| 1. |
- Gårdling, Jenny, et al.
(författare)
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Age-appropriate preparations for children with cancer undergoing radiotherapy : A feasibility study
- 2017
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Ingår i: Journal of Child Health Care. - : SAGE Publications. - 1367-4935 .- 1741-2889. ; 21:4, s. 370-380
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to test age-appropriate information and preparation procedures for children with cancer undergoing radiotherapy (RT) for feasibility and effectiveness in terms of the need for general anesthesia (GA) and anxiety. In a quasi-experimental controlled clinical trial, 17 children aged 3–18 years receiving age-appropriate preparation were compared with 16 children in a control group. Feasibility in terms of recruitment, compliance, and acceptability was assessed. Effectiveness was assessed by the number of children who underwent treatment without GA and their respective fractions and validated instruments measured the children’s anxiety and emotional behavior. The preparation parts were delivered as intended without any additional personnel and without dropouts in the intervention group (IG) and therefore found feasible and acceptable. No statistic significances were found concerning the number of children receiving GA or anxiety. However, three children planned for GA in the IG completed their treatments, including 73 fractions awake. Children receiving GA, regardless of group, showed significantly higher negative emotional behavior. Giving children individualized preparation may decrease the need for GA during RT, which gives benefits in terms of fewer risks and restrictions in life for the child and lower costs for health care.
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| 2. |
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| 3. |
- Gårdling, Jenny, et al.
(författare)
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Impact of Age-appropriate Preparations for Children With Cancer Undergoing Radiotherapy on Parents and Family Functioning, Parents' Anxiety and Hospital Costs – A Feasibility Study
- 2018
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Ingår i: Journal of Pediatric Nursing. - : Elsevier BV. - 0882-5963. ; 43, s. 51-58
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim was to evaluate the impact of age-appropriate information and preparation procedures for children with cancer undergoing radiotherapy on 1) parents and family functioning, parents' anxiety and 2) hospital costs compared to traditional care. Design and Methods: An un-matched quasi-experimental controlled clinical trial was conducted consisting of a control group including 31 parents of 16 children receiving traditional care and an intervention group including 32 parents of 17 children receiving age-appropriate preparation including seven parts. Validated instruments measured parents and family functioning and parents' anxiety. Hospital costs were calculated. Results: Parents in the intervention group showed better communication throughout their child's radiotherapy (p = 0.01) and at their child's last fraction, parental social functioning improved (p = 0.02). Parents of children receiving general anesthesia, regardless of group, showed higher levels of anxiety (p = 0.04). In general, results regarding hospital costs lacked statistical significance. Development of the intervention was calculated to be USD 4.624. Conclusion: Parents who receive age-appropriate information and preparation together with their child benefits in terms of improved communication and social functioning. When children avoid general anesthesia the parents experienced less anxiety and costs for the hospital was lowered. Practice Implication: Age-appropriate preparations consisting of basic, non-costly utilities and a structured approach are important. If more children are able to undergo radiotherapy without general anesthesia, it means for the individual child fewer risks and restrictions, and for the parents decreased anxiety. For the healthcare, it means lower costs, which enables the hospital to prioritize other areas of pediatric care.
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| 4. |
- Gårdling, Jenny, et al.
(författare)
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Parents' Lived Experiences During Their Children's Radiotherapy
- 2017
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Ingår i: Journal of Pediatric Oncology Nursing. - : SAGE Publications. - 1043-4542 .- 1532-8457. ; 34:2, s. 140-147
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of radiotherapy is to provide a cure and/or symptomatic relief for children with cancer. Treatment is delivered on a daily basis, 5 days per week, over the course of 5 to 35 days. Many parents find that leaving their children alone during treatment and exposing them to radiation is a challenging experience. To gain an understanding of parents' lived experiences, 10 parents were asked to keep a diary while their children underwent radiotherapy.METHODS: A descriptive inductive design with a hermeneutic-phenomenological approach was chosen to analyze the diaries. The parents were asked to write down their lived experiences while their children underwent radiotherapy. Daily notes, both short and long, were desirable.FINDINGS: The parents described radiotherapy as a balancing act involving a constant attempt to maintain a balance between coercing and protecting their children in order to improve their children's chances of survival. Meanwhile, the parents themselves were struggling with their own despair and feelings of powerlessness. While protecting their children, they experienced a sense of hope and felt that they had gained control.CONCLUSION: Parents' daily written reflections are important for clinical practice and provide vital knowledge. Parents need support when focusing on coercing and protecting their children and help with information and routines that enable them gain control.
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| 5. |
- Strand, Thomas, 1970-, et al.
