Educational nutritional intervention to prevent loss of health-related quality of life among older adults after a surgical treatment: design of a randomised controlled trial.

BACKGROUND: Disease-related malnutrition after a hospital stay has major consequences for older adults, the healthcare system and society. This study aims to develop and test the effectiveness of an educational video to prevent loss of health-related quality of life among live-at-home older adults after surgical treatment in a hospital. METHOD: This randomised controlled trial will occur at a regional hospital in Norway. Participants will be live-at-home adults aged 65 years and older. They will be recruited from three different surgical departments after a surgical procedure. Individuals with a body mass index below 24 and a home address in one of nine selected municipalities will be eligible for inclusion. Participants will be randomly assigned to either the intervention group or the control group. Those assigned to the intervention group will obtain access to a 6-min educational video 5 days after being discharged from the hospital. The control group will not obtain access to the video. The primary outcome will be health-related quality of life using the Norwegian Rand 36-Item Short Form Health Survey. Furthermore, we will measure body composition, number of readmissions and nutritional knowledge at inclusion and 3-month follow-up. DISCUSSION: This randomised controlled trial is expected to provide insight into whether an educational video can improve the nutritional status of older adults following a surgical procedure and discharge from the hospital. The findings will be useful for assessing how videos offering nutritional advice to older adults who have undergone a surgical procedure can improve their health-related quality of life, reduce loss of function, prevent readmission to hospital and reduce healthcare costs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05950373. Registered on 11 July 2023.

Patients' expectations of and experiences with psychosocial care needs in perioperative nursing: a descriptive study.

BACKGROUND: Meeting inpatients' psychosocial care needs is essential for their wellbeing, recovery, and positive experiences. This study aimed to describe and compare surgical inpatients' subjective perceptions of the importance of fundamental psychosocial and overall care received. METHODS: A descriptive study with a convenient sample was conducted from September 2019 to April 2020. A total of 194 surgical inpatients from Norway and Denmark answered a perioperative user participation questionnaire on the day of discharge. The questionnaire was previously face- and content validated. The questionnaire assessed patients' sociodemographic characteristics and four dimensions of fundamental care domains: Psychosocial, Relational, Physical, and System level. This study reports the results from the psychosocial domain. Descriptive statistics including frequencies, percentages, means, and standard deviations were used to analyze background information variables. The congruency between participants' expectations of and experiences with psychosocial care is presented. RESULTS: The inpatients expected (and experienced) the healthcare personnel to treat them with respect and dignity, and to be involved and informed throughout their perioperative care. The average ratings regarding these aspects of psychosocial care needs were 72.1-93.8%. There was congruency between patients' perceptions of the subjective importance (SI) of psychosocial fundamental care and their perceived reality (PR) of care. Congruency between high SI and high PR ranged from 59.1 to 92.2%, and congruency between low SI and low PR ranged from 0 to 6.6%. Incongruency between SI and PR varied between 5.9 and 39.6% and was mainly related to higher PR than SI. We found no association between education level, sex, length of stay, age, and patient expectations of or experiences with psychosocial care needs. CONCLUSIONS: Surgical inpatients in Norway and Denmark experience respectful and dignified treatment, and they feel involved and informed in their perioperative care. It is important to include patient perspectives in further research to avoid missed care and disconnection between what patients prefer and what healthcare personnel plan to do. Understanding patient preferences might also lead to less stress and workload for healthcare personnel.

Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review.

