<p>Psykisk ohälsa är ett samhällsproblem som kräver mer uppmärksamhet från sjukvårdens sida. En kronisk sjukdom drabbar både patienter och deras livskamrater och präglas av olika förluster som förändrar livet. Förlusterna skapar en klyfta mellan det liv patienter och livskamrater lever och de liv de egentligen vill leva. Det är i denna klyfta som den kroniska sorgen skapas. Kronisk sorg skiljer sig från vanlig sorg då den återkommer i perioder och växlar i intensitet. Syftet med studien var att beskriva upplevelsen av kronisk sorg hos patienter och livskamrater i samband med en kronisk sjukdom. Studien är genomförd som en litteraturstudie där 15 vetenskapliga artiklar samlades in och granskades. Resultatet visar att patienter och livskamrater upplever olika typer förluster, både fysiska, sociala och psykiska. Dessa förluster ligger till grund för upplevelsen av kronisk sorg. Genom att få kunskap om patienter och livskamraters upplevelse av kronisk sorg i samband med kronisk sjukdom kan sjuksköterskan få förståelse för dessa patienter och utifrån det hjälpa dem att hantera sorgen. Kronisk sorg är ett relativt nytt begrepp inom sjukvården och det krävs därför mer forskning för att öka kunskapen om begreppet.</p> / <p>Mental health is a problem in society and it requires more attention from the healthcare side. A chronic disease means that both patients and spouses undergo different periods of losses that change their lives in different ways. These losses create a gap between the patients and spouse’s ongoing lives and the life they really want to live. It is in this gap that the chronic sorrow is created. Chronic sorrow differs from normal grief when it recurs in periods and switches in intensity. The aim of this study was to describe the experience of chronic sorrow in patients and spouses related to a chronic disease. The study was conducted as a literature review where 15 research articles were collected and examined. The results show that patients and spouses experience different types of losses, physical, social and psychological. These losses create their chronic sorrow. By gaining knowledge of patients and spouses experiences of chronic sorrow the nurse can obtain an understanding of their situations and based on that help they cope with grief. Chronic sorrow is a relatively new concept in healthcare and therefore more research is required to increase understanding of the concept. <strong></strong></p>

Psykisk ohälsa är ett samhällsproblem som kräver mer uppmärksamhet från sjukvårdens sida. En kronisk sjukdom drabbar både patienter och deras livskamrater och präglas av olika förluster som förändrar livet. Förlusterna skapar en klyfta mellan det liv patienter och livskamrater lever och de liv de egentligen vill leva. Det är i denna klyfta som den kroniska sorgen skapas. Kronisk sorg skiljer sig från vanlig sorg då den återkommer i perioder och växlar i intensitet. Syftet med studien var att beskriva upplevelsen av kronisk sorg hos patienter och livskamrater i samband med en kronisk sjukdom. Studien är genomförd som en litteraturstudie där 15 vetenskapliga artiklar samlades in och granskades. Resultatet visar att patienter och livskamrater upplever olika typer förluster, både fysiska, sociala och psykiska. Dessa förluster ligger till grund för upplevelsen av kronisk sorg. Genom att få kunskap om patienter och livskamraters upplevelse av kronisk sorg i samband med kronisk sjukdom kan sjuksköterskan få förståelse för dessa patienter och utifrån det hjälpa dem att hantera sorgen. Kronisk sorg är ett relativt nytt begrepp inom sjukvården och det krävs därför mer forskning för att öka kunskapen om begreppet. / Mental health is a problem in society and it requires more attention from the healthcare side. A chronic disease means that both patients and spouses undergo different periods of losses that change their lives in different ways. These losses create a gap between the patients and spouse’s ongoing lives and the life they really want to live. It is in this gap that the chronic sorrow is created. Chronic sorrow differs from normal grief when it recurs in periods and switches in intensity. The aim of this study was to describe the experience of chronic sorrow in patients and spouses related to a chronic disease. The study was conducted as a literature review where 15 research articles were collected and examined. The results show that patients and spouses experience different types of losses, physical, social and psychological. These losses create their chronic sorrow. By gaining knowledge of patients and spouses experiences of chronic sorrow the nurse can obtain an understanding of their situations and based on that help they cope with grief. Chronic sorrow is a relatively new concept in healthcare and therefore more research is required to increase understanding of the concept.

