The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.

Långvarig muskuloskeletal smärta är ett globalt hälsoproblem och är den vanligaste orsaken till funktionnedsättningar hos individer. Individer med långvarig muskuloskeletal smärta har en ökad risk att drabbas av psykisk ohälsa som kan påverka individens välbefinnande och livskvalitet negativt. Individer använder olika strategier (icke farmakologiska och farmakologiska behandlingar) för att hantera smärta. Distriktssköterskan har en avgörande roll vid identifiering av individens smärtproblematik och psykisk ohälsa / Chronic musculoskeletal pain is a global health problem and is the most common cause of disability in individuals. Individuals with long-term musculoskeletal pain have an increased risk of suffering from mental illness, which can negatively affect the individual's well-being and quality of life. Individuals use different strategies (non-pharmacological and pharmacological treatments) to manage pain. The district nurse has a decisive role in identifying the individual's pain problem and mental illness.

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Introduction: There is a growing interest in how technology can be used in order to provide efficient healthcare. Aim: The aim is to explore perceptions on the use of home telemonitoring in patients with COPD.                                                                                                                             Method: Semi-structured individual interviews were carried out with eight women and five men who were part of a larger project aiming to develop and evaluate a telemonitoring system. Participants were interviewed after having used the system for two to four months. Interview transcripts were analysed with qualitative content analysis. Results: The analysis resulted in the theme a transition towards increased control and security and the categories: facing enablers or barriers, increasing control over the disease, providing easy access to care and affecting technical confidence or concern. Participants expressed initial feelings of insecurity, both in practical aspects using the telemonitoring system as well as regarding their disease. The telemonitoring system could reinforce and confirm the participants´ feelings of their current state of health, and the practical management of the telemonitoring system became easier with time.     Conclusion: Telemonitoring can be a valuable complement to healthcare with the potential to contribute to equity in care. However, in order to improve further development and implementation of telemonitoring, several actions are needed such as improved patient education and the use of co-creation. Additional research is needed particularly in the design of user-friendly systems as well as tools to predict which patients are most likely to find the equipment useful as it may result in reduced costs and increased empowerment. / Introduktion: Intresset för hur teknologi kan användas för att erbjuda effektiv sjukvård ökar. Syfte: Syftet är att utforska KOL-patienters upplevelse av att använda ett webbaserat rapporteringssystem i hemmet. Metod: Semi-strukturerade individuella intervjuer med åtta kvinnor och fem män som deltog i ett större projekt med syfte att utveckla och utvärdera ett webbaserat rapporteringssystem. De intervjuades efter att ha använt systemet två till fyra månader. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i temat en övergång till ökad kontroll och trygghet samt kategorierna: möta möjligheter eller hinder, ökad kontroll över sjukdomen, skapar lättillgänglig vård samt påverkar teknisk självkänsla eller oro. Deltagarna uttryckte till en början osäkerhetskänslor, både vad gäller praktiska aspekter i användandet av rapporteringssystemet samt kring själva sjukdomen. Det webbaserade rapporteringssystemet kunde förstärka och bekräfta deltagarnas egna känsla av mående och det praktiska hanterandet av rapporteringssytemet blev lättare med tiden. Konklusion: Webbaserade rapporteringssystem kan vara ett värdefullt komplement till sjukvården med potential att bidra till jämlik vård. I syfte att förbättra fortsatt utveckling och implementering bör förbättrad patientinformation samt vikten av att ta med användarna i utformningen beaktas. Mer forskning behövs för att optimera användarvänlighet samt att identifiera de patienter som har bäst nytta av systemet då det kan ge hälsoekonomiska vinster och inte minst öka patienters delaktighet.

