| 1. |
- Kärner, Anita, 1961-, et al.
(author)
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Centrala begrepp av betydelse för patientundervisning - Kommentarer till kunskapssammanställningen
- 2007. - 1
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In: Patientundervisning och patienters lärande. - Stockholm : Gothia :Svensk sjuksköterskeförening. - 9789172055162 ; , s. 25-30
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Book chapter (other academic/artistic)abstract
- Patientundervisning utgör en allt viktigare del i sjuksköterskans och andra yrkesgruppers professionella yrkesutövning i hälso- och sjukvården och omsorgen. För att vårdtagaren bättre ska kunna tillgodogöra sig undervisningen behövs en ökad och fördjupad kunskap om lärandeprocessen..Patientundervisning och patienters lärande beskriver lärandeprocesser och metoder för ett aktivt lärande i mötet mellan patient, närstående och vårdgivare. Den vänder sig till sjuksköterskor, arbetsterapeuter, sjukgymnaster, läkare och andra professionella yrkesutövare.
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| 2. |
- Kärner, Anita, 1961-
(author)
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Lärande i ett omvårdnadsperspektiv
- 2009. - 1:1
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In: Omvårdnadens grunder. - Lund : Studentlitteratur. - 9789144058733 ; , s. 415-438
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Book chapter (other academic/artistic)abstract
- Omvårdnadens grunder - Perspektiv och förhållningssätt syftar till att belysa omvårdnad ur olika perspektiv, för att ge underlag till kritisk diskussion och utveckling av ett reflekterat förhållningssätt i omvårdnadsarbetet. Ett antagande är att omvårdnad inte entydigt kan definieras, men genom att belysa det ur olika perspektiv skapas utkikspunkter från vilka omvårdnad kan "ses", studeras och problematiseras. I bokens kapitel medverkar ett 30-tal svenska experter, varav flertalet sjuksköterskor med doktorsexamen, och tecknar några utmaningar för framtiden. Boken tar utgångspunkt i livscykel och hälsa, vilket medför att ett flertal områden lyfts fram: patienten som person, mognad, växt, dagligt liv, kritiska övergångar mellan olika livsskeden, lidande, död, genus, sociala relationer, kulturell mångfald, livsstil, kommunikation, lärande och etik.
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| 3. |
- Kärner, Anita, 1961-
(author)
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Patients’ and Spouses’ Perspectives on Coronary Heart Disease and its Treatment
- 2005
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Doctoral thesis (other academic/artistic)abstract
- Background: Lifestyle changes and drug treatment can improve the prognosis and quality of life for patients with coronary heart disease (CHD), but their co-operation with suggested treatment is often limited. The aim of this thesis was to study how patients and their spouses conceive CHD and its treatment.Material and Methods: The research design used was inductive and descriptive. The studies were based on three complementary sets of data. Patients with CHD (n=23) and spouses (n=25) were interviewed one year after an episode of the disease. Consecutive patients with CHD derived from another investigation were interviewed within six weeks or one year after the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken by hand, were subjected to analysis within the phenomenographic framework.Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay level. They were associated with symptoms rather than with the disease. Co-operation with drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits from lifestyle changes and treatment did not give the impression of being based on a solid understanding of the importance of such changes. Incentives for lifestyle changes were classified into four categories, all of which contained both facilitating and constraining incentives. Somatic incentives featured direct and indirect physical signals. Social/practical incentives involved shared concerns, changed conditions, and factors connected with external environment. Cognitive incentives were characterised by active decisions and appropriated knowledge, but also by passive compliance with limited insights, and by the creating of routines. Affective incentives comprised fear and reluctance related to lifestyle changes and disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The cognitive and the social/practical incentives were the most prevalent.Spouses’ understanding about the causes of CHD involved both appropriate conceptions and misconceptions. Drug treatment was considered necessary for the heart, but harmful to other organs. Spouses’ support to partners was categorised, and found to be contextually bound. The participative role was co-operative and empathetic. The regulative role controlled and demanded certain behaviours. The observational role was passive, compliant, and empathetic. The incapacitated role was empathetic, unable to support, and positive to changes. The dissociative role was negative to changes and reluctant to be involved in lifestyle changes.Conclusions: These results could be useful in the planning of care and education for CHD patients. The findings also emphasise the importance of adopting a family perspective to meet the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle changes.
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| 4. |
- Kärner, Anita, 1961-, et al.
