Siblings of children with cancer are exposed to significant stress and experience challenges in many aspects of their lives throughout the pediatric cancer trajectory. As a result, siblings are at risk for acute and long-term psychosocial consequences and must be provided with appropriate supportive services during and after cancer treatment. At this time, there are no evidence-based standards to guide the supportive care of siblings of children with cancer. The purpose of this study was to explore and develop an understanding of the different ways in which siblings of children with cancer perceive their psychosocial needs are addressed from formal and informal sources. A qualitative interpretive descriptive methodology was used in the study design. Data were collected from a sample of ten siblings in Ontario whose siblings were diagnosed and treated for pediatric cancer within the past ten years. The data collection methods included semi-structured individual interviews, socio-demographic questionnaires, field notes, and the researcher’s reflexivity journal. A reflexive thematic and inductive approach was used for the analysis of the collected data. The study findings highlight that there are significant gaps in the psychosocial support provided to siblings of children with cancer. Four overarching issues were identified, including: (1) siblings’ isolation from the pediatric cancer experience, (2) limited parental awareness of siblings’ psychosocial needs, (3) needs for consistent academic and school support, and (4) needs for standardized psychosocial support from healthcare professionals and hospital systems. The study findings provide several implications for clinical practice, policy, education, and research for nurses and other healthcare professionals working in pediatric oncology settings. Recommendations include: (1) integration of psychosocial care for siblings into clinical practice, (2) development of evidence-based standards and guidelines for the psychosocial support of siblings, (3) ongoing education and training for healthcare professionals related to siblings’ psychosocial healthcare needs, and (4) additional research on standardized screening tools and interventions for siblings. / Thesis / Master of Science in Nursing (MSN)

Published Article / Psychosocial support has been defined as an ongoing process of meeting emotional, social, mental and spiritual needs, all of which are considered essential elements of meaningful and positive human development. It goes beyond simply meeting the learners' physical needs, placing greater emphasis on learners' psychological and emotional development and their need for social interaction. The Free State Department of Basic Education defines vulnerable learners as orphans, heads of child-headed households, neglected learners and all learners who do not have access to a basic set of school uniforms. The department states that there are currently 70 000 of these learners in the province. This article presents a theoretical critique, within a social justice paradigm, of efforts aimed at supporting vulnerable learners psychosocially in the rural areas of South Africa. It describes attempts to afford vulnerable learners education and addresses their marginalisation and inherent powerlessness (social justice). It argues that psychosocial support (meeting their needs) for vulnerable learners will improve their access to education.

Chronic illness is associated with conditions that may result in psychological ill-health in the adolescence. Consequently there is a need for development of preventive psychosocial support interventions for this target group. The objective was to develop, implement, and evaluate the effect of supportive intervention group program for teenagers suffering from chronic illness - aiming at increasing quality of life and supporting mental and physical health. Method: Six different intervention groups were conducted between 2007 and 2011, age 13–17. The participants diagnoses were Diabetic, Epilepsy, Lung/allergy and Turners syndrome. Eight sessions, once a week, two hours each time. Parents participated on the first and last occasion in all groups. Psychodrama exercises complemented group sessions. All groups had a part of the same program as starting point, with the two main points; psychosocial education and salutogenetic approach with adherence to Aaron Antonovskys theory on “Sense of Coherence” (SOC). Results from the evaluation with the questionnaires SOC-13 and The Ladder of Life, indicate increased mental well-being and sense of meaningfulness for all groups directly after the intervention. The qualitative evaluation show, that to meet others in the same situation created hope and the program contributed to notable therapeutic effects.

Resultat från tidigare studier visade att långtidsskador inom idrott har en stor inverkan på det psykiska välbefinnandet och fann ett behov av mer forskning kring de psykosociala aspekterna vid skador i idrott. Studiens syfte var att studera emotionella omställningar vid elithandbollsspelares långtidsskador och dess samspel med emotioner, självbild och socialt stöd. Deltagare var 7 kvinnor och 3 män inom nordisk elithandboll. Intervjuer utfördes, transkriberades och tematiserades med avseende på mening utifrån ett hermeneutiskt perspektiv. I resultatet redovisades 33 centrala emotioner som t.ex. känslor av chock vid besked av skadans allvar, ångest över att inte prestera och deppighet över skadan. Resultat för självbild och socialt stöd visade på en stor identifikation med handbollsrollen, minskat egenvärde och betydelsen av det handbollsrelaterade stödet. Det verkade råda ett hårt klimat inom elithandbollen och vår studie skulle kunna användas till att skapa mer förståelse och bättre behandlingsalternativ för skadade individer inom elithandbollen.

