Narrative Approach for Identifying Movements of Change and the Value of Therapeutic Writing Related to Chronic Pain Management

In this study, we examined extensive narratives prepared by participants who attended a chronic pain management programme where therapeutic writing was included. The aim was to explore how narrators experience the contexts in which their lives unfold following a cognitive behavioural programme. The analysis was based on a three-sphere model for context analysis, which referred to the contexts in which the narrators located their life stories: their immediate inter-subjective relationships, the collective social field, and broad cultural meaning. We identified important change processes related to adaptation. Our examination of the experience of therapeutic writing clearly indicated that therapeutic writing is helpful. We suggest that obtaining a better understanding of living with chronic pain through storytelling as part of therapeutic writing and using a three-sphere model for context analysis could improve understanding and approaches to nursing. Health carers should organize care around the experience of illness and its inter-subjective, social, and cultural consequences, which may provide a deeper understanding of identity and the core themes embedded in life stories.

Continuity of Care during Care Transition: Nurses’ Experiences and Challenges

The aim of this study was to gain increased knowledge about nurses’ experiences of care transition of older patients from hospital to municipal health care, based on two research questions: How is nurses’ experience continuity during care transition of older patients from hospital to municipal health care? How would nurses describe an optimal care transition? Nurses have a pivotal role during care transitions of older patients. More knowledge about their experiences is necessary to develop favorable improvements for this important period in the older patient’s treatment and care. The study has a qualitative explorative design with follow-up focus group interviews. Nurses (N = 30) working in hospital (n = 16) and municipal (n = 14) health care were organized in five mixed focus groups during the period October-January 2014/2015. The focus groups met twice, answering the research questions following a previously circulated semi-structured interview guide. The interview analysis was inspired by content analysis. The analysis resulted in the themes “Administrative demands challenge terms for collaboration” and “Essentials for nursing determine optimal care transitions for older patients”. Administrative demands may prevent nurses’ professional dialogue and collaboration across health care levels. Older patients’ best interests should be ensured through a collaborative relationship between hospital and municipal nurses, to form continuous care across health care levels. Clinical practice should be aware of essentials for nursing, which could influence and facilitate a more individualized and continuous transition for older patients.

Nurses' experiences with health care in pain clinics: A qualitative study

Background: Recent research has focused on the effectiveness of different treatment regimens in pain clinics,where a call for more multifaceted treatment has been highlighted.Less attention has been paid to improvements within pain clinics,and how registered nurses-who usually play a key role-perceive and experience the accessibility,treatment options and follow-up offers at public pain clinics.Objective: The overall aim was to explore and describe how nurses experience health care provided to patients with chronic non-cancer pain at pain clinics.Methods: We used 10 individual interviews with nurses working at 10 different public pain clinics in Norway.The interviews were analyzed using qualitative content analysis.Results: One theme was developed from the content analysis: "Nurses' striving to provide whole-person care in pain clinics." The nurses experienced allocation of limited resources as challenging,especially when the dilemma between accepting new patients from the waiting list and offering follow-up to existing patients became apparent.Multifaceted treatment was perceived as vital,although resources,priorities,and theoretical understanding of pain within the team were challenging.Conclusions: The needs for multifaceted and integrated treatments in chronic pain management were obvious,although this approach appeared to be too demanding of resources and time.Stronger cooperation between pain clinics in specialist care and health care providers in primary care to ensure better patient flow and treatment is required.Emphasis is placed on coherent theoretical approaches to pain management within the team in the pain clinics to ensure whole person care.

Struggle for a Meaningful Life after Obesity Treatment—A Qualitative Systematic Literature Review

Aim: The aim of this review was to describe and systemize existing literature on patient-experiences in the context of obesity treatment. The review question was: How do patients describe their experiences after obesity treatment? Background: Obesity problems vary on a continuum of intensity and types of problems during different periods of life. An increasing amount of available treatment requires patients and professionals to make choices concerning the suitability of the individual patient to undergo certain types of treatment. Surgical treatment is considered sustainable and more successful for weight loss than other interventions. Alternatively, conservative treatment of obesity may be a matter of dealing with mental issues as well as diet and exercise. In a qualitative context, a deeper understanding related to patients’ own posttreatment experiences is needed. Methods: A systematic qualitative literature review was conducted for the period from 2006 to November 2016. The search was done in Medline, Embase and CINAHL using the words: Obesity, binge eating, patient, experience or perspective, treat or therap or surgery or cognitive, intervention, programme. Results and discussion: 15 studies were included and an overview of the qualitative designs was presented. From the content analysis, one main theme, Struggle for a meaningful life during transition related to obesity treatment, was developed. The main theme was derived from three themes related to the patients’ challenges when searching for positive self-existence, for relevant treatment-support, and for a balance to obtain inner and outer control. Clinical implications: Different types of obesity treatment create processes of transitions. However, it is crucial that clinicians are aware of the potential existential struggle after obesity treatment that is experienced by the individual patients. Clearly, some patients need interventions targeting mental challenges at different levels. Future interventions should take into account that physical and mental treatment must work together.