Sjuksköterskors erfarenhet av att vårda patienter i livets slutskede enligt Liverpool Care Pathway (LCP) : En litteraturöversikt

Syfte: Att redogöra för sjuksköterskors erfarenhet av att vårda patienter i livets slutskede enligt Liverpool Care Pathway (LCP). Metod: Litteraturstudien baseras på tio vetenskapliga artiklar med kvalitativ ansats. De vetenskapliga artiklarna söktes i databaserna CINAHL, PubMed och World of Science. Inklusionskriterier var att artiklarna skulle vara primärkällor, vara skrivna på svenska eller engelska samt publicerade mellan år 2003-2013. Ytterligare inklusionskriterier var att sjuksköterskorna skulle ha erfarenhet av LCP, samt att de vetenskapliga artiklarna erhöll medel eller hög poäng vid granskningen och var godkänd av en etisk kommitté. Studier från hela världen inkluderades. Huvudresultat: Ett flertal studier visade att LCP bidrog till ett ökat självförtroende och tydligare riktlinjer för den palliativa vården. Sjuksköterskorna upplevde en förbättrad symtomkontroll och förbättrad vård efter införandet av LCP. Sjuksköterskorna var positiva till dokumentationen i LCP och det framgick också att LCP hade förbättrat och underlättat kommunikationen med närstående. LCP erbjöd stöd och vägledning i vården men det framgick också att det fanns oklarheter vad beträffar diagnostiserande av en patient som döende. Slutsats: Syftet med litteraturstudien var att undersöka sjuksköterskors erfarenhet av att vårda patienter i livets slutskede enligt Liverpool Care Pathway. Det framgick att det fanns bristande kunskaper om palliativ vård, men att införandet av LCP gett sjuksköterskor stöd och vägledning samt förbättrat kunskapen om palliativ vård. En vårdplan som LCP kan vara ett stöd för sjuksköterskan i omvårdnaden av patienter inom palliativ vård, men en sådan vårdplan kan aldrig ersätta sjuksköterskans kliniska kompetens. Det är därför viktigt att sjuksköterskor erbjuds fortlöpande utbildning inom palliativ vård, samt att en vårdplan som LCP används utifrån ett kritiskt förhållningssätt.  

Vård i livets slut av personer med demens. Personal och anhörigas upplevelse av given vård : En metasyntes

Palliativt förhållningssätt kännetecknas av helhetssyn av människan och uppnås genom stöttning av individen att leva med värdighet och största möjliga välbefinnande till livets slut oavsett diagnos eller ålder. Demens är en sjukdom som är svårt handikappande för den som drabbas och för de anhöriga är sjukdomen förödande. Den palliativa vården av personer med demens är inte optimerad. Studier visar att det dels beror på demenssjukdomen som är svår att vårda och dels för att stöd till de personer som vårdar sina anhöriga och det sociala kommunala nätverket har brister. Syfte: Att analysera upplevelsen av given vård i livets slutskede hos personer med demensdiagnos ur personalens och anhörigas perspektiv. Metod: Metasyntes utförd med Howell Major och Savin-Badins analysmodell, Qualitative Research Synthesis. Resultat: Kunskap och personcentrering var de två begrepp som blev produkten av syntesen. Begreppen fungerar som motsatser, om det finns kunskap och personcentrering så finns en bra upplevelse av given vård hos personal och anhöriga och om det brister i kunskap och personcentrering blir upplevelsen sämre. Diskussion: Kunskap om demens bland personal har i syntesen visats vara en indikator för god vård vid livets slut. Utbildning i demenssjukdom bör ske kontinuerligt och på olika nivåer beroende på vilken personalkategori som utbildas. Konklusion: Palliativ vård och demens måste få utrymme i utbildningarna av all personal, från undersköterska till specialistläkare.

