Lis Wagner

Mediating the effect of self-care management intervention in type 2 diabetes: A meta-analysis of 47 randomised controlled trials

OBJECTIVE To perform a meta-analysis assessing the effects of self-care management interventions in improving glycaemic control in type 2 diabetes by analysing the impact of different study characteristics on the effect size. METHODS A literature search in eight scientific databases up to November 2007 included original studies of randomised controlled trials involving adult patients diagnosed with type 2 diabetes and evaluating a self-care management intervention. RESULTS The 47 included studies yielded 7677 participants. The analysis showed a 0.36% (95% CI 0.21-0.51) improvement in glycaemic control in people who received self-care management treatment. In the univariate meta-regression sample size (effect size 0.42%, p=0.007) and follow-up period (effect size 0.49%, p=0.017) were identified to have significant effect on the effect size in favour of small studies and short follow-up. For type of intervention and duration of intervention there was a non-significant effect on effect size in favour of educational techniques and short interventions. CONCLUSION In type 2 diabetes, there are improvements in glycaemic control in people who receive self-care management treatment with a small advantage to intervention with an educational approach. PRACTICE IMPLICATIONS Further research on frequency and duration of intervention may provide useful information to identify the most effective regime.

Living alone, obesity and smoking: Important factors for quality of life after radiotherapy and androgen deprivation therapy for prostate cancer

Abstract Background. While effective treatment of prostate cancer with radiotherapy and hormones increase survival, adverse effects may reduce quality of life (QoL). The aim of this study was to investigate frequency and severity of self-assessed late adverse effects, and identify the patients most exposed. Material and methods. QoL of 317 cancer survivors with primary stage T1-T3 prostate cancer treated with conformal radiotherapy (70–78 Gy) and androgen deprivation therapy was analyzed by using SF-12 and EPIC-26 questionnaires. Patients were stratified into three groups, filling out the questionnaires 1–2, 2–3, and 3–4 years after radiotherapy. Differences between groups were tested with ANOVA and the χ2 test. The influence of marital status, severe obesity, smoking, stage of disease, and applied dose of radiotherapy on QoL was evaluated with multiple linear and logistic regression analyses. Results. Of 337 patients, 317 (94%) answered the questionnaire. The sexual and hormonal summary scores in the EPIC significantly improved during time since radiotherapy (p < 0.001). Current smoking had a negative effect on SF-12 Physical Component Summary (PCS) and the Mental Component Summary (MCS) scores, on EPIC bowel overall bother (OR 7.8; p = 0.003), on EPIC mean urinary incontinence scores, and on the sexual domain. Severe obesity had a negative influence on SF-12 PCS and vitality. Severe obesity also was a negative predictor for moderate-to-severe problems in the EPIC urinary incontinence, and in the hormonal domain. Living alone was associated with lower SF-12 PCS, MCS scores, and SF-12 general health, social functioning, and the EPIC hormonal domain. The stage of disease or the radiation dose had no statistically significant impact on QoL. Conclusion. Results showed significant negative associations between smoking, severe obesity and living alone on self-assessed late adverse effects after radiotherapy for prostate cancer. This information may guide rehabilitation.

The Experience of Living With Diabetes Following a Self-Management Program Based on Motivational Interviewing:

Self-management is an important part of diabetes treatment, but the promotion of self-care activities is still a challenge. In this study, we explored how living with diabetes in everyday life was experienced following a self-management intervention program based on motivational interviewing. We conducted seven focus group interviews, each comprising 3 to 5 participants diagnosed with type 1 or type 2 diabetes. Data analysis based on a phenomenological method revealed three main themes concerning diabetes self-management: becoming a self-regulating practitioner, managing the rules of self-management, and creating a supportive social network. Narrative analysis revealed a divergence in patients’ self-perceived competence in handling diabetes. The study findings indicate that people with diabetes have specific needs for support in the daily responsibility of managing diet, exercise, medication, and blood glucose monitoring. A meaningful treatment from the patient’s perspective would appear to be one aimed at overcoming problems the patient experiences in self-management of diabetes.

The effects of multidisciplinary rehabilitation: RePCa—a randomised study among primary prostate cancer patients

Background:The objective of this study is the effectiveness of multidisciplinary rehabilitation on treatment-related adverse effects after completed radiotherapy in patients with prostate cancer (PCa).Methods:In a single-centre oncology unit in Odense, Denmark, 161 PCa patients treated with radiotherapy and androgen deprivation therapy were randomly assigned to either a programme of two nursing counselling sessions and two instructive sessions with a physical therapist (n=79) or to usual care (n=82). Primary outcome was Expanded Prostate Cancer Index Composite (EPIC-26) urinary irritative sum-score.Before radiotherapy, pre-intervention 4 weeks after radiotherapy, and after a 20-week intervention, measurements included self-reported disease-specific quality of life (QoL; EPIC-26, including urinary, bowel, sexual, and hormonal symptoms), general QoL (Short-form-12, SF-12), pelvic floor muscle strength (Modified Oxford Scale), and pelvic floor electromyography. Intension-to-treat analyses were made with adjusted linear regression.Results:The intervention improved, as compared with controls, urinary irritative sum-score 5.8 point (Cohen’s d=0.40; P=0.011), urinary sum-score (d=0.34; P=0.023), hormonal sum-score (d=0.19; P=0.018), and the SF-12 Physical Component Summary, d=0.35; P=0.002. Patients with more severe impairment gained most. Pelvic floor muscle strength measured by electromyography declined in both groups, P=0.0001.Conclusion:Multidisciplinary rehabilitation in irradiated PCa patients improved urinary and hormonal symptoms, and SF-12 physical QoL.

