Susanne Knutsson

The everyday life of the young child shortly after receiving a cancer diagnosis, from both children's and parent's perspectives.

Background: Providing qualified, evidence-based healthcare to children requires increased knowledge of how cancer affects the young child’s life. There is a dearth of research focusing on the young child’s experience of everyday life. Objective: The purpose of this study was to explore young children’s and their parents’ perceptions of how cancer affects the child’s health and everyday life shortly after diagnosis. Methods: Thirteen children with newly diagnosed cancer aged 1 to 6 years and their parents, connected to a pediatric oncology unit in Southern Sweden, participated in this study through semistructured interviews. Child and parent data were analyzed as a family unit, using qualitative content analysis. Results: Everyday life was spent at hospital or at home waiting to go back to hospital. Analysis led to the following categories: feeling like a stranger, feeling powerless, and feeling isolated. Conclusions: The child wants to be seen as a competent individual requiring information and participation in care. Parents need to be a safe haven for their child and not feel forced to legitimize painful and traumatic procedures by assisting with them. Nurses play a major role in the lives of children. Research with and on the young child is necessary and a way of making them visible and promoting their health and well-being. Implications for Practice: Nurses need to reevaluate the newly diagnosed child’s care routines so as to shift focus from the illness to the child. This requires competent nurses, secure in their caring role.

The process of striving for an ordinary, everyday life, in young children living with cancer, at six months and one year post diagnosis

PURPOSE Health care focus is shifting from solely looking at surviving cancer to elements of attention relating to living with it on a daily basis.The young childs experiences are crucial to providing evidence based care. The aim of this study was to explore the everyday life of young children as expressed by the child and parents at six months and one year post diagnosis. METHODS Interviews were conducted with children and their parents connected to a paediatric oncology unit in Southern Sweden. A qualitative content analysis of interview data from two time points, six months and one year post diagnosis, was carried out. RESULTS The process of living with cancer at six months and at one year post diagnosis revealed the childs striving for an ordinary, everyday life. Experiences over time of gaining control, making a normality of the illness and treatment and feeling lonely were described. CONCLUSION Nurses have a major role to play in the process of striving for a new normal in the world post-diagnosis, and provide essential roles by giving the young child information, making them participatory in their care and encouraging access to both parents and peers. Understanding this role and addressing these issues regularly can assist the young child in the transition to living with cancer. Longitudinal studies with young children are vital in capturing their experiences through the cancer trajectory and necessary to ensure quality care.

Pre-hospital assessment by a single responder: The Swedish ambulance nurse in a new role: A pilot study

When a person with vague symptoms calls 112, the dispatchers often have difficulty prioritising the severity of the call. Their only alternative has been to send an ambulance. In Gothenburg, Sweden, a nurse-manned single responder (SR) was initiated to assess this patient group. The study aims to describe patient characteristics and assessment level made by the SR nurse among patients assessed by the dispatcher as low priority and/or vague symptoms. A consecutive journal review was conducted. During six months, 529 patients were assessed; 329 (62%) attended the emergency department (ED) or inpatient care (IC). Of these, 85 patients (26%) were assessed as high priority. Only 108 were assessed as being in need of ambulance transport. ED/IC patients were significantly older. Two hundred (38%) stayed at the scene (SS) (n = 142) or were referred to primary care (PC) (n = 58). Of the 200 SS/PC patients, 38 (19%) attended the ED within 72 hrs with residual symptoms, 20 of whom were admitted to a ward. Nine patients (4% of 200 SS/PC patients) required inpatient treatment and 11 patients stayed overnight for observation. These results suggest a relatively high level of patient safety and the usefulness of an SR among patients assessed by the dispatcher as low priority.

Children's thoughts and feelings related to visiting critically ill relatives in an adult ICU: A qualitative study

OBJECTIVES To describe and understand childrens thoughts and feelings related to visiting critically ill relatives or family members in an adult intensive care unit. DESIGN A qualitative descriptive study. METHOD Twenty-eight children (14 girls; 14 boys) that had visited a critically ill relative or family member in an adult intensive care unit were invited to participate in an interview. The material was analysed inspired by Gadamers hermeneutic philosophy and Doverborg and Pramling Samuelssons method about interviews and dialogues with children. RESULTS Children with a seriously ill/injured relative suffer. However, visiting seems to alleviate suffering. Visiting and being present as a part of the situation brought positive feelings of involvement and made it possible to show that they wanted to care for the relative. The sick relative was always on the childs mind and seeing and being with them in the intensive care unit resulted in relief and calmness, even if the relatives situation sometimes evoked feelings of despair and fear. CONCLUSION Knowledge and awareness of the fact that children are affected by the relatives condition and for their wellbeing needs to visit, caring actions must focus on helping the child become involved in the relatives situation in order to alleviate suffering.

