liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Flemme, Inger
Publications (10 of 12) Show all publications
Årestedt, K., Ågren, S., Flemme, I., Moser, D. K. & Strömberg, A. (2015). A psychometric evaluation of the four-item version of the Control Attitudes Scale for patients with cardiac disease and their partners. European Journal of Cardiovascular Nursing, 14(4), 317-325
Open this publication in new window or tab >>A psychometric evaluation of the four-item version of the Control Attitudes Scale for patients with cardiac disease and their partners
Show others...
2015 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 4, p. 317-325Article in journal (Refereed) Published
Abstract [en]

Background:The four-item Control Attitudes Scale (CAS) was developed to measure control perceived by patients with cardiac disease and their family members, but extensive psychometric evaluation has not been performed.Objective:The aim was to translate, culturally adapt and psychometrically evaluate the CAS in a Swedish sample of implantable cardioverter defibrillator (ICD) recipients, heart failure (HF) patients and their partners.Methods:A sample (n=391) of ICD recipients, HF patients and partners were used. Descriptive statistics, item-total and inter-item correlations, exploratory factor analysis, ordinal regression modelling and Cronbach's alpha were used to validate the CAS.Results:The findings from the factor analyses revealed that the CAS is a multidimensional scale including two factors, Control and Helplessness. The internal consistency was satisfactory for all scales (α=0.74-0.85), except the family version total scale (α=0.62). No differential item functioning was detected which implies that the CAS can be used to make invariant comparisons between groups of different age and sex.Conclusions:The psychometric properties, together with the simple and short format of the CAS, make it to a useful tool for measuring perceived control among patients with cardiac diseases and their family members. When using the CAS, subscale scores should be preferred.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keywords
Family; heart disease; prevention and control; psychometrics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-107731 (URN)10.1177/1474515114529685 (DOI)000357949600006 ()24671774 (PubMedID)
Available from: 2014-06-19 Created: 2014-06-19 Last updated: 2017-12-05
Flemme, I., Johansson, I. & Strömberg, A. (2012). Living with life-saving technology - coping strategies in implantable cardioverter defibrillators recipients. Journal of Clinical Nursing, 21(3-4), 311-321
Open this publication in new window or tab >>Living with life-saving technology - coping strategies in implantable cardioverter defibrillators recipients
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, p. 311-321Article in journal (Refereed) Published
Abstract [en]

Aims.  To describe coping strategies and coping effectiveness in recipients with an implantable cardioverter defibrillator and to explore factors influencing coping.

Background.  Implantable cardioverter defibrillators are documented as saving lives and are used to treat ventricular tachycardia and ventricular fibrillation. Despite the implantable cardioverter defibrillator not evidently interfering with everyday life, there is conflicting evidence regarding the psychosocial impact of an implantable cardioverter defibrillator implantation such as anxiety, depression, perceived control and quality of life and how these concerns may relate to coping.

Design.  Cross-sectional multicentre design.

Methods.  Individuals (n = 147, mean age 63 years, 121 men) who had lived with an implantable cardioverter defibrillator between 6–24 months completed the Jalowiec Coping Scale-60, Hospital Anxiety and Depression Scale, Control Attitude Scale and Quality of Life Index-Cardiac version.

Results.  Implantable cardioverter defibrillators recipients seldom used coping strategies, and the coping strategies used were perceived as fairly helpful. Optimism was found to be the most frequently used (1·8 SD 0·68) and most effective (2·1 SD 0·48) coping strategy, and recipients perceived moderate control in life. Anxiety (β = 3·5, p ≤ 0·001) and gender (β = 12·3, p = 0·046) accounted for 26% of the variance in the total use of coping strategies, suggesting that the more symptoms of anxiety and being women the greater use of coping strategies.

Conclusions.  Most recipients with an implantable cardioverter defibrillator did not appraise daily concerns as stressors in need of coping and seem to have made a successful transition in getting on with their lives 6–24 months after implantation.

Relevance to clinical practice.  Nurses working with recipients with an implantable cardioverter defibrillator should have a supportive communication so that positive outcomes such as decreased anxiety and increased perceived control and quality of life can be obtained. Through screening for anxiety at follow-up in the outpatient clinic, these recipients perceiving mental strain in their daily life can be identified.

