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Flash S, Goldsmith DM, Nelson TL, Thompson W, Flatley Brennan P. Assessing the usability of an immersive virtual reality grocery store in healthy controls. Int J Med Inform 2024; 187:105458. [PMID: 38648684 PMCID: PMC11111346 DOI: 10.1016/j.ijmedinf.2024.105458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/03/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Immersive virtual reality (IVR) as a research platform to study human behaviors is an emerging field and may be useful for studying self-care management, especially in the gap between formal healthcare recommendations and day-to-day living. Self-care activities, such as grocery shopping, can be challenging for people with chronic illness. We developed an IVR environment that simulates a real-life grocery store and conducted a usability study to demonstrate the safety and acceptability of IVR as an experimental environment. METHODS This study was a three-arm randomized control trial involving 24 participants, conducted as a usability study to evaluate aspects of the experimental condition including the effectiveness of a training exposure, the occurrence of undesirable effects associated with IVR, and participants' experiences of realism, immersion, and spatial presence. The experiment, using a head mounted device and handheld controllers, included a 10-minute training exposure, followed by one of three unique 30-minute experimental conditions which exposed participants to different combinations of tasks and stimuli, and a post-experience interview. We measured controller errors, undesirable symptoms associated with IVR, and the perception of realism, immersion, and spatial presence. RESULTS Participants used controllers effectively to interact within the IVR environment. Hand controller use errors were fewer during the experimental conditions compared to the training exposure. Minimal undesirable IVR symptoms were reported. Presence was rated in the middle range with no significant differences based on experimental condition. Overall, user experience feedback was positive. CONCLUSIONS We demonstrated that participants could engage in our IVR environment without excessive error or experiencing undesirable effects and confirmed that the virtual experience attained a level of presence necessary to effectively engage in the study. These findings give us confidence that this IVR intervention designed to explore instrumental activities of daily living is safe, effective and provides a credible, controlled simulated community-like setting.
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Affiliation(s)
- Sara Flash
- National Institute of Nursing Research, Advanced Visualization Branch, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Denise M Goldsmith
- National Institute of Nursing Research, Advanced Visualization Branch, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Tanna L Nelson
- National Institute of Nursing Research, Advanced Visualization Branch, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - William Thompson
- National Institute of Nursing Research, Advanced Visualization Branch, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Patricia Flatley Brennan
- National Institute of Nursing Research, Advanced Visualization Branch, 9000 Rockville Pike, Bethesda, MD 20892, USA; National Library of Medicine, 9000 Rockville Pike, Bethesda, MD 20892, USA.
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Smith SK, Pryce H, O'Connell GB, Hussain S, Shaw R, Straus J. 'The burden is very much on yourself': A qualitative study to understand the illness and treatment burden of hearing loss across the life course. Health Expect 2024; 27:e14067. [PMID: 38715316 PMCID: PMC11076985 DOI: 10.1111/hex.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Hearing loss is a chronic health condition that rises sharply with age. The way people respond to and cope with health conditions is influenced by their capacity to perform illness and treatment-related work. The aim was to explore the cumulative burdens of living with hearing loss and the resources mobilised to ease the burdens. METHODS A qualitative design was used with semi-structured interviews (online or in-person) with participants recruited through audiology services and nonclinical services, such as lip-reading classes. Forty-six participants with hearing loss aged between 16 and 96 years were interviewed. An abductive approach, informed by May et al.'s burden of treatment theory, was used to analyse the data. RESULTS The illness burden involved participants working to make sense of their hearing loss, engaging in emotional work in response to changes in sound, social interactions and identity and coping with the daily frustrations required to communicate with others. Abandonment and uncertainty characterised the treatment burden; participants engaged in emotional work to adjust to hearing technology and deal with the uncertainty of how their hearing might progress. To ameliorate the burdens, participants drew on internal resources (psychological, health literacy, cognitive) and external resources (social support, financial, information, technology). CONCLUSIONS The workload of hearing loss appears largely devolved to the patient and is not always visible. Our work indicates the need to widen approaches in audiological care through the implementation of lifeworld-led care, family-centred care and peer support to build support for those with hearing loss. PATIENT OR PUBLIC CONTRIBUTION We developed the project in consultation with members of the public who have lived experience of hearing loss recruited through Aston University and volunteer links to audiology services. We also consulted people more likely to be affected by hearing loss adults including adults with learning disabilities, older adults in residential care and people from South Asia (Bangladeshi, Indian and Pakistani communities). These individuals commented on the study aims, interview schedule and participant recruitment practices. One of our co-authors (expert by experience) contributed to the development and interpretation of themes and preparation of the final manuscript.
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Affiliation(s)
- Sian K. Smith
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Helen Pryce
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | | | - Saira Hussain
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Rachel Shaw
- Aston Institute of Health and Neurodevelopment and School of Psychology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Jean Straus
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
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Keogh A, Brennan C, Johnston W, Dickson J, Leslie SJ, Burke D, Megyesi P, Caulfield B. Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study. JMIR Form Res 2024; 8:e52442. [PMID: 38427410 PMCID: PMC10959238 DOI: 10.2196/52442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people's acceptance of it in practice. OBJECTIVE This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. METHODS A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. RESULTS Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. CONCLUSIONS The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs.
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Affiliation(s)
- Alison Keogh
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Carol Brennan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - William Johnston
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
| | - Jane Dickson
- Physiotherapy Department, Beacon Hospital, Dublin, Ireland
- Cardiology, Beacon Hospital, Dublin, Ireland
| | | | - David Burke
- Cardiology, Beacon Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter Megyesi
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Ferguson A, Goldsmith DM, Flatley Brennan P. Visualization of health information within immersive virtual reality environments. J Am Med Inform Assoc 2024; 31:531-535. [PMID: 37352392 PMCID: PMC10797262 DOI: 10.1093/jamia/ocad103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
The Advanced Visualization Branch of the National Institute of Nursing Research uses computer technologies to study information visualization in support of self-care management. Advanced technologies, such as immersive virtual reality (IVR), afford researchers the opportunity to study health information visualization where user-initiated information search in visually dense settings precedes acquisition, interpretation, and use. While IVR has broad applicability in healthcare, we chose to target lay people managing chronic disease because of the growing unmet need to translate clinical recommendations into everyday behaviors. To explore how lay people seek, acquire, and interpret health information in everyday settings, we developed an IVR grocery store. In this environment, a person can locate food products, read and compare nutrition labels, and use information to make food selections. The goal of this perspective is to introduce the opportunities afforded by IVR to both present and study health information visualization and to highlight critical design considerations.
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Affiliation(s)
- Allyson Ferguson
- National Institute of Nursing Research, Advanced Visualization Branch, Bethesda, Maryland, USA
| | - Denise M Goldsmith
- National Institute of Nursing Research, Advanced Visualization Branch, Bethesda, Maryland, USA
| | - Patricia Flatley Brennan
- National Institute of Nursing Research, Advanced Visualization Branch, Bethesda, Maryland, USA
- National Library of Medicine, Bethesda, Maryland, USA
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Storm M, Morken IM, Austin RC, Nordfonn O, Wathne HB, Urstad KH, Karlsen B, Dalen I, Gjeilo KH, Richardson A, Elwyn G, Bru E, Søreide JA, Kørner H, Mo R, Strömberg A, Lurås H, Husebø AML. Evaluation of the nurse-assisted eHealth intervention 'eHealth@Hospital-2-Home' on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial. BMC Health Serv Res 2024; 24:18. [PMID: 38178097 PMCID: PMC10768157 DOI: 10.1186/s12913-023-10508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. METHODS A randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention-eHealth@Hospital-2-Home-for six weeks. The intervention includes remote monitoring of vital signs; patients' self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients' and nurse navigators' engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis. DISCUSSION This protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice. TRIAL REGISTRATION Clinical trials.gov (ID 301472).
