Conducting rehabilitation groups for people suffering from chronic pain

The aim of this study was to offer guidelines for counsellors who work with rehabilitation groups of patients with chronic pain. The sample involved nine counsellors engaged in a multidisciplinary pain management programme. Two focus group interviews were conducted. Data was analysed using qualitative content analysis. These indicate that main challenges facing counsellors were related to maintaining constructive group processes and being mentally prepared. The counsellors reported that knowledge concerning self-awareness, theoretical frameworks and counselling techniques was important. Personal learning included: group leadership, teamwork, grasping the inside story and obtaining supervision. The results show how important it is to have trained counsellors who are well prepared to prevent and deal with challenging group processes. Counsellors need to understand the concept of pain and be acquainted with cognitive behavioural framework and group processes. The results indicate that counsellors perceive regular supervision as supportive and is likely to promote good team functioning

Living a meaningful life with chronic pain - further follow-up

Living a meaningful life with chronic pain seems to depend on the patient having the leading role in their own life. Adequate assistance from healthcare professionals should be balanced during changing circumstances. Successful follow‐up demands an independent biopsychosocial–spiritual–existential perspective, where patient‐centered care and a focus on resilience go together.publishedVersio

A systematic writing program as a tool in the grief process: part 1

Bodil Furnes, Elin DysvikUniversity of Stavanger, Faculty of Social Sciences, Department of Health Studies, Stavanger, NorwayObjective: The basic aim of this paper is to suggest a flexible and individualized writing program as a tool for use during the grief process of bereaved adults.Methods: An open, qualitative approach following distinct steps was taken to gain a broad perspective on the grief and writing processes, as a platform for the writing program.Results: Following several systematic methodological steps, we arrived at suggestions for the initiation of a writing program and its structure and substance, with appropriate guidelines.Discussion: We believe that open and expressive writing, including free writing and focused writing, may have beneficial effects on a person experiencing grief. These writing forms may be undertaken and systematized through a writing program, with participation in a grief writing group and with diary writing, to achieve optimal results.Conclusion: A structured writing program might be helpful in promoting thought activities and as a tool to increase the coherence and understanding of individuals in the grief process. Our suggested program may also be a valuable guide to future program development and research.Keywords: bereavement, grief process, writing proces

Dealing with grief related to loss by death and chronic pain: suggestions for practice. Part 2

Elin Dysvik1, Bodil Furnes21Department of Health Studies, Faculty of Social Sciences, 2Department of Mathematics and Natural Science, University of Stavanger, Stavanger, NorwayObjective: This paper, the second of two, represents a theoretical framework for interventions related to loss by death of someone close, or chronic pain. This work is based on our previous understanding where grief is considered an integrated experience which involves movements on several continua.Methods: We have performed a comparison between two interventions dealing with grief and chronic pain using different designs. Interrelated experiences and processes were identified.Results: Life phenomena like grief and loss caused by death and chronic pain, seem to have many qualities in common and may overlap each other. A common core containing emptiness, vulnerability and exhaustion is identified.Discussion: Despite advances in research and thinking in recent years, several issues related to grief caused by death or chronic pain remain a challenge in clinical settings and research. When preparing interventions, we must pay attention to the relearning process, the common core and the interplay between these bodily expressions.Conclusion: We believe there is a value in future research and practice to consider losses caused by death and chronic pain, together as well as separately. Our comprehensive approach indicates that understanding the processes involved in one sort of grief may help understand the processes involved in the other.Keywords: nursing, program development, grie

Mind the Gaps: A Qualitative Study Combining Patients’ and Nurses’ Reflections on Pain Care

Chronic noncancer pain is a serious health problem, one that is often associated with physical debility and emotional suffering. Although chronic noncancer pain is one of the primary reasons that people seek medical care, a significant body of evidence indicates that chronic pain is underdiagnosed and undertreated. There is a consensus among professional stakeholders in pain care that there is a need to strengthen quality, capacity, and competence in pain management at all levels of health care. Thus, there is a need for more in-depth knowledge of both the recipients and the providers of pain care, and qualitative studies can contribute to this. The aim is to explore and combine the perspectives of patients receiving pain care and registered nurses providing care at pain clinics. A multimethod design was based on two qualitative studies consisting of semistructured interviews with patients receiving pain care (N = 10) and nurses providing pain care at pain clinics (N = 10). Qualitative content analysis was applied to interpret and abstract their experiences. The themes developed from triangulation revealed significant gaps between ideal pain care and actual practice: “Dissonance in reflections on personalized care,” “A corresponding need for improved information flow in all levels,” and “A corresponding need for improved structure in pain care.” We suggest a stronger commitment to efficient information flow and person-centered communication to facilitate the patient involvement and self-management. In addition, more resources, education, and training are necessary to enable nurses and other professionals to act upon guidelines and ensure effective pain care.publishedVersio

Nurses’ experiences with health care in pain clinics: A qualitative study

Background Recent research has focused on the effectiveness of different treatment regimens in pain clinics, where a call for more multifaceted treatment has been highlighted. Less attention has been paid to improvements within pain clinics, and how registered nurses—who usually play a key role—perceive and experience the accessibility, treatment options and follow-up offers at public pain clinics. Objective The overall aim was to explore and describe how nurses experience health care provided to patients with chronic non-cancer pain at pain clinics. Methods We used 10 individual interviews with nurses working at 10 different public pain clinics in Norway. The interviews were analyzed using qualitative content analysis. Results One theme was developed from the content analysis: “Nurses’ striving to provide whole-person care in pain clinics.” The nurses experienced allocation of limited resources as challenging, especially when the dilemma between accepting new patients from the waiting list and offering follow-up to existing patients became apparent. Multifaceted treatment was perceived as vital, although resources, priorities, and theoretical understanding of pain within the team were challenging. Conclusions The needs for multifaceted and integrated treatments in chronic pain management were obvious, although this approach appeared to be too demanding of resources and time. Stronger cooperation between pain clinics in specialist care and health care providers in primary care to ensure better patient flow and treatment is required. Emphasis is placed on coherent theoretical approaches to pain management within the team in the pain clinics to ensure whole person care.publishedVersio

Abductive reasoning in nursing: Challenges and possibilities

Abduction, deduction and induction are different forms of inference in science. However, only a few attempts have been made to introduce the idea of abductive reasoning as an extended way of thinking about clinical practice in nursing research. The aim of this paper was to encourage critical reflections about abductive reasoning based on three empirical examples from nursing research and includes three research questions on what abductive reasoning is, how the process has taken place, and how knowledge about abductive reasoning based on the examples can inform nursing research and clinical practice. The study has a descriptive and explorative approach using a convenience sample of three empirical studies from nursing research. The three studies illustrate different ways to enter the abductive reasoning process in steps. They represent new caring models, which offer visual and cognitive maps for expanding nursing research, education and thus informing care. Therefore, we suggest that abductive reasoning may be beneficial for different ways of knowing and demonstrates scientific innovation to shed new light on health phenomena, which can help researchers and practitioners to gain a broader and deeper understanding of nursing care inquiry. However, more studies are needed to broaden this scope.publishedVersio