Patents experiences of in-hospital telemetry monitoring

Background

Telemetry monitoring is a cornerstone of care in in-hospital arrhythmia monitoring. Annually, a large number of patients experience arrhythmias that need to be monitored and treated during hospital stay. However, studies focusing on patients' experiences of telemetry monitoring are scarce.

Purpose

To explore and describe adult patients' experiences of in-hospital monitoring in a non-intensive care unit setting.

Methods

In-depth interviews with an inductive, explorative and descriptive design were performed before hospital discharge at two university hospitals in Norway. Twenty patients were purposefully selected. Inclusion criteria were; monitored for more than 72 hours, with at least one serious arrhythmia registered. A qualitative content analysis according to Graneheim and Lundman was performed revealing categories at a manifest level.

Findings

Patients were 25–83 years (mean 62), and had spent an average of 9 days on telemetry (3–14). Patients were monitored due to primary arrhythmia (9), STEMI (2), syncope (2), TAVI (1), acute heart failure (1), heart transplant (1), GUCH (1) and non-cardiac causes (3). Four main categories were revealed from the analysis. Firstly, patients' experienced to receive limited information related to the purpose and results of the monitoring. Communication with the staff and immediate response to arrhythmias were important factors to feel safe and taken care of during hospital stay. Secondly, patients experienced the monitoring system to be troublesome. The device and the wires attached made it challenging to maintain adequate hygiene. Patients also experienced sleeping problems related to both wires and disturbing alarms, and described pain in the neck due to the weight of the telemetry unit. Thirdly, patients' experienced a restricted range of activity. Patients experienced the restricted radius of movement as a feeling of security, even though patients also described uncomfortable feelings like “wearing an ankle brace”. Fourthly, patients' experienced uncertainty at hospital discharge as the telemetry monitoring was discontinued, especially if they still experienced arrhythmias.

Conclusion

The information provided to patients on telemetry monitoring is poor and there is need for a better system to carry the telemetry in order to ease mobilisation and facilitate good sleep. Patients need to be informed about the results of the telemetry monitoring, to help them to be familiar with their arrhytmia, and increase the experience of security after discharge.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): 1 Department of Health and Social Sciences at Western Norway University of Applied Sciences, Norway2 Department of Heart Disease, Haukeland University Hospital, Norway

Informing patients about potential adverse drug reactions after percutaneous coronary intervention reduces the occurrence of self-reported adverse drug reactions

Background

Healthcare providers are commonly reluctant to inform patients about potential adverse drug reactions (ADRs) from prescribed therapy to avoid increasing the incidence of ADRs through the nocebo effect. However, patients need information on all aspects of prescribed therapy to facilitate informed decision-making and take ownership of their care.

Purpose

To describe wether patients received information about potential ADRs from prescribed therapy before hospital discharge after percutaneous coronary intervention (PCI). Furthermore, to determine whether receiving information about ADRs is associated with incidence of self-reported ADRs.

Methods

CONCARDPCI is a prospective multicentre cohort study including 3417 patients after PCI. The study was conducted between June 2017 and May 2020 at seven large referral PCI centres in Norway and Denmark. Clinical data were collected from patients' medical records. Socio-demographic characteristics were obtained by self-report during index hospitalization after PCI. Two questions from the Heart Continuity of Care Questionnaire were used to determine if information about potential ADRs was received before hospital discharge. De novo created questions were used to determine if patients reported ADRs from prescribed therapy. Questionnaires were distributed two (T1), six (T2), and twelve months (T3) after hospital discharge to assess the incidence of self-reported ADRs in a longitudinal perspective. Logistic regression was utilised to scrutinize the aims, reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Patients were predominantly men (78%), with a mean age of 66 years (SD 11, range 20–96 years), and married or living with a partner (75%). Stable coronary artery disease was the most frequent cause of admission for PCI (30%). Before hospital discharge, 59% were informed of potential ADRs from prescribed therapy and 50% were informed what to do if ADRs occurred. The incidence of self-reported ADRs were significantly lower for those who were informed of potential ADRs compared to those who were not informed at T1 (OR 0.54, CI: 0.45–0.65, p<0.001), T2 (OR 0.56, CI: 0.46–0.70, p<0.001) and T3 (OR 0.51, CI: 0.42–0.67, p<0.001) (Figure 1). After controlling for socio-demographic and clinical variables, the incidence of self-reported ADRs were similar at T1 (OR 0.58, CI: 0.47–0.71, p<0.001), T2 (OR 0.56, CI: 0.46–0.70, p<0.001) and T3 (OR 0.53, CI: 0.42–0.66, p<0.001). Those less likely to receive information about ADRs were living alone (OR 0.75, CI: 0.59–0.97; p=0.029), women (OR 0.58, CI: 0.45–0.75, p<0.001) and those with three or more comorbidities (OR 0.68, CI: 0.47–0.98, p=0.029) compared to their counterparts.

