Omlegging av livskurs. En grunnleggende prosess i et godt liv med multippel sklerose.

Hensikten med studien har vært å framskaffe kunnskap ved hjelp av Grounded Theory metodologi (GT) om hvordan en kan leve et så godt liv som mulig med multippel sklerose (MS). Hvilke prosesser opplever personer med MS som sentrale for å skape og opprettholde et godt liv? Hva hemmer og fremmer disse prosessene? Det kvalitative forskningsintervjuet er anvendt som redskap i datainnsamlingen. Deltakere er valgt blant personer med MS som enten har vært innlagt i sykehus i forbindelse med diagnostisering eller til poliklinisk kontroll, i kontakt med MS-sykepleier, deltakere på MS-skole eller til rehabiliteringsopphold. Det er foretatt 21 individuelle intervju med 17 personer; åtte menn og ni kvinner 23 til 59 år gamle. Intervjuene er tatt opp på bånd og skrevet ordrett av. I tillegg har jeg deltatt på fem MS-skoler hvor ca. 50 personer med MS og 20 pårørende deltok, og hvor hensikten var å lære om ulike aspekter ved sykdommen og dele hverandres erfaringer gjennom en to dagers samling. Personlige beretninger fra aviser, bøker og internett ble også anvendt som data. Gjennom analyse av personenes opplevelser og erfaringer ble det utviklet en substantiv teori om omlegging av livskurs som en grunnlegende prosess i et godt liv med MS. Omlegging av livskurs betegner en prosess med fire faser: Normaliseringsfokusering, endringsfokusering, mulighetsfokusering og motstandsfokusering. Omlegging av livskurs beskriver overgang fra en livskurs uten MS til en livskurs med MS. Fasene kan overlappe hverandre, men en fase kan være mer framtredende over en periode, avhengig av indre og ytre faktorer. De indre faktorer som influerer på omleggingsprosessen utgjøres av sykdommens type og alvorlighet, varighet og synlighet. I tillegg kommer forhold som personlig bakgrunn, erfaringer og verdier. De ytre forhold som kan influere på omleggingsprosessen, er omgivelsenes reaksjoner på sykdommen slik som støtte, hjelp, forståelse, dramatisering, stakkarsliggjøring, barnsliggjøring og degradering. Behandlingsmuligheter, helsetjenestens kompetanse, organisering og holdninger, og samfunnets tilbud til personer med en kronisk sykdom som MS er av avgjørende betydning. Studiens funn diskuteres først i lys av empirisk forskning beslektet med omleggingsprosessen, som forskning om sykdomsbane (trajectory), stigma, mestring, livskvalitet og livsfenomen. Dernest diskuteres omlegging av livskurs i lys av Pahuus sin livsfilosofiske teori og Sirgys psykologiske teori om det gode liv. Endelig diskuteres kontekstens betydning for et godt liv med utgangspunkt i Veenhovens sosiologiske modell om fire kvaliteter ved det gode liv. Den substantive teorien om omlegging av livskurs kan gi forskere, helsepersonell og allmennheten en større innsikt i og forståelse for de prosessene som personer med MS må gjennom for å leve et så godt liv som mulig med en MS-diagnose. Kunnskapen kan også bidra til en felles forståelse blant helsepersonell, og ramme for forbedring av omsorgstilbudet til denne pasientgruppen. Teorien kan også være utgangspunkt for videre kunnskapsutvikling om et så godt liv som mulig med MS spesielt og kronisk sykdom generelt, og i utdanning av helse- og sosialpersonell

Student radiographers' attitudes towards the older patient: a longitudinal study

Purpose: To design, implement and evaluate the effect of an educational intervention on student radiographer attitudes across their educational tenure. Methods: In the first phase, an educational intervention that involved didactic lectures, reflective exercises and simulation suits, aimed at improving student radiographer attitudes towards the older person, was designed and implemented. Kogan’s attitudes towards older people (KoP) scale was administrated at five test points; pre-intervention; post-intervention; 6 months post intervention; 12 months post intervention and 24 months post intervention. At the final test point these quantitative data was supplemented with qualitative data for triangulation of the findings. Results: Students held positive attitudes towards older people pre intervention, these increased significantly post intervention (p=0.01). However, this increase in positive scores was not noted at 6 months and 12-months post intervention. At 24-months post intervention, although there was a slight increase in positive attitudes when compared to the 6 and 12 month scores, this increase was not found to be significant (p=.178) Conclusions: The results post-intervention suggested that an educational intervention can have a significant impact on student radiographer’s attitudes towards older people. However, the qualitative data suggests that experiences on initial clinical placement can be detrimental to attitudinal scores, particularly if the intervention does not include Dementia care strategies

Managing discomfort and developing participation in non-emergency MRI: children's coping strategies during their first procedure

