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Merone L, Tsey K, Russell D, Nagle C. "I Just Want to Feel Safe Going to a Doctor": Experiences of Female Patients with Chronic Conditions in Australia. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:1016-1028. [PMID: 36636320 PMCID: PMC9811844 DOI: 10.1089/whr.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/29/2022]
Abstract
Background The androcentric history of medicine and medical research has led to an ongoing sex and gender gap in health research and education. Sex and gender gaps in research and education may translate into real-life health inequities for women. This study aimed to explore the experiences of female patients with chronic health conditions in the Australian health system, considering existing sex and gender gaps in medicine. Methods This qualitative study used semistructured in-depth interviews with a sample of adult women with chronic conditions in Australia. Thematic analysis was undertaken, guided by Braun and Clarke. Software NVivoX64 assisted in the management of the data. Coding was performed before grouping into subthemes and central themes. To allow for potential researcher biases, the principal researcher engaged in the practice of reflexivity, including the writing of detailed notes during analysis. Results Twenty adult Australian women with chronic conditions were interviewed. Diagnoses were varied and included Ehlers-Danlos syndrome, chronic fatigue syndrome, functional neurological disorder, and inflammatory bowel disease. Four central themes emerged: diagnostic difficulties; spectrum of health care experiences; understanding medical complexity; and coping with symptoms. Conclusions Women with chronic conditions in Australia report pain, fatigue, and suffering that significantly impacts upon their daily lives. There was a shared experience of feeling that the pain and suffering of women was dismissed or not taken seriously. Many women expressed trauma because of their experiences in health care and often this led to a fear of accessing health services. The participants highlighted a need for more knowledge, understanding, and empathy from health care practitioners.
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Affiliation(s)
- Lea Merone
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.,Address correspondence to: Lea Merone, PhD, College of Healthcare Sciences, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia.
| | - Komla Tsey
- College of Arts, Society, and Education, James Cook University, Cairns, Queensland, Australia
| | - Darren Russell
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Cate Nagle
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.,Townsville Hospital and Health Service, Townsville, Queensland, Australia
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2
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Lu Y, Jin X, Feng LW, Tang CSK, Neo M, Ho RC. Effects of illness perception on negative emotions and fatigue in chronic rheumatic diseases: Rumination as a possible mediator. World J Clin Cases 2022; 10:12515-12531. [PMID: 36579115 PMCID: PMC9791537 DOI: 10.12998/wjcc.v10.i34.12515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/06/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Illness perception has long been hypothesized to be linked to psychological well-b eing in patients with rheumatic diseases, although substantial evidence is lacking, and the contribution of ruminative coping style to this relationship is unclear.
AIM To investigate the roles of illness perception and rumination in predicting fatigue and negative emotions in patients with chronic rheumatic diseases.
METHODS Illness perception, rumination, fatigue and negative emotions (i.e. depression, anxiety and stress) were assessed by the Illness Perception Questionnaire-Revised, Stress Reactive Rumination Scale, Multidimensional Assessment of Fatigue, and the Depression, Anxiety and Stress Scale respectively. Multivariate regression analysis, the Sobel test, and the bootstrap were used to identify the mediating effect of rumination.
RESULTS All five subscales of illness perception, including perceived illness identity, chronicity, cyclical nature, consequences and coherence of illness, were significantly associated with fatigue and negative emotions. In mediational analysis, rumination was found to mediate three components of illness perception (the identity, cyclical nature and consequences of illness) and negative emotions/fatigue.
CONCLUSION Perceived identity, cyclical nature, and consequences of illness are significantly associated with fatigue and negative emotions in patients with chronic rheumatic diseases and these associations are mediated by rumination. Our findings suggest that psychological intervention should target rumination to improve physical and emotional well-being of patients with chronic rheumatic diseases.
