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  • 251.
    Hjelm, Katarina
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Linnaeus University, Växjö, Sweden.
    Bard, Karin
    Linnaeus University, Växjö, Sweden.
    Beliefs about health and illness in Latin-American migrants with diabetes living in Sweden2013In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 7, p. 57-65Article in journal (Refereed)
    Abstract [en]

    The aim was to explore beliefs about health and illness in Latin American migrants diagnosed with diabetes mellitus (DM) living in Sweden, and investigated also the influence on self-care and care-seeking behavior. Migrants are particularly affected in the diabetes pandemia. Beliefs about health and illness guide health-related behaviour and health but no studies have been identified on Latin American migrants with DM. An explorative study design with focus-group interviews of nine persons aged 36-77 years from a diabetes clinic was used. Health was described from a pathogenetic or a salutogenetic perspective: 'freedom from disease or feeling of well-being', and being autonomous and able to work. Economic hardship due to high costs for medications and food for DM affected health. Individual factors such as diet, exercise and compliance with given advice, and social factors with good social relations and avoidance of stress, often caused by having experienced severe events related to migrational experiences, were considered of importance for maintaining health and could cause DM. Disturbed relations to others (social factors), punishment by Fate or God (supernatural factors), intake of drugs (diuretics) and imbalance between warmth and cold (natural factors) were also perceived as causes. A mixture of biomedical and traditional explanations and active self-care behaviour with frequent use of herbs was identified. It is important to assess the individual's beliefs, and healthcare staff, particularly nurses, should incorporate discussions of alternative treatments and other components of explanatory models and co-operate with social workers to consider the influence of economic resources and migrational experiences on health.

     

     

  • 252.
    Hjelm, Katarina
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Linnaeus University, Växjö, Sweden .
    Beebwa, Esther
    Mbarara University of Science and Technology (MUST), Uganda.
    The influence of beliefs about health and illness on foot care in ugandan persons with diabetic foot ulcers2013In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 7, p. 123-132Article in journal (Refereed)
    Abstract [en]

    Diabetes mellitus is developing into a pandemic, mainly affecting Sub-Saharan Africa, and the prevalence of complications is increasing. Diabetic foot disorders are a major source of disability and morbidity. Delay in the health care process due to patients' beliefs might have deleterious consequences for life and limb in persons with diabetic foot ulcers. No previous studies of beliefs about health and illness in persons with diabetic foot ulcers living in Africa have been identified. The aim of the study was to explore beliefs about health and illness among Ugandans with diabetic foot ulcers that might affect health-related behaviour including self-care and care seeking. An explorative study was implemented with consecutive sample and semi-structured interviews were held with 14 Ugandan men and women, aged 40-79, with diabetic foot ulcers. The main findings showed that knowledge was limited about causes, management and prevention of diabetic foot ulcers. Foot ulcers were often detected as painful, believed to heal or improve, and led to stress and social isolationbecause of smell and reduced mobility. Most lacked awareness of the importance of complete daily foot care and seldom practised self-care. Health was described as absence of disease and pain. Many feared future health which was related to contact with nurses in the professional sector from whom they sought information, help with blood tests and wound dressings and desired better organised diabetes clinics providing health education and more opening hours. Many have an underutilised potential for self-care and need education urgently, delivered in well-organised clinics aimed to raise awareness of the threat and prevent foot ulcers.

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  • 253.
    Hjelm, Katarina
    et al.
    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, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Dissimilarities in Social Support as  Described by Swedish- and Foreign-Born Persons Diagnosed with Type 2 Diabetes and Living in Sweden2014In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, no 3, p. 211-222Article in journal (Refereed)
    Abstract [en]

    Diabetes (DM) requires self-care that is demanding and may cause stress. Social support canbuffer effects of stress. No previous study has been found comparing perceptions of foreign-bornpersons with DM, concerning the content of and need for social support with a population of origin.The aim was to compare the meaning of support and its impact on the life situation in Swedishandforeign-born persons diagnosed with type 2 DM living in Sweden. A purposive sample of 74persons; 34 foreign- and 40 Swedish-born, aged 32 - 80 years, diagnosed with type 2 DM, was included.The foreign-born persons were mostly Middle Eastern and Ex-Yugoslavian refugees. Mixedmethods were used and data were collected by qualitative interviews and quantitative data collectedby the Norbeck Social Support Questionnaire (NSSQ). Studying the figures measured byNSSQ, no significant differences were found according to gender but foreign-born men scoredlower than Swedish, especially in emotional support and aid. The main findings showed that respondents,irrespective of origin, described the meaning of the concept of support mainly as informationsupport in learning to manage DM. However, foreign-born persons also focused onmedical support with regular follow-ups while Swedes emphasized the need for emotional support.Foreign- and Swedish-born persons are in general more similar than dissimilar in describingthe meaning, need and impact of support. Irrespective of origin they want to learn to manage theirdisease and thus desire and need regular follow-up and information immediately from being diagnosed.Further studies are needed as the study is based on a limited sample.

  • 254.
    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.

  • 255.
    Hjelmfors, Lisa
    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, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Mårtensson, Jan
    Hälsohögskolan, Jönköping, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Communicating prognosis and end-of-life care to heart failure patients: a survey of heart failure nurses' perspectives2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 2, p. 152-161Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Many heart failure (HF) patients have palliative care needs, but communication about prognosis and end-of-life care is lacking. HF nurses can play an important role in such communication, but their views on this have rarely been sought.

    AIMS:

    This study aims to describe HF nurses' perspectives on, and daily practice regarding, discussing prognosis and end-of-life care with HF patients in outpatient care. It further aims to explore barriers, facilitators and related factors for discussing these issues.

    METHODS:

    A national survey including nurses from outpatient clinics and primary health care centres was performed. Data was collected using a questionnaire on communication with HF patients about prognosis and end-of-life care.

    RESULTS:

    In total, 111 (82%) of the HF nurses completed the questionnaire. Most of them reported that physicians should have the main responsibility for discussing prognosis (69%) and end-of-life care (67%). Most nurses felt knowledgeable to have these discussions, but 91% reported a need for further training in at least one of the areas. Barriers for communication about prognosis and end-of-life care included the unpredictable trajectory of HF, patients' comorbidities and the opinion that patients in NYHA class II-III are not in the end-of-life.

    CONCLUSION:

    Although HF nurses feel competent discussing prognosis and end-of-life care with the HF patient, they are hesitant to have these conversations. This might be partly explained by the fact that they consider the physician to be responsible for such conversations, and by perceived barriers to communication. This implies a need for clinical policy and education for HF nurses to expand their knowledge and awareness of the patients' possible needs for palliative care.

