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Ingadottir B, Jaarsma T, Norland K, Ketilsdóttir A. Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure: A Cross-sectional Study. J Cardiovasc Nurs 2023; 38:537-545. [PMID: 37816081 DOI: 10.1097/jcn.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Promoting patients' sense of security is among the goals of nursing care within heart failure management. OBJECTIVE The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure. METHODS Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status. RESULTS The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status ( P < .01) and sense of security ( P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status. CONCLUSIONS Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.
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Granrud MD, Grøndahl VA, Helgesen AK, Bååth C, Olsson C, Tillfors M, Melin-Johansson C, Österlind J, Larsson M, Hov R, Sandsdalen T. Health Care Personnel's Perspectives on Quality of Palliative Care During the COVID-19 Pandemic - A Cross-Sectional Study. J Multidiscip Healthc 2023; 16:2893-2903. [PMID: 37790989 PMCID: PMC10543989 DOI: 10.2147/jmdh.s419442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose The provision of high-quality palliative care is challenging, especially during a pandemic like COVID-19. The latter entailed major consequences for health care systems and health care personnel (HCP) in both specialist and community health care services, in Norway and worldwide. The aim of this study was to explore how the HCP perceived the quality of palliative care in nursing homes, medical care units, and intensive care units during the COVID-19 pandemic. Methods This study had a cross-sectional design. A total of 290 HCP from Norway participated in the study (RR = 25.8%) between October and December 2021. The questionnaire comprised items concerning respondents' demographics and quality of care, the latter measured by the short form of the Quality from the Patient's Perspective-Palliative Care instrument, adapted for HCP. The STROBE checklist was used. Results This study shows that the HCP scored subjective importance as higher in all dimensions, items and single items than their perception of the actual care received. This could indicate a need for improvement in all areas. Information about medication, opportunity to participate in decisions about medical and nursing care and continuity regarding receiving help from the same physician and nurse are examples of areas for improvement. Conclusion Study results indicate that HCP from nursing homes, medical care units, and intensive care units perceived that quality of palliative care provided was not in line with what they perceived to be important for the patient. This indicate that it was challenging to provide high-quality palliative care during the COVID-19 pandemic.
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Affiliation(s)
- Marie Dahlen Granrud
- Department of Social Sciences and Guidance, Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Vigdis Abrahamsen Grøndahl
- Department of Nursing, Health and Laboratory Science, Faculty of Health, Welfare and Organization, Østfold University College, Halden, Norway
| | - Ann Karin Helgesen
- Department of Nursing, Health and Laboratory Science, Faculty of Health, Welfare and Organization, Østfold University College, Halden, Norway
| | - Carina Bååth
- Department of Nursing, Health and Laboratory Science, Faculty of Health, Welfare and Organization, Østfold University College, Halden, Norway
- Department of Health Sciences, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
| | - Cecilia Olsson
- Department of Health Sciences, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
- Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Oslo, Norway
| | - Maria Tillfors
- Department of Social and Psychological Sciences, Faculty of Arts and Social Sciences, Karlstad University, Karlstad, Sweden
| | | | - Jane Österlind
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Maria Larsson
- Department of Health Sciences, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
| | - Reidun Hov
- Centre of Development of Institutional and Home Care Services, Innland (Hedmark), Hamar Municipality, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Aurén-Møkleby M, Thoresen L, Mengshoel AM, Solbrække KN, Aasbø G. 'It's not just about me': a qualitative study of couples' narratives about home death when one of the partners is dying of cancer. Palliat Care Soc Pract 2023; 17:26323524231189517. [PMID: 37545874 PMCID: PMC10399270 DOI: 10.1177/26323524231189517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Most cancer patients state a preference for home death. Care and support from primary caregivers are important to enable dying at home. A preference for home death from the perspective of couples has rarely been investigated. Objectives To explore how a preference for home death is understood and enacted in couples where one of the partners is dying of cancer. Design A qualitative interview research design with a narrative approach was used. Methods Five couples participated in dyad interviews. During the analysis, two interviews that particularly illuminated couples' shared and individual views were chosen as the primary cases. Results The interviews show, in two highly different ways, how a preference for home death is a significant relational matter. The interviews are presented as two cases: 'Struggles in an Unknown Terrain' and 'Reliance at the Kitchen Table'. They show how a preference for home death can be understood and enacted as a struggle or as reliance based on the couple's shared biography and the partner's ability to care for the partner during the end-of-life phase. The analysis highlighted the negotiations that underpin a preference for home death. In these negotiations, the couples drew on idealised understandings of home death. These ideas were supported by cultural values related to autonomy and independence as well as participation and citizenship. Thus, in the negotiations about being cared for and caring, legitimate dependency and the maintenance of a reciprocal relationship were balanced. The presence of healthcare professionals and medical devices in the home had to be balanced with the need to maintain a sense of self and an authentic home. Conclusion A relational perspective on a preference for home death made us attentive to couples' negotiations. These negotiations give couples the opportunity to re-evaluate and reconfirm individual and mutual needs in the end-of-life phase.
