Home care with regard to definition, care recipients, content and outcome: systematic literature review.

In spite of the fact that home care has grown considerably during the last few years and will continue to grow even more in the future, home care as a phenomenon and a concept is not clearly defined. The aim of this study was to review the empirical literature for the description of home care as a phenomenon and as a concept, especially with regard to who the care recipients are, what actions and assessments are performed and what effects are achieved for the care recipient in terms of functional health status and quality of life (QoL). Twenty-six relevant studies meeting the inclusion criteria and requirements for methodological quality were identified. The phenomenon of home care is described through content, outcome and objectives. The content of home care involved a range of activities from actions preventing decreased functional abilities in old people to palliative care in advanced diseases. The outcome had two different underlying foci: (1). for the benefit of the patient based on the assumption that being cared at home increases their QoL, (2). in the interests of the society, to minimize hospital care by moving activities to the home of the patient. The objectives were found to be aiming at improving the QoL and/or maintaining independence, by means of actions and assessments, based on the patient's needs, undertaken to preserve and increase functional ability and make it possible for the person to remain at home. In conclusion, home care as a phenomenon was the care provided by professionals to people in their own homes with the ultimate goal of not only contributing to their life quality and functional health status, but also to replace hospital care with care in the home for societal reasons; home care covered a wide range of activities, from preventive visits to end-of-life care

The meaning of having to live with cancer in old age.

Little is known about how older people with cancer experience their life situation. To increase the understanding of how illness is experienced in older people with cancer, the aim of this study was to investigate the meaning of living with cancer in old age. The hermeneutic phenomenological method as described by van Manen and referred to as 'phenomenology of praxis' was used. Ten persons (seven women and three men) aged 75 and over, who had a diagnosis of cancer and who had just completed cancer treatment, were interviewed in their own homes. The analysis revealed a life world affected to varying degrees by the cancer disease. The lived experiences across the interviews were revealed in four overarching essential themes: transition into a more or less disintegrated existence, sudden awareness of the finiteness of life, redefinition of one's role in life for good and for bad, meeting disease and illness. To provide individual support and appropriate care to older people with cancer it is important for health care professionals to identify and take care of disabilities and to support the reorientation in the disintegrated life situation. It is also important to have preparedness to meet the old person's thoughts about death. Thus, it is important to encourage the old person to describe her/his illness experience to increase understanding about what is meaningful for her/him

Utvärdering av sjuksköterskeprogrammet vid Lunds universitet : Höstterminen 2012 - vårterminen 2014

2012 beslutade MedCUL (Medicinska fakultetens centrum för undervisning och lärande) och sjuksköterskeprogrammets ledning att påbörja en större utvärdering av sjuksköterskeutbildningen. Projektet består av två delar med delvis olika syften. Den första delen, som här redovisas för perioden höstterminen 2012 till och med vårterminen 2014, syftar till att ta fram underlag för förbättring av programmet. Den andra delen är ett forskningsprojekt där olika utvärderingsmetoder utprovas och jämförs. Tillvägagångssätten har varit fokusgrupper med studenter på termin tre respektive sex, enkäterna DREEM och CLES+T, intervjuer med enskilda studenter och lärare, samt analys av kursplaner och andra kursrelaterade dokument. Projektet påbörjades i samband med att programmet sjösatte en ny utbildningsplan höstterminen 2012 och de studenter som ingått i projektet representerar sex olika kohorter, fyra inom den tidigare utbildningsplanen och två inom den nuvarande. Denna rapport inleds med en sammanfattning av de olika tillvägagångssätt vi använt samt huvuddragen i resultaten (i rapportens appendix återfinns samtliga enkäter och frågemallar samt resterande resultat). I den avslutande diskussionen, där vi också ger förslag för utveckling, har vi begränsat oss till ett antal problemområden som vi menar framstått särskilt tydligt och är särskilt viktiga att göra något åt. Rapportens resultatdel rymmer dock mer än så och kan vara användbart för vidare analys och utvecklingsarbete

Att leva med cancer som äldre - livskvalitet och upplevelse av mening

Hur påverkas livssituationen för äldre som drabbas av cancer? Oftast blir sjukdomen ytterligare en belastning i en redan komplex situation. I denna artikel sammanfattas resultat från en undersökning av en grupp äldre (över 75 år) personer med cancer. Livskvaliteten påverkades mest hos yngre äldre, men gruppen är heterogen och personerna kräver ett individuellt bemötande

Living with cancer in old age. Quality of life and meaning.

The overall aim of this thesis was to investigate quality of life in people aged 75 and older with cancer in relation to age, gender, presence and type of complaints, comorbidity, living conditions, perceived economic situation, sense of coherence, receiving help for daily living and social resources. The aim was also to investigate older people’s experiences and the meaning of living with cancer in old age. The samples in the first three studies were identified in a larger population study concerning the health situation in people aged 75 and older. The first study comprised interviews with 64 persons with cancer about their experiences of living with cancer. In the second study comparisons were performed, between a study group of people with cancer (n=150) and a comparison group of people without cancer (n=138), as regards quality of life, complaints and comorbidities. In the third study gender differences were investigated between women (n=74) and men (n=76) with cancer and women (n=64) and men (n=74) without cancer. In the fourth study nine persons aged 75 and older, who had just completed cancer treatment, were interviewed about their experience of the meaning of living with cancer in old age. Interviews with people with a more lingering cancer disease revealed four main categories: living with cancer means (a) bodily, mental, social and existential experiences, (b) being aware of the disease or not, (c) handling daily life, (d) feelings of affirmation and/or rejection in encountering health care professionals. The power to choose how to approach daily life with cancer, the disease and its treatment proved to be crucial for constructively handling and outcome. People with cancer had lower (poorer) scores in different domains of QoL (EORTC QLQ C-30, SF-12), more complaints, and more self-reported diseases than those without cancer. Irrespective of having cancer or not, the oldest old had more complaints than the youngest old. Significant differences in QoL and complaints among age groups between people with and without cancer were seen only between the youngest age groups (aged 75–79 years). Women with cancer were more vulnerable than their male counterparts in QoL, SOC, perceived economic situation and social resources. Receiving help for daily living from others and degree of complaints were associated with poor QoL for both physical and mental component scores (PCS, MCS) of the SF-12. In people with cancer the factors receiving help for daily living, comorbidity, degree of complaints and pain were associated with poor QoL. Interviews in study four revealed three essential themes: a disintegrated existence, a sudden awareness of the finiteness of life, painful insights into losses but also awareness of possibilities. The old persons who just had completed treatment lived under the pressure of being in a transition stage. In conclusion cancer has an additional negative effect on QoL in old age and in combination with other diseases and especially the complaints. The most vulnerable cancer patients among older people seems to be the youngest old and women and especially cancer-related complaints have negative implications for QoL. Fatigue and pain seem to be the most excruciating symptoms in older people with cancer and thus suggesting a clinically important reduction of their QoL. Comorbidity was most pronounced in the oldest age groups and these people also had the poorest QoL. Oncology nursing to older people requires understanding of what the patients problems and needs are, also including the unspoken ones, as well as specific knowledge about management of symptoms and response to treatment in old age. These old people with cancer present a complex situation and thus require comprehensive assessment and physiological and psychosocial support as well as encouragement to make use of individual strengths and resources to maintain equilibrium during illness and treatment