| 1. |
- Engström, Åsa, et al.
(författare)
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Transition as experienced by close relatives of people with traumatic brain injury
- 2011
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Ingår i: Journal of Neuroscience Nursing. - 0888-0395 .- 1945-2810. ; 43:5, s. 253-260
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Tidskriftsartikel (refereegranskat)abstract
- When someone is afflicted by a traumatic brain injury (TBI), it entails a sudden change in the lives of their close relatives. Relatives provide the primary support system for the person with TBI, and new living patterns have to be developed by the family to achieve balance in the new situation. There is an absence of studies focusing on the process of transition for people living close to a person with TBI, especially in a long-term relationship. The aim of this study, therefore, was to describe such transitions experienced by the close relatives of people with TBI. Five close relatives, all women, who lived with or close to a person with TBI in the northern part of Sweden, were interviewed. The data were analyzed in accordance with the qualitative interpretive method and performed in a series of steps to arrive at a description of the transition. The findings of the analysis are presented in 4 categories: the starting point of the transitions, transitions in pattern of daily life, transitions in relationship, and transitions in social life. The transitions of daily life for close relatives began suddenly as the person with TBI was injured unexpectedly. The relatives could feel lonely as former friends were gone or avoided them. How the person with TBI was met by other people strongly affected how the close relatives felt. Although they struggled to lessen the dependence of the person with TBI on them, they also felt anxious about how things would be if close relatives were no longer there for that person. The findings are discussed with reference to works by the philosophers Buber, Le´vinas, and Lo¨ gstrup and theories of transition.
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| 2. |
- Eriksson, Helene, et al.
(författare)
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Ethical Dilemmas Around the Dying Patient With Stroke: A Qualitative Interview Study With Team Members on Stroke Units in Sweden
- 2014
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Ingår i: Journal of Neuroscience Nursing. - : Lippincott, Williams andamp; Wilkins. - 0888-0395 .- 1945-2810. ; 46:3, s. 162-170
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, individuals affected by severe stroke are treated in specialized stroke units. In these units, patients are attended by a multiprofessional team with a focus on care in the acute phase of stroke, rehabilitation phase, and palliative phase. Caring for patients with such a large variety in condition and symptoms might be an extra challenge for the team. Today, there is a lack of knowledge in team experiences of the dilemmas that appear and the consequences that emerge. Therefore, the purpose of this article was to study ethical dilemmas, different approaches, and what consequences they had among healthcare professionals working with the dying patients with stroke in acute stroke units. Forty-one healthcare professionals working in a stroke team were interviewed either in focus groups or individually. The data were transcribed verbatim and analyzed using content analysis. The ethical dilemmas that appeared were depending on nondecisions about palliative care or discontinuation of treatments. The lack of decision made the team members act based on their own individual skills, because of the absence of common communication tools. When a decision was made, the healthcare professionals had problems holding to the decision. The devised and applied plans could be revalued, which was described as a setback to nondecisions again. The underlying problem and theme was communication barriers, a consequence related to the absence of common skills and consensus among the value system. This study highlights the importance of palliative care knowledge and skills, even for patients experiencing severe stroke. To make a decision and to hold on to that is a presupposition in creating a credible care plan. However, implementing a common set of values based on palliative care with symptom control and quality of life might minimize the risk of the communication barrier that may arise and increases the ability to create a healthcare that is meaningful and dignified.
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| 3. |
- Kitzmüller, Gabriele, et al.
(författare)
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The Long-Term Experience of Family Life After Stroke
- 2012
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Ingår i: Journal of Neuroscience Nursing. - : American Association of Neuroscience Nurses. - 0888-0395 .- 1945-2810. ; 44:1, s. E1-E13
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Tidskriftsartikel (refereegranskat)abstract
- Stroke is a life-threatening and disabling illness known to have a significant impact on families. The purpose of this study was to illuminate the long-term experience of family life after stroke of stroke survivors and their spouses and children, particularly regarding marital and parent-child relationships. Thirty-seven narrative interviews were conducted with stroke survivors and their spouses and adult children who were minors at onset of the illness. A qualitative approach inspired by Gadamer's hermeneutic and van Manen's phenomenological understanding of lived experience was used. The analysis revealed four themes: the family as a lifebuoy, absent presence, broken foundations, and finding a new marital path. Lack of communication and altered roles and relationships endangered marital equilibrium and parent-child relationships after stroke. This study highlighted the need for professional family support as families were unprepared for the life changes that occurred. Nurses and other healthcare workers should examine family relationships and communication patterns and view the family as a unit composed of unique persons with different needs. Further research on the experiences of stroke survivors' children seems urgent.
