| 1. |
- Israelsson, Johan, 1970-
(författare)
-
Health-related quality of life after cardiac arrest
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cardiac arrest is a major health problem worldwide. For many of the afflicted, cardiac arrest is the natural end of life. For others, it is an unexpected event suddenly striking in the middle of life. During the last decades, major efforts in treatment have contributed to more people surviving their cardiac arrest. However, previous research has mainly focused on survival, while the knowledge about health-related quality of life in survivors is sparse. Hence, there is a need for more research in order to extend the knowledge about the living situations among survivors and their spouses. For example, factors associated with health-related quality of life are not sufficiently investigated. Knowledge about such factors is important in order to develop interventions and to be able to improve post cardiac arrest care. In addition, existing research shows incongruent results concerning differences in characteristics and survival between men and women. In order to provide equitable care between sexes, further studies are warranted. Aim: The overall aim of this thesis was to increase the knowledge of survival and health-related quality of life among people suffering cardiac arrest with focus on sex and other related factors. The specific aims were: to describe in-hospital cardiac arrest events with regard to sex and investigate if sex is associated with survival after controlling for known predictors and interaction effects (study I), to describe health status and psychological distress among in-hospital cardiac arrest survivors in relation to sex (study II), to investigate factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter defibrillator in relation to sex, and to compare their health-related quality of life with a general population, (study III) and to investigate if type D personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partners’ health-related quality of life (study IV). Methods: The general design in all studies (I-IV) was quantitative, cross-sectional and correlational. This thesis is based on four different data collections. Data was systematically collected using national quality registries (I and II) or by sending questionnaires to survivors (III and IV) and their spouses (IV), treated at several different hospitals in Sweden. The sample size varied between 126 and 990 across the studies. The outcomes and explanatory study variables were chosen with respect to Wilson and Cleary’s conceptual model of health-related quality of life. The main outcome variables were survival after resuscitation, survival at hospital discharge, survival at 30 days post cardiac arrest (I), and health-related quality of life measured by the Hospital Anxiety and Depression Scale (II and III) and the EuroQol-5 dimensions (II-IV). In this thesis descriptive and inferential statistics were applied. The main statistics consisted of logistic and linear regression analyses, and structural equation modelling. Results: Male sex was associated with a better chance of survival to hospital discharge, but no associations between sex and survival after resuscitation or at 30 days were identified. More men than women received resuscitation attempts when suffering an in-hospital cardiac arrest (study I). Health-related quality of life among most cardiac arrest survivors was good (II-IV), even when compared to a general population (III). However, a significant proportion reported low health status and symptoms of anxiety and depression (II and III). Women reported worse health-related quality of life compared to men, and female sex was associated with poorer health-related quality of life in the multiple regression models (II and III). Several additional factors were identified to be associated with poorer health-related quality of life: being unemployed, having a type D personality, perceiving less control, suffering from more comorbidities and suffering from more ICD-related concerns (III). In addition, older age was associated with poorer (EQ VAS) or better (HADS Anxiety) health-related quality of life, depending of outcome measure (II). Moreover, perceived control and type D personality among the survivors were associated with health-related quality of life among their spouses, but not vice versa. Conclusions: Although, sex does not appear to be an important predictor for survival, the difference between men and women regarding the proportion of resuscitation attempts should be further investigated. The majority of survivors and their spouses report good health-related quality of life similar to general populations. However, a substantial proportion suffer from health problems. Since women in general report worse health-related quality of life compared to men a higher proportion of women may be in need of support. Several factors associated with worse health-related quality of life were identified and might be used during follow-up and rehabilitation. For example, identifying type D personality might be important when screening patients at risk for health problems. Perceiving more control could be targeted by health-supportive interventions, for example person-centered care. Healthcare professionals should make efforts to identify survivors at risk of poor health-related quality of life and offer individualized support when needed. Characteristics among survivors were associated with health-related quality of life in their spouses. Including spouses in follow-up care is therefore important. Wilson and Cleary’s conceptual model for health-related quality of life appears to be applicable for choosing outcomes in cardiac arrest research and might be helpful when designing interventions to improve post cardiac arrest care.
