| 1. |
- Ekman, Inger, 1952, et al.
(författare)
-
The person-centred approach to an ageing society
- 2013
-
Ingår i: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5656 .- 2052-5648. ; 1:1, s. 132-137
-
Tidskriftsartikel (refereegranskat)abstract
- Modern care is often based on investigations such as laboratory markers and imaging - for example, x-ray or ultrasound. The results contribute to a diagnosis and, if judged necessary, treatment is initiated. This diseased-oriented approach is the prevailing mode of management in modern medicine. In contrast, person-centered care (PCC) takes the point of departure from each person´s subjective experience of illness and its impact on daily life. A patient is considered as a person with emotions and feelings. PCC is considered present within clinical care according to a definition articulated by the Centre for Person Centred Care at the University of Gothenburg (GPCC) when three core components are present: elicitation of a detailed patient narrative; formulated partnership between caregiver and patient and documentation of the partnership in the patient record. Accordingly, when there is an illness requiring care and the person is attended using these components, PCC is being applied. In most situations today, PCC is not applied as the narrative is not fully elicited or the partnership and/or the documentation are not included. It is proposed that the challenge to Society arising from changing demographics can be addressed by implementing PCC and creating an alternative to existing healthcare. The importance and benefits of such an approach on a wider scale is not yet clear as research has been limited to date. Studies in selected patient populations (heart failure and hip fractures), however, have shown promising results. As the population ages, there will be a dramatic increase in healthcare consumption. Even with technological developments, there will be a need for tremendous resources to be dedicated to care. A new organization and attitude from healthcare policymakers and providers above and beyond the present model appears required in order to respond to this demand. As part of such change, person-centred care, with the interaction between healthcare providers and the person of the patient, can facilitate, compensate and develop more effective healthcare services for the future.
|
|
| 2. |
- Berghammer, Malin, 1970-, et al.
(författare)
-
Committed to Life : Adolescents’ and Young Adults’ Experiences of Living with Fontan Circulation
- 2015
-
Ingår i: Congenital Heart Disease. - : Computers, Materials and Continua (Tech Science Press). - 1747-079X .- 1747-0803. ; 10:5, s. 403-412
-
Tidskriftsartikel (refereegranskat)abstract
- Background Single ventricle defects are among the most complex congenital heart defects and the development of advanced surgical procedures in recent decades has created the first generation of adolescents and young adults living with this condition. Yet little is known about how these individuals experience life and what impact the heart defect has on their life in general. Objective The aim was to illuminate and gain a deeper understanding of adolescents’ and young adults’ experiences of living with a surgically palliated univentricular heart. Design Seven open-ended in-depth interviews were conducted, transcribed, and analyzed according to the henomenological hermeneutical method. All adolescents and young adults operated before 1995 according to the Fontan procedure or the total cavo-pulmonary connection procedure at one pediatric cardiology unit were included in the study. They were 17–32 years of age (median age 22 years). Results The interpretation of the interview transcripts showed that the participants experienced living with a surgically palliated univentricular heart in terms of feeling exceptional, strong, and healthy. This was supported by two structural analyses, where three themes emerged: happiness over being me, focusing on possibilities, and being committed to life. Conclusion Living with a Fontan circulation included negative experiences but the analyses clearly demonstrated a feeling of being strong and healthy. An appreciation of having survived and being committed to life was found to be an integral part of the development of the interviewees’ existential growth. This probably strengthens them further in their ability to balance expectations and hurdles in life. This study provides valuable insights into the experience of patients after the Fontan procedure and the importance of a positive health care environment throughout their lives.
|
|
| 3. |
- Ekman, Inger, 1952, et al.
(författare)
-
Exploring symptoms in chronic heart failure
- 2005
-
Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842. ; 7:5, s. 699-703
-
Tidskriftsartikel (refereegranskat)abstract
- Symptoms in patients with chronic heart failure (CHF) are the cry for help, reflecting not only the physical aspects of the disease but the impact on lifestyle, anxiety, depression and expectations of the patient. Studies consistently show a difference in patients' self-assessed functional classification compared to investigator reported NYHA classification. Moreover, patient self-assessed symptoms have recently been shown to independently predict hospitalisation and mortality over 5 years. Recognition of symptoms and appreciation of their importance justifies the use of a structured assessment in order to provide optimal medical care for patients with CHF. A model of how to structure symptom assessment equally with signs is presented in this paper.
|
|
| 4. |
- Ekman, Inger, 1952, et al.
