| 1. |
- Andersson, Jenny, et al.
(författare)
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Decision‐Making in Seeking Emergency Care for Stroke Symptoms
- 2022
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Ingår i: Stroke: Vascular and Interventional Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 2694-5746. ; 2:6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious studies have shown that rapid treatment for stroke, especially ischemic stroke, reduces mortality and disability. The focus has mainly been on reducing time from arrival at hospital to start of treatment. However, the main reason for delay is often time from symptom onset to arrival at hospital. This study therefore aimed to explore decision‐making processes after the onset of stroke symptoms in patients experiencing a first‐time stroke.MethodsWe included 36 patients aged 18 and older, all of whom were hospitalized with a first‐time stroke between October 2018 and April 2020. All patients were interviewed once within 4 weeks of symptom onset and before hospital discharge. Eligible patients were identified retrospectively through a targeted review of medical records. The data were collected and analyzed according to the grounded theory methodology.ResultsIn total, 43 potential patients were identified and asked to participate. Overall, 36 patients were included in the study: 17 women (median age 77.0 years, interquartile range 17.5) and 19 men (median age 65.7 years, interquartile range 17.2). All interviewees felt fear, and this affected their decision to seek emergency care. The decision‐making processes were described by the core category of “Acting on fear.” The reason for feeling frightened determined the actions taken. The reasons were sorted into 3 main categories: (1) “seeking care”–recognized stroke symptoms and acted immediately; (2) “pending and reluctance”–suspected stroke but awaited to seek care; and (3) “seeking an explanation”–confused by symptoms.ConclusionWe found that decision‐making when experiencing stroke symptoms was complex. All patients felt fear, which determined their actions. Some patients knew about stroke symptoms and acted immediately. Others suspected stroke but still chose to wait, whereas others were confused and tried to find answers. These results could contribute to form future awareness campaigns.
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| 2. |
- Andersson, Jenny, et al.
(författare)
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Patient´s description of onset stroke symptoms : Oral Presentations. ESOC 2023 Abstract Book
- 2023
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Ingår i: European Stroke Journal. - : Sage Publications. - 2396-9873 .- 2396-9881. ; 8:2, s. 427-427
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Stroke symptoms vary and could be hard to recognize. In addition, stroke severity has decreased according to the National Institutes of Health Stroke Scale (NISSH), with less pronounced symptoms expression. Knowledge on the patient’s description of stroke symptoms is therefore needed. The aim was to describe patient’s symptoms at stroke onset.Methods: A qualitative content analysis was used. Data were collected through individual interviews with 27 patients (16 men and 11 women, median age 70.4 years). All patients were hospitalized with a first-time stroke. The interviews were conducted within 4 weeks of symptoms onset and before hospital discharge.Results: All patients had symptoms that affected their daily life. Some patients described having multiple symptoms at the same time, others had symptoms that began insidiously and worsened over time. Symptoms such as overwhelming fatigue or nausea were described as Premonition of becoming ill, feeling unwell or that something was wrong. Motoric bodily changes were multifaceted as slurred speech or dizziness, balance difficulties and losing control of the body or motor dysfunction. But also, that the surroundings were distorted, and solid objects moved around. Symptoms of Dazed and affected senses included confusion and visual impairment or headache.Conclusions: Stroke is a complex disease with several different symptoms’ expressions and could be difficult to recognize, especially when symptoms are less typical or perceived as not serious. Increased awareness of stroke symptoms among caregivers and among members of the community is important and needed.
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| 3. |
- Andersson, Jenny, et al.
(författare)
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Symptoms at stroke onset as described by patients: a qualitative study
- 2024
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Ingår i: BMC Neurology. - : Springer Nature. - 1471-2377. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke.Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level.Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another.Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this.
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| 4. |
- Andersson, Susanne, et al.
(författare)
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Attitudes Regarding Participation in a Diabetes Screening Test among an Assyrian Immigrant Population in Sweden
- 2016
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Ingår i: Nursing Research and Practice. - : Hindawi Limited. - 2090-1429 .- 2090-1437.
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Tidskriftsartikel (refereegranskat)abstract
- Immigrants from the Middle East have higher prevalence and incidence of type 2 diabetes (T2D) compared with native Swedes. The aim of the study was to describe and understand health beliefs in relation to T2D as well as attitudes regarding participation in a screening process in a local group of Assyrian immigrants living in Sweden. A qualitative and quantitative method was chosen in which 43 individuals participated in a health check-up and 13 agreed to be interviewed. Interviews were conducted, anthropometric measurements and blood tests were collected, and an oral glucose tolerance test was performed. In total, 13 of the 43 participants were diagnosed with impaired glucose metabolism, 4 of these 13 had TD2. The interviewed participants perceived that screening was an opportunity to discover more about their health and to care for themselves and their families. Nevertheless, they were not necessarily committed to taking action as a consequence of the screening. Instead, they professed that their health was not solely in their own hands and that they felt safe that God would provide for them. Assyrians' background and religion affect their health beliefs and willingness to participate in screening for TD2.
