RESUMEN
BACKGROUND: The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking. AIM: To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay. METHODS: A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis. RESULTS: The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay (P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour. CONCLUSION: Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.
Asunto(s)
Infarto del Miocardio/complicaciones , Infarto del Miocardio/psicología , Aceptación de la Atención de Salud/psicología , Anciano , Estudios Transversales , Emociones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Encuestas y Cuestionarios , Evaluación de SíntomasRESUMEN
BACKGROUND: In acute myocardial infarction the risk of death and loss of myocardial tissue is at its highest during the first few hours. However, the process from symptom onset to the decision to seek medical care can take time. To comprehend patients' pre-hospital delay, attention must be focused on the circumstances preceding the decision to seek medical care. AIM: To add a deeper understanding of patients' thoughts, feelings and actions that preceded the decision to seek medical care when afflicted by an acute myocardial infarction. METHODS: Fourteen men and women with a first or second acute myocardial infarction were interviewed individually in semi-structured interviews. Data were analysed by qualitative content analysis. RESULTS: Four themes were conceptualized: 'being incapacitated by fear, anguish and powerlessness', 'being ashamed of oneself', 'fear of losing a healthy identity' and 'striving to avoid fear by not interacting with others'. Patients were torn between feelings such as anguish, fear, shame and powerlessness. They made an effort to uphold their self-image as being a healthy person thus affected by an unrecognized discomfort. This combined with a struggle to protect others from involvement, strengthened the barriers to seeking care. CONCLUSIONS: The present study indicates that emotional reactions are important and influence patients' pre-hospital behaviour. Being ashamed of oneself stood out as a novel finding. Emotions might be an important explanation of undesired and persisting patient delays. However, our findings have to and should be evaluated quantitatively. Such a study is in progress.
Asunto(s)
Emociones , Conductas Relacionadas con la Salud , Infarto del Miocardio/psicología , Aceptación de la Atención de Salud/psicología , Adulto , Anciano , Anciano de 80 o más Años , Enfermería Cardiovascular , Miedo/psicología , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Infarto del Miocardio/enfermería , Poder Psicológico , Investigación Cualitativa , Autoimagen , Factores de TiempoRESUMEN
AIM: The aim of this study was to describe district nurses' (DNs') experiences of their knowledge development in wound management when treating patients with different types of wounds at healthcare centers. BACKGROUND: In primary healthcare, DNs are mainly responsible for wound management. Previous research has focused on DNs' level of expertise regarding wound management, mostly based on quantitative studies. An unanswered question concerns DNs' knowledge development in wound management. The present study therefore intends to broaden understanding and to provide deeper knowledge in regard to the DNs' experiences of their knowledge development when treating patients with wounds. METHODS: A qualitative descriptive design was used. Subjects were a purposeful sample of 16 DNs from eight healthcare centers in a metropolitan area in Stockholm, Sweden. The study was conducted with qualitative interviews and qualitative content analysis was used to analyze the data. RESULTS: The content analysis resulted in three categories and 11 sub-categories. The first category, 'ongoing learning by experience,' was based on experiences of learning alongside clinical practice. The second category 'searching for information,' consisted of various channels for obtaining information. The third category, 'lacking organizational support,' consisted of experiences related to the DNs' work organization, which hindered their development in wound care knowledge. CONCLUSIONS: The DNs experienced that they were in a constant state of learning and obtained their wound care knowledge to a great extent through practical work, from their colleagues as well as from various companies. A lack of organizational structures and support from staff management made it difficult for DNs to develop their knowledge and skills in wound management, which can lead to inadequate wound management.
