The overall aim was to gain insight into and understand how physicians and nurses view the implementation of empowerment group education (EGE) in diabetes. Prior to the study the physicians and nurses attended a 2-day empowerment workshop. Further, they had implemented the empowerment approach in two groups of patients with type II diabetes. Three to 9 months later they (five physicians and 11 nurses from six family practices) participated in focus group interviews to evaluate the implementation of the EGE. The interviews were audio-taped, transcribed and analysed using the constant comparative method. The main result showed a conflict in roles. The physicians and nurses knew their role in the traditional approach but not with respect to the empowerment approach, which they needed to grow into. At the same time as they started a new way of working, their role had changed from being an expert to being a facilitator. As experts they felt secure, as facilitators they needed support in their educational process. To implement EGE they required support both from the family practice and from a supervisor in direct connection with the EGE. © 2004 Elsevier Ireland Ltd. All rights reserved.

A previous study indicated that patient narratives include experiences of suffering caused or increased by health-care encounters. The aim of this study was to interpret and understand the meaning of patients' experiences of suffering related to health care from an ethical, existential and ontological standpoint. Sixteen women with breast cancer in Sweden and Finland took part in qualitative interviews analysed with a hermeneutic, interpretive approach. The outcome showed that suffering related to health care is a complex phenomenon and constitutes an ethical challenge to health-care personnel. The women's experiences of suffering related to health care tended to be of similar seriousness as their experiences of suffering in relation to having cancer. In an ethical, existential and ontological sense, suffering related to health care is basically a matter of neglect and uncaring where the patient's existential suffering is not seen and she is not viewed as a whole human being.

Objective: Many patients with cancer, women more often than men, use complementary and alternative medicine (CAM) and care. Our aim was to examine coping over 5 years (November 1995 to January 1999) in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment. The present study is part of a larger study of the outcome of anthroposophic care for women with breast cancer. Design: A nonrandomized controlled trial design was used with individual matching and repeated measurements on six occasions (at admission, 1 month, 3 months, 6 months, 1 year, and 5 years). The matching was based on the following variables: stage of disease at entry, age, treatment during the 3 months before entering the study, and prognosis. Setting: An anthroposophic hospital and conventional hospitals in Sweden. Subjects: Sixty (60) women treated with anthroposophic medicine and 60 women from an oncology outpatient department participated. Forty-nine (49) women in anthroposophic care and 51 in the outpatient group survived 1 year, 26 women in anthroposophic care and 31 in the outpatient group survived 5 years. Intervention: An anthroposophic care program. Outcome measure: Coping was measured using the Mental Adjustment to Cancer scale. Repeat measures of analysis of variance (ANOVA) were used for within-group comparisons, and effect size (ES) was used for between-group comparisons. Results: The women in anthroposophic care showed more passive and anxious coping on admission, but this decreased over time. In the women in anthroposophic care, there were small ES improvements in fighting spirit and passive, anxious coping at 4 of the measured timepoints compared to admission. Conclusion: The choice of anthroposophic care could be seen as a possible way to cope with emotional distress in this group of women with breast cancer. © Mary Ann Liebert, Inc.

OBJECTIVE: Several studies have concluded that family members in palliative home care want information about the patient's disease. The aim of this study was to describe family members' perceptions of their motivation for receiving information about the patient's disease. METHOD: Semistructured tape-recorded interviews were performed with 20 family members of patients with incurable progressive cancer who were admitted to hospital-based home care in Sweden. Data were analyzed using a qualitative phenomenographic method. RESULTS: Family members justified their informational needs by emphasizing that they needed to understand and confirm what would happen when the disease progressed, to be mentally prepared for the future, to organize their daily life, to be a source of information to others, and that receiving information was a natural right. SIGNIFICANCE OF RESULTS: This study has revealed some explanations as to why family members want information. In clinical practice, it is important that palliative care team members are aware of family members' level of knowledge and their need for information, as this mental preparation is important.

Constipation is a common and well-studied symptom in palliative care. Most previous studies have focused on the frequency and management of constipation. The current study aimed to investigate the lived experience of constipation among cancer patients in palliative hospital-based home care. Eleven cancer patients admitted to a hospital-based home care unit in Sweden who had experienced constipation participated in this study. Semi-structured interviews were conducted and a qualitative, phenomenological approach was used. Three themes emerged: bodily suffering, mental preoccupation and a reminder of death, and avoidance and social isolation. The experience of constipation was described as an extensive complete person-experience that must be prevented. To prevent unnecessary suffering nurses need to be proactive in the assessment of constipation.