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| 5. |
- Andersson, Susanne, 1957-, et al.
(författare)
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Experiences of a Novel Structured Foot Examination Form for Patients With Diabetes From the Perspective of Health Care Professionals : Qualitative Study
- 2023
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Ingår i: JMIR nursing. - : JMIR Publications. - 2562-7600. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Diabetes is a growing threat to public health, and secondary diseases like foot complications are common. Foot ulcers affect the individual's quality of life and are a great cost to society. Regular foot examinations prevent foot ulcers and are a recommended approach both in Sweden and worldwide. Despite existing guidelines, there are differences in the execution of the foot examination, which results in care inequality. A structured foot examination form based on current guidelines was developed in this study as the first step toward digitalized support in the daily routine, and was validated by diabetes health care professionals.OBJECTIVE: The study aimed to validate a structured foot examination form by assessing health care professionals' experiences of working with it "foot side" when examining patients with diabetes.METHODS: Semistructured interviews were held in a focus group and individually with 8 informants from different diabetes professions, who were interviewed regarding their experiences of working with the form in clinical practice. The users' data were analyzed inductively using qualitative content analysis. The study is part of a larger project entitled "Optimised care of persons with diabetes and foot complications," with Västra Götaland Region as the responsible health care authority, where the results will be further developed.RESULTS: Experiences of working with the form were that it simplified the foot examination by giving it an overview and a clear structure. Using the form made differences in work routines between individuals apparent. It was believed that implementing the form routinely would contribute to a more uniform execution. When patients had foot ulcers, the risk categories (established in guidelines) were perceived as contradictory. For example, there was uncertainty about the definition of chronic ulcers and callosities. The expectations were that the future digital format would simplify documentation and elucidate the foot examination, as well as contribute to the accessibility of updated and relevant data for all individuals concerned.CONCLUSIONS: The foot examination form works well as a support tool during preventive foot examination, creates a basis for decision-making, and could contribute to a uniform and safer foot examination with more care equality in agreement with current guidelines.TRIAL REGISTRATION: ClinicalTrials.gov NCT05692778; https://clinicaltrials.gov/ct2/show/NCT05692778.
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| 6. |
- Berglund, Mia, 1964-, et al.
(författare)
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Reflection tools : support for patient learning in group education
- 2024
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Ingår i: Reflective Practice. - : Taylor & Francis. - 1462-3943 .- 1470-1103. ; , s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- This qualitative study describes how reflection can be supported by using reflective tools in group education in type 2 diabetes. The changed conditions for living with a long-term illness may lead to increased anxiety and new demands that affect one’s current life situation. The didactic model, ‘The challenge – to take charge of one’s life with long-term illness’, has been developed into ‘Taking responsibility in life with type 2 diabetes – a model for group education in primary care’. Specialized diabetes nurses and dieticians received training, a manual and continuous guidance in applying the model. Reflection diaries, notes and interviews both from the patients and the caregivers were analyzed using a phenomenological hermeneutic method. The results show that using images as reflective tools engages thoughts and feelings in a way that appears to be important for one’s learning in life with a chronic illness. The images contribute to allowing a distance from one’s situation, actions, thoughts and feelings, which seems fruitful for investigating and discovering new ‘things’ about oneself. With the support of reflective tools and guiding questions, reflection is led to a deeper existential level where both caregivers and patients contribute by asking questions that support the reflection process.
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| 7. |
- Dalemo, Sofia, et al.
(författare)
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From unwelcome to supportive : Patients’ conceptions of being prescribed a glucose-lowering drug at type 2 diabetes diagnosis – a phenomenographic study
- 2024
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - 1748-2623 .- 1748-2631. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose:Guidelines recommend starting glucose-lowering drug upon type 2 diabetes mellitus diagnosis together with lifestyle changes. Lifestyle changes are as essential as the drug, earlier recommendations allowed some months of lifestyle changes while being drug-free. Prescription on diagnosis may interfere with patients’ understanding and motivation for lifestyle changes if they cannot evaluate the effect on blood glucose.Methods:A phenomenographic approach and interviews were conducted with patients who started a glucose-lowering drug at diagnosis.Results:Three qualitatively different conceptions of being prescribed glucose-lowering drugs in connection to type 2 diabetes mellitus diagnosis were found: “Drugs as something unwelcome,” “Drugs as a support,” and “Drugs as a means to reach the goal”. These conceptions range broadly from drugs as unwelcome to drugs as a support for lifestyle changes and an opportunity to influence the course of the lifelong disease to reach a goal.Conclusions:This study has identified various perspectives of patients’ understanding of the role of lifestyle changes in managing their disease. The patients undergo a process, and the perspectives vary, providing a more extensive and nuanced understanding. It is, therefore, impossible to apply a routine protocol and a person-centred approach is required when prescribing a glucose-lowering drug.