|
|
| 2. |
- Mattisson, Marie, 1968-
(författare)
-
"I'm calling for hope, comfort and maybe some advice..." : Interaction and caller satisfaction in telenursing
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The provision of nursing over the telephone is an appreciated asset in many parts of the world. Interaction between telenurse and caller is important for caller satisfaction, and satisfaction in turn is positively related to outcomes such as adherence, engagement in self-care and well-being. Despite the long history of telehealth services, research about interaction in telenursing is still in a developmental stage.Aim: The overall aim of the thesis was to develop a questionnaire that enables valid and reliable exploration of telenurse–caller interaction, and caller satisfaction with calls, and to explore interaction and its importance for caller satisfaction.Methods: The thesis applied a deductive approach based on a theoretical nursing model; the Interaction Model of Client Health Behavior (IMCHB). Interaction in the IMCHB, is divided into four components: health information, affective support, decisional control, and professional-technical competencies. In the first study (I), the Telenursing Interaction and Satisfaction Questionnaire (TISQ) was developed. Variables were identified through a literature review, structured according to the IMCHB, and worded as questionnaire items. Content validity was evaluated with input from cognitive interviews with callers, and professionals using the Content Validity Index (CVI). A consecutive sample of 1,400 callers received the TISQ by post, and test-retest reliability of single items was evaluated. In Study two (II), 25 items from the TISQ focusing on interaction between callers and telenurses were selected to form the Telenursing Interaction and Satisfaction Scale (TISS), a scale for the measurement of caller satisfaction with interaction in four subscales according to the IMCHB. Psychometric properties of the TISS were evaluated with a focus on data quality, factor structure, convergent validity, and reliability. In Study three (III), caller satisfaction with interaction (i.e., TISS scores) and their associations to overall satisfaction with calls were explored using descriptive statistics, repeated measures ANOVA and ordinal logistic regression models. In Study four (IV), 30 transcripts of authentic calls were analysed using content analysis with directed approach. A coding scheme based on the four components of interaction in the IMCHB was developed and applied for deductive categorisation of data. Manifest content of conversations (n = 37,447 words) was presented quantitatively and qualitatively. In addition, data was coded and analysed in relation to phases in the conversation process for telenursing: opening, listening, analysing, motivating, and ending.Results: The 60 item TISQ showed good content validity in the telenursing setting (I), with a Scale-CVI of 0.91. Test–retest reliability of single items was moderate to good (I). TISS-data deviated significantly from a normal distribution, but all response options were endorsed (II). The confirmatory factor analysis confirmed the four-factor structure of the TISS, and factor correlations were high (rs = 0.88 to 0.96) (II). A higher order model showed marginally deteriorated model fit values (II). Ordinal alpha, scale reliability, and test–retest reliability were satisfactory for all scales, and convergent validity was satisfactory (II). Callers expressed the highest level of satisfaction with affective support, while their satisfaction with decisional control was comparatively lower (III). Callers’ satisfaction with interaction was positively associated with overall satisfaction with calls, even when considering experienced waiting time, main result of the call, fulfilment of expectations, age, gender, self-rated health status and time of call (III). A total of 97% of manifest words in conversations were identified as nursing interaction based on the IMCHB (IV). Health information was the primary focus, particularly during the listening and analysing phases (IV). Affective support was the least prominent component, and callers’ reactions to advice were seldom discussed (IV). The opening phase was the shortest, and analysing phase the most word consuming (IV).Conclusions: The TISQ, including the TISS, provide a valid and reliable questionnaire for the study of telenurse-caller interaction, and caller satisfaction. Caller satisfaction with the interaction can be measured using the four subscales in the TISS. In cases where there is a problem with multicollinearity, a total scale score from the TISS can be utilized. All four components of interaction in the IMCHB play a crucial role in determining overall caller satisfaction with calls. Therefore, the development of interaction in telenursing need to consider all four components. The exchange of health information presents challenges for both telenurses and callers, and affective support can be provided to callers without verbalizing emotions. Among the four components, decisional control may have the largest potential for improvement in the studied setting. This can be achieved by acknowledging callers’ reactions to advice.
