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  • 1.
    Eckerblad, Jeanette
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Eriksson, Helene
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nurses conceptions of facilitative strategies of weaning patients from mechanical ventilation-A phenomenographic study2009In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 25, no 5, p. 225-232Article in journal (Refereed)
    Abstract [en]

    Background: Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality. Purpose: The purpose of the present study was to describe different conceptions of nurses facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU). Method: Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed. Findings: The findings revealed three main categories of nurses facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications. Conclusion: Although these findings need to be confirmed by further studies we suggest that nurses variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.

  • 2.
    Grönlund, V.
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Finspång, Primary Health Care in Finspång. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Carlsson, A.
    Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    The desire for a good life - patients beliefs of self-care after a coronary event2013Conference paper (Other academic)
    Abstract [en]

         

    Introduction: After a first coronary event there is an increased risk for a recurrent event. Despite that risk, 1/5 of the patients continue to smoke, 1/3 is obese and more than half of the patients have elevated blood pressure and total cholesterol. Secondary preventive self-care activities are needed to improve outcomes and the belief of patients plays a vital role in changing behavior.                         

    Aim: To examine patients’ beliefs of self-care 6-12 months after a coronary event.                         

    Method: The study design was qualitative. Twenty-five patients, including 10 women, mean age 65 years with stable coronary artery disease participated in four focus group interviews. Data were taped, transcribed and analyzed according to the conventional content analysis.                         

    Findings: Patients’ belief of self-care is influenced by their desire of a good life even though life seems fragile. Patients try to live up to the standard of health care prescription and advices. However, these achievements require behavior change and conscious boundaries, which are challenged by various obstacles such as fear of, overstrain and stress. Physical activity is considered as both a source to well-being and a necessity, but patients are uncertain and afraid for overstraining. A healthy diet is seen as important but the advices given are sometimes contradictory and create confusion. Medication is found important but not at the cost of all the side-effects. Patients also report that in order to believe in their ability and to be responsible for self-care, support from health care providers is expected. But at the same time the invaluable support and information is often not provided, creating uncertainty.                         

    Discussion: The study highlights the patients’ perspective of self-care and what they view as important in self-care after an event of coronary artery disease. The patients’ expectations on health services comprise information, support and continuous follow-up. This is necessary to facilitate the patient’s responsibility for their own care.                         

    Conclusion: Patients’ beliefs about the concept of self-care after an event of coronary artery disease are multifaceted and voluminous compared to the health care definition. The findings of the study challenge health care policies approach to self-care. There is a need to reconsider and assess what and how secondary preventive patient education should be performed after an event of coronary artery disease.  

                        

  • 3.
    Grönlund, V.
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Finspång, Primary Health Care in Finspång. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Rudenas, A.
    Östergötlands Läns Landsting, Local Health Care Services in Finspång, Primary Health Care in Finspång. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Appel, M.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    Ednarsson, T.
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kärner Köhler, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Problem-based learning after Coronary artery disease - how do patients experience it?2014Conference paper (Other academic)
  • 4.
    Hjelmfors, Lisa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Problem-based learning used in the context of cardiac rehabilitation: different scenes and different roles2014In: Studies in Continuing Education, ISSN 0158-037X, E-ISSN 1470-126X, Vol. 36, no 2, p. 218-232Article in journal (Refereed)
    Abstract [en]

    Several studies show that how patients have difficulties in changing lifestyle even though such changes are essential because they are suffering from a life-threatening disease. Coronary artery disease (CAD) patients met 13 times during a year and used problem-based learning (PBL) to improve their empowerment and self-efficacy in making lifestyle changes. District nurses functioned as tutors, helping patients to formulate issues and to state self-care goals. To identify and describe the enactment of PBL, an ethnographic approach was used, including, for example, participant observations and interviews, all derived from six sessions of the education programme. Five different enactments were found, metaphorically expressed as: ‘The study circle’, ‘The classroom’, ‘The expert consultation’, ‘The therapy session’ and ‘The coffee party’. The education programme did not always function as it was supposed to according to the model, but perhaps this should not be seen as a failure of the pedagogical intervention since these enactments as a whole seem to be a way for the patients to be able to make healthy lifestyle changes. The metaphors can broaden the understanding of what can happen when implementing problem-based learning in health care practice.

  • 5.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    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.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Broström, Anders
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jönköping University, Sweden .
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Mårtensson, Jan
    Jönköping University, Sweden .
    Moons, Philip
    Katholieke University of Leuven, Belgium .
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Thompson, David R
    Australian Catholic University, Australia .
    A good manuscript review for the European Journal of Cardiovascular Nursing2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 2, p. 102-103Article in journal (Other academic)
  • 6.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Lärande i ett omvårdnadsperspektiv2009In: Omvårdnadens grunder: Perspektiv och förhållningssätt, Lund: Studentlitteratur , 2009, 1:1, p. 415-438Chapter in book (Other academic)
    Abstract [sv]

    Omvårdnadens grunder - Perspektiv och förhållningssätt syftar till att belysa omvårdnad ur olika perspektiv, för att ge underlag till kritisk diskussion och utveckling av ett reflekterat förhållningssätt i omvårdnadsarbetet. Ett antagande är att omvårdnad inte entydigt kan definieras, men genom att belysa det ur olika perspektiv skapas utkikspunkter från vilka omvårdnad kan "ses", studeras och problematiseras. I bokens kapitel medverkar ett 30-tal svenska experter, varav flertalet sjuksköterskor med doktorsexamen, och tecknar några utmaningar för framtiden. Boken tar utgångspunkt i livscykel och hälsa, vilket medför att ett flertal områden lyfts fram: patienten som person, mognad, växt, dagligt liv, kritiska övergångar mellan olika livsskeden, lidande, död, genus, sociala relationer, kulturell mångfald, livsstil, kommunikation, lärande och etik.