  • 256.
    Hjelmfors, Lisa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    van der Wal, Martje H. L.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences. University of Groningen, Netherlands.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Martensson, Jan
    Jonköping University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Patient-Nurse Communication about Prognosis and End-of-Life Care2015In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 18, no 10, p. 865-871Article in journal (Refereed)
    Abstract [en]

    Background: Although several studies advise that discussions about prognosis and end-of-life care should be held throughout the whole heart failure (HF) trajectory, data is lacking on the prevalence and practice of such discussions in HF care. Objective: The study objective was to explore how often and why HF nurses in outpatient clinics discuss prognosis and end-of-life care in the context of patient education. Methods: This was a descriptive and comparative study. Participants were HF nurses from Swedish and Dutch HF outpatient clinics. Measurements were taken via a survey for both quantitative and qualitative data. Additional data was collected via open-ended questions and analyzed with content analysis. Results: Two hundred seventy-nine nurses registered 1809 patient conversations using a checklist. Prognosis and end-of-life care were among the least frequently discussed topics, whereas symptoms of HF was discussed most often. Prognosis was discussed with 687 patients (38%), and end-of-life care was discussed with 179 patients (10%). Prognosis and end-of-life care were discussed more frequently in The Netherlands than in Sweden (41% versus 34%, pless than0.001, 13% versus 4%, pless than0.001). The nurses did not always recognize prognosis and end-of-life care discussions as a part of their professional role. Conclusions: Currently, patient-nurse communication about prognosis and end-of-life care does not seem to be routine in patient education in HF clinics, and these discussions could be included more often. The reasons for nurses to discuss these topics were related to clinical routines, the patients situation, and professional responsibilities. To improve future care, communication with patients needs to be further developed.

  • 257.
    Hoekstra, Tialda
    et al.
    University of Groningen.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Sanderman, Robbert
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Lesman-Leegte, Ivonne
    University of Groningen.
    Perceived sexual difficulties and associated factors in patients with heart failure2012In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 163, no 2, p. 246-251Article in journal (Refereed)
    Abstract [en]

    Background Sexual dysfunction is a common problem of increasing incidence in patients with heart failure (HF). However, there is no knowledge on which demographic, clinical, and quality of life (QoL) aspects are related to difficulties in sexual activity nor on the course of sexual difficulties in patients with HF. less thanbrgreater than less thanbrgreater thanMethods Data on sexual difficulties were collected at 1 and 18 months after an HF hospitalization (n = 792, mean age 69 +/- 12 years, 35% female, mean left ventricular ejection fraction 33% +/- 14%) by the question on sexuality of the Minnesota living with HF questionnaire. Demographic and clinical factors were assessed from medical records and QoL by Minnesota living with HF questionnaire, Medical Outcome Study 36-item General Health Survey, and Ladder of Life. less thanbrgreater than less thanbrgreater thanResults In total, 48% (n = 380) of the patients perceive difficulties in sexual activity at 1 month after discharge, and 70% continued to perceive this at 18 months. Furthermore, 27% of the patients without difficulties at 1 month developed them during follow-up. Living with a partner (OR 3.76, 95% CI 2.58-5.48), younger age (OR 0.96, 95% CI 0.94-0.97)), male gender (OR 3.08, 95% CI 2.10-4.43), overall well-being (OR 1.13, 95% CI 1.00-1.27), and physical (OR 1.06, 95% CI 1.06-1.08) and emotional (OR 1.07, 95% CI 1.03-1.10) QoL were independently associated with perceived difficulties in sexual activity. less thanbrgreater than less thanbrgreater thanConclusions Perceived difficulties in sexual activity are common in patients with HF, particularly in younger and male patients and continue over time. Patients who perceive difficulties in sexual activity report a significant lower QoL and overall well-being than those who do not.

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  • 258.
    Hoekstra, Tialda
    et al.
    University of Groningen, Netherlands .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    van Veldhuisen, Dirk J.
    University of Groningen, Netherlands .
    Hillege, Hans L.
    University of Groningen, Netherlands .
    Sanderman, Robbert
    University of Groningen, Netherlands .
    Lesman-Leegte, Ivonne
    University of Groningen, Netherlands .
    Quality of life and survival in patients with heart failure2013In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 15, no 1, p. 94-102Article in journal (Refereed)
    Abstract [en]

    To examine whether self-rated disease-specific and generic quality of life predicts long-term mortality, independent of brain natriuretic peptide (BNP) levels, and to explore factors related to low quality of life in a well-defined heart failure (HF) population. less thanbrgreater than less thanbrgreater thanA cohort of 661 patients (62 male; age 71 years; left ventricular ejection fraction 34) was followed prospectively for 3 years. Quality of life questionnaires (Ladder of Life, RAND36, and Minnesota Living with Heart Failure Questionnaire) and BNP levels were assessed at discharge after a hospital admission for HF. Three-year mortality was 42. After adjustment for demographic variables, clinical variables, and BNP levels, poor quality of life scores predicted higher mortality; per 10 units on the physical functioning [hazard ratio (HR) 1.08, 95 confidence interval (CI) 1.021.14] and general health (HR 1.08, 95 CI 1.011.16) dimensions of the RAND36. Patients with low scores on these dimensions were more likely to be in New York Heart Association class IIIIV, diagnosed with co-morbidities, have suffered longer from HF, have lower estimated glomerular filtration rates, and have fewer beta-blocker prescriptions. less thanbrgreater than less thanbrgreater thanQuality of life was independently related to survival in a cohort of hospitalized patients with HF. less thanbrgreater than less thanbrgreater thanNCT 98675639.

  • 259.
    Hoekstra, Tialda
    et al.
    University of Groningen, Netherlands .
    Lesman-Leegte, Ivonne
    University of Groningen, Netherlands University of Groningen, Netherlands .
    Couperus, Margriet F
    University of Groningen, Netherlands .
    Sanderman, Robbert
    University of Groningen, Netherlands .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    What keeps nurses from the sexual counseling of patients with heart failure?2012In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 41, no 5, p. 492-499Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We sought to examine the current practice of discussing sexual health by heart failure (HF) nurses, and to explore which barriers prevent nurses from discussing sexuality. less thanbrgreater than less thanbrgreater thanMETHODS: The Nurses Survey of Sexual Counseling of Myocardial Infarction Patients and a list of barriers were used to form a questionnaire, which was sent to all HF clinics (n = 122) in the Netherlands. less thanbrgreater than less thanbrgreater thanRESULTS: The majority (75%) of nurses (n = 146) felt a certain responsibility to discuss patients sexual health. However, in practice, 61% of the nurses rarely or never addressed sexuality. Barriers that prevented nurses from addressing sexuality and that differed between nurses who do (n = 58) and do not (n = 88) discuss sexuality include a lack of organizational policy (49% vs. 79%, respectively; P andlt; .001) and lack of training (43% vs. 80%, respectively; P andlt; .001), and not knowing how to initiate the subject (24% vs. 72%, respectively; P andlt; .001). Nurses preferred to address sexuality during a follow-up visit or when discussing medication. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Although HF nurses feel responsible for discussing sexuality, this topic is rarely addressed in clinics. Several barriers were identified, relating to personal, patient, and organizational factors.

