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| 2. |
- Attebring, MF, et al.
(författare)
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Intrusion and confusion the impact of medication and health professionals after acute myocardial infarction
- 2005
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Ingår i: European Journal of Cardiovascular Nursing. - : Elsevier BV. - 1474-5151 .- 1873-1953. ; 4:2, s. 153-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Secondary prevention is important in preventing new cardiovascular events after acute myocardial infarction (AMI). AIM: To explore patients' experiences of secondary prevention after a first AMI. METHODS: A qualitative approach with hermeneutical analysis of in depth interviews was used. RESULTS: Twenty patients (12 men and 8 women, aged 34-79 years) were interviewed. None of the patients was previously treated for cardiovascular disease except one that had a history of angina pectoris. Two main themes emerged from the analysis. 1) Impact of medication: patients interpreted bodily sensations as a consequence of being medicated rather than as a result of their heart attack. The medication led to feelings of being intruded upon but also to positive feelings of security. 2) Impact of health professionals: communication with health professionals resulted in confusion about both treatment and the severity of the coronary disease. Patients expressed a need of being reassured by their physician regarding their physical status. CONCLUSIONS: Health professionals need to consider the impact of pharmacological treatment on patients' life, at least in patients who suffer from a first AMI. The point of departure in secondary preventive work must be patients' beliefs about their condition and the treatment they receive. Nurses and physicians must be aware of the information each patient has been given, and from this starting point, they have to be in concordance with one another. From the patients' perspective it is deemed necessary for the physicians to discuss the disease and the consequences it may have, both in the near future and in the long run, as soon as possible.
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| 4. |
- Brännström, Margareta, et al.
(författare)
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Living with severe chronic heart failure in palliative advanced home care.
- 2006
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 5:4, s. 295-302
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Living with severe chronic heart failure (CHF) in palliative care has been little studied. AIM: The aim of this study is to illuminate meaning of living with severe CHF in palliative advanced home care through patients' narratives. METHODS: Narrative interviews were conducted with 4 patients, tape-recorded and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. RESULTS: Meaning of living with severe CHF in palliative advanced home care emerged as 'knocking on death's door' although surviving. The course of the illness forces one to live a 'roller coaster life,' with an ongoing oscillation between ups and downs. Making it through the downs breeds a kind of confidence in one's ability to survive and the will to live is strong. Being offered a safety belt in the 'roller coaster' by the palliative advanced home care team evokes feelings of security. CONCLUSIONS: Meaning of living with severe CHF in palliative advanced home care is on one hand, being aware of one's imminent death, on the other hand, making it through the downs i.e. surviving life-threatening conditions, breed confidence in also surviving the current down. Being constructively dependent on palliative advanced home care facilitates everyday life at home.
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| 5. |
- Dudas, Kerstin, 1963, et al.
(författare)
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PCC- Impact at admission and discharge process, among patients with chronic heart failure
- 2013
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 12:Supplement 1, s. 66-67
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic heart failure (CHF) mostly affects the elderly and is a lifelong and progressive disease and the single most common cause of hospitalization with frequent re-admissions. Although many patients with CHF are independent, some patients are fragile and need extra support and care during the hospital stay and after discharge to prevent disability. A person-centred care (PCC) approach to care and planning may help to promote more efficient care and discharge-planning. Aim: To evaluate if PCC-based proactive care-planning, beginning already at admission, leads to improved efficiency in the discharge procedure compared with usual care in patients hospitalized for worsening CHF. Methods: Using a controlled before-and-after design, eligible patients with CHF were randomly assigned to either a usual care group or a PCC intervention group. Development of the PCC care and discharge plan consisted of three steps: 1) a comprehensive narrative was obtained from the patients at admission to identify each patient’s resources for and barriers to recovery; 2) a PCC plan was drawn up based on this and other clinical information and discussed with the patient Downloaded from cnu.sagepub.com at Gothenburg University Library on December 15, 2013 EuroHeartCare 2013 S67 3) the PCC plan was checked and revised where appropriate. The patients’ social situation before admission, their discharge destination, the number of days until the discharge notification was sent to the patients’ community home help service/district nurse were recorded as well as the time interval between notification and start of coordination of care between hospital staff and community home help services and district nurses. Results: 123 in the usual care group and 125 were enrolled. Most of the patients came from independent living (93.2% in the PCC group and 93.5% in the usual care group). The proportion of patients who had community home help service before admission was slightly lower in the PCC group (32.4%) compared to the usual care group (35.8%). The proportion of patients who received care from a district nurse was slightly higher in the PCC group (18.9%) than in the usual care group (13.1%). During hospitalization, the notification to the patients community home help service and/or district nurse were significantly (P = 0.04) more frequently in the PCC-group (33.8%) compared to usual care group (12.1%). Care coordination started within six days in the PCC group whereas the usual care group was more dispersed 1-29 days. Conclusion: PCC improved significantlythe efficiency of the transfer process for patients in need of community home help service and/or district nurse after discharge.
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| 6. |
- Dudas, Kerstin, 1963, et al.