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Affiliation(s)
- Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Xia Jin
- The Third Hospital of Jinan, Jinan 250132, Shandong Province, China
| | - Li-Wei Feng
- College of Education for the Future, Beijing Normal University, Zhuhai 519087, Guangdong Province, China
| | - CSK Tang
- Department of Obstetrics and Gynecology, National University of Singapore, The Chinese University of Hong Kong, Singapore 117570, Singapore
| | - Michelle Neo
- Department of Psychological Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Roger C Ho
- Department of Psychological Medicine, National University of Singapore, Singapore 119228, Singapore
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3
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Durán Bermejo D, Vázquez Campo M, Mouriño López Y. Vivencias y sentimientos de los pacientes con Parkinson. ENFERMERIA CLINICA 2020; 30:253-259. [DOI: 10.1016/j.enfcli.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/27/2019] [Accepted: 03/03/2019] [Indexed: 11/28/2022]
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4
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Muir J, Hegarty RSM, Stebbings S, Treharne GJ. Exploring the role of online health information and social media in the illness experience of arthritis-related fatigue: A focus group study. Musculoskeletal Care 2020; 18:501-509. [PMID: 32578937 DOI: 10.1002/msc.1494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Online health information (OHI) and social media have become prominent health resources for people with arthritis-related fatigue. More research is needed to understand how OHI and online social support may influence illness experiences and patient-practitioner relationships in people with arthritis-related fatigue. The present study aimed to explore how OHI and social media shape these experiences by using an inductive qualitative analysis. METHOD Seven focus groups were conducted with 21 participants aged 28-77 diagnosed with a range of rheumatic diseases. Within the focus groups, participants were asked questions about OHI, online social support and the role of OHI in their health care. The focus groups were recorded, transcribed and analysed using a combination of interpretative phenomenological analysis (IPA) and thematic analysis. RESULTS The analysis resulted in three themes: (a) how online social support changes illness experiences, (b) communicating fatigue to health professionals using OHI and (c) health care experiences online. These themes provide insight into the ways people with arthritis-related fatigue benefit from online social support, use OHI to support communication with health professionals and how they share health care for arthritis in online spaces. CONCLUSION This research expanded on previous literature addressing the role of OHI and social media in the illness experience of arthritis-related fatigue. As technology use is increasing, particularly in the current extraordinary environment of social distancing, it is critical to address the role of OHI and social media in health care. In this study, OHI and social media played a prevalent role in the health care of many participants.
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Affiliation(s)
- Julia Muir
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Simon Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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5
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Levine D, Horesh D. Suicidality in Fibromyalgia: A Systematic Review of the Literature. Front Psychiatry 2020; 11:535368. [PMID: 33173505 PMCID: PMC7538832 DOI: 10.3389/fpsyt.2020.535368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Fibromyalgia (FM), a poorly understood rheumatic condition, is characterized by chronic pain and psychiatric comorbidities, most notably depression and anxiety. Additional symptoms include sleep difficulties, fatigue, and various cognitive impairments. Furthermore, FM is surrounded by social stigma, due to the unclear nature and etiology of this condition. While there is widespread evidence for the emotional and psychological suffering of those with FM, the scope of suicidality, as well as the underlying factors that are associated with suicidal ideation and behavior among this population, are not well understood. The present review, which is the first of its kind, aims to summarize existing data on the prevalence of suicide-related outcomes among FM patients, highlight factors associated with suicidal ideation and behavior in FM, and identify gaps in the literature to better inform research and clinical care. Studies were extracted from the literature that measured suicidal ideation, attempted suicide, and/or completed suicide among FM patients. Results indicated that both suicidal ideation and suicidal behavior were prevalent among individuals suffering from FM. Psychiatric comorbidity, sleep difficulties, and inpatient hospitalization were associated with both suicidal ideation and suicidal behavior. Functional impairment was associated with suicidal ideation in FM. Factors associated with higher levels of suicidal behavior in FM included female gender, unemployment and lower income, medical comorbidity, and drug dependence. While an understanding of currently recognized risk factors is important for improving FM research and clinical care, some clear methodological and conceptual limitations of the reviewed studies were identified. Future work should focus on longitudinal studies, as well as on gaining a better biological and psychological understanding of the underpinnings of FM and suicidality.
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Affiliation(s)
- Daniella Levine
- Department of Psychology, New York University, New York, NY, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.,Department of Psychiatry, New York University Langone Medical Center, New York, NY, United States
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6
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Optimising daily diary questionnaires about fatigue, psychological flexibility and well-being: perspectives of people with rheumatic disease. Psychol Health 2019; 34:181-199. [DOI: 10.1080/08870446.2018.1520232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Williams AM, Christopher G, Jenkinson E. The psychological impact of dependency in adults with chronic fatigue syndrome/myalgic encephalomyelitis: A qualitative exploration. J Health Psychol 2016; 24:264-275. [PMID: 27098385 DOI: 10.1177/1359105316643376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic fatigue syndrome/myalgic encephalomyelitis can limit functional capacity, producing various degrees of disability and psychological distress. Semi-structured interviews explored the experiences of adults with chronic fatigue syndrome/myalgic encephalomyelitis being physically dependent on other people for help in daily life, and whether physical dependency affects their psychological well-being. Thematic analysis generated six themes: loss of independence and self-identity, an invisible illness, anxieties of today and the future, catch-22, internalised anger, and acceptance of the condition. The findings provide insight into the psychological impact of dependency. Implications for intervention include better education relating to chronic fatigue syndrome/myalgic encephalomyelitis for family members, carers, and friends; ways to communicate their needs to others who may not understand chronic fatigue syndrome/myalgic encephalomyelitis; and awareness that acceptance of the condition could improve psychological well-being.