  • 7.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Patients’ and Spouses’ Perspectives on Coronary Heart Disease and its Treatment2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Lifestyle changes and drug treatment can improve the prognosis and quality of life for patients with coronary heart disease (CHD), but their co-operation with suggested treatment is often limited. The aim of this thesis was to study how patients and their spouses conceive CHD and its treatment.

    Material and Methods: The research design used was inductive and descriptive. The studies were based on three complementary sets of data. Patients with CHD (n=23) and spouses (n=25) were interviewed one year after an episode of the disease. Consecutive patients with CHD derived from another investigation were interviewed within six weeks or one year after the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken by hand, were subjected to analysis within the phenomenographic framework.

    Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay level. They were associated with symptoms rather than with the disease. Co-operation with drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits from lifestyle changes and treatment did not give the impression of being based on a solid understanding of the importance of such changes. Incentives for lifestyle changes were classified into four categories, all of which contained both facilitating and constraining incentives. Somatic incentives featured direct and indirect physical signals. Social/practical incentives involved shared concerns, changed conditions, and factors connected with external environment. Cognitive incentives were characterised by active decisions and appropriated knowledge, but also by passive compliance with limited insights, and by the creating of routines. Affective incentives comprised fear and reluctance related to lifestyle changes and disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The cognitive and the social/practical incentives were the most prevalent.

    Spouses’ understanding about the causes of CHD involved both appropriate conceptions and misconceptions. Drug treatment was considered necessary for the heart, but harmful to other organs. Spouses’ support to partners was categorised, and found to be contextually bound. The participative role was co-operative and empathetic. The regulative role controlled and demanded certain behaviours. The observational role was passive, compliant, and empathetic. The incapacitated role was empathetic, unable to support, and positive to changes. The dissociative role was negative to changes and reluctant to be involved in lifestyle changes.

    Conclusions: These results could be useful in the planning of care and education for CHD patients. The findings also emphasise the importance of adopting a family perspective to meet the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle changes.

    List of papers
    1. Patients' conceptions of coronary heart disease – a phenomenographic analysis
    Open this publication in new window or tab >>Patients' conceptions of coronary heart disease – a phenomenographic analysis
    2003 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 1, p. 43-50Article in journal (Refereed) Published
    Abstract [en]

    Readjustment after an event of coronary heart disease (CHD) is defined to comprise cognitive, instrumental and affective components. The cognitive dimension refers to understanding of the disease. Twenty-three patients (<60 years) with CHD were interviewed about the nature of their disease and encouraged to use their own words. The study was conducted 1 year after the event of myocardial infarction (MI) and some patients had also been revascularized. The interviews were transcribed in extenso and analysed according to the phenomenographic approach. The main finding was the great variation of conceptions revealed. Six different conceptions were found concerning CHD. Some patients comprehended MI by involving (A) blood and vessels, (B) either blood or vessel or referred to (C) risk factors/symptoms. Angina pectoris was expressed as (A) insufficient heart capacity, (B) atherosclerosis/contracted vessel or as (C) symptoms. Several patients found it difficult to expand their answers and some expressed misconceptions about the course of events. Patients' pre-existing knowledge and their way of reasoning about central phenomena related to their disease should be taken into consideration in patient education and is also applicable in individual encounters with patients.

    Keywords
    coronary disease, patient education, patient knowledge, qualitative analysis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13740 (URN)10.1046/j.1471-6712.2003.00113.x (DOI)
    Available from: 2008-11-13 Created: 2008-11-13 Last updated: 2017-12-13Bibliographically approved
    2. Conceptions on treatment and lifestyle in patients with coronary heart disease: a phenomenographic analysis
    Open this publication in new window or tab >>Conceptions on treatment and lifestyle in patients with coronary heart disease: a phenomenographic analysis
    2002 (English)In: Patient Education and Counseling, ISSN 0738-3991, Vol. 47, no 2, p. 137-143Article in journal (Refereed) Published
    Abstract [en]

    Twenty-three patients with an acute event of coronary heart disease (CHD) received routine care including information about medication and lifestyle changes. They were interviewed after 1 year about their conceptions concerning drug treatment and lifestyle changes. The interviews were taped, transcribed and analysed using the phenomenographic approach. Conceptions were hierarchically categorised with regard to level of understanding. The results showed that the patients’ understanding of the effects and health benefits of their treatment was superficial as judged on an informed layman level. The knowledge was fragmentary and mechanistic. Several misconceptions were revealed. Few answers related to prognostic benefits. However, a conception about effects of stopping drug intake was risk of relapse. Some patients considered fate and heredity as the main causes of CHD. Thus, our patients had not achieved an adequate understanding of CHD treatment. The level of knowledge was lower than anticipated.

    Keywords
    Coronary disease, Drug therapy, Lifestyle, Patient education, Patients and knowledge
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13741 (URN)10.1016/S0738-3991(01)00185-9 (DOI)
    Available from: 2008-11-13 Created: 2008-11-13 Last updated: 2016-08-31
    3. Coronary heart disease: causes and drug treatment - spouses’ conceptions
    Open this publication in new window or tab >>Coronary heart disease: causes and drug treatment - spouses’ conceptions
    2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 13, no 2, p. 167-176Article in journal (Refereed) Published
    Abstract [en]

    Background. Spouses are important in the rehabilitation process of their partner after coronary heart disease event. Their knowledge and attitudes have an impact on their support to the partner concerning lifestyle changes and drug treatment after an event.

