Anticancer therapy at end-of-life: A retrospective cohort study.

BACKGROUND: A significant proportion of patients with incurable cancer receive systemic anticancer therapy (SACT) within their last 30 days of life (DOL). The treatment has questionable benefit, nevertheless is considered a quality indicator of end-of-life (EOL) care. This retrospective cohort study aims to investigate the rates and potential predictors of SACT and factors associated with SACT within the last 30 DOL. The study also evaluates the scope of Eastern Cooperative Oncology Group (ECOG) performance status and the modified Glasgow prognostic score (mGPS) as decision-making tools for oncologists. PATIENTS AND MATERIAL: This review of medical records included 383 patients with non-curable cancer who died between July 2018 and December 2019. Descriptive statistics with Chi-squared tests and regression analysis were used to identify factors associated with SACT within the last 30 DOL. RESULTS: Fifty-seven (15%) patients received SACT within the last 30 DOL. SACT within 30 last DOL was associated with shorter time from diagnosis until death (median 234 days vs. 482, p = 0.008) and ECOG score < 3 30 days prior to death (p = 0.001). Patients receiving SACT during the last 30 DOL were more likely to be hospitalised and die in hospital. ECOG and mGPS score were stated at start last line of treatment only in 139 (51%) and 135 (49%) respectively. INTERPRETATION: Those with short time since diagnosis tended to receive SACT more frequently the last 30 DOL. The use of mGPS as a decision-making tool is modest, and there is lack in documentation of performance status.

Patients' experiences with shared decision-making in home-based palliative care - navigation through major life decisions.

BACKGROUND: This study addresses the issue of shared decision-making (SDM) in a Norwegian home-based palliative care setting. The significance of patient involvement in SDM is widely acknowledged, and many patients want to participate in decisions about care and treatment. Yet, it remains a need for more knowledge regarding the initiators and approaches of SDM in the context of home-based palliative care, particularly from the patients' perspective. The aim of this study is to understand patients' experiences and preferences for SDM in home-based palliative care, seeking to enhance the quality of care and direct the planning of healthcare services. METHODS: We used a qualitative explorative design. A hermeneutic approach was employed, and data was collected through in-dept interviews with 13 patients. RESULTS: The study uncovered an overarching theme of "Navigating to reach own decisions," comprising three sub-themes: "To be trapped in life without decisions to act on"; "To surrender to others and let others deal with decisions"; "To continue to be oneself without focusing on disease and decision-making". CONCLUSIONS: The findings underscore the need for flexible, person-centered approaches in SDM, tailored to the fluctuating health literacy and changing preferences of patients in palliative care settings. Our study contributes to the understanding of SDM in palliative care by highlighting how patients navigate the balance between autonomy and reliance on HCPs. Future research should explore how healthcare systems, including HCPs' roles in the system, can adapt to the patients' dynamic needs, to ensuring that SDM will remain a supportive and empowering process for patients at all stages of their disease.

Self-reported competence among advanced practice nursing students in Denmark, Finland and Norway: a cross-sectional multicentre study.

BACKGROUND: The health care systems in the Nordic countries and worldwide are under pressure due to increased longevity and a shortage of nurses. Providing nurses with a high level of education, such as advanced practice nursing, is of great importance to ensure effective, safe and high-quality care. AIM: The aim of this study was to investigate self-reported competence using the Nurse Professional Competence Scale Short-Form for the first time among master's students of advanced practice nursing in the Nordic countries and to relate the findings to age, work obligations, child-rearing responsibilities, level of education and clinical nursing experience. METHODS: A multicentre, cross-sectional design was used in this study conducted at five universities in Denmark, Finland and Norway. The Nurse Professional Competence Scale Short-Form consisting of six competence areas was used with a maximum score of 7 per item for the analysis of single items and a transformed scale from 14.3 to 100 for analysing the competence areas (higher score equals higher self-reported competence). Descriptive and comparative statistics were used to analyse the data. RESULTS: The highest mean score was found for the competence area 'Value-based nursing care'. Students living with home-dwelling children (≤ 18 years) reported significantly higher competence in 'Nursing care', while students ≥33 years reported significantly higher competence in 'Nursing care' and 'Value-based nursing care'. No significant differences were found between students working and those not working alongside their studies, between students with and without further nursing-related education, or between students with long and short experience as nurses. CONCLUSIONS: The findings from this study might help to further develop curricula in advanced practice nursing master's programmes to ensure high-quality nursing and sustainable health care in the future. Future high-quality master's programmes might benefit from systematic collaboration between Nordic higher education institutions as also Sweden is planning master's programme. Higher age, having children at home and working while studying should not be considered causes for concern.