Chronic low back pain (cLBP) affects the quality of life of over 23% of American adults and places an immense burden on the economy.1–3 To more effectively diagnose and treat cLBP, quantitative biomarkers are needed to objectively measure pain and better identify the underlying mechanisms of cLBP. The overarching goal of this work is to create an analytical pipeline to investigate brain activity patterns measured with electroencephalogram (EEG) data of cLBP patients treated with transcutaneous spinal cord stimulation (tSCS). The specific aims of this project are to 1) investigate whether there is a difference between baseline EEG measurements and EEG measurements after transcutaneous spinal cord stimulation, 2) investigate potential brain activity patterns that may be associated with patient-reported pain scores, and 3) discuss the potential use of these brain activity patterns in wearable devices. Resting state EEG data was collected from four patients before and after completion of all tSCS therapy sessions, as well as before and after acute stimulation, for eyes open and eyes closed conditions. Patients underwent 12 or 21 tSCS sessions, with daily collection of patient-reported outcomes using a visual analog scale. EEG analysis has been done in MATLAB using the EEGLAB toolbox. A statistically significant (p

Contexte : Au Canada, une personne sur cinq vit avec une douleur chronique, une maladie fréquemment associée à d’autres maladies chroniques. Comme pour la plupart des maladies chroniques, l’engagement réussi du patient dans la gestion des symptômes est essentiel pour la gestion de la douleur chronique. Dans le contexte de multiples maladies, l’autogestion implique une priorisation quotidienne des symptômes et des maladies, ainsi que des prises de décision, ce qui peut être exigeant. L’autogestion des maladies chroniques peut nécessiter une compétence plus complexe et des tâches pour aborder les différentes implications de chaque maladie. Objectif : Notre objectif de recherche était d’explorer les types et les processus de priorisation des symptômes dans l'autogestion chez les adultes vivant avec de la douleur chronique et d'autres maladies chroniques. Devis : Cette recherche a été menée dans le cadre d’une étude plus vaste adoptant un devis mixte séquentiel explicatif. Cette recherche s’est concentrée plus particulièrement sur la partie qualitative de l’étude. Lieu(x) : Les participants recrutés pour la composante qualitative ont participé à un entretien individuel semi-structuré en ligne ou en personne au Centre hospitalier de l’Université de Montréal. Participants : Au total, 25 participants ont été interviewés, dont 18 femmes et 7 hommes. Méthodes : Les participants étaient éligibles pour participer à l’étude s’ils avaient 18 ans ou plus, vivaient avec de la douleur depuis plus de trois mois et avaient au moins une autre condition médicale pour laquelle ils recevaient un traitement ou s’engageaient dans la gestion des symptômes. Les entretiens semi-structurés ont été menés en personne ou virtuellement et ont été retranscrits intégralement. Une analyse thématique réflexive a été utilisée pour explorer les récits des patients, et une approche ouverte et itérative a été adoptée pour coder les entretiens et générer des thèmes. Résultats : Le premier thème, axé sur la priorisation des symptômes, a montré différents processus de priorisation, notamment la priorisation d'une maladie dominante, la priorisation de plusieurs maladies pour éviter des conséquences indésirables, et enfin l'absence ou les processus automatiques de priorisation. Dans le deuxième thème, nous avons identifié plusieurs caractéristiques d'une maladie, en l'occurrence la douleur chronique, qui en faisaient une priorité d'autogestion : sa nature incontrôlable et handicapante, son omniprésence, son imprévisibilité, son caractère désagréable et son invisibilité pour autrui. Dans le dernier thème, nous avons souligné que certains facteurs psychosociaux influencent les niveaux d'engagement dans l'autogestion et les processus de priorisation, notamment le soutien social et la relation patient-médecin. Conclusions : La douleur chronique était la maladie la plus souvent priorisée par les participants dans leurs tâches d’autogestion. En raison de ses caractéristiques, c’était la maladie qui avait le plus d’impact négatif sur le fonctionnement quotidien. / Context. In Canada, one out of five people lives with chronic pain, a condition frequently co-occurring with other chronic illnesses. As with most chronic illnesses, successful patient engagement in symptom management is key. In the context of multiple illnesses, self-management involves daily prioritization of symptoms and illnesses, and decision-making, which can be challenging. Self-management of chronic illnesses can require more complex competence and tasks to address the different implications of each illness. Objective. Our research objective was to explore types and processes of self-management symptom prioritization among adults living with chronic pain and other chronic illnesses. Design. This research was carried out as part of a larger study that adopted an explanatory sequential mixed-methods design. This study focused more specifically on the qualitative part of the study. Settings. Participants recruited for the qualitative component took part in a semi-structured individual interview online or in person at the Centre hospitalier de l’Université de Montréal. Participants. In total, 25 participants were interviewed, including 18 women and 7 men. Methods. To participate in the qualitative part of the study, participants were selected from the larger study and were eligible if they were 18 years old or older, experiencing pain for more than three months, and had at least one other chronic illness for which they were receiving treatment or engaged in symptom management. Semi-structured interviews were conducted in-person or virtually and were transcribed verbatim. Reflexive thematic analysis was used to explore patients’ narratives, and an open and iterative approach was adopted to code interviews and generate themes. Findings. The first theme, focus on symptom prioritization, showed different prioritization processes, including prioritizing a dominant illness, prioritizing multiple illness to avoid undesirable consequences, and finally absence of or automatic processes of prioritization. In the second theme, we identified several characteristics of an illness, in this case chronic pain that made it a self-management priority: uncontrollable and disabling nature, omnipresence, unpredictability, unpleasantness and invisibility to others. In the last theme, we highlighted that some psychosocial factors influence levels of engagement in self-management and prioritization processes, including social support and the patient-physician relationship. Conclusions. Chronic pain was the medical condition most often prioritized by participants in their self-management tasks. Because of its characteristics, it was the medical condition that had the most negative impact on day-to-day functioning.