Conclusion

Our study showed that informing patients about potential ADRs after PCI reduces the occurrence of self-reported ADRs. Information about potential ADRs should be provided regardless of cohabitation status, sex and comorbidities.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Western Norway Health Authority

Do eHealth literacy and socio-demographics predict patients' preferences for use of eHealth programmes after percutaneous coronary intervention?

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): The Western Norway Health Authority

Background

Evidence supports the use of electronic health (eHealth) programmes for patients with coronary artery disease. To date, there has been little attention toward patients’ preferences for the use of eHealth programmes, and their associations with eHealth literacy and socio-demographic factors post percutaneous coronary intervention (PCI).

Purpose

To determine how eHealth literacy and socio-demographics are associated with patients’ preferences for use of eHealth programmes assessed 12-month post PCI.

Methods

An observational cohort study recruited 3417 adult patients treated by PCI at three Norwegian and four Danish university hospitals, June 2017-May 2019. Socio-demographic data and self-reported outcomes on eHealth literacy (eHealth literacy scale) were assessed at baseline. De novo questions on preferences for use of eHealth programmes were collected 12-month post PCI. Hierarchical logistic regression models were performed.

Results

The majority of patients were men (78%), and the mean age was 66 years. Almost 40% were interested in participating in eHealth programmes. The odds of being interested in accessing a webpage with quality ensured information, health applications and online chat function with healthcare providers increased with 2-3% for each point higher eHealth literacy score, which indicates better eHealth literacy. After controlling for age, education and gender (Step 2), eHealth literacy no longer remained a significant predictor for patients’ preferences. Males had 49% higher odds for interest in a webpage with quality ensured information than females. Females had 33-34% higher odds for interest in an online chat function with healthcare providers and an individually tailored text message. The odds for interest in a webpage with quality ensured information, health applications, online chat function with healthcare providers and individually tailored text messages, decreased with 2-5% per year higher age. For individual tailored feedback on email, the odds for interes was 1% higher per year higher age. Educational level above primary school was a robust predictor for the interest in a webpage with quality ensured information (63-240%). Compared to those with primary school education level, those with college/university education had 67% higher odds for interest in short online information videos, 123% higher odds for interest in online chat function with healthcare providers and 61% higher odds for interest in individually tailored feedback on email compared to patients’ whit primary school. Patients with high school and college/university education had 34-57% lower odds for interest in individually tailored text messages than those with primary school.

Conclusions

Age, educational level and gender were important predictors of patients’ preferences for using eHealth programmes post PCI. These results are important for the further development of personalized eHealth programmes.

Perceptions of efficacy and safety of generic medicines in patients after percutaneous coronary intervention

Background

Generic medicines are bioequivalents to brand-name medicines, and compelling evidence for the safety and efficacy of generic medicines exists. However, negative perceptions about generic medicines can potentially reduce adherence to prescribed therapy and thereby efficacy of the treatment.

Purpose

To describe patients' perceptions of generic medicines after percutaneous coronary intervention (PCI), and to investigate the association between perceptions and sociodemographic and clinical factors. Furthermore, we sought to investigate if these perceptions change over time.

Methods

CONCARDPCI is a large-scale prospective multicentre cohort study on 3251 patients after PCI. The study was conducted between June 2017 and May 2020 at seven large referral PCI centres in Norway and Denmark. Clinical data, including invasive procedures and patient characteristics, were collected from the patients' medical records. Sociodemographic characteristics were obtained by self-report during index hospitalization after PCI. Postal or electronic questionnaires comprising questions regarding perceptions of generic medicines were distributed two (T1) and six (T2) months after discharge from hospital to included patients. The time intervals ensured that a sufficient amount of time had passed so that refill of prescriptions was necessary. To investigate perceptions of generic medicines and the associations with sociodemographic and clinical characteristics, logistic regression analysis was performed.