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8
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Abstract
Patients with inflammatory bowel disease can present with a wide variety of symptoms. Most are related to disease activity and should be managed with appropriate medical therapy for inflammatory bowel disease. However, some patients may develop symptoms due to the side effects of the medications, or due to immunosuppression. In these cases, the offending medications should be discontinued until resolution of the symptoms and a few may be able to restart therapy. Symptoms can also occur as an extraintestinal manifestation of the disease or due to concomitant autoimmune-mediated disorders. Regardless of the etiology, symptoms should be addressed promptly with immediate evaluation and appropriate therapy, as a delay may lead to permanent sequela.
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Affiliation(s)
- Bincy P Abraham
- Houston Methodist Hospital, 6550 Fannin St., Smith Tower, Suite 1001 Houston, TX 77030 USA
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9
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Ambrosio L, Senosiain García JM, Riverol Fernández M, Anaut Bravo S, Díaz De Cerio Ayesa S, Ursúa Sesma ME, Caparrós N, Portillo MC. Living with chronic illness in adults: a concept analysis. J Clin Nurs 2015; 24:2357-67. [DOI: 10.1111/jocn.12827] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Leire Ambrosio
- Department of Adult Nursing; School of Nursing; University of Navarre; Pamplona Spain
| | | | - Mario Riverol Fernández
- Department of Neurology; Clínica Universidad de Navarra; University of Navarre; Pamplona Spain
| | | | | | | | | | - Mari Carmen Portillo
- Department of Adult Nursing; School of Nursing; University of Navarre; Pamplona Spain
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10
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Eilertsen G, Ormstad H, Kirkevold M, Mengshoel AM, Söderberg S, Olsson M. Similarities and differences in the experience of fatigue among people living with fibromyalgia, multiple sclerosis, ankylosing spondylitis and stroke. J Clin Nurs 2015; 24:2023-34. [PMID: 25661994 DOI: 10.1111/jocn.12774] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To elucidate the experience of fatigue across several long-term illnesses, focusing on the similarities and differences. BACKGROUND Fatigue is common to many long-term illnesses, but it has been studied mainly within the context of a single illness; qualitative studies comparing the experience and its impact on daily life across different long-term illnesses are lacking. DESIGN Qualitative design. METHODS A secondary analysis was conducted of five original interview studies involving 95 persons with ankylosing spondylitis, fibromyalgia, multiple sclerosis or stroke. RESULTS Similarities and differences concerning experiences of fatigue were found across the studied long-term illnesses. All patients expressed the perception of having an unfamiliar body. Fatigue was also commonly expressed as unpredictable, uncontrollable and invisible to others. Differences were related to a constant versus a varying condition, a sudden and an uncontrollable sleepiness, a mutual reinforcement with pain and increased stress sensitivity. A lack of energy and a need for sleep and rest were common experiences, as was the impact on social relationships. There were also similarities regarding how the patients managed their daily life. The search for practical solutions and attitude adjustment differed with the fatigue characteristics. All patients felt a lack of understanding and disbelief from others. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Fatigue is commonly expressed by patients with long-term illnesses. Variations in experience are related to the type of diagnosis. The disparity between experiences influences how patients managed and adjusted to the conditions of everyday life. The illness-specific characteristics of fatigue warrant increased clinical awareness and may allow professionals to offer adequate information and establish effective methods of managing the condition. The feeling of invisibility and difficulty describing the experience of fatigue in particular highlights this need.
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Affiliation(s)
| | - Heidi Ormstad
- Buskerud and Vestfold University College, Kongsberg, Norway
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11
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Matura LA, McDonough A, Carroll DL. Symptom Prevalence, Symptom Severity, and Health-Related Quality of Life Among Young, Middle, and Older Adults With Pulmonary Arterial Hypertension. Am J Hosp Palliat Care 2014; 33:214-21. [PMID: 25294227 DOI: 10.1177/1049909114554079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic, life threatening illness that affects primarily women. The purpose of this study was to describe the prevalence of PAH symptoms and to determine whether there are differences in symptom severity and HRQOL in PAH symptoms among young, middle, and older adults with PAH. A cross sectional design was utilized. For all the age groups, shortness of breath (SOB) on exertion and fatigue were the two most prevalent symptoms. SOB on exertion had the highest symptom severity scores followed by fatigue for all groups. Symptom severity was significantly different among the groups for palpitations, abdominal swelling and nausea. For components of HRQOL, physical functioning worsened with age. All groups had diminished general health, role physical and vitality levels. There are some differences in symptom prevalence, symptom severity and HRQOL among young, middle and older adults. Awareness of these differences is important for healthcare providers to know and assess overtime. Palliative care should be an integral part of caring for patients with PAH.
