Bjørg Karlsen

The purpose is to explore and clarify the theoretical foundation for the diagnosis concept and its relevance in nursing. We adopted a meta-theoretical approach, including conceptual analysis. A purposive sampling, obtained from a literature search, provided insights into what is known, or unclear. While medical diagnoses focus mostly on etiological aspects, nursing diagnoses focus more on care. We identified suffering, adaptation, and biopsychosocial conditions as essential requirements for the concept’s ontological status. To enhance practice, nursing diagnoses demand clinical thinking, logical reasoning and causal hypotheses. Both procedures in medicine and nursing are critical in delivering adequate health care and collaboration.

Background: Chronic illness prevalence is increasing and research recruitment in these populations remains challenging. Individuals with chronic illness often have poorer quality of life, restricted access to hospitals where research occurs, and can be reluctant to participate. Researchers need multiple simultaneous strategies to achieve success. No taxonomy of recruitment factors in chronic illness research could be identified in the literature. This paper aims to describe a comprehensive taxonomy of recruitment for chronic illness research (inclusive of a nursing focus) to inform the design and reporting of recruitment strategies by creating a list of practical questions. Methods: A restricted scoping review was conducted on articles reporting on recruitment factors in chronic illness research. Main search restrictions were the number of years and databases searched with broad eligibility criteria. Included articles were critically assessed and data extracted. A code book was used to examine findings and results sections line by line, both deductively and inductively. The final codebook and the content of the codes informed the taxonomy construction and the practical questions. Results: Core components of research recruitment were identified as people, place, and project. The component of People included factors of researchers, clinicians, recruiters, and participants roles. The component of Place included factors of national or local research oversight institutions, healthcare environments, and community spaces. Finally, the component of Project included factors of research design, participant research journey, and research promotion. The final taxonomy informed a practical list of questions to aid researchers in the design and reporting of research recruitment strategies. Conclusions: The chronic illness research recruitment taxonomy describes and characterises factors reported to impact on research recruitment. It provides a framework for designing and reporting on recruitment strategies. While the taxonomy requires further testing, it is the first to offer a broad characterisation of recruitment factors in chronic illness research.

Background: Disease is one of the most central concepts in medicine as well as in nursing. What “disease” is seems to be intuitively basic for nurses but difficult to articulate and explicate as such a question deals with basic philosophical questions. As philosophy is essential to nursing to better understand the philosophical perspectives of disease, this is a question that needs further addressing. Purpose: To explore and discuss the theoretical foundation for the concept of disease and its relevance in nursing as part of an ongoing debate. Methods: A metatheoretical approach was adopted. Oria, MEDLINE, and Scopus were used to identify a purposive sampling of articles, which covered breadth and depth according to the aim of the study and dealt with philosophical aspects to extend our understanding of disease in nursing. Literature primarily published within the last 15 years from medical as well as from philosophical and healthcare domains was reviewed, debated, and systematized. Findings: Adopting the positions of objectivism and relativism related to the disease concept revealed a series of intriguing issues. We found that pathology and disease should not be “malformed” into pure normativity. Instead, normativity becomes part of an objective and pathological issue. Nurses should be aware of how new perspectives of philosophical inquiries and theories meet the position of relativism challenging objectivism that is usually taken for granted. Such a theoretical foundation may be strengthened by using a broader perspective of disease based on nurses as a professional discipline. Conclusion: Paying greater attention to philosophical issues relevant to nursing may improve nurses’ knowledge base and offer central perspectives to the advancement of the uniqueness of nursing theory and practice. Understanding the distinction between disease processes in nursing and medicine is essential for effective healthcare. Recognizing their differences can clarify nursing’s disciplinary perspective, enhance collaboration, and improve patient outcomes.