Keywords
anxiety;arrhythmia;coping;depression;implantable cardioverter defibrillator;nurses;nursing;perceived control;quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-73443 (URN)10.1111/j.1365-2702.2011.03847.x (DOI)000298793400003 ()
Available from: 2012-01-03 Created: 2012-01-03 Last updated: 2017-12-08
Franzén Årestedt, K., Ågren, S., Flemme, I. & Strömberg, A. (2010). Psychometric properties of the Swedish version of the Control Attitude Sclae for patients with heart disease and their family members. Paper presented at 10th Annual Spring Meeting on Cardiovascular Nursing.
Open this publication in new window or tab >>Psychometric properties of the Swedish version of the Control Attitude Sclae for patients with heart disease and their family members
2010 (English)Conference paper, Published paper (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63202 (URN)
Conference
10th Annual Spring Meeting on Cardiovascular Nursing
Available from: 2010-12-13 Created: 2010-12-13 Last updated: 2013-09-03
Flemme, I., Johansson, I. & Strömberg, A. (2010). Quality of life and coping strategies in recipients with an implantablecardioverter defibrillator. In: 10th Annual Spring Meeting on Cardiovascular Nursing / European Journal of Cardiovascular Nursing 9 Suppl. 1 (2010). Paper presented at 10th Annual Spring Meeting on Cardiovascular Nursing / European Journal of Cardiovascular Nursing.
Open this publication in new window or tab >>Quality of life and coping strategies in recipients with an implantablecardioverter defibrillator
2010 (English)In: 10th Annual Spring Meeting on Cardiovascular Nursing / European Journal of Cardiovascular Nursing 9 Suppl. 1 (2010), 2010Conference paper, Published paper (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-66478 (URN)
Conference
10th Annual Spring Meeting on Cardiovascular Nursing / European Journal of Cardiovascular Nursing
Available from: 2011-03-16 Created: 2011-03-16 Last updated: 2013-09-03Bibliographically approved
Flemme, I. (2009). Living with life-saving technology: Long-term follow up of recipients with implantable cardioverter defibrillator. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Living with life-saving technology: Long-term follow up of recipients with implantable cardioverter defibrillator
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The evidence that treatment of life-threatening arrhythmia (LTA) with an Implantable Cardioverter Defibrillator (ICD) can prolong life is convincing. Living with a lifelong heart disease will gradually influence the everyday life and encompasses some or all aspects of life. In order to influence health outcomes, the impact of the ICD must be considered in a broader context including not only the physical, but also the psychological and social functioning of the individual.

The general aim of this thesis was to describe everyday life in recipients living with an ICD in a longterm perspective. The aim in Paper I was to describe changes in the life situation of recipients’ with an ICD over a period of 1 year. The aim in Paper II was to describe quality of life (QOL) and uncertainty in recipients who have an ICD and to predict QOL at long-term follow-up. Fifty-six recipients participated (I) and 35 of these recipients, who had survived at least five years, were further included (II). The Quality of Life Index-Cardiac version (I, II), Mishel Uncertainty in Illness Scale-Community version (I, II), Patient ICD Questionnaire (I) and multiple regression analysis (II) were used. Higher scores indicate higher QOL and uncertainty. The questionnaires were completed before implantation, three and twelve months after implantation (I) and also five years after implantation i.e. long-term follow up (II). At the long-term follow up, the average ICD recipient had lived with an ICD for six years and nine months (6.9 years). The results showed the overall QOL and QOL in the health/functioning domain were unchanged over time. QOL in the socio-economic (p= .002) and psychological/spiritual domains (p= .012) decreased in the first year. From baseline to long-term follow up, the QOL in the family domain (p= .011) and overall uncertainty (p= .002) decreased. Uncertainty related to the information decreased at year 1 in relation to baseline (p= .001).

The aim in Paper III was to illuminate the main concern of recipients living with an ICD and how they handle this in their daily life. Sixteen recipients who had lived with an ICD between six to twenty-four months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classical grounded theory. In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command”, illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.

The aim in Paper IV was to explore relationships between OQL, coping strategies, anxiety, depression and perceived control in recipients living with an ICD and to compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication. A cross-sectional, correlational, multicenter design was used, and 147 recipients who had lived with an ICD between six to twenty-four months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale. The results showed that anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of coping with optimistic coping being the most used coping strategy. There was no relationship between QOL and coping. No differences were found in QOL, coping, anxiety, depression and perceived control between recipients implanted either on a primary or secondary preventive indication or having the device less or more than one year.

