‘A story of being invisible’: A single case study on the significance of being recognised when needing acute healthcare in the early COVID-19 Pandemic

Severe illness is often an existential threat that triggers emotions like fear, stress, and anxiousness. Such emotions can affect ill patients’ encounters with healthcare personnel. We present a single case study of an older woman who contracted COVID-19 and her challenge to be recognised by healthcare personnel in the early pandemic. Storytelling is vital to understand how patients can create meaning in illness as it gives them the opportunity to reshape and restore their past and to project a future. We used Arthur Frank’s dialogical narrative analysis to explore how one patient experienced her encounters with healthcare personnel. Although she felt very ill from COVID-19, she experienced being almost invisible and not being believed by healthcare personnel in a system marked by high stress levels and uncertainty. Despite rejections and illness, she managed to mobilise her resources, even though she depended on significant others. Her story brings forward altered self-understanding and growth. The importance of facilitating dialogical settings for healthcare professionals through patient storytelling also contributes to a broader societal understanding of illness beyond a biological perspective.publishedVersio

Older patients’ perspectives on illness and healthcare during the early phase of the COVID-19 pandemic

Background Equal access to healthcare is a core principle in Norway’s public healthcare system. The COVID-19 pandemic challenged healthcare systems in the early phase – in particular, related to testing and hospital capacity. There is little knowledge on how older people experienced being infected with an unfamiliar and severe disease, and how they experienced the need for healthcare early in the pandemic Aim To explore the experiences of older people infected by COVID-19 and their need for testing and hospitalisation. Research design An explorative and descriptive approach, with qualitative interviews conducted in October 2020. Participants and research context Seventeen participants above 60 years of age hospitalised due to COVID-19 during spring 2020 were recruited 6 months after discharge. Ethical considerations Ethical approval was granted by the Regional Committee for Medical and Health Research Ethics in South-Eastern Norway (155425). Findings The main finding was that the informants experienced vulnerability and arbitrariness. This finding was supported by three sub-themes: experiences with a severe and unfamiliar disease, the strict criteria and the importance of someone advocating needs. Discussion Participants described varying access to healthcare. Those who did not meet the national criteria to be tested or hospitalised struggled against the system. Findings reveal arbitrary access to healthcare, in contrast to Norway’s ethical principle of fair and just access to health services. Moreover, to access and receive necessary healthcare, informants were dependent on their next-of-kin’s advocacy. Conclusion Even when dealing with an unfamiliar disease, health professionals’ assessments of symptoms must be performed with an ethical obligation to applicate competent appraisal and the exercise of discernment; this is in line with care ethics and ethical standards for nurses. These perspectives are a significant part of caring and the intension of doing good.publishedVersio

Welfare technology interventions among older people living at home—A systematic review of RCT studies

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The main goal of health services is for the elderly to maintain their mental and physical health and live at home independently for as long as possible. Various technical welfare solutions have been introduced and tested to support an independent life. The aim of this systematic review was to examine different types of interventions and assess the effectiveness of welfare technology (WT) interventions for older people living at home. This study was prospectively registered in PROSPERO (CRD42020190316) and followed the PRISMA statement. Primary randomized control trial (RCT) studies published between 2015 and 2020 were identified through the following databases: Academic, AMED, Cochrane Reviews, EBSCOhost, EMBASE, Google Scholar, Ovid MEDLINE via PubMed, Scopus, and Web of Science. Twelve out of 687 papers met the criteria for eligibility. We used riskof-bias assessment (RoB 2) for the included studies. Based on the RoB 2 outcomes that showed a high risk of bias (>50%) and high heterogeneity of quantitative data, we decided to narratively summarize the study characteristics, outcome measures, and implications for practice. The included studies were conducted in six countries, namely the USA, Sweden, Korea, Italy, Singapore, and the UK. One was conducted in three European countries (the Netherlands, Sweden, and Switzerland). A total of 8437 participants were sampled, and individual study sample sizes ranged from 12 to 6742. Most of the studies were two-armed RCTs, except for two that were three-armed. The duration of the welfare technology tested in the studies ranged from four weeks to six months. The employed technologies were commercial solutions, including telephones, smartphones, computers, telemonitors, and robots. The type of interventions were balance training, physical exercise and function, cognitive training, monitoring of symptoms, activation of emergency medical systems, self-care, reduction of death risk, and medical alert protection systems. The latter studies were the first of their kind and suggested that physician-led telemonitoring could reduce length of hospital stay. In summary, welfare technology seems to offer solutions to supporting elderly people at home. The results showed a wide range of uses for technologies for improving mental and physical health. All studies showed encouraging results for improving the participants’ health status.publishedVersio