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Enfermería en Salud Comunitaria , Conocimientos, Actitudes y Práctica en Salud , Aprendizaje , Heridas y Lesiones/enfermería , Adulto , Educación Continua en Enfermería , Femenino , Humanos , Conducta en la Búsqueda de Información , Entrevistas como Asunto , Masculino , Investigación Cualitativa , SueciaRESUMEN
BACKGROUND: Several trials have demonstrated improved survival with implantable cardioverter-defibrillator (ICD) therapy. The cause and nature of death in the ICD population have been insufficiently investigated. The objective of this study was to analyze ICDs from deceased patients to assess the incidence of ventricular tachyarrhythmias, the occurrence of shocks, and possible device malfunction. METHODS AND RESULTS: We prospectively analyzed intracardiac electrograms in 125 explanted ICDs. The incidence of ventricular tachyarrhythmia, including ventricular fibrillation, and shock treatment was assessed. Ventricular tachyarrhythmia occurred in 35% of the patients in the last hour of their lives; 24% had an arrhythmic storm, and 31% received shock treatment during the last 24 hours. Arrhythmic death was the primary cause of death in 13% of the patients, and the most common cause of death was congestive heart failure (37%). More than half of the patients (52%) had a do-not-resuscitate order, and 65% of them still had the ICD shock therapies activated 24 hours before death. Possible malfunctions of the ICD were found in 3% of all patients. CONCLUSIONS: More than one third of the patients had a ventricular tachyarrhythmia within the last hour of life. Cardiac death was the primary cause and heart failure the specific cause of death in the majority of the cases. Devices remained active in more than half of the patients with a do-not-resuscitate order; almost one fourth of these patients received at least 1 shock in the last 24 hours of life.
Asunto(s)
Desfibriladores Implantables/efectos adversos , Cardioversión Eléctrica/efectos adversos , Taquicardia Ventricular/epidemiología , Taquicardia Ventricular/mortalidad , Fibrilación Ventricular/epidemiología , Fibrilación Ventricular/mortalidad , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/terapia , Falla de Equipo , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
AIM: To report a study of family members' experiences of living with a person suffering from intermittent claudication caused by peripheral arterial disease. BACKGROUND: Intermittent claudication is a symptom caused by peripheral arterial disease. Walking ability is reduced due to pain and this also affects the family members and leads to consequences such as isolation and a restricted life. DESIGN: This study has a qualitative descriptive design. METHODS: Ten spouses living with a person suffering from intermittent claudication were interviewed between December 2009-June 2010. The interviews were then analysed using qualitative thematic analysis. FINDINGS: Four themes were identified: 'Frustrating to not meet intentions', 'Undergoing changes in social life', 'Being a person on the side of things' and 'Intertwining of circumstances'. The overall theme 'Living a demanding life' illustrates that intermittent claudication has great impact on daily life among spouses. CONCLUSION: This study gives an insight into the complexities and the difficulties of living together with someone suffering from intermittent claudication, a symptom that has great impact on both the spouses' and the ill persons' lives. According to the findings in this study, it is important to gain knowledge about the spouses' experiences because an holistic perspective is essential to treat and support the ill persons and their spouses.
Asunto(s)
Adaptación Psicológica , Claudicación Intermitente/psicología , Calidad de Vida , Esposos/psicología , Anciano , Femenino , Humanos , Claudicación Intermitente/epidemiología , Claudicación Intermitente/etiología , Masculino , Enfermedad Arterial Periférica/complicaciones , Investigación Cualitativa , Autoinforme , Ajuste Social , Estrés PsicológicoRESUMEN
AIMS AND OBJECTIVES: To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. BACKGROUND: When a person is diagnosed with heart failure, the daily life of the family members is also affected. DESIGN: Randomised controlled trial. METHODS: A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. RESULTS: There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R(2) = 0·35) and depression (p = 0·021, R(2) = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). CONCLUSION: Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. RELEVANCE TO CLINICAL PRACTICE: Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.
Asunto(s)
Cuidadores/psicología , Educación no Profesional/normas , Insuficiencia Cardíaca/enfermería , Anciano , Anciano de 80 o más Años , Ansiedad , Depresión , Educación no Profesional/organización & administración , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Calidad de Vida , Apoyo SocialRESUMEN
Intermittent claudication is a symptom caused by peripheral arterial disease (PAD) and is associated with pain, impaired mobility and loss of control. Walking ability is reduced due to the pain, and both physical and social functions are often negatively affected, which may lead to patients feeling they are a burden to others. An interview study using a qualitative descriptive design to describe experiences of living with intermittent claudication caused by PAD was carried out during Winter and Spring 2009/2010. Fifteen people suffering from intermittent claudication were interviewed, and the interviews were analyzed using qualitative thematic analysis. Intermittent claudication greatly affects daily living. Six themes were identified: "Experiencing discomfort in the legs," "Moving around in a new way," "Feeling inconvenient when forced to stop," "Missing previous life," "Incorporating intermittent claudication in daily life," and "To lead a strenuous life." The main theme was "Adjusting to a restricted life." The findings show that intermittent claudication has a major impact on daily life. Apart from the severity of symptoms, how the illness is experienced differs among patients, depending on how active the ill person is or wants to be. These findings suggest that increased knowledge about living with intermittent claudication is important to understand the effects on the ill person's life, as a complement to physical examinations when planning individual treatment.
