Nature-based interventions in institutional and organisational settings:A scoping review

The objective of this review was to scope the literature on nature-based interventions that could be conducted in institutional settings where people reside full-time for care or rehabilitation purposes. Systematic searches were conducted across CINAHL, Medline, Criminal Justice Abstracts, PsycINFO, Scopus, Social Care Online and Cochrane CENTRAL. A total of 85 studies (reported in 86 articles) were included. Four intervention modalities were identified: Gardening/therapeutic horticulture; animal-assisted therapies; care farming and virtual reality-based simulations of natural environments. The interventions were conducted across a range of settings, including inpatient wards, care homes, prisons and women’s shelters. Generally, favourable impacts were seen across intervention types, although the reported effects varied widely. There is a growing body of literature on nature-based interventions that could be applied to a variety of institutional settings. Within most intervention types, there is sufficient research data available to perform full systematic reviews. Recommendations for future systematic reviews are offered.</p

Case report: Therapeutic potential of Flourishing-Life-Of-Wish Virtual Reality Therapy on Relaxation (FLOW-VRT-Relaxation)—a novel personalized relaxation in palliative care

In view of the global aging population and growing need of palliative care, innovative intervention for effective symptom management is of urgent need. Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT) is a brief, structured, manualized, and personalized psychological intervention with theoretical foundations based on stress coping theory, self-determination theory, flow theory, and attention restoration theory. With a specific focus on relaxation, FLOW-VRT-Relaxation intends to facilitate adaptive end-of-life coping through delivering personalized relaxation. This paper reports a case study of the application of FLOW-VRT-Relaxation, and discusses its therapeutic potential as a cost-effective method for reducing palliative symptoms by addressing patient's unmet needs. The case study is a 51-year-old Chinese female, diagnosed with advanced cervix cancer, and presented with unmet psychological (i.e., unfulfilled wishes) and physical needs (i.e., pain and fatigue) before FLOW-VRT-Relaxation. To address her unmet needs, FLOW-VRT-Relaxation was delivered by a registered clinical psychologist specialized in palliative care. Need assessment was first conducted, followed by a 10-min VR travel of Japan as her own choice. Relaxation was verbally coached during VR. Right after VR, consolidation with psychological components including psychoeducation, cognitive and emotional processing, and reminiscence intervention were delivered. The patient showed improvement in physical and psychological symptoms, lower sense of loneliness and engulfment, as well as enhanced peace after FLOW-VRT-Relaxation. The current findings provide encouraging initial support for the feasibility, acceptability, and therapeutic potential of using FLOW-VRT-Relaxation as a cost-effective, scalable and personalized VR relaxation for patients under palliative care. It is hoped that with its optimal use, FLOW-VRT-Relaxation can serve as an alternative therapeutic tool that effectively improves the end-on-life care

VR in Nursing Facilities - A randomized controlled multicenter pilot study analyzing the changes in the state of mind of seniors in nursing facilities through the viewing of 360° videos

Context: VR as an application to enhance well-being is sparsely researched in the elderly population. The aim of the pilot study was to analyze the effect of 360° videos of different categories on the state of mind of seniors in nursing facilities. Furthermore, for the implementation in everyday life, the usability of the system and the experience for seniors should be evaluated. Methods: The VR experience was used as a supplement to existing care services in three facilities on eight subjects. Mood state was assessed using the Questionnaire for the Assessment of Happiness before and after the intervention. Demographic data and technology acceptance were collected beforehand. After the intervention, subjects were interviewed about confounding factors and side effects, and nursing home staff were interviewed about the usability of the system and the organizational concept of implementation. Results: There was a positive effect on state of mind. Gender and spatial mobility turned out to be influencing factors. Categories containing people, animals and action achieved the highest increases in the state of mind. Interest in using technical devices correlated negatively with the change in mood state. None of the subjects found the VR goggles distracting or reported motion sickness. Very good usability was indicated by the employees. Conclusion: A very high willingness to use this technology was found among nursing staff and residents. The tendencies of the positive effect of 360° videos on the state of mind, as well as differentiation based on the mentioned characteristics gender and spatial mobility, should be verified by a larger sample to empirically validate the use of this technology to increase the quality of life

