Parents' lived experiences of parental needs for support at a burn centre

Purpose: A burn injury to a child is a traumatic event and the parent's emotional reactions and coping strategies affect the child's adaptive outcome. It is therefore important that parents get the right support. The aim was to explore parents' lived experiences of their need for support when having a child admitted to a burn centre. Methods: Semi-structured face-to-face interviews were conducted with 22 parents of children age <12 years hospitalised with an accidental burn injury, 9 to 27 days after the burn accident, from April 2017 to July 2018. A Ricoeur-inspired textual analysis method was used. Results: Four themes emerged from the analysis and describe the parents' needs for support. The parents wanted to be taken care of as a whole family and feel safe in the hands of professionals. This, in turn, depended on being informed about the child's condition and treatment, but also on getting help in dealing with feelings of guilt. Not least, parents wanted opportunities to take care of their own fundamental needs in terms of hygiene, food, adequate rest and activities. Conclusion: As an overall understanding the healthcare providers should focus on the family as a whole in care and treatment.

"Finding oneself after critical illness": voices from the remission society

The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants' lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants' narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger's concept of homelikeness and Arthur Frank's typologies of illness narratives. In conclusion listening to and acknowledging the patients' lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients' lived experience of critical illness and its aftermaths.

Staff Members’ Experience of Providing Parental Support in a National Burn Centre

Background

Paediatric burn injuries affect not only the child but the whole family, especially the parents. Knowledge of how parents are affected psychologically has increased, but there is an ongoing dearth of literature on parental support while hospitalised. There is also very little documentation of the ways in which burn staff members support parents.

Objectives

To explore staff members’ lived experiences of supporting parents with children hospitalised at a burn centre due to a burn injury.

Methods

Four focus group interviews were conducted in 2017 with a total of 21 staff members at the National Burn Centre in Norway. Seven different burn staff professions participated. Data were analysed using a Ricoeur-inspired method for text analysis and managed using NVivo 12Plus.

Results

Four themes were identified in the treatment trajectory: creating a safe, secure and trusting environment from the moment parents enter the burn centre; helping parents deal with feelings of guilt; helping parents navigate in their daily routines while continuing to be a mother or father; and gradually involving parents in wound treatment as preparation for discharge.

Conclusion

Staff must carefully consider their verbal and non-verbal (body) language and how to approach parents from the very moment they enter the burn ward. Most parents are affected by feelings of guilt and these feelings must be addressed and processed. During the treatment trajectory, parents are guided to participate in the daily care of their child and are gradually assisted in taking over the wound treatment prior to discharge.

A skin disease, a blood disease or something in between? An exploratory focus group study of patients' experiences with porphyria cutanea tarda

Background

Porphyria cutanea tarda (PCT) is characterized by fragile skin with blistering on sun-exposed areas. Symptoms typically develop in late adulthood and can be triggered by iron overload, alcohol intake, oestrogens and various liver diseases. Treatment consists of phlebotomy to reduce iron, or increasing urinary porphyrin excretion by administering chlorochin. To optimize patient care, health personnel need to understand the subjective experiences of PCT.

Objectives

To explore the experiences of persons with PCT with regard to symptoms, treatment, follow-up and prevention of the disease.

Methods

Interpretive description was used as a qualitative approach. Twenty-one participants attended three focus groups. All participants had experienced PCT symptoms during the last 5 years.

Results

Participants' experiences varied from trivializing symptoms and fragile skin to what was described as a desperate situation, with huge blisters, skin falling off and feeling as if one was in a ‘horror movie’. For some, itching was very troublesome, preventing sleep and delaying skin healing. In managing PCT a shift in focus from skin to blood was described. PCT was perceived as a chronic and systemic disease causing a range of health problems. Strategies for preventing symptoms ranged from doing nothing to frequent controls and check-ups.

Conclusions

Participants had a systemic perception of PCT, and a tendency to attribute a range of health problems to the condition. This study adds insight into the experiences patients have with PCT.

Osteoporosis in the Norwegian moose

In the last decade, an increased frequency of fractures among wild moose in the southernmost parts of Norway has been reported. This study focuses on bone mass, mechanical strength, and metal levels in the metacarpal bone of moose hunted in Aust-Agder (AA) County in southern Norway compared with control areas (CA) in more eastern and northern parts. Metacarpal bone with soft tissue from 106 AA and 37 CA animals were excised after hunting. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA) at the proximal joint (trabecular bone tissue) and 100 mm distally (cortical bone tissue). Both accuracy and reproducibility of the method in these large bones were tested. Biomechanical strength was carried out using a three point bending test in bones from nine AA and eight CA animals of the same age. Metal concentrations in bone tissue were determined by atomic absorption spectrophotometry (GF-AAS) and atomic emission spectrometry (ICP-AAS). BMD of the proximal region was 1.58 +/- 0.39 g/cm(2) (mean +/- SD) for AA, 1.88 +/- 0.58 g/cm(2) (p < 0.01) for CA, 2.08 +/- 0.36 g/cm(2) for distal AA, and 2.16 +/- 0.48 (not significant) for distal CA. In analysis of covariance (ANCOVA) tests with age and region as factors, together with weight as cofactor, there were significant effects on BMD in both the proximal and distal areas for all factors. The bending strength of metacarpal bone was 9378 +/- 1814 N and 16,707 +/- 3065 N (p < 0.01) in AA and CA animals, respectively. There was no differences in element content except for the concentration of lead, where the mean value for AA animals was 1.5 +/- 0.8 mg/kg and CA 0.4 +/- 0.3 mg/kg (p < 0.01). In conclusion, the animals from the southern part of Norway had lower bone mass, decreased mechanical strength, and an increased bone concentration of lead.

