Relationships and dynamics in families with a child with a kidney transplant-A study of parents' everyday life experiences.

BACKGROUND: Paediatric kidney transplantation is often the best choice of treatment for kidney failure with replacement therapy and represents an important change in the child's well-being. There are, however, still a number of challenges in addition to the parental role. The magnitude of intensive parental caregiving and support required by children with a kidney transplant could be disruptive to family relationships and dynamics. OBJECTIVE: To explore the experiences of family relationships and dynamics among parents of a child with a kidney transplant. DESIGN: An explorative study using a qualitative method. PARTICIPANTS: Twelve parents (seven mothers and five fathers) of seven children with a kidney transplant were included. APPROACH: A phenomenological-hermeneutic approach was applied. METHOD: Semistructured, individual interviews were conducted. The data were analysed using Ricoeur's theory of interpretation on three levels: naïve reading, structural analysis and critical interpretation and discussion. FINDINGS: Three themes were generated: Emotions during ups and downs in everyday life; Balancing different needs among children; and Opportunities and having consideration in the family. CONCLUSION: Relationships between parents that are based on mutual emotional support are significant and essential during periods of severe illness in a child. Parents who are alone or emotionally marked by their child's disease history feel vulnerable and struggle to overcome challenges. Different health situations among siblings lead to challenges in bringing up the children and emotional dilemmas among parents that impact family dynamics. Resilience in parents is a shifting phenomenon that can influence how they deal with family relationships and dynamics.

Nursing care of people with dementia in an orthopaedic acute care setting: An integrative literature review.

AIMS AND OBJECTIVES: This integrative literature review is to collect what is known about the care of people with dementia when they require a hospital admission for an orthopaedic surgical procedure and to contribute to developing an evidence-base to support nursing practice when caring for people with dementia in an orthopaedic setting. BACKGROUND: People with a dementia diagnosis are increasingly common in acute orthopaedic care settings and the admission exposes people with dementia to risks during their hospital stay. In addition, nurses find people with dementia challenging to care for due to the complexity of dual conditions. Little is known specifically about the care requirements for people with dementia in orthopaedic settings. DESIGN: Integrative literature review. METHODS: An integrative literature review and qualitative deductive content analysis using McCormack and McCance's theoretical nursing framework (Person-Centred Nursing Framework) of nine studies were undertaken. The process of the review was guided by PRISMA checklist. RESULTS: The care environment and resistance either in passive form, or through physical intervention, is common in orthopaedic nursing. Planning and delivering care for physical, cognitive and emotional needs is identified as being difficult, resulting in a lack of inclusion for patients, partly due to communication challenges. Finding ways to implement tailored care plans within standard ward routines proves difficult, and the consequence is a less than optimal care experience with adverse effects on patients characterised by an increase in dementia symptoms. CONCLUSIONS: Care for people with dementia in an orthopaedic setting is complex. It needs to be further studied so that more evidence and supporting literature can contribute to improved care for this group of patients. RELEVANCE TO CLINICAL PRACTICE: This study describes the complexity of providing fundamental care for people with dual conditions of dementia and orthopaedic injury and suggests opportunities for improvement.

Parenting a child with a kidney transplant-A study of everyday life experiences.