(author)
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The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care : design and methodology of the COR-PRIM study
- 2012
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In: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 13:110
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Journal article (peer-reviewed)abstract
- BackgroundEven though there is convincing evidence that self-care, such as regular exercise and/or stopping smoking, alters the outcomes after an event of coronary heart disease (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention programmes are structurally and pedagogically applied using adult learning principles e.g. problem-based learning (PBL). Until now, most education programs for patients with CHD have not been based on such principles. The basic aim is to discover whether PBL provided in primary health care (PHC) has long-term effects on empowerment and self-care after an event of CHD. Methods/DesignA randomised controlled study is planned for patients with CHD. The primary outcome is empowerment to reach self-care goals. Data collection will be performed at baseline at hospital and after one, three and five years in PHC using quantitative and qualitative methodologies involving questionnaires, medical assessments, interviews, diaries and observations. Randomisation of 165 patients will take place when they are stable in their cardiac condition and have optimised cardiac medication that has not substantially changed during the last month. All patients will receive conventional care from their general practitioner and other care providers. The intervention consists of a patient education program in PHC by trained district nurses (tutors) who will apply PBL to groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients in the control group will not attend a PBL group but will receive home-sent patient information on 11 occasions during the year. DiscussionWe expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy and empowerment to achieve self-care goals significantly more than one year of standardised home-sent patient information. The assumption is that PBL will reduce cardiovascular events in the long-term and will also be cost-effective compared to controls. Further, the knowledge obtained from this study may contribute to improving patients’ ability to handle self-care, and furthermore, may reduce the number of patients having subsequent CHD events in Sweden.
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| 5. |
- Kärner Köhler, Anita, 1961-, et al.
(author)
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Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model
- 2017
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In: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 31:2, s. 332-341
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Journal article (peer-reviewed)abstract
- BACKGROUND:Spousal concordance on risk factors and lifestyle habits exists and can partly be explained by patients' and spouses' health beliefs and underuse of cardiac rehabilitation. However, there have been very few qualitative comparisons of health beliefs between patients and spouses after a cardiac event.AIM:To examine and qualitatively compare the health beliefs of patients with coronary heart disease and their spouses about lifestyle habits, 1 year after the cardiac event.DESIGN:Explorative and descriptive.METHOD:Semi-structured focus group interviews were conducted with patients (n = 14) 1 year after a cardiac event, as well as individual interviews with spouses (n = 8). The transcriptions underwent a deductive qualitative content analysis, within the framework of the Health Belief Model.FINDINGS:Patients' and spouses' health beliefs about lifestyle habits qualitatively differed in most predetermined main analytical categories of the Health Belief Model. The patients relied more on their own capacity and the healthcare system than on collaboration with their spouses who instead emphasised the importance of mutual activities to establish lifestyle habits. The spouses therefore experienced problems with different family preferences compared to the patients' wishes. Moreover, only patients believed supervised exercise was beneficial for risk reduction of coronary heart disease and they related barriers for medication to a self-healing body and a meaningless life without relatives and old habits. Patients and spouses agreed that despite the severity of illness, life was captured and that normalisation to a life as usual was possible.CONCLUSION:The patients' and spouses' qualitatively different health beliefs regarding health-related behaviours imply a new approach. Nurses and associated professionals need to follow-up patients' and spouses' in primary health care to support them in a tailored way, for example in problem-based sessions. Recognition and understanding of their different views and otherness could lead to compromises and goals to work with.
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| 6. |
- Kärner Köhler, Anita, 1961-, et al.
(author)
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Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study
- 2018
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In: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 19
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Journal article (peer-reviewed)abstract
- BackgroundIn managing a life with coronary heart disease and the possibility of planning and following a rehabilitation plan, patients’ empowerment and self-efficacy are considered important. However, currently there is limited data on levels of empowerment among patients with coronary heart disease, and demographic and clinical characteristics associated with patient empowerment are not known.The purpose of this study was to assess the level of patient empowerment and general self-efficacy in patients six to 12 months after the cardiac event. We also aimed to explore the relationship between patient empowerment, general self-efficacy and other related factors such as quality of life and demographic variables.MethodsA sample of 157 cardiac patients (78% male; age 68 ± 8.5 years) was recruited from a Swedish hospital. Patient empowerment was assessed using the SWE-CES-10. Additional data was collected on general self-efficacy and well-being (EQ5D and Ladder of Life). Demographic and clinical variables were collected from medical records and interviews.ResultsThe mean levels of patient empowerment and general self-efficacy on a 0–4 scale were 3.69 (±0.54) and 3.13 (±0.52) respectively, and the relationship between patient empowerment and general self-efficacy was weak (r = 0.38). In a simple linear regression, patient empowerment and general self-efficacy were significantly correlated with marital status, current self-rated health and future well-being. Multiple linear regressions on patient empowerment (Model 1) and general self-efficacy (Model 2) showed an independent significant association between patient empowerment and current self-rated health. General self-efficacy was not independently associated with any of the variables.ConclusionsPatients with a diagnosis of coronary heart disease reported high levels of empowerment and general self-efficacy at six to 12 months after the event. Clinical and demographic variables were not independently associated with empowerment or low general self-efficacy. Patient empowerment and general self-efficacy were not mutually interchangeable, and therefore both need to be measured when planning for secondary prevention in primary health care.
