End-of-life care and euthanasia: attitudes of medical students and dying cancer patients

Introduction: In end-of-life care, supporting the factors required for a good death is a goal. Core concepts in a good death are dignity, autonomy, and the relief of suffering. Paradoxically, these concepts are used both in palliative care and to promote euthanasia, which are traditionally seen as conflicting alternatives. In this thesis, attitudes towards end-of-life care and especially euthanasia were explored in medical students and dying cancer patients. Material and methods: Two separate studies were performed: in the first study, data were collected from 165 medical students using a questionnaire (Papers I and II) and, in the second study, 66 dying cancer patients were interviewed on their attitudes to euthanasia (Papers III and IV). The data were analyzed by inductive qualitative content analysis without predetermined categories. Results: Heterogeneous attitudes to euthanasia were identified in the studies, where the medical students more frequently had a fixed opinion of opposition to or support of euthanasia, while the dying cancer patients were more often undecided. None of the dying cancer patients wanted euthanasia for themselves at the time of the interview. The medical students described a dignified death as involving relief of suffering, respect for autonomy, being nursed professionally in a secure environment, acceptance of impending death, and with limited medical-technical interventions. The students criticized the medicalization of death and preferred a “natural death”. The medical students’ attitudes toward euthanasia were explained using well-known arguments as supporting euthanasia due to respect for autonomy and the relief of suffering, and opposing euthanasia due to the sanctity of life, the fear of unwanted gradual changes in society’s norms (the slippery slope argument), doubts about the true meaning of euthanasia requests, and because of the strain put on medical staff. In contrast to the medical students’ perspectives on euthanasia, the dying cancer patients reasoning on euthanasia was more complex and involved more consideration of practical problems. The patients’ perspectives on autonomy in relation to euthanasia focused on medical decision-making, where aspects of trust and power were important. Euthanasia was not solely seen as a means to increase patient empowerment, but also, in contrast, as a means to decrease patient influence. Patients expressed various levels of trust in healthcare, ranging from complete trust to mistrust, which affected their attitudes toward euthanasia. Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead them to advocate euthanasia. Patients experiencing continued meaning in their existence and feelings of trust, and who find strategies to handle suffering opposed euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help advocated euthanasia. Conclusion: These results have possible implications for the education of medical students and the understanding of patients’ situations in end of life. The findings indicate a need for healthcare staff to address issues of trust, meaning, and anticipatory fears in patients. The results also serve as a background to the current debate on euthanasia in end-of-life care

Felles kurstilbud for pasient og behandler innen psykisk helsevern, Sykehuset Telemark, HF, Psykiatrisk klinikk, seksjon for rehabilitering

