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- Liljeroos, Maria
(author)
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Caring needs in patient-partner dyads affected by heart failure : An evaluation of the long-term effects of a dyadic psycho-educational intervention
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Introduction: As medical treatment has improved, patients with heart failure (HF) now live longer and care mostly takes place at home with partners providing the main assistance. Taking care of an ill or disabled individual imposes a well-documented burden on the partner’s healthrelated quality of life. The awareness of partners’ burdensome situation is increasing, but few interventions have targeted the needs of patientpartner dyads with HF. The results have been inconclusive and give no clear guidance on how interventional programmes should be designed to improve both patient and partner outcomes.Aim: The overall aim of this thesis was to evaluate the effects of a psychoeducational intervention delivered to patient-partner dyads with HF during long-term follow-up, and to explore the dyads’ perceived caring needs.Methods: The thesis is based on four papers that used both quantitative and qualitative data. Study I and II used a randomized controlled design with a follow-up assessment after 24 months including 155 patientpartner dyads. The control group received care as usual. The intervention group received care as usual, and in addition they participated in the nurse-led psycho-educational intervention. Data was collected using questionnaires before and 24 months after the intervention, in order to determine the long-term effects on patients and partners regarding health related quality of life, perceived control, symptoms of depression and partners’ caregiver burden (I, II). A conceptual health promotion model inspired the intervention. To describe how the model was applied, a qualitative approach analysing nurses’ documentation of the sessions with 71 dyads in the intervention group (III) was used. Study IV has an explorative design. To further explore the dyads’ perceived caring needs, focus groups interviews with 19 patient-partner dyads with heart failure (IV) were performed.Results: The intervention did not have any significant effect on physical or mental health- related quality of life, depressive symptoms, or perceived control over the heart failure among the dyads (I) or caregiver burden in the partners (II) after 24 months. Furthermore, time to first event did not differ significantly between the dyads in the intervention group and the control group (I, II). As for the partners, both the intervention and control group reported decreased physical health between the baseline assessment and the 24-month follow-up (I). The intervention was composed of three components; 1) cognitive 2) supportive, and 3) behavioural component. The analysis of the nurses’ documentation confirmed the coverage of all the components and the analysis revealed a vide range of caring needs among the dyads (III). The dyads described a need to learn about HF to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital and both the patient and the partner need to be present at the clinic visits. Meeting others who are in the same situation and sharing the burden in nurse-led group sessions was proposed as an opportunity to support each other and others (IV).Conclusions: Over the 24-month follow-up period, the intervention had a neutral effect on health- related quality of life, depressive symptoms and perceived control over the HF among the dyads, and on partners’ caregiver burden. Considering the fact that partners serve as a critical extension of the formal healthcare system, and that both patients and partners ask for more support, it will become crucial to find new ways to support dyads affected by heart failure. This thesis may be viewed as a first step in trying to understand dyads’ perceived caring needs, and it can serve as a guide in clinical work and when designing new dyadic interventions.
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- Ingadottir, Brynja, et al.
(author)
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Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery : An Evaluation Study.
- 2017
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In: JMIR Serious Games. - : J M I R Publications, Inc.. - 2291-9279. ; 5:2
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Journal article (peer-reviewed)abstract
- BACKGROUND: Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain.OBJECTIVE: The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game.METHODS: A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information.RESULTS: Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001).CONCLUSIONS: A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game's usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required.
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| 5. |
- Liljeroos, Maria, et al.
