Associations between self-care advice and healing time in patients with venous leg ulcer- a Swedish registry-based study.

BACKGROUND: Venous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient's nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff's advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors. METHODS: The sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time. RESULTS: No associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32-2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12-2.15, p = 0.009) showed an association with longer healing time. CONCLUSIONS: Neither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.

Undergraduate nursing student's attitudes to learning during clinical practice in different semesters when using a conceptual learning model grounded in a caritative caring perspective - A cross-sectional study.

AIM: To describe undergraduate nursing students' attitudes to learning during clinical practice in different semesters when using the conceptual learning model, Model for Improvements in Learning Outcomes (MILO) grounded in a caritative caring perspective. BACKGROUND: With the intention to support interlinking between theory and praxis and offer understanding and structure to facilitate learning, MILO, theoretically grounded in hermeneutics and a caritative caring perspective based on ethical values, was implemented. MILO consists of four contextual concepts (peer learning, co-clinical teachers, student-centred and student-active supervision) and four intrapersonal concepts (nursing, a reflective approach, a critical approach, quality and safety). METHODS: A descriptive comparative quantitative study design was applied at a Swedish university, 3 hospitals and 13 municipalities in one county. Cross-sectional data collected via a questionnaire developed to assess attitudes to learning related to MILO's contextual and intrapersonal concepts and their applications were used. RESULTS: 209 students in semester 3, 4 and 6 participated in 6 different clinical practice courses. In comparison, intrapersonal concepts, that is, the student's own characteristics and abilities were viewed to be of greater value for learning than contextual, that is, organisational-related concepts in all semesters. Understanding the needs of others and reflective learning were rated to be of major importance. Students in semester 3 valued the use of the applications the highest. To be supervised in pairs was rated the lowest in semester 6. Some of the concepts and their applications were to great extent not applied. CONCLUSIONS: In all semesters, fundamentals in caritative caring and characteristics and abilities related to the individual student were rated to be of greater importance for learning than environmental support. Providing students opportunities to develop independency seems essential. Use of a learning model such as MILO is dependent on a bearing of a caritative caring culture and a shared understanding between all involved in student learning during clinical practice.

Efficacy of mecobalamin (vitamin B12) in the treatment of long-term pain in women diagnosed with fibromyalgia: protocol for a randomised, placebo-controlled trial.

INTRODUCTION: Fibromyalgia causes long-term pain. It affects at least 2% of the population, the majority being women. In addition, extended symptoms corresponding to vitamin B12 deficiency occur. Findings from several studies have indicated that vitamin B12 may be a possible treatment for pain in fibromyalgia. The aim of the proposed study is to evaluate whether vitamin B12 decreases pain sensitivity and the experience of pain (ie, hyperalgesia and allodynia) in women with fibromyalgia. METHODS AND ANALYSIS: The study is a randomised, placebo-controlled, single-blind, clinical trial with two parallel groups which are administered mecobalamin (vitamin B12) or placebo over 12 weeks. 40 Swedish women aged 20-70 years with an earlier recorded diagnosis of fibromyalgia are randomised into the placebo group or the treatment group, each consisting of 20 participants. Outcomes consist of questionnaires measured at baseline and after 12 weeks of treatment. A final re-evaluation will then follow 12 weeks after treatment ends. The primary outcome is tolerance time, maximised to 3 min, which is assessed using the cold pressor test. In order to broaden the understanding of the lived experience of participants, qualitative interviews will be conducted using a phenomenological approach on a lifeworld theoretical basis (reflective lifeworld research approach). ETHICS AND DISSEMINATION: The protocol for the study is approved by the local ethical committee at Linkoping (EPM; 2018/294-31, appendices 2019-00347 and 2020-04482). The principles of the Helsinki Declaration are followed regarding oral and written consent to participate, confidentiality and the possibility to withdraw participation from the study at any time. The results will primarily be communicated through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT05008042.

Experiences of undergoing venous leg ulcer management: A reflective lifeworld research study.

Venous leg ulcers have multiple consequences for the patient. Ulcer management can be lengthy and recurrence is common. As the patient is the expert on their experiences and life, the aim of the present study was to describe patients' lived experiences of undergoing management for a venous leg ulcer. The study encompassed 16 phenomenological interviews. The analysis led to a description of the phenomenon's essence, further described by three constituents. The essential meaning of the phenomenon is described as being in an oscillation between hope and despair. Ulcer management is challenging for the patient, who feels unseen and lives with doubts during the management period. This study is considered enriching as it puts words to the patients' suffering during ulcer management and shows that reliable relationships and competence can reduce patient doubts. This knowledge should enable improvement of patient care and treatment during ulcer management.

