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Background: Postoperative pain management is important for patients' well-being and mobility. It also reduces the length of hospital stays and prevents complications. Based on our own clinical experience, data on pain in cancer patients from Norway and on postoperative pain from other countries, we expected that a substantial proportion of patients staying in Norwegian hospitals would report postoperative pain of high intensity., Material and Methods: 215 in-patients from 14 Norwegian hospitals participated in a study of pain during the first 24 hours after operations. The study was based on medical records and data reported by the patients themselves., Results: On an 11-point numerical scale, the mean intensity of pain was 3.0 (SD 2.1) during the first 24 hours. 8 % of patients reported that the intensity of even the weakest pain during rest had been ≥ 4, 38 % reported a mean intensity ≥ 4 and 11 % reported a mean ≥ 6. The medical records contained information about the intensity of postoperative pain for only 22 % of the patients. Reports from patients indicated that 52 % had been asked to report the intensity of pain on a scale as part of the hospital routine, while 78 % and 74 % had been asked about the need for additional pain alleviation and whether the medication was effective., Interpretation: Many patients reported pain of strong intensity during the first 24 hours after operations. There is a great potential for improved documentation and treatment of pain.

Objectives: Clinicians' recognition of patients' concerns is an important component of effective treatment and care. During a consultation, patients often do not express their concerns directly, but rather present them indirectly as hints or cues. The aim of this study was to explore the types of concerns and cues patients expressed in an initial consultation with a nurse at a pain clinic, how and who initiated these cues and concerns, and predictors of these expressions., Methods: Initial consultations between patients with fibromyalgia [n=58, 85% female, duration 30 minutes, mean age 47.8 y (SD 10.7)] and clinical nurse specialists (n=5) were videotaped. Patients' cues and concerns were coded using the Verona Coding Definitions of Emotional Sequences. Nurses' responses to patients' cues and concerns were evaluated using the Hierarchical Coding Scheme of Comforting Strategies. In addition, pain intensity and duration, overall evaluation of health, affect at the start of the consultation, and psychological distress were evaluated., Results: Patients expressed more cues than concerns, mostly about pain, interpersonal relationships, and/or emotional reactions. Both the lack of empathic responding and unspecific empathic responding were associated with the expression of an increased number of cues in the consultation, whereas higher evaluation of health was associated with less cues. More concerns were expressed by patients when nurses exhibited a high level of empathic responding and when the patient entered the consultation with a higher level of negative effect., Discussion: Findings from this study highlight the importance of a patient centered communication style to facilitate the expression of cues and concerns.

Purpose of Research: To determine the effect of the hope intervention (HOPE-IN) on levels of hope and psychological distress immediately (T2), 3 (T3), and 12 (T4) months following the intervention; determine the effects of the HOPE-IN on changes in patients' level of hope after controlling for baseline levels of psychological distress; and evaluate patients' level of satisfaction with the HOPE-IN., Methods and Sample: This single group, longitudinal study recruited a community-based sample which cancer. Most of the participants (n = 195) were females, married, and had breast cancer. The HOPE-IN consisted of eight 2-h sessions conducted over 8 weeks. Data were collected on demographic and clinical characteristics, hope (Herth Hope Index), psychological distress (Impact of Event Scale (IES)), and satisfaction with the HOPE-IN., Key Results: Hope scores increased significantly from T1 to T2, and then decreased slightly from T2 through T4. Both intrusion and avoidance IES scores decreased significantly from T1 to T2 and then decreased slightly from T2 to T4. The changes in hope scores remained significant even when baseline scores on intrusion were controlled for in the analyses. Baseline level of hope was negatively correlated with baseline intrusion and avoidance scores. These findings indicate that the trajectories of hope scores remained the same conditioned on intrusion or avoidance. Over 95% of the participants reported that the HOPE-IN was useful to them., Conclusions: Additional research is warranted to determine the most effective approaches to increase hope and reduce psychological distress in individuals who are living with a cancer diagnosis., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Unlabelled: The purpose of this study was to evaluate the prevalence and characteristics of pain in patients with chronic obstructive pulmonary disease (COPD) compared to a sample from the Norwegian general population. This cross-sectional study evaluated 100 COPD patients with and without pain and 333 individuals from the Norwegian population with pain. After controlling for age and sex, a significantly higher percentage of patients with COPD (45%) reported pain than the general population (34%; P = .02). No differences were found in pain intensity scores, pain interference score, or number of pain locations between COPD patients and the general population. COPD patients reported moderate-to-severe pain located primarily in the chest, shoulders, neck, and thorax. For both groups, the most common pain treatment was analgesic use. Acupuncture/transcutaneous electrical nerve stimulation was used more frequently by COPD patients (P < .001) while physiotherapy was used more frequently by the general population (P = .007) to treat their pain. Pain is a significant problem for COPD patients. Additional research is warranted to replicate these findings and to provide a more detailed characterization of how pain changes over time and influences COPD patients' ability to function and their quality of life., Perspective: Compared to the general population, pain is more common in patients with COPD and ranges from moderate to severe in its intensity., (Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.)

Aims: Mental disorders are serious public health problems and mental disorders have an impact on individuals' health-related quality of life (HRQoL). Therefore, the aim of this study was to evaluate for differences in psychological distress and HRQoL outcomes between long-term social assistance recipients (LTRs) and the general population in Norway. In addition, differences in HRQoL outcomes were evaluated in LTRs and general population who reported clinically meaningful levels of psychological distress., Methods: In this cross-sectional study, which is part of a larger study that evaluated the health and functional abilities of LTRs in Norway, 393 LTRs were compared to a similar aged group (n = 3919) from the general population. Psychological distress was measured using the Hopkins Symptom Checklist., Results: LTRs were significantly younger (p < 0.001), more likely to be male (p = 0.001), more likely to be never married or divorced (p < 0.001), and have less education (p < 0.001) than members of the general population. LTRs reported significantly higher total mean psychological distress scores than the general population. More LTRs (57.0%) than general population (10.1%; p < 0.001) reported clinically meaningful levels of psychological distress. LTRs with a psychological distress score >1.85 reported lower mental component scores on the SF-12 than general population., Conclusions: In the total sample, LTRs experienced more psychological distress and reported poorer HRQoL than the general population. Clinically meaningful levels of psychological distress occurred more frequently in LTRs than general population. The LTRs and the general population with psychological distress rated both the physical and mental components of HRQoL lower than LTRs and general population without psychological distress.