Asunto(s)
Claudicación Intermitente/rehabilitación , Enfermedades Vasculares Periféricas/complicaciones , Caminata , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Claudicación Intermitente/etiología , Masculino , Persona de Mediana Edad , Calidad de VidaRESUMEN
OBJECTIVE: The aim was to investigate if family members of patients with chronic heart failure (CHF) increased knowledge about CHF through a group-based multi-professional educational programme and whether there was an effect on patients' health care utilization. METHODS: Family members (n=128) were randomly assigned to intervention-group (IG) who received CHF education programme or control-group (CG) who received information according to hospital routines. Programme effects were evaluated with CHF knowledge questionnaire, patient readmissions and number of days hospitalised during 18 months. RESULTS: Knowledge about CHF increased in both groups, significantly higher in IG at second assessment (IG 16±1.9 vs. CG 14.9±2.1, p=0.006), and knowledge maintained at third assessment. In IG 17 patients were re-admitted at least once and 28 patients in CG due to CHF (p=0.085). There were no differences in frequency of readmissions or number of days hospitalised. CONCLUSION: A group-based multi-professional education programme increased family members' knowledge about CHF. Despite this, effect on patient's health care utilization could not be seen during follow-up period. PRACTICAL IMPLICATIONS: We suggest that CHF education programmes for family members should be provided at clinics, with information preferably repeated 2-3 times during a period of six months to maintain knowledge level.
Asunto(s)
Familia/psicología , Educación en Salud/métodos , Insuficiencia Cardíaca/psicología , Insuficiencia Cardíaca/terapia , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Procesos de Grupo , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , SueciaRESUMEN
Measuring Health Related Quality of Life has become more and more important in evaluating patients with peripheral arterial disease. This prospective longitudinal survey aimed to investigate health related quality of life over time in patients with peripheral arterial disease (PAD) undergoing percutaneous transluminal angioplasty (PTA) between December 2005 and June 2008. Health Related Quality of life was assessed using the Claudication Scale (CLAU-S) and EQ5D and the Sense of Coherence Scale was used to estimate the patients' sense of coherence. The findings of this study shows that the total CLAU-S score was improved both at one-month follow-up (p < 0.0001) and one-year follow-up (p < 0.0001) compared to baseline. There were significant differences regarding all five dimensions: every day life, pain, social life, illness-specific fears and psychological wellbeing. The EQ5D computed by index improved significantly both at one-month follow-up (p = 0.0006) and one-year follow-up (p = 0.0019) compared to baseline. Differences were found between the groups with low and moderate sense of coherence (p = 0.0169) as well as between the groups with low and high sense of coherence (p = 0.0208) regarding health related quality of life (HRQoL). This study showed that PTA improves HRQoL among individuals suffering from PAD and that the effect is sustainable over time. For more accurate results, a disease-specific instrument should be used to evaluate HRQoL.
Asunto(s)
Angioplastia , Enfermedad Arterial Periférica/psicología , Calidad de Vida , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Angioplastia/psicología , Femenino , Estudios de Seguimiento , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Enfermedad Arterial Periférica/terapia , Pronóstico , Estudios Prospectivos , Psicometría , Estadística como Asunto , Estadísticas no Paramétricas , Estrés Psicológico , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
AIM: To investigate the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer. BACKGROUND: After axillary lymph node clearance in patients with breast cancer, some women experience lymphoedema and recurrent infections. To reduce the risk of these postoperative complications, most women are advised to not have intravenous infusions in, or blood samples taken from, the arm in the operated side. Very little published data are available regarding the incidence of lymphoedema after intravenous procedures under clean conditions in the hospital setting. This study set out to investigate the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer is therefore important. DESIGN: Descriptive. METHODS: Self-reported questionnaire. RESULTS: Most of the reported complications were minor, including itching, bruises and vomiting at the time of the intravenous procedure. The most serious complication was infection in one patient needing antibiotic treatment and subsequent arm swelling. CONCLUSIONS: This study indicates that if a blood sample is taken or intravenous injection is given according to the current Swedish guidelines for health care professionals, there should be a very low risk of complications. RELEVANCE TO CLINICAL PRACTICE: If intravenous procedures are performed without any disadvantage in the arm of the operated side in women who have undergone axillary surgery, the clinical problem of finding a proper vein and the psychological concern of the women can be reduced.