Results

Most patients were men (78%), married or living with a partner (75%), elderly (mean age 66 years, SD11, range 20–96 years), and 28% were admitted to hospital due to non-ST-segment elevation myocardial infarction. At T1, 70% perceived generic medicines to be as effective, safe (68%), produce the same side effects (64%), and contain the same active ingredients as brand-name medicines (64%). Perceptions of generic medicines were similar at T2. No significant associations were found with age, marital status, living alone, taking ≥5 medications, or participation in cardiac rehabilitation. However, Danish patients (p<0.001), those with a higher education level (college/university≥4 years) (p=0.01), total household income >83,000 Euro (p=0.007), female gender (p<0.001), and history of coronary artery disease (p=0.048) had more positive perceptions of generic medicines.

Conclusion

Approximately one third of the patients had negative perceptions of generic medicines after PCI, and these negative perceptions do not seem to change substantially during the first six months after PCI. As negative perceptions of generic medicines have been found to be a barrier to medication adherence, improving patients' knowledge and confidence in generic medicines after PCI may be pivotal to reach treatment goals set forth by the 2018 ESC/EACTS Guidelines on myocardial revascularization.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): The Western Norway Health Authority

Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated

BACKGROUND

Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP).

METHODS

A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed.

RESULTS

The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index.

CONCLUSIONS

The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.

Health-Related Quality of Life in Pacemaker Patients: A Single and Multidimensional Self-Rated Health Comparison Study

Since implantation of the first permanent pacemaker in 1958, significant advances have been made in pacemaker technology. To date, however, health-related quality of life (HRQoL) in a large pacemaker population has not been investigated. With dwindling clinical resources, it is important to study HRQoL in a pacemaker population in a reliable and straightforward manner. This study aimed to determine and compare single and multidimensional self-rated health (SRH) in a pacemaker population in terms of sociodemographic characteristics, pacemaker mode and symptoms. The findings showed that irrespective of whether the perspective was single or multidimensional, this Swedish pacemaker population (n=697) with a mean age of 76 years had an acceptable HRQoL. Men, aged 65-84 years, persons who were cohabiting, who had their own dwelling, who had a DDD or who had a pacemaker for <or=3 and 4-7 years experienced better HRQoL. Efforts need to be made for women, single persons, the elderly and retired persons. In conclusion, the SRH of a pacemaker population can be trustworthy established by means of a single-dimensional SRH question.

Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review

AIMS

Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective.

METHODS

A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis.

RESULTS

Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction.

CONCLUSIONS

The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

Estimating genetic variation in sugar beets and wild beets using pools of individuals

The study describes the genetic structure in sugar beets and in wild beets (Beta vulgaris) using 30 RFLP markers. Samples consisting of pooled plant material of 100 individuals from each line and population were used to analyse 120 sugar beet breeding lines and 91 wild beet populations. Greater variation was found among the wild populations than among the breeding lines. Although the two major groups of breeding lines, monogerm and multigerm, had approximately equal amounts of genetic variation, in the monogerm group more of this variation was partitioned among the lines than within the lines. Furthermore, despite most of the variation being shared by the two groups, the two groups were found to be separated along the first two components in a principal component analysis. Computer simulations were carried out to evaluate the usefulness of the pooled-sample strategy employed in the investigation. These simulations showed the use of pooled samples to be a better alternative than that of analysing a few plants individually.

Why Iranian adolescents do not brush their teeth: a qualitative study

OBJECTIVES

To explore and describe attitudes towards tooth-brushing among Iranian adolescents.

METHODS

A series of focus-group sessions were held with 37 Iranian adolescents in schools. The groups comprised five to eight adolescents. All focus-group discussions were tape-recorded and then transcribed verbatim. All transcripts, codes and categories were read several times to extract a theme. Data were analysed using a qualitative content analysis approach.

