BackgroundThe aim of this study was to describe patients' experiences and perceived causes of persisting discomfort following day surgery. Earlier research has mainly covered symptoms and signs during a recovery period of up to one month, and not dealt with patients' perceptions of what causes persisting, longer-term discomfort.MethodsThis study is a part from a study carried out during the period May 2006 to May 2007 with a total of 298 day surgery patients. Answers were completed by 118 patients at 48 hours, 110 at seven days and 46 at three months to one open-ended question related to discomfort after day surgery constructed as follows: If you are still experiencing discomfort related to the surgery, what is the reason, in your opinion? Data was processed, quantitatively and qualitatively. Descriptive, inferential, correlation and content analyses were performed.ResultsThe results suggest that patients suffer from remaining discomfort e.g. pain and wound problem, with effects on daily life following day surgery up to three months. Among patients' perceptions of factors leading to discomfort may be wrongful or suboptimal treatment, type of surgery or insufficient access to provider/information.ConclusionsThe results have important implications for preventing and managing discomfort at home following day surgery, and for nursing interventions to help patients handle the recovery period better.

Recent studies indicate that patients experience pain after day surgery for a longer period than previously known. This requires verification. This was a prospective, descriptive correlational study. A convenience sample of 298 day surgery patients undergoing various surgical procedures was asked to report pain intensity and its interference with daily function 48 hours, seven days and three months after day surgery. Correlation and regression analyses were performed. On a NRS, 55% (n=230) reported pain (≥4) 48 hours after surgery, as did 43% (n=213) at seven days. Pain interfered with normal activities at ≥4 NRS at 48 hours and at seven days, after which it decreased.

No abstract

BackgroundThe length of stay in nursing homes before death in Sweden has significantly decreased, and nearly one-third of people die within 6 weeks of entering a nursing home. Support for the next of kin is one of the cornerstones of palliative care, but the principles are not always adhered to as recommended when caring for the elderly, which can affect the quality of life of their next of kin. The aim of this study was to explore the experiences of quality of life among the next of kin of older persons who live in nursing homes before an educational intervention of palliative care.MethodsThis is an explorative qualitative interview study with 40 next of kin using qualitative content analysis performed at baseline before the implementation of the principles of palliative care in nursing homes.ResultsThe next of kin’s experiences of quality of life were expressed in three themes: Orientation to the new life situation, Challenges in their relationship and the Significance of the quality of care in the nursing home. The next of kin experienced a sense of relief, although the older person was constantly on their minds, and they could feel lonely. The difference in the couple’slife situations was experienced as burdensome by the next of kin. The challenges in the relationship were described as stressful, related to a guilty conscience and the older person’s vulnerability. The nursing home could be a context facilitating good relations. The perceptions of quality of care in terms of person-centredness affected the quality of life of the next of kin.ConclusionsThe findings show that four factors are decisive for the quality of life of next of kin: the relationships within the family, the degree of relief that nursing home care entails as compared to home care, the older person’s health status and whether the care is person-centred. Increased knowledge and education regarding palliative care in nursing homes are needed to better meet the needs of next of kin. Implementation of palliative care should take into account the need for support for next of kin.Trial registrationNCT02708498, 15 March 2016.

The concept of patient-focused care aims to provide an environment in which the healthcare team focuses on the individual patient's needs. In order to increase our understanding of how nurses perceive and conduct patient-focused care, the issue needs to be studied in various contexts. The aims of the study were to explore nurses' descriptions of their patient-focused care, what took place during observed situations including the time spent, before and after the change of design from a more traditional to a single-bed hospital in Sweden. Non-participant observations with follow-up interviews were carried out. Data were analysed using qualitative content analysis. Three categories emerged from the analysis: Barriers to being close to the patient, Desire to be close to the patient and The influence of environment on caring. The theme Presence or absence was interpreted as the latent meaning. The conclusion was that being present is crucial in nursing when providing compassionate and effective nursing care.

