| 21. |
- Amofah, H. A., et al.
(författare)
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Octogenarian patients experiences with hypnotics in relation to sleep disturbances and delirium after aortic valve therapy
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 17, s. 104-105
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sleep disturbance and delirium are complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve replacement (TAVI), especially in octogenarian patients. Sedatives and z-hypnotics are medications distributed to promote sleep. However, a knowledge-gap exists on patient experiences with these medications, and sleep and delirium after the cardiac treatment.Aim: To explore and describe how octogenarians suffering from delirium after SAVR/TAVI experience their sleep situation related to sedatives and z-hypnotics, in a long-term perspective.Methods An explorative and descriptive design with a longitudinal qualitative approach was applied. Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium. Information about administration of sedatives and z-hypnotics was collected from the patients journals. The Confusion Assessment Method (CAM) was used to assess delirium, the Sleep Sufficient Index (SSI) and Minimal Insomnia Symptom Scale (MISS) were used to document self-reported sleep and insomnia. All measures were performed at baseline and daily the five first postoperative days. Ten patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were re-interviewed four years later, focusing on their sleep situation.Findings: For the initial interview, five men and five woman, four after TAVI and six after SAVR, mean age 83 were included. One overarching theme revealed; hours in bed represented an emotional chaos. Three sub-themes described the patients experiences with sleep and delirium, a cascade of distressful experiences, the struggle between sleep and activity and elements influencing sleep. In the category physical sleep distractions, sleep medications emerged as a sleep disturbing element but also to evoke delirium. Patients described to be offered sedatives and z-hypnotics in hospital. However, they did not have a positive experience with this as the medication did not make them sleep better. Moreover, they associated the nightmares by the sedatives Four years after the cardiac treatment, the octogenarian patients described that medication did not have a sleep promoting effect, and they did not want it.Conclusion: Octogenarian patients are vulnerable to complications like sleep disturbances and delirium. In preventing and treating these conditions, health-care professionals should be aware of the effect and side-effect of sedatives and z-hypnotics in the octogenarian patients. Our findings show that medications should be cautiously used within this group of patients.
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| 22. |
- Amofah, Hege Andersen, et al.
(författare)
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Octogenarian patients' sleep and delirium experiences in hospital and four years after aortic valve replacement : a qualitative interview study
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesSleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients' long-term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation.DesignAn explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed.SettingPatients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation.ParticipantsInclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment.ResultsFor the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; Hours in bed represented emotional chaos. Whereas three subthemes described the patients' experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep, the struggle between sleep and activity and elements influencing sleep. Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences.ConclusionsFor octogenarian patients, sleep disturbances and delirium are long-term burdens and need a greater attention in order to improve patient care.
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| 23. |
- Amofah, Hege A., et al.
(författare)
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Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement
- 2016
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 15:2, s. 168-177
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Tidskriftsartikel (refereegranskat)abstract
- Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase.Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI.Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days.Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01).Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.
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| 24. |
- Andersson, Bodil T., et al.
(författare)
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Development and psychometric evaluation of the radiographers’ competence scale
- 2012
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 2:2, s. 85-96
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Tidskriftsartikel (refereegranskat)abstract
- Assessing the competence of registered radiographers’ clinical work is of great importance because of the recent change in nursing focus and rapid technological development. Self-assessment assists radiographers to validate and improve clinical practice by identifying their strengths as well as areas that may need to be developed. The aim of the study was to develop and psychometrically test a specially designed instrument, the Radiographers Competence Scale (RCS). A cross sectional survey was conducted comprising 406 randomly selected radiographers all over Sweden. The study consisted of two phases; the development of the instrument and evaluation of its psychometric properties. The first phase included three steps: 1) construction of the RCS; 2) pilot testing of face and content validity; and 3) creation of a web-based 54-item questionnaire for testing the instrument. The second phase comprised psychometric evaluation of construct validity, internal consistency reliability and item reduction. The analysis reduced the initial 54 items of the RCS to 28 items. A logical two-factor solution was identified explaining 53.8% of the total variance. The first factor labelled “Nurse initiated care” explained 31.7% of the total variance. Factor 2 labelled “Technical and radiographic processes” explained 22.1% of the total variance. The scale had good internal consistency reliability, with a Cronbach’s alpha of 0.87. The RCS is a short, easy to administer scale for capturing radiographers’ competence levels and the frequency of using their competence. The scale was found to be valid and reliable. The self-assessment RCS can be used in management, patient safety and quality improvement to enhance the radiographic process.