    Aims and objectives. To explore spouses' conceptions concerning causes of coronary heart disease and drug treatment 1 year after the partner's cardiac event.

    Design. Qualitative with an empirical and inductive approach.

    Methods. Semi-structured interviews with strategically selected spouses (17 women and eight men) were taped. The transcripts were analysed within the phenomenographic framework.

    Results. Spouses' conceptions about causes of coronary heart disease and its treatment consisted of correct facts, as judged on a lay level, less elaborated conceptions and misconceptions. Among causes of coronary heart disease, the spouses were most knowledgeable about fat intake. They knew less about contributions from inactivity, stress and smoking. Ambivalent feelings were expressed about benefits vs. side effects of drugs. The treatment was conceived as necessary for the heart, but harmful for other organs. Men and women were evenly distributed in most of the derived categories. More women than men considered stress as a cause of coronary heart disease and also misconceived physical exercise to cause the disease.

    Conclusion. A variation of spouses' conceptions was revealed about causes of coronary heart disease and drug treatment. There was a lack of understanding concerning important parts of cardiac rehabilitation activities. These misconceptions may have implications by influencing their partner's co-operative behaviour.

    Relevance to clinical practice. Spouses' pre-existing conceptions of coronary heart disease and its treatment should be considered in the rehabilitation process of their partner. Couples with misconceptions should be given the opportunity to increase qualitatively their knowledge starting from their point of view rather than from that of the professional perspective.

    Keywords
    cardiovascular disease, causal attributions, drug treatment, phenomenography, risk factors, spouses
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13742 (URN)10.1046/j.1365-2702.2003.00871.x (DOI)
    Available from: 2005-12-23 Created: 2005-12-23 Last updated: 2016-08-31
    4. Rehabilitation after coronary heart disease: spouses’ views of support
    Open this publication in new window or tab >>Rehabilitation after coronary heart disease: spouses’ views of support
    2004 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 46, no 2, p. 204-211Article in journal (Refereed) Published
    Abstract [en]

    Background. Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles.

    Aim. The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes.

    Method. Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework.

    Findings. The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation.

    Conclusion. Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

    Keywords
    spouses, cardiac rehabilitation, support, communication, contextual analysis, phenomenography, nursing
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13743 (URN)10.1111/j.1365-2648.2003.02980.x (DOI)
    Available from: 2005-12-23 Created: 2005-12-23 Last updated: 2016-08-31
    5. Incentives for lifestyle changes in patients with coronary heart disease
    Open this publication in new window or tab >>Incentives for lifestyle changes in patients with coronary heart disease
    2005 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, no 3, p. 261-275Article in journal (Refereed) Published
    Abstract [en]

    Aim. This paper reports a study exploring how patients in the rehabilitation phase of coronary heart disease experience facilitating and constraining factors related to lifestyle changes of importance for wellbeing and prognosis.

    Background. Lifestyle change is important but complex during rehabilitation after a myocardial infarction or angina pectoris. The intentions to perform behaviours and to experience control over facilitators and constraints are important determinants of behaviour.

    Methods. A total of 113 consecutive patients below 70 years of age (84 men and 29 women) were interviewed within 6 weeks of a cardiac event and again after 1 year. Interview transcriptions and notes taken by hand were qualitatively analysed using the phenomenographic framework. The distribution of statements among the categories identified was quantitatively analysed. The data were collected in 1998–2000.

    Findings. Four main categories portrayed patients' experiences of facilitating or constraining incentives for lifestyle changes. 'Somatic incentives' featured bodily signals indicating improvements/illness. 'Social/practical incentives' involved shared concerns, changed conditions including support/demand from social network, and work/social security issues. Practical incentives concerned external environmental factors in the patients' concrete context. 'Cognitive incentives' were characterized by active decisions and appropriated knowledge, passive compliance with limited insights, and routines/habits. 'Affective incentives' comprised fear of and reluctance in the face of lifestyle changes/disease, lessened self-esteem, and inability to resist temptations. Cognitive incentives mostly facilitated physical exercise and drug treatment. Social/practical incentives facilitated physical exercise and diet change. Physical exercise and diet changes were mainly constrained by somatic, social, and affective incentives.

    Conclusion. The results illustrate important incentives that should be considered in contacts with patients and their families to improve the prospects of positively affecting co-operation with suggested treatment and lifestyle changes.

    Keywords
    adherence, cardiac rehabilitation, drug treatment, lifestyle changes, nursing, qualitative analysis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13744 (URN)10.1111/j.1365-2648.2005.03467.x (DOI)
    Available from: 2005-12-23 Created: 2005-12-23 Last updated: 2017-12-13
  • 8.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Coronary heart disease: causes and drug treatment - spouses’ conceptions2004In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 13, no 2, p. 167-176Article in journal (Refereed)
    Abstract [en]

    Background. Spouses are important in the rehabilitation process of their partner after coronary heart disease event. Their knowledge and attitudes have an impact on their support to the partner concerning lifestyle changes and drug treatment after an event.

    Aims and objectives. To explore spouses' conceptions concerning causes of coronary heart disease and drug treatment 1 year after the partner's cardiac event.

    Design. Qualitative with an empirical and inductive approach.

    Methods. Semi-structured interviews with strategically selected spouses (17 women and eight men) were taped. The transcripts were analysed within the phenomenographic framework.

    Results. Spouses' conceptions about causes of coronary heart disease and its treatment consisted of correct facts, as judged on a lay level, less elaborated conceptions and misconceptions. Among causes of coronary heart disease, the spouses were most knowledgeable about fat intake. They knew less about contributions from inactivity, stress and smoking. Ambivalent feelings were expressed about benefits vs. side effects of drugs. The treatment was conceived as necessary for the heart, but harmful for other organs. Men and women were evenly distributed in most of the derived categories. More women than men considered stress as a cause of coronary heart disease and also misconceived physical exercise to cause the disease.