An application of the caritative caring approach - nursing students' experiences of practising caring and uncaring encounters by simulation at a clinical training centre.

PURPOSE: Nurses' lack of competence to be caring affects patients' health and patients describe a desire for more individual and compassionate care. Nursing education tends, however, to focus less on the caring approach in nursing practice and more on developing knowledge in psychomotor skills. The aim of this study was to describe nursing students' experiences of simulating caring and uncaring encounters founded on the caritative perspective at a Clinical Training Centre (CTC). METHOD: A qualitative, inductive approach using a qualitative latent content analysis. Written reflections of 49 students were analysed. FINDINGS: By intertwining reflection with acting and observation, the students experienced that they achieved an open mind and gained an understanding of how important it was to treat the patient based on a caring approach. To act, first uncaring and thereafter caring, gave them an awakening. The students were touched and an overwhelming feeling of suddenly understanding human uniqueness and vulnerability appeared. CONCLUSIONS: To simulate caritative caring and uncaring encounters at the CTC enhanced students' knowledge and understanding about caring and strengthened their prerequisites to acquire a caritative ontological basic view and attitude which in the long run may lead to an increased feeling of patient well-being in the encounter.

Daily life after healing of a venous leg ulcer: A lifeworld phenomenological study.

PURPOSE: Venous leg ulcer is a recognized condition, affecting people globally. Ulcers mainly affect the elderly and recurrences are not uncommon. There is knowledge about life with venous leg ulcers, but the situation after healing is unexplored. This paper explores and describes meanings of experiences of daily life after healing of a hard-to-heal venous leg ulcer. METHODS: Lived experiences of 15 individuals with healed hard-to-heal venous leg ulcers generated data for this study. Interviews were recorded for analysis using a reflective lifeworld research approach. An essence emerged, further described by its constituents. RESULTS: Memories of a difficult time with leg ulcer were ever present, in a way becoming part of the self. A striving for control in daily life entailed a struggle to do what was best for the own body. After healing, a new normal emerged in daily life, a reality that encompassed the risk for a new ulcer. The body had changed physically, with marks alongside those from ageing, in a life that still went on. CONCLUSIONS: For those who had healed from a venous leg ulcer, life had changed. Even if they referred to life as normal, it was not the same normal as before.

Different pain variables could independently predict anxiety and depression in subjects with chronic musculoskeletal pain.

OBJECTIVES: Chronic, clinical pain states are often accompanied by distress such as anxiety and depression. The aim of this study was to determine if certain clinical pain variables could predict the level of anxiety and depression in subjects with musculoskeletal pain. METHODS: Two multiple linear regression analyses were conducted on a sample consisting of 189 subjects with clinical pain with the independent pain variables of pain intensity, the influence of pain on daily activities, pain persistence, pain duration, and the number of pain locations. The dependent variables measured anxiety and depression, respectively. RESULT: Two statistically significant models were found, where the predicted variables accounted for 37.0% of the variability in the anxiety levels and 43.7% of the variability in the depression levels. The independent variable, the influence of pain on daily activities, significantly predicted the level of anxiety. The variables, the influence of pain on daily activities and the number of pain locations, significantly predicted the levels of anxiety and depression. CONCLUSIONS: This study showed that two different independent variables, the influence of pain on daily activities and the number of pain locations, significantly predicted the levels of depression. The predictor, the influence of pain on daily activities, significantly predicted the levels of anxiety. The knowledge gained about which specific pain variables are more likely to coexist with anxiety and depression in clinical pain states could be important in implementing holistic treatment plans for chronic pain.

Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach.

The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.

In search of a caring relationship - Nursing students' notions of interactions in the nurse-patient relationship.

The aim of the study is to explore how nursing students talks about their notions on interactions in the relationship between nurse and patient. Empirical data has been obtained from 22 students in their first semester of the Swedish undergraduate nursing programme, applying thematic, individual interviews and using qualitative content analyses. The most significant finding is that although the students had none or limited pre-understanding of caring and the interaction between nurse and patient they were aware of the pre-supposes for establishing such an interplay, articulated in a desire to find out how to build an authentic and trustful caring relationship. Empirical data also show that the students, in the stage of beginners, were trying to identify and relate to basic concepts within caring science. The restricted understanding could then be understood as a matter of the students not being able to express more than they had words for. The results provide new insights into the interactions in the nurse-patient relationship, seen from the perspective of beginner students. These insights could be useful, for lecturers and clinical supervisors, who play a paramount role in the development of each student's acquisition of theoretical and practical knowledge.