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  • 260.
    Hoekstra, Tialda
    et al.
    University of Groningen, Netherlands .
    Lesman-Leegte, Ivonne
    University of Groningen, Netherlands .
    Louise Luttik, Marie
    University of Groningen, Netherlands .
    Sanderman, Robbert
    University of Groningen, Netherlands .
    van Veldhuisen, Dirk J
    University of Groningen, Netherlands .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Sexual problems in elderly male and female patients with heart failure2012In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 98, no 22, p. 1647-1652Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate perceived sexual problems in a large group of younger and older patients with heart failure (HF), with and without a partner, focusing on a broad range of perceived sexual problems, and compare this with a sample of healthy community-dwelling elderly people. less thanbrgreater than less thanbrgreater thanDesign Cross-sectional study. less thanbrgreater than less thanbrgreater thanSetting 17 HF clinics and general practices in The Netherlands. less thanbrgreater than less thanbrgreater thanParticipants 438 patients with HF and 459 healthy community-dwelling elderly people. less thanbrgreater than less thanbrgreater thanMain Outcome Measures Differences in sexual functioning, related factors and perceived causes of sexual problems between patients with HF and healthy community controls. less thanbrgreater than less thanbrgreater thanResults In total, 59% of HF patients reported sexual problems, mostly problems with erectile function. HF patients with a partner (67%) and younger patients (65%) reported significantly more sexual problems than healthy community controls (58%, p=0.011 and 53%, p=0.011, respectively). Multivariate analyses show that sexual problems in HF patients with a partner were more common in men (OR 2.73, 95% CI 1.572 to 4.753) and in those with a prescription of beta-blockers (OR 2.00, 95% CI 1.10 to 3.586). In younger patients, sexual problems were independently associated with male gender (OR 3.21, 95% CI 2.099 to 4.908) and having a partner (OR 2.00, 95% CI 1.283 to 3.110). HF patients mainly attribute their sexual problems to symptoms of HF. less thanbrgreater than less thanbrgreater thanConclusion Sexual problems are common in patients with HF, particularly in younger patients and those with a partner. As patients attribute their sexual problems mostly to HF symptoms, adequate treatment and education of HF patients is needed.

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  • 261.
    Hoekstra, Tialda
    et al.
    University of Groningen.
    Lesman-Leegte, Ivonne
    University of Groningen.
    van der Wal, Martje
    University of Groningen.
    Luttik, Marie Louise
    University of Groningen.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Nurse-led interventions in heart failure care: Patient and nurse perspectives.2010In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, no 4, p. 226-32Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Perspectives of nurses and patients on the intensity and content of disease management programmes (DMPs) in heart failure are seldom addressed but are important in optimizing these programmes. AIM: To describe the perspectives of patients and nurses on delivered care in two DMPs. METHODS: In total 442 patients (62% male; age 68±12years; LVEF 33%±14), assigned to the intervention groups of the Coordinating Study Evaluating Outcomes of Advising and Counselling in HF (COACH), and 32 registered nurses, completed questionnaires on satisfaction with the intensity and components of the DMPs. RESULTS: In spite of large differences in intensity and components, patients were satisfied with the content of both DMPs. In patients (NYHA III-IV), treatment and educational goals were more often achieved in those who received intensive support, compared to patients who received basic support (85% vs. 70%). Patients and nurses perceived that most home visits were adding significant value to the HF care, while 12% of the home visits were perceived as unnecessary by the nurses. CONCLUSION: Patients and nurses did not perceive the intense DMP as an emotional and physical burden for themselves. Patients with severe HF might be in need of more support to achieve optimal treatment and educational goals.

  • 262.
    Hoekstra, Tialda
    et al.
    University of Groningen.
    Lesman-Leegte, Ivonne
    University of Groningen.
    van Veldhuisen, Dirk J
    University of Groningen.
    Sanderman, Robbert
    University of Groningen.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Quality of life is impaired similarly in heart failure patients with preserved and reduced ejection fraction2011In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 13, no 9, p. 1013-1018Article in journal (Refereed)
    Abstract [en]

    Aims To compare quality of life (QoL) in heart failure (HF) patients with preserved ejection fraction (HF-PEF) and HF patients with reduced ejection fraction (HF-REF) in a well-defined HF population. less thanbrgreater than less thanbrgreater thanMethods and results Patients with HF-PEF [left ventricular ejection fraction (LVEF) andgt;= 40%] were matched by age and gender to patients with HF-REF (LVEF,40%). In the current study, we only included HF patients with a B-type natriuretic peptide level (BNP) andgt; 100 pg/mL. Quality of life was assessed by Cantrils Ladder of Life, RAND-36, and the Minnesota Living with Heart Failure questionnaire, and impairment of QoL was adjusted for by BNP as a marker for severity of HF. We examined a total of 290 HF patients, of whom 145 had HF-PEF (41% female; age 72 +/- 10; LVEF 51 +/- 8%) and 145 had HF-REF (41% female; age 73 +/- 10, LVEF 26 +/- 7%). All HF patients reported markedly low scores of QoL, both on the general and disease-specific QoL questionnaires. Quality of life between patients with HF-PEF and HF-REF did not differ significantly. When adjusting the QoL scores for BNP, an association between QoL and LVEF was not found, i.e. patients with HF-PEF and HF-REF with similar BNP levels had the same impairment in QoL. less thanbrgreater than less thanbrgreater thanConclusion Quality of life is similarly impaired in patients with HF-PEF as in HF-REF. These findings further support the need for more pharmacological and non-pharmacological studies in patients with HF-PEF.

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  • 263.
    Hollman Frisman, Gunilla
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Eriksson, Carrie
    Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Pernehed, Sara
    Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Mörelius, Evalotte
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    The experience of becoming a grandmother to a premature infant - A balancing act, influenced by ambivalent feeling2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 21-22, p. 3297-3305Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  To explore and describe the experience of becoming a grandmother to a premature infant.

