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  • 1. Andersson, E. K.
    et al.
    Strand, A. Sjostrom
    Willman, Ania
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Borglin, Gunilla
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Conceptions of caring among a group of coronary care nurses2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, p. S62-S62Article in journal (Other academic)
    Abstract [en]

    Background: During the last decade fundamental changes have taken place at coronary care units (CCUs) with regard to medical treatment and advanced technology in order to improve care for patients with coronary heart disease. In the past, caring in a coronary care context was described in qualitative studies mostly from the patients’ point of view. Coronary care nurses (CCNs) are considered to play a crucial role in this care although research into nurses’ conceptions of caring in this area is still scarce. Extended knowledge from the CCNs’ perspective could be of help in developing and implementing new, nurse-led interventions in a coronary care context. Aim: This study aims to describe the conceptions of caring among a group of coronary care nurses. Methods: This is an interview study. Phenomenographic interviews with open-ended questions were conducted with 21 purposefully sampled CCNs from CCUs at two different county hospitals. The audio-taped interviews took place between March and May 2013 and the data consist of 365 double-spaced pages. The age of the CCNs ranged from 23 to 63 years, the length of experience working as a registered nurse ranged from 1 to 42 years and experience as a CCN ranged from 0.5 to 27 years. A phenomenographic analysis according to the steps described by åkerlind was used. The interviews were read several times in order to gain an overall impression of the data. The central elements of the CCNs’ responses that focus on ’what’ and ’how’ were identified, condensed and summarised as a preliminary means of understanding a phenomenon. Similar responses were carefully grouped or classified and a comparison of the categories was made in order to establish the borders between them. The descriptive categories were created on the basis of similarities and differences. An iterative process was used throughout the data analysis to check interpretation against the interviews that had been transcribed verbatim and the description categories. The description categories were used to develop an ‘outcome space’ that described the wholeness of the findings. Results: The analysis is ongoing. At the beginning of 2014 we expect to present preliminary results and answer questions about qualitatively different conceptions of caring found among a group of CCNs working in CCUs and how the different conceptions of these individuals can be understood.

  • 2. Falk, Solvig
    et al.
    Wahn, Anna-Karin
    Malmö högskola, Faculty of Health and Society (HS).
    Lidell, Evy
    Keeping the maintenance of daily life in spite of Chronic Heart Failure. A Qualitative study.2007In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, no 6, p. 192-199Article in journal (Refereed)
    Abstract [en]

    Background: Patients with CHF (Chronic Heart Failure) is an increasing group in the society. They often experience increasing powerlessness and depression in daily lifte as well as difficulties adhering to other physical symptoms. Many patients have difficulties to deal with daily demands. Aims: To describe how persons, living with CHF, perceived the maintenance of their daily life. Methods: This study was following a penomenographic method in order to describe variations of perceptions. Data was collected through taped interviews, taken from 17 patients. The sample was selected from patients attending a specialist Chronic Heart Failure day care unit. Results: Five main categories were identified from 345 statements describing variations in how patients with CHF kept maintenance in their daily lite. The categories include: dealing with the realities of life, dealing with thoughts about life's infinity, taking responsibility, dealing with the surrounding world and keeping up with values of life. Conclusion: The illness symptoms clearly affected daily routines but participants showed remarkable resolve and showed that values in life could be maintained albeit with a few adjustments. No patient expressed a desire to give up. Understanding patients' perceptions the specialist nurse can transfer these knowledge to other patients in similar situations. Keywords: Daily life, Chronic Heart Failure (CHF), Phenomenography

  • 3.
    Holst, Marie
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Strömberg, A
    Lindholm, Maud
    Malmö högskola, Faculty of Health and Society (HS).
    Udén, Giggi
    Malmö högskola, Faculty of Health and Society (HS).
    Willenheimer, R
    Fluid restriction in heart failure patients: is it useful? The design of a prospective, randomised study2003In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 2, no 3, p. 237-242Article in journal (Refereed)
    Abstract [en]

    Thirst is a common and troublesome symptom for patients with moderate to severe heart failure. The pharmacological and non- pharmacological treatment as well as the nature of the disease itself causes increased thirst. There is no evidence in the literature about the usefulness of fluid restriction for heart failure patients. Formerly, when very little pharmacological treatment was available, fluid restriction was one of the few interventional options but nowadays when the pharmacological treatment has improved, its importance may be questioned. This article describes the design of an ongoing study with the aim to determine if an individualised and less restrictive fluid prescription can improve the quality of life, cardiac function and exercise capacity, and decrease in hospital admissions and thirst. This study will be performed as a two-group, 1:1 randomised cross-over study. In group 1, the patients are instructed to comply with a maximum fluid intake of 1.5 l. This is a standard treatment today. In group 2, the patients are recommended to intake a fluid, based on the physiological need of 30 ml/kg body weight/24 h, and are allowed to increase the fluid intake to a maximum of 35 ml/kg body weight/24 h. After 16 weeks, the patients will cross over to the other intervention strategy and continue for another 16 weeks.