A Cooperative Learning Intervention to Promote Social Inclusion in Heterogeneous Classrooms.

Concerning challenges with the social inclusion of children with special educational needs (SEN), it is imperative to evaluate teacher interventions that promote social inclusion. This study aimed to investigate the effects of cooperative learning (CL) intervention on social inclusion. In addition, it was investigated to what degree CL implementation affected the outcomes. Fifty-six teachers of 958 fifth-grade children were randomly selected to intervention and control groups upon recruitment to the study. The intervention teachers received training and coaching in CL and implemented this approach three to four times a week for 15 weeks. The results showed a significant but small effect of CL on children's social acceptance, but no significant effect on children's friendships and perceptions of classroom relationships. The degree of CL implementation had effect on children's social acceptance, but the effect was not consistent across social acceptance measures as a friend or a groupmate. Thus, it can be concluded that CL, conducted with the length and intensity of this study, may not lead to substantial changes in the social inclusion of children with SEN. In future studies, more focus needs to be devoted to teacher implementation of the CL approach.

Conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease.

AIM: To describe conceptions of daily life in men living with a woman suffering from chronic obstructive pulmonary disease (COPD) in different stages of the disease. BACKGROUND: A chronic disease like COPD affects not only the person living with the illness, but also the spouse. Significant tasks and demands are placed on husbands. COPD has for a long time been considered more a man's disease than a woman's disease, but according to new evidence COPD is a vast problem in women, which requires support from their spouses. The literature review did not reveal any previous studies concerning conceptions of daily life in men living with women suffering from COPD in different stages. METHODS: A phenomenographic study was conducted. Data were collected from October 2008 to October 2009 through semi-structured interviews with 19 men living with a woman suffering from COPD. FINDINGS: Two main descriptive categories were found: (1) unchanged life situation where no support was needed; (2) changed life situation related to severity of COPD, where support was needed. The categories were described from the perspective 'ME and my spouse'. Even in their caregiving situation, the men continued with their own life and activities and did not put themselves in second place. No support was needed from healthcare or municipality when the women had mild COPD, but this changed when the COPD progressed. The men felt that daily life was burdened, restricted and the partner relationship was affected, even if the disease had not reached the final stage. The COPD forced them gradually into a caregiving role, and their daily life changed. They become more of a caregiver than a spouse. The men experienced lack of knowledge and support, and they felt that health professionals and municipality did not care about them.

Conceptions of daily life in women living with a man suffering from chronic obstructive pulmonary disease.

AIM: To describe conceptions of daily life in women living with a man suffering from chronic obstructive pulmonary disease (COPD) in different stages. BACKGROUND: The spouse is often the primary caregiver to someone with COPD, and thus also affected by the consequences of the disease. No previous studies have been found focusing on conceptions of daily life in women living with a man suffering from COPD in different stages. METHODS: A phenomenographic study was conducted. Data were collected in 2008-2009 through semi-structured interviews with 21 women living with men suffering from COPD in different stages. FINDINGS: Four main descriptive categories were found: unchanged life situation where no support was needed; socially restricted life and changed roles; changes in health; and changes in the couple's relationship where support was needed. The categories are described in relation to the woman herself, in relation to the man, and in relation to others. No support was needed from society or health care when the men had mild COPD and the women experienced no change in their daily life. As the disease progressed, the women's responsibilities increased and their role changed from being a spouse to being an informal carer. Social contacts became limited, and they began to feel isolated. The women prioritized their spouse's health and well-being and compromised their own health. They experienced lack of support from health professionals and from the municipality.

'Feelings of guilt due to self-inflicted disease': a grounded theory of suffering from chronic obstructive pulmonary disease (COPD).

The aim of this grounded theory study was to illuminate the main concern of people suffering from chronic obstructive pulmonary disease (COPD) and how they handle their everyday life. Data were collected through interviews with 23 people with COPD at different stages, from mild to severe. A substantive theory was generated showing that the main concern was feelings of guilt due to self-inflicted disease associated with smoking habits. This core category was related to five managing strategies termed making sense of existence, adjusting to bodily restrictions, surrendering to fate, making excuses for the smoking-related cause and creating compliance with daily medication.