Stages of Change – Continuous Measure (URICA-E2): psychometrics of a Norwegian version

Aim: This paper is a report of research to translate the English version of the Stages of Change continuous measure questionnaire (URICA‐E2) into Norwegian and to test the validity of the questionnaire and its usefulness in predicting behavioural change. Background: While the psychometric properties of the Stages of Change categorical measure have been tested extensively, evaluation of the psychometric properties of the continuous questionnaire has not been described elsewhere in the literature. Method: Cross‐sectional data were collected with a convenience sample of 198 undergraduate nursing students in 2005 and 2006. The English version of URICA‐E2 was translated into Norwegian according to standardized procedures. Findings: Principal components analysis clearly confirmed five of the dimensions of readiness to change (Precontemplation Non‐Believers, Precontemplation Believers, Contemplation, Preparation and Maintenance), while the sixth dimension, Action, showed the lowest Eigenvalue (0·93). Findings from the cluster analysis indicate distinct profiles among the respondents in terms of readiness to change their exercise behaviour. Conclusion: The URICA‐E2 was for the most part replicated from Reed’s original work. The result of the cluster analysis of the items associated with the factor ‘Action’ suggests that these do not adequately measure the factor

Morbidity, life style and psychosocial situation in cancer survivors aged 60-69 years: results from The Nord-Trøndelag Health Study (The HUNT-II Study)

<p>Abstract</p> <p>Background</p> <p>Due to considerable health status differences in the elderly population, research limited to narrow age-spans might be an advantage. In this population-based controlled study we compare short-term (<5 years) (STS) and long-term (≥5 years) (LTS) cancer survivors and cancer-free controls aged 60-69 years from two Norwegian health registers; the Health Survey of North-Trøndelag County (HUNT-2 study) and the Cancer Registry of Norway (CRN). We examined possible factors associated with being cancer survivor.</p> <p>Methods</p> <p>Among 9,089 individuals aged 60-69 who participated in HUNT-2, 334 had been diagnosed with invasive primary cancer from 1 month to 42 years before HUNT-2 according to CRN and self-report. An overall random sample of controls without cancer five times larger than the sample of cases (N = 1,670) were drawn from the parent cohort.</p> <p>Results</p> <p>The cancer sample comprised 128 STS and 206 LTS. For most variables no significant differences were observed between LTS and STS. LTS were significantly more women, and cases with gynaecological cancer, with physical impairment and more thyroid diseases compared to STS. When comparing all the survivors with controls, the survivors showed significantly higher rate of pensioning, decreased self-rated health, more physical impairment and thyroid diseases, daily use of medication and psychotropics and higher level of anxiety and Framingham Risk score. Multivariate logistic regression analysis showed that increasing age, being female, physical impairment and thyroid diseases all were significantly associated with being survivor versus controls.</p> <p>Conclusion</p> <p>STS and LTS showed mostly similar situation. Compared to controls, the survivors reported somewhat poorer physical and mental health, but these differences were of doubtful clinical significance.</p

Hjemmet som lindrende enhet for gamle døende

Personer med langtkommen sykdom og forestående død ønsker ofte lengst mulig hjemmetid. Samhandlingsreformen pålegger kommunehelsetjenesten større ansvar for blant annet eldre og døende. Dette kan medføre at flere må dø hjemme siden tilbudet om sykehjem og plass ved lindrende enheter er begrenset. Forutsetninger for en verdig død i hjemmet, er å skape en lindrende enhet der pasienten opplever trygge rammer. De pårørende skal ha en forutsigbar situasjon og funksjon. Sykepleietjenesten skal bidra med klinisk sykepleie, være koordinator mellom helsetjenestenivåene og være til støtte for pasient, pårørende og kolleger

Smertekartlegging og medikamentell smertebehandling av eldre samtykkekompetente pasienter i sykehjem

Bakgrunn: Internasjonale og nasjonale studier viser at forekomsten av smerter hos eldre ved sykehjem varierer mellom 20 prosent og 80 prosent. Smerter hos eldre blir ofte underrapportert og underbehandlet og assosieres med redusert livskvalitet og økt avhengighet av andre. Komplekse sykdomsbilder gjør smertevurdering hos eldre spesielt utfordrende. Dessuten rapporterer eldre sjelden smerte, dels fordi smerte er vanskelig å beskrive, dels fordi smerter knyttes til det å bli gammel. Hensikt: Hensikten med studien er å beskrive smerteintensitet, lokalisasjon og behandling over tid ut fra et pasientperspektiv hos eldre, samtykkekompetente pasienter innlagt på sykehjem. Metode: En kvantitativ studie hvor spørreskjema ble anvendt til datainnsamling. Kartleggingsskjemaet Present Pain Intensity ble brukt for å registrere smertens intensitet, og et kroppskart ble anvendt for å kartlegge smertens lokalisasjon. Kartleggingen ble foretatt fem ganger i løpet av 14 dager. Resultater: Av 204 eldre oppga 94 (46 prosent) av dem smerte på alle fem kartleggingstidspunktene. Blant dem som oppga smerter, hadde 30 prosent smerte i ett eller to kroppsområder. Blant de respondentene som hadde sterk, intens eller voldsom smerte var det 48 prosent som hadde fått ordinert opioider. Det var ingen forskjell i smerteskår ved første smertekartlegging for henholdsvis menn og kvinner, ei heller for pasienter innlagt ved henholdsvis korttids- eller langtidsavdeling. Konklusjon: Studien avdekker at smerte er et undervurdert problem hos eldre pasienter på sykehjem. Det anbefales systematisk kartlegging av smerte over tid og tett oppfølging av behandling inkludert pasientens oppfatning av hva som hjelper