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| 4. |
- Liedström, Elisabeth, 1952-, et al.
(författare)
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Quality of life in spite of an unpredictable future : the next of kin of patients with multiple sclerosis
- 2010
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Ingår i: Journal of Neuroscience Nursing. - Philadelphia, USA : Lippincott Williams & Wilkins. - 0888-0395 .- 1945-2810. ; 42:6, s. 331-341
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to describe the quality of life of the next of kin of patients diagnosed as having multiple sclerosis (MS). Forty-four next of kin were interviewed and thereafter answered the Subjective Quality of Life questionnaire. The next of kin's quality of life emerged as good in terms of both external conditions and interpersonal relationships in both the interviews and the Subjective Quality of Life. In the interviews, most of the next of kin indicated a trusting and secure relationship with the cohabiting partner, but others described a strained situation with an unsatisfactory married/cohabiting life. There was worry about a worsening of the relationship in the future. In addition, the next of kin spoke of a decrease in freedom, self-actualization, and security, also of a more negative general mood and negative emotional experiences. The results of the questionnaire showed that a sense of engagement in life, having energy, self-actualization, self-assuredness, self-acceptance, security, and general mood were significantly correlated with quality of life as a whole. The study confirms that MS is a disease affecting the whole family, and the next of kin were living in uncertainty, facing an unpredictable future. The nurses could start family support groups and help the next of kin to look after their own health, giving advice on health-promoting behavior to make it possible for the person with MS to live at home even if the illness becomes worse.
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| 5. |
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| 6. |
- Nyholm, Lena, 1973-, et al.
(författare)
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Secondary insults related to nursing interventions in neurointensive care : a descriptive pilot study
- 2014
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Ingår i: Journal of Neuroscience Nursing. - 0888-0395 .- 1945-2810. ; 46:5, s. 285-291
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Tidskriftsartikel (refereegranskat)abstract
- The patients at a neurointensive care unit are frequently cared for in many ways, day and night. The aim of this study was to investigate the amount of secondary insults related to oral care, repositioning, endotracheal suctioning, hygienic measures, and simultaneous interventions at a neurointensive care unit with standardized care and maximum attention on avoiding secondary insults. The definition of a secondary insult was intracranial pressure > 20 mm Hg, cerebral perfusion pressure < 60 mm Hg and systolic blood pressure < 100 mm Hg for 5 minutes or more in a 10-minute period starting from when the nursing intervention began. The insult minutes did not have to be consecutive. The study included 18 patients, seven women and 11 men, aged 36-76 years with different neurosurgical diagnoses. The total number of nursing interventions analyzed was 1,717. The most common kind of secondary insults after a nursing measure was high intracranial pressure (n = 93) followed by low cerebral perfusion pressure (n = 43) and low systolic blood pressure (n = 14). Repositioning (n = 39) and simultaneous interventions (n = 32) were the nursing interventions causing most secondary insults. There were substantial variations between the patients; only one patient had no secondary insult. There were, overall, a limited number of secondary insults related to nursing interventions when a standardized management protocol system was applied to reduce the occurrence of secondary insults. Patients with an increased risk of secondary insults should be recognized, and their care and treatment should be carefully planned and performed to avoid secondary insults.
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| 7. |
- Prendergast, Virginia, et al.
(författare)
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Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients : results of a randomized controlled trial
- 2012
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Ingår i: Journal of Neuroscience Nursing. - : Lippincott Williams and Wilkins Ltd.. - 0888-0395 .- 1945-2810. ; 44:3, s. 134-146
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n = 25) in intubated patients in a neuroscience ICU in a 2-year randomized clinical trial. Oral health was evaluated based on the Oral Assessment Guide (OAG) on enrollment, the day of extubation, and 48 hours after extubation. There were no significant differences in the frequency of the oral care protocol. Protocol compliance exceeded 91% in both groups. The total OAG score and all eight categories significantly deteriorated (Friedman test, p < .001, Bonferroni corrected) in the standard oral care group and did not return to baseline after extubation. Large effect sizes were present at all three points in this group. Thetotal OAG score deteriorated during intubation within the comprehensive protocol group (Friedman test, p < .004) but returned to baseline status after extubation. In four categories, the ratings on tongue, mucous membranes, gingiva, and teeth did not deteriorate significantly over time. Published oral care protocols are substandard in promoting and maintaining oral health in intubated patients. A comprehensive oral care protocol, using a tongue scraper, an electrical toothbrush, and pharmacological moisturizers, was more effective for oral hygiene throughout intubation and after extubation than manual toothbrushing alone.
