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Participation in the Care Encounter among Patients with Heart Failure Receiving Home-care
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Department of Nursing, School of Health Sciences, Jönköping, Sweden.
Department of Care Science, Malmö University, and Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Sweden.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0002-4259-3671
2013 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background Heart failure is a chronic condition that affects patients’ life situation. Living with heart failure puts high demands on self-care and patient participation. Patients often need advanced care due to deterioration of their heart failure symptoms, and one option is homecare. Prerequisites for participation may differ when receiving home-care.

Objective The aim of this study was to identify and describe participation in care encounters during home visits in heart failure home-care.

Participants and setting Seventeen patients diagnosed with heart failure, aged 63-95 years, and ten registered nurses participated. The patients received home-care from three different home-care providers in Sweden.

Methods Data from nineteen home visits was collected through observations and documented by video-recordings. The verbal communication in these video-recordings was transcribed verbatim and complemented with non-verbal communication. Data was analysed using qualitative content analysis, and the video-recordings and transcribed material were analysed in parallel.

Results We identified two themes with three and four categories respectively; (a) Participation in the care encounter is made possible by interaction, including exchange of care-related information, care-related reasoning, and collaboration, and (b) Participation in the care encounter is made possible by an enabling approach, including the patient expresses their own wishes and shows an active interest, and the nurse is committed and invites to a dialogue.

Conclusion Our findings underline that patient participation is multifaceted and that the home-care context shows good potential for patient participation as the care encounters were categorised by interaction and an enabling approach.

Place, publisher, year, edition, pages
2013.
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-117093OAI: oai:DiVA.org:liu-117093DiVA: diva2:805493
Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2015-04-15Bibliographically approved
In thesis
1. Participation in heart failure home-care: Patients’ and partners’ perspectives
Open this publication in new window or tab >>Participation in heart failure home-care: Patients’ and partners’ perspectives
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Patient participation is important for improving outcomes and respecting selfdetermination and legal aspects in care. Heart failure is a chronic condition that puts high demands on self-care and patient participation. Patients often need advanced care due to deterioration of their heart failure symptoms, and one option is to provide care as home-care. There is limited knowledge of how patients with heart failure and their partners view participation in home-care.

Aim: The overall aim of this thesis was to describe different perspectives of participation in structured heart failure home-care among patients with heart failure and their partners.

Methods: All patients in this thesis received structured heart failure home-care, according to a model aiming to facilitate care, where safety, participation, and gaining knowledge about the illness and treatment, are in focus. Study I had a prospective pre-post longitudinal design including 100 patients with heart failure receiving home-care. Data was collected by selfadministered questionnaires. Study II had a descriptive design. Nineteen patients receiving home-care were interviewed, and data was analysed using qualitative content analysis. Study III had a descriptive and explorative design. Data was collected by video-recorded observations of 19 home visits and analysed by qualitative content analysis. Study IV had a parallel convergent mixed-method design including 15 partners of patients receiving structured home-care. Data was collected by interviews and self-administered questionnaires. Datasets were first analysed separately and then together.

Results: Better self-care behaviour was significantly associated with all measured aspects of participation. Participation by received information increased significantly during the 12-month follow-up (I). Patients’ descriptions of participation included communication between patients and health care professionals, access to care, active involvement in care, a trustful relation with health care professionals, and options for decision-making(II). Observed care encounters revealed that participation was made possible by; (i) interaction, including exchange of care-related information, care-related reasoning, and collaboration, (ii) an enabling approach, including the patient expresses own wishes and shows an active interest, and the nurse is committed and invites to a dialogue (III). Partners scored fairly positive for their participation in care and they performed different levels of caregiving tasks. Descriptions of participation included; adapting to the caring needs and illness trajectory, mastering caregiving demands, interacting with care providers, and gaining knowledge to comprehend the health situation. The mixed-method results showed both convergent results and expanded knowledge (IV).

Conclusions: Structured heart failure home-care facilitated participation both for patients and their partners. Patient participation with regard to received information improved significantly after receiving home-care. Aspects of patient participation were consistently associated with better self-care behaviour. Patients’ and partners’ descriptions revealed many aspects of participation, and observed home visits revealed how interaction and an enabling approach underpinned participation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 81 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1449
Keyword
Heart failure; home-care; involvement; mixed-method design; participation; partner; qualitative content analysis; self-care
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117095 (URN)10.3384/diss.diva-117095 (DOI)978-91-7519-116-4 (ISBN)
Public defence
2015-05-13, Berzeliussalen, Campus US, LInköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2015-04-30Bibliographically approved

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Näsström, LenaStrömberg, Anna

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Nursing ScienceFaculty of Health SciencesDepartment of Cardiology in Linköping
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