Thora Grothe Thomsen

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.

Integrating nurse researchers in clinical practice - a challenging, but necessary task for nurse leaders.

AIM To create awareness among nurse leaders, of what they may need to consider, when integrating nurse researchers as advanced nurse practitioners (ANP) at PhD-level among their staff. BACKGROUND In a time of transition nurse leaders may be challenged by the change towards evidence-based clinical nursing, including integrating nurse researchers in ANP positions. METHODS A collective case study including three ANPs took place at a large regional hospital in Denmark. The cases were first analysed by focusing on the generic features, functions and skills of ANPs, and second by focusing on the approaches to evidence-based practice seen in the cases. RESULTS Regardless of same position, formal level of research expertise and overall responsibility, different approaches related to each ANPs professional profile, interest, academic ambitions and personality were seen. CONCLUSION Nurse leaders must ensure a process where the content and expectations of the particular role are mutually clarified and adjusted to the individual ANP and to the specific context, in order to create a harmonious match. IMPLICATIONS FOR NURSING MANAGEMENT In order to clarify expectations regarding the inclusion of nurse researchers as ANPs at PhD level, the paper provides firm recommendations that may guide the process.

Developing Evidence-Based Practice: Documenting a Tailored Writing Course for Healthcare Practitioners

Background: With the ambition of strengthening interdisciplinary and nursing research culture and research infrastructure at a regional hospital in Denmark, several initiatives were taken, one of which was a tailor-made writing course. Methods: The course was developed and implemented using an action research-inspired approach. Aims: The course had two aims. The first was to motivate practitioners to write articles about completed developmental or research projects, the second was to establish an environment where it would be possible for the healthcare practitioners to debate issues of evidence-based practice. Findings and conclusions: This article describes the development and implementation processes of three course processes and discusses how the use of a tailored writing course can contribute to the goal of strengthening the documentation of evidence-based practice in a regional hospital.

What Facilitates "Patient Empowerment" in Cancer Patients During Follow-Up: A Qualitative Systematic Review of the Literature

Empowerment is a concept of growing importance in cancer care, but little is known about cancer patients’ experiences of empowerment during follow-up. To explore this area, a qualitative systematic literature review was conducted in PubMed, CINAHL, and PsycINFO. A total of 2,292 papers were identified and 38 articles selected and included in the review. The thematic synthesis of the papers resulted in seven analytical themes being identified: empowerment as an ongoing process, knowledge is power, having an active role, communication and interaction between patients and health care professionals, support from being in a group, religion and spirituality, and gender. Very few articles explicitly explored the empowerment of cancer patients during follow-up, and the review identified a lack of attention to patients’ own understandings of empowerment, a lack of specific focus on empowerment during follow-up, and insufficient attention to collective empowerment, as well as ethnic, social, and gender differences.

Patients’ Vulnerability in Follow-up After Colorectal Cancer: A Qualitative Action Research Study

Background: In the transition between being a hospitalized patient with cancer and resuming “normal” life, many patients experience physical, mental, and social challenges. Scientifically, as well as politically, it is therefore recommended to undertake research with a focus on rethinking and reorganizing follow-up after cancer treatment. Objective: The aim of this study was to identify the perspectives of fast-track colorectal cancer surgery patients on challenges experienced in the transition from being a hospitalized patient with cancer to being a cancer survivor. Methods: The current article represents phase 1 in an ongoing action research project. Data were analyzed by using the “interpretive description” method. Results: Twelve patients (6 male and 6 female patients; mean age, 72.4 years) participated in the study. The analyses show that the patients physically experienced readiness to leave hospital after a few days; however, shortly after returning home, most of them became mentally overwhelmed by the feeling of vulnerability that was closely related to the feeling of being handed over the responsibility for a newly cancer-operated body and a fragile life situation. Four issues that challenged the patients emerged from the analysis: restore an everyday life, participate in a follow-up program, get relevant information, and manage contact with relevant health professionals. Conclusions: The study indicates that the transition to restoring a normal life after cancer surgery had been an experience characterized by more vulnerability than expected by the patients in the study. Implications for Practice: The findings provide 4 well-defined themes, each of which constitutes a point of departure related to focused patient-centered interventions related to follow-up after cancer surgery.