    Conclusion. A variation of spouses' conceptions was revealed about causes of coronary heart disease and drug treatment. There was a lack of understanding concerning important parts of cardiac rehabilitation activities. These misconceptions may have implications by influencing their partner's co-operative behaviour.

    Relevance to clinical practice. Spouses' pre-existing conceptions of coronary heart disease and its treatment should be considered in the rehabilitation process of their partner. Couples with misconceptions should be given the opportunity to increase qualitatively their knowledge starting from their point of view rather than from that of the professional perspective.

  • 9.
    Kärner, Anita
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Rehabilitation after coronary heart disease: spouses’ views of support2004In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 46, no 2, p. 204-211Article in journal (Refereed)
    Abstract [en]

    Background. Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles.

    Aim. The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes.

    Method. Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework.

    Findings. The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation.

    Conclusion. Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

  • 10.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Göransson, Anne
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Conceptions on treatment and lifestyle in patients with coronary heart disease: a phenomenographic analysis2002In: Patient Education and Counseling, ISSN 0738-3991, Vol. 47, no 2, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Twenty-three patients with an acute event of coronary heart disease (CHD) received routine care including information about medication and lifestyle changes. They were interviewed after 1 year about their conceptions concerning drug treatment and lifestyle changes. The interviews were taped, transcribed and analysed using the phenomenographic approach. Conceptions were hierarchically categorised with regard to level of understanding. The results showed that the patients’ understanding of the effects and health benefits of their treatment was superficial as judged on an informed layman level. The knowledge was fragmentary and mechanistic. Several misconceptions were revealed. Few answers related to prognostic benefits. However, a conception about effects of stopping drug intake was risk of relapse. Some patients considered fate and heredity as the main causes of CHD. Thus, our patients had not achieved an adequate understanding of CHD treatment. The level of knowledge was lower than anticipated.

  • 11.
    Kärner, Anita
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Göransson, Anne
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Patients' conceptions of coronary heart disease – a phenomenographic analysis2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 1, p. 43-50Article in journal (Refereed)
    Abstract [en]

    Readjustment after an event of coronary heart disease (CHD) is defined to comprise cognitive, instrumental and affective components. The cognitive dimension refers to understanding of the disease. Twenty-three patients (<60 years) with CHD were interviewed about the nature of their disease and encouraged to use their own words. The study was conducted 1 year after the event of myocardial infarction (MI) and some patients had also been revascularized. The interviews were transcribed in extenso and analysed according to the phenomenographic approach. The main finding was the great variation of conceptions revealed. Six different conceptions were found concerning CHD. Some patients comprehended MI by involving (A) blood and vessels, (B) either blood or vessel or referred to (C) risk factors/symptoms. Angina pectoris was expressed as (A) insufficient heart capacity, (B) atherosclerosis/contracted vessel or as (C) symptoms. Several patients found it difficult to expand their answers and some expressed misconceptions about the course of events. Patients' pre-existing knowledge and their way of reasoning about central phenomena related to their disease should be taken into consideration in patient education and is also applicable in individual encounters with patients.

  • 12.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Wodlin, Peter
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Hjelmfors, Lisa
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study2012In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, no 110Article in journal (Refereed)
    Abstract [en]

    Background

    Even though there is convincing evidence that self-care, such as regular exercise         and/or stopping smoking, alters the outcomes after an event of coronary heart disease         (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention         programmes are structurally and pedagogically applied using adult learning principles         e.g. problem-based learning (PBL). Until now, most education programs for patients         with CHD have not been based on such principles. The basic aim is to discover whether         PBL provided in primary health care (PHC) has long-term effects on empowerment and         self-care after an event of CHD.     

    Methods/Design

    A randomised controlled study is planned for patients with CHD. The primary outcome         is empowerment to reach self-care goals. Data collection will be performed at baseline         at hospital and after one, three and five years in PHC using quantitative and qualitative         methodologies involving questionnaires, medical assessments, interviews, diaries and         observations. Randomisation of 165 patients will take place when they are stable in         their cardiac condition and have optimised cardiac medication that has not substantially         changed during the last month. All patients will receive conventional care from their         general practitioner and other care providers. The intervention consists of a patient         education program in PHC by trained district nurses (tutors) who will apply PBL to         groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients         in the control group will not attend a PBL group but will receive home-sent patient         information on 11 occasions during the year.     

    Discussion

    We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy         and empowerment to achieve self-care goals significantly more than one year of standardised         home-sent patient information. The assumption is that PBL will reduce cardiovascular         events in the long-term and will also be cost-effective compared to controls. Further,         the knowledge obtained from this study may contribute to improving patients’ ability         to handle self-care, and furthermore, may reduce the number of patients having subsequent         CHD events in Sweden.

  • 13.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Dahl, Lena
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Asklund, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    COR-PRIM: Patient education after coronary disease - Long-term evaluation in primary care2010Conference paper (Other academic)
  • 14.
    Kärner, Anita
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Hälsa - utbildning - välfärdsinstitutioner (HUV) .
    Pilhammar Andersson, Eva
    Inst. för vårdpedagogik Göteborgs universitet.
    Centrala begrepp av betydelse för patientundervisning - Kommentarer till kunskapssammanställningen2007In: Patientundervisning och patienters lärande / [ed] Gerthrud Östlinder, Stockholm: Gothia :Svensk sjuksköterskeförening , 2007, 1, p. 25-30Chapter in book (Other academic)
    Abstract [sv]

      Patientundervisning utgör en allt viktigare del i sjuksköterskans och andra yrkesgruppers professionella yrkesutövning i hälso- och sjukvården och omsorgen. För att vårdtagaren bättre ska kunna tillgodogöra sig undervisningen behövs en ökad och fördjupad kunskap om lärandeprocessen..Patientundervisning och patienters lärande beskriver lärandeprocesser och metoder för ett aktivt lärande i mötet mellan patient, närstående och vårdgivare. Den vänder sig till sjuksköterskor, arbetsterapeuter, sjukgymnaster, läkare och andra professionella yrkesutövare.