Age-related differences in the occurrence, severity, and distress of symptoms in older patients at the initiation of chemotherapy.

BACKGROUND: Evaluate for differences in occurrence, severity, and distress ratings for 32 symptoms between younger older adults (YOA, < 70 years) and older adults (OA, ≥ 70 years) at initiation of chemotherapy. METHODS: Patients (n = 125) were recruited prior to the initiation of chemotherapy and completed the Memorial Symptom Assessment Scale. Differences in occurrence, severity, and distress ratings were evaluated using Independent sample t-tests and Chi-square or Fisher's exact tests. RESULTS: On average, the older patients reported ten concurrent symptoms that equates with a moderate symptom burden. Symptoms with the highest occurrence rates were not always the most severe and/or the most distressing. Few age-related differences were found in patients' symptom experiences. When age-related differences were identified, OA reported lower occurrence, severity, and distress ratings. Nine of the ten symptoms with highest occurrence rates were common for both age groups. For severity and distress, only half of the symptoms were common. In terms of severity and distress, all of the top ten ranked symptoms were in the moderate to severe range. CONCLUSIONS: Both YOA and OA reported a moderate symptom burden and severity and distress scores in the moderate to severe range. The symptoms with the highest occurrence rates were not always the most severe/or the most distressing. Our findings suggest that different dimensions of the symptom experience (i.e., occurrence, severity, and distress) warrant evaluation in older oncology patients.

Nurse Educators' Pedagogical Approaches Addressing Student Nurses' Mental Health Care Competence: A Qualitative Study.

Nurses' mental health care competence is vital for addressing the current mental health care crisis' demand for quality in mental health care and services. These challenges also involve educational institutions. In the mental health course of the bachelor's nursing curriculum, nurse educators face multiple tasks and challenges concerning preparing students for their clinical placement. This study aimed to explore and describe nurse educators' pedagogical approaches across three universities. The study applied a qualitative and descriptive design, and data were collected from individual qualitative interviews with 13 experienced nurse educators. A content analysis approach in lines with Graneheim and Lundman was used to analyse the data. The content analysis resulted in one theme and three categories, and each category was characterised by three subcategories. The theme intentionally preparing student nurses for mental health care competence served as an overarching theme describing the educators' overall reflections and descriptions. The three categories were: activating students for the mental health context; caring for students on a personal level; and supporting students in grasping the scope of nursing within the mental health context. These categories described the varieties and complexity of nurse educators' pedagogical approaches addressing student nurses' mental health care competence.

Students' observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic.

BACKGROUND: Healthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not. METHODS: This observational study used the World Health Organization's observation tool for studying hand hygiene indication and adherence: "My five moments for hand hygiene." For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway. RESULTS: The overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them. CONCLUSIONS: Hand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers' knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.

Characteristics associated with decrements in objective measures of physical function in older patients with cancer during chemotherapy.

PURPOSE: Study purposes were to evaluate for inter-individual variability in the trajectories of three objective measures of physical function (PF) in older patients receiving chemotherapy (n = 112) and determine which characteristics were associated with worse PF. METHODS: Balance, gait speed, and chair-stand test were evaluated at initiation and 1, 3, 6, 9, and 12 months following chemotherapy. Hierarchical linear modeling was used to assess inter-individual variability in the trajectories of the three tests. Demographic, clinical, and symptom characteristics, and levels of cognitive function associated with initial levels and changes over time in each of the tests were determined. RESULTS: Gait speed and chair-stand tests improved over time. Balance declined until month 6, then increased. Characteristics associated with decreases in balance scores at initiation of chemotherapy were lower level of education and lower Karnofsky Performance Status (KPS) score. For initial levels of poorer gait speed, older age, poorer Trail Making Test B (TMTB), and worse Attentional Function Index scores were the associated characteristics. Lower KPS scores, higher body mass index, and poorer TMTB scores were associated with poorer chair-stand times at initiation of chemotherapy. Worse trajectories of chair-stand times were associated with poorer chair-stand time at enrollment. Characteristic associated with lower initial levels and improved trajectories of balance was older age at enrollment. CONCLUSIONS: Determination of characteristics associated with decrements in balance, gait speed, and chair-stand can assist clinicians to identify older oncology patients at risk for decrements in PF. Interventions to maintain and improve PF need to be implemented with higher risk patients.