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| 8. |
- Skoglund, Karin, et al.
(författare)
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Monitoring and Sedation Differences in the Management of Severe Head Injury and Subarachnoid Hemorrhage Among Neurocritical Care Centers
- 2013
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Ingår i: Journal of Neuroscience Nursing. - 0888-0395 .- 1945-2810. ; 45:6, s. 360-368
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Tidskriftsartikel (refereegranskat)abstract
- Background: The emergence of specialized neurocritical care (NCC) centers has been associated with an improved survival of patients with severe traumatic brain injury or subarachnoid hemorrhage. However, there are no established guidelines on sedation strategy or the frequency of evaluating the level of consciousness using the neurological wake-up test (NWT) in sedated NCC patients. Objectives: The aim was to compare the (1) monitoring techniques, (2) sedation principles, and (3) the use of the NWT in patients with severe traumatic brain injury or subarachnoid hemorrhage in 16 NCC centers. Method: A systematic survey of all 16 centers providing NCC in Scandinavia was performed using a questionnaire regarding the routine primary choice of sedative and analgesic compounds, monitoring techniques, and the frequency of the NWT, sent to the director of each center during 1999, 2004, and 2009. Results: The response rate was 100%. Except for one center in 1999, all included centers routinely used monitoring of intracranial and cerebral perfusion pressure. In contrast, newer monitoring techniques such as microdialysis, jugular bulb oximetry, and brain tissue oxygenation were infrequently used throughout the survey period. Approximately half of the NCC centers used propofol infusion as the primary sedative, whereas the remaining centers used midazolam infusion, and there was a marked variation in the choice of analgesia in each evaluated year. The NWT was never used in 50% of centers and six times daily in one center from 1999 to 2009. Most differences among the NCC centers remained unchanged over the evaluated 10-year period. Discussion: Although Scandinavian countries have similar healthcare systems, there were marked differences among the participating NCC centers in the choice of monitoring tools and sedatives and the routine use of the NWT. These differences likely reflect different clinical management traditions and a lack of evidence-based guidelines in routine NCC.
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| 9. |
- Westergren, Albert, et al.
(författare)
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Measurement properties of the 12-item Short-Form Health Survey in stroke
- 2014
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Ingår i: Journal of Neuroscience Nursing. - : Lippincott Williams and Wilkins Ltd.. - 0888-0395. ; 46:1, s. 34-45
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Tidskriftsartikel (refereegranskat)abstract
- Background: The 12-item Short-Form Health Survey (SF-12) was developed to measure perceived physical and mental health. Some studies of the psychometric properties, using classical test theory, of the SF-12 provide support for its use in patients with stroke, but it has not been scrutinized using recommended modern test theory approaches such as the Rasch measurement model among stroke survivors. Objectives: This study sought to explore the measurement properties of the SF-12 physical and mental health scales among people with stroke using the Rasch measurement model. Design: A cross-sectional design was used in this study. Methods: All patients discharged from a dedicated stroke unit in southern Sweden during 6 months were asked to participate 6 months later. Of 120 stroke survivors, 89 (74%) agreed to participate. Rasch analysis was used to assess the measurement properties of the SF-12 physical and mental component summary scores (PCS-12 and MCS-12, respectively). Results: For the PCS-12, we identifiedproblems with targeting, overall and item-level fit, representing local response dependency, and multidimensionality. For the MCS-12, there were problems related to targeting (the persons felt better than the scale could conceptualize) and response categories that did not function as expected. However, MCS-12 items displayed reasonable model fit without indications of multidimensionality but with signs of local response dependency. Conclusion: The measurement properties of the MCS-12 in stroke appear reasonable unless milder mental health problems are of interest, whereas those of the PCS-12 are less acceptable. Given the interdependence between MCS-12 and PCS-12 that is inherent with the standard SF-12 scoring algorithm, such data should be interpreted with caution.
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