healthcare providers affect patients' experience of the call. CONCLUSIONS The value of calling the oncological emergency telephone depends on the healthcare providers' professional competences and skills to establish a relationship that makes patients feeling accommodated and taken care of. IMPLICATIONS FOR PRACTICE Patients' and caregivers' perceptions of what constitutes a good telephone consultation represent significant knowledge that contributes to a more comprehensive and practice-based understanding of what is required to advise patients and caregivers in an oncological emergency telephone.
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Transitions during end-of-life care from the perspective of informal caregivers - A concept analysis using Rodgers' (2000) evolutionary approach. Eur J Oncol Nurs 2021; 51:101899. [PMID: 33545654 DOI: 10.1016/j.ejon.2021.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To produce a conceptual and operational definition of transition, in the context of end-of-life care, as experienced by informal caregivers. METHODS AND SAMPLE The authors used Rodgers' (2000) concept analysis framework to examine this concept. FINDINGS Common themes emerged using Rodgers' (2000) inductive approach confirming transition for informal caregivers at the end of life as a process comprising the presence of trigger(s)/event(s), awareness, instability and engagement/learning while maintaining normality. There was also duration to this process that was often unknown and unpredictable. This concept analysis provides useful insight into understanding the complex dynamics of transition during this period. The primary antecedent of this concept, prompting transition, is a diagnosis of non-curative disease for the patient. In some cases, a gradual realisation rather than a formal diagnosis that the illness has progressed to a non-curative stage, can also be an antecedent. CONCLUSION Transition during end-of-life-care for informal caregivers can be a highly emotional time for this vulnerable cohort. Effective transitioning can ensure a stability and quality end-of-life outcomes, such as a peaceful death, as the awareness and learning that it brings, prompts planning actions for terminal care. Through recognising the findings of this concept analysis, deeper insight may be gained to support the provision of care, by nurses, to informal caregivers, prompting them towards effective transitions that foster the best interest of the patient.
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Lehmann OV, Hansen M, Hurme H. This is the real “death-line” AND I am still alive: A collaborative reflexivity about life trajectories. CULTURE & PSYCHOLOGY 2020. [DOI: 10.1177/1354067x20922132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we, Olga Lehmann, Mixo Hansen and Helena Hurme, engage in a process of collaborative reflexivity upon living, aging, and dying as we attempt to make sense of the illnesses of the last author. The companionship that emerged between us in the plurality of our identities as friends, colleagues, coauthors, and women, encouraged us to revisit aspects of the theories in developmental-cultural psychology such as (a) the process of meaning-making, (b) the equifinality model in relation to aging and dying, and (c) the notion of personal life philosophies in relation to virtues. Based on our personal experiences as well as our collaborative reflexivity as scholars, we highlight that developmental-cultural psychology could more explicitly address existential transitions, such as dying and existential givens, such as uncertainty in its theories. We present as well some preliminary integrations between existential and cultural perspectives of meaning-making.
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Affiliation(s)
- Olga V. Lehmann
- Department of Mental Health, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Helena Hurme
- Department of Developmental Psychology, Åbo Akademi University, Turku, Finland
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Harley K, Willis K. Living with motor neurone disease: an insider's sociological perspective. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2020; 29:211-225. [PMID: 33411656 DOI: 10.1080/14461242.2020.1789487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 06/12/2023]
Abstract
This article is a discussion between two former colleagues and longstanding friends about the lived experience of illness and disability. In January 2013, Kirsten Harley, a promising early career sociologist was diagnosed with motor neurone disease (MND), a degenerative neurological condition with a typical life expectancy of 2-3 years. In this article, which is part interview and part shared reflection, we consider how Kirsten's knowledge of sociology has shaped her responses to the illness. We 'discuss' the process of meaning making, health system navigation, interactions with health professionals, advocacy, becoming a 'passive activist', the role of technology and what we, as sociologists, might learn from a life so dramatically changed.