Objective: A challenging but main task for clinicians is to identify patients' concerns related to their medical conditions. The study aim was to validate a new coding scheme for identifying patients' cues and concerns., Methods: 12 videotaped consultations between nurses and pain patients were coded according to the Verona Coding Scheme for Emotional Sequences (VR-CoDES). During a metainterview each patient watched his/her own video interview with the researcher to confirm or disconfirm the identified cues and concerns. A directive or an open format was applied. Quantitative and qualitative data analyses were performed., Results: Patients' confirmation in relation to the coding gave a sensitivity of 0.95 and specificity of 0.99 in the directive format and a sensitivity of 0.99 and specificity of 0.70 applying the open format. Through a qualitative analysis 83% of researcher-identified cues and concerns were validated. 17% were not confirmed or uncertain., Conclusion: The VR-CoDES seems to capture what are experienced as real concerns to patients, and proves to be a coding scheme with a high degree of ecological validity., Practice Implications: The VR-CoDES provides a valid framework for detecting patients' cues and concerns, and should be explored as a training tool to develop clinicians' empathic accuracy., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Purpose: The purposes of this study were to compare the health-related quality of life (HRQOL) of long-term social assistance recipients (LTRs) with and without chronic pain and determine the effect of select demographic, social, pain, alcohol, and illicit drug use characteristics on the physical and mental components of their HRQOL., Methods: In this cross-sectional study, which is part of a larger study that evaluated the health and functional abilities of LTRs in Norway, 405 LTRs of which 178 had chronic pain were recruited from 14 of 433 municipalities., Results: LTRs with chronic pain were older (P < .001), more often married (P = .002), feeling more lonely, (P = .048), and had more problems with alcohol (P = .035). The final regression model explained 41.2% (P < .001) of the variance in PCS scores and 32.2% (P < .001) of the variance in MCS scores. Being in chronic pain (29.7%), being older (4.7%), and never married (2%) predicted worse PCS scores. Feeling lonely (11.9%), having problems with illicit drug use (5.9%), and being in chronic pain (2.9%) predicted worse MCS scores., Conclusion: LTRs with chronic pain rated both the physical and mental components of HRQOL lower than LTRs without chronic pain. The MCS score in both groups was negatively effected.

Objectives: Long-term social assistance recipients (LTRs) struggle with numerous health issues. However, no data are available on the prevalence of chronic pain in these individuals. The purpose of this study was to determine the prevalence and characteristics of chronic pain (ie, pain >3 mo) among LTRs in Norway compared to the general population (GP)., Methods: In this cross-sectional study, which is part of a larger study that evaluated the health and functional abilities of LTRs in Norway, 405 LTRs of which 178 had chronic pain, were compared to a similar aged group (n=1455) from the general population. The LTRs were recruited from 14 of 433 municipalities., Results: The LTRs were significantly younger (P<0.001), more likely to be male (P<0.001), and had less education (P<0.001) than the GP. The prevalence of chronic pain was significantly higher in the LTR sample (44.0%) compared to the GP sample (23.9%; P<0.001). A higher percentage of LTRs compared to the GP reported accidents (P=0.002) as the cause of their pain., Discussion: The fact that 44.0% of the LTRs reported chronic pain, compared to only 23.9% of the GP suggests that chronic pain is a significant problem for LTRs in Norway. Additional research is warranted to determine the exact etiologies for and the impact of chronic pain on LTRs.

Background: Although hope is an important resource for cancer patients, few studies include it as an independent or dependent variable in quality-of-life research., Objective: The purposes of this study, in a community-based sample of cancer patients, were to evaluate the relationships between demographic and clinical characteristics, health status, hope, psychological distress, and life satisfaction and evaluate whether hope mediated the relationship between psychological distress and life satisfaction., Methods: Participants (n = 194) completed a demographic and clinical questionnaire, a single item of self-assessed health, the Herth Hope Index, Impact of Event Scale, and a single-item rating of satisfaction with life. Structural regression models were examined to evaluate the interrelationships among these variables, with life satisfaction as the primary outcome., Results: Participants were primarily women with breast cancer. In the final structural regression model that explained 60% of the variance in life satisfaction, poorer health status, lower hope, and higher psychological distress were significantly related to lower satisfaction with life. Hope was found to mediate the relationship between psychological distress and health status, such that the direct association between distress and health status was no longer significant with hope in the model. Finally, hope partially mediated the association between psychological distress and life satisfaction., Conclusions: These data suggest that hope is an important resource for oncology patients that impacts their quality of life., Implications for Practice: Hope may be an important coping mechanism that clinicians need to consider when they try to help patients reduce the psychological distress associated with cancer and its treatment.

Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory-Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important., ((c) 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objective: This study evaluated the pain experiences of patients with chronic obstructive pulmonary disease (COPD)., Sample: We studied 16 patients with severe COPD., Design: A semistructured interview was performed to obtain information on patients' experiences with pain and the impact of pain on quality of life (QOL). Data were analyzed using the methodology of Kvale., Results: Three main themes emerged: incomprehensible and unbearable pain; locked in my body and shut out from the world; and the vicious COPD circle. Patients reported moderate to severe pain located primarily in the shoulders, neck, upper arms, and chest. Patients reported a number of severe symptoms occurring simultaneously, and negatively affecting each other. Vicious circles of pain, breathlessness, sleep disturbance, and anxiety were described as exerting negative effects on patients' QOL., Conclusion: Unrelieved pain appears to be a significant problem in patients with COPD. Research is warranted to determine if pain is clustered with other symptoms, and how these symptoms affect the clinical management of COPD., (Copyright 2010 Elsevier Inc. All rights reserved.)