Det finns lite forskning om livskvalitet hos patienter med kronisk njursvikt som ännu inte startat i dialysbehandling och det är viktigt att ha kunskap om hur livskvaliteten påverkas hos dessa patienter. Syftet med litteraturstudien var att belysa olika faktorers påverkan på livskvaliteten hos patienter med kronisk njursvikt som inte startat i dialys. I studien har 16 vetenskapliga artiklar granskats och analyserats. I resultatet framkom att Hb-nivå, nutrition, sjukdomens svårighetsgrad och komorbiditet var faktorer som kunde påverka livskvaliteten. Även patienters upplevelser av antal och svårighetsgrad av symtom var påverkande faktorer. Ålder, kön, civilstånd, utbildning och arbetsstatus visade sig också kunna påverka livskvaliteten. I faktorer som patienterna kunde påverka, framkom copingstrategier och egenvård. I livskvalitet relaterat till planerad vård och omvårdnad framkom vårdplanering och specialistsjuksköterske-mottagning som faktorer som kunde påverka livskvaliteten. Genom kunskap inom detta område kan sjuksköterskan ge information och stöd till patienter och närstående och via omvårdnadsåtgärder förebygga och lindra symtom för att förbättra patienternas livskvalitet. Undersökningar av livskvalitet hos patienter med njursvikt som inte startat i dialys kan vara av värde vid utvärdering av vård och omvårdnad. Mer kvalitativ forskning om livskvalitet, coping och egenvård inom detta område behövs och sjuksköterskor behöver mer utbildning inom dessa områden för att kunna förbättra omvårdnaden. / There is little research on quality of life in patients with chronic renal failure not undergoing dialysis and it is important to know how the quality of life is affected in these patients. The aim of this literature review was to illustrate the impact of different factors on the quality of life in patients with chronic renal failure not undergoing dialysis. This study has been reviewed 16 scientific articles and analyzed. The result showed that the Hb-level, nutrition, the severity of the disease and co-morbidity were factors that could affect the quality of life. Also patients' perceptions of the number and severity of symptoms were influencing factors. Age, sex, marital status, education and work status also appeared to affect the quality of life. Among factors that patients themselves could affect were coping strategies and self-care. Well planned care and care delivered by specialist nurses did also affect the quality of life. The patients‟ quality of life may improve by the acts of the nurse, for example by providing information and support to patients and relatives, and by different nursing interventions directed towards prevention or relief of symptoms. Studies of quality of life in patients with renal failure not started in dialysis may be useful in the evaluation of health care and nursing. There is a need for more qualitative research on quality of life, coping and self-care in this field and nurses need more training in these areas in order to improve the nursing care.