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Affiliation(s)
- Kirsten Harley
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Karen Willis
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Meeker MA, McGinley JM, Jezewski MA. Metasynthesis: Dying adults' transition process from cure-focused to comfort-focused care. J Adv Nurs 2019; 75:2059-2071. [PMID: 30734354 DOI: 10.1111/jan.13970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
AIM To describe and explain the process of transition from cure-focused to comfort-focused health care as perceived and reported by patients, family members, and healthcare providers. BACKGROUND Moving into the last phase of life due to advanced illness constitutes a developmental transition with increased vulnerability for patients and family. DESIGN Qualitative metasynthesis. DATA SOURCES Medline, CINAHL, and PsycInfo databases searched from inception through March 2016. Primary research reports published from 1990 to 2015, using qualitative designs to report transition experiences of patients, family members, and/or healthcare providers were included. REVIEW METHODS Key elements were extracted and organized into matrices. Findings from each report were analysed using qualitative coding. RESULTS The sample was 56 unique reports from 50 primary studies. Patients and families emphasized the importance of receiving understandable information, emotional support, respect for personhood and control. The critical juncture of 'realizing terminality' preceded a transition to comfort-focused care. Subsequently, a shift in goals of care emphasizing comfort and quality of life could occur. Continued provision of information, effective support, respect and control promoted 'reframing perceptions' and capacity to embrace a changed identity. Reframing allowed patient and family to find meaning and value in this last phase of life and to embrace the opportunity to prepare for death, nurture relationships, and focus on quality of living. CONCLUSION Understanding the developmental process that can be engaged by patients and families at the end of life provides a theoretical basis that can inform choice and timing of interventions to reduce suffering and enhance positive outcomes.
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Madsen R, Uhrenfeldt L, Birkelund R. Transition experiences during courses of incurable cancer from the perspective of patients. Eur J Oncol Nurs 2019; 38:13-20. [DOI: 10.1016/j.ejon.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/14/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
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Lorentsen VB, Nåden D, Sæteren B. The paradoxical body: A glimpse of a deeper truth through relatives' stories. Nurs Ethics 2018; 26:1611-1622. [PMID: 29695197 DOI: 10.1177/0969733018768660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People with progressive cancer experience that their bodies change due to disease and/or treatment. The body is integral to the unity of the human being, a unity that must be perceived as whole if dignity shall be experienced. Relatives are in touch with the suffering bodies of their dear ones, physically, socially, mentally, and existentially, and thus the relatives' experiences of the bodies of their dear ones might yield insight into the concept of dignity. AIM The aim of this study is to explore relatives' experiences of the patients' bodily changes from a perspective of dignity. RESEARCH DESIGN AND METHOD A total of 12 relatives from a hospice in Norway were interviewed. Gadamer's ontological hermeneutics inspired the interpretation. ETHICAL CONSIDERATIONS The principles of voluntariness, confidentiality, withdrawal, and anonymity were respected during the whole research process. The Norwegian Social Science Data Services approved the study. RESULTS AND CONCLUSION The conversations about the body were conversations about ambivalent or paradoxical matters that shed light on the concept of dignity. The results show that the relatives got in touch with elements that otherwise would have remained tacit and unspoken, and which gave glimpses of a deeper truth, which might reveal the core of dignity. Furthermore, the relatives' confirmation of the ambivalence might be understood as a strong ethical obligation to treat the other with dignity. The confirmation may also reveal the relatives' unselfish love of the other, which can be understood as the core of ethics and ethos. Finally, the results reveal the relatives' limited insight into their dear ones' bodily changes, and we discuss the challenges of truly seeing the other. Body knowledge and the relationship between body and dignity as phenomena cannot be ignored and needs more attention and articulation in clinical nursing practice and in nursing research.