|
|
| 3. |
- Eriksson, Kerstin
(författare)
-
Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pain is a common postoperative experience. Guidelines recommend performing regular pain assessments, which include self-rated pain and additional communication to capture patients' experiences. During hospitalisation, pain intensity is found to be a vital factor influencing other aspects of an early physical recovery, and is consequently an important item in questionnaires for recovery. These tools consist of extensive questionnaires which are difficult to use in everyday clinical work. A simplified method of monitoring postoperative recovery would benefit both patients and healthcare professionals.Aim: The overall aim of this thesis was twofold: (A) to determine the ability of extending the use of pain ratings to reflect and predict early physical postoperative recovery and (B) to describe patients’ perspectives on pain assessments.Methods: The studies were carried out at one (I), three (IV) and four hospitals (II, III) involving general surgical and orthopaedic inpatients. Two quantitative methods were used based on data from questionnaires and medical records. They consisted of one cross-sectional study (I) and one study with repeated measures (IV). An association was sought between pain intensity and postoperative recovery on days 1 and 2 (I, IV), and prehospital data (IV). Two qualitative methods were used involving a phenomenographic (III) approach and Critical Incident Technique (IV), where semi-structured interviews were performed postoperatively and analysed inductively in accordance with the approach.Results: An association was found between moderate/severe average pain intensity compiled from monitoring records and impact on early physical postoperative recovery on day 1 (I). Retrospective average pain intensity at rest and during activity reflected impact on recovery on postoperative day 1 (IV). Severe pain intensity at rest and during activity on postoperative day 1 predicted impact on physical recovery items on day 2 (IV). The use of the Numeric Rating Scale (NRS 0-10) was considered to facilitate communication about pain, but to involve difficulties of interpretation and place demand on healthcare professionals and care routines (II). Patients’ descriptions of their experiences when in need of describing pain indicated two main areas: patients’ resources when needing to describe pain and ward resources for performing pain assessments (III). Descriptions of their actions when they were in pain indicated two main areas: patients used active strategies when needing to describe pain or patients used passive strategies when needing to describe pain (III).Conclusions: This thesis contributes to knowledge about the possibility of using patients' self-rated average pain intensity to reflect early physical postoperative recovery on day 1 and to predict recovery on the following day. The pain scale gave patients and healthcare professionals a shared vocabulary, which facilitated communication. Furthermore, dialogue during pain assessments was described as critical in ascertaining whether pain intensity had an impact on different aspects of physical recovery. Environmental factors such as the attitude of healthcare professionals, workload and staffing influenced how pain assessments were performed.
|
|
| 4. |
- Wikström, Lotta
(författare)
-
The clinical utility of patients’ self-rated postoperative pain after major surgery – the perspective of healthcare professionals'
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Numeric Rating Scale (NRS) is suitable in postoperative settings, yet, the implementation has shown varying results. This has raised issues about the pain scales contribution to the identifying and understanding of pain. The aim of this thesis was to describe the clinical utility of patients’ self-rated postoperative pain after major surgery from a healthcare professional perspective.The aim of study I and II was to describe healthcare professionals’ perceptions of the use of pain scales, and to through considering critical incidents describe care experiences and actions taken by healthcare professionals’ when assessing pain. Participants in study I (N=25) and II (N=24) were enrolled- registered nurses and physicians with clinical experiences of pain scales. The aims of study III and IV were to determine the clinical applicability of NRS mode- and maximum- measures, and the NRS mode- and median measures at rest and during activity based on patients self-rated pain. The aim in study IV was additionally to determine the number of NRS ratings needed for the calculation of these measures. The number of surgical and orthopedic patients who completed study III were: n=157 and study IV: n=479.Study I and II confirmed earlier findings of patients’ self-reported pain scores as a facilitator in the understanding of their postoperative pain. Organizational routines, documentation devices, clinical competence, continuity in care, collaborative actions, time, and individual routines were healthcare related factors affecting the use of pain scales (I, II). Patient-related facilitating factors were patients’ ability and willingness to communicate pain, while disability and unwillingness to communicate or inconsistency in verbal communication with observed behaviors were barriers (II). Time and multidimensional communication approaches could bridge these barriers (I, II).Study III and IV showed acceptable reliability for the mode, median and maximum measures. Rank correlations for individual median scores, based on four ratings, versus patients’ retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. The Svensson method showed an individual variation within the expected outcome and a significant systematic group change towards a higher level of reported retrospective pain. The calculated pain measures, particularly concerning pain at rest, generally were lower than patients’ recall of pain.The findings described beneficial effects of patient self-reported pain, however present healthcare did not fully support the utilization of pain scales. Because of the simple measurement characteristics, the use of daily NRS average pain measures, patients’ pain can be followed until resolved. The measures could additionally become important patient reported outcome measures and thus constitute new motivators to increase the utilization of pain scales.