BACKGROUND: Kidney transplantation in children shows excellent long-term outcomes. However, parents feel responsible for ensuring that their child adheres to complex medical interventions. The dual role - as both parent and medical caregiver - gives rise to fatigue, stress, and emotional pain. Parental and family functioning are critically important to a child's disease course, development and well-being. OBJECTIVE: To explore the experiences and perspectives of mothers and fathers of children with a kidney transplant. DESIGN: An explorative study using a qualitative method. PARTICIPANTS: Twelve parents (seven mothers and five fathers) of seven children with a kidney transplant. APPROACH: A qualitative exploratory study taking a phenomenological-hermeneutic approach. METHOD: Semi-structured individual interviews were conducted. The data were analysed using Ricoeur's theory of narrative and interpretation on three levels: naïve reading, structural analysis, and critical interpretation and discussion. FINDINGS: Four themes were generated: Kidney transplantation as a turning point, the importance of a close collaboration with health care professionals, being the child's voice, and managing the dual role as a parent, and medical caregiver in everyday life. CONCLUSION: Child kidney transplantation led to a transformation in the child, on the physical, mental, and social levels; however, the child was still in need of special attention and support. Problems with the kidney graft functioning resulted in frustration and disappointment in parents. Teamwork between a child's parents became evident, in coping with the dual role as a parent and medical caregiver. Parents aimed to maintain a clear structure related to medication and disease-related treatment. A close and trustful relationship and collaboration with health care professionals were significant and included listening to the voice of the child.

Siblings of children with chronic kidney disease: A qualitative study of everyday life experiences.

BACKGROUND: Chronic kidney disease in children has an impact on all family members. Healthy siblings, in particular, may experience negative psychological and emotional symptoms. Little attention has been paid to how they experience everyday family life and the impact of their sibling's disease. OBJECTIVES: To explore perspectives on and experiences of everyday life among siblings of children with chronic kidney disease. DESIGN: An explorative study with a qualitative method. PARTICIPANTS: Seven siblings (7-13 years) of children with chronic kidney disease (5-16 years) were included. APPROACH: The study took a phenomenological-hermeneutical approach. Semistructured individual interviews were conducted. The data were analysed using Ricoeur's theory of narrative and interpretation, on three levels: naïve reading, structural analysis and critical interpretation and discussion. FINDINGS: Three themes emerged: The illness is in the background or comes to the fore, being concerned for and taking care of the sick sibling and the importance of bonds with relatives or other significant adults. CONCLUSION: In everyday life, participants experienced that their sick sibling's illness was either in the background or came to the fore. They needed to adapt to periods of hospitalisation. They felt a need to be attentive to, take care of and have concern for the sick brother or sister. Conflicts caused feelings of loneliness; however, having knowledge about the disease provided security and meaning. Being introduced to the healthcare professionals was significant. It was important to have close relationships with friends and other adults, which gave rise to feelings of self-confidence and being supported.

The significance of relationships and dynamics in families with a child with end-stage kidney disease: A qualitative study.

AIM AND OBJECTIVES: To explore experiences and the significance of relationships and dynamics among family members living with a child with severe kidney disease. BACKGROUND: Chronic kidney disease (CKD) in children is often incurable, leading to irreversible kidney damage. End-stage kidney failure in a child impacts daily life and routines, requiring significant social adaptation for all family members. However, little is known about how individual family members experience relationships, interactions and dynamics within the family. DESIGN: A qualitative exploratory study taking a phenomenological-hermeneutic approach. METHOD: Data were collected through semi-structured individual interviews with seven fathers, seven mothers, five children with end-stage kidney disease and five siblings. The data were analysed using Ricoeur's theory of narrative and interpretation, on three levels: naïve reading; structural analysis; and critical interpretation and discussion. The Consolidated Criteria for Reporting Qualitative Research checklist has been used (see Supporting Information). RESULTS: All family members experienced relationships within and outside the family as a significant part of everyday life. The well-being of the sick child had an impact on the dynamics and emotional well-being of all family members. Siblings were in need of support; however, being fair could be challenging for parents. CONCLUSION: CKD in a child has an impact on family dynamics and on the relationships between family members. Family members are vulnerable and in need of practical help and emotional support from close relatives, friends, health professionals and other individuals around them. RELEVANCE TO CLINICAL PRACTICE: In clinical practice, the ability to reflect on, or interpret, a range of situations by initiating a dialogue is essential to shape both an individual perspective and the perspective of the entire family unit.

"If only they could understand me!" Acute hospital care experiences of patients with Alzheimer's disease.

