Lisbeth Uhrenfeldt

Can life coaching improve health outcomes? – A systematic review of intervention studies

BackgroundIn recent years, coaching has received special attention as a method to improve healthy lifestyle behaviours. The fact that coaching has found its way into healthcare and may provide new ways of engaging the patients and making them accountable for their health, justifies the need for an overview of the evidence regarding coaching interventions used in patient care, the effect of the interventions, and the quality of the studies published. However, in order to provide a clear definition of the coaching interventions selected for this review, we have found it necessary to distinguish between health coaching and life coaching. In this review, we will only focus on the latter method and on that basis assess the health related outcomes of life coaching.MethodsIntervention studies using quantitative or qualitative methods to evaluate the outcome of the life coach interventions were identified through systematic literature searches in PubMed, Embase, Psycinfo, and CINAHL. The quality of the methodology was independently assessed by three of the authors using a criteria list.ResultsA total of 4359 citations were identified in the electronic search and five studies were included; two of them were randomized controlled trials and met all quality criteria. The two studies investigating objective health outcomes (HbA1c) showed mixed but promising results, especially concerning the patient group that usually does not benefit from intensified interventions.ConclusionBecause of the very limited number of solid studies, this review can only present tendencies for patient outcomes and a preliminary description of an effective life coaching intervention.The coaching method used in these studies aims to improve self-efficacy and self-empowerment. This may explain why the studies including disadvantaged patients showed the most convincing results. The findings also indicate that some patients benefit from being met with an alternative approach and a different type of communication than they are used to from health care personnel.In order to get a closer look at what is in the ‘black box’, we suggest that the description and categorisation of the coaching methods are described more comprehensively, and that research into this area is supplemented by a more qualitative approach.

Using Sandelowski and Barroso’s Meta-Synthesis Method in Advancing Qualitative Evidence

The purpose of this article was to iteratively account for and discuss the handling of methodological challenges in two qualitative research syntheses concerning patients’ experiences of hospital transition. We applied Sandelowski and Barroso’s guidelines for synthesizing qualitative research, and to our knowledge, this is the first time researchers discuss their methodological steps. In the process, we identified a need for prolonged discussions to determine mutual understandings of the methodology. We discussed how to identify the appropriate qualitative research literature and how to best conduct exhaustive literature searches on our target phenomena. Another finding concerned our status as third-order interpreters of participants’ experiences and what this meant for synthesizing the primary findings. Finally, we discussed whether our studies could be classified as metasummaries or metasyntheses. Although we have some concerns regarding the applicability of the methodology, we conclude that following Sandelowski and Barroso’s guidelines contributed to valid syntheses of our studies.

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

BackgroundResidents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.MethodSystematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.ResultsTwenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.ConclusionsMost assessment tools are not comprehensive and do not take into account residents’ individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

Perioperative nursing in public university hospitals: an ethnography.

BackgroundIn recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly specialized operating rooms in public university hospitals?MethodsAn ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark.ResultsPatients were addressed as either human beings or objects. Likewise, the participants’ technical skills were observed and described as either technical flair or a lack of technical skills/technophobia. The different ways in which the technical skills were handled and the different ways in which the patients were viewed contributed to the development of three levels of interaction between technology and nursing care: the interaction, declining interaction, and failing interaction levels.ConclusionNursing practice at the interaction level is characterized by flexibility and excellence, while practice at the declining interaction level is characterized by inflexibility and rigidity. Nursing practice at the failing interaction level is characterized by staff members working in isolation with limited collaboration with other staff members in operating rooms. Considering that the declining and failing interaction levels are characterized by inflexibility, rigidity, and isolation in nursing practice, nurses at these two levels must develop and improve their qualifications to reach a level of flexible, excellent interaction. Nurse leaders must therefore refocus their skills on proficiency in perioperative nursing.