Background: Implantable cardioverter defibrillators (ICDs) deliver therapy in the form of an internal shock should a life-threatening arrhythmia occur. Literature suggests that patients have misconceptions regarding ICD therapy and unmet information needs. Purpose: This study assessed the feasibility of delivering a pre-implantation nurse-led educational intervention to ICD candidates. Methods: ICD candidates attending an outpatient preoperative clinic were invited to participate. Consented participants were randomized to standard care or standard care plus an educational intervention. The educational intervention addressing information gaps identified in the ICD literature was delivered during the preoperative visit. The primary outcome was feasibility with the following targeted rates, (1) 80% recruitment; (2) ≥ 95% consent; (3) 90% randomization; (4) ≥ 90% completion of questionnaires; (5) 80% of intervention sessions delivered less than 45 minutes; and (6) 90% of intervention content delivered. At baseline, demographic data and Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety scores were collected. Four weeks post-ICD implantation, participants completed the PROMIS anxiety measure, Florida Patient Acceptance Survey (FPAS), and Florida Shock Anxiety Scale (FSAS). Results: Twenty patients consented to the study (10 standard care/10 standard care plus the educational intervention). Feasibility outcomes achieved were, (1) recruitment rate of 80%; (2) consent rate of 87%; (3) 100% randomization; (4) 80% completion of questionnaires; (5) 100% of intervention sessions completed in less than 45 minutes; and (6) intervention checklist completion rate of 100%. The four-week mean (SD) FPAS scores were 80.0 (13.4) in the intervention group compared to 77.0 (16.5) in standard care. Mean (SE) four-week PROMIS scores were 45.4 (6.4) in the intervention group and 43.7 (8.6) in standard care. Mean FSAS (SD) scores were 14.7 (4.6) in the intervention group and 13.3 (3.9) in standard care. Conclusion: The results demonstrated feasibility of delivering a pre-implantation nurse-led educational intervention in an outpatient clinic setting to ICD candidates. Further studies to evaluate the effectiveness of the intervention on patient-reported outcomes are warranted. / Thesis / Master of Science (MSc) / An ICD is a medical device placed under the skin that can fix a dangerous heart rhythm. It can do so by shocking the patient’s heart if the ICD senses a dangerous heart rhythm. This study was done to determine if it is practical to deliver education to patients before they receive their ICD. Some patients feel they do not receive enough information before getting an ICD. No studies have tested how education before receiving an ICD can impact a patient’s quality of life. In this study, ten people received usual care while ten people received usual care and ICD education from a nurse before ICD implantation. The results of this study determined that it was practical for nurses to deliver ICD teaching before the ICD was implanted. A future study testing the impact of education on the quality of life of ICD patients can and should be completed.

Yes / This study explored the perspectives of Black men, originally from East Africa, living in the United Kingdom and their partners on what it means to live with diagnosed HIV. This article reports on concealment of HIVpositive status as a strategy adopted by the affected participants to manage the flow of information about their HIV-positive status. Analysis of the data, collected using in-depth interviews involving 23 participants, found widespread selective concealment of HIV-positive status. However, a few respondents had ‘come out’ publicly about their condition. HIV prevention initiatives should recognise concealment as a vital strategy in managing communication about one’s HIV-positive status.

Yes

Bakgrund: Av alla graviditeter slutar 10-20% med ett missfall, vilket betyder att det är vanligt förekommande och drabbar många kvinnor. Ett missfall kan innebära en väldigt traumatisk upplevelse för den drabbade och är både psykiskt och fysiskt påfrestande.   Syfte: Syftet med litteraturstudien är att beskriva kvinnors upplevelser av missfall.   Metod: Litteraturstudie där resultatet baseras på 10 vetenskapliga artiklar baserade på en kvalitativ ansats.   Resultat: Vid ett missfall upplevde kvinnorna i studierna ofta att vårdpersonal gav för lite information och hade bristande förståelse. Mer psykosocialt stöd var en återkommande önskan, då de sällan blev erbjudna det. Missfallet innebar mer än att förlora ett framtida barn. Det var en komplex situation, där kvinnan drabbades av både fysisk och psykisk smärta. Känslor såsom att förlora kontrollen, att skuldbelägga sig själv, oro och rädsla inför framtiden var ofta förekommande. Sorgen över vad de kunde haft var något som kunde vara i flera år efter missfallet. Att få bearbeta sorgen visade sig vara en väldigt viktig del för de flesta kvinnorna.   Slutsats: Sorg är något som de flesta kvinnor upplever efter ett missfall och många av dem efterfrågar mer stöd och hjälp i hanteringen av sorgearbetet. Att drabbas av psykisk ohälsa, såsom depression och ångest är vanligt förekommande efter ett missfall. Genom att erbjuda alla drabbade kvinnor psykosocialt stöd i anslutning till missfallet kan psykisk ohälsa och onödigt lidande förebyggas. Det finns ett behov av ett bättre bemötande samt mer information från vårdpersonal. Eftersom brist på information kan leda till att kvinnan skuldbelägger sig själv bör detta prioriteras. Sjukvårdspersonal behöver mer kunskap gällande upplevelser av missfall för att kunna ge en tillfredsställande omvårdnad där kvinnan känner sig trygg och väl bemött. Det bör dock tas hänsyn till att allas upplevelser av ett missfall är individuellt och vården bör därför anpassas därefter. / Background: Of all pregnancies, 10-20% end with miscarriage, which means that it is a common matter and affects many. It can be a very traumatic experience and the effects it has on women can be both mental and physical.   Purpose: The purpose of this literary study is to describe women's experiences of miscarriage.   Method: The method of the research is a literary study, which is based on 10 original articles, with a qualitative approach.   Results: When a miscarriage occurred, women often felt that the care staff offered limited information and had a lack of understanding. More psychosocial support was a recurring desire as the women seldom felt that they were provided with it. The miscarriage meant more to them than losing a future child. It was a complex situation where the woman was in both physical and mental pain. Emotions such as lack of control, self-blame, anxiety, fearing for the future and sorrow were frequent. Grieving over what they could have had was something that could be experienced over several years after the miscarriage. Processing the grief was a very important part for most women.    Conclusion: Grief is something that most women experience after a miscarriage and many of them are asking for more support and help in dealing with grief. To suffer from mental illness, such as depression and anxiety are common after a miscarriage. By offering all affected women psychosocial support after the miscarriage, mental illness and unnecessary suffering can be prevented. There is a need for a better refutation as well as more information from health professionals. Because of the lack of information woman sometimes blames themselves, therefore this should be a priority. Healthcare professionals need more knowledge regarding experiences of miscarriage in order to provide adequate care where the woman can feel safe and be treated well. However, it should be taken into account that everyone's experience of a miscarriage are individually and care should therefore be adjusted accordingly.

