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Sökning: WFRF:(Thylén Ingela) > (2014)

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1.
  • Brännström, Margareta, et al. (författare)
  • Sexual knowledge in patients with a myocardial infarction and their partners
  • 2014
  • Ingår i: Journal of Cardiovascular Nursing. - Philadelphia : Lippincott Williams & Wilkins. - 0889-4655 .- 1550-5049. ; 29:4, s. 332-339
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Sexual health and sexual activity are important elements of an individual's well-being. For couples, this topic is often affected after a myocardial infarction (MI). It has become increasingly clear that, after an MI, patients are insufficiently educated on how to resume normal sexual activity. However, sufficient data on the general knowledge that patients and partners have about sexual activity and MI are lacking.OBJECTIVE: The aims of this study were to explore and compare patients' and partners' sexual knowledge 1 month after a first MI and 1 year after the event and to compare whether the individual knowledge had changed over time. A second aim was to investigate whether patients and their partners report receiving information about sexual health and sexual activity from healthcare professionals during the first year after the event and how this information was perceived.SUBJECTS AND METHODS: This descriptive, comparative survey study enrolled participants from 13 Swedish hospitals in 2007-2009. A total of 115 patients with a first MI and their partners answered the Sex After MI Knowledge Test questionnaire 1 month after the MI and 1 year after the event. Correct responses generated a maximum score of 75.RESULTS: Only 41% of patients and 31% of partners stated that they had received information on sex and relationships at the 1 year follow-up. The patients scored 51 ± 10 on the Sex After MI Knowledge Test at inclusion into the study, compared with the 52 ± 10 score for the partners. At the 1-year follow-up, the patients' knowledge had significantly increased to a score of 55 ± 7, but the partners' knowledge did not significantly change (53 ± 10).CONCLUSIONS: First MI patients and their partners reported receiving limited information about sexual issues during the cardiac rehabilitation and had limited knowledge about sexual health and sexual activity.
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  • Fluur, Christina, et al. (författare)
  • Spouses’ reflections on Implantable Cardioverter Defibrillator treatment with focus on the future and the end-of-life : a qualitative content analysis
  • 2014
  • Ingår i: Journal of Advanced Nursing. - Chichester, West Sussex : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 70:8, s. 1758-1769
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim. To explore future reflections of spouses living with an implantable cardioverter defibrillator recipient with focus on the end-of-life phase in an anticipated palliative phase.Background. A history of or risk for life-threatening arrhythmias may require an implantable cardioverter defibrillator. Despite the life-saving capacity of the device, eventually life will come to an end. As discussion about preferences of shock therapy at end-of-life phase seldom takes place in advance, the implantable cardioverter defibrillator recipients may face defibrillating shocks in the final weeks of their lives, adding to stress and anxiety in patients and their families.Design. Qualitative study with in-depth interviews analysed with a content analysis.Methods. Interviews were performed with 18 spouses of medically stable implantable cardioverter defibrillator recipients during 2011–2012.Results. The spouses described how they dealt with changes in life and an uncertain future following the implantable cardioverter defibrillator implantation. Six subcategories conceptualized the spouses' concerns: Aspiring for involvement; Managing an altered relationship; Being attentive to warning signs; Worries for deterioration in the partner's health; Waiting for the defibrillating shock; and Death is veiled in silence.Conclusion. Despite the partner's serious state of health; terminal illness or death and the role of the device was seldom discussed with healthcare professionals or the implantable cardioverter defibrillator recipient. Open and honest communication was requested as important to support coping with an unpredictable life situation and to reduce worries and uncertainty about the future and end-of-life. © 2013 John Wiley & Sons Ltd.