Omvårdnadspersonals upplevelser av vård i livets slutskede : En kvalitativ intervjustudie

Syftet: Syftet med studien var att beskriva hur omvårdnadspersonal inom kommunens särskilda boende och korttidsboende upplever att vårda personer i livets slutskede.Metod: Studien bygger på åtta kvalitativa intervjuer med undersköterskor. Datainsamlingsmetoden baserades på Critical Incident Technique och som analysmetod användes kvalitativ innehållsanalys. Resultat: I intervjuerna framkom att samarbetet till de övriga i teamet och närstående hade en stor och avgörande betydelse för hur vården utvecklades. Omvårdnadspersonalen kände ibland att sjuksköterskan saknades i vissa omvårdnadssituationer. Fördelning av personal under dygnet bidrog till kontinuitet i samverkan. De upplevde att olika faktorer i miljön kunde vara både till hjälp eller till hinder i samspelet till den döende och närstående. De intervjuade talade också om vikten av att respektera patientens vilja. Omvårdnadspersonalen gav även stöd till de närstående och de kom familjerna nära. De upplevde att närvaro utan krav och stress var av betydelse för interaktionen till den döende och dess närstående. Det var viktigt att både den döende och de närstående var tillfreds med symtomlindringen. Det var viktigt att få ge ett värdigt omhändertagande efter döden. Slutsats: Det genomgåendet temat visade att interaktion och samverkan med vårdteamet, närstående och patienten var av avgörande betydelseför hur vården i livets slut skulle bli trygg och värdig.

Tha contribution of home-based technology to older people's quality of life in extra care housing

Background: British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH).  Methods: A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used.  Results: Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19].  Conclusions: The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.

What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

OBJECTIVES: There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. DESIGN: Semistructured qualitative interviews analysed using content analysis. SETTING: Hospital-based outpatient clinics and primary healthcare clinics in Sweden. PARTICIPANTS: 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). INCLUSION CRITERIA: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. RESULTS: To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. CONCLUSIONS: Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR.

Using modeling as a co-design approach in the planning process of new care environments

Current research shows a relationship between healthcare architecture and patient-related Outcomes. The planning and designing of new healthcare environments is a complex process; the needs of the various end-users of the environment must be considered, including the patients, the patients’ significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modelling utilizing system dynamics in the pre-design phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction, and then interviewed them about their experience. An explorative and qualitative design was used to describe participants’ experiences of participating in the group modelling projects. Participants (n=20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analysed by qualitative content analysis. Two themes were formed, representing the experiences in the group modeling process: ‘Partaking in the G-M created knowledge and empowerment’and ‘Partaking in the G-M was different from what was expected and required time and skills’. The method can support participants in design teams to focus more on their healthcare organization, their care activities and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema

Purpose To examine patient-reported outcome (PRO) in a selected group of Swedish patients about to receive anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME). Material and methods In this cross-sectional study, 59 patients with diabetes mellitus, who regularly visited the outpatient eye-clinics, were included. Sociodemographic and clinical data were collected and the patients completed PRO measures before starting anti-VEGF treatment. PRO measures assessed eye-specific outcomes (NEI-VFQ-25) and generic health-related quality of life (SF-36). Results The participants consisted of 30 men and 29 women (mean age, 68.5 years); 54 (92 %) patients had type 2 diabetes; Five (9%) patients had moderate or severe visual impairment; 28 (47 %) were classified as having mild visual impairment. Some of the patients reported overall problems in their daily lives, such as with social relationships, as well as problems with impaired sight as a result of reduced distance vision. Conclusions Further studies are needed to investigate PRO factors related to low perceived general health in this patient population. It is important to increase our understanding of such underlying mechanisms to promote improvements in the quality of patient care.

Living on the edge : Social exclusion and the receipt of informal care in older people

Older people have been identified as being at risk of social exclusion. However, despite the fact that care is commonly required in later life and the majority of that care provided by informal carers, a connection between social exclusion and informal care-receipt has rarely been considered. The aim of this study was to examine how informal care-receipt is related to social exclusion. A face-to-face questionnaire survey on social exclusion and informal care-receipt was carried out among older people (n=1255) living in Barnsley, United Kingdom. Multivariable analyses examined the association between social exclusion and categories of informal care-receipt: care receiver; assurance receiver; non-receiver with no need; non-receiver with need. Compared to being a non-receiver with no need participants were more likely to be a care receiver or assurance receiver if they had higher levels of social exclusion. The highest level of social exclusion, however, was found in non-receivers with need. Despite a lack of informal care and support, formal practical support and personal care was also low in this latter group. Findings are discussed in relation to the conceptualisation of care-receipt and how contact with medical services could be an opportunity for identification and appropriate referral of non-receivers with need.