    Background.  Becoming a grandmother involves a new perspective of life. Grandmothers of sick infants find themselves in a new situation with an adult child undergoing serious stress. Few studies have approached the grandmothers’ own experience of becoming a grandmother to a premature infant.

    Design.  A qualitative content analysis was used.

    Methods.  Eleven women, 52–66 years of age, who were grandmothers to premature infants born at a gestational age of 25–34 weeks, were interviewed during 2010. The infants were less than three years old at the time of the interview. The interviews were analysed with qualitative content analysis.

    Results.  The overall theme was a balancing act. Two categories of experience were identified: emotional experiences and a new role. ‘Emotional experiences’ was related to the first meeting, ambivalent feelings and confidence in care. ‘A new role’ was related to the subcategories supportive, a balance of involvement and limitations.

    Conclusions.  To become a grandmother to a premature infant was experienced as a balancing act influenced by ambivalent feelings of joy, fear and worry. The grandmothers sensed the seriousness of the situation at the same time as they wanted to be happy about the newborn infant. They worried about their adult child’s as well as the premature infant’s health but put their own needs aside. The grandmothers’ new role was a balance between being involved and supportive without disturbing.

    Relevance to clinical practice.  Neonatal intensive care unit staff should be open to grandmothers’ needs and acknowledge them as an obvious support for the immediate family of a premature infant. The grandmothers need guidance and information about what to expect concerning the infants health, the parents situation and their own role.

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  • 264.
    Holmgren, Kristina
    et al.
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Ekbladh, Elin
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Hensing, Gunnel
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Dellve, Lotta
    KTH, Royal Institute of Technology, Stockholm, Sweden .
    The Combination of Work Organizational Climate and Individual Work Commitment Predicts Return to Work in Women But Not in Men2013In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 55, no 2, p. 121-127Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze if the combination of organizational climate and work commitment can predict return to work (RTW). Methods: This prospective Swedish study was based on 2285 participants, 19 to 64 years old, consecutively selected from the employed population, newly sick-listed for more than 14 days. Data were collected in 2008 through postal questionnaire and from register data. Results: Among women, the combination of good organizational climate and fair work commitment predicted an early RTW with an adjusted relative risk of 2.05 (1.32 to 3.18). Among men, none of the adjusted variables or combinations of variables was found significantly to predict RTW. Conclusions: This study demonstrated the importance of integrative effects of organizational climate and individual work commitment on RTW among women. These factors did not predict RTW in men. More research is needed to understand the RTW process among men.

  • 265.
    Holstein, Jane
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Kjellberg, Anette
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Design for all - a challenge for occupational therapy students.2012Conference paper (Refereed)
    Abstract [en]

    Introduction: The Swedish nationalgoals for people with disabilities acknowledge diversity. Implying that actionssuch as "design for all" should be directed towards identifying andeliminating obstacles to full participation in society.

    Aim: The aim was to explore occupational therapy students' perceptions of theinter-professional course "Design for all". Methods: 150 occupational therapy students answered an evaluation questionnairewith open-ended questions directly after finishing the course. After threemonths, half of the students answered a follow-up questionnaire.

    Results: The majority of the students described the inter-professionalintegration as positive. The concrete application of the design process and therelevance in relation to real-life situations was highly evaluated. However,logistics problems such as coordinating schedules between the medical andtechnological faculties need to be further developed.

    Conclusion: It is important to gain professional competence about "Designfor all"in products, environments and services since this enable diversityin society

  • 266.
    Holstein, Jane
    et al.
    ISV HAV.
    Kjellberg, Anette
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Design för alla2009In: AT forum,2009, Stockholm: FSA , 2009Conference paper (Refereed)
    Abstract [sv]

        

  • 267.
    Hult, Håkan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Lindblad Fridh, Marianne
    Högskolan Jönköping.
    Lindh Falk, Annika
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Thörne, Karin
    The County Council of Jönköping.
    Pedagogical processes in health care: an exploratory study of pedagogic work with patients and next of kin2009In: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 22, no 3, p. 1-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Care and education have much in common, and work in the healthcare sector is closely associated with learning and teaching. It is felt that many in the healthcare and medical services are not aware of their pedagogic skills and how they can be developed. FRAME OF REFERENCE: Belonging to a community of practice means that you share perspectives, methods and language. OBJECTIVE: The aim is to describe the pedagogical discourse by identifying pedagogical processes and studying the staffs awareness of such processes or situations in which a pedagogical approach would be useful in their work with patients and next of kin. METHOD: A qualitative study based on individual and group interviews. The analysis is directed by grounded theory. RESULTS: The pedagogical processes varied in length and quality. Most were unplanned and were usually embedded in treatment. The pedagogical process is linear (planning, goal setting, teaching and evaluating) in an educational setting but we found that the beginning and end can be unclear and the goals can be vague or non-existent. The pedagogical process is best described using the concepts Read, Guide and Provide learning support. DISCUSSION: The pedagogical discourse in healthcare is almost silent. Data indicate that at the collective level there is very little support for professional development of pedagogical ability. Tacit knowledge may therefore remain silent even though it may be possible to formulate and describe it. CONCLUSIONS: There is a strong need to focus on the pedagogical parts of the work and to encourage and support the development of professional pedagogical knowledge.

  • 268.
    Ingadottir, Brynja
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Johansson Stark, Åsa
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Leino-Kilpi, Helena
    University of Turku, Finland.
    Sigurdardottir, Arun K
    University of Akureyri, Iceland .
    Valkeapää, Kirsi
    University of Turku, Finland.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2896-2908Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the possible differences between knowledge expectations and received knowledge of patients undergoing elective knee arthroplasty in Iceland, Sweden and Finland and also to determine the relationship between such a difference and both background factors and patient satisfaction with care.

    BACKGROUND: Knee arthroplasty is a fast-growing and a successful treatment for patients with osteoarthritis. Patient education can improve surgery outcomes, but it remains unknown what knowledge patients expect to receive and actually acquire during the perioperative period and what factors are related to that experience.

    DESIGN: Descriptive, prospective survey.

    METHODS: In total, 290 patients answered questionnaires about their expectations (Knowledge Expectations of hospital patients - scale) before surgery and about received knowledge (Received Knowledge of hospital patients - scale) and satisfaction with hospital care (Patient Satisfaction Scale) at discharge. Sociodemographics, clinical information, accessibility to knowledge from healthcare providers (Access to Knowledge Scale), and preferences for information and behavioural control (Krantz Health Opinion Survey) were collected as background data.

