The impact of implementing an educational intervention to enhance a family-oriented approach in specialised palliative home care: A quasi-experimental study

This is the peer reviewed version of the following article: Petursdottir, A. B., Haraldsdottir, E. & Svavarsdottir, E. K. (2018) The impact of implementing an educational intervention to enhance a family-oriented approach in specialised palliative home care: A quasi-experimental study. Scandinavian Journal of Caring Sciences, which has been published in final form at https://doi.org/10.1111/scs.12628. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Erna Haraldsdottir - orcid: 0000-0002-6451-1374 https://orcid.org/0000-0002-6451-1374Rationale Healthcare providers’ beliefs, attitudes, experiences and knowledge, which guide the care they deliver, are the key factors influencing the quality of palliative care. Education and coaching innovation are needed to translate research outcomes and adopt evidence‐based nursing care into practice. Objectives To evaluate the impact of an advanced educational and coaching programme in a family systems’ nursing approach for palliative care nurses in a home‐care setting. Methods A quasi‐experimental study using qualitative data from open‐ended questions to augment the quantitative outcome study that included a single‐group, pre‐ and post‐test design. A total population sample of nurses was recruited from a specialised palliative home care unit at a university hospital. The study utilised two self‐reported questionnaires. Results There was a statistically significant increase in the nurses’ critical appraisal of clinical nursing practice related to family nursing after participation in the educational programme than before. No statistical difference was found in items related to nurses’ experience of the interaction and reciprocity in the nurse–family relationship after participation in the programme than compared to before or in nurses’ cancer‐related beliefs. However, there was an overall significant positive change found in attitudes towards families in the total score of the Family Practice Scale. Nurses were also more positive about the further development of their knowledge and skills in advanced family nursing evident in the qualitative data. Conclusion An advanced educational intervention programme was successful in improving the nurses’ knowledge, skills, satisfaction and confidence in relation to applied family nursing approach within the context of caring for families affected by advanced/final stage cancer. However, further refinement of the implementation process is needed to enhance family care improvement and the nurses’ professional development in advanced family nursing in specialised palliative care.The study was funded by grants from the Landspitali University Hospital Scientific Fund, the Scientific Fund of the Icelandic Nurses Association and the Research Fund of Ingibjorg R. Magnusdottir (no reference numbers on funding).33pubpub

Mineral concentrations in milk from cows fed seaweed (Saccharina latissima) under different basal protein supplementation

Sixteen multiparous Holstein cows in four blocks of 4 x 4 Latin square over 4-week experimental periods were used to study the effects of seaweed (Saccharina latissima) supplement (with/without) and protein source (rapeseed meal (RSM)/wheat distiller's grain (WDG)) on milk mineral concentrations. Dietary treatments did not affect milk production and basic composition. Feeding seaweed slightly decreased milk Ca and Cu concentrations; whilst increased (by 3.3-fold) milk iodine (I) concentration, due to a higher dietary I supply. Substitution of WDG with RSM increased feed-to-milk transfer of Ca, Na, and Se and decreased that of Mg, P, Fe, and Mn; but only reduced milk Mn and I concentrations (the latter by 27 % as a potential result of increased glucosinolate intake). Seaweed supplement can improve milk I content when cows' I supply/availability is limited, but care should be taken to avoid excess milk I contents that may pose nutritional risks for young children.Peer reviewe

The effectivness of a strengths-oriented therapeutic conversation intervention on perceived support, well-being and burden among family caregivers in palliative home-care.

