| 1. |
- Andreae, Christina, 1969-, et al.
(författare)
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Does problem-based learning improve patient empowerment and cardiac risk factors in patients with coronary heart disease in a Swedish primary care setting? : A long-term prospective, randomised, parallel single randomised trial (COR-PRIM)
- 2023
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate long-term effects of a 1-year problem-based learning (PBL) on self-management and cardiac risk factors in patients with coronary heart disease (CHD).Design: A prospective, randomised, parallel single centre trial.Settings: Primary care settings in Sweden.Participants: 157 patients with stable CHD completed the study. Subjects with reading and writing impairments, mental illness or expected survival less than 1 year were excluded.Intervention: Participants were randomised and assigned to receive either PBL (intervention) or home-sent patient information (control group). In this study, participants were followed up at baseline, 1, 3 and 5 years.Primary and secondary outcomes: Primary outcome was patient empowerment (Swedish Coronary Empowerment Scale, SWE-CES) and secondary outcomes General Self-Efficacy Scale (GSES), self-rated health status (EQ-VAS), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), weight and smoking. Outcomes were adjusted for sociodemographic factors.Results: The PBL intervention group resulted in a significant improved change in SWE-CES over the 5-year period (mean (M), 39.39; 95% CI 37.88 to 40.89) compared with the baseline (M 36.54; 95% CI 35.40 to 37.66). PBL intervention group increased HDL-C level (M 1.39; 95% CI 1.28 to 1.50) compared with baseline (M 1.24; 95% CI 1.15 to 1.33) and for EQ-VAS (M 77.33; 95% CI 73.21 to 81.45) compared with baseline (M 68.13; 95% CI 63.66 to 72.59) while these outcomes remained unchanged in the control group. There were no significant differences in BMI, weight or scores on GSES, neither between nor within groups over time. The overall proportion of smokers was significantly higher in the control group than in the experimental group.Conclusion: One-year PBL intervention had positive effect on patient empowerment, health status and HDL-C at a 5-year follow-up compared with the control group. PBL education aiming to improve patient empowerment in cardiac rehabilitation should account for sociodemographic factors.
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| 2. |
- Carlsson, Nina, 1979-
(författare)
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Sorgereaktioner hos närstående till personer som avlidit till följd av plötsligt hjärtstopp
- 2022
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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.
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| 3. |
- Eckerblad, Jeanette, et al.
(författare)
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Nurses conceptions of facilitative strategies of weaning patients from mechanical ventilation-A phenomenographic study
- 2009
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397. ; 25:5, s. 225-232
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality. Purpose: The purpose of the present study was to describe different conceptions of nurses facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU). Method: Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed. Findings: The findings revealed three main categories of nurses facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications. Conclusion: Although these findings need to be confirmed by further studies we suggest that nurses variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.
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| 4. |
- Eriksson-Liebon, Magda, et al.
(författare)
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Living with non-cardiac chest pain - An inductive qualitative interview study of spouses' perspectives
- 2024
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Ingår i: Nursing Open. - : WILEY. - 2054-1058. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore spouses' experiences of living with a partner suffering from non-cardiac chest pain (NCPP). Design: An inductive qualitative study. Methods: Individual interviews (n = 10) were performed with spouses of partners having NCCP and cardiac anxiety. The analysis was performed according to Patton's guide for content analysis of qualitative data. Results: Three categories and seven subcategories were identified. First, 'a feeling of being neglected', where spouses felt ignored by healthcare professionals and excluded by their partners. Secondly, 'a tension between hope and despair' encompassed feelings of faith, support, unpreparedness for chest pain and situational frustration. Lastly, in 'a threat to ordinary life', spouses noted chest pain-induced changes impacting daily life, finances, leisure and relationships. To conclude, NCCP in partners significantly affects their spouses emotionally and practically. Spouses felt neglected and isolated, oscillating between hope and despair and experiencing faith, powerlessness and frustration. They also faced challenges in daily life and relationships.
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| 5. |
- Feldt, Amanda, et al.
(författare)
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Nurses strategies to enable continuous positive airway pressure therapy in a general medical ward context : A qualitative study
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 37:2, s. 524-533
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundContinuous positive airway pressure is a non-invasive therapy beneficial for patients with acute respiratory failure. The need for this therapy outside intensive care units is growing, but nurses face many challenges to enable this therapy in general medical wards. Aims and ObjectivesThe aim of the study was to explore nurses strategies for enabling continuous positive airway pressure therapy in a general medical ward context. MethodAn explorative qualitative design was used including semi-structured interviews with 15 Swedish nurses. Data were analysed using a conventional content analysis. ResultsThe nurses strategies included a non-hierarchical approach when utilising an intra- and interprofessional collaboration. Inexperience was compensated for by collaboration. Nurses strategies involved advanced patient-centred care using interventions to manage and ease the patients treatment and discomfort. The creation of an alliance with the patient was crucial to prevent treatment failure. The strategies were interrelated and considered as parts of a whole. ConclusionNurses described the strategy of a dynamic team that could be enlarged or decreased in tandem with other professionals, depending on the situation and the nurses needs. Nurses need to have an attentive response to the patients physical, psychosocial and relational needs and to maintain trust for a positive therapy outcome.