In this thesis, it was concluded that the ICD recipients strived to resume command over their life (III) and the more control the recipients perceived the more satisfied they were with their QOL (IV) and the more symptoms of anxiety, depression and uncertainty they experienced the less satisfied they were with their QOL (II, IV). Coping strategies were used more frequently by ICD recipient perceiving more anxiety (IV). QOL was fairly good 6,9 years after implantation and ICD recipients felt less uncertain once they had passed the first year of their illness.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. p. 61
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1116
Keywords
Anxiety, arrhythmia, defibrillators, depression, grounded theory, perceived control, qualitative, quality of life, uncertainty
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18524 (URN)978-91-7393-654-5 (ISBN)
Public defence
2009-05-28, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2013-09-03Bibliographically approved
Flemme, I., Johansson, I. & Strömberg, A. (2009). Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator.
Open this publication in new window or tab >>Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator
2009 (English)Article in journal (Other academic) Submitted
Abstract [en]

Objectives: To explore relationships between quality of life (QOL), coping strategies, anxiety, depression and perceived control in recipients living with an implantable cardioverter defibrillator (ICD) and compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication.

Methods: A cross-sectional, correlational design was used, and 147 individuals (mean age 63 years, 121 men) who had lived with an ICD between 6 to 24 months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale.

Results: Anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of the use of coping strategies with optimism being the most used coping strategy. No relationship was found between QOL and the use of different coping strategies. No differences were found in QOL, coping, anxiety, depression and perceived control between ICD recipients having the device less or more than one year and treated either on a primary or secondary preventive indication.

Conclusions: Recipients with an ICD did not use a multitude of coping strategies, but anxiety increased the use of coping. Perceived control was the most influential predictor of QOL. Practice implications: Supportive long term follow up interventions should be tailored to the recipients that have problems adapting to the device and perceive poor control in everyday life and a decreased psychological well-being.

Keywords
Anxiety, arrhythmia, defibrillators, depression, perceived control, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18523 (URN)
Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2013-09-12Bibliographically approved
Flemme, I., Hallberg, U. & Strömberg, A. (2009). "Striving to resume command" - main concern for recipients of implantable cardioverter defibrillator.
Open this publication in new window or tab >>"Striving to resume command" - main concern for recipients of implantable cardioverter defibrillator
2009 (English)Article in journal (Other academic) Submitted
Abstract [en]

Background: Earlier studies have shown that individuals with implantable cardioverter defibrillator (ICD) experience fear, stress, anxiety, and depression in their daily life, but also feelings of gratitude, safety, and belief in the future. Uncertainty and restrictions in physical, psychological and social functioning are common responses to their experiences. Aim: The aim of the study was to illuminate the main concern of individuals living with an ICD and how they handle this in their daily life.

Method: Sixteen Swedish recipients (9 men) who had lived with a defibrillator for 6 to 24 months were interviewed during 2007. Data was collected and analyzed in a simultaneous process according to guidelines for classical grounded theory.

Results: In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command” illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.

Conclusions: Based on empirical data, a substantive theory was generated illuminating the main concern for ICD recipients and strategies they used to manage this in daily life. The theory deepens the understanding of the recipients´ striving to resume command over their lives in an ongoing adjustment process which they have to face. This knowledge has clinical relevance and suggests that nurses should support the ICD recipients in this respect and thereby contribute to optimizing their sense of control in daily life. Future research could focus on the role of family members of ICD recipients and in what way they can support rather than overprotect their closely related.

Keywords
Defibrillators, implantable, heart diseases, nursing, qualitative research, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18522 (URN)
Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2013-09-03Bibliographically approved
Flemme, I., Edvardsson, N., Hinic, H., Jinhage, B.-M., Dalman, M. & Fridlund, B. (2005). Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator. Heart & Lung, 34(6), 386-392
Open this publication in new window or tab >>Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator
Show others...
2005 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 34, no 6, p. 386-392Article in journal (Refereed) Published
Abstract [en]

PURPOSE: This study describes the quality of life (QOL) and uncertainty in patients who have an implantable cardioverter defibrillator (ICD) and predicts QOL at long-term follow-up.

METHODS: Long-term follow-up was defined as 6.9 years +/- 1 year (range 4.11-8.7 years). QOL was measured with the Quality of Life Index, and uncertainty was measured with the Mishel Uncertainty in Illness Scale.

RESULTS: The overall QOL and health/functioning were unchanged over time. QOL in the socioeconomic (P = .002) and psychologic/spiritual domains (P = .012) decreased in the first year. From baseline to long-term follow-up, the QOL in the family domain (P = .011) and uncertainty (P = .002) decreased. Uncertainty was a predictor of low QOL.

