Oncology nurses' lived experiences of video communication in follow-up care of home-living patients: A phenomenological study in rural Norway.

PURPOSE: To explore the lived experiences of oncology nurses (ONs) during three months of virtual care provided through video conferencing (VC) in the follow-up care for home-living patients with cancer in rural Norway. METHOD: An exploratory study employing a descriptive phenomenological approach conducted with a purposive sample of four ONs working in primary health care in three municipalities. Individual interviews based on open-ended questions about the ONs' experiences of VC use in follow-up care were analyzed using methodology inspired by Clark Moustakas. The COREQ checklist was utilized in this study. RESULTS: ONs provided VC as a quality-promoting supplement to traditional follow-up. Their lived experiences of the phenomenon were described by the following themes: 1) Choice of VC based on care need considerations, 2) Use of VC on portable tablets facilitated contact and frequent follow-up, and 3) Adaption of relevant virtual care in person-centered and goal-oriented practice. CONCLUSION: The use of VC may contribute to accessible and frequent quality care and reduce the ONs' travel time for home visits. This study points to a need to individualize and assess the appropriateness of virtual care in challenging cancer situations. Furthermore, there is a need for larger-scale studies on how VC may influence quality care.

Introducing Videoconferencing on Tablet Computers in Nurse-Patient Communication: Technical and Training Challenges.

BACKGROUND: This article examines personnel and patient experiences of videoconferencing (VC) trials on tablet computers between oncology certified nurses (OCNs) and patients with cancer who live at home. The study points to organizational pitfalls during the introduction process. In many different arenas, the use of VC has increased recently owing to improved Internet access and capacity. This creates new opportunities for contact between patients living at home and their nurses. Video conferencing presupposes knowledge about Internet access, training, and usability of technological equipment. The aim of this pilot study was to illuminate patients' and nurses' experiences of the technical functionality, usability, and training of tablet use in VC in primary cancer care. The results point to the drawbacks concerning the introduction of VC. METHOD: A pilot study with an explorative design was used to describe patients' and OCNs' experiences of technical functionality and usability of VC on tablet computers. After a three-month trial, data were gathered, focusing on both patients' and nurses' perspectives. Individual interviews with four female OCNs, aged 32-65 (mean 46), and six patients with cancer, two men and four women aged 49-78 (mean 69), were content-analyzed. RESULTS: The analysis revealed two main categories: network connectivity and tablet usability and training and educational pitfalls. CONCLUSION: When planning VC implementation, the organizational leadership should consider network access and stability, as well as individualized VC training on tablets. Ensuring patient safety should also be a priority. Further research should provide knowledge of technological and educational pitfalls, and possible implications of VC on the care quality of nursing.

Former Work Life and People With Dementia.

Twelve persons with dementia were interviewed about their former work lives. Their motivation for choosing their past work was influenced by values of their contemporary culture. Those who had come to terms with their illness had positive feelings about their past contributions in their former paid work. However, they often felt that unpaid work was taken for granted and not fully recognized by family or society. Some wrestled with accepting their illness; they were grieving their losses, regardless of former success. Caregivers may use parts of work narratives to elevate the self-esteem and quality of life of persons with dementia.

Patient influence in home-based reablement for older persons: qualitative research.

BACKGROUND: Reablement services are rehabilitation for older people living at home, being person-centered in information, mapping and the goal-setting conversation. The purpose of this study was to gain knowledge about conversation processes and patient influence in formulating the patients' goals. There are two research questions: How do conversation theme, structure and processes appear in interactions aiming to decide goals of home-based reablement rehabilitation for the elderly? How professionals' communication skills do influence on patients' participation in conversation about everyday life and goals of home-based reablement? METHODS: A qualitative field study explored eight cases of naturally occurring conversations between patients and healthcare professionals in a rehabilitation team. Patients were aged 67-90 years old. The reablement team consisted of an occupational therapist, physiotherapist, nurse and care workers. Data was collected by audio recording the conversations. Transcribed text was analyzed for conversational theme and communication patterns as they emerged within main themes. RESULTS: Patient participation differed with various professional leadership and communication in the information, mapping and goalsetting process. In the data material in its entirety, conversations consisted mainly of three parts where each part dealt with one of the three main topics. The first part was "Introduction to the program." The main part of the talk was about mapping ("Varying patient participation when discussing everyday life"), while the last part was about goal setting ("Goals of rehabilitation"). CONCLUSIONS: Home-based reablement requires communication skills to encourage user participation, and mapping of resources and needs, leading to the formulation of objectives. Professional health workers must master integrating two intentions: goal-oriented and person-centered communication that requires communication skills and leadership ability in communication, promoting patient influence and goal-setting. Quality of such conversations is complex, and requires the ability to apply integrated knowledge, skills and attitudes appropriate to communication situations.