OBJECTIVE: The objective of this scoping review was to identify and map existing preoperative interventions, referred to as prehabilitation, in adult patients at home awaiting elective coronary artery bypass grafting surgery. This review also sought to report feasibility and patient experiences to shape clinical practice and underpin a future systematic review. INTRODUCTION: As patients age, comorbidities become more common. Strategies to improve postoperative outcomes and to accelerate recovery are required in patients undergoing coronary artery bypass grafting. Prehabilitation refers to a proactive process of increasing functional capacity before surgery to improve the patient's ability to withstand upcoming physiologic stress and, thus, avoid postoperative complications. INCLUSION CRITERIA: Studies that included adult patients waiting for coronary artery bypass grafting surgery at home and that described interventions optimizing preoperative physical and psychological health in any setting were included. METHODS: The JBI methodology for conducting scoping reviews was used to identify relevant studies in MEDLINE (PubMed), CINAHL (EBSCOhost), Cochrane Library, Embase (Ovid), Scopus, SweMed+, PsycINFO (EBSCOhost), and PEDro. Gray literature was identified searching Google Scholar, ProQuest Dissertations and Theses, MedNar, OpenGrey, NICE Evidence search, and SIGN. Studies in Danish, English, German, Norwegian, and Swedish were considered for inclusion, with no geographical or cultural limitations, or date restrictions. Two independent reviewers screened titles and abstracts, and studies meeting the inclusion criteria were imported into Covidence. Sixty-seven studies from November 1987 to September 2022 were included. The data extraction tool used for the included papers was developed in accordance with the review questions and tested for adequacy and comprehensiveness with the first 5 studies by the same 2 independent reviewers. The tool was then edited to best reflect the review questions. Extracted findings are described and supported by figures and tables. RESULTS: Sixty-seven studies were eligible for inclusion, representing 28,553 participants. Analyses of extracted data identified various preoperative interventions for optimizing postoperative and psychological outcomes for adult patients awaiting elective coronary artery bypass grafting surgery. Based on similarities, interventions were grouped into 5 categories. Eighteen studies reported on multimodal interventions, 17 reported on psychological interventions, 14 on physical training interventions, 13 on education interventions, and 5 on oral health interventions. CONCLUSION: This scoping review provides a comprehensive summary of strategies that can be applied when developing a prehabilitation program for patients awaiting elective coronary artery bypass surgery. Although prehabilitation has been tested extensively and appears to be feasible, available evidence is mostly based on small studies. For patients undergoing elective coronary artery bypass grafting to derive benefit from prehabilitation, methodologically robust clinical trials and knowledge synthesis are required to identify optimal strategies for patient selection, intervention design, adherence, and intervention duration. Future research should also consider the cost-effectiveness of prehabilitation interventions before surgery. Finally, there is a need for more qualitative studies examining whether individual interventions are meaningful and appropriate to patients, which is an important factor if interventions are to be effective.

Needs of carers participating in support groups and caring for a person with dementia: A focused ethnographic study.

AIMS: The aim is to explore and understand how support group participation meets carers' perceived needs for information and social and emotional support when caring for a person with dementia who lives at home. DESIGN: Focused ethnographic design. METHODS: Participant observations and semi-structured interviews with 25 carers were conducted. An inductive content analysis of the data was performed. FINDINGS: Two themes were identified: "Strengthening the sense of self" and "Managing uncertain benefits." CONCLUSION: Carers' level of information about dementia was partly met, thereby strengthening their sense of self and joy. Maintaining shared decision-making in financial matters was viewed as an expression of respect and reciprocity. Getting acquainted with peers and dementia coordinators was viewed as emotional and social support but was also used strategically to gain easier access to health care services. By fulfilling their needs, support group meetings became meaningful, which motivated carers to continue providing care.

User participation in perioperative hospital care research: a methodological framework for a research program.

It is important to study the well-being of patients and their relatives after receiving hospital treatment, as both the healthcare professional and the political attention towards user participation is constantly increasing. In this study, user participation is understood as a way to manage the user's rights, opportunity for choices and human rights through relationships and with their well-being as a common goal. Therefore, the health professionals' understanding of this must be increased, evidence must increasingly form the basis for the chosen actions and the professional management must support a person-oriented clinical practice. The research program's theoretical perspective for perioperative nursing is presented in this article, and it is based on answering person-oriented Fundamental of Care questions and as a methodological challenge to have user involvement as a constant activity. This theoretical and methodological choice guides the continued development of the research program. Perioperative nursing is understood from the time the patient meets the nurse at the time of admission until the time of discharge after the elective surgical treatment is completed. To our knowledge no studies regarding the outcome of FoC for the perioperative patient have been conducted. We address healthcare providers' actions, starting from when a nurse admits a patient until the day of discharge after treatment is complete, and nursing care related to elective surgical procedures in Norwegian and Danish non-university hospitals. The research program seeks insight into the experiences of current and former patients and relatives as well as the healthcare professionals who perform the treatment in Norwegian and Danish non-university hospitals. Based on results from this research program, we expect to be able to increase the healthcare professionals' competencies in Fundamental Care and to increase their openness regarding user involvement, options and human rights for the benefit of surgical patients well-being.

Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map existing preoperative interventions, referred to as prehabilitation, in adult patients at home awaiting coronary bypass grafting (CABG) surgery. This scoping review also seeks to examine the feasibility and patient experiences in order to inform clinical practice and underpin a future systematic review. INTRODUCTION: As patients age, comorbidities become more common. Strategies to improve postoperative outcomes and to accelerate recovery are required in patients undergoing CABG. Prehabilitation refers to a proactive process of increasing functional capacity before surgery to improve the patient's capacity to withstand upcoming physiologic stress and thus avoid postoperative complications. INCLUSION CRITERIA: This scoping review will consider any studies including adult patients at home awaiting CABG surgery. Studies will provide information on any prehabilitation intervention to optimize preoperative physical and psychological health status. Studies conducted in any setting will be included. METHODS: The methodology will follow the JBI recommendations for scoping reviews. Any published or unpublished source of information will be considered. Studies published in English, German, Danish, Swedish, and Norwegian will be included, with no geographical or cultural limitations. Retrieved papers will be screened by two independent reviewers, and a standardized tool will be used to extract data from each included source. The results will be presented as a map of the data extracted in a tabular form together with a narrative summary to provide a description of the existing evidence.

The effectiveness of hypnotic analgesia in the management of procedural pain in minimally invasive procedures: A systematic review and meta-analysis.

INTRODUCTION: Patients undergoing minimally invasive procedures under a light conscious sedation perceive pain and anxiety. Hypnosis used together with analgesics has been investigated in numerous studies. AIMS AND METHODS: To assess the effectiveness of hypnotic analgesia in management of pain, anxiety, analgesic consumption, procedure length and adverse events in adults undergoing minimally invasive procedures. Clinical controlled trials in which hypnosis was used together with pharmacological analgesia compared to pharmacological analgesia alone during invasive procedures were included. Seven databases were searched. The methodological quality of the studies was assessed by two reviewers using a standardised instrument for critical appraisal from Joanna Briggs Institute, 'Meta-Analysis of statistics assessment and review Instrument'. Meta-analyses using the review manager version 5.3 software were conducted on procedure length and adverse events. Results for pain, anxiety and analgesics were synthesised in narrative summaries. Conduction of the review adheres to the PRISMA checklist. RESULTS: Ten studies comprising 1,365 participants were included. A reduction in the consumption of pain medication was found between 21%-86% without aggravating pain intensity and anxiety. In few studies, significant reduction in pain intensity and anxiety was found. Meta-analysis including seven studies revealed a small beneficial effect on reducing procedure length. A meta-analysis on adverse events showed no significant reduction. Statistical heterogeneity was found among the studies included. CONCLUSION: For patients undergoing invasive procedures, hypnotic analgesia was effective in reducing consumption of analgesics. Only a slight effect was, however, found on experienced anxiety and pain intensity. It did not prolong the procedure and was safe to provide. RELEVANCE TO CLINICAL PRACTICE: Hypnosis is recommended as pain management for adults during invasive procedures. A reduced consumption of pain medication potentially has a major impact on monitoring and observation of patients following the procedure, thus improving patient safety and reducing resource consumption.

Support groups for carers of a person with dementia who lives at home: A focused ethnographic study.