Gynecological cancer patients' differentiated use of help from a nurse navigator: a qualitative study

BackgroundFragmentation in healthcare can present challenges for patients with suspected cancer. It can add to existing anxiety, fear, despair and confusion during disease trajectory. In some circumstances patients are offered help from an extra contact person, a Nurse Navigator (NN). Scientific studies showing who will benefit from the extra help offered are missing. This study aims to explore who could benefit from the help on offer from a nurse appointed as NN in the early part of a cancer trajectory, and what would be meaningful experiences in this context.MethodsA longitudinal study with a basis in phenomenology and hermeneutics was performed among Danish women with gynecological cancer. Semi-structured interviews provided data for the analysis, and comprehensive understanding was arrived at by first adopting an open-minded approach to the transcripts and by working at three analytical levels.ResultsPrior experience of trust, guarded trust or distrust of physicians in advance of encountering the NN was of importance in determining whether or not to accept help from the NN. For those lacking trust in physicians and without a close relationship to a healthcare professional, the NN offered a new trusting relationship and they felt reassured by her help.ConclusionsNot everyone could use the help offered by the NN. This knowledge is vital both to healthcare practitioners and to administrators, who want to do their best for cancer patients but who are obliged to consider financial consequences. Moreover patients’ guarded trust or distrust in physicians established prior to meeting the NN showed possible importance for choosing extra help from the NN. These findings suggest increased focus on patients’ trust in healthcare professionals. How to find the most reliable method to identify those who can use the help is still a question for further debate and research.

How to be a patient in a palliative life experience? A qualitative study to enhance knowledge about coping abilities in advanced cancer patients

To date there has been little research that reveals and describes the connection between the individual and his or her environment, which is the foundation for the coping process. These findings are part of a grounded theory study. The article shows how “the struggle to be a participant in ones own life” was identified as a central tendency in coping with advanced cancer. It involved a pattern of four life conditions: alleviation from a life-threatening illness, carry on a normal life, live with powerlessness, and find courage and strength, which were characterized by a series of limitations and resources significant to coping.

The Development of Family Nursing in Denmark Current Status and Future Perspectives

Over the past 12 years, a strong foundation for family nursing has been built in Denmark, with rapid growth in the past 3 years. A review of nursing research conducted in Denmark and published between 2002 and 2013 found 15 studies that examined family phenomena. The majority of the studies used descriptive methods with data collected from surveys and interviews involving family members either together or individually. Only five of the studies examined interventions that included families’ perspectives about the intervention being evaluated. Several current research projects lead by Danish nurses examine the implementation of family nursing knowledge to clinical settings. Integration of family nursing theory has begun in Denmark in undergraduate and graduate nursing curricula and in May 2013, the Danish Family Nursing Association was officially established. Infrastructure and financial conference support has made it possible to invite Nordic and international colleagues to meet in Denmark, which, reciprocally, expands understanding and support for family nursing within the country. Further collaboration between Danish nurse researchers, educators, and administrators will help sustain the growth of family nursing science and its application in family-focused nursing practice.

Expectations of Becoming a Nurse and Experiences on Being a Nurse

Aim: To obtain knowledge of nearly graduated nursing students expectations to becoming a nurse and experiences of being a new nursing graduate Background: The transition from student to new nursing graduate is experienced to be conflict-ridden and may result in newly registered nurses changing jobs (staff turnover) after a short period of time. Disharmony between expectations and the experience of being a nurse may complicate the transition. Method: Field work with participant observation and interviews with nine participants as nursing students and as new graduated nurses with analysis of data based on a phenomenological hermeneutic interpretation theory. Results: The nearly graduated nursing students were preoccupied with considerations about future employment as a registered nurse. The joy of finishing the education was mixed with apprehension about having to take on independency. If they as nursing students had had independent work, and if the interaction with colleagues was characterized by dialogue, andling the independency as new nursing graduate was easier.

The elderly patient's dignity. The core value of health

This study shows how care providers in hospital practice perceive the elderly patients dignity as a core value in health promoting care towards the elderly. Fifteen focus group interviews were conducted with care providers who told about their nursing practice experience. The interviews were analysed using a phenomenological hermeneutical approach. The results disclose that when caring for the elderly patients health potential, care providers saw dignity as the core value of health. Dignity was found to capture three themes: autonomy, identity, and worthiness. These themes reflect the principles of nursing practice, protecting, enhancing and promoting the elderly patients health potential. It is suggested that these themes of dignity provide a frame of reference in elder care; they shape the understanding of when health issues become a concern for health-promoting care for the elderly patient and what goals should be defined.

Identifying Factors Significant to Continuity in Basic Palliative Hospital Care—From the Perspective of Patients with Advanced Cancer

Based on the research method grounded theory and semistructured patient interviews at home following hospitalization, the aim was to provide information on issues relating to the identification and alleviation of patients’ physical and emotional problems, understood as continuity in palliative care. The interviews were based on selected problems that patients found significant. The results are distilled into the core category disheartening interactions and four categories: falling outside the professional framework, not being seen as a person, unidentified/unmet need for guidance and involvement, and patient strategy–minimizing conflict. The categories are significant in generating and maintaining continuity in basic palliative care.