Experiences of recovery from colorectal cancer surgery after hospital discharge among the oldest old: a qualitative study

Colorectal cancer affects a large number of people aged ≥80 years. Little is known about how they manage after discharge from hospital. The aim of this study was to explore the experiences of individuals aged ≥80 years recovering from surgery for colorectal cancer, and the challenges they may encounter after discharge from hospital. Data were collected between January and March 2016 through in-depth interviews with ten participants approximately one month after surgery. Inductive thematic analysis was employed to analyse the data. The COREQ checklist was used in reporting this study. Two themes were identified: Managing the recovery from CRC surgery, and Insufficient follow-up from the healthcare services after CRC surgery. The findings indicate that older people treated for colorectal cancer manage surprisingly well after discharge despite challenges in their recovery; however, there are seemingly areas of improvement in their follow-up healthcare.publishedVersio

Exploring variables affecting sense of coherence and social support in recovery after colorectal cancer surgery among the oldest old

Objective To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥80 years treated for curable colorectal cancer. Methods This exploratory, cross-sectional survey investigates 56 individuals surgically treated for stage I-III colorectal cancer between one and five years prior. Statistical analysis permitted exploration of associations between sense of coherence, perceived social support, and demographic- and clinical variables. Results Lower sense of coherence was associated with higher age, limitations in physical function, and the need for homecare nursing. Lower perceived social support was associated with re-admission, higher age at time of surgery, and male gender. No correlations were found between sense of coherence and perceived social support. Conclusion The results are important for healthcare professionals to consider when dealing with older people who underwent surgery for colorectal cancer, especially in the discharge process to facilitate optimal follow-up care and recovery.publishedVersio

Long-term recovery after colorectal cancer surgery among the old: a qualitative study

Background Colorectal cancer is the third most frequently diagnosed cancer worldwide, disproportionally affecting older people. With modern treatment, older people are surviving cancer treatment and recovery. However, only a limited number of studies on the older person’s experience of recovery exist. Knowledge of the experience of recovery among people 80 years or older is essential to optimize recovery and follow-up care. Objective The aim of this study was to explore the experiences of persons 80 years or older during recovery up to 2 years after curative colorectal cancer surgery. Methods This exploratory inductive qualitative study was conducted through 18 individual in-depth interviews between July 2020 and June 2021. Content analysis was used to analyze the data. Results The main theme identified was Recovery among the old is a complex process. It indicated that older people operated on for colorectal cancer may have intricate health challenges that affect recovery in addition to their cancer and treatment. The main theme is built upon the subthemes Individual factors affect colorectal cancer recovery and External support systems facilitate and impede colorectal recovery. Conclusion Important resources for recovery among old patients included their own coping ability and support from social networks and healthcare services. The identified barriers to recovery included other health problems and issues with healthcare services delivery. Implications for Practice It is essential for healthcare personnel in contact with older patients to be aware of factors that influence their recovery to identify and preserve the older person’s resources and implement health-promoting initiatives to optimize recovery when needed.publishedVersio

Supportive care needs of men with prostate cancer after hospital discharge: Multi-stakeholder perspectives.

Purpose This study explored the supportive care needs of men with prostate cancer (PCa) after hospital discharge based on the perceptions of multiple stakeholders. Methods Eight semi-structured focus groups and three individual interviews were conducted between September 2019 and January 2020, with 34 participants representing men with PCa, primary and secondary healthcare professionals, and cancer organizations in western Norway. Data was analysed using systematic text condensation. Results Four categories emerged: 1) men with PCa have many information needs which should be optimally provided throughout the cancer care process; 2) various coordination efforts among stakeholders are needed to support men with PCa during follow-up; 3) supportive care resources supplement the healthcare services but knowledge about them is random; and 4) structured healthcare processes are needed to improve the services offered to men with PCa. Variations were described regarding priority, optimal mode and timeliness of supportive care needs, while alignment was concerned with establishing structures within and between stakeholders to improve patient care and coordination. Conclusions Despite alignment among stakeholders’ regarding the necessity for standardization of information and coordination practices, the mixed prioritization of supportive care needs of men with PCa indicate the need for additional individualized and adapted measures.publishedVersio

Alternating between active and passive facilitator roles in simulated scenarios: A qualitative study of nursing students’ perceptions.

