Ella Danielson

Existential concerns among patients with cancer and interventions to meet them: an integrative literature review.

Objectives: An integrative literature review was undertaken to explore existential concerns among patients with cancer with respect to components, related concepts and targets of interventions.

Struggling for a Tolerable Existence: The Meaning of Men’s Lived Experiences of Living with Pain of Fibromyalgia Type

Chronic pain is a major health problem in Sweden because of its consequences in daily life. Fourteen men with fibromyalgia-type pain were interviewed regarding their experiences. A phenomenological hermeneutic method was used to interpret the transcribed interviews. Three major themes emerged: experiencing the body as an obstruction, being a different man, and striving to endure. Overall, the meaning of men’s lived experience of chronic pain was experienced as change in the body, self, and relationships. Striving to live life required achieving balance during both calm and difficult phases of the illness—struggling for a tolerable existence. Information from this study could provide guidelines for health care staff members to give empathic and supportive care to men living with a long-term illness.

Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women.

The purpose of the present study was twofold: first, to describe changes of Health-Related Quality of Life (HRQoL) during the adjuvant treatment among postmenopausal women with breast cancer; second, in the same population to identify the best predictors of Overall Quality of Life (QoL) after treatment, from perceived functioning, symptoms, emotional distress and clinical/demographic variables measured at baseline. The study group was 150 women (> or = 55 years of age) scheduled for adjuvant chemotherapy (CT, n=75) or radiotherapy (RT, n=75). They were examined before (baseline), during and after completing the treatment. Data about QoL, perceived functioning, symptoms and emotional distress were collected with the European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30, BR23 and Hospital Anxiety and Depression Scale (HADS) questionnaires. The general finding was that the adjuvant treatments were associated with decrease in overall QoL, physical and role functioning, anxiety and body image, as well as with increase in fatigue, dyspnoea, pain, nausea/vomiting, constipation and systemic therapy side effects measured over time. For women receiving CT, better emotional functioning and less pain at baseline predicted better overall QoL at the end of the treatment. For women receiving RT, better physical and emotional functioning, less breast symptoms and lower tumour stage at baseline predicted better overall QoL at the end of the treatment.

Glycaemic control and diabetes care utilization in young adults with Type 1 diabetes.

Objectives  To explore how glycaemic control in young adults is related to diabetes care utilization during the transition to adult diabetes care and if these variables differ between males and females.

Postmenopausal women with breast cancer: their experiences of the chemotherapy treatment period.

This article illustrates the experience of 20 postmenopausal women with breast cancer who had received chemotherapy treatment. The interviews were of narrative nature and analyzed with content analysis. Four themes, including 12 subthemes, described these womens life during treatment as a journey from the negative experiences of fear of the unknown, affects on body and mind, to the more positive to get by, and a transformed life. The treatment was compared with an assault on the body, and the loss of their hair was experienced more negatively than the loss of a breast. The women described a feeling of imbalance in their relationships due to lack of support from those close to them. The support from healthcare professionals was experienced both positively and negatively, and many of the women revealed variation in the professionals attitude, knowledge, and empathy. The women who chose not to work during the treatment felt pressure from society and healthcare professionals to get back to work as soon as possible. For many, especially those in a leading position, this was experienced as very difficult. The women expressed a feeling of not being afraid of dying but wanted more time to prepare themselves.

The impact of age on Health-Related Quality of Life (HRQoL) and symptoms among postmenopausal women with breast cancer receiving adjuvant chemotherapy

Background and purpose. Elderly women with breast cancer are often not given adjuvant chemotherapy (CT). One reason for this is that older women are believed to have more problems in tolerating side-effects of CT. The purpose of this study was to analyze the impact of age on health related quality of life (HRQoL) and symptoms in postmenopausal women with breast cancer undergoing adjuvant CT. Patients and methods. Eighty consecutive postmenopausal patients planned for CT were invited. Seventy-five agreed to participate (age 55–77 years). The patients completed two cancer-specific HRQoL questionnaires, The European Organisation for Research and Treatment of cancer (EORTC) EORTC-QLQ-C30, the EORTC-QLQ-BR23, and the Hospital Anxiety and Depression Scale (HADS) before, during, and 4 months after completion of treatment. The design was descriptional and longitudinal. Correlations were examined between age and change in HRQoL variables. Results. No significant correlations were found between age and any of the assessed HRQoL domains or symptom scales, except for dyspnoea and sexual functioning. Age was inversely correlated to change in dyspnoea from baseline through follow-up, whereas older women perceived their sexual functioning significantly lower at baseline. Conclusion: The results indicate that among postmenopausal patients in the age range 55–77 years consecutively selected for adjuvant CT age was not a predictor of decreased HRQoL. This supports the argument that age should not be used in isolation in decisions about adjuvant CT for breast cancer in elderly women.