    RESULTS: Patients` knowledge expectations were higher (mean 3·6, SD 0·4) than their perception of received knowledge (mean 3·0, SD 0·7). Multiple linear regression analysis showed that access to knowledge, information preferences and work experience within health- or social care explained 33% (R²) of the variation in the difference between received and expected knowledge. Patients reported high satisfaction with their care except regarding how their family was involved.

    CONCLUSION: Patients undergoing knee arthroplasty receive less knowledge than they expect, and individual factors and communication with healthcare providers during hospitalisation are related to their experience. The content of patient education and family involvement should be considered in future care.

    RELEVANCE TO CLINICAL PRACTICE: The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

  • 269.
    Ingadottir, Brynja
    et al.
    Landspitali, Iceland.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation2015In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 913-921Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe what knowledge heart failure patients expect to acquire in relation to their upcoming cardiac resynchronization therapy (CRT) device implantation, to describe their self-care and health complaints, and to explore the relationship between knowledge expectations and self-care, health complaints, and background factors. Patients and methods: Cross-sectional multicenter study with 104 patients scheduled for a first-time, elective CRT implantation in Swedish and Icelandic hospitals. Data were collected with the Knowledge Expectations of hospital patient Scale, European Heart Failure Self-care Behavior Scale, and Adjusted Postoperative Recovery Profile. Results: Patients expected most knowledge related to their disease and its treatment (median 4.0, interquartile range 0.13) and least on social issues (median 3.5, interquartile range 0.83). Their self-care was average (standardized mean 51.0 +/- 19.6) before the procedure. Patients had on average 8.2 (+/- 4.7) health complaints and rated fatigue and sexual problems as the most severe. Age was independently associated with knowledge expectations (Exp beta 0.049, P= 0.033). Conclusion: Heart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure. These expectations are similar to those of other surgical patients and they increase with age.

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  • 270. Ingadóttir, B
    et al.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Knowledge expectations of heart failure patients waiting for cardiac resynchronisation therapy implantation.2014Conference paper (Refereed)
  • 271.
    Ivars, Katrin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Nelson Follin, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Gothenburg University, Sweden.
    Theodorsson, Annette
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Ström, Jakob
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Mörelius, Evalotte
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Development of Salivary Cortisol Circadian Rhythm and Reference Intervals in Full-Term Infants2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 6, article id e0129502Article in journal (Refereed)
    Abstract [en]

    Background Cortisol concentrations in plasma display a circadian rhythm in adults and children older than one year. Earlier studies report divergent results regarding when cortisol circadian rhythm is established. The present study aims to investigate at what age infants develop a circadian rhythm, as well as the possible influences of behavioral regularity and daily life trauma on when the rhythm is established. Furthermore, we determine age-related reference intervals for cortisol concentrations in saliva during the first year of life. Methods 130 healthy full-term infants were included in a prospective, longitudinal study with saliva sampling on two consecutive days, in the morning (07:30-09:30), noon (10:00-12:00) and evening (19:30-21:30), each month from birth until the infant was twelve months old. Information about development of behavioral regularity and potential exposure to trauma was obtained from the parents through the Baby Behavior Questionnaire and the Life Incidence of Traumatic Events checklist. Results A significant group-level circadian rhythm of salivary cortisol secretion was established at one month, and remained throughout the first year of life, although there was considerable individual variability. No correlation was found between development of cortisol circadian rhythm and the results from either the Baby Behavior Questionnaire or the Life Incidence of Traumatic Events checklist. The study presents salivary cortisol reference intervals for infants during the first twelve months of life. Conclusions Cortisol circadian rhythm in infants is already established by one month of age, earlier than previous studies have shown. The current study also provides first year age-related reference intervals for salivary cortisol levels in healthy, full-term infants.

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  • 272.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and Sciences.
    Editorial Material: Developing the potential of social media in cardiovascular care2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 5, p. 386-387Article in journal (Other academic)
    Abstract [en]

    n/a

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  • 273.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    International collaborators: More than Facebook friends?2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 1Article in journal (Other academic)
  • 274.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Secondary prevention of coronary heart disease and heart failure in primary care.2008In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 94, no 9, p. 1211; author reply 1211-Article in journal (Refereed)
  • 275.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    The European Journal of Cardiovascular Nursing: It takes a team to make a journal2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 3, p. 137-137Article in journal (Other academic)
  • 276.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Writing a publication on cardiac nursing: just do it!2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, p. 265-266Article in journal (Refereed)
  • 277.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. University of Groningen, The Netherlands .
    Brons, Maaike
    University of Groningen, The Netherlands .
    Kraai, Imke
    University of Groningen, The Netherlands .
    Luttik, Marie Louise
    University of Groningen, The Netherlands .
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Components of heart failure management in home care: a literature review2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 3, p. 230-241Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Patients with heart failure (HF) need long-term and complex care delivered by healthcare professionals in primary and secondary care. Although guidelines on optimal HF care exist, no specific description of components that are applied for optimal HF care at home exist. The objective of this review was to describe which components of HF (home) care are found in research studies addressing homecare interventions in the HF population.

    METHODS: The Pubmed, Embase, Cinahl, and Cochrane databases were searched using HF-, homecare services-, and clinical trial-related search terms.

    RESULTS: The literature search identified 703 potentially relevant publications, out of which 70 articles were included. All articles described interventions with two or more of the following components: multidisciplinary team, continuity of care and care plans, optimized treatment according to guidelines, educational and counselling of patients and caregivers, and increased accessibility to care. Most studies (n=65, 93%) tested interventions with three components or more and 20 studies (29%) used interventions including all five components.

    CONCLUSIONS: There a several studies on HF care at home, testing interventions with a variety in number of components. Comparing the results to current standards, aspects such as collaboration between primary care and hospital care, titration of medication, and patient education can be improved.