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| 7. |
- Lundgren, Johan, 1977-
(author)
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Behind the Screen : -Internet-Based Cognitive Behavioural Therapy to Treat Depressive Symptoms in Persons with Heart Failure
- 2018
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Doctoral thesis (other academic/artistic)abstract
- IntroductionThe prevalence of depressive symptoms in persons with heart failure is higher than in age- and gender-matched populations not suffering from heart failure. Heart failure in itself is associated with an unpredictable trajectory of symptoms, a poor prognosis, high mortality and morbidity, and low health-related quality of life (HrQoL). With the addition of depressive symptoms to heart failure the negative health effects increase further. Though the negative consequences of depressive symptoms in heart failure are well known, there is a knowledge gap about the course of depressive symptoms in heart failure and about how to effectively manage these symptoms. Pharmacological treatment with serotonin reuptake inhibitors has not been able to demonstrate efficacy in persons with heart failure. In a few studies, cognitive behavioural therapy (CBT) delivered face-to-face, has demonstrated effects on depressive symptoms in persons with heart failure. However, currently there are barriers in delivering face-to-face CBT as there is a lack of therapists with the required training. As a solution to this, the use of Internet-based CBT (ICBT) has been proposed. ICBT has been shown to be effective in treatment of mild and moderate depression but has not been evaluated in persons with heart failure.AimThe overall aim of this thesis was to describe depressive symptoms over time and to develop and evaluate an ICBT intervention to treat depressive symptoms in persons with heart failure.Design and MethodsThe studies in this thesis employ both quantitative (Studies I, II and III) and qualitative (Studies II and IV) research methods. The sample in Study I (n=611) were recruited in the Netherlands. The participants (n=7) in Study II were recruited via advertisements in Swedish newspapers. Studies III and IV used the same cohort of participants (Study III n=50, Study IV n=13). These participants were recruited via an invitation letter sent to all persons who had made contact with healthcare services in relation to heart failure during the previous year, at the clinics of cardiology or medicine in four hospitals in southeast Sweden.Study I had a quantitative longitudinal design. Data on depressive symptoms was collected at baseline (discharge from hospital) and after 18 months. Data on mortality and hospitalisation was collected at 18 and 36 months after discharge from hospital. Study II employed three differentBehind the Screen2patterns of design, as follows: I) The development and context adaptation of the ICBT program was based on research, literature and clinical experience and performed within a multi-professional team. II) The feasibility of the program from the perspective of limited efficacy and function was investigated with a quantitative pre-post design. III) Participants’ experience of the ICBT program was investigated with a qualitative content analysis. Data on depressive symptoms was collected pre and post intervention. The time used for support and feedback was logged during the intervention, and qualitative interviews were performed with the participants after the end of the intervention. Study III was designed as a randomised controlled trial. A nine-week ICBT program adapted to persons with heart failure and depressive symptoms was tested against an online moderated discussion forum. Data on depressive symptoms, HrQoL and cardiac anxiety was collected at baseline (before the intervention started) and after the end of the intervention (approximately 10 weeks after the start of the intervention). Study IV had a qualitative design to explore and describe participants’ experiences of ICBT. The participants were recruited from within the sample in Study III and all had experience of ICBT. Data collection occurred after the ICBT program ended and was carried out using qualitative interviews by telephone.ResultsThe mean age of the samples used in this thesis varied between 62 and 69 years of age. Concerning the symptom severity of heart failure, most persons reported New York Heart Association (NYHA) class II (40-57%) followed by NYHA class III (36-41%). Ischaemic heart disease was the most common comorbidity (36-43%). The vast majority had pharmacological treatment for their heart failure. Six percent of the persons in Study I used pharmacological antidepressants. In Studies II and III, the corresponding numbers were 43% and 18% respectively.Among persons hospitalised due to heart failure symptoms, 38% reported depressive symptoms. After 18 months, 26% reported depressive symptoms. Four different courses of depressive symptoms were identified: 1) Non-depressed 2) Remitted depressive symptoms. 3) Ongoing depressive symptoms. 