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Cancer diagnosis poses enormous physical and psychosocial challenges for both the affected person and their families. This systematic review identifies the characteristics and effectiveness of nursing interventions offered to adult patients with cancer and their families. Five databases were searched, and 19 studies published from 2009 to 2020 were included. Interventions were categorized as follows: (a) interventions with supporting and cognitive components ( n = 3), (b) interventions that included skills training for the caregiver ( n = 3), (c) interventions to enhance care through managing symptoms ( n = 8), (d) interventions focusing on the dyad or family–patient relationship ( n = 4), and (e) interventions targeted to the patient’s condition ( n = 1). The results of this review offer an overview from which to carry out new studies and are useful for providing future directions within family nursing practice, taking into account the impact that the family has on the disease and the consequences the condition may bring to the whole family.

Smegenų insultas – tai ūmus neurologinis pažeidimas, atsirandantis dėl smegenų išemijos ar kraujo išsiliejimo į smegenis. Pagerėjusios insulto gydymo galimybės padidino pacientų išgyvenamumą, tačiau ši būklė lieka pagrindine ilgalaikio neįgalumo priežastimi visame pasaulyje. Didelės insultą išgyvenusių, tačiau nuo ilgalaikio neįgalumo kenčiančių pacientų priežiūros ir gydymo sąnaudos skatina skirti vis didesnį dėmesį reabilitacijos strategijų tobulinimui. Erdvinis neglektas apibūdinamas kaip būklė, kai pacientas nekreipia dėmesio į aplinką ir savo kūną, priešingoje pažeidimui pusėje. Tai labiausiai paplitęs neurokognityvinis sutrikimas, sukeliantis ilgalaikę negalią, pasireiškiantis maždaug pusei pacientų, patyrusių smegenų insultą nedominuojančiame smegenų pusrutulyje. Erdvinis neglektas apibūdinamas dėmesio, suvokimo, mokymosi, atminties, atpažinimo, motyvacijos ir emocijų raiškos sutrikimais. Šiems simptomams palengvinti buvo sukurta daugybė reabilitacijos programų ir metodų, tačiau daugelis jų nepasiekė kasdienės klinikinės reabilitacijos. Reabilitologai dažnai vengia nežinomų reabilitacijos strategijų, ypač jei jos yra naujos, brangios, komplikuotos, prieštaringos ir netestuotos klinikinėje praktikoje. Šiame darbe keliama hipotezė ir pateikiamas jos pagrindimas, kad geresnių reabilitacijos rezultatų tarp išgyvenusiųjų insultą ir kenčiančių nuo erdvinio neglekto galima pasiekti, į reabilitaciją įtraukiant pacientų pomėgius ir potraukius, juos panaudojant paciento dėmesiui atkreipti į ignoruojamą aplinką ar kūno dalį. Unikalių pacientų potraukių ir pomėgių įtraukimas į jų reabilitaciją gali padėti suaktyvinti mezolimbinę dopaminerginę sistemą, pašalinti pusrutulių disbalansą, kuris, daugelio manymu, sukelia erdvinį neglektą.

Background and purpose: Spatial neglect (SN) occurs frequently in patients with stroke, resulting in worse recovery. Without screening, the presence of SN may remain undetected and prevent initiation of alleviating strategies. There is limited evidence available to suggest bedside identification of SN in the subacute phase following stroke. Thus we set out to identify effective screening tests for SN. Method: The following index tests were used; (a) six conventional subtests of The Behavioural Inattention test (BIT), (b) an additional figure copying test, (c) a newly developed neglect experience questionnaire, and (d) an additional component added to the National Institute of Health Stroke Scale (NIHSS). The Catherine Bergego Scale (CBS) functioned as a reference frame to ascertain the presence of SN. Results: Consecutive stroke patients (N=125) were included from the Neurological Department of Landspitali University Hospital in Iceland, within two weeks following stroke. Of those 30 patients had SN. If all subtests of the BIT were administered, approximately 35% of stroke patients without SN would be incorrectly identified with the disorder. Statistically more patients without SN were identified as having SN if ≥ three tests of the BIT was administered (p=0.002). If patients did not, at stroke onset, comprehend why they had to go to the hospital, this was correlated to the presence of SN. The star cancellation and figure copying were the most sensitive paper-and pen tests to identify SN. Inclusion of an additional item to NIHSS correctly identified SN in 86% instances. Conclusion: Results contests the common belief that use of more tests increase identification of SN. Rather we found that the use a large test battery decreases sensitivity in the subacute phase following stroke. A short question about patients’ experiences of stroke onset and adding a novel item to the NIHSS provided new pragmatic ways of identifying SN. Results have been used to inform a larger cross-country study between Iceland and Lithuania, where psychometric properties of screening strategies are being further validated.