(författare)
-
Maintaining normality and support are central issues when receiving chemotherapy for ovarian cancer.
- 2004
-
Ingår i: Cancer nursing. - 0162-220X. ; 27:3, s. 177-82
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to enrich the understanding of patients' perspective of being diagnosed and treated for ovarian cancer. A qualitative approach was used to obtain knowledge and insight into patients' experiences and thoughts. Ten Swedish women, diagnosed with ovarian cancer, participated in a total of 23 interviews on 3 occasions: at the time of diagnosis, during chemotherapy, and after completion of chemotherapy. The results of the interpretation of the interviews were formulated in the form of 3 themes: (1) feeling the same despite radical castrating surgery, (2) accepting chemotherapy, and (3) maintaining normality and support. Suggestions of caring implications from our interpretation of the interview data underscore the need to support these women in learning to cope with their feelings of weakness and anxiety. The findings further indicate the potential in narrative methods to identify important issues in comprehensive cancer care.
|
|
| 5. |
- Ekman, Inger, 1952, et al.
(författare)
-
Person-centered care -ready for prime time.
- 2011
-
Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 10:4, s. 248-251
-
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.
|
|
| 6. |
- Ekman, Inger, 1952, et al.
(författare)
-
Self-assessed symptoms in chronic heart failure--important information for clinical management
- 2007
-
Ingår i: Eur J Heart Fail. - : Wiley. - 1388-9842. ; 9:4, s. 424-8
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: To compare the patients' self-assessment of the severity of their symptoms with a physicians assessment and to evaluate the ability of self-assessed symptoms and ejection fraction (EF) to predict long-term survival in heart failure patients. METHOD: Patients (n=332) evaluated symptoms using a self-administered functional classification scale (Specific Activity Scale, SAS), which is equivalent to the NYHA scale. EF and NYHA functional class was also recorded. All patients were followed over a 3-year period. RESULTS: Approximately 50% of patients classified themselves into SAS class I. In contrast, the cardiologists classified only 9% of the patients as NYHA class I. In patients with severe left ventricular dysfunction (EF
|
|
| 7. |
- Fors, Andreas, 1977, et al.
(författare)
-
Validation of the Swedish cardiac self-efficacy scale
- 2014
-
Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: Self-efficacy is patients’ confidence in their ability to initiate and maintain self-care. The purpose of this study was to validate the Swedish version of the Cardiac Self-Efficacy Scale (CSES) as a first step in preparing an evaluation of a person-centred care intervention. Methods: The study sample consisted of 288 patients (72 women, 216 men; mean age 61.6) who completed the CSES two months after hospitalization for an event of acute coronary syndrome (ACS). Construct validity was psychometrically evaluated by using confirmatory factor analysis. Model fit evaluation was estimated by performing the following tests: Chi2, the Comparative Fit Index (CFI), the Standardized Root Mean Square Residual (SRMR) and the Root Mean Square Error of Approximation (RMSEA). Results: Tentative findings indicated that the Swedish version of CSES was represented by three dimensions in comparison with the original version of the CSES that comprises two dimensions; control symptoms and maintain functioning. That is, the Swedish version of the CSES includes two factors within the control symptom dimension (compared to one in the original CSES version) while the maintain function remained as stable. Conclusions: The Swedish version of the CSES seems to be a reliable and valid measure of cardiac self-efficacy. Further it is an easily understandable questionnaire and a useful tool to identify patients’ level of cardiac specific self-efficacy.
|
|
| 8. |
- Gund, Anna, 1980, et al.