Chronic neck pain, a common cause of disability, seems to be the result of several interacting mechanisms. In addition to degenerative and inflammatory changes and trauma, psychological and psychosocial factors are also involved. One common type of trauma associated with chronic neck pain is whiplash injury; this sometimes results in whiplash-associated disorder (WAD), a controversial condition with largely unknown pathogenetic mechanisms. We studied the prevalence of chronic neck pain of traumatic and non-traumatic origin and compared the prevalence of, sociodemographic data, self-perceived health, workload and chronic lowback pain in these groups. In a ready-made questionnaire (MONICA study), we added questions about cervical spine and low-back complaints. 6,000 (72%) completed a self-administered questionnaire. 43% reported neck pain: 48% of women and 38% of men. Women of working age had more neck pain than retired women, a phenomenon not seen in men. 19% of the studied population suffered from chronic neck pain and it was more frequent in women. A history of neck trauma was common in those with chronic neck pain. Those with a history of neck trauma perceived their health worse and were more often on sick-leave. About 50% of those with traumatic and non-traumatic chronic neck pain also had chronic low-back pain. We assessed the subjective and objective neuropsychological functioning in 42 patients with chronic neck pain, 21 with a whiplash trauma, and 21 without previous neck trauma. Despite cognitive complaints, the WAD patients had normal neuropsychological functioning, but the WAD group especially had deviant MMPI results—indicating impaired coping ability and somatization.WAD patients had no alterations in cerebral blood-flow pattern, as measured by rCBF-SPECT and SPM analysis, compared to healthy controls. This contrasts with the non-traumatic group with chronic neck pain, which showed marked blood-flow changes. The blood-flow changes in the non-traumatic group were similar to those described earlier in pain patients but— remarkably enough—were different from those in the WAD group. Chronic neck pain of whiplash and non-traumatic origin appears to be unique in some respects. A better understanding of the underlying pathological mechanisms is a prerequisite for prevention of the development of such chronic pain syndromes and for improvement of the treatment of patients with severe symptoms.

Despite the efficacy of pulmonary rehabilitation programs which assist patients in managing chronic obstructive pulmonary disease (COPD), the high costs and lack of availability of such programs pose considerable barriers for underserved COPD patients, such as those living in rural communities. Because of this, patients are encouraged to actively self-manage COPD. Unfortunately, COPD patients have reported dissatisfaction with the self-management education they are provided. This mixed methods study assessed the self-management learning needs of COPD patients treated at a Certified Federal Rural Health Clinic through conducting focus group interviews (n = 2) to inform the development a targeted self-management education DVD. The effectiveness of 3 distinct educational treatments (DVD vs. Pamphlet vs. DVD Pamphlet) was evaluated by comparing outcomes related to informational needs, self-management self-efficacy, and generic/lung-specific HRQoL in a randomly-assigned, multiple-group pretestposttest design with a control group (n = 41). Focus group data was analyzed using three qualitative analysis tools. Findings from the interviews indicated that patients viewed self-management as simply taking prescribed medications and reducing activity. Patients reported a lack of knowledge and skill development related to rehabilitative activities such as controlled breathing and stress reduction. A multivariate analysis of covariance was conducted to determine the effect of 3 educational treatments on multiple outcome measures. Three nontrend orthogonal planned contrasts were tested to determine selected contrast effects. The data analysis revealed that participants receiving a DVD reported statistically significantly higher levels of lung-specific physical functioning as compared to those in the Pamphlet group. Additionally, the DVD group revealed clinically significant improvements on the physical ( 19.01) and emotional ( 10.74) functioning dimensions of lung-specific HRQoL; whereas, no such improvement occurred within the Pamphlet and control groups. Results also suggested that providing patients with a Pamphlet alone was more effective than providing participants with both interventions concurrently to increase self-management self-efficacy. The simultaneous provision of both interventions did, however, enhance generic HRQoL more so than the provision of one of the two treatments alone. Finally, any type of self-management education as compared to usual care did not statistically significantly improve outcome variables among this small sample of rural patients.

Thesis (M.Sc.), Memorial University of Newfoundland, Faculty of Medicine, 1998. / Restricted until June 1999. Bibliography: leaves 123-133.