Care interaction adding challenges to old patients’ well-being during surgical hospital treatment

Today, hospitals offer surgical treatment within a short hospital admission. This brief interaction may challenge the well-being of old patients. The aim of this study was to explore how the well-being of old hospitalized patients was affected by the interaction with staff during a fast-track surgical treatment and hospital admission for colon cancer. We used an ethnographic methodology with field observations and unstructured interviews focusing on one patient at a time (n=9) during a full day; the hours ranging from 7:45 a.m. to 8 p.m. Participants were between 74 and 85 years of age and of both sexes. The study was reported to the Danish Data Protection Agency with reference number (2007-58-0010). The encounter between old patients and the staff was a main theme in our findings elucidating a number of care challenges. The identified care challenges illustrated “well-being as a matter of different perspectives,” “vulnerability in contrast to well-being,” and “staff mix influencing the care encounter.” The experience of well-being in old cancer patients during hospital admission was absent or challenged when staff did not acknowledge their individual vulnerability and needs.Today, hospitals offer surgical treatment within a short hospital admission. This brief interaction may challenge the well-being of old patients. The aim of this study was to explore how the well-being of old hospitalized patients was affected by the interaction with staff during a fast-track surgical treatment and hospital admission for colon cancer. We used an ethnographic methodology with field observations and unstructured interviews focusing on one patient at a time (n=9) during a full day; the hours ranging from 7:45 a.m. to 8 p.m. Participants were between 74 and 85 years of age and of both sexes. The study was reported to the Danish Data Protection Agency with reference number (2007-58-0010). The encounter between old patients and the staff was a main theme in our findings elucidating a number of care challenges. The identified care challenges illustrated “well-being as a matter of different perspectives,” “vulnerability in contrast to well-being,” and “staff mix influencing the care encounter.” The experience of well-being in old cancer patients during hospital admission was absent or challenged when staff did not acknowledge their individual vulnerability and needs.

Cancer patients and positive sensory impressions in the hospital environment: a qualitative interview study

This study explores how cancer patients experience the meaning of positive sensory impressions in the hospital environment such as architecture, decoration and the interior. Data were obtained at a general hospital in Denmark by interviewing six cancer patients at two different wards. The analysis process was guided by the hermeneutical-phenomenological theory of interpretation as presented by the French philosopher Paul Ricoeur. Two main themes were identified: to preserve identity and positive thoughts and feelings. The participants experienced that positive sensory impressions in the hospital environment had a significant impact on their mood, generating positive thoughts and feelings. A view to nature also helped them to forget their negative thoughts for a while. The possibility of having a view helped some cancer patients to connect with good memories and personal life stories that enabled them to recall some of their feelings of identity. This paper adds knowledge about how cancer patients experience sensory impressions in the hospital environment. An environment that provides homeliness and offers a view to nature seems to help some patients to preserve their identity. Furthermore, positive sensory impressions and the opportunity for recreation through environmental facilities strengthen the patients positive thoughts and feelings.

Palliative patients' and their significant others' experiences of transitions concerning organizational, psychosocial and existential issues during the course of incurable cancer: a systematic review protocol