RESULTS

Four major categories emerged from the analysis: brushing teeth is a necessary evil, parental influence on not brushing teeth, brushing teeth is insignificant, and brushing teeth is a health hazard. The theme identified in the latent content described that tooth-brushing is not part of the adolescents' activities of daily living.

CONCLUSIONS

Health educators should stress on the engagement of parents, awareness of the adolescents on brushing techniques and causes of toothache, and address any misconceptions regarding tooth-brushing.

Research ethics in dissertations: ethical issues and complexity of reasoning

BACKGROUND

Conducting ethically sound research is a fundamental principle of scientific inquiry. Recent research has indicated that ethical concerns are insufficiently dealt with in dissertations.

PURPOSE

To examine which research ethical topics were addressed and how these were presented in terms of complexity of reasoning in Swedish nurses' dissertations.

METHODS

Analyses of ethical content and complexity of ethical reasoning were performed on 64 Swedish nurses' PhD dissertations dated 2007.

RESULTS

A total of seven ethical topics were identified: ethical approval (94% of the dissertations), information and informed consent (86%), confidentiality (67%), ethical aspects of methods (61%), use of ethical principles and regulations (39%), rationale for the study (20%) and fair participant selection (14%). Four of those of topics were most frequently addressed: the majority of dissertations (72%) included 3-5 issues. While many ethical concerns, by their nature, involve systematic concepts or metasystematic principles, ethical reasoning scored predominantly at lesser levels of complexity: abstract (6% of the dissertations), formal (84%) and systematic (10%).

CONCLUSIONS

Research ethics are inadequately covered in most dissertations by nurses in Sweden. Important ethical concerns are missing, and the complexity of reasoning on ethical principles, motives and implications is insufficient. This is partly due to traditions and norms that discount ethical concerns but is probably also a reflection of the ability of PhD students and supervisors to handle complexity in general. It is suggested that the importance of ethical considerations should be emphasised in graduate and post-graduate studies and that individuals with capacity to deal with systematic and metasystematic concepts are recruited to senior research positions.

Validation of the verbal and social interaction questionnaire: nurses' focus in the nurse-patient relationship in forensic nursing care

There is a need to develop a questionnaire that measures nurses' verbal and social interactions (VSI) with their patients from the nurses' perspective as well as from the patients' perspective in the psychiatric and especially in the forensic psychiatric field. The major aim of the present study was to determine the construct validity and the internal consistency reliability of the VSI questionnaire. The study had a methodological and developmental design and was carried out in four steps: construction of the items, face validity, data collection and data analysis. The number of items was reduced from 50 to 21. The factor analysis of the final 21 items resulted in three quite distinct factors, namely, 'inviting the patient to establish a relationship', 'showing interest in the patients' feelings, experiences and behaviour' and 'helping the patients to establish structure and routines in their everyday life'. The results showed satisfactory psychometric properties in terms of content validity, construct validity and the internal consistency reliability of the questionnaire.

Light vs. heavy sedation during mechanical ventilation after oesophagectomy--a pilot experimental study focusing on memory

BACKGROUND

To assess and compare the feasibility and stressful memories of light vs. heavy sedation during post-operative mechanical ventilation.

METHODS

Randomized clinical trial in one general intensive care unit (ICU) in a Swedish university hospital. Thirty-six adults were randomly assigned to receive either light [Motor Activity Assessment Scale (MAAS) 3-4] or heavy (MAAS 1-2) sedation with continuous i.v. infusion of propofol during post-operative invasive mechanical ventilation after oesophagectomy. The patients were interviewed at the general ward 5 days post-ICU using the ICU Memory Tool and the ICU Stressful Experience Questionnaire, and 2 months post-ICU using the Impact of Event Scale Revised. Patient data and hourly recorded MAAS values were collected after the interviews.

RESULTS

Seventy-four per cent of the 139 MAAS values in the light sedation group (n=18) and 79% of the 142 in the heavy sedation group (n=18) were within the targeted levels, and the median MAAS scores were 3.0 vs. 1.25, respectively. Intention-to-treat analyses showed no significant difference in the prevalence of stressful memories between groups, including endotracheal tube discomfort, presenting wide 95% confidence intervals for the difference in outcome estimates. Excluding the patients with a prolonged ICU stay (n=3), a higher prevalence of delusional memories was found in the heavy sedation group (31% vs. 0%, P=0.04).

