| 371. |
- Forsgärde, Elin-Sofie
(författare)
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Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to describe and compare pathways for older patients and the involved actors’ experiences of decision-making in acute situations in ambulatory care.Methods: The overall three-fold design, comprising exploratory, descriptive as well as comparative ones, was conducted inductively, including a mixed method with a convergent integrated approach to empirical data. The four involved studies were analysed using either quantitative or qualitative analysis methods.Results: Most older patients’ pathways when being assessed by ambulance personnel involved receiving care at hospitals. However, an increasing trend of non-conveyance to hospitals was identified during a five-year period (2014–2018), which means receiving care, for example, at home or primary healthcare (PHC) centres. Decision-making about the level-of-care for older patients was more or less uncertain for all involved actors, i.e. older patients, significant others and healthcare professionals such as ambulance personnel, registered nurses, specialists in general practice at PHC centres and community health nurses. To increase the level of certainty in the decision-making process, all actors was supported by both an individual and external dialogue. Individual dialogue gave support by using own experience and knowledge. For ambulance personnel and community health nurses, support was also partially gained from decision support tools but was regarded as insufficient when older patients had non-specific symptoms. External dialogue provided support through mutuality, and via collaboration, a common goal, trust and responsibility. Mutuality gave support through experience and knowledge being shared with all involved actors, which provided a common comprehensive understanding that facilitated consensus in the decision-making.Conclusion: The increasing level of non-conveyance to hospitals and uncertainty during decision-making highlights the need to develop and extend the availability of dialogue-based collaborations as support in ambulatory care. Dialogue-based support involves all actors contributing to the decision-making. Healthcare professionals need to be aware of the prerequisites and the support that mutuality in external dialogues brings. Healthcare organisations need to develop and extend dialogue-based collaboration in ambulatory care by combining different expertise and providing conditions to increase support in decisions adapted to older patients' needs.
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| 372. |
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| 373. |
- Frantzen, Astri Tafjord, et al.
(författare)
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Frailty Status and Patient-Reported Outcomes in Octogenarians Following Transcatheter or Surgical Aortic Valve Replacement
- 2021
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Ingår i: Heart, Lung and Circulation. - : Elsevier. - 1443-9506 .- 1444-2892. ; 30:8, s. 1221-1231
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFrailty status and patient-reported outcomes are especially pertinent in octogenarians following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) to guide treatment decisions and promote patient-centred care.AimWe aimed to determine if frailty changed 6 months after aortic valve replacement (AVR) in octogenarians, and to describe changes in self-rated health according to frailty status in patients who underwent TAVI or SAVR.MethodIn a prospective cohort study, frailty and self-rated health were measured one day prior to and 6 months after AVR. Frailty status was measured with the Study of Osteoporotic Fracture index. Self-rated health was measured comprehensively with the disease-specific Minnesota Living with Heart Failure Questionnaire, the generic Medical Outcomes Study Short Form-12 questionnaire (SF-12), and two global questions from The World Health Organization Quality of Life Instrument Abbreviated.ResultsData were available for 143 consecutive patients (mean age 83 +/- 2.7 years, 57% women; 45% underwent TAVI). At baseline, 34% were robust, 27% prefrail, and 39% frail. Overall, there was no change in the distribution of frailty status 6 months after baseline (p=0.13). However, on an individual level 65 patients changed frailty status after AVR (40 patients improved and 25 declined). Improvement in frailty status was common in prefrail (33%; n=13) and frail patients (48%; n=27). Patients had improved self-rated health after AVR, with significant differences between frailty states both at baseline (SF-12 physical: 37.4 [robust], 33.1 [prefrail], 31.6 [frail], p=0.03); SF-12 mental: 51.9 [robust], 50.8 [prefrail], 44.5 [frail], p<0.001); and at the 6-month follow-up (SF-12 physical: 45.4 [robust], 38.3 [prefrail], 32.1 [frail], p<0.001); SF-12 mental: 54.9 [robust], 49.6 [prefrail], 46.8 [frail], p=0.002).ConclusionsAdvanced treatment performed in a high-risk population allowed people to improve their self-rated health. Although frailty is associated with poor self-rated health, frailty status does not equal negative outcomes. The frail patients were those who improved most in self-rated physical and mental health. They had the lowest baseline self-rated health scores and had therefore the most to gain.
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| 374. |
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| 375. |
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| 377. |
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| 378. |
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| 379. |
- Fridlund, Bengt, et al.
(författare)
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Cardiac rehabilitation and psychosocial gender differences
- 2002
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Ingår i: Vård i Norden. - København : Sjuksköterskornas samarbete i Norden (SSN). - 0107-4083 .- 1890-4238. ; 22:3, s. 48-51
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Tidskriftsartikel (refereegranskat)abstract
- Tertiary prevention comprising treatment, care and rehabilitation of patients with heart disease is an important task for nurses and other health care professionals. This is achieved through a combination of medico-physical and psychosocial interventions, related to the male or female patient's personal, expressed problems and the personnel's know ledge. Therefore, the aim of this literature study was to highlight the comprehensiveness of the cardiac rehabilitation concept from a Nordic perspective and with focus on psychosocial gender differences. The Nordic examples of cardiac rehabilitation programmes, involving a multidisciplinary team and comprising health education, physical exercise and stress management, include no specific efforts for women. However, the efficacy of out-patient programmes is still poorly documented and there is a need to increase the attendance of eligible patients, particularly women, in these programmes. There are differences between the genders concerning the need for support from personnel and laymen in order to better reach patient's compliance. Taking the psychosocial characteristics specific to women into account, could be the first step towards increased attendance rates for women as well as reaching the proximal and distal targets with regards to cardiac rehabilitation.
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| 380. |
- Fridlund, Bengt, et al.
(författare)
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Developing and establishing the psychometric properties of an Ethos towards Wellness Questionnaire (EtWeQ)
- 2014
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Ingår i: Open Journal of Nursing. - Irvine : Scientific Research Publishing. - 2162-5336 .- 2162-5344. ; 4:7, s. 538-547
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Validated instruments exist measuring parts of personal health, ill-health and lifestyle, but there are few, if any, instruments “grasping the big picture” of wellness and ethos. Accordingly the aim was to develop and establish the psychometric properties of a 74-item Ethos towards Wellness Questionnaire (EtWeQ) with regards to content and construct validity, as well as homogeneity and stability reliability. Methods: A questionnaire based on a methodological and developmental design was sent out twice with a four week gap between, on 221 healthy middle-aged participants in four steps: item generating, content validating, statistical analyzing and establishing the final questionnaire. Results: The substantial base, consisting of content validity resulted in, besides basic characteristics, six well-defined and sufficient indexes comprising of; two health indexes (healthiness and ill-healthiness), three life context indexes (work, family, spare time), and one brief comprehensive index (ethos). The three life context as well as the ethos indexes at an ordinal scale level, identified overall satisfactory communalities of >0.30, factor loadings > 0.30, and factor total variance > 50% with regard to construct validity. The homogeneity reliability, in terms of Cronbach’s alpha coefficient > 0.70, at both occasions with a four week gap between, as well as the stability reliability in terms of intraclass correlation coefficient > 0.70, were also considered satisfactory in the same indexes. Conclusions: This newly developed, and likely the only questionnaire focusing on “grasping the big human picture”, was based on both a philosophical reasoning and empirical recommendations of wellness, is shown to be a valid and reliable measurement in screening or in follow-up of healthy people’s wellness and ethos.
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