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  • Michaelsen, Ragnhild, et al. (författare)
  • Implementation of a research-based bachelor thesis in nursing - process and experiences
  • 2014
  • Ingår i: Nordisk Tidsskrift for Helseforskning. - : UiT The Arctic University of Norway. - 1504-3614 .- 1891-2982. ; 2
  • Tidskriftsartikel (refereegranskat)abstract
    • Implementation of a research-based bachelor thesis in nursing – process and experiencesBackground: Ability to ensure quality and to evaluate own practice of nursing, is essential in order to practice a research based health care. An increase of research skills among future nurses, are thus central. The aim of this paper is to describe experiences connected with implementation of a new research-based model for examination of bachelor thesis in bachelor degree in nursing at Molde University College, Norway.Results: The curriculum has gained a clearer focus on science and research, and informative guidelines have been developed. The final bachelor thesis is now consisting of a systematic literature review based on scientific articles. The auditorium as a learning arena in the form of a thesis defence contributes to awareness of importance of research for nursing.Conclusion: The introduction of a new research based model for the bachelor thesis has strengthened the academic environment. Currently, Bachelor of Nursing has a clear focus on research and development. Newly qualified nurses are well placed to work knowledge based and to participate in development of clinical practice.
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  • Moser, Debra, et al. (författare)
  • Shared decision-making about end-of-life care for heart failure patients with an implantable cardioverter defibrillator: a national cohort study.
  • 2014
  • Ingår i: Journal of Cardiac Failure. - : Elsevier. - 1071-9164.
  • Konferensbidrag (refereegranskat)abstract
    • BackgroundWhether to deactivate an implantable cardioverter defibrillator (ICD) at end-of-life is an important question for patients with an ICD. Expert consensus statements recommend physicians discuss end-of-life issues with ICD patients before and after implantation and promote shared decision-making. The degree to which these recommendations are followed in patients with HF is unknown. The purpose of this study was to compare attitudes and knowledge about the ICD at end-of-life between ICD recipients with and without HF to determine how well HF patients could participate in end-of-life decisions.MethodsEvery ICD patient in Sweden is enrolled in a national registry. We mailed a survey about attitudes, knowledge and experiences (the End-of-Life-ICD Questionnaire) related to the ICD and end-of-life issues to all registry patients. Data on quality of life (Euro-QOL), anxiety and depression (Hospital Anxiety and Depression Scale) were collected to determine if these affected attitudes or knowledge.ResultsOf the 5,535 patients in the registry, 3,067 (1606 with HF; age 66±11 years; 21% women) participated. Despite patients with HF reporting worse quality of life (p<0.001), and greater depression (p<0.001) and anxiety (p<0.001) than their counterparts without HF, their attitudes and knowledge about the ICD at end-of-life were very similar. Only 39% of HF patients discussed illness trajectory with their doctor, fewer (14%)discussed deactivation with their doctor, and only 8% discussed their wishes with their family. A total of 40% of HF patients did not want to discuss deactivation with their doctor, and 64% felt that such discussions were warranted only as their prognosis worsened or they neared end-of-life (70%). Patients with HF had misconceptions about the ICD: 71% incorrectly believed the ICD always delivered shocks at the end-of-life; 27% believed ICD deactivation was the same as active euthanasia; 26% believed the ICD could only be deactivated by surgical removal; and 36% thought the ICD could be deactivated without their knowledge. With regard to deactivation of the ICD, 62% did not want it deactivated or could not make a choice even if they were dying of cancer. With regard to ICD generator replacement if needed, 54% of HF patients wanted it changed or were undecided (34%) in the context of being seriously ill with another condition; 65% wanted it changed or could not make a choice (26%) even if they were of advanced age. None of these attitudes or knowledge items differed from those of patients without HF.ConclusionICD recipients with HF hold many perceptions about the ICD at end-of-life that could interfere with effective decision-making. Without better knowledge about their ICD and its performance at the end-of-life, or without discussions with doctors and family members about these issues, HF patients with an ICD are ill-prepared to engage in shared decision-making about their ICD and its use at the end-of-life.
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8.