Närstående till cancersjuka hamnar ofta i skuggan. Den närstående, omgivningen och sjukvården är samtliga fokuserade på att hjälpa den cancersjuke och det är så svårt att se att det finns fler som påverkas av cancersjukdomen, nämligen de som står den cancersjuke nära. Denna kvalitativa fenomenologiska studie har som syfte att beskriva närståendes upplevelse av att leva nära någon som har en cancerdiagnos. För att få en djupare förståelse för fenomenet och dess essens använder denna studie systemteori, psykosocialt stöd samt copingteori som teoretiska utgångspunkter. Dessa bidrar till en förståelse för det socialpsykologiska perspektivet gällande vem som påverkas av en cancersjukdom, hur påverkan ter sig samt hur den hanteras. Tio informanter som samtliga lever/har levt nära någon som har/har haft en cancerdiagnos deltog. Data samlades in genom semistrukturerade intervjuer. Resultatet visade att livet förändras i samband med att någon nära får en cancerdiagnos. Det visade också att det finns en trygghet i att få förståelse från omgivningen, men att närstående även i stor utsträckning vill klara sig själva för att på så sätt kontrollera situationen. / Cancer patients’ loved one’s often end up in the shadow. The loved one, the environment and healthcare are all focused on helping the cancer patient and it is then hard to see that there are more people affected by the cancer, namely the people being close to the patient. The aim of this qualitative phenomenological study is to describe the loved one’s experience of living close to someone who has cancer. To get a deeper understanding of the phenomenon and its essence this study use system theory, psychosocial support and coping theory as theoretical points. These contribute to an understanding of the social psychology perspective to whom is affected by cancer, how they are affected and how they handle it. Ten informants who all live/have lived with someone who has/had a cancer diagnosis attended. Data were collected through semi-structured interviews. The result showed that life changes when someone close gets a cancer diagnosis. It also showed that there is a security in the environments’ understanding, but that loved one’s also to a large extent would fend for themselves and in that way get control over situation.

This study described the mentoring relationship between doctoral nursing students and their committee chairs. Twenty-two public university doctoral programs responded to a request for names and addresses of their doctoral candidates. The Major Professor Mentoring Scale was used to measure the mentoring relationship. The survey also included demographic and open-ended questions regarding the student-committee chair relationship. Surveys were mailed to 269 doctoral students with an 86% return rate. A principal components analysis was performed to identify the structure underpinning the relationship. The typical doctoral student in this sample was found to be a 44 year old Caucasian female, married with children, working full or part time while pursuing a PhD degree. Students traveled an average of 85 miles each way to campus and nearly half had selected their program based on its location. The typical committee chair was a Caucasian, tenured, associate or full professor between 46 and 69 years of age. The majority of chairs were married and had funded research projects. The students in the study reported knowing their chairs for an average of five years. The study revealed that mentoring is occurring in the majority of relationships between doctoral nursing students and their committee chairs. Students identified many strengths and weaknesses in their relationships with their chairs although the relationship appears to be largely positive. The mentoring relationship is composed of four principal components, the largest of which is psychosocial support. Dissertation support, role modeling and scholarly collaboration comprise the other three components. The factor receiving the most positive rating was role modeling, suggesting that students see their chairs as intelligent and hard-working. Students also report positive feelings about both the psychosocial and dissertation support they have received from their chairs. Students reported more neutral feelings about scholarly collaboration suggesting that this is not a frequent occurrence in the relationship. Demographic variables including age, sex, race, geographic distance and family status were not predictors for mentoring scores.