Does the cancer patient’s disease stage matter? : a comparative study of caregivers’ mental health and health related quality of life

Objective: Cancer affects both patients and their caregivers. Caregiver burden may change during different stages of the patients’ cancer trajectory. Limited research has focused on the impact of being a caregiver, assessed by the caregiver’s mental health and quality of life (QOL) during the curative and the palliative phases of the patient’s disease. The aim of this study is to compare caregivers of cancer patients during the curative and a palliative phases with respect to their mental health and health-related QOL. Method: This descriptive, cross-sectional study combines data from two studies. The first group consists of caregivers of patients with cancer in the late palliative phase and the second group consists of caregivers of outpatients with cancer who suffer from pain and/or use analgesics. Data were collected by means of standardized measures and analyzed with descriptive statistics. Results: Based on this material, no significant differences in mental health and healthrelated QOL were revealed for caregivers of cancer patients in the palliative and the curative phases, respectively. Neither education level in the caregivers, nor the patients’ functional status influenced caregivers’ mental health or QOL. Younger caregivers seem to have better physical QOL. Significance of results: Being caregivers of cancer patients seems to have a similar pattern of impact on caregivers’ mental health and quality of life regardless of the patient’s disease stage. We share some reflections about the way in which the cancer stage is divided and the appropriateness of such selection for measuring caregivers’ mental health and QOL. Additionally, we discuss the use of generic instruments for measuring specific contexts and particular samples

Symptoms in the cancer patient - Of importance for their caregivers’ quality of life and mental health?

Purpose: To examine the level of symptom burden in a sample of cancer patients in a curative and palliative phase, In addition, to determine a) whether the patients’ symptom burden and patients’ demographic variables, and b) the and caregivers’ demographic variables’ impact on the caregivers’ quality of life and mental health. Method: This descriptive, cross-sectional study combines data from two samples. The first group consists of caregivers of hospitalized patients with cancer in the late palliative phase and the second group is caregivers of outpatients with cancer who have pain and/or use of analgesics. Results: The main result showed that the symptom burden was close to equal when we compared the cancer patients in the palliative and the curative phase respectively. The whole sample of patients seemed extremely tired because they score high on items capturing fatigue or weakness. They also had problems with pain and constipation. For patients having trouble sleeping, the caregivers’ reported high level of depression, whilst caregivers’ gender had impact on the caregivers’ anxiety. The younger the patients the more impact on caregivers’ QOL mental health. Conclusion: In this study no significant differences were revealed when comparing symptom burden among cancer patients in different stages of the disease. Caregivers reported more depression when patients had trouble sleeping and more declined mental quality of life the younger the patients’ age. Female caregivers reported more anxiety than male caregiver

Kreftpasienters barrierer mot smertebehandling

Bakgrunn: Ulike faktorer hos helsepersonell, pasienten selv eller i rammefaktorene kan forklare mangelfull smertelindring hos kreftpasienter. Hos pasientene kan barrierer for optimal smertebehandling være tilbakeholdenhet med å rapportere smerte og å følge anbefalte smerteregimer. Dette kan forklares med feiloppfatninger, misforståelser eller manglende kunnskap om smerte og smertebehandling. For eksempel redsel for avhengighet, toleranse og bivirkninger eller at smerte er en uunngåelig del av sykdommen. Hensikt: Å beskrive pasientrelaterte barrierer i forhold til smerte og smertebehandling i et utvalg av norske kreftpasienter. Og undersøke om barrierer for smertebehandling påvirker pasientenes smerteintensitet og smertens påvirkning på funksjon. Metode: Studien er en beskrivende tverrsnittsundersøkelse med 217 polikliniske kreftpasienter som har smerter og/eller bruker smertestillende medikamenter hvor barriere mot smerte og smertebehandling undersøkes ved hjelp av barriereskjema (NBQ–II). Hovedresultat: De spørsmål som reflekterer de høyeste barrierene for smertebehandling er spørsmål om avhengighet, toleranse, monitorere symptomer i forhold til egen helsetilstand, nye smerter og redsel for enkelte bivirkninger som døsighet. Konklusjon: Polikliniske kreftpasienter rapporterer en del barrierer for smertebehandling og må kanskje få en mer individualisert informasjon om smerte og smertebehandling for å bedre smertebehandlingen.Background: Numerous professional, patient, and system barriers contribute to the under-treatment of pain in cancer patients. Patients may, for example, be reluctant to report pain and to use available analgesics. This reluctance is often based on erroneous beliefs or misconceptions about pain and pain medication and includes factors such as fears of addiction and tolerance, fear of side-effects, and a belief that pain is an inevitable component of the disease. Objectives: To investigate patient-related barriers to pain management in a sample of outpatients with cancer and investigate whether barriers influence patients pain intensity and pain interference with function. Method: The study is a cross-sectional descriptive study with a convenient sample of 217 cancer patients self-reporting pain and/or using analgesics assessing barriers to pain and pain management using the Norwegian version of the Barriers Questionnaire (NBQ–II). Results: Questions reflecting the highest barriers were concerns about addiction, tolerance and about the pain-medications’ ability to prevent knowledge about new pain and changes in their health. With regard to side-effects of pain medication, the highest reported level on NBQ–II was on the items concerning drowsiness. Conclusion: Out-patients with cancer still have barriers to pain management and may need more individualized information and follow-up by health personnel in order to enhance pain management. Keyword: cancer pain, patients’ barriers, pain management, outpatient

