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Widgren, Y., Silén, M., Wåhlin, I., Lindberg, M., Fransson, P. & Efverman, A. (2023). Chemotherapy-induced Emesis: Experienced Burden in Life, and Significance of Treatment Expectations and Communication in Chemotherapy Care. Integrative Cancer Therapies, 22
Open this publication in new window or tab >>Chemotherapy-induced Emesis: Experienced Burden in Life, and Significance of Treatment Expectations and Communication in Chemotherapy Care
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2023 (English)In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 22Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: Because antiemetics have become more effective and integrative therapies such as acupuncture are used in combination with antiemetics, people receiving chemotherapy for cancer today might expect less emesis than in the past. It is not previously described if and how people receiving modern antiemetics during chemotherapy experience emesis. The objective of this study was to describe experiences regarding emesis among persons undergoing emetogenic chemotherapy, and how it affects their quality of life, daily life and work. A further aim was to describe views on the significance of treatment expectations and communication with healthcare personnel while undergoing chemotherapy for cancer.

Method: Fifteen participants (median age 62 years, n = 1 man and n = 14 women, with breast (n = 13) or colorectal (n = 2) cancer) undergoing adjuvant or neo-adjuvant highly or moderately emetogenic chemotherapy were interviewed individually. The data were then analyzed using inductive thematic analysis.

Results: Three themes described the participants’ experiences: “Your whole life is affected, or continues as usual,” covering descriptions of emesis limiting some participants’ everyday lives, while others experienced no emesis at all or had found ways to manage it. Overall, participants described satisfaction with their antiemetic treatment. “Experiences and expectations more important than information”, that is, the participants reported wanting all the information they could get about possible adverse effects of treatment, although they believed previous experiences were more important than information in creating expectations about treatment outcomes. The participants reported that being seen as a unique person was of utmost importance: “Meet me as I am.” This creates trust in healthcare personnel and a feeling of safety and security in the situation.

Conclusions: These findings underline the importance of person-centered care and support in creating positive treatment expectations. Future research is called for regarding the potential antiemetic effects of positive communication regarding strengthening positive treatment expectations during emetogenic chemotherapy.

Place, publisher, year, edition, pages
SAGE, 2023
National Category
Cancer and Oncology
Research subject
Health-Promoting Work, Inkluderande arbetsliv
Identifiers
urn:nbn:se:hig:diva-43484 (URN)10.1177/15347354231217296 (DOI)001125792800001 ()38098295 (PubMedID)2-s2.0-85179678460 (Scopus ID)
Available from: 2023-12-19 Created: 2023-12-19 Last updated: 2024-04-26Bibliographically approved
Widgren, Y., Silén, M., Wåhlin, I., Lindberg, M., Fransson, P. & Efverman, A. (2023). Patients’ experiences of emesis and the significance of treatment expectations and communication during chemotherapy for cancer. Paper presented at MASCC/JASCC/ISOO Annual Meeting 2023. Supportive Care in Cancer, 31(S1), s39, Article ID 399.
Open this publication in new window or tab >>Patients’ experiences of emesis and the significance of treatment expectations and communication during chemotherapy for cancer
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2023 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 31, no S1, p. s39-, article id 399Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Introduction

Since antiemetics have become more effective, it seems plausible that patients nowadays expect less emesis than in the past. To gain a deeper understanding of the patients’ caring needs during emetogenic chemotherapy used today, the aim was to describe patients’ experiences of chemotherapy-induced emesis and how it afects quality of life, daily life, and work. Further, to describe views of the signifcance of their treatment expectations and the communication with the health care personnel when undergoing chemotherapy for cancer.

Methods

Fifteen patients (median age 62 years, n=1 man and n=14 women, with breast (n=13) or colorectal (n=2) cancer), undergoing adjuvantor neo-adjuvant highly or moderately emetogenic chemotherapy were interviewed individually. The data were then analyzed using inductive thematic analysis.