To access publisher's full text version of this article click on the hyperlink belowAIMS: To evaluate the effectiveness of a two-session multicomponent family strengths- oriented therapeutic conversation intervention among family caregivers of an individual with advanced/final stage cancer during ongoing palliative home-care. BACKGROUND: Family caregivers of patients in the advanced/final phases of cancer, experience multifaceted psychological distress and morbidity. Psychosocial interventions improve the well-being of family members who are caring for their close relative. DESIGN: A pre-experimental design with a one-group pre-test/posttests measurements. METHODS: Forty-eight family caregivers were assigned to receive two 60-90 min sessions of the intervention. The primary outcome was perceived emotional and cognitive support and psychological well-being, measured at baseline (T1). Then the participants were offered the first session of the intervention. About 1 week later, the second session was administered. The participants answered the same questionnaires again (T2) and then 2-4 weeks later (T3). The guideline; Criteria for Reporting Development and Evaluation of Complex Interventions 2, guided the reporting of the study. RESULTS: Family caregivers reported significantly higher emotional and cognitive support post-intervention (T2) and at (T3). They also reported significantly reduced stress symptoms at (T3) and reduced caregiver burden post-intervention (T2) and at (T3). CONCLUSION: The provision of the intervention contributed to extending knowledge about the usefulness of family conversations in the context of advanced/final stage cancer care. IMPACT: There is a lack of knowledge about the benefit of therapeutic conversation interventions for family caregivers. The therapeutic conversation intervention offered, resulted in perceived support, decreased stress, and decreased caregiving demands among caregivers in palliative home-care.LUH Scientific fund Scientific Fund of the Nurses Association in Icelan

Long-Term Effect of Receiving a Family Strengths-Oriented Intervention on Family Cancer Caregiver Stress, Anxiety, and Depression Symptoms: A Longitudinal Quasi-Experimental Study.

To access publisher's full text version of this article click on the hyperlink belowThe aim of this longitudinal study was to evaluate the long-term effects of providing a therapeutic conversation intervention, based on Family Systems Nursing, to family caregivers of a close relative with advanced cancer over the period before and during bereavement. To prevent adverse outcomes, caregivers need ongoing support that begins pre-loss and extends into the post-loss period. This study employed a one-group pre-test, post-test quasi-experimental design. Twenty-four caregivers participated in two intervention trials conducted over a 42-month period, receiving two intervention sessions pre-loss (Trial 1) and one intervention session post-loss (Trial 2). Significant decreases in anxiety and stress were noted over the three post-loss assessments. The final post-loss stress outcome was significantly lower than the first pre-loss score. For the depression score, there was not a significant change over time within the pre- or post-loss period. The findings provide evidence of decreasing anxiety and stress following the implementation of an extended family nursing intervention for bereaved family caregivers. Keywords: Family Systems Nursing; advanced cancer; bereavement; family caregiver; longitudinal research; palliative care.LUH Scientific fund Scientific Fund of the Nurses Association in Iceland Research Fund of Ingibjorg R. Magnusdotti

The Impact of Receiving a Family-Oriented Therapeutic Conversation Intervention Before and During Bereavement Among Family Cancer Caregivers: A Nonrandomized Trial.

To access publisher's full text version of this article click on the hyperlink belowEffective communication is the foundation of quality care in palliative nursing. As frontline palliative home care providers, nurses could foster more effective bereavement coping skills through therapeutic conversations. The purpose of this study was to evaluate the impact of a nursing intervention offered to bereaved family cancer caregivers. This was a quasi-experimental design, with a posttest-only comparison of the intervention and control groups receiving usual care. Bereaved caregivers (n = 51) receiving services from a specialized palliative home care unit participated and completed measures of depression, anxiety, stress, and grief reactions 3, 5, and 6 months after their close relative had died.There was a significant decrease in anxiety symptoms in the intervention group compared with the control group across all 3 time points. Anxiety and stress symptoms also decreased over time in the 2 groups combined, but this decrease was not observed for depression. When evaluating grief reactions, the intervention group had a lower mean of controlled grief responses, across the posttest period, than the control group.Results demonstrate that providing bereaved family caregivers the opportunity to participate in a therapeutic conversation intervention might reduce distressing symptoms in early bereavement.LUH Scientific Fund Scientific Fund of the Nurses Association in Iceland Research Fund of Ingibjorg R. Magnusdotti