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Affiliation(s)
- Lea Ann Matura
- School of Nursing, University of Pennsylvania, Philadelphia , PA, USA
| | - Annette McDonough
- Massachusetts General Hospital, University of Massachusetts, Lowell, MA, USA
| | - Diane L Carroll
- Munn Center for Nursing Research, Institute for Patient Care, Boston, MA, USA
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12
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Connolly D, McNally A, Moran D, Ryan M. Fatigue in Systemic Lupus Erythematosus: Impact on Occupational Participation and Reported Management Strategies. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14044755581862] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Deirdre Connolly
- Lecturer, Trinity College Dublin, Occupational Therapy, St James' Hospital, Dublin, Ireland
| | - Aine McNally
- Occupational Therapist, St James' Hospital, Dublin, Ireland
| | - Deirdre Moran
- Occupational Therapist, Our Lady's Hospice and Care Services, Occupational Therapy, Dublin, Ireland
| | - Margaret Ryan
- Occupational Therapist, Enable Ireland, Co. Meath, Ireland
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13
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Ameringer S, Elswick RK, Smith W. Fatigue in adolescents and young adults with sickle cell disease: biological and behavioral correlates and health-related quality of life. J Pediatr Oncol Nurs 2014; 31:6-17. [PMID: 24378816 PMCID: PMC3982311 DOI: 10.1177/1043454213514632] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This descriptive, correlational study examined fatigue and potential biological and behavioral correlates in adolescents and young adults with sickle cell disease. Sixty adolescents and young adults with sickle cell disease completed the Brief Fatigue Inventory, Multidimensional Fatigue Symptom Inventory-Short Form, Patient Reported Outcomes Measurement Information System (PROMIS) fatigue short form and measures of pain, sleep quality, anxiety, depressive mood, stress, disease severity, and quality of life. Blood samples were obtained for hemoglobin and cytokines. Fatigue scores were mostly moderate in severity. Fatigue interfered to a moderate degree with daily activities and correlated significantly with pain, sleep quality, state and trait anxiety, depressive mood, stress, and quality of life. Fatigue was correlated with hemoglobin on the PROMIS measure. Fatigue was not correlated with cytokines or age, nor differed by disease severity. Fatigue was common in these adolescents and young adults, interfered with daily activities such as school, work and exercise, and significantly correlated with several potentially modifiable factors. As life expectancy increases in sickle cell disease, research is needed to test interventions to reduce fatigue.
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Affiliation(s)
| | - R. K. Elswick
- School of Nursing 1100 East Leigh Street, Richmond, VA, 23219 Virginia Commonwealth University
| | - Wally Smith
- Department of Internal Medicine PO Box 980306, Richmond, VA 23298 Virginia Commonwealth University
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14
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Olsson M, Stafström L, Söderberg S. Meanings of fatigue for women with Parkinson's disease. QUALITATIVE HEALTH RESEARCH 2013; 23:741-748. [PMID: 23515300 DOI: 10.1177/1049732313482398] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The existing knowledge of women's experiences of living with Parkinson's disease and fatigue is limited. To gain first-hand knowledge, we interviewed 11 women using a phenomenological hermeneutic interpretation. The results indicate that the familiar daily routines of women with Parkinson's disease had changed in the sense that their bodily attachment to the world had been altered. The body no longer provided smooth access to the surrounding world; rather, the body served as a barrier to daily living. In practice, understanding this barrier can be significant in recognizing how to create positive conditions that support the women's experiences and how to formulate their care in congruence with their needs.