Bakgrunn Hensikten med denne studien er å evaluere et felles kurstilbud i myndiggjøring og bedringsprosesser som ble gjennomført ved Sykehuset Telemark HF, Psykiatrisk klinikk under betegnelsen ”Felles kurstilbud for pasienter og behandlere”. Særlig ville en utforske hvordan organiseringen og innholdet i kurset fremsto for både pasienter og behandler, samt hvilket utbytte og nytte de ønskede målgruppene har hatt gjennom kurstilbudet. Sykehuset Telemark har ønsket en evaluering av kurstilbudet innen 1. juni 2012. En forskningsbasert evalueringsstudie er gjennomført av Institutt for forskning innen rus og psykisk helse (IFPR), Høgskolen i Buskerud. Problemstilling Evalueringen retter seg mot pasienter og terapeuter i prosjektet i perioden høsten 2011. Forskningsspørsmålene for studien var: 1. Hvordan vil du som pasient eller terapeut beskrive dine erfaringer med det faglige og organisatoriske innholdet i det felles kurstilbudet i myndiggjøring og bedringsprosesser ved Psykiatrisk klinikk? 2. Hvordan vil du som pasient eller terapeut beskrive at kurset har bidratt til bevisstgjøring om egen delaktighet og rolle i bedrings- og mestringsprosessene? Metode Den metodiske tilnærmingen er kvalitativ gjennom et semistrukturert fokusgruppeintervju som ble gjennomført høsten 2012. Det deltok i alt 9 personer, fire pasienter og fem terapeuter. Fokusgruppeintervjuet ble analysert gjennom en hermeneutisk innholdsanalyse. Funn Funnene er organisert i 11 hovedtemaer: 1. Gjenkjennende likeverd og usikkerhet, 2. Fellesskapets krefter og muligheter, 3. Å være en person – ikke pasient eller terapeut, 4. Trygghet, tillit og tap av kontroll, 5. Stedets mulighetsbetingelser, 6. Nærhet og lyttende samvær, 7. Å gjøre endring og anderledeshet, 8. Kursets innhold og prosess, 9. Arena for læring – fremtredelser og valg, 10. Fremtiden etter kurset og 11. Personlig profesjonalitet. Konklusjoner Basert i studiens forskningsspørsmål, er det grunnlag for å konkludere med følgende: 1. Deltakerne, både pasienter og terapeuter har erfart at kurset har hatt avgjørende betydning i deres personlige og gjensidige prosesser knyttet til empowerment og recovery. 2. Den rene og enkle struktur og organisering avstudiekurset er et eksempel på hvordan det enkelt kan gjøres for å bringe brukermedvirkning, fagpersoners og pasienters roller og kompetanse knyttet til empowerment og recovery på dagsorden. Kurset er et meget godt og velegnet eksempel på kvalitetsutvikling og tjenesteutvikling på et konkret plan. 3. Tradisjonelle opplæringsprogrammer som er utformet med parallelle kurs for henholdsvis terapeuter og pasienter på deres respektive og ulike arenaer vil gå glipp av gjensidighet, deling og bevissthet omkring deres felles menneskelighet som dette kurset har kunnet tilby. 4. Resultatene fra denne studien kan gi verdifulle bidrag til arbeidet med å styrke og videreutvikle samarbeidende praksiser i tjenestene i psykisk helsevern og rusbehandling. Særlig gjelder dette deltakernes kunnskaper om at kurset ga innsikt om behovet for å arbeide sammen på en rekke og ulike måter. 5. Valg av sted og kontekst for gjennomføring av kurset synes å være meget betydningsfullt for opplevesene av kurset. Tilrettelagte møteplasser og agendaer utenfor det profesjonelle domenets kontroll syntes å hjelpe både terapeuter og pasienter til å løsne opp og vise seg frem for hverandre på nye måter. Begge parter inntok roller mer som medmennesker og borgere som muliggjorde felles refleksjon om meninger, liv og terapi. 6. Pasientene opplevde å være aktive kunnskapstilbydere gjennom kurset og slik sett kunne bidra til tjenesteutvikling ved å fokusere på sammenhenger og innholdet i den terapeutisk prosessen sammen med terapeutene. Pasientene opplevde seg som anerkjente og verdsatte medlemmer av gruppen og sett på som ansvarlige personer med viktig kunnskap og erfaringer som kan gi vekst og utvikling for pasienter så vel som terapeuter. 7. Studiens sentrale resultat er at kurset gav deltakerne erfaringer og opplevelser med å se hverandre mer som mennesker med sterke og svake sider. Dette var svært positivt for den terapeutiske relasjonen. Oppdagelsen, gjenkjennelsen og erfaringen av den felles menneskelighet var slående

Profiles of and practices in crisis resolution and home treatment teams in Norway: a longitudinal survey study

<p>Abstract</p> <p>Background</p> <p>Crisis resolution and home treatment (CRHT) is one of the more recent modes of delivering acute mental health care in the community. The objective of the study was to describe the standardizations and variations in the CRHT teams in Norway in order to gain knowledge regarding the structures and processes of CRHT teams.</p> <p>Methods</p> <p>A longitudinal survey of five CRHT teams in Norway was carried out for a period of 18 months with two sets of questionnaires-one for CRHT team profiles for a bi-yearly survey and the other for services and practices of CRHT teams for a monthly survey.</p> <p>Results</p> <p>The five CRHT teams were configured by a set of common basic characteristics in their operations, while at the same time were variant in several areas of the teams' structures and processes. Significant differences among the teams were evident in terms of the structural aspects such as service locality, staffing and team make-up, caseload, service hours, and travel time, and the process aspects such as the number of referrals received, referral source, admission, service duration, and discharge destination. These variations are reflected upon the perspectives regarding the nature of mental health crisis, the conflicting policies in mental health services, and the nature of home-based mental health care.</p> <p>Conclusions</p> <p>The diversity in the way CRHT teams are established and operate needs to be examined further in order to understand the reasons for such variations and their impact on the quality of services to service users and in relation to the total mental health service system in a community.</p

Confiabilidad inter-observador del Nursing Activities Score entre profesionales de la salud en una Unidad de Cuidado Intensivo