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| 25. |
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| 26. |
- Andersson, Bodil T., et al.
(författare)
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Radiographers' areas of professional competence related to good nursing care
- 2008
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Ingår i: Scandinavian Journal of Caring Sciences. - : Blackwell Munksgaard. - 0283-9318 .- 1471-6712. ; 22:3, s. 401-409
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Tidskriftsartikel (refereegranskat)abstract
- Background: Radiographers’ ability and competence is a matter of vital importance for patients. Nursing care is an integral part of the radiographer’s work. The demand for high competence in clinical activities has increased in diagnostic radiology and has had an impact on the development of the profession.Aim: The aim was to describe the radiographer’s areas of professional competence in relation to good nursing care based on critical incidents that occur in the course of radiological examinations and interventions.Method: A descriptive design with a qualitative approach, using the Critical Incident Technique was employed. Interviews were conducted with a strategic sample of registered radiographers (n = 14), based at different hospitals in Sweden.Ethical issues: The appropriate ethical principles were followed. All the participants provided informed consent, and formal approval for conducting the research was obtained according to national and local directives.Results: The data analysis resulted in two main areas; direct and indirect patient-related areas of competence, which describe the radiographers’ skills that either facilitate or hinder good nursing care. In the direct patient-related area of competence, four categories emerged, which illustrate good nursing care in the patient’s immediate surroundings. In the indirect patient-related area of competence, four categories illuminated good nursing care that is provided without direct contact with the patient.Conclusions: The study highlights the different areas of the radiographer’s unique professional competence. The findings provide insight into the radiographer’s profession, on one hand as a carer and on the other as a medical technologist as well as highlighting the importance of each role. The radiographer’s work encompasses a variety of components – from caring for the patient to handling and checking the technical equipment.
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| 27. |
- Andersson, Bodil T., et al.
(författare)
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Radiographers' areas of professional competence related to good nursing care
- 2008
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 22:3, s. 401-409
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Radiographers' ability and competence is a matter of vital importance for patients. Nursing care is an integral part of the radiographer's work. The demand for high competence in clinical activities has increased in diagnostic radiology and has had an impact on the development of the profession.AIM: The aim was to describe the radiographer's areas of professional competence in relation to good nursing care based on critical incidents that occur in the course of radiological examinations and interventions.METHOD: A descriptive design with a qualitative approach, using the Critical Incident Technique was employed. Interviews were conducted with a strategic sample of registered radiographers (n = 14), based at different hospitals in Sweden.ETHICAL ISSUES: The appropriate ethical principles were followed. All the participants provided informed consent, and formal approval for conducting the research was obtained according to national and local directives.RESULTS: The data analysis resulted in two main areas; direct and indirect patient-related areas of competence, which describe the radiographers' skills that either facilitate or hinder good nursing care. In the direct patient-related area of competence, four categories emerged, which illustrate good nursing care in the patient's immediate surroundings. In the indirect patient-related area of competence, four categories illuminated good nursing care that is provided without direct contact with the patient.CONCLUSIONS: The study highlights the different areas of the radiographer's unique professional competence. The findings provide insight into the radiographer's profession, on one hand as a carer and on the other as a medical technologist as well as highlighting the importance of each role. The radiographer's work encompasses a variety of components--from caring for the patient to handling and checking the technical equipment.
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| 28. |
- Andersson, Bodil T.