Review question/objective The objective of this review is to identify, appraise and synthesize the best available evidence exploring palliative patients’ or their significant others’ experiences of transitions during the course of incurable cancer. In this review, transitions are conceptualized as experiences concerning organizational, psychosocial and existential issues. More specifically, the review question is: What kinds of transitions do palliative patients and their significant others experience during the course of incurable cancer; in particular experiences relating to transitions concerning organizational, psychosocial and existential issues? Background Cancer is the leading cause of death worldwide.1 Specifically, 7.6 million people worldwide died from cancer in 2008 and deaths caused by cancer are expected to continue rising.1 In 2030, it is projected that 13.1 million people will die from cancer.1 Treating cancer requires a careful selection of one or more interventions such as surgery, radiology and/or chemotherapy.2 The treatment of cancer is complemented by psychological support. The goal of treatment is to cure cancer or to prolong life, while improving the patients quality of life. During the course of cancer, palliative care may be needed, the aim of which is to relieve rather than cure the symptoms caused by cancer.3 Palliative care aims to improve patients’ and their families’ experienced quality of life when facing life‐threatening illness by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement. An initial search in the databases CINAHL, Scopus, PsycINFO, PubMed, JBI COnNECT+, Cochrane Library, and Trip database shows that no systematic review on the proposed topic exists, or is currently underway. Findings from an initial search of existing reviews concerning experiences of transitions during the course of incurable cancer from the perspective of patients or significant others are centered around interventions and improving the experience of quality of life of adult cancer caregivers,4 distress and its management in couples facing incurable cancer,5 outcomes of bereavement interventions,6 relatives and preparing for the death of their loved one with cancer,7 advanced cancer patients’ prognostic information preferences,8 depression assessment and classification in palliative cancer patients,9 potential factors relevant to coping in patients with advanced cancer,10 religion and coping with chronic illness,11 and why patients choose chemotherapy near the end of life.12 Most similar to the objective of this review, Blum and Sherman13 have conducted a review of transitions from the relatives’ perspectives during the course of cancer and the topic ‘existential needs’, from a patient perspective was examined by Henoch and Danielson.14 From an organizational perspective, modern palliative care is closely connected to the development of the modern hospice movement, founded by Dame Cicely Saunders at St. Christopher Hospice in London 1967.15 The hospice philosophy has since proliferated and is now adopted worldwide. The word ‘palliative’ derives from the Latin word ‘pallium’ meaning a cover or cloak and ‘palliative’ is defined as ‘to relieve without curing’.15 Often palliative care includes multidisciplinary staff such as nurses, doctors, physiotherapists, occupational therapists, chaplains and volunteers.15 Palliative care is centered on both patients and their relatives. Studies have found that relatives are an important resource and part of preparation concerning organizing and preparing psychologically for transfer from the intensive care unit to a medical ward.17 Also, including family members of chronically ill patients in physician patient communication has a positive effect on the patients compliance and quality of life.18 In oncology nursing, families are acknowledged as a focus on care in many countries.19 Because of this central role of relatives in the course of cancer, both patients’ and relatives’ experiences of transitions will be included in this review. Concerning the relevance of conducting this review, findings from existing studies that confirm patients and their significant others having experiences of transitions related to the topic of this review have been identified; it is known that patients navigating through the course of incurable cancer describe their experiences through the metaphors ‘troubled water’ and ‘landmines’.20 Understanding the severity of suffering from incurable cancer takes time and at first denial can be experienced.21 Patients not only experience intra‐ and inter‐hospital transitions as unpredictable, scary, stressful and as sliding into insignificance,22 but also from a positive perspective when transfer is experienced as transitions into recovery and relief. Transfers between care settings and providers in same care settings involve the risk of patients and their significant others experiencing negative transitions such as feeling abandoned, which does not meet their needs of continuity of care and smooth transitions.23 Furthermore, transfers between settings of care and between providers are opportunities for errors and thus negative experiences of transitions concerning communication about many aspects of care.23, 24 Focusing on transitions is important because: “Every transition begins with an ending”.25(p11) “Meaning that people have to let go of familiar ways of being in the world that defines who they are”.26(p320) Being in transition is a process which requires time as people gradually experience how they disengage from ways of defining self and old behaviour.27 Kralik et al.26 elaborates on transition with the sentence: “People undergo transition when they need to adapt to new situations or circumstances in order to incorporate the change event into their lives”.26(p320) Significant others who are caring for a loved one suffering from incurable cancer experience both guilt and relief when their loved one is admitted to hospital and care thereby is handed over to hospital professionals.28 Also, significant others may feel helpless and alone during the course of incurable cancer; watching a loved one suffer and not being able to remove or reduce the suffering makes significant others experience death of their loved one as a relief.29 Results from these existing studies thereby show that incurable cancer patients and their significant others experience transitions concerning existential,20, 21, 22, 28, 29 psychosocial28 and organizational23, 24 issues. Currently, no systematic reviews exist concerning these experiences; therefore, it is important to provide further elaboration on the existing studies within this area. This review will contribute knowledge that professionals in health care can include in their clinical work when making a professional assessment of the palliative care needs of their patients or their relatives during the course of incurable cancer. Definitions: For the purpose of this review the following definitions will be used: Palliative: Understood from WHOs definition of palliative care: “Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life‐threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”.3 Patients: One who receives medical attention, care, or treatment.30 Significant other: A person, such as a family member or close friend, who is important or influential in ones life.30 Experiences: Understood from a phenomenological perspective including an openness to the experiences: “A phenomenological perspective includes a focus on the life world, an openness to the experiences of the subjects, a primacy of precise descriptions, attempts to bracket foreknowledge and a search for invariant essential meanings in the descriptions”.31(p38‐39) Transition: “A transition denotes a change in health status, in role relations, in expectations, or in abilities. It denotes changes in needs of all human systems. Transition requires the person to incorporate new knowledge, to alter behavior and therefore to change the definition of self in social context, of a healthy or ill self, or of internal and external needs, that affects the health status”.32(p42) Organizational: Understood within the angle of ‘corporate culture’ described by Curtin: “The corporate culture embodies the organizational values that implicitly and explicitly specify norms, shape attitudes and guide the behaviors of the members of the organization”.33(p219) This review will focus on organizational corporate culture from the perspective of patients and their significant others concerning their experiences with the following environments: hospitals, hospices, nursing homes, primary health care and outgoing specialized palliative care units. Psychosocial: Understood from the definition of ‘psychosocial oncology’: “Psychosocial oncology is defined as a discipline that is concerned with all clinical and scientific attempts to clarify the significance of psychological and social factors in the development and course of cancer. Furthermore, it addresses psychological and social factors in the patients and familys process of coping with the disease and attempts to apply this knowledge systematically to prevent, early detection, diagnosis, treatment, at rehabilitation of cancer patients”34(p580) Existential: Understood from a phenomenological perspective described by Mackey: “Heidegger believed there were many ways for the human being to be‐in‐the‐world but the most significant way was in being aware of ones own Being”.35 That is, capable of inquiring into ones own being, capable of wondering about ones own existence.36,38 He named this state dasein. In Heideggers terms, for