|
|
| 5. |
- Andreae, Christina, 1969-
(författare)
-
Appetite in patients with heart failure : Assessment, prevalence and related factors
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Appetite is an important component in nutrition for maintaining the food intake needed by the body. Decreased appetite is a common clinical problem in patients with heart failure. It has a negative impact on food intake and possibly on malnutrition and health outcomes. There is a lack of evidence on how to assess appetite in heart failure. Furthermore, there are knowledge gaps about factors associated with appetite and which role appetite plays for health status in heart failure. Aim: The overall aim of the thesis was to investigate appetite in patients with heart failure. Four studies were conducted with the goal to evaluate the psychometric properties of the Council on Nutrition Appetite Questionnaire (CNAQ) (I) and to explore the prevalence of decreased appetite and related factors associated with appetite in patients with heart failure (II-IV). Methods: A multicenter study was conducted in three outpatient heart failure clinics in the center of Sweden during 2009-2012. Data were collected through a baseline measurement (I-IV) and an 18-month follow-up (IV). The first study was a psychometric evaluation study (I), while the other studies had an observational cross-sectional design (II-III) and an observational prospective design (IV). One hundred and eighty-six patients diagnosed with heart failure and experiencing heart failure symptoms participated at baseline. At the 18-month follow-up study (IV), one hundred and sixteen participants from the baseline participated. Data were collected from medical records (pharmacological treatment, comorbidity, left ventricle ejection fraction, time of diagnosis), self-reported questionnaires (demographic background data, appetite, symptoms of depression, health status, sleep, self-reported physical activity), objective measurements (anthropometric assessment of body size, blood samples, six minutes’ walk test, and physical activity measured with an actigraph) and clinical assessment (New York Heart Association (NYHA) functional classification, and cognitive assessment). The main outcome variables included appetite (I, II and IV) and health status (III). Descriptive and inferential statistics were used in the studies (I-IV). Results: The majority of the participants had moderate heart failure symptoms, i.e., NYHA class II (n=114, 61%). Most of the participants were men (n=130, 70%). Mean age was 70,7 years, (SD=11,0), and mean BMI was 28.7 (SD=5.3). The CNAQ showed acceptable psychometric properties for assessing appetite in patients with heart failure (I). This thesis shows that 38% of the participants experienced an appetite level that put them at risk of weight loss (I). It was shown that factors such as biological, medical, psychological (II) and physical activity/exercise capacity (IV) are associated with appetite. Also, appetite was associated with impaired health status. However, this association was found to be moderated by symptoms of depression (III). Neither appetite nor physical activity changed during the 18-month follow-up (IV). Conclusion: Decreased appetite is a serious phenomenon that needs attention in the care of patients with heart failure. Health care professionals can now use a validated and simple appetite instrument to assess appetite in heart failure. In addition, attention should be paid to elderly patients and those who have symptoms of depression, sleep problems, impaired cognitive function and impaired physical activity, as well as to patients on suboptimal medical treatment. Higher appetite was shown to contribute to a better health status, but this was only evident in patients without symptoms of depression. Therefore, special attention should be paid to symptoms of depression, as this risk factor affected the association between appetite and health status. This thesis enhances the understanding of the magnitude of the problem with decreased appetite in heart failure both in numbers and factors. New priorities in nutrition care and new ideas can be established, both in practice and in research, in order to improve a nutrition care that is vital for patients with heart failure.
|
|
| 6. |
- Berg, Katarina, 1959-
(författare)
-
Patients’ perspectives on recovery from day surgery
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A large number of elective surgical patients in Sweden and elsewhere have their surgical procedure performed in a day surgery context. The surgical care event, with its postoperative surveillance, is brief at the surgery unit and patients are discharged home with the intention that they should manage postoperative recovery mainly themselves. However, several patients attest to being in an exposed situation when assuming responsibility for recovery at home. The overall aim of this thesis was to attain comprehensive knowledge of postoperative recovery following day surgery from a patient perspective.A questionnaire, the Post-discharge Surgical Recovery scale, was translated into Swedish and evaluated regarding its psychometric properties in a Swedish context. A sample of 607 day surgery patients who had undergone orthopaedic, general or gynaecological surgery self-rated their recovery at postoperative Days 1, 7 and 14 using the Post-discharge Surgical Recovery scale and the Quality of Recovery-23. Health-related quality of life was assessed before and 30 days after the surgical procedure, using the EQ-5D. In a second sample, 31 patients were interviewed in their homes regarding their recovery after day surgery. The interviews were conducted on postoperative Days 11-37, and focused on the meaning of recovery, self-care and perceptions of recovery. Data were explored by means of a phenomenographic analysis.The Post-discharge Surgical Recovery scale showed satisfactory psychometric properties when used among Swedish day surgery patients. Following discharge, recovery included both physical and emotional perspectives. Recovery varied, and influencing factors were found to be type of surgery, age, perceived health and emotional status on the first postoperative day. Orthopaedic patients had a more protracted recovery process compared to general surgery and gynaecological patients, along with more postoperative pain and lower health-related quality of life. Patients perceived that postoperative recovery comprised different internal and external factors and a large amount of responsibility regarding their recovery and surgical outcome. To be prepared for recovery at home, patients wanted knowledge and understanding about the normal range of recovery following their specific surgical procedure, and needed support from different sources in their surroundings.This thesis provides insight into day surgery patients’ postoperative situation. Based on the studies, individualized and well thought-out support appears favourable in order to have confident and well prepared patients at home. In contrast to smooth and easy patient care at the surgery unit, the postoperative phase seems to be a weak link in the day surgical continuity of patient care. Postoperative care needs to be further improved to increase quality and patients’ overall satisfaction with the day surgical experience. Attention should be paid to patients’ physical and emotional resources and needs.
