Family members’ experiences of “wait and see” as a communication strategy in end-of-life decisions

The aim of this study is to examine family members’ experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient’s preferences, and how did they view their role as family members in the decision-making process? A constructivist interpretive approach to the grounded theory method of qualitative research was employed with interviews of 27 bereaved family members of former ICU patients 3–12 months after the patient’s death. The core finding is that relatives want a more active role in end-of-life decision-making in order to communicate the patient’s wishes. However, many consider their role to be unclear, and few study participants experienced shared decision-making. The clinician’s expression “wait and see” hides and delays the communication of honest and clear information. When physicians finally address their decision, there is no time for family participation. Our results also indicate that nurses should be more involved in family–physician communication. Families are uncertain whether or how they can participate in the decision-making process. They need unambiguous communication and honest information to be able to take part in the decision-making process. We suggest that clinicians in Norwegian ICUs need more training in the knowledge and skills of effective communication with families of dying patients

How to use visual methods to promote health among adolescents: a qualitative study of school nursing

Aims and Objectives: Public health nurses attended a 3-day course to learn the use of visual methods in health dialogue with adolescents. The aim of this study was to explore how to use visual methods to promote health among adolescents in a school nursing context. Background: Photovoice is a visualising technique that enables adolescents to participate in health promotion projects in a school setting. Photovoice also enhances work of public health nurses and other health professionals. Design: This was a qualitative action research study. We developed and conducted a course in visual methods and used data from focus group discussions in combination with participant observations involving public health nurses working in school health services. Methods: We conducted focus group interviews (n = 40) using separate semi-structured discussion guides before and after a course in visual methods. The interviews were audio recorded and transcribed verbatim, and we documented the workshops (n = 8) through field notes. We collected the data from January-October 2016. Data were analysed and coded into themes and subthemes using systematic text condensation. We reported the study in accordance with the COREQ checklist. Findings: Public health nurses found photovoice useful in school nursing. The use of images offered pupils an active role in dialogues and more control in defining the topics and presenting their stories. When nurses allowed adolescents to bring images into conversations, they discovered new insights into public health promotion. The public health nurses pointed out the benefits and challenges of using new methods in practice. Conclusion: Public health nurses considered photovoice to be useful in health promotion and other public health issues. Involving pupils in bringing images to conversations offered them an active role and voice in health promotion. Relevance to Clinical Practice: We recommend the use of photovoice and visual technologies (e.g., smartphones) in health promotion activities for adolescents.</p

Ethical challenges experienced by public health nurses related to adolescents’ use of visual technologies

Background: Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents’ use of visual technologies and social media also raises ethical concerns. Aims: We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. Research design: This is a qualitative study utilizing data from focus group discussions Participants and research context:We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access for the study and the Norwegian Center for Research Data that reviewed and approved the study. All participants gave informed consent. Findings: : In adolescents’ use of visual materials with public health nurses, ethical concerns were raised regarding suicide ideations, socially unacceptable content, violation of privacy, and presentations of possible child neglect. The nurses utilized their professional knowledge and experience when identifying and navigating these ethical dilemmas; they resolved ethical uncertainties through peer discussion and collaboration with fellow nurses and other professionals Discussion: We discussed the findings in light of Annemarie Mol’s interpretation of the ethics of care. Mol expands the notion of ethical care to include the action of technologies.</p