AIMS: To explore and understand carer participation in support groups when caring for a person with dementia who lives at home. DESIGN: Focused ethnographic design. METHODS: Participant observations and semi-structured interviews were conducted from January-December 2015. The data were collected from four support groups in the Danish primary healthcare system. Interviews were conducted with 25 carers. An inductive content analysis of the data was performed. RESULTS: Three themes were identified: emotional well-being due to peer and family support, emotional sense of togetherness despite hardships and emotional and ethical considerations in caregiving. CONCLUSION: Support group participation with positive peer interaction increases carer self-esteem and feelings of togetherness, and an awareness of maintaining the care receiver`s dignity and prevention of conflicts with families, resulting in an improvement in carer well-being, leading to increased motivation to continue caring. Carers who hid their group participation face a potential conflict with the care receiver. IMPACT: By sharing positive experiences, carers have increased self-esteem and feelings of togetherness, which can have a positive impact on their motivation to continue caring. Positive peer interaction encouraged a shift in focus from negative to positive experiences, resulting in an improvement in carer well-being. Joint group participation prevented conflicts in families. To protect the care receivers, carers kept support group participation a secret. Healthcare professionals could improve carer well-being by focusing on positive caring experiences in support groups.

Transformation of health professional/patient caring relationships through information and communication technologies used in telemedicine: a scoping review protocol.

REVIEW OBJECTIVES/QUESTIONS: The objectives of this scoping review are to examine and map how telemedicine via information and communication technology (ICT) transforms caring relationships between health professionals and patients and how this transformation is conceptualized.The questions of this review are.

Understanding how patients use visualization during ablation of atrial fibrillation in reducing their experience of pain, anxiety, consumption of pain medication and procedure length: Integrating quantitative and qualitative results.

BACKGROUND: Patients who undergo radiofrequency ablation of atrial fibrillation with a light conscious sedation often feel pain during the procedure which can be difficult to relieve with pharmacological pain treatment alone. In a quasi-experimental study, it was found that visualization together with usual pain medication reduced the amount of analgesics used. In addition, patients spontaneously expressed pain significantly fewer times outside the scheduled measurements. No difference was found in the perception of pain intensity or anxiety and procedure length in the study. In a subsequent qualitative study with patients from the intervention group in the quantitative study, patients reported visualization as a positive experience which helped them manage pain and anxiety by supporting their individual strategies and without inconvenience. AIM: To examine patients' experiences with the effect of visualization during ablation of atrial fibrillation and its association with pain intensity, anxiety, pain medication and procedure length. METHODS: A mixed-method study with explanatory sequential design including a quasi-experimental study with a control and an intervention group and a qualitative interview study with semi-structured interviews. The results from the two studies in the mixed method study have been integrated by merging and constructing follow-up joint displays. RESULTS: Three themes were identified from the integration of the results from the quantitative and qualitative studies when analyzing and interpreting the results: "Zero pain is not always the goal"; "Not a real procedure time reduction but a sense of time shrinkage" and "Importance of the nurse's presence, visualization or not". CONCLUSION: Visualization can help patients to manage procedural pain when going through ablation of atrial fibrillation but the effect of an intervention such as visualization cannot be measured by pain intensity because the effect of visualization helps patients to cope with the pain and not to reduce the experience of pain intensity. It was shown that the patients had a feeling of reduced procedure time, although it was not reduced statistically significantly by using visualization. Finally, patients did not feel high anxiety during the procedure which was in line with very low values of anxiety measured in the quantitative study but at the same time the presence of the staff was of great importance to them in providing a feeling of security. A reduction of analgesics as found in the study is not only a matter of safety, it is also important in the patient's perception.

Oral hygiene in patients with chronic obstructive pulmonary disease: a scoping review protocol.

SCOPING REVIEW OBJECTIVE: It is hypothesized that systematic oral hygiene may reduce airway infections in patients with chronic obstructive pulmonary disease (COPD). Before considering doing a systematic review, a scoping review is necessary to explore and map literature on the subject and identify which interventions have been carried out, if there is relevant literature available for a systematic review, or if further research should be initiated.The objective of this scoping review is to comprehensively identify and describe qualitative or quantitative literature reporting of non-invasive interventions that have been carried out to improve oral hygiene and relieve and/or reduce respiratory tract infections, exacerbation and/or hospital readmission in patients with diagnosed with COPD. A further objective is to undertake a comprehensive search to identify qualitative literature reporting on the experiences of oral hygiene in people diagnosed with COPD and/or their relatives and/or healthcare providers (HCPs).Specifically, the scoping review questions are as follows.