Bakgrund: När en person drabbats av kronisk njursvikt är dialysbehandling eller njurtransplantation de enda alternativen för överlevnad. Välbefinnandet kan komma att påverkas av den livsomställning som krävs för vårdsökande personen. Behandling med hemodialys är tidskrävande och påfrestande då den innebär begränsningar i det dagliga livet.Syfte: Att beskriva upplevelser av att leva med och hemodialys. Metod: Litteraturöversikt med en integrerad analys utifrån 10 vetenskapliga artiklar. Resultat: Resultatet beskrivs genom två underkategorier; Välbefinnande som beskriver de positiva aspekterna vårdsökande upplevde i det dagliga livet samt vikten av stöd från familj och vänner. Illabefinnande som beskriver vilka begränsningar och restriktioner som vårdsökande upplevde i det dagliga livet samt påverkan på dagliga aktiviteter som uppstod i samband med behandlingen. Välbefinnande innehar två underkategorier och illabefinnande innehar fyra underkategorier. Slutsatser: Välbefinnandet påverkades hos vårdsökande personer. Stöd från familj och vänner samt vårdpersonal ansågs som värdefullt. Återkommande faktorer som ansågs påfrestande var känslan av konstant törst samt svårigheten att leva som önskat / Background: For a person who’s suffering from chronic renal failure, are dialysis or kidney transplant the only option for survival. The well-being can be affected by the life adjustment that is required of the patient. Treatment with hemodialysis is time-consuming and stressful as it involves limitations in daily life. Aim: To describe the experiences of living with hemodialysis. Method: Literature review with an integrated analysis based on 10 scientific articles. Results: The results are described in two categories; Well-being that describe the positive aspects which patients experienced in daily life and the importance of support from family and friends. Malaise that describes the limitations and restrictions that patients experienced in daily life and the impact on daily activities that arose in connection with the treatment. Well-being contains two subcategories and malaise contains four subcategories. Conclusions: The well-being impacted the patients. Support from family and friends as well as from health professionals were considered as valuable. Recurring factors considered stressful was the feeling of constant thirst and difficulty of living as desired.

The purpose of this study was to examine the interrelationships among the themes of Taylor's (1983) Cognitive Adaptation Theory for schoolagers with asthma. In addition, the influence of Taylor's (1983) themes on the children's social behavior was also tested. The three themes of Taylor's (1983) theory included A Search for Meaning, Restoration of Self-Esteem, and Gaining a Sense of Self-Mastery. Two components of A Search for Meaning included the Impact of Disease and the Cause of Disease. Relating Behaviors-Cooperating Behaviors was the index of social behavior. Forty-five Caucasian children between the ages of seven and ten years who had a diagnosis of asthma and did not have any mental disability were the convenient sample. Data were collected in the children's homes. Three questionnaires and two interviews were used to measure Taylor's (1983) themes and Relating Behaviors-Cooperating Behaviors. Descriptive statistics were used to answer the research questions and provide additional findings related to the conceptual framework. Two relationships among Taylor's (1983) themes were significant (p ≤ .05). Children who reported greater impact of asthma upon their lives (Impact of Disease) reported lower self-esteem (Restoration of Self-Esteem). Children who reported greater impact of asthma upon their lives (Impact of Disease) also reported a lesser internal locus of control orientation (Gaining a Sense of Self-Mastery). The Cause of Disease was the only concept which correlated significantly with Relating Behaviors-Cooperating Behaviors and thus, influenced this concept. Children who named a cause for their asthma reported more relating and cooperating skills. The Cause of Disease explained 6.5% of the variance for Relating Behaviors-Cooperating Behaviors. Characteristics of the children's asthma condition and their families were significantly related to the themes of Taylor's (1983) theory and Relating Behaviors-Cooperating Behaviors. Developmental differences were found from age group analyses. The classification of the children's responses for the cause of asthma and reliability and validity estimation for the HIIS were also reported. Five potential sources of error which may have affected the findings included design, instrument, subject, investigator, and specification errors. Suggestions for future research with the conceptual framework were discussed.