(author)
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Dialogues between nurses, patients with heart failure and their partners during a dyadic psychoeducational intervention : a qualitative study
- 2017
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In: BMJ Open. - : BMJ. - 2044-6055. ; 7:12
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Journal article (peer-reviewed)abstract
- Objectives: To describe nurses’ documentation of the content in a psychoeducational intervention inspired by Stuifbergen’s model addressing cognitive, supportive and behavioural needs of patient–partner dyads affected by heart failure.Design: A descriptive qualitative design was used analysing nurses’ documentation in a dialogue guide based on a health promotion model.Settings: The dialogue guide was used during three nurse-led sessions at two heart failure clinics in Sweden with patients affected with heart failure and their partners during the years 2005–2008.Participants: The dialogue guides from 71 patient–partner dyads were analysed using direct deductive content analyses. Patients’ mean age was 69 years and 31% were female, partners’ mean age was 67 years and 69% were female.Results: The findings supported the conceptual health promotion model and identified barriers, recourses and self-efficacy described by the dyads within each category.Conclusion: The dyads described that during the sessions, they had gained enhanced knowledge and greater confidence to handle their life situation and expressed that they needed psychoeducational support during the whole illness trajectory. The results may guide and help to improve content and quality when caring for patients affected with heart failure and their partners and also when designing new interventions.Trial registration number: NCT02398799; Post-results.
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| 6. |
- Luttik, Maria, et al.
(author)
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Attitudes of nurses towards family involvement in the care for patients with cardiovascular diseases
- 2017
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In: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16:4, s. 299-308
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Journal article (peer-reviewed)abstract
- INTRODUCTION: There is increasing evidence supporting the relationship between family support and patient outcomes. Therefore, involving families in the care of cardiovascular patients is expected to be beneficial for patients. The quality of the encounter with families highly depends on the attitudes of nurses towards the importance of families in patient care.AIM: The aim of this study was to describe the attitudes of nurses towards family involvement in patient care and to investigate the individual contributions of demographic, professional and regional background characteristics.METHOD: A survey was distributed among cardiovascular nurses attending an international conference in Norway and a national conference in Belgium. Nurses were asked to complete a questionnaire, including the Families' Importance in Nursing Care - Nurses' Attitudes scale. The study population consisted of respondents from Belgium (n = 348) and from Scandinavian countries (Norway, Sweden and Denmark; n = 77).RESULTS: In general, nurses viewed the family as important in care. However, attitudes towards actively inviting families to take part in patient care were less positive. Higher educational level and a main practice role in research, education or management were significantly associated with more positive attitudes. Furthermore, the attitudes of respondents living in Scandinavia were more positive as compared to the attitudes of respondents living in Belgium.CONCLUSION: Education on the importance of families and active family involvement in patient care seems to be necessary in basic, undergraduate education, but also in clinical practice. More research is necessary in order to explore the cultural and regional differences in the attitudes of nurses towards the involvement of families in patient care.
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| 7. |
- Verheijden Klompstra, Leonie, 1982-, et al.
(author)
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Exergaming through the eyes of patients with heart failure : A qualitative content analysis study
- 2017
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In: Games for Health Journal. - : Mary Ann Liebert. - 2161-783X .- 2161-7856. ; 6:3, s. 152-158
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Journal article (peer-reviewed)abstract
- Objective: Exergaming appears to be a promising tool to increase exercise capacity in patients with chronic heart failure (HF). Therefore, it is important to obtain more in-depth knowledge about preferences, attitudes, use, and abilities in regard to exergaming. The aim of this study was to describe the experiences of patients with HF when using an exergame platform at home.Materials and Methods: A qualitative descriptive study using content analysis was conducted on interviews with 14 patients with HF (6 women, ages ranging between 56 and 81 years). The patients were recruited from three centers in Sweden included in a randomized controlled study. These patients had access to an exergame platform at home and were advised to exergame for 30 minutes per day.Results: The analysis resulted in three categories describing patients' experience of exergaming: (1) making exergaming work, (2) added value of exergaming, and (3) low appeal of exergaming.Conclusion: This is the first study that explores how patients with HF experience using an exergame platform at home. The study provided important information on what aspects to discuss when initiating an exergame platform at home and following patients who may want to use an exergame platform at home. The results also revealed that this technology may be suitable for some patients, while others prefer other kinds of physical activity.
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