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Affiliation(s)
- Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway.
| | - Ingvild Margreta Morken
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Rosalynn C Austin
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- National Institute of Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex, Southampton, SO17 1BJ, UK
| | - Oda Nordfonn
- Department of Health and Caring Science, Western Norway University of Applied Science, Stord, Norway
| | - Hege Bjøkne Wathne
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Kristin Hjorthaug Urstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Bjørg Karlsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Ingvild Dalen
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Section of Biostatistics, Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Kari Hanne Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine, and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alison Richardson
- National Institute of Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex, Southampton, SO17 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Mailpoint 11, Clinical Academic Facility (Room AA102), South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Edvin Bru
- Centre for Learning Environment, University of Stavanger, Stavanger, Norway
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune Mo
- Department of Cardiology, St. Olav's Hospital, and Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Hilde Lurås
- Avdeling for Helsetjenesteforskning (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
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Lee HP, Hsu WY, Liu YH, Chang YC, Cheng SM, Chiang HH. Sense of Coherence as a Mediator Between Functional Status and Health-Related Quality of Life in Patients With Heart Failure. J Nurs Res 2024; 32:e311. [PMID: 38190326 DOI: 10.1097/jnr.0000000000000590] [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: 01/10/2024] Open
Abstract
BACKGROUND Poor functional status relating to heart failure (HF) negatively affects health-related quality of life (HRQOL). Patients with HF, especially those with New York Heart Association (NYHA) Class III or IV HF, often exhibit poor HRQOL because of physical limitations and HF-related symptoms. Although sense of coherence (SOC) has been reported to be a determinant of HRQOL, its role as a mediator between functional status and HRQOL remains unclear, and few studies have explored the prevalence of HF in patients in NYHA Classes I and II. PURPOSE This study was designed to investigate SOC as a mediator between different functional status classes and HRQOL in patients with HF. METHODS A cross-sectional study was conducted on patients with HF recruited from a hospital in northern Taiwan from April 2020 to September 2020. The Minnesota Living with Heart Failure Questionnaire and a questionnaire on sociodemographic characteristics; functional classification in terms of NYHA Classes I, II, and III; and SOC were administered. The PROCESS v3.5 (by Andrew F. Hayes) macro was applied to analyze the effects, and Model 4 was used to examine the mediating role of SOC on the relationship between NYHA functional class and HRQOL. RESULTS Of the 295 participants, SOC was found to mediate the effects of functional status on HRQOL more significantly in patients in Class II than those in Class III but not more significantly in patients in Class I than those in Class III. A weaker mediating effect of SOC was noted on the relationship between functional status and HRQOL in patients with HF in NYHA Class II than those in Class III. CONCLUSIONS In patients with HF, poor functional status often reduces HRQOL significantly. SOC mediates the relationship between functional status and HRQOL more significantly in those in NYHA Class II than those in Class III. Nursing staff should work to increase patients' SOC by strengthening their coping capacity and improving their functional status to improve their HRQOL.
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Affiliation(s)
| | | | - Yu-Hsuan Liu
- MSN, RN, Lecture, School of Nursing, Hsin-Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Yue-Cune Chang
- PhD, Professor, Department of Mathematics, Tamkang University, Taipei, Taiwan
| | - Shu-Meng Cheng
- MD, Professor, Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan; and School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Hsun Chiang
- PhD, RN, Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan
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Eckerblad J, Klompstra L, Heinola L, Rojlén S, Waldréus N. What frail, older patients talk about when they talk about self-care-a qualitative study in heart failure care. BMC Geriatr 2023; 23:818. [PMID: 38062397 PMCID: PMC10704742 DOI: 10.1186/s12877-023-04538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Self-care plays a crucial role in the management of heart failure (HF) and is especially important for older patients who are frail. However, there is limited knowledge about how frail, older patients with HF perceive and experience self-care. Therefore, the aim of this study was to describe the experiences of self-care among frail, older patients with HF. METHODS A qualitative descriptive design with semi-structured interviews with frail, older patients diagnosed with HF (n = 19; median age 82 years). Thematic analysis, guided by Braun and Clarke, was used to analyse the data. RESULTS Two main themes emerged from the analysis: 1) "To maintain my health," encompassing various aspects such as hygiene practices, engaging in physical activity, medication adherence, following a healthy diet, and ensuring adequate rest; and 2) "To maintain my well-being and happiness," highlighting the importance of hobbies, maintaining independence, participating in social activities, and creating a supportive environment. CONCLUSION This study provides valuable insights into the perspectives of frail, older patients with HF regarding self-care. It was observed that older patients often associate self-care with general well-being, hygiene, and happiness. Clear communication between healthcare providers and patients is essential to align different perspectives on self-care and ensure that self-care plans are tailored to individual needs. Moreover, addressing the emotional well-being and happiness of patients should be prioritized, as these factors play a significant role in promoting self-care adherence.
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Affiliation(s)
- Jeanette Eckerblad
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Linda Heinola
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Rojlén
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Stockholm, Sweden.
- Theme Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
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Johnsson N, Strandberg S, Tuvesson H, Fagerström C, Ekstedt M, Lindberg C. Delineating and clarifying the concept of self-care monitoring: a concept analysis. Int J Qual Stud Health Well-being 2023; 18:2241231. [PMID: 37506372 PMCID: PMC10392281 DOI: 10.1080/17482631.2023.2241231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
AIM To delineate and clarify the meaning of the concept of self-care monitoring from a patient perspective. METHODS A systematic search was performed in the databases ASSIA, CINAHL, PsycInfo, and PubMed (January 2016-September 2021). A selection of 46 peer-reviewed articles was included in the study and analysed using Rodgers' Evolutionary Method for Concept Analysis. RESULTS The following four attributes were identified: Tracking symptoms, signs, and actions, Paying attention, Being confident, and Needing routines, creating a descriptive definition: "Self-care monitoring is an activity that means a person has to pay attention and be confident and needs routines for tracking symptoms, signs, and action." The antecedents of the concept were shown to be Increased knowledge, Wish for independence, and Commitment. The concepts' consequences were identified as Increased interaction, Perceived burden, and Enhanced well-being. CONCLUSIONS This concept analysis provides extensive understanding of self-care monitoring from a patient perspective. It was shown that the concept occurs when a person practices self-care monitoring at home either with or without devices. A descriptive definition was constructed and presented with exemplars to encourage practice of the concept in various healthcare settings and could be of relevance to people with chronic illnesses or other long-term conditions.
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Affiliation(s)
- Natali Johnsson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Hanna Tuvesson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Cecilia Fagerström
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Mirjam Ekstedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
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Jamil S, Khan A, Ansari H. Comment on "Burden of Treatment in Patients With Chronic Heart Failure-A Cross-Sectional Study". Curr Probl Cardiol 2023; 48:101894. [PMID: 37399853 DOI: 10.1016/j.cpcardiol.2023.101894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Affiliation(s)
| | - Ayesha Khan
- Dow University of Health Sciences, Karachi, Pakistan
| | - Hamza Ansari
- Dow University of Health Sciences, Karachi, Pakistan
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10
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Jorro-Barón F, Suárez-Anzorena I, Roberti J, Mazzoni A, Vita T, Alonso JP, Villarejo A, de la Vega B, Ditata F, Facta Á, Flores D, Mastantuono C, Saa R, San-Dámaso E, Vega G, Renedo F, Fernández A, Fernández-Nievas S, García-Elorrio E. Quality improvement collaborative to optimize heart failure care in patients from a network of clinics in Argentina during the COVID-19 pandemic. Int J Qual Health Care 2023; 35:mzad060. [PMID: 37572096 DOI: 10.1093/intqhc/mzad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/22/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023] Open
Abstract
Heart failure (HF) is a major clinical and public health problem associated with significant mortality, morbidity, and health-care costs. Despite the existence of evidence-based guidelines for the optimal treatment of HF, the quality of care remains suboptimal. Our aim was to increase the use a care bundle in 50% of enrolled subjects during their hospitalization and discharge and to reduce their readmission for HF causes by 10%. We conducted an uncontrolled before-after study in eight hospitals in Argentina to evaluate the effect of a quality improvement intervention on the use of an HF care bundle in patients with HF New York Heart Association (NYHA) Class II-III. The HF bundle of care included medication, continuum of care, lifestyle habits, and predischarge examinations. Training and follow-up of multidisciplinary teams in each center were performed through learning sessions and plan-do-study-act improvement cycles. Data collectors reviewed bundle compliance in the health records of recruited patients after their hospital discharge and verified readmissions through phone calls to patients within 30-40 days after discharge. We recruited 200 patients (83 before and 127 during the intervention phase), and bundle compliance increased from 9.6% to 28.3% [odds ratio 3.71, 95% confidence interval (8.46; 1.63); P = .002]. Despite a slow improvement during the first months, bundle compliance gained momentum near the end of the intervention surpassing 80%. We observed a non-significant decreased readmission rate within 30 days of discharge due to HF in the postintervention period [8.4% vs. 5.5%, odds ratio 0.63, 95% CI (1.88; 0.21); P = .410]. Qualitative analysis showed that members of the intervention teams acknowledged the improvement of work organization and standardization of care, teamwork, shared mental model, and health record completeness as well as the utility of training fellows. Despite the challenges related to the pandemic, better care of patients with HF NYHA Class II-III was possible through simple interventions and collaborative work. Graphical abstract.