‘Brain fog’, guilt, and gratitude: experiences of symptoms and life changes in older survivors 6 months after hospitalisation for COVID-19

Purpose Several of those who have been infected with COVID-19 suffer from the post-COVID-19 condition months after the acute infection. Little is known about how older survivors have experienced the consequences and how these have affected their lives. The aim of this study was to explore how older survivors experienced post-COVID-19 condition and life changes approximately 6 months after hospitalisation for COVID-19. Methods The study had an explorative and descriptive design. Semi-structured interviews were performed with 17 participants from two local hospitals, 11 men and 6 women, aged 60 years and older (age range 60–96), approximately 6 months after hospitalisation for COVID-19. A thematic descriptive analysis inspired by Braun and Clarke was used. Results Two main themes and seven subthemes were revealed. The main themes were: From few to various persistent symptoms and Existential thoughts and reflections. Most of the participants experienced various physical and/or cognitive symptoms, such as reduced physical fitness, heavy breathing, fatigue, and ‘brain fog’. On the other hand, they also experienced guilt and gratitude for having survived. The recognition of having achieved other life perspectives was also present. Conclusion Six months after undergone COVID-19 the participants still experienced various distressing symptoms, which were in line with larger studies. The novel findings of this study were connected to the existential area, where the patients’ thoughts and reflections of guilt, gratitude, and new life perspectives were revealed. These findings are important for health professionals to consider when treating patients after COVID-19.publishedVersio

“This path I must walk alone”. Challenges experienced by older patients while recovering from severe COVID-19 – a qualitative study

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: In March 2020, the COVID-19 pandemic challenged both the Norwegian population and healthcare system. In this study we explored how older men and women experienced rehabilitation and recovery after hospitali sation due to severe COVID-19. Methods: Semi-structured interviews with 17 participants aged 60–96 years were performed 6 months after dis charge from hospital. A thematic descriptive analysis was conducted. Results: The results revealed that the participants experienced a challenging span between loneliness and com panionship in recovering from severe COVID-19. The four subthemes highlighted experiences of being discharged to home and left to themselves, the importance of exercise and companionship at rehabilitation stay, requirement of self-efort and time to recover, and the challenging span between loneliness and companionship when being with family. Conclusion: Among participants, the experiences of loneliness throughout the recovery period were striking. An individualised approach including psychological support should be emphasized in primary healthcare to promote recovery in older survivors after severe COVID-19 and their next-of-kin.publishedVersio

Slik håndterer sykepleiere og brukere vond lukt i hjemmet

Bakgrunn: Ubehagelig lukt i hjemmet eller fra en person er sosialt uakseptabelt og skambelagt. Hvordan hjemmesykepleiere erfarer og håndterer ubehagelig lukt i samhandling med brukere, og hvordan brukerne opplever sykepleierens handlingsvalg, er per i dag et lite utforsket område. Hensikt: Hensikten med studien er å undersøke hvordan sykepleiere erfarer og håndterer luktproblematikk i hjemmet, og hvordan brukere opplever og vurderer sykepleiernes handlingsvalg. Metode: Vi foretok en kvalitativ studie med observasjon og intervju av 30 sykepleiere og 11 pasienter i 3 hjemmesykepleiedistrikter i en større norsk by. Resultat: Ubehagelig lukt i hjemmene var oftest forårsaket av sykdom og sviktende hygiene hos brukerne. Sykepleierne oppfattet lukt i hjemmet som skambelagt. De oppfattet brukerne som dobbelt sårbare fordi både person og hjem var utsatt for andres avsky. De ønsket å beskytte brukerne mot skammen. De vanligste handlingsstrategiene var å fjerne lukt gjennom praktisk handling, unngå å vise kroppslige reaksjoner på lukt og forholde seg tause om luktproblematikk. Brukerne opplevde at luktfjerning gjennom praktisk handling var viktig for sosial trygghet. Taushet forsterket skammen og ensomheten og bidro i noen tilfeller til et svekket behandlingstilbud. Brukerne ønsket større åpenhet. Konklusjon: Det er behov for større åpenhet og fagkunnskap om luktproblematikk i hjemmet. Det er viktig å etterspørre brukernes erfaringer og ønsker for å utvikle et adekvat pleie- og behandlingstilbud