‘It has given me tools to meet patients’ needs’: students’ experiences of learning caring science in reflection seminars

This qualitative study aims to describe nursing students’ experiences of learning caring science by using reflection seminars as a didactic model. A reflective lifeworld research approach according to Husserl’s phenomenological philosophy was used. Findings suggest that reflective seminars increased understanding of caring science, other people and one’s self. Moreover, substance-oriented reflection and lifeworld perspectives provided a good learning environment. Learning prerequisites were found to be openness, honesty, respect, trust, security, justice, parity and shared responsibilities along with having a common platform and a clear framework. These findings highlight conditions for a culture conducive to learning and for gaining embodied knowledge, but also present concerns regarding the difficulty and importance of establishing a good learning environment. A need to create meaningfulness, establish caring as conscious, reflective acts and show the value in personal differences were also found. These findings offer an important perspective necessary for preparing nurses to perform good quality care.

Following Young Children’s Health and Functioning in Everyday Life Through Their Cancer Trajectory

Background: Knowledge of living with childhood cancer, through the trajectory, is sparse. Aim: The aim of this study was to follow young children’s health and functioning in everyday life through their cancer trajectory. Methods: Data were gathered longitudinally from a group of 13 young children and their parents connected to a pediatric oncology unit in Sweden. The International Classification of Functioning, Disability and Health for Children and Youth structure was used to identify difficulties in health and functioning in everyday life, in interview and questionnaire data. Descriptive statistical analysis was performed to show patterns of difficulty over a 3-year period from diagnosis. Results: Difficulties experienced by children declined and changed over time. An increase in difficulties with personal interactions with others and access to and support from health care professionals was seen 2 to 3 years after diagnosis and start of treatment. Similar patterns are seen within individual children’s trajectories in relation to diagnosis but individual patterns were seen for each child. Conclusions and Clinical Implications: Health care professionals need to plan for ongoing contact with school services and information and support pathways, beyond the treatment period. A person-centered philosophy of care is required throughout the cancer trajectory.

Participating in reflection seminars: Progressing towards a deeper understanding of caring science described by nursing students

Few studies focus on how reflection seminars can support the learning of knowledge in caring science when inserted throughout the curriculum. The aim of this study was to describe students’ experiences of participating in reflection seminars, using lifeworld theory and focusing on caring science. A qualitative descriptive study based on interviews was carried out, and ten students between 21 and 33 years of age volunteered to participate. A reflective lifeworld research approach was used. Reflection seminars contribute to developing students’ ability to relate to caring and life. A deeper understanding is obtained when reflection sessions are spread over a longer period and when reflection becomes a process. The process helps caring science to become more natural and useful. Reflective seminaries based on a theoretical foundation contribute to facilitate learning more readily. A good atmosphere pervaded by a lifeworld perspective characterized by openness and thoughtfulness contributes to learning.

Noise in the ICU patient room – Staff knowledge and clinical improvements

INTRODUCTION The acoustic environment in the intensive care unit patient room, with high sound levels and unpredictable sounds, is known to be poor and stressful. Therefore, the present study had two aims: to investigate staff knowledge concerning noise in the intensive care unit and: to identify staff suggestions for improving the sound environment in the intensive care unit patient room. METHOD A web-based knowledge questionnaire including 10 questions was distributed to 1047 staff members at nine intensive care unit. Moreover, 20 physicians, nurses and enrolled nurses were interviewed and asked to give suggestions for improvement. RESULTS None of the respondents answered the whole questionnaire correctly; mean value was four correct answers. In the interview part, three categories emerged: improving staffs own care actions and behaviour; improving strategies requiring staff interaction; and improving physical space and technical design. CONCLUSION The results from the questionnaire showed that the staff had low theoretical knowledge concerning sound and noise in the intensive care unit. However, the staff suggested many improvement measures, but also described difficulties and barriers. The results from this study can be used in the design of future interventions to reduce noise in the intensive care unit as well as in other settings.

Reflective seminaries grounded in caring science and lifeworld theory – A phenomenological study from the perspective of nursing students

Background: Creative strategies are needed in nurse education to integrate theory, practice and lived experiences.Towards that end, reflective seminars, conducted in congruence with reflective life ...

Children as relatives to a sick parent: Healthcare professionals’ approaches:

An illness or injury sustained by a family member affects all family members. It is consequently important that a child’s need to be involved in a family member’s care is clearly recognized by healthcare professionals. The aim of this study was to describe healthcare professionals’ approaches to children as relatives of a parent being cared for in a clinical setting. A web-based study-specific questionnaire was sent and responded to by 1052 healthcare professionals in Sweden. Data were analysed using descriptive statistics and qualitative analysis. The results show that guidelines and routines are often lacking regarding involving children in the care of a parent. Compared to other areas, psychiatric units seem to have enacted routines and guidelines to a greater extent than other units. The results indicate that structured approaches based on an awareness of the children’s needs as well as a child-friendly environment are vital in family-focused care. These aspects need to be prioritized by managers in order to support children’s needs and promote health and wellbeing for the whole family.