Lifeworld perspectives of people with dementia: a meta-aggregation of qualitative studies.

OBJECTIVES: This meta-aggregation aims to interpret and synthesize present knowledge on the lifeworld perspectives of people with dementia and develop a model for guidance in clinical practice. METHOD: The data consist of four meta-syntheses describing different lifeworld perspectives in accordance with van Manen's existentials: lived relations, lived space, lived time and lived body. The meta-aggregation summarizes a range of views expressed by people with dementia in qualitative, interview-based studies, with the aim of generating a reliable model based on the studies' findings. RESULTS: In total, 88 studies among 1,191 persons with dementia were included. Sixteen areas of focus were found, representing four perspectives: (a) lived relations, consisting of connectedness, independence, equality and competence; (b) lived space, consisting of belonging, meaningfulness, safety and security, and autonomy; (c) lived time, consisting of being rooted in the past, being in the present, viewing the future and being in process; and (d) lived body, consisting of being functional, trustworthy, adaptable and presentable. A model shaped as a tree trunk captures the lifeworld perspectives of people with dementia. CONCLUSION: Sixteen areas were revealed from this meta-aggregation and form the basis of a model. This model may be used as a guide for health care personnel to ensure the overall lifeworld-perspectives of people with dementia in care for the target group and conduct lifeworld-preserving care with a person-centred approach.

Fighting the waves; Covid-19 family life interference in a neurodevelopmental disorder-caregiver population.

INTRODUCTION: The current COVID-19 pandemic interferes with family lives across the world, particularly families of children with neurodevelopmental disorders (NDDs) are at a greater risk for being negatively impacted by the pandemic. Together with representatives from this caregiver population the aim was to explore the interference associated with normal family life caused by the COVID-19 pandemic. METHOD: This is a descriptive study using a cross-sectional design. Following a strategic network sampling strategy, a user-developed national survey was completed by a larger sample (N = 1,186) of parents and informal caregivers of children with NDDs. The survey utilized a combination of both closed and open-ended questions, and a logistic regression analysis was carried out to assess the association between family characteristics, characteristics of the child, and COVID-19 related family life interference. Before carrying out the regression an inductive content analysis of the open-ended question on `How has the isolation affected the family´ was carried out to construct the outcome variable. RESULTS: The initial analysis indicated that the COVID-19 pandemic induced a shift in everyday family life and a lack of guidance and support related to managing the challenges they were facing. Caregivers who reported that COVID-19 had significantly interfered with their family life, were more likely to report having anxious children, and to have experienced an increased number of conflicts at home. The logistic regression showed that both anxious children and increased conflicts considerably increased the risk for reporting family life interference compared to those that reported no increased conflicts or anxious children. DISCUSSION: Considering how the COVID-19 related increased conflicts at home and anxious children threaten the family life of the NDD caregiver population, as an external source of family stress, which might lead to negative impact on their mental and physical well-being, the need for further research in collaboration with user representatives is apparent. Our study suggests that more information should be provided to healthcare providers, social professionals, peers, people with NDDs, and caregivers of people with NDDs about the potential threats that a stressful life event such as the current pandemic can pose to their mental and physical health and their family life.

'What matters to you?'-a qualitative study on the views of nursing home residents with dementia regarding the health care they receive.

AIMS AND OBJECTIVE: This study's aim is to examine what matters to nursing home residents with dementia by exploring their perceptions of nursing home health care through the conceptual lens of person-centred care. BACKGROUND: Dementia is a major contributor to nursing home placement. To understand the meaning of living with dementia, the inclusion of persons with dementia in research studies is essential. METHODS: In total, 35 in-depth qualitative interviews were conducted with people who have dementia and live in nursing homes. A thematic analysis was applied to analyse the data. Checklist for qualitative studies: Consolidated Criteria for Reporting Qualitative Research (COREQ) https://www.equator-network.org/reporting-guidelines/coreq/ RESULTS: The analysis revealed one overarching theme with four sub-themes. Different matchings of person-centred care and routines in health care being the overarching theme. The four sub-themes were as follows: (a) understanding of the interplay between disabilities and ageing; (b) participating based on one's own preferences and needs; (c) incongruence between the person with dementia's preferences and needs and health-care support; and (d) working conditions: the relationship between residents and health-care providers. Despite the substantive focus of researchers on person-centred care and the positive impact on the nursing home health care of those who receive it, the results showed that nursing home residents still want more person-centred care. CONCLUSIONS: The results indicate that the incongruence between general routines and individual preferences and needs, as well as the demand to operationalise the person-centred dimensions of health-care behaviour in nursing homes, must be resolved. Health care in nursing homes must focus on enabling residents to participate in daily activities and sustain their personhood and sense of self. RELEVANCE TO CLINICAL PRACTICE: Based on the residents' statements, the results contribute to the fields of dementia education, health-care provision and policy-making and may be used to achieve person-centredness and governance.