Patients with dementia as co-morbidity find hospital stays challenging, because the focus is primarily on the somatic cause for the admission, with less emphasis on the needs pertaining to dementia-related support and care. This results in poorer holistic outcomes, compared to patients without dementia, and an increased cost for the healthcare sector and, society as a whole. The quest is to make hospitals a dementia-friendly context, because this is likely to lead to better patient outcomes for people with dementia generally; however, further research is required to understand where gains may be made in this regard. This study conducted participant observation research strategies to follow patient journeys with Alzheimer's disease admitted to orthopaedic wards, to learn about their experiences as patients. Longitudinal data were gathered by following patients on both day and evening shifts within a specialist orthopaedic hospital ward, commencing at patient admission and concluding at time of discharge. The data were interpreted from a phenomenological-hermeneutic perspective, inspired by Ricoeur's interpretation theory. The study revealed a communication style among nurses who failed to take into account the comprehensive needs of patients with dementia, in terms of timely information exchange and clinical relevance. Patients expressed the desire to be more fully engaged in the care decision-making, together with indicating their appreciation of the work of the health professionals who cared for them. The data revealed that the process of getting to know the patient at the beginning of every shift left little room to alleviate patients' experienced distress, caused by being in hospital. This resulted in patients who were less involved in the caring situation, or, if a patient took the initiative to act, intentions ended up being misinterpreted as disruptive behaviour. The findings have relevance for staff and ward management who are interested to strive to enhance the patient journey as a dementia-friendly hospital.

Nurses' experiences of delivering acute orthopaedic care to patients with dementia.

BACKGROUND: Nurses who care for acute patients with dementia in a hospital setting report a variety of challenges in regard to meeting the complex needs of their patients. In particular, known barriers to optimal care include a lack of knowledge about dementia, lack of dementia-friendly acute clinical environments, lack of time to care for the individual patient and a prioritised focus on the medical issues that triggered the hospitalisation. Research to date has not specifically focused on nurses' experiences of caring for people with dementia in orthopaedic wards. AIM: This study investigates nurses' experiences of caring for people with dementia, in an acute orthopaedic hospital ward setting. DESIGN: Qualitative interviews. METHODS: This qualitative study employs hermeneutic phenomenological research methods. Eight Danish nurses were interviewed in an orthopaedic ward about their experiences in caring for orthopaedic patients with dementia. Nurses with various levels of expertise were selected for interview so that a full range of nursing experiences could inform the research study. RESULTS: The results of the study revealed two major themes: "Nurse communication and patient information" and "Care compromise", with three and four sub-themes, respectively. These findings are used to illustrate how, and why, nurses' experiences of caring for patients with dementia contribute a discontentment and negative preconceived perception by some nurses towards their acute care of patients with chronic dementia. The results are discussed in the context of Interactional Nursing Practice theory and describe the challenges experienced by acute care orthopaedic nurses who care for patients with dementia. CONCLUSION: Orthopaedic nurses find it challenging and professionally difficult to provide person-centred care for patients with dementia during an acute orthopaedic hospital admission. IMPLICATIONS FOR PRACTICE: Orthopaedic nurses should work to adopt a positive attitude, and person-centred approach, towards dementia care. It is also recommended that the electronic patient record should be supplemented by oral dissemination to some extent, as information, plans of action and knowledge about the care situation for patients with dementia has a tendency to drown in chronological data presentation.

Everyday life experiences in families with a child with kidney disease.