Introduction: Colorectal cancer (CRC) creates elevated self-management demands and unmet support needs post-discharge. Follow-up care through eHealth post-primary surgery may be an effective means of supporting patients’ needs. This integrative review describes the evidence regarding eHealth interventions post-hospital discharge focusing on delivery mode, user-interface and content, patient intervention adherence, impact on patient-reported outcomes and experiences of eHealth. Methods: A university librarian performed literature searches in 2021 using four databases. After screening 1149 records, the authors read 30 full-text papers and included and extracted data from 26 papers. Two authors analysed the extracted data using the ‘framework synthesis approach’. Results: The 26 papers were published between 2012 and 2022. The eHealth interventions were mainly delivered by telephone with the assistance of healthcare professionals, combined with text messages or video conferencing. The user interfaces included websites, applications and physical activity (PA) trackers. The interventions comprised the monitoring of symptoms or health behaviours, patient information, education and counselling. Evidence showed a better psychological state and improved PA. Patients reported high satisfaction with eHealth. However, patient adherence was inadequately reported. Conclusions: eHealth interventions may positively impact CRC patients’ anxiety and PA regardless of the user interface. Patients prefer technology combined with a human element.

Background: Heart failure (HF) is a clinical syndrome with high incidence rates, a substantial symptom and treatment burden, and a significant risk of readmission within 30 days after hospitalization. The COVID-19 pandemic has revealed the significance of using eHealth interventions to follow up on the care needs of patients with HF to support self-care, increase quality of life (QoL), and reduce readmission rates during the transition between hospital and home. Objective: The aims of this review are to summarize research on the content and delivery modes of HF posthospitalization eHealth interventions, explore patient adherence to the interventions, and examine the effects on the patient outcomes of self-care, QoL, and readmissions. Methods: A restricted systematic review study design was used. Literature searches and reviews followed the (PRISMA-S) Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension checklist, and the CINAHL, MEDLINE, Embase, and Cochrane Library databases were searched for studies published between 2015 and 2020. The review process involved 3 groups of researchers working in pairs. The Mixed Methods Appraisal Tool was used to assess the included studies’ methodological quality. A thematic analysis method was used to analyze data extracted from the studies. Results: A total of 18 studies were examined in this review. The studies were published between 2015 and 2019, with 56% (10/18) of them published in the United States. Of the 18 studies, 16 (89%) were randomized controlled trials, and 14 (78%) recruited patients upon hospital discharge to eHealth interventions lasting from 14 days to 12 months. The studies involved structured telephone calls, interactive voice response, and telemonitoring and included elements of patient education, counseling, social and emotional support, and self-monitoring of symptoms and vital signs. Of the 18 studies, 11 (61%) provided information on patient adherence, and the adherence levels were 72%-99%. When used for posthospitalization follow-up of patients with HF, eHealth interventions can positively affect QoL, whereas its impact is less evident for self-care and readmissions. Conclusions: This review suggests that patients with HF should receive prompt follow-up after hospitalization and eHealth interventions have the potential to improve these patients’ QoL. Patient adherence in eHealth follow-up trials shows promise for successful future interventions and adherence research. Further studies are warranted to examine the effects of eHealth interventions on self-care and readmissions among patients with HF.

BACKGROUND Heart failure (HF) is a clinical syndrome with high incidence rates, a substantial symptom and treatment burden, and a significant risk of readmission within 30 days after hospitalization. The COVID-19 pandemic has revealed the significance of using eHealth interventions to follow up on the care needs of patients with HF to support self-care, increase quality of life (QoL), and reduce readmission rates during the transition between hospital and home. OBJECTIVE The aims of this review are to summarize research on the content and delivery modes of HF posthospitalization eHealth interventions, explore patient adherence to the interventions, and examine the effects on the patient outcomes of self-care, QoL, and readmissions. METHODS A restricted systematic review study design was used. Literature searches and reviews followed the (PRISMA-S) Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension checklist, and the CINAHL, MEDLINE, Embase, and Cochrane Library databases were searched for studies published between 2015 and 2020. The review process involved 3 groups of researchers working in pairs. The Mixed Methods Appraisal Tool was used to assess the included studies’ methodological quality. A thematic analysis method was used to analyze data extracted from the studies. RESULTS A total of 18 studies were examined in this review. The studies were published between 2015 and 2019, with 56% (10/18) of them published in the United States. Of the 18 studies, 16 (89%) were randomized controlled trials, and 14 (78%) recruited patients upon hospital discharge to eHealth interventions lasting from 14 days to 12 months. The studies involved structured telephone calls, interactive voice response, and telemonitoring and included elements of patient education, counseling, social and emotional support, and self-monitoring of symptoms and vital signs. Of the 18 studies, 11 (61%) provided information on patient adherence, and the adherence levels were 72%-99%. When used for posthospitalization follow-up of patients with HF, eHealth interventions can positively affect QoL, whereas its impact is less evident for self-care and readmissions. CONCLUSIONS This review suggests that patients with HF should receive prompt follow-up after hospitalization and eHealth interventions have the potential to improve these patients’ QoL. Patient adherence in eHealth follow-up trials shows promise for successful future interventions and adherence research. Further studies are warranted to examine the effects of eHealth interventions on self-care and readmissions among patients with HF.