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Affiliation(s)
| | - Lisbeth Thoresen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | - Gunvor Aasbø
- Institute of Health and Society, University of Oslo, Oslo, NorwayDepartment of Research, Cancer Registry of Norway, Oslo, Norway
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Michel C, Seipp H, Kuss K, Hach M, Kussin A, Riera-Knorrenschild J, Bösner S. Key aspects of psychosocial needs in palliative care - a qualitative analysis within the setting of a palliative care unit in comparison with specialised palliative home care. BMC Palliat Care 2023; 22:100. [PMID: 37480117 PMCID: PMC10360287 DOI: 10.1186/s12904-023-01227-z] [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: 01/17/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The number of palliative care patients with complex needs is increasing in developed countries. In addition to physical aspects and symptom control, psychosocial aspects are of great importance for palliative care patients. The aim of this study was to understand which psychosocial aspects are important to patients, relatives and health professionals within the setting of a palliative care unit in comparison with specialised palliative home-care (SPHC). METHODS We used a qualitative design based on semistructured interviews, which were coded via qualitative content analysis. The study took place in the state of Hesse, Germany, and data collection was conducted in 2017 (interviews from the ELSAH study, which was conducted in a SPHC) and 2018 (supplementary interviews conducted in a palliative care unit). The results from both settings were compared. RESULTS In the palliative care unit, 10 health professionals, 11 patients and 8 relatives were interviewed. In the outpatient setting, we interviewed 30 health professionals, 14 patients and 14 relatives. We identified four key psychosocial issues related to palliative care that were relevant in both the inpatient and outpatient settings: care planning, patient-centred care, a protected environment with feelings of safety, and psychological well-being. In addition, immediate availability of medical staff, greater relief of the relatives and better accessibility of psychological care were more important in the inpatient setting than in the specialised palliative home care setting. CONCLUSIONS Knowledge and application of the identified key issues may improve patient-centred palliative care. Accessibility of psychological care and immediate availability of medical staff may be important factors for enhancing psychological well-being in the inpatient palliative care setting. Consideration of the identified key issues may help to develop more collaborative transitions between the palliative care unit and the SPHC and may help to provide palliative care patients and their families with care that is appropriate and feasible for them. TRIAL REGISTRATION The underlying comparative study of the outpatient setting of specialised palliative home-care (ELSAH) was registered within the German Clinical Trials Register DRKS-ID: DRKS00012421, ( https://drks.de/search/de/trial/DRKS00012421 ) on 19th May 2017.
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Affiliation(s)
- Cathrin Michel
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany.
| | - Hannah Seipp
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Katrin Kuss
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Michaela Hach
- Professional Association of Specialised Palliative Homecare in Hesse, Wiesbaden, Germany
| | - Andrea Kussin
- Department of Anaesthesia and Intensive Care Therapy, Philipps-University of Marburg, Marburg, Germany
| | | | - Stefan Bösner
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
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Martín-Martín J, Pérez-Díez-Del-Corral M, Olano-Lizarraga M, Valencia-Gil S, Saracíbar-Razquin MI. Family Narratives About Providing End-of-Life Care at Home. JOURNAL OF FAMILY NURSING 2022; 28:17-30. [PMID: 34165346 DOI: 10.1177/10748407211025579] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Currently, the dying process in Spain is moving to the home environment where responsibility for care falls largely on the family, thereby challenging and testing the stability of the family. Previous research has focused on the impact of illness on the primary caregiver; therefore, a knowledge gap exists. This study aimed to understand families' unitary experiences of providing home care to terminally ill family member. Using the "Model of Interpersonal Relationship Between the Nurse and the Person/Family Cared For," narrative research included family and individual interviews with nine families (9 groups/23 individuals). Thematic narrative analysis was used to interpret the interviews. The results highlight the impact of illness on family well-being as a whole. Family members often felt abandoned while caring for an ill family member and wished to be cared for themselves. However, their immediate community and the nurses caring for their ill family member neglected them. A paradigm shift is required by society and in home care at the end of life to better support the family.
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Affiliation(s)
- Jesús Martín-Martín
- University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute, Pamplona, Spain
| | | | - Maddi Olano-Lizarraga
- University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute, Pamplona, Spain
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Hov R, Bjørsland B, Kjøs BØ, Wilde-Larsson B. Pasienters opplevelse av trygghet med palliativ omsorg i hjemmet. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/issn.2387-5984-2021-01-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Availability as key determinant in the palliative home care setting from the patients' and family caregivers' perspectives: A quantitative-qualitative-content analysis approach. Palliat Support Care 2021; 19:570-579. [PMID: 34676810 DOI: 10.1017/s147895152000125x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE A sense of security is important in palliative home care. Yet, knowledge about which components contribute most to feeling secure from the patients' and family caregivers' perspectives, especially since the introduction of specialist palliative home care, is sparse. The goal of the current study was to determine the key components contributing to a sense of security and how they relate to each other as experienced by patients and family caregivers in specialist and generalist palliative home care. METHODS The current sub-study, as part of a larger study, was performed in different regions in Germany. Palliative care patients and family caregivers of at least 18 years of age, being cared for at home were interviewed using semi-structured interview guides following a three-factor model and analyzed by using a combined quantitative-qualitative-content approach. RESULTS One hundred and ninty-seven patients and 10 carers completed interviews between December 2017 and April 2019. The majority of patients were diagnosed with an oncological disease. Sense of security was mentioned particularly often suggesting its high relevance. We identified nine subcategories that were all mentioned more frequently by specialist than generalist palliative home care recipients in the following order of priority and relation: (i) patient-centeredness: availability, provision of information/education, professional competence, patient empowerment, and trust (ii) organizational work: comprehensive responsibility, external collaboration, and internal cooperation, and (iii) direct communication. SIGNIFICANCE OF RESULTS The work of specialist palliative home care services in particular was perceived as very effective and beneficial. Our findings confirm a previously developed three-factor model allowing for generalizability and revealed that availability was most important for improving the sense of security for effective palliative home care.
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Lersveen GL, Devik SA. Opplevelse av trygghet i hjemmebasert palliativ omsorg: pasienters og pårørendes perspektiv. TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-03-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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