  • 15.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Bergdahl, Björn
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Incentives for lifestyle changes in patients with coronary heart disease2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, no 3, p. 261-275Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports a study exploring how patients in the rehabilitation phase of coronary heart disease experience facilitating and constraining factors related to lifestyle changes of importance for wellbeing and prognosis.

    Background. Lifestyle change is important but complex during rehabilitation after a myocardial infarction or angina pectoris. The intentions to perform behaviours and to experience control over facilitators and constraints are important determinants of behaviour.

    Methods. A total of 113 consecutive patients below 70 years of age (84 men and 29 women) were interviewed within 6 weeks of a cardiac event and again after 1 year. Interview transcriptions and notes taken by hand were qualitatively analysed using the phenomenographic framework. The distribution of statements among the categories identified was quantitatively analysed. The data were collected in 1998–2000.

    Findings. Four main categories portrayed patients' experiences of facilitating or constraining incentives for lifestyle changes. 'Somatic incentives' featured bodily signals indicating improvements/illness. 'Social/practical incentives' involved shared concerns, changed conditions including support/demand from social network, and work/social security issues. Practical incentives concerned external environmental factors in the patients' concrete context. 'Cognitive incentives' were characterized by active decisions and appropriated knowledge, passive compliance with limited insights, and routines/habits. 'Affective incentives' comprised fear of and reluctance in the face of lifestyle changes/disease, lessened self-esteem, and inability to resist temptations. Cognitive incentives mostly facilitated physical exercise and drug treatment. Social/practical incentives facilitated physical exercise and diet change. Physical exercise and diet changes were mainly constrained by somatic, social, and affective incentives.

    Conclusion. The results illustrate important incentives that should be considered in contacts with patients and their families to improve the prospects of positively affecting co-operation with suggested treatment and lifestyle changes.

  • 16.
    Kärner, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    P161 Poster COR-PRIM: Longitudinal Study on PBL in Self-Care after CVD Preliminary Results from a Pilot Study2011Conference paper (Other academic)
  • 17.
    Kärner Köhler, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 2, p. 332-341Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Spousal concordance on risk factors and lifestyle habits exists and can partly be explained by patients' and spouses' health beliefs and underuse of cardiac rehabilitation. However, there have been very few qualitative comparisons of health beliefs between patients and spouses after a cardiac event.

    AIM:

    To examine and qualitatively compare the health beliefs of patients with coronary heart disease and their spouses about lifestyle habits, 1 year after the cardiac event.

    DESIGN:

    Explorative and descriptive.

    METHOD:

    Semi-structured focus group interviews were conducted with patients (n = 14) 1 year after a cardiac event, as well as individual interviews with spouses (n = 8). The transcriptions underwent a deductive qualitative content analysis, within the framework of the Health Belief Model.

    FINDINGS:

    Patients' and spouses' health beliefs about lifestyle habits qualitatively differed in most predetermined main analytical categories of the Health Belief Model. The patients relied more on their own capacity and the healthcare system than on collaboration with their spouses who instead emphasised the importance of mutual activities to establish lifestyle habits. The spouses therefore experienced problems with different family preferences compared to the patients' wishes. Moreover, only patients believed supervised exercise was beneficial for risk reduction of coronary heart disease and they related barriers for medication to a self-healing body and a meaningless life without relatives and old habits. Patients and spouses agreed that despite the severity of illness, life was captured and that normalisation to a life as usual was possible.

    CONCLUSION:

    The patients' and spouses' qualitatively different health beliefs regarding health-related behaviours imply a new approach. Nurses and associated professionals need to follow-up patients' and spouses' in primary health care to support them in a tailored way, for example in problem-based sessions. Recognition and understanding of their different views and otherness could lead to compromises and goals to work with.

  • 18.
    Lundgren, Johan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Kärner Köhler, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Peter
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Internet-based cognitive behavior therapy for patients with heart failure and depressive symptoms: A proof of concept study2015In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 98, no 8, p. 935-942Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was (1) to describe the development of a guided internet-based CBT (ICBT) program adapted to patients with heart failure (HF) and (2) to evaluate the feasibility of the ICBT program in regard to depressive symptoms, the time used by health care providers to give feedback, and participants perceptions of the ICBT program. Method: A multi-professional team developed the program and seven HF patients with depressive symptoms were recruited to the study. The Patient Health Questionnaire-9 (PHQ-9) and the Montgomery Asberg Depression Rating-Self-rating scale (MADRS-S) were used to measure depression, and patients were interviewed about their perceptions of the program. Results: Based on research in HF and CBT, a nine-week program was developed. The median depression score decreased from baseline to the end of the study (PHQ-9: 11-8.5; MADRS-S: 25.5-16.5) and none of the depression scores worsened. Feedback from health care providers required approximately 3 h per patient. Facilitating perceptions.(e.g. freedom of time) and demanding perceptions (e.g. part of the program demanded a lot of work) were described by the patients. Conclusion: The program appears feasible and time-efficient. However, the program needs to be evaluated in a larger randomized study.