BACKGROUND: Chronic kidney disease in children is a complex medical and psychosocial disease with factors that differ from the adult disease in significant ways. Among parents, there is uncertainty about disease progression and lack of confidence in caring for the child. The disease has an impact on the emotional and social well-being of the whole family. OBJECTIVES: To investigate everyday life experiences from the perspectives of members of a family that includes a child with end stage renal disease. METHOD: The study took a phenomenological-hermeneutical approach. Semi-structured individual interviews were conducted with seven fathers, seven mothers, five children with kidney disease and five siblings. The data were analysed using Ricoeur's theory of narrative and interpretation, on three levels: naïve reading, structural analysis, critical interpretation and discussion. RESULTS: It was significant that everyday life and caring for the child were structured around parents' energy reserves. The disease left its mark and changes to daily life caused anxiety, especially for siblings. The search for normalcy was significant and, although the families coped with conditions around the disease, it could be a challenge. CONCLUSION: Family members feel vulnerable and concerned and need attention, support and care. Limitations in everyday life cause a dilemma, and the well-being of one family member has an impact on the well-being of the family as a whole. IMPLICATIONS FOR PRACTICE: Health care professionals should focus on the impact of the family's experiences and needs, and the parents' role in family relationships, to support the entire family unit.

The lived experiences of emotionally insecure nursing students: A qualitative study.

Research shows that students who feel emotionally insecure are at risk of dropping out of nursing educational program. It is, therefore, important to support student resilience in the international nursing education. The aim of this study was to investigate the lived experiences of undergoing a nursing education as an emotionally insecure student. The method was conducted within a phenomenological-hermeneutic approach, inspired by the French philosopher Paul Ricoeur's theory of narrative and interpretation, which is conducted in a three-phased structure: Naïve reading, structural analysis and critical interpretation and discussion. Seven participants were included in the study. The findings show that feeling emotionally insecure can be linked to not feeling good enough and feeling misunderstood - yet, with hidden resources. Nurse educators must be aware that emotionally insecure students can easily feel shame, must be willing to help clear up potential misunderstandings and should be curious about resources that might be hidden, such as competence awareness. Hidden resources might be related to protective factors and resilience. The study points to ways in which the relation between nurse educators and students can affect resilience, and that students are not solely either resilient or emotionally insecure; resilience may exist within vulnerability.

Patients' experiences during the first 12 weeks after discharge in fast-track hip and knee arthroplasty - a qualitative study.

BACKGROUND: Due to the shortened length of stay in fast-track total hip and knee arthroplasty, patients must at a very early stage following surgery take responsibility for their postoperative care and treatment. It is important to establish if this treatment modality of fast-track is not only cost-effective, but meets patients' expectations and needs. AIM: To explore the lived experience of patients in fast-track total hip and knee arthroplasty during the first 12 weeks after discharge. METHODS: A phenomenological-hermeneutic approach was used inspired by Ricoeur's theory of narrative and interpretation. Data were collected through semi-structured interviews with 8 patients 2 and 12 weeks after discharge. FINDINGS: Through the structural analysis 3 themes emerged: 1) Dealing with transition between hospital and home, 2) Pain and self-management of medication, 3) Challenges in rehabilitation. CONCLUSION: Patients appreciated only 1 or 2 days in hospital. However, they were not sufficiently involved in the discharge planning. There was a feeling of uncertainty and being left on their own after discharge, which could affect their pain management and recovery at home. There is a need to develop in partnership with each individual patient a post discharge plan of care and rehabilitation to meet their individual needs, preferences and mode of motivation.

Experiences of living kidney donors during the donation process.

BACKGROUND: The shortage of organs from deceased donors has led to more living donation. Furthermore, immunological developments have made it possible to perform kidney transplantation despite preformed antibodies against the donor organ. This has led to a broader recruitment base of living donors. OBJECTIVE: The objective was to investigate experiences and considerations on becoming, and during the process of being, a living kidney donor. MATERIALS AND METHODS: Interviews and participant observation were conducted before, during and after the donation. Data were analysed in accordance with Ricoeur's theory of interpretation on three levels: naïve reading, structural analysis and critical interpretation and discussion. Eighteen potential donors over the age of 18 were included. RESULTS: Potential donors' decision to donate was based on a desire to help the recipient. At all stages of the process, donors experienced joy, dilemmas, vulnerability and hope. Rejected donors experienced frustration and disappointment. The accepted donors experienced both joy and vulnerability. Interaction between the donor and the recipient and the relatives played a significant role. The transition from being a healthy individual to being a surgical patient was an overwhelming experience. CONCLUSION: The process of donating a kidney and the return to everyday life involved significant experiences of joy, dilemmas, vulnerability and hope that influenced donors' lives on physical, psychological and social levels. Support and clear communication from the health professionals was essential.

