From good health to illness with post-infectious fatigue syndrome: a qualitative study of adults’ experiences of the illness trajectory

Abstract Background Municipal drinking water contaminated with the parasite Giardia lamblia in Bergen, Norway, in 2004 caused an outbreak of gastrointestinal infection in 2500 people, according to the Norwegian Prescription Database. In the aftermath a minor group subsequently developed post-infectious fatigue syndrome (PIFS). Persons in this minor group had laboratory-confirmed parasites in their stool samples, and their enteritis had been cured by one or more courses of antibiotic treatment. The study’s purpose was to explore how the affected persons experienced the illness trajectory and various PIFS disabilities. Methods A qualitative design with in-depth interviews was used to obtain first-hand experiences of PIFS. To get an overall understanding of their perceived illness trajectory, the participants were asked to retrospectively rate their functional level at different points in time. A maximum variation sample of adults diagnosed with PIFS according to the international 1994 criteria was recruited from a cohort of persons diagnosed with PIFS at a tertiary Neurology Outpatient Clinic in Western Norway. The sample comprised 19 women and seven men (mean age 41 years, range 26–59). The interviews were fully transcribed and subjected to a qualitative content analysis. Results All participants had been living healthy lives pre-illness. The time to develop PIFS varied. Multiple disabilities in the physical, cognitive, emotional, neurological, sleep and intolerance domains were described. Everyone more or less dropped out from studies or work, and few needed to be taken care of during the worst period. The severity of these disabilities varied among the participants and during the illness phases. Despite individual variations, an overall pattern of illness trajectory emerged. Five phases were identified: prodromal, downward, turning, upward and chronic phase. All reached a nadir followed by varying degrees of improvement in their functional ability. None regained pre-illness health or personal and professional abilities. Conclusions The needs of persons with this condition are not met. Early diagnosis and interdisciplinary rehabilitation could be beneficial in altering the downward trajectory at an earlier stage, avoiding the most severe disability and optimising improvement. Enhanced knowledge among health professionals, tailored treatment, rest as needed, financial support and practical help would likely improve prognosis

Younger stroke survivors' experiences of family life in a long-term perspective: a narrative hermeneutic phenomenological study

The psychosocial consequences following a stroke are known to be challenging, influencing the stroke survivors’ ability to participate in and carry out the taken-for-granted roles and activities in family life. This study explored how living with the consequences of stroke impacted on family life in the late recovery phase, that is, six months or more after stroke onset. Twentytwo stroke survivors aged 20–61 years were interviewed in-depth six months to nine years after stroke onset. The interviews were analyzed applying a narrative, hermeneutic phenomenological approach. The findings revealed challenges that varied with time, from an initial struggle to suffice in and balance the relationships and roles within the family early after the stroke, towards a more resigned attitude later on in the stroke trajectory. The struggles are summarized in two main themes: “struggling to reenter the family” and “screaming for acceptance.” Nonestablished people living with stroke and stroke survivors in parental roles seem to be particularly vulnerable. Being provided with opportunities to narrate their experiences to interested and qualified persons outside the home context might be helpful to prevent psychosocial problem

Telemedicine in diabetes foot care delivery: health care professionals’ experience

Background: Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals’ experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Methods: Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2). Results: The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants’ attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high. Conclusions: Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way. Keywords: telemedicine, diabetic foot ulcer, focus groups, interpretive description, health care professional

An intervention designed to improve sensory impairments in the elderly and indoor lighting in their homes: an exploratory randomized controlled trial

Background: Vision and hearing impairments in the elderly (aged over 80 years) and poor indoor lighting conditions in a home-care setting are risk factors for functional decline, reduced social participation, withdrawal, and accidents. Objective: We aimed to evaluate the changes in vision, hearing, and lighting conditions in the homes of participants aged over 80 years after implementation of a clinical intervention. Methods: We undertook an exploratory randomized, controlled experimental study of sensory impairments and lighting conditions in the homes of elderly aged over 80 years who received home care. The intervention group (IG) received advice and encouragement to improve their vision, hearing, and indoor lighting conditions in the home, with a 10-week follow-up period. The control group (CG) received their usual care and underwent the same vision and hearing tests but were provided no intervention. Results: Vision and hearing (self-assessed) and tested by Wilcoxon rank-sum test were significantly better (P=0.025 and P=0.008, respectively) in the IG after the intervention and follow-up. The test between the groups showed a significance of P=0.026 for visual acuity and P=0.098 for pure-tone average. The maximum and minimum lighting levels were significantly improved in the IG after the intervention (P=0.002 and P=0.039, respectively) but were unchanged in the CG. Conclusion: Several of the IG participants did not follow all of the advice; however, among those who did, vision, hearing, and lighting conditions were all significantly improved. It appears that modest interventions have great potential for improving vision and hearing. Older patients in the home-care setting cannot be expected to take the necessary action to improve their sensory impairments by themselves. They require close monitoring, help from a specialist, and help to improve the indoor lighting conditions in their homes

