| 1. |
- Alharbi, Tariq, 1979, et al.
(författare)
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Experiences of person-centred care – patients’ perceptions: qualitative study
- 2014
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 13:28
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Tidskriftsartikel (refereegranskat)abstract
- Background Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partnership in the new care model 1 year after its implementation. Methods Sixteen participants were interviewed, selected from two wards in a medical department where a new care model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of the directed approach to content analysis was to investigate to what extent the new care model had been implemented, using patients’ perspectives to describe the level of implementation. A coding framework was developed based on a theoretical paper that described the key features of the new care model. Results The implementation of person-centred care had clearly occurred to a large degree, even if some patients appeared not to have been exposed to the model at all. Aspects of the newly implemented care model were obvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt listened to and that their own perception of the situation had been noted. Patients spontaneously expressed that they felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not every ailment or aspect of a patient’s illness needed to be addressed or resolved for open listening to be perceived as a positive experience. Conclusions The findings indicate that even though some patients were not interested in participating and playing an active role in their own care, this might relate to a lack of understanding on how to invite them to do so and to increase their confidence. To change healthcare from a paternalistic system to care where patients are seen as partners may require pedagogical skills.
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| 2. |
- Alharbi, Tariq, 1979, et al.
(författare)
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Organizational culture and the implementation of person centered care: Results from a change process in Swedish hospital care
- 2012
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510. ; 108:2-3, s. 294-301
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding.
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| 3. |
- Alharbi, Tariq, 1979, et al.
(författare)
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The impact of organizational culture on the outcome of hospital care: After the implementation of person-centred care
- 2014
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 42:1, s. 104-110
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To measure the effect of organizational culture on health outcomes of patients 3 months after discharge. Methods: a quantitative study using Organizational Values Questionnaire (OVQ) and a health-related quality of life instrument (EQ-5D). A total of 117 nurses, 69% response rate, and 220 patients answered the OVQ and EQ-5D, respectively. Results: The regression analysis showed that; 16% (R2 = 0.02) of a decreased health status, 22% (R2 = 0.05) of pain/discomfort and 13% (R2 = 0.02) of mobility problems could be attributed to the combination of open system (OS) and Human Relations (HR) cultural dimensions, i.e., an organizational culture being dominated by flexibility. Conclusions: The results from the present study tentatively indicated an association between an organizational culture and patients' health related quality of life 3 months after discharge. Even if the current understanding of organizational culture, which is dominated by flexibility, is considered favourable when implementing a new health care model, our results showed that it could be hindering instead of helping the new health care model in achieving its objectives.
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| 4. |
- Carlström, Eric, 1957, et al.
(författare)
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The association between subcultures and resistance to change – in a Swedish hospital clinic
- 2014
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Ingår i: Journal of Health Organisation & Management. - 1477-7266. ; 28:4, s. 458-476
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Tidskriftsartikel (refereegranskat)abstract
- Summary: Purpose: The purpose of this paper was to explore the different subcultures and the employees’ preparedness for change at an orthopaedic clinic in a university hospital in Sweden. The idea was to describe how different working groups might react to the change, in order to discover the possible impact of the model prior to implementation. This approach was based on the fact that costly implementation processes have had disappointing results and limited impacts on some organisations. Design: Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire (OVQ) and Resistance to Change Scale (RTC). Findings: The results suggest a dominance of a human relations culture i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease resistance to change. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour. Practical implications: By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change. Originality/value: The rational goal/internal processes dimension exerted a stronger association with resistance to change than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low resistance to change. The results are contrary to the accepted understanding of public organisations known to be slow to change. Keywords: Change, Organisational culture, Healthcare, Working groups, Person-centred care, Sweden. Paper type: Research paper
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| 5. |
- Carlström, Eric, 1957, et al.
(författare)
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The unannounced patient in the corridor - trust, friction and person centered care.
- 2017
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 32:1
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Tidskriftsartikel (refereegranskat)abstract
- In this study, a Swedish cancer clinic was studied where three to four unscheduled patients sought support from the hospital on a daily basis for pain and nutrition problems. The clinic was neither staffed nor had a budget to handle such return visits. In order to offer the patients a better service and decrease the workload of the staff in addition to their everyday activities, a multidisciplinary team was established to address the unscheduled return visits. The team was supposed to involve the patient, build trust, decrease the friction, and contribute to a successful rehabilitation process. Data were collected from the patients and the staff. Patients who encountered the team (intervention) and patients who encountered the regular ad hoc type of organization (control) answered a questionnaire measuring trust and friction. Nurses in the control group spent 35% of their full‐time employment, and the intervention group staffed with nurses spent 30% of their full‐time employment in addressing the needs of these return patients. The patients perceived that trust between them and the staff was high. In summary, it was measured as being 4.48 [standard deviation (SD) = 0.82] in the intervention group and 4.41 (SD = 0.79) in the control group using the 5‐point Likert scale. The data indicate that using a multidisciplinary team is a promising way to handle the problems of unannounced visits from patients. Having a team made it cost effective for the clinic and provided a better service than the traditional ad hoc organization.
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| 6. |
- Dudas, Kerstin, 1963, et al.
(författare)
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Implementering av person-centrerad vård i slutenvården
- 2014
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Ingår i: Personcentrering inom hälso- och sjukvård – från filosofi till praktik. Inger Ekman (red.). - Stockholm : Liber. - 9789147114054 ; , s. 172-206
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 7. |
- Hansson, Elisabeth K, 1954, et al.
(författare)
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Person-centred care for patients with chronic heart failure - a cost-utility analysis
- 2016
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 15:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Costs of care for patients with chronic heart failure have been estimated at between 1% and 2% of the total health care expenditure in Europe and North America. Two-thirds are for inpatient care. Person-centred care (PCC) asserts that patients are persons and should not be reduced to their diseases alone. Aims: The aim of this study was to estimate the cost–utility of PCC when compared with conventional care in patients hospitalized for worsening chronic heart failure. Methods and results: Data for the cost–utility analysis were collected alongside a prospective clinical intervention study with a controlled before and after design from 2008 to 2010. Patient-specific resources used and preference-based health status data were collected at an individual level. Only 63% received PCC as intended illustrating the difficulties of introducing new methods in established organizations. The group intended to have PCC yielded higher costs in comparison with the conventional care group. The incremental cost was estimated as €98. The costs for those who actually received PCC, per protocol (PP) (63%) were significantly (p=0.026) lower than for those in the conventional care group, with an incremental cost-saving of €863. For the first three months, patients in the conventional care group showed decreasing health-related quality of life, with a corresponding improvement in the PCC(PP) group. Conclusion: It must be emphasized, however, that these positive effects, both cheaper and somewhat better, were obtained only among those receiving the PCC intervention in its intended form, PCC(PP).