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Affiliation(s)
- Facundo Jorro-Barón
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
| | - Inés Suárez-Anzorena
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
| | - Javier Roberti
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
| | - Agustina Mazzoni
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
| | - Tomás Vita
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
| | - Juan Pedro Alonso
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
| | - Agustina Villarejo
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
| | - Bibiana de la Vega
- Cardiology, Hospital Centro de Salud "Zenón Santillán", Tucuman T4000, Argentina
| | | | - Álvaro Facta
- Cardiology, Hospital Privado de Comunidad, Mar del Plata B7602, Argentina
| | - David Flores
- Cardiology, Hospital Nacional de Clínicas, Córdoba X5000, Argentina
| | - Cristian Mastantuono
- Cardiology, Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires C1430, Argentina
| | - Raquel Saa
- Cardiology, Hospital Central, Mendoza M5589, Argentina
| | - Esteban San-Dámaso
- Cardiology, Hospital Italiano Garibaldi, Rosario, Santa Fe S2200, Argentina
| | - Gustavo Vega
- Cardiology, Hospital el Carmen, Mendoza M5589, Argentina
| | - Florencia Renedo
- Fundacion Favaloro Hospital Universitario, Buenos Aires C1093, Argentina
| | | | - Simón Fernández-Nievas
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
| | - Ezequiel García-Elorrio
- Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires C1414, Argentina
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11
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Morken IM, Wathne HB, Karlsen B, Storm M, Nordfonn OK, Gjeilo KH, Urstad KH, Søreide JA, Husebø AM. Assessing a nurse-assisted eHealth intervention posthospital discharge in adult patients with non-communicable diseases: a protocol for a feasibility study. BMJ Open 2023; 13:e069599. [PMID: 37536967 PMCID: PMC10401255 DOI: 10.1136/bmjopen-2022-069599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION A growing number of patients with non-communicable diseases (NCDs), such as heart failure (HF) and colorectal cancer (CRC), are prone to comorbidity, a high rate of readmissions and complex healthcare needs. An eHealth intervention, however, could potentially ameliorate the increasing burdens associated with NCDs by helping to smoothen patient transition from hospital to home and by reducing the number of readmissions. This feasibility study therefore aims to assess the feasibility of a nurse-assisted eHealth intervention posthospital discharge among patients with HF and CRC, while also examining the preliminary clinical and behavioural outcomes of the intervention before initiating a full-scale randomised controlled trial. The recruitment ended in January 2023. METHODS AND ANALYSIS Twenty adult patients with HF and 10 adult patients with CRC will be recruited from two university hospitals in Norway. Six hospital-based nurse navigators (NNs) will offer support during the transition phase from hospital to home by using a solution for digital remote care, Dignio Connected Care. The patients will use the MyDignio application uploaded to an iPad for 30 days postdischarge. The interactions between patients and NNs will then be assessed through direct observation and qualitative interviews in line with a think-aloud protocol. Following the intervention, semistructured interviews will be used to explore patients' experiences of eHealth support and NNs' experiences of eHealth delivery. The feasibility testing will also comprise a post-test of the Post-System Usability Questionnaire and pretesting of patient-reported outcomes questionnaires, as well as an inspection of user data collected from the software. ETHICS AND DISSEMINATION The study has been approved by the Norwegian Centre for Research Data (ID.NO: 523386). All participation is based on informed, written consent. The results of the study will be published in open-access, peer-reviewed journals and presented at international and national scientific conferences and meetings.
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Affiliation(s)
- Ingvild Margreta Morken
- Department of Quality and Health Technologies, University of Stavanger Faculty of Health Sciences, Stavanger, Norway
- Research Department, Research Group of Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
| | - Hege Bjøkne Wathne
- Department of Public Health, University of Stavanger Faculty of Health Sciences, Stavanger, Norway
| | - Bjørg Karlsen
- Department of Public Health, University of Stavanger Faculty of Health Sciences, Stavanger, Norway
| | - Marianne Storm
- Research Department, Research Group of Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger Faculty of Health Sciences, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Oda Karin Nordfonn
- Department of Health and Caring scienses, Western Norway University of Applied Sciences, Stord, Norway
| | - Kari Hanne Gjeilo
- Clinic of Cardiology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristin Hjorthaug Urstad
- Department of Public Health, University of Stavanger Faculty of Health Sciences, Stavanger, Norway
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Husebø
- Research Department, Research Group of Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger Faculty of Health Sciences, Stavanger, Norway
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12
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Hoerold M, Heytens H, Debbeler CM, Ehrentreich S, Rauwolf T, Schmeißer A, Gottschalk M, Bitzer EM, Braun-Dullaeus RC, Apfelbacher CJ. An evidence map of systematic reviews on models of outpatient care for patients with chronic heart diseases. Syst Rev 2023; 12:80. [PMID: 37149625 PMCID: PMC10163805 DOI: 10.1186/s13643-023-02227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/30/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Chronic heart disease affects millions of people worldwide and the prevalence is increasing. By now, there is an extensive literature on outpatient care of people with chronic heart disease. We aimed to systematically identify and map models of outpatient care for people with chronic heart disease in terms of the interventions included and the outcomes measured and reported to determine areas in need of further research. METHODS We created an evidence map of published systematic reviews. PubMed, Cochrane Library (Wiley), Web of Science, and Scopus were searched to identify all relevant articles from January 2000 to June 2021 published in English or German language. From each included systematic review, we abstracted search dates, number and type of included studies, objectives, populations, interventions, and outcomes. Models of care were categorised into six approaches: cardiac rehabilitation, chronic disease management, home-based care, outpatient clinic, telemedicine, and transitional care. Intervention categories were developed inductively. Outcomes were mapped onto the taxonomy developed by the COMET initiative. RESULTS The systematic literature search identified 8043 potentially relevant publications on models of outpatient care for patients with chronic heart diseases. Finally, 47 systematic reviews met the inclusion criteria, covering 1206 primary studies (including double counting). We identified six different models of care and described which interventions were used and what outcomes were included to measure their effectiveness. Education-related and telemedicine interventions were described in more than 50% of the models of outpatient care. The most frequently used outcome domains were death and life impact. CONCLUSION Evidence on outpatient care for people with chronic heart diseases is broad. However, comparability is limited due to differences in interventions and outcome measures. Outpatient care for people with coronary heart disease and atrial fibrillation is a less well-studied area compared to heart failure. Our evidence mapping demonstrates the need for a core outcome set and further studies to examine the effects of models of outpatient care or different interventions with adjusted outcome parameters. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020166330).
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Affiliation(s)
- Madlen Hoerold
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany.
| | - Heike Heytens
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Carla Maria Debbeler
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Saskia Ehrentreich
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Thomas Rauwolf
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Alexander Schmeißer
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Marc Gottschalk
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Eva Maria Bitzer
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, Freiburg, Baden-Würtemberg, 79117, Germany
| | - Ruediger C Braun-Dullaeus
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
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13
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Vellone E, Rebora P, Iovino P, Ghizzardi G, Baricchi M, Alvaro R, Sili A, Barello S, Ausili D, Trenta AM, Pedroni C, Dellafiore F, Arrigoni C, Riegel B, Caruso R. Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial. Res Nurs Health 2023; 46:190-202. [PMID: 36566360 DOI: 10.1002/nur.22289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/26/2022]
Abstract
In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.