Understanding nursing practice in stroke units: a Q-methodological study.

Abstract Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses' involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses' practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills. Implications for Rehabilitation Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care. Views of stroke unit team members on nurses' involvement in rehabilitation have not been reported previously. Nurses can routinely incorporate rehabilitation principles in their care. Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals

What is the matter with crushing pills and opening capsules?

Artikkelen beskriver en studie hvor hensikten var å kartlegge i hvilken grad medisiner blir knust og blandet inn i pasientenes mat og drikke ved sykehjem, samt i hvor stor grad dette gjaldt medisiner som ikke skal administreres på denne måten.This study aims to map out to what degree medication is being crushed and mixed into the patients' food and beverages and how often this practice included medication, which has a statement in the Norwegian pharmaceutical compendium that this should not be done (inappropriately altered medication (IAM)). Data from a total of 2108 patients in 151 wards in 65 nursing homes were collected. The data contained information about the kind of drugs the patient received, in which form it was given and how it was given. Patient characteristics and ward characteristics were also recorded. Twenty‐three per cent were given at least one drug mixed into their food or beverages and 10% were given at least one IAM. This study shows a malpractice regarding one aspect of medication in nursing homes. Even though we need more knowledge, we know enough to take action to raise the quality of the administration of medicines in nursing homes

De økonomiske aspektene av Storbritannias motvillighet mot en ny verdenskrigs fremstilling i britiske aviser mellom 1937-38

Bachelor-oppgaveBachelor-thesi

An organisation working mainly reactively instead of proactively: a qualitative study of how frail users of home care services and their next of kin experience crises

Background: Frail people receiving home care services face an increased risk of developing crisis, which can result in adverse events, coercive measures, and acute institutionalisation. The prevalence of frailty is expected to increase due to the ageing population in most countries. However, our knowledge of the process leading to crises among frail community-dwelling patients remains limited. The aim of our study was to explore how users of home care services and their next of kin experienced crises and how these crises were approached by home care services. Methods: A qualitative explorative design with 21 interviews was conducted. We explored crises within the last year that had led to an acute institutionalisation (hospital or nursing home) or to an unstable situation with high risk of institutionalisation. Systematic text condensation (STC) was used to analyse the data. Results: Our findings are summarised into one overarching theme; an organisation working mainly reactively instead of proactively, which is supported by four subthemes: (1) insufficient communication—a determinant of crises, (2) the lack of a holistic approach, (3) a sense of being a burden, and (4) the complexity of crises. The reactive approach is demonstrated in the participant’s experience of insufficient communication and the lack of a holistic approach from the service, but also in the user’s sense of being a burden, which seems to be reinforced by the experienced busyness from the staff in the home care services. This reactive approach to crises seems to have contributed to difficulties in detecting the various stressors involved in the complex process leading to crisis. Conclusions: Our findings suggest that home care services tend to be characterised by a reactive approach to rising instability and the development of crises for users. This can be interpreted as an emergent property of the organisation and the adaptation towards exceeding demands due to insufficient capacity in health care services. We recommend the use of multicomponent care programmes comprising interdisciplinary case conferences in home care services to implement a cultural change that can shift the service from a reactive, fragmented, and task-oriented approach to a more proactive approach.publishedVersio

Incongruence between nurses\u27 and patients\u27 understandings and expectations of rehabilitation

Aims and objectives. To explore nurses\u27 understandings and expectations of rehabilitation and nurses\u27 perceptions of patients\u27 understandings and expectations of rehabilitation.Background. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation.Design. Qualitative.Method. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses\u27 everyday practice.Findings. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses\u27 understandings and expectations of rehabilitation and what they perceive patients to understand and expect.Conclusion. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation.Relevance to clinical practice. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery.<br /