To explore facilitating and inhibiting factors in the inpatient care of patients with functional neurological disorders as experienced by interdisciplinary teams of healthcare professionals.Qualitative focus group interviews were conducted with 18 healthcare professionals of various professions. Data were analyzed using qualitative content analysis with inductive coding of data.Two main categories were formulated: (a) Giving the diagnosis to patients - a moment of fragility and opportunities, and (b) Organization of care - ensuring the continuity and protecting patients' self-image. One overarching theme tied the two categories together: Establishing coherence in the inpatient trajectory - moving from stigmatization toward competent care. Coherence and steadiness in care was a prerequisite for transparency in goalsetting and for designating the responsibilities of individual healthcare professionals. Stigma and having clinical experience and knowledge of functional neurological disorders, as two counter-factors, influenced the extent to which this was achieved. Examples of facilitating factors for enhancing competent care were documentation of symptoms, effective ways of passing on clinical information, education, professional dialog, and organizational support.To nurture competent care, guidelines, structured educational initiatives and other supportive actions should be promoted. We provide ideas for the next logical steps for clinical practice and research.IMPLICATIONS FOR REHABILITATIONClose collaboration between interdisciplinary healthcare professionals plays an important role for reaching optimal results in the rehabilitation of inpatients with functional neurological disorder.There is currently limited knowledge regarding the facilitating and inhibiting features encountered by interdisciplinary healthcare professionals in the provision of care for patients with a functional neurological disorder.The findings show that a working environment that endorses a skillful culture of practice and which facilitates actions to reduce problems that hamper effective teamwork needs to be promoted.Solutions that help to solve many obstacles encountered by the team of healthcare professionals in the care provision of patients with functional neurological disorders include open dialog regarding symptoms, diagnosis and treatment, effective ways of documenting and reporting symptoms, and availability of guidelines and supporting educational material.

Complexity leadership in the collaboration between academia and clinical nursing is gaining momentum. In this chapter, the focus is on our attempts to embrace complexity leadership as faculty members who hold joint positions at the Faculty of Nursing at the University of Iceland and Landspitali, the National University Hospital of Iceland. We put emphasis on the implications of this concept to expand the collaborative practice between academia and clinical nursing. Short cases that originate in the area of nursing care for vulnerable chronically ill adults are presented. These cases illustrate how complexity leadership has been used in clinical research and healthcare, to develop assessment methods that reflect the needs and requirement of patients, and have helped to increase research utilization and participation of nurses in clinical research projects.

To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home.A mixed method prospective study of 15 patients with neglect after a right hemisphere stroke, 1 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a 'mixing matrix' and integrated by 'following threads'. Finally, a synthesis was written into a vignette.The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants.Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect. Implications for Rehabilitation Findings demonstrate that identification of spatial neglect and the way symptoms of neglect impact on daily life functioning of stroke patients must be carefully pursued by health-care professionals working in stroke rehabilitation. Areas that should receive professional attention in the rehabilitation process include: preparing patients and their family for fluctuations related to neglect in the patient's own home, locating issues that might impact safety, and identifying unique factors that either enhance or diminish neglect within each patient's daily life context. The results of this study could be used to develop more wide-ranging assessment strategies to assist health-care professionals in identifying neglect after hospital discharge, for instance by expanding existing ecological assessment tools and including qualitative evaluation of test performance in paper-pencil tests, such as the star cancellation and figure copying.