Speciation of arsenic in milk from cows fed seaweed

Background: Including seaweed in cattle feed has gained increased interest, but it is important to take into account that the concentration of toxic metals, especially arsenic, is high in seaweed. This study investigated the arsenic species in milk from seaweed-fed cows. Results: Total arsenic in milk of control diets (9.3 ± 1.0 μg As kg-1, n=4, dry mass) were significantly higher than seaweed-based diet (high-seaweed diet: 7.8 ± 0.4 μg As kg-1, p < 0.05, n=4, dry mass; low seaweed diet: 6.2 ± 1.0 μg As kg-1, p < 0.01, n=4, dry mass). Arsenic speciation showed that the main species present were arsenobetaine (AB) and arsenate (As(V)) (37% and 24% of the total arsenic, respectively). Trace amounts of dimethylarsinic acid (DMA) and arsenocholine (AC) have also been detected in milk. Apart from arsenate being significantly lower (p < 0.001) in milk from seaweed-fed cows, than in milk from the control group, other arsenic species showed no significant differences between groups. Conclusion: The lower total arsenic and arsenate in seaweed diet groups indicates a possible competition of uptake between arsenate and phosphate and the presence of AC indicates a reduction of AB occurred in the digestive tract. Feeding a seaweed blend (91% Ascophyllum nodosum and 9% Laminaria digitata) does not raise As-related safety concerns for milk

114. Effect of grazing and feeding management on milk mineral concentrations

Application. Pasture intake and non-Holstein genetics were negatively correlated with milk I, Mn, and Cu, and positively correlated with milk Ca and P; but other feeds and mineral supplementation also influenced milk mineral concentrations. Introduction. Milk is a good source of minerals (Ca, Mg, P and K) and trace elements (I, Se, Zn), which are essential for optimum health [2]. Pasture intake may increase milk Ca and P concentrations but decrease Cu and Se concentrations, although pasture composition, plant maturity, and animal/environmental factors will also have an effect [1]. This study aimed to (i) investigate the milk mineral concentrations in herds with different pasture intakes, and (ii) assess the relative impact of individual feeds. Material and methods. Bulk-tank milk samples (n = 359) were collected monthly (over 12 months) from 30 dairy farms, and animal diet and breed were gathered via questionnaire. Three groups of 10 farms represented contrasting grazing management between April-September: high pasture intake (HP; 28–65% DMI), standard pasture intake (SP; 5–18% DMI), outdoors with low/limited pasture intake (LP; 0–3% DMI). Milk mineral concentrations were determined using ICP-MS. Analysis of variance by linear mixed effects models used pasture intake (HP, SP, LP), months (12 months), and their interaction as fixed factors. Farm ID was used as a random factor. A multivariate redundancy analysis (RDA; CANOCO 5) assessed the relative impact of breed and feeds on milk mineral concentrations. Results. When compared with HP and LP farms, milk from SP farms contained significantly less Ca (−50 mg/kg and −45 mg/kg, respectively) and P (−25 mg/kg and −29 mg/kg, respectively) (Table 1). The RDA indicated that pasture intake and non-Holstein genetics were negatively correlated with milk I, Mn, and Cu, and positively correlated with milk Ca and P. Grass/grass-clover silage and dry-straights were positively correlated with I, Mn, Cu, Mo, Zn and negatively correlated with Na. Intakes of maize silage, blends, moist by-products, oils and minerals were negatively correlated with Mn, Cu, Mo, Zn, Ca and P. Milk from low/no grazing periods contained, on average, more I (+21.1%), Mn (19.5%), Cu (+16.9%), Zn (+6.1%) and Mo (+5.5%), than milk produced from the grazing season, although between-month differences were not always significant

Iceland screens, treats, or prevents multiple myeloma (iStopMM): a population-based screening study for monoclonal gammopathy of undetermined significance and randomized controlled trial of follow-up strategies

Monoclonal gammopathy of undetermined significance (MGUS) precedes multiple myeloma (MM). Population-based screening for MGUS could identify candidates for early treatment in MM. Here we describe the Iceland Screens, Treats, or Prevents Multiple Myeloma study (iStopMM), the first population-based screening study for MGUS including a randomized trial of follow-up strategies. Icelandic residents born before 1976 were offered participation. Blood samples are collected alongside blood sampling in the Icelandic healthcare system. Participants with MGUS are randomized to three study arms. Arm 1 is not contacted, arm 2 follows current guidelines, and arm 3 follows a more intensive strategy. Participants who progress are offered early treatment. Samples are collected longitudinally from arms 2 and 3 for the study biobank. All participants repeatedly answer questionnaires on various exposures and outcomes including quality of life and psychiatric health. National registries on health are cross-linked to all participants. Of the 148,704 individuals in the target population, 80 759 (54.3%) provided informed consent for participation. With a very high participation rate, the data from the iStopMM study will answer important questions on MGUS, including potentials harms and benefits of screening. The study can lead to a paradigm shift in MM therapy towards screening and early therapy