  • Strömberg, Anna, et al. (författare)
  • ICD Recipients Understanding of Ethical Issues, ICD Function, and Practical Consequences of Withdrawing the ICD in the End-of-Life
  • 2014
  • Ingår i: Pacing and Clinical Electrophysiology. - : Wiley-Blackwell. - 0147-8389 .- 1540-8159. ; 37:7, s. 834-842
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The current international expert consensus statements recommend that clinicians should discuss elective implantable cardioverter defibrillator (ICD) deactivation before implantation of the device, and then consistently during the illness trajectory. However, no previous studies have investigated predictors of ICD patients knowledge about end-of-life issues or whether knowledge influences patients attitudes about deactivation. Methods: This nationwide survey study (n = 3,067) had a cross-sectional correlational design of self-reported data. Participants were recruited from the Swedish ICD and Pacemaker Registry and asked to complete a questionnaire about knowledge in relation to the ICD and end-of-life. Results: Only 79 respondents (3%) scored correctly on all 11 questions. The mean sample score was 6.6 +/- 2.7 out of a maximum score of 11. A total of 835 participants (29%) had an insufficient knowledge when using the 25th percentile as a cutoff. Younger ICD recipients, those cohabiting, male participants, and those who had received shocks, had a generator replacement, or who had discussed illness trajectory with their physician were more likely to have sufficient knowledge on the end-of-life issues. Insufficient knowledge was associated with indecisiveness to make decisions about ICD deactivation in the end-of-life situations, and with favorable attitudes about replacing the ICD even if seriously ill or have reached an advanced age, and keeping the shock therapy of the ICD even in a terminal phase of life when dying from cancer or other serious chronic illnesses. Conclusion: Insufficient knowledge is common among ICD recipients and is associated with attitudes and decisions that may result in a stressful and potentially painful end-of-life situation.
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  • Thylén, Ingela, et al. (författare)
  • Characteristics associated with anxiety, depressive symptoms, and quality-of-life in a large cohort of implantable cardioverter defibrillator recipients
  • 2014
  • Ingår i: Journal of Psychosomatic Research. - : Elsevier. - 0022-3999 .- 1879-1360. ; 77:2, s. 122-127
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveAlthough most patients with implantable cardioverter defibrillators (ICDs) adjust well, some have considerable psychological distress. Factors associated with psychological adjustment in ICD-recipients are still not well understood. Our purpose was to describe quality-of-life (QoL) and prevalence of self-reported symptoms of anxiety and depression in a large national cohort of ICD-recipients, and to determine socio-demographic, clinical, and ICD-related factors associated with these variables.MethodsA cross-sectional, correlational design was used. All eligible adult ICD-recipients in the Swedish ICD- and Pacemaker Registry were invited to participate. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and QoL with the EuroQol-5D.ResultsA total of 3067 ICD-recipients (66 ± 11 years, 80% male) were included. The mean HADS score was 3.84 ± 3.70 for anxiety symptoms and 2.99 ± 3.01 for symptoms of depression. The mean EQ-5D index score was 0.82 ± 0.21. The probability of symptoms of anxiety and depression was associated with younger age, living alone, and a previous history of myocardial infarction or heart failure. Additionally, female ICD-recipients had a higher probability of symptoms of anxiety. A higher level of ICD-related concerns was most prominently related to symptoms of anxiety, depressive symptoms and poorer QoL, while number of shocks, ICD-indication and time since implantation were not independently related.ConclusionsIn this large cohort of ICD-recipients, the association of ICD-related concerns with symptoms of anxiety, depressive symptoms, and poor QoL suggests that ICD specific factors should be addressed in order to improve outcomes.
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10.
  • Thylén, Ingela, et al. (författare)
  • Concerns about implantible cardioverter defibrillator shocks mediate the relationship between shocks and psycological distress.
  • 2014
  • Konferensbidrag (refereegranskat)abstract
    • Background: Although most implantable cardioverter defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not been investigated. Our objectives were to (1) describe ICD-related concerns, and (2) examine whether the relationships between receipt of defibrillating shocks and psychological distress were                        mediated by patients’ concerns related to their ICD.                    Methods and Results: All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3,067 completing the survey (55% response). Their mean age was 66+11 years, and 80% were male. One third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression (OR 1.58 and OR 3.04, respectively). The association between receipt of shocks and psychologically distress were mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety,and 54% of the relationship between shocks and symptoms of depression, see Figure 1.                    Conclusion: Having high ICD-related concerns has a bigger impact on psychological distress than receipt of an actual shock. Screening                        for ICD-related concerns in clinical practice may identify patients at risk of psychological distress, which could provide                        a specific target for intervention. Interventions tailored to individual patients’ needs can - besides addressing device-related                        education and anxiety about shocks - also include relaxation and stress management, cognitive restructuring, social support                        and/or group discussions, and exercise programs.
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