Asunto(s)
Axila/cirugía , Neoplasias de la Mama/cirugía , Infusiones Intravenosas/efectos adversos , Escisión del Ganglio Linfático , Flebotomía/efectos adversos , Adulto , Anciano , Neoplasias de la Mama/patología , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
AIMS AND OBJECTIVES: To describe the care-seeking process from interpretation of an initial symptom to the decision to seek medical care in patients with an acute myocardial infarction. BACKGROUND: Patients afflicted by symptoms of an acute myocardial infarction delay in seeking care far exceeding the desired time limits. This results in avoidable loss of life. There is thus a need to understand these patients' initial discomfort, appraisal and behaviour to design interventions that could reduce delay in care-seeking. DESIGN: Focus group discussions with patients who had had a recent acute myocardial infarction. METHODS: The analysis of the transcribed text was inspired by the self-regulatory model of illness behaviour. RESULTS: Patients with acute myocardial infarction describe problems to identify the exact time of onset of often vague symptoms. Their experiences of symptoms did not match their expectations. These patients exhibit self-regulatory illness behaviour that seems to cause a considerable delay in care-seeking. CONCLUSIONS: We found indications of a pertinent shift in appraisal and coping-strategy when a patient changes from self-regulative illness behaviour to seeking care - the turning point. This shift seems to be affected by several partly contradictory influences and it takes a considerable time for a person to reach this stage. All aspects of the patients' self-regulative illness behaviour have to be considered if we want patients to seek medical care more rapidly. RELEVANCE TO CLINICAL PRACTICE: Our findings are important to consider in future design of public health and rehabilitation strategies to save patient lives. To identify the turning point is a profitable way to deepen the understanding of patient behaviour during the initial phase of an acute myocardial infarction.
Asunto(s)
Conducta de Enfermedad , Infarto del Miocardio/psicología , Aceptación de la Atención de Salud , Adaptación Psicológica , Grupos Focales , Humanos , Infarto del Miocardio/terapiaRESUMEN
UNLABELLED: Self-reported conditions have become increasingly important in patient care, and perceived loneliness and social relationships in patients with chronic heart failure (CHF) are not sufficiently investigated. AIM: The aim was to investigate perceived loneliness and social support in patients with CHF. Further, to investigate whether loneliness and social support might be associated with gender, age, healthcare utilization and mortality. METHODS: One hundred and forty nine patients with CHF, hospitalised at least once during a 4-month period in 2006, completed a self-reported questionnaire including measurements about loneliness and social support. Healthcare utilization was assessed prospectively by frequency of readmissions and number of days hospitalised during 1 year. RESULTS: Loneliness was reported by 29 (20%) participants. They were more often women (p<0.001) and younger (p=0.024). Patients who perceived loneliness had fewer social contacts (p=0.033), reported lower occurrence of emotional contacts (p=0.004), were less satisfied with social contacts and close relationships (p<0.001). Those reporting loneliness had more days hospitalised (p=0.044), and more readmissions to hospital (p=0.027), despite not having more severe CHF. CONCLUSION: Loneliness is a health-related risk indicator in that patients with CHF who perceived loneliness have more healthcare utilization than those who do not report loneliness despite not having more severe CHF.