Patients’ lived experiences of a reduced intake of food and drinks during illness: a literature review

Scand J Caring Sci; 2013; 27; 184–194 Patients’ lived experiences of a reduced intake of food and drinks during illness: a literature review Aim:  This study aims to identify patients’ lived experiences of having a reduced intake of food and drink during illness, through a literature review. Methods:  Scientific studies were selected through a systematic search of CINAHL, PubMed, SweMed, British Nursing Index, Psycinfo and EMBASE. A deductive thematic analysis was performed on the studies included. The analysis provided three main themes: (i) serving of food and drink – patient experiences. (ii) Modifications related to illness – patient experiences. (iii) Nutritional care provided by healthcare professionals nutritional care – patient experiences. Findings:  Generally speaking, the findings showed high satisfaction with the food served at hospitals. However, patients’ individual tastes and preferences as to when and where to eat were found to affect their intake of food and drink. Physical changes because of illness were stated as the main reason for the patients’ lived experiences of a reduced intake of food and drink. These experiences seemed to be related to negative feelings, such as anxiety and shame during meals. Furthermore, the literature review revealed a lack of professional assistance during meals and insufficient guidance on how to handle specific nutritional problems. Conclusions:  Patients expect committed nursing care in regard to nutritional advice during illness and assistance in meal-related situations. Nurses need to refocus on fundamental caring.

Exploring the development of a cultural care framework for European caring science

The aim of this paper is to discuss the development of a cultural care framework that seeks to inform and embrace the philosophical ideals of caring science. Following a review of the literature that identified a lack of evidence of an explicit relationship between caring science and cultural care, a number of well-established transcultural care frameworks were reviewed. Our purpose was to select one that would resonate with underpinning philosophical values of caring science and that drew on criteria generated by the European Academy of Caring Science members. A modified framework based on the work of Giger and Davidhizar was developed as it embraced many of the values such as humanism that are core to caring science practice. The proposed caring science framework integrates determinants of cultural lifeworld-led care and seeks to provide clear directions for humanizing the care of individuals. The framework is offered to open up debate and act as a platform for further academic enquiry.

Caring for nursing staff among proficient first-line nurse leaders

The aim of this qualitative study was to investigate proficient first-line nurse leaders’ caring for the nursing staff. The study was undertaken in Benner and Wrubel’s caring framework. Ten leaders were interviewed and data were analyzed following a hermeneutic approach. Caring for the nursing staff was imperative for the leaders; it was a moral agency linked to an ambition to perform high-quality care. The ambition could be assistance in bedside care, dialoguing with the staff, or planning for staff development. Further studies are needed and proficient nurse leaders need opportunities to discuss their ways of caring for the staff.