Women's lived experiences of learning to live with osteoporosis: a longitudinal qualitative study.

BACKGROUND: A vast amount of literature exists concerning pharmaceutical adherence in osteoporosis. However, the process of learning to live with osteoporosis over time remains largely unknown. The purpose of this study was to gain a deeper understanding of the continued process of how women learn to live with osteoporosis. Our objective was to explore what characterizes women's experiences of living with osteoporosis during the first year after diagnosis, when patients are prescribed anti-osteoporotic treatment, without having experienced an osteoporotic fracture. METHODS: Forty-two narrative qualitative interviews were conducted with fifteen recently diagnosed Danish women. A longitudinal design was chosen since this allows an investigation of the perspective over time. The interviews were conducted in the period of March 2011 to August 2012. Data were analyzed using a phenomenological-hermeneutic interpretation of text. No medical records were available for the researchers. All information with the exception of T-score was self-reported. RESULTS: The participants' experiences could be described in two key themes developed through the analysis: 1) "To become influenced by the medical treatment" which consisted of two sub-themes "taking the medication", and "discontinuing the medication". 2) "Daily life with osteoporosis", which was characterized by three sub-themes: "interpretation of symptoms", "interpretation of the scan results" and "lifestyle reflections". The results highlighted that learning to live with osteoporosis is a multifaceted process that is highly influenced by the medical treatment. In some cases, this is a prolonged process that can take around one year. CONCLUSIONS: The results suggest a need for improved support for individual women during the complex process of learning to live with osteoporosis. The study adds new knowledge that can be useful for healthcare professionals taking a health-oriented stance when supporting women in self-management of their illness. Further investigations of lived experiences over time in the field of osteoporosis research are therefore needed.

Time delay to surgery for appendicitis: no difference between surgical assessment unit and emergency department.

BACKGROUND: In Denmark, emergency departments (EDs) are replacing acute surgical and medical units. The aim of this study was to compare the trajectory of patients undergoing surgery on the suspicion of appendicitis in a surgical assessment unit (SAU) and EDs with an observation unit, respectively. The primary outcome measure was the time from hospital arrival-to-decision for surgery. MATERIALS AND METHODS: A comparative retrospective study with a cross-sectional design and a before-and-after design was carried out during January 2011 to December 2012 at a SAU and an ED at a university hospital (U-SAU and U-ED) and at an ED at a regional hospital (R-ED). Data included time of arrival, decision for surgery, surgery and discharge, and number of blood tests. RESULTS: In total, 250 patients were included. Time to decision for surgery was 4.50, 4.95, and 4.63 h (P=0.58) in the U-SAU, R-ED, and U-ED, respectively. Time from decision for surgery to start of surgery was 4.60, 3.29, and 4.12 h in the U-SAU, R-ED, and U-ED, respectively. The difference was significant between the U-SAU and R-ED (P=0.05) and between R-ED and U-ED (P=0.03). Time from surgery to discharge from the hospital was 17.88, 19.28, and 15.13 h in the U-SAU, R-ED, and U-ED, respectively. The difference was significant between the EDs (P=0.02). Significantly more blood tests were performed in the EDs than in the U-SAU. CONCLUSION: The introduction of EDs with observation units did not influence time to decision for surgery, but more blood tests were performed.

It is not just a Minor Thing - A Phenomenological-Hermeneutic Study of Patients' Experiences when afflicted by a Minor Heart Attack and Participating in Cardiac Rehabilitation.