Aim To describe the characteristics of couple-based intervention studies that address sexuality following cancer. Background Sexuality-related problems are common among cancer survivors and their partners. Design Systematic literature review with a narrative summary of results. Data sources Electronic searches were conducted in PubMed, CINAHL and PsychINFO. We included studies published from 1 January 2009 - 31 December 2016. Additional information was retrieved by scrutinizing reference lists, conducting citation tracking and contacting authors. We included all types of quantitative intervention studies published in the English language which contained outcome measures corresponding to the neo-theoretical framework of sexuality—sexual function, sexual relationship and sexual self-concept. Review Methods Our review was guided by the Joanna Briggs Institute reviewer's manual. Data were extracted and appraised using the standardized checklists for quantitative studies. This assessment was conducted independently by two reviewers. A third reviewer was involved if consensus could not be reached. Results Fourteen studies were included. Interventions were delivered face-to-face, by telephone or via the Internet. Sessions ranged from 1-8, with a duration from 2-22 weeks. Most studies offered ≥3 sessions. Interventions addressed unique concerns and/or provided general education. There was little agreement on the use of outcome measures. Most studies inadequately described fidelity to the study protocol and the training of interventionists. Conclusion There was no clear consensus about how couple-based interventions are best structured. The results provide tentative evidence for how the quality of future research studies can be improved and how knowledge can be used in clinical practice.

Aims and objectives. To explore and describe the experience of eating and eating-related difficulties in stroke survivors living at home.Background. The ability to consume food and to take pleasure in eating is anessential part of life. For people with stroke, eating difficulties are frequent. Aphenomenological perspective of stroke survivors’ experience of eating difficultiesexceeding the acute stroke event and in-hospital rehabilitation is missing.Design. A qualitative study founded on the Husslarian descriptive phenomenology.Methods. Colaizzi’s seven phases of data analysis provided a systematic approachto explore 17 in-depth interviews from seven participants and how eating difficul-ties influenced their daily lives.Results. Eating difficulties revealed themselves in participants’ relationship with theouter world in far-reaching disruptions of habits, capacities and actions. Four keythemesilluminatingtheeatingdifficultiesemerged:(1)preservingdignitybynotconvey-ing serious problems, (2) staying vigilant to bodily limitations, (3) stepping out of thesecurity zone and (4) moving on without missing out. The findings exposed that eatingdifficulties might not only lead to serious consequences such as malnutrition but also,andequallyimportantly,leadtolossesintheexistential, socialandculturallifeworld.Conclusions. The experience of eating difficulties entails an ongoing readjustmentprocess, which is strongly influenced by interactions with other people. The find-ings suggest that individualised long-term support is needed to facilitated the useof helpful strategies to manage eating difficulties.Relevance to clinical practice. The long-term losses that people with eating diffi-culties experience are not reflected in conventional screening tools and interven-tions. To avoid haphazard identification presupposes professional knowledge ofhow eating difficulties are woven into daily life. This knowledge may informinnovative nursing strategies reaching beyond immediate rehabilitation. Partner-ship-based practice may provide an important framework to establish uniqueneeds and to mobilise relevant actions and resources.Key words: adult nursing, eating problems, nurse–patient relationship, phenome-nology, rehabilitation, strokeWhat does this study contribute tothe wider global clinicalcommunity?

Problem identification To systematically review qualitative evidence regarding patients' experiences of living with multiple myeloma. The main objective was to gain structured understanding of this experience, which is a prerequisite for advancing nursing care and ensuring it is effective. . Literature search Qualitative research articles from January 2005 to March 2016 were located in CINAHL®, PubMed, and Scopus. Supplementary resources were found by scrutinizing reference lists and performing citation tracking. All included articles fulfilled predetermined criteria. . Data evaluation Three reviewers independently assessed the risk of methodologic bias by using the Joanna Briggs Institute (JBI) Qualitative Assessment and Review Instrument. The JBI methodology of meta-aggregation was used to synthesize findings. . Synthesis Eleven studies fulfilled the eligibility criteria. From these, 84 findings were extracted. Each finding was assigned a level of credibility. Conclusions Patients with myeloma require a different form of follow-up compared to patients with many other cancers because of its chronic nature. Results demonstrate that widespread physical, emotional, and social challenges were experienced by patients throughout their illness trajectories, even in periods of remission. Nursing care should incorporate knowledge of patients' experiences. . Implications for practice The results provide directions for nurses to improve supportive strategies in the care of patients with multiple myeloma. The categories provide a useful framework for developing clinical assessment tools.