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Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/psicología , Soledad/psicología , Apoyo Social , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Servicios de Salud/estadística & datos numéricos , Insuficiencia Cardíaca/enfermería , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Readmisión del Paciente/estadística & datos numéricos , Factores de Riesgo , Distribución por Sexo , Encuestas y CuestionariosRESUMEN
CONTEXT: Interprofessional learning activities in health care are being gradually introduced on an international basis and therefore cross-cultural and internationally collaborative research into the outcomes of these activities is needed. Hence, it is necessary not only to translate research instruments into the language of the culture in which they are to be used, but also to adapt them culturally if they are to fulfil the testing purposes for which they are intended. It is also necessary to test a translated instrument in order to ensure that it retains its intended psychometric properties. METHODS: In the present study, the Readiness for Interprofessional Learning Scale (RIPLS) was adapted for use in a Swedish student population. Cross-cultural adaptation was performed according to recommended guidelines. The Swedish version was tested on a group of students from various health care professions (n = 214). Cronbach's alpha coefficient was adopted to ensure internal consistency. RESULTS: Minor discrepancies during the different translation processes were identified and corrected. Confirmatory factor analysis suggests that the model had an acceptable fit, implying that the factor structure of the scale did not undergo any significant changes by being subjected to translation. The psychometric qualities of the instrument were comparable with those of the English-language version. CONCLUSIONS: This study presents the cross-cultural adaptation of the RIPLS and demonstrates that its subscale Teamwork and Collaboration is the only reliable subscale. The other 2 subscales (Professional Identity, and Roles and Responsibilities) probably require further scrutiny and development, at least in the Swedish population.
Asunto(s)
Educación Médica/métodos , Personal de Salud/educación , Relaciones Interprofesionales , Estudiantes de Medicina/psicología , Actitud del Personal de Salud , Comparación Transcultural , Humanos , Cooperación Internacional , Aprendizaje , SueciaRESUMEN
This follow-up study describes the former students' lasting impressions of a two-week interprofessional course on a training ward aimed at enhancing the understanding of the roles of other professions and the importance of communication for teamwork and for patient care as well as providing an opportunity for profession-specific training. A questionnaire with both closed and open-ended questions was sent to 633 former students two years after the course and 348 (55%) responded. The course was rated as very good and most of the former students had lasting and positive impressions. Ninety-two percent of respondents encouraged teamwork in their present work and 90% wanted to retain the course. The qualitative analysis of the open-ended questions resulted in five categories describing students' perceptions: professional role development, working in teams, tutoring, patient care and future aspects of the course and real world practice. Our results suggest that interprofessional training during undergraduate education provides lasting impressions that may promote teamwork in students' future occupational life.
Asunto(s)
Prácticas Clínicas/normas , Competencia Clínica , Empleos en Salud/educación , Grupo de Atención al Paciente , Evaluación de Programas y Proyectos de Salud , Estudiantes del Área de la Salud/psicología , Adulto , Femenino , Hospitales de Enseñanza/métodos , Humanos , Relaciones Interprofesionales , Masculino , Modelos Educacionales , Terapia Ocupacional/educación , Especialidad de Fisioterapia/educación , Aprendizaje Basado en Problemas , Investigación Cualitativa , Estudiantes de Medicina/psicología , Estudiantes de Enfermería/psicología , Encuestas y Cuestionarios , SueciaRESUMEN
AIMS AND OBJECTIVES: The purpose of this study was to describe Registered Nurses' incentives to use nursing diagnoses in clinical practice. BACKGROUND: The use of nursing diagnoses is scarce in Swedish patient records. However, there are hospital wards were all nurses formulate and use nursing diagnoses in their daily work. This leads to the question of what motivates these nurses who do use nursing diagnoses in clinical practice. DESIGN: A qualitative descriptive design. METHODS: A purposeful sampling of 12 Registered Nurses was used. Qualitative interviews to collect data and a content analysis were performed. RESULTS: Five categories were identified: identification of the patient as an individual and as a whole, a working tool for facilitating nursing care, increasing awareness within nursing, support from the management and influence on the professional role. The principle findings of this study were: (i) that the Registered Nurses perceived that nursing diagnoses clarified the patient's individual needs and thereby enabled them to decide on more specific nursing interventions, (ii) that nursing diagnoses were found to facilitate communication between colleagues concerning patient care and thus promoted continuity of care and saved time and (iii) that nursing diagnoses were perceived to increase the Registered Nurses' reflective thinking leading to a continuous development of professional knowledge. CONCLUSIONS: The present findings suggest that the incentives to use nursing diagnoses originate from effects generated from performing a deeper analysis of the patient's nursing needs. Further research is needed to test and validate the usability and consequences of using nursing diagnoses in clinical practice. Motivating factors found in this study may be valuable to Registered Nurses for the use and development of nursing diagnoses in clinical care. Moreover, these factors may be of relevance in other countries that are in a similar situation as Sweden concerning application of nursing diagnoses.