|
|
| 7. |
- Carlsson, Nina, 1979-
(författare)
-
Sorgereaktioner hos närstående till personer som avlidit till följd av plötsligt hjärtstopp
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syfte: Avhandlingens övergripande syfte var att utforska sorgereaktioner hos närstående till personer som avlidit till följd av plötsligt hjärtstopp. De specifika syftena var att: belysa innebörder av levda erfarenheter av att förlora en nära person som avlidit till följd av plötsligt hjärtstopp (I), beskriva symtom på förlängd sorg och självskattad hälsa hos närstående, samt att jämföra partners och icke-partners (II), undersöka samband mellan symtom på förlängd sorg och psykisk ohälsa samt identifiera associerade faktorer (III), undersöka sorgereaktioner i relation till socialt och professionellt stöd, sex och tolv månader efter förlusten (IV).Metod: Datainsamlingen genomfördes genom kvalitativa intervjuer (n=12) (I) samt via enkäter sex (n=108) (I-III) och tolv (n=69) (IV) månader efter dödfallet. Enkäterna innehöll bakgrundsfrågor samt mätinstrumenten: Prolonged Grief Disorder (PG-13), RAND-36, Health Index (HI), Minimal Insomnia Symptom Scale (MISS), Hospital Anxiety and Depression Scale (HADS), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Multidimensional Scale of Perceived Social Support (MSPSS). Intervjudata analyserades utifrån fenomenologisk hermeneutik (I) och enkätdata analyserades med beskrivande och inferentiell statistik (II-IV).Resultat: Under hjärtstoppshändelsen befann sig närstående i ett gränsland mellan liv och död. Efter dödsfallet var närståendes berättande betydelsefullt i sökandet efter förståelse och mening. Att sakna svar kunde hålla kvar närstående i liminalitet och försvåra sorgeprocessen (I). Var femte närstående (18%) rapporterade symtom på förlängd sorg sex månader efter förlusten. Även symtom på ångest (30%) och depression (19%) var vanligt medan få rapporterade symtom på posttraumatisk stress (6%) (II). Dessa symtom samexisterade i hög grad (rs=0,69-0,79) (III) och kunde även kvarstå eller förvärras över tid (IV). Både socialt och professionellt stöd var signifikant associerat med symtom på förlängd sorg och psykisk ohälsa (III-IV). En majoritet (86%) rapporterade att de inte erbjudits stöd från hälso- och sjukvården vid dödsfallet (II).Slutsats: För att underlätta sorgeprocessen bör närstående erbjudas professionellt stöd under hjärtstoppshändelsen och uppföljande samtal efter dödfallet. Genom ett proaktivt professionellt stöd och användning av validerade mätinstrument kan närstående i behov av ytterligare psykologiskt stöd identifieras.
|
|
| 8. |
- Ljungholm, Linda, et al.