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Affiliation(s)
| | - Dagfinn Nåden
- Oslo and Akershus University College of Applied Sciences, Norway
| | - Berit Sæteren
- Oslo and Akershus University College of Applied Sciences, Norway
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Tryselius K, Benzein E, Persson C. Ideas of home in palliative care research: A concept analysis. Nurs Forum 2018; 53:383-391. [PMID: 29687445 DOI: 10.1111/nuf.12257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To explore the concept of home and its' expressed spatialities in current palliative care research. BACKGROUND Home is a central environment for living, caring, and dying. However, pure investigations of the sets of ideas linked to the concept seemed missing. Although identified as an important location, spatial perspectives expressed through the concept of home appeared unexplored. DESIGN Rodgers' evolutionary concept analysis. DATA SOURCES Scientific articles published between January 2009 and September 2015. REVIEW METHODS Rodgers' evolutionary concept analysis. Resulting attributes were explored from two geographically informed spatial perspectives. RESULTS As main results, six attributes were identified and explored: Home as actor-capable of acting; emotional environment-something people have feelings for; place-a part of personal identity and a location; space-complex and relational spatial connections and a site for care; setting-passive background and absolute space; becoming-a fluid spatiality constantly folded. Examples of attributes and suggestions for further concept development were identified. CONCLUSIONS The concept reflects various sets of ideas as well as expressing both relational and absolute perspectives of space. The most challenging for nursing research and practice seems to be investigation, operationalization, and testing the implementation of sets of ideas reflecting a relational thinking of space.
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Affiliation(s)
- Kristina Tryselius
- Department of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Eva Benzein
- Department of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Carina Persson
- Department of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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Hilding U, Allvin R, Blomberg K. Striving for a balance between leading and following the patient and family - nurses' strategies to facilitate the transition from life-prolonging care to palliative care: an interview study. BMC Palliat Care 2018; 17:55. [PMID: 29615009 PMCID: PMC5883396 DOI: 10.1186/s12904-018-0311-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background The transition from life-prolonging to palliative care (PC) can be challenging often characterized by psychical, physiological, social and existential changes. Knowledge of how to support the patient and family in this specific care phase is lacking, and this area needs to be further explored. The aim of this study was to investigate strategies that registered nurses (RNs) use to ease the transition from life-prolonging care to PC for patients with incurable disease. Methods The study has a descriptive design. Fourteen RNs working in a specialized PC unit were interviewed. The data were analysed using content analysis. Results The RNs’ strategies can be described under the categories “Getting to know the patient and creating a relationship”, “Providing support”, “Adapting to individuals’ needs” and “Enabling conversations”. Conclusion The findings show that the RNs in this population used strategies that not only took time but also required knowledge about the transition process and required the ability to identify and meet patients’ and families’ unique needs. Patients’ difficult and exposed situation needs to be addressed through a structured follow-up after informing about the change from life-prolonging care to PC. RNs have a unique role of supporting both the patient and the family in the transition from life-prolonging care to PC for patients with incurable disease.
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Affiliation(s)
| | - Renée Allvin
- Clinical Skills Centre, Örebro University Hospital, Örebro, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-70182, Örebro, Sweden
| | - Karin Blomberg
- Örebro University Hospital, Örebro, Sweden. .,Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-70182, Örebro, Sweden.
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Standing HC, Rapley T, MacGowan GA, Exley C. ‘Being’ a ventricular assist device recipient: A liminal existence. Soc Sci Med 2017; 190:141-148. [DOI: 10.1016/j.socscimed.2017.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 08/08/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
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Saarnio L, Boström AM, Gustavsson P, Hedman R, Öhlén J. Temporally and spatially shaped meanings of at-homeness among people 85 years and over with severe illness. Int J Older People Nurs 2017; 13. [PMID: 28840645 DOI: 10.1111/opn.12165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to illuminate how meanings of at-homeness are temporally and spatially shaped by older people with severe illness. BACKGROUND At-homeness can be understood as a feeling of being metaphorically at-home while experiencing well-being. The research field of at-homeness among older people with severe illness is under researched and knowledge about how at-homeness is shaped by time and place is limited. METHOD Narrative interviews were conducted in Sweden with a total of twenty men and women who were aged 85 years or over and affected by severe illness. The narrative interviews were analysed based on a phenomenological hermeneutical method. RESULTS Meanings of at-homeness that were shaped temporally and spatially were interpreted, where time and place were shaped individually by other aspects and also interwoven. Two main inter-related themes were constructed: shaping at-homeness through relying on a familiar place and shaping at-homeness through continuous balancing between the past, present and future. CONCLUSION AND IMPLICATIONS At-homeness is temporally and spatially shaped in two ways: through a process over time, or momentarily, where older people's earlier experiences and expectations are interwoven with their experiences of place and the people around them. The results of this study would be applicable to similar societal contexts. For future research, it is important to continue to study how at-homeness can be promoted for severely ill older people, in specific situations and over time.
