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| 2. |
- 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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| 3. |
- Ekman, Inger, 1952, et al.
(författare)
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Effects of person-centred care in patients with chronic heart failure: the PCC-HF study
- 2012
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 33:9, s. 1112-1119
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Person-centred care (PCC), emphasizes a partnership in care between patients and health care professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate. Methods and results: During 2008-2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n=123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at 5 designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same 5 wards. PCC was then implemented at these wards and evaluated in 125 patients. LOS and 6-month readmission were extracted from patient records. ADL was evaluated at baseline and discharge and HRQL at baseline and after three months. In the analysis of all patients, LOS was reduced by one day (p=0.16) while retaining ADL (p=0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (p=0.01) and ADL level better preserved (p=0.04). HRQL and time-to-first readmission did not differ. Conclusions: In this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients’ HRQL.
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| 4. |
- Ekman, Inger, 1952, et al.
(författare)
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Pulmonary oedema - A life threatening disease
- 2007
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Ingår i: Eur J Cardiovasc Nurs. - 1474-5151.
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim was to describe the health history of patients after pulmonary oedema and investigate how they perceive their condition and treatment. METHODS: In part one of the study medical records of patients treated for acute pulmonary oedema (n=44) were reviewed regarding social status, health history, medication and cause of the pulmonary oedema. In part two, interviews were performed focusing on the patients' conceptions of the illness, current situation and effects of pulmonary oedema on daily life. RESULTS: One-year mortality was 65% and all but 3 patients had a previous heart diagnosis. Analyses of the interviews yielded five categories: A suffocating feeling; trust in care providers; medication - an annoyance but also a saviour; dealing with existential issues alone or with relatives; concurrent diseases affecting daily life. CONCLUSION: Patients' who experience a pulmonary oedema have several heart-related conditions and a very poor prognosis. Experiencing pulmonary oedema is an anxiety-provoking situation and patients should be regularly and carefully monitored.
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| 5. |
- Ekman, Inger, 1952, et al.
(författare)
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Standard medication information is not enough : poor concordance of patient and nurse perceptions
- 2007
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Ingår i: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 60:2, s. 181-186
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Tidskriftsartikel (refereegranskat)abstract
- AIM:This paper is a report of a study to describe patient and nurse perceptions of patient satisfaction with information about the medicines at two heart failure clinics after medication up-titration and information-giving.BACKGROUND:Chronic heart failure is a major cause of hospitalization. Poor adherence to medications increases mortality and heart failure-related hospitalizations. To achieve mutual goal-setting (concordance) regarding medication-taking behaviours, health providers need to understand patient information needs regarding the prescribed medicines.METHODS:A convenience sample of 56 patients with chronic heart failure referred for an up-titration of medicines and information-giving about the condition and treatment completed the Satisfaction about Information about Medicines Scale at their first and last visits. Nurses completed the same questionnaire after each patient's final visit, assessing the patient's need for further information. The data were collected between 2002 and 2004.RESULTS:Patient scores indicated statistically significantly more satisfaction with their information at the final visit compared with the first visit (P = 0.005). However, at the programme conclusion, nurses (n = 7) rated patients to be appropriately informed while patients reported a persistent need for further information (P = 0.011).CONCLUSION:Further research should evaluate more advanced pedagogical strategies such as how to address patients' expectations about the effect of medicines when actual effects of the treatment are related to mortality and morbidity at the population level and may not result directly in symptom relief at an individual level.
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| 6. |
- Hedemalm, Azar, 1960, et al.
(författare)
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A review of records from follow-up visits for immigrant and Swedish patients at a heart failure clinic
- 2007
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Ingår i: Eur J Cardiovasc Nurs. - 1474-5151. ; 6:3, s. 216-22
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Forskningsöversikt (refereegranskat)abstract
- Today, nearly 20% of the Swedish population originates from multiethnic backgrounds. Patients' symptom expressions, adherence to health regimens, and communication with health-care professionals have been shown to be related to their ethnic and cultural backgrounds. PURPOSE: To describe documented care of immigrant patients and matched Swedish patients at a heart failure clinic. METHOD: Journal audit of records of 25 immigrant and 25 matched Swedish patients with HF included from the patient registration database at the hospital where they were cared for. RESULTS: In the immigrant group, significantly fewer clinical parameters were assessed during their visits and fewer patients were scheduled for follow-up visits. Analyses revealed that some of the items recommended in the European Society of Cardiology guidelines for non-pharmacological HF care were overlooked for both of the groups. CONCLUSIONS: We found that medication adjustments and information about the condition and treatment were fairly similarly documented between Swedish and immigrant patients while significantly fewer clinical measurements and follow-up visits were documented for the immigrant group.
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| 7. |
- Hedemalm, Azar, 1960, et al.