Interdisciplinary collaboration experiences in creating an everyday rehabilitation model: a pilot study.

BACKGROUND: When functional impairment occurs, assistance to achieve self-help can lead to qualitatively more active everyday life for recipients and better use of community resources. Home-based everyday rehabilitation is a new interdisciplinary service for people living at home. Rehabilitation involves meeting the need for interprofessional services, interdisciplinary collaboration, and coordination of services. Everyday rehabilitation is a service that requires close interdisciplinary cooperation. The purpose of this study was to gain knowledge about employees' experiences with establishing a new multidisciplinary team and developing a team-based work model. METHOD: The study had a qualitative design using two focus group interviews with a newly established rehabilitation team. The sample consisted of an occupational therapist, two care workers with further education in rehabilitation, a nurse, a physiotherapist, and a project leader. Data were analyzed by thematic content analysis. RESULTS: The data highlight three phases: a planning phase (ten meetings over half a year), a startup phase of trials of interdisciplinary everyday rehabilitation in practice (2 months), and a third period specifying and implementing an everyday rehabilitation model (6 months). During these phases, three themes emerged: 1) team creation and design of the service, 2) targeted practical trials, and 3) equality of team members and combining interdisciplinary methods. CONCLUSION: The team provided information about three processes: developing work routines and a revised team-based flow chart, developing team cooperation with integrated Trans- and interdisciplinary collaboration, and working with external exchange. There is more need for secure network solutions.

Life stories of people on sick leave from work because of mild mental illness, pain and fatigue.

BACKGROUND: Many people experience some form of mild mental illness, chronic pain and fatigue feelings that lead to long-term absences from the workplace. OBJECTIVE: The article examines narrations about developmental experiences and adult life of people in need of back to work rehabilitation. METHODS: Narrative interviews were analyzed within a qualitative content analyses design. The sample was purposive, with 16 working-age adults at rehabilitation because of mild mental illnesses, chronic pain, and fatigue feelings. Ethical approval, was obtained from The Regional Committee for Medical Research Ethics, Health Region Central Norway. Reference no.: 2010/1323. RESULTS: There were stories about more or less stressful childhoods. In adult life, there were turns at various ages from meaningful work engagement, to struggle in private life from long lasting strain, stressful family situations or crises. CONCLUSIONS: Illness may develop when experiencing crises or strain over time in private situations, this in combination with expectations and requirements in working life. Not only working environments, but also the private situations, life history events, and self-esteem of individuals, should be taken into consideration in the rehabilitation program. There is a need of research on working life that support the employee's positive self-image, and on effective rehabilitation when needed.

Next of kin of cancer patients - challenges in the situation and experiences from a next of kin course.

PURPOSE: To gain more knowledge about the challenges facing the next of kin of cancer patients and how a cognitive-based course for these next of kin helps them handling the challenges they are facing. METHODS: Focus groups were used to explore the experiences, thoughts, and perceptions of the next of kin about specific challenges and their participation in the course. A thematic content analytical approach was used. RESULTS: Three focus groups were convened with each group consisting of 4-7 adults. A total of 9 women and 7 men, aged 32 to 78 years, were included in the sample. The following two main themes emerged in the results: Fighting three battles and From distance to acceptance. This study shows that the difficult situations next of kin experience require the next of kin to gain a new understanding of challenges, which involves a comprehensive learning process. CONCLUSION: The results suggest that a cognitively oriented course for the next of kin fill a need for help for them to learn and cope, but further research in this area is recommended.

The role of next of kin of patients with cancer: learning to navigate unpredictable caregiving situations.