4) New depressive symptoms. The highest risk for readmission to hospital and mortality was found among persons in the groups with ongoing and new depressive symptoms.A nine-week ICBT program consisting of seven modules including homework assignments on depressive symptoms for persons with heart failure was developed and tested. The RCT study (Study III) showed no significant difference in depressive symptoms between ICBT and a moderated discussion forum. Within-group analysis of depressive symptoms demonstrated a significant decrease of depressive symptoms in the ICBT group but not in the discussion forum group.The participants’ experience of ICBT was described in one theme: ICBT- an effective, but also challenging tool for self-management of health problems. This theme was constructed based on six categories: Something other than usual healthcare; Relevance and recognition; Flexible, understandable and safe; Technical problems; Improvements by live contact; Managing my life better.ConclusionAfter discharge from hospital, depressive symptoms decrease spontaneously among a large proportion of persons with heart failure, though depressive symptoms are still common in persons with heart failure that are community dwelling. Depressive symptoms in persons with heart failure are associated with increased risk of death and hospitalisation. The highest risks are found among persons with long-term ongoing depressive symptoms and those developing depressive symptoms while not hospitalised.ICBT for depressive symptoms in heart failure is feasible. An intervention with a nine-week guided self-help program with emphasis on behavioural activation and problem-solving skills appears to contribute to a decrease in depressive symptoms and improvement of HrQoL.When ICBT is delivered to persons with heart failure and depressive symptoms the participants requests that the ICBT is contextually adapted to health problems related to both heart failure and depressive symptoms. ICBT is experienced as a useful tool for self-care and something other than usual healthcare. ICBT also requires active participation by the persons receiving the intervention, something that was sometimes experienced as challenging.
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| 8. |
- Ranheim, Albertine Elisabeth, et al.
(author)
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Eliciting reflections on caring theory in elderly caring practice
- 2011
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In: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 6:3
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Journal article (peer-reviewed)abstract
- Caring theories are the description and conceptualization of the care that is given in caring practise by nurses and other professional caregivers with the aim of verbalizing and communicating caring phenomena. Intermittently, a theory-practice gap is given expression- that theory does not go along with clinical practice in caring. The aim of this study was an investigation into the possible disparity between theory and practice in caring by analysing nurses' lived experience of the understanding of caring theory in practice in the context of municipal elderly care. Hermeneutical phenomenology was the research approach used to explore the lived experience of caring science theories in caring practice from the perspective of 12 nurses working in municipal care for elderly. The findings shows that the nurses Impulsively described their experience of detachment to caring theory, but when describing their caring intentions, the relationship to theory became apparent, and even confirmed their practice. As such, a seedbed exists for caring theory to be reflected on and cultivated in caring praxis. However, as the nurses describe, the caring theory must be sensitive enough for the nursing practitioners to accept. The gap revealed itself on an organisational level, as the nurses' commission in municipal care did not correspond with their caring intention. We believe it is important to seriously consider what we want to achieve as a caring profession. We have to reflect on our responsibility as culture carriers and knowledge developers.We must make the disparate forces of intention and organization become one intertwining force.
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| 9. |
- Sjögren, Elaine, 1955-, et al.
(author)
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The critical friend – a way to develop as a tutor in problem-based learning groups
- 2021
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In: Högre Utbildning. - Oslo, Norway : Cappelen Damm Akademisk AS * Nordic Open Access Scholarly Publishing. - 2000-7558. ; 11:3, s. 39-48
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Journal article (peer-reviewed)abstract
- Tutors in problem-based learning (PBL) need to reflect on their role, to prevent stagnation. We aimed to explore the learning experiences of tutors gained by being and having a critical friend in a PBL group. Eight teachers, from several professional programs at the Faculty of Medicine of a Swedish university, participated in a cross-program activity involving the being and having a critical friend to improve their skills as PBL group tutors. They were individually interviewed, and the transcriptions were subjected to conventional qualitativecontent analysis. The results revealed that a critical friend from another discipline can be useful and that experiences from both roles, to be and to have a critical friend, is necessary for reflection and learning, and thus optimal results. We conclude that support from the organisation, knowledge sharing, and communication are required to enable a systematic use of critical friends to be implemented with credibility.
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