CONCLUSION: QOL was reasonably good 6.9 years post-ICD implantation. Patients felt less uncertain once they had passed the first year of their illness.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18521 (URN)10.1016/j.hrtlng.2005.05.003 (DOI)16324957 (PubMedID)
Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2017-12-13Bibliographically approved
Flemme, I. (2004). Health-related quality of life in recipients with an implantable cardioverter defibrillator due to life-threatening arrhythmias: a 5 year follow-up. (Licentiate dissertation).
Open this publication in new window or tab >>Health-related quality of life in recipients with an implantable cardioverter defibrillator due to life-threatening arrhythmias: a 5 year follow-up
2004 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to describe self-reported health-related quality of life (HRQoL) in recipients with an implantable cardioverter defibrillator (ICD) due to life-threatening arrhythmias over a 5-year period. The design was prospective and longitudinal. Fifty-six patients participated in Paper I, and 35 of these patients, who had survived at least five years, were included in paper II. All patients had received their ICD as a form of secondary prevention. The Quality of Life Index-Cardiac version (QLI-C), Mishel Uncertainty in Illness Scale-Community version (MUIS-C), and multiple regression analysis were used. Higher scores indicate higher HRQoL and uncertainty. The questionnaires were completed on four occasions: before implantation, at three months and at 1 year and 5 years after implantation. ICD recipients were also asked how many shocks they had perceived. At the 5-year data collection, the average ICD recipient had lived with an ICD for 6 years and 9 months. In general HRQoL was lower at year 1 than at baseline (p = 0-033). A decrease in the socioeconomic domain was observed at year 1 (p = 0.006) but improved again at year 5 (p = 0.027) although it remained below the baseline value. ICD recipients' satisfaction with the family domain decreased from the time of the ICD implantation (p < 0.001) and from year 1 (p = 0.039) to year 5 after implantation. Uncertainty related to information had decreased at year 1 in relation to baseline (p < 0.001). A decrease in overall uncertainty was observed at year 5 in relation to year 1 (p = 0.009) as well as at year 6 in relation to baseline (p = 0.009). The longer the ICD recipient had lived with the device, the greater the risk of receiving a shock. However, ICD recipients who received shocks reported being less troubled by them over time. Uncertainty was identified as a predictor of Low HRQoL. The recipients reported a higher level of HRQoL at year 5 than at year 1. HRQoL was reasonably good 5 years after implantation, and the ICD recipients felt more secure and perceived their ICD as a lifesaver.

Publisher
p. 52
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 67
Series
Omvårdnadsforskning vid Hälsouniversitetet i Linköping ; 13
Keywords
defibrillators implantable, ICD shocks, life-threatening arrhythmia, quality of life, satisfaction, uncertainty
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24302 (URN)3921 (Local ID)91-7373-844-1 (ISBN)3921 (Archive number)3921 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-09-10
Bolse, K., Flemme, I., Ivarsson, A., Jinhagen, B.-M., Carroll, D., Edvardsson, N., . . . Fridlund, B. (2002). Life situation related to the ICD implantation: self-reported uncertainty and satisfaction in Swedish and US samples. European Journal of Cardiovascular Nursing, 1(4), 243-251
Open this publication in new window or tab >>Life situation related to the ICD implantation: self-reported uncertainty and satisfaction in Swedish and US samples
Show others...
2002 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 1, no 4, p. 243-251Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to describe changes in the life situation related to the ICD implantation of Swedish and US samples with regard to uncertainty and satisfaction. The life situation was measured by reference to the uncertainty caused by the condition and satisfaction with the life situation. Inferential statistics were used to analyse changes within and between the Swedish and US samples. Uncertainty showed a statistically significant difference between the Swedish and US samples before as well as after the ICD implantation. A higher level of uncertainty was indicated for the US sample prior to the ICD implantation and for the Swedish sample following the implantation. In the Swedish sample, satisfaction with life showed a statistically significant difference within the socio-economic domain, indicating a higher degree of satisfaction 3 months after implantation. Satisfaction within the domains of health and functioning, socio-economics and psychological-spiritual showed a statistically significant difference between the Swedish and US samples both before and after ICD implantation, indicating a higher degree of satisfaction in the US sample. The previous study shows that the ICD-patient's life situation is changed after the implantation and that it is necessary to provide the patient with information and education based on their own preconditions. The fact that US sample was investigated at a later stage after ICD implantation than the Swedish sample may have influenced the results of the study.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26818 (URN)10.1016/S1474-5151(02)00048-8 (DOI)11431 (Local ID)11431 (Archive number)11431 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
Organisations

Search in DiVA

Show all publications