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| 8. |
- Koinberg, Ingalill, 1955, et al.
(författare)
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Impact of a person-centered intervention for patients with head and neck cancer: A qualitative exploration
- 2018
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: People affected by head and neck cancer (HNC) experience a variety of multifaceted health-related problems during the treatment process, based on both the disease and side effects, several years after the treatment is complete. This study investigated a person-centred intervention using transition theory as a framework. Aim: Thus, the aim of the present study was to explore patients' experience of the transition and person centred care from diagnosis to the end of the treatment period. Methods: Interviews were conducted with 12 persons included in the person-centred intervention group. The patients were recruited from a randomised controlled study. We used a directed deductive content analysis as an analysis method. Results: There was a distinct transition between being a healthy person to being diagnosed with a serious disease. The majority of the participants felt that the diagnosis had put their lives in the balance; they felt both healthy and sick at the same time, and all participants described that their symptoms and side effects were the worst possible and totally unexpected. Of great importance was the health-care plan, comprising self-management goals which were formed in partnership between the patient and the nurse. The participants experienced that their interaction and engagement with lay persons and healthcare professionals supported a gradual acceptance of the situation and a sense of relief with a kind of awareness of the disease. Conclusion: The intervention played a significant role in promoting a healthy transition. Person-centredness and transition theory can help healthcare professionals to be more confident and resourceful in supporting people affected by HNC. © 2018 The Author(s).
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| 9. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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Person-centred care compared with standardized care for patients undergoing total hip arthroplasty-a quasi-experimental study.
- 2014
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Ingår i: Journal of orthopaedic surgery and research. - : Springer Science and Business Media LLC. - 1749-799X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- A common approach to decrease length of stay has been to standardize patient care, for example, by implementing clinical care pathways or creating fast-track organizations. In a recent national report, it was found that Sweden's healthcare system often fails to anticipate and respond to patients as individuals with particular needs, values and preferences. We compared a standardized care approach to one of person-centred care for patients undergoing total hip replacement surgery.
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| 10. |
- Allwood, Jens, 1947, et al.
(författare)
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On the need for an ethical understanding of health-care accountability
- 2015
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Ingår i: Journal of Organisational Transformation and Social Change. - 1477-9633. ; 12:2, s. 121-137
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, as in many other Western countries, public health care is challenged by increasing demands for care and continuing budget deficits. Person-centred care (PCC) has been introduced as a new strategy to ameliorate the perceived fragmentation in care and is expected to decrease treatment time, reduce the need for return visits, as well as increase patient satisfaction. However, the changing clinical practices necessary for the PCC approach are assumed to require new accountability practices. This article is primarily an attempt to provide a conceptual analysis of ethical accountability, i.e. a type of accountability that takes into account the human relational responsibility, partial incoherence, and power of reflection. On the grounds of this characterisation, the article aims to provide a basis, among other things, for a discussion of the possibilities of identifying and empirically studying the multimodal expressions in communication that are relevant for this type of accountability. After an initial discussion of the debate on the limits of viewing accountability as transparency, we then turn to our methodological approach and introduce a conceptual analysis of accountability. Next, we discuss some additional features of accountability. Finally, we discuss the possibilities of empirically studying the institutionalisation of ethically informed accountability within person-centred health care.
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| 11. |
- Caesar, Ulla, et al.
(författare)
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A sense of being rejected : Patients’ lived experiences of cancelled knee or hip replacement surgery
- 2021
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundGrowing care queues, reduced access to care and cancelled surgery are realities for some patients being treated with total hip or knee replacement surgery in Sweden.Most of the patients on the waiting lists have experienced pain and limited motion for a varying period of time, with a negative effect on their everyday lives. Overbooked surgical schedules are already contributing to the lengthy waiting times, but, with the addition of cancellations, longer waiting times will increase still further and may affect patients’ well‐being.MethodsIn the present study, we aimed to illuminate the experience of having planned surgery cancelled, based on narratives from 10 participants. The interview transcriptions were analysed using a phenomenological hermeneutic approach.ResultsThe comprehensive analyses revealed that the participants described the agony of being deselected and the additional impression of being excluded. Metaphors of being damaged and feeling physical pain were used and the interpretations referred to the cancellations as unpleasant. Additionally, the important relationship and the trust between the health workers and the patient were negatively affected by the cancellation.ConclusionAfter the cancellation, the participants expressed being vulnerable and from their perspective the cancelled surgery affected them deeply; in fact, much more than the healthcare workers appeared to understand. Therefore, information around the cancellation must be given respectfully and with dignity, in a dialogue between the patient and the healthcare workers. Taken together, to enable an opportunity to be involved in the continued care. The cancellations should be seen as an interruption, in which the patients’ chance of living a pain‐free, active life is postponed.
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| 12. |
- Caesar, Ulla, et al.
(författare)
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Incidence and root causes of cancellations for elective orthopaedic procedures : a single center experience of 17,625 consecutive cases.
- 2014
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Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 8:24
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery.METHODS: The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once.RESULTS: Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations.CONCLUSIONS: In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process.
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| 13. |
- Dudas, Kerstin, 1963, et al.