Pain is a major problem in the nursing home population, with a prevalence range of 27% to 84%. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain, 2008). It has an impact on many aspects of a person's emotional, social, and physical functioning, and on quality of life (QoL) The purpose of this study was to describe pain and QoL in a nursing home population that could self-report pain and to examine the association between QoL and pain in these patients. Pain was measured by a verbal rating scale from "no pain" to "severe pain." Quality of life was measured by the Dementia Quality of Life Questionnaire (DQoL) consisting of five domains: self-esteem, positive affect/humor, feeling of belonging, and sense of esthetics and negative affect. Totally, 106 patients, with a mean age of 86 years (SD 6.5, range 65-102) with a Mini Mental State Examination (MMSE) score >11 were included, and 87% had mild or moderate reduced cognitive function. In total, 55% reported pain, and out of those, 55% reported mild, 29% moderate, and 16% severe pain. A significant association was found between scores on the negative affect domain and reported pain (t = 3.17; p < .01) and pain intensity (r = 0.40; p < .01). No significant associations were found between the other domains and pain. This study shows that pain has a negative effect on mood. Examining the relationship between pain and negative feelings in persons with reduced cognitive function may suggest new areas of intervention for reducing pain and negative feelings in this patient population., (Copyright 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Pain measurement in nonverbal older adults is best based on behavioural observation, e.g. using an observational measurement tool such as Doloplus-2. The purposes of this study were to examine the use of Doloplus-2 in a nonverbal nursing home population, and to evaluate its reliability and validity by comparing registered nurses' estimation of pain with Doloplus-2 scores., Method: In this cross-sectional study, Doloplus-2 was used to observe the pain behaviour of patients aged above 65 years who were unable to self-report their pain. Nurses also recorded their perceptions of patient pain (yes, no, don't know) before they used Doloplus-2. Data on demographics, medical diagnoses, and prescribed pain treatment were collected from patient records. Daily life functioning was measured and participants were screened using the Mini Mental State Examination., Results: In total, 77 nursing home patients were included, 75% were women and the mean age was 86 years (SD 6.6, range 68-100). Over 50% were dependent on nursing care to a high or a medium degree, and all were severely cognitively impaired. The percentage of zero scores on Doloplus-2 ranged from 17% (somatic reactions) to 40% (psychosocial reactions). Cronbach's alpha was 0.71 for the total scale. In total, 52% of the patients were judged by nurses to be experiencing pain, compared with 68% when using Doloplus-2 (p = 0.01). For 29% of the sample, nurses were unable to report if the patients were in pain., Conclusions: In the present study, more patients were categorized as having pain while using Doloplus-2 compared with nurses' estimation of pain without using any tools. The fact that nurses could not report if the patients were in pain in one third of the patients supports the claim that Doloplus-2 is a useful supplement for estimating pain in this population. However, nurses must use their clinical experience in addition to the use of Doloplus-2, as behaviour can have different meaning for different patients. Further research is still needed about the use of Doloplus-2 in patients not able to self-report their pain.

The purposes of this study were to determine a clinically significant cutpoint for worst pain and to evaluate for differences in the use of pain coping strategies between oncology inpatients with mild (i.e., worst pain intensity scores of 4) pain based on results of the cutpoint analysis. Oncology inpatients in pain (n=224) completed the Coping Strategies Questionnaire (CSQ), the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Fifty-six percent had moderate to severe pain. Patients in the moderate to severe pain group had significantly poorer Karnofsky Performance Status scores (P=0.04) and significantly lower ratings of overall health (P<0.0001). No differences were found between the two pain groups on any of the subscales of the CSQ, except catastrophizing (P<0.0001). Compared with the mild pain group, patients in the moderate to severe group scored significantly higher on this subscale. In addition, patients in the moderate to severe group used more passive coping strategies (P=0.02). Except for catastrophizing, the number and types of pain coping strategies used by this sample of hospitalized patients do not appear to be influenced by their pain intensity scores. Finally, when the CSQ scores of these hospitalized oncology patients were compared with those found in previous studies of oncology outpatients and patients with chronic noncancer pain, the scores were similar.

Purpose: The aims of this paper were to evaluate the relationship between chronic pain and global quality of life (GQOL) and to explore the effect of possible confounders, mediators, and moderators such as selected demographic variables, chronic illnesses, stress-related symptoms, fatigue, and subjective health of the relationship between chronic pain and GQOL., Methods: We used a cross-sectional design, including 1,893 respondents from a population of 4,000 of Norwegian citizens, aged 19-81 years, who were randomly drawn from the National Register by Statistics Norway in November 2000 (48.5%). Pain duration of more than 3 months was categorized as having chronic pain. The Quality of Life Scale, the Fatigue Severity Scale, and the Posttraumatic Stress Scale were used as our main dependent and independent variables, respectively. A series of multiple regression analyses (GLM in SPSS) were applied using GQOL as the dependent variable, entering subsets of independent variables in a theoretically predefined sequence., Results: In the total model, there was no significant relationship between chronic pain and GQOL. The model explained 39% of the variance in GQOL. For direct effect sizes, stress-related symptoms were related most strongly to GQOL, followed by subjective health, fatigue, chronic illnesses, and selected demographic variables., Conclusion: These findings support the assumption of a complex and indirect relationship between chronic pain and GQOL.

The Barriers Questionnaire II (BQ-II) was developed to assess barriers to effective pain management. The purpose of this study was to evaluate the psychometric properties of the BQ-II in a sample of Norwegian cancer patients. The BQ-II was translated into Norwegian and pilot tested with eight oncology outpatients. Then, a convenience sample of 321 cancer patients from two different sites was recruited to maximize the number of questionnaires available for the psychometric analyses. Patients were included if they: were >18 years of age; had a diagnosis of cancer; and self-reported pain and/or use of analgesics. Construct validity of the Norwegian version of the BQ II (NBQ-II) was evaluated using an exploratory factor analysis. A seven-factor solution was found that was more consistent with the original version of the BQ. Construct validity of the NBQ-II was demonstrated through positive correlations between most of the subscale and total scores on the NBQ-II and pain intensity and pain interference scores. Finally, Cronbach's α coefficients of ≥0.7 for six of the seven subscales and 0.89 for the total scale demonstrated acceptable levels of internal consistency. In conclusion, the NBQ-II demonstrated adequate psychometric properties. However, further revision and testing of the questionnaire should be performed to confirm the factor structure that was identified in this study., (© 2008 The Authors. Journal compilation © 2008 Nordic College of Caring Science.)

Objectives: The aims of this study of oncology outpatients with cancer pain were to perform an exploratory factor analysis (EFA) of the 48-item Coping Strategy Questionnaire (CSQ) and a confirmatory factor analysis of the 6-factor solution of the Coping Strategy Questionnaire-Revised (CSQ-R) suggested by Riley and Robinson in 1997. In addition, differences in latent factor means and in the CSQ-R subscale scores between inpatients and outpatients were evaluated., Methods: Data from oncology outpatients (n=217) and inpatients (n=225) with pain were used. The Mplus program was used to perform both the EFA and confirmatory factor analysis treating the items as ordinal, and using robust maximum likelihood estimation. Quartimin oblique rotation was used for the EFA. Model fit was evaluated with the chi test, the comparative fit index, the root mean square error of approximation, and the standardized root mean square residual, as well as by substantive evaluation of the solutions., Results: The EFA of the original 48-item CSQ did not reproduce the factor structure defined by Rosentiel and Keefe. The 6-factor structure from the 27-item CSQ-R fit both the inpatient and outpatient data well with strong factorial invariance, as well as the combined data, allowing some correlated errors among items. Differences were found between the 2 samples for the ignoring, catastrophizing, and praying latent factor means, and for the catastrophizing and praying subscale means., Discussion: The 27-item CSQ-R is recommended for use as a clinical instrument. However, further research of the 6-factor structure is recommended to identify reasons for the correlated errors.