  • 278.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Deaton, Christi
    Central Manchester University Hospital NHS Fdn Trust, England .
    Fitzsimmons, Donna
    Belfast Health and Social Care Trust, North Ireland University of Ulster, North Ireland .
    Fridlund, Bengt
    Jonköping University, Sweden .
    Hardig, Bjarne M.
    Physiocontrol Sweden Jolife AB, Sweden Lund University, Sweden .
    Mahrer-Imhof, Romy
    Zurich University of Appl Science, Switzerland .
    Moons, Philip
    University of Leuven, Belgium Copenhagen University Hospital, Denmark .
    Noureddine, Samar
    Amer University of Beirut, Lebanon .
    O'Donnell, Sharon
    University of Dublin, Ireland .
    Pedersen, Susanne S.
    Tilburg University, Netherlands Erasmus MC, Netherlands University of Southern Denmark, Denmark Odense University Hospital, Denmark .
    Stewart, Simon
    Baker IDI Heart and Diabet Institute, Australia .
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. 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 .
    Tokem, Yasemin
    Izmir Katip Celebi University, Turkey .
    Kjellstrom, Barbro
    Karolinska Institute, Sweden .
    Research in cardiovascular care: A position statement of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 1Article in journal (Refereed)
    Abstract [en]

    To deliver optimal patient care, evidence-based care is advocated and research is needed to support health care staff of all disciplines in deciding which options to use in their daily practice. Due to the increasing complexity of cardiac care across the life span of patients combined with the increasing opportunities and challenges in multidisciplinary research, the Science Committee of the Council on Cardiovascular Nursing and Allied Professionals (CCNAP) recognised the need for a position statement to guide researchers, policymakers and funding bodies to contribute to the advancement of the body of knowledge that is needed to further improve cardiovascular care. In this paper, knowledge gaps in current research related to cardiovascular patient care are identified, upcoming challenges are explored and recommendations for future research are given.n/a

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  • 279.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Mårtensson, Jan
    Sexual dysfunction in heart failure patients.2014In: Current heart failure reports, ISSN 1546-9549, Vol. 11, no 3, p. 330-336Article in journal (Refereed)
    Abstract [en]

    Heart failure has a severe impact on different aspects of a patient's life, including sexual function. Sexual problems are common in heart failure (HF) patients, both in men and women, and are not always adequately addressed and treated in the current health care system. Several factors have been described to be related to sexual problems, such as activity intolerance, psychological factors, physiological factors, cardiac medications, recreational habits and co-morbidity. The current review summarizes knowledge that can help clinicians treat sexual dysfunction in HF patients. After a good assessment, several steps are advised, including improving HF and co-morbid conditions, discussing psychosocial problems, worries and misunderstandings, managing risk factors and considering PDE-5 inhibitors or other libido enhancing agents.

  • 280.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ågren, Susanna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Quality of life and symptoms of depression in advanced heartfailure patients and their partners2010In: Current Opinion in Supportive and Palliative Care, ISSN 1751-4266, Vol. 4, no 4, p. 233-237Article in journal (Refereed)
    Abstract [en]

    Purpose of review: To provide an overview of factors related to quality of life and symptoms of depression in heart failure patients and their partners. Furthermore, to give an overview of interventions that can be effective in improving their quality of life and decrease depressive symptoms.Recent findings: Quality of life of patients with heart failure and their partners is poor compared with their age-matched peers from the general population and also compared with patients suffering from other chronic diseases. Furthermore, many heart failure patients are depressed. Depressive symptoms of patients and of their partners seem to be interrelated, making interventions complicated but needed.Although the number of studies that specifically target improvement of quality of life and depression in heart failure patients and their partners is still small, several interventions are known to improve quality of life, and these could be implemented in daily care.Summary: This review considers demographic and clinical factors that are related to quality of life and depressive symptoms and addresses interventions that can contribute to improvement of quality of life of heart failure patients and their partners and decrease depressive symptoms.Education on self-care management and physical exercise are important elements of disease management programs. A multidisciplinary care approach including optimizing medical therapy and optimal symptom management is advised, focusing both on the patient and the caregiver. Treatment and care should not only focus on heart failure, but also address the consequences of co-morbidities and the side-effects of therapies.

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  • 281.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Ben Gal, Tuvia
    Rabin Medical Centre, Israel; Tel Aviv University, Israel.
    Boyne, Josiane
    Maastricht University, Netherlands.
    Vellone, Ercole
    University of Roma Tor Vergata, Italy.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Dickstein, Kenneth
    University of Bergen, Norway.
    Fridlund, Bengt
    Jonköping University, Sweden.
    Hoes, Arno
    University of Medical Centre Utrecht, Netherlands.
    Piepoli, Massimo F.
    AUSL Piacenza, Italy; Fdn Toscana G Monasterio, Italy.
    Chiala, Oronzo
    University of Roma Tor Vergata, Italy.
    Martensson, Jan
    Jonköping University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: the rationale, design and methodology of the HF-Wii study; a multicentre randomized controlled trial2015In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, no 7, p. 743-748Article in journal (Refereed)
    Abstract [en]

    Aims

    Exercise is known to be beneficial for patients with heart failure (HF), and these patients should therefore be routinely advised to exercise and to be or to become physically active. Despite the beneficial effects of exercise such as improved functional capacity and favourable clinical outcomes, the level of daily physical activity in most patients with HF is low. Exergaming may be a promising new approach to increase the physical activity of patients with HF at home. The aim of this study is to determine the effectiveness of the structured introduction and access to a Wii game computer in patients with HF to improve exercise capacity and level of daily physical activity, to decrease healthcare resource use, and to improve self-care and health-related quality of life.

    Methods and results

    A multicentre randomized controlled study with two treatment groups will include 600 patients with HF. In each centre, patients will be randomized to either motivational support only (control) or structured access to a Wii game computer (Wii). Patients in the control group will receive advice on physical activity and will be contacted by four telephone calls. Patients in the Wii group also will receive advice on physical activity along with a Wii game computer, with instructions and training. The primary endpoint will be exercise capacity at 3months as measured by the 6min walk test. Secondary endpoints include exercise capacity at 6 and 12 months, level of daily physical activity, muscle function, health-related quality of life, and hospitalization or death during the 12 months follow-up.

    Conclusion

    The HF-Wii study is a randomized study that will evaluate the effect of exergaming in patients with HF. The findings can be useful to healthcare professionals and improve our understanding of the potential role of exergaming in the treatment and management of patients with HF.

    Trial registration

    NCT01785121

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  • 282.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Larsen, Torben
    University of Southern Denmark, Odense.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Practical guide on home health in heart failure patients2013In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 13, no 4Article in journal (Refereed)
    Abstract [en]

    Introduction: Chronic heart failure is a common condition affecting up to 15 million people in the extended Europe. Heart failure is burdensome and costly for patients in terms of decreased quality of life and poor prognosis, and it is also costly for society. Better integrated care is warranted in this population and specialised heart failure care can save costs and improve the quality of care. However, only a few European countries have implemented specialised home care and offered this to a larger number of patients with heart failure. less thanbrgreater than less thanbrgreater thanMethod: We developed a guide on Home Health in Heart Failure patients from a literature review, a survey of heart failure management programs, the opinion of researchers and practitioners, data from clinical trials and a reflection of an international expert meeting. less thanbrgreater than less thanbrgreater thanResults: In integrated home care for heart failure patients, it is advised to consider the following components: integrated multidisciplinary care, patient and partner participation, care plans with clear goals of care, patient education, self-care management, appropriate access to care and optimised treatment. less thanbrgreater than less thanbrgreater thanDiscussion: We summarised the state of the art of home-based care for heart failure patients in Europe, described the typical content of such care to provide a guide for health care providers.