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Affiliation(s)
- Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- School of Nursing, Midwifery and Paramedicine Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | | | - Marina Baricchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Serena Barello
- Department of Psychology, EngageMinds Hub-Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alessia M Trenta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Cardiology Center Monzino IRCCS, University of Milan-Bicocca, Milan, Italy
| | | | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Mary MacKillop Institute for Health Research, Australian Catholic University, North Sydney, Australia
- International Center for Self-Care Research
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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14
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Hong L, Hou C, Chen L, Huang X, Huang J, Liu W, Shen X. Developing a competency framework for extracorporeal membrane oxygenation nurses: A qualitative study. Nurs Open 2023; 10:2449-2463. [PMID: 36463394 PMCID: PMC10006586 DOI: 10.1002/nop2.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/22/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
AIM To develop a competency framework applicable to Chinese extracorporeal membrane oxygenation (ECMO) nurses. DESIGN A qualitative study was performed following the consolidated criteria for reporting qualitative research. METHODS Semi-structured interviews based on the critical incident technique were conducted among 21 ECMO care providers recruited from five well-known ECMO centres in Guangzhou, China. Interview transcripts were coded and analysed using the constant comparative method. The data collection period lasted from November 2021 to April 2022. RESULTS A competency framework for ECMO nurses was identified. It included four domains: knowledge, skills, behaviours and attitudes, containing 33 subcompetencies and 66 items. RELEVANCE TO CLINICAL PRACTICE This framework can be a reference for the assessment and training of ECMO nurses.
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Affiliation(s)
- Liwei Hong
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Chunyi Hou
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Lihua Chen
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiaoqun Huang
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Jingye Huang
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Weijuan Liu
- Department of PediatricsFirst Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiangxiang Shen
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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15
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Gheiasi SF, Cheraghi MA, Dastjerdi M, Navid H, Khoshavi M, Peyrovi H, Khachian A, Seylani K, Esmaeili M, Navab E. Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure. Clin Nurs Res 2023; 32:648-659. [PMID: 36788432 DOI: 10.1177/10547738221147402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.
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16
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Yoshimura M, Kawamura M, Hasegawa S, Ito YM, Takahashi K, Sumi N. Development and validation of the Care Transitions Scale for Patients with Heart Failure: A tool for nurses to assess patients' readiness for hospital discharge. Jpn J Nurs Sci 2023; 20:e12522. [PMID: 36755473 DOI: 10.1111/jjns.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/06/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023]
Abstract
AIM This study aimed to develop and assess the validity and reliability of the Care Transitions Scale for Patients with Heart Failure (CTS-HF) as a nurse-reported measure for evaluating patients' readiness for hospital discharge. METHODS We conducted a cross-sectional study of cardiovascular ward nurses from 163 hospitals across Japan. Structural validity was assessed using exploratory factor analysis with development participants and confirmatory factor analysis with validation participants. Convergent validity was assessed by correlation with the Discharge Planning of Ward Nurses scale (DPWN). Hypotheses testing for construct validity was performed as comparisons between subgroups of transitional care practice. RESULTS Valid responses were obtained from 704 nurses (development participants, n = 352; validation participants, n = 352). The final scale comprised 21 items divided into six factors: "Clear preparation for how to manage health at home," "Adjusting to home care/support system," "Transitions of medication management from hospital to home," "Dealing with patients' concerns and questions," "Transitions of disease management from hospital to home," and "Family support." Indices of fit supported these results (comparative fit index = 0.944, root mean square error of approximation = 0.057). The CTS-HF was significantly correlated with the DPWN. The nurses' subgroup with higher transitional care practice had higher CTS-HF scores. Cronbach's alpha was .93 for the CTS-HF. CONCLUSIONS The CTS-HF showed sufficient reliability and validity for use in evaluating discharge care. Further studies are needed regarding the usefulness of this scale in nursing practice.
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Affiliation(s)
- Mai Yoshimura
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masumi Kawamura
- Department of Nursing, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Satoko Hasegawa
- Department of Nursing, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Keita Takahashi
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Naomi Sumi
- Department of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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17
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Cardona M, Sav A, Michaleff ZA, Thomas ST, Dobler CC. Alignment of Doctors' Understanding of Treatment Burden Priorities and Chronic Heart Failure Patients' Experiences: A Nominal Group Technique Consultation. Patient Prefer Adherence 2023; 17:153-165. [PMID: 36713974 PMCID: PMC9880013 DOI: 10.2147/ppa.s385911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/18/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To identify and rank areas of treatment burden in chronic heart failure (CHF), including solutions, that should be discussed during the clinical encounter from a patient, and doctors' perspective. PATIENTS AND METHODS Patients with CHF and clinicians managing heart failure were invited. Nominal group technique sessions held either face to face or online in 2021-2022, with individual identification of priorities and voting on ranking. RESULTS Four patient groups (N=22) and one doctor group (N=5) were held. For patients with heart failure, in descending order of priority Doctor-patient communication, Inefficiencies of the healthcare system, Healthcare access issues, Cost implications of treatment, Psychosocial impacts on patients and their families, and Impact of treatment work were the most important treatment burdens. Priorities independently identified by the doctors aligned with the patients' but ranking differed. Patient solutions ranged from involvement of nurses or pharmacists to enhance understanding of discharge planning, through to linkage between health information systems, and maintaining strong family or social support networks. Doctors' solutions covered timing medicines with activities of daily living, patient education on the importance of compliance, medication reviews to overcome clinical inertia, and routine clinical audits. CONCLUSION The top treatment burden priorities for CHF patients were related to interaction with clinicians and health system inefficiencies, whereas doctors were generally aware of patients' treatment burden but tended to focus on the complexity of the direct treatment work. Addressing the priority issues identified here can commence with clinicians becoming aware of the issues that matter to patients and proactively discussing feasible immediate and longer-term solutions during clinical encounters.
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Affiliation(s)
- Magnolia Cardona
- Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Correspondence: Magnolia Cardona, Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine Level 4, HSM Building 5, Bond University, Robina, Queensland, 4226, Australia, Tel +61 7 5595 0170, Email
| | - Adem Sav
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zoe A Michaleff
- Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Sarah T Thomas
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Claudia C Dobler
- Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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18
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Clements L, Frazier SK, Lennie TA, Chung ML, Moser DK. Improvement in Heart Failure Self-Care and Patient Readmissions with Caregiver Education: A Randomized Controlled Trial. West J Nurs Res 2022; 45:402-415. [PMID: 36482693 DOI: 10.1177/01939459221141296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Caregivers support heart failure (HF) self-care with little HF education. The purpose of this study was to evaluate the effectiveness of a caregiver-only educational intervention aimed at improving caregiver self-efficacy, perceived control, and HF knowledge, as well as patient self-care and 30-day cardiac readmission. In total, 37 patients and their caregivers were randomly assigned to a control condition or a caregiver-only educational intervention with telephone follow-up. Outcomes included patient 30-day cardiac readmission, patient self-care, caregiver self-efficacy, caregiver perceived control, and caregiver HF knowledge. Linear mixed model, Kaplan–Meier, and Cox regression analyses were used to determine the effects of the intervention on outcomes. Self-care maintenance ( p = 0.002), self-care management ( p = 0.005), 30-day cardiac readmission ( p = 0.003), and caregiver perceived control ( p < 0.001) were significantly better in the intervention group. The results suggest that interventions targeting caregiver HF education could be effective in improving HF patients’ 30-day cardiac readmissions, patient self-care, and caregiver perceived control.