(författare)
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Equality in the care and treatment of immigrants and native Swedes--a comparative study of patients hospitalised for heart failure
- 2008
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7:3, s. 222-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare immigrant and Swedish patients with heart failure (HF) regarding symptoms, diagnosis, medical treatment, discharge planning, readmission and mortality. The method was descriptive and retrospective using an audit protocol to review data from 214 medical records of 107 immigrants and 107 Swedish patients hospitalised for HF or chronic heart failure during 1994-2003. Descriptive statistics and significance testing were performed. Few differences between the patient groups were observed. Significantly larger number of immigrants were referred to the nurse-led HF clinic follow-up visits (P=0.026). Significantly more immigrants had ischemic heart disease on admission (P=0.025) and were prescribed short-acting nitrates at discharge (P=0.026). More Swedes were prescribed medications for insomnia (P=0.029). More immigrants than Swedes are referred to HF clinic after discharge, suggesting that physicians rely on specialised nurses to provide follow-ups, tailored to the needs of immigrant patients. The study indicates that the Swedish health care system has achieved its aim of equality in the care and treatment of this patient group. Further studies are needed to determine if this also applies to the quality of the provided care and treatment.
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| 8. |
- Hedemalm, Azar, 1960, et al.
(författare)
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Reported adherence and social support among immigrants compared to native Swedes
- 2010
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Ingår i: Journal of Immigrant and Minority Health. - : Springer Science and Business Media LLC. - 1557-1912 .- 1557-1920. ; 12:1, s. 124-131
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Tidskriftsartikel (refereegranskat)abstract
- Challenges experienced by heart failure patients have seldom been studied from the perspective of immigrants. OBJECTIVE: To describe and compare immigrant and native Swedish patients regarding changes in physical limitation, emotional state, social support and self-care. METHOD: A comparative study was conducted including 23 consecutively selected immigrants and 46 Swedish patients. Baseline and 4-month follow-up interviews were conducted using the Kansas City Cardiomyopathy Questionnaire, Short Form-36, Hospital Anxiety and Depression Scale, MOS Social Support Survey, and European Heart Failure Self-Care Behaviour Scale. RESULTS: A larger number of immigrants adhered to prescribed medications (P = 0.02) and significantly less (P = 0.048) felt having somebody to confide to compared to Swedish patients. However the distress level, frequency and severity of symptoms and signs, physical function, emotional state and self care were similar between the groups over time. CONCLUSION: Caregivers should be aware that immigrants may be in need of greater emotional support than has previously been anticipated.
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| 9. |
- Hedemalm, Azar, 1960, et al.
(författare)
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Symptom recognition and health care seeking among immigrants and native Swedish patients with heart failure
- 2008
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: It is not known what patient perceptions or beliefs lead to beneficial decisions or response patterns in symptom interpretation among heart failure (HF) patients, especially immigrants. The aim of this study was to explore and compare symptom recognition and health care seeking patterns among immigrants and native Swedes with HF. METHODS: The study used a qualitative design. Semi-structured interviews were conducted with 42 patients with HF, of whom 21 were consecutively selected immigrants and 21 were randomly selected Swedish patients. The interviews were analysed using content analysis. RESULTS: A majority of the immigrant patients sought health care for symptoms and signs, such as breathing difficulties, fatigue and swelling. Twice as many immigrants as Swedes were unaware of "what the illness experience entailed" and which symptoms indicated worsening of HF. CONCLUSION: The symptoms that patients sought care for, were similar among immigrants and Swedes. However, when interpreting symptoms more immigrants were unaware of the connection between the symptoms/signs and their HF condition. More tailored educational interventions might improve recognition of worsening symptoms in immigrant patients with chronic heart failure.
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| 10. |
- Mohammadi, M., et al.
(författare)
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Relationship between blood pressure levels and adherence to medication in patients with chronic heart failure: how come?
- 2009
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Ingår i: Vasc Health Risk Manag. - 1178-2048. ; 5:1, s. 13-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether change in objective signs during up-titration of angiotensin-converting enzyme (ACE)-inhibitors in patients with chronic heart failure affect perception of information about medicines and subjective activities such as self-care. METHODS: Consecutive patients referred for up-titration of ACE-inhibitors were included. Patients were given the Satisfaction with Information about Medicines Scale and the European Heart Failure Self-Care Behaviour Scale at their first visit and when the target dose was reached. Blood pressure, pulse and s-creatinine were measured at each visit. RESULTS: Relationships were found between change in systolic (r = 0.224, p = 0.044) and diastolic (r = 0.361, p = 0.001) blood pressure and change in self-care scores and were also observed at baseline (r = 0.324, 0.398, p = 0.001, 0.000) and follow-up (r = 0.317, 0.253, p = 0.004, 0.022). Diastolic blood pressure correlated with the "potential problem of medication" score (r= -0.263, p = 0.007). CONCLUSION: Patients with a more advanced disease usually have a lower blood pressure. Hence, the relationship between blood pressure and self-care scores might indicate that patients are more motivated to adhere to prescriptions the more advanced the stage of their disease.
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