Validation of the Danish version of the constipation risk assessment scale (CRAS).

INTRODUCTION: The Constipation Assessment Scale (CRAS) was developed in order to enable the prediction of the risk of developing constipation. The scale needs validation in acute and elective patients with common disorders. MATERIALS AND METHOD: Two hundred and six acute patients with hip fracture and 200 elective patients with total knee or hip replacement were included. They were assessed with CRAS before surgery and their defecation pattern, stool consistency and degree of straining were measured at admission and 30 days after surgery. RESULTS: The prevalence of constipation was 0.49 for the acute patients and 0.34 for the elective patients. Sensitivity was 0.67 and 0.57. Specificity was 0.54 and 0.52. Positive predictive value was 0.59 and 0.38, whereas the negative predictive value was 0.63 and 0.7. CONCLUSION: When used in an orthopaedic ward, the prognostic accuracy of CRAS is poor and it cannot be recommended as a screening tool.

Living with symptoms of attention deficit hyperactivity disorder in adulthood: a systematic review of qualitative evidence.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) relates to four dimensions of behavior: inattentiveness, restlessness, impulsiveness and hyperactivity. Symptoms affect multiple areas of daily life such as academic performance and social functioning. Despite the negative effects of ADHD, people diagnosed with ADHD do not necessarily regard themselves as being impaired. However, it is unclear how adults with ADHD experience and manage their symptoms. OBJECTIVES: To identify and synthesize the best available evidence on how adults experience living with ADHD. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adults with confirmed ADHD diagnosis. PHENOMENA OF INTEREST: How adults with ADHD experience and manage the symptoms of ADHD and links between protective factors provided by relatives, friends, fellow students, mentors and colleagues. TYPES OF STUDIES: Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, content analysis or ethnography. SEARCH STRATEGY: A three-step search strategy identified published and unpublished qualitative studies from 1990 to July 2015. METHODOLOGICAL QUALITY: Studies meeting the inclusion criteria were independently assessed by two reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION: Data were extracted from 10 included studies using the JBI-QARI. DATA SYNTHESIS: Qualitative research findings were synthesized using the JBI-QARI. RESULTS: A total of 103 findings from 10 studies were aggregated into 16 categories that were meta-synthesized into four synthesized findings: "Adults are aware of being different from others and strive to be an integrated, accepted part of the community;" "Adults with ADHD are creative and inventive;" "Adults with ADHD develop coping strategies in striving for a healthy balance in life" and "For adults with ADHD, accomplishing and organizing tasks in everyday life is a challenge but it can also be rewarding." CONCLUSION: Adults with ADHD have problems stemming from ADHD symptoms in relation to interacting in social relationships, academic functioning and being part of the community at the workplace and performing work tasks; they work harder to perform tasks and strive to be accepted and to be equal members of the community.Protective factors that support their ability to manage daily life with ADHD are personal strategies such as reminders and performing tasks within a given structure. Others close to them can assist by coaching, reminding them of appointments and so on. Superiors can assist by structuring the work tasks and setting up clear rules and limits for the tasks. Medication has proven to be very useful as it leads to less hyperactivity and enhances ability to stay focused and be more organized. Finally, insight into ADHD has a positive impact on the ability to manage the consequences of ADHD.Health professionals should, when advising adults with ADHD, fundamentally see them as persons who have a problem and not as problem persons, emphasize strategies adults themselves can apply such as structuring everyday tasks and informing them about positive effects and possible side effects of medication. Policy-makers could launch campaigns targeted at employers with information about the competencies adults with ADHD possess and how employers can benefit from these by structuring work tasks. When promoting employees with ADHD, it should be to positions with more advanced hands-on functions and not positions with administrative duties.

The perception of partnership between parents of premature infants and nurses in neonatal intensive care units: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify how parents of premature infants in neonatal intensive care units (NICUs) and nurses perceive their partnership.The review questions are: how do parents of premature infants and nurses perceive their partnership during hospitalization in NICUs? What barriers and facilitators to partnership can be identified?