Stroke patients with severe symptoms of hemispatial neglect (HN) are known to experience a weaker recovery than those less affected from the outset. Correct identification of HN is therefore important throughout the course of rehabilitation. To explore: (i) the course of clinical symptoms in stroke patients with moderate/severe HN from acute setting to home, (ii) changes in sensitivity of diagnostic tasks over time, and (iii) agreement between the researcher’s and patients’ HN assessments. Out of 79 consecutive patients, we included 23 patients with moderate/severe HN following right hemisphere stroke. The Catherine Bergego Scale was used as a benchmark for HN and to measure the congruence between the researcher’s and patients’ HN assessments. Diagnostic tasks included star cancellation, line crossing, line bisection, m-fluff test, figure copying, and clock drawing. Data were collected at t1: sub-acute stroke (days: M ± SD = 10.3 ± 5.25), t2: during rehabilitation (days: M ± SD = 51 ± 8), and t3: following discharge (days: M ± SD = 141.5 ± 47.3). (i) 20 out of 23 patients had HN at t3. Associated stroke challenges included paralysis, sensory loss, visual deficits, and extinction. (ii) Combining the star cancellation and figure copying yielded the highest sensitivity at all time points, even in patients with mild HN at t3. (iii) Patients’ HN scores differed from the researcher’s at t1. The difference was insignificant at t3. Joint consideration of stroke severity, functional difficulties, and patients’ insight into neglect provides new knowledge to increase clinicians’ recognition of HN. More extensive studies are needed to validate bedside screening with star cancellation and figure copying.

We used a phenomenological approach to gain insight into the experiences of self, other, and world in patients with hemispatial neglect within the first month following stroke. Comprehensive descriptions of circumstances were conjoined with open-ended interviews of 12 participants. The neglect experience was captured in the overarching theme, “getting the left right,” which encompasses the two subthemes of (a) surreal awareness of the left and (b) emergence of a different world. Patients had unclear perceptions of their own body and surroundings, their attention was brittle, and they encountered bewildering reactions from other people. They simultaneously pursued the ineffable neglected space and searched for coherence. The vulnerability, loss, and conflicting perceptions that patients with neglect face should be acknowledged and alleviation sought. Facilitating methods should provide additional opportunities for patients to communicate their experiences. We underscore the importance of readjusting the current approaches of neglect and emphasizing meaningfulness in professional guidance.