(författare)
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PCC- Impact at admission and discharge process, among patients with chronic heart failure
- 2013
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 12:Supplement 1, s. 66-67
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chronic heart failure (CHF) mostly affects the elderly and is a lifelong and progressive disease and the single most common cause of hospitalization with frequent re-admissions. Although many patients with CHF are independent, some patients are fragile and need extra support and care during the hospital stay and after discharge to prevent disability. A person-centred care (PCC) approach to care and planning may help to promote more efficient care and discharge-planning. Aim: To evaluate if PCC-based proactive care-planning, beginning already at admission, leads to improved efficiency in the discharge procedure compared with usual care in patients hospitalized for worsening CHF. Methods: Using a controlled before-and-after design, eligible patients with CHF were randomly assigned to either a usual care group or a PCC intervention group. Development of the PCC care and discharge plan consisted of three steps: 1) a comprehensive narrative was obtained from the patients at admission to identify each patient’s resources for and barriers to recovery; 2) a PCC plan was drawn up based on this and other clinical information and discussed with the patient Downloaded from cnu.sagepub.com at Gothenburg University Library on December 15, 2013 EuroHeartCare 2013 S67 3) the PCC plan was checked and revised where appropriate. The patients’ social situation before admission, their discharge destination, the number of days until the discharge notification was sent to the patients’ community home help service/district nurse were recorded as well as the time interval between notification and start of coordination of care between hospital staff and community home help services and district nurses. Results: 123 in the usual care group and 125 were enrolled. Most of the patients came from independent living (93.2% in the PCC group and 93.5% in the usual care group). The proportion of patients who had community home help service before admission was slightly lower in the PCC group (32.4%) compared to the usual care group (35.8%). The proportion of patients who received care from a district nurse was slightly higher in the PCC group (18.9%) than in the usual care group (13.1%). During hospitalization, the notification to the patients community home help service and/or district nurse were significantly (P = 0.04) more frequently in the PCC-group (33.8%) compared to usual care group (12.1%). Care coordination started within six days in the PCC group whereas the usual care group was more dispersed 1-29 days. Conclusion: PCC improved significantlythe efficiency of the transfer process for patients in need of community home help service and/or district nurse after discharge.
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| 14. |
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| 15. |
- Dudas, Kerstin, 1963, et al.
(författare)
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Person-centred care and empowerment
- 2014
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Ingår i: European Journal of Cardiovascular Nursing. - 1474-5151. ; 13:Suppl. 1. April 2014
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 16. |
- Dudas, Kerstin, 1963, et al.
(författare)
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Person-centred care inluences the belief in medication in patients with chronic heart failure
- 2013
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Ingår i: European Journal of Heart Failure.. - : Wiley. - 1567-4215 .- 1388-9842 .- 1879-0844. ; 12:Supplement 1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: Many patients with chronic heart failure (CHF) seem to fail in adherence to prescribed medication. Confidence in the prescribed medication as well as misconceptions in communication between patient and health care professionals, are well known factors contributing to patients’ adherence. Moreover, patients with CHF have to manage a complex medication treatment and non-adherence seems to be more likely if there is a lack of belief in medication. Person-centered care (PCC) emphasizes partnership between patient and health care professionals including the creation of a common care-plan. Therefore we evaluated if PCC affects patients’ beliefs about prescribed medicines compared to usual care in patients hospitalized for worsening CHF. Methods: Using a controlled before-and-after design, patients hospitalized for worsening CHF were assigned to either a usual care group or a PCC intervention group. Patient-reported belief about their medication was assessed with the Belief about Medication Questionnaire (BMQ). The BMQ consists of three domains: 1) General harm, 2) General overuse, and 3) General Benefit. Results: In total, 248 patients were included in the study; 123 in the usual care group and 125 in the PCC intervention. The PCC group had a significant better score than the usual care group in the BMQ domain General Overuse, mean=9.06 (SD=2.20) vs. mean =9.76, (SD= 4.48) ( p=0.04). There were no differences between the PCC group and the Usual care group in the domain General Harm p=0.70 [mean=12.6 (SD=3.1) vs. mean =12.9 (SD= 3.4)].and General Benefit p=0.31 [mean=16.5 (SD=2.2) vs. mean =16.8 (SD= 2.0]. Conclusion: We found that patients receiving PCC did not belief that medication is overused to the same extent as patients in usual care. These results support our previous findings of less feeling of uncertainty in relation to illness and medication, shorter length of hospital stay and better functional status by applying PCC.
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| 17. |
- Dudas, Kerstin, 1963, et al.
(författare)
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Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care
- 2013
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 12:6, s. 521-528
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Tidskriftsartikel (refereegranskat)abstract
- Background:Many patients with chronic heart failure (CHF) experience uncertainty regarding the treatment and characteristics of their illness. Person-centred care (PCC) emphasizes patient involvement in care. We have previously shown that PCC improved outcomes such as length of hospital stay and activities of daily living in patients with CHF. The impact of PCC on self-reported uncertainty in illness among patients hospitalized for CHF is still unknown.Aim:To evaluate whether PCC is associated with less self-reported uncertainty in illness compared with usual care in patients hospitalized for worsening CHF.Methods:Using a controlled before-and-after design, eligible CHF patients were assigned to either a usual care group or a PCC intervention group. Patient-reported uncertainty in illness was assessed at hospital discharge with the Cardiovascular Population Scale (CPS). The CPS consists of two domains: 1) Ambiguity (about illness severity); and 2) Complexity (of treatment and system of care).Results:Two hundred and forty-eight patients were included in the study; 123 in the usual care group and 125 in the PCC intervention. The PCC group had better scores than the usual care group in the CPS domains complexity (M=15.2, SD=4.7 vs. M=16.8, SD=4.7; p=0.020) and ambiguity (M=27.8, SD=6.6 vs. M=29.8, SD=6.9; p=0.041).Conclusion:Patients with CHF were less uncertain in their illness after PCC, which may help to equip and empower patients to manage their illness. Together with earlier findings of shortened hospital stay and improved activities of daily living, this indicates that PCC should be a standard approach for hospital care of patients with worsening CHF.
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| 18. |
- Ekman, Inger, 1952, et al.
(författare)
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Effects of person-centred care in patients with chronic heart failure: the PCC-HF study
- 2012
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 33:9, s. 1112-1119
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Person-centred care (PCC), emphasizes a partnership in care between patients and health care professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate. Methods and results: During 2008-2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n=123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at 5 designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same 5 wards. PCC was then implemented at these wards and evaluated in 125 patients. LOS and 6-month readmission were extracted from patient records. ADL was evaluated at baseline and discharge and HRQL at baseline and after three months. In the analysis of all patients, LOS was reduced by one day (p=0.16) while retaining ADL (p=0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (p=0.01) and ADL level better preserved (p=0.04). HRQL and time-to-first readmission did not differ. Conclusions: In this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients’ HRQL.