Healthcare professionals' perceptions of dignity-preserving care for older home-dwelling women with incurable cancer in Norway.

Municipal end-of-life care for older home-dwelling patients with cancer is a complex matter requiring healthcare professionals (HCPs) to recognize gender differences in a social, historical and organizational context. A qualitative approach was chosen to explore and identify HCPs value-based principles and organizational conditions promoting dignity-preserving care practice for these women. HCPs recognized the importance of sheltering the women's identity, their sense of being home and acknowledged their personal preferences as value-based principles, whereas creating a flexible culture of care, establishing a functional professional collaboration and developing individualized plans of care, were crucial organizational conditions influencing the practice of dignity-preserving care.

Is neuroticism relevant for old cancer survivors? A controlled, population-based study (the Norwegian HUNT-3 survey).

PURPOSE: Personality traits, particularly neuroticism, have an impact on people's health and lifestyle. Due to lack of previous studies, we examined old cancer survivors (OCSs) versus cancer-free age-matched controls aged ≥ 70 years, regarding prevalence of high neuroticism, health problems in those with high and low neuroticism, and sociodemographic and clinical variables that were significantly associated with high neuroticism. METHODS: We merged data from a Norwegian population-based health study (the HUNT-3) and from the Cancer Registry of Norway identifying OCSs. Three cancer-free controls were drawn at random for each OCS. Neuroticism was self-rated on a brief version of Eysenck Personality Questionnaire. Between-group statistical comparisons were made between OCS and controls, and among their subgroups with high and low neuroticism. Logistic regression analyses were used to investigate independent variables significantly associated with high neuroticism. RESULTS: Twenty-nine percent of OCSs reported high neuroticism while controls reported 30%. OCSs showed significantly lower rate of good life satisfaction than controls. All other between-group comparisons were nonsignificant. Being OCSs was not significantly related to high neuroticism in the regression analyses. Sociodemographic, general health, and lifestyle issues, lack of energy, and low life satisfaction remained significantly associated with high neuroticism in the multivariable analysis. CONCLUSIONS: The prevalence of high neuroticism was similar in OCSs and controls. High neuroticism was associated with negative health and lifestyle issues in both groups.

Health-related quality of life in patients with colorectal cancer in the palliative phase: a systematic review and meta-analysis.

BACKGROUND: The occurrence of colorectal cancer has doubled over the last 50 years and many people are living with the disease in the palliative phase. Therefore, it is important that healthcare personnel have knowledge about the patient's health-related quality of life (HRQoL). The aim of this review is to investigate how HRQoL is reported by means of different measures for patients in the palliative phase of colorectal cancer and examine which sociodemographic and clinical factors are associated with the mean scores reported for HRQoL. METHOD: A systematic review and meta-analysis using forest plots in STATA were conducted. The databases MEDLINE, CINAHL, Embase, Amed, and SveMed+ were used for the systematic searches with combinations of terms for colorectal cancer, the palliative phase and HRQoL. The Cochrane handbook and the PRISMA checklist from 2009 were utilised. RESULTS: In total, 710 articles were identified. Eleven quantitative studies met the inclusion criteria and six were included in the meta-analysis. Five of the 11 studies had a longitudinal design, while the other six had a cross-sectional design. The meta-analyzes shows that the average HRQoL in palliative phase was 62.9 (56.8-69.0) 15D was 0.76 (0.73-0.79), EQ-5D was 0.67 (0.62-0.73), and VAS was 64.1 (53.7-74.4). Multiple sociodemographic and clinical variables were associated with HRQoL and a higher prevalence of common cancer symptoms were reported than gastrointestinal symptoms. CONCLUSION: This systematic review revealed that patients with colorectal cancer report low HRQoL. Furthermore, it shows that what affects HRQoL is complicated, including multiple clinical and sociodemographic variables. This underlines the need for further research. To ensure the best possible care, it is important that all healthcare professionals have easy access to knowledge about HRQoL in patients with colorectal cancer, and what impacts it in the last phase of life.