Background: Uncertainty still exists whether coeliac patients living on a gluten-free diet for several years are ensured a nutritionally balanced diet. Objective: To evaluate the dietary habits of adults with longstanding coeliac disease Design: The intake of nutrients and foods was assessed in 49 Swedish coeliac patients (32 women) aged 45-64 years treated for 8-12 years using 4-day dietary record. Compliance with the diet was ascertained by showing a villous intestinal structure at repeat biopsy or normal serological tests. The control group (n:498) consisted of a general population sample of same age. Results: The coeliac patients showing the same energy intake as controls had a lower intake of fibre, niacin equivalents, folate, vitamin B12, calcium, phosphorus and zinc. In relation to recommended intakes, low levels of fibres, folate, vitamin E and selenium were seen in both coeliacs and controls. Significant differences between coeliac patients and controls were seen for half of the food groups under study and this was particularly true for women. Conclusions: The results suggest that Swedish coeliac patients living on a gluten-free diet for several years need to improve their dietary habits. To this end, regularly visiting a dietitian could be helpful to introduce oat-based options and increase the intake of fresh fruits and greens.

Researchers and practitioners in several Western countries have recently developed tools for assessing the situation of the carers of adults who are ill, elderly or have disabilities. The present article describes the impact of three such assessment tools, from Canada, the UK and Sweden, on the professional practice of assessors. All tools were tested in agency-based studies. Focus groups, workshops and interviews with assessors were employed to understand the impact on professionals and their practice. An Australian researcher and case manager comments on these experiences from her unique perspective. The results reveal that the use of carer assessments can lead to changes in the appropriateness of intervention by informing practitioners of issues which are given little attention, but which impact on the adequacy of interventions to the service user. Across the projects, most workers found that the tools facilitated a more comprehensive, in-depth and carer-focused assessment. Experience across all the projects suggests that, used sensitively, such tools and approaches can play a key role in transforming the relationship between carers, and the health and social care system. Giving carers a legitimate voice, acknowledging their perspective and expertise, and making them central to assessment processes accords them status both as active partners, and as individuals with their own needs and aspirations, rather than seeing them primarily as resources. As a result of their experiences, many workers and administrators concluded that home-care programmes must change their mandate to include carers among their clients, raising the issue of available monetary and human resources to meet the needs of this group. In addition, as our Australian colleague points out, time, efficiency, relevance, benefit and minimal intrusiveness are important factors for practitioners which influence their use of assessment tools.

Topical butyrate has been shown to be effective in the treatment of ulcerative colitis (UC). Butyrate is derived from colonic fermentation of dietary fiber, and our aim was to study whether UC patients could safely increase the fecal butyrate level by dietary means. We enrolled 22 patients with quiescent UC (mean age, 44 years; 45% women; median time from last relapse, 1 year) in a controlled pilot trial lasting 3 months. The patients were instructed to add 60 g oat bran (corresponding to 20 g dietary fiber) to the daily diet, mainly as bread slices. Fecal short-chain fatty acids (SCFAs) including butyrate, disease activity, and gastrointestinal symptoms were recorded every 4 weeks. During the oat bran intervention the fecal butyrate concentration increased by 36% at 4 weeks (from 11 +/- 2 (mean +/- SEM) to 15 +/- 2 mumol/g feces) (p < 0.01). The mean butyrate concentration over the entire test period was 14 +/-1 &mu;mol/g feces (p < 0.05). Remaining fecal SCFA levels were unchanged. No patient showed signs of colitis relapse. Unlike controls, the patients showed no increase in gastrointestinal complaints during the trial. Yet patients reporting abdominal pain and reflux complaints at entry showed significant improvement at 12 weeks that returned to baseline 3 months later. This pilot study shows that patients with quiescent UC can safely take a diet rich in oat bran specifically to increase the fecal butyrate level. This may have clinical implications and warrants studies of the long-term benefits of using oat bran in the maintenance therapy in UC.