(författare)
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An intervention-based study of how MRI is perceived by patients with spinal metastasis after adjustments to the examination procedures
- 2018
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Ingår i: Journal of Radiology Nursing. - Philadelphia, PA : Elsevier. - 1546-0843 .- 1555-9912. ; 37:2, s. 119-125
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to explore magnetic resonance imaging (MRI) experiences of patients with spinal metastasis after adjustments to the examination procedures have been made in accordance with the findings from a previous study. MRI is an important medical technology, which is considered to be the first choice of examination method when diagnosing and evaluating spinal metastatic tumors. It is a challenge to care for patients who experience anxiety and pain during an MRI. However, several aspects of the examination can be adjusted to improve the care for these patients. Findings from previous research were used to develop a care intervention, the effects of which are explored in this study. Qualitative deductive-inductive content analysis was used in this study. Eleven patients with spinal metastasis were interviewed about their experiences of going through an MRI scan based on an intervention designed in accordance with the findings from previous research. The findings showed that adjustments to the examination often were perceived as beneficial. However, patients needed to be involved in the decisions that influenced their own care. Time was an important component that affected the need for being prepared as well as the degree of personalization of the examination. This study shows that patients need to be seen as unique individuals, and they need to be able to influence the care that is given to them. The personalization of and adjustments to the examination routines need to be carried out in agreement with the patient.
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| 6. |
- Strand, Thomas, 1970-
(författare)
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Hjälp mig att hjälpa dig! : upplevelser och uppfattningar av undersökning med MRT för personer med metastaser i ryggen
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to explore how patients with spinal metastasesexperience a magnetic resonance imaging examination (MRI). Furthermore,the purpose was to investigate the radiographers’ perceptions of the patients’care needs and what measures can be taken to relieve the suffering associatedwith an MRI examination.Methods: The design for all four studies was qualitative with content analysisused in Studies I, III and IV and a phenomenographic approach in Study II.Main Findings: The results showed that the patients could experience worry,anxiety, insecurity and pain during an MRI examination. These adverse feelingscan be reduced by adjustments to the examination’s routines as well as byadjustments to the examination’s settings. A short break in the middle of theexamination can be beneficial if the patient is involved in the decision regardingthe break or other adjustments made in conjunction with the examination.Radiographers’ perceptions of the caring for patients were influenced by theircaring perspective and their approach towards what they consider to be essentialin the care of patients with spinal metastasis. The radiographers used theirintuition as a moral compass when they decided what, when and how to adjustthe different aspects of the MRI examination. A shortage of time can affect theextent of the adjustments that can be made as well as the establishment of acaring relationship with the patient.Conclusions: The patients may feel a sense of security when they receive correctinformation prior to and during the examination. Patients want to influencetheir own care. The personalization and adjustments of the examinationroutines need to be performed in agreement with the patient. The radiographersshould not use intuition as the foundation for their care and assumptions aboutthe care needs of the patients should be avoided. The
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| 7. |
- Strand, Thomas, 1970-, et al.
(författare)
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The Experience of Patients With Neoplasm Metastasis in the Spine During a Magnetic Resonance Imaging Examination
- 2014
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Ingår i: Journal of Radiology Nursing. - Philadelphia, PA : Elsevier. - 1546-0843 .- 1555-9912. ; 33:4, s. 191-198
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to explore the experience of a magnetic resonance imaging (MRI) examination by patients with neoplasm metastasis in the spine. MRI is the most accurate method to diagnose and evaluate suspected metastatic disease in the spine. Patients may experience anxiety because of the fear of pain, fear of the unknown, and the apprehension about what the test might reveal. The study had a qualitative design, and the collected data were analyzed by means of latent content analysis. Twelve semistructured in-depth interviews were carried out starting with the question “Can you tell me about your experience of the MRI examination?” Four themes were identified: “motivation,” “worry and anxiety,” “insecurity,” and “security.” The patients were highly motivated to be examined by MRI, although most of them did experience some degree of worry or anxiety. The level of worry or anxiety was generated by the perception that an MRI examination was unpleasant, uncomfortable, or by the fear of what the result would show. All participants experienced some degree of insecurity, but in different ways, the insecurity of the patient could be reduced and the patients could experience a greater degree of security. The feelings of insecurity or security could be influenced by the radiographer, patients themselves, and MRI equipment. This study shows that most patients usually experience worry and anxiety. If the patients are motivated, they can manage to go through the examination in spite of the previously mentioned adverse feelings. Patients' feelings tend to fluctuate between a sense of insecurity and one of security. © 2014 Association for Radiologic & Imaging Nursing.