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Affiliation(s)
- Linda Clements
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | | | - Terry A. Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Misook L. Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
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19
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Haas D, Pozehl B, Alonso WW, Diederich T. Patient Satisfaction With a Nurse Practitioner–Led Heart Failure Clinic. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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20
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Austin RC, Schoonhoven L, Richardson A, Kalra PR, May CR. Qualitative interviews results from heart failure survey respondents on the interaction between symptoms and burden of self-care work. J Clin Nurs 2022. [PMID: 35945903 DOI: 10.1111/jocn.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Following a cross-sectional survey, a sub-sample of participants was interviewed to explore the interaction between symptoms and burden of treatment. BACKGROUND Burden of treatment considers both the work associated with illness and treatment, including self-care work, as well as the individuals' capabilities and resources to engage in that work. The recent survey revealed the existence of a complex interaction. DESIGN Qualitative abductive analysis of semi-structured interviews. METHODS Adults with heart failure who participated in the survey were purposely sampled and invited to participate in semi-structured interviews. Location and mode of interview varied by participant choice. Excerpts from the verbatim transcripts were assessed for interactions between symptoms and burden of treatment, and when identified these were characterised and explained. We followed COREQ checklist for reporting. The patient research ambassador group was involved from research design to dissemination. RESULTS Participants (n = 32) consistently discussed how symptoms altered their capability to engage in self-care work. As symptom intensity increased the difficultly of their self-care work increased. A number of intervening factors appeared to influence the relationship between symptoms and burden of treatment. Intervening factors included illness pathology, illness identity, the value of the tasks attempted and available support structures. These factors may change how symptoms and burden of treatment are perceived; a model was constructed to explain and summarise these interactions. CONCLUSIONS The interaction between symptoms and burden of treatment is complex. Intervening factors-illness identity and pathology, task value and performance, and available support structures-appear to exert a strong influence on the interaction between symptoms and burden of treatment. RELEVANCE TO CLINICAL PRACTICE These intervening factors present clinicians and researchers with opportunities to develop interventions that might reduce burden of treatment and improve symptoms and quality of life. CLINICAL TRIAL REGISTRATION SYMPACT was registered with ISRCTN registry: ISRCTN11011943.
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Affiliation(s)
- Rosalynn C Austin
- Department of Cardiology, Portsmouth Hospitals University NHS Trust (PHU), Portsmouth, UK.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust (PHU), Portsmouth, UK.,College of Medical, Veterinary and Life Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) North Thames, London, UK
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Informal Caregivers’ Experiences with Performing Telemonitoring in Heart Failure Care at Home—A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10071237. [PMID: 35885765 PMCID: PMC9324585 DOI: 10.3390/healthcare10071237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Informal caregivers have an important role in caring for family members at home. Supporting persons with a chronic illness such as heart failure (HF) in managing their self-care is reported to be a challenge and telemonitoring has been suggested to be of support. Aim: to explore informal caregivers’ experiences with performing non-invasive telemonitoring to support persons with HF at home for 30 days following hospital discharge in Norway and Lithuania. Methods: A qualitative explorative study of informal caregivers performing non-invasive telemonitoring using lung-impedance measurements and short message service (SMS). Data was collected using semi-structured interviews with informal caregivers of persons with HF in NYHA class III-IV in Norway and Lithuania. Results: Nine interviews were conducted with informal caregivers of persons with HF who performed non-invasive telemonitoring at home. A sequential process of three categories emerged from the data: access to support, towards routinizing, and mastering non-invasive telemonitoring. Conclusion: Informal caregivers performed non-invasive telemonitoring for the first time in this study. Their experiences were of a sequential process that included access to support from health care professionals, establishing a routine together, and access to nurses or physicians in HF care as part of mastering. This study highlights involving informal caregivers and persons with HF together in the implementation and future research of telemonitoring in HF care.
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22
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Kauppi W, Axelsson C, Herlitz J, Jiménez-Herrera MF, Palmér L. Patients' lived experiences of breathlessness prior to prehospital care - A phenomenological study. Nurs Open 2022; 9:2179-2189. [PMID: 35606842 PMCID: PMC9190685 DOI: 10.1002/nop2.1247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/12/2021] [Accepted: 05/10/2022] [Indexed: 01/10/2023] Open
Abstract
Aims and objectives The study aimed to describe how breathlessness is experienced by patients prior to prehospital care. Design A qualitative phenomenological design. Methods Lifeworld interviews were conducted with 14 participants. The analysis was carried out within the descriptive phenomenological framework. Results The essential meaning of the breathlessness phenomenon is described as an existential fear in terms of losing control over one’s body and dying, which involves a battle to try to regain control. This is further described by four constituents: being in an unknown body, striving to handle the situation, the ambiguity of having loved ones close and reaching the utmost border. Conclusions Patients describe a battling for survival. It is at the extreme limit of endurance that patients finally choose to call the emergency number. It is a challenge for the ambulance clinician (AC) to support these patients in the most optimal fashion.
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Affiliation(s)
- Wivica Kauppi
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,PreHospen- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Christer Axelsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,PreHospen- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Emergency Medical Service (EMS), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,PreHospen- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | | | - Lina Palmér
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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23
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Yoshimura M, Sumi N. Measurement tools that assess the quality of transitional care from patients' perspective: A literature review. Jpn J Nurs Sci 2022; 19:e12472. [PMID: 35132783 DOI: 10.1111/jjns.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/06/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
AIM Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient's perspective and identify its components. METHODS Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly "very good or adequate," according to COSMIN criteria. However, content validity and development were mostly "inadequate or doubtful" or not reported. The main components of included measures comprised "self-care after discharge," "providing information to the patient," "patient engagement in the care plan," and "dealing with patient's concerns." CONCLUSION The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.
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Affiliation(s)
- Mai Yoshimura
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Naomi Sumi
- Department of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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24
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Cruz-Martínez RR, Wentzel J, Bente BE, Sanderman R, van Gemert-Pijnen JE. Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis. JMIR Cardio 2021; 5:e31985. [PMID: 34855608 PMCID: PMC8686487 DOI: 10.2196/31985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. OBJECTIVE This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. METHODS Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. RESULTS In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. CONCLUSIONS Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions.
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Britt Elise Bente
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,General Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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25
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Durante A, De Maria M, Boyne J, Jaarsma T, Juarez-Vela R, Strömberg A, Vellone E. Development and psychometric testing of the European Heart Failure Self-Care behaviour scale caregiver version (EHFScB-C). PATIENT EDUCATION AND COUNSELING 2021; 104:2106-2111. [PMID: 33516593 DOI: 10.1016/j.pec.2021.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The European Heart Failure Self-Care Behaviour Scale (EHFScBS) is used worldwide to measure heart failure (HF) patient self-care, but a caregiver version does not exist. OBJECTIVE To develop and test the European HF Self-Care Behaviour Scale for Caregivers (EHFScBS-C) in a population of informal caregivers of HF patients. METHODS The EHFScBS-C was derived from the EHFScBS to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C was developed in English and then translated into Italian, Spanish and Dutch, after which it was back-translated. EHFScBS-C data were collected from 193 HF caregivers enrolled in Italy, Spain and the Netherlands. RESULTS Exploratory factor analysis revealed two factors with supportive fit indices (CFI = 0.990; RMSEA = 0.048): caregivers' contributions to HF self-care related to medical issues, and caregivers' contributions related to lifestyle. Internal consistency reliability was supported as well (Cronbach's alpha 0.90 for the overall scale). Construct validity was demonstrated with significant correlations with the Caregiver Preparedness Scale. CONCLUSION AND PRACTICE IMPLICATIONS The EHFScBS-C has adequate validity and reliability for its use in clinical practice and research to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C can be used in combination with the EHFScBS to conduct dyadic studies.