(författare)
-
Measuring patients' experiences of continuity of care in a primary care context - Development and evaluation of a patient-reported experience measure
- 2024
-
Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 80:1, s. 387-398
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundContinuity of care is viewed as a hallmark of high-quality care in the primary care context. Measures to evaluate the quality of provider performance are scarce, and it is unclear how the assessments correlate with patients' experiences of care as coherent and interconnected over time, consistent with their preferences and care needs.AimTo develop and evaluate a patient-reported experience measure of continuity of care in primary care for patients with complex care needs.MethodThe study was conducted in two stages: (1) development of the instrument based on theory and empirical studies and reviewed for content validity (16 patients with complex care needs and 8 experts) and (2) psychometric evaluation regarding factor structure, test-retest reliability, internal consistency reliability, and convergent validity. In all, 324 patients participated in the psychometric evaluation.ResultsThe Patient Experienced Continuity of care Questionnaire (PECQ) contains 20 items clustered in four dimensions of continuity of care measuring Information (four items), Relation (six items), Management (five items), and Knowledge (five items). Overall, the hypothesized factor structure was indicated. The PECQ also showed satisfactory convergent validity, internal consistency, and stability.Conclusion/ImplicationsThe PECQ is a multidimensional patient experience instrument that can provide information on various dimensions useful for driving quality improvement strategies in the primary care context for patients with complex care needs.Patient or Public ContributionPatients have participated in the content validation of the items.
|
|
| 9. |
- Ljungholm, Linda
(författare)
-
Patients’ experiences of continuity of care : What is needed and how can it be measured?
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim for this thesis was to explore continuity of care through patients’, family carers’, and health care personnel’s perceptions, and to develop and evaluate a patient-reported experience measure of continuity of care.Method: This thesis consists of four studies; I have a qualitative explorative design and II have a qualitative descriptive design, whereas III and IV are methodological studies. In studies I and II, data were collected from four geographically disparate areas in Sweden; in studies III and IV, data were collected in one of these areas. Data were collected using individual (I, II, III), focus groups, pair interviews (II), and questionnaires (III, IV). Data were analyzed using constructivist grounded theory (I), conventional content analysis (II), and according to classical test theory (III), and Rasch measurement theory (IV).Results: For patients to experience continuity of care, all aspects were interconnected, as access to tailored information was essential for gaining mutual understanding regardless of who was performing a care task. This required clarity in responsibilities and roles, interprofessional collaboration, and a trusting relationship over time and space between each link in the patient’s care trajectory (I). Further, Study II showed that to achieve continuity of care, professional and cross disciplinary cooperation at micro, meso and macro levels were needed. Continuity of care is dependent on long-term and person-centered relationships, dynamic stability in the organizational structure, and shared responsibility for cohesive care enabling uniform solutions for knowledge and information exchange (II). Studies III and IV resulted in the Patient-Experienced Continuity of care Questionnaire (PECQ). The instrument contains 20 items measuring four dimensions of continuity of care: Information (four items), Relation (six item), Management (five item), and Knowledge (five item). Overall, the PECQ showed satisfactory measurement properties according to classical test theory and Rasch measurement theory (III, IV) regarding factor structure, unidimensional, local independence, response category function, differential item functioning for age and sex, and internal consistency reliability.Conclusion: Continuity of care is perceived as multidimensional, containing several important aspects working in synergy and varying over time. To achieve continuity of care, information and knowledge sharing need to cross disciplinary and organizational boundaries. Collaborative responsibility is needed, vertically through all levels of the system, instead of focusing on personal responsibility horizontally. The PECQ can provide information on different dimensions of continuity, useful for driving quality improvements in the primary care context.
|
|
| 10. |
- Norinder, Maria
(författare)
-
A person-centred approach to support family caregivers in specialised home care : The Carer Support Needs Assessment Tool Intervention
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Family caregivers are crucial providers of support and care for patients with lifethreatening illness and many report unmet support needs. With the use of quantitative and qualitative methods this thesis aimed to evaluate the Carer Support Needs Assessment Tool (CSNAT) and explore experiences and potential effects of utilising the Carer Support Needs Assessment Tool Intervention (CSNAT-I) among family caregivers and registered nurses in the context of specialised home care. The results showed that the CSNAT tool was valid and reliable for use among family caregivers in specialised home care (I). Family caregivers reported most the need for additional support concerning “Knowing what to expect in the future” (I, II). They reported and described how higher levels of need for more support were associated with poorer quality of life (II). The intervention was effective in significantly increasing family caregivers’ preparedness for caregiving (p = 0.002) (IV). Participating nurses expressed that their everyday clinical practice changed while learning to use the CSNAT-I and they experienced professional and personal growth (III). Their assessments and supportive inputs shifted from reactive towards proactive and more in collaboration with family caregivers. When utilizing the CSNAT-I, family caregivers experienced their conversations with nurses as co-created, providing new perspectives and insights which increased their involvement and helped in finding solutions (V).In conclusion, this thesis gives further weight to the importance of addressing family caregivers' support needs as a part of nursing.
|
|