Empowering education in patients with colorectal cancer

Today, as cancer morbidity and consequently the pressure on healthcare systems have increased, the effectiveness of nursing interventions is emphasised in the care of patients with cancer. Research on empowering education for cancer patients is, however, limited. The goal of this study was to produce new knowledge of the effect of empowering patient education in patients with colorectal cancer. In the first phase, an overview of systematic reviews (n=17) was conducted on nursing interventions and their effectiveness in patients with cancer. Interviews were conducted with patients with colorectal cancer (n=15) on their expectations for nursing during chemotherapy. Knowledge produced in the first phase was also used in the planning of the method and content of the intervention in this study. In the second phase, an empowering education intervention was developed, and its effect was tested in a randomised controlled trial for patient-reported outcomes and register data in patients with colorectal cancer (43 + 40). According to the overview of systematic reviews, the nursing interventions were educational, psychosocial, psychological, activity-based as well as interventions supporting coping. Based on the results, an educational intervention, which also included elements supporting patients’ coping was selected for this study. According to the patient interviews, patients' expectations consisted of (1) empowering knowledge, (2) human encounters, and (3) good care. In this study, these themes were used in offering empowering knowledge of nutrition impact side-effects and support for self-care using teach-back method. The difference in change was nearly significantly higher in the activation level and statistically significant in the knowledge level associated with malnutrition and in the number of additional contacts to the outpatient clinic in favour of the intervention group As a conclusion, empowering patient education can improve the patient activation level and knowledge in patients with colorectal cancer. It can also reduce contacts to the outpatient clinic due to nutrition impact side effects, thus reduce health care costs.Suolistosyöpää sairastavien potilaiden voimavaraistumista tukeva ohjaus Sairastuvuus syöpään ja sen myötä paine terveydenhuoltojärjestelmää kohtaan lisääntyy, jolloin hoitotyön toimintojen vaikuttavuus hoitotyössä korostuu. Tutkimus syöpää sairastavien potilaiden voimavaraistumista tukevasta ohjauksesta on kuitenkin vähäistä. Tutkimuksen tavoitteena oli tuottaa uutta tietoa voimavaraistumista tukevan potilasohjauksen vaikuttavuudesta. Ensimmäisessä vaiheessa analysoitiin kirjallisuuskatsauksen avulla (n=17) hoitotyön interventioita ja niiden vaikutusta syöpää sairastavien potilaiden hoidossa. Suolistosyöpää sairastavia potilaita (n=15) haastateltiin heidän odotuksistaan hoitotyötä kohtaan solunsalpaajahoidon aikana. Tuotettua tietoa hyödynnettiin myös tämän tutkimuksen intervention suunnittelussa. Toisessa vaiheessa kehitettiin potilaiden voimavaraistumista tukeva ohjausinterventio ja arvioitiin sen vaikutusta suolistosyöpää sairastaviin potilaisiin (43 + 40) satunnaistetun kontrolloidun tutkimusasetelman avulla. Hoitotyön interventiot olivat opetuksellisia, psykososiaalisia, psykologisia, liikunnallisia ja potilaiden selviytymistä tukevia. Tässä tutkimuksessa interventioksi valikoitui opetuksellinen interventio, joka sisälsi myös selviytymistä tukevia elementtejä. Potilaiden odotukset koostuivat 1) voimavaraistumista tukevasta tiedosta 2) inhimillisestä kohtaamisesta ja 3) hyvästä hoidosta. Näitä teemoja hyödynnettiin tarjoamalla potilaille voimavaraistumista tukevaa tietoa ravinnon saantia heikentävistä sivuvaikutuksista ja niiden itsehoidosta takaisin opettamisen mallin avulla. Aktivaatiotaso kasvoi koeryhmässä melkein merkitsevästi enemmän verrattuna kontrolliryhmään. Vajaaravitsemukseen liittyvä tiedontaso kasvoi tilastollisesti merkitsevästi enemmän koeryhmässä. Yhteydenottojen määrä poliklinikalle hoitosyklien välillä oli tilastollisesti merkitsevästi vähäisempää koeryhmässä verrattuna kontrolliryhmään. Voimavaraistumista tukeva ohjaus saattaa parantaa suolistosyöpää sairastavien potilaiden tiedon tasoa ja aktivaatiotasoa. Se vähentää yhteydenottoja poliklinikalle ravinnon saantia heikentävien sivuvaikutusten vuoksi säästäen siten terveydenhuollon kustannuksia