  • 283.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Lesman, Ivonne
    van Veldhuisen, Dirk J.
    Letter: Disease Management for Nondepressed Heart Failure Patients Only Fact or Artifact? Reply2010In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 56, no 24, p. 2049-2050Article in journal (Other academic)
    Abstract [en]

    n/a

  • 284.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Lesman-Leegte, Ivonne
    University Medical Centre Groningen,The Netherlands.
    The value of the quality of life2010In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 12, no 9, p. 901-902Article in journal (Other academic)
    Abstract [en]

    This editorial refers to Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality by J. Iqbal et al., published in this issue on pages 1002-1008.

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  • 285.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Louise Luttik, Marie
    University of Groningen.
    Home care in heart failure: towards an integrated care model2011In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 13, no 8, p. 823-824Article in journal (Other academic)
    Abstract [en]

    This editorial refers to The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home-vs. clinic-based management of chronic heart failure patients by S. Stewart et al., published in this issue on pages 909-916.

  • 286.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Nikolova-Simons, Mariana
    Philips Research Briarcliff, NY USA .
    H L van der Wal, Martje
    University of Medical Centre Groningen, Netherlands .
    Nurses strategies to address self-care aspects related to medication adherence and symptom recognition in heart failure patients: An in-depth look2012In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 41, no 6, p. 583-593Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Despite an increasing body of knowledge on self-care in heart failure patients, the need for effective interventions remains. We sought to deepen the understanding of interventions that heart failure nurses use in clinical practice to improve patient adherence to medication and symptom monitoring. less thanbrgreater than less thanbrgreater thanMETHODS: A qualitative study with a directed content analysis was performed, using data from a selected sample of Dutch-speaking heart failure nurses who completed booklets with two vignettes involving medication adherence and symptom recognition. less thanbrgreater than less thanbrgreater thanRESULTS: Nurses regularly assess and reassess patients before they decide on an intervention. They evaluate basic/factual information and barriers in a patients behavior, and try to find room for improvement in a patients behavior. Interventions that heart failure nurses use to improve adherence to medication and symptom monitoring were grouped into the themes of increasing knowledge, increasing motivation, and providing patients with practical tools. Nurses also described using technology-based tools, increased social support, alternative communication, partnership approaches, and coordination of care to improve adherence to medications and symptom monitoring. less thanbrgreater than less thanbrgreater thanCONCLUSION: Despite a strong focus on educational strategies, nurses also reported other strategies to increase patient adherence. Nurses use several strategies to improve patient adherence that are not incorporated into guidelines. These interventions need to be evaluated for further applications in improving heart failure management

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  • 287.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Riegel, Barbara
    University of Pennsylvania School of Nursing, USA.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Self-care behaviours in heart failure: international similarities and differences2012Conference paper (Other academic)
  • 288.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and Sciences.
    Steinke, Elaine
    Wichita State University, KS, USA .
    20 Things You Didnt Know About Sex and Heart Disease2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 3, p. 207-208Article in journal (Other academic)
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  • 289.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Arts and Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    20 Things You Didn't Know About European Cardiac Nurses2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 4, p. 291-292Article in journal (Other academic)
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  • 290.
    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, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Heart Failure Clinics Are Still Useful (More Than Ever?)2014In: Canadian Journal of Cardiology, ISSN 0828-282X, E-ISSN 1916-7075, Vol. 30, no 3, p. 272-275Article in journal (Refereed)
    Abstract [en]

    Heart failure (HF) clinics have had an important role in optimal HF management and the effectiveness of these clinics has been studied intensively. A HF clinic is one of the various ways to organize a HF disease management program. There is good evidence that HF disease management can improve outcomes in HF patients, but it is not clear what the optimal components of these programs are and what the relative effectiveness of a HF clinic is compared with other forms of HF management. After initial positive reports on the effect of HF clinics, these clinics were implemented in many countries, although in different formats and of varying quality. In this article we describe the initial need for HF clinics, reflect on their development over time, and discuss the role of HF clinics in context of the current need for HF disease management.

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  • 291.
    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, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ben Gal, Tuvia
    Rabin Medical Centre, Israel.
    Cameron, Jan
    Australian Catholic University, Australia.
    Driscoll, Andrea
    Deakin University, Australia.
    Duengen, Hans-Dirk
    Charite, Germany.
    Inkrot, Simone
    Charite, Germany.
    Huang, Tsuey-Yuan
    Chang Gung University of Science and Technology, Taiwan.
    Ngoc Huyen, Nguyen
    University of Tokyo, Japan.
    Kato, Naoko
    University of Tokyo, Japan.
    Koeberich, Stefan
    University of Heart Centre Freiburg Bad Krozingen, Germany.
    Lupon, Josep
    Hospital University of Germans Trios and Pujol, Spain.
    Moser, Debra K.
    University of Kentucky, KY USA.
    Pulignano, Giovanni
    S Camillo Forlanini Hospital, Italy.
    Rejane Rabelo, Eneida
    University of Federal Rio Grande do Sul, Brazil.
    Suwanno, Jom
    Walailak University, Thailand.
    Thompson, David R.
    Australian Catholic University, Australia.
    Vellone, Ercole
    Tor Vergata University, Rome, Italy.
    Alvaro, Rosaria
    Tor Vergata University, Rome, Italy.
    Yu, Doris
    Chinese University of Hong Kong, Hong Kong.
    Riegel, Barbara
    University of Penn, USA.
    Comparison of self-care behaviors of heart failure patients in 15 countries worldwide2013In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 92, no 1, p. 114-120Article in journal (Refereed)
    Abstract [en]

    Objective

    Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents.

    Methods

    Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale.

    Results

    In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries.

    Conclusion

    Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide.

    Practice implications

    Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.