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| 19. |
- Ekman, Inger, 1952, et al.
(författare)
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Person-centered care -ready for prime time.
- 2011
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 10:4, s. 248-251
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Tidskriftsartikel (refereegranskat)abstract
- Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.
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| 20. |
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Höftfraktur hos äldre- Att bevara patientens förmåga
- 2010
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Höftfraktur hos äldre - Att bevara patientens förmåga Området höftfrakturer är väl dokumenterat i den vetenskapliga litteraturen, men kunskapen är spridd och svår att överblicka. I Höftfraktur hos äldre samlar man därför aktuell kunskap och beskriver vård och behandling på ett enhetligt sätt, vilket gör boken till den första i sitt slag. Boken redogör på ett lättillgängligt sätt för hur det akuta mottagandet ska se ut och hur den postoperativa vården och rehabiliteringen ska vara uppbyggd. I alla dessa sammanhang sätter man individen och dennes självständighet i centrum. Höftfraktur hos äldre är avsedd för sjukvårdspersonal inom ortopedi och geriatrik, blivande sjuksköterskor, sjukgymnaster, arbetsterapeuter och läkare. Den kan också med fördel användas av verksamhetschefer och administrativ personal. I boken medverkar flera experter inom geriatrik och ortopedi. Den är redigerad av Jón Karlsson, Lars-Eric Olsson och Ewa Waern, alla verksamma vid Sahlgrenska Universitetssjukhuset i Göteborg.
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| 21. |
- Joelsson, Maud, et al.
(författare)
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Patients’ experience of pain and pain relief following hip replacement
- 2010
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Ingår i: Journal of Clinical Nursing. - 1365-2702. ; 19:19-20, s. 2832-2838
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Tidskriftsartikel (refereegranskat)abstract
- Aims. The aim of this study was to describe patients’ experience of pain and pain relief following hip replacement surgery. Background. Each year, a large number of patients undergo hip replacement surgery. Previous research has focused largely on the long-term effects on pain for patients who undergo hip replacement surgery and to a lesser degree on their subjective, early postoperative pain experience. Design. A descriptive qualitative design was used. Methods. The study was carried out in an orthopaedic ward at a hospital in Sweden during 2006. Qualitative interviews were conducted with 15 patients who had undergone hip replacement surgery. Data were analysed by means of qualitative content analysis. Results. The postoperative pain experience was characterised in terms of interrelated contexts of time, various bodily activities and postoperative pain intensity. The postoperative pain intensity was characterised in terms of intensive and worst imaginable, strange feelings and fear and a feeling of faintness. Easing of postoperative pain was related to professional care features, such as nursing staff, pharmacological pain relief and technical aids. Self-care features were related to relieving body positions, endurance and looking ahead. Conclusion. Although the development of total hip replacement surgery has been very successful, there are issues that need to be addressed in relation to postoperative pain management. The findings in this study show that there are reasons for making a more concerted effort to develop postoperative pain management, particularly during the first few days after surgery. Relevance to clinical practice. The results provide some indication that pain management for this group of patients in the early postoperative period needs to be improved to reduce the fear of moving and improve the process of regaining independence. Devoting more attention to the patients during the initial postoperative phase may be the key to improve the training and making it even more effective.
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| 22. |
- Johansson, Lena, 1972, et al.
(författare)
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Decreased physical health-related quality of life—a persisting state for older women with clinical vertebral fracture
- 2019
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Ingår i: Osteoporosis International. - London : Springer London. - 0937-941X .- 1433-2965. ; 30:10, s. 1961-1971
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Tidskriftsartikel (refereegranskat)abstract
- In a population-based study of older Swedish women, we investigated if clinical vertebral fracture was associated with lower health-related quality of life (HRQoL) and determined whether the association remained over time. Clinical vertebral fracture was associated with lower HRQoL and the effect persisted for up to 18.9 years.IntroductionVertebral fractures are often associated with back pain and reduced physical function, which might result in isolation and depression. As a result, women with vertebral fractures often have lower health-related quality of life (HRQoL), but during what time frame the decrease lingers is unclear. Therefore, the aim of this study was to investigate if clinical vertebral fracture and hip fracture were associated with lower HRQoL and to determine whether the associations remained over time.MethodsVertebral fracture assessments (VFA) were performed using dual-energy X-ray absorptiometry. Data regarding prior fractures, medications, medical history, and physical activity was collected using a questionnaire. Self-rated physical HRQoL was assessed using the 12-Item Short-Form Health Survey (SF-12). Women with clinical vertebral fractures were divided into tertiles according to time since fracture onset and their HRQoL was compared with non-fractured women.ResultsIn a population-based cross-sectional study of 3028 women aged 77.8 ± 1.63 (mean ± SD), a total of 130 (4.3%) women reported at least one clinical vertebral fracture. Women with a clinical vertebral fracture, divided into tertiles (T1–T3) depending on time since the fracture occurred, had lower HRQoL (T1: 36.3 ± 10.8; T2: 41.0 ± 9.94; and T3:41.6 ± 11.4) than women without fracture (46.2 ± 10.6; p < 0.001). Using linear regression analysis, clinical vertebral fracture was associated with reduced physical HRQoL for up to 18.9 years, independently of covariates (age, height, weight, smoking, prior stroke, mental HRQoL, grip strength, and lumbar spine BMD).ConclusionsClinical vertebral fracture was associated with lower self-rated physical HRQoL, for up to 18.9 years after time of fracture. © 2019, The Author(s).
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| 23. |
- Lotzke, Hanna, et al.