Results

Three themes described the patients’ experiences: ”The whole life gets affected, or goes on as usual”, covering descriptions of how some patients experienced the emesis to limit their everyday lives, while others experienced no emesis at all or had found ways to manage it; ”Information is important for creating expectations, but experiences even more”, i.e., the patients expressed that they wanted all the information they could get about possible adverse efects from the treatment, even though they believed previous experiences to be more important than information for creating expectations about treatment outcomes. Overall, the participants described satisfaction with their antiemetic treatment; and ”Meet me as I am”, including the participants expressed being seen as a unique person to be the of utterly importance. It creates trust in the health care personnel and a feeling of safety and security in the situation.

Conclusions

These findings underline the importance of person-centered care ands upport in creating positive treatment expectations. Future research is welcomed regarding potential antiemetic efects of positive communication, strengthening positive treatment expectations during emetogenic chemotherapy

Place, publisher, year, edition, pages
Springer, 2023
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-43517 (URN)10.1007/s00520-023-07786-4 (DOI)
Conference
MASCC/JASCC/ISOO Annual Meeting 2023
Available from: 2024-01-05 Created: 2024-01-05 Last updated: 2024-01-05Bibliographically approved
Silén, M. & Svantesson Sandberg, M. (2022). Etiskt stöd till personalen: etikronder. In: Silfverberg, G. (Ed.), Etikarbete i vårdens vardag: (pp. 103-125). Stockholm: Appell Förlag
Open this publication in new window or tab >>Etiskt stöd till personalen: etikronder
2022 (Swedish)In: Etikarbete i vårdens vardag / [ed] Silfverberg, G., Stockholm: Appell Förlag , 2022, p. 103-125Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Appell Förlag, 2022
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-40313 (URN)9789198664201 (ISBN)
Available from: 2022-10-27 Created: 2022-10-27 Last updated: 2022-12-05Bibliographically approved
Lundin, K., Silén, M., Strömberg, A., Engström, M. & Skytt, B. (2022). Staff structural empowerment - observations of first-line managers and interviews with managers and staff. Journal of Nursing Management, 30(2), 403-412
Open this publication in new window or tab >>Staff structural empowerment - observations of first-line managers and interviews with managers and staff
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2022 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 30, no 2, p. 403-412Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to study how first-line managers act to make structural empowerment accessible for nursing staff. Furthermore, to relate these observations to the manager's and their nursing staff's descriptions regarding the staff's access to empowering structures.

BACKGROUND: Staff access to empowering structures has been linked to positive workplace outcomes. Managers play an important role in providing the conditions for structural empowerment.

METHOD: Five first-line managers were observed for two workdays. Managers and staff (n=13) were thereafter interviewed. Field notes and interviews were analyzed using directed content analysis.

RESULTS: The managers displayed intentional actions that could enable their staff access to empowering structures. Managers and staff described the importance of staff's access to empowering structures.

CONCLUSION: Staff who perceive to have access to structural empowerment have managers who are present and available. Unanimity among managers and staff existed in regard to the importance of staff having access to structural empowerment. The managers work continually and intentionally, doing many things at the same time, to provide the staff access to empowering structures.

IMPLICATIONS FOR NURSING MANAGEMENT: The study shows the importance of promoting managers' awareness of staff's access to structural empowerment and maximizing managers' presence and availability to their staff.

Place, publisher, year, edition, pages
Wiley, 2022
Keywords
hospital, nurse managers, nurses, observation, structural conditions, working conditions
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-37389 (URN)10.1111/jonm.13513 (DOI)000732481200001 ()34783103 (PubMedID)2-s2.0-85121509064 (Scopus ID)
Available from: 2021-11-18 Created: 2021-11-18 Last updated: 2023-02-17Bibliographically approved
Lundin, K., Silén, M., Strömberg, A., Engström, M. & Skytt, B. (2021). Observations and interviews describing first-line manager’s work at hospitals where the staff rates high access to empowering structures. In: : . Paper presented at Nordic Conference in Nursing Research (NCNR 2021), 4-6 October, 2021, Copenhegen, Denmark.
Open this publication in new window or tab >>Observations and interviews describing first-line manager’s work at hospitals where the staff rates high access to empowering structures
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2021 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background

In times where hospitals are struggling with recruitment as well as keeping their current workers healthy and willing to stay on, it is important to identify factors that can help work organizations in their work of providing conditions for a good work environment and for a leadership that promotes health and development.

