Britt-Inger Saveman

The meaning of the lived experience of hope in patients with cancer in palliative home care

The aim of this study was to illuminate the meaning of the lived experience of hope in patients with cancer in palliative home care. Narrative interviews with 11 patients were interpreted using a phenomenological–hermeneutic method, inspired by Ricoeur. The findings revealed a tension between hoping for something, that is a hope of getting cured, and living in hope, that is reconciliation and comfort with life and death. This tension is highlighted, according to the views of the French philosopher Gabriel Marcel, as a state of ‘recollection’. The interviewees told of the hope of living as normally as possible and of the experience of confirmative relationships as dimensions of their lived experience of hope. These findings show that hope is a dynamic experience, important to both a meaningful life and a dignified death, for those patients suffering from incurable cancer.

The Use of the Personal Digital Assistant (PDA) Among Personnel and Students in Health Care: A Review

Background Health care personnel need access to updated information anywhere and at any time, and a Personal Digital Assistant (PDA) has the potential to meet these requirements. A PDA is a mobile tool which has been employed widely for various purposes in health care practice, and the level of its use is expected to increase. Loaded with suitable functions and software applications, a PDA might qualify as the tool that personnel and students in health care need. In Sweden today, despite its leadership role in mobile technologies, PDAs are not commonly used, and there is a lack of suitable functions and software applications. Objective The aim of the present review was to obtain an overview of existing research on the use of PDAs among personnel and students in health care. Methods The literature search included original peer-reviewed research articles written in English and published from 1996 to 2008. All study designs were considered for inclusion. We excluded reviews and studies focusing on the use of PDAs in classroom situations. From March 2006 to the last update in May 2008, we searched PubMed, CINAHL, Cochrane, IngentaConnect, and a local search engine (ELIN@Kalmar). We conducted a content analysis, using Nielsen’s Model of System Acceptability as a theoretical framework in structuring and presenting the results. Results From the 900 references initially screened, 172 articles were selected and critically assessed until 48 articles remained. The majority originated in North-America (USA: n=24, Canada: n=11). The categories which emerged from our content analysis coincided to a certain extent to Nielsen’s Model of System Acceptability (social and practical acceptability), including usefulness (utility and usability) subcategories such as learnability, efficiency, errors, and satisfaction. The studies showed that health care personnel and students used PDAs in patient care with varied frequency. Most of the users were physicians. There is some evidence that the use of a PDA in health care settings might improve decision-making, reduce the numbers of medical errors, and enhance learning for both students and professionals, but the evidence is not strong, with most studies being descriptive, and only 6 randomized controlled trials. Several special software programs have been created and tested for PDAs, and a wide range of situations for their use have been reported for different patient groups. Drug and medical information were commonly accessed by PDA users, and the PDA was often viewed as the preferred tool when compared to paper-based documents. Some users regarded the PDA easy to operate, while others found it difficult in the beginning. Conclusions This overview of the use of PDAs revealed a positive attitude towards the PDA, which was regarded as a feasible and convenient tool. The possibility of immediate access to medical information has the potential to improve patient care. The PDA seems to be a valuable tool for personnel and students in health care, but there is a need for further intervention studies, randomized controlled trials, action research, and studies with various health care groups in order to identify its appropriate functions and software applications.

One step towards the understanding of hope: a concept analysis

Hope is an essential concept in nursing which has not been satisfactorily explored. The purpose of this article is to elucidate the concept of hope, using a technique of concept analysis described by Walker and Avant (1995). The critical attributes revealed were; future-orientation, positive expectation, intentionality, activity, realism, goal-setting, and inter-connectedness. Various illustrative cases are presented as well as antecedents and outcomes. The discussion highlights some critical aspects of the method used and the results of this analysis may serve as a guide for further empirical research. In order to grasp the true nature of hope, complementary research studies employing a variety of methodological approaches are needed.

The Meaning of Hope in Healthy, Nonreligious Swedes

This study aims to illuminate the meaning of the lived experience of hope as narrated by healthy Swedish adults, who considered themselves as nonreligious. Twenty-four interviewees were asked to narrate their experience of hope. A phenomenological-hermeneutical analysis was performed and the meaning of the lived experience of hope was interpreted as an internal process (i.e., hope related to being), which is linked to the experience of meaning and the awareness of one’s possibilities in life. This awareness releases energy and activates thoughts and feelings, enabling the person to make good and meaningful choices. The process generates a sense of independence, freedom, and inner peace. Hope related to being is a prerequisite for an external process (i.e., setting goals). Setting goals comprises action and the expectation of a positive outcome. Hope related to doing nurtures hope related to being. The findings also revealed that hope related to doing is reconstructed throughout the life process.

Bicycle injury events among older adults in Northern Sweden: a 10-year population based study.

Bicycles are a common mode of transportation and injured bicyclists cause a substantial burden on the medical sector. In Sweden, about half of fatally injured bicyclists are 65 years or older. This study analyzes the injury mechanisms, injuries, and consequences among bicyclists 65 years or older and compare with younger bicyclists (< or =64) and older adults as passenger car drivers, to give a basis for an injury preventive discussion for this age group. Umeå University Hospitals primary catchments area had 142,000 inhabitants in 2006. Nearly all injured road users in the well-defined geographic area are treated at this hospital and a 10-year data set (N=456) of injured bicyclists aged 65+ from the hospitals continuous injury registration (1997-2006) was analyzed. The results show that the annual injury incidence was 2.4 and 2.2 per 1000 men and women, respectively, aged 65 or older. For men the incidence rate was constant in the three age groups 65-74, 75-84 and 85+, while it decreased strongly for women. The incidence rate for old adults as passenger car drivers and younger bicyclists was 1.0 and 4.6, respectively. Most frequent injury mechanisms were falls when getting on or off a bicycle (20%) and by potholes or irregularities on the ground, edge of a sidewalk, or similar (13%). Only 6% were hit by cars, trucks, or buses. Half of the injured suffered fractures or dislocations, and 10% suffered concussion or more serious intracranial injuries. Getting on or off the bicycle caused most fractures (especially a high fraction of the hip and femur fractures) and resulted in 27% of all inpatient days in hospital. Three individuals died. One-third of the injured were treated as inpatients for a total of 1413 days (on average 9 days), with 69% of the days being caused by fractures. The cost for out- and inpatient acute treatment was approximately USD 4700 (SEK 33,000) per injured. The results merit an interest for this target group; bicycle injuries among older adults are costly both for the individual and the medical sector. Injury mitigation strategies focused on the needs of this group are probably as well motivated as those focused on older car drivers.

