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- Tishelman, Carol, et al.
(författare)
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Using undergraduate nursing students as mediators in a knowledge transfer programme for care for patients with advanced cancer
- 2008
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Ingår i: European Journal of Cancer Care. - : Hindawi Limited. - 0961-5423 .- 1365-2354. ; 17:3, s. 253-260
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Tidskriftsartikel (refereegranskat)abstract
- Nursing today faces numerous challenges. Societal changes lead to reorganization of health care, changing workloads with sicker patients in hospital and home care, and limited economic resources. The increasing and changing nature of knowledge needed for expert care provision challenges nurses to continually update their competencies. These are issues demanding proactive and dynamic changes in the way nurses conceive their mandates and practice. The aim of the action-research project presented here was to foster improved quality of care for patients with advanced cancer through collaborative endeavours integrating cancer nursing clinical practice, research and education in a knowledge exchange programme. The programme was based on input about caregiving needs from multi-professional staff caring for patients with advanced cancer in a variety of healthcare settings. Undergraduate baccalaureate nursing students were then engaged in literature studies to help address these needs. Results of the studies were communicated back to the involved clinicians in a variety of ways. In this paper, we discuss what we have experienced as opportunities and obstacles in conducting the project, based on our reflections and external evaluations. This is linked to a broader discussion of ways of integrating cancer nursing research, education and practice.
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- Hahne, Pia, et al.
(författare)
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Changes in profesionals’ beliefs following a palliative care implementation programme at a surgical department: a qualitative evaluation
- 2017
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Ingår i: BMC Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background One ambition regarding palliative care is that it should be more accessible to patients and families regardless of care setting. Previous studies show many difficulties and shortcomings in the care of patients with palliative care needs in acute care facilities, but also challenges regarding efforts to implement palliative care. The aim of this study is to evaluate how the implementation of palliative care, using a combination of integration and consultation strategies, can change beliefs regarding palliative care among professionals in a surgical department. Method In order to explore professionals’ experiential outcome of an educational implementation strategy, a before-after qualitative design was used. The study was based on three focus group discussions. Two discussions were conducted before introducing the implementation strategy and one was conducted after. The participants consisted of five nurses and two specialist surgeons from a surgical department in Sweden. The focus group discussions revealed a variety of different attitudes and beliefs, which were analysed using qualitative systematic text condensation. Results Beliefs regarding palliative care were identified in seven areas; the importance of palliative care, working methods in palliative care, team collaboration in palliative care, collegial support, discussions about diagnosis, symptoms at the end of life, and families of patients in palliative care. Changes in beliefs were seen in all areas except one: team collaboration in palliative care. Conclusion It is possible to change the beliefs of health care professionals in a surgical department regarding palliative care through the implementation of palliative knowledge. Beliefs were changed from an individual to a collective development where the group initiated a shared palliative working method. The changes observed were palliative care being described as more complex and participants differentiating between surgical care and palliative care.
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- Leveälahti, Helena
(författare)
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The road to diagnosis and treatment of patients with lung cancer
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lung cancer is the third most common cancer among men and women in Sweden. More than 3000 persons/year are diagnosed with lung cancer. Despite the presence of many and intense symptoms at diagnosis, most patients still receive the diagnosis in advanced stages without possibility of resection. It is therefore important to obtain more knowledge, from different perspectives, about underlying factors leading to delay in the care trajectory to diagnosis and treatment start. The overall aim for this thesis is to obtain more knowledge about factors which may delay diagnosis and treatment start in lung cancer through - exploring the length of different time spans from first symptom to treatment" Start, and relationships between reported symptoms, demographic and medical characteristics and these time spans (Study I) - exploring how patients with lung cancer conceptualise the onset of sickness (Study II). As a variety of factors related to patients, providers and the health care system can contribute to delay in diagnosis and treatment, medical records were examined from 314 patients diagnosed with primary lung cancer at a specialist clinic. Analyses included cluster analyses, descriptive analyses and Cox's regression. The results show that tumor-specific symptoms led to health care system visits to a greater extent than systemic symptoms did, despite reports of weight loss, fatigue and appetite loss as common first symptoms. Elderly people (>75 years) risked longer time spans between first health care system visit and specialist referral and treatment start in comparison to other age groups. Age <60 years was associated with a shorter time span from first health care visit to treatment start. People living alone risked extended time from specialist referral to diagnosis. Studies about delay in lung cancer are predominantly based on data from medical records And present as is in study I, in terms of number of days between different key events in the care pathway. In order to complement previous studies, audio-taped semi-structured explorative interviews from 41 patients were analysed. Findings are based on retrospective narratives one year after diagnosis. However, many participants spontaneously reflected over possible causes for their disease with reference to their biographies. The onset of lung cancer often integrated of past and present aspects of patients' lives in a type of "biographical continuity", which is in contrast to the biographical disruption often described in relation to cancer diagnosis. Findings also indicate a wide array of bodily experiences leading to diagnosis, including symptoms seen as related to other disorders, systemic complaints not conceptualised as symptoms or as indicating a serious problem, and more rarely, symptoms triggering immediate action.
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- Lövgren, Malin, et al.
(författare)
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Time spans from first symptom to treatment in patients with lung cancer : The influence of symptoms and demographic characteristics
- 2008
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Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X .- 0001-6381. ; 47:3, s. 397-405
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cancer stage at diagnosis is the most important prognostic factor for lung cancer (LC), but most patients are diagnosed with advanced disease with many and intense symptoms. This study explores relationships between LC patients' first symptoms, symptoms triggering health care system (HCS) contact, demographic/clinical characteristics, and time spans in the care trajectory from first symptom(s) to treatment start.MATERIALS AND METHODS: Medical records were examined from all 314 patients diagnosed with primary LC in 2003 at a Department of Respiratory Medicine, in Stockholm Sweden. Descriptive analysis was used to examine symptoms and time spans in the care trajectory. Cox regression analysis was conducted to explore the influence of symptoms and demographic/clinical characteristics on the time spans.RESULTS: Tumor-specific symptoms led to HCS visits to a greater extent than did systemic symptoms, despite reports of weight loss, fatigue and appetite loss as common first symptoms. Minor differences between women and men were found regarding specific symptoms. The study confirms that the time spans from first symptoms reported to treatment start are extensive, exceeding Swedish national recommendations. A lump/resistance, neurological symptoms, appetite loss, hemoptysis and non-thoracic related pain were associated with significantly shorter time spans in the care trajectory. People >74 years old risked longer time span from first HCS visit to treatment start.CONCLUSION: This study indicates a need for a more efficient LC care trajectory. Elderly patients could be particularly vulnerable for longer time spans.
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