Redefining relationships and identity in young adults with type 1 diabetes

AIM This paper is a report of a study exploring the meaning of interactions with and supports of self-management from parents and other significant others for young adults with type 1 diabetes. BACKGROUND Adolescence and young adulthood is known to be a critical period for people living with diabetes in terms of diabetes control, which is why support from significant others is of utmost importance during the transition to adult life. METHOD A grounded theory approach was used. Interviews with 13 young adults with type 1 diabetes and 13 parents 2 years after transfer to adult diabetes care were conducted during 2006-2007. Internet communication between young people on a diabetes website was also included in the constant comparative analysis. FINDINGS Transition to adult life for young adults with diabetes was characterized by a relational and reflexive process leading to ongoing redefinition of relationships and identity. Parents were perceived as the most reliable supporters, compared to partners, siblings and other significant others. Chat friends can also become important through emotional, social and diabetes-related support in internet communication. The young adults showed growing awareness of their own capacities, shortcomings and emotional reactions, reflections which contribute to a redefinition of self. CONCLUSION Further research is needed to explore how contemporary interactions contribute to development of the self. By focusing on supporting relationships, nurses are in a strategic position to develop knowledge and modify clinical programmes that promote diabetes management and care by taking supporting interactions into account from a contemporary point of view.

Outcomes of an educational intervention for the family of a person with bipolar disorder: a 2‐year follow‐up study

This study aimed to analyse the outcomes of an educational intervention for family members living with a person with bipolar disorder. A longitudinal study was conducted comprising a 10-session educational intervention designed for families with members in outpatient mental health care. Thirty-four family members agreed to participate. Data were collected on five occasions, at baseline and during a 2-year follow-up through self-assessment instruments: the Carers of Older People in Europe Index, the Jalowiec Coping Scale-40, the Sense of Coherence questionnaire and the Social Adaptation Self-evaluation Scale. The results showed that the condition had a considerable negative impact on the family members as carers, but the educational intervention increased their understanding, which facilitated the management of their lives. A significant improvement in stress management was seen over time and social functioning was retained. The study showed that families living with one member with bipolar disorder benefited from the educational intervention in terms of increasing understanding of the condition and reducing stress. Mental health care needs to develop educational interventions further and offer the families support to strengthen their ability to manage with the situation.

The Swedish version of the Frommelt attitude toward care of the dying scale: Aspects of validity and factors influencing nurses' and nursing students' attitudes

Background: Nurses’ attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language. Objectives: The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients. Methods: A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used. Results: The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach &agr;’s. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients. Conclusions: Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses’ attitudes toward caring for dying patients. Implication for Practice: Care culture might influence nurses’ attitudes toward caring for dying patients; the benefits of education need to be explored.

Description of unexplained chest pain and its influence on daily life in men and women.

Background: Patients with unexplained chest pain have seldom organic pathology. Although both physical and psychological factors have been studied and suggested as causes of chest pain. Aim: The aim was to describe the experience of unexplained chest pain and its influence on daily life situation in men and women. Methods: Nine women and eleven men with unexplained chest pain, aged 31–62 years were interviewed. A qualitative descriptive design was used. The interviews were analyzed by content analysis focusing on experience by gender. Results: The results embraced two domains descriptions and consequences of chest pain and daily life situation. Words like pressure, cramp, strong, or burning were used in the descriptions of the chest pain experienced with more similarities than variations between men and women. Physical, psychological and social consequences due to chest pain influenced daily life. The men specifically reported having a ‘fast tempo’ in their lives, with stress at work being seen as a feature experienced by both men and women. Conclusions: This study shows that men and women had more similarities than variations in descriptions of chest pain. Their unexplained chest pain influenced their functions in daily life that led to, especially for the men, few contacts outside the family and therefore a weak social network.