Introduction: Building on existing work, this paper aims to develop a detailed analysis of the practical coping strategies developed by children who had not previously experienced an MRI, regarding a non-emergency examination of the brain. Methods: Semi-structured interviews with 22 children, aged between eight and sixteen years, were conducted immediately post-procedure. Emergent data were thematically analysed in line with the core precepts of Grounded Theory, and triangulated against interview data with their parents where pertinent. Results: The primary concern among interviewees related to how they had coped with the discomfort of an unfamiliar medical procedure; this was recurrently managed through a process herein termed Participation Development. This comprised three phases. The first, preparative participation, describes the children’s reported attempts to ready themselves for the examination (with parents) ahead of arriving in hospital. The second, enabling participation, describes how the children (with input from parents and radiographers) endeavoured to understand what was to come, and select viable distraction techniques. Finally, sustaining participation describes the children’s reports of actualizing their preparations during the examination itself. Where the overall process of participation development was successful, the children reported a sense of mastery, growth and even joy. Conclusion: While much work in the domain portrays children as relatively ‘passive’ agents’ during an MRI procedure, the findings herein point to how they can (with varying degrees of success) actively and constructively work with others. This, it is contended, has direct import for the improvement of support, both prior to and within a procedure itself

Managing discomfort and involving participation in non-emergency MRI: children’s coping strategies during a first procedure

Purpose: Building on existing work, this paper aims to develop a detailed analysis of the practical coping strategies developed by children who had not previously experienced an MRI, regarding a non-emergency examination of the brain. Materials and Methods: Semi-structured interviews with N=22 children, aged between eight and sixteen years, were conducted immediately post-procedure. Emergent qualitative data were thematically analysed in line with the core precepts of Glaserian Grounded Theory. Results: The primary concern among interviewees related to how they had coped with the discomfort (prospective and extant) of an unfamiliar medical procedure; this was recurrently managed through a process herein termed Involving Participation. This comprised three phases. The first, participation preparation, describes the children’s reported attempts to ready themselves for the examination (with parents) ahead of arriving in hospital. The second, enabling participation, describes how the children (immediately before examination, with input from parents and radiographers) endeavored to understand what was to come, and select viable distraction techniques. Finally, sustaining participation describes the children’s reports of actualizing their preparations during the examination itself. Where the overall process of participation development was successful, the children reported a sense of mastery, growth and even joy. Conclusion: While much work in the domain portrays children as relatively ‘passive’ agents during an MRI procedure, the findings herein point to how they can (with varying degrees of success) actively and constructively work with others. This, it is contended, has direct import for the improvement of support, both prior to and within a procedure itself

Student radiographer attitudes towards the older patient: a longtitudinal study

Background: The ageing population is creating greater pressure on health care services; radiology is no exception. Care of the older population has been reported as inadequate and as a consequence of the Mid-Staffordshire enquiry, care of the older patient has become a central feature of education and training. However little evidence exists as to the effectiveness of this education in the radiography arena. Method: This longitudinal study evaluated student radiographer attitudes towards older people. In the first phase an educational intervention, aimed at improving student radiographer attitudes towards the older person was designed and implemented. Attitudes were measured pre and post intervention using Kogan's attitudes towards older people scale (KoP). Students were then followed throughout their training to determine any changes in attitudes. Results: Students held positive attitudes towards older people pre intervention, which increased significantly post intervention (p=0.01). This significance was not noted at 6 and 12 months' post intervention; here average scores reduced to an almost identical level to those found pre-intervention. At 24 months' post intervention attitudinal scores increased, though this was not found to be significant. Conclusion: The initial results suggested that an educational intervention can have a significant impact on student radiographer's attitudes towards older people. However, the six and twelve months' post intervention scores suggest that these positive attitudes do not endure. Though the 24 months' post intervention findings demonstrate an increase in positive attitudes, these were still lower than the immediate post-intervention

Remodelling the Life Course: Making the Most of Life with Multiple Sclerosis

The aim of the study was to develop a substantive grounded theory on how to live a life as good as possible with multiple sclerosis (MS). The question of how to improve the quality of life is of key importance when speaking of a chronic illness like MS. We still have little knowledge of this important question from the patients’ perspective. Classic grounded theory was used to explore patients’ experiences of living with MS. The aim was to identify their main concern and how they process this concern at different phases in their life course. Twenty-one interviews were conducted with 17 participants diagnosed with multiple sclerosis. Participant observation at five courses for people with a multiple sclerosis diagnosis generated field notes. The participants’ main concern was how to live a life as good as possible in spite of their deteriorating health. The participants met this challenge through a process of remodelling the life course, in four phases: postponing (keeping up a normal life), adjusting (moving on to a changed life), restructuring (doing the best of it in a changed life), and transforming (preventing illness from controlling life). The remodelling process is influenced by the individual context, like the current health situation, biography, relations, and structural conditions. The process of remodelling helps us understand what facilitates and what hinders patients with MS from living a good life