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Affiliation(s)
- Malin Olsson
- Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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15
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Karakurt P, Ünsal A. Fatigue, anxiety and depression levels, activities of daily living of patients with chronic obstructive pulmonary disease. Int J Nurs Pract 2013; 19:221-31. [DOI: 10.1111/ijn.12055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | - Ayla Ünsal
- School of HealthAhi Evran University Kırşehir Turkey
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16
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Kirshbaum MN, Olson K, Pongthavornkamol K, Graffigna G. Understanding the meaning of fatigue at the end of life: An ethnoscience approach. Eur J Oncol Nurs 2013; 17:146-53. [DOI: 10.1016/j.ejon.2012.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 04/26/2012] [Accepted: 04/28/2012] [Indexed: 01/05/2023]
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17
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Stridsman C, Lindberg A, Skär L. Fatigue in chronic obstructive pulmonary disease: a qualitative study of people's experiences. Scand J Caring Sci 2013; 28:130-8. [DOI: 10.1111/scs.12033] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Caroline Stridsman
- Department of Health Science; Division of Nursing; Luleå University of Technology; Luleå Sweden
- The OLIN studies; Sunderby Hospital; Luleå Sweden
| | - Anne Lindberg
- The OLIN studies; Sunderby Hospital; Luleå Sweden
- Department of Public Health and Clinical Medicine; Division of Medicine; Umeå University; Umeå Sweden
| | - Lisa Skär
- Department of Health Science; Division of Nursing; Luleå University of Technology; Luleå Sweden
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18
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Czuber-Dochan W, Dibley LB, Terry H, Ream E, Norton C. The experience of fatigue in people with inflammatory bowel disease: an exploratory study. J Adv Nurs 2012; 69:1987-99. [PMID: 23215959 DOI: 10.1111/jan.12060] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/11/2022]
Abstract
AIMS To explore fatigue, the impact it has on daily life and the strategies used to ameliorate the symptom, as described by people with inflammatory bowel disease. BACKGROUND Fatigue is the most troublesome symptom during remission of inflammatory bowel disease. Fatigue affects people's daily functioning, impacting on quality of life. There is limited understanding of the nature of and the ways fatigue in inflammatory bowel disease is experienced and managed in everyday adult life. DESIGN An epistemological interpretive approach to understand participants' self-reported experiences of disease-related fatigue. METHODS A convenience sample of 46 participants was recruited from the Crohn's and Colitis UK member database. Five focus group interviews (November 2008-February 2009) were conducted, audio-recorded, transcribed, and analysed using an inductive thematic framework. FINDINGS Five themes were identified: the experience of fatigue, causes of fatigue, managing fatigue, consequences of fatigue, and seeking support. Fatigue had a debilitating effect on the social and emotional well-being of participants and limited their employment opportunities. People used a range of strategies to cope and reported that fatigue-related issues seemed to be poorly understood by clinicians and were not addressed in medical consultations. CONCLUSION Fatigue was an inextricable part of daily life for some people with inflammatory bowel disease. Specialist nurses and medical colleagues need to address the personal, social, and economic consequences of fatigue, whilst further nursing research would improve understanding of the impact of fatigue and help develop appropriate intervention strategies for people with inflammatory bowel disease.
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Montali L, Frigerio A, Riva P, Invernizzi P. ‘It's as if PBC didn’t exist’: The illness experience of women affected by primary biliary cirrhosis. Psychol Health 2011; 26:1429-45. [DOI: 10.1080/08870446.2011.565876] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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20
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Dalteg T, Benzein E, Fridlund B, Malm D. Cardiac Disease and Its Consequences on the Partner Relationship: A Systematic Review. Eur J Cardiovasc Nurs 2011; 10:140-9. [DOI: 10.1016/j.ejcnurse.2011.01.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Tomas Dalteg
- School of Health and Caring Sciences, Linneaus University, Kalmar, Sweden
- Department of Emergency Care, Emergency Ward, County Hospital Ryhov, Jönköping, Sweden
| | - Eva Benzein
- School of Health and Caring Sciences, Linneaus University, Kalmar, Sweden
| | - Bengt Fridlund
- Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Dan Malm
- Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
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21
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Arvidsson S, Arvidsson B, Fridlund B, Bergman S. Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study. BMC Musculoskelet Disord 2011; 12:102. [PMID: 21599884 PMCID: PMC3141606 DOI: 10.1186/1471-2474-12-102] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 05/20/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rheumatic diseases have a significant adverse impact on the individual from physical, mental and social aspects, resulting in a low health-related quality of life (HRQL). There is a lack of longitudinal studies on HRQL in people with rheumatic diseases that focus on factors promoting HRQL instead of risk factors. The aim of this study was to investigate the associations between suggested health promoting factors at baseline and outcome in HRQL at a 12 month follow-up in people with rheumatic diseases. METHODS A longitudinal cohort study was conducted in 185 individuals with rheumatic diseases with questionnaires one week and 12 months after rehabilitation in a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors. The associations between SF-36 subscales and the health factors were analysed by multivariable logistic regressions. RESULTS Factors predicting better outcome in HRQL in one or several SF-36 subscales were being younger or middle-aged, feeling painless, having good sleep structure, feeling rested after sleep, performing low effort of exercise more than twice per week, having strong sense of coherence (SOC), emotional support and practical assistance, higher educational level and work capacity. The most important factors were having strong SOC, feeling rested after sleep, having work capacity, being younger or middle-aged, and having good sleep structure. CONCLUSIONS This study identified several factors that promoted a good outcome in HRQL to people with rheumatic diseases. These health factors could be important to address in clinical work with rheumatic diseases in order to optimise treatment strategies.