BACKGROUND: To improve cardiac care, especially cardiac rehabilitation, patients' perspectives should be better addressed. In Denmark, patients afflicted by a minor heart attack in terms of unstable angina pectoris or non-ST-elevation myocardial infarction are treated in fast-track programmes with subacute treatment in hospital, early discharge and follow-up specialised outpatient cardiac rehabilitation. Knowledge of these patients' experiences of their life situation is essential to develop sufficient care protocols. AIM: To gain in-depth understanding of how patients afflicted by a minor heart attack experience their life situation when following cardiac rehabilitation. METHODS: Focus group interviews and individual interviews were conducted with 11 patients enrolled in the cardiac rehabilitation programme. Data consisted of text in the form of transcribed interviews. A three-phased interpretation inspired by Paul Ricoeur's theory of interpretation was applied. FINDINGS: As an overall concept, the patients experienced being forced into a demanding life shaking journey. Three themes emerged: Difficulty accepting the disease: facing the disease is a difficult challenge for the patients, leading to vulnerability and helplessness; Understanding that life has become frail: patients feel shaken as they realise that the disease is chronic and life-threatening; and An altered life: patients must adjust to new limitations in their everyday lives. CONCLUSIONS: Patients experience an overall demanding transition when they are afflicted by a minor heat attack, whereby their lives are sweepingly changed. Supporting patients' integrity, which becomes vulnerable during the various stages of transitions, is essential to ensure a healthy outcome. Being together with fellow patients during cardiac rehabilitation is a facilitating factor in the course of transition.

Patient experience in fast-track hip and knee arthroplasty--a qualitative study.

AIMS AND OBJECTIVES: To explore the lived experience of patients in fast-track primary unilateral total hip and knee arthroplasty from the first visit at the outpatient clinic until discharge. BACKGROUND: Fast-track has resulted in increased effectiveness, including faster recovery and shorter length of stay to about two days after hip and knee arthroplasty. However, the patient perspective in fast-track with a median length of stay of less than three days has been less investigated. DESIGN: A qualitative design. METHODS: A phenomenological-hermeneutic approach was used, inspired by Paul Ricoeur's theory of narrative and interpretation. Eight patients were included. Semi-structured interviews and participant observation were performed. RESULTS: Three themes emerged: dealing with pain; feelings of confidence or uncertainty - the meaning of information; and readiness for discharge. Generally, the patients were resistant to taking analgesics and found it difficult to find out when to take supplementary analgesics; therefore, nursing staff needed enough expertise to take responsibility. Factors that increased patients' confidence: information about fast-track, meeting staff before admission and involving relatives. In contrast, incorrect or conflicting information and a lack of respect for privacy led to uncertainty. In preparing for early discharge, sufficient pain management, feeling well-rested and optimal use of time during hospitalisation were important. CONCLUSION: The study shows the importance of dealing with pain and getting the right information and support to have confidence in the fast-track programme, to be ready for discharge and to manage postoperatively at home. RELEVANCE TO CLINICAL PRACTICE: In fast-track focusing on early discharge, there is an increased need for evidence-based nursing practice, including a qualified judgement of what is best for the patient in certain situations. The knowledge should be gleaned from: research; the patients' expertise, understanding and situation; and nurses' knowledge, skills and experience.

From donation to everyday life: Living kidney donors' experiences three months after donation.