From a first person perspective: Soldiers' experiences three decades after an avalanche - A qualitative interview study.

STUDY OBJECTIVES: The aim of this study was to explore indirectly exposed soldiers' subjective experiences following an avalanche. Three decades after the trauma, this study describes the perceived impact of the disaster by peers of those who survived or died in the avalanche. METHOD: A qualitative, cross-sectional, study based on 17 individual interviews with persons indirectly exposed to an avalanche. Data was analysed according to qualitative content analysis. FINDINGS: The findings revealed 'being a significant first person' as the main theme. Two categories were developed: 1) Experience of closeness to the victims 2) Experience of distance post-disaster. The categories elaborated two subcategories each: 1) Could have been me 2) Sadness, grief, shame and guilt over losing friends and 1) Unorganized military service post-disaster 2) Anger towards the system. CONCLUSION: The soldiers indirectly exposed to the avalanche need to be seen both as a person and as a group. Both immediately following and decades after the disaster, the informants wanted the military to offer adequate follow-up.

Dignity of older home-dwelling women nearing end-of-life: Informal caregivers' perception.

BACKGROUND: Most older people wish to live in the familiar surroundings of their own home until they die. Knowledge concerning dignity and dignity loss of home-dwelling older women living with incurable cancer should be a foundation for quality of care within municipal healthcare services. The informal caregivers of these women can help increase the understanding of sources related to dignity and dignity loss. AIM: The aim of this study was to explore informal caregivers' perceptions of sources related to dignity and dignity loss in end-of-life of older home-dwelling women with incurable cancer. RESEARCH DESIGN AND METHOD: The study was founded upon Gadamer's philosophical hermeneutics. In-depth interviews with 13 informal caregivers were carried out, and four participant observations were performed during home meetings. ETHICAL CONSIDERATION: The study was based on voluntary participation, informed consent, confidentiality and the opportunity to withdraw at any time. The Norwegian Social Science Data Services approved the study. RESULTS: Three main sources important in preserving the older women's dignity were identified: maintaining one's self-concept, remaining hopeful and sustaining freedom of choice. We also identified three main sources that lead to dignity loss: Sensing loss of human value, experiencing absence of gentleness and feelings of being treated as an object. DISCUSSION AND FINAL CONSIDERATIONS: On the individual level, the opportunity to maintain one's self-concept and control in life, preserved dignity, while feelings of existential loneliness led to dignity loss. On the relational level, being confirmed as worthy human beings promoted the women's dignity, whereas dignity loss was related to uncaring behaviours from healthcare professionals. On the societal level, individual decisions concerning travel situations and the place to stay when nearing end-of-life were of crucial importance. Constituting these women's living space, these perspectives should be emphasized in healthcare professionals' educational training and in the municipal end-of-life care of these patients.

Open Dialogue Approach: Exploring and Describing Participants' Experiences in an Open Dialogue Training Program.

Open dialogue (OD) is a family-oriented approach that has demonstrated good outcomes in treatment of first-episode psychosis. OD focuses on communication as a joint process of constructing meaning among patients, their social networks, and professionals. The current study investigates how 42 participants experienced a training program in OD. The study comprises a cohort with a longitudinal design. Data were collected by means of semi-structured questionnaires and contained quantitative and qualitative data. Descriptive analysis was performed to analyze quantitative data and thematic analysis for qualitative data. Findings show that participants' learning outcomes and confidence with using OD with patients, social networks, and professionals increased significantly throughout the training program. Reflection and role play were essential learning methods. Participants defined themselves as in-progress and considered the training program educational, engaging, and varied. Three main themes arose from the data: Developing an OD Training Program, Competence Development "From Novice to Expert," and Participation and Commitments. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 38-47.].

The Experience of Lived Time in People with Dementia: A Systematic Meta-Synthesis.

INTRODUCTION: For people with dementia, lived time is important to understand, as the condition affects memory, perceptions of time, and life expectancy. The aim of this study was to locate, interpret, and synthesize the experience of lived time for people with dementia. METHOD: This article presents a qualitative systematic meta-synthesis. The theoretical framework of lifeworlds by van Manen provided the context for the study. The Critical Appraisal Skills Programme criteria for qualitative studies were used to appraise the studies. Sixty-one qualitative research studies based on interviews with people with dementia were included in the review. The analysis followed the principles of interpretive synthesis. RESULTS: Four categories were revealed: (1) rooted in the past - "I am the same as before"; (2) focussing on the present - "Nobody has tomorrow"; (3) thinking about the future - "What is going to happen to me?"; and (4) changes in the experience of self over time - "I used to…." The latent overall meaning was expressed as "being engaged with the dimensions of time." DISCUSSION/CONCLUSION: The experience of lived time is an active and important one, enabling people to manage the dementia journey. Future work involving people with dementia should foreground the experience of lived time.