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Affiliation(s)
- Susann Arvidsson
- Research and Development Centre Spenshult, Spenshult hospital for rheumatic diseases, SE-313 92 Oskarström, Sweden
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Barbro Arvidsson
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
- Gjøvik University College, Faculty of Nursing Science, Gjøvik, Norway
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Stefan Bergman
- Research and Development Centre Spenshult, Spenshult hospital for rheumatic diseases, SE-313 92 Oskarström, Sweden
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[Importance of fatigue, sleep quality and mood in patients with chronic obstructive pulmonary disease and the need for measurement instruments]. Arch Bronconeumol 2011; 45 Suppl 5:2-6. [PMID: 20116755 DOI: 10.1016/s0300-2896(09)72948-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The effect of chronic obstructive pulmonary disease (COPD) on patients and their perception of wellbeing goes beyond functional respiratory alterations. Fatigue, mood and sleep alterations constitute a complex of interrelated symptoms affecting perception of health status. Fatigue is a highly important symptom due to its frequency, clinical repercussions and association with other manifestations. Functional alterations during sleep are of various degrees of severity and are most important in sleep apnea-hypopnea syndrome. Mood alterations are important because of their frequency, clinical repercussion and prognostic implications. In the last few years, several measurement instruments have been developed to quantify these manifestations, such as the Living with COPD scale (LCOPD), the COPD and Asthma Fatigue Scale (CAFS) and the COPD and Asthma Sleep Impact Scale (CASIS).The present article reviews the clinical relevance of these manifestations and the measurement instruments available for their evaluation.
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Abstract
PURPOSE The symptom most frequently associated with sickle cell disease (SCD) is pain, but recent research is beginning to indicate that fatigue as an increasingly important symptom of this disease upon which to focus research efforts. This article explores biological and behavioral factors that can potentially contribute to fatigue in SCD. ORGANIZING FRAMEWORK A biobehavioral framework guides this discussion of factors that may contribute to SCD fatigue. FINDINGS The pathophysiology of the disease process, such as the profound hemolytic anemia and unpredictable vasoocclusive crises, suggests that individuals with SCD are at risk for both acute and chronic fatigue. For example, hypoxemia can cause muscle weakness and produce oxidative stress, which, in turn, increases fatigue. Sickled erythrocytes disrupt the vascular endothelium and stimulate proinflammatory cytokines, which are linked to sleep disruptions. Pain, the most notorious symptom of SCD, has a complex and mechanistically poorly understood relationship with fatigue. CONCLUSIONS Little is known about the symptom of fatigue in SCD. Considering the biological and behavioral factors of SCD that could potentially contribute to fatigue, there is a great need for research on the nature and potential mechanisms of fatigue in SCD. CLINICAL RELEVANCE Fatigue in SCD may negatively affect quality of life. Understanding factors that may contribute to fatigue aids the clinician in identifying causes and determining treatment.
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Affiliation(s)
- Suzanne Ameringer
- Virginia Commonwealth University, School of Nursing, Richmond, VA, USA
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Bonner A, Wellard S, Caltabiano M. The impact of fatigue on daily activity in people with chronic kidney disease. J Clin Nurs 2010; 19:3006-15. [DOI: 10.1111/j.1365-2702.2010.03381.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Larsson C, Mårtensson L. Experiences of problems in individuals with hypersensitivity to odours and chemicals. J Clin Nurs 2010; 18:737-44. [PMID: 19239540 DOI: 10.1111/j.1365-2702.2008.02599.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The purpose of the study was to describe how individuals with hypersensitivity to odours and chemicals handle their problems. BACKGROUND One group of patients we often encounter consists of those with upper and lower respiratory problems who also have a pronounced sensitivity to odours and chemicals. Earlier studies have shown that these symptoms can be related to sensory hyperreactivity (SHR). This hyperreactivity is characterised by respiratory tract symptoms triggered by odours and chemicals, along with high sensitivity to inhaled capsaicin and a positive score on the chemical sensitivity scale for SHR. However, there is still a lack of studies in which SHR sufferers describe their situations in their own words. DESIGN The study was conducted using a qualitative approach. METHODS Eight individuals with confirmed SHR were selected from a population-based epidemiological study and interviewed. A qualitative content analysis was performed on the data. RESULTS Four themes emerged from the data analysis: Limitations in one's life situation, Lack of understanding from others, Concern that the symptoms will develop into a serious disease and Disparagement of one's own personal experience. The results show how individuals manage their daily lives with the help of various strategies, how they relate to other people, how they cope with their concerns and the fact that they sometimes choose to disparage their own experience of their problems. CONCLUSION The results indicate that people with SHR experience limitations in their life situations. These limitations consist of the adjustments they make to avoid triggering factors. RELEVANCE TO CLINICAL PRACTICE To improve care, nurses need to know how people experience SHR and how they cope with their hypersensitivity to odours and chemicals.