CONCLUSIONS

This small randomized-controlled pilot study suggests that a light sedation regimen during short-term post-operative mechanical ventilation after major surgery is feasible without increasing patient discomfort.

Acute coronary syndrome: social support and coping ability on admittance

AIM

To compare social support and coping ability in acute coronary syndrome patients at the time of the cardiac event with a healthy community-based sample, with regard to age, sex, education and marital status.

METHOD

The study comprised 241 patients and 316 healthy controls. The participants answered a self-administered questionnaire that included three well-established scales. Multiple logistic regression was used in the analysis to compare the health situation between the patients and controls.

RESULTS

Persons suffering from acute coronary syndrome rated emotional support significantly lower than the healthy controls. However, there were no differences between the two groups in terms of socio-demographic variables.

CONCLUSION

This study indicates that social support may be a predictor of acute coronary syndrome.

Caught in an artificial split: a phenomenological study of being a caregiver in the technologically intense environment

A symbiotic relationship exists between technology and caring, however, technologically advanced environments challenge caregivers. The aim of this study is to uncover the meaning of being a caregiver in the technologically intense environment. Ten open-ended interviews with intensive care personnel comprise the data. A phenomenological analysis shows that ambiguity abounds in the setting. The act of responsibly reading and regulating instruments easily melds the patient and the machinery into one clinical picture. The fusion skews the balance between objective distance and interpersonal closeness. The exciting captivating lure of technological gadgets seduces the caregivers and lulls them into a fictive sense of security and safety. It is mind-boggling and heart-rending to juggle 'moments' of slavish mastery and security menaced by insecurity in the act of monitoring a machine while caring for a patient. Whenever the beleaguered caregiver splits technique from human touch, ambiguity decays into ambivalence. Caring and technology become polarized. Everyone loses. Caregiver competence wanes; patients suffer. The intensive care unit should be technologically sophisticated, but also build-in a disclosive space where solace, trust, and reassurance naturally happen. Caring professionals need to balance state-of-the-art technology with integrated and comprehensive care and harmonize the demands of subjectivity with objective signs.

Stressful memories and psychological distress in adult mechanically ventilated intensive care patients - a 2-month follow-up study

AIM

To investigate patients' psychological distress in relation to memory and stressful experiences in the intensive care unit (ICU), and to identify early predictors for the development of high levels of acute post-traumatic stress disorder (PTSD)-related symptoms.

METHODS

A prospective cohort study was performed over 18 months in two general ICUs, including 313 intubated mechanically ventilated adults admitted for more than 24 h, 226 of whom completed the study. Patients were interviewed 5 days and 2 months post-ICU concerning their memories and psychological distress. The instruments used were the ICU Memory Tool, ICU Stressful Experience Questionnaire, Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised (IES-R).

RESULTS

High symptom levels of anxiety, depression and acute PTSD 2 months post-ICU were present in 4.9%, 7.5% and 8.4% of the 226 patients, respectively. Psychological distress 2 months post-ICU was associated with experiences of the ICU rated as extremely stressful and with high levels of anxiety and depression 5 days post-ICU, but not with amnesia or delusional memories without factual recall of the ICU. Female sex, signs of agitation (increasing proportion of Motor Activity Assessment Scale scores of 4-6) and feelings of extreme fear during the ICU stay were significantly and independently associated with IES-R scores of 30 or more.

CONCLUSIONS

Extremely stressful experiences of the ICU are associated with subsequent psychological distress. Female sex, agitation and extreme fear during the ICU stay seem to increase the risk of developing high levels of acute PTSD-related symptoms.

Computer-supported telephone nurse triage: an evaluation of medical quality and costs

AIM

To evaluate a telephone nurse triage model in terms of appropriateness of referrals to the appropriate level of care, patient's compliance with given advice and costs.

BACKGROUND

A key concern in each telephonic consultation is to evaluate if appropriate.

METHOD

An evaluative design in primary health care with consecutive patients (N = 362) calling telephone nurse triage between November 2002 and February 2003.