Patient empowerment: a systematic review of questionnaires measuring empowerment in cancer patients

Abstract Background: There is an increased attention to and demand for patient empowerment in cancer treatment and follow-up programs. Patient empowerment has been defined as feeling in control of or having mastery in relation to cancer and cancer care. This calls for properly developed questionnaires assessing empowerment from the user perspective. The aim of this review was to identify questionnaires and subscales measuring empowerment and manifestations of empowerment among cancer patients. Materials and methods: We conducted a systematic search of the PubMed, PsycINFO and CINAHL databases. Empowerment and multiple search terms associated with empowerment were included. We included peer-reviewed articles published in English, which described questionnaires measuring empowerment or manifestations of empowerment in a cancer setting. In addition, the questionnaire had to be a patient-reported outcome measure for adult cancer patients. Results: Database searches identified 831 records. Title and abstract screening resulted in 482 records being excluded. The remaining 349 full text articles were retrieved and assessed for eligibility. This led to the inclusion of 33 individual instruments measuring empowerment and manifestations of empowerment. Of these, only four were specifically developed to measure empowerment, and two were originally developed for the cancer setting, whereas the remaining two were developed elsewhere, but adapted to the cancer setting. The other 29 questionnaires were not intended to measure the concept of empowerment, but focused on patient-centered care, patient competence, self-efficacy, etc. However, they were included because part of the instrument (at least five items) was considered to measure empowerment or manifestations of empowerment. Conclusion: Our study provides an overview of the available questionnaires, which can be used by researchers and practitioners who wish to measure the concept of empowerment among cancer patients. Very few questionnaires were explicitly developed to explore empowerment, and the review brings to light a significant lack of questionnaires that measure patient empowerment comprehensively.

Conceptualizing patient empowerment in cancer follow-up by combining theory and qualitative data

Abstract Background: Patient empowerment (PE) may be defined as the opportunity for patients to master issues important to their own health. The aim of this study was to conceptualize PE and how the concept manifests itself for cancer patients attending follow-up, in order to develop a relevant and sensitive questionnaire for this population. Material and methods: A theoretical model of PE was made, based on Zimmerman’s theory of psychological empowerment. Patients who were in follow-up after first line treatment for their cancer (n = 16) were interviewed about their experiences with follow-up. A deductive thematic analysis was conducted to contextualize the theory and find concrete manifestations of empowerment. Data were analyzed to find situations that expressed empowerment or lack of empowerment. We then analyzed what abilities these situations called for and we further analyzed how these abilities fitted Zimmerman’s theory. Results: In all, 16 patients from two different hospitals participated in the interviews. PE in cancer follow-up was conceptualized as: (1) the perception that one had the possibility of mastering treatment and care (e.g. the possibility of ‘saying no’ to treatment and getting in contact with health care when needed); (2) having knowledge and skills regarding, for example treatment, care, plan of treatment and care, normal reactions and late effects, although knowledge and information was not always considered positively; and (3) being able to make the health care system address one’s concerns and needs and, for some patients, also being able to monitor one’s treatment, tests and care. Conclusion: We conceptualized PE based on Zimmerman’s theory and empirical data to contextualize the concept in cancer follow-up. When developing a patient reported outcome measure measuring PE for this group of patients, one needs to be attentive to differences in wishes regarding mastery.

The impact of using peer interviewers in a study of patient empowerment amongst people in cancer follow-up

A range of benefits have been reported from engaging peer interviewers in qualitative interviews, but little systematic evaluation exists to assess their impact on both process and outcomes of qualitative interviews in health research.

The experience of being a participant in one’s own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary disease: a longitudinal study

ABSTRACT Purpose: In healthcare related to hospital discharge and follow-up, it is acknowledged that patient participation can strengthen self-management in patients with chronic obstructive pulmonary disease. However, the meaning of participation in care following a severe acute exacerbation is less described. Therefore, the aim of this part of a larger study was to explore patients’ experiences of participating in their care around discharge and in their subsequent day-to-day care at home. Method: The study was designed as a qualitative, longitudinal study. Data were collected by repeated participant observations and in-depth interviews with 15 patients within a period of 18 months post-discharge. A phenomenological-hermeneutic approach was used to interpret the data. Results: Before discharge, the patients struggled to regain a sense of control in their efforts to build up strength, and acquire sufficient clarity and confidence to face self-management at home. At home, the patients strived to comply with advice and encouragement in a struggle to stay motivated and confident, and to ask for help. Conclusions: With more knowledge about patients’ participation in care, healthcare professionals can encounter patients in ways that are sensitive to their specific care and support needs and, thereby, contribute to the promotion of patients’ health and well‐being.

Not for the World of Theorizing But for the Need of Knowledge in the Nursing Discipline: The Significance of Establishing a National Interpretive Description Network

Research networks have significant value and are essential for conducting high-quality applied health research. In this article, we describe the establishment, content, and contribution of a Danish national qualitative interpretive description (ID) network. There are only a few examples of clinical research networks and in most qualitative research methodology is not highly prioritized. Still, a number of nurses and allied health professionals work with qualitative methods and applied health research. This may call for different kinds of networks depending on the geographical context, management support, background, and goal of the network. In this article, we share our knowledge of different kinds of networks and in particular our experiences with an ID knowledge-creating network. The network has provided us with results in the form of stimulating professional conversations and discussions. It has also strengthened the methodological depth of our research and the epistemological standpoints.