  • 4.
    Holst, Marie
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Willenheimer, Ronnie
    Mårtensson, Jan
    Lindholm, Maud
    Strömberg, Anna
    Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care.2007In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 6, no 2, p. 153-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Improved self-care behaviour is a goal in educational programmes for patients with heart failure, especially in regard to daily self-weighing and salt and fluid restriction.

    AIMS: The objectives of the present study were to: (1) describe self-care with special regard to daily self-weighing and salt and fluid restriction in patients with heart failure in primary health care, during one year of monthly telephone follow-up after a single session education, (2) to describe gender differences in regard to self-care and (3) to investigate if self-care was associated with health-related quality of life.

    METHODS: The present analysis is a subgroup analysis of a larger randomised trial. After one intensive educational session, a primary health care nurse evaluated 60 patients (mean age 79 years, 52% males, 60% in New York Heart Association class III-IV) by monthly telephone follow-up during 12 months.

    RESULTS: The intervention had no effect on quality of life measured by EuroQol 5D and no significant associations were found between quality of life and self-care behaviour. Self-care behaviour measured by The European Self-care Behaviour Scale remained unchanged throughout the study period. No significant gender differences were shown but women had a tendency to improve adherence to daily weight control between 3- and 12 months.

    CONCLUSION: The self-care behaviour and quality of life in patients with heart failure did not change during one year of monthly telephone follow-up after a single session education and this indicates a need for more extensive interventions to obtain improved self-care behaviour in these patients.

  • 5. Nilsson, Ulrica G.
    et al.
    Ivarsson, Bodil
    Alm-Roijer, Carin
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Svedberg, Petra
    the SAMMI-study group,
    The desire for involvement in healthcare, anxiety and coping in patients and their partners after a myocardial infarction2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 5, p. 461-467Article in journal (Refereed)
    Abstract [en]

    Background: There is a lack of data about the information preferences of patients and their partners after a myocardial infarction. Aim: This paper explores anxiety, depression, coping and the desire to be actively involved in care in relation to age, gender and education level in myocardial infarction patients and partners. Methods: One hundred and twenty-eight patients and their partners answered the Swedish version of the Krantz Health Opinion Survey, the Hospital Anxiety and Depression Scale, and the Mastery Scale one year after the patient’s myocardial infarction. Results: More active roles in decision-making during care were desired by females, younger patients and partners, and patients and partners with higher education levels. Female partners reported more anxiety than male partners, and female patients reported more depression than male patients. No differences between groups were detected in coping; overall coping was rated high. Conclusions: Secondary prevention should consist of person-centred support to both the patients and their partners, since factors such as age, gender and education level can influence information preferences during patient care.

  • 6. Nässtrom, L.
    et al.
    Jaarsma, T.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Strömberg, A.
    Factors associated with heart failure patients' views of participation in care2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1_suppl, article id P46Article in journal (Other academic)
    Abstract [en]