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Affiliation(s)
- Lotta Saarnio
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Health Care Sciences, Ersta sköndal University College, Stockholm, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Geriatric Medicine, Danderyd hospital, Stockholm, Sweden
| | - Petter Gustavsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ragnhild Hedman
- Department of Health Care Sciences, Ersta sköndal University College, Stockholm, Sweden
| | - Joakim Öhlén
- Centre for Person-Centered care, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Understanding the Essential Meaning of Measured Changes in Weight and Body Composition Among Women During and After Adjuvant Treatment for Breast Cancer: A Mixed-Methods Study. Cancer Nurs 2016; 40:433-444. [PMID: 27636128 DOI: 10.1097/ncc.0000000000000427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Changes in weight and body composition among women during and after adjuvant antineoplastic treatment for breast cancer may influence long-term survival and quality of life. Research on factual weight changes is diverse and contrasting, and their influence on women's perception of body and self seems to be insufficiently explored. OBJECTIVE The aim of this study was to expand the understanding of the association between changes in weight and body composition and the women's perception of body and selves. METHODS A mixed-methods research design was used. Data consisted of weight and body composition measures from 95 women with breast cancer during 18 months past surgery. Twelve women from this cohort were interviewed individually at 12 months. Linear mixed model and logistic regression were used to estimate changes of repeated measures and odds ratio. Interviews were analyzed guided by existential phenomenology. RESULTS Joint displays and integrative mixed-methods interpretation demonstrated that even small weight gains, extended waist, and weight loss were associated with fearing recurrence of breast cancer. Perceiving an ambiguous transforming body, the women moved between a unified body subject and the body as an object dissociated in "I" and "it" while fighting against or accepting the body changes. CONCLUSIONS Integrating findings demonstrated that factual weight changes do not correspond with the perceived changes and may trigger existential threats. IMPLICATIONS FOR PRACTICE Transition to a new habitual body demand health practitioners to enter a joint narrative work to reveal how the changes impact on the women's body and self-perception independent of how they are displayed quantitatively.
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Pedersen B, Groenkjaer M, Falkmer U, Mark E, Delmar C. “The ambiguous transforming body” – A phenomenological study of the meaning of weight changes among women treated for breast cancer. Int J Nurs Stud 2016; 55:15-25. [DOI: 10.1016/j.ijnurstu.2015.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 02/08/2023]
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Horne G, Payne S, Seymour J. Do patients with lung cancer recall physician-initiated discussions about planning for end-of-life care following disclosure of a terminal prognosis? BMJ Support Palliat Care 2016; 9:197-201. [PMID: 26842461 DOI: 10.1136/bmjspcare-2015-001015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/04/2015] [Accepted: 01/10/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Communicating with patients about their prognosis and goals of care, including offering opportunities to engage in advance care planning (ACP) is widely recognised as best practice. Little is known about terminally ill patients' perceptions of communication and ACP practice following disclosure of their terminal prognosis. OBJECTIVES To examine whether terminally ill patients with lung cancer and their relatives recall conversations with disclosing physicians, about their concerns, goals of care or any offers to engage in ACP. METHODS Qualitative study using semistructured interviews with patients and their family members. The study setting was a cancer centre and cancer unit in northern England. RESULTS 25 patients with advanced lung cancer (18 men and 7 women, aged 47-85) and 19 family members, mainly from lower social economic classes, took part in the study. Participants had little or no recall of physicians initiating discussions about their concerns, or goals of care and did not perceive that they had been provided with either information about or opportunities to engage in ACP. Some participants reported a sense of abandonment following the disclosure of a terminal prognosis. This sense was compounded by a range of difficult emotional experiences following the disclosure. CONCLUSIONS It may be inappropriate to initiate discussions about end-of-life care planning immediately following the disclosure of a terminal prognosis. To avoid patients feeling abandoned physicians need to consider how they or another appropriate person can provide information and opportunities for terminally ill patients to engage in a process of ACP. TRIAL REGISTRATION NUMBER 06/Q2307/22.