Pain is a significant symptom in cancer patients. Understanding of patients' experiences in relation to pain management is important in evidence-based nursing in the field of pain. The aim of this study was to explore cancer patients' experiences of nursing pain management during hospitalization for cancer treatment. Eighteen cancer patients participated in the study, all with advanced cancer, including skeleton metastases. The female participants all had breast cancer, and the male participants all had prostate cancer. Data were collected by in-depth interviews, and qualitative description was used to entail low-inference interpretation to reach an understanding of the essence of pain and nursing pain management. Patients found it somewhat difficult to express their expectations of nursing pain management and competencies. However, 1) being present and supportive; 2) giving information and sharing knowledge; 3) taking care of medication; and 4) recognizing the pain emerged as themes in nursing pain management. Although patients believed that nurses were caring persons, they perceived differences between nurses in the ways they handled pain management. Furthermore, some patients experienced a lack of information from nurses in relation to pain management. Although cancer patients' experiences showed the importance of nurses in pain management, it seems that nurses should have a clearer role in cancer pain management in relation to counseling and patient education. The results from this study can increase nurses' awareness of their role in pain management as a first step in improving pain management for patients.

Objective: The aims of this study were to describe hope in a sample of hospitalized oncology patients in pain and to determine if various demographic, clinical, and pain characteristics were related to hope. In addition, the individual item and total Herth Hope Index (HHI) scores for these oncology inpatients with pain were compared with those from the general Norwegian population., Method: Oncology inpatients in pain (n = 225) were recruited from the Norwegian Radium Hospital. The research instruments included the HHI, the Brief Pain Inventory (BPI), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Data were analyzed using descriptive statistics, Pearson's correlations, and one-sample t tests., Results: Total HHI scores in oncology inpatients with pain were comparable to a similar sample in Taiwan. The Norwegian oncology inpatients reported significantly higher total HHI scores than the general Norwegian population. The largest difference was on the item "I feel scared about my future." No relationships were found between total HHI scores and any of the pain intensity scores. Significant relationships were found between total HHI scores and the more psychosocial interference items on BPI and sleep., Significance of Results: The higher levels of hope in the oncology inpatients with pain compared with the general Norwegian population may reflect a "response shift" in the patients' evaluation of hope. Although the difference is relatively small, it may represent a clinically meaningful difference. The fact that significant relationships were found between HHI scores and the more psychosocial interference scores on BPI suggest that hope may be more related to psychosocial effects on pain than on its physical effects.

The pain experience of patients with heart failure (HF) and its impact on their quality of life (QOL) has not been described in sufficient detail. This study sampled patients hospitalized with HF to describe the prevalence and severity of bodily pain; evaluate differences in bodily pain related to selected demographic and disease-specific characteristics; and evaluate the effect of selected demographic, disease-specific characteristics, bodily pain, and mental health on QOL. Two items from the Medical Outcomes Study--Short Form (SF-36) were used to measure pain, and one subscale of the SF-36 was used to evaluate mental health. The Minnesota Living With Heart Failure Questionnaire was used to measure QOL. Patients with HF (n=93) had a mean age of 75 years, were predominantly male (65%), and lived alone (47.3%). Lung diseases and diabetes were the most common comorbidities; 58% were categorized as New York Heart Association (NYHA) Class III, whereas 58% of the sample was diagnosed with HF in the past four years. Of note, 85% of the patients reported pain and 42.5% said that it was in the severe or very severe range. No demographic variables were associated with pain, whereas a higher number of chronic conditions were associated with pain. SF-36 mental health and pain scores, as well as NYHA class, explained 34.1% of the variance in QOL in patients with HF. These data suggest that pain is highly prevalent and has a significant impact on the QOL of patients with HF. However, additional research is warranted to determine the specific causes and characteristics of pain in these patients.

Unlabelled: Cut-points (CP) for pain severity are useful because they may help clinicians to identify patients with clinically significant pain. However, a need exists to evaluate whether different pain severity groups differ on selected demographic, clinical, and pain characteristics, as well as on factors that may be amenable to psychoeducational interventions such as self-efficacy for pain management, coping strategies, and barriers to pain management. In this cross-sectional study of 210 oncology outpatients with pain, an optimal CP of 4 was found using ratings of average pain intensity. The variables that provided a unique contribution to the prediction of membership in the >4 CP group were gender, presence of breakthrough pain, comorbidities, barriers to pain management, and total self-efficacy for pain management. In addition, patients in the >4 CP group reported lower scores on physical, role, cognitive, and global health function., Perspective: An average pain CP of >4 could be used to screen oncology outpatients with clinically significant pain. Clinicians must consider a number of demographic, clinical, and pain characteristics as part of their pain assessment procedures. The effectiveness of psychoeducational interventions aimed at barriers and patients self-efficacy for pain management need to be tested.

Objectives: Inadequate adherence with an analgesic regimen may be a reason why oncology patients experience unrelieved pain. However, only a limited number of studies have evaluated the prevalence rates for adherence and no studies have attempted to determine predictors of adherence in patients with cancer pain. On the basis of concepts from the Health Belief Model, the purposes of this study were to describe oncology outpatients' level of adherence with an analgesic regimen and to evaluate the direct and indirect effects of selected demographic variables, pain characteristics, barriers to pain management, and self-efficacy (SE) on adherence with an analgesic regimen., Methods: A descriptive, cross-sectional study recruited outpatients from oncology clinics in a large, tertiary referral cancer hospital in Norway. A sample of 174 oncology outpatients completed a demographic questionnaire, the Brief Pain Inventory, 2 self-reported adherence measures, the Barriers Questionnaire, and a SE questionnaire., Results: Only 41% of the patients were adherent with their analgesic regimen. In the regression analysis, 29.9% of the variance in adherence was explained. Higher adherence scores were associated with male sex, and also lower SE for physical function scores, higher average pain intensity scores, higher pain relief scores, and the use of strong opioid analgesics., Conclusions: Improvements in pain management may occur if clinicians routinely assessed patients' level of adherence with their analgesics regimen.