Asunto(s)
Actitud del Personal de Salud , Motivación , Diagnóstico de Enfermería/estadística & datos numéricos , Personal de Enfermería en Hospital/psicología , Competencia Clínica , Comunicación , Continuidad de la Atención al Paciente , Conocimientos, Actitudes y Práctica en Salud , Necesidades y Demandas de Servicios de Salud , Salud Holística , Humanos , Relaciones Interprofesionales , Rol de la Enfermera/psicología , Auditoría de Enfermería , Diagnóstico de Enfermería/clasificación , Investigación Metodológica en Enfermería , Registros de Enfermería , Personal de Enfermería en Hospital/educación , Participación del Paciente , Atención Dirigida al Paciente , Investigación Cualitativa , Apoyo Social , Encuestas y Cuestionarios , Suecia , Pensamiento , Administración del TiempoRESUMEN
AIMS: The aim of this study is to describe patients' experiences of living with oesophageal cancer and how they seek information. BACKGROUND: Oesophageal cancer is a devastating disease with poor prognosis. Nursing care for individuals with oesophageal cancer requires increased knowledge of how they experience illness and how it affects them. METHOD: Data were collected by semi-structured, qualitative interviews with 13 participants. Content analysis was used to analyse data. RESULTS: Four themes were identified: (i) Experiences of becoming a patient diagnosed with oesophageal cancer is distinguished by the participants' experiences of vague symptoms, of receiving the diagnosis and of existential concerns evoked by the illness. (ii) Experiences of undergoing investigations and treatment consist of the participants' experiences of extreme tiredness in relation to investigations and treatment. (iii) Experiences of intrusions in daily life is conceptualized by the participants' experiences of how the illness influenced their daily life. (iv) Managing a life-threatening illness consists of a variety of strategies, which the participants employed to manage their life-threatening illness. CONCLUSIONS: The participants were unprepared of receiving a diagnosis of oesophageal cancer. Dysphagia, fatigue and uncertainty influenced the participants' everyday life. To manage the illness one of their strategies was seeking for information. The physicians were considered the main source of information, but family as well as friends with medical knowledge were also acknowledged as valuable sources. RELEVANCE TO CLINICAL PRACTICE: Understanding patients' experiences of living with oesophageal cancer is important to improve nursing care. When caring for these patients, focus ought to be on the whole family. In nursing care, it is important to be aware of the effects of dysphagia and fatigue. Health-care professionals ought to organize meetings with fellow patients and recommend literature and websites that provide patients with high quality information.
Asunto(s)
Neoplasias Esofágicas/psicología , Actividades Cotidianas , Adulto , Anciano , Dieta , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/fisiopatología , Neoplasias Esofágicas/terapia , Fatiga , Humanos , Entrevistas como Asunto , Persona de Mediana EdadRESUMEN
PURPOSE: To investigate the amount and severity of podiatric problems in individuals with EDS as well as the consequences on daily life activities, and to compare these results with the results from a comparison group of the general population. METHOD: The Manchester Foot Pain and Disability Schedule (MFPDS) and a demographic and foot-specific form were mailed. RESULTS: One hundred and thirty-six individuals with EDS and 292 from the comparison group responded. The median MFPDS total score in the EDS group was 33 (range 17-49) (mean 32, SD 8) and in the comparison group 17 (range 17-41) (mean 19, SD 4) (P < 0.001). The items most frequently marked with 3 points in the EDS group were: 'I avoid standing for a long time', 'I catch the bus or use the care more often', and 'I get irritable when my feet hurt' (56, 46 and 43%, respectively). When comparing the NRS score (i.e. Numeric Rating Scale) regarding pain intensity between the EDS group (median 5) and the comparison group (median 0), a statistically significant difference was found (P < 0.001). Other foot problems than pain were reported by 73% (n = 100) of the EDS group and by 21% (n = 60) of the comparison group (P < 0.001). The presence of flat feet in the EDS group and the comparison group was reported by 55% (n = 75) and 8% (n = 23) respectively. CONCLUSION: Individuals' with EDS endure difficulties with their mobility due to their foot problems and related disability. It is therefore of utmost importance to find ways to assess the actual foot status for this group and to support the individuals with solutions to their problems with ambulation.