“Non-palliative care” – a qualitative study of older cancer patients’ and their family members’ experiences with the health care system

Background Among all cancer patients in the palliative phase, ¾ have reached the age of 65. An aging population will increase the number of people afflicted with cancer, and create challenges for patients, family members and health services. Nevertheless, limited research has focused explicitly on the experiences and needs of older cancer patients in the palliative phase and their families. Therefore, the aim of this study is to explore what older home dwelling cancer patients in the palliative phase and their close family members, as individuals and as a family, experience as important and difficult when facing the health services. Methods We used a qualitative descriptive design. Data was collected through family group interviews with 26 families. Each interview consisted of an older home dwelling cancer patient and one to four family members with different relationships to the patient (e.g. spouse, adult children and/or children-in-law). Data was analysed by qualitative content analysis. Results The main theme is “Non-palliative care” – health care services in the palliative phase not tailored to family needs. Three themes are revealed: 1) exhausting cancer follow-up, 2) a cry for family involvement, and 3) fragmented care. Conclusion The health services seem poorly organised for meeting the demands of palliative care for older home dwelling cancer patients in the palliative phase and their family members. Close family members would like to contribute but health services lack systems for involving them in the follow-up of the patient

“Non-palliative care” – a qualitative study of older cancer patients’ and their family members’ experiences with the health care system

Background Among all cancer patients in the palliative phase, ¾ have reached the age of 65. An aging population will increase the number of people afflicted with cancer, and create challenges for patients, family members and health services. Nevertheless, limited research has focused explicitly on the experiences and needs of older cancer patients in the palliative phase and their families. Therefore, the aim of this study is to explore what older home dwelling cancer patients in the palliative phase and their close family members, as individuals and as a family, experience as important and difficult when facing the health services. Methods We used a qualitative descriptive design. Data was collected through family group interviews with 26 families. Each interview consisted of an older home dwelling cancer patient and one to four family members with different relationships to the patient (e.g. spouse, adult children and/or children-in-law). Data was analysed by qualitative content analysis. Results The main theme is “Non-palliative care” – health care services in the palliative phase not tailored to family needs. Three themes are revealed: 1) exhausting cancer follow-up, 2) a cry for family involvement, and 3) fragmented care. Conclusion The health services seem poorly organised for meeting the demands of palliative care for older home dwelling cancer patients in the palliative phase and their family members. Close family members would like to contribute but health services lack systems for involving them in the follow-up of the patient

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

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

The trajectory of symptom burden in exposed and unexposed survivors of a major avalanche disaster: a 30 year long-term follow-up study

Background Limited research exists concerning the long-term effects of avalanches on survivors’ mental health beyond the first years after the accident. The aims of this study were to describe and evaluate possible differences in long-term mental health symptoms after a major avalanche disaster between exposed and unexposed soldiers using a longitudinal design. Method Present mental health symptoms were examined among avalanche exposed (n = 12) and unexposed (n = 9) soldiers by PTSS-10, IES-15 and STAI-12 in four waves (1986–1987 and 2016). Results Binary logistic regression revealed that the odds to score above the cut-off were significantly lower for both groups after one year compared to baseline for PTSS-10 (p = 0.018) and significantly lower after 30 days compared to baseline for IES-15 (p = 0.005). Data did not reveal significant differences between the exposed and unexposed groups regarding adjusted PTSS-10, IES-15 or STAI-12 mean scores compared. Linear mixed model-analyses revealed significant effects of time. The adjusted mean scores declined over time for both groups: PTSS-10 (p = 0.001), IES-15 (p = 0.026) and STAI-12 (p = 0.001), and the time trajectories for PTSS-10 were significantly different between the groups (p = 0.013). Although not significant (all p > 0.05), results indicated that a larger proportion of soldiers in the exposed group experienced posttraumatic stress symptoms (5/12) (PTSS-10 score ≥ 4) and distress symptoms (6/12) (IES-15 score ≥ 26) above cut-off points, 30 years post-disaster. Conclusions The course of mental health symptoms may persist, and even increase, in selected and trained military personnel 30 years after exposure to a natural disaster. These findings may be of great importance for health authorities planning appropriate follow-up