Aim: The aim of this study was to examine pain and quality of life in a group of preoperative chronic low back pain patients (n = 25) and a group of postoperative chronic low back pain patients (n = 101) treated with instrumented fusion 1-8 years ago., Background: Reduced quality of life is common in chronic low back pain patients and the aim of treatment is to improve quality of life., Design: In the present study, a comparative survey design was used., Methods: The McGill Pain Questionnaire and the SF-36 Health Survey were used to examine pain and quality of life., Results: The pre- and postoperative groups did not differ with regard to age, gender, education, other chronic conditions or previous spinal surgery. Compared with the preoperative group, the postoperative group reported significantly lower total, sensory, affective and evaluative pain, used less pain medication (p < 0.05) and reported better scores in all SF-36 components (p < 0.05), except for general health. The effect size was > or =0.8 for all pain components and > or =0.4 for all SF-36 components, except for general health (effect size = 0.009). With regard to long-term follow-up, patients who underwent surgery 5-8 years ago reported better physical role functioning (p < 0.05) compared with those who underwent surgery 1-2 years ago., Conclusion: Results showed that the postoperative group reported significantly less pain and better physical and mental health compared with the preoperative group. However, despite surgery, the postoperative group reported suffering from pain and reduced quality of life. Relevance to clinical practice. Psychosocial interventions focusing on psychosocial consequences of pain are needed to modify the pain experience and increase the quality of life in patients who have undergone this kind of surgery.

Purpose: To determine the self-reported prevalence rates for cancer, non-cancer, and both cancer and non-cancer pain and to determine if there were differences in demographic, clinical, and pain characteristics among the three pain groups., Methods: Patients were screened in outpatient oncology clinics for the presence of pain and/or analgesic use. Patients who reported pain completed the study questionnaires., Results: A total of 1790 patients were available for screening in the outpatient clinics and 1549 (86.5%) completed the screening questionnaire. Out of them, 332 (21.4%) reported pain or used analgesics. Of the 217 patients who completed the study questionnaires, 53% had only cancer pain (pain due to cancer and/or treatment), 25.3% had non-cancer pain, and 21.7% had both cancer and non-cancer pain. No differences were found, among the three pain groups, in pain intensity or pain duration. However patients in the cancer and non-cancer pain group had higher pain interference scores, higher severity scores for various pain descriptors, and a higher number of pain locations., Conclusions: These findings suggest that outpatients with a combination of cancer and non-cancer pain may be at greater risk for under-treatment of pain. Oncology clinicians and primary care providers need to perform a comprehensive pain assessment of all oncology patients in order to be able to formulate an effective pain management plan.

Aim: To examine differences in reported pain, pain management and satisfaction with pain management between middle-aged and elderly patients. The study also examined differences in global quality of life (QoL) and pain interference with patient function between middle-aged and elderly patients with bone metastases., Method: A one-day prevalence study was performed, targeting hospitalized cancer patients 18 years and over in Norwegian hospitals; 79 patients with bone metastases were included., Results: In total, 89% of patients reported daily pain, and there was no significant difference between the two age groups (p=0.52). Elderly patients reported significantly higher scores for 'worst pain' (p=0.036) and 'pain severity intensity' (p=0.027), but received strong opioids for their cancer pain significantly less often than middle-aged patients (p=0.024). We found a significant linear association between increasing age and decreasing scores on Cleeland's pain management index (p=0.002). There were no statistically significant differences between age groups in satisfaction with pain management, pain interference with functioning or global QoL., Conclusion: These results indicate that more focus is needed on pain management in elderly cancer patients with bone metastases.

Background: Cutpoints (CPs) for mild, moderate and severe pain are established and used primarily in cancer pain. In this study, we wanted to determine the optimal CPs for mild, moderate, and severe pain in joint replacement surgery candidates with osteoarthritis (OA) of the hip or knee, and to validate the different CPs., Methods: Patients (n = 353) completed the Brief Pain Inventory (BPI), the WOMAC Arthritis Index, and the SF-36 health status measure. Optimal CPs for categorizing average pain with three severity levels were derived using multivariate analysis of variance, using different CP sets for average pain as the independent variable and seven interference items from the BPI as the dependent variable. To validate the CPs, we assessed if patients in the three pain severity groups differed in pain as assessed with WOMAC and SF-36, and if BPI average pain with the optimal CPs resulted in higher correlation with pain dimensions of the WOMAC and SF-36 than other CPs., Results: The optimal CPs on the 0-10 point BPI scale were CP (4,6) among hip patients and CP (4,7) among knee patients. The resulting pain severity groups differed in pain, as assessed with other scales than those used to derive the CPs. The optimal CPs had the highest association of average pain with WOMAC pain scores., Conclusion: CPs for pain severity differed somewhat for patients with OA of the hip and knee. The association of BPI average pain scores categorized according to the optimal CPs with WOMAC pain scores supports the validity of the derived optimal CPs.

Aim: In a sample of patients who underwent instrumented spinal fusions for chronic low back pain (CLBP), the purposes of this study were: to determine the amount of pain patients experienced and to determine the impact of length of time since surgery, use of pain medication and their outlook on the future on these pain intensity scores., Background: An increasing number of people report CLBP and one of the treatments is instrumented fusion., Method: The study used a cross-sectional design. Visual analogue scales were used to measure pain intensity in different locations and a single item measured patients' view of the future. Data were collected in November 2001., Results: The sample consisted of 101 patients (71% women) aged 26-59 years treated with instrumented fusion 1-8 years ago. As many as 87% reported pain 1-8 years after the surgery. Most patients reported pain of low-to-moderate intensity in the neck and shoulders, back and hips, feet and legs and in total pain. As many as 45% of the patients did not take pain medication and patients using more analgesics reported more pain than those using fewer analgesics (p < 0.05). Patients with a more positive outlook on the future reported significantly less pain in all of the locations that were evaluated (p < 0.01)., Conclusion: A high percentage of patients with CLBP continue to experience pain 1-8 years after spinal fusion. A positive outlook towards the future seems to be associated with less pain in these patients. Relevance to clinical practice. Patients who continue to experience pain and have a more negative outlook on the future may benefit from psychoeducational interventions that teach them how to better cope with their pain.

Unlabelled: This study describes the prevalence and occurrence of diabetic foot ulcer (DFU) pain and the impact of DFU pain on health-related quality of life (HRQL) using generic and disease specific instruments. Data were obtained from 127 patients with DFU who were recruited from 6 hospital-based diabetic outpatient clinics. HRQL was measured using the Medical Outcome Study-Short Form (SF-36) and the Diabetes Foot Ulcer Scale (DFS). Occurrence of pain was assessed using 2 items from the DFS (ie, pain while walking and/or standing and pain during the night related to foot ulcer problems). Seventy-five percent reported some pain related to DFU and 57% reported DFU pain while walking and/or standing and also during the night. Twenty-five percent reported pain none of the time. A higher percentage of patients with pain reported having a prescription for an analgesic medication than those without pain. Patients who reported pain most or all of the time had statistically and clinically significantly poorer HRQL than those who did not report pain. These findings suggest that pain associated with DFU is a significant clinical problem. Additional research is warranted to further characterize the pain associated with DFU and its impact on patient outcomes and HRQL., Perspective: Numerous basic and clinical studies have focused on pain associated with diabetic peripheral neuropathy. Findings from this study suggest a new pain problem in patients with diabetes, namely, pain associated with foot ulcers, that warrants further investigation.