Women with long-standing coeliac disease express poorer health-related quality of life (HRQoL) than men do for unclear reasons. This led us to explore differences in their understanding of HRQoL using a phenomenographic approach. We interviewed 10 coeliac subjects (mean age 57 years, range 35-73) who had been on a gluten-free diet for 10 years and had scored either high or low in the Short Form 36 Health Survey (SF-36) General Health and Vitality scales. Three dimensions were revealed that pertained to their perception of HRQoL: bodily sensations, social consequences and coping strategies. Within these, the women experienced more bowel symptoms than men did, despite keeping to a strict diet. This item was the only one predicting the SF-36 scores. The women also described more distress caused by the restrictions in daily life, closely related to their controlling of food contents. The coeliac men took advantage of using a problem-oriented coping approach while the women seeking an emotionally oriented strategy showed less satisfaction with the outcome. We conclude that the intriguing difference in HRQoL between coeliac men and women may have some of its origin in the way living with the disorder is conceptualized and coped with. The results imply that in the management of coeliac patients, gender-related aspects need to be taken into account to improve treatment outcome.

Celiakiboken vänder sig i första hand till personer med celiaki (glutenintolerans) och deras närstående men också till andra som kommer i kontakt med celiaki. Innehållet är vetenskapligt granskat och kan användas vid utbildning och fortbildning av vårdpersonal på alla nivåer. Boken förmedlar tio unika nycklar till ett gott, glutenfritt liv med hög livskvalitet. Den tar upp olika typer av celiaki, hur gluten påverkar tarmen, olika symtom hos både vuxna och barn samt de senaste resultaten inom aktuell forskning. Ett stort utrymme ägnas åt själva behandlingen med mat utan gluten.

Becoming parents of a child with Down's syndrome (DS) challenges the adjustment ability in parenthood. Individuals with higher sense of coherence (SOC) are supposed to manage stressors better than those with lower SOC. The aims of this study were to investigate parental self-perceived stress, SOC, frequency of gainful employment and amount of time spent on child care in Swedish DS parents (165 parents, 86 mothers, 79 fathers) and to compare those with control parents of healthy children (169 parents, 87 mothers, 82 fathers). The mean age of the children was 4.7 years. Parents responded to questionnaires separately including Hymovich's Parent Perception Inventory as stress measurement and Antonovsky's short version of the Orientation to Life. No differences concerning total employment rate were observed, but the DS mothers were more often employed part-time than control mothers. The DS parents did not spend more time on child care than the control parents and they did not differ in mean SOC score, but the DS parents perceived greater stress. The differences in stress, particularly between the DS and control mothers, were related to time-demanding areas. Parents with high SOC scores experienced significantly less self-perceived stress.

Background: The aims of present study were to study sickness absence among Swedish parents of children with Down's syndrome (DS) and to compare their rates of absence with those of control parents. Sickness absence data for 165 DS parents were compared with those for 174 control parents, all data were for the period 1997-2000. Sickness absence rates were also related to parental self-perceived health, stress and sense of coherence. Methods: The self-administrated measures of parental self-perceived health, stress and sense of coherence were compared with the number of days of sickness absence. Results: In about two-thirds of the parents in both the study and the control group, no days of sickness absence were registered. Six of the DS parents had remarkably large numbers of days of sickness absence (more than 100 per year). None of the control parents had such high sickness absence rates. It is speculated that there is a small group (less than 5%) of parents who are more vulnerable to the birth of a child with DS. Apart from these six DS parents, sickness absence was not more frequent among the DS parents than among the control parents. DS parents stayed at home to care for their sick DS child three times more often than control parents did for their non-disabled child. DS fathers took greater responsibility in the care of their temporarily sick child and stayed at home to care for the child even more often than control mothers did. DS parents with sickness periods experienced small deterioration in self-perceived health, significantly higher stress and decreased sense of coherence in comparison with parents without sickness periods. Conclusions: There was a great similarity in sick leave rates due to one's own sickness between DS and control parents, but a small group of DS parents (<5%) may be more vulnerable. DS fathers stayed at home to care for their sick DS child remarkably often. © 2006 The Authors. Journal Compilation © 2006 Blackwell Publishing Ltd.

The purpose of this article is to explore the meaning of palliative care in the context of the caring relationship described by nurses providing such care in the home. Eleven nurses were interviewed, and the transcripts were analyzed using the hermeneutic narrativism method. The study found that the nurses'' narrative account of a caring relationship can be represented by a metaphor: an inevitable journey by train, characterized by the three themes of transit points, time, and guidance. Each journey passes through the same four points in chronological order. Time always moves forward, but the duration of the journey can be either long or short. Having more time creates better conditions for developing a caring relationship. The nurse provides guidance through a journey that she has made before, although each journey is unique. A caring relationship signifies commitment and involvement. © 2007 Lippincott Williams & Wilkins, Inc.

Background: Becoming autonomous is an important aspect of teenagers’ psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support.

Objective: The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes.