The effectiveness of individual rehabilitation on health status in patients with heart failure: A quasi-experimental study.

Patients with heart failure (HF) live with a serious disease, and need long-term rehabilitation care. Elements in rehabilitation for patients with HF are based on the recommendations from the European Society of Cardiology and focuses on self-care and adherence in general. The aim of this study is to test the effect of individually prepared rehabilitation plans measured on health status (HS). The study design is quasi-experimental. Patients in the control group follow the conventional rehabilitation. For the patients in the intervention group. an individual rehabilitation plan was prepared and followed up by telephone after 4 and 12 weeks. For all patients, HS was measured with Short Form-36. One hundred sixty-two patients are included in the study, of which 137 (84.6%) consented. There were no differences in HS before and after the intervention. There are no significant differences by use of a systematically prepared intervention compared with usual care for patients with HF measured on HS 3 months after discharge from the outpatient clinic.

The effectiveness of systematic perioperative oral hygiene in reduction of postoperative respiratory tract infections after elective thoracic surgery in adults: a systematic review.

BACKGROUND: Nosocomial infections are a significant contributor to patient morbidity and mortality. Nosocomial infections significantly increase hospital length of stay and total hospital costs. Thoracic surgery, mechanical ventilation and/or admission to an intensive care unit are known to increase patients' risk for nosocomial respiratory tract infection. OBJECTIVES: To identify, appraise and synthesize the best available evidence on the effectiveness of systematic perioperative oral hygiene in the reduction of postoperative respiratory airway infections in adult patients undergoing elective thoracic surgery. INCLUSION CRITERIA: Patients over the age of 18 years who had been admitted for elective thoracic surgery, regardless of gender, ethnicity, diagnosis severity, co-morbidity or previous treatment.Perioperative systematic oral hygiene (such as mechanical removal of dental biofilm or plaques and/or systematic use of mouth rinse) performed by patients themselves or by healthcare staff (such as nurses).Randomized controlled trials and quasi-experimental studies.Nosocomial infections, specifically respiratory tracts infections, and surgical site infections SEARCH STRATEGY: Multiple databases (PubMed, CINAHL, Embase, Scopus, Swemed+, Health Technology Assessment Database and Turning Research Into Practice [TRIP] database) were searched from 1980 to December 2014. Studies published in English, German, Danish, Swedish and Norwegian were considered for inclusion in this review. METHODOLOGICAL QUALITY: Two independent reviewers used the standard critical appraisal tool from the Joanna Briggs Institute to assess the methodological quality of studies. DATA EXTRACTION: The process of data extraction was undertaken independently by two reviewers using tools from the Joanna Briggs Institute. DATA SYNTHESIS: Quantitative results were synthesized in meta-analysis. RESULTS: This review includes six studies: three randomized controlled trials and three quasi-experimental studies.The absolute magnitude of the summary effect sizes were: for nosocomial infections relative risk (RR) 0.65 (95% confidence interval [CI] 0.55-0.78) for respiratory tract infections RR 0.48 (95%CI: 0.36-0.65) and for deep surgical site infections RR 0.48 (95%CI 0.27-0.84). CONCLUSIONS: Systematic perioperative oral hygiene reduces postoperative nosocomial, lower respiratory tract infections and surgical site infections but not urinary tract infections. The effect is statistically, clinically and practically significant.Perioperative decontamination of the nasopharynx and/or oropharynx is a strategy worth pursuing. The intervention is cheap and can easily be carried out by the patients themselves. (Grade A)Studies testing decontamination of the nasopharynx and/or oropharynx have until now only included patients undergoing thoracic surgical procedures. As the interventions are cheap, easy to carry out and have a great impact on the patients' outcome, it is recommendable to carry out more studies involving other type of patients undergoing major surgery with a high prevalence of nosocomial infections, respiratory tract infections and surgical site infections.

Physical health problems experienced in the early postoperative recovery period following total knee replacement.