(författare)
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Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: A study protocol of a person-centred randomised controlled trial
- 2016
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Following lumbar fusion surgery, a successful outcome is empirically linked to effective rehabilitation. While rehabilitation is typically postoperative, the phase before surgery - termed prehabilitation - is reportedly an ideal time to prepare the patient. There are presently no guidelines for prehabilitation before lumbar fusion surgery. Physical activity has well-known health benefits, and staying physically active despite pain is a major principle in non-pharmacological chronic low back pain treatment. Psychological factors such as fear of movement, pain catastrophizing and low self-efficacy are known to be barriers to staying active. No studies have investigated prehabilitation protocols that promote physical activity and target psychological risk factors before lumbar fusion surgery. The aim of our proposed randomised controlled trial is to investigate whether patients who undergo lumbar fusion surgery for degenerative disc disease experience better functioning with a physiotherapeutic prehabilitation program (PREPARE) based on a cognitive behavioural approach compared to conventional care. Methods/Design: We will recruit 110 patients between 18-70 years of age with degenerative disc disease who are waiting for lumbar fusion surgery. These patients will be randomly assigned to receive either PREPARE or conventional care. PREPARE uses a person-centred perspective and focuses on promoting physical activity and targeting psychological risk factors before surgery. The primary outcome will be disability measured using the Oswestry Disability Index 2.0. Secondary outcomes will include functioning (patient-reported and performance-based), physical activity (accelerometer), health-related quality of life, back and leg pain intensity, pain catastrophizing, kinesiophobia, self-efficacy, depression, anxiety, satisfaction with treatment results and health economic factors. Data will be collected at baseline (preoperatively) after the intervention (preoperatively), 3 and 8 weeks, 3, 6, 12, 24 and 60 months postoperatively. Discussion: We hypothesise that the focus on promoting physical activity and targeting psychological risk factors before surgery will decrease disability and help the patients to be more active despite pain both before and after surgery. We will use a combination of outcome measures both patient-reported and performance-based, as well as accelerometer data. This will provide a more comprehensive picture of the patient's functioning than just patient-reported outcomes alone. Trial registration: Current Controlled Trials ISCRTN17115599, Retrospectively Registered 18 May 2015. © 2016 The Author(s).
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| 24. |
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| 25. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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A cost-effectiveness study of a patient-centred integrated care pathway
- 2009
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Ingår i: Journal of Advanced Nursing. ; 65:8, s. 1626-35
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of the study was to compare costs and consequences for an integrated care pathway intervention group with those of a usual care group for patients admitted with hip fracture. BACKGROUND: Rehabilitation for patients with hip fracture consists of training in hospital and/or in a rehabilitation unit, and on their own at home with assistance from community care staff. It is important for hospitals to provide methods of care that can safeguard these older patients' physical function and potential for independent living. METHODS: A consecutive sample of 112 independently living participants, aged 65 years or older and admitted to hospital with a hip fracture, were included in the study. Data were collected over an 18-month period in 2003-2005. A cost-effectiveness analysis was performed to compare an integrated care pathway intervention (treatment A) with usual care (treatment B). RESULTS: There was a 40% reduction for each participant in the average total cost of treatment A of euro 9685 vs. euro 15,984 for treatment B. Moreover, clinical effectiveness was much improved. The cost-effectiveness ratio for treatment A was euro 14,840 vs. euro 31,908 for treatment B. In addition, 75% of the participants in treatment A were successfully rehabilitated vs. 55% in treatment B. CONCLUSIONS: The recovery trajectory for hip fracture surgery may be shortened if nurses pay more attention to the individual patient's resources and motivation for rehabilitation. The application of an integrated care pathway with individualized care appears to enhance both rehabilitation outcomes and cost-effectiveness
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| 26. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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Admitted with a hip fracture: patient perceptions of rehabilitation
- 2007
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Ingår i: Journal of clinical nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 16:5, s. 853-9
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: The aim of this study was to describe the hip fracture patients' own perceptions of their situation and views of their responsibility in the rehabilitation process. BACKGROUND: Although much research has been conducted on various aspects of the rehabilitation process in patients with a hip fracture, no attention has been given to the patients' own views of their situation at the start of this transitional process. METHOD: Thirteen informants with a hip fracture, aged 71-93 years, were interviewed postoperatively at a Swedish hospital. Phenomenographic analysis of the interview transcripts was performed. RESULTS: The informants varied greatly in their engagement in the rehabilitation process, in their conceptions of who was responsible for their recovery and in their views on the need for information pertinent to their condition. Three categories of description were formulated: the Autonomous, i.e. patients who were self-sufficient and used to taking care of themselves and who searched for relevant information; the Modest, i.e. frail patients in need of more support who wanted information, but did not ask for it; and the Heedless, i.e. patients who were already dependent, who were not aware of their own responsibility and not interested in information. The informants also shared some traits: they all needed more information although not all were aware of it, they all worried about their future ability to walk again and they all had a strong zest for life. RELEVANCE TO CLINICAL PRACTICE: Our results suggest that differences in patients' perspectives on the rehabilitation process need to be taken into account to enhance outcomes. Inadequate knowledge and engagement on the part of patients, with a hip fracture, probably have an impact on their rehabilitation outcome, but the degree of impact is uncertain.
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| 27. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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Effects of nursing interventions within an integrated care pathway for patients with hip fracture
- 2007
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Ingår i: Journal of advanced nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 58:2, s. 116-25
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper reports a study to evaluate the contribution of nursing care within an integrated care pathway for patients with hip fracture. BACKGROUND: There is growing interest in quality assurance in health care. Integrated care pathways are a method to achieve this goal, and are a multi-professional team approach where the requirement for nurses to work effectively within the team is important. However, the nurses' role and contribution within the team have not been well described. METHOD: A quasi-experimental, prospective study comparing an intervention group with a comparison group was carried out. One hundred and twelve independently living patients, aged 65 years or older and admitted to a Swedish hospital with a hip fracture, were consecutively selected. Pathological fracture and severe intellectual impairment (Pfeiffer's test <3 points) served as exclusion criteria. The intervention was designed to focus on patients' motivation and their prerequisites for rehabilitation and was based on the concept of transition. The main outcome measure was the number of patients restored to preoperative activities of daily living levels in 2003-2004. FINDINGS: In the intervention group 21% were restored to activities of daily living to level A (independent) at discharge, whereas only 5% in the comparison group were restored to this level. No patients in the intervention group, admitted as independent, remained at activities of daily living level F (dependent), whereas 16% remained at level F in the comparison group (P=0 x 003). CONCLUSION: When admitting older patients with a hip fracture, it is important to acquire good knowledge about each patient and their prerequisites and to offer them accelerated rehabilitation in accordance with their individual ability. By monitoring process indicators during the transition, serious deviations from the care plan can be avoided.