Nurse's Evaluation of a Pain Management Algorithm in Intensive Care Units

Background: Many patients have memories of pain during intensive care unit stay. To improve pain management, practice guidelines recommend that pain management should be guided by routine pain assessment and suggest an assessment-driven, protocol-based, stepwise approach. This recommendation prompted the development of a pain-management algorithm. Aim: Evaluate the feasibility and clinical utility of this algorithm. Design: A descriptive survey. Settings: One medical/surgical intensive care unit, one surgical intensive care unit, and one postanesthesia care unit at two hospitals in Norway. Participants/Subjects: Nurses working at the three units. Methods: A pain-management algorithm, including three pain assessment tools and a guide to pain assessment and pain management, was developed and implemented in three intensive care units. Nurses working at the three units (n = 129) responded to a questionnaire regarding the feasibility and clinical utility of the algorithm used. Results: Our results suggested that nurses considered the new pain-management algorithm to have relatively high feasibility, but somewhat lower clinical utility. Less than half of respondents thought that pain treatment in clinical practice had become more targeted using the tree pain-assessment tools (45%) and the algorithm for pain assessment and pain management (24%). Conclusions: Pain-management algorithms may be appropriate and useful in clinical practice. However, to increase clinical utility and to achieve more targeted pain treatment, more focus on pain-treatment actions and reassessment of patients’ pain is needed. Further focus in clinical practice on how to implement an algorithm and more focus on pain-treatment action and reassessment of patients’ pain is needed.acceptedVersio

Tilfredshet og fremtidsplaner blant nyutdannede sykepleiere ett år etter endt utdanning

Aims: To identify factors affecting newly qualified nurses’ satisfaction and future career plans. Method: Electronic survey in spring 2018. Results: 129 (36%) of 360 invited nurses graduated 2017 participated. The majority were satisfied with their choice of career, identified themselves as nurses and aspired for further education. A quarter planned changing position. A fifth considered changing profession. High satisfaction correlated with a professionally stimulating work environment, collegial support, opportunity to provide nursing care in accordance with own values, high professional identity and low probability of turnover and dropout. Independent responsibility in a supporting environment, professional feedback and high weekly employment correlated with high professional self-confidence.  Part-time positions increased the likelihood of turnover. Conclusion: Newly qualified nurses emphasize opportunities for professional development and quality in their work and are likely to leave their position and the profession when expectations are not met. More knowledge concerning how expectations and professional values affect professional integration is needed to increase retention.Hensikt:  Å kartlegge faktorer som påvirker nyutdannede sykepleieres tilfredshet og videre yrkesplaner. Metode: Elektronisk spørreundersøkelse våren 2018. Resultat: 129 (36%) av 360 inviterte sykpleiere uteksaminerte våren 2017 deltok. Flertallet var tilfredse med yrkesvalget, oppfattet seg som sykepleiere og planla videreutdanning. En fjerdedel planla å slutte i stillingen. En femtedel vurderte å bytte yrke. Høy tilfredshet korrelerte med et faglig stimulerende arbeidsmiljø, mulighet til å yte sykepleie i samsvar med egne verdier og lav sannsynlighet for å bytte stillingen og yrke. Selvstendig ansvar og et støttende arbeidsmiljø, tilbakemelding på arbeidet og høy stillingsbrøk korrelerte med høy faglig selvtillit. Deltidsstilling økte sannsynligheten for turnover. Konklusjon: Nyutdannede vektlegger muligheter for fagutvikling og kvalitet i arbeidet, og har lav terskel for å slutte i stilling og yrke når forventninger ikke innfris. Det er behov for mer kunnskap om hvordan forventninger og faglige verdier påvirker integrering i yrkesrollen for å forebygge tendens til høy turnover og tidlig frafall