Impact of Chronic Heart Failure on Elderly Persons' Daily Life: A Validation Study

Background: Knowledge about how elderly persons perceive the impact of chronic heart failure (CHF) on daily life is important when planning nursing care. For this purpose, disease specific instruments are needed. However, few instruments have been developed or tested specifically on elderly persons. Aim: To validate a Swedish version of the Minnesota Living with Heart Failure Questionnaire (LHFQ) on elderly persons with CHF, and use it to describe the impact of CHF on daily life in the same population. Methods: The sample comprised of 357 persons, aged between 65 and 99, diagnosed with CHF. A questionnaire including background data, the LHFQ and the SF-12 was used. Results: A factor analysis resulted in four dimensions: physical, emotional, treatment and pleasure. LHFQ showed convergent validity and ability to discriminate between known groups. Cronbachs α for the total scale was 0.94. Impairments in the physical dimension were most common, especially fatigue (88%) and shortness of breath (87%). Conclusions: The LHFQ showed satisfying psychometric properties in an elderly Swedish population with CHF and can, with minor alterations, be recommended for research and clinical use. The impact of chronic heart failure on daily life was mostly physical, but other impairments were also common.

Long-term Follow-up of Patients with Mild Traumatic Brain Injury: A Mixed-method Study

OBJECTIVE To characterize the long-term consequences of mild traumatic brain injury regarding post-concussion symptoms, post-traumatic stress, and quality of life; and to investigate differences between men and women. DESIGN Retrospective mixed-methods study. SUBJECTS/PATIENTS AND METHODS Of 214 patients with mild traumatic brain injury seeking acute care, 163 answered questionnaires concerning post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire; RPQ), post-traumatic stress (Impact of Event Scale; IES), and quality of life (Short Form Health Survey; SF-36) 3 years post-injury. A total of 21 patients underwent a medical examination in connection with the survey. The patients were contacted 11 years later, and 10 were interviewed. Interview data were analysed with content analysis. RESULTS The mean total RPQ score was 12.7 (standard deviation; SD 12.9); 10.5 (SD 11.9) for men and 15.9 (SD 13.8) for women (p = 0.006). The 5 most common symptoms were fatigue (53.4%), poor memory (52.5%), headache (50.9%), frustration (47.9%) and depression (47.2%). The mean total IES score was 9.6 (SD 12.9) 7.1 (SD 10.3) for men and 13.0 (SD 15.2) for women (p = 0.004). In general, the studied population had low scores on the Short Form Health Survey (SF-36). The interviews revealed that some patients still had disabling post-concussion symptoms and consequences in many areas of life 11 years after the injury event. CONCLUSION Long-term consequences were present for approximately 50% of the patients 3 years after mild traumatic brain injury and were also reported 11 years after mild traumatic brain injury. This needs to be taken into account by healthcare professionals and society in general when dealing with people who have undergone mild traumatic brain injury.

Social support and its association with health-related quality of life among older patients with chronic heart failure

Background: Social support is generally known to influence health-related quality of life (HRQoL), but this association is not well explored among older patients with chronic heart failure. Aims: (1) To describe social support in older patients with chronic heart failure in relation to gender. (2) To investigate if age, gender, cohabitation, perceived financial situation, and disease severity are associated with social support. (3) To investigate if social support is associated with HRQoL after controlling for age, gender, and disease severity. Methods: Data were collected in a sample of 349 patients (≥65 years) with chronic heart failure. Patients’ HRQoL was measured with the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. The Interview Schedule for Social Interaction measured social support. Data were analysed with descriptive statistics, repeated-measure ANOVA, and multiple linear regression analyses with robust standard errors. Results: Social support was generally rated high, although being a man, living alone, perceiving a problematic financial situation, and high disease severity (NYHA) were associated with lower levels of social support. Age was not associated with social support. Social support was generally associated with HRQoL, in particular the emotional dimensions. Conclusion: Taking social support into account when caring for older patients with heart failure can be of importance for improving or maintaining HRQoL.

Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs - a retrospective study, 1992-2009

BackgroundDrowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.MethodsDuring an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.ResultsDuring the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (≤18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688 /4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.ConclusionPresence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.

Family Nursing Research for Practice: The Swedish Perspective

This article offers a synthesis of the significant developments and progress of family nursing in Sweden. A review was conducted to locate Swedish family nursing research produced over the past 10 years. CINAHL, Medline, and PubMed were the primary databases used to locate approximately 75 family nursing studies conducted in Sweden. The majority of the studies used descriptive methods with data collected from surveys and interviews involving nurses and family members either together or individually. Only a few of the studies examined family nursing interventions. This article also reports the results of a recent survey of Swedish nurses that examined how family nursing is used in practice. After 10 years of creating a strong foundation for family-focused nursing in Sweden, there is still a need for nurse researchers, educators, and administrators to collaborate in the implementation of family nursing to practice.