The significance of fellow patients for the patient with cancer: what can nurses do?

Based on two qualitative studies, this article describes the significance of fellow patients in cancer wards, and the relevance for health personnel involved in patient-patient relationships is discussed. Using grounded theory, in-depth interviews were conducted in the first study with 21 adult cancer patients and in a follow-up study with 8 patients and 27 health care providers. The findings indicate that the significance of fellow patients for the patient with cancer can be described in terms of three different dimensions: attitudes toward own illness, interpersonal relationships, and environmental factors. Although contact with fellow patients most often seems to engender positive experiences, some negative experiences are reported also. The suggestions in this article for practical implications are meant to help nurses and other health care providers to promote positive and prevent negative consequences in patient-patient relationships in hospitals.

Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up

The effectiveness of arthroscopic surgery, supervised exercises, and placebo was compared in 125 patients with rotator cuff disease (impingement syndrome stage II) in a randomized clinical trial. The median age was 48 years, and the median duration of complications was 1 to 2 years. The treatments were arthroscopic subacromial decompression performed by 2 experienced surgeons, an exercise regimen supervised for 3 to 6 months by 1 experienced physiotherapist, or 12 sessions of detuned soft laser (placebo) for 6 weeks. The criterion for success was a Neer shoulder score > 80. Fifteen (50%) and 11 (22%) of the patients randomized to placebo and exercises, respectively, had surgery during the 2 1/2-year follow-up period and were classified as having failure with the treatments. The success rate was higher (P < .01) for patients randomized to surgery (26 of 38) and exercises (27 of 44) compared with the placebo group (7 of 28). The odds ratio for success after surgery compared with exercises was 1.5 (95% confidence interval 0.6 to 3.7; P = .49). Including all patients who underwent operation, the success rate in those not on sick leave (19 of 21) before surgery was higher compared with those on sick leave (18 of 36) (adjusted odds ratio 5.6 [1.2 to 29.2]). Similar results were observed for patients not receiving versus those receiving regular pain medication before surgery (adjusted odds ratio 4.2 [1.2 to 15.8]).

[Clexane (enoxaprin) or Fragmin (dalteparin) for thrombolytic prevention in hip replacement surgery?]

In an attempt to reduce medical costs it was decided that four Oslo hospitals should use the same low molecular weight heparin (LMWH) for thromboprophylaxis. Clexane was chosen because it was slightly cheaper than Fragmin. Experts in haematology stated that a daily dose of 40 mg Clexane was equivalent to 5,000 units of Fragmin in high risk surgery. After changing from Fragmin to Clexane for thromboprophylaxis in connection with total hip replacement, an unacceptable increase in perioperative bleeding complications was experienced. Thus, after being used in 18 patients, use of Clexane was discontinued. We compared the group given Clexane with the last 18 total hip replacement patients who had received Fragmin. The two groups were comparable with regard to base line characteristics. In both groups the thromboprophylaxis was started the evening before the operation. We found a statistically significant increase in postoperative wound and drain-site discharge and in number of days with elevated body temperature in the Clexane group. Even though the Clexane group received an average of 1.5 blood units more, their haemoglobin value at discharge from the department was significantly lower. We conclude that a daily dose of Clexane led to more bleeding than 5,000 units of Fragmin did.

Uptake of metal ions in moss from artificial precipitation

Uptake in Hylocomium splendens and Sphagnum fuscum, of Zn, Cu, Cd, and Pb from artificial solutions of precipitation at ambient concentration levels was investigated. The primary objective was to study to what extent major cations and possibility anions in the precipitation might affect the uptake by competition or possibly by complexing reactions. In addition the effect on metal uptake of pH and temperature was studied. The uptake of Zn and partly Cu was lower from precipitation with a high content of seasalt. With increasing metal concentration an increasing amount of Zn and Cu accumulated in the moss. These observations suggest that cations in the precipitation such as Na(+) and Mg(2+) may affect the uptake by competition. Possibly also Cl(-) may interfere by complexing reactions. Uptake of Zn and Cd was pH dependent. The uptake of all four metals increased with temperature. The results from this work appear to be significant with respect to the interpreation of data from atmospheric deposition surveys based on moss analysis.