  • 19.
    Lundgren, Johan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Kärner Köhler, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    The effect of guided web-based cognitive behavioral therapy on patients with depressive symptoms and heart failure-: A randomized controlled trial.2016Conference paper (Other academic)
    Abstract [en]

    Background: The aims of this study were to: (I) evaluate the effect of a nine-week guided Internet-based Cognitive Behavioral Therapy (ICBT) program on depressive symptoms (DS) in patients with HF; (II) to assess factors associated with the change in DS; and (III) to investigate the effect of the ICBT program on cardiac anxiety and QoL.

    Methods: Fifty participants were included and randomized into two treatment arms: ICBT or an online moderated discussion forum (DF). Data were collected at baseline and at the nine-week follow-up; the Patient Health Questionnaire- nine, (DS); the Cardiac Anxiety Questionnaire, (cardiac-related anxiety); the Minnesota Living with Heart Failure questionnaire, (QoL). Intention to treat analysis was used. Between group differences were determined by analysis of covariance.

    Results: In the ICBT-group (n=25), DS improved significantly (P=.02). Also cardiac anxiety in the subscale of fear decreased significantly (P=.04) between baseline and the follow up in the ICBT-group. QoL improved in the ICBT-group by 6 points in the total score and 2.4 points in the physical factor, but this was not significant (P=.09 and P=.12). In the DF-group (n=25) no significant change in the level of DS was found (P=.36). There were no significant differences in the change in DS between the DF- and the ICBT-group (P=.21), nor in cardiac related anxiety (P=.22) or in QoL (total score P=.09, physical factor P=.07). In the ICBT-group, the number of logins to the web-portal correlated significantly with improvement in DS (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in DS.

    Conclusions: Guided ICBT adapted for persons with HF and DS can potentially reduce DS, cardiac anxiety and increase QoL, but is not statistically superior to participation in an online DF.

  • 20.
    Lundgren, Johan Gustav
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Kärner Köhler, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Peter
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    The Effect of Guided Web-Based Cognitive Behavioral Therapy on Patients With Depressive Symptoms and Heart Failure: A Pilot Randomized Controlled Trial.2016In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 18, no 8, p. 1-13, article id e194Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Depressive symptoms, and the associated coexistence of symptoms of anxiety and decreased quality of life (QoL), are common in patients with heart failure (HF). However, treatment strategies for depressive symptoms in patients with HF still remain to be established. Internet-based cognitive behavioral therapy (ICBT), as guided self-help CBT programs, has shown good effects in the treatment of depression. Until now, ICBT has not been evaluated in patients with HF with depressive symptoms.

    OBJECTIVE: The aims of this study were to (1) evaluate the effect of a 9-week guided ICBT program on depressive symptoms in patients with HF; (2) investigate the effect of the ICBT program on cardiac anxiety and QoL; and (3) assess factors associated with the change in depressive symptoms.

    METHODS: Fifty participants were randomized into 2 treatment arms: ICBT or a Web-based moderated discussion forum (DF). The Patient Health Questionnaire-9 was used to measure depressive symptoms, the Cardiac Anxiety Questionnaire (CAQ) was used to measure cardiac-related anxiety, and the Minnesota Living with Heart Failure questionnaire was used to measure QoL. Data were collected at baseline and at follow-up at the end of the 9-week intervention. Intention-to-treat analysis was used, and missing data were imputed by the Expectation-Maximization method. Between-group differences were determined by analysis of covariance with control for baseline score and regression to the mean.

    RESULTS: No significant difference in depressive symptoms between the ICBT and the DF group at the follow-up was found, [F(1,47)=1.63, P=.21] and Cohen´s d=0.26. Secondary within-group analysis of depressive symptoms showed that such symptoms decreased significantly in the ICBT group from baseline to the follow-up (baseline M=10.8, standard deviation [SD]=5.7 vs follow-up M=8.6, SD=4.6, t(24)=2.6, P=.02, Cohen´s d=0.43), whereas in the DF group, there was no significant change (baseline M=10.6, SD=5.0, vs follow-up M=9.8, SD=4.3, t(24)=0.93, P=.36. Cohen´s d=0.18). With regard to CAQ and QoL no significant differences were found between the groups (CAQ [d(1,47)=0.5, P=.48] and QoL [F(1,47)=2.87, P=.09]). In the ICBT group in the CAQ subscale of fear, a significant within-group decrease was shown (baseline M=1.55 vs follow-up M=1.35, P=.04). In the ICBT group, the number of logins to the Web portal correlated significantly with improvement in depressive symptoms (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in depressive symptoms. This study is underpowered because of difficulties in the recruitment of patients.

    CONCLUSIONS: Guided ICBT adapted for persons with HF and depressive symptoms was not statistically superior to participation in a Web-based DF. However, within the ICBT group, a statically significant improvement of depressive symptoms was detected.

    CLINICALTRIAL: Clinicaltrials.gov NCT01681771; https://clinicaltrials.gov/ct2/show/NCT01681771 (Archived by WebCite at http://www.webcitation.org/6ikzbcuLN).