(författare)
-
Care@Distance – Disease Management för hjärtsviktspatienter i hemmet
- 2007
-
Ingår i: Medicinteknikdagarna, 2-3 October 2007, Örebro, Sweden. - : Svensk förening för medicinsk teknik och fysik, Örebro Läns Landsting, Örebro Universitet, Stiftelsen för strategisk forskning, Vetenskapsrådet, Vinnova.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Antalet äldre i samhället ökar, och med det kostnaderna p.g.a. kroniska åldersrelaterade sjukdomstillstånd. Ett sådant tillstånd är hjärtsvikt vilket drabbar ca 2 % av västvärldens befolkning. Forskning har visat att IT-baserad hemvård för s.k. Disease Management kan resultera i minskade kostnader så väl som ökad livskvalitet hos patienterna. Inom projektet Care@Distance är avsikten att utforma ett sådant system där tyngden ligger dels på regelbundna dagliga enkla mätningar av fysiologiskt relaterade parametrar såsom vikt och blodtryck, och dels på formulär där patienten svarar på några enkla frågor om det upplevda tillståndet. Syftet är att få med både objektiv och subjektiv information som sedan kan ligga till grund för en förbättrad vård av den enskilde patienten. Systemet utformas främst för att skapa underlag för en bättre långsiktig behandling, terapi och för uppföljning av Treatment Compliance, men även för att hantera akuta situationer genom t.ex. larm till vårdgivaren. Under projektets tid har ett samarbete med DAGA-kliniken på Östra sjukhuset upprättats, genom bl.a. diskussioner om frågeformulärets utformning. Under våren 2007 har även två förstudier genomförts på kliniken, den första med inriktning mot patientdelen av systemet, och den andra mot vårdgivarsidan. Studien visar att patientdelen är lätthanterad ur patientsynpunkt samt att intresse för systemet finns. Även på vårdgivarsidan är resultaten positiva när det gäller design, funktioner och intresse, men utrymme för förbättringar finns. Fortsatta studier i form av ett längre försök i hemmet hos patienter är planerat under sommaren och hösten 2007. Under sommaren kommer även patientdelen att vidareutvecklas med ny programvara. Ett framtida projekt innefattar att utveckla en metod för att utnyttja EBI (Elektrisk Bio-Impedans). Med relativt enkla och robusta mätningar förväntas mycket användbar och relevant information om sjukdomstillståndet kunna erhållas med denna metod, men detta kräver att ny sensorteknik utvecklas för hemmiljön.
|
|
| 9. |
- Gund, Anna, 1980, et al.
(författare)
-
Care@Distance - Home Monitoring System for CHF Patients
- 2007
-
Ingår i: Tromsø Telemedicine and eHealth Conference, 11-13 June, 2007, Tromsø, Norway.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The number of elderly people in the society is increasing, and with that the expected the health care costs. One reason for this is that the probability of contracting a chronic illness increases with age. Congestive heart failure (CHF) is a typical such illness and it affects approximately 2 % of the population in the western world. Most of the patients are over 60 years of age. By using IT-based home care solutions for follow-up, disease management and treatment compliance these costs can potentially be reduced at the same time as the care of the patient can be improved. It is a matter of patient quality as well as reduced costs. Many CHF patients tend to return to hospitals with acute conditions where they are admitted for care, only to be discharged a couple of days later. This results in considerable costs for the health care sector, and suffering and insecurity for the patient. Studies have shown that using tele-care, or eHealth, symptoms can be discovered earlier than with traditional care. There is also a better possibility to study and improve patient treatment compliance. Within Care@Distance the intention is to develop a system that can support in acute situations as well as in the long term disease management. Regular daily measurements of physiological data, such as body weight and blood pressure will be done, together with questionnaires where the patients describe their actual medical situation. The combined objective and subjective information can then form a foundation for improving the care of the individual patient. In this project the type of physiological data to be collected and the questionnaire have been defined in collaboration with the DAGA-clinic at Östra Hospital, and Institute of Health and Care Sciences at Sahlgrenska Academy, both situated in Gothenburg, Sweden. The system is build up of two parts. One is the home client and the other the system server consisting of a web portal for medical personnel together with a central database. The home client is currently a portable Tablet PC combined with a scale and a blood pressure monitor. The computer program is designed to assist the patient carrying out the different measurements and questionnaires. The results are initially stored on a local database in the home client. Measurements will be made of body weight and blood pressure and questions of the current health status of the patient will be asked. These surveys will typically be performed one or several times a day depending on the patient's health status. When the measurement session is over the local database is synchronized with a central database. Measured data and results are sent to the central database, and the home client checks for updates, new configurations, etc. Health care personnel access the information on the central database when needed through the web portal. Besides examining the patient's physiological data and questionnaire results the personnel can also administrate the home client i.e. define measurements, measurement intervals, questionnaire forms etc. Currently a first generation of the system is out on trial on healthy volunteers in order to verify the functionality of the system. So far the results are promising, and have also led to a number of improvements of both the home client and the web portal. The first clinical trial will begin in the spring of 2007 where a small trial group, identified by the DAGA-clinic, will participate. The focus of this trial is to establish and evaluate interdisciplinary work procedures and technical infrastructure. Following this the system will be stepwise developed regarding measurements and increased functionality. Of special interest in the future of this project is to develop and verify sensors based on the use of Electric Bio Impedance (EBI). This technique allows for a robust, cheap and relatively simple way to acquire physiological information of large clinical value in relation to CHF treatment e.g. heart function and fluid balance. The ambition is to develop and verify different designs of this kind of sensors, suitable for the home care environment, where user-friendliness is one important factor.