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Affiliation(s)
- Angela Durante
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Division of Nursing, Linköping University, Linköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
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26
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Austin RC, Schoonhoven L, Clancy M, Richardson A, Kalra PR, May CR. Do chronic heart failure symptoms interact with burden of treatment? Qualitative literature systematic review. BMJ Open 2021; 11:e047060. [PMID: 34330858 PMCID: PMC8327846 DOI: 10.1136/bmjopen-2020-047060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Explore the interaction between patient experienced symptoms and burden of treatment (BoT) theory in chronic heart failure (CHF). BoT explains how dynamic patient workload (self-care) and their capacity (elements influencing capability), impacts on patients' experience of illness. DESIGN Review of qualitative research studies. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsycINFO, Scopus and Web of Science were searched between January 2007 and 2020. ELIGIBILITY CRITERIA Journal articles in English, reporting qualitative studies on lived experience of CHF. RESULTS 35 articles identified related to the lived experience of 720 patients with CHF. Symptoms with physical and emotional characteristics were identified with breathlessness, weakness, despair and anxiety most prevalent. Identifying symptoms' interaction with BoT framework identified three themes: (1) Symptoms appear to infrequently drive patients to engage in self-care (9.2% of codes), (2) symptoms appear to impede (70.5% of codes) and (3) symptoms form barriers to self-care engagement (20.3% of codes). Symptoms increase illness workload, making completing tasks more difficult; simultaneously, symptoms alter a patient's capacity, through a reduction in their individual capabilities and willingness to access external resources (ie, hospitals) often with devasting impact on patients' lives. CONCLUSIONS Symptoms appear to be integral in the patient experience of CHF and BoT, predominately acting to impede patients' efforts to engage in self-care. Symptoms alter illness workload, increasing complexity and hardship. Patients' capacity is reduced by symptoms, in what they can do and their willingness to ask for help. Symptoms can lower their perceived self-value and roles within society. Symptoms appear to erode a patient's agency, decreasing self-value and generalised physical deconditioning leading to affective paralysis towards self-care regimens. Together describing a state of overwhelming BoT which is thought to be a contributor to poor engagement in self-care and may provide new insights into the perceived poor adherence to self-care in the CHF population. PROSPERO REGISTRATION NUMBER CRD42017077487.
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Affiliation(s)
- Rosalynn C Austin
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mike Clancy
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
- Faculty of Health and Science, University of Portsmouth, Portsmouth, Hampshire, UK
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) North Thames, London, UK
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27
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Tan QY, Cox NJ, Lim SER, Coutts L, Fraser SDS, Roberts HC, Ibrahim K. The Experiences of Treatment Burden in People with Parkinson's Disease and Their Caregivers: A Systematic Review of Qualitative Studies. JOURNAL OF PARKINSONS DISEASE 2021; 11:1597-1617. [PMID: 34334419 DOI: 10.3233/jpd-212612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BackgroundHigh treatment burden is associated with poor adherence, wasted resources, poor quality of life and poor health outcomes. Identifying factors that impact treatment burden in Parkinson's disease can offer insights into strategies to mitigate them.ObjectiveTo explore the experiences of treatment burden among people with Parkinson's disease (PwP) and their caregivers.MethodsA systematic review of studies published from year 2006 was conducted. Qualitative and mixed-method studies with a qualitative component that relate to usual care in Parkinson's disease were included. Quantitative studies and grey literature were excluded. Data synthesis was conducted using framework synthesis.Results1757 articles were screened, and 39 articles included. Understanding treatment burden in PwP and caregivers was not the primary aim in any of the included studies. The main issues of treatment burden in Parkinson's disease are: 1) work and challenges of taking medication; 2) healthcare provider obstacles including lack of patient-centered care, poor patient-provider relationships, lack of care coordination, inflexible organizational structures, lack of access to services and issues in care home or hospital settings; and 3) learning about health and challenges with information provision. The treatment burden led to physical and mental exhaustion of self-care and limitations on the role and social activities of PwP and caregivers.Conclusion:There are potential strategies to improve the treatment burden in Parkinson's disease at an individual level such as patient-centered approach to care, and at system level by improving access and care coordination between services. Future research is needed to determine the modifiable factors of treatment burden in Parkinson's disease.
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Affiliation(s)
- Qian Yue Tan
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, UK
| | - Stephen E R Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Laura Coutts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon D S Fraser
- National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.,School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
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28
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Jose P, Ravindranath R, Joseph LM, Rhodes EC, Ganapathi S, Harikrishnan S, Jeemon P. Patient, caregiver, and health care provider perspectives on barriers and facilitators to heart failure care in Kerala, India: A qualitative study. Wellcome Open Res 2021; 5:250. [PMID: 33959683 PMCID: PMC8078213 DOI: 10.12688/wellcomeopenres.16365.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aimed to understand the barriers and facilitators to high-quality HF care in Kerala, India. Methods: Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). Additionally, focus group discussions (n=3) were conducted with patients and their caregivers. All interviews and focus group discussions were transcribed verbatim. Textual data were analysed using thematic analysis. Results: Patients’ motivation to change their lifestyle behaviours after HF diagnosis and active follow-up calls from health care providers to check on patients’ health status were important enablers of high-quality care. Health care providers’ advice on substance use often motivated patients to stop smoking and consuming alcohol. Although patients expected support from their family members, the level of caregiver support for patients varied, with some patients receiving strong support from caregivers and others receiving minimal support. Emotional stress and lack of structured care plans for patients hindered patients’ self-management of their condition. Further, high patient loads often limited the time health care providers had to provide advice on self-management options. Nevertheless, the availability of experienced nursing staff to support patients improved care within health care facilities. Finally, initiation of guideline-directed medical therapy was perceived as complex by health care providers due to multiple coexisting chronic conditions in HF patients. Conclusions: Structured plans for self-management of HF and more time for patients and health care providers to interact during clinical visits may enable better clinical handover with patients and family members, and thereby improve adherence to self-care options. Quality improvement interventions should also address the stress and emotional concerns of HF patients.
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Affiliation(s)
- Prinu Jose
- Public Health Foundation of India, New Delhi, India
| | - Ranjana Ravindranath
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | - Linju M Joseph
- Center for Chronic Disease Control, New Delhi, India.,University of Birmingham, Birmingham, UK
| | - Elizabeth C Rhodes
- Yale Center for Implementation Science, Yale School of Medicine, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, Connecticut, USA.,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Connecticut, USA
| | - Sanjay Ganapathi
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | | | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
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29
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Jose P, Ravindranath R, Joseph LM, Rhodes EC, Ganapathi S, Harikrishnan S, Jeemon P. Patient, caregiver, and health care provider perspectives on barriers and facilitators to heart failure care in Kerala, India: A qualitative study. Wellcome Open Res 2021; 5:250. [PMID: 33959683 PMCID: PMC8078213 DOI: 10.12688/wellcomeopenres.16365.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 02/23/2024] Open
Abstract
Background: Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aimed to understand the barriers and facilitators to high-quality HF care in Kerala, India. Methods: Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). Additionally, focus group discussions (n=3) were conducted with patients and their caregivers. All interviews and focus group discussions were transcribed verbatim. Textual data were analysed using thematic analysis. Results: Patients' motivation to change their lifestyle behaviours after HF diagnosis and active follow-up calls from health care providers to check on patients' health status were important enablers of high-quality care. Health care providers' advice on substance use often motivated patients to stop smoking and consuming alcohol. Although patients expected support from their family members, the level of caregiver support for patients varied, with some patients receiving strong support from caregivers and others receiving minimal support. Emotional stress and lack of structured care plans for patients hindered patients' self-management of their condition. Further, high patient loads often limited the time health care providers had to provide advice on self-management options. Nevertheless, the availability of experienced nursing staff to support patients improved care within health care facilities. Finally, initiation of guideline-directed medical therapy was perceived as complex by health care providers due to multiple coexisting chronic conditions in HF patients. Conclusions: Structured plans for self-management of HF and more time for patients and health care providers to interact during clinical visits may enable better clinical handover with patients and family members, and thereby improve adherence to self-care options. Quality improvement interventions should also address the stress and emotional concerns of HF patients.