Objectives: To describe age differences in chronic pain and to evaluate for differences in demographic and health-related variables among younger (18-39 years), middle-aged (40-59 years), and older adults (60-81 years) who reported chronic pain., Methods: A total of 4000 Norwegian citizens were mailed a questionnaire that measured pain, quality of life, mood, and demographic and health-related variables., Results: Of the total sample (n = 1912), 19.2% of the younger age group, 27.5% of the middle-aged group, and 31.2% of the older group reported chronic pain (ie, >3 months duration). A total of 58.9% of the participants in chronic pain reported having a chronic disease, with the most common being musculoskeletal problems, chronic pain disorder, and osteoarthritis. Participants in the older age group reported pain of longer duration and more comorbidities and received pain treatment more often. They had higher total quality of life scores, were more satisfied with their material comforts and social life, and reported better mood. The middle-aged group reported the largest number of pain locations, reported having fibromyalgia more frequently, and reported that the cause of their pain was not known. They were less satisfied with their social life than the older age group. The younger age group reported the highest rates of injury and accidents as the cause of their pain, and almost 43% of this age group was not receiving any treatment of their chronic pain., Conclusion: This study found that the prevalence rates for chronic pain do vary with age and that the middle-aged group may be a high-risk group of patients with chronic pain.

Background: Hope is seldom described in patients with heart failure, despite high morbidity and mortality for this population., Objectives: To describe hope in hospitalized patients with heart failure and to evaluate influences of demographic and health-related variables on hope., Methods: Ninety-three patients with heart failure and 441 healthy control subjects completed questionnaires about sociodemographics, health indices, disease severity, and the Herth Hope Index., Results: The patients with heart failure had a mean age of 75 years; 65% were men, and 47% lived alone. Lung diseases and diabetes were the most common comorbid diseases, with 58% classified as New York Heart Association class III. The mean global hope score among patients with heart failure was 37.69 (SD 5.3). Patients with skin (P = .01) and psychiatric (P = .02) disorders reported lower hope scores. Number of comorbid diseases was the only predictor of hope related to disease-specific variables (P = .01). Mean age of the control subjects was 60 years, and 66 (15%) lived alone. Once demographic variables were controlled for, patients with heart failure had significantly higher global hope scores than did control subjects., Conclusions: Adaptation to a life-threatening illness may induce a "response shift" that causes such patients to have more hope than the general population. Patients with heart failure may be more concerned with the past than the future. How patients judge their health and satisfaction with life influences their hope. Interventions supporting hope in patients with heart failure may influence treatment goals.

The relationship between pain and quality of life (QOL) in cancer patients is complex due to the number and the diversity of factors that can influence pain and QOL. The aims of this study of oncology outpatients with pain from bone metastasis were: 1) to determine the extent to which pain characteristics (i.e., severity, duration, meaning of pain, and perceived availability and efficacy of pain relief), psychological distress (i.e., depression), physical functioning, social functioning and QOL are intercorrelated, and 2) to determine which of these variables are important predictors of QOL. A total of 157 oncology outpatients completed questionnaires that evaluated pain, QOL, depression, physical functioning, and social functioning at the time of enrollment into a randomized clinical trial that evaluated the effectiveness of a psychoeducational intervention to improve cancer pain management. Pearson product moment correlation coefficients were calculated to examine the relationships among the study variables. A blockwise, hierarchical multiple regression analysis was performed to determine which variables were the most important predictors of QOL. Meaning of pain was significantly correlated with all the other variables, in particular pain intensity and duration. The most important factors that predicted QOL were depression, social functioning, and physical functioning. Depression proved to be the most important predictor of QOL.

Background: Because of better health care, most people with cystic fibrosis (CF) now survive into adulthood, raising issues related to quality of life. Few studies have focused on satisfaction with broader life domains in people with CF. The aim of this article was to examine the impact of living with CF from a global quality of life perspective., Methods: The sample consisted of 86 adults with CF recruited from the Norwegian Competence Centre for Cystic Fibrosis and a control group of 1021 individuals from the general population (GP). The Norwegian version of the Quality of Life Scale was used to measure global quality of life (satisfaction with broader life domains) in both groups., Results: The mean global quality of life score was 84.88 for the CF group and 83.33 for the GP group. This difference was significant after controlling for age, sex, educational level, and marital status, indicating that people with CF have better global quality of life. The groups also differed significantly on other specific measures of life satisfaction. Persons with forced expiratory volume in 1 second values below 30% of predicted values reported the lowest mean global quality of life value., Conclusions: These results suggest the existence of a type of response shift in the CF group through changes in life standards and goals. However, people with CF who have low forced expiratory volume in 1 second values may need special attention from health care professionals on issues related to global quality of life.

Objective: A study was undertaken to test the psychometric properties of the Fatigue Severity Scale (FSS), and to explore the relationship between fatigue and sociodemographic variables in the general population., Method: A national representative sample of 1893 respondents was randomly selected from a pool of 4,000 Norwegians aged 19-81 years. A mailed questionnaire that included the FSS was used to measure fatigue severity., Results: The FSS showed satisfactory internal consistency (Cronbach's alpha 0.88). The prevalence of high fatigue (FSS score > = 5) was 23.1% in the total sample. More women (26.2%) than men (19.8%) experienced high fatigue (p = 0.004). Respondents with chronic illness (more than six months) reported a higher mean (M = 4.69, SD = 1.35) than the rest of the sample (M = 3.67, SD = 1.17) (p<0.001). An inverse correlation was found between fatigue and level of formal education (r = 0.20, p<0.001)., Conclusion: The psychometric properties of the Norwegian version of FSS were satisfactory. To avoid over-diagnosing people for high level of fatigue, the threshold for high fatigue probably should be 5 on the FSS scale instead of 4 as had been suggested originally, but further validation of the cut-off point is needed.