RESULTS

The advice was considered adequate in 325 (97.6%) cases. The patients' compliance with self-care was 81.3%, to primary health care 91.1% and to Accident and Emergency department 100%. The nurses referred self-care cases (64.7%) and Accident and Emergency cases (29.6%) from a less adequate to an appropriate level of care. The cost saving per call leading to a recommendation of self-care was euro 70.3, to primary health care euro 24.3 and to Accident and Emergency department euro 22.2.

CONCLUSIONS

The telephone nurse triage model showed adequate guidance for the patients concerning level of care and released resources for the benefit of both patients and the health care system.

Effects of a self-care program on the health-related quality of life of pacemaker patients: a nursing intervention study

An experimental, multi-centre, randomized study with a nurse-led intervention was conducted with the aim of evaluating the effects on HRQoL of a 10-month self-care program for pacemaker patients. In the present study, there were no significant differences in HRQoL when comparisons were made between the experimental group and the control group. Results show two main findings for patients in the self-care program (n = 97; mean age 71 years): a significantly better HRQoL in terms of experiencing the symptoms that were the reason for pacemaker implantation, as having decreased or disappeared, and a higher level of perceived exertion in a 1 1/2-minute stair test compared with patients who had standard checkups (n = 115; mean age 73 years). It is important to actively include pacemaker patients in a self-care program while still in the acute phase in the hospital. Health care professionals should support the patient in a kind and professional manner by providing clear, relevant information, and planning a self-care program based on the nurse's assessment of the patient's needs. To enable patients to manage their life situations, training and continued education for health care professionals is necessary so that their efforts are based on a holistic approach to nursing care and recognition of the patient perspective, with emphasis on developing education and counselling for women, patients with atrial fibrillation/sick sinus disease, and patients whose pacemakers have ventricular pacing.

Primary Health Care Nurses' conceptions of involuntarily migrated families' health

BACKGROUND

Involuntary migration and adaptation to a new cultural environment is known to be a factor of psychological stress. Primary Health Care Nurses (PHCNs) frequently interact with refugee families as migrant health needs are mainly managed within Primary Health Care.

AIM

To describe the health of the involuntary migrated family in transition as conceptualized by Swedish PHCNs.

METHOD

Thirty-four PHCNs from two municipalities in Sweden were interviewed and phenomenographical contextual analysis was used in analysing the data.

FINDINGS

Four family profiles were created, each epitomizing the health characteristics of a migrated family in transition: (1) a mentally distressed family wedged in the asylum-seeking process, (2) an insecure family with immigrant status, (3) a family with internal instability and segregated from society, and (4) a stable and well-functioning family integrated in society. Contextual socio-environmental stressors such as living in uncertainty awaiting asylum, having unprocessed traumas, change of family roles, attitudes of the host country and social segregation within society were found to be detrimental to the well-being of the family.

CONCLUSION

Acceptance and a clear place in society as well as clearly defined family roles are crucial in facilitating a healthy transition for refugee families. Primary Health Care Nursing can facilitate this by adopting a family system perspective in strengthening the identity of the families and reducing the effects of socio-environmental stressors.

Primary Health Care Nurses' conceptions of involuntarily migrated families' health

BACKGROUND

Involuntary migration and adaptation to a new cultural environment is known to be a factor of psychological stress. Primary Health Care Nurses (PHCNs) frequently interact with refugee families as migrant health needs are mainly managed within Primary Health Care.

AIM

To describe the health of the involuntary migrated family in transition as conceptualized by Swedish PHCNs.

METHOD

Thirty-four PHCNs from two municipalities in Sweden were interviewed and phenomenographical contextual analysis was used in analysing the data.

FINDINGS

Four family profiles were created, each epitomizing the health characteristics of a migrated family in transition: (1) a mentally distressed family wedged in the asylum-seeking process, (2) an insecure family with immigrant status, (3) a family with internal instability and segregated from society, and (4) a stable and well-functioning family integrated in society. Contextual socio-environmental stressors such as living in uncertainty awaiting asylum, having unprocessed traumas, change of family roles, attitudes of the host country and social segregation within society were found to be detrimental to the well-being of the family.

CONCLUSION

Acceptance and a clear place in society as well as clearly defined family roles are crucial in facilitating a healthy transition for refugee families. Primary Health Care Nursing can facilitate this by adopting a family system perspective in strengthening the identity of the families and reducing the effects of socio-environmental stressors.