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Affiliation(s)
- Prinu Jose
- Public Health Foundation of India, New Delhi, India
| | - Ranjana Ravindranath
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | - Linju M. Joseph
- Center for Chronic Disease Control, New Delhi, India
- University of Birmingham, Birmingham, UK
| | - Elizabeth C. Rhodes
- Yale Center for Implementation Science, Yale School of Medicine, Connecticut, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Connecticut, USA
| | - Sanjay Ganapathi
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | | | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
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30
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Nordfonn OK, Morken IM, Bru LE, Larsen AI, Husebø AML. Burden of treatment in patients with chronic heart failure - A cross-sectional study. Heart Lung 2021; 50:369-374. [PMID: 33618147 DOI: 10.1016/j.hrtlng.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with heart failure (HF) must manage both a demanding treatment regimen and self-care, which may lead to a burden of treatment. The purpose of this study was to assess the levels of burdens from treatment and self-care and its associations with psychological distress and health-related quality of life. METHODS In this cross-sectional study we collected self-report data from 125 patients diagnosed with HF, New York Heart Association classification II and III, who received care in a nurse-led HF outpatient clinic. Clinical variables were collected from the medical records. Data analyses comprised descriptive statistics and partial correlations. RESULTS The participants mean age was 67 (±9.2), most were male (74,4%) and the majority had reduced ejection fraction (EF 35.4 ± 10.8). The highest mean burden scores emerged for insufficient medical information (34.65, range 0-86), difficulty with health care service (34.57, range 0-81), and physical and mental fatigue (34.12, range 0-90). Significant positive associations were observed between physical and mental fatigue from self-care, role and social activity limitation, and psychological distress, and health-related QoL. CONCLUSION Burden of treatment is an important aspect of HF treatment as it contributes to valuable knowledge on patient workload. This study emphasizes the need to simplify and tailor the treatment regimens to alleviate the burden.
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Affiliation(s)
- Oda Karin Nordfonn
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway.
| | - Ingvild Margreta Morken
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway; Department of Cardiology, Stavanger University Hospital, PB 8100, 4068 Stavanger, Norway
| | - Lars Edvin Bru
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, PB 8100, 4068 Stavanger, Norway; Department of Clinical Science, University of Bergen, PB 7800, 5020 Bergen, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway
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31
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Affiliation(s)
- Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure- Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail code J3-4, Cleveland OH 44195.
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32
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Roberti J, Vita T, Piastrella J, Porley C, Pereyra L, Diez M, Renedo F, Fairman E, Fernández A, Thierer J, García Elorrio E. Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina. BMJ Open 2020; 10:e040028. [PMID: 33376162 PMCID: PMC7778781 DOI: 10.1136/bmjopen-2020-040028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF). SETTING Hospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF. PARTICIPANTS Twenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting. METHODS This study used a mixed-method design; it was conducted between August 2019 and January 2020. The development of a care bundle (a set of evidence-based interventions applied to improve clinical outcomes) involved three phases: (1) a literature review to define the list of interventions to be evaluated; (2) a modified Delphi panel to select interventions for the bundle and (3) definition of the HF care bundle. Also, the process included three rounds of scoring. RESULTS Twenty-six interventions were evaluated. The interventions in the final bundle covered four categories: medication, continuum of care, lifestyle habits, predischarge tests. These were: medication: beta-blockers, angiotensin receptor neprilysin inhibitors or ACE-inhibitors, furosemide and antimineralocorticoids; continuum of care: follow-up appointment, daily weight monitoring; lifestyle habits: smoking cessation counselling and low-sodium diet; predischarge tests: renal function, ionogram, blood pressure control, echocardiogram and determination of decompensating cause. CONCLUSION Following a systematic mixed-method approach, we have developed a care bundle of interventions that could decrease readmission of patients with HF. The application of this bundle could contribute to scale evidence-based interventions.
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Affiliation(s)
- Javier Roberti
- CIESP, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Tomás Vita
- Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Carlos Porley
- Heart Failure, Novartis Argentina SA, Buenos Aires, Argentina
| | | | - Mirta Diez
- Heart Failure Service, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Florencia Renedo
- Heart Failure Service, Fundacion Favaloro Hospital Universitario, Buenos Aires, Federal District, Argentina
| | - Enrique Fairman
- Heart Failure Service, Clinica Bazterrica, Buenos Aires, Argentina
| | | | - Jorge Thierer
- Heart Failure Service, CEMIC, Buenos Aires, Argentina
| | - Ezequiel García Elorrio
- Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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The Effect of the Teach-Back Method on Knowledge, Performance, Readmission, and Quality of Life in Heart Failure Patients. Cardiol Res Pract 2020; 2020:8897881. [PMID: 33299604 PMCID: PMC7707936 DOI: 10.1155/2020/8897881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/10/2020] [Accepted: 11/03/2020] [Indexed: 12/31/2022] Open
Abstract
Background Among chronic diseases, heart failure has always been a serious challenge imposing high costs on health systems and societies. Therefore, nurses should adopt new educational strategies to improve self-care behaviors and reduce the readmissions in heart failure patients. This study aimed to determine the effect of the teach-back method on knowledge, performance, readmission, and quality of life in these patients. Methods This clinical trial was conducted in patients with heart failure (n = 70) hospitalized in the internal wards of the Baqiyatallah al-Azam Medical Center in Tehran (2019). Routine discharge educations were provided in control patients. Self-care topics were taught to the intervention groups by the teach-back method. A cardiac self-care questionnaire was used to assess the knowledge and practice of patients immediately after intervention and three months after patient discharge. Also, SF-36 was presented to each patient. Readmission(s) and quality of life were followed up by telephone interviews three months after patient discharge. Repeated measures analysis of variance and related post-hoc tests were performed for within-group comparisons before, immediately after, and 3 months after teach-back education. Wilks' lambda multivariate tests were conducted for simultaneous comparison of quality of life subscales between intervention and control groups. Also, logistic regressions were after controlling for baseline measures and confounders. Results Findings showed significant improvement in the patients' knowledge and performance immediately after teach-back education, though this effect was slow in the long term after discharge. Also, the frequency of readmissions decreased and the quality of life (except physical function) increased in the patients through teach-back education. By controlling for the pretest effect, the posttest scores for the relevant components of the quality of life suggested improvement in both intervention and control patients. This improvement in the quality of life was confirmed by controlling for baseline measurements using binary logistic regression analysis. Conclusion Teach-back education improved patients' knowledge and performance, readmission frequency, and quality of life.
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Östman M, Bäck-Pettersson S, Sundler AJ, Sandvik AH. Nurses' experiences of continuity of care for patients with heart failure: A thematic analysis. J Clin Nurs 2020; 30:276-286. [PMID: 33141466 DOI: 10.1111/jocn.15547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/06/2020] [Accepted: 10/23/2020] [Indexed: 01/04/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to describe nurses' experiences of continuity of care for patients with heart failure. BACKGROUND Heart failure is a life-influencing condition that causes varying care needs over time with risks of fragmentation. Nurses play an important role in caring for patients with heart failure. However, nurses' experiences of continuity of care seem to be less explored in this context. DESIGN A qualitative study with a descriptive design. METHODS Four focus groups were chosen to collect the data, and the analysis was made by using a method for thematic analysis. A purposeful sampling of nurses (n = 14) with experiences from hospital-connected heart failure clinics, primary healthcare centres and municipal home healthcare settings was recruited. The COREQ checklist was used in this study. RESULTS The nurses' experiences of continuity of care for patients with heart failure were described in four themes: access and flexibility, responsibility and transparency, trustful and caring relationships and communication and collaboration. CONCLUSIONS The results indicate that nurses have an excellent position to act as the "hub" in caring for patients with heart failure, but they need to have the possibility of networking and establishing trusting relationships with their colleagues. From the nurses' point of view, mutual trust between the nurse, the patient and the patient's next of kin is crucial for promoting and maintaining continuity of care in patients with heart failure. RELEVANCE TO CLINICAL PRACTICE To promote continuity of care for patients with heart failure, nurses expressed the necessity of establishing trusting relationships in a continuity-promoting organisation with seamless coordination. Nurses can be the "hub" supporting a person-centred care approach based on the patients' needs. There seems to be a need for better collaboration with common guidelines across and within primary healthcare centres, hospital-connected heart failure clinics and municipal home healthcare settings.