Objetivo : Analizar la confiabilidad inter-observador del NAS entre administradores y enfermeras clínicas en la UCI. Método : Estudio metodológico desarrollado en una UCI general en Noruega. En una muestra seleccionada el NAS fue aplicado en 101 pacientes críticos por tres clases de evaluadores: Enfermeras asistenciales, médicos intensivistas y enfermeras gestoras. La confiabilidad inter-observador fue analizada mediante el test de Kappa. Resultados : Los promedios del NAS fueron 88,4(DE=16,2) y 88,7(DE=24,5) respectivamente para las enfermeras asistenciales y gestoras. Los médicos obtuvieron un promedio NAS inferior 83,7;DE=21,1). Las 18 intervenciones médicas tuvierón mayor concordancia entre las enfermeras asistenciales y los médicos (85,6), en comparación con las enfermeras asistenciales y gestoras (78,7). En las cinco actividades de enfermería, los coeficientes Kappa fueron bajos entodas las actividades y entre todos los grupos. Conclusión : El estudio mostró confiabilidad inter-observador satisfactorias para el NAS entre las enfermeras asistenciales y gestoras.Objetivo Analisar a confiabilidade interobservadores do NAS entre enfermeiros intensivistas e administradores em UTI. Método Estudo metodológico desenvolvido em UTI geral, de adultos, na Noruega. Em uma amostra selecionada, o NAS foi aplicado em 101 pacientes por três avaliadores: enfermeira assistencial, médico intensivista e enfermeira gestora. A confiabilidade interobservadores foi analisada por meio do teste Kappa. Resultados As médias NAS foram 88,4(SD=16,2) e 88,7(SD=24,5) respectivamente para enfermeiros assistenciais e gestores. Os médicos obtiveram média NAS inferior (83,7; SD=21,1). As 18 intervenções médicas tiveram maior concordância entre enfermeiros assistenciais e médicos (85,6), comparativamente aos enfermeiros assistenciais e gestores (78,7). Nas cinco atividades de enfermagem, os coeficientes Kappa foram baixos em todas as atividades e entre todos os grupos. Conclusão O estudo mostrou confiabilidade interobservadores satisfatória para o NAS entre enfermeiros assistenciais e gestores.Objective To analyze the interrater reliability of NAS among critical care nurses and managers in an ICU. Method This was a methodological study performed in an adult, general ICU in Norway. In a random selection of patients, the NAS was scored on 101 patients by three raters: a critical care nurse, an ICU physician and a nurse manager. Interrater reliability was analyzed by agreement between groups and kappa statistics. Results The mean NAS were 88.4 (SD=16.2) and 88.7 (SD=24.5) respectively for the critical care nurses and nurse managers. A lower mean of 83.7 (SD=21.1) was found for physicians. The 18 medical interventions showed higher agreement between critical care nurses and physicians (85.6%), than between critical care nurses and nurse managers (78.7). In the five nursing activities the Kappa-coefficients were low for all activities in all compared groups. Conclusion The study indicated a satisfactory agreement of nursing workload between critical care nurses and managers

"Uten oss går det ikke"- pårørendes erfaringer med psykisk krise

Artikkelen tar opp temaet pårørende som en ressurs.Pårørendes situasjon har tradisjonelt vært lite ivaretatt og inkludert i psykiske helsetjenester (Sosial- og helsedirektoratet 2008; Aare 2010). Historisk har det vært liten faglig og forskningsmessig oppmerksomhet rundt hvordan pårørende bidrar i samarbeidet med tjenesteapparatet. Pårørende har sjeldent blitt oppfattet som en støttespiller for sitt familiemedlem eller som personer med behov for informasjon eller bistand

CRISPR/Cas9 genome editing of potato StDMR6-1 results in plants less affected by different stress conditions

Potato is the third most important food crop, but cultivation is challenged by numerous diseases and adverse abiotic conditions. To combat diseases, frequent fungicide application is common. Knocking out susceptibility genes by genome editing could be a durable option to increase resistance. DMR6 has been described as a susceptibility gene in several crops, based on data that indicates increased resistance upon interruption of the gene function. In potato, Stdmr6-1 mutants have been described to have increased resistance against the late blight pathogen Phytophthora infestans in controlled conditions. Here, we present field evaluations of CRISPR/Cas9 mutants, in a location with a complex population of P. infestans, during four consecutive years that indicate increased resistance to late blight without any trade-off in terms of yield penalty or tuber quality. Furthermore, studies of potato tubers from the field trials indicated increased resistance to common scab, and the mutant lines exhibit increased resistance to early blight pathogen Alternaria solani in controlled conditions. Early blight and common scab are problematic targets in potato resistance breeding, as resistance genes are very scarce. The described broad-spectrum resistance of Stdmr6-1 mutants may further extend to some abiotic stress conditions. In controlled experiments of either drought simulation or salinity, Stdmr6-1 mutant plants are less affected than the background cultivar. Together, these results demonstrate the prospect of the Stdmr6-1 mutants as a useful tool in future sustainable potato cultivation without any apparent trade-offs

«Ambulant akutteam - Et sikkerhetsbelte for mennesker i psykisk krise?»

The objective of this study is to contribute with in-depth knowledge based on persons’ subjective experiences within mental health crisis and support and help from a Crisis Resolution/Home Treatment (CR/HT) team. The study has a qualitative, exploratory design and qualitative interviews were conducted with seven persons. They have experiences with both inpatient treatment in hospitals and support from a CR/HT teams. The informants revealed a variety of experiences as service users in the different helping contexts. The experiences of the CR/HT team’s accessibility, availability and flexibility, was highlighted as important.  The Service users felt they were taken more seriously and met as a fellow human being in the home setting as opposed to hospital ward. The informants also emphasized how the CR/HT team helped them to feel more safe and secure. This study offers some in-depth insights of being on the receiving end of mental health services. It is important to include experience based user knowledge in the evidence base of practice development