BACKGROUND: As the number of patients with end stage kidney disease continues to rise internationally, living kidney donation remains a favourable treatment option. Long waiting times on dialysis can be avoided and short and long-term outcomes are better, when compared with deceased donor transplantation. Living kidney donation is a safe procedure for healthy individuals who have completed a rigorous screening programme. Significant experiences can occur during the recovery period. OBJECTIVE: To investigate donors' experiences of donation and their recovery period, in the first three months after donation. MATERIALS AND METHODS: The study took a phenomenological-hermeneutic approach. Open interviews were conducted three months after donation. Data were interpreted and discussed in accordance with Ricoeur's text interpretation theory on three levels: naïve reading, structural analysis and critical interpretation and discussion. FINDINGS: The donation process was experienced as an 'expedition', including preparations, the operation, recovery and everyday life. Positive feelings were challenging to describe; however health troubles and vulnerability were evident. A closer relationship and a need to follow the recipient's progress implied that patient and donor felt they were a part of each other. Support from relatives was important but could also be a burden. CONCLUSION: The kidney donation process is experienced as being like on an expedition, involving positive feelings, vulnerability, a closer patient-donor relationship and challenges around family relationships. It is essential that nurses are aware of the complexity of the situation and focus on the impact of the process, to support and facilitate donors' needs.

Empowered to gain a new foothold in life--A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack.

This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR). CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients' particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1) receiving a helpful but limited caring hand, (2) being supported to find new values in life, and (3) developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients' total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting programmes and further involvement of relatives must be considered.

Relieved or disappointed--experiences of accepted and rejected living kidney donors: a prospective qualitative study.

AIM AND OBJECTIVES: To investigate the perceived experiences and considerations among potential kidney transplantation donors in relation to acceptance or rejection as donors. BACKGROUND: Kidney transplantations are successfully performed in all Western countries, but the prevalence of patients waiting for organs from deceased donors far exceeds the number of organs available. This shortfall has promoted donation by living donors, who enter the donation process with feelings of hope, concern and patience to be accepted or rejected for donation. DESIGN: A phenomenological-hermeneutic approach was applied in the study. METHODS: Semi-structured interviews were conducted with 16 participants. Data were interpreted and discussed in accordance with Ricoeur's theory of interpretation involving: naïve reading, structural analysis, critical interpretation and discussion. RESULTS: Accepted donors experienced relief and delight. Reflections were made on being prepared for donation and on the risks involved. Relationships between donors and recipients became closer. Rejected donors experienced frustration and disappointment, including anxiety about the recipient's prospects. Rejected donors reflected on the reason for rejection, and this could include considerations about changes to their own lifestyle. Reactions from relatives had an impact on donors. CONCLUSIONS: The study concluded that both the accepted and rejected donors were vulnerable and in need of attention, engagement, support and care. The study draws attention to the need for healthcare professionals to be open and sensitive to the donors' descriptions of their unique experiences of being accepted or rejected for kidney donation. RELEVANCE TO CLINICAL PRACTICE: Nurses should be aware that dialogue with donors, including reflections on experiences, is important to reduce and alleviate vulnerability and to give the best possible support and attention, including the opportunity to promote optimal postdonation outcomes.

Nursing in fast-track total hip and knee arthroplasty: A retrospective study.

AIM: To describe the increased activity in total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2002 to 2012 in a single orthopaedic department, the organisation of fast-track and its consequences for nursing care. METHODS: Retrospective, descriptive design. Data collection; from the hospital administrative database, local descriptions of fast-track, personal contact and discussion with staff. RESULTS: The number of operations increased threefold from 351 operations in 2002 to 1024 operations in 2012. In 2012, THA/TKA patients had a postoperative mean LOS of 2.6/2.8 days. Nurses had gained tasks from surgeons and physiotherapists and thus gained more responsibility, for example, for pain management and mobilisation. Staffing levels in the ward in 2002 and 2012 were almost unchanged; 16.0 and 15.8 respectively. Nurses were undertaking more complicated tasks. CONCLUSION: Nursing care must still focus on the individual patient. Nurses need to have enough education to manage the complex tasks and increased responsibility. To prevent undesirable outcomes in the future, there is a need to pay attention to the nursing quality in balance with the nursing budget. It may, therefore, be considered a worthwhile investment to employ expert/highly qualified professional nurses in fast-track THA and TKA units.