Objective

The aim was to study how first-line managers act at units where the staff has rated their access to empowering structures as high and to describe this together with the first-line managers' and their staff's descriptions regarding the staff's access to empowering structures by using Kanter's theory of structural empowerment as a framework. 

Method

A descriptive design with a qualitative approach collecting data using both observations and interviews. The study sample consisted of five first-line managers (FLM) and 13 staff members, at hospital units in different parts of Sweden, where the staff had rated their access to empowering structures as high using the Conditions of Work Effectiveness Questionnaire – II (CWEQ II) in a previous data collection.

Both the first and last author conducted 80 hours of observations, following each FLM during two workdays, and 15 hours of interviewing both the FLMs and staff members. Fieldnotes of what the FLMs were doing were taken during the observations. On the third day at the unit, interviews were conducted with the FLM and two or three out of their staff. The interviews were semi-structured with questions related to the observations and questions inspired by Kanter’s theory. Data from both MP3 files and notebooks were transferred into a Word document and directed content analysis informed by Kanter’s theory was performed on the material as a whole.

Results

Preliminary results from the ongoing analysis indicate that findings in both the observations and interviews often confirm and support each other.

 

Keywords
hospital, nurse managers, nurses, observation, structural conditions, working conditions
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-40020 (URN)
Conference
Nordic Conference in Nursing Research (NCNR 2021), 4-6 October, 2021, Copenhegen, Denmark
Available from: 2022-09-28 Created: 2022-09-28 Last updated: 2023-02-17Bibliographically approved
Silén, M. & Svantesson, M. (2019). Impact of clinical ethics support on daily practice: First-line managers' experiences in the Euro-MCD project. Journal of Nursing Management, 27(7), 1374-1383
Open this publication in new window or tab >>Impact of clinical ethics support on daily practice: First-line managers' experiences in the Euro-MCD project
2019 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 7, p. 1374-1383Article in journal (Refereed) Published
Abstract [en]

AIM: To explore first-line managers' experiences of what Moral Case Deliberation has meant for daily practice, to describe perceptions of context influence and responsibility to manage ethically difficult situations.

BACKGROUND: In order to find measures to evaluate Moral Case Deliberation, the European Moral Case Deliberation Outcome instrument was developed and is now in the stage of revision. For this, there is a need of several perspectives, one of them being the managerial bird-eye perspective.

METHOD: Eleven first-line managers at workplaces, participating in the European Moral Case Deliberation Outcome instrument project, were interviewed and thematic analysis was applied.

RESULTS: Managers' experiences were interpreted as enhanced ethical climate: a closer-knit and more emotionally mature team, morally strengthened individuals, as well as ethics leaving its marks on everyday work and morally grounded actions. Despite organizational barriers, they felt inspired to continue ethics work.

CONCLUSION AND IMPLICATIONS: This study confirmed, but also added ethical climate aspects, such as morally grounded actions. Furthermore, adding ethical climate as a construct in the European Moral Case Deliberation Outcome instrument should be considered. First-line managers need clear directives from their managers that ethics work needs to be prioritized for the good of both the staff and the patients.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
first-line managers, impact of ethics on everyday work, moral case deliberation
National Category
Other Medical Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-30556 (URN)10.1111/jonm.12818 (DOI)000474970200001 ()31220384 (PubMedID)2-s2.0-85068915942 (Scopus ID)
Funder
AFA Insurance
Note

Funding:

