AbstractBackground and aimsPersistent (chronic) pain is a common phenomenon in adolescents. When young people are referred to a pain clinic, they usually have amplified pain signals, with pain syndromes of unconfirmed ethology, such as fibromyalgia and complex regional pain syndrome (CRPS). Pain is complex and seems to be related to a combination of illness, injury, psychological distress, and environmental factors. These young people are found to have higher levels of distress, anxiety, sleep disturbance, and lower mood than their peers and may be in danger of entering adulthood with mental and physical problems. In order to understand the complexity of persistent pain in adolescents, there seems to be a need for further qualitative research into their lived experiences. The aim of this study was to explore adolescents’ experiences of complex persistent pain and its impact on everyday life.MethodsThe study has an exploratory design with individual in-depth interviews with six youths aged 12–19, recruited from a pain clinic at a main referral hospital in Norway. A narrative approach allowed the informants to give voice to their experiences concerning complex persistent pain. A hermeneutic analysis was used, where the research question was the basis for a reflective interpretation.ResultsThree main themes were identified: (1) a life with pain and unpleasant bodily expressions; (2) an altered emotional wellbeing; and (3) the struggle to keep up with everyday life.The pain was experienced as extremely strong, emerging from a minor injury or without any obvious causation, and not always being recognised by healthcare providers. The pain intensity increased as the suffering got worse, and the sensation was hard to describe with words. Parts of their body could change in appearance, and some described having pain-attacks or fainting. The feeling of anxiety was strongly connected to the pain. Despair and uncertainty contributed to physical disability, major sleep problems, school absence, and withdrawal from leisure activities. Their parents were supportive, but sometimes more emotionally affected than themselves. The adolescents described how they strived for normality and to not become an outsider. Being met with necessary facilitation from school was important, as well as keeping up with friends. These adolescents had all been treated by an interdisciplinary pain team, and stated that they had an optimistic view of the future, despite still having some symptoms.ConclusionsThe study provides new insights into adolescents’ own experiences of complex persistent pain occurring unexpectedly, developing dramatically over time, and influencing all parts of their everyday lives. The adolescents entered vicious cycles, with despair and decreased physical and social functioning, with the risk of isolation and role-loss. However, these young people seem to have a strong motivation to strive for normalcy.ImplicationsThese findings may encourage healthcare providers to perceive adolescents’ persistent pain through the lenses of a biopsychosocial approach. We suggest that further research into adolescents with persistent pain should include longitudinal studies of quality of life and gender perspectives.

PurposeTo explore relationships of socio-demographic variables, health behaviours, environmental characteristics and personal factors, with physical and mental health variables in persons with morbid obesity, and to compare their health-related quality of life (HRQoL) scores with scores from the general population.MethodsA cross-sectional correlation study design was used. Data were collected by self-reported questionnaire from adult patients within the first 2 days of commencement of a mandatory educational course. Of 185 course attendees, 142 (76.8%) volunteered to participate in the study. Valid responses on all items were recorded for 128 participants. HRQoL was measured with the Short Form 12v2 from which physical (PCS) and mental component summary (MCS) scores were computed. Other standardized instruments measured regular physical activity, social support, self-esteem, sense of coherence, self-efficacy and coping style.ResultsRespondents scored lower on all the HRQoL sub-domains compared with norms. Linear regression analyses showed that personal factors that included self-esteem, self-efficacy, sense of coherence and coping style explained 3.6% of the variance in PCS scores and 41.6% in MCS scores.ConclusionPersonal factors such as self-esteem, sense of coherence and a high approaching coping style are strongly related to mental health in obese persons.

BackgroundMorbid obesity is a progressive, chronic condition associated with failed attempts at change and repeated relapses.AimThere seems to be little previous research into the understanding of the everyday life of morbidly obese adults. We wanted to gain more knowledge about characteristics of eating habits and body image as well as motivational forces for change.MethodsA qualitative approach was chosen in order to gain insight into how morbidly obese adults experience everyday life. Qualitative interviews are well suited to provide insight into themes from the interviewee's life story from the subjects’ own perspectives. To gain insight into such processes, a narrative approach that allowed the informants to give voice to their ways of doing, thinking and feeling in daily life, was adopted. The informants comprised seven women and four men aged of 26–56 years, recruited from a population of obese individuals who had participated in a weight reduction course. A hermeneutic approach was used where the research question was the basis for a reflective interpretation.ResultsThe following meaning-units were identified: to be perceived as overweight; and to see oneself as overweight. Ingrained habits: the struggle between knowing and doing; acting without knowing; and eating is soothing.ConclusionsSeeing oneself as an obese person is a gradual process that implied experiencing oneself as different from significant others, such as (slim) siblings and friends. To experience a gap between knowing and doing concerning food habits in everyday life indicates that informants value they have a choice. This is an important insight to consider when framing interventions to support this vulnerable group.