  • 21.
    Lundgren, Johan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Peter
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Australian Catholic Univ, Australia.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Kärner Köhler, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Patient Experiences of Web-Based Cognitive Behavioral Therapy for Heart Failure and Depression: Qualitative Study2018In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 9, article id e10302Article in journal (Refereed)
    Abstract [en]

    Background: Web-based cognitive behavioral therapy (wCBT) has been proposed as a possible treatment for patients with heart failure and depressive symptoms. Depressive symptoms are common in patients with heart failure and such symptoms are known to significantly worsen their health. Although there are promising results on the effect of wCBT, there is a knowledge gap regarding how persons with chronic heart failure and depressive symptoms experience wCBT. Objective: The aim of this study was to explore and describe the experiences of participating and receiving health care through a wCBT intervention among persons with heart failure and depressive symptoms. Methods: In this qualitative, inductive, exploratory, and descriptive study, participants with experiences of a wCBT program were interviewed. The participants were included through purposeful sampling among participants previously included in a quantitative study on wCBT. Overall, 13 participants consented to take part in this study and were interviewed via telephone using an interview guide. Verbatim transcripts from the interviews were qualitatively analyzed following the recommendations discussed by Patton in Qualitative Research amp; Evaluation Methods: Integrating Theory and Practice. After coding each interview, codes were formed into categories. Results: Overall, six categories were identified during the analysis process. They were as follows: "Something other than usual health care," "Relevance and recognition," "Flexible, understandable, and safe," "Technical problems," "Improvements by real-time contact," and "Managing my life better." One central and common pattern in the findings was that participants experienced the wCBT program as something they did themselves and many participants described the program as a form of self-care. Conclusions: Persons with heart failure and depressive symptoms described wCBT as challenging. This was due to participants balancing the urge for real-time contact with perceived anonymity and not postponing the work with the program. wCBT appears to be a valuable tool for managing depressive symptoms.

  • 22.
    Ranheim, Albertine Elisabeth
    et al.
    Department of Health, Care and Social Welfare, Division of Caring Sciences, University of Mälardalen, Eskilstuna.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Eliciting reflections on caring theory in elderly caring practice2011In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 3, p. 7296-Article in journal (Refereed)
    Abstract [en]

    Caring theories are the description and conceptualization of the care that is given in caring practise by nurses and othe rprofessional caregivers with the aim of verbalizing and communicating caring phenomena. Intermittently, a theory-practice gap is given expression- that theory does not go along with clinical practice in caring. The aim of this study was an investigation into the possible disparity between theory and practice in caring by analysingnurses’ lived experience of the understanding of caring theory in practice in the context of municipal elderly care. Hermeneutical phenomenology was the research approach used to explore the lived experience of caring science theories in caring practice from the perspective of 12 nurses working in municipal care for elderly. The findings shows that the nurses Impulsively described their experience of detachment to caring theory, but when describing their caring intentions, the relationship to theory became apparent, and even confirmed their practice. As such, a seedbed exists for caring theory to be reflected on and cultivated in caring praxis. However, as the nurses describe, the caring theory must be sensitive enough for the nursing practitioners to accept. The gap revealed itself on an organisational level, as the nurses’ commission in municipal care did not correspond with their caring intention. We believe it is important to seriously consider what we want to achieve as a caring profession. We have to reflect on our responsibility as culture carriers and knowledge developers. We must make the disparate forces of intention and organisation become one intertwining force.

  • 23.
    Ranheim, Albertine
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Arman, Maria
    Karolinska Institute, Stockholm. Sweden.
    Rehnsfeldt, Arne Wilhelm
    Karolinska Institute, Stockholm, Sweden.
    Berterö, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Embodied reflection in practice-Touching the core of caring2010In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 16, no 3, p. 241-247Article in journal (Refereed)
    Abstract [en]

    A study was performed with the aim of clarifying the integration of the caring act of touch with reflection on caring theory. Seven participant nurses in elderly care volunteered as coresearchers and performed a caring act called Rhythmical Embrocation, together with reflective dialogues on caring theory. The project lasted for 6 months and at the end qualitative interviews with participants were used to evaluate the study. The findings showed an opening of awareness, embodied moments of presence and an extended ability to act creatively in caring. In this study, the movement between theory and practice was the integration of the caring act with reflection on basic caring concepts. Implications for praxis development are that implementation and reflection by teams over certain caring acts might open the door to an expanded view of ones own caring ability that in the long run will benefit the patient.

  • 24.
    Ranheim, Albertine
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Caring Theory and Practice - Entering a Simultaneous Concept Analysis2012In: Nursing Forum, ISSN 0029-6473, Vol. 47, no 2, p. 78-90Article in journal (Refereed)
    Abstract [en]

    PROBLEM.  To better understand the approach of caring in nursing and the role of theory in practice, we wanted to consolidate the caring theory of Watson with the empirical findings from the three studies performed to reveal nurses' caring intentions and their lived experience of reflecting caring theory in practice.

    METHOD.  Through a simultaneous concept analysis of nine concepts, caring science theory was consolidated with the findings of the three empirical studies to reveal the dynamics of caring theory and caring practice.

    FINDINGS AND CONCLUSION.  These nine concepts were found to be interrelated with the advanced concept of mediating care, which emphasizes that mediating care calls for an authenticity of being and ability—an ability to be present to self and others in the dynamism of openness and frames of thought.

  • 25.
    Ranheim, Albertine
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Caring Theory and Practice: entering a Simultaneous Concept AnalysisManuscript (preprint) (Other academic)
    Abstract [en]

    To better understand the approach of caring in nursing and the role of theory in practice, we wanted to consolidate the empirical findings from three studies performed to reveal nurses’ caring intentions, their lived experience of reflecting caring theory in practice, with caring theory by Watson (1979, 2008).

    Through a simultaneous concept analysis (SCA) of nine concepts, caring theory was consolidated with the findings of three empirical studies – to reveal the dynamics of caring theory and practice. In conclusion these nine concepts interrelate to the advanced concept mediating care. Mediating care is the visualized outcome or evidence for the intertwining of theory and practice in caring.

  • 26.
    Ranheim, Albertine
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Challenge for theory and practice in elderly care: intertwining forcesManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: Investigating into the possible disparity between theory and practice in caring by analysing nurses’ lived experience of the understanding of caring theory in practice in the context of municipal elderly care.