Background: Population-based studies suggest that prevalence of chronic pain is increasing. The purpose of this study was to determine the prevalence of chronic pain in a sample drawn from the general Norwegian population. In addition, the characteristics of chronic pain, as well as differences in demographic characteristics and health-related variables between persons with and without chronic pain were evaluated., Methods: A total of 4000 Norwegian citizens, were randomly drawn from the National Register, by Statistics Norway and were mailed a questionnaire., Results: The response rate was 48.5%. The majority of the sample was female (51%), married (59%), and working for pay (69%) with a mean age of 45.2 years. The prevalence of chronic pain in the total sample was 24.4%, and 65% of the participants with chronic pain indicated that they had experienced chronic pain for over 5 years. The cause of the pain was not specified by 57% of the participants in chronic pain, and 31% reported no pain treatments. Women, older individuals, persons with less education, and those who were pensioned, reported chronic pain more frequently. The results of a logistic regression analysis indicate that the variables that provide unique contributions to predicting pain group memberships were: gender, education, being frequently ill, or having a chronic illness., Conclusions: These findings suggest that chronic pain is a significant problem in the general Norwegian population, and that gender, education, being frequently ill, or having a chronic illness are important variables in predicting pain group membership.

In 1994, the World Health Organization Quality of Life (WHOQOL) Group developed the procedure (the WHOQOL 100) to measure quality of life in healthy and ill persons from diverse cultures. The purpose of this study was to analyze the psychometric properties of a 26-item version of the WHOQOL 100, the WHOQOL-BREF, when applied to the Norwegian general population. The questionnaire was sent to 4,000 randomly selected Norwegian citizens aged 19 to 81 years. The response rate was 48.5%. Cronbach's alpha ranged from .60 in the social relationships domain to .84 in the physical health domain. Factor analysis resulted in a four-component solution partly supporting the established domain structure. Multiple regression analysis with sex, age, education, cohabitation and self-reported disease as independent variables explained 28%, 8%, 4%, and 15% of the variance for the physical health, psychological, social relationships and environmental domains, respectively. Self-reported disease was the strongest factor. The results appear to be promising regarding scaling qualities, discriminative power, and domain structure.

The purpose of this study was to evaluate for gender differences in the experience of chronic pain and the impact of chronic pain on quality of life (QOL). A total of 1,912 out of 4,000 Norwegian citizens returned a mailed questionnaire, and 24.4% reported chronic pain. More women than men reported chronic pain, and women reported significantly higher pain intensity scores than men did. Although the duration of chronic pain was similar in women and men, women more often received treatment for their chronic pain. Men in chronic pain reported a poorer QOL than women did. Although specific variables that predicted present pain intensity in women and men differed, the variables that explained the largest percentage of the variance in pain for both genders were the disease and the pain location variables. These findings support previously published studies that document gender differences in chronic pain and extend the work to the impact of chronic pain on QOL.

Objective: The purpose of this study was to evaluate the psychometric properties of the Herth Hope Index (HHI) in a representative sample of the Norwegian population., Methods: The HHI-N was administered to 4000 people randomly selected from the Norwegian population. 1893 questionnaires were usable, yielding a response rate of 48.5%., Results: The internal consistency of the HHI-N, estimated by Cronbach's alpha, was 0.81. Factor analysis resulted in a two-factor solution, which explained 38% of the variance. The correlation between hope and overall quality of life was 0.48 (p < 0.001), and between hope and fatigue severity -0.30 (p < 0.001)., Significance of Results: Further testing, especially with regard to the dimensionality of the instrument, is recommended.

Background: Entering an institution constitutes one of the most difficult developmental challenges for older people, and may lead to increased dependency because of reinforcing environmental events such as the interaction pattern of the staff., Aims and Objective: The aim of this paper was to describe the pattern of social interaction between nursing home residents and the nursing staff during mealtimes., Design and Methods: Six residents of a nursing home in a suburb of Oslo were observed. Data were collected during 120 systematic observations. Different types of behaviour relating to the residents' level of independence when interacting with the staff were examined using a structured observational scheme developed by Baltes., Results: Data showed that the residents' maintenance of independent self-care was the most predominant behaviour. Residents were rarely socially active. The behaviour of one resident varied among meals. Observations of independent self-care maintenance during interactions between the residents and the staff were sometimes consistent and sometimes inconsistent. The response of the nursing staff to the residents' social engagement was variable. Generally, however, they did not respond at all and seldom displayed engagement-supportive behaviour., Conclusions: The results represent a challenge to the nursing staff to increase social interaction during mealtimes, and also to examine their inconsistent behaviour towards the residents., Relevance to Clinical Practice: Mealtime appears to be a good opportunity to foster the independence of the residents as well as to enhance social activity in the form of informal conversation. Greater consistency of staff behaviour is required, based on ethical values such as consideration of the residents' self-esteem and autonomy, thereby stimulating independent self-care at mealtimes. Inconsistent behaviour, often based on values that are not clarified, may, on the contrary, lead to increased dependence of the residents.

The main aim of the present study was to derive norms or reference values from the general Norwegian population for the Norwegian version of the Quality of Life Scale (QOLS-N). In addition, associations between socio-demographic and health variables on the level of quality of life were examined. The sample consisted of 1893 subjects from a total of 4000 randomly selected Norwegian citizens representative of the entire Norwegian population, aged 19-81. The subjects received a mailed questionnaire containing the QOLS-N. Results show that the mean quality of life score was 84.1 (SD 12.5). Women reported a higher quality of life than men. People with higher levels of education reported a higher quality of life. Those who were married or cohabitating reported the highest quality of life and those who were unemployed reported a lower quality of life than those who worked. In addition, people reporting long-term diseases or health problems scored significantly lower on quality of life. These results could serve as reference values for the level of quality of life, as measured by the QOLS-N in the Norwegian population.

Purpose: Hope was evaluated in Norwegian patients with cystic fibrosis (CF)., Participants: The subjects were 87 Norwegian adults with CF and a control group of 1020 from the general population (GP)., Methods: Subjects completed a questionnaires that included the Herth Hope Index and demographic variables. Data on health-related variables were collected for the CF group., Results: The mean age of the CF patients was 29 years (range 18-54). Almost 50% had a forced expiratory volume for one second percent predicted (FEV1%) below 50%, and 21% reported perceiving being in a bad phase of the disease. The CF patients reported lower (poorer) levels of hope than the GP sample, especially for the item scared about the future. However, they scored higher on inner strength and were younger, more often living alone, unmarried, not in paid work, but with similar educational levels. Levels of hope increased with increasing age in the CF patients but decreased for the GP subjects. The health variable that most affected hope in the CF sample was pulmonary function, not the presence of asthma or chronic lung infections., Conclusions: Persons growing up with CF experience many challenges. CF patients expressed slightly lower levels of hope and were more scared of the future. They scored higher on inner strength than the general population.