I Sverige lider cirka 50 000, främst äldre personer av svårläkta bensår. Venös insufficiens är vanligaste sjukdom som orsakar svårläkta bensår. Behandlingen kan vara besvärlig och oftast påverkar patientens vardag. Syftet med studien var att beskriva patienters upplevelser av att leva med svårläkta bensår. En litteraturöversikt med kvalitativ ansats baserad på vetenskapliga artiklar genomfördes. Artiklarna söktes i databaser, analyserades och sammanställdes för att finna meningsbärande innehåll med utgångspunkten i patienters upplevelser. Resultatet visade att svårläkta bensår påverkade patienternas dagliga liv och välbefinnande på olika sätt och presenterades under fyra teman: Styrd av smärta, lukt och läckage i vardagen, Besvärlig behandling, Begränsningar som påverkar människans kroppsuppfattning, Betydelsen av vårdmötet. Patienterna hade negativa upplevelser av att leva med svårläkta bensår vilket orsakade mycket lidande och begränsade deras rörlighet och sociala liv. De upplevde dåligt självförtroende och en förlorad kontroll över sin egen kropp. Sjuksköterskor bör ha bättre förståelse för och ha kunskaper om hur det är att leva med svårläkta bensår för att ge en god patientcentrerad omvårdnad.

Bakgrund: Många personer lever idag med någon typ av bensår, varav venösa bensår är de allra vanligaste. Bensåret uppkommer ofta till följd av ett yttre hudtrauma hos de med venös insufficiens. Sjuksköterskan har en viktig roll när det kommer till omhändertagande och behandling av patienter i denna grupp. Syfte: Syftet med litteraturstudien var att undersöka patienters upplevelser av att leva med svårläkta venösa bensår. Metod: Litteraturstudie med kvalitativ ansats där tio studier analyserats. Resultat: Litteraturstudien utmynnade i fyra kategorier samt tio underkategorier. Svårläkta venösa bensår påverkar patienters förmåga att utföra vardagliga aktiviteter, dels på grund av de fysiska symtomen och dels på grund av den negativa psykiska inverkan som känslor av skam och nedstämdhet har. Såret innebär att ingå i ett förhållande med sjukvården, där kontinuitet och delaktighet är viktigt för patienterna. Olika metoder för att hantera situationen framkom. Konklusion: Resultaten visar på vikten av att se på patienten och omvårdnaden ur ett helhetsperspektiv, där inga aspekter får glömmas bort. Reflektioner över litteraturstudiens resultat leder till en bredare kunskap om hur vården kan förbättras för dessa patienter. / Background: Many persons are affected by hard-to-heal wounds with venous leg ulcers being the most common. The ulcer is usually caused by trauma to the leg in patients suffering from venous insufficiency. Nurses carry an important role in caring for this group of patients. Aim: The aim of this literature study was to explore patients’ experiences of living with hard-to-heal venous leg ulcers. Method: Literature study with a qualitative approach, where ten studies have been analyzed. Results: Four categories and ten subcategories emerged. Hard-to-heal venous ulcers greatly affect patients’ everyday life, partly due to the physical symptoms and partly to the psychological impact of feelings of shame and depressive thoughts. Developing an ulcer means entering into a relationship with health care professionals, such as nurses, and the study found that patients place a high value on the continuity of care and involvement. Different strategies to cope with the situation emerged. Conclusion: The results point to the importance of holistic care and provide a broad understanding of the experiences of patients’ living with hard-to-heal venous ulcers; the results can be used to improve care for these patients.