“Is there anything else you would like to tell us?” – A thematic analysis of free-text comments from a self-management questionnaire with people affected by cancer

Background: Researchers are frequently using open-ended questions at the end of questionnaires that invite respondents to add, in their own words, further information about issues covered in the questionnaire. The aim of this study was to present the qualitative findings from the further information section at the end of a questionnaire that was designed to collect data on aspects of self-management in people affected by cancer. Methods: Respondents were asked: ‘Thinking about how you manage your health and health care, if there is anything else you would like to tell us about your experience, please write in the box below.’ Free-text responses were analysed thematically. Results: 128 participants completed the free-text response at the end of the questionnaire. The main overarching theme was the concept of the participants “moving on” from cancer and developing a meaningful life for themselves following diagnosis and treatment. For most, this incorporated making adjustments to their physical, social, psychological, spiritual and emotional wellbeing. “Luck” was another overwhelming theme where many participants stated they were “glad to still be alive” and “consider myself very lucky.” Participants reported adjustments made to health behaviours such as leading an active lifestyle and making changes to their diet and nutrition. The final theme incorporates the participants identifying their main sources of support, both clinical and non-clinical, some of which they stated “could not have done it without them.” Conclusions: The findings highlight the valuable insight that free-text comments can add as a data source at the end of self-completion questionnaires with people affected by cancer

SafeSpace: what is the feasibility and acceptability of a codesigned virtual reality intervention, incorporating compassionate mind training, to support people undergoing cancer treatment in a clinical setting?

Objectives: The SafeSpace study codesigned and tested a virtual reality (VR) intervention, incorporating relaxation and compassionate mind training to determine acceptability/feasibility in an oncology setting and evaluate impact on physical/psychological well-being and quality of life. Design: A two-phase study. Phase I determined key characteristics using an experienced-based codesign approach. Phase II evaluated the intervention using various measures and qualitative interviews in a mixed methods approach. Descriptive statistics were used to analyse measures data and framework analysis to analyse interviews. Setting: A specialist cancer centre, UK. Participants: 11 in phase I and 21 in phase II. Participants were in cancer treatment, recovery or palliative care. Primary and secondary outcome: Primary outcome: acceptability of the intervention, assessed by >60% uptake of three sessions. Secondary outcomes: impact on psychological well-being using EQ-5D/QLQ-C30, Profile of Mood Scale, Warwick and Edinburgh Mental Well-being Scale, Depression and Anxiety Severity Scale 21, Self-Compassion Scale, Acceptance and Action Questionnaire and a locally developed questionnaire to capture self-compassion post use. Physiological impact was assessed by change in heart rate (HR)/HR variability and electrodermal activity (EDA). Results: Twenty participants (mean age=48.7 years; SD=16.87); 65% (n=13) completed three sessions. Mental well-being improved following each use and from baseline to after session 3 (VR 1—z=2.846, p≤0.01; VR 2—z=2.501, p≤0.01; VR 3—z=2.492, p≤0.01). There was statistically significant difference in mean scores for EDA at mid-session and post session compared with pre session (F (1.658, 4.973)=13.364, p<0.05). There was statistically significant reduction in stress levels from baseline to post session 3. Participants found the intervention acceptable and highlighted areas for development. Conclusion: The intervention is acceptable and feasible and has shown positive effects on mental well-being/stress in the oncology setting. Larger studies are needed to confirm findings