BACKGROUND: The length of stay in hospital following total knee replacement is markedly shortened due to fast-track programmes. Patients have to be responsible for their recovery at a very early stage. The aim of this study was to investigate the prevalence of physical health problems and the level of exercising in the early recovery period after discharge from hospital following total knee replacement. METHOD: A cross-sectional survey was conducted using a questionnaire. A total of 86 patients were included following first-time elective total knee replacement. Descriptive statistics were used. RESULTS: The majority of the patients experienced leg oedema (90.7%). Secondary to this were pain (81.4%), sleeping disorders (47.7%) problems with appetite (38.4%) and bowel function (34.9%) were the most frequently identified physical health problems. In total, 69.8% of the patients indicated that they did not exercise or only partly exercise as recommended, but without associated experience of pain. CONCLUSION: Patients experienced a wide range of physical health problems following total knee replacement and deviation from recommended self-training was identified. These findings are valuable for health professionals in regard to improve treatment as well as patient education and information.

Testing a reality orientation program in patients with traumatic brain injury in a neurointensive care unit.

PRIMARY OBJECTIVE: The aim of this study was to examine the effect of a systematic reality orientation program (RO) introduced in a neurointensive care unit on duration of posttraumatic amnesia (PTA) and outcomes of patients with traumatic brain injury (TBI). RESEARCH DESIGN: This study used a quasiexperimental, prospective design. METHODS AND PROCEDURES: Twenty-four patients (intervention) with a significant TBI classified as moderate-to-severe injuries as measured by scores of less than 12 on the Glasgow Coma Scale underwent an RO program compared with a similar group of 38 patients (control) who received a conventional rehabilitation program. The Rancho Los Amigos Score was used to assess the cognitive level 24 hours after the end of sedation, and the Galveston Orientation and Amnesia Test was used daily to assess orientation and duration of PTA. The Glasgow Outcome Scale Extended was then used as an indicator of clinical outcome after 12 months. MAIN OUTCOMES AND RESULTS: The preliminary results indicated that patients who received the RO had a higher mean of the Glasgow Outcome Scale Extended (SD = 1.53) than those receiving the usual care (SD = 1.35) despite that the groups differed significantly (p = .01) in PTA duration. CONCLUSION: Patients with TBI may benefit from early assessment and systematic RO nursing intervention. The RO may facilitate patients with PTA to regain orientation and interact with their surroundings in the neurointensive care unit to optimize the recovery. However, further studies with focus on timing, intensity, and duration are needed to evaluate the influence of an early RO approach on PTA and outcomes in patients experiencing TBI.

Visualisation during ablation of atrial fibrillation - stimulating the patient's own resources: Patients' experiences in relation to pain and anxiety during an intervention of visualisation.

BACKGROUND: Going through ablation of atrial fibrillation can be accompanied by pain and discomfort when a light, conscious sedation is used. Visualisation has been shown to reduce the patients' perception of pain and anxiety during invasive procedures, when it is used together with the usual pain management. PURPOSE: The purpose of this study was to investigate patients' experiences with visualisation in relation to pain and anxiety during an intervention consisting of visualisation, when undergoing ablation of atrial fibrillation. METHODS: Qualitative interviews were conducted with 14 patients from a study population of a clinical controlled study with 147 patients. The transcribed interviews were analysed according to qualitative methodology of inductive content analysis. FINDINGS: Four categories emerged from the interviews: 'approach to visualisation'; 'strategies of managing pain'; 'strategies of managing anxiety' and 'benefits of visualisation'. The transversal analyses revealed two overall themes which highlight the experiences of being guided in visualisation during ablation of atrial fibrillation: 'stimulation of the patients' own resources' and 'being satisfied without complete analgesia' CONCLUSION: Visualisation used during ablation of atrial fibrillation was reported as a positive experience with no serious inconvenience: It seemed that visualisation did not produce complete analgesia but the patients expressed that it provided some pain relief and supported their individual strategies in managing pain and anxiety. Our findings indicate that visualisation for acute pain during ablation of atrial fibrillation was associated not only with a decrease in experience of pain but also with high levels of treatment satisfaction and other non-pain-related benefits.