Heart failure management programmes in Europe

BACKGROUND

The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe.

METHOD

A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes; and a survey to describe the content in countries where at least 30% of the hospitals had a programme.

RESULTS

Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding.

CONCLUSION

Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

Nurse specialists in adult congenital heart disease: the current status in Europe

AIM

Recommendations for the management of adults with congenital heart disease indicate that specialist referral centres should employ nurse specialists who are trained and educated in the care for these patients. We surveyed the involvement, education and activities of nurse specialists in the care for adults with congenital cardiac anomalies in Europe.

METHODS

The Euro Heart Survey on Adult Congenital Heart Disease has previously showed that 20 out of 48 specialist centres (42%) have nurse specialists affiliated with their programme. Fifteen of these 20 centres (75%) validly completed a web-based survey tool.

RESULTS

Specialist centres had a median number of 2 nurse specialists on staff, corresponding with 1 full-time equivalent. In most centres, the nurse specialists were also affiliated with other cardiac care programmes, in addition to congenital heart disease. The involvement of nurse specialists was not related to the caseload of inpatients and outpatient visits. Physical examination was the most prevalent activity undertaken by nurse specialists (93.3%), followed by telephone accessibility (86.7%), patient education (86.7%), co-ordination of care (73.3%), and follow-up after discharge (73.3%). Patient education covered mainly prevention and prophylaxis of endocarditis (100%), cardiovascular risk factors (92.3%), sport activities (92.3%), the type and characteristics of the heart defect (92.3%), the definition and aetiology of endocarditis (84.6%), cardiac risk in case of pregnancy (84.6%), and heredity (84.6%). Two third of the nurse specialists were involved in research.

CONCLUSION

This survey revealed gaps in the provision of care for these patients in Europe and demonstrated that there is room for improvement in order to provide adequate chronic disease management. The results of this study can be used by individual hospitals for benchmarking.

Life events, social support and sense of coherence among frequent attenders in primary health care

OBJECTIVES

The aim of this survey was to compare stressful life events, social support and sense of coherence (SOC) between frequent attenders (FAs) and normal attenders (controls) in primary health care.

STUDY DESIGN

A cross-sectional study was conducted in a primary healthcare centre in the south-west of Sweden.

METHODS

A postal questionnaire was sent to 263 frequent attenders and 703 normal attenders. The questionnaire comprised sociodemographic variables and scales of stressful life events, social support and SOC. The results from the questionnaire were compared between the groups, and the significance of the variables in terms of attendance was tested in a multiple regression analysis.

RESULTS

More of the FAs were secondarily single, they had more chronic diseases and were more often living on a sickness/disablement pension than the controls. FAs did not report more stressful life events than the controls nor was their experience of events more negative. Social support was as strong among FAs as among controls, and it had no significant effect on their frequent attendance. FAs had a significantly weaker SOC compared with controls. The variables that significantly influenced frequent attendance were high age [odds ratio (OR) = 1.02], chronic disease (OR = 3.08), sickness/disablement pension (OR = 2.46) and SOC (OR = 0.97).

CONCLUSIONS

SOC had a significant influence on frequent attendance in primary health care, but stressful life events and social support did not. FAs did not report more stressful life events. However, due to an inadequate coping strategy, indicated by a weak SOC, the life events probably caused them more symptoms and diseases, and thereby a higher consulting frequency.

Patients with heart failure in primary health care: effects of a nurse-led intervention on health-related quality of life and depression

AIMS

To determine the effects of a nurse-led intervention designed to improve self-management of patients with heart failure in a primary health care setting regarding health-related quality of life and depression.

METHODS

Patients at eight primary health care centres were screened by the Diagnosis Related Groups registry for the diagnosis of heart failure and eligibility for a cluster randomised study. A total of 153 patients were included (n=78 in the intervention group, 54% males, mean age 79 years, 59% in New York Heart Association class III-IV). The intervention involved patient and family education about heart failure and self-management and monthly telephone follow-up during 12 months by a primary health care nurse.