What matters to you when the nursing is your home: a qualitative study on the views of residents with dementia living in nursing homes.

BACKGROUND: Dementia is recognised as one of the greatest global public health challenges. A central tenet of national health and social care policy is to ensure that services support people in achieving their personal well-being and outcomes, defined as the things important to people in their lives, also people with dementia. The aim of this study is to explore what matters to nursing home residents with dementia based on their perceptions of nursing homes as home. METHODS: There were conducted 35 interviews with people with dementia in nursing homes. We conducted the in-depth unstructured qualitative interviews. Thematic analysis was applied to analyse the data. RESULTS: The analysis resulted in one over-arching theme "tension between the experiences of a nursing home being a home and an institution" and five themes; "myself and my relationships with fellow residents", "creation of individualised living spaces", "single rooms with personal decor that enhances a sense of connectedness", "transition between the old home and the new home" and "significant activities providing meaning". The participants stated that the transition to the supported, structured living environment in nursing homes to be a clear need based on immediate, serious safety concerns. They went from being masters of their own lives to adhering to nursing home routines. Fellow residents could be both resources and burdens, creating feelings of security and insecurity. A home-like environment was created by allowing the participants to bring their important personal belongings into private spaces. The participants said they needed to be able to decorate their rooms to their own specifications. They wanted involvement in meaningful activities. CONCLUSIONS: The findings showed that 'home' was an emotive word that awakened many associations. The participants reported mixed feelings and stated that they could thrive even if they missed their old homes. What mattered was that the participants felt safe, had single rooms where they could retire from the community, their own belongings and did activities. The participants wanted greater possibilities for meaningful relations. They appreciate that nursing home were similar to their previous homes. They desired opportunities to continue some activities they did in their former home.

Nurses' job involvement and association with continuing current position-A descriptive comparative study.

AIMS AND OBJECTIVES: The aim of the study is to examine nurses' job involvement and intentions to continue in their current position. BACKGROUND: Globally, the supply of nurses fails to meet the labour markets' high demand. Compared to specialist health service, the community health service has the greatest challenge when it comes to nursing shortage. There is a lack of studies comparing nurses working in different parts of the healthcare system in research focusing on nurses' intentions to continue in their current position. Similarly, there has been relatively little research on nurses' job involvement, even less how it is associated with retaining the nurses, despite indications that job involvement may be the key to job-related motivated behaviour. DESIGN: A descriptive comparative study with a cross-sectional design. METHODS: The study comprises 297 nurses from the community health service and specialist health service, respectively. The relationships between nurses' intention to continue and participant characteristics were examined using binary logistic regression. Reporting followed the STROBE guidelines. RESULTS: Nurses in the community health service are older, have more children under the age of 18 and hold more permanent positions than nurses in the specialist health service. Job involvement is the only variable associated with nurses' intention to continue in their current position regardless of whether the nurse works in the community health service or specialist health service. CONCLUSIONS: The results indicate that the community health service has the same possibilities as the specialist health service to retain nurses in their current jobs. RELEVANCE TO CLINICAL PRACTICE: The results indicate that nursing leaders/employers with a goal to retaining nurses are recommended to focus on improving the nurses' job involvement.

Dignity and loss of dignity: Experiences of older women living with incurable cancer at home.

In this study, we explored and identified crucial experiences that constitute dignity and loss of dignity among older women living with incurable cancer at home. In-depth interviews with 13 women, and participant observations of five of these women, were performed. Hermeneutical interpretations of interview texts and field notes were conducted. Crucial experiences that preserved the women's dignity included having a sense of control, making one's own decisions, experiencing hope and meaningfulness, feeling valued as a human being and having the opportunity to be in a treasured and nurturing environment. Dignity loss was related to losing the opportunity for self-determination, sensing hopelessness and worthlessness in a shroud of illness, experiencing violation of their personal life and being situated in surroundings that enhanced their sense of disconnection and alienation. Quality of care was experienced as more important than the physical place in which to spend their final stage of life. The findings suggest that dignity preservation should be a core dimension in care for older women living with incurable cancer at home. Future research should investigate how dignity-preserving care can be organized and practiced within municipal palliative care services.