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| 8. |
- Dalemo, Sofia, et al.
(författare)
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From unwelcome to supportive. Patients' conceptions of being prescribed a glucose-lowering drug at type 2 diabetes diagnosis - a phenomenographic study
- 2024
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Ingår i: INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING. - 1748-2623 .- 1748-2631. ; 19:1
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Forskningsöversikt (refereegranskat)abstract
- PurposeGuidelines recommend starting glucose-lowering drug upon type 2 diabetes mellitus diagnosis together with lifestyle changes. Lifestyle changes are as essential as the drug, earlier recommendations allowed some months of lifestyle changes while being drug-free. Prescription on diagnosis may interfere with patients' understanding and motivation for lifestyle changes if they cannot evaluate the effect on blood glucose.MethodsA phenomenographic approach and interviews were conducted with patients who started a glucose-lowering drug at diagnosis.ResultsThree qualitatively different conceptions of being prescribed glucose-lowering drugs in connection to type 2 diabetes mellitus diagnosis were found: "Drugs as something unwelcome," "Drugs as a support," and "Drugs as a means to reach the goal". These conceptions range broadly from drugs as unwelcome to drugs as a support for lifestyle changes and an opportunity to influence the course of the lifelong disease to reach a goal.ConclusionsThis study has identified various perspectives of patients' understanding of the role of lifestyle changes in managing their disease. The patients undergo a process, and the perspectives vary, providing a more extensive and nuanced understanding. It is, therefore, impossible to apply a routine protocol and a person-centred approach is required when prescribing a glucose-lowering drug.
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| 9. |
- Ekelöf, Katarina, et al.
(författare)
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A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates : a study protocol
- 2022
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 22, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An intact umbilical cord allows the physiological transfusion of blood from the placenta to the neonate, which reduces infant iron deficiency and is associated with improved development during early childhood. The implementation of delayed cord clamping practice varies depending on mode of delivery, as well as gestational age and neonatal compromise. Emerging evidence shows that infants requiring resuscitation would benefit if respiratory support were provided with the umbilical cord intact. Common barriers to providing intact cord resuscitation is the availability of neonatal resuscitation equipment close to the mother, organizational readiness for change as well as attitudes and beliefs about placental transfusion within the multidisciplinary team. Hence, clinical evaluations of cord clamping practice should include implementation outcomes in order to develop strategies for optimal cord management practice.METHODS: The Sustained cord circulation And Ventilation (SAVE) study is a hybrid type I randomized controlled study combining the evaluation of clinical outcomes with implementation and health service outcomes. In phase I of the study, a method for providing in-bed intact cord resuscitation was developed, in phase II of the study the intervention was adapted to be used in multiple settings. In phase III of the study, a full-scale multicenter study will be initiated with concurrent evaluation of clinical, implementation and health service outcomes. Clinical data on neonatal outcomes will be recorded at the labor and neonatal units. Implementation outcomes will be collected from electronic surveys sent to parents as well as staff and managers within the birth and neonatal units. Descriptive and comparative statistics and regression modelling will be used for analysis. Quantitative data will be supplemented by qualitative methods using a thematic analysis with an inductive approach.DISCUSSION: The SAVE study enables the safe development and evaluation of a method for intact cord resuscitation in a multicenter trial. The study identifies barriers and facilitators for intact cord resuscitation. The knowledge provided from the study will be of benefit for the development of cord clamping practice in different challenging clinical settings and provide evidence for development of clinical guidelines regarding optimal cord clamping.TRIAL REGISTRATION: Clinicaltrials.gov, NCT04070560 . Registered 28 August 2019.
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| 10. |
- Kjellsdotter, Anna, et al.
(författare)
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To take charge of one's life : group-based education for patients with type 2 diabetes in primary care - a lifeworld approach
- 2020
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The number of people suffering from diabetes worldwide, including Sweden, has increased. To strengthen the patient's empowerment and thus improve their ability to take care of their own health, patient education in self-care management plays a central role in diabetes care.Purpose: The specific aim in this study was to describe patients' experiences of group-based education using the Taking charge of one's life with type 2 diabetes model.Methods: A qualitative approach with a phenomenological lifeworld perspective was used. The study was based on group and individual interviews and reflection books.Results: The group-based education model made it possible for the patients to learn through reflection concerning their own and others' experiences. The learning that occurred with support from the group reflections and the reflection books contributed to the understanding of the complexity of the illness. This increased the motivation and desire to be responsible for the treatment and implementation of habits. The group contributed to a sense of belonging and community that inspired a continued and active learning.Conclusion: The results showed that from the patients' perspective, this didactic model was both suitable and appreciated, supporting and facilitating learning.
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