    Purpose: Participation of patients with chronic heart failure (CHF) in their care is important for improving outcomes. The aim of this study was to explore factors that were associated with patient views of the importance of involvement and participation in care. Methods: Baseline data from 100 CHF patients enrolled to home care in Sweden were used. A linear regression analysis, using enter method, was performed with three subscales (participation, information and needs) of a questionnaire measuring patient views of involvement in care, as the dependent variable. Socio-demographic (age, education, gender, home help service, co-habiting, smoking, alcohol) and clinical characteristics (NYHA-class, co-morbidities measured by Charlson Comorbidity Index), health (EuroQoL 5D), perceived control (Control Attitude Scale), and self-care behavior (European Self-Care Behavior Scale) were included to determine independent factors associated with participation. Results: Sixty-two percent were men, mean age 82 years, the majority (80%) was in NYHA-class III. Patients scored a mean level of 7.6 ± 2.0 (theoretical range 1-10) for the satisfaction of their participation in heart failure care. The regression analysis showed that patients view of the importance of participation was significantly associated with co-habiting (β = 0.25, t = 2.09 p = 0.04) and self-care behavior (β = -0.33, t = -3.44, p < 0.001). These variables explained 22% of the variance of importance of participation. The degree to which patients stated that they had received information about CHF and treatment was significantly related to gender (β = -0.23, t = -2.22, p = 0.03), self-care behavior (β = -0.42, t = -4.34, p < 0.001) and knowledge (β = 0.24, t = 2.25, p = 0.03). These variables explained 21% of the variance of information subscale. Meeting patients need regarding questions and respect was significantly associated with symptoms of depression (β = -0.25, t = -2.29, p = 0.02), self-care behavior (β = -0.37, t = -3.95, p < 0.001) and knowledge (β = 0.23, t = 2.25, p = 0.03). These variables explained 22% of the variance. Conclusion: Patient views of involvement, receiving information, ability to ask questions and being treated with respect were strongly associated with self-care behavior. Other factors influencing satisfaction with involvement and participation were higher level of knowledge, lower degree of depressive symptom, male gender and co-habiting. Interventions that focus on participation to improve self-care seem promising and need to be studied.

  • 7.
    Nässtrom, Lena
    et al.
    Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden..
    Luttik, Marie Louise
    Hanze Univ Appl Sci Groningen, Res Grp Nursing Diagnost, Groningen, Netherlands..
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Strömberg, Anna
    Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden.;Linköping Univ, Dept Cardiol, Linköping, Sweden..
    Exploring partners' perspectives on participation in heart failure home-care - a mixed method design2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 1 Suppl, p. S70-S70, article id P192Article in journal (Other academic)
    Abstract [en]

    Introduction: Previous research has shown that partners and other family members are involved in the care for patients with heart failure, and have an important role regarding outcomes in chronic illness. This involvement included support, both emotionally and practically, and partners often contributed to self-care activities. Partners quality of life may be negatively affected when caring for a person with heart failure, and worse mental health have also been reported. Partners have described both positive and negative experiences of involvement in care, but there is a lack of knowledge of how partners of patients with heart failure view participation in care when the patients receive home-care.Purpose: The aim of this study was to gain a broader understanding of the partners’ perspectives on participation in the care for patients with heart failure receiving structured home-care.Methods: A convergent parallel mixed method design was applied with data from interviews analysed with qualitative content analysis, and questionnaires statistically analysed (n=15). Initially results were analysed separately and thereafter merged in a final interpretation with regard to whether they were comparable and convergent, expanded the understanding, or were inconsistent.Results: Partners scored that they were satisfied with most aspects of participation, information and contact. Qualitative findings revealed four different aspects of participation; adapting to the caring needs and illness trajectory, coping with caregiving demands, interacting with health care providers, and need for knowledge to comprehend the situation. Combining the two datasets showed both confirmatory results that were convergent and also gave expanded knowledge that broaden the understanding of partner participation in this context.Conclusions: The results revealed different levels of partner participation, with most partners being satisfied with their participation in care, but some partners expressed a fear of demands to come in the future. Heart failure home-care included good opportunities for both participation and contact during home visits, necessary to meet partners’ ongoing need for information to comprehend the situation.

  • 8. Näsström, Lena L
    et al.
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Strömberg, Anna
    Patients Descriptions of Participation in Structured Heart Failure Home Care2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no suppl 1, p. S72-S72, article id P199Article in journal (Other academic)
    Abstract [en]

    Background: A growing number of patients with heart failure (HF) will need lifelong care and one option is to provide advanced HF care in the patient’s home. A Euro - pean integrated home care model has been developed and tested in the Netherlands and Sweden. The model pro - vides structured home care with the goal that patients will experience participation, safety and have knowledge about their disease and treatment. The aim of this study was to examine how HF patients, who receive a structured home care, describe participation in the care. Method: Swedish HF patients receiving structured home care at four different settings were included in the study. Strategic sampling was used to reach a variation regard - ing severity of HF, different needs of home-care, age and gender. A total of 19 open ended interviews have been con - ducted. The interviews were analyzed with qualitative con - tent analysis, where categories were developed inductively. Results: In the preliminary findings 5 categories with asso - ciated subcategories emerged on how patients with HF described participation in structured home care. To expe - rience room for communication including having room for dialogue and receiving care-related information was described as important for participation. To have accessi - bility to care through planned home visits or patient initi - ated visits facilitated participation. The patients described participation by engaging in self care and to collaborate with the home care team. To have trust in the home care team with confidence for competence and have continu - ity to meet individual needs was of importance. To have options to make decisions was expressed as a will to make decisions or to entrust decisions to the caregiver, but some - times patients opportunity to choose was restricted due to different aspects and impeded participation. Conclusion/significance of the study: The findings describe different aspects of participation among patients with HF who receive structured home care. Home visits facilitated communication between the patient and care - giver and enables participation. Getting information was an important condition for participation that often was met during home visits. Good accessibility to care increased feeling of participation as well as to meet caregivers of whom they trust. Own desire to make choices vary depend - ing on what choice it regards and also between different individuals. However, several patients expressed a complex situation with several health care contacts, where the opportunity for participation was limited.