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Affiliation(s)
| | - Sheila Payne
- Division of Health Research, Faculty of Health and Medicine, International Observatory on End of Life Care, Furness College, Lancaster University, Lancaster, UK
| | - Jane Seymour
- Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Abstract
PURPOSE This narrative review is concerned with the ways in which the relationships between time and chronic illnesses have been chartered in recent literature. It aims to identify types of time (referred to here as temporal structures) most commonly reported in chronic illness literature and to assess their bearing on people's lived experiences. METHODS Literature searches of three electronic databases (Google Scholar, MEDLINE, and PubMed) were carried out in November 2014 of articles published between 1970 and 2013 using the following search terms (and derivatives): chronic illness AND time AND (patient OR carer). The review followed four procedural steps: (a) comprehensive search, (b) temporal structure appraisal, (c) synthesis of findings, and (d) critical appraisal. RESULTS Forty studies met the inclusion criteria and were included for review. Four types of called temporal structures had a strong presence in the literature: calendar and clocked time, biographical time, past-present-future time, and inner time and rhythms. The first three temporal structures are largely understood socially, and the fourth is predominantly understood in and through the body. Several studies reported more than one temporal structure as informing people's chronic illness experiences. A wide array of chronic illnesses were represented in these studies. Few studies reported on the experiences of people with multi-morbid chronic illnesses. CONCLUSION Chronic illness induces new relationships to time. Drawing on Hyden (Sociol Health Illn 19(1):48-69, 1997), it is suggested that "narrative" storytelling--as a temporally informed analytic device---might prove effective for reconciling the tensions emergent from new and multiple relationships to time that chronic and multiple illnesses create. Opportunities exist for healthcare practitioners and health services to offer patients illness support that is cognisant of their relationships to time.
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Giuliani L, Piredda M, Ghilardi G, D Marinis MG. Patients’ Perception of Time in Palliative Care. J Hosp Palliat Nurs 2015. [DOI: 10.1097/njh.0000000000000179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ellingsen S, Roxberg Å, Kristoffersen K, Rosland JH, Alvsvåg H. The pendulum time of life: the experience of time, when living with severe incurable disease--a phenomenological and philosophical study. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:203-215. [PMID: 25205069 DOI: 10.1007/s11019-014-9590-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to gain a deeper understanding of the experience of time when living with severe incurable disease. A phenomenological and philosophical approach of description and deciphering were used. In our modern health care system there is an on-going focus on utilizing and recording the use of time, but less focus on the patient's experience of time, which highlights the need to explore the patients' experiences, particularly when life is vulnerable and time is limited. The empirical data consisted of 26 open-ended interviews with 23 participants receiving palliative care at home, in hospital or in a nursing home in Norway. The theoretical frameworks used are mainly based upon K. Martinsens philosophy of care, K. E. Løgstrup phenomenological philosophy, in addition to C. Saunders' hospice philosophy, L. Feigenberg's thanatology and U. Qvarnström's research exploring patient's reactions to impending death. Experience of time is described as being a movement that moves the individual towards death in the field of opposites, and deciphered to be a universal, but a typical and unique experience emerging through three integrated levels: Sense of time; where time is described as a movement that is proceeding at varying speeds. Relate to time; where the awareness of limited life changes the understanding of time to be more existential. Being in time; where limited time seems to clarify the basic living conditions and phenomena of life. The existence of life when the prospect of death is present is characterized by emotional swings that move within polarizing dimensions which is reflected in the experience of time illustrated as the moves of the pendulum in a grandfather clock. The diversity of the experience of time is oscillating between going fast or slow, being busy or calm, being unpredictable but predictable, safe or unsafe and between being good or bad, depending on the embodied situation of the individual.
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Affiliation(s)
- Sidsel Ellingsen
- Department of Nursing and Health Care, Haraldsplass Deaconess University College, Bergen, Norway,
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