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| 28. |
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| 29. |
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| 30. |
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| 31. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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Evaluation of person-centred care after hip replacement-A controlled before and after study on the effects of fear of movement and self-efficacy compared to standard care
- 2016
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The goal of total hip arthroplasty (THA) is optimal pain relief and a normalized health-related quality of life. Anxious patients describe more pain and more difficulties than non-anxious patients during rehabilitation after THA. The aims of the present study were twofold: (1) to identify vulnerable patients using the general self-efficacy scale (GSES) and the Tampa scale for Kinesiophobia (TSK), and (2) to evaluate if person-centred care including the responses of the instruments made rehabilitation more effective in terms of shortening hospital length of stay. Methods: The design of the study was quasi-experimental. Patients scheduled for THA, a control group (n = 138) and an intervention group (n = 128) were consecutively recruited. The intervention was the provision of person-centred care which was designed to reduce the negative effects of low self-efficacy and high levels of pain-related fear of movement. Results: Patients with low GSES in the intervention group had shorter length of stay (LoS) by 1.6 days (95 % CI 0.16-3.15) p-value 0.03. Patients with high TSK in the intervention group had shorter LoS by 2.43 days (95 % CI 0.76-4.12) p-value 0.005. For patients who had both, the reduction of LoS was 2.15 days (95 % CI 0.24-4.04) p-value 0.028. Conclusions: The GSES and the TSK instrument were found useful as tools to provide information to support patients which reduced the LoS by 1.67 days in the whole intervention group (95 % CI 0.72-2.62) p-value 0.001. More importantly, vulnerable patients such as ASA group 3 probably gained the most from the extra support, they had a reduction with 6.78 days (95 % CI 2.94-10.62) p-value 0.001. © 2016 The Author(s).
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| 32. |
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| 33. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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Höftfraktur
- 2009
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Ingår i: Prehospital akutsjukvård Redaktörer Leif Svensson Björn-Ove Suserud. - Stockholm : Liber. - 9789147084487 ; , s. 428-434
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 34. |
- Olsson, Lars-Eric, 1951
(författare)
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Integrated care pathways and Patient-centered care a cost-effective combination
- 2008
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Ingår i: 8th Annual Integrated Care Conference 2008.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To perform an economic evaluation of two treatment approaches in participants with an acute hip fracture. Design A cost-effectiveness analysis was performed to compare an intervention treatment (treatment A) with standard care (treatment B)1. The intervention treatment was an integrated care pathway (ICP)2. Participants were selected consecutively and the treatment study used a before-and-after design. Setting An orthopaedic ward at a hospital southwest of Sweden. Participants 112 independently living participants, aged 65 years or older and admitted to hospital with a hip fracture, were included. The exclusion criteria were pathological fracture and severe intellectual impairment (Pfeiffer's test < 3 points). Outcome The main outcome was hospital’s total treatment costs for each participant undergoing surgery for a hip fracture, where effectiveness was measured using the Katz ADL index. Results The main result was a 40% reduction for each participant in the average total cost for treatment A € 9,685 vs. € 16,002 for treatment B (p=0.000). Moreover, effectiveness was significantly improved. The cost-effectiveness ratio for treatment A was € 14,840 vs. € 31,908 for treatment B. In addition, 75% of the participants in treatment A were successfully rehabilitated vs. 55% in treatment B. Conclusion The use of an ICP was cost-effective, with the greatest reduction in hotel costs. A longer hospital stay was related to more investigation costs, which appeared to be unrelated to the participants’ medical condition. The cost of developing the ICP had already been covered after three partici-pants. No 30-day re-admission was recorded in either group and the one-year mortality rate was 16% in both groups.
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| 35. |
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| 36. |
- Olsson, Lars-Eric, 1951
(författare)
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Patients with acute hip fractures; motivation, effectiveness and costs in two different care systems
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract The care of patients with a hip fracture in Sweden varies a lot in terms of length of hospital stay and these patients are often subjected to multiple transferrals for other than medical reasons. How this affects the rehabilitation result is largely unknown but it is probably not in the best interest of the patients. The overall aim was to investigate the hospital care for patients with acute hip fractures - their own perceptions of their situation and comparison of effectiveness and costs using two different care systems. A qualitative method was used to describe the patients? perceptions of their situation after hip fracture surgery. A quasi-experimental design was used to compare the Integrated Care Pathway (ICP) intervention group to a comparison group and a cost-effectiveness method was used for the economic evaluation. The patients in the qualitative study varied greatly in their engagement in the rehabilitation process but common traits among all the patients were: the need for more information, strong worry for future physical ability and a very strong zest for life. The ICP included a patient-motivated accelerated training programme based on the individual patients? own perceptions and motivation for rehabilitation. The ICP intervention group had a significantly shorter length of hospital stay (12.2 vs. 26.3 days; p<0.000) the rehabilitation was more successful (36 patients vs. 27 were discharged as low dependent) (p=0.003). Moreover, there was a 40% reduction of the average total cost in the intervention group (p=0.000). The results suggest that differences in patients? perspectives on the rehabilitation process need to be taken into account to enhance outcomes. It was found to be important to obtain good knowledge about patients´ prerequisites and subject them to an accelerated rehabilitation in accordance with their personal ability. The transition theory was intertwined within the ICP providing help for caregivers when assisting the patients to develop new knowledge and skills. The use of an ICP was cost-effective and the cost for developing the ICP was accrued already after three patients.