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| 6. |
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| 7. |
- Grönlund, V., et al.
(författare)
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The desire for a good life - patients beliefs of self-care after a coronary event
- 2013
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1873-1953.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: After a first coronary event there is an increased risk for a recurrent event. Despite that risk, 1/5 of the patients continue to smoke, 1/3 is obese and more than half of the patients have elevated blood pressure and total cholesterol. Secondary preventive self-care activities are needed to improve outcomes and the belief of patients plays a vital role in changing behavior. Aim: To examine patients’ beliefs of self-care 6-12 months after a coronary event. Method: The study design was qualitative. Twenty-five patients, including 10 women, mean age 65 years with stable coronary artery disease participated in four focus group interviews. Data were taped, transcribed and analyzed according to the conventional content analysis. Findings: Patients’ belief of self-care is influenced by their desire of a good life even though life seems fragile. Patients try to live up to the standard of health care prescription and advices. However, these achievements require behavior change and conscious boundaries, which are challenged by various obstacles such as fear of, overstrain and stress. Physical activity is considered as both a source to well-being and a necessity, but patients are uncertain and afraid for overstraining. A healthy diet is seen as important but the advices given are sometimes contradictory and create confusion. Medication is found important but not at the cost of all the side-effects. Patients also report that in order to believe in their ability and to be responsible for self-care, support from health care providers is expected. But at the same time the invaluable support and information is often not provided, creating uncertainty. Discussion: The study highlights the patients’ perspective of self-care and what they view as important in self-care after an event of coronary artery disease. The patients’ expectations on health services comprise information, support and continuous follow-up. This is necessary to facilitate the patient’s responsibility for their own care. Conclusion: Patients’ beliefs about the concept of self-care after an event of coronary artery disease are multifaceted and voluminous compared to the health care definition. The findings of the study challenge health care policies approach to self-care. There is a need to reconsider and assess what and how secondary preventive patient education should be performed after an event of coronary artery disease.
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| 8. |
- Hjelmfors, Lisa, et al.
(författare)
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Problem-based learning used in the context of cardiac rehabilitation : different scenes and different roles
- 2014
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Ingår i: Studies in Continuing Education. - : Routledge. - 0158-037X .- 1470-126X. ; 36:2, s. 218-232
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Tidskriftsartikel (refereegranskat)abstract
- Several studies show that how patients have difficulties in changing lifestyle even though such changes are essential because they are suffering from a life-threatening disease. Coronary artery disease (CAD) patients met 13 times during a year and used problem-based learning (PBL) to improve their empowerment and self-efficacy in making lifestyle changes. District nurses functioned as tutors, helping patients to formulate issues and to state self-care goals. To identify and describe the enactment of PBL, an ethnographic approach was used, including, for example, participant observations and interviews, all derived from six sessions of the education programme. Five different enactments were found, metaphorically expressed as: ‘The study circle’, ‘The classroom’, ‘The expert consultation’, ‘The therapy session’ and ‘The coffee party’. The education programme did not always function as it was supposed to according to the model, but perhaps this should not be seen as a failure of the pedagogical intervention since these enactments as a whole seem to be a way for the patients to be able to make healthy lifestyle changes. The metaphors can broaden the understanding of what can happen when implementing problem-based learning in health care practice.
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| 9. |
- Hultberg, Josabeth, et al.
(författare)
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Dealing with being prescribed cardiovascular preventive medication : a narrative analysis of qualitative interviews with patients with recent acute coronary heart disease in Sweden
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:12
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Tidskriftsartikel (refereegranskat)abstract
- Objective To explore how patients with experience of acute coronary heart disease make sense of, and deal with, the fact of being prescribed cardiovascular preventive medication. Design Qualitative interview study. Setting Swedish primary care. Participants Twenty-one participants with experience of being prescribed cardiovascular preventive medication, recruited from a randomised controlled study of problem-based learning for self-care for coronary heart disease. Methods The participants were interviewed individually 6-12 months after their hospitalisation for acute coronary disease. A narrative analysis was conducted of their accounts of being prescribed cardiovascular preventive medication. Results Four themes shape the patients experiences: A matter of living concerns an awareness of the will to live linked to being prescribed cardiovascular preventive medication regarded in the light of the recent hospitalisation. In Reconciliation of conflicting self-images, patients dealt with being prescribed preventive medication through work to restore an identity of someone responsible in spite of viewing the taking of medication as questionable. The status of feeling healthy, while being someone in need of medication, also constituted conflicting self-images. Following this, taking medication was framed as necessary, not as an active choice. Being in the hands of expertise is about the seeking of an answer from a reliable prescriber to the question: Is this medication really necessary for me? Existential labour was done to establish that the practice of taking cardiovascular preventive medication was an inevitable necessity, rather than an active choice. Taking medicines no longer a big deal could be the resulting experience of this process. Conclusions Unmet existential needs when being prescribed cardiovascular preventive medication seem to be a component of the burden of treatment. A continuous and trustful relationship with the prescribing doctor may facilitate the reconciliation of conflicting self-images, and support patients in their efforts to incorporate their medicines taking into daily life.
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