  • 9. Näsström, Lena
    et al.
    Mårtensson, Jan
    Idvall, Ewa
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Strömberg, Anna
    Participation in the care encounter among patients with heart failure receiving home-care2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 1 suppl, p. S2-S2, article id P3Article in journal (Other academic)
    Abstract [en]

    Background: Heart failure is a common chronic condition that affects patients’ life situation and puts high demands on self-care and patient participation. Patients often need advanced care due to deterioration of their heart failure symptoms, and one option for care is home-care. Purpose: The aim of this study was to identify and describe participation in care encounters during home visits in heart failure home-care. Methods: This study had a qualitative design. Seventeen patients diagnosed with heart failure and ten registered nurses participated. The patients received structured heart failure home-care from one out of three home-care units in Sweden. Patients gave written informed consent and nurses gave verbal informed consent. Data from nineteen home visits was collected through observations and documented by video-recordings. The verbal communication in these video-recordings was transcribed verbatim and complemented with non-verbal communication. Data was analysed using qualitative content analysis, and the video-recordings and transcribed material was analysed in parallel. Results: Two themes with three and four categories respectively were identified (i) Participation in the care encounter is made possible by interaction, including exchange of care-related information, care-related reasoning, and collaboration, and (ii) Participation in the care encounter is made possible by an enabling approach, including the patient expresses their own wishes and shows an active interest, and the nurse is committed and invites to a dialogue. These two themes are related to each other, but separated by content. Together, they constitute participation in the home-care encounter. Both themes were represented in all observed care encounters, but the extent and depth of each category varied. Conclusion: The heart failure home-care context showed good potential for patient participation as the care encounters were categorised by interaction with mutual influence and an enabling approach reflected in both patients and nurses. The findings could be used for further develop home-care for patients with heart failure. It is important that care is organised and planned so that there is enough space for both parties during the encounter.

  • 10.
    Schlyter, Mona
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Östman, Margareta
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Engström, Gunnar
    André-Petersson, Lena
    Tydén, Patrik
    Leosdottir, Margrét
    Personality factors and depression as predictors of hospital-based health care utilization following acute myocardial infarction2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 4, p. 318-325Article in journal (Refereed)
    Abstract [en]

    Background: Whether personality factors and depressive traits affect patients’ utilization of health care following an acute myocardial infarction is relatively unknown. The aim of this study was to examine whether hospital-based health care utilization after a myocardial infarction was correlated with patients’ personality factors and depressive symptoms. Methods: We studied 366 myocardial infarction patients admitted to Malmö University Hospital between 2002 and 2005 who subsequently participated in a cardiac rehabilitation programme. The patients were followed for two years after their index event. We investigated whether personality factors and depressive traits were correlated with the participants’ health care utilization, defined as a) out-patient Cardiology visits and phone calls to a physician, nurse or a social worker, and b) acute visits or admissions to the Emergency or Cardiology Departments, using negative binominal regression analysis. Results: In unadjusted comparisons neuroticism predicted more out-patient contacts. This significance remained after adjusting for age, sex, smoking, alcohol consumption and size of the myocardial infarction (measured as max level on troponin-I and left ventricular ejection fraction). There were no significant correlations between other personality factors or depression and out-patient contacts. None of the personality factors or depression predicted acute admissions. Conclusion: Apart from neuroticism, personality factors did not explain utilization of health care in terms of Cardiology out-patient contacts or acute admissions in myocardial infarction patients participating in a cardiac rehabilitation programme. Neither did depressive symptoms predict more health care utilization. This might indicate a robust cardiac rehabilitation programme offered to the study subjects, minimizing the need for additional health care contacts.

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