    Background: Caring theories are the description and conceptualization of the care that is given in caring practise by nurses and other professional caregivers with the aim of verbalizing and communicating caring phenomena. Intermittently, a theory –practice gap is given expression- that theory does not go along with clinical practice in caring.

    Method: Hermeneutical phenomenology was the research approach used to explore the lived experience of caring science theories in caring practice from the perspective of 12 nurses working in municipal care for elderly.

    Findings: A detachment to caring theory was enunciated, but when describing their caring intentions, the nurses’ relationship to theory became apparent, and even confirmed their practice. As such, a seedbed exists for caring theory to be reflected on and cultivated in caring praxis. However, as the nurses describe, the caring theory must be sensitive enough for the nursing practitioners to accept. The gap revealed itself on an organisational level, as the nurses’ commission in municipal care did not correspond with their caring intention.

    Conclusion: We believe it is important to seriously consider what we want to achieve as a caring profession. We have to reflect on our responsibility as culture carriers and knowledge developers. We must make the disparate forces of intention and organisation become one intertwining force.

  • 27.
    Roos, Susanne
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Gastrointestinal Symptoms and Well-Being of Adults Living on a Gluten-Free Diet: A Case for Nursing in Celiac Disease2009In: Gastroenterology Nursing, ISSN 1042-895X, Vol. 32, no 3, p. 196-201Article in journal (Refereed)
    Abstract [en]

    Women with celiac disease (CD) living on a gluten-free diet (GFD) show a lower health-related quality of life and report a higher rate of gastrointestinal (GI) symptoms than men with CD. Uncertainty exists as to whether GI symptoms may explain the poorer treatment outcome of women with CD. This study was designed to explore relationships of GI symptoms and psychological well-being in men and women with long-standing CD. Patients with CD (n = 108; 59% women), aged 45-64 years, treated with a GFD for at least 8 years were evaluated by the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being index. The results show that women with a high rate of GI symptoms have no lower level of psychological well-being than corresponding men with CD and that women with CD with reduced psychological well-being have no more GI symptoms than corresponding men. Our results fail to support the notion that the reduced subjective health in CD is explained by GI symptoms. They may be secondary to perceived difficulties in managing everyday life, suggesting that launching a nurseled follow-up may be helpful, as has been proven to be useful in other lifelong disorders.

  • 28.
    Roos, Susanne
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Kärner, Anita
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Psychological well-being of adult coeliac patients treated for 10 years2006In: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 38, no 3, p. 177-180Article in journal (Refereed)
    Abstract [en]

    Background

    Adults with longstanding coeliac disease generally report reduced quality of life. Uncertainty remains whether this is a sign of depression, thought to be a feature of the disorder.

    Aim

    To assess the psychological well-being in adults with long-treated coeliac disease.

    Patients and methods

    Fifty-one coeliac disease adults (59% women) aged 45–64 years diagnosed in 1984–1988 and showing evidence of remission 8–12 years later were examined by the Psychological General Well-being index. One hundred and eighty-two (57% women) adults of same age served as population controls.

    Results

    The coeliac disease patients showed no more signs of anxiety, depressed mood or distress than the controls as assessed by the Psychological General Well-being index, 103 (95% confidence interval (95% CI) = 99–107) versus 103 (95% CI = 100–106). However, unlike controls, the coeliac disease women showed a significantly lower Psychological General Well-being index than the coeliac disease men, 97 (95% CI = 91–103) versus 111 (95% CI = 106–117) (P < 0.003).

    Conclusion

    Long-treated adult coeliac disease patients showed no difference in psychological well-being to population controls, suggesting that signs of depressed mood is no feature of well-treated coeliac disease. The observation that coeliac disease women living in Sweden experience poorer outcome of treatment than coeliac disease men is a cause of concern and calls for further studies.

  • 29.
    Tingström, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study2018In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, article id 76Article in journal (Refereed)
    Abstract [en]

    Abstract

    Background:

    In managing a life with coronary heart disease and the possibility of planning and following a

    rehabilitation plan, patients

    ’ empowerment and self-efficacy are considered important. However, currently there is

    limited data on levels of empowerment among patients with coronary heart disease, and demographic and clinical

    characteristics associated with patient empowerment are not known.

    The purpose of this study was to assess the level of patient empowerment and general self-efficacy in patients six

    to 12 months after the cardiac event. We also aimed to explore the relationship between patient empowerment,

    general self-efficacy and other related factors such as quality of life and demographic variables.

    Methods:

    A sample of 157 cardiac patients (78% male; age 68 ± 8.5 years) was recruited from a Swedish hospital.

    Patient empowerment was assessed using the SWE-CES-10. Additional data was collected on general self-efficacy

    and well-being (EQ5D and Ladder of Life). Demographic and clinical variables were collected from medical records

    and interviews.

    Results:

    The mean levels of patient empowerment and general self-efficacy on a 0–4 scale were 3.69 (±0.54) and

    3.13 (±0.52) respectively, and the relationship between patient empowerment and general self-efficacy was weak

    (

    r = 0.38). In a simple linear regression, patient empowerment and general self-efficacy were significantly correlated

    with marital status, current self-rated health and future well-being. Multiple linear regressions on patient empowerment

    (Model 1) and general self-efficacy (Model 2) showed an independent significant association between patient

    empowerment and current self-rated health. General self-efficacy was not independently associated with any of the

    variables.

    Conclusions:

    Patients with a diagnosis of coronary heart disease reported high levels of empowerment and general

    self-efficacy at six to 12 months after the event. Clinical and demographic variables were not independently associated

    with empowerment or low general self-efficacy. Patient empowerment and general self-efficacy were not mutually

    interchangeable, and therefore both need to be measured when planning for secondary prevention in primary health

    care.

    Trial registration:

    NCT01462799.

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