(författare)
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Radiographers’ Professional Competence : Development of a context-specific instrument
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aim of this thesis was to explore and describe radiographers‟ professional competence based on patients‟ and radiographers‟ experiences and to develop a context-specific instrument to assess the level and frequency of use of radiographers‟ professional competence.Methods: The design was inductive and deductive. Both qualitative and quantitative methods were used. The data collection methods comprised interviews (Studies I-II) and questionnaires (Studies III-IV). The subjects were patients in study I and radiographers in studies II-IV. In study I, 17 patients were interviewed about their experiences of the encounter during radiographic examinations and treatment. The interviews were analysed using qualitative content analysis. In study II, 14 radiographers were interviewed to identify radiographers‟ areas of competence. The critical incident technique was chosen to analyse the interviews. Studies III and IV were based on a national cross-sectional survey of 406 randomly selected radiographers. Study III consisted of two phases; designing the Radiographer Competence Scale (RCS) and evaluation of its psychometric properties. A 42-item questionnaire was developed and validated by a pilot test (n=16) resulting in the addition of 12 items. Thus the final RCS comprised a 54-item questionnaire, which after psychometric tests was reduced to 28 items. In study IV, the 28-item questionnaire served as data. The level of competencies was rated on a 10-point scale, while their use was rated on a six-point scale.Results: In study I, the female patients‟ comprehensive understanding was expressed as feelings of vulnerability. The encounters were described as empowering, empathetic, mechanical and neglectful, depending on the radiographers‟ skills and attitudes. Study II revealed two main areas of professional competence, direct patient-related and indirect patient-related. The first focused on competencies in the care provided in close proximity to the patient and the second on competencies used in the activities of the surrounding environment. Each of the two main areas was divided into four categories and 31 sub-categories that either facilitated or hindered good nursing care. In study III the analysis condensed the 54-item questionnaire in two steps, firstly by removing 12 items and secondly a further 14 items, resulting in the final 28-item RCS questionnaire. Several factor analyses were performed and a two factor-solution emerged, labelled; “Nurse initiated care” and “Technical and radiographic processes”. The psychometric tests had good construct validity and homogeneity. The result of study IV demonstrated that most competencies in the RCS received high ratings both in terms of level and frequency of use. Competencies e.g. „Adequately informing the patient‟, „Adapting the examination to the patient‟s prerequisites and needs‟ and „Producing accurate and correct images‟ were rated the highest while „Identifying and encountering the patient in a state of shock‟ and „Participating in quality improvement regarding patient safety and care‟ received the lowest ratings. The total score of each of the two dimensions had a low but significant correlation with age and years in present position. The competence level correlated with age and years in present position in both dimensions but not with the use of competencies in the “Nurse initiated care” dimension.Conclusion: This thesis has shown that professional competence is important in the encounter between patient and radiographer. It has also demonstrated that radiographers‟ self-rated professional competence is based on nursing, technological and radiographic knowledge. From a radiographer‟s perspective, „Nurse initiated care‟ and „Technical and Radiographic processes‟ are two core dimensions of Radiographer Competence Scale. The 28-item questionnaire regarding level and frequency of use of competence is feasible to use to measure radiographers‟ professional competence.
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| 29. |
- Andersson, Bodil T., et al.
(författare)
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Radiographers' self-assessed level and use of competencies : a national survey
- 2012
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Ingår i: Insights into Imaging. - : Springer Science and Business Media LLC. - 1869-4101. ; 3:6, s. 635-645
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe radiographers' self-assessed level and use of competencies as well as how sociodemographic and situational factors are associated with these competencies, particularly related to work experience.METHODS: A cross-sectional design was employed. Radiographers (n = 406) completed the self-administered 28-item questionnaire encompassing two dimensions: 'Nurse-initiated care' and 'Technical and radiographic processes'. The level of competencies was rated on a 10-point scale and the frequency of use on a 6-point scale.RESULTS: Most competencies received high ratings both in terms of level and frequency of use. In 'Nurse-initiated care' the competency 'Adequately informing the patient' was rated the highest, while 'Identifying and encountering the patient in a state of shock' and 'Participating in quality improvement regarding patient safety and care' received the lowest ratings. In 'Technical and radiographic processes' the highest rated competencies were 'Adapting the examination to the patient's prerequisites and needs' and 'Producing accurate and correct images'. The lowest frequency of use was 'Preliminary assessment of images'.CONCLUSION: The main findings underline the radiographers' high competency in both 'Nurse-initiated care' and 'Technical and radiographic processes'. The lower rated competencies emphasise the importance of continuous professional education and quality improvement.MAIN MESSAGES :• Assessing radiographers' clinical competencies is fundamental for ensuring professional standards.• Most competencies received high ratings both in the nursing and in the radiographic dimensions.• The highest rated competencies focussed on information and adaptability to the patients needs.• The lowest rated competencies focussed on encountering the patient in shock and image assessments.• Age, years in present position and work place only explained a relatively small part of competency.
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| 30. |
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