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Affiliation(s)
- Christel Larsson
- Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden
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Hassankhani H, Taleghani F, Mills J, Birks M, Francis K, Ahmadi F. Being hopeful and continuing to move ahead: religious coping in Iranian chemical warfare poisoned veterans, a qualitative study. JOURNAL OF RELIGION AND HEALTH 2010; 49:311-21. [PMID: 19396547 DOI: 10.1007/s10943-009-9252-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 04/06/2009] [Indexed: 05/11/2023]
Abstract
There is a substantial number of Iranian war veterans, exposed to sulfur mustard, who suffer from serious long term progressive health problems involving their respiratory organs, eyes, and skin. Little is known, however, about these casualties' experiences of living with the consequences of sulfur mustard poisoning. This qualitative study aims to provide greater insight into how war veterans live with the consequences of the poisoning and involved 17 Iranian war veterans who had been poisoned by sulfur mustard during the Iran-Iraq conflict. Each participant was interviewed using a semi-structured interview schedule and the data generated through this process was analyzed using constant comparative data analysis technique. Data analysis resulted in "religious beliefs and practices" as a main category, which included two sub-categories: religious value centered life and religious support. Findings suggest that religious belief assists veterans to accept the impact of poisoning on their lives and adapt their lifestyles accordingly, to participate in religious social activities and feel socially supported, and to be hopeful about the future and live their lives as fully as possible.
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Affiliation(s)
- Hadi Hassankhani
- Nursing and Midwifery Faculty, Isfahan University of Medical Sciences, Isfahan, Iran.
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Hassankhani H, Taleghani F, Mills J, Birks M, Francis K, Ahmadi F. The challenges experienced by Iranian war veterans living with chemical warfare poisoning: a descriptive, exploratory study. Scand J Caring Sci 2010; 24:290-8. [PMID: 20230514 DOI: 10.1111/j.1471-6712.2009.00719.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This exploratory, descriptive study investigates the experiences of Iranian war veterans living with chronic disease acquired as a result of chemical warfare. Sulphur mustard (SM) is considered one of the most important agents of chemical warfare and was widely used during the Iran-Iraq conflict in 1980-1988. There are approximately 100 000 Iranian SM casualties who suffer from serious long-term progressive health problems involving their respiratory organs, eyes and skin. Seventeen male Iranian war veterans aged between 30 and 59 years and four victims' family members participated in the study. Data was generated during individual in-depth interviews that used open-ended questions. Grounded theory techniques, including the constant comparative method of concurrent data generation and analysis, were employed in the analysis of data. Preliminary results indicate two main thematic categories: social isolation and physical disability. It is argued that a lack of knowledge about the outcomes of SM poisoning, physical restrictions and difficulty in adjusting socially decreases war veterans' functional capacity and levels of independence.
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Affiliation(s)
- Hadi Hassankhani
- Nursing and Midwifery Faculty, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abstract
Because of the widespread nature of chronic fatigue, health care providers need a common understanding of chronic fatigue to enable effective communication. To aid this understanding a concept analysis was undertaken using a modified version of Rodger’s evolutionary method of concept analysis. The literature review yielded many resources focused on defining fatigue and relating it to many diverse chronic conditions. This article also discusses the differences between chronic fatigue and acute episodes of fatigue. Chronic fatigue is a subjective, unpleasant, changeable, and exhausting experience that adversely affects quality of life. Whereas rest or sleep often relieves acute fatigue, chronic fatigue is unrelenting. Chronic fatigue has multiple antecedents and is a component of a diverse array of chronic diseases.