Background: High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators’ guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator’s role during simulated scenarios. Methods: A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation. Results: One main category, “Alternating between active and passive facilitation,” emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students’ understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator’s presence in the simulation room during the simulated scenarios influenced students’ emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed. Conclusions: The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.publishedVersio

Translation and psychometric testing of the Norwegian version of the “Patients’ Perspectives of Surgical Safety Questionnaire”

Purpose To translate the Patients’ Perspectives of Surgical Safety (PPSS) questionnaire into Norwegian and to test it for structural validity and internal consistency. Design This is a methodological study. Methods The original 20-item PPSS questionnaire was translated into Norwegian using a model of translation-back translation. We assessed content validity via a pretest with 20 surgical patients. A sample of 218 surgical patients in a university hospital in Norway completed the PPSS questionnaire. Psychometric analysis included item characteristics, and structural validity was evaluated by an exploratory factor analysis. Internal consistency was calculated using Cronbach's alpha. Findings We successfully translated and adapted the Norwegian PPSS questionnaire. Completion rate was 74%. Missing values were less than 5% and all 20 items had a high skewness (≥15 %) ranging from 52.8% to 95.9%. The exploratory factor analysis yielded two significant factors that explained 45.15% of variance. The Cronbach's alpha for Factor 1 “Team interaction safety” was 0.88 and for Factor 2 “Patient's ID safety”, 0.82. Overall, most patients reported a high sense of surgical safety. Conclusions The first Norwegian version of the PPSS measuring surgical patients’ perception shows promising psychometric properties regarding structural validity and internal consistency. However, future research on PPSS should provide an examination of construct validity, validation and testing in other populations of surgical patients. To improve safety of the surgical trajectory, it is necessary to pay more attention to patients’ perceptions of surgical safety.publishedVersio

Psychometric testing of the Norwegian version of the Simulation Design Scale, the Educational Practices Questionnaire and the Student Satisfaction and Self-confidence in Learning Scale in nursing education

Introduction Simulation-based learning is a well-established technique in nursing education. However, there is a need for reliable and validated evaluation tools across both national boundaries and cultural conditions. Such evaluation tools may contribute in identifying areas for improvement in simulation-based learning from the nursing students’ perspective. Objectives The aim of this study was to test three widely used American questionnaires – the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, for psychometric properties among Norwegian undergraduate nursing students. Methods A descriptive cross-sectional study was conducted at a university simulation center in southern part of Norway. A total of 105 undergraduate nursing students participated, giving a response rate of 77%. An exploratory factor analysis was used to examine construct validity. Cronbach's alpha was applied in order to establish the questionnaires’ internal consistency. Results The exploratory factor analyses displayed the same number of extracted factors as the number of subscales in each of the original American questionnaires. However, the item-factor structure differed from the original item-subscales. The Cronbach's alpha was > 0.7 for all three questionnaires, indicating acceptable internal consistency. Conclusion Psychometric testing of the Norwegian versions of the three questionnaires, the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, could be used as valid instruments for nursing students to evaluate important aspects of simulation-based learning. This also makes it easier to compare evaluation results of SBL across languages and cultural boundaries. However, to confirm the construct validity of the factors extracted in this study, further multi-site studies are needed to perform a confirmatory factor analysis in a new, large sample.publishedVersio

Norwegian nursing students' evaluation of vSim® for Nursing

Background: vSim® for Nursing is the first web-based platform linked to the nursing education curriculum. It is an American simulation tool, developed in 2014 through a collaboration between Wolters Kluwer Health, Laerdal Medical and the National League for Nursing. To our knowledge, no studies have evaluated vSim® for Nursing from the nursing students’ perspective in Norway. The aim of the study was to evaluate second year Norwegian nursing students’ experiences with the virtual clinical simulation scenario in surgical nursing from vSim® for Nursing. Methods: A descriptive and a convergent mixed method design was utilised. The method comprised a 7-item questionnaire with five open-ended questions. Sixty-five nursing students participated in the study. Results: The majority of Norwegian nursing students evaluated the virtual clinical scenario in surgical nursing from vSim® for Nursing useful, realistic and educational in preparing for clinical placement in surgical care. However, a small portion of the nursing students had trouble understanding and navigating the American vSim® for Nursing program. Conclusions: Introducing virtual simulation tools into the nursing education encompasses faculty and student preparation, guidance from faculty members during the simulation session and support for students who are facing difficulties with the simulation program.publishedVersio

Gastric bypass – no quick fix for lifestyle changes. Patient experiences two years after bariatric surgery.

Gastric bypass – no quick fix for lifestyle changes. Patient experiences two years after bariatric surgery. The aim of the study was to examine which factors affect the patient's ability to cope with lifestyle changes, the importance of social support to maintain lifestyle changes and how patients experience follow-up from healthcare professionals, two years after surgery. A qualitative exploratory design was chosen. Three focus group interviews were conducted with 13 patients. Content analysis was used to analyse the interviews. The findings revealed three themes; from knowledge to action, the importance of social support, and insufficient follow-up from the healthcare service. The patients need structure in everyday life, self-discipline and social support to reinforce self-efficacy and to manage and maintain lifestyle changes. Information and support from healthcare professionals should be tailored to where the patient is in the change process.publishedVersio

A cross‐sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management—Implications from a system perspective

Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management—including barriers and opportunities—across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross‐sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management