Slik håndterer sykepleiere og brukere vond lukt i hjemmet

Ubehagelig lukt i hjemmet eller fra en person er sosialt uakseptabelt og skambelagt. Hvordan hjemmesykepleiere erfarer og håndterer ubehagelig lukt i samhandling med brukere, og hvordan brukerne opplever sykepleierens handlingsvalg, er per i dag et lite utforsket område. Hensikten med studien er å undersøke hvordan sykepleiere erfarer og håndterer luktproblematikk i hjemmet, og hvordan brukere opplever og vurderer sykepleiernes handlingsvalg. Vi foretok en kvalitativ studie med observasjon og intervju av 30 sykepleiere og 11 pasienter i 3 hjemmesykepleiedistrikter i en større norsk by. Ubehagelig lukt i hjemmene var oftest forårsaket av sykdom og sviktende hygiene hos brukerne. Sykepleierne oppfattet lukt i hjemmet som skambelagt. De oppfattet brukerne som dobbelt sårbare fordi både person og hjem var utsatt for andres avsky. De ønsket å beskytte brukerne mot skammen. De vanligste handlingsstrategiene var å fjerne lukt gjennom praktisk handling, unngå å vise kroppslige reaksjoner på lukt og forholde seg tause om luktproblematikk. Brukerne opplevde at luktfjerning gjennom praktisk handling var viktig for sosial trygghet. Taushet forsterket skammen og ensomheten og bidro i noen tilfeller til et svekket behandlingstilbud. Brukerne ønsket større åpenhet. Det er behov for større åpenhet og fagkunnskap om luktproblematikk i hjemmet. Det er viktig å etterspørre brukernes erfaringer og ønsker for å utvikle et adekvat pleie- og behandlingstilbud

Using documentary films to teach nurses about gender and the vulnerabilities facing older men with advanced dementia

Aims and objectives: to review short documentary films about older men with advanced dementia to use in teaching, and therein address the gender imbalance in the dementia care curricula and create opportunities to learn about masculine vulnerability.Background: there has been a growing recognition of the role of gender in respect of vulnerability, with emerging evidence suggesting a need to acknowledge and prioritise dementia as a global women's health issue. Whilst a focus on women is understandable—more women are affected by dementia than men—gender does not equal women. It is important for nursing students, nurses and allied health professionals to understand the vulnerabilities facing older men with dementia as well, including gay men, who may face additional challenges.Design: discursive paper outlining the limitations of using mainstream fiction films in dementia care education and reviewing three short documentary films about older men with advanced dementia to use in teaching.Methods: we summarised the literature on using films in nurse education and review three short documentary films about older men with advanced dementia and their (male) caregivers in the context of international nursing standards and concept of vulnerability.Conclusions: education is key to understanding and improving the lived experience of dementia. Our article endorses the use of films in the classroom but highlights that mainstream fiction films about people (women) with dementia are not always appropriate for pedagogic purposes. Our review of three short documentary films on older men with advanced dementia uncovers an untapped teaching resource for care educators

Older patients’ perspectives on illness and healthcare during the early phase of the COVID-19 pandemic

Background Equal access to healthcare is a core principle in Norway’s public healthcare system. The COVID-19 pandemic challenged healthcare systems in the early phase – in particular, related to testing and hospital capacity. There is little knowledge on how older people experienced being infected with an unfamiliar and severe disease, and how they experienced the need for healthcare early in the pandemic Aim To explore the experiences of older people infected by COVID-19 and their need for testing and hospitalisation. Research design An explorative and descriptive approach, with qualitative interviews conducted in October 2020. Participants and research context Seventeen participants above 60 years of age hospitalised due to COVID-19 during spring 2020 were recruited 6 months after discharge. Ethical considerations Ethical approval was granted by the Regional Committee for Medical and Health Research Ethics in South-Eastern Norway (155425). Findings The main finding was that the informants experienced vulnerability and arbitrariness. This finding was supported by three sub-themes: experiences with a severe and unfamiliar disease, the strict criteria and the importance of someone advocating needs. Discussion Participants described varying access to healthcare. Those who did not meet the national criteria to be tested or hospitalised struggled against the system. Findings reveal arbitrary access to healthcare, in contrast to Norway’s ethical principle of fair and just access to health services. Moreover, to access and receive necessary healthcare, informants were dependent on their next-of-kin’s advocacy. Conclusion Even when dealing with an unfamiliar disease, health professionals’ assessments of symptoms must be performed with an ethical obligation to applicate competent appraisal and the exercise of discernment; this is in line with care ethics and ethical standards for nurses. These perspectives are a significant part of caring and the intension of doing good