Recognition of good work is not only rewarding and enjoyable; it may also serve as a source of consciousness raising for professional and ethical guidelines in the work place.

Background: Learning in skills centers has a long tradition in nursing education. Nurse educators struggle to substantiate their opinions on the efficacy of simulation technologies over traditional methods of instruction and it is suggested that they should re-evaluate their methods when teaching psychomotor skills. A necessary step before evaluation is to unravel what the students are actually doing in the skills center. Purpose: The purpose of this study was to explore nursing students' practical skills training in the skills centre to label and define generic learning actions used during the learning of two specific skills; wound care and dressing, and sterile gloving. Methods: A qualitative observational study of nursing students' practical skill training in the skills center was developed. Students across three cohorts were video recorded while practicing wound cleaning and dressing, and donning and removing sterile gloves. Verbal interaction on the video recordings was transcribed. The core analytical process was the joint listening to and watching of videos with following discussions of interpretations and development of categories. Results: Seven categories of learning actions were developed: Parallel action and self-instruction, watch and copy, collaborating to find solutions, giving support, seeking support, recontextualising the skill, and humorous enactment with the equipment. The categories are exemplified and discussed in light of learning theory and research on aspects of scaffolding. Conclusions: The learning actions described in this study are a starting point in detailing students learning actions during skills training. Students' learning in other practical nursing skills should be studied to accumulate more knowledge about students' learning actions and how peer interaction supports or hampers learning. The relevance of the learning actions should be explored in the clinical setting. A goal is to lay the groundwork for better design of learning in skills centers in nursing education.

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BackgroundUser involvement is increasingly important in developing relevant health care services. The aim of this study was to contribute to a deeper understanding of user involvement and patients’ experiential knowledge as recognized and incorporated into clinical practice by rehabilitation professionals.MethodsA qualitative design using a grounded theory approach was applied. Data were collected by observations of the interprofessional meetings at two rehabilitation units treating patients with traumatic brain injury and multiple trauma and by individual semi-structured interviews with rehabilitation professionals.ResultsThe professionals recognized and incorporated user involvement into clinical practice as formal or authentic. Formal user involvement was sometimes considered pro forma. Incorporating patient’ experiential knowledge was considered a part of authentic user involvement. Possible gaps between the patients’ experiential knowledge and professional expertise were recognized. Challenges included dealing with ‘artifacts’, sources of information external to the patients’ own experiences, and addressing the patients’ possibly reduced insight due to trauma.ConclusionPatients’ experiential knowledge was recognized as an essential component of the professionals’ knowledge base. The professionals considered user involvement and patients’ experiential knowledge as part of their clinical practice. Implementation of user involvement and contribution of patients’ experiential knowledge could be improved by understanding the issues raised in practice, such as possible negative consequences of user involvement in form of burdening or disempowering the patients. A better understanding of the characteristics and measures of user involvement is necessary in order to be able to offer its full benefits for both the patients and the professionals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1808-5) contains supplementary material, which is available to authorized users.

Aim The aim was to explore how nurse mentors experience the assessment of nursing students in clinical placements at hospitals and in municipal health care. Design The study is qualitative with an explorative and descriptive design. Methods Based on an interview guide, we conducted 19 individual qualitative interviews and four focus group interviews with nurse mentors from various levels and fields of nursing education at a Norwegian university. Results Feedback in and on action was an integrated part of the formative assessment. In the summative assessment, where the university lecturer also participates, the nurse mentors perceived their role as passive. A disturbing finding was that divergent views on the student's competence sometimes occurred in these situations, thus challenging the credibility of the student assessment. Perceptions of nursing values and concerns embedded in nursing practice as collective criteria appear to have an impact on the mentors’ assessment of the nursing students.