published_or_final_version / Medicine / Master / Doctor of Medicine

People living with renal failure experience enormous challenges, yet very little is known about life with this disease. The goal of this research was to gain an integrated understanding of the lives of people with renal failure. An understanding of life with renal failure that includes cultural, institutional and historical contexts may provide health care practitioners with the kind of information and insights necessary to improve medical practice. Thus far, medical practice has been based on a biomedical model of care that focuses almost exclusively on the physical aspects of illness. From this perspective, people with kidney disease are seen as autonomous and rational individuals. In this research, a sociocultural multiple case study approach was utilized in order to gain a situated understanding of life for four people with renal disease. This research revealed that life with renal failure is work. While it is the people living with renal failure who do the bulk of the work, friends and family also work to "live" with renal disease. Participants and their significant others learn about and become experts on life with this disease. A gap was found between practitioners' understanding of disease and participants' lived experience — resulting in many negative repercussions. Medical-based knowledge is lacking because it does not consider the three relevant sources of knowledge: practitioners, participants and participants' significant others. This research argues for a bridge between the home world and the hospital world, so that a broader community of practice is created. An account of the lived experience of people with renal failure that includes these factors can inform "best practice" because it provides a richer and more authentic picture of life with this illness. It is from this perspective that health care practitioners can begin to broaden their understanding of renal failure as it is "lived", and, so informed, can better provide the kinds of education and support that will enhance the lives of people with this illness.

Self-regulation is the capacity to exert control over cognition, emotion, behavior, and physiology. Since chronic pain interferes with the ability to self-regulate, the primary goal of this study was to examine, in rodents, the effects of chronic pain on self-regulation processes. Sixteen male Sprague-Dawley rats were divided into two groups: (1) chronic constriction injury of the infraorbital nerve (CCI-ION) and (2) naïve. Testing confirmed that CCI-ION animals had significant mechanical allodynia compared to naïve animals (p<0.001). A two-part self-regulation behavioral paradigm consisting of a cued go/no-go task and a subsequent persistence task was developed based on human paradigms. In the cued task, both groups made fewer incorrect lever presses in post-surgery trials (p<0.001); naive animals had a greater decrease in number of incorrect presses than CCI-ION animals (p=0.06). Similarly, both groups had a larger correct to total lever presses ratio in post-surgery trials (p<0.001); naïve animals had a greater increase than CCI-ION animals (p=0.06). In the persistence task, naïve animals experienced a greater decrease in lever presses (p=0.08) than did CCI-ION animals (p=0.66). These results suggest that animals experiencing chronic pain were not able to learn as well as naïve animals, and may have difficulty responding to novel environmental demands.

This program of research examines the experience of chronic pain in a community sample. While, it is clear that like patient samples, chronic pain in non-patient samples is also associated with psychological distress and physical disability, the experience of pain across the total spectrum of pain conditions (including acute and episodic pain conditions) and during the early course of chronic pain is less clear. Information about these aspects of the pain experience is important because effective early intervention for chronic pain relies on identification of people who are likely to progress to chronicity post-injury. A conceptual model of the transition from acute to chronic pain was proposed by Gatchel (1991a). In brief, Gatchel’s model describes three stages that individuals who have a serious pain experience move through, each with worsening psychological dysfunction and physical disability. The aims of this program of research were to describe the experience of pain in a community sample in order to obtain pain-specific data on the problem of pain in Queensland, and to explore the usefulness of Gatchel’s Model in a non-clinical sample. Additionally, five risk factors and six protective factors were proposed as possible extensions to Gatchel’s Model. To address these aims, a prospective longitudinal mixed-method research design was used. Quantitative data was collected in Phase 1 via a comprehensive postal questionnaire. Phase 2 consisted of a follow-up questionnaire 3 months post-baseline. Phase 3 consisted of semi-structured interviews with a subset of the original sample 12 months post follow-up, which used qualitative data to provide a further in-depth examination of the experience and process of chronic pain from respondents’ point of view. The results indicate chronic pain is associated with high levels of anxiety and depressive symptoms. However, the levels of disability reported by this Queensland sample were generally lower than those reported by clinical samples and consistent with disability data reported in a New South Wales population-based study. With regard to the second aim of this program of research, while some elements of the pain experience of this sample were consistent with that described by Gatchel’s Model, overall the model was not a good fit with the experience of this non-clinical sample. The findings indicate that passive coping strategies (minimising activity), catastrophising, self efficacy, optimism, social support, active strategies (use of distraction) and the belief that emotions affect pain may be important to consider in understanding the processes that underlie the transition to and continuation of chronic pain.