In aging societies worldwide, spouses take on great responsibility for care when their partner continues to live at home. Nursing home placement occurs when the partner becomes too frail due to multimorbidity, and this will cause a change in the spouse’s life. This study aimed to explore the spouse’s experience of their partner’s move to a nursing home. Two interviews were conducted at 9-month intervals within the project entitled “Implementation of Knowledge-Based Palliative Care in Nursing Homes”. Thirteen spouses from both urban and rural areas were included, with an age-range of 60–86 years (median 72). Qualitative content analysis was performed. The main findings were captured in two themes: Breaking up of close coexistence and Towards a new form of daily life. The first encompassed processing loneliness, separation and grief, exhaustion, increased burden, and a sense of guilt. The second encompassed a sense of freedom, relief, acceptance, support and comfort. Professionals in both home care and nursing home care need to develop and provide a support programme conveying knowledge of the transition process to prevent poor quality of life and depression among the spouses. Such a programme should be adaptable to individual needs and should ideally be drawn up in consultation with both partners.

Background: The worries of next of kin about their older loved ones in nursing homes can be extensive and can adversely affect their subjective experiences of their own physical, mental and social well-being. It is thus of utmost importance to measure the quality of life of next of kin in a valid and reliable way. Methods: The design is a cross-sectional study with psychometric evaluation based on classical test theory in preparation for a planned educational intervention study on palliative care. An abbreviated version of the World Health Organization's quality-of-life self-assessment instrument WHOQOL, the Swedish WHOQOL-BREF, was completed by 254 next of kin of older persons in 30 nursing homes. Data quality was assessed via the mean, median, item response, missing values, and floor and ceiling effects. Reliability was estimated using Cronbach's alpha and corrected item-total correlations. Construct validity was estimated by Spearman's rank correlation, and model fit was assessed using confirmatory factor analysis. Results: The rate of missing data was low (less than 2%). Ceiling effects ranged from 11 to 43% and were above 20% for 21 of 24 items. The corrected item-total correlations varied between 0.35 and 0.68 and were thus well above the lower limit of 0.30. Cronbach's alpha was 0.83, indicating satisfactory internal consistency. The confirmatory factor analysis indicated a fair to close model fit (comparative fit index 0.93, root mean squared error of approximation 0.06). Conclusions: The findings suggest that the WHOQOL-BREF may constitute a reliable and valid measure of quality of life for use among next of kin to older persons in nursing homes. When interpreting the results, it is important to assess the ceiling effect, as it may restrict the ability of the WHOQOL-BREF to detect true positive changes in quality of life over time. Trial registration: NCT02708498.

BackgroundIn implementing new programs of care, such as person-centered care, there is a risk that the focus will be at an organizational level, instead of a level that describes what happens in the personal development among staff. The aim of this study was to describe experiences of the implementation process of a learning supporting model designed to increase patient involvement and autonomy in care. The project, which lasted 2 years, involved training sessions, supervision and reflective meetings. Over the period, the staff who participated focused on developing their dialogues with patients to make the patients aware of their own capabilities and to encourage them to be fully involved in the treatment. A reflective lifeworld approach was used. Data were collected through interviews, notes and written stories, and analyzed using hermeneutic analysis with a focus on meanings.ResultsAt the beginning of the project, the participants perceived the model as abstract and difficult to understand but supervision and reflection sessions enabled understanding and changed the participants’ approach to caring. The participants described the model as an approach used in challenging patients to become involved in their care and to take charge of their lives when living with a chronic life-threatening disease. The participants’ experience of implementing the model has not been easy but has led to increased self-confidence and feelings of improved competence in dialogue with patients.ConclusionsUsing the PARISH model when critically examining the results shows that in the implementation process there were some difficulties, e.g. the context was supportive and facilitating but there was no appointed facilitator. By making participation in improvement work voluntary, the impact of such work becomes less efficient, less cost-effective and probably less sustainable. Furthermore, implementation needs encouragement since changing approaches takes time and requires patience. Group supervision sessions seem an appropriate way to translate research into practice; systematic scheduled and mandatory group supervision sessions would, therefore, probably make implementation more robust and sustainable. In addition, a well-trained facilitator would be able to motivate staff to undertake daily reflection and participate in group supervision sessions. Reflection seems to be a key component in the personal learning necessary to change work routines and approaches.