AIMS AND OBJECTIVES: The aims of this study are to develop knowledge about (1) the experiences of next of kin in caring for seriously ill patients with cancer and (2) the effects of strain and support on the next of kin's ability to cope. BACKGROUND: Better treatment has resulted in patients with cancer normally living longer. Because this treatment is typically administered in a polyclinic or at home, next of kin inherit the largely unknown and demanding role of caregiver. DESIGN: A qualitative, descriptive and interpretive design. METHODS: Focus group interviews were used. The sample comprised 16 adults who were the next of kin of patients with cancer. A thematic content analysis was performed, the text coded for meaning units, condensed and interpreted based on the understanding of the next of kin's role and ability to handle the situation. RESULTS: The role of next of kin is multifaceted and challenging. It is important for next of kin to be near and to take care of the sick. Next of kin's acceptance of the situation plays a crucial role in their ability to cope and to look forward. The unpredictability of the situation adds stress and affects the daily routines. CONCLUSIONS: Providing next of kin with knowledge, support and guidance is important in helping them to understand and cope with the situation and to reduce the amount of strain that they experience in the caregiving role. RELEVANCE TO CLINICAL PRACTICE: This study emphasises the importance of health workers in possessing the knowledge and competence required to educate, guide and support the next of kin of those with cancer. Health workers should provide care to next of kin, and a support system for next of kin must also be available.

Experiences of day care and collaboration among people with mild dementia.

AIMS: The study was designed to assess how a day care programme once a week, for seven weeks, with group collaboration and social and cultural activities was experienced by clients. The aim was to provide some insight into how older adults with mild cognitive impairment perceive and experience day care. BACKGROUND: As a consequence of social withdrawal, older adults with mild dementia may suffer a loss of meaningful social life and mental stimulus. Person-centred and collaborative day care may provide support to remaining abilities and facilitate for social activities. Little is known about client experiences and whether and how day care gives meaning to everyday life of persons with mild dementia. DESIGN: A qualitative interview study in a narrative content analysis design. METHODS: This study involved narrative interviews with nine Norwegian clients, aged 77-88 years of age, living at home, all being old people with mild dementia. RESULTS: Three main themes emerged: 'Ambivalence Shifts to Interest', 'Meaningful Engagement Engenders Wellbeing' and 'Social Fellowship Promotes Life Contentment'. The findings gave insights into how people with mild dementia had positive experiences from a once-a-week day programme. CONCLUSIONS: This study demonstrates feelings of more meaningful lives, well-being and contentment as effects of collaborative day care participation. Safe transfer was a prerequisite to participate. There is a need of more research on how to facilitate person-centred and collaborative day care provided for groups in different contexts, culturally pluralistic groups and groups of younger seniors with mild dementia. RELEVANCE TO CLINICAL PRACTICE: Persons with mild dementia may practice remaining social and collaborative skills when care facilitate and moderate participant involvement. Therefore, facilitating for clients' feelings of control in secure environments, narrative conversations, group activities and collaborative group interaction are suggested.

Cancer nurses narrating after conversations with cancer outpatients: how do nurses' roles and patients' perspectives appear in the nurses' narratives?

AIM: The aim of this study was to contribute to knowledge of nursing practice in the cancer care field by exploring cancer nurses' perceptions of conversations with cancer outpatients. BACKGROUND: Current practice at cancer outpatient clinics in Norway is that nurses have planned conversations with patients and relatives as a follow-up after patient-physician conversations about assessment and medical treatment. Little is known about nurses' experiences of conversations in the ambulatory context. This study reports the experiences of initial patient-nurse consultations. Data were collected in 2006-2007. DESIGN: A qualitative phenomenological hermeneutic study was performed. A purposive sample of 12 cancer nurses was selected for qualitative interviews where nurses were narrating about conversation experiences. Significance and meaning of conversation experiences were analysed within a hermeneutic perspective, inspired by Ricoeur. Anonymity and voluntary participation procedures were followed. Ethical approval for the study was obtained from the Regional Committee for Medical Research Ethics of the region. FINDINGS: There were plots of nurses experiencing conversations as hard work, routine work or artistry. The nurses' conceptualizations of their roles as an information provider, or patient-centred caring role were rooted in rules of the nursing community or in humanistic caring ethics. Differences of nurses' perceptions and experiences of conversations are explained by different attitudes and role appreciations. CONCLUSION: Cancer nurses' role appreciation and meaning horizons are guiding their perceptions of patient-nurse communication. Feeling free to act in interplay with patients' voices, the patients' perspectives become foreground. There is an educational challenge here in terms of developing methods to help nurses to discover how their mental work and meaning horizons guide conversational practice.