Abduction, deduction and induction are different forms of inference in science. However, only a few attempts have been made to introduce the idea of abductive reasoning as an extended way of thinking about clinical practice in nursing research. The aim of this paper was to encourage critical reflections about abductive reasoning based on three empirical examples from nursing research and includes three research questions on what abductive reasoning is, how the process has taken place, and how knowledge about abductive reasoning based on the examples can inform nursing research and clinical practice. The study has a descriptive and explorative approach using a convenience sample of three empirical studies from nursing research. The three studies illustrate different ways to enter the abductive reasoning process in steps. They represent new caring models, which offer visual and cognitive maps for expanding nursing research, education and thus informing care. Therefore, we suggest that abductive reasoning may be beneficial for different ways of knowing and demonstrates scientific innovation to shed new light on health phenomena, which can help researchers and practitioners to gain a broader and deeper understanding of nursing care inquiry. However, more studies are needed to broaden this scope.

Research suggests that guided self-determination programmes can support self-management of diabetes by empowering self-determined goal setting and competence building. As most research in this area has focused on people with type 1 diabetes, knowledge is lacking on how adults with type 2 diabetes mellitus experience participation in such programmes. This study reports the modelling phase of a complex intervention design that explored the experiences of adults with type 2 diabetes who participated in a nurse-led guided self-determination programme in general practice and examines how the programme affected patients’ motivation to self-manage diabetes. The qualitative design with semistructured interviews included 9 adults with type 2 diabetes who participated in the programme. Qualitative content analysis was used to analyse the data. The findings indicate that the participants experienced new life possibilities after participating in the programme, which seemed to have a positive influence on their motivation for self-management. Through reflections about how to live with diabetes, the participants reinterpreted their life with diabetes by gradually developing a closer relationship with the disease, moving towards acceptance. The fact that dialogue with the nurses was seen to be on an equal footing helped support the participants to become more self-determined.

Background: Individuals with type 2 diabetes mellitus (T2DM) are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. Many patients do not reach recommended treatment goals, and thus it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM. Objective: The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the Guided Self-Determination (GSD) eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. Methods: We used a qualitative design in which data were collected through individual interviews. The sample consisted of 10 patients who completed the GSD eHealth intervention, and data were analyzed using qualitative content analysis. Results: The qualitative content analysis yielded 2 main themes. We labeled the first theme as “Written reflection affects awareness and commitment in diabetes self-management”, which reflects 2 subthemes, namely, “Writing creates space and time for autonomous reflection” and “Writing influences individuals’ focus in diabetes self-management”. We labeled the second theme as “Written reflection is perceived as inapplicable in diabetes self-management”, which reflects 2 subthemes, namely, “Responding in writing is difficult” and “The timing of the writing is inappropriate”. Conclusion: Our findings indicate that written reflection in the context of the GSD eHealth intervention may be conducive to motivation for diabetes self-management for some patients. However, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. We advocate further development and examination of the GSD as a “blended” approach, especially for those who consider written reflection to be difficult or unfamiliar.