Asunto(s)
Actividades Cotidianas , Síndrome de Ehlers-Danlos/fisiopatología , Enfermedades del Pie/fisiopatología , Dolor , Adulto , Anciano , Evaluación de la Discapacidad , Síndrome de Ehlers-Danlos/clasificación , Síndrome de Ehlers-Danlos/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
AIMS: This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. CONTEXT: A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. MATERIAL AND METHODS: A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). RESULTS: The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. CONCLUSIONS: The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members.
Asunto(s)
Educación Médica/métodos , Actitud del Personal de Salud , Competencia Clínica/normas , Educación en Enfermería/métodos , Hospitales de Enseñanza/métodos , Humanos , Relaciones Interprofesionales , Terapia Ocupacional/educación , Terapia Ocupacional/métodos , Especialidad de Fisioterapia/educación , Especialidad de Fisioterapia/métodos , Encuestas y CuestionariosRESUMEN
AIM: The aim of this study was to deepen understanding of the relationship between autonomy and integrity in interactions between patients and individual health care workers in real-life care situations. METHOD: The data reported here are from a 6- and 12-month follow-up of the teaching of ethics to health care professionals working with older people. The data collection method used was participant observation. Health professionals' caring behaviour in everyday situations was observed from the point of view of patients' autonomy and integrity. Theoretical frameworks relating to autonomy and integrity were used to analyse the data. FINDINGS: The structural framework was useful for identifying the two concepts and their relationship in everyday situations. The data suggest that the two concepts are ethically complex. Autonomy is grounded in respect for patients' ability to choose, decide and take responsibility for their own lives. Autonomy varies within and between individuals and is dependent on context and on those involved. It stresses the intrinsic value of patients, which marks their worth independently of others. Integrity, however, is bound to patients' very existence, no matter what their physical and mental conditions, and must be respected regardless of their ability to act autonomously. CONCLUSION: The concepts of autonomy and integrity appear to presuppose one another and to be indivisible if older adult patients' dignity is to be maintained. This implies that when patients' autonomy is supported their integrity is protected and, consequently, their dignity upheld.
Asunto(s)
Relaciones Enfermero-Paciente , Autonomía Personal , Adulto , Anciano , Actitud del Personal de Salud , Competencia Clínica , Dependencia Psicológica , Ética en Enfermería , Femenino , Estudios de Seguimiento , Enfermería Geriátrica , Humanos , Masculino , Competencia Mental/psicología , Persona de Mediana EdadRESUMEN
Ehlers-Danlos syndrome (EDS) is a relatively rare, inherited connective tissue disorder and skin hyperextensibility, joint hypermobility, chronic joint and limb pain, blood vessel and tissue fragility are frequent symptoms. The aims of this study were to describe the degree to which individuals with EDS accept and cope with perceived limitations related to the syndrome, and to determine the relationships between acceptance of disability (AD), sense of coherence (SOC), functional health status and background data. Four questionnaires were mailed: the AD scale Modified (ADM), the SOC Scale, the Sickness Impact Profile (SIP) and a background form. The respondents with EDS were recruited through the EDS National Association in Sweden and the response rate was 74% (69 females and eight males). The Ethical Committee at Huddinge University Hospital (ref. no. 152/95) approved the study. This study has shown that the level of AD and SOC in individuals with EDS is similar to other patient groups, e.g. individuals with ostomy and with diabetes. Further, the SOC was in concordance with that of the general population. Those working full-time accepted their disability to a greater degree than those on sick leave or disability pension. A multiple regression analysis showed that a greater AD was associated with a higher level of SOC and a better functional health status. The SOC and SIP together accounted for 50% of the variance in the ADM. For health promotion in nursing practice it is important to have insight into the problem areas which may influence the overall life situation for an individual with EDS. A key issue for nurses is to identify individuals with low acceptance of their disease and/or low SOC in order to support these persons' adaptation process. Future research on EDS may be directed towards projects focusing on the development and implementation of models to strengthen the level of AD and SOC in this group.