The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994–2020

Abstract Background Based on findings of increasing alcohol consumption in older adults, it is important to clarify the health consequences. Using data from the Tromsø study, we aimed to investigate the relationship between different levels of alcohol consumption in old adulthood and self-rated health trajectories and all-cause mortality. Methods This is an epidemiological study utilizing repeated measures from the Tromsø study cohort. It allows follow-up of participants from 1994 to 2020. A total of 24,590 observations of alcohol consumption were made in older adults aged 60–99 (53% women). Primary outcome measures: Self-rated health (SRH) and all-cause mortality. SRH was reported when attending the Tromsø study. Time of death was retrieved from the Norwegian Cause of Death Registry. The follow-up time extended from the age of study entry to the age of death or end of follow-up on November 25, 2020. Predictor: Average weekly alcohol consumption (non-drinker, &lt; 100 g/week, ≥100 g/week). We fitted two-level logistic random effects models to examine how alcohol consumption was related to SRH, and Cox proportional hazards models to examine its relation to all-cause mortality. Both models were stratified by sex and adjusted for sociodemographic factors, pathology, biometrics, smoking and physical activity. In addition, all the confounders were examined for whether they moderate the relationship between alcohol and the health-related outcomes through interaction analyses. Results We found that women who consumed ≥100 g/week had better SRH than those who consumed &lt; 100 g/week; OR 1.85 (1.46–2.34). This pattern was not found in men OR 1.18 (0.99–1.42). We identified an equal mortality risk in both women and men who exceeded 100 g/week compared with those who consumed less than 100 g/week; HR 0.95 (0.73–1.22) and HR 0.89 (0.77–1.03), respectively. Conclusions There was no clear evidence of an independent negative effect on either self-rated health trajectories or all-cause mortality for exceeding an average of 100 g/week compared to lower drinking levels in this study with up to 25 years follow-up. However, some sex-specific risk factors in combination with the highest level of alcohol consumption led to adverse effects on self-rated health. In men it was the use of sleeping pills or tranquilisers and ≥ 20 years of smoking, in women it was physical illness and older age. </jats:sec

Additional file 2 of The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994–2020

Additional file 2: Table S2. All-cause mortality risk by alcohol consumption according to cohort. The Tromsø Study 1994–2020. HR; hazard ratios, are based on cox proportional hazard models with repeated measures of alcohol consumption. All time-varying scores were updated in 2001, 2007–08, and 2015–16 for those who participated. All estimates are adjusted for education, age and including all listed covariates. End of follow-up on November 25, 2020. Exponentiated coefficients; 95% confidence intervals in brackets. *p <  0.05, **p <  0.01, ***p <  0.001. aIn 1994–95, the seven-item CONOR Mental Health Index (CONOR-MHI) was used, whereas in the three subsequent surveys, the ten-item Hopkins Symptom Check List-10 (HSCL-10) was used bHII measures somatic diseases according to the impact that each condition has on SRH. cSubjects reporting the use of either or both sleeping pills/tranquilisers. In 1994–95, the time frame asked was “during the last two weeks”, while in the three subsequent surveys it was “during the last four weeks”. cSubjects reporting the use of either or both sleeping pills/tranquilisers. In 1994–95, the time frame asked was “during the last 2 weeks”, while in the three subsequent surveys it was “during the last 4 weeks”

Additional file 1 of The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994–2020

Additional file 1: Table S1. Characteristics of the participants ≥60 years according to survey. The Tromsø Study 1994–2016. aOnly participants < 70 years were asked the question “how often do you drink 6+ units in one occasion” in 1994–95. bThe proportion includes the use of either or both sleeping pills/tranquilisers. In 1994–95, the time frame asked was “during the last two weeks”, while in the three subsequent surveys it was “during the last four weeks”. cHII measures somatic diseases according to the impact that each condition has on SRH. dIn 1994–95, the seven-item CONOR Mental Health Index (CONOR-MHI) was used, whereas in the three subsequent surveys, the ten-item Hopkins Symptom Check List-10 (HSCL-10) was used

Recognition as a valued human being: Perspectives of mental health service users

Samarbeidsbasert forskning med brukermedvirkning innenfor psykisk helsearbeid i fokus.Artikkelen tar for seg sårbarhet i relasjoner mellom psykiatriske tjenester og fagfolk som arbeider i kommunebaserte psykiske helsetjenester. Hensikten var å utforske hvordan brukerne av disse tjenestene beskrev og ga mening til sine møter med andre mennesker. Forskningen er et samarbeidsprosjekt mellom forskere og personer med erfaringsbasert kunnskap. Dataene er hentet fra 19 intervjuer med 11 personer som er avhengige av psykiske helsetjenester minst tre ganger i uken. Resultatene bekrefter at gjensidighet er grunnleggende for relasjoner. Det er viktig å anerkjenne den enkelte brukeren, og dette innebærer et personlig engasjement hos den profesjonelle omsorgsyteren