Nyutdannet sykepleier, - forventninger og utfordringer i møte med yrkesrollen

Abstract  The purpose is to explore expectations of the professional role and graduate’s first experiences as a professional nurse. The study has a descriptive retrospective design. The method is a survey, and the sample (N=129), 36% of the graduates from a Norwegian university in the Spring of 2017. The graduates were looking forward to start working but dreaded the responsibility and lack of competence. The first months as a professional were characterized by fear of inadequacy and work overload, correlating with limited knowledge of routines and disease-related issues, challenges in clinical assessment, little feedback, and insecurity for the assessment of others. The majority were almost immediately in charge of nursing care with limited supervision. The study confirms that graduates are unprepared for the complex workday of the professional role. Furthermore, mentoring schemes need improvement, and the nursing education should emphasis on practice in independent professional assessment. Challenges in the student-nurse transition still exist and underline a need for more knowledge to address this.Studiens hensikt er å utforske forventninger til yrkesrollen, og hvordan nyutdannede erfarer den første tiden som sykepleier. Studien har et deskriptivt retrospektivt design. Metoden er en spørreundersøkelse, og utvalget (N=129) er 36% av uteksaminerte sykepleiere fra et sørnorsk universitet våren 2017. De nyutdannede gledet seg til å begynne å arbeide, men gruet seg for ansvaret som sykepleier og for manglende kompetanse. Den første tiden som yrkesaktiv var preget av redsel for utilstrekkelighet og stor arbeidsbelastning, som korrelerte med lite kjennskap til rutiner og sykdomsrelaterte problemstillinger, utfordringer i klinisk vurdering, lite tilbakemelding og usikkerhet for andres vurdering. Flertallet fikk tidlig selvstendig ansvar, men begrenset opplæring. Studien bekrefter at nyutdannede er lite forberedt på yrkesrollens sammensatte arbeidshverdag, at mentorordninger for nyutdannede bør styrkes, og at utdanningen i større grad bør vektlegge øvelse i selvstendig faglig vurdering. Overgangen til yrkesrollen er fortsatt utfordrende og understreker et behov for mer kunnskap om tiltak som kan endre dette

Pain in intensive care unit patients—A longitudinal study

Aim: To assess occurrence of pain during the first 6 days of intensive care unit (ICU) stay and evaluate associations between occurrence of pain and selected patient‐related variables. Design: A longitudinal study. Methods: Adult ICU patients from three units were included. Patients' pain was assessed with valid pain assessment tools every 8 hr during their first 6 days in ICU. Possible associations between occurrence of pain and selected patient‐related variables were modelled using multiple logistic regression. Results: When pain was assessed regularly with pain assessment tools, 10% of patients were in pain at rest and 27% were in pain during turning. The proportions of patients who were in pain were significantly higher for patients able to self‐report pain, compared with patients not able to self‐report (p < .001). Several predictors were associated with being in pain. It is important to be aware of these predictors in order to improve pain management.publishedVersio

Pain in intensive care unit patients—A longitudinal study

Aim: To assess occurrence of pain during the first 6 days of intensive care unit (ICU) stay and evaluate associations between occurrence of pain and selected patient‐related variables. Design: A longitudinal study. Methods: Adult ICU patients from three units were included. Patients' pain was assessed with valid pain assessment tools every 8 hr during their first 6 days in ICU. Possible associations between occurrence of pain and selected patient‐related variables were modelled using multiple logistic regression. Results: When pain was assessed regularly with pain assessment tools, 10% of patients were in pain at rest and 27% were in pain during turning. The proportions of patients who were in pain were significantly higher for patients able to self‐report pain, compared with patients not able to self‐report (p < .001). Several predictors were associated with being in pain. It is important to be aware of these predictors in order to improve pain management.publishedVersio

Professional development practitioners’ and managers’ experiences with nurse anaesthetists with master’s degree - a cross-sectional study in Norway

Bakgrunn: Anestesisykepleierutdanningen varierer i Norden. Tidligere studier har utforsket forventninger tilmasterkompetanse. Formålet var å utforske fagutviklingssykepleiere og ledere på anestesiavdelinger i Norgesine erfaringer med anestesisykepleiere med mastergrad. Vi hadde en hypotese om at fagutviklingssykepleiereog ledere hadde ulike erfaringer, og at de med og de uten masterkompetanse hadde ulike erfaringer.Metode: Tverrsnittsundersøkelse med bruk av spørreskjema. Ledere (n = 75) og fagutviklingssykepleiere(n = 161) innen anestesisykepleie fra hele Norge deltok. Resultat: Totalt 30 ledere (40%) og 60 fagutviklingssykepleiere(37%) responderte. Respondentene erfarte at masterkompetanse i svært stor eller stor grad bidrar til fagutviklingog kunnskapsbasert praksis. Likevel er det varierende om og hvordan det tilrettelegges for masterutdanning. Respondentene med masterutdanning var signifikant mer positiv til masterutdanning sammenlignet med deuten masterutdanning. Konklusjon: Til tross for positive erfaringer med masterkompetanse i anestesisykepleie,tilrettelegges det i liten grad i avdelingene for at studenter skal kunne gjennomføre masterutdanningen.acceptedVersio