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  • 292.
    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)
  • 293.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Fridlund, B
    Jonköping University.
    De Geest, S
    Katholieke University Leuven.
    Martensson, J
    Unit Research and Dev Primary Care, Jonköping, Sweden .
    Moons, P
    Katholieke University Leuven.
    M Norekval, T
    Haukeland Hospital.
    Smith, K
    Ninewells Hospital.
    Steinke, E
    Wichita State University.
    R Thompson, D
    University of Leicester.
    Sexual counselling of cardiac patients: Nurses perception of practice, responsibility and confidence2010In: EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING, ISSN 1474-5151, Vol. 9, no 1, p. 24-29Article in journal (Refereed)
    Abstract [en]

    Background: Cardiac patients may experience problems with sexual activity as a result of their disease, medications or anxiety and nurses play an important role in sexual counselling. We studied the practice, responsibility and confidence of cardiac nurses in the sexual counselling of these patients. Method: An adapted version of the nurses survey of sexual counselling of MI patients was administered during a scientific meeting of the Council on Cardiovascular Nursing and Allied Professionals within the European Society of Cardiology. Results: Most of the 157 cardiovascular nurses (87%) who completed the survey felt responsible to discuss sexual concerns with their clients, especially when patients initiated a discussion. However in practice, most respondents rarely addressed sexual issues. The items that nurses reported to counsel patients were closely related to the cardiac disease, symptoms and medications and seldom more sensitive subjects (e.g. foreplay, positions). Nurses estimated that their patients could be upset (67%), embarrassed (72%) or anxious (68%) if they were asked about sexual concerns. One-fifth of the nurses felt they had insufficient knowledge and 40% sometimes hesitated to discuss sexual concerns with clients because they might not know how to answer questions. Additional education on sexuality was significantly related to being more comfortable and active in sexual counselling. Conclusion: Although cardiac nurses feel responsible and not anxious discussing patients sexual concerns, these issues are not often discussed in daily practice. Nurses might need more knowledge and specific practical training in providing information on sexual concerns and sexual counselling to cardiac patients.

  • 294.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, 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 Centre, Department of Cardiology UHL.
    Thompson, David R.
    Australian Catholic University, Australia .
    What’s going on at age 11: development of the European Journal of Cardiovascular Nursing2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no 1, p. 7-8Article in journal (Other academic)
  • 295.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Thompson, David R.
    Australian Catholic University, Melbourne, Australia .
    Beyond the Eurozone in cardiovascular nursing research: Filling the scatter plot2013In: Heart & Lung: The Journal of Acute and Critical Care, ISSN 0147-9563, Vol. 42, no 1, p. 1-3Article in journal (Other academic)
  • 296.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    van der Wal, M H L
    van Veldhuisen, D J
    Diversity in management of heart failure patients.2006In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 12, no 7, p. 584-5Article in journal (Refereed)
  • 297.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Actiever worden met een spelcomputer2011In: Ledenmagazine, de Hart & Vaatgroep, Vol. 28, no 3, p. 15-15Article in journal (Other (popular science, discussion, etc.))
  • 298.
    Jansson, Inger
    et al.
    School of Social and Health Sciences, Halmstad University, Sweden.
    Törnvall, Eva
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Implementation of evidence-based practice by standardized care plans: A study protocol2013In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, no 8A, p. 51-57Article in journal (Refereed)
    Abstract [en]

    Background: Patient records should both transfer and create knowledge about patients and their health care. A standardized care plan could be a way to implement evidence-based care directly in practice and improve the documentation in patient records. The aim of this study is to investigate and compare the development and implementation process of a standardized care plan in hospital and primary health care. A further aim is to evaluate the effects on the quality of documentation and the care given in two contexts. Methods and Analysis: Realistic evaluation will be used as a framework to investigate the implementation process. According to this framework, possible contexts, mechanisms, and outcomes in the study will be considered. The study will be performed in two contexts: an orthopedic clinic and primary health care centers. In both contexts, the two key mechanisms will be the same: the implementation process will be driven by internal facilitators (practitioners at the units) and the process will be guided by the Rules and Regulations for interoperability in the Health and Social Care specification, “National information structure for standardized care plans”. Two outcomes of the study will be studied: to investigate the development and implementation process by an evaluation of fidelity and to evaluate how a standardized care plan affects the quality of documentation and the use of evidence-based care. Discussion: Implementation of the SCP will probably meet the same resistance as implementation of guidelines. Documentation of care is an important but resource-consuming requirement in health care, a more standardized method of documenting is requested by health professionals. This project can provide insight into the complex process of developing and implement an SCP in different contexts, which will be useful in further implementation processes.

  • 299.
    Johannesson, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Olsson, Mats
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Petersson, Göran
    Högskolan i Kalmar.
    Silèn, Charlotte
    Centre for Medical Education, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm.
    Learning features in computer simulation skills training2010In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 10, no 5, p. 268-273Article in journal (Refereed)
    Abstract [en]

    New simulation tools imply new opportunities to teach skills and train health care professionals. The aim of this study was to investigate the learning gained from computer simulation skills training. The study was designed for optimal educational settings, which benefit student-centred learning. Twenty-four second year undergraduate nursing students practised intravenous catheterization with the computer simulation program CathSim. Questionnaires were answered before and after the skills training, and after the skills examination. When using CathSim, the students appreciated the variation in patient cases, the immediate feedback, and a better understanding of anatomy, but they missed having an arm model to hold. We concluded that CathSim was useful in the students’ learning process and skills training when appropriately integrated into the curriculum. Learning features to be aware of when organizing curricula with simulators are motivation, realism, variation, meaningfulness and feedback.

  • 300.
    Johansson, Peter
    et al.
    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.
    Alehagen, Urban
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    van der Wal, Martje H. L.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. University of Groningen, Netherlands.
    Svensson, Erland
    Swedish Def Research Agency, Linkoping, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Vitamin D levels and depressive symptoms in patients with chronic heart failure2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 207, p. 185-189Article in journal (Refereed)
    Abstract [en]

    Background: Vitamin D (Vit D) is suggested to play a role in the regulation of physical function as well as in depression. Since, Vit D deficiency is common in patients with heart failure (HF), this study aims to explore if Vit D levels are associated with depressive symptoms and if this association is mediated by the patients physical function. Method: 506 HF patients (mean age 71, 38% women) were investigated. Depressive symptoms and physical function were measured with the Centre for Epidemiological Studies Depression Scale and the physical function scale from the RAND-36. Vit D was measured in blood samples Results: At baseline there was no relationship between depressive symptoms and Vit D levels. However, at 18 months follow-up 29% of patients with Vit D < 50 nmol/l at baseline had depressive symptoms compared 19% of those with Vit D levels >50 nmol/l (p < 0.05). Only in patients with Vit D < 50 nmol/l, Vit D correlated significantly to physical function and depressive symptoms (r = .29, p < 0.001 and r = .20, p < 0.01). In structural equation modelling an indirect association between Vit D and depressive symptoms was found, mediated by physical function (B = 0.20). This association was only found in patients with Vit D levels <50 nmol/l. Conclusion: In HF patients with Vit D < 50 nmol/l, Vit D is associated to depressive symptoms during follow-up and this association is mediated by physical function. This relationship is not found in patients with Vitamin D level >50 nmol/l. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

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