Objectives To identify rehabilitation interventions that can be integrated into ward-based nursing for patients with hemispatial neglect following stroke in the right brain hemisphere. Design A systematic review of interdisciplinary literature. Data sources A preliminary literature search without time limits was conducted in the Cochrane Controlled Trials Register. We then searched the PubMed, CINAHL and PsychINFO databases for relevant articles published between January 2006 and June 2014. Selected journals were searched manually. Additional resources were explored by scrutinizing reference lists and tracking citations of the selected articles. Review methods Titles and abstracts were matched with the inclusion criteria. Articles were read in their entirety if the abstracts adhered to inclusion criteria or if there was any uncertainty. Two reviewers evaluated the risk of methodological bias independently by using quantitative appraisal forms from the Johanna Briggs Institute (JBI). Any disagreements were resolved by consensus. Authors of nine studies were contacted to acquire additional information. The JBI Reviewers' Manual was used to guide the overall procedure of the review. We used the PRISMA statement to ensure precise reporting of the results. The selected studies were graded according to the strength of their evidence (Levels 1–5); the proposed interventions were given recommendation grades (Grades A–D). Results Using 41 original studies, 11 interventions were identified. These comprise: (1) contralesional neck vibration (Grade C); (2) emotionally salient stimuli and reward (Grade D); (3) family participation and intensity of training (Grade C); (4) limb activation training (Grade C); (5) mental imagery training, (Grade D); (6) mirror therapy (Grade C); (7) music therapy (Grade D); (8) right half-field eye patching (Grade D); (9) smooth pursuit eye-movement training (Grade B); (10) virtual reality and computer-based training (Grade C); and (11) visual scanning training (Grade D). Conclusion A total of 11 promising rehabilitation interventions were found. Encouraging results were, in particular, seen with smooth pursuit eye-movement training. It should be noted that the general low level of evidence and the diversity of interventions makes it difficult to endorse specific priorities and combinations for implementation. Instead, interventions should be applied after careful evaluation of each patient's unique capacities and problems. We include suggestions for operationalization into ward-based care in "Discussion" section. We also emphasize the need to integrate evidence-based interventions into nursing care to further stimulate rehabilitation outcomes and future research.

The aim of this review is to extend professional understanding of the various mechanisms that make smoking cessation difficult for patients with chronic obstructive pulmonary disease (COPD). Smoking in people with COPD is a major challenge for health care today. In spite of significant advances in knowledge about the processes of nicotine addiction, current interventions to support smoking cessation in patients with COPD are less successful than hoped for. A wealth of literature has confirmed that nicotine addiction is a powerful force and that smoking is not simply an unhealthy lifestyle or destructive behavior. However, research based on this realization is still in its infancy. To increase understanding and to develop ways of enhancing smoking cessation in patients with COPD, we review and synthesize knowledge found in neurobiology and phenomenology. We use neurobiology to explain the neurochemical changes that take place in addiction in order to substantiate phenomenological perspectives of smoking in patients with COPD. We relate the smoking experience to the concept of “affordances”—in this context “smoking affordances”—to analyze how smoking affects action possibilities in individuals with COPD. Combining these perspectives helps to illuminate the manifold and unique issues related to smoking addiction in patients with COPD.

In this article, we review the latest trends of data collection methods in phenomenological nursing studies. Subsequently, by using a philosophical analysis, mainly inspired by Merleau-Ponty’s embodied phenomenology and a case construction of an individual with hemi-spatial neglect—a common disorder following stroke—we explore the concepts “body schema,” “body image,” and “affordances.” Applying these concepts helps to illuminate the temporal, spatial, and perceptual world of people encountering discrepancy between perception and reality because of disease—a discrepancy seen in hemi-spatial neglect. Concepts to capture the multifaceted challenges that occur under these circumstances are lacking. Systematically incorporating the aforementioned concepts might help to advance phenomenological research and articulate these difficulties. We propose suggestions on data generation to reveal situated, meaning-infused, embodied experiences in patients with hemi-spatial neglect. The need to step beyond the privileged emphasis on interviews, toward experimenting with other approaches of data collection, is underscored.

To describe and identify various perspectives on eating difficulties following stroke to enable theory development and facilitate advancement of interventions.Concept analysis in line with Morse's principles of exploring pragmatic utility was used throughout the data collection and analysis. Peer-reviewed research on eating difficulties was systematically and critically appraised. Literature included the bibliographic databases, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and PsycInfo, published up until November 2011. A total of 33 key articles were included in the final analysis.A conceptual model of eating difficulties is presented showing the multiple affecting factors, namely meaning-related, functional and contextual factors and the consequences of non-intervention, feeling of loss, social isolation, negative sensations and depression - all of which potentially increase the impact of disease severity, functional outcome and quality of life. Based upon the dimensions identified, the definition of eating difficulties was synthesized as "any activity and emotional requirement and relations, which alone or in combination interfere with the process of preparing food, transferring food into the mouth, chewing and swallowing".Eating difficulties have profound effects on people. The conceptual model serves to guide health care professionals to assess and help stroke patients in facing a life with eating difficulties.