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Alsén P, Brink E, Persson LO. Living with incomprehensible fatigue after recent myocardial infarction. J Adv Nurs 2008; 64:459-68. [DOI: 10.1111/j.1365-2648.2008.04776.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Theander K, Jakobsson P, Torstensson O, Unosson M. Severity of fatigue is related to functional limitation and health in patients with chronic obstructive pulmonary disease. Int J Nurs Pract 2008; 14:455-62. [DOI: 10.1111/j.1440-172x.2008.00720.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
AIM This paper is a report of a concept analysis of chronic fatigue. BACKGROUND Fatigue is a prevalent symptom encompassing both acute and chronic manifestations. It is chronic fatigue that is most problematic because of its duration and impact on life quality. The rise in prevalence of chronic conditions will result in a need to address coexistent symptoms, clarification of which is needed. Chronic fatigue is one of the most common symptoms in chronic illness. Clarification of the concept and an understanding of its use by discipline are needed. DATA SOURCES The evolutionary method of concept analysis was used to ascertain the attributes, antecedents, consequences and surrogate terms for chronic fatigue. A review of the literature published between 1966 and 2007 was carried out to determine the contextual use of the concept of chronic fatigue among disciplines. Sources used for this analysis included CINAHL, Medline, PsychINFO and Social Work Abstracts and the search yielded 66 papers. RESULTS The chronic fatigue experience is associated with a multitude of physical, psychological and social factors. The defining attributes of chronic fatigue are constancy, abnormality, whole-body experience, inexplicability and disabling. The antecedents of chronic fatigue are physical disease, psychopathology, female gender and a history of abuse. Consequences found include social isolation and stigmatization, physical inactivity, psychological disturbances and a reduced quality of life. CONCLUSION Further research is needed to identify the aetiology of chronic fatigue and to address the social context of living with this disabling symptom.
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Williams A, Dunning T, Manias E. Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement. J Adv Nurs 2007; 57:244-56. [PMID: 17233645 DOI: 10.1111/j.1365-2648.2006.04093.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement. BACKGROUND Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis. METHOD A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005. FINDINGS Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study. CONCLUSION Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.
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Affiliation(s)
- Allison Williams
- School of Nursing, The University of Melbourne, Carlton, Victoria, Australia.
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Neill J, Belan I, Ried K. Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review. J Adv Nurs 2006; 56:617-35. [PMID: 17118041 DOI: 10.1111/j.1365-2648.2006.04054.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper reports a systematic review of non-pharmacological interventions for fatigue in adults with three common autoimmune conditions. BACKGROUND A considerable proportion of people with multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus experience compromised quality of life due to fatigue. Recent reviews of pharmacotherapies for fatigue in these conditions remain inconclusive, and systematic evidence for effectiveness of non-pharmacological interventions was unavailable. Our paper addresses this gap. METHODS The literature search used the key words fatigue, energy, multiple sclerosis, rheumatoid arthritis and systemic lupus. It included 19 electronic databases and libraries, three evidence-based journals, two internet search engines, was dated 1987-2006, and limited to English. Non-pharmacological experimental studies about fatigue comprising more than five adults were included. Meta-analysis was not possible due to diverse interventions and outcome measures, therefore studies were analysed by types of interventions used to reduce fatigue. RESULTS Of 653 hits, 162 papers were reviewed, and 36 met the inclusion criteria. Thirty-three primary studies reported 14 randomized controlled trials and 19 quasi-experimental designs. Most interventions were tested with people with multiple sclerosis. Exercise, behavioural, nutritional and physiological interventions were associated with statistically significant reductions in fatigue. Aerobic exercise was effective, appropriate and feasible for reducing fatigue among adults with chronic autoimmune conditions. Electromagnetic field devices showed promise. The diversity of interventions, designs, and using 24 different instruments to measure fatigue, limited comparisons. CONCLUSION Low impact aerobic exercise gradually increasing in intensity, duration and frequency may be an effective strategy in reducing fatigue in some adults with chronic auto-immune conditions. However, fatigue is a variable and personal experience and a range of behavioural interventions may be required. Well-designed studies testing these promising strategies and consensus on outcome fatigue measures are needed.
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Affiliation(s)
- Jane Neill
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia.
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Mayor V. Long-term conditions. 3: Being an expert patient. Br J Community Nurs 2006; 11:59-63. [PMID: 16493308 DOI: 10.12968/bjcn.2006.11.2.20441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This third article in the series focusing on long-term conditions explores the patient perspective. Drawing on the experiences of seven people affected by a variety of long-term conditions, it illustrates how the journey towards being an expert patient is often lengthy and traumatic. Pre- and post-diagnosis phases are narrated, and the process of becoming an expert patient described. The articles suggests that there is significant potential for the development of a reciprocal relationship between patients and health professionals framed by mutual learning and advice.
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