Design and method: Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis.

Participants: Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes.

Findings: The lived experiences of the transition towards autonomy in self-management were characterized by the over-riding theme “hovering between individual actions and support of others”. The findings indicate that individual self-reliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme “confirmation of others” showed that parental encouragement increased the certainty of teenagers’ standpoints; peers’ acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers’ self-esteem.

Conclusion: In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations.

The aim of this study was to compare self-perceived health among diabetic patients who experienced threat of blindness with those who had already gone blind. Another aim was to explore different aspects of self-care in relation to self-perceived health among the subjects. Twenty-one diabetic patients under threat of becoming blind and 23 with diabetes-related blindness agreed to participate in the study. The participants were compared with an age- and gender-matched nondiabetic reference group. Self-perceived health was measured using the 63-item Swedish Health-Related Quality of Life Survey (SWED-QUAL) questionnaire. Data on diabetes-related variables were collected from the patient's hospital records. An interview guide was created for measuring dimensions of self-care. Patients with threat of becoming blind showed better self-perceived health than blind patients, but no differences were found in comparison with the Swedish reference group. Blind patients scored lower in 6 of the 13 health domains and they reported more problems with diabetes self-care than patients with threat of becoming blind. One of the 13 health domains, role limitations due to physical health, seemed to be associated with impaired self-care although only a partial understanding could be demonstrated. The results show that blind patients need specific support to cope well with different self-care situations. A great challenge in future research in diabetes is to implement education programs suitable especially for patients who have gone blind because of diabetes. © 2005 Elsevier Inc. All rights reserved.

The aim of the present study was to analyze whether strong sense of coherence (SOC) or power or the combination of strong SOC and power was related to blind diabetic patients' self-perceived health, burden of diabetes, glycaemic control and self-care among blind people. In some variables we wanted to compare subjects with diabetes-related blindness with people who were blind for other reasons than diabetes. The present descriptive study included 39 blind subjects from three ophthalmic outpatient clinics who agreed to participate, 23 were blind due to diabetes and 16 were blind for other reasons. Power was explored during semi-structured interviews, SOC was measured with the SOC-scale and burden of diabetes with semantic differential in diabetes (SDD) questionnaires. A single Likert scale (EVGFP) was used to measure self-perceived health. Participants with the combination of strong SOC and power perceived better health, experienced less burden of diabetes and had better glycaemic control than those with the combination of weak SOC and non-power. Nearly all participants with diabetes experienced problems with self-care, especially with the insulin treatment. The results highlight the importance of education that increases SOC and power as well as developing visual aids that assist blind people with diabetes in different self-care situations. © 2004 Elsevier Ireland Ltd. All rights reserved.

The objective of this study was to investigate student nurses' ability to handle a pain assessment situation. A systematic way of working based on knowledge within the area is emphasised in nursing education today. The performance of 32 student nurses at a university college in Sweden took place in an arranged assessment situation that closely simulated clinical practice. The conversation between the student and the patient (a voluntary patient) was videotaped and analysed with content analysis according to predetermined components of pain assessment. The results showed that one-third of the students had performed adequately based on the requirements for pain assessment in the curriculum for nursing education. Two-thirds of the group did not handle the situation systematically and also showed a lack of knowledge of pain assessment, and among these was a group of students whose performance was inadequate. The results indicate that during their education it is very important for student nurses to obtain experience and guidance in how to work systematically and to have their knowledge and skills in pain assessment evaluated. © 2003 Elsevier Science Ltd. All rights reserved.

Considers how family and professional carers can work together more effectively in order to provide the highest quality of care to people who need support in order to remain in their own homes. Adopting a temporal perspective, this book looks at key transitions in caregiving and is useful for health care students and professionals

Considers how family and professional carers can work together more effectively in order to provide the highest quality of care to people who need support in order to remain in their own homes. Adopting a temporal perspective, this book looks at key transitions in caregiving and is useful for health care students and professionals.

http://Considers how family and professional carers can work together more effectively in order to provide the highest quality of care to people who need support in order to remain in their own homes. Adopting a temporal perspective, this book looks at key transitions in caregiving and is useful for health care students and professionals