|
|
| 10. |
- Gund, Anna, 1980, et al.
(författare)
-
Care@Distance, Home Monitoring System for Patients with Congestive Heart Failure
- 2006
-
Ingår i: Medicinteknikdagarna, 3-4 October 2006, Uppsala, Sweden.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Allt eftersom antalet äldre och långtidssjuka ökar i samhället, förväntas också kostnaderna för sjuk- och hälsovård att öka. Hjärtsvikt är en sjukdom som drabbar omkring 2 % av befolkningen i västvärden, och de flesta patienter är över 60 år. Denna sjukdom spelar därför tillsammans med ett antal andra vanliga åldersrelaterade sjukdomar en stor roll i denna ökning. Med hjälp av IT-baserad hemövervakning och behandlingsuppföljning av hjärtsviktspatienter kan vi potentiellt både minska sjukvårdskostnaderna och förbättra vården för den enskilda individen. Inom Care@Distance är avsikten att utforma ett sådant system där tyngden ligger dels på regelbundna dagliga enkla mätningar av fysiologiskt relaterade parametrar såsom t.ex. vikt, blodtryck och puls, och dels formulär där patienten själv beskriver sin situation. Syftet är att få med både objektiva och subjektiva resultat vilka sedan kan ligga till grund för en förbättrad vård av den enskilde patienten. Systemet utformas för att hantera såväl akuta situationer, t.ex. genom att larma vårdpersonal vid avvikelser utifrån uppsatta gränser, samt skapa underlag för en bättre långsiktig behandling och terapi. Sjukvårdskostnaderna förväntas härigenom reduceras i och med att sjukdomen kan behandlas bättre och färre akutsituationer uppstår. Dessutom, och minst lika viktigt, förväntas patientens livssituation förbättras. Både typen av mätdata samt frågeformulär utarbetas i samarbete med DAGA-kliniken på Östra sjukhuset i Göteborg och Vårdvetenskapliga fakulteten vid Sahlgrenska Akademien. Behandlingsmässigt innebär Care@Distance att patienten kommer att erbjudas likartade mätningar och frågor hemma som vid återbesök på kliniken. Skillnaden är att hemmet kan dessa frågor ställas, och mätningar göras, flera gånger om dagen, medan de på kliniken kanske bara görs varannan månad. Detta ger bl.a. vårdgivaren en större informationsmängd att fatta vårdrelaterade beslut på. De första fältförsöken kommer att ske i början av hösten 2006. En liten försöksgrupp på ca 3-5 personer, identifierade med hjälp av DAGA-kliniken på Östra sjukhuset, kommer att medverka initialt. Fokus i dessa första test är att etablera och utvärdera arbetssätt och teknisk infrastruktur. Generellt är systemet utformat för att vara mycket användarvänligt i alla delar. I ett nästa steg skall EBI (Elektrisk Bio-Impedans) testas för att om möjligt inkluderas i mätmodaliteterna. Med relativt enkla och robusta mätningar förväntas mycket användbar och relevant information om sjukdomstillståndet hos de aktuella patienterna kunna erhållas med denna metod.
|
|