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| 37. |
- Olsson, Lars-Eric, 1951
(författare)
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Person centrert omsorg
- 2011
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Ingår i: Haugesund Norge.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 38. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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Sänkt kostnad vid höftfraktur
- 2007
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Ingår i: Incitament. ; :16, s. 272-282
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 39. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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The integrated care pathway reduced the number of hospital days by half: a prospective comparative study of patients with acute hip fracture
- 2006
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Ingår i: Journal of orthopaedic surgery and research. - 1749-799X. ; 1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The incidence of hip fracture is expected to increase during the coming years, demanding greater resources and improved effectiveness on this group of patients. The aim of the present study was to evaluate the effectiveness of an integrated care pathway (ICP) in patients with an acute fracture of the hip. METHODS: A nonrandomized prospective study comparing a consecutive series of patients treated by the conventional pathway to a newer intervention. 112 independently living patients aged 65 years or older admitted to the hospital with a hip fracture were consecutively selected. Exclusion criteria were pathological fracture and severe cognitive impairment. An ICP was developed with the intention of creating a care path with rapid pre-operative attention, increased continuity and an accelerated training programme based on the individual patient's prerequisites and was used as a guidance for each patient's tailored care in the intervention group (N = 56) The main outcome measure was the length of hospital stay. Secondary outcomes were the amount of time from the emergency room to the ward, to surgery and to first ambulation, as well as in-hospital complications and 30-day readmission rate. RESULTS: The intervention group had a significantly shorter length of hospital stay (12.2 vs. 26.3 days; p < 0.000), a shorter time to first ambulation (41 vs. 49 h; p = 0.01), fewer pressure wounds (8 vs. 19; p = 0.02) and medical complications (5 vs. 14; p = 0.003) than the comparison group. No readmissions occurred within 30 days post-intervention in either group. CONCLUSION: Implementing an ICP for patients with a hip fracture was found to significantly reduce the length of hospital stay and improve the quality of care.
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| 40. |
- Olsson, Lars-Eric, 1951, et al.
(författare)
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What patients tell us and what we choose to hear
- 2009
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Ingår i: The European Society of Cardiology congress 2009 in Nice.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Recent research has shown that severity of symptoms is assessed differently by health professionals and the patients themselves. Patients self reported symptoms (breathlessness) independently predict mortality up to five years, even after controlling for 16 covariates. Method: 60 patients admitted for worsening CHF have been interviewed regarding their lifestyle and view of their condition and treatment. Both the interviews and the medical records will be analyzed using content analysis. Content analysis is fundamentally empirical in its orientation and entails a systematic reading of body of texts. Findings Preliminary findings indicate that 90 % (n=50) of the patient records contain 85 % information of signs (UCG, edema, auscultation) and only 15 % is about patients’ history ( symptom). The research interviews contained 90 % information concerning symptoms, home situation, social situation and so on. The non-concordance between patients´histories and documentation may have led to inefficient care and thereby delayed discharge. Tentative analysis of the text revealed two parallel processes: One process was driven by the physicians who were investigating signs, in order to confirm the suspected heart failure. The other process was driven by the patient who, by communicating symptoms to the nurses, sought symptom alleviation. The medical process appears to be of superordinate significance and hinders the communication between nurses and physicians. Conclusion: The medical summary after discharge stated that although the woman was suffering from a heart condition, the symptoms she was admitted for did not emanate from her heart condition. All investigations confirmed that both her signs and symptoms were associated with her workload and distressful social situation. Hence, vital information seems not to have been communicated in a productive way between the patient, the nurses and the physicians. The non-concordance between patients´ histories and documentation may have led to inefficient care and thereby delayed discharge. This study is part of: PICAP-HF Study
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| 41. |
- Svensson, Hilda, Filosofie doktor, 1979-, et al.
(författare)
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A painful, never ending story : older women's experiences of living with an osteoporotic vertebral compression fracture
- 2016
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Ingår i: Osteoporosis International. - London : Springer London. - 0937-941X .- 1433-2965. ; 27:5, s. 1729-1736
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Tidskriftsartikel (refereegranskat)abstract
- Vertebral compression fractures (VCF) cause pain and decreased physical ability, with no known well-established treatment. The aim of this study was to illuminatethe experience of living with a VCF. The results show that fear and concerns are a major part of daily life. The women's initial contact with health-careproviders should focus on making them feel acknowledged by offering person-centered and tailored support.INTRODUCTION: In the past decade,osteoporotic-related fractures have become an increasingly common and costlypublic health problem worldwide. Vertebral compression fracture (VCF) is the second most common osteoporotic fracture, and patients with VCF describe anabrupt descent into disability, with a subsequent desire to regain independence in everyday life; however, little is known of their situation. The aim of thisstudy was to illuminate the lived experience of women with an osteoporotic VCF.METHODS: Ten women were interviewed during 2012-2013, starting with an open-endedquestion: could you tell me what it is like to live with a vertebral compression fracture? The verbatim transcribed interviews were analyzed using a phenomenological hermeneutical approach.RESULTS: The narrative provided descriptions of living in turmoil and chaos, unable to find stability in their life with little improvement regarding pain and physical function. Shifts from periods of constant pain to periods of fear of constant pain created a loss of confidence and an increased sense of confinement.The structural analysis revealed fear and concerns as the most prominentexperience building on five themes: struggling to understand a deceiving body,breakthrough pain fueling fear, fearing a trajectory into isolation, concerns of dependency, and fearing an uncertain future.CONCLUSIONS: Until researchers find a successful prevention or medical/surgical treatment for osteoporotic VCFs, health-care providers and society abandon these women to remain in a painful and never ending story. © 2015, The Author(s).
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| 42. |
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| 43. |
- Wolf, Axel, et al.
(författare)
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Dependency, subjective health and care experience among patients hospitalised in internal medicine
- 2011
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Ingår i: European Journal of Cardiovascular Nursing. ; 10:SUPPLEMENT 1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Dependency, subjective health and care experience among patients hospitalised in internal medicine A. Wolf1, L.E. Olsson1, K. Swedberg2, I. Ekman1 1University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden; 2Sahlgrenska University Hospital/Ostra, Institute of Medicine/Dpt Emergency & Cardiovascular Medicine, Gothenburg, Sweden Background: Hospitalised frailed patients are at risk of a downward trajectory in their physical state and general health status. Limited information is available about how subjective health and physical status impact on patients’ care experience with a potential impact on hospital readmission. Objectives: Explore whether subjective health and physical dependence affect the care experiences of patients, and analyse how patients report communication during their hospitalisation. Design: A Swedish adapted version of The Picker Institute “In patient” survey was used. Instrument items relate to how the patient perceives specific areas of care rather than general satisfaction with care. The study population was divided into two groups: frail-dependent and non-frail and independent, analysing how self-rated health and physical dependency impacts the care satisfaction. Setting: Patients discharged from internal, medicine wards at six regional and university hospitals in different parts of Sweden during the period 2008–2009. Results: The survey was sent to 6,034 patients and 3,813 patients responded (63.2%). Good, self-rated health and physical independence were significant predictors of a more positive care experience in areas important for decreasing the frequency of hospital readmission. Of the frail patients with low self-rated health and high physical dependence, 35% reported acceptable participation in decision making compared with 64% in the non-frail group (good health and independence) (p ≤ 0.05). Conclusion: Our findings indicate a care paradox: conventional care delivered by healthcare professionals in Swedish internal medicine wards provides communication and patient participation that to an higher extend acknowledge the need and resources of the non-frail patients (i.e. those in good health), resulting in a care which does not correspond enough to the well-being of frail patients.