Objective. To determine glycaemic control in elderly patients with diabetes living in community dwelling. Design. Descriptive, cross-sectional and open. Prospective with regard to blood glucose. Setting. Community-dwelling in-patients. Subjects. From a total number of 351 patients in seven Swedish centres of community dwelling we identified and recruited all 45 patients with diabetes receiving treatment with insulin, and/or oral medication. Main outcome measures. Blood glucose was measured fasting, 2 h after breakfast, in the evening and at night, for three consecutive days. Results. Mean HbA1c was 5.9 ± 1.1% (range 3.6-8.6%). The patients were split in three HbA1c-groups for analysis: lower- (3.6-5.3%), middle-(5.4-6.3%) and higher-tertile (6.4-8.6%). The groups where similar with regard to age, time in community dwelling, ability to eat and move around independently, but body mass index was lower in the lower tertile (P < 0.003 and P < 0.04, compared with middle- and higher-tertiles). We recorded 14 episodes with blood glucose ≤4.0 mmol L-1 in eight patients. Blood glucose ≤4.0 mmol L-1 was mostly recorded during night (n = 8) or in the morning (n = 3). Conclusions. Swedish patients with diabetes in community dwelling are over- rather than undertreated and have low HbA1c levels. Despite very regular eating habits and near total compliance with medication, hypoglycaemias are frequent and possibly linked to malnutrition.

Considers how family and professional carers can work together more effectively in order to provide the highest quality of care to people who need support in order to remain in their own homes. Adopting a temporal perspective, this book looks at key transitions in caregiving and is useful for health care students and professionals

Considers how family and professional carers can work together more effectively in order to provide the highest quality of care to people who need support in order to remain in their own homes. Adopting a temporal perspective, this book looks at key transitions in caregiving and is useful for health care students and professionals

The need for all health care professionals to develop research appreciation skills has been recognized and emphasized.  Otherwise, research remains irrelevant and unrelated to practice.  Traditional research textbooks have used the format of the research process which makes research seem even more difficult and remote. This book is different.  Because the purpose of research appreciation is to enable practitioners to use research to develop and improve practice, it focuses instead on the skills of research appreciation and application which are distinct from the skills necessary to undertake research.  It prepares you to access, critically evaluate, understand and use research-based literature within the multi-disciplinary context of today's health services, and emphasises:

• The range of sources of knowledge which inform nursing practice
• Contemporary research and the context in which health care research and development takes place
• Critical evaluation of research reports and research-based literature, examining the implication of project design and conduct
• The range of skills needed for the application of research findings and innovation within practice

[No abstract available]

The present study describes pain- and stress-coping strategies and life satisfaction in subgroups of fibromyalgia patients. Thirty-two females with fibromyalgia syndrome (FMS) and 21 healthy pain-free women were studied. Those with FMS were classified as thermal (both heat and cold) pain sensitive or slightly cold pain sensitive based on pain thresholds determined using a Thermotest device. Global stress-coping styles, life satisfaction, and specific pain-coping strategies were measured. Patients classified as thermal pain sensitive were affected by physical symptoms to a greater extent than were those classified as slightly cold pain sensitive. The thermal pain sensitive group used more diverting attention coping strategies than the slightly cold pain sensitive group did. Separating fibromyalgia patients into subgroups might increase the potential for improving nursing care of these patients. Through the use of effective coping strategies in dealing with stress and pain, life satisfaction may also be enhanced.

Objective.—To study work attendance despite headache in 2 different workplaces and its economic impact.

Background.—Literature on the economic impact of headache traditionally has focused on direct costs. Little is known concerning headache experienced at work and its costs due to loss of effectiveness and productivity.

Method.—We sent a questionnaire to 800 employees in Sweden—400 at a technology company (private employee population) and 400 at a university hospital (public employee population). We attempted to assess the prevalence of headache, work attendance despite the presence of acute headache, and the impact of acute headache upon work effectiveness. Subjects self-scored decreased work effectiveness resulting from headache during the previous 3 months and recorded the number of days at work despite headache. From these data, we estimated the economic loss resulting from headache.

Results.—The survey response rate was 71.5%. The prevalence of headache was 64% in the private employee population and 78% in the public employee population. Thirty-nine percent of the private employees and 57% of the public employees reported experiencing headache as a result of stress. Fifty percent reported that they went to work despite headache, and the mean number of days at work despite headache, during the previous 3 months, was 6.6 days in the private employee group and 6.1 days in the public employee group. A 25% decrease in work effectiveness was estimated, and, extrapolating from our data, we calculated the cost of lost effectiveness due to headache among employers in Sweden to be approximately 1.4 billion euros a year.

Conclusion.—The economic burden of headache experienced at work is substantial, suggesting that workplace-based treatment and prevention programs emphasizing stress management may be financially, as well as clinically, advantageous.