(författare)
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Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care
- 2013
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 12:6, s. 521-528
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Tidskriftsartikel (refereegranskat)abstract
- Background:Many patients with chronic heart failure (CHF) experience uncertainty regarding the treatment and characteristics of their illness. Person-centred care (PCC) emphasizes patient involvement in care. We have previously shown that PCC improved outcomes such as length of hospital stay and activities of daily living in patients with CHF. The impact of PCC on self-reported uncertainty in illness among patients hospitalized for CHF is still unknown.Aim:To evaluate whether PCC is associated with less self-reported uncertainty in illness compared with usual care in patients hospitalized for worsening CHF.Methods:Using a controlled before-and-after design, eligible CHF patients were assigned to either a usual care group or a PCC intervention group. Patient-reported uncertainty in illness was assessed at hospital discharge with the Cardiovascular Population Scale (CPS). The CPS consists of two domains: 1) Ambiguity (about illness severity); and 2) Complexity (of treatment and system of care).Results:Two hundred and forty-eight patients were included in the study; 123 in the usual care group and 125 in the PCC intervention. The PCC group had better scores than the usual care group in the CPS domains complexity (M=15.2, SD=4.7 vs. M=16.8, SD=4.7; p=0.020) and ambiguity (M=27.8, SD=6.6 vs. M=29.8, SD=6.9; p=0.041).Conclusion:Patients with CHF were less uncertain in their illness after PCC, which may help to equip and empower patients to manage their illness. Together with earlier findings of shortened hospital stay and improved activities of daily living, this indicates that PCC should be a standard approach for hospital care of patients with worsening CHF.
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| 7. |
- Ekman, Inger, 1952, et al.
(författare)
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Gender makes a difference in the description of dyspnoea in patients with chronic heart failure.
- 2005
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Ingår i: Eur J Cardiovasc Nurs. - : Oxford University Press (OUP). - 1474-5151. ; 4:2, s. 117-21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dyspnoea is a common symptom of chronic heart failure (CHF). In the community setting, patients with CHF are most often women. Aim: To examine the impact of gender on the description of dyspnoea and to explore which clinical variables support a diagnosis of CHF. Methods: From four primary health care centres, 158 patients with CHF were included. Patients were examined with echocardiography and a cardiologist assessed the diagnosis of CHF. The patients filled in a questionnaire containing 11 descriptors of dyspnoea. Results: A diagnosis of CHF was confirmed in 87 (55%) patients (47 males and 40 females). One descriptor, I feel that I am suffocating, was significantly scored higher in CHF patients ( p=0.014) as compared to non-CHF patients. Three descriptors, My breath does not go in all the way ( p=0.006), I feel that I am suffocating ( p=0.040), and I cannot get enough air ( p=0.0327) were significantly scored higher among men with CHF, compared to no descriptor among women with CHF. Being male (OR=2.7; CI: 1.3–5.6, p=0.008), having diabetes (OR=5.6; CI: 1.7–18.2, p=0.004), IHD (OR=3.3; CI: 1.3–8.5, p=0.014), and a borderline significance for age (OR=1.04; CI: 0.99–1.08, p=0.058) predicted a confirmed diagnosis of CHF. Conclusion: Three descriptors of dyspnoea were associated with CHF among men, whereas no such association was found among women. Our results suggest that gender is an important factor and should—together with age, underlying heart disease, and diabetes—be taken into account when symptoms are evaluated in the diagnosis of CHF in primary care.
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| 8. |
- Ekman, Inger, 1952, et al.
(författare)
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Person-centered care -ready for prime time.
- 2011
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 10:4, s. 248-251
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Tidskriftsartikel (refereegranskat)abstract
- Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.
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| 9. |
- Ekman, Inger, 1952, et al.
(författare)
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Person-centred care: looking back, looking forward
- 2021
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 20:2, s. 93-95
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Tidskriftsartikel (refereegranskat)abstract
- An interdisciplinary group of clinical and non-clinical academics in Sweden created a research centre for the study of person-centred care (PCC) in long-term illness: the University of Gothenburg Centre for Person-Centred Care (GPCC). The GPCC steering committee formulated a position paper with three ‘simple routines’ to initiate, implement, and safeguard PCC in daily clinical practice. The EJCN accepted this position paper for publication in 2011. This brief review seeks to present how PCC, as defined in the position paper, has been used in research and published in EJCN during the past 5 years (2016–20). Clinical implications and future research in PCC are also suggested.
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| 10. |
- Ekman, Inger, 1952, et al.
(författare)
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Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study.
- 2017
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Ingår i: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. - : Oxford University Press (OUP). - 1873-1953. ; 16:7, s. 646-654
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Tidskriftsartikel (refereegranskat)abstract
- Ineffective medication management contributes to repeated hospitalisation and death among patients with heart failure. The meaning ascribed to medications and the influence of meaning on how patients manage medications is unknown. The purpose of this study was to explore the meaning and expectations associated with medication use in high-risk, non-adherent patients with heart failure.Patients ( n=265) with heart failure were screened for adherence to prescribed medication using the Morisky medication adherence scale (MMAS). Patients (MMAS score <6; n=44) participated in semistructured interviews, analysed using qualitative content analysis. Of 17 initial themes (223 representative segments), the overarching theme 'unmet expectations' consisted of two subthemes 'working to be heard' by professionals and 'resignation' to both the illness and medications. Patients' expectations were challenged by unexpected work to communicate with providers in general (72 representative segments), and specifically regarding medications (118 representative segments) and feelings of resignation regarding the medication regimen (33 representative segments).These findings suggest that unmet expectations contribute to poor medication management. Improved listening and communication by providers, to establish a common understanding and plan for managing medications may strengthen patient beliefs, resolve feelings of resignation and improve patients' ability to manage medications effectively.
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