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| 44. |
- Wolf, Axel, et al.
(författare)
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Impacts of patient characteristics on hospital care experience in 34,000 Swedish patients
- 2012
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Standardized patient surveys are widely used for assessing quality of healthcare from the patient perspective. An important purpose of such surveys is to identify disparities in care among different patient groups. The purpose of this study was to 1.) evaluate aspects of the validity of the adapted Swedish version of the Picker Patient Care Experience -15 (PPE-15) survey and 2.) examine the explanatory value of various socio-demographic and health characteristics in predicting patients’ care experiences. Methods A retrospective cross-sectional study design was used. Patients discharged from internal medicine wards at regional and university hospitals in different parts of Sweden during 2010 were invited to participate in the regularly administered national care-experience survey for hospital care. The internal validity of the PPE-15 was assessed with Cronbach’s alpha and item-scale correlations. Pearson product–moment correlation coefficients were used to compare PPE-15 total scores with overall care satisfaction ratings and Spearman correlation coefficients were used to compare PPE-15 total scores with various patient characteristics. Multiple linear regression analysis was performed to examine the influence of various patient characteristics on PPE-15 scores. Results The response rate was 66% (n = 34 603). Cronbach’s alpha was 0.87. The correlation between the PPE-15 total score and overall care satisfaction was high (0.62, p < 0.0001). Good self-rated health (SRH) and having Swedish as native language were associated with better care experiences and poorer experiences with greater healthcare utilization, higher age, functional impairment and being female. All examined characteristics, except language, were significant predictors in the regression model and SRH was the strongest predictor; however, the model explained only 7% of the total variance. Vulnerable patients (i.e. poor SRH and functional impairment) reported significantly less positive care experiences than did non-vulnerable patients (mean PPE-15 score 75 vs 85; p < 0.0001). Conclusions Our results supported the internal validity of the Swedish adapted version of the PPE-15. The explanatory value of the examined patient socio-demographic and health characteristics was low, suggesting the need for exploring other patient-related determinants of care experiences. Our findings also suggest a care paradox: patients in greatest need of hospital care are least satisfied with the quality of the care they receive.
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| 45. |
- Wolf, Axel, et al.
(författare)
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Self-efficacy and personal resources among patients with worsening CHF.
- 2012
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Ingår i: European Journal of Heart Failure Supplements ( 2012 ) 11 ( S1 ). ; 11:S1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background. Personal resources such as functional status and self-efficacy comprise the patient’s toolbox for self-management in Chronic Heart Failure (CHF). Yet little is known about how these resources are utilised during a period of deteriorating CHF. Aim. This study ́s objective was to describe self-rated functional status and self-efficacy in patients after hospital admission for worsening CHF. Methods.A mixed method design was chosen. Instruments that measure resources of self-efficacy (General Self-Efficacy scale (GSES)), activity of daily living (Functional Recovery Scale (FRS)) and CHF specific functional status (New York Heart Association class (NYHA)) were combined with pa- tient interviews that explored personal resources in everyday life. Patients (n=248) were assessed, interviewed and completed questionnaires within 24-48 hours of admission to one of five designated internal medicine wards. Results. The average patient (n=248) was 79 years old and in NYHA class II-III. Levels of independ- ence and self-efficacy were high, with a significant correlation between decreased functional status (NYHA) and decreased self-efficacy (r=-0.27, p <0.001). Patient interviews (n=32) strengthened the quantitative findings. Conclusion. In patients admitted to hospital with worsening CHF, we found high levels of personal resources, while increased NYHA class seemed to have a negative relationship with the patient’s self confidence. Further studies should investigate how interventions adapted to patient resources could impact patient-reported outcomes of self-efficacy, especially in higher NYHA classes.
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| 46. |
- Wolf, Axel, et al.
(författare)
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Use of Smartphones in person-centred eHealth diaries in patients above 75 years.
- 2012
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Ingår i: European Journal of Heart Failure Supplements. ; 11:S1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose Remote monitoring of patients with Chronic Heart Failure (CHF) has yielded mixed and often disappointing results. One reason could be that remote monitoring mirrors a disease focused and patriarchal way of looking at the patient, hence only promoting a one-way communication between the patient and the physician/nurse. Therefore, we investigated the feasibility of a simple smartphone application for self-monitoring of signs and symptoms in patients above 75 years. Methods We screened and found 16 eligible patients above 75 years being hospitalized for worsening CHF. Patients were eligible if they had used any kind of cellphone prior to the study and did not present cognitive or severe physical impairment. Twelve of the eligible patients declined participation. Patients were trained to use a Google Android smartphone with the installed application for weight, dyspnea and fatigue. They were also trained how to interpret the visual trends of their signs and symptoms. Patients were encouraged to use the application every other day for the following 3 months. Semi-structured interviews were performed within the first 48 hours after admission and at 3-month focusing on their perception and need for e-health solutions in everyday life. Results The included patients (n=4) were between 85 and 95 years and were classified as NYHA class III or IV. Little instruction in using the smartphone was needed, and at the 3-month follow up, all patients had used the application frequently. Findings indicated that patients who experience no symptom relief at discharge expressed little meaning of monitoring symptoms alteration. Patients who shifted in severity in their dyspnea or weight expressed both usefulness and self-confidence in monitoring their symptom changes. The visual weight and dyspnea trend were perceived as helpful, the visual trends of fatigue were reported as less useful. Conclusion To our knowledge, this is the first study to evaluate a smartphone based symptom diary for elderly patient with CHF. Preliminary findings indicate a feasibility of a smartphone application for elderly patients. Our findings suggest that a smartphone based E-health diary should be further explored in patients with symptomatic diseases.
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