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Affiliation(s)
- Malin Östman
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Region Västra Götaland, Närhälsan Källstorp Health Centre, Trollhättan, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, R, D&E Centre Fyrbodal, Västra Götaland, Sweden
| | - Siv Bäck-Pettersson
- Region Västra Götaland, Research and Development Primary Health Care, R, D&E Centre Fyrbodal, Västra Götaland, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ann-Helén Sandvik
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Sepehrian E, Pooralmasi M, Abdi A, Rajati M, Mohebi S, Tavakol K, Rajati F. Life After Myocardial Infarction: A Qualitative Study on Experiences of Kurdish Patients Affected by Iran-Iraq War. PATIENT-RELATED OUTCOME MEASURES 2020; 11:209-219. [PMID: 33132705 PMCID: PMC7592835 DOI: 10.2147/prom.s265124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022]
Abstract
Background Coronary artery disease (CAD) is a major cause of death globally. Myocardial infarction (MI) secondary to CAD affects patients’ quality of life and their lifestyle. The experience of war can affect people’s perception of phenomena. Given the scarcity of information in Kurdish patients with MI, the current study was designed to explore the lived experiences of individuals after MI in Kurdish patients affected by Iran–Iraq war. Methods This interpretive-phenomenological study was conducted on eleven patients with MI (9 men, 2 women) at Imam Ali Hospital, Center for Heart Diseases, in Kermanshah, Iran, considering MI as a phenomenon. Data was collected by a semi-structured interview and analyzed using the Van Mannen method. We employed the Lincoln and Guba criteria to examine the credibility, confirmability, dependability, and transferability of data. MAXQDA software was used for data management. We followed the COREQ checklist to ensure the rigor of our study Results Four themes and ten sub-themes were emerged as (1) “changes in the quality of life” including (a) negative physical outcomes, (b) mental effects, (c) social support, (d) adopting healthy behaviors, (e) increase or decrease in self-efficiency, (f) previous experience, and (g) developing future behaviors; (2) “bodily perceptions and medical care” including (a) medical care: saving or terminating life?, (b) a new message from the heart; (3) “returning to spirituality against death” including (a) spirituality as a guiding principle, (b) accepting death as an eventual destiny; and (4) denial. Conclusion The results suggest that MI could change the quality of physical and mental health of the person, anywhere from deterioration to full recovery. Furthermore, the influence of spirituality and previous experience of war to overcome the complications of MI has been discussed, leading to either acceptance or denial of MI, and the consequences.
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Affiliation(s)
- Elahe Sepehrian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Pooralmasi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Critical Care and Emergency Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mojgan Rajati
- Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siamak Mohebi
- Department of Health Education and Health Promotion, Faculty of Public Health, Qom University of Medical Sciences, Qom, Iran
| | - Kamran Tavakol
- School of Medicine, Howard University, Washington, DC, USA
| | - Fatemeh Rajati
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Austin RC, Schoonhoven L, Richardson A, Kalra PR, May CR. How do SYMPtoms and management tasks in chronic heart failure imPACT a person's life (SYMPACT)? Protocol for a mixed-methods study. ESC Heart Fail 2020; 7:4472-4477. [PMID: 32940966 PMCID: PMC7754908 DOI: 10.1002/ehf2.13010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/16/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022] Open
Abstract
Aims Patients with chronic heart failure (CHF) struggle to follow self‐care plans, which may lead to worsening illness and poor quality of life. Burden of treatment (BoT) describes this workload and its impact on patients' lives. Suggesting the balance between a patient's treatment workload and their capability to manage it is crucial. If BoT is reduced, self‐care engagement and quality of life may improve. This article describes the SYMPACT study design and methods used to explore how symptoms and management tasks impact CHF patients' lives. Methods and results We used a sequential exploratory mixed‐methods design to investigate the interaction between symptoms and BoT in CHF patients. Conclusions If symptoms and BoT are intrinsically linked, then the high level of symptoms experienced by CHF patients may lead to increased treatment burden, which likely decreases patients' engagement with self‐care plans. SYMPACT may identify modifiable factors to improve CHF patients' experience.
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Affiliation(s)
- Rosalynn C. Austin
- School of Health Sciences, Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUK
- Department of CardiologyPortsmouth Hospitals University NHS TrustHampshireUK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUK
- Julius Center for Health Sciences and Primary CareUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Clinical Academic FacilityUniversity Hospital Southampton NHS Foundation TrustTremona RoadSouthamptonUK
| | - Paul R. Kalra
- Department of CardiologyPortsmouth Hospitals University NHS TrustHampshireUK
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life SciencesUniversity of Glasgow and the University of PortsmouthGlasgowUK
| | - Carl R. May
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
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Nordfonn OK, Morken IM, Lunde Husebø AM. A qualitative study of living with the burden from heart failure treatment: Exploring the patient capacity for self-care. Nurs Open 2020; 7:804-813. [PMID: 32257268 PMCID: PMC7113501 DOI: 10.1002/nop2.455] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/25/2019] [Accepted: 01/20/2020] [Indexed: 12/20/2022] Open
Abstract
Aim To explore how patients with heart failure perceive their capacity to manage treatment and self-care. Design A qualitative descriptive study. Methods Patients (N = 17) were recruited from a nurse-led heart failure outpatient clinic from May-August 2017. Data were collected through individual semi-structured interviews and analysed using systematic text condensation. Results Three main themes were identified as follows: "Personal characteristics," "Coping strategies" and "Emotional and informative support." The first main theme contained the subthemes "inherent strength" and "maintenance of a positive attitude." The second main theme included the subthemes "selective denial," "ability to adapt by setting new goals" and "careful selection of information." The third main theme contained the subthemes "support from health professionals enhancing patient capacity," "support from next of kin in patients' self-care" and "practical support and hope from peers."
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Affiliation(s)
- Oda Karin Nordfonn
- Department of Public Health Faculty of Health Sciences University of Stavanger Stavanger Norway
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Stord Norway
| | - Ingvild Margreta Morken
- Department of Public Health Faculty of Health Sciences University of Stavanger Stavanger Norway
- Department of Cardiology Stavanger University Hospital Stavanger Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health Faculty of Health Sciences University of Stavanger Stavanger Norway
- Department of Gastroenterological Surgery Stavanger University Hospital Stavanger Norway
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Son YJ, Lee Y, Lee HJ. Effectiveness of Mobile Phone-Based Interventions for Improving Health Outcomes in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1749. [PMID: 32156074 PMCID: PMC7084843 DOI: 10.3390/ijerph17051749] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/28/2022]
Abstract
Mobile phone-based interventions are increasingly used to prevent adverse health outcomes in heart failure patients. However, the effects of mobile phone-based interventions on the health outcomes of heart failure patients remain unclear. Our review aims to synthesize the randomized controlled trials (RCT) of mobile phone-based interventions for heart failure patients and identify the intervention features that are most effective. Electronic searches of RCTs published from January 2000 to July 2019 were conducted. Primary outcomes included all-cause mortality, readmission, emergency department visits, length of hospital stays, and quality of life. Secondary outcomes were self-care behaviors, including medication adherence and other clinical outcomes. A total of eight studies with varying methodological quality met the inclusion criteria and were analyzed. Voice call intervention was more frequently used compared with telemonitoring and short message services. Our meta-analysis showed that voice call interventions had significant effects on the length of hospital stays. However, no significant effects on all-cause mortality, readmission, emergency department visits, or quality of life were found. Compared to other mobile phone-based interventions, voice calls were more effective in reducing the length of hospital stay. Future studies are needed to identify which features of mobile phone-based intervention most effectively improve health outcomes.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
| | - Yaelim Lee
- College of Nursing, The Catholic University of Korea, Seoul 06591, Korea;
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan 48520, Korea
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Grant JS, Graven LJ. Heart failure caregivers’ support services: Implications for palliative care. PROGRESS IN PALLIATIVE CARE 2020. [DOI: 10.1080/09699260.2020.1716146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Joan S. Grant
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, Birmingham, AL 35294-1210, USA
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Aamodt IT, Lycholip E, Celutkiene J, von Lueder T, Atar D, Falk RS, Hellesø R, Jaarsma T, Strömberg A, Lie I. Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study. J Med Internet Res 2020; 22:e15445. [PMID: 31909717 PMCID: PMC6996721 DOI: 10.2196/15445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/22/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals—one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.
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Affiliation(s)
- Ina Thon Aamodt
- Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Edita Lycholip
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine of the Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine of the Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Thomas von Lueder
- Department of Cardiology B, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.,Institute of Clinical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Research Support Services, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Hellesø
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tiny Jaarsma
- Division of Nursing, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Anna Strömberg
- Division of Nursing, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Irene Lie
- Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
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