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| 8. |
- Törnqvist, Erna, et al.
(författare)
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Children having magnetic resonance imaging: A preparatory storybook and audio/visual media are preferable to anesthesia or deep sedation.
- 2015
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Ingår i: Journal of Child Health Care. - : SAGE Publications. - 1741-2889 .- 1367-4935. ; 19:3, s. 359-369
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Tidskriftsartikel (refereegranskat)abstract
- As a magnetic resonance imaging (MRI) examination lasts about 45 minutes and as the technique is sensitive to motion, children are often given sedation or anesthesia. The aim of this study was to examine whether children aged three to nine years could undergo MRI while awake and achieve adequate image quality if age-adjusted routines were used. A two-group controlled experimental design was used. Thirty-six children were assigned to a control group and underwent MRI with the prevalent routines. Thirty-three children were assigned to an intervention group and underwent the MRI while awake. The age-adjusted routine included a booklet and a story book, a model of the MRI scanner with the MRI sound, and a DVD film during the examination. In the control group, 30 children underwent the examination under anesthesia and 6 underwent the examination while they were awake. All had acceptable examinations. In the intervention group, 33 children had their examination while awake and 30 of them had acceptable examinations. The parents' satisfaction with the care was assessed to be equal or higher in the intervention group and the costs were calculated to be lower. Thus, many children receiving age-appropriate preparation and distraction can undergo MRI examinations while awake.
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| 9. |
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| 10. |
- Törnqvist, Erna
(författare)
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Going through magnetic resonance imaging - patients’ experiences and the value of information and preparation for adults and children
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Magnetic resonance imaging (MRI) is becoming an increasingly common form of exami¬nation for both adults and children. Although it is non-invasive and considered painless, both adults and children experience anxiety during the examination. The technique is sensitive to motion and for that reason many children are anaesthetised. The aim of this thesis was to improve patient care through exploring adult patients’ experiences of undergoing MRI, to examine the value of increased written information for adult patients and to examine whether children receiving age-adjusted preparation and realisation of MRI could go through the examination without deep sedation or anaesthesia. A further aim was to study over a five year period, the commonness of the use of MRI versus CT for children, and the occasions on which the children had deep sedation or anaesthesia. To examine the patients’ lived experience of going through an MRI examination, nineteen patients were interviewed and the interviews were analysed with hermeneutic phenomeno¬logical analysis (Paper I). A two group controlled experimental design was used to examine the impact that increased written information in connection with MRI had on patient anxiety and image quality (motion artefacts). The written information that was part of the prevalent routine was given to 118 adult patients (control group) while 124 patients received also in¬creased written information (intervention group). Anxiety was measured and image quality concerning motion artefacts was assessed (Paper II). Data from the radiological information system were scrutinised for all children between 0 and 15 years having had MRI or computer tomography (CT) over a period of five years (Paper III). A two-group controlled experimental design was used to examine whether or not children between the ages of three and nine could go through MRI awake. The usual preparation was given to 36 children (control group) and age-adjusted preparations and the opportunity to watch films during the MRI were given to 33 children (intervention group). Data were collected concerning the examination, motion artefacts, and parent satisfaction, and costs were calculated (Paper IV). The results showed that the essential feeling experienced when undergoing MRI was that of being in another world with a great variation in degree of perceived threat to one’s self-control. This had an impact on the effort it took for the patients to handle the situation and thus on their need for support (Paper I). Increased written information did not decrease patient anxiety but it did significantly decrease the number of patients assessed to have image motion artefacts (Paper II). For children under 16 years of age there was a significant increase in the number of MRI examinations compared to CT over the five year period: however, there was no decrease in the number of CT examinations. Deep sedation or anaesthesia was used on 43% of MRI and 7% of CT occasions (Paper III). Of the 36 children having MRI with the routine procedure, 30 had deep sedation or anaesthesia and six were awake. They all had acceptable examinations. Of the 33 children having age-adjusted preparations 30 had the examination awake with acceptable image quality, two refused the examination and one examination was terminated due to severe image motion artefacts. More children in the intervention group had motion artefacts (although the results were acceptable for diagnostic purposes) than in the control group. Parents were equally or more pleased with the care in the intervention group than in the control group and significantly so concerning communication. The costs were calculated to be lower in the intervention group (Paper IV). In conclusion the studies show that there are great variations in the experiences of patients undergoing MRI examinations and that care needs to be individualised. Although increased written information decreased the number of patients with image motion artefacts it was not enough to decrease patient anxiety. The number of MRI examinations for children are increasing, and with age-adjusted preparations and routines more children can undergo MRI without deep sedation or anaesthesia.
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