RESULTS

The effects of the nurse-led intervention were limited. Significant differences were found in the physical dimension measured by the SF-36 health survey, and in depression measured by the Zung Self-rating Depression Scale. In comparison within groups at the 3 and 12-month follow-up, the intervention group significantly maintained their health-related quality of life measured by the SF-36 health survey, and their experience of depression measured by the Zung Self-rating Depression Scale to a greater extent than in the control group, especially among women.

CONCLUSION

A nurse-led intervention directed toward patients with heart failure in a primary health care setting resulted in limited effects between the groups, although the physical and mental status were retained during 12 months of follow-up to a greater extent than in the control group.

Nurse-led follow-up on demand or by a physician after breast cancer surgery: a randomised study

The value of routine follow-up with frequent visits to a breast cancer specialist-both in terms of detection of recurrence and patient satisfaction-has been questioned. The aim of this study was to compare nurse-led follow-up on demand versus physician follow-up after breast cancer treatment with regards to patients' well-being, satisfaction, access to medical care and medical safety. Two hundred and sixty-four consecutively selected women with newly diagnosed breast cancer, classified as UICC stage I or stage II, were randomised to follow-up at two hospitals in Sweden, either by routine medical follow-up, the physician group (PG, n=131), or on demand by a specialist nurse, the nurse group (NG, n=133). Measures were done at baseline and twice a year over a period of 5 years by means of a questionnaire containing the Hospital Anxiety and Depression Scale (HAD), and the Satisfaction and Accessibility (SaaC) scale. Number of contacts with the health care services, number of diagnostic procedures, and time to recurrence or death were monitored. The ratings of HAD and SaaC did not show any statistically significant differences between the groups. The levels of anxiety and depression were generally low and levels of patient satisfaction high. There were no differences between the groups concerning time to recurrence or death. This study indicates that women with breast cancer in stages I to II can be followed up by a specialist nurse with high patient satisfaction and good medical safety.

Cancer patients' experiences of care related to pain management before and after palliative care referral

Pain is the main problem for patients with cancer referred to palliative care (PC). Pain management in PC requires a multidimensional approach. A questionnaire was used to determine cancer patients' experiences of care related to pain management, before and after being referred to PC, and to also discover possible correlations between pain control and other aspects of care. Seventy-five consecutive patients from two PC teams were included in the study. The patients had experienced a statistically significant (P < 0.01) improvement in care after being referred to PC, despite the fact that pain control had not been optimized. Patients' description of 'pain control' after being referred to PC had a statistically significant correlation with their 'feeling of security' and 'continuity of care' throughout the same period. The conclusion is that care provided in PC is vital to successful pain management. Pain control depends not only on analgesics but also on many other aspects of care provided by the nurse. Continuity of care and the opportunity to talk increases the patients' feeling of security, which is also of utmost importance to successful pain management.

Time distribution factors of hospital and home care among chronic haemodialysis patients

Today, many studies are available that focus on haemodialysis; however studies on the time distribution factor involved are lacking. It is therefore important to study the distribution of time, taking into account outpatient care, inpatient care and home care. The aim of the study was to chart over a five-year period, the time distribution factors of hospital care and home care among chronic haemodialysis patients. The design of the study was descriptive, and the data material was drawn from a patient register (N = 61). The data analysis was performed by means of both descriptive and inferential statistics.

Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial

AIM

The aim of this trial was to prospectively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality, morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge.

METHODS

A total of 106 patients were randomly assigned to either follow-up at a nurse-led heart failure clinic or to usual care. The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses, delegated the responsibility for making protocol-led changes in medications. The first follow-up visit was 2-3 weeks after discharge. During the visit the nurse evaluated the heart failure status and the treatment, gave education about heart failure and social support to the patient and his family.

RESULTS

There were fewer patients with events (death or admission) after 12 months in the intervention group compared to the control group (29 vs 40, p=0.03) and fewer deaths after 12 months (7 vs 20, p=0.005). The intervention group had fewer admissions (33 vs 56, p=0.047) and days in hospital (350 vs 592, p=0.045) during the first 3 months. After 12 months the intervention was associated with a 55% decrease in admissions/patient/month (0.18 vs 0.40, p=0.06) and fewer days in hospital/patient/month (1.4 vs 3.9, p=0.02). The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group (p=0.02 and p=0.01).

CONCLUSIONS

Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.