Objective: The aims of this study were to describe hope in a large sample that was drawn from the general Norwegian population and to examine how sociodemographic and health-related variables were related to hope., Methods: Of 4,000 adult citizens, randomly drawn from the National Register, 1,912 (49%) returned the Norwegian version of the Herth Hope Index (HHI)., Results: When demographic and health-related variables were controlled for, age, gender, marital status, and employment status were significantly related to hope. The most important health-related variable was self-assessed health status, with participants who were satisfied with their health reporting significantly higher levels of hope. Participants who indicated that they had a chronic disease reported significantly higher hope scores compared to those without a chronic disease. Older men, individuals who were receiving a pension or were unemployed, and individuals who were widowed or unmarried reported the lowest levels of hope. In this study, an individual's subjective evaluation of his/her health was the most important health-related predictor of hope., Significance of the Research: The most important health-related variable that predicted hope was self-assessed health in that participants who were satisfied with their health reported higher levels of hope. This finding suggests that an individual's subjective assessment of health is a better predictor of hope than the presence a chronic disease. Knowledge about levels of hope in the general population can be used as reference values against which an individual score or a group mean may be compared.

Objective: The aim of the study was to obtain knowledge about leg and foot ulcer care performed by nurses in community health care., Design: This is a descriptive observational study. SETTINGAND SUBJECTS: The sample consisted of Norwegian home care nurses (n = 31), student nurses (n = 30), and patients with leg and foot ulcers (n = 32). Thirty-five ulcer treatments were observed in the patients' homes., Methods: A structured observation form with space for additional notes and assessments was used. Photographs were taken of the ulcers. Information on background variables for patients and nurses was collected, and descriptive and interpretive analyses were performed. Nursing students made the observations., Results: In 16 situations the patients had no ulcer diagnosis, and most of the patients (79.9%) had other serious chronic diseases. The home care nurses were uncertain about their assessment of the ulcers, and the treatment principles were not always current; for example, dry dressings and normal saline were used for cleansing. Twenty-eight different dressing combinations were used on the 35 ulcers. Compression was used on undiagnosed ulcers, sometimes incorrectly. Hand-washing routines were poor, and the treatment was often poorly documented. Poor working conditions were also observed, such as bad lighting in the room. The majority of the ulcer treatments lasted 20 to 30 minutes., Conclusion: The study identifies areas where leg and foot ulcer treatment by home care nurses can be improved with respect to technique and documentation.

Background: We present the results of a study of adults with cystic fibrosis, with an emphasis on their experience of symptoms and treatment, future prospects, and quality of life., Material and Methods: 86 adults (above the age of 18) with cystic fibrosis, recruited through the Norwegian Centre for Cystic Fibrosis. The response rate was 84%; average age of respondents 29; 48% were women., Results: The most frequently reported symptoms were coughing, phlegm and fatigue. 26% experienced great difficulties living with cystic fibrosis. 75% were satisfied with their life and 71% had a positive outlook for the future. Lung function was the variable most strongly related to symptoms, treatment and outlook for the future., Interpretation: It is possible to experience life as good even though one is living with a life-threatening disease such as cystic fibrosis.

The aim of this study was to examine to what extent demographic and disease-specific variables affected pain in cancer patients. Two to three weeks after their last hospitalization, 1,453 cancer patients completed questionnaires measuring demographic variables, quality of life, and pain (EORTC-QLQ C-30). Response rate was 72.1%. Data on type of cancer and the severity of the disease were also compiled. Sixty percent of the sample reported some pain. Type of cancer, presence of metastases, and time until death were significant predictors of experienced pain. The patients' experience of pain was mainly associated with disease-specific variables. Sex, age, level of education, and co-habitation were not related to pain, but employment status was. The patients on disability pensions had significantly more pain than the patients who were working or studying. Special attention should be given to patients with advanced prostate cancer with a short time to live, as they reported the most pain.

The purpose of this qualitative study was to illuminate experiences of growing up and living with cystic fibrosis (CF). The patients' and their families' encounters with health care and social services were of particular interest. Four focus groups (adults with CF and parents of children with CF) were conducted. Three main themes emerged from the analysis: "From uncertainty to certainty," "A demanding but normal life," and "A wish for continuity, stability, and respect." As also documented by other studies on the chronically ill, normalization seems to be an important strategy, a strategy that seems not to be fully understood by the helpers.

Background: As the number of people diagnosed with cancer increases and the treatment of cancer changes and improves, the challenges and problems nurses experience in clinical practice are also changing., Aims: To describe the problems that nurses in cancer care face in their day-to-day practice. Such information can be used to improve the quality of nursing care., Design: A questionnaire was distributed to half of the members of the Norwegian Society of Nurses in Cancer Care (n = 464). Instrument. The survey questionnaire had previously been used in a Canadian study. The nurses were asked to consider 80 different areas relevant to cancer nursing and to indicate the extent to which each posed a problem for them in clinical practice. The sex, age and educational level of the nurses were also recorded, together with the work setting and number of years they had been employed in nursing., Results: The response rate was 43% (199 of 464). The area the nurses experienced as being the greatest problem in their clinical practice was patients' anxiety. Problems connected with nutrition, the development of the cancer itself and grieving, and symptoms like nausea and vomiting and fatigue were also frequently rated as problems. The results also show some significant correlations between the rating of problems and variables such as work setting, years in practice and educational level., Conclusions: The present study shows that nurses in cancer care mainly experience psychological issues as problems in their clinical practice, which confirms previous research. The impact of work setting, years in clinical practice and education was surprisingly small. As the majority of nurses today will meet cancer patients during their professional careers, further research is needed in this area.

Objective: The aim was to survey the views of a sample of district nurses on their own level of knowledge about the treatment of leg and foot ulcers and what they considered to be the most important issues in wound treatment., Design: A descriptive design was used., Setting and Subjects: The subjects were all the nurses who treated leg and foot ulcers in the community health care service in Oslo, Norway, during autumn 1999. The subjects were selected after consultation with senior nurses., Instruments: A structured questionnaire with blank spaces for in-depth comments was used., Methods: The head of the nursing service in all 25 urban districts received a letter about the study with a questionnaire that they passed on to the nurses treating ulcers. Out of 173 eligible nurses, 102 (59%) filled in the questionnaires. Descriptive and interpretative analyses were then made., Results: Most of the participating nurses (60%) believed that their knowledge of wound treatment was insufficient. A high degree of uncertainty related to wound treatment situations was also found. The uncertainty included wound treatment, wound assessment, wound healing products, and wound causes. The main sources of the nurses' knowledge were their own nursing practice and colleagues. Twenty different factors of importance in wound treatment were reported. The most frequently mentioned factors were: wound healing, continuity in the treatment process, alleviation of pain, hygiene, compression therapy, and diagnosis. The lowest scores were awarded to documentation and economic factors., Conclusions: The nurses perceived their knowledge of leg and foot ulcer treatment to be insufficient. Their own nursing practice and colleagues were their main sources of knowledge.