- University of Gävle

Available from: 2019-08-22 Created: 2019-08-22 Last updated: 2021-04-14Bibliographically approved
Silén, M. & Svantesson, M. (2019). Is ethical climate an outcome of Moral Case Deliberation?. In: : . Paper presented at ICCEC 2019 - 15th International Conference on Clinical Ethics Consultation, 22-25 May 2019, Vienna, Austria.
Open this publication in new window or tab >>Is ethical climate an outcome of Moral Case Deliberation?
2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-30761 (URN)
Conference
ICCEC 2019 - 15th International Conference on Clinical Ethics Consultation, 22-25 May 2019, Vienna, Austria
Available from: 2019-10-09 Created: 2019-10-09 Last updated: 2021-04-01Bibliographically approved
Silén, M., Skytt, B. & Engström, M. (2019). Relationships between structural and psychological empowerment, mediated by person-centred processes and thriving for nursing home staff. Geriatric Nursing, 40(1), 67-71
Open this publication in new window or tab >>Relationships between structural and psychological empowerment, mediated by person-centred processes and thriving for nursing home staff
2019 (English)In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 40, no 1, p. 67-71Article in journal (Refereed) Published
Abstract [en]

Person-centred care has been shown to have positive outcomes for patients and for staff. However, the complexity of the link between structural conditions, work in a person-centred manner and outcomes for staff is insufficiently described. We tested the relationship between structural empowerment and psychological empowerment, as mediated by nursing home staff members’ self-ratings of working in a person-centred manner, the person-centred climate and thriving. Questionnaires were distributed to staff working in 12 nursing homes in Sweden. A serial mediation model was tested. The results showed that higher access to structural empowerment was related to higher psychological empowerment mediated by staff working in a more person-centred manner, improved person-centred climate, and improved staff ratings of thriving. These results point to the importance of strengthening the preconditions for staff to work in a person-centred manner and nursing home managers play an important role in this.

Keywords
Nursing home staff, Outcomes, Person-centred processes, Structural conditions
National Category
Other Medical Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-27863 (URN)10.1016/j.gerinurse.2018.06.016 (DOI)000459952500010 ()30120010 (PubMedID)2-s2.0-85051509200 (Scopus ID)
Note

Funding:

- University of Gävle- Uppsala University- Regional Development Council of Gävleborg 

Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2022-09-20Bibliographically approved
Silén, M. (2018). Etiska aspekter på omvårdnad och prioriteringsspekter på omvårdnad och prioritering. In: Hommel, A. & Andersson, Å. (Ed.), Kvalitetsutveckling inom omvårdnad: sjuksköterskans professionella ansvar (pp. 29-43). Lund: Studentlitteratur AB
Open this publication in new window or tab >>Etiska aspekter på omvårdnad och prioriteringsspekter på omvårdnad och prioritering
2018 (Swedish)In: Kvalitetsutveckling inom omvårdnad: sjuksköterskans professionella ansvar / [ed] Hommel, A. & Andersson, Å., Lund: Studentlitteratur AB, 2018, p. 29-43Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur AB, 2018
National Category
Nursing
Research subject
no Strategic Research Area (SFO)
Identifiers
urn:nbn:se:hig:diva-40310 (URN)9789144121338 (ISBN)
Available from: 2022-10-27 Created: 2022-10-27 Last updated: 2022-12-05Bibliographically approved
Svantesson, M., Silén, M. & James, I. (2018). It’s not all about moral reasoning: Understanding the complex content of Moral Case Deliberation. Nursing Ethics, 25(2), 212-229
Open this publication in new window or tab >>It’s not all about moral reasoning: Understanding the complex content of Moral Case Deliberation
2018 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 25, no 2, p. 212-229Article in journal (Refereed) Published
Abstract [en]

Background:

Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain.

Objective:

To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces.

Methods:

A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority.

Ethical considerations:

No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation.

Findings:

Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%).

Conclusion:

The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

Keywords
Clinical ethics; ethics consultation; ethics rounds; healthcare professionals; Moral Case Deliberation; psychosocial aspects; qualitative research
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-23612 (URN)10.1177/0969733017700235 (DOI)000429899900008 ()28421865 (PubMedID)2-s2.0-85044337153 (Scopus ID)
Funder
AFA Insurance
Available from: 2017-02-13 Created: 2017-02-13 Last updated: 2022-09-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9457-9521

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